Gut Health Series Part 2: Constipation, Diarrhea, Reflux, Hormones, and What a Gut Protocol Looks Like

Part two of Dr. S’s three-part gut health series with guest Haley Paul focuses on common digestive issues and practical, individualized approaches. They discuss constipation and why it’s not always just a lack of fiber or water, emphasizing experimenting with different fibers (ground flaxseed, soaked chia seeds, stewed apples for apple pectin, beetroot, and careful low-dose psyllium with plenty of water). They cover reasons constipation can persist despite dietary changes, including structural factors, psychological factors (anxiety, depression, trauma), bowel retraining, medications, and methane SIBO, which is strongly linked to slow transit and can be a “game changer” when treated. They also discuss chronic diarrhea patterns, often linked to overgrowth, and the importance of assessing triggers like dairy (lactose intolerance) and fatty meals (including bile acid malabsorption), with stool characteristics as clues. For reflux, they explain how low stomach acid can cause heartburn through slowed digestion and fermentation pressure, note common trigger foods, caution against long-term OTC antacid/PPI use without investigation, and recommend GP testing for Helicobacter pylori, which is common in the UK and can suppress stomach acid while increasing ulcer and stomach cancer risk. The episode then explores how gut bacteria influence hormone activation, recycling, and elimination via beta-glucuronidase (affected by certain bacteria and high-protein diets), and how shifts during perimenopause/menopause can affect symptoms; they also describe emerging research linking gut dysbiosis, reduced microbial diversity, and increased inflammatory bacteria with PCOS and endometriosis (including interest in Fusobacterium). Finally, they outline what a clinician-led gut protocol can look like: starting with dietary fundamentals (including “crowding out”), then using accredited comprehensive stool testing beyond standard GP pathogen-focused tests to assess microbes, enzymes, inflammatory markers, and zonulin. They describe the protocol phases (Remove, Replace, Re-inoculate, and sometimes Repair), including possible supports like bitters, betaine HCl (with caution), ox bile, lactase, pancreatic enzymes, targeted probiotics (including Saccharomyces boulardii), retesting after pausing probiotics, and leaky-gut supports such as L-glutamine (with caution for excitatory symptoms), marshmallow root, and zinc carnosine, mentioning specific supplement brands used in practice. They close by stressing personalization, avoiding supplement guesswork, and previewing part three on testing and protocols.

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Dr Safia Debar
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