Dr. Sarah Moore
Gut health...a key to wellness
There has been an explosion of information in the media and the scientific literature promoting gut health as the foundation of all aspects of our health and wellbeing. Alongside this eruption has come a plethora of products and protocols for healing and maintaining your gut health, with the promise of resolving an array of symptoms, from acne to anxiety.
Unfortunately, like many solutions that are advertised as a quick-fix, people are disappointed when, despite religiously sticking to their new gut protocol, they aren’t seeing any improvements after a week or two or maybe even a month, so they give up and go back to their old ways.
Understanding the root cause
I believe the key to healing any health problem is to first understand the underlying predisposing factors, triggers and ongoing agitators for the health problem, including the physiological and pathological processes at play. This is the foundational philosophy of Functional Medicine. Once we can conceptualise why a particular illness has arisen, we can then proceed to address each factor in a systematic way and consequently return to wellness.
It starts with the gut
Issues with gut health are at the root cause of almost every, if not every, symptom that arises in patients that I see. It may not be the only contributing issue, however starting with healing the gut often brings significant improvements in a range of symptoms that one may not have realised were related to underlying gut imbalance.
I would just like to mention that gut health is the foundation of Ayurvedic medicine, ancient Indian tradition and sister science of Yoga. Knowledge of the importance of caring for the gut has been around for tens of thousands of years, so it is interesting to me that we have become so fascinated by gut health again in recent times. When you think about it, it makes a lot of sense. The gut is the main organ through which we absorb most of our nutrients for every cell in our body. If our gut isn’t working properly, we don’t absorb the necessary “fuel” to supply energy to our cells; consequently they cannot function optimally and we start feeling less well. Further to this, the gut is also our main organ of elimination and detoxification, so again, if the gut is not functioning well we retain toxins that can be reabsorbed into our blood stream and create damage to our cells and organs. Over time, our cells become more and more dysfunctional and eventually are not able to work at all. Then we develop disease.
Agni, our digestive fire
In Ayurveda, digestion in the gut is referred to as Agni or digestive fire. It is responsible for metabolic conversion of food to energy such that it can used to fuel the body’s processes. Digestion within the gut is divided into different phases, including:
moistening and softening of the food in the upper part of the stomach
transformation of the food by digestive enzymes in the low part of the stomach
separation and assimilation of nutrients in the small intestine
elimination of waste from the large intestine
If there is imbalance in the digestive process at any stage, either over activity or under-activity, then this can lead to a range of different symptoms, such as bloating, heartburn or constipation, depending on where the imbalance is occurring. If these imbalances are not resolved, over time Ama forms, which can also be thought of as inflammation. Chronic inflammation can then adversely affect the rest of the body’s metabolic functions, causing symptoms in any body system depending on the individuals predisposing factors. Over time, untreated inflammation will eventually lead to disease.
The gut examined
At this point, I think it would be helpful to consider the different parts of the gut and the role each plays in the body’s physiology, as this provides us with an understanding of how to care for our gut to optimise its function.
Enzymes in the gut are critical to digestion. If these enzymes are deficient or in excess, digestion can be out of balance, leading to a range of gut symptoms. There are many enzymes in the gut that have their own specific functions, so I think it would be useful to focus on a couple enzymes that can impact on not only gut function but systemic health.
You may have heard of the pancreatic enzymes amylase and lipase, which are important for breaking down dietary starch and dietary fats respectively. When the pancreas becomes inflamed, either acutely due to gallstones or intestinal obstruction, or chronically due to persistent alcohol use, then these enzymes are released in excessive amounts, leading to pancreatitis. Initial gut symptoms include nausea, vomiting and abdominal pain, but if pancreatitis is left untreated, a systemic inflammatory response can occur, causing fever, jaundice (due to liver dysfunction), unstable blood pressure and heart rate, muscle spasms (due to low calcium levels) and difficulty breathing. Hence, it is important to consider how to prevent such enzyme imbalances. Thankfully, lifestyle choices such as avoiding too much dietary starch, fat and alcohol will be very effective at keeping pancreatic enzymes in balance, and maintain good gut health.
The gut microbiome is made up of billions bacteria that allow our gut to function normally. The key to a healthy microbiome is diversity of organisms. The food that our gut bacteria require to maintain their diversity is dietary fibre, that is, lots of fruit and vegetables. Foods that feed the “wrong” type of organisms and create imbalances include sugar and processed foods. Another important factor impacting the microbiome is stress. Stress in the body leads to increased levels of cortisol and adrenaline, which cause inflammation. Inflammation kills off important organisms and leave others to grow out of control. When the microbiome is out of balance, this leads to dysbiosis. Dysbiosis has been linked to a range of systemic health issues, including autoimmune disease, allergy, obesity and mental illness such as depression and anxiety. Therefore, diet and stress management are important strategies for maintaining a healthy gut micriobiome AND healthy mind-body.
The gut lining is made up of a range of different cells, a mucous layer and numerous proteins that work together to allow certain molecules to cross through the gut lining into the blood stream, while keeping others inside the gut lumen to be eliminated. When the gut lining is functioning normally, we absorb the required nutrients that provide us with the fuel we need to drive our metabolism. If the gut lining is damaged, for example in an individual with Coeliac Disease who has eaten gluten, then the gut barrier is compromised, and molecules that would normally be prevented from passing through into the blood stream are able to pass through, circulating to other organs and causing inflammation. This is what we call “leaky gut” syndrome. Excess sugar, processed foods and other foods such as dairy can also cause inflammation that consequently disrupts the gut lining. “Leaky gut” can underlie a range of health conditions, including allergy and eczema, autoimmune disease and migraines. Consequently, choosing a diet that maintains a healthy gut barrier is key to staying well.
Our gut plays a pivotal role in our body’s immune system. Immune lymphoid tissue, called Peyer’s patches, are located beneath our gut lining in the small intestine, waiting for organisms, food and environmental molecules to be presented to them so they can respond with immune defences to protect against toxins. Immunoglobulins are also involved, to allow the body to develop tolerance to a range of molecules and prevent troublesome immune reactions, such as allergic reactions. There is a complex relationship between various cells of the immune system that allow it to detect and eliminate unwanted pathogens and toxins while allowing nutritious food to be absorbed and metabolised. If there too many pathogens, toxins or allergens, the immune system can become overwhelmed, leading to inflammation and dysfunction in the gut as well as the rest of the body. This can result in symptoms such as allergy and eczema, chronic sinus symptoms and autoimmune disease. Consequently, it is important to be aware of the various pathogens, toxins and allergens that can affect the gut so they can be avoided or treated appropriately.
The gut really is the body’s gatekeeper, contributing to maintaining a healthy balance within our body, allowing fuel in and keeping toxins out. Disruption to the gut enzymes, microbiome, barrier or immune system can lead to dysfunction in the gut, allowing damaging molecules through the gut into our circulation and our organs, setting up inflammation that can lead to disease. Consequently, it is vital to consider the gut whenever symptoms arise in any part of the body, and include gut healing as an important part of an holistic treatment plan.