GUT HEALTH
Understanding It
and Treating
Digestive Disorders
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TABLE OF CONTENTS
How a Healthy Gut Functions | 4
Common Digestive Diseases | 8
Additional Resources | 18
How a Healthy Gut Functions
Common Digestive Diseases
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UNDERSTANDING GUT
HEALTH AND DIGESTIVE
DISORDERS
When your gut health is out of whack, it can aect everything
— from what you eat to going out with friends to how well
you perform at work. Dealing with painful gas, abdominal
cramps or belching, and chest pain drains your energy and
can be embarrassing in public. But staying home and limiting
yourself to just a few safe foods is no way to live either.
Learning how gut health works and what you can do to help
your digestive system run smoothly can have a positive impact
on your life. In this guide, we explain gut health, and provide
information about some of the most common gastrointestinal
(GI) conditions and answer frequently asked questions about
probiotics, leaky gut, what to eat and so much more.
How a Healthy Gut Functions
Common Digestive Diseases
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HOW A HEALTHY GUT
FUNCTIONS
The main goal of digestion is to move food through the GI
tract, which starts in the mouth and ends with the anus.
Hormones and nerves send signals to muscles lining the GI
tract to move food along.
During the journey, stomach acid, bile and enzymes break
down food so nutrients can be absorbed and used for energy
and tissue repair. Bacteria in your GI tract (called gut flora
or the microbiome) play a major role in turning food into
substances your body can use.
Exercise and Gut Motility
People who are bedridden or who spend most of their
time sitting or lying down may have more problems with
constipation. That’s because matter moves more slowly
through your GI tract when you’re less active.
The longer digested food matter sits in the large intestine —
where water is absorbed from the liquid mixture to create
solid waste (stool) — the drier it becomes, making it more
dicult to pass. If you deal with constipation, try incorporating
mild to moderate exercise into your daily routine to help get
things flowing.
How a Healthy Gut Functions
Common Digestive Diseases
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Microbiome: Your Internal Garden
The microbiome is like a garden. Feed it the right food in the
right amount and it’ll flourish, according to experts at Johns
Hopkins Medicine.
The microbiome is a combination of bacteria, fungi and
viruses that live in your gut. Although it seems odd, humans
are meant to have these microorganisms living inside them.
The microbiome is important because it helps us digest food.
Bacteria break down essential nutrients like iron and vitamin
B12 so that we can digest them.
Coexisting with these helpful bacteria (called probiotics) is
so important that they and the substances that feed them
(prebiotics) are naturally found in breast milk, indicating
that it’s vital for our GI tracts to be populated with these
microorganisms from the start.
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There are numerous strains of bacteria in your gut, and they
can change depending on what you eat. Eating more fiber
promotes the growth of good bacteria because fiber-rich
foods tend to contain a lot of prebiotics. On the other hand,
eating more sugar and simple carbohydrates, like white bread
and chips, can cause harmful bacteria to grow rapidly.
With the right kind of nutrients, the microbiome protects
your health. But too much or too little of one thing or
another upsets the balance of bacteria in the gut. That can
lead to digestive distress.
Should you take a prebiotic or probiotic
supplement?
Probiotic supplements have been popular for a long time, and
now prebiotics are gaining ground. But, say the experts, it’s
better to get them from food than from a pill — supplements
aren’t regulated, so you can’t be sure what you’re really getting.
Fermented foods are a good source of probiotics, and some
contain prebiotics as well. If you want to populate your
microbiome with more beneficial bacteria, start with eating
small quantities of probiotic-rich foods, such as:
• Yogurt
• Kefir
• Kimchi
• Sauerkraut
• Miso
• Kombucha
How a Healthy Gut Functions
Common Digestive Diseases
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Causes of Dysfunction
The best way to maintain a healthy gut is a healthy lifestyle
that includes regular exercise and a balanced, nutritious diet
full of whole foods. Gut problems can develop when you:
• Eat a low-fiber diet
• Don’t move enough
• Experience high levels of stress
• Undergo surgery
• Use antibiotics and heartburn medications
• Have anxiety or depression
• Take pain relievers frequently
These factors can alter the balance of the microbiome,
allowing bad bacteria to grow unchecked. If digestive diseases
run in your family, you may be more sensitive to these
environmental changes to your gut health.
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Common Digestive Diseases
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COMMON DIGESTIVE
DISEASES
In the United States, 60 to 70 million people deal with
digestive diseases ranging from diverticulitis to gallstones to
chronic constipation. Some gut health problems are short-
lived while others are a lifelong problem. This section oers
information on three of the most common digestive diseases.
