Where to start with gut health: why the gut comes third in my order
Where to start with gut health is a question I am asked constantly, and the answer is often a step or two before the gut itself. This article explains why I usually begin with the stress response and steady energy, what your digestion needs from you in the meantime, what a settled gut makes possible for your hormones and nutrient absorption, and when the gut should come first.
Where to start with gut health: the question behind the question
Most people begin with the gut because that is where the symptom is. They change what they eat, add a probiotic, cut out gluten or dairy, and try another round of an elimination diet. Some of it helps for a while. Then the bloating, the unpredictable bowels or the tiredness after meals return, and they wonder what else is left to try.
I work through the body's systems in a six-phase clinical order of operations: a practical way of deciding where to begin and what to support next. The body works as one connected system, so the phases overlap and the right starting point depends on the person. In that order the gut sits at step three. The nervous system and energy supply come before it, and drainage and hormones come after.
The reason is practical. Digestion is one of the first things the body turns down when it believes it is under pressure, and it needs a steady fuel supply to do its work. Working on the gut while the body is still stressed and running on empty tends to stall. The rest of this article explains why, and what you can do for your gut while the earlier steps take shape.
What digestion needs before the first bite
Digestion starts before you eat. The sight and smell of food, and even the thought of it, set off the cephalic phase of digestion. Your brain signals through the vagus nerve, and your mouth waters, your stomach starts to make acid and your pancreas and gall bladder prepare their enzymes and bile. This only happens fully when your body is in what is often called the rest-and-digest state.
Under sustained stress your body shifts to the opposite state. Adrenaline and cortisol rise, blood flow moves towards the muscles and the brain, digestive secretions fall and the gut changes how it moves. This makes sense for a short emergency, as digesting lunch can wait while you deal with a threat. When the pressure lasts for months or years, you eat in that state at every meal.
Stomach acid is the first domino. It breaks down protein, helps your body absorb minerals and vitamin B12, and signals the pancreas and the gall bladder to release their contents further down. If less acid is made, every later step receives less of what it needs. The food may then be less thoroughly digested by the time it reaches the lower bowel, where bacteria ferment what is left. That produces gas, and gas produces the bloating and discomfort that send people searching for a gut protocol.
I explain the stress side in more detail in the gut-stress connection. The practical point is that a gut can be doing its job well and still struggle, because the state your body is in decides how well the whole process runs.
Why steady energy comes before the gut
The second step in my order is energy and blood sugar. It matters for the gut in three ways.
The gut has a cleaning cycle that needs gaps between meals. Between meals, once the stomach and small intestine are empty, a wave of muscle activity called the migrating motor complex sweeps through the small intestine roughly every 90 to 120 minutes. It moves leftover food and bacteria along towards the colon. It only runs when you are not eating. If you graze all day, the wave rarely gets its turn. When this cleaning cycle works poorly, bacteria can build up in the small intestine, a pattern known as SIBO. Whether that applies to any one person needs a proper assessment through a GP or specialist. A pattern of three or four proper meals with gaps between them looks after the cycle, and it costs nothing.
Sugar and refined carbohydrate give gut bacteria a lot to ferment. A body that is tired and craving sugar eats more of it. More fermentable carbohydrate that is not fully digested means more gas.
The gut lining renews itself constantly. The cells that line your gut are replaced every few days, and that renewal needs protein, minerals and energy. A body that is skipping meals and living on coffee has less to build with.
Steadier energy comes from ordinary habits: regular meals, protein at each one, less caffeine and later. I go through them in eating regularly when life is busy and why caffeine can make you more tired.
What tends to go wrong when the gut goes first
These are the usual traps when people start with the gut while the earlier steps are still unsettled.
Probiotics too soon. Evidence for probiotics is mixed and depends on the strain and the person. In some people extra bacteria add to the gas while digestion is still struggling. I would sooner you build the conditions first. My article on rewilding your gut looks at how to bring diversity back through food.
Long elimination diets. Cutting out food after food can shrink your diet to a handful of safe choices, make mealtimes more anxious and reduce the variety your gut bacteria feed on. Short, careful, purposeful trials have a place. A permanent shrinking list is hard to justify.
Removing gluten before testing. If there is any chance you have coeliac disease, ask your GP for the blood test before you cut gluten out, because the test only works while you are eating it.
More fibre as the automatic answer. Fibre helps many people and aggravates others. I introduce one food source at a time and watch what happens to gas, discomfort and stools. If fibre consistently makes pain or distension worse, I stop and look further, and I would want your GP to know too.
Strong antimicrobial protocols without an assessment. These are better guided by a practitioner than started alone from a list online.
What you can do for your gut at every step
The first two steps in my order do not stop you looking after your digestion. Several of the practices that matter most for the gut are also the ones that settle the stress response.
Pause before you eat. This is the Calm Eating Pause. Sit with both feet supported and put your phone aside. Take three soft breaths, making the exhale slightly longer than the inhale. Notice your hunger, your tension and your pace without trying to change them. Start with a smaller first portion, pause halfway through and see how you feel. Chew enough for the food to become easy to swallow. There is no bite-count to reach.
Breathe into your belly. Lie or sit comfortably with one hand over your lower ribs or abdomen. Breathe quietly through your nose if that feels comfortable and let your lower ribs widen, without pushing the belly out. Make the exhale slightly longer than the inhale and keep this up for two to five minutes. Stop if you feel dizzy, breathless, panicky or in more pain.
Keep meals regular, with gaps. Three proper meals, or two meals and one planned snack with protein, and a gap of several hours between them. Leave about two to three hours between your last meal and bedtime.
