A few weeks ago, as part of a Weekend Reading post, I mentioned that I’d soon be reviewing Gutbliss, a new title from Dr. Robynne Chutkan, MD. Today I’m making good on that promise, in the hopes that you’ll find the book’s content as intriguing and important as I do.
I met Dr. Chtukan a little over a year ago. In the brief time since we’ve known each other, she has inhabited many roles in my life. Robynne is first and foremost an esteemed mentor and professional role model. From her, I’ve learned about the kind of attention to detail that goes into the physician’s diagnostic process. I’ve learned that it is possible for a physician to be as empathetic as she is effective. I’ve learned that practicing medicine entails both the capacity to wield knowledge powerfully, and the ability to acknowledge that medicine is an imperfect science, full of mystery and unanswered questions. I’ve learned that a stark division need not exist between the often polarized worlds of what we might call “allopathic” and “alternative” medicine. It’s possible for physicians to offer their patients treatments and care from both traditions while avoiding some of their biases.
Robynne is also my employer. I now work part time in her office, the Digestive Center for Women in Chevy Chase, MD, as an in-house nutritionist. Sometimes this means offering guidance to newly diagnosed celiac patients, who are daunted by the process of transitioning to a gluten free diet. Sometimes it means working with folks who have IBS or other chronic digestive struggles to identify trigger foods (and healing foods). Sometimes it means sharing basic, essential nutrition advice (eat more fiber, eat whole foods, eat regular meals, eat variety) to patients who simply want to make smarter food choices.
When Robynne and I aren’t working together, we share our enthusiasm for wholesome food, yoga, literature, and all things green. It has been a joy to watch Gutbliss unfold–I met Robynne as she was completing the book, so I know how much time and effort went into it–and it’s now a pleasure to share it with CR readers. Of course, I’m a little biased about this title, given my friendship with the author. But I can say with honesty that I have learned a great deal from reading Gutbliss, and I believe that many of you will, too.
As most CR readers know, I became interested in veganism because of a long and colorful history of GI problems. I was a colicky baby, an irregular toddler, and I began showing the symptoms of what would become an intense case of IBS (irritable bowel syndrome) as a pre-teen. Naturally, my eating disorder only compounded and intensified the trouble. By my early twenties, digestive upset–ranging from irregularity to recurring cramps that were sometimes incapacitating, and once so intense that they sent me to an emergency room–shadowed my life. I was always anxious about when the next flare up would strike. After some searching, I found a gastroenterologist who gave me a few important tips, such as avoiding artificial sweetener, not chewing gum, and steering clear of carbonated beverages. He also made the fateful suggestion that I try removing dairy from my diet. The rest is history: I decided to give veganism a try, got into raw food a couple years later, and ultimately experienced tremendous relief. While my IBS can and does return if I’m very stressed or not taking care of myself properly (which was not uncommon during my post-bacc), it no longer dominates my life.
Grateful as I am to have learned how to manage my digestive issues, I often wish it hadn’t taken me so long to become educated and empowered. I wish that I’d had resources earlier on to help me figure out what was going on, and why I was so often uncomfortable. Like many women, I was told (with a hint of condescension) that IBS was mostly stress-related, and that I should try to “worry less.” I knew that stress was a trigger, of course, but I also knew intuitively that there were physiological factors involved in my symptoms. I also knew–even if my physician denied it–that diet must be playing a significant role in the problem. I wish someone had given me a copy of Gutbliss way back then.
Gutbliss is, at least on first inspection, a book about the epidemic of bloating that seems to plague so many people these days, women especially. It analyses some of the common sources of bloating, such as IBS, food intolerances or allergies, SIBO, leaky gut syndrome, dysbiosis (microbial imbalances in the body), as well as inflammatory bowel disease (Crohns and Colitis, which are among Robynne’s areas of expertise). If you ask me, though, Gutbliss is really a rejoinder to the notion, still shared among numerous doctors, that women who have digestive travails are really just “stressed out.” Because certain digestive problems, such as gallstones or IBS, affect women disproportionately, and because it’s an ancient medical bias that women are more “hysterical” than men, there’s still a tendency to assume that female digestive complaints are driven by anxiety, rather than biology. Of course, stress and biology are intertwined: stress alters hormone balance and suppresses immune function. And since hormone balance and immunity interact with the digestive system, it’s often the case that stress triggers a bout of IBS, or a flare up of colitis. So there’s plenty of validity to the premise that stress is (in part) to blame.
But are stress and anxiety the only, or even the primary, cause of female digestive upset? Robynne doesn’t think so, and in Gutbliss, she’ll tell you why not. The book makes clear–in fascinating detail–that there are physiological and endocrinological differences between men and women that affect digestion. Did you know, for instance, that womens’ large intestines are about ten centimeters longer, on average, than mens’? This means more twists and turns, which means more places where gas can get trapped (hence bloating) and a greater risk of constipation. Women also have reproductive organs, which vie for space with the large intestine; in male bodies, the colon is located further up in the abdomen, which gives it more space. Men have tighter abdominal walls, due to their higher levels of testosterone, which means that their bowels bulge less than womens’ do (which may be why you hear your male friends complaining about bloating far less than your female ones). Hormonal fluctuations throughout a woman’s cycle can impact bloating and regularity, as can perimenopause and menopause. Finally, women are more prone to thyroid disorders than men are, which can play a role in bloating and regularity as well.
