The Four Pillars of Great Gut Health

There are two things I’m certain of: our country has gone crazy and our guts are a mess. Since this isn’t a place for my political stream of consciousness, let’s focus on the GI stuff. 

Gut related issues accounts for an easy majority of concerns brought to my attention on a daily basis. There’s a good reason for most of us to have achy-breaky guts, and it’s not just political strife causing nauseousness.

It’s because we’re not doing what we’re supposed to.

In keeping with our Wellness Pyramid, we’ll outline the 4 things that we’re doing wrong that contributes to our GI issues, and discuss how to fix them.

Everybody, and I mean, well, almost everybody, can stand to benefit if they make these tweaks. And the best point of the article? The biggest benefits come from changes that cost you nothing. 

Everybody Poops

Now I’m a born wise guy who gets down on lowbrow humor, but I will keep it together, mostly, for this. I’m a trained professional, for wellness sake.

But poop and diarrhea are hilarious words. Fart jokes are great. It’s ok to laugh and snicker when you read them. I am doing so as I write them.

A marker for good gut health is regular, easy bowel movements. We have very loose definitions (“omg is that a poop pun you just made???”) for regular in the medical world. Regular should mean, typically, once daily. Some of us have regular, healthy movements twice daily. Whatever it is for you, that’s normal.

What isn’t normal is straining. Small sizes. Ill-formed stools. Not getting a “clean break”. Any variation of frequency and consistency (more frequently than normal and poorly formed, or less frequently than normal and hardened), and you may be having diarrhea or constipation.

I bring this up because people who discuss gut health go into these lofty dreams and visions about what the gut is doing. They talk about immune health, mood, nutrition, and all the other wonderful things the gut does BEFORE they talk about regular movements. Is it because it makes people uncomfortable? Probably. First and foremost, gut health starts with regular, easy bowel movements. If that isn’t happening, forget about all the other wonderful stuff.

Infinity War is coming out soon, so I’m in an Avengers mood. In other words, bowel movements should be less Steve Rogers

Image result for steve rogers

And more Captain America.

Why Our Guts Aren’t Working Right

It’s pretty simple, actually, why most of us have gut issues. I’ve pulled out what I deem the four most important things that you can directly control. Thinking again about our Wellness Pyramid there are things we can do with lifestyle changes first, and then there are self-care options like supplements.

If we aren’t doing these things first, we can’t be certain any problem we are currently facing couldn’t be easily fixed (I need a much better way to say this – once and for all!).

Here are the four reasons our guts are a mess:

  1. We don’t drink enough water
  2. We don’t eat nearly enough fiber
  3. We take horrible probiotics if we take one at all
  4. We don’t get the right kinds of prebiotics in our diet.

Gut Fix #1: Water

We discussed hydration in our Cramps post. Here’s the skinny if you don’t like reading my weekly novels:

  • We need at least 1 liter (33 ounces, or 2 water bottles) of water daily if we were just to sit on the couch for 24 hours
  • Most of us do more than sit on the couch, so we need much more than 1 liter. Our recommendation is to drink half your body weight in ounces. I am 220 pounds and fairly active at work, so I need 110 ounces, not the 64 ounces that are traditionally recommended
  • We drink lots of dehydrating things. Caffeine and alcohol deplete the body’s water, so we need to make up for each serving with an additional 8-12 ounces to counteract the dehydrating effects. That brings my total up to 130 ounces a day.

Some people are on fluid-restricted diets due to their heart health, so discuss your fluid limits with a doctor.

Yes, you may go to the bathroom more regularly. Make sure you don’t drink all your water 30 minutes before bed. Instead, spread it throughout the day. Set a timer on your phone if you must. “Hey Siri, remind me when I’m thirsty.” After a week or two of improved fluid status, your urgency will decrease; it’s really about consistency and adapting to the change.