Choose warm, cooked food when your digestion is touchy. Soups, stews, porridge, dhal and roasted vegetables tend to be easier on a sensitive gut than large raw salads and cold smoothies, and you can add raw food back as things settle.
Introduce fermented foods slowly. Live yoghurt, kefir and sauerkraut feed a varied community of gut bacteria. Start with a spoonful and build up over several weeks if your gut stays comfortable.
Choose your after-dinner tea with care. Fennel, chamomile and ginger teas have a long history of use for digestive comfort. Peppermint relaxes the valve at the top of the stomach, so it can make reflux worse in some people.
Try a bitter taste before the main course. A few leaves of rocket, chicory or watercress, or a bitter herbal drink, has been used traditionally to prepare the digestive system for a meal. The bitter taste stimulates saliva and the release of digestive juices.
What a settled gut makes possible
You will usually notice when the first steps are in place. Sleep is steadier, your energy holds through the afternoon without leaning on coffee, and you can sit down to a meal without rushing. At that point the gut gets its turn, and several things open up.
Absorption. Magnesium, zinc, iron and vitamin B12 pass through the gut wall into the body. Your nerves, your energy production and your hormone production all depend on them. If you absorb them poorly, what you take in goes further when digestion improves.
The microbiome at work. The bacteria in your colon ferment fibre into short-chain fatty acids, including butyrate, which is a main fuel for the cells lining the colon. A varied diet rich in plants feeds a varied community of bacteria. My article on how your gut microbiome affects energy, mood, immunity and digestion goes into this.
A link with your hormones. Gut bacteria help determine how much oestrogen leaves the body in the stool and how much is taken back in. This community of bacteria is sometimes called the estrobolome. It is one of the reasons that, in my order, the gut comes before hormones. If you want to see how food and gut bacteria meet in this area, I look at it in phytoestrogens explained, and hormone support: why I look at stress, blood sugar and the gut first explains the thinking behind the order.
When the gut should come first
The order is a default that bends to the person. Some people arrive calm, with steady energy, and their gut is where the difficulty sits. Some have an acute digestive problem that deserves attention now, and it would be unkind to ask them to wait. I begin with whichever system is loudest, and I keep the others in view.
If you are not sure where to begin, the EarthWise health quiz helps you find the area giving you the most trouble.
Questions I am often asked
Should I take digestive enzymes or betaine hydrochloride? I would not start betaine hydrochloride without advice. It is not suitable if you have a stomach ulcer or take anti-inflammatory painkillers. If you wonder whether your digestion is under-producing acid or enzymes, that conversation belongs with a practitioner who can look at your whole history.
I take medication for reflux. Should I stop it? Please do not stop or reduce prescribed medication without talking to your GP. The steps in this article can be done at the same time, and you can review the medication with your GP as things change.
Is gluten the problem? For some people it is, and coeliac disease needs a proper test while you are still eating gluten. For many others the stress response, the pattern of eating and the amount of refined food explain more. I would test and reflect before removing a food group.
Are probiotics ever the right choice? They can be, particularly for specific situations such as after a course of antibiotics, and a practitioner or pharmacist can guide the strain. I would add them after the basics are working, so that they land in a gut that is ready for them.
Herbs traditionally used for digestive support
Herbal medicine has a long tradition of working with digestion, and two groups of herbs matter most. Bitters are herbs with a bitter taste that has traditionally been used to prepare the digestive system for food. Carminatives are aromatic herbs traditionally used for digestive comfort after eating. I explain the category in what is a digestive tonic.
I formulated Gut Ease from four herbs:
Globe Artichoke (Cynara scolymus). A bitter herb traditionally used to support digestion and the flow of bile.
Calendula (Calendula officinalis). Traditionally used for gentle digestive comfort.
Chamomile (Matricaria chamomilla). A carminative with a long history of use for digestive comfort.
Centaury (Centaurium erythraea). A bitter herb traditionally used to support digestion.
Gut Ease also contains three Australian Bush Flower Essences: Peach Flowered Tea Tree, Bottlebrush and Dagger Hakea. I formulated it to support digestive comfort. It sits alongside the steps above, and it works best when you take it consistently over weeks.
The product page carries the full safety information. Please read it before you start. If you take prescribed medication, particularly for acid reflux or the liver, or if you have gallstones or a bile duct problem, or an allergy to plants in the daisy family, speak to your GP or practitioner first.
When to see your GP
Digestive symptoms are common, and some deserve a proper look. Please see your GP if you notice:
blood in your stools, or black stools
a change in your bowel habit that lasts more than a few weeks
unexplained weight loss, or a loss of appetite
difficulty or pain when swallowing
severe, persistent or worsening abdominal pain
bloating that does not settle, especially if it comes with a swollen abdomen or in a woman in her fifties or older who has not had it before
tiredness with pale skin or breathlessness, as this can point to anaemia
diarrhoea that wakes you at night, or a family history of coeliac disease, inflammatory bowel disease or bowel cancer
If you take prescribed medication and are thinking of adding a herbal product, please check with your GP or pharmacist first.
Where this fits
The gut sits in the middle of the order for a reason. It depends on the calm and steady energy that come before it, and it supports the hormones and drainage that follow. If you would like to see how the whole chain connects, my article on supplements not working and why it helps to find your starting point follows one woman's symptoms from her first poor nights to her hot flushes, and nervous system support explains why step one comes first.
Sarah Burt is a registered naturopath, medical herbalist and iridologist with 25+ years of clinical experience. All EarthWise tonics are formulated by Sarah based on her clinical protocols.
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This article is for informational purposes only and is not intended to diagnose, treat or cure any health condition. Always consult a qualified health practitioner before making changes to your health regimen.
