BEYOND DIET: What Else Is Important For Healing Gut Issues?

The saying goes that “Food Is Medicine”...

This is because the nutrients we eat inform our biochemistry - they are the building blocks of what makes our cells and fuels our wellbeing. Changing what you eat can change your state of health. The computer programming analogy of “Garbage In, Garbage Out” applies just as well to human health as it does to software: our health is founded upon the quality and variety of the food that we consume.

In this context, however, it can be very tempting to imagine that dietary change is all that’s necessary to completely revolutionise your health. This is particularly true in the case of digestive health. Because symptoms seem to always occur as a result of eating foods, it is natural to assume that the food is the issue. Change the diet, change the digestive health.

And in some ways, this can be true - if you begin from a place of eating only garbage, replacing that with only nutrient-dense foods will undoubtedly transform your digestion.

But in my clinic I get people through the door who have tried every diet possible and whose response to not feeling better has been to try to diet harder, restrict further. I have written before about how combining all of these restrictions is not healthy for the body, or the mind.

The reason for this is that food is just part of the puzzle when it comes to digestive health. Food might be medicine, but it is not a universal miracle. Sometimes, food is not the actual problem - even when digestive health is the main issue. This means that food choices, restrictions and eliminations may not be the solution.

So how do you go about addressing a digestive issue? Well it certainly starts with diet. But if your diet is good - so whether that’s Paleo or AIP, just gluten-, dairy- and sugar- free etc. - and you’re still struggling digestively, you may find a low histamine or low FODMAP diet being recommended.

Histamine and FODMAP foods react within the body in a certain way, so needing to avoid these foods is typically evidence of compromised health, rather than a pathology that you should have to live with permanently. Not being able to tolerate histamine or FODMAPs isn’t actually about the foods that contain these things - it’s indicative of an underlying pathology that needs to be addressed.

Actually Treating Infections, Parasites & SIBO

Most often, histamine and FODMAP intolerance or sensitivity is rooted in microbiome health. So if you’re having histamine or FODMAP sensitivity a sensible place to explore is the microbiome itself: investigating, using Functional Diagnostic testing, pathogenic bacterial issues, parasites and also SIBO and/or yeast issues.

That doesn’t mean that your digestive symptoms are solely the result of what you can see on a stool test - and that ‘treating’ everything found on the test will resolve things. However, interpreting stool tests in the context of your case history, symptoms and experience is a valuable way to understand whether gut pathologies play a causal role in your digestive symptoms.

For this reason, I would highly recommend working alongside a practitioner. I have yet to see an online protocol that is in any way as nuanced and as complex (basically, layered) as a practitioner would prescribe - nor with as much holistic support. You cannot just wade in and treat dysbiosis in someone if they are immunocompromised or struggling with detoxification. You especially cannot simply treat pathogenic bacteria if there is too much intestinal permeability involved. Treating gut pathologies is part science, part art - and whilst you could learn the skills, sometimes it is clinical experience and having seen hundreds of similar gut cases which most informs the eyes of a practitioner when they are assessing your case.

However, the point must be made that whilst sometimes a gut protocol will include a dietary component, by the time you get to treating gut pathologies you are only ever using the diet as an adjunct to therapy. This means that the diet is largely alleviating symptoms, sometimes touching a bit on the cause - but mostly, it is the therapeutic supplements or medications which take over in reshaping the microbiome.

Healing the Gut Lining

Then there are the situations where the bacteria are “OK” but the gut itself is inflamed, irritated or hyperpermeable. Again, sometimes diet is responsible for this - though this can be because dietary intake has created the inflammation OR because the dietary intake has not been sufficient to nourish and nurture the gut lining.

This means that by all means you can fill your diet with collagen-based bone broth, foods rich in fat soluble vitamins and amino acids which nourish the gut. You can also consume prebiotic and probiotic foods which can assist with bacterial diversity and growth - and it is the microbiome which help you to make the short chain fatty acids which contribute to the integrity of the gut wall.

But then there’s the pure fact that sometimes you need MORE support than you can get through diet alone.

I describe myself as a relatively ‘supplement-light’ practitioner. Unless my patients are doing treatment protocols I like to keep their supplement intake to basics and minimums - not trialling every newfangled popular supplement on the market. However, if you’re struggling with the integrity of the gut lining I would always suggest supporting a good dietary intake (note: supporting - supplements should supplement a great diet, not try to remedy a rubbish diet) with supplements. This can include a variety of Vitamins A and D, L-Glutamine, Slippery Elm & Marshmallow, Colostrum, Collagen Powders and also Saccharomyces Boulardii.

