Gut imbalance, symptoms, causes and how to fix it

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Our gut is home to trillions of different microorganisms, with many of these microbes being beneficial or commensal bacteria, which play an important role in digestion, nutrient absorption, immunity and overall health and wellness.

A healthy gut microbiome is balanced and diverse, packed with beneficial bacteria such as Bifidobacterium, Lactobacillus and more, which support your body in functioning at its best. When this balance is disrupted, normal digestive and immune processes can be impaired, and a range of symptoms may develop.

Gut dysbiosis is an imbalance which occurs when potentially harmful bacteria become overrepresented and disrupt the overall balance of bacteria in our gut. This causes an imbalance between beneficial and disruptive bacteria which can undermine the gut's ability to function effectively and may cause multiple unwanted symptoms, with potential impacts on overall health [1, 2].

Gut dysbiosis is generally considered to be multifactorial, meaning there are a number of contributing factors including lifestyle, diet, genetics, prior infections, and in some cases, the use of certain medications including antibiotics and NSAID’s such as Naproxen. [2, 3].

What are the symptoms of an unhealthy gut?

The symptoms of gut dysbiosis can vary from person to person. Some individuals may experience common digestive issues such as bloating, diarrhoea, constipation, indigestion, and stomach discomfort, whereas others may experience chronic fatigue, weight changes, mood changes, or sleep disturbances. Research also suggests that gut imbalances may manifest through skin changes, via a bidirectional communication pathway known as the gut–skin axis [4].

Some people with gut symptoms may also notice that they tolerate certain foods less well than before, although this can have a range of possible explanations and should not be assumed to be caused by dysbiosis alone.

What causes a gut imbalance?

There are several factors that research suggests may contribute to gut dysbiosis.

Medication: Antibiotics, while effective against fighting infections, can also eliminate beneficial gut bacteria, leading to imbalances and dysbiosis. Prolonged or frequent antibiotic use is a recognised contributor to dysbiosis [3]. Other types of medicine that may impact the balance of the gut include NSAIDs like Naproxen and Proton Pump Inhibitors such as Omeprazole, which research suggests can reduce the bacterial richness of the gut microbiome.

Diet: A western style diet, high in processed foods, sugars, and saturated fats but low in fibre has been associated with a reduction in the diversity and number of beneficial gut bacteria. It can also increase inflammation throughout the body, increasing chances of developing chronic conditions.[6].

Excessive alcohol intake: Research indicates that frequent consumption of alcohol can damage the gut lining and alter the composition of the gut microbiota, making the environment more hospitable to harmful microbes [7].

Chronic stress: High levels of stress hormones such as cortisol have been associated with negative effects on gut balance and the strength of the gut barrier, potentially reducing the number of beneficial bacteria [8].

Lifestyle: A lack of physical activity has been associated with changes to the composition and activity of the gut microbiome that may affect digestive function [9].

Gastrointestinal infections: Infections like post infectious IBS which can begin after an episode of gastroenteritis can lead to potentially long-lasting changes in the gut microbiota composition. [10].

Sleep quality: Poor sleep quality and lack of sleep may disrupt the gut microbiome, according to emerging research [11].

Environmental factors: Exposure to pollutants, chemicals, and certain medications can adversely affect gut bacteria [12].

Intestinal parasites: Parasites like Giardia lamblia, Blastocystis hominis, and Entamoeba histolytica can compete with commensal bacteria for nutrients and space. This competition has been shown to reduce populations of beneficial bacteria such as Lactobacillus and Bifidobacterium [13]. Over time, that shift may disrupt the normal balance of the microbiome, leading to dysbiosis.

Testing for intestinal parasites may be appropriate in some cases, particularly where symptoms suggest infection.

How is gut dysbiosis tested and identified?

Understanding the state of your gut microbiome typically begins with a thorough assessment that can cover a number of different approaches. This will usually involve a holistic approach that explores previous medical history, assessment of symptoms, dietary and lifestyle habits, as well as any medication that has been taken, particularly antibiotic use.

