Since we started our work as the Digestive Nutrition Clinic, one of the health professionals whom we’ve admired from afar—finding her work and approach both insightful and highly useful—is Andrea Hardy, RD, a registered dietitian and Canada’s gut health expert.
Through her personal struggle with irritable bowel syndrome, Andrea recognizes the importance of creating meaningful conversation using supporting science to help patients take charge of their gut health. She works to spread the message that gut health is for everyone – and that nutrition and lifestyle changes are the most impactful, simple ways to take care of your gut microbiota!
We reached out to Andrea with a few of our questions and she was more than happy to talk to us. Andrea’s excitement for her work is so evident in her answers. You will definitely enjoy this interview as much as we did!
Digestive Nutrition Clinic (DNC): What inspired you to focus on the gut microbiome?
Andrea Hardy: I was inspired to focus on the gut microbiome because of my personal experience with IBS. I struggled with IBS back when it was considered to be a diagnosis that was ‘all in your head’. As a new grad, I felt dismissed, and confused - even as a dietitian I felt like I didn’t know where to turn! So I jumped into the research, and started to learn. Over time, the research began to shift towards implicating bacteria in our gut - which made a lot of sense to me. I’ve been hooked on keeping up on the research, and applying it as we’re able to practice, ever since!
DNC: Which are your top prebiotic foods to feed the microbiome while on the low FODMAP diet?
Andrea Hardy: With the low FODMAP diet, we are removing fermentable carbohydrates, which is, in essence, our prebiotic containing foods. However, I do like to ensure that my patients hit their fibre targets for the day, and keep in mind, the low FODMAP diet is 1) not all or nothing and 2) not forever. I like to encourage intake of chickpeas and lentils, low FODMAP nuts & seeds, low fodmap fruits (my faves are kiwi, and yellow green bananas), and resistant starches from oats, potatoes, and other whole grains. It takes work to hit your fibre targets on the low FODMAP diet, so I usually encourage chia seeds, or additional fibre, like psyllium to meet targets. As well - other things that may one day be considered prebiotics include omega-3’s, and polyphenols - so I try to include those as well through food.
DNC: How do you take care of your own gut microbiome?
Andrea Hardy: I take care of my guts using Ignite’s ‘4 Pillars of Gut Health in IBS management’. Nutrition, medication management, stress management, and the gut microbiota make up the pillars. For nutrition, I choose a variety of different foods (variety is key!), and include as much FODMAP’s as I can tolerate (I’m way past elimination and reintroduction, I am in the maintenance phase!). I choose to eat a plant based diet about half the time, watching my intake of meat, and finding balance with whole and processed foods. I’m not all or nothing - I still enjoy a diet coke at the movies, and a burger from McDonald’s every now and again (shocker!)- there’s just NO evidence that including these foods once and a while are somehow going to ‘ruin’ your health - too many people get caught up in the black and white! I also try to eat something living every day. For medication management, I always take a probiotic when I travel, or when I take antibiotics. I don’t typically require many other meds - however, I will use laxatives strategically as I am IBS-C. I don’t place a lot of judgement on it, and I know my body pretty well - but I will utilize ones as a back-up plan if needed. (Working with your RD on these back-up plans can be helpful!). For stress management, I practice mindfulness, yoga, and I like to say ‘golf is my meditation.’ I also practice a LOT of self compassion - very key to learning to live with a chronic gut disease. Each of these pillars works to helping the last pillar - the gut microbiota!
DNC: What non-dietary recommendations do you make to keep the gut microbiome healthy?
Andrea Hardy: Oh my non-dietary recommendations - I think I spoiled them in the last question. I am a wild fan of psychology. Everyone should work with a psychologist if they have the means or pay for benefits! It’s so incredibly empowering to take care of your mental health, or at the very least, develop coping strategies for when times are tough. We’re human, things are going to get tough sometimes, and the frustration and anxiety of living with a chronic disease can be hard! Also - I like to say 5-10 minutes of mindfulness practice a day. Exercise in a way you enjoy, get enough GOOD QUALITY sleep, spend time with your loved ones, nurture relationships. Put yourself first, and practice self compassion. Phew - it’s a long list and there’s so much more - but I do have to say often times - what we’re feeling and thinking is FAR more important than what we eat.
DNC: What is your take on the long-term impact of a low FODMAP diet on the gut microbiota?
Andrea Hardy: The low FODMAP diet is a SHORT TERM, band aid solution, to understand your triggers. I like to say - we want to solve the underlying problem, and the majority of times, food isn’t going to cut it. We need to work on all aspects of health. While I see in my practice the majority of patients (75, 85%) feeling 50-80% better after 4 weeks on the low FODMAP diet, the evidence is really quite poor, which sucks. I think finding the right FIT of patient for the low FODMAP diet, and ensuring other pillars of IBS management are covered is key to success. As well, I’m super intrigued about the role of selective prebiotic supplements to manage IBS, hypnotherapy to manage IBS, etc - and how we can utilize those tools, because the low FODMAP diet is hard, stressful, and if done incorrectly, leads to food stress and anxiety, plus it absolutely compromised the gut microbiota - we’ve seen it in multiple studies. Don’t panic though! Our gut microbiota is highly resilient and quite stable - so as long as you get back to reintroduction, it’s HIGHLY probable it will return to normal.
DNC: How do you handle patients who are afraid to re-introduce food?
Andrea Hardy: Food fears is a BIG concern. The low FODMAP diet increases fixation on food, and how it impacts our symptoms. I like to say we have to ‘name it to tame it’. I explain the gut brain connection, we work on body trust, and will loop in a psychologist as necessary. We work on self compassion, and take our time, getting where we need to go - but this, and eating disorders, are two of my biggest concerns with the low FODMAP diet, which is why patient selection is so key!
DNC: Can you tell us your thoughts on the potential of personalized dietary approaches based on one’s specific gut microbiota?
Andrea Hardy: Every time we think we’re progressing in the right direction with the gut microbiota, our mind is BLOWN and we realize we have THAT much more work to do. It’s like thinking earth is the only planet, and BAM! There’s more. And then thinking ‘ok, well, this is the only set of planets' and BAM! you find out you’re only one galaxy. We are nowhere NEAR being able to recommend personalized diet changes based on the gut microbiota. In fact, of the companies that do them currently, I see a lot of ‘overpromising’, and comparing us to rats. And one thing we know about the gut microbiota is, when we try to apply findings in rats to humans, it RARELY translates. They’re a good model to start with, but we can’t base evidence for humans off them. Another side note - the form of testing, the way they collect the stool, and the type of sequencing companies do is also not best practice when it comes to analysis of the gut microbiota. So, hold onto your cash, and save it for what I would guess to be another 10 years.
DNC: You are a strong advocate of increased fiber to feed the microbiome. Which would be the best ways to do that while on a low FODMAP diet?
Andrea Hardy: Oh I am FIBRE CRAZY. For good reason! It’s the one thing we’re confident has a significant positive effect on the microbiota, and a very food-first approach to helping patients improve their gut health and overall health. It ties into the answer above, but a variety of low FODMAP fruit and veg, pulses (chickpeas and lentils), nuts and seeds, and whole grains is the way to go - plus a fibre supplement if needed!