8 tips to improve your gut health

As a gastroenterologist, one of my major goals is to help people poop better. That means talking more openly about our gut health in general.

It often amazes me how little we talk about something so intrinsic to our basic functioning. Recall, for example, how many times proper toothbrushing technique was drilled into our heads as children. But for reasons inexplicable to doctors like myself, when it comes to burping, farting, pooping or anything to do with our gut, we draw the line.

Perceived stigma about these topics can keep people from getting the answers and help they need to improve their overall health. For me, no question is off limits or too embarrassing. In fact, if you do have a question you’d like me to answer in a future column, please send it to me here.

So what should you know about your gut health? Here are eight science-backed tips I’ve covered in previous columns.

1. Don’t strain or linger on the toilet.

Sitting and pushing for prolonged periods of time - which tends to happen while scrolling through social media on the commode - can compromise the supportive tissue in our anal canals, potentially leading to symptomatic haemorrhoids. This is why I frequently remind my patients that they have one job, and one job only, when they take a seat.

Decades ago, doctors thought constipation and a low-fibre diet were the prime reasons people got symptomatic haemorrhoids. But studies over the years have not proved this consistently. And a high-fibre diet doesn’t clearly lower the risk of developing engorged hemorrhoids - though it is recommended as treatment.

Today, we think symptomatic hemorrhoids can be related to these factors - but it’s a more complex relationship. They are more likely a result of straining and hard stools (which can certainly occur with constipation, though not always). If your diet is rich in fibre but you’re still straining, talk to a gastroenterologist to help address why - there may be an issue with the pelvic floor muscles that could be improved with physical therapy.

2. Know what’s ‘normal’ for you.

Most of the adults who come to my gastroenterology clinic have no idea what would be considered a “normal” bowel pattern. A general rule of thumb is that anywhere from three bowel movements per week to three per day is within the range of “normal.” Once-a-day bowel movement is great for many people. But the key to a healthy stool frequency is that however often it happens, it should be comfortable.

If you consistently have a bowel movement once a day, but to do so you have to strain significantly and take laxatives, then I’d say there may be a problem. If this sounds like you, speak with your doctor about ways to have easier bowel movements. Sometimes simple fixes such as increasing your water and fibre intake or boosting your exercise routine (which can stimulate your bowels) can make a big difference. On the other hand, if you have a bowel movement only every second or third day, but doing so is effortless without bloating, pain or undue straining, then that’s a healthy and “normal” pattern.

3. Avoid taking drugs like ibuprofen.

Drugs like ibuprofen can damage our gut lining. That’s why you should avoid taking nonsteroidal anti-inflammatory drugs, or NSAIDs - such as ibuprofen, naproxen and aspirin - whenever possible. If you do need to take them, use the smallest dose for the shortest time feasible.

I don’t get too concerned if my patients take one or two doses every now and then. But through regular use, such as several times a month or more, NSAIDs are well-known to increase intestinal permeability.

Many people live with conditions like migraines, chronic back pain or bad period cramps and take NSAIDs on a regular basis to treat their symptoms. If that’s you, I’d advise you to have a chat with your physician and explore NSAID alternatives. Because NSAIDs do work well - and are cheap and over the counter - you may have never felt the need to discuss what else to try instead.

4. Minimise your intake of sugary drinks and red meat.

Although we don’t have control over many aspects of why we develop cancer - including our genetics, our environment and our early-childhood exposures - there are a few areas where our own decisions can have a big impact.

I advise many of my patients to start by changing their diet. Eating a Mediterranean-style diet, which is rich in legumes, nuts, fruits and vegetables, can reduce the risk of colorectal cancer by around 18 percent. But so many people have been raised on a diet of highly processed, low-fibre meals, and their palates are accustomed to it. I have only rarely met patients who can go from zero to 100 when it comes to a dietary change.

That is why I recommend reducing your intake of foods that have been linked to colon cancer. That means avoiding sugar-sweetened beverages (such as sodas), red and processed meats, refined grains and alcohol whenever possible.

5. Go on. Try a bidet.

Bidets are gentle and hygienic. I recommend them all the time for my patients with loose stools, like in irritable bowel syndrome, who find that constant wiping makes their skin raw. Bidets are also excellent for anyone who might struggle with balance or coordination reaching back to wipe and especially fantastic for people with hemorrhoids or anal fissures, or those who are recovering postpartum.

I get it, though: It can be hard to get over the weirdness of trying a new thing in an area where you don’t try new things often. But once you experience that level of freshness, it becomes so intuitive that it’s hard to go back to just plain wiping.

There is a bit of a learning curve when it comes to adjusting the water pressure and getting into all the nooks and crannies. And unless you’ve got a fancy bidet with a dryer, you’ll need to dab the area dry with a sheet of toilet paper or a clean towel.

6. Eat a fibre-rich diet.

The vast majority of us are not meeting the daily dietary fibre recommendations. But we should all be eating a fibre-rich diet. This time-tested recommendation remains one of the strongest-studied ways to promote and preserve a healthy microbiome and improve your overall health.

Eating a low-fibre diet leads to the loss of major categories of bacteria - and once certain groups are lost, they can be lost for good, even if you try to ramp up fibre intake later. So the time to act is now. The more diverse your diet, the more diverse your microbiome, and the healthier you are. So choose a variety of high-fibre plants, nuts and fermented foods to feed your microbiome the nutrient buffet it deserves.

7. Worried about smelly gas? Try this.

Ninety-nine percent of intestinal gas is made up of nitrogen, oxygen, hydrogen, carbon dioxide and methane. These gases are odorless; it’s the 1 percent that contains sulfur, such as hydrogen sulfide, that ruins it for everyone else. When the bacteria in our colons metabolise our food, they can produce those sulfur-containing gases.

If you need a simple solution in a pinch - an upcoming work conference or a date in cozy quarters with someone special - take bismuth subsalicylate (Pepto-Bismol). Not only has it been shown to neutralise more than 95 percent of sulfide gases in the gut and to reduce symptoms of flatulence, but it can also prevent traveler’s diarrhea. There is some concern about salicylate toxicity if you use it regularly long term, but if you need it for a day or two to ease your social discomfort, by all means, take 524 milligrams by mouth four times a day beforehand.

8. Think twice before cutting dairy entirely.

About two-thirds of the world’s population develops difficulties as the molecule that breaks down lactose in the small intestine, known as the lactase enzyme, switches off as we age. Without enough lactase, intact lactose cruises into the colon, where it gets fermented by our microbiome, leading to the production of gas and bloating.

Despite these symptoms, my advice as a gastroenterologist is: Don’t go cold turkey on dairy.

Studies have found that most people with lactose intolerance can tolerate at least 12-15 grams of lactose in one sitting - the equivalent of about one cup of milk. This is important because dairy products are some of our main sources of calcium and vitamin D. Furthermore, eating small amounts of lactose regularly can have a prebiotic effect by promoting the kinds of gut bacteria that can better metabolize lactose and improve our tolerance.

Try spreading out dairy intake over the course of the day and eat it with other foods, or choose low-lactose or lactose-free dairy products. Instead of plain, natural yogurt, try plain Greek yogurt, which has about half the lactose.

You can also try taking an oral lactase enzyme replacement such as Lactaid around 15 minutes before consuming higher-lactose-containing meals. These don’t work for everyone, and the data from randomised controlled trials is limited. However, it’s a simple and safe enough experiment to try for yourself.

*Trisha Pasricha is a physician and journalist who writes the Ask a Doctor column. She is an instructor of medicine at Harvard Medical School.