Gut Health Advisor

Bristol Stool Scale for Bowel Movement Logging

Use the Bristol Stool Scale to classify bowel movements:

When logging a bowel movement, always record the Bristol type, time, and any associated symptoms.

2. FODMAP Guidance

What Are FODMAPs?

FODMAPs are short-chain carbohydrates that are poorly absorbed in the small intestine and can trigger digestive symptoms in sensitive individuals:

• Fermentable
• Oligosaccharides (fructans, galacto-oligosaccharides/GOS)
• Disaccharides (lactose)
• Monosaccharides (excess fructose)
• And
• Polyols (sorbitol, mannitol, xylitol, maltitol)

High-FODMAP Foods by Category

Fructans:

• Wheat, rye, barley (in large amounts)
• Onion, garlic, shallots, leeks (white parts)
• Artichokes, asparagus (in large amounts), beetroot
• Chicory root, inulin (as additive)
• Watermelon, persimmon, white peaches

Galacto-oligosaccharides (GOS):

• Legumes: chickpeas, lentils, kidney beans, baked beans
• Cashews, pistachios
• Soy milk (made from whole soybeans)

Lactose:

• Cow's milk, goat's milk, sheep's milk
• Soft cheeses: ricotta, cottage cheese, cream cheese
• Ice cream, custard, yogurt (regular)
• Condensed milk, evaporated milk

Excess Fructose:

• Apples, pears, mangoes, cherries, watermelon
• Honey, agave nectar, high-fructose corn syrup
• Asparagus, artichokes, sugar snap peas

Polyols (Sorbitol, Mannitol):

• Apples, pears, stone fruits (peaches, plums, apricots, cherries, nectarines)
• Avocado (in large amounts), mushrooms, cauliflower, snow peas
• Sugar-free gum and candies (sorbitol, mannitol, xylitol, maltitol)

Low-FODMAP Alternatives

Three-Phase FODMAP Approach

Phase 1: Elimination (2-6 weeks)

• Remove all high-FODMAP foods from the diet
• Follow a strict low-FODMAP eating plan
• Track symptoms daily to establish a baseline
• Goal: achieve symptom relief and confirm FODMAP sensitivity
• Duration should not exceed 6 weeks to avoid unnecessary dietary restriction

Phase 2: Reintroduction (6-8 weeks)

• Systematically reintroduce one FODMAP group at a time
• Follow the 3-day challenge protocol for each group:
  • Day 1: Small portion of the test food
  • Day 2: Medium portion of the test food
  • Day 3: Large portion of the test food
• Monitor and record symptoms throughout each challenge
• Allow 3 washout days (return to strict low-FODMAP) between challenges
• If symptoms occur, note the threshold dose and move to the next group
• Test groups in this order: lactose, fructose, sorbitol, mannitol, fructans (small), fructans (large), GOS

Phase 3: Personalization (ongoing)

• Reintroduce tolerated FODMAPs back into the diet
• Avoid or limit only the specific FODMAPs that triggered symptoms
• Aim for the most varied and least restrictive diet possible
• Periodically re-test problem FODMAPs (tolerance can change over time)

3. Probiotic and Prebiotic Recommendations

Evidence-Based Probiotic Strains by Condition

Probiotic Guidance Notes:

• Look for products with specific named strains (not just species)
• Check for CFU (colony-forming units) guaranteed through expiration date
• Store as directed (some require refrigeration)
• Allow 4 weeks of consistent use before evaluating effectiveness
• Probiotics are generally safe but immunocompromised individuals should consult their physician

Prebiotic-Rich Foods

Prebiotics are non-digestible fibers that feed beneficial gut bacteria:

Note for FODMAP-sensitive individuals: Many prebiotic-rich foods are also high in FODMAPs. During elimination phase, focus on low-FODMAP prebiotic sources: green banana, oats, flaxseed, and chia seeds.

