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Gut health is essential health—and we all know, when it acts up, it can wreak havoc on our day-to-day. Here, tips and advice from experts for how to take back control of your GI well-being.
More practical ways to optimize your gut health
Eat the Rainbow
Ask Dr. Elena Ivanina, a board-certified gastroenterologist, about the number one thing you can do to optimize your diet and she’s clear: Add more colorful foods to your plate. She explains that it all comes down to the polyphenols that are found in food. One famous example? The anthocyanins (or water-soluble plant pigments) that are found in purple foods—everything from blueberries to purple potatoes.
Polyphenols are antioxidants in plant foods that are anti-inflammatory and extremely good for you. They range from decreasing inflammation to helping keep cancer at bay.
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THINGS TO DO
THINGS TO KNOW
HOW TO ADAPT
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What is your best piece of advice for someone navigating gut health issues?
One of the key preventative steps is understanding your body’s triggers. For example, reactions to various foods and alcohol. If you know what your body can digest and tolerate, then you can prevent so many flares by either avoiding or minimizing that trigger or using digestive enzymes to support your system.
What is something that people often get wrong about gut health?
People often think over-restriction leads to healing, but restriction is usually a Band-Aid and often leads to disordered eating. That said, something like a cleanse can be helpful if you have slow motility. So many people are experiencing incomplete evacuation, which is causing a slow build-up of residual stool that eventually leads to many symptoms like bloating, gas, abdominal pain and even health conditions like leaky gut, diverticulosis, hemorrhoids and more. Doing a cleanse after a vacation where you didn’t poop for a week or after having persistent incomplete bowel movements can remove the backup and reset your gut motility, leading to better bowel movements. (FYI, a cleanse is best done under the guidance of a gastroenterologist to be sure it’s done safely.)
Fibermaxxing is trending—what’s your professional take?
Fibermaxxing is a great trend, especially in a world overrun by protein optimization. You need to optimize both fiber and protein naturally and focus on reaching the recommended fiber goals of 25 grams per day (for women) and 38 grams per day (for men), and then see how high you can comfortably max it out. Aiming for 30 plants per week and daily fermented food is key!
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— Dr. ELENA IVANINA
DO, MPH, board-certified gastroenterologist
THINGS TO DO
THINGS TO KNOW
HOW TO ADAPT
— DR. ELENA IVANINA
DO, MPH, board-certified gastroenterologist
Something you can think about doing every day is keeping in mind the 5 P’s of gut health when it comes to what you’re eating.
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Prebiotics, probiotics, postbiotics, polyphenols and protein—per Dr. Ivanina, each one of these helps support your digestive system and should be incorporated into your daily diet. For example, prebiotics help feed the good bacteria in your gut, whereas probiotics include foods that have live cultures like yogurt. Postbiotics are the substances that probiotics make, while proteins come from both animals and plants. Finally, there are polyphenols. Altogether, they support a diverse microbiome that will help protect you from chronic disease.
Consider the 5 P's
— dr. elena ivanina
DO, MPH, board-certified gastroenterologist
Abdominal breathing is different in that you’re actually breathing and your stomach is going in and out, not your chest. This will activate the vagus nerve.
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Stress in life is a given, but according to Dr. Ivanina, it’s also a part of everyone’s gut health journey. How come? It’s all related to the gut-brain axis, which basically means that the gut affects the brain and the brain affects the gut. It’s a bidirectional relationship. This is where abdominal breathing comes in.
Practice Abdominal Breathing
The Check-In
GUT HEALTH EDITION
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Ask Dr. Elena Ivanina
DO, MPH
SHUTTERSTOCK/PUREWOW
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Ask Claire Rifkin
MS, RDN, LDN
Your most pressing gut-health questions, answered
THINGS TO DO
THINGS TO KNOW
HOW TO ADAPT
THINGS TO DO
THINGS TO KNOW
HOW TO ADAPT
— Claire Rifkin
MS, RDN, LDN, Women’s Health Dietitian
There are truly so many things that could be going on when you’re dealing with gut health issues.
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According to Claire Rifkin, a women’s health dietician, one of the most important things to do when navigating gut health symptoms is never to go it alone. Consulting a gastroenterologist and procuring an official diagnosis should always be the first step. After that, you can focus on food, supplements and lifestyle changes that can ideally provide you with symptom relief.
Get a Diagnosis
— Claire Rifkin
MS, RDN, LDN, Women’s Health Dietitian
That might look like taking a few deep breaths with an elongated exhale. Tell your digestive tract that there is going to be food on the way.
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Reality check: Eating in a rushed state can increase gastrointestinal symptoms and our perception of them because visceral sensitivity can be heightened under stress, Rifkin explains. The antidote? Building in a bit of space between you and the meal.
Create a Digestive Runway
— Claire Rifkin
MS, RDN, LDN, Women’s Health Dietitian
When you compress a huge meal into one sitting, that can lead to reflux, abdominal pain, bloating, gas. [That’s why you want to] try to eat at the same time—and consistently—every day.
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Our gut is highly rhythmic, which means the more that we can eat at consistent intervals that are relatively around the same time each day, the better we’ll feel, Rifkin says.
Predictability matters
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WHAT IS THE BEST THING YOU CAN DO EACH DAY TO IMPROVE GUT HEALTH FOR THE LONG-TERM?
Eat fiber! And eat a variety of it. Berries, leafy greens, oats, legumes, nuts, seeds, whole grains. Research consistently shows that microbial diversity (you know, the vast variety of micro-organisms inhabiting your gut) improves with a greater diversity of fiber-rich plant foods. It’s also associated with metabolic resilience, immune regulation and a reduced GI symptom burden. For reference, we want to aim for about 25-38 grams of total fiber per day.
