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Start With Your Gut
Gut health is central to overall health. Your body depends on a healthy gut function for nutrient absorption, healthy immune function, hormonal balance and detoxification.

Optimal digestion is vital for absorbing nutrients from your food which in turn are essential for supporting fertility and a healthy pregnancy. If you are not digesting and absorbing well, it really doesn't matter how healthy your diet is. It is unlikely that you'll be getting the nutrients required to fully support your fertility.

Digestion begins in your brain. Thinking about food and experiencing it through sight and smell prepares you for digestion. Chewing food thoroughly mechanically breaks it down and releases salivary amylase to begin starch digestion.

When food reaches your stomach, stomach acid (HCI) and pepsin begin protein digestion and separate essential nutrients for absorption in the small intestine. Low stomach acid is a common issue because stress, refined carbohydrates, medications, non-steroidal anti-inflammatory drugs, the birth control pill, nutrient deficiencies, food sensitivities and alcohol all can deplete it. You also need optimal HCI levels to trigger the next stage of digestion, which moves food into the small intestine. If you eat while feeling stressed you may notice a feeling of fullness, bloating or heartburn as the food begins to ferment in your tummy.

When food reaches your small intestine, your pancreas releases bicarbonate and pancreatic enzymes to neutralize stomach acid and prepare nutrients for absorption. Your gallbladder releases bile to emulsify fats. Leftovers, such as fiber and other waste, become food for your gut bacteria in the colon. Gut bacteria ferment fiber and produce nutrients such as short-chain fatty acids, B vitamins and vitamin K2 to keep the cells of the colon healthy. Bacteria also help move waste through the colon for excretion. Since there are multiple steeps and organs involved in the digestive process, there are many potential opportunities for issues to arise.

Stress and Digestion
Optimal digestion relies on you being in a relaxed state. Stress and anxiety shift you into fight or flight; in this state your body prioritizes survival, and digestion will be put on the back burner.

Leaky Gut
Your digestive tract is separated from your bloodstream by a thin border made of mucosal cells. These cells are tightly packed together to form a protective barrier between the outside world and inside your body. Increased permeability (leaky gut) occurs when the tight junctions become loose, allowing incompletely digested food molecules, pathogens and waste products to enter the bloodstream.

Autoimmunity
Autoimmunity is a condition of immune confusion, where the body mistakenly attacks its own healthy tissue. A leaky gut, genetics and a triggering event provide the perfect storm for autoimmunity to develop. Autoimmunity can manifest as infertility or pregnancy loss. Autoimmune conditions such as lupus, thyroid autoimmunity and celiac disease are associated with infertility and miscarriage. Endometriosis and PCOS have both been associated with altered immune function and a greater prevalence of autoimmune disease.

Hormone Balance, Detoxification and Your Gut
Your gut houses your microbiome, which consists of trillions of bacteria. There is a strong connection between your gut, your microbiome and hormone health. When hormones have done their job, your body packages them up for safe elimination so they don't continue to act. This is done primarily through the gut. Issues like constipation or an imbalance of gut bacteria (dysbiosis) can prevent your body from properly detoxifying and eliminating hormones, especially estrogen. This can lead to reabsorption which may affect hormone balance and cause unpleasant symptoms like bloating, cramping, heavy periods and irritability. It is essential to move your bowels every day to remove the estrogen your body no longer needs.

Does Your Gut Need Some TLC?
Regularly experiencing any of the following symptoms suggests that your gut may require support:

Bloating
Discomfort and/or belching after meals
Nausea
Heartburn or acid reflux
Feeling of fullness, food sitting in tummy
Stomach cramps
Diarrhea or loose stools
Constipation or difficulty passing stools
IBS
Undigested food in stools
Hives, rashes, eczema, acne rosacea
Allergies, asthma, sinus infections, stuffy nose
Fungus or yeast infections

Associated conditions:

Autoimmune disease
Endometriosis
PCOS
Implantation failure
Recurrent miscarriage
Unexplained infertility

Optimizing Gut Health

Gut rebalancing takes time. My 5R framework helps restore balance through 5 steps: remove, replace, repopulate, repair and rebalance. No need to implement all at once but work through each step.

Remove
The goal is to remove potentially inflammatory foods. Leaky gut and food sensitivities go hand-in-hand, so it's important to remove foods that may cause sensitivity to improve gut health. Consistently eating foods that you are sensitive to leaves the immune system in a constant state of alarm, resulting in leaky gut and chronic inflammation.

The most common sensitivities I encounter are gluten, dairy and soy. Gluten is the protein found in wheat and other grains. Wheat is the most common source of gluten. Dairy isn't an issue for everyone but can be problematic. Remove for 30 days and then explore what works for you by reintroducing different types of dairy products one at a time. Note if you experience any symptoms.

If you can tolerate dairy, keep in mind that quality is key and use it as a flavor highlight. Look for whole milk from organic grass-fed cows and avoid low-fat and fat-free.

Soy tends to be heavily sprayed with pesticides unless organic and contains anti-nutrients which may interfere with mineral absorption and protein digestion. Soy may also affect hormone balance and is a common food allergen.

Other common triggers that may cause sensitivity include corn, eggs, nuts, nightshades, legumes and yeast. Experiment with removal and reintroduce some.

Replace
Support gut transit time and motility and include nutrients to optimize digestive secretions:

Eat fiber. Aim for at least 30g of fiber every day. This should be easy to achieve if you make vegetables the foundation of your diet. Fiber acts as fuel for your gut bacteria. Strive for vegetable variety. Optimize stomach acid (HCI). Zinc is a co-factor for stomach acid production and supports tissue healing and sense of taste. Eat naturally bitter foods such as hickory, collard greens, kale, spinach and watercress to stimulate your liver to produce bile. Bile acids are critical for the digestion and absorption of fats and fat-soluble vitamins.

Repopulate
Make a happy home for your gut bacteria: Include prebiotic foods. Prebiotic fibers provide food for beneficial bacteria. Good sources include apples, artichokes, asparagus, garlic, leeks and onions. Eat fermented foods. Fermented foods are abundant in beneficial microbes and prebiotic fiber. Live yogurt, kefir, kimchi and sauerkraut are all probiotic foods.

Repair
Include foods rich in nutrients that help restore the gut lining to optimize nutrient absorption and immune tolerance: Collagen - bone broth is one of the most nourishing foods for the gut. It is rich in collagen, a key protein within the gut lining. L-glutamine - this amino acid is considered one of the most important nutrients to support gut healing. Omega-3 fatty acids - these fats help reduce inflammation and improve gut health. Vitamin A - needed for the health of mucosal cells. Eggs and liver are abundant in vitamin A. Vitamin C - dark green leafy vegetables, broccoli, bell peppers and berries are rich in vitamin C, which is needed for collagen synthesis. Eat a plant-centric diet and you'll be getting plenty of vitamin C. Vitamin D is important for immune function. Vitamin D is made in your skin in response to sun exposure. You may need to supplement your levels.

Rebalance
This could be the hardest step as it involves breaking habits and managing stress as an underlying cause of digestive distress. Find strategies to manage stress - refer back to Module 2 Week 3 to review the information there.

Read my blog - Gut Health and the Microbiome Connection to Optimal Fertility here.