I was honored to have Jeanne Northsworthy, Certified Nutritionist and Health Coach, join me for a recent class, “The Cancer Prevention Lifestyle.”

We talked about the many lifestyle factors that account for up to 40% of cancer risk, including the benefits of eating plenty of plant foods like fruits, vegetables, whole grains, beans, and lentils.

Jeanne demoed this one-pot lentil stew, which is as versatile as it is delicious. It certainly gave me some fresh inspiration for my (admittedly limited) lentil repertoire!

Listen to Insight Into Health!

Podcast:

Check out my latest podcast episode with Analise Hagstrom, RN, MSN, CPNP-PC, where we talked about bowel movements and constipation:

Radio show:

If you missed Insight Into Health live on KSVY 91.3 radio on Monday at 7 pm PT, check out the recording below when I spoke with Lions Club District Governor Carl Steiner about what the Lions Club is, the history of the Lions Club, and several of the community service initiatives they support:

Thanks for being here,

~Allison

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This information is meant to educate and inspire but is not medical advice. Please consult your healthcare team to determine what is most appropriate for you.

We talked about how bowel movements strongly indicate overall health, then focused on constipation. Analise explained that less frequent, firmer, or incomplete bowel movements can be signs, and that triggers include changes in routine, food and drink, illness, and negative experiences such as pain or anxiety.

She recommends starting with lifestyle changes: more fluids, fiber, movement, and consistent meals. If those aren’t enough, over-the-counter options such as polyethylene glycol (MiraLax) or psyllium (Metamucil) can provide short-term relief while you figure out what works long term.

More about Analise and the Center for Pediatric Growth and Wellness at pedsgrowth.com.

More about me at allisonmckeany.com.

Leave a comment

Thanks for being here,

~Allison

This information is meant to educate and inspire, but is not medical advice. Please consult your healthcare team to determine what is most appropriate for you.

Listen to the episode:

This week, I spoke with Lions Club District Governor Carl Steiner about who and what the Lions Club is, the history of the Lions Club, and several of the community service initiatives they support:

• Vision: access to vision screening, glasses, and other interventions

• Diabetes: awareness and education

• Clean water & hunger

• And more!

To learn more about the Lions Club and to find one in your community, visit lionsclubs.org. You can also find more about volunteer opportunities at communityservicewithlions.org.

Leave a comment

Thanks for being here,

Allison

This information is meant to inform and inspire but is not personal health or medical advice. Please speak with your healthcare team about what is right for you.

Digestion

Eating is just the first step in getting nutrients into your body.

Most of the protein, carbohydrate, and fat in a meal comes in pieces too large to pass through the lining of your intestines into your bloodstream, a process called absorption. While vitamins and minerals are already small, they’re often locked inside the food itself.

Digestion is the mechanical and chemical process that breaks food down so absorption can happen:

• Proteins are broken down into amino acids (and small chains of two or three amino acids)

• Carbohydrates are broken down into simple sugars, like glucose

• Fats are broken down mainly into fatty acids and monoglycerides

• Vitamins and minerals are freed from the food they’re bound in

Fiber is the exception here. While your body can’t digest it, the bacteria in your large intestine can and they turn it into compounds that help keep your gut healthy. More on that to come.

Digestive Tract vs. Digestive System:

• Digestive tract: the long, continuous “tube” where food enters, is digested and absorbed, and anything left over is pushed out.

• Digestive system: the digestive tract plus the organs that help with digestion, including the salivary glands, liver, gallbladder, and pancreas. The vagus nerve, a direct line between your brain and gut, helps control the whole process.

Mouth

Digestion begins before food even reaches your mouth. The sight, smell, and even the thought of food get your saliva and stomach acid flowing.

Chewing is mechanical digestion: each bite breaks food into smaller and smaller pieces.

As saliva mixes with food, an enzyme called amylase starts breaking down carbohydrates. This is chemical digestion. Digestive enzymes are like tiny scissors that “cut” long chains of nutrients into smaller bits, and more enzymes will join the digestive party soon.

Caring for your mouth and teeth is an underappreciated part of digestive health. Broken or missing teeth make chewing difficult, which may lead you to avoid harder-to-chew foods like veggies, nuts, and seeds, or to swallow them before they’re well chewed. That puts extra burden on the stomach and may cause digestive upset as poorly chewed food travels through the digestive tract.

On top of that, gum disease can increase inflammation throughout the body. It’s linked to a higher risk of heart disease, harder-to-control blood sugar, and slower healing.

Taking Care of Your Mouth

Fun fact: I once considered dental school. I didn’t go. So I’ll let Harvard Health be your guide to oral health.

Esophagus

After you swallow, food travels down the esophagus to the stomach, passing through a ring of muscle called the lower esophageal sphincter (LES). The LES acts like a valve: it opens to let food in, then closes tightly behind it. If the LES doesn’t close properly, or relaxes at the wrong time, stomach contents, including acid, can flow backward into the esophagus.

This is known as reflux. It’s one of the most common digestive complaints, and about 20% of US adults have GERD, its chronic form.

Reflux and GERD are more than just uncomfortable. Over time, untreated chronic reflux can lead to Barrett’s esophagus, a change in the lining of the esophagus that raises the risk of esophageal cancer.

Stomach

Chemical digestion really gets going in the stomach. Stomach acid kills potentially harmful pathogens and activates enzymes that break down protein, while the stomach’s muscular walls churn food into even smaller particles. The stomach then releases its contents, a little at a time, into the small intestine.

The stomach also plays a key role in absorbing vitamin B12. Stomach acid frees B12 from the food it’s bound to, and the stomach makes intrinsic factor, a protein that binds to B12 and is needed to absorb it later in the small intestine. This is why long-term use of acid-suppressing medication, or other changes to the stomach, can raise the risk of B12 deficiency.

The stomach also helps regulate hunger and fullness. As it fills, stretch receptors in the stomach wall signal fullness to the brain through the vagus nerve. When it’s empty, it releases ghrelin, the “hunger hormone.”¹.

Small Intestine

When partially digested food leaves the stomach, it enters the small intestine, where most digestion and absorption happen.

Remember, digestion is the mechanical and chemical process of breaking food down into tiny pieces so the body can absorb it. Absorption is the process of moving nutrients from the digestive system into the bloodstream, which delivers them throughout the body.

The small intestine has three sections: the duodenum, jejunum, and ileum (I still remember “DJI,” my memorization trick from college).

The liver, gallbladder, and pancreas all connect to the duodenum through small ducts, delivering more of the ingredients needed for chemical digestion.

• Bile is made in the liver, stored in the gallbladder, and released when you eat to emulsify dietary fat. Emulsifying breaks fat into smaller droplets so enzymes can digest it more easily.

  • Without a gallbladder, bile trickles into the intestine continuously instead of being released in a concentrated burst. This may cause loose stools and urgency after high-fat meals.

• Pancreatic enzymes digest carbohydrates (amylase), fats (lipase), and proteins (proteases). The pancreas also releases bicarbonate to neutralize stomach acid.

  • When the pancreas doesn’t make or deliver enough digestive enzymes, it’s called exocrine pancreatic insufficiency (EPI). It’s managed with pancreatic enzyme replacement therapy (PERT), taken with each meal and snack.

Conditions of the Small Intestine

Small Intestinal Bacterial Overgrowth (SIBO)

We all have health-promoting bacteria in our large intestine (more on the microbiome next time). But when too many bacteria build up in the small intestine, symptoms such as bloating, gas, diarrhea and/or constipation, abdominal pain, and nutrient deficiencies may occur. This is known as small intestinal bacterial overgrowth, or SIBO.

