You can probably think of someone who suffers from inflammatory bowel disease, joint pain, cardiovascular problems, or thyroid problems. Someone who’s constantly getting sick and has slow recovery. But not all people who fit this profile are couch potatoes who stuff themselves with fried food and never step foot inside a gym. Some are athletes who diligently focus on their diet but have these problems all the same.
 
So what do you do when you’re following a strict Paleo diet and you STILL have some of the symptoms listed above? What do you do if you track every macronutrient in your diet but for some reason still can’t reach your ideal weight? There are multiple reasons you might have trouble performing at your best, but when all else fails, it might be time to start looking into your gut health.
 
Why is gut health so important?
 
It is estimated that our gut contains 100 trillion microorganisms made up of 400 different bacterial species. That’s 10 times more bacteria than all the human cells in the entire body. Our gut flora is involved in numerous critical processes, such as fighting off infections and regulating metabolism. In fact, our gut flora actually accounts for upwards of 75 percent of our immune system. Its other functions include helping our body digest specific foods that may be problematic for our stomach or small intestine, producing vitamin B and vitamin K, and combatting numerous aggressive microorganisms that we are exposed to daily.
 
As a result, it should come as no surprise when gut flora problems are tied to a variety of autoimmune conditions like Hashimoto's, inflammatory bowel disease, type 1 diabetes and even autism. On a superficial level, you can’t ignore your gut and attain your ideal physique naturally, since gut flora dysregulation (leaky gut) is linked to increased production of insulin and increased hypothalamus inflammation which causes leptin resistance. Consistently elevated levels of insulin lead not only to fat gain but also to atherosclerosis, heart disease, and chronic inflammation. Leptin resistance, when your body does not respond to leptin signaling (which is involved in the inhibition of hunger and proper thyroid function) is particularly nasty.
 
What Is leaky gut syndrome?
 
Leaky gut syndrome is technically referred to as increased intestinal permeability or intestinal hyperpermeability. In this condition, large protein molecules leak into the bloodstream, which causes an immune response. Your body then senses these so-called invaders and attempts to attack them, resulting in a whole host of inflammatory and hormonal compensations including chronically elevated insulin levels, cortisol dysregulation, leptin resistance, and testosterone deficits in men. So why does your gut health suffer even when you’re eating healthy?
 
Truthfully, we’re just learning about our gut health and the wide-ranging impact that it has on our day to day life, but there are a few specific issues that we know deteriorate our gut health. These include:
 
Overuse of antibiotics and NSAIDS
Sugar, processed foods, and either low or high-carb diets
Low fermentable food intake
Chronic exposure to grains, industrial seed oils, and processed foods
Mismanaged stress
 
At this point, you might be thinking that you need to focus on improving your gut health before it becomes a problem or you might identify with a host of the issues described above. Let’s talk about what we may be doing that we think is helping but is actually hurting us.
 
Stress and the gut
 
Gut health is impacted by the amount of daily stress that you encounter. Studies show that stress can change gastric secretion, gut mobility, mucosal permeability, barrier function, visceral sensitivity, and mucosal blood flow. Further down the primrose path, we see the connection between corticotrophin releases factors (CRF) and HPA dysregulation. Stress-induced gut changes cause more CRF activity which wears on the hypothalamic-pituitary axis to release more cortisol. Stress can manifest itself in a variety of ways in the gut, causing gastroesophageal reflux disease, ulcers, inflammatory bowel disease, inflammatory bowel syndrome and food allergies.
 
Now how does all this time into your physique and performance goals?
 
So you’re on a strict Paleo or low carb diet to optimize your performance and physique, but for some reason, you’re just not lean enough despite your best efforts. Your gut health could be the reason for your lack of fat loss.
 
Continually tweak your carbohydrate intake
 
The topic of carbohydrates and the proper amounts needed in one’s diet is extremely complex, so it should come as no surprise that gut bacteria is impacted by carbohydrate amounts as well. Very low carb diets have been shown to starve both good and bad gut bacteria. So while a very low carb diet can be helpful for treating a variety of gut issues, it may also be the cause of the initial problem. Conversely, high carbohydrate diets routinely seen in the performance and physique worlds are problematic as well, since gut bacteria prefer sugar and starch. My best advice is to eat on the lower end of the carbohydrate spectrum while you implement a few of the other strategies mentioned in this article. You can also implement occasional high carb refeeds, once or twice per week, to assess your tolerance to varying carbohydrate amounts.
 
Many people in the industry would lead you to believe that the answer is always the same: more cardio and fewer carbohydrates. That might work, but at the expense of muscle mass, hormone health, and general day to day well-being. You also tend to see this in high performing athletes, who despite their success just never seem to be able to get as lean as they would like. As previously established, leaky gut leads to cortisol dysregulation. Cortisol impacts multiple different metabolic pathways, one of which is to mobilize liver glycogen, raise blood glucose and promote insulin resistance.
 
Truth be told, all that extra work and little to no carbohydrates likely does soak up that extra amount of insulin released due to the leaky gut or poor gut health in general, but it’s not an optimal, long-term strategy. Instead, a long-term eye on health yields short term physique and performance gains in fat loss, recovery, strength and muscle mass since improved gut health increases nutrient absorption and hormonal health.
 
Not everyone can eliminate stress or take a two-week vacation on a desert island with no cell phone. What you can do is actively manage your stress from day to day.
 
