Your Gut - the epicentre of your health - Part II
“All disease begins in the gut”
Hippocrates
In the Part I of this article, we looked at
What does a healthy gut look like?
What are all these microbes doing, and why do we need them?
What causes gut dysbiosis?
What are the symptoms of ‘gut dysbiosis’.
So we have established that ratio of good to bad bacteria is key, and so is diversity of microbes. We have touched on what you might see as symptoms of dysbiosis, although I am keen to stress you may have no symptoms. Now we move on to what gut dysbiosis will do to you - in the short term and in the long term, how you can test for it and what you can do about it.
What does ‘gut dysbiosis’ cause in the short term?
Intestinal permeability (or ‘Leaky Gut’). Leaky gut is when the tight junctions between the cells that make up the epithelium (the single layer of tightly packed cells that form your gut wall), become “leaky” as a result of poor lifestyle and food choices, allowing pathogens, undigested food molecules and toxins from inside the gut to pass unregulated into the bloodstream, triggering an immune reaction, inflammation and eventually autoimmune disease.
Among the worst of these substances slipping into your bloodstream are lipopolysaccharides (LPSs) which are toxic biproducts of pathogenic (bad) bacteria. If the LPSs stay inside your gut, all is fine. But you really don’t want this stuff in your blood (a high level is called ‘metabolic endotoxemia’). If you were to inject LPSs into your veins, you body would start to shut down and you’d enter septic shock.
Leaky Gut is extremely common and many chronic inflammatory diseases are linked to it (0). Of course, when you develop Leaky Gut you don’t suffer instantaneous effects. Its much more insidious than that. Every day your gut will leak tiny amounts of toxic substances into your blood and that will put your immune system on high alert, causing inflammation and pushing your body into a stressed state. We know that LPSs and other toxic substances can contribute to a number of different health problems including obesity, type 2 diabetes, thyroid problems, depression, low mood and anxiety.
Allergies – normally your gut bacteria are responsible for teaching your immune system how to tolerate dietary proteins and environmental allergens such as pollen or dust mites. But when they are disrupted, this teaching process goes out the window and the body has a negative reaction to allergens (1) (2). This is often the root cause of eczema and acne. Ensuring a healthy microbiome in expecting mothers and babies, may, on the other hand, help prevent the onset of allergic diseases (3)
Anaemia. Those with abnormal gut flora often have a particular group of pathogenic bacteria which are iron-loving. They consume whatever iron the person gets from the diet, leaving that person deficient in iron (4). Many doctors prescribe iron tablets in these circumstances, but it has been shown in a large number of studies conducted all over the world that supplementing iron makes these bacteria grow stronger and does not remedy anaemia. It also gives anaemic patients a lot of unpleasant side effects.
IBS stands for Irritable Bowel Syndrome and is a label used by conventional medicine for a bunch of symptoms. 20% of the world’s population is thought to have it. IBS is directly related to gut dysbiosis. In IBS sufferers there are too many of the harmful bacteria, and not enough of the ‘good’ bacteria. If you have it, you will know it’s pretty miserable – made worse by the fact it is often accompanied by depression and anxiety because of the gut-brain axis connection. It is at least now recognised as a legitimate gastrointestinal disorder, as opposed to psychosomatic, but current treatments focus on alleviating symptoms as opposed to fixing the underlying problems. A low FODMAP diet, which eliminates certain carbs that feed intestinal bacteria, is an effective short-term strategy to give relief from symptoms and help the bacteria ratio get back under control. (5) (6) but this is not a long-term strategy, as your body needs FODMAPs. The key is to follow this by both probiotic and prebiotic treatment. (7) (8)
SIBO stands for Small Intestinal Bacterial Overgrowth and is a special subset of IBS (about 60 - 80%) in which the small intestine is populated by bacteria that shouldn’t be there. Compared to the colon (where the majority of our gut bacteria hang out), the healthy small intestine will have a very low concentration of bacteria. Bacterial overload in the small intestine massively interferes with digestion and nutrient absorption (not great, as this is where all the nutrient absorption takes place). SIBO can be confirmed with a breath test in which your production of methane and hydrogen will be measured before and after drinking a sugary solution. It is notoriously difficult to treat, and antibiotics might be necessary. Rifaximin, which is also effective in treating IBS, is a good one and does less harm to the gut that most others.