Many of these symptoms are “non-specific,” meaning they can have many causes, so SIBO isn’t diagnosed by symptoms alone. It’s diagnosed with a hydrogen and methane breath test and is typically treated with antibiotics.

SIBO often comes back, so preventing recurrence means addressing the underlying cause, such as slow gut motility, and being aware of dietary and supplement triggers (including probiotics!).

Celiac Disease:

Gluten sensitivity is more common than we once thought and has earned its own name: non-celiac gluten sensitivity. Celiac disease is different. It’s an autoimmune condition triggered by gluten, a protein found in wheat, barley, and rye.

Common symptoms include bloating, diarrhea, and/or constipation after eating gluten, though some people have few digestive symptoms at all. Over time, untreated celiac disease can lead to fatigue, anemia, bone loss, skin rashes, and weight loss.

Celiac disease is diagnosed with blood antibody tests and usually confirmed with an intestinal biopsy. Testing must happen while you’re still eating gluten, so don’t go gluten-free before you’re tested. The only treatment is a lifelong gluten-free diet.

Keep in mind that having one autoimmune condition raises the risk of others. With celiac disease, the most common are type 1 diabetes and autoimmune thyroid disease.

Food Intolerances

Food intolerances happen when the digestive system has trouble breaking down or absorbing a food. This may be due to a missing or inadequate enzyme (e.g., lactose intolerance) or poor absorption (like fructose or polyols). It is important to note, food intolerances are not food allergies:

Common Food Intolerances

• Lactose intolerance: not enough lactase enzyme to break down lactose (milk sugar).

• Fructose malabsorption: incomplete absorption of fructose (in fruit, honey, and high-fructose corn syrup).

• Polyol (sugar alcohol) sensitivity: sorbitol, mannitol, xylitol, and other “-ols,” found naturally in foods like peaches, plums, apricots, cherries, apples, pears, mushrooms, and cauliflower, and in many “sugar-free” products.

• FODMAPs: Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols are a group of carbohydrates that some people have trouble digesting (more on these below).

When undigested food components reach the large intestine, gas, bloating, and/or diarrhea may occur.

Large Intestine/Colon

“Large intestine” and “colon” are often used interchangeably, but technically the large intestine has three parts: the cecum (a pouch where the small intestine empties into the large intestine), the colon, and the rectum (where stool is stored until it passes out through the anus).

The colon is the longest part of the large intestine and has four continuous sections. The ascending colon travels up the right side of your abdomen, the transverse colon crosses from right to left, the descending colon travels down the left side, and the sigmoid colon is an S-shaped curve that leads to the rectum.

Microbiome

The microbiome has many jobs, including fermenting undigested fiber into short-chain fatty acids, supporting immune function, and producing vitamins (like vitamin K and several B vitamins, such as biotin and folate).

The microbiome is also an integral part of the “gut-brain axis,” a two-way communication network between the digestive tract and the brain.

We still have a lot to learn about the microbiome and all the ways it affects health. We don’t know exactly what makes up a healthy microbiome, or whether there’s even an ideal one. What we do know is that a diverse, balanced community seems to matter more than any single “good” microbe.

Prebiotics, Probiotics, & Postbiotics — oh my!

Talking about the microbiome inevitably brings up questions about the “biotics,” which refers to living things:

Probiotics: Food or Supplement?

If you read “probiotic” and think of a supplement, I don’t blame you. The claims on those bottles are enticing! (For more on navigating supplements, check out my Supplements 101 Health Guide.)

The truth is, we don’t know enough about most probiotics (which types, how much, which combinations, or for how long) to confidently recommend them for most conditions. There are exceptions, of course, such as using probiotic supplements to reduce the risk of antibiotic-associated diarrhea (there’s another “biotic” for ya).

For now, my recommendations for probiotic supplements are:

1. Food first. Include probiotic foods as often as possible (ideally daily), such as yogurt with live and active cultures, kefir, sauerkraut, kimchi, and kombucha. For sauerkraut and kimchi, choose refrigerated, unpasteurized versions, since heat processing kills the live microbes.

2. If you’re healthy, you probably don’t need a probiotic supplement.

3. If you’re interested in a probiotic for a health condition or digestive complaint, talk with your doctor. Feel free to share this resource on evidence-based probiotic use for various conditions with them.¹

4. If you do use a probiotic supplement, remember it’s usually meant for a specific purpose and time frame, not forever. My Supplements 101 Health Guide walks you through how to tell whether a supplement is working and when you no longer need it.1

Common Large Intestine Complaints

Poop, Stool, Bowel Movement, Feces, #2, Passing Gas, Tooting, Breaking Wind…

Talking about what comes out of our bodies makes most people squirm, which, in my opinion, is why we’ve invented so many names to get around the discomfort.

Yet what comes out of your body is an important sign of what’s going on inside it. So please get comfortable looking at your poop, talk with your healthcare team about anything that concerns you, and remember…Everyone Poops!

Clinicians use the Bristol Stool Chart (caution, there are visuals!) to describe stool consistency, so using the chart’s numbers is an easy way to talk poop without the awkwardness. Regardless, look at your poop! It tells you and your care team a lot.

Fiber

Even though our bodies can’t digest fiber, its trip through the digestive system still offers plenty of benefits. And let me tell you… those benefits go waaay beyond bowel regularity.

First, a quick review: fiber isn’t just one thing. Like vitamins and minerals, it’s a category, and it can be sorted in a few ways. The same fiber can even fit more than one category:

1. Solubility (what does the fiber do in water?)

Soluble Fibers

Soluble fibers dissolve in water and form a gel-like substance. This gel softens stool, slows digestion, and keeps you full longer. (Think of foods like oats and beans, which change when sitting in water.)

Insoluble Fibers

Insoluble fibers don’t dissolve in water. Instead, they add bulk and move through the digestive tract, supporting bowel regularity. (Think of foods like most vegetables and fruit skins, which don’t change when sitting in water.)

2. Fermentability (what does the microbiome do with it?)

Prebiotic Fibers

Prebiotics are fibers your body can’t digest but your gut bacteria can. When these bacteria ferment prebiotics, many of the byproducts are beneficial for health.

Prebiotic fibers are mostly soluble, but some insoluble fibers and resistant starch can also act as prebiotics. Examples include onion, garlic, leeks, and asparagus, which provide especially good fuel for those bacteria.

Resistant Starch

While not technically a fiber, resistant starch acts like a prebiotic fiber in the body. After potatoes, rice, and semolina pasta are cooked and cooled2, some of their starch is transformed into resistant starch. This is because it “resists” digestion in the small intestine and provides a food source for the microbiome. Plus, because less carbohydrate is absorbed, resistant starch has less impact on blood sugar.

3. Fiber-ish

FODMAPs

As the first word in the acronym implies, Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols (FODMAPs) are short-chain carbohydrates that are poorly absorbed in the small intestine and then fermented by gut bacteria. Here are examples of each FODMAP category:

• Oligosaccharides: wheat, onion, garlic, beans, and lentils

• Disaccharides: lactose in milk and other dairy products

• Monosaccharides: honey, apples, and mango

• Polyols: sugar alcohols in stone fruits and sugar-free products

As you can see, some FODMAPs are fibers, and some are not.

