This site is intended for Healthcare Professionals only

Conditions bookmark icon off

A gut feeling

We are all familiar with the sayings “trust your gut” and “follow your gut” but what is this intuitive value we have placed here? Training Matters explores why the gut has become known as the epicentre of health and how to maintain it.

Some 2,000 years ago, Hippocrates (albeit apparently) said: “All diseases begin in the gut.” Whether he definitively said it or not, there is certainly substance to the statement, with more research showing that the gut is linked to various aspects of our health; mental, physical, and emotional. A healthy gut is also linked to the prevention of certain conditions and diseases, but how?

Understanding the gut

Medical nutritionist, Dr Sarah Brewer, says the gut microbiome “acts like an endocrine organ that can influence your mood, metabolism and have significant effects on your glucose control, energy levels, cholesterol balance, obesity, sleep and fatigue in ways that are not yet fully understood”. The gut microbiome is best thought of as an ecosystem home to over 1,000 different bacterial species, viruses, fungi and parasites and is unique to each individual, changing throughout our lives. “Your gut is sterile at birth but quickly becomes colonised by bacteria so that, by adulthood, it contains an estimated 3.8 trillion bacteria. These, plus all the microbial products they contain or secrete (e.g. proteins, nucleic acids, genes, toxins and signalling molecules) form what’s known as your gut microbiome.” Also where the enteric nervous system is located – in the lining of the gastrointestinal (GI) system – the gut is connected to the brain via neural pathways. This is why the gut has been referred to as a ‘second brain’ because the brain and the gut microbiome are physically connected and constantly transfer messages to each other. It is also because our gut can perform many tasks independently of the brain, like producing 95 per cent of the serotonin in our bodies – a chemical messenger responsible for stabilising our mood. This is why when you are nervous, you feel ‘butterflies in your stomach’ or feel like you need the bathroom despite having just gone, as our brains and guts communicate and influence each other constantly. Dr Brewer further elaborates that: “Serotonin also acts as a brain transmitter, regulating mood, and influences how the brain ‘switches off’ gut signals so you aren’t aware of what might otherwise prove uncomfortable gut contractions. Faulty interactions between the gut and brain is now thought to play a role in how we cope with stress and anxiety, and the development of symptoms associated with irritable bowel syndrome.”

The gut microbiome operates in a symbiotic relationship with us, the host. If we feed our gut nutrients, it will be able to perform its tasks well – regulate our bowel movements, flush waste from our bodies, absorb nutrients and secrete enzymes. If we do not provide the nutrients it needs, aspects of health will suffer, leading to digestive issues or irregular emotional patterns amongst other potential issues. Similarly, if we are stressed or feel anxious our gut may react in turn, for example with flare-ups of irritable bowel syndrome (IBS). An unhealthy gut can also lead to:

  • Leaky gut syndrome, a hypothetical condition where the gastrointestinal lining absorbs more water than nutrients, causing it to ‘leak’
  • Dysbiosis, which refers to an imbalance of bacterial composition and changes to metabolic activities
  • Inflammatory bowel disease (IBD) which is chronic inflammation of the GI tract.

“The gut will regulate our immune system, protect against certain diseases, and boost mood”

Eat the rainbow

To maintain or improve gut health, we need to “replenish [our] probiotic bacteria regularly – ideally every day – with fermented foods”, Dr Brewer advises. Examples of these foods are kimchi, yoghurt, tempeh, kefir, sourdough and kombucha. Prebiotics – high fibre foods – are likewise important for the gut. They provide energy for gut flora and stimulate the growth of new bacteria. This helps to create a more diverse gut microbiome, and the more diverse the bacteria in the gut, the better. Examples of prebiotic foods are mushrooms, artichoke, bananas, cabbage, apples, chickpeas, oats, whole grain wheat and red kidney beans. Regular exercise also contributes to a healthy gut, as it causes more oxygen to reach the brain and bloodstream and the core body temperature heats up, conditions that researchers say are ideal for bacteria in the gut to flourish.

In an ideal relationship between microbiome and human, the gut will regulate our immune system, protect against certain diseases, and boost mood. Other signs of a healthy gut are passing healthy stools, good gut transit time, regular bowel movement patterns, little to no bloating and no discomfort during bowel movement.

Luckily, with gut health becoming more researched and talked about, there are numerous self care tips and over-the-counter (OTC) products that pharmacy teams can suggest for customers wanting to maintain or improve their gut health. The main message is clear: eating a diverse array of pre and probiotic foods, nutrient-dense wholefoods containing magnesium and fibre is what the gut needs to maintain a healthy population of digestive bacteria. “The best way to help maintain a healthy gut is to eat a Mediterranean-style diet which is rich in fruit and vegetables (for soluble and insoluble fibres), dairy products (for calcium), lean meats and fish (for proteins such as collagen, glucosamine and other building blocks related to good gut health), olive oil (for anti-inflammatory polyphenols) and prebiotic foods like onions, leeks, asparagus and garlic to stimulate the growth of helpful bacteria. Following a Mediterranean style diet can increase levels of probiotic bacteria in the gut by almost 10 per cent compared with a meat-rich Western style diet,” noted Dr Brewer. “Lifestyle factors such as exercise, alcohol consumption and smoking can impact your bowel bacterial balance, too.”