Do fruits and vegetables make things worse?
 
FODMAP is short for Fermentable Oligosaccharides Disaccharides, Monosaccharides and Polyols. FODMAPS are short-chain carbohydrates that are incompletely absorbed by the GI tract and are very readily fermented to increase gut bacteria. Due to their osmatic properties, fluid movement also increases in the lower intestine
 
There are two big, common, non-scientific symptoms that may clue you into your FODMAP intolerance. Does eating certain ‘healthy’ foods lead to instantaneous bloating, gas pain, and the need to find a toilet? Do obvious visual symptoms such as skin conditions or anxiety, regardless of medical treatment, continue to get worse despite your efforts to eat better? If so, you may have a FODMAP intolerance. Abdominal pain, inconsistent or frequent bowel movements, skin conditions, anxiety, depression, mental illness, and confusion are all common symptoms.
 
While stress and lifestyle factors no doubt contribute to FODMAP intolerance to a degree, research points to small intestinal bacterial overgrowth as an issue. When these so-called bad bacteria are present in the small intestine, carbohydrates will undergo excessive fermentation and encourage further growth of uncontrolled gut bacteria.
 
If you think you have a FODMAP intolerance issue, you’ll want to improve gut bacteria, improve your digestive health, avoid or minimize gluten and, of course, minimize FODMAP exposure in your diet. I am not saying to never eat these foods again, but if they cause significant gut health issues, they need a time out or to be eaten in smaller amounts.
 
Some popular health food that can worsen FODMAP symptoms includes coconut milk, apples, peaches, mangoes, watermelon, dried fruit, asparagus, broccoli, Brussels sprouts, cauliflower, onions, garlic, and avocados. I find this chart from Monash University to be very helpful.
 
Soluble vs. insoluble fiber
 
We tend to think that a vegetable is a vegetable, but that’s not the case when you’ve got some gut impairment going on. Vegetables such as broccoli, cauliflower, corn, onions, and cabbage are high in insoluble fibers that may exaggerate an already inflamed gut. On the other hand, carrots, potatoes, yams, and squash contain soluble fibers that are generally well-tolerated, even with an inflamed gut.
 
How do you eat insoluble fibers if they cause such problems?
 
First, remove the stems and grate or chop them up. Do anything to make them smaller. Personally, I have terrible digestive issues when I eat broccoli or cauliflower but feel completely fine when I eat them after they’ve been riced. You’ll also want to thoroughly steam the insoluble fibers so that they are easier to digest.
 
How to fix your gut
 
While the severity of every situation is different, there are a few general steps that typically result in a positive outcome.
 
Step One: Sleep More
 
While it may come as a surprise to many, just a slight disturbance in normal sleep patterns can lead to shifts in basal inflammatory cytokines which are associated with future metabolic derangement in otherwise healthy people. We also know that interrupted sleep patterns and a lack of sleep lead to insulin sensitivity and glucose metabolism issues in individuals with healthy blood glucose levels. It’s safe to say that for leaky gut, which is an inflammation-based condition, sleep should be the first place to look.
 
Step Two: Use a Probiotic!
 
I’ve seen countless articles immediately call for a probiotic (or multiple products for different strands of bacteria), but I’d rather you perform a holistic review of your diet instead of just taking a probiotic and calling it a day. After you assess your diet and sleep, consider jumping on a high-quality probiotic.
 
Step Three: Start Eating Fermented Foods
 
Why are fermented vegetables always recommended for individuals with gut health problems? For starters, the process of fermenting the food actually pre-digests it and breaks down the sugar. Bad gut bacteria feeds and thrives on sugar, so reducing and removing it is a solid strategy. Fermented foods are also high in probiotic organisms which can fix your gut over time. These foods are readily available these days but buyer beware: you must purchase your fermented foods in the refrigerated section of the grocery store, and they should be raw.
 
Sauerkraut is available everywhere, but you don’t want the version that is sold as a topping for hot dogs because that kind is filled with maltodextrin. I purchase Trader Joes’ raw sauerkraut and love it. Kombucha is sold almost everywhere these days as well and is a smart choice for occasional usage.
 
Step Four: Rebuild Stomach Acid
 
Acid-suppressing drugs, highly acidic foods, and daily stress all continually depress our digestive stomach acid. Our bodies thrive when we have the proper amount of stomach acid. Low stomach acid can manifest itself in a variety of ways including decreased nutrient absorption, bacterial overgrowth, increased chances of illness or infection and a general lack of well-being. Medically, your doctor can recommend a Heidelberg Test to assess if you truly have insufficient hydrochloric acid.
 
Oftentimes, supplementary hydrochloric acid (HCL) can start the rebuilding process. Some individuals need to stay with supplemental HCL for months, while others see positive changes in weeks. It all depends on the severity of your gut problems.
 
Step Five: Start Adding in Digestive Enzymes
 
Feel better after step one through four and some diet tweaks? Great! If not, then you might want to consider adding in some digestive enzymes.
 
If we can restore stomach acid production, then we can restore our healthy pH levels which signal the pancreas to produce enzymes. While there are a lot of supplemental digestive enzymes to choose from, I favor a multi-pronged approach, including

protease, pancreatic, bromelain, ox bile, and ginger.
 
Improving your gut health is not a quick fix. It takes time and adherence to dietary changes. That said, the long-term payoff is completely worth the effort as you’ll see tangible benefits in your health, physique, and performance.