Functional Medicine Approaches to Gut Health Issues

Dr. Angie Martinez, M.D
Functional Medicine Doctor
Gut & Digestive Health Expert

Elimination Diet | Foods List | Shakes | Intermittent Fasting | Supplements

In our last article, we talked about why gut health is so important to overall health. But, what can you do about it? Functional medicine considers the impact of lifestyle and diet on gut health, the first step is to understand a patient’s whole life.

A 27 year old female patient came to me with unexplained joint pain. She had been diagnosed with undifferentiated connective tissue disease, a fairly non-specific diagnosis. Her doctors wanted her to start steroids and anti-inflammatory medications to manage the pain. She wanted more answers, why was this happening?

In the case of this patient and all my patients, I start with a detailed medical history. I ask questions about their lifestyle, their diet, and the extent of their symptoms. Often people come in with symptoms that seem to have nothing to do with the gut, like the patient mentioned above, and through an in-depth evaluation, it becomes clear that the problem is stemming from gut health.

This particular patient revealed she was under extreme stress at work. She ate a high carbohydrate, low fat diet. Although she was healthy overall, I had an inkling that she had gut issues that were triggering the joint pain due to stress and an inflammatory diet.

The Elimination Diet & Gut Health

For patients with a history of digestive issues and other unexplained conditions, I like to start with a restrictive elimination diet for 4 to 6 weeks. This diet is designed to eliminate the top foods known to trigger an allergic or inflammatory response in the body.

The idea with the elimination diet is to naturally reduce inflammation in the gut by eliminating common triggers. This will allow the gut to naturally heal and repair. After 4-6 weeks on the diet, the patient will be reevaluated to see what symptoms still need to be addressed.

How restrictive the diet needs to be is largely dependent on the patient’s concerns. If a patient has inflammatory conditions like arthritis or joint pain, then we may also want to eliminate all inflammatory foods. If the symptoms are not as severe, we might try a slightly less restrictive diet that eliminates only dairy and gluten.

The patient started on this diet, eliminating inflammatory foods and lowering her carbohydrate intake, particularly those coming from grains. She also worked on managing her stress from work with cognitive behavioral therapy and meditation.

Within a short period of time, the joint pain was gone. This gave me an indication that inflammation in the gut may have been the underlying cause of the joint pain. The gut can heal very quickly with the right protocol. Although every case is not quite as simple, starting with diet can get us major results without wasting a lot of time or money with expensive testing.

I’m very conscientious of the price of extensive testing for patients. Rather starting with testing, I prefer to use a natural elimination diet strategy first. If there are still issues after trying the elimination diet, then I might order specific tests based on the patient’s remaining concerns.

For example, I may consider a SIBO test (small intestinal bacterial overgrowth) or other stool tests if digestive symptoms remain.

But, I believe it is always best to start a gut health program as the foundational approach, then consider additional tests later if needed. In many cases, after 4-6 weeks on the diet, the progress made is very significant and there is no need for more testing.

Creating a Gut-Healthy Elimination Diet

A restrictive elimination diet can be a challenging food plan to follow, especially if you are eating a lot of the foods that need to be eliminated. On the other hand, gut health issues can cause devastating symptoms that may have a profound effect on your quality of life. I find that these are the times where many people find the motivation and the desire to start, even with the most restrictive version of the diet.

Foods to Avoid On the Gut Health Elimination Diet

In general, we eliminate the top foods that can trigger an allergic or inflammatory response in the gut. These include:

Dairy
Gluten
Grains
Soy
Eggs
Processed deli meat
Processed condiments
Caffeine
Alcohol

The goal is to eliminate inflammation in the gut, which will translate to the entire body. Many of these foods cause sensitivities for many people, therefore eliminating them will immediately improve gut health. This can allow time for the stomach and gut lining to heal.

Learn more about the elimination diet.

Foods That Heal the Gut

“If Mother Nature didn’t make it, then you are better off not eating it.”

If you are unsure if you should eat a certain food while on the elimination diet, you can start by simply taking out the foods that Mother Nature did not make.

Our ancestors ate only whole, natural foods, and on a healthy state, that is probably the best option. These days, however, things aren’t always that way anymore. We have changed, our lifestyles have changed, our environment has changed, and our food options have changed, in more ways than one.

The goal of the elimination diet is to include many gut healing foods in their most natural form. This includes:

Rainbow veggies:
A variety is best. But, be sure to include dark leafy green vegetables which are very high in phytonutrients and fiber.
Dark colored fruits:
Start with one or two servings a day, and look for deep colored fruits like blueberries, blackberries, strawberries, pomegranates and cherries. These will give you the most nutritional value and antioxidants.
High quality protein:
Look for high quality lean meat and fish, preferably wild caught. Commercial meat often contains a lot of hormones and antibiotics that can disrupt the good bacteria in your gut. Wild caught fish are highest in anti-inflammatory omega-3 fats. Also, stick to the smaller fish such as salmon or herring, as they tend to be less exposed to toxins and heavy metals found in the ocean.
Fermented foods:
Foods with healthy bacteria, like yogurt or Kombucha, help support the good bacteria in the gut.
Medicinal types of herbal teas:
Certain teas help control inflammation, support healthy digestion and boost immune system, such as dandelion, ginger and turmeric.

