Trust your Gut Insights Into Digestive Health

Lorraine Maher, MScDietitan

Overview• What is all this fuss about gut about?

• The biology and life inside our guts

• Gut bacteria and health

• What should we eat??•Diet •Fermented foods•Probiotics•Prebiotics

• Top Tips

Gut Health

•Gut health, leaky gut, bloating, top Googled terms

•Dubbed the next new ‘Mega Trend’

• The scientific community is all over it

• Your own world - your inner universe

•What truth lies out there….

Why is the Gut Important?•Gut health relates to functioning of our entire gastrointestinal tract from entry 👄 to exit 💩

•Gut disorders are DEBILITATING & SOCIALLY ISOLATING

•People with IBS said they would give up 25% of their remaining life to get relief from their gut symptoms!

• It’s importance extends to other organs like your brain, heart, kidney & liver.

• It does this is through the trillion of bacteria that live in our gut

Our Inner Universe

Bacteria

40,000,000,000,000

Bacteria•Digests food components we're unable to break down e.g. fibre

•Manufacturing vitamins & other health-enhancing molecule e.g. vitamin K, B12, Biotin, Folate & Thiamine

•Training our immune system

• Guarding our intestinal turf against the intrusion of pathogens.

Gut Bacteria

• Your gut microbiome is unique

• How we are delivered, whether we are breast fed or bottle fed, what our diet is like, how clean you are kept...

• Our immune system isn't challenged the way it used to be

• Hygiene hypothesis: Our immune system isn't challenged the way it used to be

• Is this why more cases of eczema, asthma and IBS?

• It's ok not to get the antibacterial gel out of your bag

• Our bodies are incredibly good at killing off anything unwanted

• Our immune system needs to learn how to battle these things off from an early age. 

The Many Parts (and Functions) of the Gut

HAZDA

Hazda• Hadza community in Tanzania• World’s last surviving pre-agricultural societies• Healthiest guts in the world in terms of diversity. • They live in the same spot eating the same food.• The indigenous ethnic diet consists of fruit, vegetables, game

and birds they’ve hunted.• The HAZDA noticeably lack many common western ailments

including diabetes and asthma.• The average Hadza person has >40% more bacteria than

westerners. 

HAZDA• The advent of agriculture has radically altered our diet.

• Labor-saving devices, sedentary existence, antibiotics and cesarean section

• Increasingly processed and fibre-free foods.

• Our own microbiota can change significantly from day to day in response to what we've been eating

• The Hadza get 100 of fibre a day in their food, on average.

• We average 15 grams per day

Gut Bacteria & Health

IBS• Syndrome

• Affects 1.8 worldwide - prevalent

• Unpleasant symptoms

• Taboo to talk about it

• Can be debilitating

• Dietary interventions that can help

• Connected to diet. No cure. But manage.

• Anxiety, stress

•Gut infections

FODMAPs•Acronym.

•Chemistry nightmare

•Rapidly fermented carbohydrate by gut bacteria.

•Can stimulate symptoms in hyper sensitive

•4 week exclusion then reintroduce foods.

•Linked to prebiotics

•Stress is a big player

•Eating on the run

•Not chewing foods

Its taboo to talk about …. No. 2’s!

• We all do it - break the stigma!

• Talk more

• Increase awareness of what’s going on in our gut

• Go if you have an urge

• If any changes, consult your GP

Leaky gut

• It’s not black and white

•From time to time we all can have a slightly leaky gut

•Being stressed can acutely increase the leakiness of your gut wall.

•De-stress = gut happiness!

Leaky gut• It is a symptom rather than a cause of disease.

• Visit your GP

• Check in with a registered dietitian

Weight Management•Gut bacteria help regulate hunger hormones & blood sugars

•High fibre foods are nutrient-dense & calorie-light

•People in the healthy weight range tend to have more good bacteria

•Probiotics maybe helpful

•New study underway looking at 💩 transplants as a weight loss strategy!

