Why Gut Health Affects So Much More Than Digestion

What do hormones, fatigue, inflammation, skin health, metabolism, mood and thyroid health have in common? Your gut may be part of the picture.

Sometimes when people see that I specialize in both gut health and hormonal health, they wonder how those two areas are related.

Other times, they'll ask me: “But do you also work with fatigue? Inflammation? Skin problems? Metabolism? Mental health?”

The answer is yes—and this is actually one of the things I love most about specializing in gut health.

When I was in medical school, my mentors repeatedly taught us to look to the gut when we were trying to understand the root causes of chronic health concerns. I believed them then, but after more than 10 years in clinical practice, I believe it more than ever.

Natural medicine asks us not to simply name a symptom, but to ask why that symptom is happening in the first place.

And for so many seemingly unrelated symptoms, the gastrointestinal system is one of the places I look.

Your digestive tract doesn't just determine whether you feel bloated after dinner or have a bowel movement every day. It influences nutrient status, immune activity, inflammation, hormone metabolism, detoxification, cholesterol regulation, the microbiome and much more.

Here are some of the reasons gut health can have such far-reaching effects.

1. Your gut determines what you actually absorb from your food

You can eat an incredibly nutrient-dense diet, but first you have to digest and absorb those nutrients.

That process starts long before food reaches the intestines.

Adequate stomach acid helps begin protein digestion and supports the absorption and availability of certain nutrients. Pancreatic enzymes help break carbohydrates, proteins and fats into smaller components. Bile is particularly important for digestion and absorption of fats and fat-soluble vitamins.

Then the small intestine has to actually absorb those nutrients.

Problems anywhere along that chain can potentially interfere with optimal digestion and absorption.

Some of the things I consider include:

• Low stomach acid or impaired upper GI digestion

• Inadequate pancreatic enzyme output

• Altered bile flow

• Dysbiosis, or an imbalance in the gut microbiome

• Rapid or very slow intestinal transit

• Intestinal inflammation

• Conditions that damage the intestinal lining or cause true malabsorption

Why does this matter outside of the digestive system?

Because your body needs amino acids, essential fatty acids, iron, B vitamins, magnesium, zinc and countless other nutrients to make energy, neurotransmitters, thyroid hormones, sex hormones and enzymes.

When we're looking at fatigue, mood, metabolism, thyroid health or hormonal symptoms, assessing nutrient status—and asking why deficiencies are occurring—is often an important part of the bigger picture.

2. Your gut is also an immune organ

Most people think about the gastrointestinal tract as a digestive organ.

But it's also an incredibly important part of the immune system.

The gut-associated lymphoid tissue, or GALT, represents a major component of the body's immune defenses. And our intestinal microbes constantly interact with this immune system.

Beneficial bacteria do much more than help us have good bowel movements.

They help maintain the intestinal barrier, produce useful metabolites, compete with potentially problematic organisms and communicate with our immune system.

When the balance of the microbiome changes, those interactions can change too.

Certain gram-negative bacteria, for example, contain lipopolysaccharide (LPS) in their outer membranes. LPS can stimulate a powerful immune response, particularly when intestinal barrier function is compromised and microbial products reach places they shouldn't.

My medical-school mnemonic for LPS was considerably less sophisticated: “little pieces of shit.”

Pardon my French, but more than a decade later, I still haven't forgotten it—so apparently it worked.

The important part is that intestinal inflammation and altered barrier function may contribute to inflammatory signaling beyond the GI tract.

And systemic inflammation doesn't always look like a stomachache.

People may experience fatigue, brain fog or a general sense of not feeling well. Inflammatory processes are also relevant to metabolic, cardiovascular, skin, joint and mental health.

This is one reason I may investigate the microbiome in a patient whose primary complaint doesn't seem digestive at all.

3. The gut plays an important role in hormonal health

This is where my two clinical specialties—gut health and hormone health—really start to overlap.

Hormones don't simply get produced, do their job and disappear.

They have to be metabolized and eliminated.

Estrogens, for example, undergo metabolism in the liver and some estrogen metabolites are secreted into bile and delivered to the intestinal tract for elimination.

But the microbiome can influence what happens next.

Certain intestinal bacteria produce an enzyme called beta-glucuronidase, which can deconjugate estrogen metabolites in the intestine. This creates an opportunity for some estrogen to be reabsorbed rather than eliminated.

The collection of gut bacteria and microbial genes involved in estrogen metabolism is sometimes referred to as the estrobolome.

This doesn't mean that every hormonal imbalance is caused by your microbiome—or that an elevated stool beta-glucuronidase automatically explains someone's symptoms.

But it illustrates something I think is incredibly important:

Hormonal health doesn't exist independently of digestive health.