Tip: During the elimination diet, many of my patients find it very useful to keep a food dairy and track the foods they eat along with how these foods made them feel.

Shakes for Gut Health?

You might be asking yourself, why am I talking about a shake when it is well known that eating whole foods is best?
Many times we are dealing with extensive damage to the gut, so we need an effective treatment, based on our current state of health. Taking in nutrients in liquid form is an easy, convenient way to allow the gut to heal and repair.

In a high quality shake, the protein is already broken down. This allows for easier digestion, so your body can use the nutrients right away. Whereas, if you ate a piece of chicken, it takes a lot more work for the body to break it down and utilize it. People with IBS and other gut issues can struggle to digest their food properly. This may mean they are not getting enough protein to build and repair the gut lining.

For this reason, I find that nutritional shakes with gut healing foods and nutrients, may be very effective because liquids are easier to digest. While I often tailor the shake recipes to each patient, there are a few common guidelines you may find useful if you consider making gut healthy shakes.

Leafy greens:
Due to their high phytonutrients content.
Protein powders:
Preferably plant based vegan options. If you don’t find these palatable, you can also use grass-fed whey protein from a clean source. These are high in amino acids, such as glutamine that helps rebuild the gut lining.
Fiber:
Feeds the good bacteria in the gut. Most people don’t get enough fiber in their diets. When adding fiber to the shake, it is important to start slow, and gradually increase to an amount you can tolerate. Some people may need more fiber than others.
Olive oil or MCT oil:
Can help lubricate the gut, especially if you have occasional constipation.

Always speak with your doctor before you start any diet or supplement program for gut health, as supplements (including the serving size) may be different in each case.

It’s Not About Perfection – It’s About Making Gut Healthy Choices

The foods you may find available can vary greatly by where you live and your budget. Don’t feel discouraged if you can’t always eat a perfect diet or some foods are unavailable. Try to follow as many of these gut health guidelines as you can, and fine tune your diet based on the foods that are available and affordable to you.

I often get asked whether choosing organic fruits and vegetables is the best option, if these aren’t accessible or affordable. The bottom line is you want to eat high-quality fruits and vegetables, even if they are not organic. Fruits and vegetables are high in fiber, antioxidants and other vital nutrients.

I do stress the “Dirty Dozen,” a list of fruits and vegetables that are typically exposed to the most herbicides. For these twelve fruits and veggies, you do want to choose organic.
For more information, see: dirty dozen.

Intermittent Fasting & Gut Health

In addition to the elimination diet, time restricted eating or intermittent fasting may be beneficial for gut health. With intermittent fasting you are changing the time that you eat. Normally, you eat all your food within an 8 hour window, for example between 10am to 6pm. This allows the stomach to rest, the liver to detoxify, and the circadian rhythms to reset.

That’s what we did back in our ancestors’ days when food wasn’t always available. When you fast, your body has an opportunity to activate certain mechanisms that promote healing. Allowing the gut to stay quiet for a few hours a day, can also change the bacterial makeup, as bad bacteria doesn’t do very well when there is limited food supply.

Start with just an overnight fast of 12 hours and gradually increase your fasting time as you feel comfortable. Although everyone benefits from some amount of digestive rest, the amount of time each individual needs to fast can vary.

Supplements for Gut Health

I find that certain supplements can be beneficial for gut health, although every person may need a different supplement protocol. I can make a list of many ingredients that could heal your gut; this doesn’t mean you should take them all. In fact, this can not only be expensive but can also backfire.

In my clinic, I like to divide the gut into its different layers and decide what layer we want to focus on first. For example, we may use supplements such as fiber, aloe vera or DGL (Deglycyrrhizinated Licorice) for the mucus layer. I may look into different supplements to fix the gut villi layer, or to promote bowel movements.

When it comes to supplements and protocols for gut health, remember that you do not have to fix every little hole. The body is an amazing machine. Fix the big issues and your body may be able to fix the rest on its own.

My 5 Best Supplements for Gut Health

Protein powders, preferably plant based, contain amino acids needed for the repair of the gut lining.

Natural anti-inflammatory supplements such as omega 3 fatty acids can also be very helpful in controlling inflammation, especially if you find it hard to get a good source of wild caught fish in your area. Other supplements that may help to support gut health include:

Vitamin D to support your immune health
Probiotics & prebiotics
Zinc to assist in the gut repair process, especially since many people are deficient or have low levels of zinc.

The Risk of Taking Too Many Supplements

I often get asked, is there such a thing as taking too many supplements, and yes, I think there is. We need to remember that we live side-by-side with bacteria in our body. When we take supplements, the bacteria can also use some of these supplements, including the bad bacteria. For this reason, you may want to ask yourself whether you are getting all the benefits from a supplement or are you also supporting an imbalance that already exists.

Taking too many supplements can also become a burden, so you may give up. Who wants to swallow all these different pills? You always want to focus on those supplements that give you the biggest benefit.

Your Gut and Your Health

If you believe you have underlying gut issues or are struggling with chronic disease, it is important to start addressing these concerns with a trained functional medicine practitioner. Only in working with a professional, can you begin to understand how your whole life can impact your gut. I hope you find this total-wellness approach to a gut health helpful. I wish you the very best success in your journey to a better health.