The blue poop challenge: You eat a blue muffin and track how long it takes for your body to process it (yes… blue outcome). Transit time is a good indicator for physical and mental health. In this article we explain the importance of a good poop and a healthy gut, based on the latest scientific evidence. We also give you tips on how to improve your health and mood, by improving your gut.
Gut problems are very common
Gut problems, also known as disorders of gut-brain interaction are disorders related to any combination of motility (movement) disturbance, visceral hypersensitivity (increased sensitivity to stimuli from the gut presumably due to increased sensitivity of intestinal nerves), altered immune function, altered gut microbiome, and altered central nervous system processing.[2]
A large-scale multinational study withover 73.000 respondents in 33 countries in 6 continents has shown that over 40 percent of persons worldwide have disorders of gut-brain interaction, which affect the quality of life and health care use.[3]
More common in women
These disorders, such as irritated bowel syndrome (IBS) are more common in women than in men.[4] Women with IBS have been reported to feel more fatigue, depression, anxiety, and lower quality of life than men with IBS [5] The mechanisms behind these differences are still largely unknown. [6] One possible explanation is that women differ from men in the way they experience, deal with and report somatic disturbances.
Another explanation is that women show differences in brain structure and function compared to men, including higher levels of GABA. This is an inhibitory neurotransmitter that influences the activity of neurons that control digestion. The nerves controlling the intestines are less excitable and receive more inhibitory signals from the brain, offering one explanation of why digestion problems are more common in women.[7]
Sex hormones might also play a role in explaining the differences between women and men. Ovarian hormones variations along the menstrual cycle affect gastrointestinal function in both healthy and IBS populations. They can modulate pain processing by interacting with neuromodulator systems and the emotional system responsible for pain perception. These hormones can also modulate the susceptibility to stress, which is a crucial factor in IBS occurrence and the severity of its symptoms.[8]
What causes gut problems?
There is growing evidence that many aspects of our lifestyle and environment contribute to the development of disease.[9] Numerous factors are associated with disorders of gut brain interactions, such as infections, low grade inflammation and several factors that trigger immune activation.[10]
Genetics and environment
Genetic predisposition making a person more vulnerable undercertain circumstances, also plays a role. For example, while a genetic basis for gluten intolerance (celiac disease) clearly exists, it is believed that environmental factors such as an increase in gluten in the human diet accounts for the rising prevalence of this disease.[11]
Lifestyle
Lifestyle factors are strongly associated with disorders of gut-brain interaction. Such as the intake of processed foods (How artificial is your food?)that are high in fat, and sugar and low in fiber (Lose weight by eating fiber) ; being overweight; not exercising enough; smoking; and taking drugs, medication and alcohol.[12] Almost 70 percent of our immune activity takes place in the gut. Many chronic diseases such as diabetes type 2, obesity, cardiovascular diseases, dementia, and also high blood pressure, high cholesterol and mental health issues are related to an inadequate lifestyle.[13]
Sleeping disorders are often related to an inappropriate lifestyle and gut problems. Poor sleep can worsen these problems. Short sleep can influence dietary choices, as well as meal timing, and the circadian system (the internal process that regulates the sleep–wake cycle) drives temporal changes in metabolic patterns. Maybe you recognize this: after a short night you have more appetite for sweets or junk food, and feel more hungry. Chronic sleep disorders are associated with metabolic disorders such as obesity and diabetes type 2. Research has shown that going to bed later that usual, even for a single night, can worsen blood sugar response after eating the next morning.[14]) Patients with inappropriate dietary habits and chronic digestive disorders often sleep less and show lower sleep efficiency, compared with healthy individuals.[15]
Stress can affect sleep patterns and lifestyle factors such as a disturbed eating pattern or a higher intake of substances. Stress can also by itself result in alterations of the brain-gut interactions, leading to gut problems. [16]
Ageing
The deterioration process of the body is the primary risk factor for the majority of disease, such as cancer, diabetes, cardiovascular disorders, and neurodegenerative diseases. Aging also affects all functions of the gastrointestinal system: motility, enzyme and hormone secretion, digestion, and absorption.[17]
Altered gut microbiome
The gastrointestinal tract that runs from mouth to anus harbours a complex and dynamic population of micro organisms, called the gut microbiome. This is a collection of all genetic material from microbes in the gut. Intestinal bacteria play a crucial role in maintaining immune and metabolic balance and protecting against pathogens. [18]
The microbiome has several tasks. It extracts nutrients from food; digest fiber and protein; makes vitamin B and K; shapes the immune system; and protects against pathogens. Especially the digestion of fiber is important: Microbes turn fiber into molecules such as short-chain fatty acids. These molecules are important for gut health, blood sugar and cholesterol, appetite control and the immune system.[19]
The precise mix of microbes in the gut influence health. Diversity and high levels of ‘good’ microbes are related with health benefits.[20] Altered gut bacterial composition has been associated with inflammatory, metabolic and neurologic diseases, infections and disorders of gut brain interaction. [21] A lower diversity of microbes and a higher level of harmful ‘bad’ bacteria increase the risk of disease such as inflammatory bowel syndrome, diabetes type 2, eczema and arthritis.[22]
Many factors can influence microbiome composition in early life, including infection, mode of birth delivery, use of antibiotic medications, the nature of nutritional provision, environmental stressors, and genetics. Stress can significantly impact the microbiome-gut-brain axis at all stages of life, and as we age microbial diversity diminishes.[23]
Nutrition also plays an important part. A Western diet, high in processed food and low in fiber can lower the diversity of the microbiome. Research has shown that the loss of diversity can become permanent within generations. Furthermore, a Western diet is associated with higher levels of harmful bacteria in the gut, compared to a diet that is more plant- based and unprocessed (How bad is eating meat?).[24]
Why is the gut called the second brain?
