Think balance, diversity and routine

“Our gut is a complex machine,” says Dr Ajay Verma, a consultant gastroenterologist at Kettering general hospital in Northamptonshire. “It is constantly providing us with the nutrition we need, initially to grow and develop, and then for us to survive, thrive and repair from injury and illness.” How can we keep it functioning well? Put simply: “Make sure what you put into it is balanced, and that you clear out its waste products adequately,” says Verma.

“In a general gastroenterology clinic, the most common conditions we see are irritable bowel syndrome (IBS), gastroesophageal reflux disease, inflammatory bowel disease and constipation,” says Dr Nisha Patel, a consultant gastroenterologist and interventional endoscopist at Imperial College healthcare NHS trust in London. “A healthy gut is built on three main things: balance, diversity and routine.”

Give your gut a break

The starting point for good gastric health is focusing on a diet that is high in fibre, fruit, vegetables, legumes and wholegrains, says Patel, and avoiding irritants: “alcohol, caffeine, fatty or spicy foods and artificial sweeteners. We know that large, late meals can also trigger gastrointestinal symptoms.”

Ultimately it is about “everything in moderation and giving your gut a break sometimes”, says Verma. “If you’ve had a heavy, rich meal one day, then the next day have something a bit lighter, so it can recover from the excesses.”

“Studies have shown that a Mediterranean diet leads to better digestive health,” says Dr Nurulamin Noor, a clinical lecturer in gastroenterology at the University of Cambridge and Cambridge University Hospitals. “So eat plenty of fruit, vegetables and fish, and try to reduce or have a low intake of processed foods, high-fat dairy foods and red meats.”

What are some of the best things to eat to aid digestion? “Kiwi is one of the most effective dietary interventions for constipation,” says Verma. “We also recommend linseeds or flax seeds, because these are low-cost, natural laxatives that are very well tolerated. Stir them into yoghurt with some fruit.”

Get involved with fibremaxxing

It is likely that you aren’t consuming enough fibre. “Over 90% of Americans don’t meet their fibre goals,” says Dr Wendi LeBrett, a California-based gastroenterologist; a 2023 report found that 96% of British people aged 11 and up don’t eat enough fibre, either. The accepted recommendation is 25-35g of fibre per day depending on your size, and a few servings of fruit will help you on your way, LeBrett says: “An apple has about 4g of fibre. Then for lunch or dinner, a serving of beans can get you 5-6g of fibre.” From almonds to broccoli to oranges, you often have to consciously choose fibre to meet the target, says LeBrett. “Some people need to take a fibre supplement to reach that goal.”

If you don’t have digestive issues, it is still well worth trying to max out on fibre. “We know there is a strong association between how much fibre you have and a lower risk of getting colon cancer,” says LeBrett. “It feeds your gut microbiome, and that plays a role in your mood, skin and many other factors around your body. Fibre has been shown to be beneficial for cardiometabolic health: it helps with blood sugar regulation, cholesterol and overall heart health.”

For those focusing on protein, Verma says: “You may be having more protein in your diet to help with muscle building and the way your body functions, but that may mean you reduce how much fibre you have.” Again, being mindful of balance is key; add more fibre where necessary, says Verma.

More fibre can help to deal with wind, too. “Wind to a degree is a normal phenomenon as we digest our food,” says Verma. “If you have a lot of wind, it is probably because you’ve got stuff sat in your bowels for longer than it needs to be. Increase the amount of fibre in your diet to clear your bowels as much as possible.”

Cut down on UPFs

“We’re in a bit of a mess with bowel cancer,” says Verma. “We are seeing more and more people with these cancers under the age of 50, with high profile-cases such as Deborah James and Adele Roberts. We are still not fully sure why these cancers are rising among younger people, but some have suggested, without concrete evidence, that ultra-processed foods (UPFs) may be a component of that.”

“It is virtually impossible to have a UPF-free diet,” continues Verma. “Having a burger is not a terrible thing: having a burger twice a day, every day for a week, is a problem. Make sure you are having regular meals, that a proportion of them are fresher, and you have plenty of fruit and vegetables, so you are getting all the vitamins and minerals you need.”

And take up bowel cancer screenings when offered, says Verma. “In the UK, individuals aged 50-74 will be sent a national screening faecal immunochemical test (a poo test for blood) every two years and, if positive (even if with no concerning symptoms), they will be offered an urgent colonoscopy.”

Eat like a gut doctor

What do gastroenterologists eat and avoid, knowing what they do? “I eat a varied, plant-rich, low-sugar, moderate-fat, low-UPF diet, avoiding too much alcohol,” says Patel. “It sounds boring, but I try not to make it boring. I never say no to things; I will eat pizza very happily. It is all about balance. Life’s got to be fun.”

“I focus on a healthy, Mediterranean-style diet and try to restrict having takeaways and processed foods,” says Noor. Meanwhile, LeBrett says that what she restricts is processed meats, like sausage, bacon and ham: “We know that they have a strong colorectal cancer risk, so I try to limit that. But sometimes I really want bacon in my sandwich, and once in a while is fine. I don’t buy it to cook at home.”

