Advance with MUSC Health

Getting Your Gut Health in Check with Alaine Mills, RD

December 14, 2022
Alaine Mills, R.D.

New research shows that gut health is a vital component to keeping our body's ecosystem healthy. In this episode of Advance with MUSC Health, Alaine Mills, RD, a dietitian at the MUSC Health and Wellness Institute and director of the Institute's Gut Health Program, talks about the importance of gut health and how a plant-based diet contributes to creating a healthy and diverse gut microbiome.

"What's really interesting is that the research shows that when you switch to more plant foods, and you start incorporating more plant foods into your diet, that can create changes in your gut microbiome overnight. So, you can already start to see benefits on that biological level."
— Alaine Mills, RD

Topics Covered in this Show

  • Mills explains how a dietitian differs from a nutritionist. She says that a way to remember the difference is that not every nutritionist is a dietitian but every dietitian is a nutritionist. Dietitians have a degree in nutrition and more than 50% of dietitians have an advanced degree as well. They also follow a code of ethics and are required to be licensed by most states.
  • Her nutrition philosophy is to focus on adding nutrition to your diet rather than subtracting foods from it. Focusing on adding plant-based food is a key component of the Gut Health Program she runs at MUSC Health.
  • She explains how the gut microbiome contributes to our gut health and why our gut health is important for the entire ecosystem of our health.
  • The long-term goal she has for everyone in the program is to be eating 30 different types of plant foods per week.
  • New research shows that when you start incorporating more plant foods into your diet, changes occur in your gut microbiome overnight at the biological level.
  • As you consistently incorporate more plant foods into your diet over time, Mills says you will feel more energized and may stop experiencing symptoms such as bloating, distention, stomach pain and cramps.
  • The Gut Health Program at MUSC Health is individualized to each person who joins. It has a meal planning component that creates an automatic grocery list from your weekly meal plans.
  • Participants also meet with Mills once a month to talk about progress and she offers guidance and accountability.
  • Participants also have access to a mindfulness expert at the Institute, as Mills says there's a big connection between the gut, your brain health and your mood.
  • The Gut Health program is just one innovative initiative at the newly launched MUSC Health and Wellness Institute. Mills says a big goal of the Institute is to prevent chronic diseases. Patients can be referred to the program by their physician or enroll online.

Read the Show Transcript

Erin Spain [00:00:04] Welcome to Advance with MUSC Health. I'm your host, Erin Spain. This show's mission is to help you find ways to preserve and optimize your health and get the care you need to live well. You may have heard of the term gut health, but do you know why it's important and how to keep it in check? Today's guest is here with answers and some tips we can all follow to improve our gut health through the foods we eat. Alaine Mills is a registered dietitian at the MUSC Health and Wellness Institute, where she leads the Gut Health Program and other diet and lifestyle focused initiatives for patients. Welcome to the show.

Alaine Mills, RD [00:00:46] Thank you so much for having me, Erin.

Erin Spain [00:00:48] You're a dietitian. Explain what you do at MUSC Health and how a dietitian differs from people who call themselves nutritionists, for example. Tell me about what you do and your profession.

Alaine Mills, RD [00:01:01] I get this question like almost every day. So, a little saying that you can remember is that every registered dietitian is a nutritionist. But not every nutritionist is a registered dietitian. So, basically, a registered dietitian has a degree in nutrition. Over 50% of dietitians have an advanced degree as well. And then they've done a supervised practice study. So, like an internship is what it's called, where they practice under a dietitian for about a year before they can then sit for their R.D. exam to become a registered dietitian and then we're also licensed by the state that you work in, in most states. So, you know, we have a code of ethics that we follow. So, that is something that protects the community, because if you have someone that's not licensed, that hasn't been, you know, through the classes that we take, dietitians take anatomy and physiology to help understand the structure and function of the GI tract and your gut health. We take biology, microbiology and nutritional biochemistry, all these classes that help us truly understand nutrition, because nutrition is a science, just like, you know, your medical doctor, it goes through training, a registered dietitian goes through training and we're a medical professional. So, it's not that we're not nutritionists, we are, but we're also licensed medical professionals. So, you can trust a registered dietitian. So, a nutritionist may have training or they may not. So, you just need to check in to their credentials. So, that's kind of the difference. There's a lot of different areas that dietitians work in, a lot of dietitians at MUSC work in the hospital and inpatient where they're helping people. They might be helping them get it to feeding or, you know, intravenous nutrition, something like that, helping people in the ICU and then there's lots of different outpatient dieticians in all kinds of areas that specialize in diabetes. They might specialize that we have a great pediatric heart health program and there's a ketogenic program, and all dietitians specialize in different things. I work in the MUSC Health and Wellness Institute, which is kind of like a holistic place where you can come to improve your health, work on your fitness, work on your nutrition, work on your mindfulness, all of that together.

