Introduction
Even with the surge of awareness around our digestive well-being, gut talk still feels a bit taboo. We talk around it all the time, citing regularity and balance, marvelling at the microbiome or admitting to a bit of bloating. But, we cringe a bit when talk about gas, constipation, poop, and perhaps the most dreaded word of them all, diarrhea.

In Good for Your Gut, we are going to get real to gain a true understanding of what is going on with our gut and the ways we can find healing when it goes off the rails. Whether you’re just curious about your gut health as part of your self-care or you have something that needs fixing, it’s time to set aside any hesitations that you might have about gut stuff. We are hardwired to think it’s kind of icky, but it’s natural and if we don’t talk about it, we can’t improve our well-being.

Not convinced it’s a major issue? It is estimated that 16 percent of adults in the United States struggle with constipation. If that doesn’t seem like a big number, when we do the math it’s more than 50 million Americans who aren’t pooping regularly.

If you’re picking up this book, you either recognize that gut health is important or something is going on in your gut right now. Perhaps you have not said a word to your doctor for fear of embarrassment. I get it. It is one thing to talk about digestive health in general and quite another to admit to having digestive issues yourself.

So why don’t I start? Digestive health was not my first love—it was inflammation. When I started learning about anti-inflammatory nutrition, the fact that inflammation is intertwined with gut health wasn’t really on the radar.

However, I could not ignore that the vast majority of clients I was talking to on a daily basis had questions about their gut health. Whether it was finding a dietitian who understood celiac disease, why they couldn’t find a gluten-free trail mix, or looking for answers about their digestive issues when their medical tests came back clear, people needed help. Since they weren’t finding it elsewhere, I jumped into the void along with them.

As a dietitian, gaining a clear understanding of what was going on for my clients was tough at first. The microbiome wasn’t a household term like it is now. Gut-brain connection? Way too out there. Even trickier, when I was starting out, I had just one clinical gold-standard diet at my disposal—the gluten-free diet for celiac disease. The only accepted evidence-based nutritional therapy for digestion at the time was meant just for those with celiac disease. Everyone else was left adrift in chat groups, blogs, and—if they were lucky—the office of an integrative practitioner looking for a path forward.

In the early days, even the low-FODMAP diet was considered controversial. It is now considered (close to) gold standard for those with irritable bowel syndrome (IBS). We’ll do plenty of talking about FODMAPs in Chapter 6.

Why Gut Stuff Is Hard to Fix

Not having agreed-upon therapeutic diets is the first challenge of being a digestive health dietitian. It’s up to me to piece together the latest research on food and digestion, to understand the ability of certain nutrients to alter digestive function or gut healing, and to navigate any issues my clients are having with actually digesting healthy foods.

To add another wrinkle, addressing digestive issues is tough because I can’t see what’s going on in your gut. You tell me you’re bloated, but it might be difficult for me to determine if your belly is actually distended. Of course, just because I can’t see it doesn’t mean it isn’t happening. A lot of digestive health—short of having a doctor place a camera inside your gut—is based on subjective experience. How do you feel? Where do you feel it? What does your poop look like to you?

Barriers like these are probably why it took so long for functional digestive issues like IBS to be taken seriously by the medical community. If you have IBS, on paper “nothing is wrong” with you except maybe you poop a lot and you feel pain or urgency. There is no lab test to diagnose your issue like there are for high cholesterol or blood sugars. We have diagnostic criteria, but IBS is also defined by subjective terms such as pain, which is tricky because we all have a different tolerance to pain. So, I did everything I could to understand what my clients were going through. Honestly, sometimes I was a bit skeptical of what I was hearing. I was still an outsider to their experience. And then I wasn’t.

In my twenties, I never once thought about my gut health. I was lucky to be healthy and I took full advantage: eating veggie burgers and fries at 10 p.m. or dancing all night and going to school after four hours of sleep. I always felt pretty good, so other than generally eating well—I was studying to be a dietitian, after all—I didn’t take any other steps to protect my health.

And then I got pregnant with my son. As a dietitian working in holistic health, I was super focused on creating a healthy environment for my baby. I ate my veggies, avoided coffee, went to yoga, and even took probiotics. I was now learning about the microbiome and wanted my own bacterial flora to be healthy so I could pass it on to him. However, nature had a little wrench to throw in the works.

My son was delivered early, just shy of thirty-six weeks. I had to give birth to him on an antibiotic drip because I had not yet done the routine thirty-seven-week screening to be sure I was free of a dangerous microbe called group B strep. I’m happy to report that he was born healthy. After that came the sleepless nights, constant takeout dinners, and the stress of caring for a new baby. Within a few months, I wasn’t feeling as good as I used to. Exhausted, I chalked it up to new mom syndrome until the pain started—searing pain that made me feel like my gut was exploding. It made it almost impossible to sit down sometimes.

