Gina Kaye (Host): Welcome to Live Greater, a University of Maryland Medical System podcast. Information for a healthier you from the University of Maryland Medical System. I'm Gina Kaye, and joining me today is Dr. Mohammad Abdallah, gastroenterologist at Charles Regional Medical Group in La Plata, Maryland. Doctor, thank you so much for joining us today.

Mohammad Abdallah, MBBS: Thank you for having me today. Hopefully, we can give some guidance for our patients in digestive health. I'm pretty sure there's a lot of listeners waiting for some advice today.

Host: Perfect. Let's dive into our questions. Many people feel like they have to follow a strict diet to have "good digestion." Is that really true, or are there simpler habits that can make a difference?

Mohammad Abdallah, MBBS: So, here's my good news. Luckily, no. Most people don't need a strict or restrictive diet to have a good digestion. In fact, the foundation of digestive health have a few simple habits. Those include eating regular meals, not skipping meals when you have to eat your meals, staying well-hydrated. And the third one is eating enough fibers.

And most of gastrointestinal association tell us that following those main principles is enough as a starting point to improve your digestive health. In fact, following a restrictive diet and restricting your diet can cause a lot of problems and can backfire. So, it can lead to nutritional deficiencies, it can lead to anxiety around eating, and in some cases, it can lead to eating disorders. So, the goal is to build a pattern of eating that works for your body, not to follow the latest trending elimination diets and have anxiety about your diet.

Host: When you talk with patients about digestion, what does normal or healthy digestion actually look like? Are occasional bloating, gas, or changes in bowel habits something people should expect from time to time?

Mohammad Abdallah, MBBS: There is a wide range of normal. Anything between having three bowel movements every day and three bowel movements a week is considered normal as long as you're not having pain and you're passing stool comfortably. Occasionally, you can't every day and every time, and then you can have occasion bloating, you can have some gas, some minor changes, and those are extremely common. And as long as they're not a sign of anything serious and they're only happening occasionally, they can be exacerbated by what you eat, by stress, by travel, sometimes hormonal changes or just simply eating more than you usually eat. Symptoms can happen, and they can be completely normal.

The key difference to differentiate if this is something that is normal from not is if there's persistent worsening or interfering with the quality of your life. And here comes the rule of understanding those symptoms

Host: There's a lot of talk, I know as a female especially, about getting enough fiber, and fiber gets a lot of attention for gut health. So, why is fiber so important, and how can people add more of it without making bloating or discomfort worse?

Mohammad Abdallah, MBBS: I'm glad you asked this question. So, fiber is one of the most important things for digestive health. it does increase the stool bulk, it helps stool hold water, so the stool is coming out softer and easier to pass. In addition to that, we do have some good bacteria or what we call the microbiome in our digestive system, and that good bacteria feeds on the fibers, and it can be very beneficial for us.

Now, it's very important to know how much fiber do we need. It's recommended for males to eat at least 35 grams of fiber every day, and for females to be 25 grams every day. Now, the surprising and the interesting fact is that most Americans, they barely meet half of that. The average American is only eating 16 grams of fiber a day. So, it's very important that we try to meet the demand of the fiber that our body needs.

Now, if you want to add fiber to your system and you feel that you're not eating enough fiber, the key thing is to add it slowly. So, I would advise you to add 5 grams every week till you meet your goal. Because if you start eating a lot of fibers suddenly without adding slowly, you might have some side effects from that, like bloating.

Another important fact is that we need to know what type of fiber do we need to eat. So, there is two main groups of fibers. There is soluble fibers and there is insoluble fibers. What we need is soluble fibers. Those are like oats, like psyllium, like barley, and like beans. Those are good for us. And we found that they're helpful for most of the GI conditions like irritable bowel syndrome and most of the GI symptoms.

The other very important fact, and I want people to hear me very well when I'm talking about this fact, is that when we eat fiber, we need to pair it very well with water. Fibers alone without drinking enough water is not going to improve your symptoms. So, pairing those things together is essential to improve your digestive health.

Host: Well, you took the words right out of my mouth because my next question was how does hydration affect digestion, especially constipation, bloating, or how people feel after eating a meal?

Mohammad Abdallah, MBBS: So, hydration is critical for your digestion. As we said, it does help fiber do its job. So, the fiber in the digestive system holds the water and it softens the stool. So without enough fluids, fibers are not going to work. And it's also important to know how much water do you drink, and it's recommended to drink at least eight cups of non-caffeinated water every day.

The other helpful thing about water is that it can helps with the post-meal discomfort and the post-meal bloating. So, if you're having some bloating after eating and if you're having some discomfort, look at how much water you're drinking. You might need more water.

Host: Another hot topic, and I hear a lot about this on social media as well, probiotics and prebiotics. How do they affect gut health? And this is where I'm really curious too, does everyone need to take them?

Mohammad Abdallah, MBBS: Probiotics are live beneficial bacteria. So, we all have what we call microbiome in our gut. It's a mix of a lot of types of bacteria and fungi and viruses as well. And probiotics are supplements that we can take that contain live beneficial bacteria. And prebiotics are the fibers that feed that bacteria, that beneficial bacteria.

