Sunday, January 1, 2012

Handling Gut Dysbiosis and Leaky Gut Syndrome is an Important Pathway to Better Health

The following entry is based on my notes from a teleconference given by Dr. Bill Hemmer, D.C., a chiropractic physician in Tuscola, Illinois, who happens to know a lot about this subject. This entry is dedicated, in gratitude, to Dr. Hemmer.

All diseases begin in the gut,” Hippocrates said more than 2000 years ago.

Strictly speaking, this may not be true. It may be that all disease begins with central nervous system dysfunction. There's an area of the brain, for example, called the insular cortex on which is mapped sensory input from different areas of the body, including the gut. For example, if the stomach or intestines become distended, sensory receptors embedded in the walls of these structures communicate such information to the insular cortex. And it is known, for instance that when there is a functional disturbance in this part of the brain, it can lead to an inability to modulate the perception of pain in the gut, contributing to irritable bowel syndrome.

I digress. But it's a digression worth pursuing. The relationship between the brain and the gut as it relates to health is a bit of a chicken-egg conundrum. Does neural dysfunction leading to impaired circulation to the gut cause the gut to be “leaky,” subsequently leading to a cascade of autoimmune-type problems? Or do the autoimmune-type problems that arise due a leaky gut create systemic effects that ultimately affect the function of the brain? Probably both things occur; and from a practical, clinical perspective, to worry too much about such distinctions is sort of silly. 75-80 percent of lymphoid tissue (this is where lymphocytes, key players in the immune system, hang out) resides in and around the digestive tract. No matter what the root cause of disease, it's clear that optimizing gut function is hugely beneficial. When the gut works the way it's supposed to, the immune system doesn't work nearly as hard as when the gut is dysfunctional.

'Tis the Season for Gut Dysbiosis

Dysbiosis refers to an imbalance in the ratio of beneficial to non-beneficial bacteria or flora that inhabit our digestive tracts. During the holiday season, when it's easy to overindulge in rich foods that mess with this balance, dysbiosis is a common result. Our digestive tracts contain 3.5 to 5 pounds of gut flora, which can be separated into 3 different groups:
  1. Essential gut flora. The main members of this group are bifidobacteria, lactobacteria, strains of E. Coli, peptostreptococcus, and enterococcus. The composition of your gut flora is specific to you—it's as individual as your fingerprint. This is one reason why some people do really well on a specific probiotic supplement (a source of essential gut flora), and other people don't do so well.
  2. Opportunistic gut flora. This include Bacteriods, Peptococci, Staphylococci, Strepococci, Bacilli, Clostridia, Yeasts, Enterobacteria, Fuzobacteria, Eubacteria, Cantenobacteria. All of these microbial agents mutate and become as individual as your fingerprint. In a healthy gut the essential flora keeps these agents under very tight control. In the absence of adequate numbers of essential gut flora, the opportunistic flora cause a lot of the dysbiosis.
  3. Transitional Flora. These are typically bacteria from the environment that we take in with foods and beverages. As long as the gut is healthy these organisms don’t cause any problems. However, if there's a change in gut function—especially in the stomach—the transitional flora can cause problems.

The Environment of the Stomach

The stomach's environment is naturally very acidic. It should have a pH of about 2. This is necessary for three reasons—first, to activate the stomach enzymes; second, to digest proteins, fats, and minerals; and third, to kill the bacteria and parasites found in foods. If the environment of the stomach is not acidic enough, you can have problems. In effect, a lack of stomach acid can seed the gut with the opportunistic flora that cause dysbiosis.
Paradoxically, when people experience acid reflux, the root cause typically is not enough stomach acid. The common intervention is to take acid-stopping medication, which typically just exacerbates the problem.

Acid-Stopping Medications: Short-Term Relief, Long Term Problems

In the very short-term, acid stopping medication helps with the symptoms, but over the long term, it can cause real problems.
One problem is that the absence of hydrochloric acid fails to activate the digestive enzyme pepsin, and food starts to rot in the stomach, producing organic acids. This is what you experience when you belch or have acid reflux. Adequate natural acid production is necessary not only to close the lower esophageal sphincter to prevent reflux, but also to allow the pyloric sphincter to open so that food can pass from the stomach into the duodenum (the first part of the small intestine). So, without adequate acid production, you can get slow stomach emptying and bloating combined with reflux.
Another complication with taking acid-stopping medication is that it creates functional changes in the stomach lining that perpetuates dependence upon the medication. The mucosa of the stomach forms a protective barrier between stomach acid and the underlying tissue and smooth muscle. If the stomach's acid production decreases, so does the function of the mucus-secreting columnar epithelial cells. This means that in the presence of an acid, the stomach cannot adequately protect itself—hence the reliance on acid stopping medication.
Yet another complication of acid-stopping medications is that they work by affecting the function of parietal cells of the stomach, which also secrete a substance called intrinsic factor. Intrinsic factor is necessary for the absorption of vitamin B12. Because Vitamin B12 is necessary for the production of red blood cells as well as the proper functioning of nerve cells, a deficiency of this vitamin induced by acid-stopping medication can have serious, adverse affects on one's overall health.
It is possible to wean yourself from acid stopping medications. Doing so involves a regimen of whole food supplementation to rebuild the stomach lining.