While many people have good intentions of eating a diverse and healthy diet, exercising often, refraining from drinking too much and limiting the amount of stress they take on, daily life can often offset these intentions. Dr Brewer recommends taking a psyllium seed supplement for fibre and a probiotic supplement to provide the gut with the nutrients it needs, and there are many options the pharmacy team can suggest to customers. “What is most important is to look for either lactobacilli and bifidobacterial in a supplement,” says Dr Brewer. It is especially important to remind customers to take a probiotic supplement if they are on antibiotics. Antibiotics destroy bad bacteria, but they also destroy good bacteria, hence our needing to replace them and encourage bacterial growth with a probiotics supplement. Pharmacy teams can also remind customers that antibiotics should only be taken when absolutely necessary to avoid their harsh impact on the gut microbiome.

Yogurt is a great accessible example of a probiotic food.

Red flags

A healthy gut should effectively ward off certain diseases and infections, but when it is unhealthy, it may provide some of the first signs indicative of more serious conditions. Pharmacy teams should be on the lookout for the following ‘red flags’ in customers experiencing gut health issues:

  • Abdominal masses
  • A family history of ovarian cancer
  • Rectal masses
  • People with anaemia
  • Rectal bleeding
  • Unintentional and unexplained weight loss
  • A family history of bowel cancer
  • Change in bowel habit in those aged > 60 lasting for longer than six weeks.

Anyone presenting with any of these issues should be referred to the pharmacist or their GP.

Customers with unexplained weight loss should be referred to the pharmacist. 

Running a successful weight management service

Samantha Sutton, pharmacist at John Bell & Croyden in London, walks us through the pharmacy’s weight management service.

Nutrition and weight management are intricately connected, and often indicate a lot about each other. Nutrition issues may influence weight, and vice versa. Weight management services are a way for people with a body mass index (BMI) of 30 or more to receive medicated weight loss treatment from the pharmacy. The service is paid for by the customer, with the goal to lose five per cent of their body mass in three to six months. “Medication that was used for diabetes and insulin level control is now being licensed for weight loss. It suppresses your appetite, and your insulin levels are standard, so you’re not having the peaks and troughs that you would have if you were fasting or avoiding meals,” explains Samantha. The medication works in conjunction with a healthy diet and exercise. “When you take part in this service, you are saying that you are happy to take the medication, but also, that you agree to try and reduce the amount of sugar and salt in your diet and implement some sort of exercise,” she adds. Once a BMI less than 30 is reached, the treatment is considered successful and is withdrawn.

There are various forms of medication, but the most commonly used are self-injectable pens or injections which customers need to inject either once a day or once a week. As it may cause gastrointestinal side effects, the dosage follows a titration system over three to six months to allow people to adapt. One of the most important aspects of running a successful weight management service that uses injectables is making sure that customers are aware they will have to self-inject, that they know how to do this correctly and are comfortable doing so. If not, they are unlikely to be able to keep up with the process every day or each week, and weight loss becomes improbable. “This is why consultations for the service aren’t just 10 minutes. We discuss every aspect of the service with them”, Samantha adds, “to make sure they have all the information”. Injectable-averse customers can opt for oral capsule medication options, but these often incur severe gastrointestinal side effects.

Medication can only be provided by pharmacists or qualified healthcare professionals, but support staff can play a large role in information gathering. This includes establishing the customer’s BMI, calculated with their weight and height. Thereafter, it is useful to gather information about a customer’s lifestyle. “Really actively listening to the patient is so important”, Samantha adds, noting how weight loss management is multifaceted. “For example, [someone] might brush over saying ‘I’m a lawyer,’ but if we are actively listening, this may prompt us to ask more about their work environment or indicate potential high stress levels”, which may mean less time to cook, so more takeout, or being so busy and not having time to exercise. If the customer qualifies for the service, they will need to commit to making changes in these areas. If they don’t qualify, these are the areas where they can be advised by pharmacy teams to focus their energy. “We don’t want people to walk away empty handed. If we can’t provide the service, we hope to give them some advice to help them on their weight management journey,” Samantha says.

An individualised approach to each customer is crucial to success with this service, she adds. Being overweight is a health risk, and a priority would be to get the customer’s BMI down, but pharmacy teams also need to look at the aspects that may contribute to a person’s unhealthy weight, such as mental health, stress, or other contributing health factors that may not have been picked up on yet, like thyroid issues. Being aware of wider influential issues, such as these, is what Samantha describes as providing a complete holistic weight management service that extends beyond simply prescribing medication. “Team members can also provide self care and lifestyle advice, pick up on red flags and provide signposting or referral advice. For example, if someone doesn’t qualify but they are not exercising because they struggle greatly with energy levels, we could suggest getting blood tests to see their blood sugar levels,” she explains. “We can refer people to have their thyroid checked. And if that comes up, then you’d be like, right, okay, this weight loss service isn’t for you, but you should go see your GP.”

A successful weight management service, Samantha suggests, comes down to:

  • Having the right equipment, such as scales
  • Private consultation rooms for patient comfort
  • Discussing the diet and exercise changes needed
  • A team trained to provide medication but also pick up and advise on wellbeing and lifestyle changes
  • A welcoming environment in the pharmacy.

The best place for patients to self-inject weight loss medication is in their abdomen, upper arm or front of thighs.

Copy Link copy link button