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Digestive & gut health

When I started in practice I was staggered by the number of people, both adults and children, suffering from constipation, diarrhoea, increased gas, bloating, burping after eating, painful cramps and spasms, reflux, acidity, fatigue, IBS and the many other symptoms of gastrointestinal distress.

There are more than 200 over-the-counter remedies for digestive disorders, many of which – most unfortunately – can create additional digestive problems in their place. Digestive complaints are amongst the most common reasons for individuals seeking medical help, and that’s not even the worst news.

Digestive & gut healthMany medics don’t seem to be aware that once we have a compromised digestive system it can play out over our entire bodies leading to allergies, arthritis, autoimmune conditions, acne, chronic fatigue, mood disorders, intolerances, autism and more. So having a healthy gut is central to out entire health. It is connected to almost everything that happens in our bodies. That’s why I almost always start helping people treat chronic health problems by fixing their gut. First let me explain what happens in there.

What’s going on in there?
Our digestive system is responsible for breaking down & absorbing all the food we eat and then delivering subsequent nutrients to your body’s cells in order to thrive. Over a lifetime, the average person ingests more than 25 tons of food; however, as well providing nutrients this food may also contain damaging bacteria, viruses and toxins. The gut wall, or mucosal layer, has the unique role of both providing protection to the body by preventing entry of toxins or pathogens across this dynamic layer yet at the same time allowing in health-promoting nutrients & molecules.

The stomach: Acts as a reservoir for food and mixes the food bolus with HCL (hydrochloric acid) and enzymes. The stomach produces HCL to create an acidic environment that favours the initial breakdown of proteins; in addition many microorganisms/pathogens are destroyed by this low Ph.

Both too much and too little acid can cause digestive complications and symptoms for both can be very similar (burping, reflux and bloating). The importance is in actually ascertaining if the individual has hyper or, indeed, hypochlorhydria (low stomach acid pH) and not, as is too often the case, assuming that the symptoms are as a result of too much acid. An amazing statistic that I read recently claims that approximately 44% of adults self-medicate with antacids or other similar medications. These drugs function by decreasing or neutralizing the level of stomach acid by blocking the function of the parietal cell that produces it. But, here is the kicker, your body produces stomach acid for a number of good reasons, and requires it to stay healthy. It’s necessary to start the digestion process of proteins, activate digestive enzymes ,keep bacteria from growing in your small intestine, and help you absorb important nutrients like calcium, magnesium, and vitamin B121. It begs the question, "what are the long term consequences of taking a product that significantly inhibits these actions?"

In my clinic, after taking a full case history and then if deemed appropriate, I use a test called The Gastro-Test® to determine gastric (stomach)Ph. It is a non-invasive FDA approved diagnostic tool, click here to view a video.

The small intestine, pancreas & gall bladder: Once your food has spent some time in the stomach being liquefied into a substance called chyme it is methodically squirted into the first part of the small intestine- the duodenum. The very presence of chyme in the duodenum triggers the release of two hormones: cholecystokinin & secretin which serve the following functions (1) sending a message to the brain, telling us we are full. (2) Telling the stomach to slow down the emptying process. (3) Triggers both the pancreas to release digestive juices to further breakdown food molecules and the gall bladder to release bile for the emulsification of fats.

If the first part of the digestion process in the stomach has not been effective, most commonly because there is insufficient levels of HCL to kick-start this whole process off, then these subsequent triggers don’t occur and in turn, small intestine digestion & its absorptive function become compromised. Digestive enzymes from the pancreas don’t flow as readily and the gall bladder may not release bile to emulsify fats - all resulting in food molecules not being broken down into their smaller components to ultimately be absorbed. These remaining larger molecules can start to ferment and/or irritate the lining of the gut wall causing damage and a condition called “leaky gut”. In addition they can lead to an overgrowth of bacteria in the small intestine, which shouldn’t ordinarily have that large a population of bacteria. For many more people, low-grade overgrowth of bacteria in the small intestine leads to bloating, gas, abdominal pain and diarrhea.

