Adapted from episode 108 of The Perfect Stool podcast with Lindsey Parsons, EdD, Gut Health Coach and edited for readability.
1. Detoxes and cleanses are the ultimate gut health solution or weight loss solution
I’m sure you’ve seen advertised gut detox kits or cleanse plans on the internet that claim they can remove toxins in your gut, or billed as the ultimate solution to a gut health problem, or the best way to lose weight quickly. The gut detox kits might have herbs, fiber, probiotics, something laxative perhaps. Cleanses may be restrictive diets with particular foods emphasized each day or come in kit form as well.
If you were considering a detox kit or cleanse for weight loss, the benefits will likely be short-lived as most of these cleanses are not sustainable in the long-term. While some studies report short-term benefits like weight loss and improved insulin sensitivity, there is insufficient compelling evidence to support the use of “detox” diets for long-term weight management or toxin removal. Even worse, these cleansing diets may lead to temporary weight loss due to reduced calorie intake but often result in weight gain when normal eating habits are resumed. The main consideration for me when it comes to weight loss is that whatever method you’d like to use to lose weight and maintain weight loss needs to be sustainable. That’s why, for example, I rarely recommend a ketogenic diet, because I’ve never met anyone who could sustain that in the long term, not to mention I’ve met several people, including myself, who have had bad reactions and gallbladder issues from such a high fat diet. In one case, I had a friend end up with a gallbladder removal after trying keto, but more commonly, as was the case for me, shooting pains likely indicative of gallbladder issues after following a keto diet for a short time. Of course there are people who can and do sustain keto long-term, but most people crave carbs too badly and eventually come off of it onto a plan that’s much less healthy. So I’m an advocate of starting with something sustainable and losing weight gradually in a way you’re willing to live with for the rest of your life.
Another consideration with a sudden detox or cleanse is a die-off or Herxiemer reaction, especially if you have a very poor diet to begin with full of sugar and processed foods. It’s actually better to gradually go off these types of foods so that as your body starts to detoxify from them naturally, you don’t have headaches, a flu-like feeling or other die-off reactions. A gradual elimination diet with a scheduled reintroduction, like the autoimmune paleo diet, is a better choice if you’re trying to determine whether you have food sensitivities, or trying to stop what seem like autoimmune symptoms or general ill health.
As for gut detox kits or supplements, there was a double-blind, placebo controlled study on one detox supplement containing a 1350 mg blend of papaya leaf, cascara sagrada bark, slippery elm bark, peppermint leaf, red raspberry leaf, fenugreek seed, ginger root, and senna leaf. Participants took it for 4 weeks. The study concluded that “No beneficial or harmful effects of supplementation were found for body composition, waist circumference, gastrointestinal symptoms, or blood markers.” If I had to dig in on why there were no changes, just looking at the ingredients and the dosage, I’d say this. Some of those ingredients individually I know are successful in helping with gut issues. For example, senna leaf teas are well known for helping with large intestine motility for constipation, ginger root is helpful with small intestine motility, and is often included in prokinetic agents for SIBO, and peppermint leaf is known to be helpful with bloating and IBS/SIBO symptoms and slippery elm is good in the case of gastritis and healing the lining of the stomach and small intestine. But each ingredient has a particular best dosage, use and function and just throwing everything into one detox kit no matter what your issue is will not likely produce the desired results. In this study, also, participants were healthy, so it wasn’t looking at the product’s results on people with a particular condition.
But in most cases, gut detox kits or programs will have a limited duration like a week to ten days, and the needed duration for, for example herbal supplements to kill off gut pathogens, may be 4-6 weeks. Or if you’re dealing with well-entrenched systemic candida, you may be looking at 8 months’ worth of treatments, switching active agents every couple months to prevent resistance.
Now there are some higher quality kits, say for example, Microbiome Labs Total Gut Restoration – Kit 2*, but again, they’re for particular situations. I would recommend a kit and plan like that for dysbiosis, but not for SIBO, because at week 5 you’re already introducing prebiotics including FOS that would feed the bacteria that cause SIBO. But most people choosing these kits haven’t done a stool test or SIBO breath test and aren’t quite sure what they’re using the kit to deal with. You could have bloating, for example, from SIBO, from candida overgrowth, or from low stomach acid, among other things. So there’s not really a one-size fits all solution you can just grab in a kit.