I include FODMAPs here because a “low FODMAP” diet is a relatively new intervention for IBS and has brought a ton of confusion along with it.

Most people can tolerate FODMAPs. If this is true for you, continue to enjoy! The byproducts of FODMAP fermentation by the microbiome have a growing list of health benefits.

However, for those with IBS, certain FODMAPs may cause gas, bloating, and discomfort. If this is you, please, please, please know this before you try a low FODMAP diet: it is meant to be a short-term elimination diet to help you identify IBS triggers, not a long-term super-strict diet.

Plus, it is complicated to implement on your own!

Frustratingly, many people are given a handout and told to “try a low FODMAP diet” without guidance or support. The patients who eventually make their way to me have either given up trying or have been on a diet so restrictive for so long that I am concerned about nutrient deficiencies.

So please, keep my fellow dietitians and ask for support if this is something you’d like to try.

The Benefits of Fiber

Keeps stools soft and regular

Ok, yes, fiber has been typecast as the poop nutrient, and for good reason! If you’ve never had trouble pooping, consider yourself lucky, because the ability to have easy bowel movements is something too many people take for granted.

Fiber helps you stay regular in a couple of ways. First, soluble fibers absorb water, keeping stool soft and easy to pass. Second, insoluble fibers increase the bulk moving through the digestive tract, which stimulates the muscles of the digestive system and keeps everything moving.

Supports satiety

Fiber-rich foods take longer to eat and add volume to your meals, helping you stay satisfied. The gel formed by the soluble fibers also slows how quickly food leaves the stomach. You can amplify this effect by pairing fiber-rich foods with lean proteins and healthy fats.

Manages blood sugar

The gel formed by soluble fiber slows how quickly carbohydrates are digested and absorbed, which helps prevent sharp spikes in blood sugar after eating. Over time, diets higher in fiber are linked to better blood sugar control and a lower risk of type 2 diabetes.

Lowers cholesterol

Soluble fibers, such as the beta-glucan in oats and the fiber in beans and psyllium, bind to bile acids in the digestive tract and carry them out of the body in stool. Your liver then pulls cholesterol from the blood to make more bile, which lowers circulating LDL cholesterol levels.

Decreases colorectal cancer risk

Higher fiber intake, especially from whole grains, is associated with a lower risk of colorectal cancer. This may be because fiber speeds the movement of stool through the colon, bulks and dilutes its contents, and feeds the microbiome.

Feeds your gut microbiome

The bacteria in your microbiome rely on fiber as their main fuel. When they ferment it, they produce short-chain fatty acids like butyrate, which support the health of the colon lining and may play a role in immune function and inflammation. A variety of fiber-rich plant foods supports a more diverse microbiome, which is why eating many different plants matters more than relying on a single source.

Comes with an entourage

Finally, fiber-rich foods are often packaged with other important nutrients: vitamins, minerals, phytochemicals. So eating those fruits, veggies, whole grains, nuts, seeds, and lentils brings a whole lot more than fiber to the party. Cheers!

Fiber in Common Foods

The truth is, most foods contain a mix of different fiber types, as you can see in the chart of common fiber-rich foods below. For most people, variety is key. Eating lots of different fiber-rich foods provides lots of different fiber types, which can contribute to the impressive list of benefits outlined above.

While many people can enjoy a wide range of fiber-rich foods, those with digestive problems may need to be a little more selective. If this is you, please work with your doctor, and potentially a gastroenterologist and dietitian, to determine whether changing the types or amounts of fiber you eat will help.

How Much Fiber Do You Need?

Most guidelines recommend about 25 grams of fiber per day for women and 38 grams per day for men. However, many experts agree that if tolerated, more may be better, and not only because of the fiber itself. It may also be because of the countless other nutrients in fiber-rich foods that work their magic together.

Unfortunately, most adults in the US get only about half of the minimum recommendation. If this is you, please take an extra look at the chart above. Adding an extra serving of fruit, beans, or nuts each day can go a long way toward getting the many benefits that fiber-rich foods provide.

But… easy does it. Adding too much fiber at once can cause gas and bloating, so start slow. Add a new fiber-rich food to your typical intake every few days to let your digestive system and microbiome adjust.

The Perfect Pairing

As you now know, soluble fiber works by absorbing fluid to form a gel that softens stool, increases satiety, and helps manage blood sugar and cholesterol levels.

Yet, this also means that the benefits of soluble fiber depend on having enough fluid to work.

Why is this? I like to think of soluble fiber as a kitchen sponge: dry and hard when left out on the counter but soft and pliable once it gets wet. Not enough fluid means dry, hard stools and sluggish digestion. Not fun.

How much

Several factors determine how much fluid an individual needs3, including gender, activity level, and medical conditions, among others.

Typical recommendations range from about 2.1 L per day for women to nearly 3 L per day for men. (For context, 2.1 L is about 9 cups or 71 oz, and 3 L is about 13 cups or 100 oz.)

I talk about fluid a lot with my patients, and I only recently realized that when I say “fluid,” many hear “water.” For those who aren’t big water drinkers, hearing they need over 2 L per day can be overwhelming!

The good news is that ALL FLUIDS COUNT. You heard that right. Water counts. Coffee counts. Tea counts. Milk counts. Carbonated beverages count. Heck, even juices and sugar-sweetened and artificially sweetened beverages count.

I say this to get their attention, and it usually works. Their facial expressions alone show me that they’re relieved they don’t have to force themselves to guzzle bottles of water.

Then I explain that, based on their situation, we may need to modify how much of that fluid comes from caffeine, sugar, carbonation, or whatever else. But the message doesn’t change: all fluids count! Stay tuned for a whole post dedicated to fluids and hydration!

When to be careful: Fiber isn’t one-size-fits-all.

• IBS: Some fibers ferment quickly and can trigger gas and bloating. Soluble, less fermentable fibers such as psyllium are often better tolerated than wheat bran. A dietitian can help you sort out what works.

• IBD (Crohn’s disease or ulcerative colitis): During a flare, or if you have a narrowed bowel, high-fiber foods may need to be limited. Follow your care team’s guidance.

• SIBO: Fermentable fibers, including prebiotics and high FODMAP foods, can feed bacteria in the small intestine and worsen gas and bloating. Tolerance varies a lot, so work with a dietitian to adjust types and amounts rather than cutting fiber across the board.

• Diverticulitis: During an active flare, your care team may recommend temporarily limiting fiber or following a clear liquid diet. Fiber is typically added back gradually once symptoms settle, so follow your care team’s guidance.

  • Diverticulosis: Having pouches in the colon wall is not a reason to avoid fiber. Higher fiber intake is linked to a lower risk of diverticulitis flare. The old advice to avoid nuts, seeds, and popcorn is not supported by current evidence.

• Bowel surgery, strictures, or swallowing problems: Ask your doctor before increasing fiber.

• Medications: Fiber can affect how some medications are absorbed, so ask your pharmacist about timing.

New bleeding, black stools, ongoing changes in bowel habits, or unexplained weight loss are worth a call to your doctor. These shouldn’t be treated with fiber alone.

The take-home

Fiber deserves its time in the spotlight. From digestive health to metabolic health to cardiovascular health, plant-based fiber-rich foods have so much to offer for many of us.

So go out there and enjoy! (slowly, of course 😉)

Leave a comment

Thanks for being here,

~Allison

This information is meant to inform and inspire and is not personal health or medical advice. Please speak with your healthcare team about what is right for you.

Part 1 explained what digestion is and why it matters, and began a journey through the digestive system.