Mini Rant: We don’t listen to our bodies enough. Our thirst mechanism shuts off because it’s tired of yelling all day at you and you not listening. Then your muscles start yelling out “HEYYYY I’M DRYING UP HERE!” Our bowel habits change; we have to strain a bit or movements become irregular. If you are like me, dehydration directly results in my arrhythmia starting up. Why does it take us so long to listen?

So, drink more fluids for a million reasons, but do it also for your gut.

Gut Fix #2: Dietary Fiber

Dietary fibers and fiber supplements will get its own post shortly. Here’s the 3-minute review:

Dietary fibers are partially digestible parts of our food that help bulk up our stools and help move everything along the lower GI tract. It’s the roughage. They come predominantly from fruits and vegetables, but also from beans, grains, and other sources.

Based on a 1000 calorie diet (remember most of us are at 1500 or 2000 calories a day), adults should be getting 25-30 grams of fiber per day.

In reality, most people only get 15 grams of dietary fiber a day. This most directly contributes to irregular bowel habits and unhealthy GI tracts. Add the water on there, and you have dehydrated, slow-moving, small stools. The slower it moves, the more dehydrated it becomes, making gut health worse.

It’s crucial to eat varied dietary fibers. Here are some sources of foods that are rich in dietary fibers:

  • Veggies (the crunchier the better!)
  • Fruits with edible seeds 
  • Whole grains – barley, brown rice, millet, whole oats
  • Beans 
  • Brown rice
  • Nuts (pecans, almonds, walnuts) 
  • Popcorn (WOOT WOOT!)

You can use supplements to help out with dietary fiber intake, but we’d prefer you get this done with your food. Our Vital Greens and Reds formula contains dietary fiber along with the special broccoli extract and a serving of both fruits and vegetables. Traditional fibers includes things like psyllium. My personal favorite recommendation for a dietary fiber? Chia. Ch-ch-ch-chia pets were those silly shapes you stick chia seeds to and it grows hair. Grind up those seeds into a powder and add it to a smoothie or soft food and you are good to go. Chia is gentle; it’s the prime ingredient for fiber in many baby formulas.

Gut Fix #3: Probiotics

In our article Gut Wars, we talked about the importance of probiotics. Basically, if your gut is a community, in order for it to thrive and have the real estate values increase, we need lots of good neighbors, police, low crime and few seedy individuals. Because of our varied diets, stress levels, medicines and the supplements we take, that community is constantly under attack. The good neighbors are getting forced out. The cops are going crooked.

When done correctly, probiotics are a way for you to keep those good neighbors and cops in plentiful supply. If something wipes them out, the cavalry is coming in your next dose.

Maintaining a healthy normal flora has tremendous health impact across your body, but it all starts in the GI tract. They help metabolize some drugs, absorb certain nutrients, and can help maintain proper fluid status in the gut.

You’ve heard me say it before: “The supplement industry is poorly regulated. There aren’t enough resources for proper enforcement of those regulations.” As a result, many supplements you take can be contaminated, contain non-absorbable forms of nutrients, or not even meet basic labeled claims (too high or too low).

If they can’t get it right for Vitamin C, which is super simple, how are they going to ensure live microorganisms will stay alive, attach to your gut lining, and then reproduce and grow into colonies?

If the supplement industry is a mess, probiotics are where they show their true colors. People take the WORST probiotics imaginable.

I certainly am not blaming the consumer. How would they know? It feels like I’m the only idiot out here screaming about this, and I’m not loud enough to reach everyone (yet).

Most probiotics contain the wrong strains – not enough good neighbors, and some contain a whole cast of new seedy characters not normally found in our guts. Most probiotics can’t and don’t guarantee the potency of their product, so even if there were a few good guys, they’ve got slingshots instead of tanks.

We have our Probiotic Buying Guide that touches on some major points, but here’s the skinny for probiotics. We can’t just buy something that says “Probiotic.” Instead, we must find products that:

  • Have specific strains that are proven beneficial to humans
  • Dose those strains appropriately
  • Maintain the potency of the strains through expiration. This may mean keeping them cold, sometimes it means not exposing them to extreme temperatures.