The gut-brain interaction, also known as the gut-brain axis (GBA) consists of bidirectional communication between the central and the enteric nervous system.[25] The nervous system consists of two parts. The central nervous system (CNS) consists of the brain and spinal cord. It combines information from the entire body and coordinates activity across the body.[26] The peripheral nervous system contains all nerves outside the central nervous system. It connects the central nervous system to all areas of the body. It allows the brain and spinal cord to receive and send information to other areas of the body, which allows us to react to stimuli in ourenvironment.[27]
The enteric nervous system (ENS) is the nervous system of the gastrointestinal tract, the digestive system from the mouth to the anus. It is the only part of the peripheral nervous system capable of local autonomous function. This system can detect the physiological condition of digestive system, integrate information about it and provide output to control and adjust it. Autonomous, without input of the central nervous system. [28]
The ENS has a two-way connection with the central nervous system, working together to control the digestive system in the context of local and whole body physiological demands. [29] The connection links the emotional and cognitive centers of the brain with peripheral intestinal functions. Because of its extent and its degree of autonomy, the ENS has been referred to as a second brain.[30]
But there is more…
Gut microbiome
The microbiome and the brain communicate with each other via various routes including the immune system, the vagus nerve and the enteric nervous system.[31] This interaction appears to be bidirectional: signals go from gut-microbiota to brain and from brain to gut-microbiota. [32]
Gut microbes are capable of producing most neurotransmitters found in the human brain. They can influence central neurochemistry and behavior, and certain bacteria can have an impact on stress responses and cognitive functioning. [33]
Disfunction of the enteric nervous system is often linked to digestive and neurological disorders, and microbiome are implicated in many conditions such as autism, anxiety, obesity, schizophrenia, Parkinson's disease, and Alzheimer's disease.[34] Manipulating the gut microbiota with for example probiotics can alter brain function and function as part of the treatment of gut-brain axis disorders, such as depression and autism. (Weight loss with fibers) [35]
How to assess gut health?
Gut health refers to the effective digestion and absorption of nutrients, the normal function of the immune and endocrine (hormonal) system, gut microbiota and metabolism, and gut motility.[36] As shown above, gut health is strongly related to physical and mental health in a broader sense.
There are several ways to check the health of your gut. If you regularly suffer from bloating, nausea, diarrhea, constipation, or fluctuations between both, something is off and you are more susceptibleto illness and chronic disease. Fatigue is also a very common symptom.[37]
Besides being aware of these symptoms, you can check gut health via the traditional ways of stool consistency and frequency. In other words: do you have nice firm poop, and do you go regularly?[38]
A more informative indicator for gut health is transit time, the time from input (mouth) to output (anus), since normal motility of the gastrointestinal tract is a key factor in maintaining gut health. Furthermore, transit time is an indicator for the health of the microbiome as well as for the risk of cardiometabolic diseases.[39]
Blue Poop Challenge
The Blue Poop Challenge is an easy safe way to test your gut health at home. Just bake two muffins per person and use blue eatable dye for the batter. Record the day and time you eat it, and the day and time you spot a blue outcome for the first time. This is your transit time. You can eat anything you like in between.[40]
The outcome
If it takes less than 14 hours to get a blue outcome, the transit time is fast. It is normal if it takes between 14 to 58 hours to first spot a blue outcome, and slow if it takes longer than 59 hours. (The most common transit time in extensive research[41] was 28.7 hours).
