From the Guidelines
Healthcare providers can optimize gut health through a comprehensive approach that includes dietary modifications, stress management, physical activity, adequate sleep, and judicious use of supplements when indicated, as supported by recent studies 1. To optimize gut health, several evidence-based lifestyle strategies can be employed.
Key Recommendations
- Dietary interventions should focus on increasing fiber intake to 25-38g daily through diverse plant foods, incorporating fermented foods like yogurt, kefir, and sauerkraut, and reducing ultra-processed foods, artificial sweeteners, and excessive alcohol.
- Providers should encourage patients to manage stress through mindfulness practices, deep breathing exercises, or yoga for 15-20 minutes daily, as chronic stress negatively impacts gut barrier function and microbiome composition.
- Regular moderate exercise for 150 minutes weekly improves gut transit time and microbial diversity.
- Sleep hygiene practices to achieve 7-9 hours of quality sleep nightly help maintain circadian rhythm-dependent gut functions.
- When clinically indicated, probiotic supplements containing Lactobacillus and Bifidobacterium strains at 1-10 billion CFU daily may benefit specific conditions like antibiotic-associated diarrhea or irritable bowel syndrome.
Rationale
These recommendations are based on the most recent and highest quality studies, including those published in 2024 1, which emphasize the importance of a balanced diet, stress management, and regular physical activity in maintaining gut health.
Specific Considerations
- A Mediterranean-style diet rich in fruits, vegetables, complex carbohydrates, and monounsaturated fats, and low in added sugar, salt, red meats, and ultraprocessed foods, can be beneficial for patients with inflammatory bowel disease (IBD) 1.
- Exclusive enteral nutrition using liquid nutrition formulations can be an effective therapy for induction of clinical remission and endoscopic response in Crohn’s disease, particularly in children 1.
- Parenteral nutrition may be necessary for patients with IBD who have severe malnutrition, high-output gastrointestinal fistula, or short bowel syndrome, and should be transitioned to customized hydration management and oral intake whenever possible 1.
From the Research
Lifestyle Strategies for Optimizing Gut Health
Lifestyle strategies play a crucial role in optimizing gut health, and healthcare providers can recommend the following approaches:
- Diet: Different diets, such as Western, ketogenic, vegan, gluten-free, and Mediterranean, can shape gut microbiota 2. Modulation of diet has the potential to both beneficially and detrimentally impact microbiota composition and its interaction with the host 3.
- Physical activity: Physical activity is known to be useful for preventing and treating several diseases, and it can also shape gut microbiota 2.
- Probiotics: Probiotic organisms, such as Lactobacillus acidophilus and Bifidobacterium spp., can provide excellent therapeutic benefits and balance disturbed intestinal microflora 4. Probiotics have been shown to prevent and ameliorate the course of digestive disorders, allergic disorders, and inflammatory bowel disorders 5.
- Stress reduction: Lifestyle interventions like stress reduction can impact the gut microbiome and gastrointestinal symptoms 6.
- Mind-body therapies: Mind-body therapies, herbs, and certain supplements can be used as complimentary approaches to manage common gastrointestinal conditions 6.
Mechanisms of Action of Probiotics
Probiotics have diverse, heterogeneous, and strain-specific mechanisms of action, including:
- Colonization and normalization of perturbed intestinal microbial communities 5
- Competitive exclusion of pathogens and bacteriocin production 4, 5
- Modulation of fecal enzymatic activities associated with the metabolization of biliary salts and inactivation of carcinogens and other xenobiotics 5
- Production of short-chain and branched-chain fatty acids 5
- Cell adhesion and mucin production 5
- Modulation of the immune system 5
- Interaction with the brain-gut axis by regulation of endocrine and neurologic functions 5