Cancer

Gut Brain Connection

• “Butterflies” in your belly when nervous • You can feel a lot of anxiety from working a high-stress job or

being stuck in traffic. • Your brain and body release stress hormones such as adrenaline

and cortisol, which communicate with the nerves in your gut brain • Can cause stomach upset, bloating, and diarrhoea.• Consuming lots of processed and sugary foods lead to spikes in

blood sugar and the production of excitotoxins

Depression

Anxiety & Depression• About half of those with depression also experiencing anxiety.

• A diet rich in whole grains, vegetables, and fruits is healthiest

• Don’t skip meals.

• The gut-brain axis is also very important, since a large percentage (about 95%) of serotonin receptors are found in the lining of the gut.

• Potential of probiotics

Diet

What Advice to Follow

DietitiansHere are 6 things you may not know about dietitians

# We are also qualified nutritionists 

$ We specialise across all areas of nutrition

% We love food (we’re not the food police)

& We understand the science of food

' We are all about individualised care, no one-size fits all

Dara O’Briain

“Dietitian is like dentist, and nutritionist is like tooth-i-ologist”

Nutribollocks

Nutribollocks

Diet - what to eat???

Fibre, Fibre, Fibre, and more FIBRE! 

30g Every Day

• Breakfast: One serving of whole-grain bran flake cereal (5g), topped with half a sliced banana (1.5g) and milk

• Morning snack: 24 almonds (3.3g) mixed with a quarter cup of raisins (1.5g)

• Lunch: Turkey sandwich made with 2 slices of whole wheat bread, plus lettuce, and tomato (5g), and an orange (3.1g)

• Afternoon snack: Yogurt topped with half a cup of blueberries (2g)

• Dinner: Grilled fish served alongside a salad made with romaine lettuce and shredded carrots (2.6g), plus half a cup of cooked spinach (2g), and half a cup of lentils (7.5g)

• After-dinner: 3 cups popped popcorn (3.5g)

Plant Based

Diet diversity“Diet diversity” is the latest buzz word to hit the gut health space…

(1) It’s a measure of how varied your diet is in respect to plant-based foods

(2) ⬆ diet diversity is linked with ⬆ gut health

Unfortunately the diversity of the average diet is rather poor.

GOAL: count the number of different plant species you consume over the next week including fruit, veg, grains, legumes etc If it’s under 20 try increase it the follow week

Having a really diverse plant-based diet is the best way to improve your gut health rather than taking a probiotic.

Variety is key - each vegetable contains different nutrients that the gut thrives on

A high adherence to a Mediterranean diet have a diverse microbiome, with many types of bacteria performing different functions.

Diet DiversityGOAL:

Count the number of different plant species you consume over the next week

If it’s under 20 try increase it the follow week

Improving diversity preferred over taking a probiotic.

Variety is key

A high adherence to a Mediterranean diet have a diverse microbiome, with many types of bacteria performing different functions.

Wholegrain• Those who eat wholegrain diet have significantly better gut health + immune function

UNFORTUNATELY it’s estimated # in % people don’t eat ANY wholegrains 😖

So what’s the difference between whole and refined grains? •bran: fibre-rich outer layer•germ: nutrient packed inner layer•endosperm: starchy layer

✔Wholegrains contain all 3 ✖Refined grains contain only endosperm

TAKE HOME: next time you're shopping check ingredient lists for the word “whole”

Increasing Fibre•Gradually increase fibre •Drink plenty of water

Fibre

Increasing your fibre intake by 7g/day can lead to:

• 8% decrease in bowel cancer• 6% decrease in T2DM• 9% decrease CVD• 9% decrease heart attacks• 7% reduction in strokes

Fermented Foods• Heralded as new ‘Superfood’

• Fermented foods that contain live bacteria but…..