Transit time is negatively associated with stool consistency and positively associated with stool frequency. This means that a longer transit time corresponds with constipation and a shorter transit time with diarrhea; and a longer transit time is associated with fewer weekly bowel movements (toilet visits with results). [42]
Transit time and health
Transit time affects gut microbiota composition and function.A longer transit time is associated with a change in the diversity and metabolism in the microbiome, such as an increase in relative adbundance of almost all bacterial species. Especially of Akkermansiamuciniphila, Bacteroides and Alistipes spp. Akkermansia muciniphila is a bacterium with a healing effect on the disrupted metabolism in obesity such as inflammation of fat tissue and insulin resistance.[43] Bacteroides has a role in promoting health but is also associated with diarrhea, inflammatory bowel disease, and colorectal cancer.[44] Alistipes may have protective effects against some diseases, including liver fibrosis, colitis, cancer immunotherapy, and cardiovascular disease, but is also pathogenic in colorectal cancer and associated with mental signs of depression.[45]
Although diversity and richness of the microbiome might be preferred, the composition within that diversity is crucial: the perfect mix and high levels of good microbes. Furthermore, a longer transittime also gives rise to higher levels of potential degradation products as well as other effects that can negatively affect cardiometabolic health.[46]
Additionally, a longer transit time is predictive of greater visceral fat: fat surrounding vital organs related to a higher risk of chronic diseases (often measured via waist size). A longer transit time is also associated with higher postprandial responses, meaning higher glucose and triglyceride concentrations after a meal, which is an independent risk factor for cardiometabolic disease. Conversely, a healthier microbiome is predictive of lower visceral fat and postprandial responses. [47]
To sum it up
Transit time is a good indicator for the health of your gut and your risk of cardiometabolic diseases. A normal transit time is somewhere between 14 to 58 hours.
How to improve your gut health?
Gut health can be improved with changes in lifestyle such as in nutrition, exercise, improving sleep (melatonin, the sleep- hormone, has protective effects against stress induced damages of the digestive system[48]), not smoking and drinking, and reducing stress.
Since we are all unique, all have a unique microbiome and all respond in a unique way to food and exercise, there is not a one size fits all approach.(Why your friend loses weight but you don't) There never is in life. Nevertheless, research[49] has shown there are some general guidelines to improve the microbiome with nutrition, exercise and behavioral adjustments.
Nutrition
As mentioned, a Western diet with processed foods, high in fat and sugar and low in fiber is harmful for the health of the gut and microbiome, and for health in general. (How artificial is your food?)
Also, restrictive diets are not good for the health of the gut. The gut microbiome needs a balanced diet rich of nutrients. Artificial sweeteners, often part of restrictive diets due to the lack of calories, are also something to avoid since they are associated with changes in the microbiome.[50]
A Mediterranean diet on the other hand, is beneficial as we mentioned in our previous article about the harmful effectof fructose. Nuts, seeds, colorful vegetables and fruits contain lots of nutrients, fiber and polyphenols (anti-oxidants with anti- inflammatory effect). Also, coffee increases the diversity of the microbiome. And by preventing late night snacking, the gut microbes can recover, as well as clean up the gut at night to keep the gut healthy and to support the immune system. [51]
Probiotica, fiber and prebiotica
Nutrition high in fiber and in fermented products can support a healthy gut, increase the diversity of the microbiome and decrease inflammation and positively effect the immune system.[52]
Probiotic foods are fermented foods such as live yoghurt, kombucha and sauerkraut that contain living microbes that can increase the amount of good microbes and the diversity of the microbiome in the gut. [53] Probiotics affect the gut brain interactions and attenuate the development of stress-induced disorders in the digestive system.[54]
Prebiotic foods such as legumes, bananas, muesli and bread, contain fermentable fibers that are digested by the body. This type of fiber can bind bile acids, glucose, cholesterol and fatty acids and form short-chain fatty acids (SCFA). As mentioned earlier, SCFA are an important source for the immune system; they have a positive effect on the gut- brain aix and they relate to serotonin, the happiness hormone.. Non- fermentable fibers such as in wheat, vegetables, cabage and apples are not digested by the body. They take up fluids, improve gut motility and give afeeling of satiation [55]
Nutrition for athletes
Gut problems are common among athletes. Many elite athletes suffer from disorders such as a leaky gut, increase catabolism and depression. The psychosocial and physical demands during intense exercise can initiate a stress response, resulting in the release of stress and catabolic hormones, inflammatory cytokines and microbial molecules. There is evidence of a high correlation between physical and emotional stress during exercise and changes in the composition of the microbiome.
Common dietary recommendations for athletes are primarily based on a low consumption of plants, which is associated with reduced microbiome diversity, lower production of short chain fatty acids and neurotransmitters. A diet containing more plant-based foods and fiber can improve microbiome in athletes.[56] (How bad is eating meat?)