Erin Spain [00:03:00] You work with many different patients at MUSC Health. People with really specific health conditions and those looking to make either short or long-term changes to their diets. Share with me your nutrition philosophy and what you offer patients.

Alaine Mills, RD [00:03:14] My nutrition philosophy is a lot about addition and not subtraction. So, when you see, you know, in the media, on social media and things like that, there are a lot of times warning you about what foods to take out of your diet. But my nutrition philosophy is more about what foods you can add to your diet to help promote your health and when you're adding in more nutritious foods that, those maybe not so healthy foods, they kind of fall off without you having to make these grand rules to remove them. So, that's kind of my philosophy is that we need to add more healthy foods to our diet and that all foods can fit into a healthy diet. And I kind of work with my patients, like you said, first, focusing on short term goals to help us reach those long-term goals.

Erin Spain [00:03:55] Tell me about some of the patients who come in to see you. How do they make their way to you? Why are they coming?

Alaine Mills, RD [00:04:00] We do get referrals from our MUSC doctors, will send patients for a number of reasons or, you know, we just get people from the community that are looking to stay healthy. So, that's kind of what the MUSC Health and Wellness Institute was created with the idea of more about prevention, because a lot of times people are waiting until their doctor says, Oh, your A1C is high, you have pre-diabetes to come and visit with a dietitian or a health coach or an exercise specialist. So, we are really trying to focus on getting people here to help optimize their health, help to keep them healthy. So, we're out in the community, you know, at different events spreading information about our new Health and Wellness Institute. So, a lot of my patients come, you know, just because they met me, they heard about us, and they want to come in and learn how we can help optimize their health.

Erin Spain [00:04:46] Today, we're talking really specifically about something called gut health. And as I mentioned when I was introducing you, gut health is a term that folks may have heard of in recent years, but maybe they don't really understand what it means. So, explain it to me. What is gut health and what makes a gut healthy or unhealthy?

Alaine Mills, RD [00:05:05] The gut microbiome. It's basically a community of trillions of bacteria in your intestines and specifically in your large intestine is where many of them lie. Basically, those gut bacteria, they work together to create an ecosystem that helps promote health. It plays a big role in our health, and there's lots and lots of new research coming out about that. And that's why the topic is so hot and why people are so interested in it. But so the bacteria that's in your large intestine and throughout your gastrointestinal tract, it feeds on fiber and that helps to create health promoting components like short chain fatty acids. So, it helps to promote health to have a healthy, diverse gut microbiome. And the food that we eat really drastically can change your gut health.

Erin Spain [00:05:50] So, when people say their gut health is in a good place, what would that look like? I guess on the scientific level.

Alaine Mills, RD [00:05:56] If your gut is healthy, that would mean that you had a diverse ecosystem of good bacteria in your gut. Everyone's gut is different, so there's not one healthy gut microbiome picture. You had a healthy gut. You're not going to be experiencing GI issues like constipation, diarrhea, bloating, distension, things like that.

Erin Spain [00:06:18] And is it also found to be connected to specific health conditions, issues with gut health?

Alaine Mills, RD [00:06:24] Yes, definitely. So, of course, conditions like irritable bowel disease and irritable bowel syndrome. But also new emerging research is showing that a healthy gut is associated with lower incidences of diseases like type two diabetes, hypertension, cardiovascular disease, even. There's some research on asthma. All of this is new, like I said, but there is a lot of research to show that a healthy gut helps to keep you from having those chronic diseases.

Erin Spain [00:06:50] MUSC Health has developed and you are leading the gut health program. Why did you start this program?

Alaine Mills, RD [00:06:56] So, we started this program because gut health is so important and all this new emerging research is showing how important it is and also research is showing that our typical Western diet is very poor for gut health. So, that's why we wanted to create this program. And the program is individualized and highly evidence based.

Erin Spain [00:07:13] Let's talk about this typical Western diet. What do we mean when we talk about the Western diet?

Alaine Mills, RD [00:07:19] So, the Western diet is a diet that's pretty much high in calories. It's high in saturated fat, which is the type of fat that promotes inflammation in the body found in red meats, processed meats, higher fat dairy products. It's going to be high in sodium and other preservatives. And so it's just got a lot of processed foods and not a lot of whole foods, not a lot of whole fruits and vegetables. So, it's more based on processed, easy convenience foods. So, that's what our typical or standard American diet kind of is. And that's what promotes all of these chronic diseases obesity, type two diabetes, cardiovascular disease.

Erin Spain [00:07:56] So, a lot of this new research coming out really points to a more plant-based diet as being beneficial for gut health and that's something that you're promoting through this program. But some folks may take pause when they hear a plant-based diet and think, you're talking about a vegan diet, but what is plant-based eating?

