Ashlee Williams, MD: Did you know that the trillions of bacteria living in your gut play a crucial role in how you feel, think and function? The foods you eat can either support or disrupt this delicate ecosystem. So what should you be eating to keep your gut thriving? Welcome to The Healthier You Podcast. I'm Dr. Ashlee Williams, and today I'm talking to Dr. Margaret Schwiesow, a Board Certified Gastroenterologist at Kaiser Permanente, to discuss the best foods for gut health, from fiber rich veggies to probiotic packed super foods. Plus, we'll share tips on how to build a diet that supports digestion, reduces inflammation, and keeps your microbiome balanced. Dr. Schwiesow thank you so much for being here today.

Margaret Schwiesow, DO: Thank you for having me. Pleasure to be back.

Host: It's great to have you back. Okay, Dr. Schwiesow can you explain why gut health is so important and how it impacts overall wellbeing?

Margaret Schwiesow, DO: Sure. Well, let's start with this concept of the gut microbiome. So the gut microbiome, as you know, is the ecosystem of the very diverse, microorganisms. So anything from bacteria, viruses, protozoa, and fungi. And they line our digestive tract. So all the way from the mouth, stomach, small intestine, large intestine, as well as the gallbladder and appendix.

Most of your gut microbiome resides within the large intestine, which is colon, and these bugs have incredibly important effect on our overall health. So not only are they responsible for our digestion, digestive health, they're responsible for our cardiovascular health, metabolic health, as well as mental health.

There's so much you can do to nourish them to allow them to thrive and therefore, get a better overall health. There are things that you can't do, but things that you can do. And one of them is diet, and we will dive into this in a second. But aside from diet, there's all these other lifestyle things that you can do.

So anything from sleeping well, exercising, from avoiding toxins such as alcohol or smoking, to really managing your stress. And one of the things that I want to mention before we go into the diet, is really sleep. So everybody knows we should get eight hours of rest. But why does it matter for the gut microbiome?

Well, think of the gut microbiome as your laundry service. They absolutely need to sleep at night. They need that rest to regenerate, recuperate. So they wake up the next day and they're ready to process your food. If you are snacking in the middle of the night or late night snacking, that truly disturbs the gut microbiome and it does not allow them to recuperate that well.

Host: So what symptoms should people look for as signs of issues with their gut health?

Margaret Schwiesow, DO: So there's a plethora of symptoms. So let's start with your digestive system. So the typical signs and symptoms of gut dysbiosis or disturbed microbiome is actually abdominal bloating, cramping, gas, and change in bowel habits. So anything from diarrhea to constipation or both as well as food intolerances.

Many people will tell us, you know, I cannot digest certain foods because when I do, I get severe pain and bloating and gas, and that is a sign that there's a problem within your gut microbiome. But also other system like for example, your skin. So very frequent acne, eczema or rosacea could be a sign that there's something wrong with your gut microbiome.

Another organ, let's take your brain, for example. So very frequent fatigue or brain fog, or even anxiety and depression. This is all, this also can be a sign that there's something wrong with your gut microbiome. Joint issues, right? Joint aches and pains of your body could be another sign. 

Another example that there's something wrong with your gut microbiome could be weight fluctuation. Let's say you are not really changing the way you eat, but you are gaining excessive weight, so that could be a sign that there's a problem, or frequent illnesses, like very frequent upper respiratory infections could be a sign that there's something wrong with a gut microbiome as well as these sugar cravings.

Remember that the bad bacteria that resides in your digestive tract; they love sugar, they love fat, and they love salt. So if you are craving these foods, that could be a sign that you have dysbiosis with predominance of the bad bacteria.

Host: Interesting. So you mentioned weight fluctuation. How does diet influence the gut health? Are there specific foods that can help maintain a balanced microbiome?

Margaret Schwiesow, DO: Yes, absolutely. The way to think about this is that remember that the bacteria that resides within your digestive tract, you are ultimately responsible for providing the right substrate or the right nutrients for them to grow. And the right substrate or nutrients comes from the prebiotic fiber. Okay. So that's the right food that they need to replicate and then grow. So, where does fiber come from? Fiber comes from plants, right? So anything from your vegetables, your fruits, but things like legumes, which are beans, lentils, chickpeas, things like whole grains, which are oats, bulgar, millet, buckwheat, to nuts and seeds, as well as, herbs and spices.

So these are considered plants. So you absolutely need to fill your plate with plants, in order for these good bacteria to develop. Once the bacteria in your colon gets these foods, they will start converting these foods into something called short chain fatty acids, which are a profoundly important anti-inflammatory molecules that will regulate your immune system and your health.

Host: Okay. Well thanks for bringing up the prebiotics. There's so much talk about probiotics and prebiotics. What is the difference and should people incorporate both into their diet?

Margaret Schwiesow, DO: Yes. So, absolutely. So you can't really do one without the other. So think of a prebiotic is essentially the food or the substrate for the probiotic to consume and grow. So probiotic is the actual live organism, and prebiotic is the food that you'll supply for that organism to digest and grow and replicate.

So really the best way to think about this is the prebiotics come from food and it comes from the indigestible insoluble fiber. And the probiotics are the actual organisms. So, a lot of times, we get asked, how about I just buy a pill? Because that's seems way easier than really trying to figure out what foods to eat and whatnot.