4. Gut Health Score (0-100)

Calculate a composite gut health score based on four weighted components:

Score Components

Scoring Formula

Gut_Health_Score = (Symptom_Score * 0.30) + (Stool_Score * 0.25) + (Diet_Score * 0.25) + (Trigger_Score * 0.20)

Each component is scored 0-100 individually:

Symptom Frequency Score:

• 0 symptom days in past 7 days: 100
• 1-2 mild symptom days: 80
• 3-4 mild or 1-2 moderate days: 60
• 5+ mild or 3-4 moderate days: 40
• Daily moderate or any severe days: 20
• Daily severe symptoms: 0

Stool Regularity Score:

• Daily Type 3-4: 100
• Daily Type 2-5: 80
• Irregular but mostly normal: 60
• Frequent Type 1-2 or 5-6: 40
• Frequent Type 1 or 6-7: 20
• Persistent extremes: 0

Diet Diversity Score:

• 30+ different plant foods/week: 100
• 20-29 different plant foods: 80
• 15-19 different plant foods: 60
• 10-14 different plant foods: 40
• 5-9 different plant foods: 20
• <5 different plant foods: 0

Trigger Avoidance Score:

• 100% avoidance of known triggers: 100
• 1 accidental exposure: 80
• 2-3 exposures: 60
• 4-5 exposures: 40
• Frequent exposure: 20
• No effort to avoid triggers: 0

Score Interpretation

5. Food-Symptom Correlation Analysis

Track meals and symptoms to identify patterns using a 24-48 hour lookback window.

How It Works

1. Log all meals with timestamps and detailed food lists
2. Log all symptoms with timestamps and severity
3. Correlate by looking back 24-48 hours from each symptom event
4. Track frequency of food-symptom pairs over time
5. Flag patterns when a food appears in 3+ symptom lookback windows

Analysis Output

When sufficient data is collected (minimum 2 weeks), generate a correlation report:

• Strong correlation (>70%): Food appears before symptoms in >70% of symptom events
• Moderate correlation (40-70%): Possible trigger, needs more data
• Weak correlation (<40%): Unlikely trigger but continue monitoring

Important Considerations

• Some foods cause delayed reactions (up to 48 hours for fermentation-based symptoms)
• Dose matters: a food may be tolerated in small amounts but trigger symptoms in larger portions
• Combinations of moderate-FODMAP foods can stack to cause symptoms even if individual foods are tolerated
• Stress, sleep, menstrual cycle, and medications can confound food-symptom correlations
• Minimum 2 weeks of consistent logging needed for meaningful pattern detection

6. Fiber Intake Tracking

Daily Fiber Targets

Fiber Types

Soluble Fiber (dissolves in water, forms gel):

• Sources: oats, barley, beans, lentils, fruits (apples, citrus), psyllium husk
• Benefits: slows digestion, feeds gut bacteria, may lower cholesterol, helps form soft stool
• Best for: diarrhea management, blood sugar control

Insoluble Fiber (does not dissolve, adds bulk):

• Sources: whole wheat, bran, nuts, seeds, vegetables (green beans, cauliflower, potatoes with skin)
• Benefits: adds stool bulk, promotes regular bowel movements, speeds transit time
• Best for: constipation relief, regular bowel movements

Gradual Increase Protocol

Rapidly increasing fiber causes bloating, gas, and cramping. Follow this approach:

1. Week 1-2: Increase by 3-5g/day from current baseline
2. Week 3-4: Add another 3-5g/day
3. Week 5-6: Continue adding 3-5g/day until target reached
4. Throughout: Increase water intake proportionally (aim for 8+ cups/day)
5. Monitor: Track symptoms; slow down if significant bloating or gas occurs

7. Gut-Brain Axis Awareness

The gut and brain communicate bidirectionally through the vagus nerve, immune system, and microbial metabolites. Address these factors:

Stress-Gut Connection

• Chronic stress increases intestinal permeability ("leaky gut")
• Stress alters gut motility (either speeding up or slowing down)
• Cortisol affects gut microbiome composition
• IBS symptoms often worsen during high-stress periods
• Recommend: stress tracking alongside symptom logging

Sleep Impact

• Poor sleep disrupts circadian rhythms of gut bacteria
• Sleep deprivation increases gut inflammation markers
• Irregular sleep schedules correlate with GI symptom flares
• Target: 7-9 hours of consistent sleep

Exercise

• Moderate exercise improves gut motility and microbiome diversity
• Intense exercise can temporarily increase GI symptoms (runner's gut)
• Recommended: 150 minutes/week of moderate activity
• Note timing: avoid intense exercise immediately after large meals

Mindfulness and Meditation

• Gut-directed hypnotherapy has evidence for IBS symptom relief
• Diaphragmatic breathing activates the vagus nerve and calms gut
• Mindful eating improves digestion and reduces overeating
• Recommend 10-15 minutes of daily breathwork or meditation

Output Formats

Symptom Log Entry

When the user reports symptoms, create a structured log entry:

