In the post The Basics of Digestion, we discussed digestion fundamentals with a few important takeaways. To recap, we discussed the importance of:
1. The cephalic phase of eating- In this phase, we engage with our brain-gut connection by creating a ritual around thoughtfully preparing our foods, using our senses and focusing on the first two mindfulness questions. We are allowing for adequate time for the stimulation of our saliva and gastric juices which contain digestive enzymes to flood our mouth and stomach, getting our bodies primed and ready for digestion. This sets us up for the optimal absorption of the nutrients we are eating!
2. Chewing our food- In this phase we are ingesting our food and chewing it as best as we can, breaking it down into the smallest pieces possible. This allows for the best mixing of our food with saliva and enzymes which can facilitate optimal digestion. This is the perfect time to engage in the third set of mindfulness questions to see how we are feeling while eating as in the cephalic phase, we want to take our time with this process for it to be the most beneficial!
This brings us to this follow up science post that initiates the conversation about digestive issues. Now that we have a better understanding of how digestion works, let’s take a deeper look at how The Livy Method can best support those who may have concerns or healing needed for their digestive issues.
Because there are so many possible digestive issues, this article will focus on the most common issues that most people have. These articles do not take the place of your doctor or health care provider (HCP). If you have more in-depth issues or concerns, it is very important to consult with your HCP and communicate any questions or concerns with them!
Hypochlorhydria, otherwise known as the low production of the stomach acid HCL (Hydrochloric Acid)
As we discussed in The Basics of Digestion, during the cephalic phase, once our chewed foods enter our stomach, parietal cells that are contained in the lining of our stomach begin to release hydrochloric acid. This occurs in order to create an acidic environment to activate the digestive enzyme called pepsin. This begins the process of converting proteins into amino acids to enable utilization by the body. This acidic environment also protects our bodies from bacteria and pathogens that may have been ingested. However, to do this effectively, the PH (“Potential for Hydrogen” which is a scale from 1-14 that measures how acidic or alkaline a substance is) must be extremely low or acidic, measuring between 1.5-2 on the PH scale. Now that is acidic!!!!
However, some people have issues producing enough stomach acid for a variety of reasons which can have a major impact on their digestion!
Age
As we age our production of HCL decreases, becoming more common in those over 65. This can have an impact on how those who are aging digest their foods.
Chronic stress
Stressful events activate our brain and stimulate our sympathetic nervous system (SNS) which is also known as the “fight or flight” response in our bodies. This response is meant to be short-term and is activated to deal with whatever emergency has arisen. When the emergency is over, our bodies are meant to settle back down to our normal parasympathetic nervous system (PSNS) state, otherwise known as the “rest and digest” state. When our SNS is activated, we release cortisol which many of us know as the “stress hormone,” in order to fight the emergency. From the perspective of digestion, the SNS decreases blood flow to the digestive system, including the stomach, so it can focus on providing good blood flow to the heart, lungs, and brain! This decreased blood flow ultimately leads to lower HCl levels and a decrease in mucous production (which lines and protects the stomach), which has the potential to injure the fragile lining of the gut. Damage to this lining may cause inflammation, ulcers, and impact nutrient absorption. As you can see, if our bodies are in a chronic or prolonged state of stress, there can be a great impact on our digestive system!
Poor diet low in nutrients & lifestyle factors
B vitamins and minerals, such as iron and zinc, are responsible for the production of HCL in our bodies. Having a diet low in these nutrients can affect our production of HCL. Lifestyle factors such as smoking and drinking can also decrease our absorption of these vitamins and minerals, impacting how much HCL we are producing.
Helicobacter pylori (H. pylori) infection
H. Pylori is one of the most common bacterial infections in the world, being said to affect up to 67% of the global population (Bernstein, S., & Khatri, M., 2020, December). H. pylori colonizes and lives in the stomach lining of the stomach, and is thought to be transmitted by the ingestion of food, water, and/or shared food, water, and utensils. It can also be contracted through contact with saliva or other bodily fluids of infected people. H. pylori is more common in countries or communities that lack clean water or good sewage systems.