Part 2 took an in-depth look at what happens in the small intestine and the common causes of digestive complaints that start there, including celiac disease, SIBO, and food intolerances.

Part 3 looked at the large intestine: what happens there, and what to know when things don’t go quite right.

Let’s get into Part 4!

Most people know fiber is “good.”

But why?

Well, even though our body doesn’t absorb fiber, its trip through the digestive system still offers plenty of benefits. And let me tell you… the benefit goes waaay beyond bowel regularity.

Fiber Types

Before we get into the benefits of fiber, a quick review of fiber types. You read that right: fiber isn’t one thing.

Fiber is a category, just like vitamins and minerals. To complicate matters, fiber can be sorted in a few different ways, and the same fiber can fit into more than one category:

1. Solubility (what does the fiber do in water?)

Soluble Fibers

Soluble fibers dissolve in water and form a gel-like substance. This gel softens stool, slows digestion, and keeps you full longer. (Think of foods like oats and beans, which change when sitting in water.)

Insoluble Fibers

Insoluble fibers don’t dissolve in water. Instead, they add bulk and move through the digestive tract, supporting bowel regularity. (Think of foods like most vegetables and fruit skins, which don’t change when sitting in water.)

2. Fermentability (what does the microbiome do with it?)

Prebiotic Fibers

Prebiotics are fibers your body can’t digest but your gut bacteria can. When these bacteria ferment prebiotics, many of the byproducts are beneficial for health.

Prebiotic fibers are mostly soluble, but some insoluble fibers and resistant starch can also act as prebiotics. Examples include onion, garlic, leeks, and asparagus, which provide especially good fuel for those bacteria.

Resistant Starch

While not technically a fiber, resistant starch acts like a prebiotic fiber in the body. After potatoes, rice, and semolina pasta are cooked and cooled1, some of their starch is transformed into resistant starch. This is because it “resists” digestion in the small intestine and provides a food source for the microbiome. Plus, because less carbohydrate is absorbed, resistant starch has less impact on blood sugar.

3. Fiber-ish

FODMAPs

As the first word in the acronym implies, Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols (FODMAPs) are short-chain carbohydrates that are poorly absorbed in the small intestine and then fermented by gut bacteria. Here are examples of each FODMAP category:

• Oligosaccharides: wheat, onion, garlic, beans, and lentils

• Disaccharides: lactose in milk and other dairy products

• Monosaccharides: honey, apples, and mango

• Polyols: sugar alcohols in stone fruits and sugar-free products

As you can see, some FODMAPs are fibers, and some are not.

I include FODMAPs here because a “low FODMAP” diet is a relatively new intervention for IBS and has brought a ton of confusion along with it.

Most people can tolerate FODMAPs. If this is true for you, continue to enjoy! The byproducts of FODMAP fermentation by the microbiome have a growing list of health benefits.

However, for those with IBS, certain FODMAPs may cause gas, bloating, and discomfort. If this is you, please, please, please know this before you try a low FODMAP diet: it is meant to be a short-term elimination diet to help you identify IBS triggers, not a long-term super-strict diet.

Plus, it is complicated to implement on your own!

Frustratingly, many people are given a handout and told to “try a low FODMAP diet” without guidance or support. The patients who eventually make their way to me have either given up trying or have been on a diet so restrictive for so long that I am concerned about nutrient deficiencies.

So please, keep my fellow dietitians and ask for support if this is something you’d like to try.

The Benefits of Fiber

Keeps stools soft and regular

Ok, yes, fiber has been typecast as the poop nutrient, and for good reason! If you’ve never had trouble pooping, consider yourself lucky, because the ability to have easy bowel movements is something too many people take for granted.

Fiber helps you stay regular in a couple of ways. First, soluble fibers absorb water, keeping stool soft and easy to pass. Second, insoluble fibers increase the bulk moving through the digestive tract, which stimulates the muscles of the digestive system and keeps everything moving.

Supports satiety

Fiber-rich foods take longer to eat and add volume to your meals, helping you stay satisfied. The gel formed by the soluble fibers also slows how quickly food leaves the stomach. You can amplify this effect by pairing fiber-rich foods with lean proteins and healthy fats.

Manages blood sugar

The gel formed by soluble fiber slows how quickly carbohydrates are digested and absorbed, which helps prevent sharp spikes in blood sugar after eating. Over time, diets higher in fiber are linked to better blood sugar control and a lower risk of type 2 diabetes.

Lowers cholesterol

Soluble fibers, such as the beta-glucan in oats and the fiber in beans and psyllium, bind to bile acids in the digestive tract and carry them out of the body in stool. Your liver then pulls cholesterol from the blood to make more bile, which lowers circulating LDL cholesterol levels.

Decreases colorectal cancer risk

Higher fiber intake, especially from whole grains, is associated with a lower risk of colorectal cancer. This may be because fiber speeds the movement of stool through the colon, bulks and dilutes its contents, and feeds the microbiome.

Feeds your gut microbiome

The bacteria in your microbiome rely on fiber as their main fuel. When they ferment it, they produce short-chain fatty acids like butyrate, which support the health of the colon lining and may play a role in immune function and inflammation. A variety of fiber-rich plant foods supports a more diverse microbiome, which is why eating many different plants matters more than relying on a single source.

Comes with an entourage

Finally, fiber-rich foods are often packaged with other important nutrients: vitamins, minerals, phytochemicals. So eating those fruits, veggies, whole grains, nuts, seeds, and lentils brings a whole lot more than fiber to the party. Cheers!

Sources of Fiber

The truth is, most foods contain a mix of different fiber types, as you can see in the chart of common fiber-rich foods below. For most people, variety is key. Eating lots of different fiber-rich foods provides lots of different fiber types, which can contribute to the impressive list of benefits outlined above.

While many people can enjoy a wide range of fiber-rich foods, those with digestive problems may need to be a little more selective. If this is you, please work with your doctor, and potentially a gastroenterologist and dietitian, to determine whether changing the types or amounts of fiber you eat will help.

How Much Fiber Do You Need?

Most guidelines recommend about 25 grams of fiber per day for women and 38 grams per day for men. However, many experts agree that if tolerated, more may be better, and not only because of the fiber itself. It may also be because of the countless other nutrients in fiber-rich foods that work their magic together.

Unfortunately, most adults in the US get only about half of the minimum recommendation. If this is you, please take an extra look at the chart above. Adding an extra serving of fruit, beans, or nuts each day can go a long way toward getting the many benefits that fiber-rich foods provide.

But… easy does it. Adding too much fiber at once can cause gas and bloating, so start slow. Add a new fiber-rich food to your typical intake every few days to let your digestive system and microbiome adjust.

The Perfect Pairing

As you now know, soluble fiber works by absorbing fluid to form a gel that softens stool, increases satiety, and helps manage blood sugar and cholesterol levels.

Yet, this also means that the benefits of soluble fiber depend on having enough fluid to work.

Why is this? I like to think of soluble fiber as a kitchen sponge: dry and hard when left out on the counter but soft and pliable once it gets wet. Not enough fluid means dry, hard stools and sluggish digestion. Not fun.

How much

Several factors determine how much fluid an individual needs2, including gender, activity level, and medical conditions, among others.

Typical recommendations range from about 2.1 L per day for women to nearly 3 L per day for men. (For context, 2.1 L is about 9 cups or 71 oz, and 3 L is about 13 cups or 100 oz.)