Alaine Mills, RD [00:08:13] A vegan diet is plant based, but a plant-based diet doesn't have to be vegan. So, a plant-based diet is just going to be really high and rich in plant-based foods like whole grains, fruits, vegetables, legumes, nuts and seeds. So, it's going to be mainly based on those plant-based foods. So, for somebody, their plant-based diet might be vegan, it might be vegetarian, it might be pescatarian where they're mostly eating plants, but they do eat some fish and some yogurt and some dairy products. But it's not going to be the diet where we're having one huge piece of meat on our plate and one tiny garnish of vegetables. It's going to be kind of the opposite of that.

Erin Spain [00:08:51] Folks who are listening, who maybe they haven't eaten this way before and they're used to having a lot of protein in their diet, a lot of animal protein in their diet. What do you say when they are worried about how it's going to affect their ability to exercise or their energy levels?

Alaine Mills, RD [00:09:05] The great thing about a plant-based diet is that it has a lot of energy because plants are mostly carbohydrate foods and carbohydrates are what gives our body energy. So, it definitely helps your energy levels. And when people switch to a more plant-based diet, they actually usually experience an increase in energy. And plant foods do contain protein. It's kind of a little bit of a myth that we don't get enough protein. You know, if you were to ask a random person on the street, they would probably say that they need more protein, that, you know, they're not getting enough protein. But really, research shows that typically people get enough protein, if not too much protein. And so plant foods do have protein. They have a lot of protein and they can contain complete protein. There's a myth that if you are only eating plants and you have to eat complementary proteins together, but you really just need to eat a variety of different plants. You know, legumes like beans and things like peas have a ton of protein in them. Hemp seeds, sunflower seeds, nuts, they all have protein. Even things like broccoli and spinach have protein. So, you can get enough protein on an exclusively vegan diet. Certainly on a plant-based diet where you're including some animal foods, it's quite easy to get enough protein.

Erin Spain [00:10:15] Give me an example of a day of meals and the gut health program. What does that look like?

Alaine Mills, RD [00:10:20] So, it's going to be different. It's going to be individualized because what is great about our gut health program and what's great about just working with a dietitian is that we're never going to prescribe a generic plan because everybody has different food preferences. And there's actually a lot of research, too, on if you're eating foods that you don't like. You're not going to be as satisfied if you're eating foods you know that you enjoy. So, there's a component of that as well. So, we'll kind of sit down together, I'll get your food preferences, and from there we'll build a plan for you and we'll have list of plant-based foods because you're going to be trying to increase the servings of plant-based foods so that you have a variety of different plant based foods to help feed your gut microbiome. So, we'll kind of pick through those, pick through the ones that you've tried before that you liked, pick through the ones that you don't like, pick through the ones that you haven't eaten in years and want to try again, or the ones that you've never tried. And figure out some recipes that we could incorporate for you to try with those. And generally, a meal plan is going to include multiple meals throughout the day because if you're trying to get 30 different plant foods per week, you know, into your diet, you're not going to do that with only eating one meal a day.

Erin Spain [00:11:26] So, this may require a little bit of a longer trip to the grocery store the first few times. How do you coach people through that?

Alaine Mills, RD [00:11:34] Yeah. So, when you join the gut health program, we have a meal planning program, so you know, we'll create that meal plan for you and then it actually creates an automatic grocery list from the meals that we have planned for you for the week so you'll have your grocery list for all the meals that you're going to eat for the week. So, it actually might be quicker and it's definitely going to be more efficient because you're not going to end up with a bunch of foods that you don't even have a plan for. I find a lot of my clients that go to the store without a plan, so then they're like, oh, you know, she said, beets are good. I'll buy those. But then you don't really have a plan or a recipe to eat those. You don't have anything to eat them with. So, if you're incorporating beets, you're going to have maybe a recipe for cooked beets with feta and walnuts, you know? So, you're going to have that list already together. So, you'll purchase those foods and you'll also only purchase enough for what you need so you don't have as much waste.

Erin Spain [00:12:21] For folks who are maybe feeding a family. They have a spouse, they have children, other folks that they're creating these meals for. Talk me through the little bit of the change management that people can do with their families and loved ones when they start incorporating more plant-based foods.

Alaine Mills, RD [00:12:35] A family dynamic can make it seem like it could be a lot more difficult, but again, like we'll create recipes and meals that can work for you and your family. And it may be that, you know, you're adding a side of something to your meal that perhaps your youngest child won't try. But exposing children, especially to foods, helps them become open to trying them. So, that's something that people don't really realize is even having your kids help you cook or at least letting them see you eat the food that will make them more willing to try those foods. So, you got to kind of jump in and not say, oh, you know, no, my family won't eat that. Well, you're going to eat it and they're going to see and that's going to help influence them.

