The Gut Health Checklist


Getting your digestive health in order before and during pregnancy can not only have massive health benefits for you, but your baby will benefit, too.
The Gut Health Checklist

I’ve been getting so many questions about gut health and healing lately that I decided it was time to address the issue.

I approach gut health with the science and sensibilities I rely on in my private practice as a registered dietitian and fertility expert. For this post, I’m going to feed you some key strategies I use with my clients so you can work to improve gut health on your own through diet and lifestyle. In the end, I’ve put together a comprehensive “checklist” for you to see where your gut health stands, understand the severity of your symptoms and provide insight on whether or not you should seek the guidance of a practitioner in addition to implementing my strategies.

If you’re pregnant or trying to conceive, I’m sure you are already paying attention to what you eat to fuel your body correctly for the enormous task you’re asking it to complete. You know that proper nutrition builds healthy babies. It also helps prevent many - often avoidable - pregnancy complications. But did you know that your microbiome plays a vital role in how the nutrients you eat get to you and baby? It does. In fact, due to this - and via other mechanisms - your microbiome also influences pregnancy complications like preeclampsia, gestational diabetes, and beyond.

This is where the term “gut health” comes into play.

Your microbiome is composed of all the bacteria that live on (and inside of) your body. It sounds crazy, but we are all covered with bacterial cells inside and out. Our digestive systems alone house 100 trillion of them. The vast majority of these bacteria, or microbes, are highly beneficial to us, working with our cells to benefit the entire body. However, some microbes are… less beneficial, and it’s not necessarily black and white which ones will affect which people in what way. Our individual microbiomes are unique, influencing almost every aspect of overall health and metabolism. 

That’s a LOT of work for a bunch of teeny tiny bacteria. When your microbiome is healthy and thriving, it keeps your body running smoothly and reduces your disease risk. The problem is that many of us have a significant imbalance of good and bad bacteria in our microbiome and don’t even realize it. We often think that if we don’t have digestive problems (gas, bloating, constipation, diarrhea), we are in the clear. Still, symptoms of imbalance - or dysbiosis - can be a little more complicated to identify and navigate.

The good news is that you have some time to find solutions if you are trying to conceive. But if you are pregnant, and as your pregnancy progresses, the urgency with which you want to address potential gut health issues rises a bit because it doesn’t only influence your health; it can impact your pregnancy and baby's health.

During pregnancy, your body changes, but not just because you’re growing with your baby.

The most significant changes you’ll experience are shifts in your immune system and how your body creates and then quells inflammation. Additionally, estrogen and progesterone, two hormones that increase during pregnancy, will fluctuate. As a result of all of these shifts, your microbiome and gut health will be impacted. At a minimum, you might experience a change in your normal digestion process. This is partly due to the slowing of your digestion to help you extract more nutrition from your food, but it is also caused by alterations in your microbiome (oh, and hormones). 

During pregnancy, you are at risk for new, opportunistic bacteria to populate your gut. Depending on which kind stakes its claim in your digestive tract, you may be at an increased risk of certain complications that could impact your and your baby's health.

"What is at risk for me, personally?"

Preterm birth

Preterm birth is when birth occurs before 37 weeks and is the leading cause of long-term disability and mortality for infants. The microbiome's health in the gut, vagina and even the mouth has been linked to an increased risk of preterm birth. While not everything is within our control, there are many ways to help prevent preterm birth by altering your diet: getting in your nutrients, including omega-3 essential fatty acids.


Preeclampsia is a condition that happens late in pregnancy and leads to dangerously high blood pressure and protein spilling into the urine. Gum disease and off-kilter bacterial balance in the mouth increase a mother’s risk of preeclampsia. I remember the first time I saw this connection made in the research. I was pregnant with my first child and struggled with gum disease, leading to more frequent dentist trips and overall discomfort. While I didn’t develop preeclampsia, I paid close attention to it before conceiving my second. Bacteria in the mouth can cause inflammation, but they can also “translocate,” meaning they can travel to other body parts, making them an under-discussed threat to a healthy pregnancy.

Gestational Diabetes

Pregnant women who develop gestational diabetes have been studied to have less diversity in their gut microbiomes and more inflammation-triggering bacteria overall.

Excessive weight gain 

Dysbiosis has been associated with high pre-pregnancy weight and weight gain during pregnancy. Healthy weight gain during pregnancy lowers the risk of preeclampsia, diabetes, and other pregnancy complications.
A healthy microbiome can reduce your risk of pregnancy-related complications, but equally importantly, it can set your baby up for developmental success and avoid difficulties for them.

"What is at risk for baby?"

The stakes are high since they receive 100% of their initial microbiome from you.

Studies show that an entirely unique microbiome locks into place in the placenta and amniotic fluid as they develop. Maternal intestinal inflammation in utero (or maternal inflammation, in general) can alter brain and nervous system set points and stress points before a baby is even born. That stress point then, in turn, can impact how the microbiome develops and proliferates.

After birth, the infant’s gut bacteria are influenced by a whole host of factors: type of delivery, genetics, the mother’s age, and even the actual size of the newborn. The type and variety of strains that ultimately colonize in their bodies at birth can have long-term effects.

