One look at the abundance of sugar, artificial chemicals and toxins in the Standard American diet and the following statistic probably won’t come as much of a surprise: 60 to 70 million people in the United States are affected by digestive diseases (1)—and there’s plenty of science focusing on how an unhealthy gut can sap vitality. But digestive woes don’t come out of nowhere, and it’s best to take action before they go from an “issue” to a “condition” or a “disease.”

When the digestive system isn’t functioning optimally, the body can be slowed down by nutrient shortfalls and an excess of pathogens and toxins—and the fallout of that goes beyond bloat and GI distress. Issues with sleep, energy, mood, immunity and skin health, as well as inflammation, allergies, headaches and anxiety, can all be red flags of poor digestive health, even if the digestive system isn’t throwing off any of the usual signs that it might need help. “Naturopathic doctors have always advocated that when treating any ailment, it’s best to focus on optimizing digestion first,” says Robin Rogosin, VP of product development for LifeSeasons, Lewisville, TX. “Using this approach, many discomforts can be resolved quickly, even without addressing them directly.” Kim Hapke, N.D., a naturopathic doctor with Metabolic Maintenance, Sisters, OR, agrees, adding, “Digestion means absorption of nutrients needed to support every system in the body, and the gut is the barrier to pathogens and toxins from the outside world. [Digestive issues] won’t always be the cause of a problem, but should be ruled out as a possible contributor.”

Why the gut is key The gut is “lined with 100 million neurons that produce more than 30 neurotransmitters to ensure optimal functioning of digestion and elimination,” Rogosin explains. And the gut and those neurons do much more than just digest. “This tract regulates bone mass and mood,” she continues. “It is now believed that 95% of the body’s serotonin is found in the bowels. The microbiome and the nervous system mediate the complexity of messaging from our gut to our brain.” The gut is complex, and it is far from isolated.

Gut-Brain Axis—The gut-brain axis “consists of bidirectional communication between the central and the enteric nervous system, linking emotional and cognitive centers of the brain with peripheral intestinal functions” (2). Researchers believe this crosstalk not only ensures the proper maintenance of gastrointestinal homeostasis, but may have impact, motivation, and higher cognitive function (2). What’s more, adds Anke Sentko, VP of regulatory affairs and nutrition communication at BENEO, Mannheim, Germany, “Short chain fatty acids formed during fermentation positively influence satiety regulation in the brain, reducing appetite and subsequent food intake.” So if positively influencing cognitive functions doesn’t inspire your customers to focus on gut health, telling them about how a healthy gut may reduce their appetite just might.

Immune system—The gastrointestinal tract is the primary point of interaction between the body and pathogenic microorganisms (3). As Sam Michini, VP of marketing and strategy at Deerland Probiotics, Kennesaw, GA, explains, “The gut is the primary residence of the immune system; 70% of the immune system lies in the digestive tract.” And it’s a good thing it does: Animal studies revealed that the gut microbiome shapes intestinal immune response (3). According to the reviewer of that study, “Establishing an infection requires the initial task of colonizing the host. For intestinal pathogens this can pose a difficult problem as all mammals are stably colonized by a consortium of bacteria that can act as a barrier to infection” (3). Keep the natural bacteria healthy, and pathogens will have a harder time finding a place to colonize.

Skin—We all know that sugary food is bad for our skin, but preliminary research is showing a connection between the gut microbiome and skin health. In a study of 300 patients, 80% who took L. acidophilus and L. bulgaricus saw clinical improvement in their acne; the research also suggested that probiotics support acne improvement when added to standard care and that orally consumed probiotics reduce markers of inflammation and oxidative stress (4). Alan Cheung, owner of Belle and Bella, Lexington, MA, notes, “If our gut is in a state of dysbiosis, the toxins will manifest on our skin. That’s why, at Belle and Bella, we developed a Skin Therapy Probiotic.”

Steps to Improving Gut Health Sometimes the digestive system gives off useful cues—a customer battling concerns like bloat or irregularity might come in looking for a digestive health supplement right off the bat. Other times, concerns will be vague, and digestive health may not be top of mind.