Avoid toxins

Aside from UPFs and alcohol, there are other things that can be harmful to the gut, says LeBrett, “such as certain types of medications, like nonsteroidal anti-inflammatory drugs (NSAIDs)”. She also advises against the overuse of antibiotics.

“Smoking can cause reflux and increase the risk of bowel cancer,” says Verma.

Clear out your bowels

“We must make sure that, when we poo, we clear out the bowels properly,” says Verma. You should feel empty, and not gassy or bloated. “Like any machine, if the waste product doesn’t clear, then that machine might not work as well as you’d want it to.” Squat stools help to “open up the bowel, allowing easier defecation”, Verma adds. “Some swear by them.”

How often is “normal” varies greatly. “This is one of the most common questions I get asked,” says Patel. “People come in saying, ‘What is normal? Because I’m sure this can’t be right.’ But normal really is a range, and it might vary, anywhere from three times a day to three times a week. Any of those will be healthy if it’s your usual pattern.”

Deal with stress

“We know that the gut and brain are in constant conversation,” says Patel. “Stress can speed up or slow down gut motility. It can heighten pain sensitivity, and trigger bloating and cramping. In some people, it can alter the microbiome as well. It is often why people feel symptoms during certain stressful periods. Managing stress isn’t soft advice: it really is the core of good health.” To address stress, Patel advocates “slow, diaphragmatic breathing exercises that affect the nerves and signal to the gut to slow down or speed up, depending on the symptoms. Failing that, we suggest cognitive behavioural therapy and gut-directed hypnotherapy.”

“We’re only starting to scratch the surface on how important the brain-gut connection is,” says LeBrett. “There are certain conditions, like IBS or functional dyspepsia, where we think that there is an issue with how the brain and the gut communicate. People always quote the fact that there are more serotonin receptors in your gut than there are in your brain. The same hormones and neurotransmitters that affect the brain can also impact the gut.”

Stay hydrated

Hydration is one of the simplest, underrated ways to stabilise digestion, says Patel, “particularly when the gut is sensitive to stress. Water softens the stool and supports the smooth movement of stools through the colon, so low intake obviously causes harder stools, which affects draining and you get bloated.” Although 1.5-2 litres a day might sound like a lot, this includes coffee, fruit, soups and other food. “I have a bottle that tells me to drink 150-200ml every hour, so I maintain my hydration that way,” says Patel.

Move your body

“Movement is really important in promoting digestion,” says LeBrett. “I always recommend walking after a meal if you’re able to. I walk after dinner; it helps to promote digestion and gets your body ready for sleep and rest as well.”

Exercise-wise, the recommendation is 150 minutes a week – “not specifically for the gut per se, but for the body generally”, says Patel. “Core strengthening exercises, such as pilates and yoga, help with the diaphragmatic breathing and to regulate the gut/brain axis.”

Brush your teeth

“The digestive tract is anywhere from your mouth to your bottom end,” says Noor. “We know that oral health is really important and probably has a major role in diseases lower down the gut, but it is relatively underappreciated.” To be on the safe side, good oral health care, brushing, flossing and seeing the dentist are advisable.

Get enough sleep

The gastroenterologists all stress the importance of prioritising sleep. LeBrett has researched the impact of sleep on digestion: “Studies show that, in patients with IBS who had poor sleep, it was associated with worsened symptoms the next day.”

Ditch the probiotics

“Some people swear by probiotics,” says Verma, “but we don’t have compelling evidence that they can be used for a wide variety of conditions. Probiotic yoghurt drinks are not expensive, so if someone taking them feels well on them, then it’s not an unreasonable step.”

“It is more important to focus on prebiotics,” adds LeBrett. “The food that we eat – fruit, vegetables, wholegrains, legumes – that the microbiome thrives on.”

See a doctor when …

“We can all have stomach bugs and get a bit of bleeding if we’ve got a sore bottom,” says Verma. “But if you have rectal bleeding or a change in your bowel habits that persists for three to four weeks or more, then you should get that checked out. Another red flag symptom is unintentional weight loss. If you suddenly lose half a stone, then it is always worth seeking medical advice.”

Don’t be embarrassed

Patients often apologise when they’re talking about digestive symptoms, says Patel, but “we talk about it every day, and there is really no embarrassment on our side. It is only a desire to help people feel better, put their mind at ease and to rule out anything serious. I always say to my patients that their symptoms really do matter, and they deserve to feel well. Getting help early is always the best step.”

“There was a study that found scrolling on the toilet and smartphones in the toilet increases your risk of haemorrhoids, and can also cause pelvic floor dysfunction,” says LeBrett. “I won’t say I never do it, but it is something I try not to do. Plus, it’s not very hygienic to have your phone in the bathroom.”

But Verma has a more relaxed approach: “A direct link between phone use and bowel issues has not been proven and perhaps may be a simple association. Those who need to spend a lot of time in the loo will often use their phone to pass the time.”