And the reason why there's a profound problem with just taking a pill is that there's no one pill that will change the composition of and diversity of your gut microbiome. The reason why it's so important to actually shift your mindset towards really eating the right foods is because when you're eating the right foods, you are providing a lot of different substrate to different species. The beauty of the gut microbiome does not lie in just one bacteria. It's the diversity of the gut microbiome that makes it so powerful. So you really want to bring a lot of different food, fibers, onto your plate to really assure that you are growing multiple species of bacteria.

Host: Do you have any additional dietary tips to support a healthy gut?

Margaret Schwiesow, DO: Yes. So, you've probably heard the saying, eat the rainbow, right? So this concept of eating the rainbow just basically assures that by eating different colors of different vegetables, legumes, or fruit. You are truly bringing a lot of diverse nutrients, a lot of micronutrients, so vitamins, minerals, as well as different types of polyphenols and prebiotic fibers.

Okay? Because, like I said, that actually will assure the diverse, replication of diverse species, and then that's what makes it so powerful.  

One of the best dietary habits that I recommend is actually focusing on eating 30 plants in a week. It can sound overwhelming, but it's actually not that difficult to do. The 30 plant concept comes from research, but basically it assures that you are eating diverse, colorful plate and you are bringing different phytonutrients or polyphenols onto your plate.

For example, let's take bell peppers. Red bell pepper versus green bell pepper versus orange bell pepper. They all provide a completely different phytonutrients. They provide different colors, different phytochemicals that are very important for a healthy gut. So if you're making a stir fry at home, slice them all up and you are going to get three points right here, right there.

So, um, to just make a conscious decision to incorporate as many colors onto your plate as possible, because that will translate into a more healthy and diverse microbiome.

Host: Yes, so there's a growing trend of eating 30 different plant-based foods per week, so thanks for breaking that down for us. Can you talk about the lifestyle changes that people can make to improve their gut health?

Margaret Schwiesow, DO: Yes. So, obviously, first lifestyle change that you have the power to do is your decision of what goes onto your plate. I hear many times, you know, Doc, I just don't have the time to do this, but you ultimately have to put something on your plate at least three times a day. So you have the privilege to choose the right foods, and now you know that in order to really diversify your gut microbiome, you do need plants on your plate.

Aside from that, you should also consider adding fermented foods to your diet. And the reason why you should do that is because fermented foods already have live microorganisms or probiotic, and you can certainly reap another health benefit of fermented foods. I recommend starting very slowly and gradually build it up to three different types of fermented foods per day.

So the examples are, kimchi, yogurt, kefir, sauerkraut, miso or kombucha. These are certainly options that you should explore. Going back to the diet, remember that you shouldn't overdo it. So let's say, you know, an average American consumes 10 grams of fiber per day.

So if that's you, you can't go from eating 10 grams of fiber per day to eating 30 or 40 grams of fiber per day. You will not feel good doing that. This has to be a very gradual process. Just to give you an example, let's say you're starting to go to the gym and you really want to build up some biceps and you are not going to lift up very heavy weights right away, you're going to start very, very slowly, small weights, and over time you're going to work it up so, in the next three to four months you'll be able to lift more weight. So treat your gut the same way, right? So when you're starting on this health venture, make sure that you are making small changes and small progress every day.

Another lifestyle change that we don't talk about is exercise and particularly strength training or resistance training. There's more and more research that comes out that shows that strength training is extremely beneficial for gut health. So I always recommend, yes, running and walking is great, but also pick up some dumbbells and lift some weight because that is actually, that will have a great effect on your gut microbiome.

One of the, things that I do have to mention is that you should, try to reduce your exposure to recurrent antibiotic use. And obviously you have to work with your physician on this one. But, please understand that the more antibiotic rounds, you take per year, that will have a negative effect on your gut microbiome.

So let's say if you have an isolated infection, you absolutely need to take an antibiotic. Then you go ahead and do that. But remember that aside from killing that bad bacteria, the antibiotics will also kill a lot of the good species residing in your colon. So there are ways to help recover the gut microbiome. So this would be the time to perhaps boost up your intake of fermented foods. This could be a time where you can speak with your primary care doctor about other probiotic options. This has to be discussed with your primary care doctor.

Host: Thank you. Always great to check in with your primary care doctor. All right, well, thank you so much for this great information Dr. Schwiesow. We learned a lot about gut health and how a combination of diet, lifestyle, and healthy habits can support a balanced microbiome. Here are the top takeaways. One, a healthy gut is essential for digestion, immune function, and mental wellbeing.

Two, eating fiber rich foods, fermented foods, and prebiotic foods supports gut health. Three, probiotics add beneficial bacteria to your gut while prebiotics help them thrive. But supplements should be approached with caution. Four, avoiding processed foods, excessive sugar, and artificial sweeteners can improve gut health.

And five, eating a variety of 30 plant-based foods per week enhances gut bacteria diversity. Lifestyle factors like managing stress and exercising also contribute to a healthy gut. For more information from our experts, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcast.

If you enjoyed this episode, be sure to subscribe and share it with others who may find it helpful. Thank you, and from all of us at Kaiser Permanente, be well.