It is possible to get some probiotics from your diet. Lacto-fermented foods like sauerkraut, kefir, and yogurt contain beneficial strains. There are some downsides. First, you’re getting a mixed bag with your diet. With maintaining normal flora, you have to be consistent.

With foods, you get varied amounts of varied substrains. Second, there are calories to consider. Third, the cost can actually be higher per day with foods, even if you factor in your normal diet costs. Probiotics are among our Vital 5 because it is an easy, inexpensive way to get consistent, concentrated amounts of specific strains, calorie-free.

A well made probiotic will cost about 80 cents to $1.20 a day, but price doesn’t correlate to quality. Some brands that are Vitality Approved, like Florajen, can be bought from various other sources, but the cold chain may not be properly maintained. Yes, even apples to apples comparison is really apples to truck tires. You have to be vigilant and understand the whole process.

Probiotic Complete is our mainstay. It has 4 potent human strains and is proven to be temperature stable for up to 2 years. It has a special nitrogen washed foil packaging to reduce the risk of moisture and light from degrading the probiotic. And compared to similar quality probiotics on the market, it is much cheaper. I’m a big probiotic fan. Throw away all your other supplements and take just probiotics, the benefit is that great.

Gut Fix #4: Prebiotics

If we do all this work ensuring we have fluids, roughage, a healthy normal flora, we have to be sure we are feeding those good bacteria to help them thrive. Prebiotics are food for probiotics. We discussed prebiotics and argued that prebiotics should be called “Probiotic Food” in our Prebiotic vs. Probiotic blog, so check that out for the in-depth treatment if you missed it. No one has changed the name yet, but one day, just maybe we’ll get it done 🙂

If we take care of our dietary fiber deficiency (Gut Fix #3), we definitely are addressing the lack of prebiotics in our diet as well. Dietary fiber has indigestible compounds, like inulin, that our gut microbes feast out on.

The issue is that some dietary fiber-based prebiotics can cause bloating and gas. What’s worse: they feed not only GOOD bacteria, but the BAD ones too.

We don’t eat much bark these days. Arabinogalactin is a prebiotic from birch trees that not only feeds good bacteria but starves out specific strains of bad bacteria.

Prebiotics are crucial. Get them from your diet. Consider taking a prebiotic supplement with arabinogalactin, as it will help Gut Fix #1 through #3 by starving out the bad, opportunistic microbes in your gut, preventing further problems.

Get Regular, Be Super

Our guts are a mess, but they don’t have to be. We can make a few simple changes and turn our guts into healthy, happy, well-oiled factories.

It’s easy to look for the next “quick fix.” This past week a patient called me about peppermint oil capsules for their IBS. While there are some data saying that using the right product is worth the experiment, my advice to this patient was simple: fix everything else first. She barely eats greens, takes a Walmart brand probiotic, and drinks nothing but soda.

Until we address each health concern by climbing the Wellness Pyramid, taking supplements is simply putting a Band-Aid on a bullet hole.

This advice won’t fix everyone, of course. Some people have inflammatory bowel disease and a myriad of other gut-related illnesses. We have access to unique formulas that can support gut health for those people, but everyone must start with the basic information put forth here.

No matter the person or the situation, though, we have to do all we can to control as many variables as we can. Fluids, dietary fibers, probiotics, prebiotics. For your gut to be the hero it can be, it has to be really good at being regular. Like Captain America.

Just trying to keep it real…

Neal Smoller, PharmD
Owner, Pharmacist, Big Mouth

Dr. Neal Smoller, Holistic Pharmacist

About Neal Smoller

Dr. Neal Smoller, PharmD, is a licensed pharmacist: and owner of Village Apothecary, an independent pharmacy in the most famous small town in America—Woodstock, NY. He’s also the host of the popular wellness podcast, The Big Mouth Pharmacist.”


The Vital 5

Nutrients you shouldn’t live without
The Vital 5 Nutrients You Shouldn't Live Without