Exercise
Exercise stimulates motility, shortens transit time and increases the diversity of the microbiome.[57] Meeting the daily exercise standards is requires to maintain current health, not even to improve it!
Fix your food, fix your brain
Disorders of gut brain interactions are associated with very poor quality of life and high healthcare use. These disorders can cause chronic symptoms throughout the gut such as ongoing pain. These symptoms can worsen due to ineffective coping that results in stress. Psychiatric comorbidities such as depression and anxiety are highly prevalent in patients with gut problems. It is implied that mood disorders "cause" gastrointestinal symptoms. In some cases, gut problems arise first, followed by mood disorders, but also the other way around. Mechanisms that play a role are low grade inflammation of the body, chronic infections, systematic immune activation, altered microbiome and abnormalities in serotonin metabolism [58].
Changes in lifestyle such as in nutrition, exercise and sleep can help to improve gut brain interactions and relieve symptoms. Lifestyle coaching and behavioral therapy, if necessary supported with antidepressants, can help to develop more effective coping mechanisms.[59]
Concluding
Your poop tells it all. Garbage in is garbage out. If you eat processed foods, high in fat and sugar, low in fiber; if you do not exercise regularly, or sleep well, you are doing harm to your physical and mental health.
With some simple adjustments in your nutrition and exercise regime, you can improve your microbiome and with that your physical and mental health, and decrease the risk of infections and diseases. Furthermore, you will feel better on a daily basis.
Take it one step at a time. Start with changing one thing for three weeks. For example: eat three vegetables every day at lunch time. After a few weeks, that step has become a habit. Go from there, to the next little step. By taking small steps, you increase your chance of success, and by doing so, you can create your own flywheel of health improvement. (How to develop sustainable healthy habits)
Start today!
Create your own health!©
References
Image retrieved from cleaneatingmag.com
[1] AsnicarF, Leeming ER, Dimidi E, Mazidi M, Franks PW, Al Khatib H, Valdes AM, Davies R,Bakker E, Francis L, Chan A, Gibson R, Hadjigeorgiou G, Wolf J, Spector TD,Segata N, Berry SE. Blue poo: impact of gut transit time on the gut microbiomeusing a novel marker. Gut. 2021 Sep;70(9):1665-1674. doi:10.1136/gutjnl-2020-323877. Epub 2021 Mar 15. PMID: 33722860; PMCID: PMC8349893.
[1] https://joinzoe.com/learn/how-to-improve-gut-health
[2] SperberAD, Bangdiwala SI, Drossman DA, Ghoshal UC, Simren M, Tack J, Whitehead WE,Dumitrascu DL, Fang X, Fukudo S, Kellow J, Okeke E, Quigley EMM, Schmulson M,Whorwell P, Archampong T, Adibi P, Andresen V, Benninga MA, Bonaz B, Bor S,Fernandez LB, Choi SC, Corazziari ES, Francisconi C, Hani A, Lazebnik L, LeeYY, Mulak A, Rahman MM, Santos J, Setshedi M, Syam AF, Vanner S, Wong RK,Lopez-Colombo A, Costa V, Dickman R, Kanazawa M, Keshteli AH, Khatun R, MalekiI, Poitras P, Pratap N, Stefanyuk O, Thomson S, Zeevenhooven J, Palsson OS. WorldwidePrevalence and Burden of Functional Gastrointestinal Disorders, Results of RomeFoundation Global Study. Gastroenterology. 2021 Jan;160(1):99-114.e3. doi:10.1053/j.gastro.2020.04.014. Epub 2020 Apr 12. PMID: 32294476.
[3] Sperber AD, Bangdiwala SI,Drossman DA, Ghoshal UC, Simren M, Tack J, Whitehead WE, Dumitrascu DL, Fang X,Fukudo S, Kellow J, Okeke E, Quigley EMM, Schmulson M, Whorwell P, ArchampongT, Adibi P, Andresen V, Benninga MA, Bonaz B, Bor S, Fernandez LB, Choi SC,Corazziari ES, Francisconi C, Hani A, Lazebnik L, Lee YY, Mulak A, Rahman MM,Santos J, Setshedi M, Syam AF, Vanner S, Wong RK, Lopez-Colombo A, Costa V,Dickman R, Kanazawa M, Keshteli AH, Khatun R, Maleki I, Poitras P, Pratap N,Stefanyuk O, Thomson S, Zeevenhooven J, Palsson OS. WorldwidePrevalence and Burden of Functional Gastrointestinal Disorders, Results of RomeFoundation Global Study. Gastroenterology. 2021 Jan;160(1):99-114.e3. doi:10.1053/j.gastro.2020.04.014. Epub 2020 Apr 12. PMID: 32294476.
