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Evidence Based

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The Best Way to Improve Gut Health

Written by Dr. Michael Ruscio, DC on December 19, 2024

Written by Dr. Michael Ruscio, DC on December 19, 2024 — Reviewed by Kellie Blake

A Clinician’s Perspective Based on Research and Clinical Insights

One of the most common questions we get at the clinic is: What is the best way to improve my gut health?

Over the years, I’ve learned to interpret this as: Is there a quick and easy way to improve my gut health?

Here’s my response: There’s no magic bullet to fix your gut. For most people, simply taking a supplement or increasing fiber intake or exercising more—without changing the diet—won’t be enough.

The good news is that, while there isn’t a magic bullet, it is possible to improve gut health without much difficulty. I’ve seen a step-by-step process repeatedly transform people’s gut health and sustain their overall health in the long term.

Step 1: Evaluate

Before making any changes to diet, lifestyle, or supplements, I have my clients evaluate the current state of their gut health. We work together to create a detailed history of their symptoms and note any incidents (like a round of antibiotics or a period of high stress) that may have set off any gut troubles.

We then assess whether they are experiencing one or more of these digestive symptoms: 

• Abdominal pain
• Excessive gas
• Bloating
• Constipation
• Diarrhea
• Acid reflux
• Indigestion
• Feeling too full after eating only a little
• Food reactions
• Heartburn

And then we look for non-digestive symptoms that serve as signs of an unhealthy gut, such as: 

• Fatigue 1
• Depression 2 3
• Anxiety 3 4
• Brain fog 5
• Skin problems 6 7
• Joint pain 8
• Insomnia 9
• Hormone imbalances 10 11
• Dry or thinning hair 12 13

Sometimes, when my clients begin to see improvements in their gut health, they find it’s easy to forget just how bad they felt before. So, we note their current symptoms to get a clear baseline. As time goes on, we can compare before-and-after treatment effects to gauge their progress and identify whether we need to make adjustments. 

Step 2: Adjust the Diet

Once we know what their baseline looks like, I work with my clients on perhaps the most essential step toward achieving a healthy gut: upgrading the diet. By the time people get to the clinic, they are often eating what they believe to be a healthy diet. But I inform them that a diet that works for some doesn’t work for all, and we figure out a diet that supports gut health while excluding their particular triggers.

To start, I typically recommend one of the following healthy, whole-foods diets to improve gut health: 

• Paleo diet: Perhaps the best diet for reducing inflammation 14, it eliminates grains and dairy and focuses on meat, fish, fruits, vegetables, and healthy fats.
• Mediterranean diet: Also ranked highly for curbing inflammation, it includes many whole grains, healthy fats, meat, fish, fruits, vegetables, and even moderate amounts of red wine 14. 
• Low-FODMAP diet: The best known diet for reducing IBS (irritable bowel syndrome) symptoms 15, it eliminates or reduces grains, dairy, and certain fermentable carbohydrates that may contribute to gas, bloating, and abdominal pain.
• Elemental diet: This liquid nutritional shake (similar to a protein shake but with more micronutrients) is designed to temporarily give the gut a rest from digestion 16 17, eliminate intestinal overgrowths 18, and reduce inflammation 16.

Which of these options is right for each of my clients depends on their symptoms and tolerance to certain foods. The least restrictive diet is the Mediterranean diet, while the most restrictive is an elemental diet. For people with worse symptoms, we’ll often use an elemental diet shake for a few days to two weeks to help them transition to a Paleo or low-FODMAP diet. 

Avoid Gut Irritants and Fine-Tune as Needed

An elimination diet will provide guidelines around what to eat and what not to eat. But no matter what’s on the “allowed” list, it’s important to avoid any foods that irritate the gut and trigger symptoms. These may include obvious things, like ultra-processed foods, sugar, additives, preservatives, and alcohol 19. They may also include less obvious ingredients, such as grains, veggies, and legumes that are high in fermentable carbohydrates (FODMAPs). 

Discovering what your gut can and can’t tolerate is an individualized process. For example, fiber is generally healthy and good for the gut, but many people find it difficult to digest some kinds of fiber (like prebiotics, which are high in FODMAPs) when their gut health is compromised. Prebiotics are a popular gut health product that can increase healthy bacteria, but research has clearly shown they aren’t helpful for people with IBS symptoms 20. 

The good news here is that people who are sensitive to certain types of dietary fiber (insoluble ones like prebiotics and resistant starch) can still get enough fiber for good gut health. Indeed, a low-FODMAP diet reduces irritating dietary fibers while allowing some soluble fibers in many foods and supplements. 

And more good news: After eliminating high-FODMAP foods for up to 2 months, most people can add over half of them back into the diet once their gut has healed 21. 

In addition to fiber, I coach my clients to watch for other foods—such as wheat, shellfish, soy, or dairy—that provoke symptoms. Whether we’re talking about food allergies, sensitivities, or intolerances, all food reactions may be signs of inflammation in the gut. Therefore, while healing the gut, it’s important to avoid foods that cause symptoms. 

Bottom line: Diet is the most important step to start healing the gut. A Paleo diet is our favorite option at the clinic because it’s nutrient-dense, includes a wide range of foods, and reduces inflammation. If symptoms don’t improve on a Paleo diet, we have our clients try a low-FODMAP diet, which is the best option we know of for reducing gut symptoms in people with common gut issues. For a more intensive gut reset, we’ll have them try an elemental diet, which can let the gut rest 16 17 and eliminate intestinal overgrowths 18.

Step 3: Add Strategic Supplements

Once my clients have their individualized diet elements in place (or at least they’re on their way), we discuss a few key supplements to support the gut. The top four supplements we use in the clinic are probiotics, herbal antimicrobials, glutamine, and (after the gut has stabilized) prebiotics. 

