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Nutrition and wellness trends, many of them misguided, continued to flourish last year. But what is the new year for if not starting fresh and promising your patient’s gut a healthy new beginning, leaving the bad ideas behind? To help your patients, here’s a top 10 list of things they should not be doing to their gut in 2025.
Do not overload your gut on protein—
it might be worse for your gut health than you thought!
We’re in the middle of a protein craze, with many people desperate to increase their protein intake—so desperate that they are relying on processed powders and bars to get to their goals. What many may not know is that processed protein powders and bars full of whey and other animal proteins may be causing gut issues.
Animal protein is typically the main source of dietary protein in the United States. Eating more protein corresponds to an increasing amount of undigested protein entering the colon. Colonic bacterial fermentation of undigested protein into by-products that directly contact the colonic mucosa is one of the potential mechanisms through which protein may contribute to the development of colorectal cancer.1,2 The by-products of protein fermentation, including ammonia, phenolic and indolic compounds, and hydrogen sulfide, may contribute to DNA damage and changes in colonic epithelial cells.2 Encourage your patients to talk to you about how much protein they really need and to always prioritize both protein and fiber intake and not sacrifice one for the other.
Do not underestimate the damage alcohol does to the gut!
The US Surgeon General Vivek Murthy recently released an advisory highlighting alcohol use as a leading preventable cause of cancer in the United States and calling for warning labels to increase awareness of links to seven types of cancer.3 Alcohol use is extremely common: In 2019-2020, 72% of US adults reported they consumed 1 or more drinks per week,4 but less than half of US adults know about the relationship between alcohol and cancer risk.5 Drinking alcohol is damaging to the gastrointestinal tract, in particular, and it is associated with GI cancers such as liver and CRC. Dry January and other actions can help patients realize alcohol is not necessary and, in fact, likely contributes to their health issues.
Do not forget to get screened for colon cancer!
CRC is the third most diagnosed cancer and the second leading cause of cancer-related death in the United States, so early detection is key. Despite this, many people are not aware of when to start screening (45 years for average-risk individuals), and only about 50% end up getting screened. In 2024, screening for CRC became easier with more options available to patients. A cell-free DNA blood test was introduced and was found to have 83% sensitivity for CRC, which is similar to the accuracy of current stool tests in studies.6 So now, you can tell your patients there are no excuses not to get screened for colon cancer.
Do not ignore all the food recalls and outbreak news!
2024 was certainly a busy year for gut infections and foodborne illness. Not connected via social media to breaking stories about food recalls? Stop what you’re doing right now and follow @FDArecalls on X as well as @fdafoods on Instagram if you don’t already because this is information you need to know as soon as possible to help prevent you and your patients from getting sick. The multistate outbreak of E. coli [Escherichia coli] O157:H7 infections linked to yellow onions served at McDonald’s and the multistate outbreak of Shiga toxin–producing E. coli O121:H19 infections linked to organic carrots sickened multitudes of people—many of whom likely could have avoided illness if they knew about the recalls earlier.
Do not use GLP-1 drugs without understanding the consequences to the GI tract.
Glucagon-like peptide-1 receptor agonist (GLP-1) medications such as semaglutide (Ozempic/Wegovy, Novo Nordisk) and tirzepatide (Zepbound, Lilly) are everywhere, and it seems like everyone is on them. But they are not without significant consequences to your gut. The popular GLP-1 medications for weight loss have a whole list of GI side effects, including a higher risk for aspiration pneumonia after endoscopy7 and symptoms such as heartburn and constipation. This can affect clinical situations including endoscopy. Evidence supports prolonged fasting as the optimal approach to preventing aspiration, rather than stopping the medication.8
Quick Gut Health Tips for Patients
Take it easy on the protein.
Alcohol takes a toll on the gut.
Get screened for colorectal cancer.
Follow the news on foodborne disease outbreaks.
Know what GLP-1s can do to the GI tract.
Nutrition is a key component of IBD therapy.
If you have H. pylori, treat it.
Throw out the artificial sweeteners.
Avoid misleading TikTok trends.
Not all probiotics are the same.
Do not treat IBD without addressing nutrition.
Diet plays a critical role in inflammatory bowel disease, and the old philosophy of “diet doesn’t matter” is no longer relevant.9 Educate your patients about the value of a Mediterranean diet rich in a variety of fresh fruits and vegetables, monounsaturated fats, complex carbohydrates, and lean proteins, and low in ultra-processed foods, added sugar, and salt. In addition, a diet low in red and processed meat may reduce flares in patients with ulcerative colitis. Monitor patients for vitamin D and iron deficiencies, and in certain clinical situations, a vitamin B12 deficiency. Having a nutritionist/registered dietitian on the care team managing IBD patients is key.
Do not forget to treat Helicobacter pylori if you are positive.
Helicobacter pylori is a common stomach infection with many potential clinical consequences, including gastritis, ulcers, and even cancer. Many people are tested for it, but it is important to realize that a positive test revealing active infection should always be treated, as well as followed up with a test of cure afterward. The good news is that treatment options are expanding and, for the first time, there are alternatives to proton pump inhibitors such as potassium-competitive acid blockers (PCABs). In fact, for treatment-naive patients with H. pylori infection, dual therapy with a PCAB and amoxicillin is suggested as an option for first-line treatment.10
Do not use artificial sweeteners.