[4] SperberAD, Bangdiwala SI, Drossman DA, Ghoshal UC, Simren M, Tack J, Whitehead WE,Dumitrascu DL, Fang X, Fukudo S, Kellow J, Okeke E, Quigley EMM, Schmulson M,Whorwell P, Archampong T, Adibi P, Andresen V, Benninga MA, Bonaz B, Bor S,Fernandez LB, Choi SC, Corazziari ES, Francisconi C, Hani A, Lazebnik L, LeeYY, Mulak A, Rahman MM, Santos J, Setshedi M, Syam AF, Vanner S, Wong RK,Lopez-Colombo A, Costa V, Dickman R, Kanazawa M, Keshteli AH, Khatun R, MalekiI, Poitras P, Pratap N, Stefanyuk O, Thomson S, Zeevenhooven J, Palsson OS. WorldwidePrevalence and Burden of Functional Gastrointestinal Disorders, Results of RomeFoundation Global Study. Gastroenterology. 2021 Jan;160(1):99-114.e3. doi:10.1053/j.gastro.2020.04.014. Epub 2020 Apr 12. PMID: 32294476.
[5] Kim, Y.S., & Kim, N. (2018). Sex-Gender Differences in Irritable Bowel Syndrome. Journal of neurogastroenterology and motility, 24(4), 544–558. https://doi.org/10.5056/jnm18082
[6] Idem
[7] American Physiological Society (APS). (2015, March 30). Whygastrointestinal disorders afflict women more often. ScienceDaily. Retrieved January 1, 2022 from https://www.sciencedaily.com/releases/2015/03/150330134409.htm
[8] MeleineM, Matricon J. Gender-related differences in irritable bowel syndrome:potential mechanisms of sex hormones. World J Gastroenterol. 2014 Jun14;20(22):6725-43. doi: 10.3748/wjg.v20.i22.6725. PMID: 24944465; PMCID:PMC4051914.
[9] Hall EH, CroweSE. Environmental and lifestyle influences on disorders of the large and smallintestine: implications for treatment. Dig Dis. 2011;29(2):249-54. doi:10.1159/000323930. Epub 2011 Jul 5. PMID: 21734392.
[10] TalleyNJ. What Causes Functional Gastrointestinal Disorders? A Proposed DiseaseModel. Am J Gastroenterol. 2020 Jan;115(1):41-48. doi:10.14309/ajg.0000000000000485. PMID: 31895721.
[11] Talley NJ. WhatCauses Functional Gastrointestinal Disorders? A Proposed Disease Model. Am JGastroenterol. 2020 Jan;115(1):41-48. doi: 10.14309/ajg.0000000000000485. PMID:31895721; Hall EH, Crowe SE. Environmental and lifestyle influences ondisorders of the large and small intestine: implications for treatment. DigDis. 2011;29(2):249-54. doi: 10.1159/000323930. Epub 2011 Jul 5. PMID: 21734392.
[12] Hall EH, CroweSE. Environmental and lifestyle influences on disorders of the large and smallintestine: implications for treatment. Dig Dis. 2011;29(2):249-54. doi:10.1159/000323930. Epub 2011 Jul 5. PMID: 21734392.
[13] Ben Witteman. Voeding en leefstijlbij chronische (darm)aandoeningen: de hoeksteen van de behandeling. JaarcongresVereniging Arts en Leefstijl. November 2021
[14] Tsereteli, N., Vallat,R., Fernandez-Tajes, J. et al. Impact of insufficient sleep on dysregulatedblood glucose control under standardised meal conditions. Diabetologia (2021).https://doi.org/10.1007/s00125-021-05608-y
[15] VerniaF, Di Ruscio M, Ciccone A, Viscido A, Frieri G, Stefanelli G, Latella G. Sleepdisorders related to nutrition and digestive diseases: a neglected clinicalcondition. Int J Med Sci. 2021 Jan 1;18(3):593-603. doi: 10.7150/ijms.45512.PMID: 33437194; PMCID: PMC7797530.
[16] KonturekPC, Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinicalconsequences, diagnostic approach and treatment options. J Physiol Pharmacol.2011 Dec;62(6):591-9. PMID: 22314561.
[17]Dumic, I., Nordin, T., Jecmenica, M., Stojkovic Lalosevic,M., Milosavljevic, T., & Milovanovic, T. (2019). Gastrointestinal TractDisorders in Older Age. Canadian journal of gastroenterology & hepatology, 2019, 6757524. https://doi.org/10.1155/2019/6757524.