Most people can benefit from some kind of probiotic supplement as part of their gut health protocol. At this point, dozens of high-quality studies show that probiotics are safe and effective for improving leaky gut, reducing inflammation, increasing levels of beneficial bacteria, and correcting dysbiosis 22. 

At the clinic, we recommend a probiotic system we developed called Triple Therapy. We find that combining a multi-species Lacto/Bifido probiotic, S. boulardii (a probiotic yeast), and a soil-based probiotic offers the most comprehensive and effective gut support. 

Although they’re not quite as effective as probiotic supplements, probiotic foods (like kefir, kombucha, sauerkraut, and kimchi) can be great, too. I encourage clients who can tolerate them to add these fermented foods in as extra support for a healthy digestive system.

After incorporating probiotics, my clients and I decide together what to try next. If I suspect they have a leaky gut, we may add in glutamine, which can support the gut wall 23 24 to reduce leaky gut 25 and inflammation 26. If I suspect they have SIBO (small intestinal bacterial overgrowth), we’ll typically incorporate a series of herbal antimicrobials to eradicate it 27 28 29. 

Once the gut has stabilized, we may add in prebiotics to boost the levels of good bacteria in the gut 20 30. Prebiotics may be especially helpful if we suspect a Candida overgrowth.

Step 4: Make Lifestyle Changes

As they adjust to their diet and supplements, the next step for my clients is to focus on lifestyle factors that influence their gut health. For most people, that means upgrading their exercise, stress management, and sleep. 

Exercise

A meta-analysis studying the gut microbiota of athletes and healthy non-athletes found that athletes had microbiomes that were higher in the beneficial bacteria that make butyrate, a short-chain fatty acid that can help reduce inflammation, support the immune system, and provide energy. This suggests that exercise may have a significant impact on the composition of the gut microbiome, perhaps in ways that benefit the whole body 31.

Another meta-analysis found that doing moderate to high-intensity exercise for 30–90 minutes at least 3 times per week (150–270 minutes per week) for at least 8 weeks should positively shift the gut microbiome in both patients and healthy populations 32. 

When I work with people who aren’t used to a regular exercise routine, I recommend that they simply start by walking for 30–60 minutes a day, 3 or more times a week. Walking is great for improving gut motility (how food moves through your gastrointestinal tract), supporting digestion after a meal, and increasing blood circulation to support the body’s organs. 

Stress Management

Stress levels and digestion seem to have a bidirectional relationship that can contribute to a vicious cycle of high stress and poor gut health 33. Essentially, the more chronic stress we experience, the worse our gut health tends to be, and vice versa. 

When we consider stress management, we want to look at practices that calm the nervous system and get us spending more time in parasympathetic—or rest-and-digest—mode. Here are some research-backed (and often free) stress relievers that may also support gut health: 

• Mindfulness practices (like meditation, tai chi, qigong, or yoga) 34 35
• EFT tapping 36
• Spending time in nature 37

Regular exercise can also reduce stress 38, help us adapt to stress 39, and reduce gut inflammation 40. 

Sleep

The last lifestyle pillar for gut health is getting good-quality sleep. A meta-analysis looked at whether poor sleep is a gut stressor and found that normal sleep may increase microbiota diversity, whereas poor sleep may increase gut dysbiosis. In other words, better sleep quality seems to reduce the prevalence of bad gut bacteria. 

Sleep quality can also influence the circadian rhythm, hunger cues, digestion, and of course energy levels, which all have varying impacts on the gut. 

Great basic practices my clients typically follow to create healthy sleep habits are:

• Exercise regularly, ideally in the morning, and not too close to (within 2–3 hours of) bedtime 41
• Don’t drink coffee or other caffeinated beverages in the afternoon 42
• Maximize outdoor light exposure in the morning and limit light exposure in the evening 43
• Wake up and go to bed at the same times each day, even on weekends 43
• Try to be asleep by 11 pm and get 7–8 hours of sleep each night 44
• Eat meals at the same times each day, and avoid eating much (like a full meal) within a few hours of bedtime 43
• Don’t take naps after 4 pm 43
• Use bluelight-blocking glasses when looking at screens after dark 45

Essentially, each of these lifestyle elements—exercise, stress management, and sleep—interacts with and influences the other, working together to improve gut health. This is why, at the clinic, we focus on building a foundation of nutrition and healthy habits, rather than focusing on improving one lab marker or specific symptom. It’s all about creating the right environment for the gut—and everything else—to thrive. 

Step 5: Maintain and Enjoy!

When I see my clients make progress and change their gut health for the better, I first encourage them to celebrate the achievement. That they’ve taken action to improve their well-being and feel better deserves acknowledgment. 

Now is the time to reintroduce healthy foods that were problematic for their gut before. The main thing is to go slow and reintroduce foods one at a time, especially when it comes to fiber. They can also experiment with reducing their supplements to find their minimum effective doses. 

If some symptoms pop up during this process, I assure my clients not to worry. They can just return to the original protocol, let their gut calm down, and try again. It’s truly awesome to witness my clients’ pleasant surprise at what their gut can handle now.

Rely on Solid Foundations for a Healthy Gut

Improving digestive health and supporting the microorganisms that benefit the gut usually come down to a few key pillars: diet, strategic supplements, and lifestyle. Though these aren’t a one-step quick fix, the effects can be lasting. Once we learn to implement these pillars, we’ll never be lost again when it comes to gut healing. 

For clinical support on your gut healing journey, please reach out to us at the Ruscio Institute for Functional Health, or check out my book, Healthy Gut, Healthy You.

The Ruscio Institute has developed a range of high-quality formulations to help our clients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you. The information on DrRuscio.com is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.