All disease begins in the gut
Hippocrates 460 – 370 BC
This idea of ‘gut health’ isn’t new. Hippocrates, the Greek physician referred to as the father of medicine, is credited with the quote above some 2000+ years ago. Whether or not there’s any validity to it, is a topic for another blog post but the gut has always been an area of focus and fascination when it comes to health.
Fast forward to today and the term ‘gut health’ is everywhere; it’s fast becoming part of our everyday language. The term is used more and more frequently by the average person on the street, in the scientific literature and with food products that are promoted to improve gut health. Not only that, ‘gut health’ is becoming a health goal in and of itself, as if it’s something that’s easily measurable, achievable and actually important.
But what IS gut health?
Gut Health: a new goal for personal health?
Western medicine is largely reductionist; the body has been broken down into its individual systems; cells, tissues and organs have been compartmentalized with specialization. Some are experts in hormones and metabolism, others the cardiovascular system for example. While this makes perfect sense in many ways since no one can be an expert in everything, it often results in a lack of integration where each practitioner [and ‘health focus’] works in silos ignoring the inter-connectedness that is the human body.
When it comes to the digestive tract (a.k.a. ‘the gut’), Western medicine’s approach has historically been to view it simply as an organ of digestion and elimination; if things aren’t moving along, use a laxative, if things are moving too quickly, numb the bowel with an opiate derivative like Imodium. Gas? Bring on the antacids. Even organic disease like cancer, Celiac, and IBD are viewed as challenges of digestion & elimination with little regard to the impact these diseases have on the gut’s role in other areas of health.
Things are changing though. It’s now understood that to have good health, we must work towards achieving and maintaining a healthy gut by focusing on the gut as a whole and ensuring all players in gut health are at their best:
- the muscles that make up the digestive tract
- the immune system that is embedded throughout
- gut bacteria
- the gut’s nervous system (unique neurons found in the gut)
- and supporting the gut’s role in endocrine function, cardiovascular health and metabolism
Defining gut health
The challenge with gut health as a health/medical goal is that it lacks a standardized definition and it’s unclear how to assess it and measure it. Experts in this field are working towards that (1) but it’s a work in progress; a working definition along the lines of:
“a state of physical & mental well-being in the absence of gastrointestinal (GI) complaints which require the consultation of a doctor, in the absence of indications of, or risk for, bowel disease and in the absence of confirmed bowel disease”
In other words, gut health is present when someone is physically & mentally overall well, who doesn’t have any GI complaints [cramps, gas, bloating, irregular bowel movements, reflux etc] making them visit their doctor and who doesn’t have any symptoms or risk factors for, or has any confirmed bowel disease [cancer, IBD, colitis, ulcers, Celiac etc].
This definition considers both sides of the ‘gut health’ equation; the person who expects to be overall well without any GI symptoms who, at the very least, doesn’t need to go to the doctor and it considers the health professionals’ viewpoint who must consider risk factors/signs and symptoms for possible GI disease/dysfunction when counselling a client even if the client/patient doesn’t voice any complaints.
It’s the best working definition/approach we have to date to use when working with clients, one which will continue to evolve and be refined in the future
Relevance of gut health
Whatever the definition of gut health is or will be, assessing all aspect of digestive health (and by extension mental health) is relevant and a worthy goal. This is because intestinal complaints are one of the main reasons people go to the doctor; these include heartburn/reflux, gas, bloating, nausea, food intolerances, belching, indigestion, diarrhea/constipation, loss of appetite and more.
Despite the lack of a clear definition, 5 criteria have been proposed (1) that might inform a more objective definition of gut health; criteria that can be used in an integrative & functional way to help clients address many of the common gut complaints they face – gut issues that are often connected to and influenced by, other health issues.
| Major Criteria for a Healthy GI System | Specific Signs of GI Health |
| Effective digestion & absorption of food | 1. Normal nutritional status & effective absorption of food, water, vitamins & minerals.
2. Regular bowel movements, normal transit time & no abdominal pain. 3. Normal stool consistency, and little to no nausea, vomiting, diarrhea, constipation, & bloating. |
| Absence of GI Illness | 1. No acid peptic disease, gastro-esophageal reflux disease, or other gastric inflammatory disease.
2. No enzyme deficiencies, or carbohydrate intolerances. 3. No IBD, Celiac disease, or other inflammatory state. 4. No colorectal or other GI cancer. |
| Normal & stable intestinal microbiota | 1. No bacterial overgrowth/SIBO
2. Normal composition & vitality of the gut microbiome 3. No GI infections/parasites or antibiotic-associated diarrhea |
| Effective immune status | 1. Effective GI barrier function, normal mucous production & no enhanced bacterial translocation.
2. Normal levels of IgA, normal activity of immune cells. 3. Immune tolerance & no allergy or mucosal [gut lining] hypersensitivity. |
| Status of well-being | 1. Normal quality of life.
2. Balance neurotransmitter production & normal function of the enteric [gut] nervous system. |
Goal of gut health
Gut health as a ‘thing’ may be challenging to define, measure/assess and achieve as a goal in and of itself but we know when we don’t have it; issues such as gas, bloating, cramps, loss of appetite, reflux etc that send us to the pharmacy or doctor remind us that many don’t have good gut health. Considering the criteria above, we can see that the digestive tract is so much more than just an organ of digestion and elimination but one that has many layers that need attention if we are to have the best gut health possible. The goal of gut health is one where all of the gut’s needs are met; allowing it to function fully so that we can have the best overall health possible.
Optimizing Gut Function
- Getting the best digestion, absorption & elimination
- Reducing the risk for increased intestinal permeability [gut barrier dysfunction]
- Supporting gut bacteria [microbiota] ecology
- Addressing gut & overall inflammation
- Supporting gut-based immunity
- Supporting gut-derived neurotransmitter function
- Stress reduction and achieving good mental health