What is ‘gut health’ – is it merely an absence of gut disease? ‘Good for gut health’ is a term often emblazoned on food packaging, though rarely do they explain what aspect of the food validates the claim. With one in five people in the UK experiencing Irritable Bowel Syndrome at some point in their life and the widespread use of over-the-counter medications aimed at our digestive systems, one might conclude that merchandisers have identified another significant market category.
As an isolated claim, ‘good for gut health’ will probably grab the attention of all those suffering the occasional bloat (is that most of us?), and it’s conveniently vague enough to slip past rigorous legislation aimed at preventing spurious health claims being used to help sell products. But ‘Gut health’ should not only signify an absence of gastrointestinal disease and a symptom free status, it should also encompass the following:
- Effective digestion
- A healthy mucosal tissue that effectively absorbs nutrients, whilst also being a barrier to pathogens
- Balanced immune tolerance (to the dietary nutrients passing through and being absorbed)
- A good habitat for the microbial populations (that serve to enhance the gut’s barrier, digestive and immune functions).
Because these four are all necessary functions of a healthy gut, and if any one of them falters, gastrointestinal discomfort and risk of disease may be just around the corner.
Of course defining the term gut health is one thing, but actually measuring the complex mechanisms it encompasses is another. Historically, the focus of healthcare has been to investigate, measure and diagnose disease or a state of pathology. So can ‘gut health’ – if it’s an absence of disease and a goal that sits within the realm of disease prevention – actually be measured? Turns out it can . . .
Positive health goals and disease prevention is very much the domain of Functional Medicine practitioners trained in Nutritional Therapy, who work upstream to optimise the body’s systems – in particular intestinal function – rather than simply suppressing or managing downstream symptoms of disease. Working upstream they need to be able to assess and measure intestinal function within objective parameters, and will employ an armoury of functional tests to this end. It’s worth pointing out here that a well functioning gut has been shown to contribute to health in many more ways beyond the intestines, including influence over mood, mental health and the immune system.
The two main functional entities that are central to gut health are its microflora (the trillions of beneficial bacteria that live on the surface of the gut), and the actual intestinal surface, that has a two way function: to absorb nutrients, whilst blocking undigested food and pathogens. We call this its barrier function.
And these entities can be measured,. Our intestinal microflora co-exist with us in a mutually beneficial relationship, contributing to our metabolism as well as our immune systems. Their numbers and diversity help to keep opportunistic colonising pathogens in check. This resident microbiota can be measured via stool samples using DNA-based sequencing technologies. Research shows that possessing the greatest microbial diversity is associated with good gut health. Such testing can then inform therapeutic probiotic protocols if required.
Our intestinal barrier function can also be tested, as abnormal permeability – where the gut surface may be behaving more like a colander than fine cheesecloth – can result in undigested food and other particles trafficking through to the bloodstream. Such incursions can upset the delicate balance between tolerance, or an immune response causing inflammation and food sensitivities, as well as infectious and inflammatory GI diseases, raising risk of autoimmune conditions and multiple health problems.
A measure of gut hyper-permeability can be shown using blood tests that might reveal increased presence of bacteria specific antibodies, or immune complexes to undigested proteins or viruses. In the event of an overly leaky gut being revealed, a nutritional therapist will first identify the likely causes of the leakiness – or failure of the barrier – then embark on dietary protocols designed to restore the integrity of the barrier.
Effective Digestion is a third entity that is also measurable. Digestion and metabolism are the processes by which your body converts the food you eat into energy and structural repairs. The vitamins and minerals in your food also support myriad, complex processing functions, chemical reactions and the nervous system. So knowing you’re getting what you need from your diet is extremely useful, and the Organic acids urine test can do just that. It also assesses the adequacy of your digestive enzyme production, without which food would not get digested. It can reveal precisely what nutrients from a person’s diet are actually being absorbed and utilised, and conversely – what may be lacking. By identifying any weaknesses in a person’s metabolism, or inadequacy of digestive function, or nutrient shortfall, dietary protocols can be tailored to the individual’s requirements.
When it comes to diet, one size does not fit all and different lifestyles that put different stresses on metabolism result in varying nutrient needs. Our inherited genetic dispositions also vary and create different needs in the nutrient department too.
With research now showing the health of our guts has profound effects on the other systems of our bodies, ‘Good Gut Health’ needs to be everyone’s goal.
Functional Medicine that looks upstream to optimise the health of all the body’s systems represents a very useful adjunctive approach to healthcare, because by improving the body’s ability to function well and bring back into balance any systems that are veering away from the optimum, will support the body’s very real ability to stay healthy. These practices represent effective strategies of preventative medicine that could also make a meaningful contribution towards keeping our health systems more affordable.
Bischoff SC (2011)’Gut health’: a new objective in medicine? BMC Medicine 9:24
Arora SK et al., (2015) Microbiome: Paediatricians’ perspective. Indian J Med Res. 142(5):515-24.