The stomach lining is responsible for producing HCL and mucous, but also protects the stomach itself from the HCL it produces. Any compromise in the tissue of the stomach can lead to something called “gastritis” or inflammation of the stomach, leading to the stomach becoming inflamed, ulcers (sores), and/or bleeding of the tissue. This affects the cells that secrete the HCL potentially causing a decreased production of this stomach acid, causing hypochlorhydria, as well as the potential for the decreased ability to digest the foods eaten.
Most cases of those colonized with H. pylori are asymptomatic (show no symptoms) but may lead to the emergence of symptoms showing later in life, develop into stomach or duodenal ulcers, or result in gastric cancer for 1-3% of those colonized. The good news is that with good hygiene, the likelihood of acquiring H. Pylori is greatly reduced, and is easily diagnosed and treatable with antibiotics and medications!
Long term use of antacid medications and other medications
Sometimes those with hypochlorhydria, experience symptoms that are similar to acid reflux or GERD (gastroesophageal reflux disease) and take medications to suppress those symptoms. A specific kind of antacid that people take are called proton pump inhibitors (PPIs). PPIs target the production of stomach acid by suppressing the parietal cells in the stomach from producing HCL. However, these cells also produce something called intrinsic factor (IF) that helps the small intestine absorb vitamin B12. Long term use of these PPIs may potentially cause a deficiency in B12 absorption. Vitamin B12 is an important component in helping our body produce red blood cells and if deficient in this vitamin over time, can lead to a condition called pernicious anemia. These can also impact our absorption of minerals as well if taken for prolonged periods. The big takeaway here is that those who think they have acid reflux or GERD, may actually be affected by having low gastric acid. If there is not enough gastric acid in our stomach, the food is not able to be broken down in the way it was meant to and spends a prolonged amount of time there. This allows the food to ferment and begin to release gases which cause our stomachs to feel bloated, causes burping and creates an acidic feeling in our stomachs. However, if you have been on PPIs for a long time, it is very important to have a discussion and consult your HCP about your medications before discontinuing them, or if you have any questions or concerns about your symptoms! This is a very individualized process and can have different impacts for different individuals.
Gastric bypass and other gastric surgeries
Finally, the last cause of hypochlorhydria is in the case of those that have a history of gastric bypass surgery or other surgeries of the stomach. In these cases, the stomach does not function in the way it had prior to the surgery. This can be a fairly large topic, but the big takeaway is that following The Livy Method as described in the summary can help support the digestive system as optimally as possible. You may have to be mindful of certain foods that can cause symptoms for you! This is very individual and is different for everyone!
Symptoms of hypochlorhydria
Here are some signs that you may not be producing enough stomach acid. They usually show up a few hours after you have eaten and may include:
Feeling like you want to eat even when you are not hungry, feeling too full after regular meals, indigestion, gas or flatulence, bloating, constipation, diarrhea, soreness or burning in your mouth, stomach upset and cramps, undigested food in stool, nausea, and heartburn.
Acid reflux and gastroesophageal reflux disease
In normal digestion, after chewing and swallowing your food, the food travels down the esophagus via muscular contractions called peristalsis. This “bolus” enters the stomach via the LES or lower esophageal sphincter, a muscular ring which opens to allow food into your stomach. Once the food or bolus enters, the LES closes to stop food and acidic stomach juices from flowing back into the esophagus.
What Is GERD?
Gastroesophageal reflux disease or GERD, is a chronic digestive disorder that occurs when stomach contents, which includes the acidic digestive juices, backs up from the stomach via the LES into the esophagus resulting in heartburn or acid indigestion. This occurs when the LES is weak or relaxes when it should not. Interestingly, an acidic environment triggers the closure of the LES, so in some cases, acid reflux occurs when there is incidence of hypochlorhydria! While it is common for people to experience acid reflux and heartburn once in a while, having symptoms that affect your daily life or occur at least twice each week could be a sign of GERD.
Risk factors for GERD
Having weight to lose
Having extra weight and fat on our body, especially in the abdominal region, can increase the pressure on our stomach causing the LES to open and cause reflux. This can also make our bodies less efficient at emptying the stomach contents into our small intestine.
Pregnancy
Heartburn is common in pregnancy and can get worse as the pregnancy progresses. Hormones that support pregnancy can cause the digestive system to slow down. Peristalsis decreases and as the baby grows, the pressure on the stomach increases and can cause reflux.