The Environment of the Small Intestine

There's a bacterial layer that covers the entire length of the digestive tract, and this layer produces antibacterial, antiviral, and antifungal substances which dissolve the membranes of pathogenic bacteria and viruses so that the cells of the immune system can kill the invading microbial agents.
The gut epithelium is estimated to get 60 to 70 % of its energy from healthy bacterial activity. Therefore, if your gut does not have a good bacterial layer, then there is less energy available for the gut epithelium. If there is degradation of gut epithelium, it can lead to leaky gut syndrome, which is covered in more detail below.
The inner surface of the small intestine is lined with projections called villi that are lined with mucus-producing cells called goblet cells as well as enteroendocrine and paneth cells. The enteroendocrine cells produce a variety of hormones that regulate everything from the release of stomach and pancreatic secretions to intestinal motility and contraction of the gallbladder. The paneth cells lysozyme, an antibacterial enzyme whose function, like many of the substances secreted by essential gut flora, is to digest the cell walls of non-beneficial bacterial. The idea is to create a healthy enviroment so nutrients can be absorbed efficiently via hairlike projections called microvilli present on the cells that line the villi.

Major Useful Functions of Essential Gut Flora

Here is a summary of the major useful functions of friendly bacteria found in the gut:
  • Producing short-chain fatty acids, which supply a valuable proportion of human energy requirements.
  • Producing a number of valuable nutrients notably B-complex vitamins and vitamin K. In fact, the majority of vitamin K is produced by essential bacteria in the gut.
  • Participating in the metabolism of drugs, hormones and carcinogens.
  • Protecting the host from infection by pathogenic bacteria (through competing for space and production of anti-bacterial substances amongst other methods.)
  • Maintaining a healthy intestinal pH.
  • Enhancing immune function.

Factors that Disrupt the Balance of Gut Flora

There are a number of factors that can disrupt the balance of organisms in the intestines and lead to overgrowth of the less desirable species. The most important factors are:
  1. Antibiotic use 
  2. Use of birth control drugs 
  3. The use of hormones—especially immunosuppressant drugs such as steroids                    
  4. Diet 
  5. Alcohol 
  6. Stress

How A Deficiency of Essential Gut Flora Contributes to Wheat and Dairy Sensitivities
Milk and wheat proteins are digested in two stages. In the first stage, they are broken apart into peptides by hydrochloric acid in the stomach. However, in the process of breaking down these proteins, some of them are converted into morphine-like substances—casomorphines and glutenomorphines; and these two morphine-like substances move into the small intestine. Here, in the second stage, the small intestine is supposed to break down these morphine-like substances further. But if there's a shortage of essential bacteria to support the cells that line the small intestinal villi, then the morphine-like substances don't get broken down, they make it into the bloodstream, and it can make a person sort of “punch-drunk,” giving them a sleepy, dopey type of feeling after they eat along with bloating.

If babies have a milk or gluten intolerance, for example, they quickly nod off after eating; because they don't have the ability to adequately break down the casomorphines or glutenomorphines, or both. 


The Four Different Types of Gut Dysbiosis and Their Symptoms
The four different types of gut dysbiosis include:
  1. Putrefaction dysbiosis
  2. Fermentation dysbiosis
  3. Deficiency dysbiosis
  4. Sensitization dysbiosis
In general, dysbiosis causes fatigue, headaches, and intestinal upsets. It can make it difficult for you to think clearly, and can even contribute to anxiety, depression, or mood swings.

Putrefaction Dysbiosis

Putrefaction dysbiosis is caused by diets high in animal fat and flesh and low in insoluble fiber. This decreases bowel transit time and increases the concentration of bacteriods that kill the healthy flora. This, of course, increases colon cancer risk and, by increasing the number of bacterial enzymes present, it messes with your body's ability to clear hormones. This also produces an excess of ammonia, which has a negative effect on the body's functions in general—but with liver and kidney detoxification specifically. So this is a bad situation. Not only does bowel transit time increase greatly; but the pH of the small intestine is all messed up; you're producing excessive amounts of ammonia ; and your liver and kidneys can't effectively handle the toxic load or clear carcinogens.