• Not all fermented foods contain live bacteria

• Some die off during the fermentation process

Fermented vs Probiotics

Not all fermented foods contain live bacteria

they do NOT have probiotic activity

KefirKefir is fermented milk drink made from kefir “grains” (a mix of good bacteria & yeast).

• Kefir has ⬆ impact on gut bacteria

• Homemade kefir contains ⬆ bacteria compared to supermarket bought kefir.

Fermented foods• Don’t have to have them your diet

• Dabble if you enjoy it - include if you want

• They contain good bugs, cheap and taste good

• In addition some fermented foods are high in FODMAPs and therefore may not be well tolerated by everyone.

• Evidence is lacking for what benefit

• Not a panacea ;-)

Gluten

• Rapidly growing food market

• Expected to be worth £550 million by 2019.

• Coeliac disease = 1-2% of the population

• Non-celiac gluten sensitivity = 1-7% of population

• Be wary of gluten free isle: more sugar, less fat and less fibre

Non Coeliac Gluten Sensitivity

•Characterized by symptom improvement after gluten withdrawal in absence of celiac disease.

•The mechanisms are unclear

•Foods with gluten often contain fructans, a type of carbohydrate

•Investigated gluten vs fructans

Conclusions Fructans rather than gluten induced symptoms

Gut Bone Connection

* Up the calcium 🥛🧀

* Get your daily dose of Vit D ☀

* 💊 in the ❄

* Include weight bearing exercise 1

* Be good to your gut!

Chewing food

• Chewing your food well

• Chew 20 times can help people with

• 10 vs 40 times, 40 times, absorbed lots more of nutrients

• Those who eat quickly not absorbing

• Often overlooked

• Easy to shovel it down

Foods to Minimise• Processed foods - additives, packaged, complex names,

protein bars,

• Occasionally fine but if surviving on this then bad

Sweeteners

Ketogenic diets•A ketogenic diet (aka keto diet) is essentially a really low carb diet

•Also typically low in dietary fibre

•The keto diet does have its place in medical nutrition therapy (e.g. For some epileptic patients).

•With respect to the general population the body of evidence says it's NOT the way to go for a happier, healthier life.

Probiotics

Probiotics• Widely available

• To take with no gut symptoms?

• Specific for specific conditions?

• Now quite generic

• Lactobacillious vs bifidobacteria

• Which to trust?

ProbioticsProbiotics are named by a 3 level system

For example, Lactobacillus Casei Shirota is derived from:1) genus ➡Lactobacillus2) species ➡ Casei 3) strain ➡ Shirota

There are over 180 Lactobacillus SpeciesThere are >2000 of different Lactobacillus strains

Probiotics - When & How to Take

• On an empty stomach with water

• Avoid hot drinks 20-30 mins either side of taking them.

• Many of which are sensitive to hot temperatures.

Taking Antibiotics?

•Antibiotics are really useful at fighting off bacterial infections

•They also cause major changes to the balance of our gut bacteria

•Can sometimes results in diarrhoea

•Probiotics will help protect people from getting diarrhoea

•Take as soon as you start the antibiotics and continue for at least one week after the end of the course

Travelling• Travellers’ diarrhoea can occur due to a bacterial

or viral infection during or following a trip to specific countries.

• It affects 20-50% of international travellers ➡ 10million people annually!

• If you are going to a part of the world where travellers’ diarrhoea is common then you might consider taking the probiotic

• Saccharomyces boulardii • or a mixture of probiotics called Lactobacillus acidophilus &

Bifidobacterium bifidum

Travelling

• Not usually routine

• Different fluids, foods, sleeping patterns

• Not comfortable

• Gut brain connection

Flying• If you suffer with long haul flights

• Restricting foods such as onion, garlic, legumes, figs, dates etc…

• When these foods are fermented they produce gas in the gut

• But this gas expands as the plane climbs

Constipation•Constipation is common

•Symptoms include infrequent bowel movements, hard stools, a bloated stomach & straining.