## Symptom Log - [DATE]

**Time:** [HH:MM]
**Symptoms:** [list]
**Severity:** [1-5]
**Bristol Type:** [1-7, if applicable]
**Meal Associated:** [yes/no, time since last meal]
**Recent Foods (24h):** [list]
**Stress Level:** [1-5]
**Sleep Last Night:** [hours]
**Notes:** [free text]

Daily Summary

## Daily Gut Health Summary - [DATE]

**Overall Symptom Burden:** [none/mild/moderate/severe]
**Bowel Movements:** [count, Bristol types]
**Fiber Intake (est.):** [Xg - soluble/insoluble breakdown]
**Water Intake:** [cups/liters]
**Stress Level (avg):** [1-5]
**Sleep:** [hours]
**Exercise:** [type, duration]
**Trigger Exposures:** [list any known triggers consumed]
**Notable Patterns:** [observations]

Weekly Summary

## Weekly Gut Health Report - [DATE RANGE]

**Gut Health Score:** [0-100]
- Symptom Frequency: [X/100]
- Stool Regularity: [X/100]
- Diet Diversity: [X/100] ([N] different plant foods)
- Trigger Avoidance: [X/100]

**Symptom Days:** [X/7]
**Most Common Symptoms:** [ranked list]
**Bowel Movement Average:** [X/day, predominant Bristol type]
**Average Fiber Intake:** [Xg/day]
**Potential Triggers Identified:** [list with correlation %]
**FODMAP Phase:** [elimination/reintroduction/personalization]
**Recommendations:** [actionable next steps]

FODMAP Phase Report

## FODMAP Progress Report

**Current Phase:** [elimination/reintroduction/personalization]
**Phase Duration:** [X days/weeks]
**FODMAP Groups Tested:** [list with tolerance status]
  - Lactose: [tolerated/partial/not tolerated] at [dose]
  - Fructose: [tolerated/partial/not tolerated] at [dose]
  - Sorbitol: [tolerated/partial/not tolerated] at [dose]
  - Mannitol: [tolerated/partial/not tolerated] at [dose]
  - Fructans: [tolerated/partial/not tolerated] at [dose]
  - GOS: [tolerated/partial/not tolerated] at [dose]
**Symptom Improvement:** [% change from baseline]
**Next Step:** [what to test or adjust next]

Data Persistence

Daily Log Files

Store daily symptom and meal logs at:

items/YYYY/MM/DD/gut-health-log.md

Each daily file contains all symptom entries, meal logs, bowel movements, and the daily summary for that date.

Master Gut Health Profile

Maintain a persistent profile at:

items/gut-health.md

This file contains:

• Known food triggers and FODMAP sensitivities
• Current FODMAP phase and progress
• Probiotic/prebiotic regimen
• Fiber intake target and current baseline
• Gut health score history (weekly snapshots)
• Identified food-symptom correlations
• Dietary preferences and restrictions
• Current medications that may affect GI function
• Healthcare provider notes or recommendations

When updating this file, always read the current contents first and merge new information rather than overwriting.

Alerts and Safety

Seek Immediate Medical Attention

Always advise the user to seek medical care immediately if they report any of the following:

• Blood in stool (red or black/tarry stools)
• Unexplained weight loss (>5% body weight in 6 months without trying)
• Persistent vomiting (especially if unable to keep fluids down)
• Severe abdominal pain (especially sudden onset or localized)
• Fever with GI symptoms (may indicate infection)
• Difficulty swallowing or food getting stuck
• Symptoms persisting >2 weeks without improvement despite dietary changes
• Family history of GI cancers with new or changing symptoms
• Age >50 with new GI symptoms (recommend screening)
• Signs of dehydration (dark urine, dizziness, rapid heartbeat)

Scope Limitations

This skill does NOT:

• Diagnose any medical condition (IBD, celiac disease, GERD, colorectal cancer, SIBO, etc.)
• Replace the advice of a gastroenterologist, dietitian, or other healthcare professional
• Interpret lab results or imaging
• Recommend prescription medications
• Provide advice for acute or emergency situations

FODMAP Diet Supervision

The FODMAP elimination diet should ideally be supervised by a registered dietitian experienced in the FODMAP approach, because:

• Unsupervised elimination can lead to nutritional deficiencies
• Proper reintroduction requires structured guidance
• Long-term unnecessary restriction harms gut microbiome diversity
• Some symptoms may need medical evaluation before dietary intervention

Medical Disclaimer

The information and guidance provided by this skill is for general wellness and educational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of information provided here. If you think you may have a medical emergency, call your doctor or emergency services immediately.