Given that gut health plays such an integral role in overall wellness, it’s best to take a minute to start a conversation. “By engaging customers in conversation and focusing on healthy digestion, you can excel in advocating for their good health,” says Rogosin. “How do they feel after they eat? Distended? Tired? Do they have healthy elimination at least once a day? Do they drink enough water, and eat an abundance of fruit, vegetables, and other high fiber foods like beans?” Dr. Hapke has a few more questions to tack on: Do they cook their own food? Do they take a minute to be present before eating? Do they pay attention to what they’re eating? She explains, “For many people, better digestion will be a result of better stress management around mealtimes.” Having that background from consumers can help pinpoint the best strategies. Here are three with proven benefits:

Cultivate calm—Dr. Hapke’s worries about stress management around meals are, well, distressingly valid. Customers who eat breakfast in the car, lunch at their work desk, and dinner in the 10 minutes between work and evening errands or activities don’t give their bodies time to produce digestive enzymes or direct resources to the digestive tract. They would be better served by giving their bodies the time necessary to naturally produce digestive enzymes than they would by grabbing a supplement, and those who suffer from anxiety might even benefit from a calming supplement before they would benefit from a digestive health supplement, says Dr. Hapke. “Optimal digestion and anxiety and stress are states that are opposed to each other.”

She means that literally. The sympathetic nervous system, or the “fight or flight” system, is the one we sit in when feeling anxious or worried. The parasympathetic nervous system is the “rest and digest” system, and we are physically incapable of entering it while anxious. “So many people in our society are eating meals in a stressful fashion that it is seen as a normal way to function,” says Dr. Hapke. Unfortunately, it’s the furthest thing from normal. When in the sympathetic nervous system, the body thinks it has to deal with an angry bear; it doesn’t realize that the uptick in stress hormones is because the owner of that body is worried about being late for work or about a sick child. As such, the body directs resources away from the digestive tract, which has little to do with the immediate ability to run from—or punch—a bear; this prevents the digestive tract from optimally digesting. It is therefore vital to breathe, relax, eat slowly and rest, so the brain and the body know it’s time to digest.

Focus on Diet—Is it possible to overemphasize diet? Sam Michini, VP of marketing and strategy at Deerland Probiotics and Enzymes, Kennesaw, GA, says definitely not. “Conventional diets remain abundant in unhealthy processed convenience foods that often contain preservatives, artificial sweeteners and sugars,” he says. “These all negatively affect the gut microbiome by encouraging the growth of Candida albicans along with undesirable strains of bacteria.”

The standard American diet is SAD indeed. A 2018 study revealed that migration from a non-western country to the United States is associated with “immediate loss of gut microbiome diversity and function in which US-associated strains and functions displace native strains and functions” (5). Cultivating a healthy microbiome with a dietary overhaul can alter the microbiome for the better—and in doing so improve overall health and help reduce risk of obesity.

A good diet for digestion includes plenty of fermented foods. Most cultures have something traditional—sauerkraut, miso, kimchi—and yogurt is always popular. Kombucha is also appealing for those who prefer a drink option. “We have always taken in probiotics through food,” says Cheung. “And most consumers would rather get their nutrition through food than pills. Let’s face it, who doesn’t like to eat? According to the IPA, the Global Retail Value of Probiotics in 2016 was $40 billion; 74% of that was in yogurt sales, and only 11% was in supplement form.” He thanks Danone for their ads starring Jamie Lee Curtis, which cemented in consumers’ minds the association of probiotics and digestive health with yogurt.

Another plus: With food, customers get extra nutrients. Cheung points out that yogurt, for instance, contains calcium and vitamin D, as well as healthy bacteria. He extols the virtues of homemade yogurt: “With our yogurt starter and yogurt maker, you can make your own yogurt at home with any type of milk, no added sugar, and a higher live probiotic count per serving than store-bought yogurt.” For customers who don’t have the time or inclination to make their own yogurt, an in- store yogurt bar could be a smash hit.

Get a supplement assist—Sometimes, diet isn’t enough, or a good diet is inaccessible. Customers should always talk to a doctor before beginning a supplement regimen, but they might find that a digestive care supplement is exactly what they need.