As a dietitian—and a skeptical one at that—I visited my physician more than once to ensure that I didn’t have celiac disease or any other serious cause of my distress. My symptoms didn’t suggest that I had something like Crohn’s disease because I wasn’t pooping all day long, but something was seriously up. This pain could not be normal. The fact that I had about thirty seconds between the urge to go and actually going was not normal. I found myself living in the world of “something’s wrong, but the tests are clear,” like so many of my clients.

Over the past ten years, I have tried many supplements, dietary strategies, and integrative therapies to try to get to the root cause of my digestive issues. Eventually, I found a set of solutions that has helped me feel healthier than I’ve ever been. One of the greatest gifts that this experience has given me is the ability to intuitively respond to what my body needs. However, this book isn’t about just telling others to do what I did. Instead, I will draw on the latest research and my experience working with clients for over a decade to share the most effective strategies to support digestive well-being. I know that what works for one person may not work for another. I can have two clients with the same condition who respond to nutritional therapy quite differently.

What the Heck Is Wrong with Our Gut?

In North America, our digestive health is in the toilet. Literally. It is estimated that sixty to seventy million Americans and about twenty million Canadians have digestive issues. However, these statistics are not the same around the world. Most countries in Europe have far lower rates of IBS, despite the cheese, wine, and pasta. Inflammatory bowel disease (IBD) is less common in Africa and Asia, although rates in Asia are climbing alongside Western-style diets.

How is this possible? There are a number of potential reasons, and the real answer is probably a combination of culprits. Our hyper-sterilized environment is thought to lead to immune systems that overreact, which may contribute to allergy, autoimmunity, and perhaps digestive disease. It’s known as the hygiene hypothesis because apparently you can be too clean. Some countries may not recognize or diagnose digestive issues—or its citizens may not have access to non-urgent medical care—as many of us do here in North America, although there is research to suggest that conditions such as celiac disease are more prevalent now than ever before.

In 2009, researchers were able to study blood samples taken fifty years earlier and compare them to blood samples from modern adults. What they found was that levels of the celiac disease antibody were four times higher in 2009 than in the late 1940s. Of course, our rate of celiac disease in North America is still only about 1 percent, which is a lot less than you might have guessed. In Italy, it’s actually closer to 7 percent. Seems unfair, given how good the pasta is there. So why are health gurus telling us all to avoid gluten if perhaps only 1 percent of us need to? Let the scientific record show that gluten isn’t evil and we don’t all need to be avoiding it.

Low vitamin D levels could contribute to our risk, as we see more IBD in countries farther from the equator, but that doesn’t explain what’s going on in Asia, a continent with a hefty dose of tropical countries. It is thought that vitamin D may influence the way the body reacts to pathogens, which are disease-causing microbes. What’s more, vitamin D insufficiency is rampant in IBD, perhaps affecting 60 to 70 percent of patients. Another study suggests that supplementing with just 2,000 IU of vitamin D3 daily helps to decrease inflammation in Crohn’s disease. Vitamin D is an interesting nutrient, as it isn’t readily available in our food supply—our body is designed to make it in our skin upon exposure to UV light. Living indoors and living in far northern and southern reaches may mean that we are more at risk of gut inflammation due to a lack of vitamin D.

Then there is the matter of the trillions of little critters living in our gut known as the micro biota. The word microbiota means “tiny life” and I’ll use this term interchangeably with gut bacteria and gut flora, which are more popular terms. Our gut microbes—or microbiota—seem to be doing all manner of fascinating things in the darkest recesses of our colon. Here is just a sample:

• Fermenting our digestive leftovers to create short-chain fatty acids that decrease the pH of our gut. A slightly more acidic gut helps prevent the growth of disease-causing bacteria.

• Feeding our gut cells and calming inflammation through those same short-chain fatty acids.

• Producing vitamins, like anti-inflammatory vitamin K, that are absorbed into our body and help us absorb more calcium and iron.

• Improving the function of the gut barrier by increasing the thickness of the protective mucus layer that covers it. Sounds icky, but it’s very important.

• Communicating with our gut—or enteric—nervous system and producing helpful little neurotransmitters like serotonin.

• Telling our immune system to calm unnecessary inflammatory responses.

Keeping these microbes happy is in our best interest and we’re not doing a very good job of it. Pretty much 100 percent of all the gut problems we experience are connected to unhappy gut microbes. If you do not feed friendly gut bacteria the plant food they need, they might not grow well. What will grow to take their place? The wrong kind of gut bacteria that cause inflammation, wreck your gut, and mess up your bowel movements.