I talk about fluid a lot with my patients, and I only recently realized that when I say “fluid,” many hear “water.” For those who aren’t big water drinkers, hearing they need over 2 L per day can be overwhelming!

The good news is that ALL FLUIDS COUNT. You heard that right. Water counts. Coffee counts. Tea counts. Milk counts. Carbonated beverages count. Heck, even juices and sugar-sweetened and artificially sweetened beverages count.

I say this to get their attention, and it usually works. Their facial expressions alone show me that they’re relieved they don’t have to force themselves to guzzle bottles of water.

Then I explain that, based on their situation, we may need to modify how much of that fluid comes from caffeine, sugar, carbonation, or whatever else. But the message doesn’t change: all fluids count! Stay tuned for a whole post dedicated to fluids and hydration!

When to be careful: Fiber isn’t one-size-fits-all.

• IBS: Some fibers ferment quickly and can trigger gas and bloating. Soluble, less fermentable fibers such as psyllium are often better tolerated than wheat bran. A dietitian can help you sort out what works.

• IBD (Crohn’s disease or ulcerative colitis): During a flare, or if you have a narrowed bowel, high-fiber foods may need to be limited. Follow your care team’s guidance.

• SIBO: Fermentable fibers, including prebiotics and high FODMAP foods, can feed bacteria in the small intestine and worsen gas and bloating. Tolerance varies a lot, so work with a dietitian to adjust types and amounts rather than cutting fiber across the board.

• Diverticulitis: During an active flare, your care team may recommend temporarily limiting fiber or following a clear liquid diet. Fiber is typically added back gradually once symptoms settle, so follow your care team’s guidance.

  • Diverticulosis: Good news! Having pouches in the colon wall is not a reason to avoid fiber. Higher fiber intake is linked to a lower risk of diverticular problems. The old advice to avoid nuts, seeds, and popcorn is not supported by current evidence.

• Bowel surgery, strictures, or swallowing problems: Ask your doctor before increasing fiber.

• Medications: Fiber can affect how some medications are absorbed, so ask your pharmacist about timing.

New bleeding, black stools, ongoing changes in bowel habits, or unexplained weight loss are worth a call to your doctor. These shouldn’t be treated with fiber alone.

The take-home

Fiber deserves its time in the spotlight. From digestive health to metabolic health to cardiovascular health, plant-based fiber-rich foods have so much to offer for many of us.

So go out there and enjoy! (slowly, of course 😉)

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Thanks for being here,

~Allison

For more about fiber, check out this podcast from Gastropod.

Listen to Insight into Health:

Podcast:

In this second episode on digestive health, I walk you through the most frequent digestive complaints I hear from my patients and discuss common causes and interventions. Listen below, or anywhere you listen to podcasts (links to Apple & Spotify).

KSVY Radio:

This week, I spoke with Certified Nutrition Consultant and Health Coach Jeanne Norsworthy about her background and the differences between a nutritionist and a registered dietitian. Listen below:

You can find more about digestive health in my latest article series, “The Ins & Outs of Digestive Health”:

Part 1: Mouth to Middle

Part 2: Where the Action Happens

Part 3: Down & Out

To learn more about me, visit allisonmckeany.com.

Subscribe — for free! — to receive the next article on fiber and get access to all of my health guides, recipes, and more!

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This information is meant to educate and inspire but is not medical advice. Please consult your healthcare team to determine what is most appropriate for you.

Listen to the episode:

This week, I spoke with Certified Nutrition Consultant and Health Coach Jeanne Norsworthy about her background and the differences between a nutritionist and a registered dietitian.

Find out more about Jeanne at www.worthysf.com and @worthyhealthandwellness on Instagram.

Leave a comment

Thanks for being here,

Allison

This information is meant to inform and inspire but is not personal health or medical advice. Please speak with your healthcare team about what is right for you.

Listen to the episode:

This week, check out my conversation with the TJ Carter Band on her new album (The 6 Hour Record), music, creativity, and moments of magic. They also played two songs from the album live on the air!

Leave a comment

Thanks for being here,

Allison

Listen to the episode:

This week, I spoke with Ron Leal, my neighbor and fellow KSVY host. Ron has hosted In Step in Tech every Saturday 10-11 am for nearly 20 years.

I then chatted with about the power of music.

Leave a comment

Thanks for being here,

Allison

This information is meant to inform and inspire but is not personal health or medical advice. Please speak with your healthcare team about what is right for you.

Listen to the episode:

This week, I spoke with Scott Murray, board president of Cancer Support Sonoma, about their biggest fundraising event of the year called Wig Out.

Leave a comment

Thanks for being here,

Allison

This information is meant to inform and inspire but is not personal health or medical advice. Please speak with your healthcare team about what is right for you.

Listen to the episode:

This week, I spoke with Mario Castillo of Buckelew Programs about suicide prevention and more.

More about the 988 Suicide & Crisis Lifeline here.

Leave a comment

Thanks for being here,

Allison

This information is meant to inform and inspire but is not personal health or medical advice. Please speak with your healthcare team about what is right for you.

Part 2 took an in-depth look at what happens in the small intestine and the common causes of digestive complaints that start there, including celiac disease, SIBO, and food intolerances.

Today, we wrap up the series with the large intestine: what happens there, and what to know when things don’t go quite right.

Large Intestine/Colon

“Large intestine” and “colon” are often used interchangeably. Technically, the large intestine has three parts: the cecum (a pouch where the small intestine empties into the large intestine), the colon, and the rectum (where stool is stored until it passes out through the anus).

The colon is the longest portion of the large intestine and is made up of four continuous sections. The ascending colon travels up the right side of your abdomen. The transverse colon crosses from right to left. The descending colon travels down the left side, and the sigmoid colon, which is an S-shaped curve that leads to the rectum.

As contents move through the colon, water and electrolytes are absorbed and stool is condensed. The colon is also home to most of your gut microbiome: the community of bacteria, fungi, and other microbes that plays a key role in our health.

Poop, Stool, Bowel Movement, Feces, #2, Passing Gas, Tooting, Breaking Wind…

Talking about what comes out of our bodies makes most people squirm, which is why, in my opinion, we’ve invented so many names to get around the discomfort.

Yet what comes out of your body is an important sign of what’s going on inside it. So please get comfortable looking at your poop, talking with your healthcare team about anything that concerns you, and remember... Everyone Poops!

Microbiome

The microbiome has many roles, including fermenting undigested fibers to produce short-chain fatty acids, supporting immune function, producing vitamins (e.g., vitamin K and several B vitamins, such as biotin and folate), and more.

The microbiome is also an integral part of the “gut-brain axis,” a two-way communication network between the digestive tract and the brain.

We still have a lot to learn about the microbiome and all the ways it affects health. We don’t know exactly what makes up a healthy microbiome, or if there even is an ideal one. What we do know is that a diverse, balanced community seems to matter more than any single “good” bacterium or other microbe.

Prebiotics, Probiotics, & Postbiotics — oh my!

Talking about the microbiome assuredly brings up thoughts of, and questions about, the “biotics.” First, some terms:

• “-biotic” refers to living things.

• “Pre-” means before, so prebiotics are the fibers and other compounds that feed the living gut microbes.

• “Pro-” means in support of, so probiotics are live bacteria and other microbes that may support health.

• “Post-” means after, so postbiotics are what’s left behind after microbes ferment fibers and other substances. These include short-chain fatty acids like butyrate, vitamins, and more.

Probiotics: Food or Supplement?