Is leaky gut syndrome a real health
problem?
If you’ve spent any time searching the internet for information
on GI conditions, you’ve probably come across the term “leaky
gut syndrome.” It’s a popular topic in alternative health circles,
but it isn’t recognized as a medical diagnosis in mainstream
medicine.
However, a similar condition called increased intestinal
permeability (intestinal hyperpermeability) may aect people
with inflammatory bowel disease (IBD) such as celiac disease
and ulcerative colitis.
In healthy people, the lining of the gut allows nutrients to pass
through to the bloodstream, but a protective lining keeps
harmful organisms out. Chronic inflammatory diseases of
the gut can damage that lining and lead to trouble absorbing
nutrients and keeping out the bacteria that can lead to disease.
The leaky gut syndrome theory describes how toxins and
bacteria cross into the body through the “leaky gut” and then
transmit inflammation beyond the GI tract. Some parts of this
theory are based in fact, but much is fiction.
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Common Digestive Diseases
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Irritable Bowel Syndrome (IBS)
When you’re doubled over in abdominal pain, and running
to the bathroom or sitting there for what feels like hours, it’s
frustrating to get test results that say everything is normal.
Such is the case for those with IBS, a common condition for
which there is no known cause.
IBS aects up to 15% of the population and is nearly twice as
common in women. Symptoms like abdominal pain, diarrhea
and constipation come and go and can range from mild to
severe.
Is it IBS or IBD?
It’s easy to see why people often confuse irritable bowel
syndrome (IBS) and inflammatory bowel disease (IBD). The
two conditions share many of the same symptoms, and it’s
possible for those with IBD to also have IBS.
However, IBD refers to a group of autoimmune diseases in
which the immune system mistakenly attacks the GI tract,
while IBS is an abnormal functioning of the intestines. IBD is
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a more serious condition that causes chronic inflammation
and can lead to permanent damage in the GI tract as well as
an increased risk of colorectal cancer. Crohn’s disease and
ulcerative colitis are inflammatory bowel diseases.
Causes
IBS symptoms occur when matter moves through the large
intestines too quickly or too slowly. Doctors aren’t sure
exactly what causes this. Various factors may contribute to the
onset of IBS, such as:
• Stressful events early in life
• Depression and anxiety
• Food sensitivities
• GI tract infections
• Problems with gut-nerve signaling to the brain
Does small intestine bacterial overgrowth (SIBO)
cause IBS?
Most of the microbiome in the gut resides in the large
intestine, with lesser amounts in the small intestine. SIBO
happens when bacterial levels in the small intestine are too
high.
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This can cause IBS symptoms when you eat carbohydrates,
which feed these bacteria. The bacteria produce excessive gas
and sometimes cause loose, watery stools and problems with
nutrient absorption.
SIBO is more likely when you’ve had:
• Severe food poisoning or gastroenteritis — an
inflammation of the stomach and intestines
• Gastric bypass or abdominal surgery
• Long-term use of proton pump inhibitors — drugs that
treat acid reflux by suppressing stomach acid
• Frequent use of antibiotics
SIBO can often be treated with the lifestyle changes
recommended for those with IBS symptoms. However, if you
have a severe case of SIBO, your doctor may also recommend
using antibiotics to quickly reduce bacterial levels in your gut.
SIBO can be diagnosed with a breath test. Learn more about
the risk factors and treatment of SIBO.
IBS Treatment
The goal of IBS treatment is to relieve symptoms. This is
typically accomplished through lifestyle changes, medications
or both. Medications are generally recommended based on
the person’s most distressing symptom and include:
• Laxatives, to increase flow of stool
• Anti-diarrhea drugs, to slow stool movement
• Anti-spasmodic drugs, to reduce intestinal cramping
• Antidepressants, to lessen pain signals
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Beneficial Diet
Certain types of nutrients in food increase the growth of
bacteria. These are called fermentable oligosaccharides,
disaccharides, monosaccharides and polyols (FODMAPs).
If you have IBS, your health practitioner may recommend
that you you avoid foods high in FODMAPs to see whether
it reduces symptoms. It’s not a diet you want to stay on
indefinitely, but can be helpful to stay on just until the bacteria
overgrowth is contained and you feel better.
After your symptoms improve — usually in four to six weeks
— you can slowly start adding high-FODMAP foods back into
your diet and note how your gut responds. Understanding
which foods cause symptoms can help you control IBS. Learn
about the FODMAP diet.
Wondering if you have IBS? Learn more about how irritable
bowel syndrome is diagnosed.
