The Gut Health Checklist
I’ve been getting so many questions lately related to gut health and healing that I decided it was time to address the issue.
I approach gut health with the science and sensibilities I rely on in my private practice as a registered dietitian and fertility expert. For this post, I’m going to feed you some key strategies I use with my clients so you can work to improve gut health on your own through diet and lifestyle. At the end, I’ve put together a comprehensive “checklist” for you to see where your gut health stands, understand the severity of your symptoms, and provide insight on whether or not you should seek the guidance of a practitioner in addition to implementing my strategies.
If you’re pregnant or trying to conceive, I’m sure you are already paying attention to what you eat in order to fuel your body properly for the enormous task you’re asking it to complete. You know that proper nutrition builds healthy babies. You know that it also helps prevent many - often avoidable - pregnancy complications. But did you know that your microbiome plays an important role in how the nutrients you eat get to both you and baby? It does. In fact, due to this - and via other mechanisms - your microbiome also influences pregnancy complications like preeclampsia, gestational diabetes, and beyond.
This is where the term “gut health” comes into play.
Your microbiome is composed of all the bacteria that live on (and inside of) your body. Sounds kind of crazy, but we are all covered with bacterial cells, inside and out. Our digestive systems alone house 100 trillion of them. The vast majority of these bacteria, or microbes, are highly beneficial to us, working with our own cells to benefit the entire body. However, some microbes are… less beneficial, and it’s not necessarily black and white which ones will affect which people in what way. Our individual microbiomes are unique, influencing almost every aspect of overall health and metabolism.
That’s a LOT of work for a bunch of teeny tiny bacteria. When your microbiome is healthy and thriving, it keeps your body running smoothly and reduces your risk of disease. The problem is that many of us have a significant imbalance of good and bad bacteria in our microbiome and don’t even realize it. We are often of the mindset that if we don’t have digestive problems (gas, bloating, constipation, diarrhea) we are in the clear, but symptoms of imbalance - or dysbiosis - can be a little more complicated to identify and navigate.
The good news is that, if you are trying to conceive, you have some time to find solutions. But if you are pregnant, and as your pregnancy progresses, the urgency with which you want to address potential gut health issues rises a bit, because it doesn’t only influence your own health, it can impact your pregnancy and the health of baby.
During pregnancy your body changes, but not just because you’re growing with your baby.
In fact, some of the biggest changes you’ll experience are shifts in your immune system and the way your body creates and then quells inflammation. Additionally, estrogen and progesterone, two hormones that increase during pregnancy, will be fluctuating. As a result of all of these shifts, your microbiome and gut health will be impacted. At minimum, you might experience a change in your normal digestion process. This is due in part to the slowing of your digestion in order to help you extract more nutrition from your food, but it is also caused by alterations in your microbiome (oh, and hormones).
During pregnancy, you are at risk for new, opportunistic bacteria to populate your gut. Depending which kind stakes its claim in your digestive tract, you may be at an increased risk of certain complications that could impact the health of both you and your baby.
"What is at risk for me, personally?"
Preterm birth is when birth occurs before 37 weeks and is the leading cause of long-term disability and mortality for infants. The health of the microbiome in the gut, vagina, and even the mouth have been linked to an increased risk of preterm birth. While not everything is within our control, there are many ways to help prevent preterm birth by altering your diet: specifically, getting in your nutrients, including omega-3 essential fatty acids.
Preeclampsia is a condition that happens late in pregnancy that leads to dangerous high blood pressure and spilling of protein in the urine. Gum disease and off-kilter bacterial balance in the mouth increases a mother’s risk of preeclampsia. I remember the first time I saw this connection made in the research. I was pregnant with my first child, and struggling with gum disease which led to more frequent trips to the dentist and overall discomfort. While I didn’t develop preeclampsia, it was something I paid close attention to prior to conceiving my second. Bacteria in the mouth can cause inflammation but they can also “translocate”, meaning they can travel to other parts of the body making them an under-discussed threat to a healthy pregnancy.