Again - I would heartily recommend working with a practitioner. Some of the above come in very nice blends that are practitioner-grade only. Additionally, you may need further nutrient support such as using Zinc Carnosine and B vitamins. You may also need to experiment with direct anti-inflammatories such as Quercetin or Curcumin.

However, whether for a short time or for a more prolonged period, it is often utilising some additional (supplemental) support that can make the difference that the diet never could to the integrity of your gut lining and to decreasing the inflammation within.

Mindset and Emotions

Now, I am a Functional Medicine Practitioner because I believe that without the foundations of biochemistry we are fighting a losing battle with our bodies and our minds.

However, I also refer to myself as an integrative practitioner which means I incorporate psychology and emotional wellbeing into my practice. Most often - when all of the physical issues above are addressed and yet still symptoms remain - the complications with digestion emanate from the nervous system or the mindset.

Let me be really clear - this isn’t about problems being in your head. It’s about the neurological wiring being patterned by both past experiences and current mentalities which are influencing the way your nervous system is working.

The nervous system is vital to govern the way we bring food into our bodies. Firstly, it innervates the gastrointestinal tract which means that it governs motility and the way food moves through us. Too tense and motility either slows, or speeds up rapidly. This can make for constipation (and all of the problems that leads to) or rapid gastric emptying - which can eventually create serious nutrient deficiencies. Both of these conditions can create inflammation.

But more than this, the gastrointestinal system is built on delicate concentrations of acidity, bile, chime, enzymes etc. Everything needs to be released at the right time for adequate breakdown and assimilation of molecules from food. If this system (which is regulated by the activation of the parasympathetic nervous system, so ‘rest and digest’ mode) isn’t activated then the checks and balances of gut function go awry. Once or twice, this doesn’t matter - but when this becomes a chronic condition problems arise.

This literally means - from an entirely physiological standpoint - that if you’re eating in a state of stress you will not digest your food properly.

But on top of this there is also mentality and perspective. Our mindset has the ability to put us on high alert if we feel threatened, emotionally distressed about what we’re eating or even just emotionally distressed whilst we’re eating.

On high alert, our nervous system’s attention is turned up to maximum because it is trying to protect us against threats - real or perceived - within the immediate environment. That includes the food on your plate, however benign or ‘good for you’.

This whole process, in turn, increases immune activity. When you are stressed and on hyper-alert then every ‘attacking’ system in your body is prepped for action. This creates excessive reactivity, immune responses and a higher-than-normal release of inflammatory cytokines in response to food. This literally creates symptoms.

I wrote last week about the Nocebo effect in relation to gluten. Well in the above paragraph is what is, in part, happening in the Nocebo effect. The fear that something might happen often causes it to happen because you have prepared your body to be in fight or flight mode. A system in fight or flight cannot rest and digest and so the result is symptoms.

It is this last area that fascinates me, personally and professionally. I am proof positive of the way that both emotions/mindset AND physiological issues can directly alter our neurological and immune receptiveness to food. Hacking this system isn’t something that can be done overnight, nor easily. But for many of my clients it is this predisposition to hyper-alert responsiveness upon eating that really must be tackled if digestive issues are to be resolved.

When it comes to the modern epidemics of illnesses, I am not someone who is in one camp criticising glyphosate, immunisations, antibiotics, modern diets or big pharma. In truth, all of these play a role. But I am also noticing that the major influence in our modern world is stimulation. We are constantly being bombarded by things that our nervous systems have to face, deal with, compute, rationalise, assess and learn from.

The constant presence of rolling media is, even if not directly experienced as stressful, stimulating. In a world where our nervous systems are constantly being bombarded with ‘stuff’ it doesn’t take a lot to tip this system over the edge into distress and feeling under threat. Add in some tricky life experiences or a history of emotional confusion or baggage around food and real physiological symptoms can arise in response to eating just about any food.

It is this area that I enjoy really honing in on for my clients - and it the one that yields the most results. Once gut bugs are treated and the gut lining is restored - and the diet is rich in nutrition and taste - sometimes the major thing holding us back is the emotion we carry (around ourselves, our bodies, our lives and our foods). Tackling this latter part is truly offering holistic healthcare.