Ten years ago, clinical dietitian Elaine McGowan thought she would be out of a job by 2022. Conversations around gut health were becoming commonplace and she hoped that people were understanding what a healthy diet looked like.
Instead, though, she’s busier than ever. McGowan and consultant gastroenterologist Professor Barabara Ryan, who 13 years ago joined forces as The Gut Experts, are seeing more cases than ever of people with poor gut health.
Experts are increasingly seeing cases of poor gut health linked to restrictive, ‘healthy’ diets.Credit:iStock
Many of them fall under a new category of digestive sufferer: the healthy eating fanatic. While they still see cases of people who have stereotypical poor gut health habits (not eating any fibre, etoposide and cisplatin for lung cancer eating too fast, drinking carbonated drinks and exercising vigorously after eating), around 20 per cent of the cases they see in their clinic in Ireland are well-intentioned people who, in a desire to eat more healthily, have created a gut health problem.
Typical dietary changes that are stirring up trouble include wheat and lactose restrictions, drastically increasing fibre intake and following vegan diets.
One young woman they helped had previously had no digestive trouble. It was when she started working out at the gym more and making “healthy” diet changes that the problems started.
After listening to what her new diet was composed of, they discovered she was eating huge amounts of fructans and fructose; spinach and kale smoothies and prune and date bowls, the very kind of breakfast championed in attractive photographs on Instagram. “But it was actually causing her bloating symptoms because she was eating too much fruit and fibre,” says Ryan.
While it made sense to ensure she was eating fibre , going from a low level of fibre and increasing it dramatically can cause bloatedness and increase bowel frequency and diarrhoea.
“We’ve all been told to feed our gut bacteria, which is a great thing to do for your overall health, but if you’re taking loads of fibre, your gut bacteria can be singing, but your gut can be screaming,” says McGowan.
As The Gut Experts, they instead advocate an approach to increasing fibre that goes low and slow; they recommend a daily intake of 20 grams to start with.
Much of their advice is reassuringly about moderation and your own individual tolerance. Meat, red wine and dark chocolate get their thumbs up just as much as kefir and kimchi.
Ryan’s ears always prick up, she says, when she hears someone talking about “Food Rules”: “It can sometimes be difficult to know if someone has a digestive condition or a borderline eating disorder.”
“We’re seeing a lot more people eating very rigid diets, and yet they are not feeling great. And they’re cutting out more and more things because they’re trying to manage their gut symptoms but going about it the wrong way.”
What starts as trying to eat a little more healthily can lead to trying to eliminate sugars and eat less saturated fats. “That moves on quite quickly to more restrictive diet regimes, such as eliminating dairy and wheat.”
McGowan and Ryan advise consulting your doctor if you’re experiencing digestive problems. However they acknowledge that while GPs are good at spotting “red flag” symptoms (weight loss, sudden and acute changes in bowel habit, mouth ulcers, passing blood and getting up in the night with abdominal pain), they are often ill-equipped to help people suffering from irritable bowel syndrome (IBS), a common condition causing stomach cramps, bloating, diarrhoea and constipation.
“We’re seeing a lot more people eating very rigid diets, and yet they are not feeling great.”
“Western medicine is set up to sift out serious pathologies like cancer. So people who have non-life-threatening conditions like IBS, where it does affect your quality of life but not the longevity, can find it hard to access medical advice.”
And when people feel like their doctors aren’t listening to them, it drives them towards the internet.
“Teenagers are very influenced by social media and the perceived notion of what your body should look like,” says McGowan. “It is normal to have a bit of bloating after a meal and for the stomach to distend a little bit. But that’s exaggerated on social media.”
They bemoan the demonisation of animal proteins. “I think if people want to do the plant-based thing for moral or ethical reasons, then OK. But if it’s for perceived health benefits, we personally don’t believe it’s a more healthy approach.”
Doing the sums on what you would need to eat to get your iron and calcium requirements from a purely vegan diet, McGowan says it worked out to be three bowls of kale, 18 tablespoons of lentils and 75 almonds a day.
Legumes, a staple of a plant-based diet, can be problematic for gut-sufferers. Credit:iStock
“You have to really try really hard to meet all your nutritional requirements and that’s difficult to do without eating a lot of bloating foods,” says Ryan.
Legumes is problematic for gut sufferers when taken in large quantities. If you are following a plant-based diet their advice is to take in smaller quantities of legumes (chickpeas, lentils, peas etc). Use tinned ones and rinse them well. You can also try taking alpha-galactosidase, a digestive enzyme that breaks down the carbohydrates in beans into simpler sugars to make them easier to digest. “But really it’s about finding your individual tolerance,” says Ryan.
Tinned chickpeas are probably the easiest tolerated. And generally, she adds, so are meat substitutes tempeh, quorn and tofu.
“We’re all about moderation, but we live in a time of extremes.”
Animal proteins are well tolerated by the gut, “particularly cheeses,” says Ryan. “We’re not saying you need to eat a keto diet. It’s about balance.”
“We’re all about moderation, but we live in a time of extremes.”
It is estimated that almost one-quarter of Australians avoid wheat or gluten, despite only one per cent of the population being coeliac.
“Free from” aisles are a regular fixture of supermarkets today.
McGowan and Ryan worry that people are opting to restrict their diet, instead of adjusting amounts or exploring better quality gluten (for example, it’s best to swap out high GI sliced white bread).
“For most other people if you eat a big bowl of pasta, you might feel a bit bloated, but that’s normal enough. It does not mean you have to cut it out completely, but you should eat a smaller amount if you want to feel comfortable,” says Ryan.
They also question how much better for the gut gluten-free products are. A 2018 UK study surveyed more than 1700 products and found that gluten-free foods had more fat, salt and sugar than gluten-including counterparts.
“People go down a strict road of ‘food rules’ where certain foods become the enemy, but there are no such rules. There isn’t one food that’s ‘bad’,” says Ryan.
Much maligned wheat, she asserts, actually feeds your gut blood bacteria, helps your bowels move regularly and is very good for overall health.
Concerned by the amount of confusion they’ve seen in people who are trying to be healthy, they’ve written a book to share some of their knowledge.
What Every Woman Needs to Know About Her Gut is specifically aimed at women – IBS is three times more common in women than men – however, much of their advice is applicable to men too.
Their FLAT gut diet plan is all about finding your own tolerance levels of common triggers:
F is for the Fs; fibre, fructans (wheat-based foods like pasta, breads and cereals) and fructose (fruit sugar).
L is for lactose, milk sugars.
A is for alliums, onions and garlic, which have particular potency for gut sufferers because they have a sugar chain similar to bread and pasta.
T is the mind and body connection. “Mental health is really important, and stress plays a huge role. We all know that what’s going on in our head has a huge effect on what’s going on in our gut. Seventy per cent of serotonin is produced by gut bacteria. So what you eat has a huge effect on your mental health.”
Together they have a combined 50 years of experience working in gut health.
“We’re not whippersnappers,” says Ryan, which is why they think they’re well-placed to counter some of the spurious advice on social media platforms.
When McGowan started her clinical dietitian career she would be constantly explaining how home-cooked favourites like cabbage were causing excess wind. Then she moved into the era of the takeaway, where clients would be troubled by the triggering garlic and onions that formed the base of dishes. Today she’s trying to educate healthy eaters who might be overdoing it on fermented foods and fibre.
“Our colleagues in the field are also seeing patients day in and day out who are really confused by all the noise out there,” says McGowan. “There are a lot of conflicting dietary messages and poor quality information. We’re trying to help people navigate them as best we can.”
Back to digestive basics
The Telegraph, London
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