If you are reading “probiotic” and think of a supplement, I don’t blame you. The claims on those bottles are enticing! (For more on navigating supplements, check out my Supplements 101 Health Guide.)

The truth is, we don’t know enough about most probiotics (types, amounts, combinations, or duration) to confidently recommend them for most conditions. There are exceptions, of course, such as using probiotic supplements to reduce the risk of antibiotic-associated diarrhea (there’s another “biotic” for ya).

For now, my recommendations regarding probiotic supplements are:

1. Food first. Include food sources of probiotics as often as possible (ideally daily), such as yogurt with live and active cultures, kefir, sauerkraut, kimchi, and kombucha. For sauerkraut and kimchi, choose refrigerated, unpasteurized versions, since heat processing kills the live microbes.

2. If you’re healthy, you probably don’t need a probiotic supplement.

3. If you’re interested in a probiotic for a health condition or digestive complaint, talk with your doctor. Feel free to share this resource with them on evidence-based probiotic use for various conditions.1

4. If you do use a probiotic supplement, remember it’s usually meant for a specific purpose and time frame, not forever. Part of my Supplements 101 Health Guide walks you through how to tell if a supplement is working and when you no longer need it.

Common Large Intestine Complaints

In the patients that I see, digestive symptoms are among the main causes of poor quality of life. I suspect that this is due to the physical discomfort, but also social taboos and the fact that it may affect what a person can comfortably eat when out and about.

• Gas: A natural process and created as a byproduct of bacterial fermentation and/or swallowed air (eating quickly, chewing gum, carbonated drinks, sleep apnea machines).

  • Most healthy adults pass gas 10 to 20 times a day. Most gas has no odor, though eating eggs, meat, dairy, beans, and some veggies may increase the amount of fragrant sulfur in these gases.

  • Don’t let a fear of gas prevent you from eating fiber! If you are working on increasing fiber in your diet, go slowly. Add one new fiber-rich food every few days to give your microbiome a chance to adjust.

• Bloating is a sensation of fullness or tightness in the abdomen caused by trapped gas, slow digestion, or merely being more sensitive to normal amounts of digestive gases. Bloating may be worsened by swallowing large amounts of air, eating large meals, constipation, certain foods, and food intolerances.

  • Distention is more of a medical term that refers to a visible and measurable increase in the size of the abdomen. Bloating can occur with and without abdominal distention.

• Constipation has several medical definitions, based on bowel movement frequency, stool consistency, ease of passing stool, and the sense of completeness. Because every digestive system has its own rhythm, the best clue is often a change from an individual’s typical bathroom habits.

  • Frequency: “Normal” ranges widely, from several times a day to every other day. A change in pattern (e.g., twice a day to every other day) with other symptoms is often more important than frequency alone. That said, fewer than three bowel movements a week is a sign that you may be constipated.

  • Consistency: Clinicians use the Bristol Stool Chart (caution, there are visuals!). Type 4, "smooth, soft, and snake-like," is the goal (some providers say "like soft serve"). Types 1 and 2, hard and lumpy, point to constipation. Look at your poop! It tells you and your care team a lot.

  • Ease: When you feel the urge to have a bowel movement, go! A healthy bowel movement shouldn’t require straining or cause pain and typically takes no more than 5 minutes. Straining and long toilet sits raise your risk of hemorrhoids.

    • Pro tip: Due to the shape of your colon and rectum, it can help to put your feet up on a stool to raise your knees to, or above, the level of your hips (if comfortable). This straightens out the trip the stool has to make (which explains why hunter-gatherers squatted to poop).

  • Completeness: Simply having regular bowel movements doesn’t clear you from being constipated. Daily, small, incomplete movements can slowly cause a stool to back up. How can you tell if you’ve had a complete bowel movement? Well, first look at the amount and compare it to what is typical. Then check in with how you feel — if you feel like there is more in there, there likely is. Finally, a complete bowel movement usually comes with pretty easy cleanup, if you know what I mean. If you are wiping for days, that may be a sign that there is more in there.

• Diarrhea is, in some ways, the opposite of constipation: more frequent, urgent, very loose or watery stools (Bristol Type 6 or 7). Common causes include viral or bacterial infections, parasites, food intolerances, medications (including antibiotics), and chronic conditions like IBS, celiac disease, and inflammatory bowel disease.

  • Diarrhea can increase the risk of dehydration, so consuming enough fluids is a high priority. Sip water, broth, or an oral rehydration solution (such as Pedialyte), which replaces both fluid and electrolytes. Sports drinks and juice are okay in a pinch, but they’re high in sugar and lower in sodium, and sugary drinks may worsen diarrhea in some people.

• Parasites (ex: Giardia, Cryptosporidium): Spread through contaminated water, food, or person-to-person contact. They can cause diarrhea, gas, bloating, cramping, nausea, and weight loss if the infection goes on for a while.

• Diverticulosis/Diverticulitis: Diverticulosis means small pouches (diverticula) have formed in the wall of the colon. It’s common, increases with age, and usually causes no symptoms. If those pouches become inflamed or infected, it’s called diverticulitis (“-itis” means inflammation), which often includes abdominal pain (typically lower left), fever, nausea, and changes in bowel habits.

  • It was once thought that small food particles like seeds, nuts, and popcorn could get trapped in diverticula and cause inflammation and infection. However, newer research shows that eating these foods does not increase the risk of developing diverticulitis, and eating more high-fiber foods is a helpful way to prevent constipation, which may lead to a diverticulitis “flare.” Note, if you do experience a diverticulitis flare, check with your medical team about appropriate nutrition recommendations.

IBS vs. IBD:

• The names sound alike, and both can cause abdominal pain and changes in bowel habits, but they are different conditions. IBS is a disorder of how the gut functions. IBD involves visible inflammation and tissue damage.

  • IBS (Irritable Bowel Syndrome): A disorder of “gut-brain interaction”, meaning the two-way messages between the gut and the brain affect how quickly (or slowly) contents move through the digestive tract and often being more sensitive to the feelings of normal digestion. IBS may cause bloating, gas, bowel urgency, and symptoms that flare with stress, certain foods, or disrupted sleep. In short, the gut looks normal on testing, but it doesn’t work normally.

    • Subtypes: IBS-C (constipation-predominant), IBS-D (diarrhea-predominant), IBS-M (mixed, alternating between the two), and IBS-U (unclassified). Symptoms can shift between subtypes over time.

  • IBD (Inflammatory Bowel Disease): Chronic inflammation of the digestive tract that damages the gut lining. The exact cause isn’t known, but genetics, the immune system, the microbiome, and environmental factors all play a role. In short, the digestive tract does not look normal, and inflammation is present.

    • Crohn’s disease: Can affect any part of the GI tract, though it most often involves the end of the small intestine and the colon.

    • Ulcerative colitis (UC): Affects only the colon and rectum.

Having IBS does not lead to IBD, though the two can coexist. IBS is typically treated with dietary changes, stress management, and symptom-targeted medications. IBD is treated with medications and sometimes surgery.

Hemorrhoids:

Hemorrhoids are swollen veins in the rectum and anus and can occur both internally and externally. They are very common and rarely dangerous, but can cause bleeding, pain, and itching. More on digestive health “red flags” soon, but please consult your doctor if you have rectal bleeding so that the cause can be investigated.

Hemorrhoids are often caused by chronic constipation, straining during bowel movements, sitting on the toilet for long periods, low fiber intake, pregnancy, and heavy lifting. Risk rises with age.

