When my patients come to see me for their annual exam, I always ask about nutrition and digestive issues including whether they are experiencing any occasional bloating, gas, constipation and/or diarrhea. Many times my patients answer yes, but aren’t sure what to do about their symptoms. They are so used to living with the symptoms and inconvenience, they don’t take that next step for relief. And yet, with a few questions, we can often get to the root of the problem and then together come up with some solutions.

Are Donuts A Food Group?

I saw a patient, who I’ll call Karen (not her real name) who had a combination of occasional diarrhea, gas and bloating and constipation. As we talked about what she had eaten over the last 2 days, she started recognizing how a few things might be contributing to her symptoms.

A self-described picky eater, who didn’t like vegetables, Karen laughed and asked me if donuts and coffee could be considered a real food group. That’s because she stopped at her favorite donut shop on the way to work for a few glazed donut holes and an extra large black coffee for the stressful 45 minute morning commute. By the time she pulled into her parking spot at work, she was invariably bloated, the waistband of her pants was feeling tighter, and though she was a little reluctant to admit it, she sometimes had diarrhea.

I also noticed that Karen’s typical lunches and dinners consisted of mostly breads, potatoes, pasta combined with a whisper of protein, the rare smattering of iceberg lettuce and little to no dairy. She liked to snack on bananas and peanut butter pretzels in the afternoon with another cup of coffee. It was difficult to know exactly what was causing Karen’s digestive symptoms because she had many different possible reasons. We know that digestive issues can be caused by stress, food and beverage choices or a combination of factors.

The Universe in your Tummy

I talked to Karen about the billions of beneficial bacteria that live in all of our Gastrointestinal (GI) systems, aka The Gut which collectively are known as the “Gut Biome”, or if you want to be fancy, our GI microbiota.

We usually think of bacteria as being bad for you, but we all have a complex, essential ecosystem living within our tummies! That’s right, there are billions of beneficial, good healthy bacteria that live in various parts of our bodies working their magic to keep us healthy.

Though everyone has their own unique combination of bacteria, most people have two types of beneficial bacteria, Lactobacillus and Bifidobacterium.

The Delicate Balance 

When the beneficial bacteria are in balance, they work their magic to keep us healthy, contributing to a healthy immune system, helping us digest our food, and keeping us feeling our best. When they are out of balance, the more problematic bacteria make more gas, leading to occasional bloating that can be combined with constipation and diarrhea. These symptoms may be signals that your GI bacteria may be out of balance.

I talked to Karen about the universe of bacteria in her gastrointestinal tract that were trying to get her attention, literally trying to communicate with her in the only way they know how: by causing bloating, gas and diarrhea. Her symptoms suggested that she was out of balance and that her beneficial bacteria were crying out for a little help. Luckily Karen was motivated to make a few changes to her routine.

Restoring the Balance

One thing I’ve found over the years with my patients is that most of us know what to do to be healthy, but it’s easy to get overwhelmed and give up if we try to make too many changes all at once. I’ve also learned that it’s counter productive to ask people to give up their favorite foods, because extreme changes only work for a short time. I know from my own personal experience that even the idea of giving up chocolate sends me running straight to the pantry for some … you guessed it … chocolate!

Karen loved her coffee and donuts in the morning and to her they “off-limits.” She was very clear that they would continue to be part of her normal routine. However, she was open to the idea of having a salad for lunch, trying to incorporate a few carrots at dinner and instead of pretzels in the afternoon, substituting yogurt or a cheese stick and branching out with different kinds of fruits, like blueberries or any fruit in season.

More Vegetables

I have many patients like Karen who have a variety of digestive issues. I often suggest keeping a food diary for a 2-4 weeks and incorporating more vegetables and fruits to keep a healthy balance within the digestive tract. The recommended goal is 3 – 5 servings of vegetables every day and 1 – 2 fruits. An easy way to do this is to have a big salad every day for lunch with cherry tomatoes and cucumber, snack on carrots and then to have 1 – 2 cups of cooked broccoli, zucchini or other vegetables at dinner. Of course, there are a million other ways to get more vegetables, I just find it helpful to provide ideas and tips to patients.

My own experience

Not only have I been taking a probiotic for my own digestive balance for years, I also recommend them to patients and friends who have occasional digestive issues. I really saw the benefit for myself after returning from trips to underdeveloped countries, where I had been working in hospitals and clinics and where I had my share of digestive issues including occasional gas, bloating and diarrhea. I’ve been taking a probiotic for years and it has been very helpful keeping my GI system happy and in balance.

What about Probiotics?

Look for a probiotic that contains beneficial bacteria similar to what is already in your GI system:

  • Lactobacillus gasseri
  • Bifidobacterium bifidum
  • Bifidobacterium longum

Other times to consider a probiotic

I advise my patients to use a daily probiotic if they have taken certain medications, such as antibiotics.  I also ask them to check with their healthcare provider about using a probiotic after having a colonoscopy to help restore the beneficial bacteria that might have been depleted after the prep for the procedure.

I also ask patients to use their occasional symptoms of gas, bloating, diarrhea and constipation as a guide. As always, if you have more severe symptoms or have had chronic diarrhea, constipation, bloating or abdominal that has been present for more than a few days, do contact your healthcare provider for an evaluation.

Choosing a Probiotic

Choose a probiotic that will have plenty of live good bacteria not just when you buy the product, but also that will have the same high numbers by the date of expiration stamped on the bottom of the package. 

You can find this by looking at the number of CFU’s, the Colony Forming Units. Look at the package for the number of CFU’s that will be present at expiration. Ideally, there should be over 1 billion.

Because I travel so much, I also want a probiotic that does not need refrigeration. 

Many yogurts and Kefir also contain probiotics which are referred to as live cultures. I’d love to know how you keep your Gut Biome healthy, drop me a line.

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