[18] Thursby,E., & Juge, N. (2017). Introduction to the human gut microbiota. The Biochemical journal, 474(11), 1823–1836.https://doi.org/10.1042/BCJ20160510; Hall EH, Crowe SE.Environmental and lifestyle influences on disorders of the large and smallintestine: implications for treatment. Dig Dis. 2011;29(2):249-54. doi:10.1159/000323930. Epub 2011 Jul 5. PMID: 21734392.
[19]https://joinzoe.com/learn/the-gut-microbiome-and-your-health.Retrieved Jan 3, 2022.
[20]idem
[21] Thursby,E., & Juge, N. (2017). Introduction to the human gut microbiota. The Biochemical journal, 474(11), 1823–1836.https://doi.org/10.1042/BCJ20160510; Hall EH, Crowe SE.Environmental and lifestyle influences on disorders of the large and smallintestine: implications for treatment. Dig Dis. 2011;29(2):249-54. doi:10.1159/000323930. Epub 2011 Jul 5. PMID: 21734392.
[22]https://joinzoe.com/learn/the-gut-microbiome-and-your-health.Retrieved Jan 03, 2022.
[23] Cryan JF, O'Riordan KJ, Cowan CSM, Sandhu KV,Bastiaanssen TFS, Boehme M, Codagnone MG, Cussotto S, Fulling C, Golubeva AV,Guzzetta KE, Jaggar M, Long-Smith CM, Lyte JM, Martin JA, Molinero-Perez A,Moloney G, Morelli E, Morillas E, O'Connor R, Cruz-Pereira JS, Peterson VL, ReaK, Ritz NL, Sherwin E, Spichak S, Teichman EM, van de Wouw M, Ventura-Silva AP,Wallace-Fitzsimons SE, Hyland N, Clarke G, Dinan TG. The Microbiota-Gut-BrainAxis. Physiol Rev. 2019 Oct 1;99(4):1877-2013. doi: 10.1152/physrev.00018.2018.PMID: 31460832.; Rinninella, E., Raoul, P., Cintoni, M., Franceschi, F.,Miggiano, G., Gasbarrini, A., & Mele, M. C. (2019). What is the Healthy GutMicrobiota Composition? A Changing Ecosystem across Age, Environment, Diet, andDiseases. Microorganisms, 7(1), 14. https://doi.org/10.3390/microorganisms7010014.
[24]https://joinzoe.com/learn/the-gut-microbiome-and-your-health.Retrieved Jan 03, 2022.
[25] Carabotti,M., Scirocco, A., Maselli, M. A., & Severi, C. (2015). The gut-brain axis:interactions between enteric microbiota, central and enteric nervous systems. Annals of gastroenterology, 28(2), 203–209.
[26] https://www.medicalnewstoday.com/articles/307076.Retrieved Jan 1st 2022.
[27] https://www.verywellmind.com/what-is-the-peripheral-nervous-system-2795465.Retrieved Jan 1st 2022.
[28]http://www.scholarpedia.org/article/Enteric_nervous_system. Retrieved Jan 1st2022; Carabotti, M., Scirocco,A., Maselli, M. A., & Severi, C. (2015). The gut-brain axis: interactionsbetween enteric microbiota, central and enteric nervous systems. Annals of gastroenterology, 28(2), 203–209;Rao, M., Gershon, M. The bowel and beyond: the enteric nervous system inneurological disorders. Nat Rev Gastroenterol Hepatol 13, 517–528 (2016). https://doi.org/10.1038/nrgastro.2016.107
[29] http://www.scholarpedia.org/article/Enteric_nervous_system.Retrieved Jan 1st 2022.
[30]Carabotti, M., Scirocco, A., Maselli, M. A., & Severi, C.(2015). The gut-brain axis: interactions between enteric microbiota, centraland enteric nervous systems. Annals of gastroenterology, 28(2), 203–209;Rao, M., Gershon, M. The bowel and beyond: the enteric nervous system inneurological disorders. Nat Rev Gastroenterol Hepatol 13, 517–528 (2016). https://doi.org/10.1038/nrgastro.2016.107
[31]CryanJF, O'Riordan KJ, Cowan CSM, Sandhu KV, Bastiaanssen TFS, Boehme M, CodagnoneMG, Cussotto S, Fulling C, Golubeva AV, Guzzetta KE, Jaggar M, Long-Smith CM,Lyte JM, Martin JA, Molinero-Perez A, Moloney G, Morelli E, Morillas E,O'Connor R, Cruz-Pereira JS, Peterson VL, Rea K, Ritz NL, Sherwin E, Spichak S,Teichman EM, van de Wouw M, Ventura-Silva AP, Wallace-Fitzsimons SE, Hyland N,Clarke G, Dinan TG. The Microbiota-Gut-Brain Axis. Physiol Rev. 2019 Oct1;99(4):1877-2013. doi: 10.1152/physrev.00018.2018. PMID: 31460832.