A gut microbiome health test in the form of a stool sample can provide detailed, personalised information about the composition and diversity of the bacteria within your gut. Our gut microbiome reports are designed to be informative and personalised, helping you better understand the bacterial landscape of your gut. They are not a clinical diagnosis. If you are new to gut microbiome testing and want to understand what a gut microbiome test is, our guide explains how they work, why you might consider one, and what they can help you to identify. Whilst there is no agreed upon optimal gut microbiome profile, a microbiome test can still provide information on the composition and relative abundance of bacteria in the gut, which may help highlight patterns that could be relevant when considered alongside symptoms, diet, lifestyle, and medical history.

In certain circumstances, a blood test may also be conducted by a healthcare professional to determine if any inflammation is present within the body. Nutrient deficiencies are also worth exploring, as these can also be linked to gut health issues.

Breath tests and microbiome tests provide different types of information. Breath testing is used more specifically in the assessment of small intestinal bacterial overgrowth, whereas a microbiome test may provide broader information about bacterial composition.

How is a gut imbalance treated?

There is no single treatment pathway for gut dysbiosis, that said, a range of diet and lifestyle modifications are broadly supported by evidence as a first line approach to restoring the natural balance and function of the gut microbiome [14]. The general principle is to feed beneficial bacteria whilst reducing the conditions that allow less favourable microbial patterns to thrive.

Diet and lifestyle modifications are widely considered to form the foundation of restoring the natural environment of bacteria within the gut. Understanding what bacteria you have within your gut and what foods may support them is useful in implementing appropriate dietary changes.

More general dietary modifications that the evidence supports include reducing sugar intake, increasing daily fibre tot he NHS recommended 30g daily, and the inclusion of fermented foods that are rich in probiotics, all of which may help to support beneficial bacterial populations. [14, 15].

Understanding what foods are good for your gut health and why, will help you to make better dietary choices long-term.

Increased physical activity, maintaining an adequate sleeping pattern and implementing effective stress management techniques are also supported by research as contributing positively to gut microbiome balance [9, 11].

Learn more about how to improve your gut health naturally with dietary and lifestyle changes.

In some cases, targeted interventions such as specific probiotic supplementation or antimicrobial protocols may be appropriate, but these should only be undertaken under the supervision of a qualified healthcare professional.

Can a gut imbalance lead to other conditions?

Poor gut health has been linked to a range of chronic conditions, and as more research is carried out on the gut microbiome, we continue to learn about how microbiome imbalances may contribute to long term health outcomes if not addressed [2]. It is important to note that much of this research is associative, and the relationship between gut dysbiosis and these conditions is an active area of investigation. Gut dysbiosis should not be assumed to directly cause these conditions.

Autoimmune disorders: Imbalances in gut bacteria have been associated with conditions including rheumatoid arthritis, type 1 diabetes, and multiple sclerosis, though the mechanisms involved are still being studied [16].

Digestive conditions: Dysbiosis and increased gut permeability , sometimes referred to as leaky gut, are associated with the development of irritable bowel syndrome, inflammatory bowel disease, and gastroesophageal reflux disease [17].

Metabolic disorders: An imbalanced microbiome has been associated with an increased risk of obesity, metabolic syndrome, and type 2 diabetes. Research suggests that certain bacterial imbalances, such as elevated Firmicutes and reduced Bacteroidetes, may be associated with obesity, though this relationship is complex and not yet fully understood [18].

Mental health: The gut-brain axis is a bidirectional communication pathway between the brain and the gut. Research suggests that microbiome imbalances may contribute to mental health issues including anxiety and depression via this pathway, though this is an emerging field and causation has not been established [19].

Immune function: The beneficial bacteria within our gut play a role in educating our immune system. Dysbiosis may weaken immune responses, which could increase susceptibility to infections and illness [1].

IBS: Gut dysbiosis is recognised as a significant contributing factor in the development and severity of IBS symptoms. Whilst gut dysbiosis alone is not considered sufficient to cause IBS, it is regarded as a significant factor in both the development of the condition and the severity of symptoms in certain individuals [17].

