Tips for helping your gut microbiome

What is the gut microbiome?

The gut microbiome varies from person to person. People may have 300-1000 species of bacteria in their gut microbiome, and it’s estimated that the gut has about 100 trillion bacteria total! Lucy Mailing PhD says that if we pick any 2 people, on average they will only have about 1/3 of the same gut bacteria. The other 2/3 will vary drastically due to their genetics, environment, diet, antibiotic use, mode of birth, and other factors. Due to that variation, there probably isn’t a specific universally healthy microbiome. She says “At the moment, a healthy microbiome is probably the microbiome you have when you’re healthy!”

While scientists are still working to understand more about the microbiome, we do know that gut infections are not part of a healthy microbiome. Things like parasites, fungi, and certain pathogenic bacteria need to be treated.

How do we try and keep our microbiome healthy?

That’s going to be individual to each person depending on their microbiome and what it needs, but there are some general ways we can help our gut:

-Treat any gut infections.

-Reduce our stress, especially chronic stress, so that our body can reside primarily in rest-and-digest mode rather than chronically in fight-or-flight mode.

-Make sure we have good digestion, which involves having enough stomach acid.

-Look at our diet. Our diet greatly affects our gut microbiome, and over consumption of ultra-processed foods, sugar, and highly refined carbs can inflame the gut, so limiting these and instead prioritizing a variety of nutrient dense food. It’s not about never eating dessert (for example) again – it’s about our overall eating pattern. We don’t need to be scared of a donut or chips, but instead we can limit these as treats, prioritizing and eating much more nutrient dense food instead as the foundation of our diet.

-Eat enough fiber. Fiber is vital for gut health and also is associated with health benefits outside of GI tract. Eating enough fiber can help with constipation, bowel regularity, diarrhea, and more. If we can, eat more plant foods and a diversity of them. Fiber is found in foods like vegetables, fruits, nuts, legumes, and whole grains. We can buy fruits and vegetables frozen or canned – we don’t need to just buy raw produce.

There’s different types of fiber like fermentable and unfermentable fibers, soluable and insoluble. Different types of fiber may cause GI upset for some people, so if we have digestive problems, we may need to figure out which types of fiber are the easiest for us to digest. If we’re increasing our fiber intake, it’s recommended to do so slowly, as well as increase our water intake and this may help avoid or minimize GI upset

-Doing major health behaviors like getting enough sleep, getting enough daily movement, getting sunshine, drinking enough water, socializing, etc.

It’s easy with our health to think that we aren’t doing enough, or to put too much focus on what we think we are doing “wrong” vs what we are doing well. The goal isn’t to go down every single rabbit hole, or blame ourselves, or stress ourselves out trying to make 100 changes to our lifestyle at once, but rather to have more awareness of how our lifestyle impacts our health.

For example, if we have trouble getting adequate sleep, we can identify that as an area we want to work on, but without blaming or judging ourselves. We can spend the time it takes to address that and figure out what works for us: what feels natural and easy to follow. Once we’ve made that into our new habit/way of living, then (should we choose to) we can look at another aspect of our health. It’s important to have patience and compassion with ourselves while making any changes, because modern life can be hard and we are doing the best we can.

Should I get a stool sample?

While many doctors do a stool sample as a part of their diagnostic workup, it may not be necessary. It’s also vital to understand the limitations of a stool test. Unfortunately, some providers (typically functional medicine doctors/ naturopaths) are using these tests for diagnostics in a way that they are not designed to be used.

A stool sample is just a snapshot of the bacteria in your stool, and this may not be reflective of the bacteria in your actual microbiome. That science is just not there yet, so be wary of the different claims that certain tests or practitioners make to use a stool sample to identify and treat gut dysbiosis.

There is a difference between a comprehensive stool sample vs a standard stool sample. A comprehensive stool sample will go a lot more in depth than a standard stool sample. Depending on the test, they can look for bacterial and pathogenic overgrowth, parasitic pathogens, fungi/yeast, inflammatory markers, immune markers, beneficial bacteria, and more. However, just because you have a high of an opportunistic bacteria in your stool sample doesn’t mean that it’s causing you a problem. Unfortunately, some providers lack nuance in understanding how to use these tests, which often leads to over treating. Providers should be analyzing the test within the clinical context: alongside any other tests the patient has done, the results of the overall stool test itself (for example: are there multiple high levels of opportunistic bacteria?), and patient symptoms.

Different stool tests can have pros and cons (in terms of what they look for, the method used, their reliability, etc). Some doctors use a combination of different stool tests because of this. Whether a doctor uses a stool test or not, they should be taking a close look at your symptoms as well as any other lab tests you’ve done to get a big picture of your gut health.

What doctor can help me with my gut health?

It will depend on what you are looking for. Some people may see a GI doctor, naturopath, or functional medicine doctor – but the important thing is the person you work with has experience and expertise in addressing gut health, SIBO, or whatever you are trying to treat. There is often a lack of evidenced-based medicine with naturopaths and functional medicine doctors, so make sure to research before choosing one of those doctors should you go down that path.

Taking probiotics

Probiotics are defined as “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host” (Hill et al, 2014).

We hear often that probiotics are supposedly great for XYZ, so one might wonder if they need to take probiotics? And the answer is no, you don’t have to. What you need is individual and depends on your own gut microbiome and gut health.

There’s actually conflicting opinions on whether probiotics are even needed for healthy individuals, with some researchers now saying that they aren’t needed. We often hear that we should take probiotics alongside antibiotics, but new research suggests that probiotics may actually slow recovery of the normal microbiome after antibiotics. I’ve linked a write up below on this from Lucy Mailing PhD.

Probiotic benefits are strain specific

Evidence is actually showing that the benefits a person can get from probiotics are disease specific and strain specific. Various probiotics have been studied in randomized placebo controlled human trials for their efficacy and safety for IBS, skin conditions, anxiety, depression and more.

So I think an important question if you are thinking about probiotics is “Why do I want to take probiotics? Am I looking to help a certain condition?” If so, look to see if a specific strain has been found in studies to be beneficial for it.

If you are using a probiotic that claims to have certain health benefits, there should be evidence on that strain to back up those claims, and hopefully even on that specific product. However, my understanding is that there’s not a general consensus on which specific probiotics are the best for which conditions.

Fermented foods

Some fermented foods can have microorganisms in them. My understanding is that the ones that have been properly fermented and contain live bacteria may be beneficial for gut health for some people. You don’t have to eat fermented foods, but if you like them, things like raw sauerkraut, kimchi, kefir, kombucha, etc, can be a delicious way to potentially help your gut microbiome.