We do have some evidence that some strains of probiotics can be helpful in some GI conditions like irritable bowel syndrome and preventing some gastrointestinal infections and improving overall symptoms and digestive health. However, and this is very important, not all probiotics are the same. So when we're talking about the benefits of probiotics, it's strain specific, it is dosage specific, and it's condition specific. If you take a probiotic and it doesn't work, it doesn't mean that your probiotics are not working for you.

The American Gastrointestinal Association, because we don't have enough evidence on probiotics. And because there is a lot of strains and it's different from a patient to other patients, they did not recommend starting probiotics for all the population. But here is my advice. Most of the probiotics are not harmful. So if you want to try a certain type of probiotics, you can give it a try. But my advice, give it couple of weeks, up to four weeks. And if it's not working, stop that probiotics. Don't waste your money on it, and maybe you need to talk to your doctor or your gastrointestinal specialist.

Host: Great advice. A lot of people suspect certain foods are causing their symptoms. How can someone identify possible trigger foods without cutting out too much or becoming afraid to eat?

Mohammad Abdallah, MBBS: This is a very critical subject. This is where I see a lot of patients go wrong. They start cutting food after food, and they end up not eating anything, and they're still symptomatic and they're feeling miserable, and this time malnourished and anxious as well. Regarding restricting diet and eliminating diet, there is some certain guidance regarding that.

If you want to do that, I would advise you to start with what we call food and symptom diary. Write down everything that we eat and your symptoms every day, what time you eat them, and what time you're having your symptoms. And after two weeks, when you're having enough information, you can see what factors you're suspecting, what food is causing your symptoms. And then, you can start eliminating the suspected food. And after you eliminate that food and you feel better, then you can reintroduce that food to confirm that it's the reason of your symptoms.

Another more complex way to do that is doing a diet that is called low FODMAP diet, and it's a very well-studied diet. It also contains certain foods that you can restrict in a matter of restriction, reintroduction, and then personalization depending on what's the best for you. And it's very important that when we do those changes, they're guided by a physician or a dietician. Because sometimes if we do them by ourselves, we end up cutting food after another and we end up feeling anxious and miserable and not eating what we have to eat.

Host: So, speaking of becoming afraid to eat, for people who may have been dealing with digestive symptoms for a while, eating can become stressful. How do you help patients enjoy food again while still managing those symptoms?

Mohammad Abdallah, MBBS: If every meal that you eat is going to cause anxiety for you rather than enjoyment, then we need to help you, and you need some help. The first thing to know is that there is a deep connection between the brain and the gut. So if you're having anxiety when you're eating, that anxiety is going to lead to more GI symptoms, and the GI symptoms are going to lead to more anxiety, and it's going to be a vicious cycle of symptoms.

So, a few things that can help you is that we need to work to reframe the relationship between us and the food. The goal is not to have a perfect diet. We just need to find a comfortable, flexible pattern that is going to work for us. The second thing is that we need to look on not just what we eat, also we need to look at how we are eating. So, eating slowly, having regular meals, and not eating on the run can make a huge difference. The third thing is that, if those symptoms are severe for you and they're causing a lot of anxiety, you will need to talk to a doctor or a GI psychologist who can help you with those symptoms to make you feel better.

And the important thing to say here that food should not be our enemy. Actually, food should be the way that we enjoy certain parts of our lives, and our digestive health is very important for us to avoid that anxiety.

Host: I feel like a lot of us are getting it wrong. There's so much information out there that we just guess. So, what symptoms are signs that someone should stop guessing about their diet and just have a talk with their doctor?

Mohammad Abdallah, MBBS: This is a very important question. And if there's one thing I want the listeners to pay attention for in this podcast is this question. So, those are symptoms that if you have or if your friend or family have, they need medical attention, and we need to make sure that there's nothing serious going on. So, things like unintentional weight loss, if you're losing weight without trying, this is something that needs a doctor attention and need more evaluation. Any blood in the stool is something that we need to look into. Any vomiting, any difficulty swallowing food. Also, iron deficiency anemia is one of those things.

If you are above the age of 50 and you're having new symptoms, you could have something new that we need to look into and find what's causing your symptoms. Also, if you have a family history of colon cancer, inflammatory bowel disease, and celiac disease, you might be someone who have higher risk of having serious GI conditions.

And also, if you're having any other symptoms that is worsening, progressive, and is not responding to the changes to the diet that we mentioned earlier in this podcast, I would recommend to talk to your physician.

Host: So as we wrap this up, if listeners remember just one thing about eating for better digestion, what would you want that to be? And is there anything you'd like to add as we wrap up our conversation today?

Mohammad Abdallah, MBBS: My advice is to keep it simple and sustainable. So, you don't need a perfect diet or the latest trending diet to improve your digestion. Just eat regular meals, do not skip meals, drink enough water, and gradually increase the fiber intake. Those basic habits, most of the times work better for your gut than any trending diet or any expensive pre or probiotics. And if you're having any of the red flags that we mentioned, do not keep guessing, talk to your gastroenterologist. And that's what we are here for. We're here to help you. And hopefully, we can figure things out together to make your life better and to make you enjoy the food again.

Host: Dr. Abdallah, thank you very much for your time today.

Mohammad Abdallah, MBBS: Thank you for having me. Appreciate it

Host: Listen to more at umms.org/podcast, YouTube or your favorite podcast platform. If you enjoyed this podcast, please share it on your own social media channels. Thank you 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.