•Recent studies have shown that probiotics may help to ease the symptoms of constipation.

•If you suffer from constipation, try products that contain Bifidobacterium Lactis for a trial period of four weeks.

•If they don’t work, try another brand or stop taking them

Prebiotics

Prebiotics

• PRE - non-digestible parts of foods that feed bacteria

• “Fertiliser” for your gut bacteria

• Encourage growth of types bacteria that improve health  

• Naturally occurring in food - fruit and veg, wholegrain

• Most prebiotics are dietary fibres, but not all dietary fibres are prebiotics!

Prebiotics

The word ‘prebiotic’ is seldom used on the label.

Look in the ingredients list for •Galacto-oligosaccharides (GOS)•Fructo-oligosaccharides (FOS)•Oligofructose (OF)•Chicory fibre•Inulin

Synbiotics•SYNergist

effect

No one size fits all

Other stuff….

Nutrition Supplements

• Fresh food is best

• Clever marketing

• Whole oats better than beta gluten

• The whole foods makes the food works

• In isolation not getting the benefit

• So boring concept of whole foods still best

Sleep

• Sleep deprivation leads to increased food intake • In fact the study suggested when sleep deprived you eat an additional

385cals/day, which is the equivalent of 3 biscuits

Food choices were also ⬆ in fat, ⬇ in protein with no difference in carbohydrates. ....

MECHANISM? 🤔 Hormones, brain-reward activation & maybe even our gut microbes!

MindfulnessThis simple meditation is a good place to start:

• Sit somewhere quiet and set a timer for 3 minutes• Take a deep breath and blow it all out.• Close your eyes.• Inhale and focus entirely on that breath: Feel the air go all the way

in and your belly expand, and then exhale, blowing all the air slowly out of your mouth, feeling your belly contract

• Continue, focusing all your mental energy on each inhale and each exhale.

• When your mind wanders, simply bring your focus back to your breath.

• Let your thoughts drive quietly by in your mind, like cars zipping down a road. Continue until your timer goes off.

It doesn’t matter if you spend all but one breath wandering around in your mental landscape—the effort to meditate is what counts.

Take a Tech Break

Exercise• Improved health promoting bacteria in active people• Increased muscle mass linked with good bacteria

• Active people also ate moredietary fibre & less processed meat.

➡sedentary= less than 90mins/wk mod intensity exercise➡active=at least 3hrs/wk mod intensity exercise

Runners Gut

For people with sensitive tummies (around 30% of us!) eating a meal high in fibre & fructose before a run could make your gut symptoms worse

For those may suffer, running long distance/ intense workout, pre-run don't:# more than one piece of fruit $ takes concentrated drinks eg. Soft drinks, fruit juice & standard energy drinks% high fibre cereals& supplements containing sweeteners (called sugar alcohols) like xylitol

What TO eat pre-run?• Rice cakes with nut butter + banana + water/electrolyte drink • Instant quick oats with plant based milk

Not Helpful….• Bowel cleanse

• Activated charcoal

• Anecdotal advice

• Hair analysis

• Spending ++ on supplements

Food Intolerance Tests• Companies taking advantage of people with “intolerance”

testing• People spending hundreds of €€€€€ getting them• There is no blood test that can diagnose a food

intolerance• Currently there is no valid blood/ skin tests to diagnose

food intolerances (unlike allergies)...• See a registered dietitian or registered nutritionist for safe

credible advice.• DON’T WASTE YOUR MONEY!

Conclusions• Fibre is your friend

• Aim for 15 types veg every week

• Aim for 10 types fruit each week

• Variety is key!

• Count how many you eat!!!

• Ultimate gut health diversity

• Choose wholegrains over refined grains.

Conclusions

• Give fermented foods a try

• Chew, chew, chew

• Swerve stress

• Sleep better

• Exercise regularly

• Listen to your gut