The gut wall and a leaky gut
: In a healthy gut lining (mucosa) the epithelial cells that make up the mucosa are tightly packed together like a brick wall and have contact points called tight junctions. This surface is semi-permeable, thereby allowing properly digested food molecules to pass across into the bloodstream; but at the same time acting as a barrier, preventing larger damaging molecules like partially digested food, foreign particles, pathogens such as infectious bacteria or viruses across. The absorptive surface is formed from finger like projections called villi which are coated in cells called enterocytes that complete the final digestive process and absorb the nutrients into the bloodstream.

Both the enterocytes and tight junctions can become damaged by toxins, such as bacterial and fungal by-products, incomplete digested food, food additives, alcohol, over-the counter drugs like NSAIDs, and foreign microbes. When damaged the tight junctures between the cells expand, creating a “gap”, enabling the absorption of these larger and toxic molecules across the gastrointestinal tract mucosa into the bloodstream and general circulation. These now antigenic molecules can provoke immune reactions and cause a heavy burden on the liver to try and detoxify, all contributing to a toxic load of the system and symptoms and conditions start to occur.

Interestingly, “beneficial bacteria” in the gut act as the housekeepers for the digestive tract. They coat the entire surface of the gut, providing another layer of protection from invaders and toxins by providing a natural barrier and producing a lot of anti-bacterial, anti-viral and anti-fungal substances. Read more on gut bacteria below.

The most useful, and non-invasive method for the assessment of intestinal mucosal integrity is a functional test that consists of measuring the passive permeability of two sugars, mannitol and lactulose. Neither mannitol, a single sugar, nor lactulose, a double sugar, are metabolised in the body. While mannitol is easily absorbed, lactulose is only absorbed to a limited degree. For the test, the patient drinks a liquid containing a known quantity of the two sugars; the test measures the amounts of lactulose and mannitol recovered in the urine after 6 hours. Elevated levels of lactulose and mannitol indicate increased intestinal permeability and “leaky gut” condition; an increased ratio of lactulose to mannitol shows that the mucosal pore size has expanded, allowing larger molecules entry to the body.

Gut Immunity
Approximately 70% of our total immune system is located within the GI tract. The primary purpose of this gut immune system is to provide a first line of defence- termed "innate immunity". The cells that are embedded here are constantly in contact with foods, microbes and toxins and as such make innumerable immunological decisions every day. As the gut makes its decisions, it then relays information from the innate to the adaptive and systemic immune system. The gut is where health begins, and is also home to a plethora of innumerable species of bacteria that form a symbiotic relationship with the host (us!) to establish “tolerance” and immune balance. 

The gut bacteria
The human body is home to trillions of micro organisms that we call microflora or gut flora. The largest colonies of microbes live in our digestive system, where a healthy adult on average carries 1.5-2kg of bacteria in their gut .They play a number of vital roles in the body:

  • Keeping the bad guys out – having the right levels of “beneficial or essential” bacteria helps to prevent more opportunistic or pathogenic microbes from taking up residence in our gut. Some of the beneficial bacteria also actively produce antibiotic-like substances, anti-fungal and anti-viral substances that dissolve membranes of viruses and bacteria.
  • Fermentation of fibre – A diet rich in vegetables, fruits and wholegrains provides an excellent mix of soluble and insoluble fibre. The fermentation of insoluble fibre by some species of microflora form short chain fatty acid (SCFAs) and as such serve several important functions:
    • Provide energy for the cells that line the colon.
    • Act as anti-diarrhoeal agents by removing sodium and water from the colon.
    • Deter the colonisation of pathogens in the bowel.
  • Modulate and condition the immune system – Approximately 70% of our immune system is located in the gut wall and gut flora has a dynamic influence on this immune system, literally priming it for appropriate action. Our immune system has two different modes of attack, based on the invader. One mode is for dealing with organisms like bacteria, viruses and fungi that get inside our cells. The 2nd is for attacking pathogens found outside our cells, In blood and other bodily fluids ie:- parasites and chemicals. A healthy immune system is able to switch back and forth between these two modes, but if one side becomes too dominant, it can result in the immune system running amock and a host of symptoms from allergies to autoimmune responses can be the net effect. Amazingly the gut flora is vital for helping to maintain this delicate balancing act between the two sides and as such aiding immune tolerance.

The notion that diet might have profound effects on immune responses or inflammatory diseases has never been taken that seriously, said Professor Mackay. We believe that changes in diet, associated with western lifestyles, contribute to the increasing incidences of asthma, Type 1 diabetes and other autoimmune diseases. Now we have a new molecular mechanism that might explain how diet is affecting our immune systems.