Delayed emptying of the stomach (gastroparesis)
Some people have a medical condition called gastroparesis that causes a delay in gastric emptying time. To recap, our stomach and intestines have strong involuntary muscular contractions that propel food through the digestive tract. Gastroparesis is a condition that affects the normal spontaneous movement of these muscles, otherwise known as motility, in the stomach. The stomach's motility is slowed down or does not function, preventing the stomach from emptying properly. What this means is there can be a delay in the movement of the contents of the stomach to the small intestine, resulting in reflux. This can be an isolated issue, or precipitated by other medical conditions like diabetes.
Lifestyle factors such as smoking, certain foods and drinks including chocolate, mint, fried foods, coffee, and alcohol
The nicotine from tobacco, chocolate, mint and alcohol can actually relax the LES causing reflux. Some people find fried foods, coffee, acidic or spicy foods can make symptoms of GERD worse.
Large meals
Eating a large meal can cause an increase in abdominal pressure on the stomach resulting in reflux.
Eating too soon before bed
After eating, wait 2 to 3 hours before lying down. When you are lying down, the contents of your stomach can push against the LES resulting in reflux, whereas sitting up allows gravity to promote the proper movement and flow of food down the digestive tract. Also, as we are preparing for bed, and the production and secretion of melatonin increases in our bodies as it gets darker, our bodies will want to focus on rest and repair as opposed to digestion. In fact, our digestion naturally slows due to the release of these hormones, and is an important part of something called our “circadian rhythm”! This is why it is recommended to finish our meals earlier in the evening, minimizing late evening snacking, as it promotes the optimal environment for digestion!
Hyperchlorhydria
Some people’s bodies naturally have an overproduction of gastric HCL. It may not be an issue for some, but for others it may cause issues with reflux.
Medications
Some prescription medications, over the counter medications, and supplements may cause GERD. Consult your HCP or pharmacist to discuss your medications if you have questions.
GERD Symptoms
The most common symptom of GERD is heartburn (acid indigestion). It is described as a burning chest pain that starts behind your breastbone and moves upward to your neck and throat. Many people describe that it feels like food is coming back into the mouth, leaving an acid, sour or bitter taste, lasting as long as 2 hours. Besides pain you may also have nausea, bad breath, trouble breathing, difficulty swallowing, vomiting, the wearing away of tooth enamel, or the feeling of a lump in your throat. If you have acid reflux at night, you may also have a lingering cough, laryngitis that comes on suddenly or gets worse, or issues with sleep. If you have concerns with any of these symptoms, follow up with your HCP!
Check out this video for more details!
Living without a gallbladder
Many of our members are coming into this program without a gallbladder, and are concerned that they will have issues following the plan, or with weight loss because of this.
To recap from last week, the liver is a large organ located above the stomach in the upper abdomen. The liver produces bile which is stored in the gallbladder, stores glucose and nutrients and also helps remove toxins from the body.
When we eat fatty foods the gallbladder (a small pouch) is stimulated to secrete bile via the bile ducts to the small intestine, which helps to emulsify the fats making it easier for lipases (enzymes that break down fat) to do their job!
The good news is that your body can still function well without a gallbladder! Although it acts as a storage area for your bile, the liver amazingly adapts to this change in your body and will still produce bile! However, it does this by producing it in continuous drips delivering it directly into the small intestine. This means that your body is still capable of producing bile for the emulsification of fats.
Some people have no issues without having a gallbladder. However, others may have to monitor foods that may cause them digestive discomfort like gas, bloating and diarrhea, limit the ingestion of fried fatty foods, or limit large meals. But as discussed below, The Livy Method supports those without a gallbladder really well!!!
Inflammatory bowel disease (IBD) and inflammatory bowel syndrome (IBS)
Inflammatory bowel disease (IBD) is a general term used to describe disorders that involve chronic inflammation of the digestive tract. The 2 major types of IBD include:
Ulcerative colitis
This condition involves inflammation and sores (ulcers) along the superficial (top layer) lining of the large intestine (colon) and rectum.
Crohn's disease
This type of IBD is characterized by inflammation of the lining of the digestive tract, which can involve the deeper layers of the digestive tract, involve any part of the small or large intestine, and may be continuous or involve multiple segments of the small or large intestine.