The major symptoms of this type of dysbiosis is chronic constipation and bloating with occasional bouts of diarrhea. Flatulence that occurs is...well, putrid.

The way to stop this is to eat less animal fat, increase dietary fiber and take probiotics while also increasing your intake of soluble fiber (prebiotics). The bacteria in your gut use soluble fiber as food. So if you supply the good bacteria—the probiotics—and you also feed it with a prebiotic—soluble fiber—you will create a healthier environment in your gut, and you won't have to take the probiotic for the rest of your life. Standard Process makes a very good product called Prosynbiotic, which has a probiotic and a prebiotic in it.

Often, taking this supplement for two to three months, in conjunction with the appropriate dietary changes, does a lot to handle this problem. Good sources of soluble fiber (prebiotics) include oats and oat bran; dried beans and peas; nuts; barley; flax seed; the flesh of fruits such as apples, pears, plums, and berries; vegetables such as carrots, broccoli, Jerusalem artichokes; sweet potatoes; and psyllium husk, among others.


Fermentation Dysbiosis
This type of dysbiosis is also referred to as Small Intestine Bacterial Overgrowth or SIBO. The biggest issue is that SIBO is is often indistinguishable from Candidiasis (overgrowth of a fungal yeast). Both types of patients suffer from carbohydrate intolerance, diarrhea, anemia, weight loss (or gain if it's been going on a long time—they'll have toxic issues and retain water), malnutrition, flatulence (typically not putrid as in putrefaction dysbiosis), and abdominal pain.

Differentiating between Candidiasis and SIBO: The Spit Test Procedure
The most common form of dysbiosis is Candidiasis. This is very similar to SIBO and has the exact same symptoms. One way to differentiate between Canidiasis and SIBO is to either rule in or rule out Candidiasis by performing a simple test, called the “Spit Test.”

First thing in the morning, put tap water in a clear glass. Before brushing your teeth or eating anything, generate as much saliva as you can and spit into the glass and see what happens. If there are downward projections from the layer of saliva into the water and little flecks of stuff falling downward, or if everything just sinks to the bottom, chances are you have Candidiasis. The saliva should simple dissipate over the surface of the water.

The Breath Hydrogen Test

If the Candida test is inconclusive, there is a reliable test for SIBO. It’s called the breath hydrogen test. The amount of hydrogen is measured after a sugar solution in given, and an increase in the level of hydrogen indicates a positive test. The reference for this is: www.mybreathtestkit.com

The cost is about $125. If you don't have Candidiasis, and you and your health care provider conclude your problem is bacterial in natural, this one way to find out for sure.


Factors that Encourage Bacterial Overgrowth:
  • Decreased stomach acid production. The body's normal production of acid decreases by 30 years of age, and by the time you're 50, it decreases by percent. An astute person who is taking acid-stopping medication will ask, “Then why am I on something that decreases my acid production even further.” This is, of course, a great question. See the discussion above on the environment of the stomach.
  • Sluggish bowel motility. This leads to an increased opportunity for fermentation to take place, subsequently leading to bacterial overgrowth.
  • Immune deficiency.
  • Malnutrition: this is a huge problem, because when people can't afford good food, they eat crap.

How SIBO and Candida Contribute to a Leaky Gut

Any carbohydrate consumed can be fermented by bacteria to produce toxic wastes. Dietary sugars can also be fermented to produce ethanol. With this chronic exposure to toxic waste products and ethanol comes an impairment of intestinal permeabilty, which can easily leads to leaky gut syndrome, allowing larger-than normal proteins as well as bacteria and parasites through the gut into the abdominal cavity.
When someone has an overgrowth of Candida albicans, which is a fungal yeast, it also contributes to impaired intestinal permeability. This is because the Candida creates little tentacle-like projections that burrow through and into the intestinal wall, forming channels that create or exacerbate a leaky gut.

Foods to Avoid in Handling Fermentation Dysbiosis

With fermentation dysbiosis, starch and soluble fiber can exacerbate the abnormal gut ecology. When the small intestine is involved, simple sugars are also not advisable. A diet free of cereal grains and added sugar is recommended.
Patients can tolerate fruits, fats, and starchy vegetables to varying degrees, depending on their situation. It varies by individual. So it's something that you just need to monitor.
One thing that can be tremendously helpful for people with both SIBO and Candida overgrowth is eating carrots, because—despite containing soluble fiber—they contain oligosaccharides that inhibit the binding of enterobacteria onto the mucus that provides a protective covering for the internal surfaces of the intestines.