• Probiotics—If you’re looking for something new consider spore-forming bacteria. Tina Anderson, CEO and co-founder of Just Thrive Probiotics, Park Ridge, IL, says, “They are reconditioning the gut rather than just reseeding the gut.” One study revealed that in 30 days, supplementation with a spore-based probiotic—specifically, 4 billion spores from Bacillus indicus HU36, B. subtilis HU58, B. coagulans, B. licheniformis, and B. clausii—resulted in a “blunting of dietary endotoxin, triglycerides, and potentially systemic inflammation” (6). The researchers speculated that the underlying cause was a change in the gut microbiome, a change in gut permeability, or a combination of the two (6).

Besides the health benefits, spore-forming bacteria have a high survival rate (7). “Survivability of common probiotics is a big issue in the industry,” Anderson says. “Having 50 billion CFUs in a probiotic is only helpful if you can confirm that 50 billion CFUs are surviving in the digestive tract. Unfortunately, survivability studies with some probiotics indicate that more than 99% of the strains cannot survive digestion.” Thus, she says, the focus should be on quality not quantity. “Studies on B. indicus HU36 and B. subtilis HU58 have shown a 30% favorable shift in the microbiome with only 3 billion CFUs per day.”

The issue of quality or quantity is one that Sid Shastri, of Kaneka Nutrients, Pasadena, TX, also stresses. “Of crucial importance when consuming probiotics is to know the exact genus, species and clinical documentation of the strain,” he says. “On the one hand, it has been repeatedly demonstrated that some probiotic effects appear to be general species benefits. For example, capability of Bifidobacteria to stimulate the immune system seems to be species specific, while other benefits appear to be strain-specific—for instance, L.rhamnosus GG strain ATCC53103 has a high capacity to adhere to intestinal epithelium, but scientific research has shown that generic strains of L.rhamnosus GG may be devoid of epithelium-binding genes because of genomic deletions spanning dozens of genes. Clearly, intake of billions of bacteria devoid of genes producing a health benefit can be rather useless. As probiotics for human usage demand substantiation of efficacy by a clinical trial, clinical data will reveal optimal strain specific dosage.” At Kaneka Nutrients, he adds, the approach is to find the minimum CFU count that exerts the clinical benefit.

An additional tip for your customers from Anderson: Probiotics should be taken with the biggest meal of the day. Just Thrive conducted a Gut Model Study on B. indicus HU36. “The study revealed that it used food to germinate throughout the intestines. In essence,” she says, “these strains are using food to fuel themselves as they make their way through the intestinal tract.” This advice is useful with non-spore-forming strains, too. One study on Lactobacillus helveticus R0052, L. rhamnosus R0011, Bifidobacterium longum R0175 and Saccharomyces cerevisiae boulardii found survival was best either with a meal or 30 minutes before a meal (8). Survival when given with milk was significantly better than when given with apple juice or water (8). The researchers concluded that non-enteric coated probiotics should, therefore, be taken with or just prior to a meal containing fats (8).

• Prebiotics—Prebiotics are non-digestible fibers that provide food for bacteria in the gut. In the opinion of Sentko, they are the best thing people can do for their digestive health. Among the most heavily studied prebiotics are oligosaccharides, which—alongside inulin (another well-studied prebiotic)—can be found in chicory root. “Numerous worldwide studies with chicory root fiber, from infants to the elderly, confirm that prebiotics are preferred feed for bifidobacteria in the human intestine,” she says. “Supporting the good bacteria inside by giving them the feed they love so that they multiply, grow, and can do more good in supporting the host’s health. This is the natural way of supporting digestive health and a number of other health related aspects. This is the future.”

Moreover, Sentko wants retailers to know, “One out of two consumers associate prebiotics with a healthy digestive system. Consumers are increasingly aware of the benefits of prebiotics and are looking for products supporting digestive health and overall wellbeing.” • Enzymes—Difficulties or irregularities surrounding elimination might point to probiotics and prebiotics, but discomfort after consuming different foods may call for enzymes. “Taking a blend of enzymes and probiotics is an easy way to support digestion,” says Rogosin. “Combining the ability to assimilate nutrients from our food and food for the microbiome will optimize digestion. LifeSeasons Digestivi-T, for instance, helps break down food and contains beneficial bacteria to promote the health of the entire digestive tract.” Dr. Hapke agrees that if customers have no choice but to eat-on-the-go or can’t cook a homemade meal, an enzyme supplement can make a difference. She adds, “If someone is avoiding groups of foods such as protein, carbs, fiber, etc., because they ‘don’t sit well,’ digestive enzymes may help them expand their diet.”