Those with ulcerative colitis and Crohn's disease have symptoms of diarrhea, rectal bleeding, abdominal pain, fatigue and weight loss.
Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome, or IBS, is a group of symptoms that affect your digestive system. It’s a common but uncomfortable gastrointestinal disorder. Those with IBS have symptoms of excessive gas, abdominal pain, and cramps.
IBS is a type of functional gastrointestinal (GI) disorder. A functional disorder or issue is when a person has symptoms of a condition, but the condition itself is unable to be identified or diagnosed by medical testing methods. These conditions, also called disorders of the gut-brain interaction, can affect how the gut and brain work together. When one is affected by IBS, the IBS can cause the digestive tract to be easily stimulated, affecting peristalsis (contraction of the digestive smooth muscle). This overstimulation can result in abdominal pain, diarrhea and constipation. People with IBS may have a lower pain tolerance, and research has also suggested that people with IBS may have bacterial overgrowth in the GI tract which may also contribute to their symptoms (Cleveland Clinic, 2020, September).
Check out this video for more information!
How The Livy Method helps support the body
The Livy method by the very nature of its design helps to support the body in digestion and improve our overall health! Here is a summary of how the program best supports all aspects of your digestive health.
1. Chew, chew, chew, chew and take smaller bites when eating to stimulate your saliva and digestive enzymes, while focusing on your practice of mindfulness. This can eliminate symptoms associated with low stomach acid and can help maintain an appropriate level of HCL in your stomach.
2. The Livy Method recommends eating nutrient rich foods loaded with lots of veggies, leafy greens, some fruit, and grains, which are high in vitamins, minerals, and fiber. These recommended foods can help increase your stomach acid levels, heal the digestive system, promote vitamin absorption, and promote the growth of healthy gut flora. It is also recommended to decrease the ingestion of processed foods, deep fried foods, and foods high in sugars which can cause inflammation in the stomach, decrease acid activity, and trigger acid reflux symptoms. Adding in fermented vegetables and fluids such as kimchi, sauerkraut, kefir, and pickles can also naturally improve your stomach acid levels. These foods also have probiotic effects that can help improve digestion, fight harmful bacteria, and reduce inflammation caused by low stomach acid.
3. Raw apple cider vinegar with the mother is a fermented liquid made from crushed apples, bacteria, and yeast. ACV is rich in protein and enzymes and is bacterial in nature, which can help break down food and improve gut health. Like lemon juice, raw apple cider vinegar can help increase stomach acid levels because of its acidic properties, introducing more acid into the digestive tract when ingested. Both lemon juice and ACV are a 2 on the PH scale!
There is definitely a rabbit hole one can enter when looking at the benefits of using ACV or lemon water! There is limited evidence on its use as something to help stimulate bile production and the diet industry’s proclamation of it being a fat burner and insulin stabilizer. However, it can be a great way to start the day in a positive way, by cleansing our palate and setting us up for success!! It’s much like a physical action led intention which is a great addition to our daily intentions!!
As a final note, to help protect your teeth and the more sensitive tissues of your mouth and esophagus, you may want to dilute your ACV or lemon juice in a good amount of water if you can, and/or brush your teeth after 30 minutes of drinking.
4. While following the Livy Method, we are aiming to consume at least six meals and snacks a day, with a good mix of carbs, protein, and healthy fat at each meal. The Livy Method also focuses on eating to satisfaction and not overeating during these meals. This ensures that the digestive system is not overloaded and can handle the amount of food we give it! This helps to prevent heartburn from the stomach acids going back from the stomach into the esophagus, and may also prevent any subsequent gas, nausea, or vomiting. This also maximizes nutrient absorption! Even though you will reach a point where you won’t necessarily be eating this often, the principles will be the same, eating what makes you feel good, eating to satisfaction and nurturing your body!
5. The Livy Method also recommends eating earlier in the evening and not too late at night! As discussed, eating before dark or up to two hours after sunset promotes better digestion. This allows your body to focus on rest and repair as opposed to digestion when our natural levels of melatonin are at their highest! This also allows more time for our food to travel from our stomach to our small intestine, reducing the risk of reflux. Sleeping on our left side is the most optimal position for digestion as it applies the least amount of pressure on our LES, and promotes better flow in the digestion pathway. Lying on our right side causes increased pressure on our LES, and is the least favoured position for digestion.