Deficiency Dysbiosis

Use of antibiotics and low amounts of soluble fiber creates an absolute deficiency of normal gut flora. If you've been on antibiotics once or twice over the last six months to two years, it's unlikely that this would decimate the beneficial gut flora. Chronic antibiotic use, on the other hand, can. But for the most part, if someone has been on a normal course of antibiotics to handle an infection, it's relatively easy to replenish the beneficial gut flora by putting them on a one-to two-month course of a product called ProSynbiotic, a Standard Process supplement I mentioned before. It combines a synergistic blend of four research-supported probiotic strains and two prebiotic fibers to support gut flora and overall intestinal health.
Aside from antibiotic use, it's usually a shortage of soluble fiber in the diet that causes this type of dysbiosis. The shortage of soluble fiber leads to diminished beneficial gut flora, which provide many beneficial functions to aid proper digestion.
Therefore, deficiency dysbiosis is associated with irritable bowel syndrome and food intolerance, because the gut hates undigested food. The bowel becomes irritable, because food is not being digested properly in the stomach and the first part of the small intestine.
Another thing to be aware of is that deficiency and putrefaction dysbiosis are often found together in the same individual. If you have undigested food containing large amounts of animal fat; you're not eating enough soluble fiber; and on top of that, you're somewhat immune challenged due to chronic inflammation from a leaky gut and you're taking antibiotics; chances are high that you have both putrefaction and deficiency dysbiosis.
What's the remedy? Improve stomach digestion, decrease animal fats, increase soluble fiber, and supplement with probiotics.

Sensitization Dysbiosis

This type of dysbiosis occurs when there is an increased immune response to normal gut flora. The abnormal gut flora creates it’s own antibodies to attack normal gut flora. So there's a fight going on in your small intestine when this occurs.
Fermentation and sensitization dysbiosis are often also found in the same individual. With fermentation dysbiosis, there's an increase in toxic wastes and ethanol, and the accompanying SIBO (small intestinal bacterial overgrowth), or Candida overgrowth, or both, allows increased gut permeability; and the increased gut permeability allows larger-than-normal proteins as well as bacteria, viruses, and parasites to get to places where they ought not be, and the immune system responds accordingly.


Leaky Gut Syndrome

Leaky gut syndrome is essentially an autoimmune problem that manifests when larger-than normal protein particles and harmful bacteria, viruses, and parasites are allowed to cross into the abdominal cavity from the gut. If someone has SIBO, Candida albicans overgrowth, or any combination of putrefaction or fermentation dysbiosis, you have to fix the gut, otherwise you will never handle the autoimmune type problems that occur subsequent to development of a leaky gut.

Great Smoky Mountain lab has a manitol test to check for Leaky gut called the Intestinal Permeability test. This is considered the gold-standard test for gut permeability. You need not necessarily go to the expense of having this test done, however. A good place to start in terms of figuring out what's going on is the test for Candidiasis described earlier. If that's inconclusive, you and your health care practitioner can pretty much tell from symptoms what type of dysbiosis you're dealing with, and you can proceed from there. Actually, as discussed above, the treatment for both Candidiasis and fermentation dysbiosis is very similar. A very popullar treatment is the “Weed and Feed” protocol developed by Australian medical herbalist Kerry Bone. It involves killing off the yeast and the non-beneficial bacteria while taking in probiotics and prebiotics to create a more beneficial environment in the gut.

The bottom line is that anyone with any combination of the forms of dysbiosis and leaky gut needs both soluble and insoluble fiber in their diet. Soluble fiber is food for the good bacteria in your lower small intestine and proximal large intestine and absorbs toxins dumped into the digestive tract from the liver, gallbladder and kidneys. If you don't have enough soluble fiber, then all the toxins can get reabsorbed downstream.

Insoluble fiber has two basic functions:

  1. Acting as bulk 
  2. Scrubbing the walls of the digestive tract to help prevent buildup of junk and sludge over time. 
You have to be careful with insoluble fiber under some circumstances. If someone has a putrefaction dysbiosis, they have decreased bowel transit time, there's a very good chance they are going to have even more trouble—get even more bound up—if they take insoluble fiber. If, on the other hand, you get some probiotics and soluble fiber into the person, it handles the problem pretty well.

Parasitic Infection of the Large Intestine

Parasitic infection is the next thing to consider if you to have problems that are not resolving. Parasitic infection is more common than you might assume, says Hemmer. “It all comes down to the stomach,” he says. “If you don't have enough acid in your stomach to kill these things, they will pass right through your stomach and small intestine and into the large intestine, where they set up shop.”

Parasitic infection is likely when someone complains of bloating and distension, abdominal pain, and diarrhea—but typically first thing in the morning or right before retiring for the evening (because that's when parasites like to come out to play!). If you do have a parasitic infection, there are some natural remedies that work really well.

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