If a customer is dealing with discomfort after eating and a conversation reveals that he or she doesn’t avoid groups of foods, Michini suggests considering an “elimination diet”—avoiding groups of foods one at a time until the customer determines what isn’t sitting well. Why? Proteins, carbs and fats all require different enzymes for digestion: lactase or amylase will break down a carbohydrate, but all the lactase in the world won’t break down a single molecule of fat. Fat requires a fat-digesting enzyme, like lipase, which, in turn, can’t break down carbs. Proteins require protease, or bromelain; fiber requires cellulase or pectinase—and this is by no means a complete list. It’s also worth keeping in mind that bodies only produce so many enzymes, such that if a person begins drinking protein shakes as a fitness aid, they might find themselves incapable of digesting it, and might find a supplement like ProHydrolase—which breaks down the peptides in proteins—useful.

Another option for consumers: Enzyme formulations that are based on the type of diet one follows. That’s the approach of the Pure Essence product line, which offers options to help people on a keto diet, those on a vegan diet, and those on an omnivorous diet get the enzymes necessary to break down what they actually eat, with a goal of easing digestive difficulties across the board.

If a customer is waffling between probiotics and enzymes, consider Michini’s advice: “Our modern diets often lead to impaired digestion, and healthy digestion requires optimal enzyme activity to break down the foods we eat, as well as probiotics to maintain a healthy gut flora.” Suggest that they talk to their doctor about trying both.

• Herbals—For customers who prefer herbs, options abound. Peyton Berookim, M.D., director of the Gastroenterology Institute of Southern California, Beverly Hills, CA, recommends prickly pear cactus, olive leaf extract, and apple extract—the three main components in Bioflux, his recipe for heartburn and indigestion relief. “Prickly pear cactus provides a gel coating that soothes the stomach and esophagus,” Dr. Berookim says. “The antioxidants in the olive plant help clean the cellular damage and help stop tissue irritation and stress. Apple extract is loaded with polyphenols, which help nourish the tissues of the upper digestive tracts. All together, they may provide relief and protection from further damage.”

Gaia Herbs stocks several traditional herbal extracts: black walnut, dandelion root, peppermint, and goldenseal root are all, according to the company, used to support the digestive process.

Final Takeaway No matter what product theoretically works best for a customer, ensure that the products you stock are the best quality. “I would encourage retailers to ask for human clinical trials on finished formulations,” says Anderson. A strain or herb that works just fine on its own might not work at all in concert with another. Ask for the science. Be confident in what’s on your shelves. WF


Correction: In the print edition, Dr. Hapke's name is misspelled Dr. Hopke.
  1. National Institute of Diabetes and Digestive and Kidney Diseases, “Digestive Disease Statistics for the United States.” Posted November 2014. Accessed 12/04/18.
  2. Marilia Carabotti et al., “The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems,” Annals of Gastroenterology, 28(2), 203-209(2015).
  3. June Round and Sarkis Mazmanian, “The gut microbiome shapes intestinal immune responses during health and disease,” Nature Reviews Immunology, 9(5), 313-323(2014).
  4. Whitney Bowe and Alan Logan, “Acne vulgaris, probiotics and the gut-brain-skin axis—back to the future?” Gut Pathogens, 3(1), 2011.
  5. Pajau Vangay et al., “US Immigration Westernizes the Human Gut Microbiome,” Cell, 175(4), 962-972(2018).
  6. Brian McFarlin et al., “Oral spore-based probiotic supplementation was associated with reduced incidence of post-prandial dietary endotoxin, triglycerides, and disease risk biomarkers,” World Journal of Gastrointestinal Pathophysiology, 8(3), 117-126 (2017).
  7. Bader, A. Albin, and U. Stahl, “Spore-forming bacteria and their utilization as probiotics,” Beneficial Microbes, 3(1), 67-75(2012).
  8. Tompkins, I. Mainville, and Y. Arcand, “The impact of meals on a probiotic during transit through a model of the human upper gastrointestinal tract,” Beneficial Microbes, 2(4), 295-303(2011).