We’re also now beginning to understand that from the moment you’re born, it’s incredibly important to be colonised by the right kinds of gut bacteria. The kinds of foods you eat directly determine the levels of certain bacteria in your gut.

Changing diets are changing the kinds of gut bacteria we have, as well as their by-products, particularly short chain fatty acids. If we have low amounts of dietary fibre, then we’re going to have low levels of short chain fatty acids, which we have demonstrated are very important in the immune systems of mice”. -

  • Many vitamins are synthesized by the microflora of the colon, including Vitamin K, and the B vitamins thiamine (B1), riboflavin (B2), nicotinic acid (B3), pyridoxine (B6), biotin and folate .

Different types of bacteria
Essential or beneficial flora: These bacteria are referred to as our indigenous friendly bacteria. The main members of this group are: Bifidobacteria (Bifidobacterium bifidum), Lactobacteria (Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus rhamnosus), Propionobacteria, Peptostreptococci and Enterococci.

Opportunistic flora: This is a large group of various microbes: Bacteriods, Peptococci, Staphylococci, Streptococci, Bacilli, Clostridia, Yeasts, Enterobacteria, Fuzobacteria, Eubacteria, catenobacteria and many others. There are around 500 various species of microbes known to science so far, which can be found in the gut. In a healthy person their numbers are limited and are tightly controlled by the beneficial flora. Each of these microbes is capable of causing various health problems if they get out of control.

Transitional flora: These are various microbes which we daily swallow with food and drink. When the gut is well protected by the beneficial bacteria, this group of microbes pass through our digestive tract without doing any harm, but if the population of the beneficial flora is damaged and not functioning well this group of microbes can cause disease.

Why your gut may be in trouble
There are many factors today that damage the beneficial gut flora and knock our digestive system off balance.

  • Our low fibre, high sugar, processed food, nutrient poor, high calorie diet that makes all the wrong bacteria and yeast grow in the gut leading to a damaged ecosystem.
  • Overuse of medications that damage the gut or block normal digestive function – things like anti-inflammatories, antibiotics (It takes between 4 to 8 weeks depending on the species of beneficial bacteria to re-establish in the gut after taking antibiotics), acid blocking drugs, and steroids.
  • Chronic low-grade infections or gut imbalances with overgrowth of bacteria in the small intestine, yeast overgrowth, parasites, or even more serious gut infections.
  • Toxins damage the gut such as mercury and mould toxins.
  • Lack of adequate digestive enzyme function – which can come from acid blocking medication use or zinc deficiency.
  • Stress can alter the gut nervous system causing a leaky gut and changing the normal bacteria in the gut.

So you may have read this because you are suffering from IBS or related conditions such as chronic diarrhoea, constipation, bloating, reflux, cramps or spasms and if so, hopefully you can see that given the right case history taking and functional testing, nutritional therapy may help to uncover what has been causing these symptoms and in turn create a bespoke plan to restore you back to health. Similarly, it is highly apparent that the integrity of your gastrointestinal tract plays a significant role in your overall health and wellbeing, and that many health issues seemingly totally unrelated to the gut, such as fatigue, eczema, psoriasis or inflammatory conditions can be traced here and as such very often becomes a primary focus for an initial treatment protocol.

The whole picture
At Nutritional Values we use the Functional Medicine model to assess your health. This means seeking to identify interactions between different systems in the body through comprehensive case history taking, your presenting signs and symptoms and on occasion, functional laboratory testing. The goal is to identify and address the triggers and underlying causes of your health problems that can often cause imbalances in body systems rather than simply focusing on symptoms.

As part on my on going commitment and passion to this fasinating area of health, in May 2013 I completed post gradute training with The Institute of Functional Medicine in relation to gastrointestinal health & function through an intensive 2.5 day advanced practice training program.

To book an appointment or speak to Tanya click here.

Functional Medicine Module Graduate London 2013References
1.Ruscin, J.M., Page, R.L., and R.J. Valuck. 2002. Vitamin B(12) deficiency associated with histamine(2)-receptor antagonists and a proton-pump inhibitor. The Annals of Psychopharmacology. 36(5) 812-816