[32]Carabotti, M., Scirocco, A., Maselli, M. A., & Severi, C.(2015). The gut-brain axis: interactions between enteric microbiota, centraland enteric nervous systems. Annals of gastroenterology, 28(2), 203–209.
[33]Carabotti, M., Scirocco, A., Maselli, M. A., & Severi, C.(2015). The gut-brain axis: interactions between enteric microbiota, centraland enteric nervous systems. Annals of gastroenterology, 28(2), 203–209.
[34]Rao,M., Gershon, M. The bowel and beyond: the enteric nervous system inneurological disorders. Nat Rev Gastroenterol Hepatol 13, 517–528 (2016). https://doi.org/10.1038/nrgastro.2016.107
[35] Dinan TG, Cryan JF. TheMicrobiome-Gut-Brain Axis in Health and Disease. Gastroenterol Clin North Am.2017 Mar;46(1):77-89. doi: 10.1016/j.gtc.2016.09.007. Epub 2017 Jan 4. PMID:28164854.
[36] AsnicarF, Leeming ER, Dimidi E, Mazidi M, Franks PW, Al Khatib H, Valdes AM, Davies R,Bakker E, Francis L, Chan A, Gibson R, Hadjigeorgiou G, Wolf J, Spector TD,Segata N, Berry SE. Blue poo: impact of gut transit time on the gut microbiomeusing a novel marker. Gut. 2021 Sep;70(9):1665-1674. doi:10.1136/gutjnl-2020-323877. Epub 2021 Mar 15. PMID: 33722860; PMCID: PMC8349893.
[37] https://joinzoe.com/learn/how-to-improve-gut-health
[38] AsnicarF, Leeming ER, Dimidi E, Mazidi M, Franks PW, Al Khatib H, Valdes AM, Davies R,Bakker E, Francis L, Chan A, Gibson R, Hadjigeorgiou G, Wolf J, Spector TD,Segata N, Berry SE. Blue poo: impact of gut transit time on the gut microbiomeusing a novel marker. Gut. 2021 Sep;70(9):1665-1674. doi:10.1136/gutjnl-2020-323877. Epub 2021 Mar 15. PMID: 33722860; PMCID: PMC8349893.;Tottey, W., Feria-Gervasio, D., Gaci, N., Laillet, B., Pujos, E.,Martin, J. F., Sebedio, J. L., Sion, B., Jarrige, J. F., Alric, M., &Brugère, J. F. (2017). Colonic Transit Time Is a Driven Force of the GutMicrobiota Composition and Metabolism: In Vitro Evidence. Journal of neurogastroenterology and motility, 23(1), 124–134. https://doi.org/10.5056/jnm16042.; ; Roager HM, HansenLBS, Bahl MI, et al. Colonictransit time is related to bacterial metabolism and mucosal turnover in thegut. NatureMicrobiology. 2016; 1. doi:10.1038/nmicrobiol.2016.93
[39] Idem
[40] Idem
[41] Idem
[42] Idem
[43] https://www.wur.nl/nl/Landingspagina-redacteuren/nl/show/Darmbacterie-Akkermansia-remt-obesitas.htm.Retrieved Jan 02, 2022.
[44] Yiqiu Fei, Zuobing Chen, Shengyi Han, Shuobo Zhang, Tianfang Zhang, Yanmeng Lu, Björn Berglund, Hang Xiao, Lanjuan Li, Mingfei Yao. (2021) Roleof prebiotics in enhancing the function of next-generation probiotics in gutmicrobiota. Critical Reviews in Food Science andNutrition 0:0, pages 1-18.