Also, when it comes to detoxification, the body does a pretty good job expelling toxins on its own with natural mechanisms, through the lymph system, the liver and kidneys, skin, lungs and digestive system. Of course some people do have markers on an Organic Acids Test* or NutrEval Test* that indicate that they aren’t detoxing well, such has high pyroglutamic or low glutathione, or elevated markers for some environmental pollutants. In that case, I’d likely recommend N-acetyl-cysteine or NAC* or glycine, if certain gut health markers are out of whack, as they are precursors to glutathione, but that’s with specific evidence of liver overload or dysfunction.
The average person doesn’t need a detox kit, they just need to gradually move towards a healthy lifestyle and maintain it through regular exercise, a well-balanced Mediterranean style diet, physical activity, stress management, good sleep, stopping smoking and reducing alcohol consumption. In place of detoxes, short-term fasting or elimination diets can be considered for resetting the gut and promoting healing, particularly when dealing with food sensitivities, autoimmunity, chronic gut issues, or symptom flare-ups.
2. Drinking at all with meals will dilute your stomach acid too much
So I’ve had a lot of guests on my show talking about not drinking with meals, and if you’re anything like me, you would choke if you didn’t have liquids for washing down your food. So I wanted to check the veracity of this claim.
What I found was a study in which participants drank a full glass of water, then they tested stomach pH. Now optimal stomach pH is quite acidic at 1.5-3.5 and but to digest protein properly, you’ll want a pH in the 1.5-2.2 range. Just a reminder from high school chemistry, a low pH is more acidic, a high pH is more alkaline.
So in the study, a glass of water, and water is around 7 in pH, did in fact increase stomach to a pH of 4 for 3 minutes. So if you extrapolate that a bit, it’s hard to image that small sips of water in between bites of food are going to significantly increase pH for any reasonable amount of time. However, I could see some value in pausing between sips of water and more food to allow the stomach to reacidify. But this idea of going completely without liquid seems a bit over the top to me.
3. Popping a probiotic will fix your gut health issues
Probiotics are live beneficial bacteria that people can take as supplements or naturally digest by eating certain foods such as kimchi, yogurt, kefir, kombucha, sauerkraut and other fermented foods. The idea is that by taking probiotics you can rebalance your gut by increasing the levels of beneficial bacteria and limiting the amount of harmful bacteria. They have grown extremely popular recently, and many supplements, drinks and foods include the tiny organisms. Most of these forms of probiotic supplements include the Lactobacillus and Bifidobacterium genera. Despite the craze surrounding probiotics, it’s been difficult for consumers to understand the inconsistencies in claims between scientific studies and supplement companies’ advertisements. It is hard to take in all of this marketing information and reasonably determine the effectiveness of various probiotics and what specific benefits they provide and in what situations.
This confusion happens because there is actually an incredible diversity in types of probiotics, and each of these types of probiotics works differently and on different health conditions. There is no standard probiotic, a fact that the natural health industry often overlooks when marketing and selling probiotic products. This presentation implies that all the microorganisms are homogeneously beneficial, and perpetuates the myth that simply popping any probiotic will automatically help with any health and in particular gut health condition. As convenient as this would be, it’s unfortunately not the case. Probiotics require a precision approach that pays attention to scientific and medical studies in order to figure out what the right choice of probiotic is to address specific issues.
When I suggest probiotics to clients, it’s always specific to their condition, and I often recommend either a probiotic yeast, Saccromyces Boulardii*, that has been well studied with specific conditions like H pylori, for instance, or a spore-based probiotic* that has been studied for reshaping the gut microbiome in a beneficial manner and in particular with SIBO, or a very specific strain of a lactobacillus probiotic for their particular condition. The means not just Lactobacillus reteuri, for example, but Lactobacillus reteuri DSM 19738, which is the name including the genus, species and strain name. Or more recently, now that we have some anaerobic strains available, I might recommend a probiotic like Akkermansia Muciniphila*, for people whose Akkermansia is showing up as below detectable levels on a stool test. But I almost never randomly grab a multi-strain lacto/bifido probiotic as a cure-all for all clients.