How does gut dysbiosis impact our health in the long term?
Osteoporosis and bone health issues – studies show that there is a crucial link between the gut microbiome and skeletal issues. Two of the underlying causes of osteoporosis are inflammation and nutrient deficiencies. A healthy gut microbiome enhances the absorption of critical bone-building nutrients, including D and K2, calcium and magnesium.
Obesity - the gut microbiota appears to play a role in the development and progression of obesity (9). It seems that gut dybiosis increases the amount of energy (calories) obtained from the diet, increases appetite, and screws up satiety mechanisms (10). It also causes systemic inflammation which precedes the development of “diabesity” (obesity and type 2 diabetes) and which merits being the subject of a separate article.
Most studies of overweight and obese people show a lower diversity of microbes. Germ-free mice that receive faecal microbes from obese humans gain more weight than mice that receive microbes from healthy weight humans. A large study of UK twins found that the genus Christensenella was rare in overweight people and when given to germ free mice prevented weight gain. This microbe and others (such as Akkermansia) correlate with lower visceral fat deposits. Although much of the evidence comes from mouse models, long term weight gain (over 10 years) in humans consistently correlates with low microbiome diversity, and this association is exacerbated by low dietary fibre intake (11).
Brain disorders - the gut microbiome influences the brain and neurobehaviour via the gut-brain axis, which links the enteric nervous system of the gut (the gut-brain) to the central nervous system (the brain-brain) (12).
Disruptions of the gut microbiome are implicated in a whole range of psychiatric disorders: autism (13), ADHD (14), anxiety (15), depression (16) (17), Alzheimers (18) and Parkinson’s (19). Conversely, restoration of a healthy gut with prebiotics and probiotics has been clearly show to alleviate symptoms of such disorders (20) (21).
Prozac is the most widely used antidepressant drug. In the UK in 2018, 71 million prescriptions were given compared with 38 million in 2008 (22). Prozac works by increasing the availability of serotonin. Your gut microbes make serotonin from an amino acid called tryptophan. Tryptophan is an essential amino acid, meaning it can’t be made in the body - you have to eat it. It is found in salmon, eggs, chicken, spinach, nuts, seeds, milk and soy. If you don’t have tryptophan in your diet, serotonin can’t be made. (And while I am at it, the production of serotonin is increased during periods of fasting and hugely reduced if you snack frequently).
Autoimmune diseases - emerging research suggests that gut bacteria may trigger autoimmune disorders, not just those directly linked to the gut such as Crohn’s disease and ulcerative colitis, but also non-intestinal autoimmune disorders such as lupus, multiple sclerosis, rheumatoid arthritis (23), type 1 diabetes, Parkinson’s and Hashimoto’s disease (thyroid) (24) (25) . Current research strongly suggests that autoimmunity (loss of self-tolerance) develops via a complex interaction between genetics, the environment and gut health.
Type 1 and type 2 Diabetes. Gut dysbiosis is highly associated with insulin dysfunction in type 1 diabetes (26). Children with type 1 diabetes have lower levels of lactobacilli and bifidobacterium, and reduced microbial diversity compared to healthy children (27).
The gut microbiome also plays a crucial role in type 2 diabetes. High blood sugar can directly impair gut barrier function (causing Leaky Gut), alter the microbiome and increase susceptibility to gut infection (28). Several studies show that opportunistic pathogens are increased, while microbes that produce butyrate are decreased in type 2 diabetes (29). The resulting dysbiosis allows leakage of harmful bacterial metabolites into the bloodstream, causing chronic inflammation, an important underlying cause of type 2 diabetes (30). So, which came first, the high blood sugar/diabetes or the leaky gut/inflammation? The honest answer is that we still don’t know, but regardless, its abundantly clear that we need to treat the gut and metabolic health simultaneously in order to break this vicious cycle (31).
Cancer, particularly breast and colon cancer (xx). Research shows that the gut microbiome of women with breast cancer differs significantly from that of healthy women. Gut microbes, capable of metabolising estrogens, influence the body’s estrogen levels; too many or too few may drive the development of estrogen-sensitive cancers, such as breast and ovarian (32). Furthermore, exposure to what are called xeno-estrogens (estrogen-like compounds in the environment, like BPA in water bottles, plastic packaging and cash register receipts) alters the gut microbiome in a way that can influence breast cancer development.