But your baby’s microbiome will continue to develop after birth. Breastfeeding will change it as they grow. Recent studies have now shown, for example, that when a baby starts to develop a cold, their saliva and the microflora in their mouths will chemically signal through the nipple to their mother’s breast to alter its milk. The immunoglobulins in mom’s breast milk will change to keep that cold at bay. Isn’t that amazing?!

Many factors play into the health of baby’s microbiome, and some even yield tangible consequences in very positive ways.

"How do I optimize my gut health for the sake of my baby (and myself!)?"

The best way to support a healthy gut is to feed it nourishing foods.

The microbiome in your gut is ever-evolving and is something that you should constantly be keeping tabs on and paying strict attention to. 

Many people take a probiotic supplement, but, as I’ve said before and will say again, we should all always be aiming to get what we need through food first.


Luckily, fermented foods like pickles, pickled vegetables, kimchi, natto, and some fermented beverages are here to save the day. Fermented foods are preserved in a way that increases their shelf life, punches up the nutritional content, and packs a hefty dose of probiotics to help strengthen your gut flora. To get the most health benefits, be sure to choose unpasteurized pickled vegetables (they will be in the grocery store's refrigerated section), as the process of pasteurization kills off beneficial bacteria. Fermented dairy containing lactic acid bacteria, such as yogurt, kefir, and aged cheese, is also a great addition, as they often contain more vitamin K2 levels due to fermentation. Studies also show that maternal intake of fermented milk products has been shown to reduce eczema and allergic rhinitis (hay fever) in infants, so be sure to add these to your diet if you can tolerate them. Also, when shopping for fermented beverages like kombucha, read the label and check the amount of added sugar each serving contains.


Similarly, prebiotic fiber can help regulate and target pathogenic bacteria in your gut and increase microbial diversity. Prebiotics are types of fiber that promote the growth of beneficial bacteria. They play an influential role in halting the development of several inflammatory diseases and conditions, including allergies, which can often result from disturbed gut colonization or reduced microbial diversity. Plus, in helping to restore and enhance our gut flora, prebiotics also help improve the manufacturing of some nutrients like vitamin K, vitamin D, and B vitamins. Dandelion greens, garlic, onions, asparagus, and oats are all great examples of foods high in prebiotic fiber.


Your gut and digestion can also affect your stress levels and daily habits. If you’re feeling out of whack, ensure you’re

  • Breathing properly (deeply and into your abdomen)
  • Eating in a slow, seated state (avoid eating on the go)
  • Resting & digesting (genuinely tapping into your hunger cues)
  • Getting enough rest (try progressive muscle relaxation)

I won’t say avoid probiotics because they can be great. I will say avoid blindly taking just any old probiotic.

Your gut microbiome co-evolves with you. Like everything in the world of nutrition and supplements (and healthcare and medical treatment), what works for someone else might not work for you. Your probiotic should be personalized to your individual needs and lifestyle. Remember: microbial diversity is critical, so eating various fermented and prebiotic foods truly contributes to the array of microorganisms in your gut.

Look to natural remedies to help you regulate.

As an herbalist, I’ll point you to a few of my favorite safe botanicals to support motility in your digestive tract. Consider utilizing lion’s mane, which improves vagus nerve function to help catalyze healthy movement and get your gut feeling better. Powdered or whole (fresh or dried) forms of mushrooms are excellent sources of polysaccharides (unlike tinctures) which are also great for gut bacteria. Gentle botanical bitters, like dandelion, burdock root, and chamomile, are also great herbs to turn to. Interestingly, our gut has bitter receptors that help move our bile, liver, and stomach motility. 

If you begin to incorporate some of these strategies and still have issues, you might be experiencing something more intense.

"How do I know if my symptoms are irregular?"

Enter my checklist.

  • Have you suffered from digestive issues for years?
  • Do symptoms affect your daily life?
  • Are you frequently constipated or have loose stools, OR do you fluctuate between both?
  • Have you tried probiotics and cannot tolerate them?
  • Do you have a growing list of foods you can’t tolerate? 
  • Do you have frequent heartburn (GERD, reflux, acid indigestion)?
  • Do you notice that you sometimes have undigested food in your stool?
  • Have you experienced skin rashes, hives, or eczema after you eat certain foods? 

Did you check any of the above boxes? If yes, a whole host of microbiome problems could be at play inside of you. You might not have enough digestive juices to do the work, especially if you’re eating while you’re stressed and on the go; you may have disrupted motility or know that something is just not right with your digestion. 

I strongly advise you to consider working with a functional medicine practitioner who is well-versed in gut health issues. So many people will take an over-the-counter medication, probiotic, or another supplement to solve their problems, but finding the root cause can be a needle in the haystack if you’re not sure what you’re looking for. You’ll want to find someone who can use appropriate testing to identify your imbalance.

The right nutrients can help
from both food AND supplements.
“Your gut health is essential to your baby’s health and how you feel and function daily, so make it a priority to get on the right track and support your system.”
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