9 things that patients should know about gut health
As a gastroenterologist, Mohamad Mokadem, MD, has heard countless pieces of dietary advice that simply don't make medical sense.
The suggestion to avoid food composed of ingredients you can't pronounce is one tip he's always disagreed with.
"Whether you can pronounce an ingredient is not a scientific measure of safety," said Dr. Mokadem, a professor of medicine at the University of Iowa Carver College of Medicine and the interim section chief for gastroenterology and hepatology for the Iowa City VA Healthcare System. "Choose mostly minimally processed, nutrient-rich foods. Judge a product by its overall nutritional value—not by how difficult its ingredients are pronounced."
That suggestion is one of many tips related to gut health that Dr. Mokadem shared in the latest episode of the AMA podcast “Health vs. Hype.”
"Health vs. Hype"—produced in partnership with iHeartRadio—takes on medical misinformation, viral health trends, DIY medicine, and common health myths to help listeners understand what’s real, what’s risky, and what’s backed by science. Host Trace Dominguez fact-checks popular health claims, explains how medical misinformation spreads, and reveals the real-world consequences of getting it wrong.
University of Iowa Health Care is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
There is no test to ID healthy gut health
"Comfortable digestion, regular bowel movements, and not having persistent pain or bloating are important signs that the digestive system is functionally well," Dr. Mokadem said. "‘Regular’ does not necessarily mean having a bowel movement every day. Normal frequencies vary among even healthy people."
There are different ways to define good gut health
"Medical gut health means ... that the digestive system is moving food normally, absorbing nutrients, and maintaining its protective barrier from harmful exposure to the environment," he said. "I would define gut health less as achieving a perfect function or perfect microbiome environment—that's what, what probably most people think—and more as having a comfortable, dependable digestive function, good nutrition, and no background warning signs of disease."
Gut microbiomes vary and evolve
"There's no single ideal microbiome that everyone should have," Dr. Mokadem noted. "I like to think of the gut microbiome as a living ecosystem. It contains many different microorganisms that interact with one another and with our own body parts. So that ecosystem is highly personal. It is shaped by a person's age, and diet, and genetics, and geography, what medication they take, and how quickly food moves through the digestive tracts. It also changes over time."
Your gut has a complex relationship with antibiotics
"Our gut microbiome, like any other bacteria or microbiome that's not even living with our gut, [is] very sensitive to any drug that can affect their replication or their division," he said. "Antibiotics, with all their variable mechanisms of working, they're still very effective in disturbing microbial communities."
Antibiotics are designed to treat unwanted bacteria that are causing an infection, but to do so, they go through the gut. As a result, the gut will be affected.
"But the interesting part is that after whatever incident has passed, it [the gut microbiome] always tends to reprogram and rearrange to the composition it was before," Dr. Mokadem said. "We still don't understand how, but it's amazingly consistent."
Put your focus on healthy diet
"I wouldn't focus much on changing the microbiome before we understand the healthy microbiome for your body specifically," Dr. Mokadem said. "Then we can probably target a personalized medicine when we understand the conditions that [create] the ideal healthy microbiome."
See your doctor for abnormal symptoms
"People should seek medical evaluation with tests recommended by their provider if they have warning signs like unexplained weight loss, persistent vomiting, long, unexplainable pain, difficulty swallowing, turning yellow, or having fever," he said. "We call those associated alarming signs. Your body's trying to tell you there is something abnormal."
Common symptoms such as occasional gas or bloating are often harmless, Dr. Mokadem explained.
"You do not need to keep buying tests or supplements to chase an ideal microbiome or preventive health measure," he said. "When you're not having symptoms, it's just eating the right healthy, variable diet and doing your age-appropriate screening for cancers and conditions that we know about.”
Probiotics can be helpful, but are not a necessity
"Probiotics can be useful for the right person, the right condition, and using the right strain, but they're not universally beneficial for everyone,” Dr. Mokadem said.
"Most people do not need to take a probiotic routinely,” he added. “A probiotic is a live microorganism. It's like a mimicker of a microbiome, like a super microbiome, that has been shown to provide a health benefit when taken in adequate amounts. But probiotics in general is a broad category. It's not a single treatment. Its effect depends on the specific strain or combination of strains of certain bacteria, the dose and the condition being treated. So far, we have very few conditions that [we are] reliably confident specific strains of probiotic or engineered microorganisms can help with it."
The intestinal lining isn’t a solid wall
When it comes to so-called leaky gut, "some people might confuse the leakiness [that] is happening through the wall of the intestine," Dr. Mokadem said. "The intestinal lining is not meant to be a solid, impenetrable wall. It's there to allow certain things to pass and to block passage of certain things. When it's injured and it's diseased and it's broken for whatever reason, that function of selective filtering—allowing certain types of nutrients or micronutrients or water or minerals to enter and block certain bacterial toxins or harmful materials from the environment to get to our body through the intestines—gets disrupted."
Get screened for colorectal cancer
"People should take recommended colorectal screening seriously," Dr. Mokadem said. "It's one of the third most common cancers now in the world. Screening matters, and it can change lives."
Learn more about what doctors want patients to know about gut health.