And a 2018 study in Cell using multiple stool samples using the best technology available for categorizing the bacteria in stool, called metagenomic sequencing, plus analysis of two samples taken via endoscopy, found that probiotics taken with antibiotics deeply delayed and perturbed the reconstitution of a normal gut microbiome in healthy individuals. But again, keep in mind that the starting point was a healthy gut microbiome, so this doesn’t necessarily apply to dysbiotic microbiota. Lucy Mailing does an in-depth analysis of this study and the pushback from some people in the gut health community if you want to dig further in, but her recommendation is protecting gut hypoxia, meaning an oxygen-free colon, by using butyrate supplements while taking antibiotics if you have a healthy microbiome to start.
And if you’re looking for specific probiotic recommendations, I have a blog I update periodically called “Choosing the Right Probiotic to Heal What Ails You” that you can consult for more specific condition-related recommendations.
4. A gluten-free diet is necessary for optimal gut health
So this is a topic that I’ve done podcasts about, and I have recommended that if you’re struggling with gut health issues, you should try going off gluten. But it’s certainly not a magical ticket to perfect gut health and often, once gut healing is finished, going back on gluten is totally possible and not harmful. Now of course if you’re diagnosed with Celiac disease or non-celiac gluten sensitivity, you should legitimately plan to avoid gluten for life, and that fact will be reinforced every time you eat gluten and feel miserable, if you first eliminate it strictly. Celiac disease is an autoimmune disorder that results in intestinal damage from eating gluten and is effectively managed by strictly avoiding gluten. I should add that I know there are lots of people out there and who I’ve seen as clients who have celiac that’s undiagnosed because they went off gluten, felt better, and never took the test while on gluten. So if you suspect celiac, it’s best to take the test while you’re still eating gluten. While you can test for the genetic pre-disposition for celiac at any time, testing for antibodies (Tissue Transglutaminase IgA antibody being the typical first line test) is best done while eating gluten. Gluten sensitivity, while associated with some gastrointestinal symptoms, lacks specific evidence of intestinal damage. However, for sensitive individuals, there is an extended opening of the tight junctions between cells in the intestines, meaning a leaky gut, which is a precondition for autoimmune disease. So if you’re experiencing any active autoimmune disease, you should avoid gluten. But for the remainder of people, any improvement experienced when avoiding gluten may be related to the fact that wheat is a FODMAP food, which is a type of fiber that is fermented by gut bacteria and produces bloating, or simply because gluten is a large, hard to digest protein and if your digestion is impaired, any more complex proteins may cause you issues.
All this to say that if you do go off gluten while dealing with gut health issues, unless you got a stool or other test indicating sensitivity. And I do see a good number of people, even people who are supposedly gluten-free, who have elevated anti-gliadin IgA antibodies on the GI Map Test*. But if you have no solid evidence of a sensitivity, then you can safely try gluten again once your gut health issues are resolved. I myself, while I was actively dealing with elevated antibodies for Hashimoto’s thyroiditis, went off gluten for years. But I have slowly reintroduced high quality gluten-based breads more and more, but mind you, only ones that have had a complete rise which eliminates most gluten, and after many years of my Hashimoto’s antibodies testing in the normal range. But I don’t go crazy with it because bread is a FODMAP and as someone with autoimmune IBS that causes SIBO to recur, I bloat when I eat too many FODMAPs.
But for those who don’t have recurrent SIBO or a known gluten sensitivity, it’s worth reintroducing high quality whole grain bread products. This is because lots of gluten-free foods lack essential nutrients like folic acid and iron, or they contain less fiber, and may be higher in sugar and fat compared to their gluten-containing counterparts, or are dominated by white rice flour, opening up the possibility of arsenic toxicity, due to the high levels of arsenic in certain types of rice. But just a quick note to say that I was worried about the whole arsenic in rice thing for a while and consequently made a real effort to not use rice flour in my gluten-free baking, but rather use a mixture of millet, sorghum, cassava, oat flour and tapioca starch in my homemade gluten-free flour, and just use some high quality gluten-free bread products from Food for Life and rice/corn chips like the Lundberg ones and only occasional rice flour based products from a local bakery. And then I was eating primarily white jasmine rice at the time. And when I did a hair mineral analysis a number of months back, I had no arsenic show up at all. But anyway, the idea that gluten-free diets are universally more nutritious or prevent disease has not been scientifically proven, so it’s important to figure out what is a genuine medical condition or sensitivity before making a final decision on gluten.