It makes sense to avoid fake food, but now we have the evidence to back that up. Investigators have shown that eating non-sugar sweeteners leads to significant changes in microbiome diversity and composition as well as levels of circulating inflammatory markers.11 They looked at subjects eating non-aspartame, non-sugar sweeteners (NANS) (n=35) and aspartame only (ASP) (n=9) and compared them with 55 controls. Compared with controls, NANS affected polysaccharide biosynthesis and D-galactose degradation, and ASP significantly enriched biosynthesis of cylindrospermopsin, a potential cancer-causing compound that can adversely impact the liver and nervous system. Two cytokines with protective properties, interleukin (IL)-6 and IL-10, were decreased in the ASP group compared with controls. It sounds like it’s time to finally throw away those sugar substitute packets.
Do not let TikTok convince you that taking trendy products like prebiotic sodas will fix your gut health.
Gut health is all the rage on TikTok and the hashtag #guttok has almost 728 million views. You’ll be sure to find some TikTokers swearing by products like prebiotic soda to “heal your gut.” But do not be fooled by catchy reels! Many influencers do not have a medical background, let alone are board-certified in gastroenterology, and are just pushing products to make money or selling quick fixes to gain followers. There are no quick fixes to building a healthy gut and, therefore, if patients are experiencing gut issues, they should discuss them with a gastroenterologist, who can provide guidance and evidence-based treatment to help them get better.
Do not just start taking any probiotic off the shelf and expect results.
Interest in microbiome therapeutics and use of live biotherapeutic products, such as probiotics and fecal microbiota transplant (FMT), continues to grow. In fact, in 2024, the American College of Gastroenterology Monograph on Microbiome Therapeutics was published summarizing where we stand with the use of these modalities in GI conditions.12 And the conclusion is that we have strong evidence for using microbiome therapeutics for Clostridioides difficile infection (CDI) and treatments such as fecal microbiota, live-jslm (Rebyota, Ferring) already are available as prescription medication.
Emerging indications for live biotherapeutic products include inflammatory bowel disease (Crohn’s, ulcerative colitis, pouchitis), disorders of gut–brain interaction such as irritable bowel syndrome and small intestinal bacterial overgrowth, and even oncologic conditions such as graft-versus-host disease and immune checkpoint inhibitor colitis.13 Patients should not just take any probiotic off the shelf and expect results. They should talk to a gastroenterologist about evidence-based ways to use microbiome therapeutics for their specific conditions.
References
- Corpet DE, Yin Y, Zhang XM, et al. Colonic protein fermentation and promotion of colon carcinogenesis by thermolyzed casein. Nutr Cancer. 1995;23(3):271-281.
- Liao LM, Loftfield E, Etemadi A, et al. Substitution of dietary protein sources in relation to colorectal cancer risk in the NIH-AARP cohort study. Cancer Causes Control. 2019;30(10):1127-1135.
- Office of the US Surgeon General. Alcohol and Cancer Risk 2025. Accessed January 9, 2025. https://www.hhs.gov/sites/ default/ files/ oash-alcohol-cancer-risk.pdf
- Alcohol Research Group. Updated US drinking norms (2020 data). Accessed January 9, 2025. https://arg.org/news/ updated-us-drinking-norms-2020-data/
- American Institute for Cancer Research. 2019AICR Cancer Risk Awareness Survey. Accessed January 9, 2025. https://www.aicr.org/assets/ can-prevent/ docs/ 2019-Survey.pdf
- Chung DC, Gray DM, Singh H, et al. A cell-free DNA blood-based test for colorectal cancer screening. N Engl J Med. 2024;390(11):973-983.
- Yeo Y-H, Gaddam S, Ng WH, et al. Increased risk of aspiration pneumonia associated with endoscopic procedures among patients with glucagon-like peptide 1 receptor agonist use. Gastroenterology. 2024;167(2):402-404.
- Facciorusso A, Ramai D, Dhar J, et al. Effects of glucagon-like peptide 1 receptor agonists on upper gastrointestinal endoscopy: a meta-analysis. Clin Gastroenterol Hepatol. 2024 Aug 12. doi:10.1016/j.cgh.2024.07.021
- Hashash JG, Elkins J, Lewis JD, et al. AGA clinical practice update on diet and nutritional therapies in patients with inflammatory bowel disease: expert review. Gastroenterology. 2024;166(3):521-532.
- Chey WD, Howden CW, Moss SF, et al. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2024;119(9):1730-1753.
- Hosseini A, Barlow GM, Leite G, et al. Consuming artificial sweeteners may alter the structure and function of duodenal microbial communities. iScience. 2023;26(12)108530.
- [No authors listed] American College of Gastroenterology monograph on microbiome therapeutics. Am J Gastroenterol. 2024;119(1S):Si-Sv.
- Newman KL, Allegretti JR. Emerging noninfectious indications for live biotherapeutic products in gastroenterology. Am J Gastroenterol. 2024;119(1S):S30-S35.
This article is from the February 2025 print issue.