When I’m working with patients with gut health symptoms, I talk about factors that may have caused a ‘microbiome injury’. This isn’t a medical term, but one that I have coined to help explain factors that can negatively impact your gut health.
For example, long-term or intense antibiotic use can cause a microbiome injury, as can acute or prolonged stress, such as financial insecurity, trauma or bereavement. Long-term use of other meds can also impact, which is why it’s important to ensure you’re only taking medicines you really need.
Food poisoning, gastroenteritis and restrictive diets can also cause microbiome injuries. Restrictive diets can be as simple as following the keto diet for six months or as complex as anorexia nervosa.
As a consultant gut health dietitian, it’s my job to help repair and restore less-than-ideal microbiomes.
As many of the factors that influence how the microbiome begins, such as how we’re delivered at birth, via caesarean or vaginally, whether we’re breast or bottle fed, how we’re weaned, even how many toilets we have in our house as a child, are completely out of our control, it can feel unmanageable to restore an unhealthy microbiome.
The good news is that your microbiome is constantly evolving. In fact, every night, different populations of the microbiome ebb and flow in terms of numbers.
This means that your microbiome is easily influenced for the better, and there are plenty of actionable steps we can take to start it on the course to improve it almost immediately.
Sophie Medlin, consultant dietitian, founder of CityDietitians and chair of the British Dietetic Association for London. Sophie also works alongside our in-house nutritionist and research experts to assess, rate and test the best probiotics, best vitamin D, best creatine and the best magnesium.
How long can it take to restore gut health?
What we have seen from research and what I note from my clinical practice is that the longer a problem has gone on for, the longer it takes to restore the microbiome and reduce symptoms.
For example, a patient who has had symptoms since an infection requiring multiple rounds of antibiotics 12 months ago will get better much faster, likely within months, than a patient who has had gut issues since their twenties, which can take years.
This doesn’t mean there is no hope for someone who has had symptoms of a poor microbiome for years. Just that the time it takes to improve will be more protracted.
The microbiome is an ecosystem, like a rainforest recovering from deforestation. The worse the damage, the longer it takes for plants, animals, insects and microbial species to come back and flourish.
We know that those with the most positive health outcomes and least disease risk have a richly diverse microbiome. This means having many hundreds of different species of bacteria carrying out different jobs such as maintaining a healthy gut lining, supporting immunity, downregulating inflammation, digesting food and making vitamins.
Unfortunately, commercial testing for microbiome quality and diversity isn’t very reliable at the moment, and since your microbiome changes day to day and even overnight, what we can glean from it isn’t very relevant.
The key to understanding how well your microbiome is functioning is to look at gut symptoms and wider health problems, such as poor immunity, mood and skin.
The great news is that from myriad studies and subsequent papers published, including this one from Cell that outlines the important part fibre and fermented foods can play in gut health, we know that we can take people with very low microbiome diversity scores all the way into the top 10% of the population, so all is definitely not lost.
Do antibiotics destroy gut health?
When you take antibiotics, you might read that your gut health will be destroyed. The truth is that short courses of narrow-spectrum antibiotics cause minimal damage and the microbiome is shown to recover quickly.
Unfortunately, long courses of broad-spectrum antibiotics used over weeks or months for problems such as acne and recurrent urinary tract infections can cause significant damage and the loss of key species.
This is one of the reasons why antibiotics are used only when needed and prescribed responsibly. However, it’s always important to remember that antibiotics can be life-saving, so we shouldn’t be scared to use them when needed.
How to fix gut health
Here are my top tips for recovering a less-than-ideal microbiome and protecting it from injury. You can also read more from me on this in: I’ve spent 20 years fixing patients’ gut health – here’s what actually works.
Eat a wide variety of plants every day
This may seem obvious, but when you’re busy, you can easily slip into having toast for breakfast, a sandwich at lunch and minimal vegetables with your evening meals.
Having nuts and fruit with breakfast, salad, soup or raw veg with our lunch, and two to three vegetables with our evening meal, plus a snack of nuts and/or dried fruit, will all add up quickly to make a more resilient and diverse microbiome.
It can be helpful to remember that all the different species of bacteria prefer different plant foods, so the diversity of your diet will dictate the diversity of your gut bacteria. You have to feed them if you want them to thrive.
Adding a new plant to your diet can even bring a dormant or dead species of bacteria in your gut back to life.
Herbs, spices, beans, lentils and wholegrains are all plants to experiment with adding into your diet to improve microbial diversity.