When I'm working with menstrual symptoms, estrogen-related concerns or other hormone imbalances, I may also be thinking about bowel regularity, fiber intake, liver metabolism and the microbiome.

Want to read more about the link between hormonal health and gut health? Click here

4. Your GI tract is one of your body's major routes of elimination

Hormones aren't the only compounds your body needs to process and eliminate.

The liver transforms many endogenous compounds and substances we're exposed to so they can ultimately leave the body through urine or stool.

And this is one reason I'm much less interested in trendy “detoxes” than I am in supporting the body's normal physiology.

Is someone moving their bowels regularly?

Are they consuming enough fiber?

Is their digestive system functioning well?

Is there significant intestinal inflammation or dysbiosis?

Your liver can do its job beautifully, but the GI tract still plays an important role in getting certain waste products out of the body.

Supporting detoxification isn't necessarily about drinking a special juice.

Sometimes it's about making sure you poop.

5. Gut health and cardiovascular health are connected

Here's another connection that surprises people.

Your gut microbiome can influence cardiovascular and metabolic health through multiple pathways.

One particularly important connection involves bile acids and cholesterol.

Cholesterol is used to make bile acids, which are secreted into the intestine. Much of that bile is eventually reabsorbed, but some is eliminated in stool.

Soluble fiber can help increase fecal bile acid excretion, which is one reason adequate fiber intake can be beneficial for cholesterol management.

Gut bacteria also metabolize fiber into short-chain fatty acids, including butyrate, which have important effects on intestinal and metabolic health.

This is one reason a heart-healthy diet isn't simply about eating less fat.

I'm also thinking about fiber diversity, plant foods and the gut microbiome.

6. The gut-brain connection is very real

Your gut and brain are in constant communication.

This relationship is known as the gut-brain axis, and communication travels in both directions through neural, immune, endocrine and microbial pathways.

This is one reason stress can immediately affect digestion—and why gastrointestinal health can, in turn, influence how we feel.

Gut microbes can produce or influence metabolites involved in nervous-system signaling, while intestinal inflammation can affect immune signaling throughout the body.

This doesn't mean that anxiety or depression is simply a “gut problem.” Mental health is complex and deserves to be treated that way.

But it does mean that when I'm taking a whole-person approach to someone's health, I don't consider the brain and GI tract completely separate systems.

7. Your skin may be telling us something about your gut

Acne. Rosacea. Eczema. Psoriasis.

These are all conditions where researchers continue to investigate connections between the gut microbiome, immune system and skin—sometimes referred to as the gut-skin axis.

Again, that doesn't mean dysbiosis is the cause of every skin condition.

But clinically, it can be an important clue.

If someone comes to me with acne that looks hormonal, for example, hormones are one of the first places I'll investigate.

But what if their hormone testing looks relatively normal?

What if we've worked on blood sugar, inflammation, nutrition and hormone balance, and the acne still isn't improving?

That's when I start asking what else we're missing.

Sometimes I turn my attention to the microbiome.

Certain patterns of dysbiosis—and organisms such as H. pylori—can grab my attention in these cases, particularly when there are digestive symptoms or other reasons to suspect altered GI function.

This is why I like comprehensive stool PCR testing

When I suspect the gut may be contributing to someone's larger health picture, I don't love shooting in the dark.

Rather than automatically prescribing a probiotic or telling everyone to eliminate the same five foods, I want to understand what's actually happening.

In selected patients, I use comprehensive PCR-based stool testing to help evaluate the GI environment.

Depending on the test and clinical situation, this may provide information about certain bacteria, parasites and other microorganisms as well as markers related to digestion, intestinal immune activity or inflammation.

I interpret these results in the context of the patient's symptoms and medical history. Comprehensive stool testing doesn't replace validated diagnostic testing for specific GI diseases, and detecting an organism's DNA doesn't necessarily mean that organism is causing a patient's symptoms.

But when used thoughtfully, testing can give us information that helps me develop a much more individualized plan.

Because I don't just want to know:

“Which probiotic should you take?”

I want to know:

Why isn't your digestive system functioning optimally—and could that be affecting the rest of your health?

Gut health is whole-body health

This is why I love specializing in gut health.

Yes, I work with bloating, constipation, diarrhea and reflux.

But I'm also thinking about the bigger picture.

Nutrient status.Inflammation.Hormones.Metabolism.Thyroid health.Skin.Immune function.Cardiovascular health.The gut-brain connection.

The body doesn't operate as a collection of completely independent systems—and I don't believe our healthcare should approach it that way either.

If you've been working on hormones, fatigue, skin, inflammation or other chronic symptoms and feel like you're still missing a piece of the puzzle, your gut may be worth a closer look.

I work with clients nationwide via telehealth, using an individualized naturopathic approach to help connect those dots and determine where it makes sense to dig deeper.

Want to order your GI Map today? visit my online store!