6. Because many of us come into this process with digestive issues, we are less able to absorb and process nutrients, vitamins, and minerals from our food. This is why supplementation is recommended as a companion to the food plan. It can help our bodies function the most optimally and can also help heal our bodies, eventually allowing us to process our nutrients better on our own. As discussed in The Basics of Digestion: Part 1, adding in prebiotics and probiotics also aids in the production and absorption of B vitamins and vitamin K in the colon, and also improves the colonization of helpful bacteria in our digestive system, which is vital to the digestive process! Check out this video on the importance of the microbiome of our digestive system!
7. Canadian digestive bitters can also be very helpful for the digestive process as recommended in the supplements post. Digestive bitters are groups of herbs that have very bitter qualities and stimulate the bitter receptors that are found in the mouth, gut, and pancreas (contrary to popular belief that they are just found in the tongue). As a result, they stimulate the production of saliva and they can help to naturally stimulate gastric juices and bile flow, which results in enhanced digestion!
8. Maintaining a journal that includes a food diary is a great add when following The Livy Method. Journaling how certain foods make you feel can really give insights into what foods cause digestive discomforts or issues, and help you identify potential intolerances!
9. Stress management is imperative to the weight loss process and also helps manage the brain-gut connection! Using stress management techniques and the other methods recommended on plan decreases external stimulation that can literally “stress” our digestive system, promoting the body to function as best it can!
10. Finally, following the Livy Method ensures that you are adequately hydrated! Water as we all know here is vital to life and can maximize our success! It is involved in almost every chemical reaction in the body, particularly in the processing of our nutrients and the absorption of vitamins and minerals in the body. It can be particularly helpful in preventing constipation because water helps soften your stools! So… sip, sip, sip that water and get in just enough!
Now that we have explored some of the issues with digestion, stay tuned for our next science post, where we will take a deeper dive into more of the hormones involved in regulating our hunger and feelings of satiety, eating breakfast and how making it high in protein sets up our day for success, and will conclude our discussion on digestion by looking at how long it takes our bodies to process and digest the foods that we eat.
References
AllHealthGo. (2018, August 30). Living without a gallbladder [Video]. Youtube. https://www.youtube.com/watch?v=l2eb7mSIvuk
Bernstein, S., & Khatri, M. (2020, December 7). What is H. pylori? WebMD. https://www.webmd.com/digestive-disorders/h-pylori-helicobacter-pylori
Bhargava, H.D. (2020, September 11). Gerd. WebMD. https://www.webmd.com/heartburn-gerd/guide/reflux-disease-gerd-1#:~:text=Gastroesophageal%20reflux%20disease%2C%20or%20GERD,get%20heartburn%20or%20acid%20indigestion.
Bolen, B., & Hall, M. (2020, December 7). Keep a food diary to identify food triggers. Verywell Health. https://www.verywellhealth.com/how-to-keep-a-food-diary-1945006
Brennan, D. (2021, November 15). What is hypochlorhydria? WebMD. https://www.webmd.com/digestive-disorders/what-is-hypochlorhydria
Cuenca, L. (2013, May 30). The bittersweet truth of sweet and bitter taste receptors. Harvard University: The Graduate School of Arts and Sciences. https://sitn.hms.harvard.edu/flash/2013/the-bittersweet-truth-of-sweet-and-bitter-taste-receptors/
Dunne, C., Dolan, B., & Clyne, M. (2014). Factors that mediate colonization of the human stomach by helicobacter pylori. World Journal of Gastroenterology, 20(19), 5610–5624. https://doi.org/10.3748/wjg.v20.i19.5610
Granger, N.D., Morris, J. D., Kvietys, P. R., & Granger, J. P. (2018). Physiology and Pathophysiology of Digestion. Morgan & Claypool Life Science Publishers.
Guy-Evans, O., & McLeod, S. (2021, May 18). Parasympathetic nervous system functions. SimplyPsychology. https://www.simplypsychology.org/parasympathetic-nervous-system.html#:~:text=The%20parasympathetic%20nervous%20system%20is,voluntary%20control%2C%20therefore%20being%20automatic.&text=The%20parasympathetic%20nervous%20system%20leads%20to%20decreased%20arousal.
