Transcription:
How to Have a Healthy Gut

Joey Wahler (host): YOu've heard the term I can feel it in my gut. Ah, but what exactly is your gut? And what's the best way to keep it healthy? We're discussing good gastrointestinal health.

Welcome to the Live Greater Podcast Series, information for a healthier you from the University of Maryland Medical System. Thanks for listening. I'm Joey Wahler.

Our guest, Dr. Sagal Ali, gastroenterologist at UM Charles Regional Medical Group, Gastroenterology in Waldorf

LA Plata, Dr. Ali. Thanks for joining us.

Dr. Sagal Ali: Thank you for having me.

Joey Wahler (host): So first simply put, what do we mean by our gut and how does it affect our overall health?

Dr. Sagal Ali: So the gut is the gastrointestinal tract, which is a pathway from your mouth to your rear. So gut health is the function and balance of everything that goes on there. and within the gut, there is the human gut microbiome, which is a collective of organisms, such as bacteria, viruses and fungi that live naturally within our gastrointestinal system. So what it means or how it affects our overall health is in a lot of different ways.

To start, many of the microbes in your gut are forms of good bacteria that help with digestion, nutrient absorption and more. But when the guts bacteria falls out of balance, you can experience various GI problems. One of these problems that's commonly seen is irritable bowel syndrome. Another way that the gut can affect your health is with your body's metabolism. The gut bacteria can also play a role in increasing the risk of diabetes and obesity, when the levels become imbalanced.

The gut also plays a role in brain health. So the brain and the gut have a strong connection, which is why some people feel sick to their stomach under stress. In fact, the brain and the gut sends signals to one another all the time. So for this reason problems with your gut or imbalance in the gut bacteria can contribute to anxiety, depression, or even stress, but it's also important to know that the reverse can happen also. And then last but not least the gut plays a huge role in our immune system.

The interaction between the two really begins at birth, the moment the body encounters bacteria for the first time and the microbiome in the gut helps the immune cells distinguish between foreign entities that enter the body and allow the immune system to attack these as appropriate. So again, when there's an imbalance in these things, it can really put you at risk of infections.

Joey Wahler (host): Gotcha. Interesting that you mentioned the connection between gut and brain. I was not aware of that. So regarding diet or otherwise, what are some simple ways, some basic ways that we can keep good gut health on our own.

Dr. Sagal Ali: So I think a lot of people think that maintaining good gut health is very complicated, but in reality, the most important way to have a healthy gut is really to just live a healthy lifestyle. So making sure to stay hydrated, drink lots of water because drinking plenty of water may be linked to increasing that diversity in the bacteria of the gut. Also reducing the amount of processed foods, high sugar, and high fat foods. And instead trying to eat a diet that's high in fiber that will also contribute to the healthy gut microbiome.

Joey Wahler (host): Gotcha. So now what are some ways that an unhealthy gut shows itself? What are the symptoms?

Dr. Sagal Ali: Sometimes stomach disturbances can be signs of an unhealthy gut. Some of these symptoms may include gas, bloating, constipation, diarrhea, or even heartburn. An imbalance gut will usually have difficulty processing food and eliminating waste. Another way that an unhealthy gut shows itself is either gaining or losing weight without making any specific changes to your diet or your exercise habits.

Joey Wahler (host): So having said that at what point typically, should we see a gastroenterologist like yourself for care? When do we know we've crossed that line?

Dr. Sagal Ali: So some of the, what we call red flag signs or symptoms include the following; if you're having abdominal pain with eating, if you're experiencing unintentional weight loss, if you develop any acute change in your bowel patterns, or if you see blood in your stool, for whatever reason, those are the big ones that should prompt you to seek evaluation in a semi-urgent fashion. Now I do also think that there is benefit from seeing a gastro intestinal doctor as well.

If you experience chronic issues with bloating, diarrhea, constipation, or heartburn, because sometimes there a workup may be indicated to evaluate for celiac disease or possibly what's called H pylori. That is a bacteria that can sometimes affect the lining of the gut. And in some specific cases, an endoscopy or colonoscopy might be the most appropriate part of that.

Joey Wahler (host): And speaking of which you led me beautifully into my next question, I wanted to ask you about some of the ways that you make someone's unhealthy gut healthy again, let's talk about a few of those procedures because colonoscopy is of course the gold standard, if you will, right? It really tells you a lot of what you need to know.

Dr. Sagal Ali: Yeah, so endoscopy and colonscopies really are reserved more so for diagnosing some of these. Specific GI issues, but in reality, an endoscopy or a colonoscopy, doesn't do a great job of determining whether your, gut is very well balanced. Now it does do a very good job of, determining polyp growth in any part of the GI tract, but particularly the colon. It does a really good job of picking up inflammation and things like that. And those can sometimes determine gut health, but. Other cases, those can be present in people who have absolutely no symptoms. So it's kind of a balance between using what the patient is experiencing and their clinical symptoms with kind of what we see on endoscopy and colonoscopy.