Pregnant women who develop gestational diabetes have been studied to have less diversity in their gut microbiomes and more inflammation-triggering bacteria overall.
Excessive weight gain
Dysbiosis has been associated with a high pre-pregnancy weight and weight gain during pregnancy. Healthy weight gain during pregnancy lowers risk of preeclampsia, diabetes, and other pregnancy complications.
A healthy microbiome can reduce your risk of a lot of pregnancy-related complications for you, but equally importantly, it can set your baby up for developmental success and avoid complications for them.
"What is at risk for baby?"
Considering they receive 100% of their initial microbiome from you, the stakes are high.
Studies show that an entirely unique microbiome locks into place in the placenta and amniotic fluid as they develop. Maternal intestinal inflammation in utero (or really, maternal inflammation, in general) can alter brain and nervous system set points and stress points before a baby is even born. That stress point then, in turn, can impact how the microbiome develops and proliferates.
After birth, the infant’s gut bacteria are influenced by a whole host of factors: type of delivery, genetics, the mother’s age, even the actual size of the newborn. The type and variety of strains that ultimately colonize in their own bodies at birth can have long-term effects.
But your baby’s microbiome will continue to develop after birth. Breastfeeding will change it as they grow. Recent studies have now shown, for example, that when a baby is starting to develop a cold, their saliva and the microflora in their mouths will chemically signal through the nipple to their mother’s breast to alter its milk. The immunoglobulins in mom’s breast milk will change to try to keep that cold at bay. Isn’t that amazing?!
There are many factors that play into the health of baby’s microbiome, and some even yield tangible consequences in very positive ways.
"How do I optimize my gut health for the sake of my baby (and myself!)?"
The absolute best way to support a healthy gut is to feed it healthy foods.
The microbiome in your gut is ever-evolving, and is therefore something that you should be constantly keeping tabs on and paying strict attention to.
Many people take a probiotic supplement, but, as I’ve said before and will say again, we should all always be aiming to get what we need through food first.
Luckily, fermented foods like pickles, pickled vegetables, kimchi, and natto, and some fermented beverages are here to save the day. Fermented foods are preserved in a way that not only increases their shelf life, but they also punch up the nutritional content and pack a big dose of probiotics to help strengthen your gut flora. To get the most health benefits, be sure to choose unpasteurized pickled vegetables (they will be in the refrigerated section of the grocery store), as the process of pasteurization kills off beneficial bacteria. Fermented dairy containing lactic acid bacteria, such as yogurt, kefir, and aged cheese, is also a great addition as they often contain more vitamin K2 levels due to the fermentation process. Studies also show that maternal intake of fermented milk products has been shown to reduce eczema and allergic rhinitis (hay fever) in infants, so be sure to add these into your diet if you can tolerate them. Also, when shopping for fermented beverages, such as kombucha, be sure to read the label and check the amount of added sugar each serving contains.
Similarly, prebiotic fiber can help regulate and target pathogenic bacteria in your gut and increase microbial diversity. Prebiotics are types of fiber that promote the growth of beneficial bacteria. They play an influential role in halting the development of several inflammatory diseases and conditions, including allergies, which can often be a result of disturbed gut colonization or reduced microbial diversity. Plus, in helping to restore and enhance our gut flora, prebiotics also help improve the manufacturing of some nutrients like vitamin K, vitamin D and B vitamins. Dandelion greens, garlic, onions, asparagus, and oats are all great examples of foods high in prebiotic fiber.
Your gut and digestion can also be affected by your stress levels and daily habits. If you’re feeling out of whack, ensure you’re
- Breathing properly (deeply and into your abdomen)
- Eating in a slow, seated state (avoid eating on-the-go)
- Resting & digesting (truly tapping into your hunger cues)
- Getting enough rest (try progressive muscle relaxation)
I won’t say avoid probiotics, because they can be great. I will say avoid blindly taking just any old probiotic.
