I’m a gut scientist – six signs your digestion isn’t normal

Gut health is now a top wellness priority for many, thanks to a growing body of research which suggests the state of your gut influences everything from your mood to sleep quality. “Gut health is about much more than whether you’re bloated or how often you go to the toilet,” says Dr Megan Rossi, dietitian, author, gut health scientist and founder of The Gut Health Doctor. “The gut interacts extensively with the immune system, metabolism and the gut–brain axis.” A healthy gut even produces more mood-regulating microbes such as serotonin (95 per cent of which is made in the stomach). “In an ideal world, a healthy gut is one that you don’t have to think about too much,” says Rossi. “You’re generally free from troublesome digestive symptoms such as bloating, abdominal pain or reflux – as a rough guide, experiencing these less than once a month.” Shorts That doesn’t mean being entirely symptom-free. “A little bloating after a particularly high-fibre meal for example is completely normal and isn’t necessarily a bad thing,” says Rossi. “When our gut microbes ferment certain fibres (which is generally a beneficial process), gas is naturally produced as a by-product. So, we shouldn’t become fearful of every bit of bloating.” The distinction, she explains, is when symptoms become frequent or start to interfere with day-to-day life. Here are some potential signs your gut may not be functioning well, and what to do about it. You’re regularly constipated How often you go isn’t the only measure of constipation, explains specialist gut health dietitian Rosie Abbott. “For example, if you regularly take more than a few minutes to go, need to strain, pass hard stools or never feel like your bowels have completely emptied, these can all be signs of constipation, even if you’re opening your bowels every day.” Equally, if you’re opening your bowels fewer than three times a week, it’s worth investigating. “There are lots of potential causes. One of the first things I’d look at is whether you’re getting enough fibre – and enough fluid alongside it, because fibre needs fluid to do its job properly,” says Rossi. “Physical inactivity can contribute, too, as can certain medications, changes in routine and ignoring the urge to go. Stress and the gut–brain axis can also influence gut movements, and in these cases just adding more fibre can make symptoms worse. This is why it’s important to understand the why behind your constipation.” Importantly, Rossi adds: “Persistent constipation can sometimes have an underlying medical cause, so if it’s new, unexplained or isn’t improving, speak to your doctor rather than simply adding more and more fibre.” How often you go isn’t the only measure of constipation, explains specialist gut health dietitian Rosie Abbott You feel like you need to undo your trousers by the end of the day Bloating “can feel like you’ve got a balloon in your gut,” Rossi explains. “While distension is when you can actually see your abdomen expand. Some people also experience pain alongside it.” There are more than 20 different triggers for bloating she will consider when working with patients in her clinic. “Sometimes it’s simply that someone has increased their fibre intake too quickly and hasn’t given their gut microbes time to adapt – what I call becoming ‘fibre fit.’ Other possibilities include constipation, or lactose intolerance, or consuming lots of sugar alcohols (or polyols) which are found in some sugar-free products. Small intestinal bacterial overgrowth is another cause, although in reality it’s less common than social media suggests.” You seem to be getting sick frequently “Around 70 per cent of the body’s immune cells are located within or associated with the gut, and there’s constant communication between our gut microbes, the intestinal barrier and immune system,” Rossi explains. “So, if you’re the one that always seems to catch every bug going around, it might mean your gut needs some support. For example, you might not be getting enough plant diversity (your gut bacteria love all different types of plants). It might also mean it’s worth adding a specific probiotic that contains both LGG and BB-12 strains (scientific name for types of bacteria), as this combination has been clinically proven to reduce not only symptoms but duration of infections like cold and flu.” Very loose or frequent stools, or very hard or infrequent stools “Regularly having very loose or watery stools, needing to open your bowels frequently, or at the other extreme having hard stools that are difficult or infrequent to pass, can indicate diarrhoea or constipation,” says Hall. “There are many possible causes, including diet, medications, IBS, food intolerances or an underlying gastrointestinal condition such as coeliac disease or inflammatory bowel disease (IBD).” You have to follow an increasingly restrictive diet to control your gut symptoms “This is one I see frequently in clinic,” Rossi says. “Someone starts by removing one food because it makes them uncomfortable, then another, and before long they’re avoiding entire food groups just to keep their symptoms under control. That’s a sign to investigate what’s actually driving the symptoms rather than continuing to restrict. The problem with unnecessary restriction, she adds, “is that it can reduce nutritional adequacy and plant diversity and can have a significant impact on someone’s relationship with food and quality of life.” You experience lots of particularly smelly wind “Everyone produces wind, and its smell can be affected by what we eat and by the bacteria in our gut,” Abbott says. “A noticeable increase in wind or a change in its smell, particularly alongside bloating or a change in bowel habit, can sometimes indicate that your digestion isn’t working as well as it could. Diet, constipation, stress, food intolerances and changes in the gut microbiome can all contribute.” Changes in gut and digestive issues you should never ignore “The important message is that common gut symptoms aren’t always IBS, food intolerance or ‘a sensitive gut,’” Rossi says. “For bowel cancer, red flags include blood in your stool or bleeding from your bottom, an unexplained persistent change in your normal bowel habits, unexplained weight loss, persistent abdominal pain or a lump, and unusual tiredness or shortness of breath, which can be associated with anaemia (picked up with a simple blood test).” “For ovarian cancer, persistent bloating is particularly important because it’s very easy to mistake it for a digestive issue. Other symptoms include pelvic or abdominal pain, feeling full unusually quickly or losing your appetite, and needing to urinate more frequently or urgently. “Coeliac disease is another important one because it doesn’t always present as the stereotypical diarrhoea after eating gluten,” she adds. “It can present with persistent unexplained gut symptoms, abdominal pain or bloating, diarrhoea or constipation, fatigue, unexplained weight loss or iron-deficiency anaemia. It’s therefore important that coeliac disease is considered before someone is simply labelled as having IBS. And importantly, don’t start a gluten-free diet before you’ve been properly tested for coeliac disease as removing gluten can affect the accuracy of the tests.” How to know when it’s time to speak to a specialist “It can be completely normal to experience some digestive symptoms now and again,” Abbott says. “These don’t necessarily mean there is something wrong with your gut. What matters is whether symptoms are persistent, troublesome or represent a significant change from what is normal for you.” That said, if you notice a new, persistent or unexplained change in your bowel habit, or experience any red-flag symptoms, your first port of call should be your GP, Abbott continues. “They can take a detailed history and, where appropriate, arrange initial investigations such as blood tests or stool tests. Depending on your symptoms and the results, they m