Joey Wahler (host): And for those unfamiliar, in a nutshell, what are those two procedures? What's involved in endoscopy and colonoscopy? Because it's really, I know having had it done myself multiple times. It's really simple as can be. Oftentimes people are scared of the unknown, but it's really about as easy as you can get in the medical field. Right?

Dr. Sagal Ali: You're absolutely right. And I actually have a lot of patients who tell me after the procedure is done it was way better than they would've expected. It. They're very routine procedures. Both of the procedures are generally, not everywhere, but generally done with anesthesia. An endoscopy is a procedure where we take a small scope that has a camera on the end of it, and go in through the mouth, into the esophagus, stomach and the first part of the small intestine.

That procedure allows us to evaluate all of those areas, assess for things such as inflammation, any abnormalities in the anatomy, any ulcer disease, things like that, but also allows us to take biopsies of the tissue, and those kinds of things. Usually an endoscopy is very quick, takes about five to 10 minutes. A colonoscopy is very similar, where again, there's a scope of the camera on the end of it, but it evaluates the entire colon.

And the reason that we do colonscopies most routinely is for colon cancer screening to detect any potential precancerous polyps that may be developing in the colon to remove those and hopefully reduce the risk of any of those polyps developing into colon cancer in the future.

Joey Wahler (host): Now there's much talk about probiotics and prebiotics in the media. What are those and who are they best suited for?

Dr. Sagal Ali: So you're right. There's been a lot of media attention and the general public has really picked up on probiotics and prebiotics and probiotics in a nutshell are living microscopic organisms, including certain bacteria and yeast that are usually found in foods and dietary supplements. Prebiotics on the other hand are a specialized plant fiber that access food for good bacteria. So it stimulates the growth among the preexisting good bacteria.

Now, although there are a lot of prebiotics and probiotics that are available over the counter for the consumer to buy, the American Gastroenterological Association actually has recently put out guidelines for 2020 that for most digestive conditions, there's actually not a lot of evidence to support the use of probiotics. There are a couple of settings where it's shown some benefit, but for the most part, for most people, we actually don't have a lot of research for it. And so right now where it stands with the AGA or the American Aastroenterological association, is that we don't necessarily recommend it except for those three situations.

Joey Wahler (host): Understood. Now on the subject of recent trends, gluten free food has become much more popular in recent years. I know we have one local supermarket where they have aisles of gluten free food. So what about gluten? Should everyone give it up to be healthier or is that taking it too far?

Dr. Sagal Ali: Yeah. I actually think in some situations it's taking it a little bit too far. I agree with you that it's become a huge fad. In reality, the only people who benefit from avoiding gluten are those with celiac disease, which is an autoimmune disease against gluten or in those people who have gluten intolerance. If you don't fall within one of those two categories, there's really no benefit of avoiding gluten, and most gluten products actually have a lot of good, healthy fibers. So when people just generally try to avoid gluten, they end up consuming a lot less fiber than they previously may have done, and that can also put them at risk for kind of disrupting their gut microbiome and the bacteria in the gut.

Joey Wahler (host): So gluten can be our friend then, huh?

Dr. Sagal Ali: Gluten can be, gluten can be. So I always recommend, celiac diseases is very easily tested with blood work, and that can be done in a physician's office. And gluten intolerance, in people who do have symptoms that may suggest either celiac disease or gluten intolerance, and some of those can be diarrhea, it can be bloating, it can be anemia. And people who don't have celiac disease, but still have some of those symptoms. usually what we recommend is trying doing a trial of gluten avoidance.

Usually for at least six weeks or so, while at the same time, documenting very, extensively in a food journal and a symptom journal to see whether or not there's actually any symptom improvement. And if you reintroduce gluten into your diet after say six weeks and your symptoms significantly get worse, or you're experiencing some of the things you were before, that suggests that you have a gluten intolerance. If you're not one of those two groups, gluten can be your friend.

Joey Wahler (host): Okay, good to know. So in summary, what's the main message doctor you want our listeners to take away from our conversation regarding what to keep in mind about good health?

Dr. Sagal Ali: The most important thing that I want people to focus on is maintaining a well-balanced diet and an active lifestyle. and above that, if I can go just one step further is, telling people that it's important to listen to your body. If there are any acute changes in your symptoms, I think it's always a good idea to discuss these with a healthcare provider. If there are any questions, there are a lot of products over the counter, always a good idea to discuss it with your healthcare provider, because your gut will thank you.

Joey Wahler (host): I'm sure it will. Well, great advice and valuable information, Dr. Sagal Ali. Thanks so much again.

Dr. Sagal Ali: Thank you.

Joey Wahler (host): And to find more shows just like this one, you can visit umms.org/podcast. Again, that's umms.org/podcast. If you found this podcast helpful, please do share it on your social media. And thanks for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again. Hoping your health is good health. I'm Joey Wahler.