How to take care of your digestive system: an expert guide in 20 steps
Ever wondered if you have IBS or a gluten allergy? Confused about probiotics and fermented foods? Five experts give the ultimate guide to a healthy, happier gut
1. "Listen to your body; if it tells you gluten doesn’t agree with you, it probably doesn’t," say Stephanie Moore and Elaine Williams who developed the Health Regime, a seven-day gut restoration programme, at Grayshott Spa.
Take a minute before you eat any meal. Eating when stressed is a common cause of bloating, which many of our clients think is normal because it happens day in, day out. But it’s not, and you can reduce it if you calm your system before eating. Taking a few deep breaths replaces the arousal-based nervous system associated with stress with the calming parasympathetic nervous system. When this is activated, digestion can work properly again.
2. Gargle for two minutes a day
Digestion starts in the brain when the vagus nerve, running between the brain and the gut, sends signals triggering the production of stomach acid and digestive enzymes. Many people with poor digestion have a weak vagal signalling process. There are a few ways to strengthen it: you can sing or gargle for two minutes each day, or use a tongue depressor to stimulate your gag reflex two or three times.
You don’t have to be coeliac to react to gluten. We now know that many people have a measurable reaction to gluten that doesn’t cause the damage to the microvilli that would class them as coeliac. It’s called non-coeliac gluten sensitivity, and it affects far more people than coeliac disease does. Listen to your body; if it tells you gluten doesn’t agree with you, it probably doesn’t.
3. Leave 12 hours between dinner and breakfast
The gut lining consists of a single layer of cells that replenish every 72 hours, but this repair cannot take place effectively if your gut is working hard on digestion at the same time. Leaving 12 hours between meals gives a clear period for the gut to focus on repair and replenishment. But do not fast for the sake of your gut – it sends the body into shock and overburdens the liver.
4. Excess acid may not be the cause of your problems
Many people who suffer from indigestion, acid reflux or heartburn think it is because they produce too much acid, but it is just as likely that they don’t produce enough. This triggers a pressure change in the stomach which allows the sphincter at the top to open, letting the contents pass back out. Eating a little protein at each meal and chewing well both raise acid production. Also try a tablespoon of raw cider vinegar (it must be the type that contains the mother sediment) in a glass of water immediately before you eat.
5. "Most people have one issue that leads to 70 per cent of their gut symptoms – your focus should be finding and eliminating that one trigger before you try anything else," says Sam Bearfoot, aka The Digestion Detective.
The most effective way to improve gut health is to drink more water. The gut is a long slippery tube, and for good gut function you need to keep that slipperiness, which will happen if you are hydrated. But do not hydrate with sugary drinks – they simply feed less healthy gut bacteria in the bowel. I’m also wary of smoothies because of the raw food they contain. Raw food takes one and half times more energy to break down than cooked. In a healthy gut that’s fine, but if your digestion is taxed it can trigger problems.
7. Love your gut
If you are constantly uncomfortable, you can quickly come to resent your gut. One of the first things I ask clients to do is turn that around. Think of those symptoms as telling you something is not right and giving you a chance to fix it. Once you adopt that mindset, trying to find the solution to a problem seems more manageable.
8. Change one thing at a time
Clients often tell me they feel better after giving up everything at once – gluten, dairy and sugar, for example – and so feel that they must do so for the rest of their lives. But most people have one issue that leads to 70 per cent of their gut symptoms – your focus should be finding and eliminating that one trigger before you try anything else.
9. It is not always IBS
About a third of sufferers, particularly those who have loose bowels as their main symptom, have a problem called Sibo (small intestinal bacterial overgrowth). In this, gut bacteria that normally live in the large intestine populate the small intestine instead, triggering such problems as loose bowels, bloating and abdominal cramps. Normally it is treated with an antibiotic that wipes out the bacteria overgrowth, but it also kills the healthy bugs in your system. US researchers claim to have come up with a herb-based antibiotic that attacks only the unwanted bacteria in the bowel. See more at siboinfo.com.