Elevated levels of certain bacteria such as Streptococcus bovis and Helicobacter pylori are associated with an increased risk of colon cancer, due to the bacteria’s pro-inflammatory effect on colon tissue (33)
It looks like the state of one’s gut also has an influence on how someone responds to cancer immunotherapy, according to this recent study (34). Correcting imbalances in your microbiome is crucial both for preventing and treating cancer.
Cardiovascular disease - gut dysbiosis causes bacteria to move from the gut into the bloodstream (‘Leaky Gut’) causing an inflammatory response that triggers the growth and build-up of arterial plaque (atherosclerosis), which ultimately can cause stroke or heart attack. These plaques have been found to contain bacterial DNA identical to that present in the gut, further supporting this notion (35).
Certain gut microbes produce metabolites that don’t do your heart any favours. These are TMAO, uremic toxins, and lipopolysaccharides (LPSs). We have already covered LPSs. TMAO causes inflammation which leads to Leaky Gut, uremic toxins cause vascular smooth muscle cell calcification (which leads to hardening of the arteries) (36), atrial fibrillation and cardiac cell dysfunction (37).
How do you know how if your microbiome is in good shape?
After reading Part 1 of this article, my brother rang me and said that it was very interesting and all that, but as he didn’t have any gut symptoms, he was pretty relaxed about it all. Of course, I rang one of my practitioners and asked his view on this comment. He said that so many reasonably serious gut conditions don’t give rise to symptoms. One chap he had tested had Calprotectin levels through the roof (a marker of inflammation in the colon) and soon after his test, he was diagnosed with bowel cancer. A woman who thought she was in very good shape turned out to have sky high levels of beta-glucaronidase, an enzyme that is a key part of our ability to detoxify pharmaceuticals, carcinogens, bile acids and estrogen. When too high, that process can’t work properly and is a condition associated with PMS, endometriosis, breast, prostate and ovarian cancers. Lastly, he pointed out that 22% of coeliacs are asymptomatic and therefore go undiagnosed, significantly raising the level of inflammation in the body, leading to chronic disease and early morbidity.
The first thing to do, if you want to know the answer to this question, is to clean up your diet and lifestyle as much as you can – for a couple of months. Once you have done that, you could consider doing a comprehensive stool test. The one that I would recommend for a whole host of reasons, but not least because it comes with a very comprehensive and user-friendly report, and therefore doesn’t require you to appoint a practitioner, is GI 360 by Doctors Data (an awesomely good lab), marketed by Regenerus Labs in the UK.
Regenerus also have an excellent video on their website called How to Pick the Right GI Test which I think is well worth watching.
How do we heal our gut and keep our microbes happy?
Eat enough fibre. Fibre falls into two categories, soluble and insoluble. ‘Soluble’ fibre dissolves in water, forms a gel, and is easily digested (fermented) by microbes in the colon, producing Short Chain Fatty Acids (SFCAs) in the process. We want lots of these, you will remember. Soluble fibre also slows the rate at which carbs are converted to glucose which is really important for blood sugar control (38). The best sources are asparagus, Jerusalem artichokes, squashes, parsnips, beetroots, sweet potatoes, white potatoes, oats, lentils, apples and berries.
All vegetables are actually carbs (& fibre), but some have a much higher carb content than others. (You probably think of potatoes and parsnips as carbs, but not cabbage and broccoli). If you consider going on a low-carb diet for weight loss (sensible), you must be careful to take out the bad carbs (sugar and refined flour, wheat and wheat products) and leave in the good carbs. The carby vegetables in this list are the carbs you should cut LAST. You need them.
For those who can’t or won’t get enough soluble fibre into their diet, prebiotic supplementation is the work around. They do the same job as soluble fibre, serving as nourishment for the good bacteria while not fuelling the growth of the bad guys.
Insoluble fibre meanwhile does not dissolve in water and is less readily fermented by microbes in the colon. However, it plays a vital role in helping control the consistency of food in our digestive tract as well as the pace at which it passes through. Cabbage, celery, greens of all types, broccoli, cauliflower, sprouts, corn, whole peas, peppers, aubergines, onions, garlic and leeks are all high in insoluble fibre.