Much more on food and lifestyle interventions to prevent constipation and promote healthy bowel movements next week, but for now, know that eating enough fiber, drinking enough fluids, regular exercise, and limiting time sitting on the toilet can all prevent hemorrhoids.

Listen to Insight into Health:

Podcast:

It is Digestive Health Month on the Insight into Health podcast! Listen to my conversation with Dr. Marci L. Hardy, PhD, MA, as we discuss how to feel more comfortable talking about your bodily functions (links to Apple & Spotify).

KSVY Radio:

If you missed Insight into Health live on KSVY 91.3 radio on Monday at 7 pm PT, check out my conversation with the TJ Carter Band on music, creativity, and moments of magic.

Thanks for being here,

~Allison

This information is meant to educate and inspire but is not medical advice. Please consult your healthcare team to determine what is most appropriate for you.

Dr. Hardy previously joined me in episode #8 — You are the Expert on Your Body to talk about advocating for yourself and your loved ones to ensure you are getting the attention and care you need from your healthcare providers.

In this episode, Dr. Hardy expands on her patient advocacy approach to overcoming the social taboos of talking about digestive function and symptoms more generally, as well as specifics, such as reflux, bloating, abdominal pain, constipation, and diarrhea.

If just reading this makes you squirm, remember… Everyone Poops!

For more about digestive health, including reflux, gas, bloating, and more, check out The Ins & Outs of Digestive Health — Part 1 and Part 2.

More on the Bristol Stool Chart

Check out this digestive health comic book Dr. Hardy told me about after the podcast recording was complete!wq

More about Marci’s work can be found at drmarcihardy.com and @drmarcihardy on LinkedIn, Facebook, and Instagram.

For more about me, Allison McKeany, check out allisonmckeany.com.

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This information is meant to educate and inspire but is not medical advice. Please consult your healthcare team to determine what is most appropriate for you.

I’m excited to share that I was recently a guest on the Exam Room Nutrition podcast with host Colleen Sloan, a pediatric PA and registered dietitian whose show helps busy clinicians feel more confident answering their patients’ nutrition questions.

We talked about how to respond when a patient says, "I want to be healthy," including the value of finding a person's health "why" instead of starting with a list of "shoulds." I also shared my Insight Into Health framework as a way to start that conversation.

Give it a listen! 👇

Episode 170: What Does “Healthy” Actually Mean?

Thank you, Colleen, for having me and for such a thoughtful conversation!

Listen to Insight Into Health:

Podcast:

Check out my latest podcast episode with Kathy Hutchinson and Janessa Dusek of Active Wellness Center about women’s health and resistance training. Follow Insight Into Health in your favorite podcast app to hear new episodes every Wednesday (links to Apple & Spotify).

KSVY Radio:

If you missed Insight into Health live on KSVY 91.3 radio on Monday at 7 pm PT, check out my conversation with Ron Leal, my neighbor and fellow KSVY host. Ron has hosted In Step in Tech every Saturday 10-11 am for nearly 20 years.

Thanks for being here,

Allison

allisonmckeany.com

This information is meant to educate and inspire, but is not medical advice. Please consult your healthcare team to determine what is most appropriate for you.

Kathy is an exercise physiologist and the Medical Integration Coordinator with Active Wellness Center, with extensive experience in cardiac rehabilitation, Parkinson's disease, and general medical fitness.

Janessa is a personal trainer certified in corrective exercise, pre- and postnatal care, women’s fitness, and senior fitness. She also created the Active Wellness Center's Women's Strength Training Series.

Together, we discussed the physical changes that occur from perimenopause into postmenopause and how to think about resistance training goals, whether you are in your 20s & 30s, 40s, and 50s, or in your postmenopause years.

Kathy and Janessa shared many gems about fitness, listening to your body, and showing up for yourself.

Resources discussed during this episode:

Dr. Mary Claire Haver

Thanks for being here,

Allison

allisonmckeany.com

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We started in the mouth, moved down the esophagus and into the stomach, and took a brief stop to talk about the #1 digestive complaint: reflux.

Today, we will continue the digestive journey from the stomach through the small intestine, large intestine, and beyond.

Small Intestine

When partially digested food leaves the stomach, it enters the small intestine, where most digestion and absorption occur.

Remember, digestion includes many mechanical and chemical processes that break food down into tiny pieces so they can be absorbed. Absorption is the process of moving nutrients from the digestive system into the bloodstream to then be delivered throughout the body.

The small intestine has three sections: the duodenum, jejunum, and ileum (I still remember “DJI” as my memorization trick in college).

Duodenum

The gallbladder, liver, and pancreas all connect to the duodenum to supply additional components involved in chemical digestion.

• Bile is produced in the liver, stored in the gallbladder, and released on demand to emulsify dietary fat. Emulsification is essentially breaking fat into smaller droplets for easier digestion.

  • Without a gallbladder, bile drips continuously rather than being released in a concentrated burst, which may result in loose stools and bowel urgency after high-fat meals.

• Pancreatic enzymes are released to digest carbohydrates (amylase), fats (lipase), and proteins (protease).

  • When the pancreas doesn’t produce or deliver enough digestive enzymes to the small intestine, it’s known as Exocrine Pancreatic Insufficiency (EPI), which is managed with pancreatic enzyme replacement therapy (PERT) taken before each meal.

Jejunum

Most nutrients are absorbed in the jejunum section of the small intestine. Villi and microvilli (folds and folds-within-folds of this section) increase surface area to allow for maximum absorption.

Ileum

The longest section of the small intestine, the ileum is where vitamin B12 is absorbed with help from intrinsic factor. The ileum also contains immune tissue that responds to harmful substances before the remaining contents enter the large intestine.

Diseases of the Small Intestine

Small Intestinal Bacterial Overgrowth (SIBO)

We all have health-promoting bacteria in our large intestine (more on the microbiome next time). But when these bacteria overcolonize the small intestine, symptoms such as bloating, gas, diarrhea and/or constipation, abdominal pain, and nutrient deficiencies may occur. This condition is known as Small Intestinal Bacterial Overgrowth, or SIBO.

However, since many of these symptoms are “non-specific” (meaning they can arise due to many factors), SIBO isn’t diagnosed by symptoms alone. SIBO diagnosis is made based on the results of a hydrogen or methane breath test and is typically treated with antibiotics.

Preventing SIBO from returning requires awareness of dietary and supplement (including probiotics!) triggers.

Celiac Disease:

While gluten sensitivity is more common than we once thought (and has earned the term Non-Celiac Gluten Sensitivity), celiac disease is an autoimmune condition triggered by gluten, a protein found in wheat, barley, and rye.

Common celiac disease symptoms include bloating, diarrhea, and/or constipation after eating gluten. Long-term, unmanaged symptoms may include fatigue, anemia, bone loss, skin rashes, and weight loss.

Celiac disease is diagnosed by blood antibody testing and/or intestinal biopsy, and the only treatment is a lifelong gluten-free diet.

It’s important to keep in mind that having one autoimmune condition increases a person’s risk for others, including rheumatoid arthritis, type 1 diabetes, psoriasis, and more.

Food Intolerances

Food intolerances occur when the digestive system has difficulty digesting a food. This may be due to a missing or inadequate enzyme (ex: lactose intolerance) or poor absorption (like fructose or FODMAPs).