Healthwise Staff. (2020, April 25). GERD: Controlling heartburn by changing your habits. C.S. Mott Children’s Hospital: University of Michigan Health. https://www.mottchildren.org/health-library/ut1339
Harvard Health Publishing. (2020, July 6). Understanding the stress response: Chronic activation of this survival mechanism impairs health. Harvard Medical School. https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response
Heda, R., Toro, F., & Tombazzi, C.R. (2021, May 9). Physiology, pepsin. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537005/#:~:text=Parietal%20cells%20within%20the%20stomach,hydrogen%20ions%20and%20decrease%20pH.
How to manage acid reflux after bariatric surgery. (n.d.). Southern Nevada Bariatrics. Retrieved March 30, 2022, from https://www.southernnevadabariatrics.com/blog/how-to-manage-acid-reflux-after-bariatric-surgery
Intrinsic factor. (2022, March 21). MedlinePlus. Retrieved March 30, 2022, from https://medlineplus.gov/ency/article/002381.htm#:~:text=Intrinsic%20factor%20is%20a%20protein,cells%20in%20the%20stomach%20lining.
Irritable bowel syndrome (IBS). (2020, September 24). Cleveland Clinic. Retrieved March 30, 2022, from https://my.clevelandclinic.org/health/diseases/4342-irritable-bowel-syndrome-ibs
Mayo Clinic Staff. (2021, July 8). Chronic stress puts your health at risk: Chronic stress can wreak havoc on your mind and body. Take steps to control your stress. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037#:~:text=Cortisol%20also%20curbs%20functions%20that,reproductive%20system%20and%20growth%20processes.
Mayo Clinic Staff. (2021, May 18). Helicobacter pylori (H. pylori) infection. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/h-pylori/symptoms-causes/syc-20356171
Mayo Clinic. (2010, April 22). Heartburn, acid reflux, GERD [Video]. Youtube. https://www.youtube.com/watch?v=TdK0jRFpWPQ
Mayo Clinic Staff. (2020, October 10). Gastroparesis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/gastroparesis/symptoms-causes/syc-20355787#:~:text=Gastroparesis%20is%20a%20condition%20that,food%20through%20your%20digestive%20tract
Morris, J.D., Granger, D. N., Granger, J. P., & Kvietys, P. R. (2018). Physiology and Pathophysiology of Digestion: Part 2. Biota Publishing.
Nambudripad, R. (2021, February 28). SIBO: A doctor's guide to the root cause of bloating and IBS [Video]. Youtube. https://www.youtube.com/watch?v=1WPv2FijZ5s
Nelson, D. (2020, March 3). What does pH stand for and mean? Science Trends. https://sciencetrends.com/what-does-ph-stand-for-and-mean/
Overview: Gallbladder removal. (2021, December 8). NHS. Retrieved March 30, 2022, from https://www.nhs.uk/conditions/gallbladder-removal/#:~:text=Living%20without%20a%20gallbladder,continuously%20into%20your%20digestive%20system
Sethi, S., & Anthony, K. (2019, March 7). How to increase stomach acid at home. Healthline. https://www.healthline.com/health/how-to-increase-stomach-acid#outlook
Stomach. (n.d.). National Cancer Institute. https://training.seer.cancer.gov/anatomy/digestive/regions/stomach.html#:~:text=Four%20different%20types%20of%20cells,Chief%20cells
The brain-gut connection. (n.d). Johns Hopkins Medicine. Retrieved March 30, 2022, from https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-brain-gut-connection
Water Science School. (2019, June 19). pH scale. United States Geological Survey. https://www.usgs.gov/media/images/ph-scale-0#:~:text=pH%20is%20a%20measure%20of,hydroxyl%20ions%20in%20the%20water
Warwick, K.W., & Eske, J. (2020, July 29). How can you naturally increase stomach acid? Medical News Today. https://www.medicalnewstoday.com/articles/how-to-increase-stomach-acid
Your digestive system: 5 ways to support gut health. (n.d). Johns Hopkins Medicine. Retrieved March 30, 2022, from https://www.hopkinsmedicine.org/health/wellness-and-prevention/your-digestive-system-5-ways-to-support-gut-health