Speaking of fiber, are supplements the answer?
No! I see people spending so much money on supplements while eating virtually no fiber. Clinically speaking, most commercial probiotic strains do not permanently colonize the gut. Their benefits are often strain-specific and context-dependent. In fact, for certain GI conditions, they can cause more harm than good. What tends to have a more consistent, lasting impact is prebiotic intake, which is the fermentable fibers that feed the beneficial bacteria already living in your gut. You can get these from fiber and plant foods like oats, bananas and legumes. That’s really where most people should be starting.
What is your best advice for managing the stress that arises with gut health issues?
Stress is absolutely a trigger for gut issues. The gut-brain axis is bidirectional, which means that stress activates the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. This slows gastric motility, alters intestinal permeability and increases visceral hypersensitivity, which is all just a fancy way of saying: You’re stressed and it’s making your tummy hurt. That’s why someone can eat the exact same meal two days in a row and only have symptoms on the stressful day. The good news is there are ways to manage daily stress in relation to our gut health. Things like consistent meal timing, adequate sleep, regular movement and managing caffeine intake are all ways we can mitigate stress.
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Ask Dr. Claire Brandon
MD
Answers to your biggest questions about the gut-brain axis
THINGS TO DO
THINGS TO KNOW
HOW TO ADAPT
THINGS TO DO
THINGS TO KNOW
HOW TO ADAPT
— Dr. claire brandon
MD, gastrointestinal psychiatrist
If you’re feeling nervous or anxious, you’ve probably had the experience where you’re like: ‘Oh, I’m feeling that in my stomach’ or ‘My stomach is doing flips.’ A lot of times, people are experiencing that in a more severe way.
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Working on your brain and mental health is just as important as trying to find an answer to the gut symptoms you’re having, according to Dr. Claire Brandon, MD, a gastrointestinal psychiatrist. She says it’s critical to target both of these rather than treat them in isolation. Certain techniques like down-regulation with breathing or treating panic will lead to gut symptoms almost immediately going down.
Your Mental Health Matters
— DR. claire brandon
MD, gastrointestinal psychiatrist
[It] helps them be more consistent in taking medication as well as being consistent in their daily routines. Exercise, eating in an anti-inflammatory way—that’s incredibly hard to do if you’re also dealing with depression or anxiety.
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Having Crohn’s or Colitis means you’re automatically at a higher risk for anxiety and depression, according to Dr. Claire Brandon. Since the two work in tandem, she says that treating depression and anxiety symptoms often yields relief when it comes to overall gut health, given that it makes it easier to stick to a routine that applies to your physical health.
Consistency Counts
— dr. claire brandon
MD, gastrointestinal psychiatrist
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Number one, you can remind your brain that you’re not actually trapped. At the same time, we’re trying to help our nervous system feel like it’s not going to cycle on itself.
In her practice, Dr. Claire Brandon often talks with patients about the anxiety that comes from feeling trapped in a car with a stomach that’s acting up. How do you regulate your nervous system? Practicing various relaxation techniques on a regular basis can help prevent you from catastrophizing the next time you’re faced with that situation.
You Have to Train Your Nervous System
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What is your best piece of advice for someone navigating the mental side of gut health issues?
Once we have a better understanding of stress and cortisol in our body, we have a better chance of reducing the risk of acute symptoms. Acute symptoms tend to be less common in disorders of the gut-brain axis. In fact, this is the result of long-standing behavioral and cognitive patterns that have been provoked over time. But feeling dysregulated can often show up as “suddenly my symptoms are worse,” when they’ve actually been brewing all along.
Often I’m encouraging patients to get really great at controlled breathing techniques. If we need to get out of a situation that our body is interpreting as “fight or flight,” this is something that we can lean on. I also like to encourage patients to pick a couple of things to be consistent about. Start small; maybe you’re taking a walk after a meal daily. You might be working on incorporating fiber every morning. It’s basically about teaching your nervous system that there is something we can rely on, and then we can build from there.
What are some ways to manage the stress that arises with gut health issues?
Any physical or psychological stress can result in a “fight or flight” reaction and cause higher cortisol levels. Our body interprets this as shutting down our gut and anything that isn’t immediately helpful to survival. So if you’re in a constant state of anxiety/stress, and we’re not treating that or doing something about that, what chance do we have to get out of this loop? I encourage patients to be very involved in psychological work. It helps them see themselves as capable of being their own advocate. In my work, I’m helping patients use cognitive behavioral therapy, biofeedback and psychodynamic treatments alongside medications to help them combat this very complex (but very treatable) constellation of symptoms. My major piece of advice is that motivation to get better is the key. If you aren’t fully buying in, it’s tough to make progress, but luckily that is also in your control.
What is something that people often get wrong about the mental health connection to gut health?
People often hear that they have a gut-brain axis disorder and therefore their doctor thinks that the symptoms are “in their head.” They think their doctor is being dismissive and that they’ve simply missed something, so how could a psychiatrist help? The reality is that our mental health is always talking to our gut. The central and enteric nervous systems have always been connected, and they talk to each other, so if one is in distress, the other is likely to experience distress as well. You can have physical symptoms, and they can also respond to psychological care.
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something, so how could a psychiatrist help? The reality is that our mental health is always talking to our gut. The central and enteric nervous systems have always been connected, and they talk to each other, so if one is in distress, the other is likely to experience distress as well. You can have physical symptoms, and they can also respond to psychological care.