Erin Spain [00:13:15] How do people feel after switching their diet and how long does it take before they can start feeling some effects?

Alaine Mills, RD [00:13:21] What's really interesting is that the research shows that when you switch to more plant foods and you start incorporating more plant foods into your diet, that can create changes in your gut microbiome overnight. So, you can already start to see benefits on that biological level. It doesn't mean I don't want to make people think that, you know, they eat some more plants and then the next day they wake up and they feel amazing. You know, they feel like a new person. As you incorporate more plant foods over time and you're consistent with that, you will feel more energized. You're going to stop experiencing symptoms like bloating, distention, stomach pain and cramps. You're going to have improvements in your bowel function, less constipation, less diarrhea, things like that. So, you're going to have improvements in your overall digestive health, which can really, really help you to feel better and more energized.

Erin Spain [00:14:09] Besides the meal planning and the one-on-one interaction with you, what else is included in the Gut Health Program?

Alaine Mills, RD [00:14:14] So, you'll meet with me first and we'll get a full history of your gut health and all the symptoms that you may or may not be experiencing. And then we'll start creating that meal plan, and then we'll set up times for check-ins that are kind of strategic to check in on how you're doing with your meal plan and how many plans you're getting for the week. And then we'll map out a plan for you to get towards those long-term goals, which the long-term goal I have for everyone in the program is to be eating 30 different types of plant foods per week. So, we'll be working together, you know, every other week or once a month, maybe towards later in the program. And then you will also work with some of the experts in our mindfulness center. There's a big connection between the gut and your brain health and your mood. So, we have some experts that help work with you on mindfulness. You'll work with them as well all throughout that plan. You'll be following the meal plan and you'll be getting check-ins with me through, we have an electronic system called healthy where you'll be, you know, I'll be sending you messages to check in for that accountability piece because that's a really big important part of this, too, is a lot of times people say, oh, I know what I need to do. I just can't do it. I just I won't do it. So, that accountability piece, somebody checking in on you is really, really key for that.

Erin Spain [00:15:21] This idea of eating 30 different plants in a week, where does that come from?

Alaine Mills, RD [00:15:26] There's a lot of research that the more variety of plants you eat, the better that is for your microbiome. So, the bacteria that are in your gut, they are going to be healthier and thrive more, the more different types of plants that you're eating. So, you know, if you hear somebody say eat three to five servings of vegetables a day, that doesn't specify, can it just be broccoli every time? So, you don't want that. You want to eat a lot of different types of vegetables and fruits and nuts and seeds and even whole grains. So, the more variety, the better and there's some research to show 30 is a good number. If you're trying to get five a day, and that's going to add up to 30, say you have oatmeal. Well, oatmeal is a plant-based food, so that's one. Then maybe you add flaxseed to your oatmeal, that's two, you put two different types of berries in your oatmeal. That's two more. And then maybe you put some walnuts in there. Well, you've already got five just in oatmeal. And then maybe for lunch you have a salad with four different vegetables, something like that. So, I don't want to say that it's easy, but if you prioritize it, it can be done and it will become easy, you know, the longer you do it.

Erin Spain [00:16:26] And how much time do you think people should set aside every day to work on their meal plan or to cook or to get into these recipes?

Alaine Mills, RD [00:16:34] It doesn't have to be much time and it's going to depend on the person. So, if I'm working with somebody that they work 12 hour days and they don't have time, then we're going to come up with something that they can do on their day off to meal prep and meal plan, and they're going to pack all their food that they can take with them on the go and then maybe even do some preparatory things for the foods that they are going to eat at home. So, maybe we're going to go ahead and chop up some things and just put them in the fridge so they're ready to just throw on a pan and put in the oven. And definitely there's going to be one day a week where you're grocery shopping with your meal plan, you know, when you have a little bit more time. But it really doesn't have to take much time. But if you really like cooking, it could take more time. So, it kind of depends, but it doesn't have to take that much time. You can definitely do semi-homemade things. The oatmeal, for example, that doesn't require really any preparation. So, I'm all about helping busy people figure it out.

Erin Spain [00:17:24] The last question is the question we ask everyone who comes on the show, what do you do to optimize your health and live well?

Alaine Mills, RD [00:17:31] Just practicing what I preach is so important to me, you know, it's my passion. So, I eat healthy and I exercise and I practice mindfulness and I work in a great place that helps me to prioritize that. I prioritize my health. I prioritize saying no if I need to so that I get my personal things like exercise and cooking and all of that done.

Erin Spain [00:17:50] Thank you so much, Alaine Mills, for coming on the show and telling us about the Gut Health Program and sort of demystifying what we mean by gut health. I really appreciate it.

Alaine Mills, RD [00:17:59] Yeah, of course. Thank you so much for having me. I love talking about this, so any time.

Erin Spain [00:18:08] For more information on this podcast, check out