While nutrient dense, insoluble fibre can be irritating to the digestive system for people who have an inflamed gut, or who suffer from gas and bloating, and these people may need to limit this category of veggies until problems disappear. Alternately you can moderate their effect by peeling them, cooking them thoroughly (raw is not a good idea for those with gut problems), or fermenting them which makes them far more digestible.
As you can see, both types of fibre are important. If supporting your microbiome is a priority (and I hope you are getting the message that it should be) you should try and get 25-30 different plants (including nuts and seeds) a week into your diet, and 25g of fibre a day (women)/38g a day (men).
Eat probiotic-rich foods – these are fermented foods, rich in good bacteria and therefore wonderful for your gut. The fermentation process makes foods more digestible. Unless you suffer from high histamine, you should try and get some into your diet every day. Sauerkraut, pickles, yoghurt, miso, tempeh, kombucha, kefir and kimchi are delicious ways to add probiotics to your diet. Polish women are known to eat 30 lbs of sauerkraut a year. When they move to the US, they tend to eat a lot less. Polish women living in the US have dramatically higher rates of breast cancer than their cousins in Poland who are wolfing down the kraut.
Eat more polyphenol-rich foods – these are phytonutrients found in plants such as berries, dark chocolate, virgin olive oils and many herbs. The good critters love them, feed on them and in turn protect us. One such bug is Akkermansia, which loves cranberry, pomegranate, and green tea. When it is in abundance, it creates that protective layer that protects the gut lining and protects against Leaky Gut, autoimmune diseases and even heart-disease and diabetes. (39). It turns out this bug is also necessary for certain cancer treatments to work, such as immunotherapy. Tea is probably the most researched out of all the high polyphenol foods, with many studies proving the prebiotic effects of tea. Several phytochemicals in tea inhibit the growth of gut pathogens such as E.Coli and Salmonella. For coffee lovers, one of the main chemical compounds in coffee, chlorogenic acid, increases gut bacterial production of SCFAs (40). And here is the best news in this article: red wine also contains polyphenols that would appear to have a similarly beneficial impact on gut bacteria (41). Yippee!
Take Probiotics – research on probiotics has exploded in recent years, with studies assessing their effects on conditions ranging from depression to obesity. Probiotics show promise in alleviating anxiety, depression and perceived stress (42). They also improve fasting insulin and HbA1c in type 2 diabetics (43) and reduce the rate of cold and flu infections in adults (44). However, no probiotic can cancel out the harmful effects of an unhealthy diet on the gut microbiome, so the intake of fibre, polyphenols and fermented foods should remain the priority.
A safe and high-quality probiotic is Every Day Max by OptiBac. This has 75 bn CFUs, max strength live cultures, combining 3 of the most important strains: Lactobacillus acidophilus, and two strains of Bifidobacterium. It is gluten-free, dairy-free and vegan and safe during pregnancy. Having said that, we are all biochemically individual, and if you take a product and don’t feel better on it, you should cease to take it and seek professional advice.
Conclusion
As we know, the roots of a tree, invisible, hidden deep under the ground, play a crucial role in the wellbeing of every branch, every twig and every little leaf of that tree, no matter how far they may be from those roots. In the same way, the diverse and multiple functions of the gut microbiome reach in the body far beyond the gut itself.
Digestive problems can be uncomfortable and disruptive to our everyday lives. Poor diet, antibiotic overuse, and chronic stress cause the digestive system to malfunction in several ways. This in turn leads to a cascade of systemic reactions and contributes to everything from abdominal pain and skin problems to autoimmune disease, depression, obesity, osteoporosis, diabetes and worse.
I cannot stress too strongly how important a healthy gut is to your overall health and long-term wellbeing. It is the NUMBER ONE aspect of your physiology that any functional doctor will focus on, whether you are looking to maintain your health and prevent chronic disease or treat one you are already suffering from. If you are willing to put some effort into becoming a bit healthier than you are right now, this is where you should start.
* Please note that the information in this article is for your general knowledge only and is not a substitute for professional medical advice or treatment for specific medical conditions. Always consult your Dr/GP before making any health care decisions and/or adjusting prescribed medications/dosages. *
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