Food intolerances differ from food allergies and food sensitivities:

• Food allergies are an immune system response to a food protein, resulting in reactions that can range from mild to severe or life-threatening (such as with peanut allergy). Even tiny exposures can trigger a reaction.

• Food sensitivities are a less medically precise and less validated term for reactions that don’t clearly fit the intolerance or allergy category, such as foods that cause headaches, fatigue, or skin issues.

Common Food Intolerances

• Lactose Intolerance: Inadequate lactase enzyme to break down lactose (dairy sugar).

• Fructose Malabsorption: Incomplete absorption of fructose (fruit, honey, high-fructose corn syrup).

• Polyol (Sugar Alcohol) Sensitivity: Sorbitol, mannitol, xylitol, and other “-ols” (found naturally in peaches, plums, apricots, cherries, apples, and pears, and in many “sugar-free” products).

Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols — aka FODMAPs — refer to a group of compounds that may be difficult to digest for some people. Lactose is a disaccharide, fructose is a monosaccharide, and polyols are, well, polyols.

If undigested food components make their way into the large intestine, gas, bloating, and/or diarrhea may occur. Much more on the large intestine and microbiome next week, but for now, here’s what you need to know about why those oh-so-undesirable symptoms occur:

• Gas is produced as a byproduct of fermentation in the large intestine.

• Bloating occurs when excess gas builds up and puts pressure on the intestinal walls.

• Diarrhea occurs because unabsorbed components pull water into the large intestine by osmosis, while other fermentation byproducts speed up how quickly contents pass through (and out).

If this last section made you squirm, just wait until we really take on the large intestine, microbiome, and fiber next week.

Thanks for being here,

~Allison

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Listen to Insight Into Health:

Check out my latest podcast episode with Karen Louise Scheuner, RD, about supplements and perimenopause. Listen on Substack below, or follow Insight Into Health wherever you listen to podcasts (here are the links to Apple & Spotify).

Thanks for being here,

Allison

Leave a comment

This information is meant to inform and inspire and is not personal health or medical advice. Please speak with your healthcare team about what is right for you.

Check out more about supplements in my Supplements 101 guide.

As mentioned during our conversation, magnesium-rich foods include nuts and seeds (especially pumpkin seeds and chia seeds), beans, lentils, whole grains, leafy greens, dark chocolate (>70% cacao), and more.

More about Karen: mindful-nutrition.com
More about me: allisonmckeany.com

Thanks for being here,
~Allison

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Thanks for being here (and for giving this one a try),

~Allison

Subscribe now

Thanks for being here (and for giving this one a try),

~Allison

This is the first of a three-part series on digestion, digestive health, and the causes of common digestive complaints.

Digestion

Putting food into your mouth is the first of many steps to getting nutrients into your body.

The protein, carbohydrate, fat, vitamins, and minerals you eat during a meal are too large to pass through the lining of your intestines into your bloodstream, a process known as absorption.

Digestion is the mechanical and chemical process that makes that possible:

• Proteins are broken down into amino acids

• Carbohydrates are broken down into simple sugars (like glucose)

• Fats are broken down into fatty acids and glycerol

• Vitamins are freed from the food matrix they’re bound in

Digestive Tract vs. Digestive System:

• Digestive tract refers to the nearly 30-foot “tube” where food enters, is digested and absorbed, and anything leftover is pushed out.

• Digestive system refers to the digestive tract and other organs that aid digestion, including the salivary glands, liver, gallbladder, pancreas, and the vagus nerve.

Mouth

Digestion begins the moment food enters your mouth.

The act of chewing is known as physical digestion, where food is broken into smaller and smaller pieces with each bite.

When saliva mixes with food, amylase starts breaking down carbohydrates via chemical digestion. Amylase is an enzyme. Digestive enzymes are like tiny scissors that “cut” long strings of nutrients into smaller bits. More enzymes join the digestive party soon.

Taking care of your mouth and teeth is an underappreciated factor in digestive health. Broken or missing teeth can make chewing difficult, which leads to one of two problems: healthy, harder-to-chew foods (like veggies, nuts, seeds) get avoided altogether, or they get swallowed before being adequately chewed, putting extra burden on the stomach to do work the mouth should have already done.

On top of that, excess mouth bacteria can increase inflammation throughout the body, increasing the risk of heart disease, high blood sugar, and slowing the body’s healing capacity.

Taking Care of Your Mouth

Fun fact: I considered going to dental school. I didn’t. So here is what I have to say about keeping your mouth healthy:

• Brush your teeth twice a day

• Floss daily

• Stay hydrated, though limit sugary and acidic foods and drinks

• Avoid tobacco

• Address teeth grinding

• See a dentist regularly or as needed to address any bleeding, sensitivity, bad breath

Esophagus

After you swallow food, it travels down through the esophagus into the stomach, passing through a valve called the lower esophageal sphincter (LES). The LES’s job is to open to let food in and then close tightly after it passes through.

If the LES doesn’t close properly, or relaxes at the wrong time, stomach acid moves backward into the esophagus. This is known as reflux. It affects an estimated 20% of US adults and is the most common digestive complaint.

Heartburn vs. Reflux vs. GERD

While often used interchangeably, there are some slight differences:

• Heartburn is the feeling of burning in the chest/throat

• Reflux/Acid Reflux is the process of stomach contents flowing into the esophagus

• Gastroesophageal Reflux Disease (GERD) is when reflux is chronic and causes irritation &/or damage to the esophagus, burping, sore throat, cough, bad breath

Reflux and GERD are more than just uncomfortable; untreated and unmonitored chronic reflux increases the risk of Barrett’s esophagus, which is a change to the lining of the esophagus associated with increased risk of esophageal cancer.

Reflux Triggers

There are common food and lifestyle factors that may trigger reflux, though everyone's triggers are different.

Reflux Best Practices

Stomach

Chemical digestion really gets going in the stomach. Stomach acid kills potentially harmful pathogens and breaks food down into even smaller particles before releasing the contents into the small intestine.

The stomach is also where intrinsic factor is produced, which is a protein that binds to vitamin B12 and is required for its absorption later in the small intestine. This is why altering the stomach’s acidity or composition (for example, with long-term acid-suppressing medication) can raise the risk of vitamin B12 deficiency.

The stomach also plays a role in hunger and fullness. As it fills, stretch receptors (mechanoreceptors) in the stomach wall signal fullness to the brain via the vagus nerve1.

Common Stomach Symptoms, Explained

• Nausea & vomiting are often protective reflexes to expel harmful substances

• Burping releases excess gas from the stomach through the mouth, often caused by swallowing air from eating and drinking too quickly, carbonated beverages, or chewing gum

• Gastritis is inflammation of the stomach lining, often triggered by excessive use of NSAIDs (like ibuprofen or aspirin) and/or alcohol

• H. pylori is a bacterial infection causing ulcers in the stomach lining (peptic ulcers), treated with antibiotics

• Gastroparesis is delayed stomach emptying, often causing bloating and nausea

• Functional dyspepsia is the feeling of early fullness & abdominal pain when eating, often related to large meals, eating too fast, consuming high-fat foods, or stress

• Hiatal hernia occurs when the stomach pushes through the diaphragm, often worsening reflux

Next week we head into the small and large intestine, where digestion and absorption really pick up speed. We’ll explore the microbiome and common causes for the dreaded gas, bloating, constipation, and diarrhea. Yay!

Leave a comment

Thanks for being here,

~Allison

Please remember that this information is meant to educate and inspire but is not medical advice - please consult your healthcare team to determine what is most appropriate for you.