4.4 The Nurse’s Role in the Promotion of Gut Health

Gut health is crucial for overall well-being, affecting everything from immunity to mental health. The balance of our digestive system and gut microbiome plays a key role in maintaining proper bodily functions and preventing chronic diseases.

Nurses need to understand how diet, medications, and various conditions impact gut health. By recognizing these factors, they can better support patients in maintaining a healthy gut and addressing related health issues.

Gut Health and the Role of Nurses

Concept of gut health homeostasis

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• Balance and stability of the digestive system and gut microbiome maintains proper digestion, absorption, and elimination of nutrients while supporting a healthy gut barrier function
• Gut health homeostasis is crucial for overall well-being as it significantly influences immune system function, with 70-80% of immune cells residing in the gut and the gut microbiome helping train and regulate immune responses
• Proper gut health affects nutrient absorption and utilization, ensuring the body receives essential nutrients for optimal functioning
• Gut health impacts mental health through the gut-brain axis, where the gut microbiome communicates with the central nervous system, and imbalances have been linked to mood disorders, anxiety, and depression
• Maintaining gut health homeostasis contributes to chronic disease prevention, including obesity, type 2 diabetes, cardiovascular disease, and certain cancers
• The enteric nervous system plays a crucial role in regulating gut function and communicating with the central nervous system

Dietary influences on gut microbiome

• Prebiotics, non-digestible plant fibers found in foods like garlic, onions, leeks, asparagus, and bananas, feed beneficial gut bacteria and promote their growth and activity
• Probiotics, live microorganisms found in fermented foods like yogurt, kefir, sauerkraut, and kimchi, help restore and maintain a healthy gut microbiome balance when consumed
• Consuming a diverse range of nutrient-dense foods supports a diverse and resilient gut microbiome while providing essential nutrients for optimal digestive function
• Processed and high-sugar foods can disrupt the gut microbiome balance, promoting the growth of harmful bacteria and inflammation, and have been linked to increased intestinal permeability (leaky gut)
• A diet rich in diverse plant-based foods promotes gut microbiota diversity, which is associated with better overall health outcomes

Medication effects on gut health

• Antibiotics can disrupt the gut microbiome balance by killing beneficial bacteria, potentially leading to antibiotic-associated diarrhea and C. difficile infections, but probiotics may help restore the gut microbiome after antibiotic use
• Proton pump inhibitors (PPIs) reduce stomach acid production, altering digestive processes, and long-term use may lead to nutrient malabsorption (vitamin B12, magnesium) and increased risk of enteric infections and C. difficile
• Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause gastrointestinal irritation, increase intestinal permeability, and may lead to ulcers, bleeding, and inflammation in the digestive tract, with risks increasing with higher doses and prolonged use
• Opioids can slow down gut motility and cause constipation, potentially leading to intestinal blockages and bacterial overgrowth, and chronic use can result in opioid-induced bowel dysfunction

Gut health vs pathological conditions

• Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, is characterized by chronic inflammation of the digestive tract and associated with gut microbiome imbalances (dysbiosis), and may benefit from dietary modifications and probiotic supplementation
• Irritable bowel syndrome (IBS), a functional gastrointestinal disorder affecting bowel habits and causing abdominal pain, is linked to gut microbiome alterations and increased intestinal permeability, and may improve with a low-FODMAP diet and stress management techniques
• Celiac disease, an autoimmune disorder triggered by gluten consumption, leads to damage of the small intestine lining and nutrient malabsorption, requiring strict adherence to a gluten-free diet for management
• Metabolic disorders, such as obesity and type 2 diabetes, are associated with gut microbiome imbalances that may contribute to low-grade inflammation and insulin resistance, and prebiotic and probiotic interventions may help improve metabolic health

Factors affecting gut health

• Gastrointestinal pH influences the growth of different bacterial species and affects nutrient absorption
• Mucosal barrier function is essential for protecting the gut lining from harmful substances and pathogens
• Stress can impact gut motility and alter the balance of gut bacteria, potentially leading to digestive issues