[45] Parker,B. J., Wearsch, P. A., Veloo, A., & Rodriguez-Palacios, A. (2020). TheGenus Alistipes: Gut Bacteria With Emerging Implications to Inflammation,Cancer, and Mental Health. Frontiers in immunology, 11, 906. https://doi.org/10.3389/fimmu.2020.00906
[46] AsnicarF, Leeming ER, Dimidi E, Mazidi M, Franks PW, Al Khatib H, Valdes AM, Davies R,Bakker E, Francis L, Chan A, Gibson R, Hadjigeorgiou G, Wolf J, Spector TD,Segata N, Berry SE. Blue poo: impact of gut transit time on the gut microbiomeusing a novel marker. Gut. 2021 Sep;70(9):1665-1674. doi:10.1136/gutjnl-2020-323877. Epub 2021 Mar 15. PMID: 33722860; PMCID: PMC8349893.;Tottey, W., Feria-Gervasio, D., Gaci, N., Laillet, B., Pujos, E.,Martin, J. F., Sebedio, J. L., Sion, B., Jarrige, J. F., Alric, M., &Brugère, J. F. (2017). Colonic Transit Time Is a Driven Force of the GutMicrobiota Composition and Metabolism: In Vitro Evidence. Journal of neurogastroenterology and motility, 23(1), 124–134. https://doi.org/10.5056/jnm16042.; ; Roager HM, HansenLBS, Bahl MI, et al. Colonictransit time is related to bacterial metabolism and mucosal turnover in thegut. NatureMicrobiology. 2016; 1. doi:10.1038/nmicrobiol.2016.93
[47] AsnicarF, Leeming ER, Dimidi E, Mazidi M, Franks PW, Al Khatib H, Valdes AM, Davies R,Bakker E, Francis L, Chan A, Gibson R, Hadjigeorgiou G, Wolf J, Spector TD,Segata N, Berry SE. Blue poo: impact of gut transit time on the gut microbiomeusing a novel marker. Gut. 2021 Sep;70(9):1665-1674. doi:10.1136/gutjnl-2020-323877. Epub 2021 Mar 15. PMID: 33722860; PMCID: PMC8349893.;Tottey, W., Feria-Gervasio, D., Gaci, N., Laillet, B., Pujos, E.,Martin, J. F., Sebedio, J. L., Sion, B., Jarrige, J. F., Alric, M., &Brugère, J. F. (2017). Colonic Transit Time Is a Driven Force of the GutMicrobiota Composition and Metabolism: In Vitro Evidence. Journal of neurogastroenterology and motility, 23(1), 124–134. https://doi.org/10.5056/jnm16042.; ; Roager HM, HansenLBS, Bahl MI, et al. Colonictransit time is related to bacterial metabolism and mucosal turnover in thegut. NatureMicrobiology. 2016; 1. doi:10.1038/nmicrobiol.2016.93
[48] KonturekPC, Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinicalconsequences, diagnostic approach and treatment options. J Physiol Pharmacol.2011 Dec;62(6):591-9. PMID: 22314561..
[49] ProfessorTim Spector’s Top 5 Gut Health Tips to Improve Your Gut Health (joinzoe.com). RetrievedJan 03, 2022
[50] https://joinzoe.com/learn/how-to-improve-gut-health.RetrievedJan 03, 2022
[51]https://joinzoe.com/learn/the-gut-microbiome-and-your-health.Retrieved Jan 03, 2022.
[52] Remco Kort. Het belang vanmicrobiele diversiteit voor onze gezondheid. Jaarcongres Vereniging Arts enLeefstijl. Nov 2021.
[53] https://joinzoe.com/learn/the-gut-microbiome-and-your-health.Retrieved Jan 03, 2022.
[54] KonturekPC, Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinicalconsequences, diagnostic approach and treatment options. J Physiol Pharmacol.2011 Dec;62(6):591-9. PMID: 22314561.
[55] Ben Witteman. Voeding en leefstijl bij chronische (darm)aandoeningen: de hoeksteen van de behandeling. JaarcongresVereniging Arts en Leefstijl. November 2021; https://joinzoe.com/learn/gut-health-affects-sleep.Retrieved Jan 03, 2022.
[56] ClarkA, Mach N. Exercise-induced stress behavior, gut-microbiota-brain axis anddiet: a systematic review for athletes. J Int Soc Sports Nutr. 2016 Nov24;13:43. doi: 10.1186/s12970-016-0155-6. PMID: 27924137; PMCID: PMC5121944.
[57] Ben Witteman. Voeding en leefstijlbij chronische (darm)aandoeningen: de hoeksteen van de behandeling. JaarcongresVereniging Arts en Leefstijl. November 2021
[58] HoltmannG, Shah A, Morrison M. Pathophysiology of Functional GastrointestinalDisorders: A Holistic Overview. Dig Dis. 2017;35 Suppl 1:5-13. doi:10.1159/000485409. Epub 2018 Feb 8. PMID: 29421808.; Koloski N, Holtmann G,Talley NJ. Is there a causal link between psychological disorders andfunctional gastrointestinal disorders? Expert Rev Gastroenterol Hepatol. 2020Nov;14(11):1047-1059. doi: 10.1080/17474124.2020.1801414. Epub 2020 Aug 17.PMID: 32715790.
[59] FikreeA, Byrne P. Management of functional gastrointestinal disorders. Clin Med(Lond). 2021 Jan;21(1):44-52. doi: 10.7861/clinmed.2020-0980. PMID: 33479067;PMCID: PMC7850201.