5. A healthy gut is solely determined by diet
I have a lot of clients who doggedly pursue dietary changes from paleo to keto to carnivore to fasting to long-term low FODMAPs or low-oxalate or low-histamine diets or some combo thereof in an effort to improve their gut health. And in the course of this, I find that they can get in a dangerous downward spiral quickly where their body is used to so few foods, they react to almost everything. While I definitely approve of advocating for yourself and trying as much as you can on your own and in assistance of any protocols I might recommend, diet is just one piece of the puzzle when it comes to restoring gut health and maintaining a healthy gut. In many cases with overgrown bacteria or candida, antimicrobial herbs or spore-based probiotics, or serum bovine immunoglobulins may be necessary to eliminate pathogens as well. Then on top of that, various lifestyle and environmental factors also significantly influence your gut microbiota. Habits like smoking and a lack of exercise, for instance, can have a substantial impact on the large bowel and potentially the gut microbiota, increasing the risk of gastritis and colorectal cancer. Stress, through its influence on colonic motor activity via the gut-brain axis and increase in cortisol resulting in increased blood sugar, can alter the gut microbiota, possibly reducing the presence of beneficial bacteria and contributing to IBS-like symptoms. Underlying health conditions, such as diabetes, prediabetes and autoimmune disorders can further complicate gut health. Beyond lifestyle and health, factors like poor sleep patterns and even travel can also affect gut health. Sleep deprivation has been linked to changes in gut microbiota and increased gut inflammation, while travel, especially to foreign destinations, raises the risk of contracting parasites and bacterial infections that impact gut health. So, while diet is a crucial component of gut health, it’s only one piece of the puzzle. A holistic approach that includes managing stress, getting regular exercise, and considering other factors is essential for promoting and maintaining a healthy gut.
6. The more fiber, the better
While most people who consume a typical western diet don’t get enough fiber, consuming too much fiber in the wrong situation or too quickly can have negative effects on your digestive system and overall health too. While dietary fiber offers several benefits, including improved stool consistency, regularity, digestion, and potential protection against diseases like cardiovascular issues and colon cancer, it’s important to know when and how to introduce added fiber. The recommended adequate Intake for fiber is around 25 grams for adult women and 38 grams for adult men, and ideally this should come from your food, but if you can’t get enough from your food, and decide to take a fiber supplement, you should do it gradually. Even adding fiber via food like beans is ideally done more slowly. Most people know that a sudden intake of beans leads to gas, which is because most people’s microbiota doesn’t have enough of the gas-eating bacteria that feed on the gas produced by the microbes that ferment the beans into gas. So if you’re on a long-term fiber increasing plan, it’s best to start with a tablespoon of beans or lentils, ideally cooked from dry beans, properly soaked and rinsed (and I mention beans and lentils as they’re some of the highest-fiber foods) and work your way up to ½ cup a day or more. And for a fiber supplement, start with a pinch and work your way up to 5 or 7 grams a day. Rapidly upping your fiber intake can lead to gastrointestinal discomfort, as the bacteria in your gut may digest the excess fiber, resulting in gas, bloating, cramps, and abdominal pain. Or for people with constipation, excess fiber may stop you up even more if you don’t pick the right one or haven’t done other things to promote motility first. Moreover, excessive fiber can hinder calcium absorption, potentially causing more harm than good, so you’ll want to take that excess fiber away from supplements and meals. Promoting unrestricted fiber consumption as a strategy for appetite suppression, fullness, and weight loss is not a healthy approach. Balancing your fiber intake and gradually increasing it in line with your individual needs, conditions and tolerance is the key to reaping its benefits without adverse side effects. And if you want more info on fiber types, I did a whole episode on fiber in episode 96, which I’ll link in the show notes.
So that’s the six gut health myths for today. As always, if you want some professional help, I work with clients with gut and all over chronic health issues. So if you’re struggling with bloating, constipation, diarrhea, soft stool, acid reflux, IBS, IBD or any type of chronic disease, etc. and want to get to the bottom of it, that’s what I help my clients with. You’re welcome to set up a free, 30-minute breakthrough session with me (Lindsey). We’ll talk about what you’ve been going through and I’ll tell you about my 3- and 5- appointment health coaching programs in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me.