10. Raise your knees on the lavatory
We are not designed to defecate sitting down. We are supposed to squat, which straightens the colon and reduces pressure. Modern lavatories don’t make this position possible, so place your feet on toilet rolls – I use the bathroom bin – to raise your knees higher than your hips, which changes the colon angle. There’s also a device called Squatty Potty that puts you in the right position.
11. You don’t need to poo daily
The idea that you need a daily bowel movement is simply not true for 75 per cent of us. Normal bowel activity is classed as anything more than three times a week and fewer than three times a day. And nor does it have to be a “perfectly formed” stool – normality is anything from putty to Maltesers. So long as you pass it easily it is OK.
12. More fibre is not always the solution
The first thing a constipation sufferer tries is to increase fibre intake. But there is a type called slow transit constipation for which this is the worst solution – it will lead to more bloating, wind and pain. If you try raising your fibre intake and things get worse, then stop. First try eating only fruit-based fibre, which is easier to digest than harder fibres such as bran. If that still doesn’t work, seek advice. Eating regularly is as important as what is in your meals – eating triggers the bowel to move, so if you skip meals you are more likely to develop constipation simply because it’s not getting that stimulus.
13. Don’t be afraid of laxatives
Many people who have constipation think laxatives will make the bowel lazy, but that isn’t the case. If you have had your bowel checked to ensure there is no underlying condition that needs treatment, using laxatives when you need them is not harmful. Colonic irrigation, though, is not helpful. In the hands of a trained practitioner you are safe from bowel damage, but gut bacteria are important to bowel health, and washing out the colon depopulates the bacteria levels.
14. Take your PPIs
On an empty stomach Proton pump inhibitors such as omeprazole, which are used to tackle conditions such as acid reflux or heartburn, are among the most commonly prescribed medications in Britain. The trouble is that many people use them incorrectly. Failing to take them on an empty stomach reduces their efficacy by some 40 per cent.
15. Keep a food diary
But be warned: often people are so sure certain foods are behind their symptoms that when they study their diary they merely look for proof of their beliefs. This may result in cutting out foods they don’t need to, which in extreme cases can lead to malnourishment. Look at any food diary with an open mind, or ask a dietitian or digestive health specialist to do so for you.
16. Drink a daily cup of bone broth
Christine Bailey is a nutritionist based in Berkshire who runs workshops on how to cook for a healthy gut:
Eat more liver. It is one of the single best sources of vitamins A and D, which protect the mucus membrane of the gut. If you really cannot bear the idea of eating liver as it comes, sneak it into things like burgers – you still get the nutrients. I also suggest people with poor gut health drink a daily cup of bone broth. It is packed with minerals and collagen that help restore the integrity of the gut lining.
17. Consume fermented foods
Traditionally these were always part of our diet: we would eat raw milk or cheeses made from it that would re-inoculate our body with good bacteria that the gut needs to thrive. Now, though, we rarely re-establish this via our diets. I recommend adding such foods as sauerkraut, kimchi, kefir, kombucha, tempeh or fermented pickles to your daily meal plans.
18. Avoid sugar
It has a profoundly adverse effect on the gut. Sugar feeds harmful bacteria which then cause bloating and all manner of damage to the gut lining. And it is not only the sugar found in sweets and chocolate – be wary of concentrated doses in energy drinks, fruit juices and many low-fat foods.
19. Take a probiotic
Not all bacteria is equal, though – you need to ensure you are taking a species, strain and subtype that has shown good results. I recommend products that contain Lactobacillus GG, which has been shown to have clear effects at fighting inflammation and can therefore help problems such as Crohn’s disease, colitis or IBS. Saccharomyces boulardii is a probiotic yeast particularly good at fighting problems such as traveller’s diarrhoea or upset stomachs caused by antibiotics. Products containing many billions of bacteria are also not necessarily better. If you take a super-strength probiotic you are flooding your gut with new inhabitants. This can shock the system and lead to bloating.
20. Symptoms are not always food-related.
I have seen people who have been fighting poor gut health with various diets for years. To me, this means the root cause of the problem has not been identified. People often fail to consider that they might be carrying a parasite, and 70-80 per cent of the people I test with unresolved gut symptoms have one. If you have poor digestion but do not know why, undertake a stool test to check for anything unwanted.