Dr. Yevgenia Pashinsky is a board-certified gastroenterologist in New York City. She completed her medical education at the Mount Sinai Medical Center, where she received training in Internal Medicine and Gastroenterology. Her interests include colon cancer prevention, irregular bowel habits, inflammatory bowel disease, abnormal liver function as well as women’s gastrointestinal health and nutrition.
We sat down with Dr. Pashinsky to find out the truth about gut health. Read the full interview below.
Q: What does a gastroenterologist do?
Gastroenterologists are medical doctors with specialized training in the diagnosis and treatment of diseases and disorders that affect the digestive system. The human digestive organs include the esophagus, stomach, small intestine, colon, rectum and anus along with the liver, gallbladder and pancreas. In addition to diagnosing and treating diseases, gastroenterologists also focus on preventing certain ones such as colon and esophageal cancer using colonoscopy and endoscopy.
Q: We hear a lot about gut health these days. What does gut health really entail?
Gut health can mean different things to different people. A narrow definition would be the absence (or prevention) of digestive system diseases, especially cancer and inflammatory conditions like Crohn’s disease or colitis. Perhaps a broader definition of gut health would be a state of overall digestive wellness as defined by consistently smooth functioning of the systems: having regular and comfortable bowel movements, feeling digestively well after meals. Nowadays, people often speak of gut health as a proxy for the health of the gut microbiome, whose composition we now understand to be at least somewhat related to feelings of digestive wellbeing and the prevention of certain diseases. We generally understand a healthy gut microbiome to be one that has abundant numbers of a very diverse array of bacteria, including the types of organisms known to produce metabolites (or, byproducts of their fermenting fiber from our diets) that have beneficial effects for human health. There is no single standard for what constitutes a ‘healthy’ gut microbiome, however, and, to date, no known way to manipulate the gut microbiome to resemble a standard model even if there were.
Q: How can a person eat to improve their gut health?
Speaking generally, the best thing a person can do to support gut health is to eat a high fiber diet that contains a variety of different whole, plant based foods– vegetables, fruits, roots, whole grains, legumes, nuts and seeds. A diverse array of fiber nourishes a diverse array of species in the gut microbiome, and is the single strongest predictor of its diversity. Diets high in fiber–particularly from fruits and vegetables– are also strongly associated with reduced risk of digestive system cancers and development of inflammatory bowel disease.
It is important to recognize, however, that not everyone can eat this way comfortably. Foods that are nutrient rich and objectively healthy can produce painful gas or bloating, diarrhea or even constipation for people whose digestive systems are affected by a variety of different conditions. I often tell my patients that sometimes objectively ‘good’ foods can still make you feel bad. When this is the case, I refer my patients to a qualified registered dietitian to help them figure out how to eat the gut-healthiest diet they can comfortably tolerate. There’s no need to martyr yourself with terrible gas pain or abdominal cramps just to eat a giant kale salad. It’s just not worth it.
Q: What are some of the worst habits for gut health?
Antibiotics have consistently been shown to negatively affect gut health due to their effects on the microbiome and its diversity, so unnecessary exposure (ie for the common cold) can lead to issues down the line. The goal is the shortest course of antibiotics and only with proper indication.
Very extreme elimination diets in which you avoid multiple food groups without proper doctor or dietician oversight (especially high fiber foods– such as whole grains, fruits, legumes, “nightshade” vegetables, certain nuts, or seeds) can also have a devastating effect on the gut microbiome even in a very short period of time. It’s ironic that many such regimens are marketed as ‘anti-inflammatory’ or ‘gut healing,’ as they are very much the opposite. Eating less fiber means you are eating more animal protein and fat– and higher levels of these nutrients relative to fiber-containing carbohydrates is associated with higher risk of digestive disease and overall systemic inflammation.
Q: How is our gut health related to our overall health?
This is a question for which we are very much still in the process of understanding. The GI tract is the greatest surface area of your body in direct communication with the outside world and your largest immune organ. It is responsible for nutrient intake, houses billions of microorganisms that have far reaching effects & functions, and is closely connected with most other organ systems. We know that the gut can communicate with the brain in a two-way direction using both chemical messengers that our own cells produce as well as those produced by the gut microbiota. Some links have been established between what’s happening in the gut and psychological and cognitive conditions, from depression and anxiety to Alzheimer’s and Parkinson’s disease– but we don’t yet fully understand the nature of these links. The state of the gut microbiome also seems related to metabolic health and disease risk– from obesity high cholesterol levels to type II diabetes. We’ve also seen a relationship between frequent antibiotic use in infancy and early childhood with later risk of developing autoimmune diseases and food allergies. There is clear evidence of certain dietary patterns influencing gastrointestinal malignancies and inflammatory conditions.
Based on what researchers know right now, however, there’s not much actionable advice we can give in order to modify disease risk mediated by the state of the gut other than: eating as diverse and high fiber a diet you can comfortably enjoy, get adequate sleep and exercise, and avoid smoking or taking unnecessary medications. It may not be new and exciting advice, but it’s the soundest, most evidence based advice we have available.
You can learn more about Dr. Yevgenia Pashinsky at Qwell.
Consult your primary care provider, to learn if a gastroenterologist visit is right for you.