Your gut microbiome co-evolves with you. Just like everything in the world of nutrition and supplements (and healthcare and medical treatment), what works for someone else might not work for you. Your probiotic should be personalized to your individual needs and lifestyle. Remember: microbial diversity is key, so eating a variety of fermented and prebiotic foods truly contributes to the array of microorganisms in your gut.
Look to natural remedies to help you regulate.
As an herbalist, I’ll point you to a few of my favorite safe botanicals to support motility in your digestive tract. Consider utilizing lion’s mane, which improves vagus nerve function to help catalyze healthy movement and get your gut feeling better. Powdered or whole (fresh or dried) forms of mushrooms are great sources of polysaccharides (unlike tinctures) which are also great for gut bacteria. Gentle botanical bitters, like dandelion, burdock root, and chamomile, are also great herbs to turn to. Interestingly, our gut has bitter receptors that help get our bile and liver moving, and our stomach motility going too.
If you begin to incorporate some of these strategies and are still having issues, you might be experiencing something more intense.
"How do I know if my symptoms are irregular?"
Enter my checklist.
- Have you suffered with digestive issues for years?
- Do symptoms affect your daily life?
- Are you frequently constipated or have loose stools OR do you fluctuate between both?
- Have you tried probiotics and cannot tolerate them?
- Do you have a growing list of foods that you can’t tolerate?
- Do you have frequent heartburn (GERD, reflux, acid indigestion)?
- Do you notice that you sometimes have undigested food in your stool?
- Have you experienced skin rashes, hives, or eczema after you eat certain foods?
Did you check any of the above boxes? If yes, a whole host of microbiome problems could be at play inside of you. You might not have enough digestive juices to do the work, especially if you’re eating while you’re stressed and on the go, you may have disrupted motility, or simply know that something is just not right with your digestion.
I strongly advise you to consider working with a functional medicine practitioner who is well versed in gut health issues. So many people will simply take an over-the-counter medication, probiotic, or other supplement to try to solve their problems, but finding the root cause can be a needle in the haystack if you’re not sure what you’re looking for. You’ll want to find someone who can utilize appropriate testing to identify your specific imbalance.
Your gut health is not just important to your baby’s health, but to how you feel and function day to day, so make it a priority to get on the right track and support your system.
- "Pregnancy: How Your Digestion Changes." University of Rochester Medical Center. Web. Accessed July 2021. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=P09521#:~:text=Pregnancy%20hormones%20can%20affect%20the,also%20affected%20with%20delayed%20emptying.
- Maria Elisa Perez-Muñoz, Marie-Claire Arrieta, Amanda E Ramer-Tait, Jens Walter. “A critical assessment of the ‘sterile womb’ and ‘in utero colonization’ hypotheses: implications for research on the pioneer infant microbiome”. National Center for Biotechnology Information. Web. Published April 2017. Accessed July 2021. https://www.ncbi.nlm.nih.gov/pubmed/28454555.
- Bilodeau, Kelly. “Fermented foods for better gut health”. Harvard Medical School Health Blog. Web. Published May 2018. Accessed July 2021. https://www.health.harvard.edu/blog/fermented-foods-for-better-gut-health-2018051613841.
- Randi J. Bertelsen, PhD, Anne Lise Brantsæter, PhD, Maria C. Magnus, Margaretha Haugen, PhD, Ronny Myhre, PhD, Bo Jacobsson, MD PhD, Matthew P. Longnecker, MD ScD, Helle M. Meltzer, PhD, and Stephanie J. London, MD, DrPH. “Probiotic milk consumption in pregnancy and infancy and subsequent childhood allergic diseases”. US National Library of Medicine, National Institutes of Health. Web. Published Jan 2014. Accessed July 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912862/.
- Justin L Carlson, Jennifer M Erickson, Beate B Lloyd, Joanne L Slavin. “Health Effects and Sources of Prebiotic Dietary Fiber”. US National Library of Medicine, National Institutes of Health. Web. Published Mar 2018. Accessed July 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6041804/.
- “Stress Management: Doing Progressive Muscle Relaxation”. University of Michigan Medicine. Web. Accessed July 2021. https://www.uofmhealth.org/health-library/uz2225.