So, the fact that digestive issues tend to affect women disproportionately isn’t all about our propensity to stress out, or be anxious. There are anatomical and biological factors that predispose us to gut trouble. Robynne also describes how digestive disorders can have special kinds of consequences for female patients. Women with celiac disease, for example, can become infertile or experience miscarriage if they’re not properly diagnosed or treated. Women with inflammatory bowel disease can experience irregular menstrual cycles. Pelvic floor problems after childbirth can have affect a woman’s large bowel. From start to finish, diagnosis to treatment, women tend experience digestive illnesses differently than men do.
This isn’t only a book for women, however. It’s also a lively, readable explanation of how and why common digestive problems–ones that affect both women and men–develop. My readers who take an interest in the gut already (and there are lots of you, I know!) will be familiar with some of what Robynne discusses, such as the microbiome or celiac disease. But you may be less familiar with SIBO (small intestinal bacterial overgrowth), parasites, leaky gut syndrome, or conditions like microscopic colitis. Even if you are familiar with these diagnoses, I guarantee that you’ll learn new facts about their origin and treatment. I certainly did. I’ve been a self-taught student of gut health for years now, but Gutbliss has increased my understanding dramatically.
Not surprisingly, Gutbliss is also a book about food and the food system. While she is careful to note that food isn’t always the culprit behind digestive issues (a point which I think is important), Robynne makes clear that eating nutrient rich, whole foods, plant-centric diets can benefit nearly anyone hoping to improve digestive health. She’s passionate about fiber, and the many ways in which it can help to keep the digestive tract healthy and gut flora balanced (she recommends psyllium powder for those hoping to boost fiber intake–start gradually, she says, and work up from there). She comes down very hard on processed foods, along with artificial sweeteners, refined sugars and grains, GMOs, and excessive animal protein. She has a nuanced approach to gluten (her chapter on celiac is informative), but it’s one of the substances that is omitted from her 10 day plan at the end of the book, along with alcohol, refined sugar, soy, caffeine, and dairy.
Do you have to do the 10-day plan to benefit from Gutbliss? I don’t think so. Gluten, soy, and caffeine make appearances in my diet, and–having spent years exploring and refining what works for my body and my digestion–I’m not compelled to cut them out, even if I’m conscious of how I consume them. It’s also worth noting that the Gutbliss plan isn’t vegan, though Robynne is extremely supportive of vegan diets. As with all health and wellness books, you can take what you need from Gutbliss, and modify it to fit your own philosophy. For example, I’m much more persuaded of the health benefits of soy than Robynne is. But could one enjoy some organic tofu and still follow the basic principle of the Gutbliss plan, which is to eat real food, avoid processed snacks, forgo artificial sweeteners, and boost fiber intake? Absolutely. Better yet, you needn’t worry about good/evil thinking in this book. Last week, when I reviewed David Katz’s new book, I mentioned how grateful I am for the fact that he allows for some flexibility. Robynne does, too. She recognizes that health is about enjoyment as well as beneficial choices. She makes clear to readers that a fine glass of wine with dinner, a cup of morning coffee, wholesome desserts, and other pleasures can be enjoyed as part of a healthy, happy, and gut-friendly lifestyle, so long as one is moderate and mindful.
Since many of my readers are already whole foodies who eat a ton of plants, you may not find that you need guidance on how to refine your diet for gut health. But what I believe you’ll take away from Gutbliss is information: lively and illuminating information from a medical professional who has been studying the gut for decades. More importantly still, the book may offer you–as it offered me–a sense of validation, an assurance that the gut distress you experience or have experienced in the past isn’t all “in your head.” GI illness can be terribly disruptive and profoundly isolating. There’s still quite a stigma surrounding “below the belt” problems, and many people are afraid to talk about their symptoms. Friends and family can’t necessarily see what’s going on when you suffer from irregularity, IBS, IBD, or SIBO, so it’s often hard to articulate how bad the symptoms are. And again, there’s that suspicion, so prevalent when one has a GI disorder, that the person suffering has somehow brought it upon him or herself with an anxious personality type.
There’s no doubt that stress and anxiety are factors in gut illness, and that treatment should involve stress management to whatever extent possible. But that doesn’t mean that patients and doctors shouldn’t also explore what else might be going on, from bacterial imbalance to parasites to pelvic floor problems. If you’re one of the many people who live with GI trouble, Gutbliss will give you a greater sense of how to start asking questions. And if you’re lucky enough to have a sturdy gut, the book may still teach you some fascinating facts about how your digestive system works, and how healthy foods can keep it strong.
You can read an interview with Dr. Chutkan here, or take some time to peruse her website. Whether you explore the book or not, know that I’m always wishing all of my readers a quick path to blissful digestion!