If you find that introducing new foods causes gut symptoms, speak to a dietitian about the least impactful fruits and vegetables to introduce first. These will include carrots, green beans, courgettes, the heads of broccoli (not the stalks), peppers, lettuce and spinach.
And for fruits: clementines, kiwis, pineapple, raspberries, strawberries and oranges.
Here are some handy tips for healthy bowel movements from a gastroenterologist
Avoid restrictive diets unless medically necessary
Any dietary pattern that restricts the variety of foods in your diet or excludes food groups is one to avoid if you want to enjoy good gut health and all the benefits of a flourishing microbiome.
The reason your gut health suffers from restrictive diets is because all the different beneficial bacteria need different plant foods, including wholegrains, to survive in the gut.
A perfect illustration of this is that if you remove dairy or gluten from your diet, the number of bacteria that help digest it decreases because we aren’t feeding them.
This means when you consume dairy or gluten, you have gut symptoms because you don’t have enough of the bacteria in your bowel to help digest them.
The key to resolving this is to very gradually reintroduce these foods alongside probiotics and sometimes prebiotics to increase the bacteria that digest the foods slowly without triggering symptoms.
If you have a dairy allergy or coeliac disease, this unfortunately doesn’t apply. However, the principle is still relevant to other foods, such as beans and pulses.
Listen to our podcast: Debunking the biggest food and diet myths, featuring Sophie Medlin and our in-house nutritionist, Shefalee Loth.
Work on stress management
Stress has a huge impact on your gut microbiome, and finding ways to manage this is key to restoring a healthy balance.
Find something that fits in with your life, whether it’s yoga, meditation, walking in nature, hypnotherapy or speaking to a professional. This can help restore a poorly functioning microbiome and develop a mind and body that are more resilient to stress in the long term.
Stress management can be really tricky if you’re stressed because of your gut symptoms, thus creating a negative feedback loop. If this is the case, tackle it with a dietitian who can help manage symptoms and a therapist who can help reduce the impact of stress on the mind and body.
Interested in meditation? See our guide to mindfulness apps compared: features, costs and what to expect
Consider probiotics
If you have had a microbiome injury, either decades ago or you’ve recently had to take antibiotics, this is the ideal case for the use of probiotics.
If you’re not sure where to start, take a look at Which? Reviews of the best probiotics and choose one of the Best Buys with a wide range of strains.
Remember that the longer the problem has been established, the longer it will take to resolve. With probiotics, we always say to take them for three months to see the benefit, and if you haven’t seen an improvement in symptoms within three months, try a different brand.
If you need to take antibiotics, take probiotics alongside them and for at least one month after for a short course of antibiotics and at least three months after for a long course or a broad-spectrum antibiotic.
Probiotics will only be able to survive and flourish in the gut if you feed them with plenty of plants, so unfortunately just taking the pill and thinking you’ve ticked the box won’t work.
Limit ultra-processed foods, alcohol and late nights
Ultra-processed foods (UPFs), alcohol and poor sleep habits all negatively affect your microbiome.
It’s both the ingredients in UPFs, such as preservatives and emulsifiers, and the displacement of whole foods in the diet by UPFs that negatively impact our microbiome.
Alcoholic drinks impact the microbiome directly as you’re consuming ethanol, which is antimicrobial, and through promoting the growth of unfavourable bacteria.
Like us, gut bacteria have a circadian rhythm or ‘body clock’, so keeping a healthy sleep-wake cycle supports us and them.
Often, I see patients with poor gut health who also struggle with sleep. We think this is bidirectional, meaning that disrupted gut bacteria affect sleep by reducing key neurotransmitters, and that a lack of sleep in turn disrupts gut bacteria.
Getting on top of sleep hygiene is key to resolving a poor microbiome and building microbiome resilience.
If you’re struggling to get some shut-eye, read our seven expert-backed tips for better sleep
Exercise
Your gut bacteria love exercise, and of course, it has other wide-reaching benefits. Athletes typically enjoy greater microbiome diversity than the general population.
Gut bacteria particularly like moderate-intensity exercise such as jogging or powerwalking, swimming, aerobics and weight training, and they don’t especially like high-intensity training such as HIIT or sprinting, as these increase our stress hormones temporarily.
If you’re new to exercise, build up slowly by using apps like Couch to 5km or None to Run.
If it feels difficult to take all the advice above, start with one of the tips and break it down into small goals so you can make a start on recovery. You don’t have to do everything all at once, and even if you tried to, the stress of a huge lifestyle change would set you back.
Slow, steady and gentle wins the race when it comes to restoring your microbiome.
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