[Sticky] Why did taking X stop helping my gut?
It's not uncommon for people to begin some sort of an intervention, say the use of a probiotic or supplemental fiber, and to see acute improvements in things like motility. Over time the product stops working and people go back to ground zero or worse. Obviously a frustrating and confusing experience.
So what gives? Well, often times taking a supplement can yield beneficial results by improving a gut function such as motility. But if the pathway you address isn't the underlying cause, you'll simply prop up motility while allowing the underlying cause to get worse. Ultimately, the system fails and you're stuck to pick up the pieces.
This is why we push lifestyle as the foundation of building gut health. What we do on a day to day basis has a strong influence on the function of our gut. Our behaviors, such as when and how much we eat, how active we are, our light exposure, sleep, and stress all play an important role in regulating how our gut works. And supplements simply won't do the job.
Take hyperglycemia and type 2 diabetes. Even acute bouts of hyperglycemia, those that most people can achieve simply by being sedentary and binge eating low quality food on the weekends, impairs gut function. It does this by weakening the lower esophageal sphincter while reducing gastric emptying, motility, and bile and enzyme secretion. (1)
Initially, this is just how the GI tract responds to lower glucose. When blood glucose increases too rapidly, one of the best ways to reduce it is to halt digestion and the transit of food from the stomach to the small intestine where it's absorbed. But regularly doing this causes injury to nerves of the autonomic nervous system and the enteric nervous system, which is the resident nervous system in the gut. It also changes the microbiome and predisposes to small intestinal bacterial overgrowth.
Repeated exposure to hyperglycemia makes matters worse by causing persistent autonomic and enteric nerve damage, which is the case in people with uncontrolled type 1 diabetes, pre-diabetes, and Type 2 diabetes. The final act in this story is even worse, as these conditions cause a neuronal re-wiring of the gut that essentially puts the brakes on motility and enzyme secretion in the stomach, small intestine, and causes spastic motility in the distal colon. (2)
Taking fiber can help promote motility in the colon through its transformation in to the short chain fatty acid butyrate by the microbiome. One of the ways butyrate does this is through modulating the enteric nervous system. (3) Butyrate also acts as the primary fuel source for the cells of the colon, but it won't affect the re-wiring that occurs due to hyperglycemia. Only eliminating hyperglycemia and making it a rarer occurrence will do that.
Supplements won't make up for bad habits. The migrating motor complex, the postmeal motility pattern that helps move food from the small intestine to the colon, typically takes 3 hours after a meal to kick in. Eating a substantial amount of calories will always shut down the migrating motor complex.
So if you eat every 3 hours from the moment you get up to the time you go to bed, your transit time is going to be longer than someone who only eats 3 times a day. Taking fiber won't correct this problem, you have to address the behavior first. Then, if need be, incorporating fiber can bolster your gut health further.
Creating good habits that optimize gut health should be the foundation of all protocols to improve gut disorders. Addressing gut health without putting the gut in a position to succeed is an approach destined for failure.