Understanding and addressing the factors contributing to gut dysbiosis at an early stage may be important for preventing and reducing the risk of potential long term health conditions.

Can a gut imbalance go away on its own?

In some cases, your body can correct a gut imbalance on its own without the need of treatment or diet and lifestyle changes. However, when common symptoms start to appear and persist, this may suggest that your gut could benefit from support.

The first line treatment option is usually diet and lifestyle modifications to help feed the good bacteria in your gut which will help to reduce the numbers of bad bacteria and correct the imbalance. 

However, if symptoms are persistent, severe, or worsening, you should consult your GP. Some symptoms of gut dysbiosis, such as significant changes in bowel habits, blood in stools, unintentional weight loss, or persistent abdominal pain, should always be assessed by a doctor promptly.

In Summary

Spotting the signs of gut dysbiosis at an early stage can help to reduce the risk factors of developing many chronic conditions that are linked to it. It is widely accepted that diet and lifestyle changes should be adopted as a first line treatment option for gut dysbiosis, contributing to better health outcomes and improved quality of life. 

Understanding and addressing the main factors that contribute to gut dysbiosis is important for supporting long term gut health and overall wellbeing.

References

[1] Sender R, et al. Revised Estimates for the Number of Human and Bacteria Cells in the Body. Cell. 2016. 
[2] Carding S, et al. Dysbiosis of the gut microbiota in disease. Microbial Ecology in Health and Disease. 2015.
[3] Ramirez J, et al. Antibiotics as Major Disruptors of Gut Microbiota. Frontiers in Cellular and Infection Microbiology. 2020.
[4] Prescott SL, et al. The skin microbiome: impact of modern environments on skin ecology, barrier integrity, and systemic immune programming. World Allergy Organization Journal. 2017.
[5] https://feelgut.co.uk/blogs/gut-health/proton-pump-inhibitors-and-the-gut-microbiome
[6] Zinöcker MK, Lindseth IA. The Western Diet–Microbiome-Host Interaction and Its Role in Metabolic Disease. Nutrients. 2018. 
[7] Bishehsari F, et al. Alcohol and Gut-Derived Inflammation. Alcohol Research. 2017. 
[8] Madison A, Kiecolt-Glaser JK. Stress, depression, diet, and the gut microbiota: human–bacteria interactions at the core of psychoneuroimmunology and nutrition. Current Opinion in Behavioral Sciences. 2019. https://pmc.ncbi.nlm.nih.gov/articles/PMC7213601/
[9] Mach N, Fuster-Botella D. Endurance exercise and gut microbiota: A review. Journal of Sport and Health Science. 2017.
[10] Thabane M, Marshall JK. Post-infectious irritable bowel syndrome. World Journal of Gastroenterology. 2009.
[11] Smith RP, et al. Gut microbiome diversity is associated with sleep physiology in humans. PLOS ONE. 2019. https://pubmed.ncbi.nlm.nih.gov/32668369/
[12] Tsiaoussis J, et al. Effects of single and combined toxic exposures on the gut microbiome: Current knowledge and future directions. Toxicology Letters. 2019.
[13] Burgess SL, Petri WA. The intestinal bacterial microbiome and E. histolytica infection. Current Tropical Medicine Reports. 2016.
[14] Wastyk HC, et al. Gut-microbiota-targeted diets modulate human immune status. Cell. 2021.
[15] Hill C, et al. Expert consensus document: The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nature Reviews Gastroenterology & Hepatology. 2014.
[16] Vatanen T, et al. Gut microbiome and autoimmune diseases. Frontiers in Immunology. 2022. 
[17] Pittayanon R, et al. Gut Microbiota in Patients With Irritable Bowel Syndrome—A Systematic Review. Gastroenterology. 2019.
[18] Turnbaugh PJ, et al. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature. 2006.
[19] Cryan JF, et al. The Microbiota-Gut-Brain Axis. Physiological Reviews. 2019.