How to have a Healthy Gut
By Dr. Ian Wallace

Are you tired of wildfire smoke as well? Yup, me too. Not so excited for more one hundred plus degree days? Same here. What I never get tired of talking about is a healthy gut. It has so many interesting areas to think about, from the mechanical digestion part of the stomach, to the complex chemical digestion of the pancreas and small intestine and finally the water saving measures of the large intestine. With such complexity, it’s easy to understand the confusion around probiotics, supplements and what is a healthy diet. There are many ways to help the gut function well and plenty of ways to sabotage it’s job. In this article I just wanted to touch on three of them. First, I wanted to touch on the theory of leaky gut, then review probiotic usage, and finally some ideas on herbal supplements.

As I mentioned, the gut is a wondrous place. Even as recently as 2014 there have been articles attempting to verify the size of the digestive tract. Scientists publishing in the Scandinavian Journal of Gastroenterology calculated we have roughly 350 square feet of absorptive surface area, while others proposed a surface area closer to 3500 square feet. As with most things in life, it’s probably somewhere in between those two numbers. In some ways we all have a leaky gut. It’s the way that food, nutrients, medications and hydration makes its way into the body. When you suffer from leaky gut syndrome your body is allowing too many things through. The holes in the intestinal lining are too large, and they are inflamed so they don’t function correctly, or they are in the wrong areas. Current theory holds that the process is started by our diet of low fiber foods that are high in sugars and saturated fats along with consuming too much alcohol, and stress. There is already data linking leaky gut with several GI diseases such as inflammatory bowel diseases, wheat intolerance issues, and irritable bowel syndrome. Treatment of leaky gut can be difficult but the core component is to decrease inflammation in the gut by changing the diet and reducing stress. Beyond that, some people start taking supplements that promote a healthy gut, such as probiotics.

People have been using probiotics for a long time. From when yogurt was first invented around 5000 B.C. in Mesopotamia and kombucha was first brewed in Manchuria around 220 B.C., humans have been taking pre and probiotics. Any food source that is elevated in good gut bacteria is essentially a probiotic. The prebiotics are the good fibers and sugars that can help the probiotic organisms develop. Only certain gut problems seem to be responsive to probiotics. These include diarrhea after you have taken an antibiotic, ulcerative colitis or irritable bowel syndrome. Probiotics might help other conditions, we just don’t know for sure. Some types of bacteria that are beneficial are: Bifidobacterium, Lactobacillus, Leuconostoc, Saccharomyces boulardii, and Streptococcus. Probiotics are safe for most people. The only people who should be wary of them are folks with cancer (sometimes they cause rare blood infections) or people who have immune system problems. When you are trying to pick a probiotic keep in mind what are sometimes called the three D’s. You need a diversity of species in the probiotic – so not just one type of bacteria but many. You need a sufficient dose of the bacterias, which is usually greater than 10 billion colony forming units. Finally, you need to pick a delivery method that works for you – enteric coated capsules, powder, gummies, etc. If you can’t take the probiotics because you don’t like the taste or the texture or something else they won’t help your gut. In addition to probiotics many people take herbal supplements to try and improve their health.

Herbal supplements are derived from plants or plant extracts and are not regulated by the Food and Drug Administration the same way that prescription medications are. Many people with chronic medical problems take herbal supplements. Estimates are that 20-25% of people taking a prescription medication will also be taking a supplement. Some will interact with various medications while others will have no effect. The only way to be on the safe side is to let your doctor know which herbal supplements you are taking and have them check for interactions. Some that are known to interact with most medications include Goldenseal (Hydrastis canadensis) and St. John’s wort (Hypericum perforatum) while many have a very low risk of causing problems. Low risk herbal supplements include Black cohosh (Actaea racemosa), Cranberry (Vaccinium spp.), Ginkgo (Ginkgo biloba), Ginseng (Panax quinquefol), Saw palmetto (Serenoa repens) and Valerian (Valeriana officinalis). One place that I use for researching supplements is the Memorial Sloan Kettering Cancer Centers Integrative Medicine website (https://www.mskcc.org/cancer-care/integrative-medicine). It’s free and they tend to have nicely written monographs on the supplements my patients are using.

Just two other things before I end. First, coronavirus is still with us and while I wish I had a magic wand to make it all go away, getting a vaccine is your best bet in reducing your risk of ending up in the hospital or worse. We have people testing positive in our clinic system. If you take care of a pre-teen or teen, remember the vaccine is available for those age 12 and older. Second, I want to make a plug for colon cancer screening. The U.S. Preventive Services Task Force lowered the recommended starting age for colon cancer screening to start at age 45 years old. This might be a stool based test or a colonoscopy. You would need to sit down and talk about it with your doctor to determine which is right for you.

While the gut is a mysterious place, we have the ability to affect its health with each and every meal. Choosing a diet that is high in good dietary fiber, low in processed foods, low in processed sugars/saturated fats can be part of your overall plan for great health. Stay healthy and eat well.