Gastroesophageal Reflux Disease (GERD)
When the contents of your stomach back up into your
esophagus, it can cause a burning sensation in your chest or
some vomit in the back of your throat. Commonly called
heartburn or acid reflux, it’s not alarming if it only happens
occasionally.
But if you experience reflux more than twice per week
for several weeks, it could be GERD. This chronic digestive
problem aects about 20% of the population and can damage
the esophagus, increasing the risk of esophageal cancer.
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Causes
Normally, the lower end of the esophagus (the lower
esophageal sphincter) tightens to keep stomach acid and
food from coming up the tube. But for those with GERD,
the sphincter is not able to close as tightly as it should. The
sphincter may weaken due to:
• Increased weight from pregnancy
• Pressure from being overweight or obese
• Smoking or secondhand smoke
• Medications for:
• Pain
• Sleeping
• High blood pressure
• Asthma and allergies
• Depression
Treatment
GERD can often be controlled through lifestyle changes such
as losing weight and quitting smoking, along with occasional
over-the-counter medication. If GERD is more severe, your
doctor may also recommend prescription medications and
possibly surgery if symptoms remain uncontrolled.
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Common medications for GERD include:
• Antacids, to neutralize stomach acid
• H2 blockers, to stop stomach acid production
• Proton pump inhibitors, to lower the amount of acid the
stomach produces
Beneficial Diet
Unfortunately, no medication in the world that can reverse
the eects of consuming a super-sized cola, burger and fries
right before going to bed. What you eat and how you eat is
important.
People with GERD should eat smaller meals throughout
the day and follow a Mediterranean diet, which focuses on
vegetables, fruit, fish, nuts and olive oil. Avoid anything that
triggers symptoms — some people find that they’re sensitive
to acidic, spicy or pungent foods, for example.
Just as important as what you eat is when you eat, especially
dinner. If you have a full stomach and lie down, it’s like tipping a
teapot over — the contents may pour out.
The best strategy is to make lunch the biggest meal of the day,
with something lighter for dinner, such as soup or salad. Then
stay upright for at least three hours after eating.
Learn more about a GERD diet about how we diagnose
GERD.
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Crohn’s Disease
Crohn’s disease is an autoimmune condition (an illness
caused by the body turning on itself) that usually targets the
intestines, but can strike anywhere in the GI tract. Symptoms
range from abdominal cramps and diarrhea to skin rashes and
joint problems.
When the immune system attacks the gut, it creates
inflammation (the body’s response to injury). Over time,
this constant irritation can lead to permanent damage and
increased risk of cancer. Crohn’s disease can develop at any
age, but it is more likely to happen when people are in their
teens or 20s.
Causes
What causes Crohn’s disease remains a mystery, but
contributing factors may include:
• Genes, because inflammatory bowel disease tends to run in
families
• Bacteria, because microorganisms in the gut may trigger an
immune response
• Smoking, because research indicates it may double your risk
of getting the disease
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Treatment
People with Crohn’s disease may be tempted to stop taking
their medications when they’re feeling well. But it’s best to talk
with your doctor and decide together whether that’s a smart
decision. The disease can still cause internal damage even if
you don’t have any symptoms.
The goal of treating Crohn’s disease is to prevent and reduce
flare-ups — periods when symptoms worsen. This is done
primarily through the use of medication, although bowel rest
(eliminating solid foods for a few days) or surgery may be
necessary in severe cases.
Your doctor may prescribe one or more of several
medications available to help people with Crohn’s disease,
including the newest category: biologics therapy medications.
These drugs target the antibodies attacking the gut and are
very eective.
Medications used to treat Crohn’s disease include:
• Aminosalicylates, to reduce inflammation
• Steroids, for short-term suppression of the immune system
and to reduce inflammation
• Immunomodulators, to lessen overall immune system
activity
• Biologics, to prevent the immune system from attacking the
gut
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Beneficial Diet
During a flare-up, your doctor may recommend a low-residue
diet to provide relief from painful symptoms. This diet is
deliberately low in fiber, which reduces the number and size
of bowel movements. Foods you should temporarily eliminate
include whole grains, raw vegetables, dairy and some other
foods. (Get more details about the low-residue diet.)
Even during periods of remission, it’s important to consider
your diet. Crohn’s disease can cause you to have problems
getting enough iron and vitamins B12 and D from food. Taking
a daily multivitamin may help. A simple blood test can tell your
doctor if levels of these nutrients are low enough to warrant
prescription strength vitamins or even intravenous infusions.
Learn more about Crohn’s disease symptoms and diagnosis
procedures.
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