Gut Health - a.k.a. your enteric system or second brain
[This is an excerpt from the book I collaborated on Lighten Up! 7 Weeks to Release, Recharge and Revitalize! By Dr. Christina Tarantola, owner of Enlightened Wellness Solutions.]
One of the most important things you can do for your health involves an organ system that technically doesn’t touch the inside of your body. I’m talking about the gut: the alimentary canal, the gastrointestinal tract (GIT), which is the hollow tube of interconnected organs that food passes through - from mouth to anus. The length of this canal if unfolded outside the body is about seven times as long as a person’s body, the majority of which is the small intestine! This complex system features a series of varying environments for the food to pass through, where it is converted each step of the way into a form that can be absorbed inside the body into a usable form, while the unusable mass is effectively eliminated out of the body.
In recent years, it has been elucidated that there is a highly advanced population of bacterial flora inhabiting our guts, which is known as the ‘microbiome.’ In fact, there is more bacteria living inside an individual’s gut than there are human cells! That’s a whole new perspective on what is considered a ‘human’ and where we end and ‘non-self’ begins. The microbiome is crucial to our state of health on many levels: the natural flora fends off potentially pathogenic bacteria, helps metabolize food in the final stages of digestion, and aids in absorption of certain vitamins.
In addition, the gut houses the enteric nervous system (ENS), which is known as ‘the second brain.’ The ENS consists of neurons embedded in the submucosal layers of the gastrointestinal tract. It is part of the autonomic nervous system, and may be influenced by the sympathetic and parasympathetic systems (via the Vagus nerve) or act independently of them. Besides having a role in digestive function by influencing peristalsis and production of enzymes, the ENS also uses the same neurotransmitters as the central nervous system. In fact, most of the serotonin in the body is found in the gut, as well as about half of the body’s dopamine! Other important compounds in the gut are glutamate, norepinephrine, nitric oxide, neuropeptides, enkephalins (endorphin family) and benzodiazepines. These substances connect the ‘two brains’ and result in a complex network between our mental/emotional state and our gut, where the state of one affects the other. This connection is implicated in frequent bouts of diarrhea when a person is nervous, or depression/anxiety when the gut is not working properly. Now you know that your ‘gut feeling,’ ‘butterflies in your stomach’ has a physiological basis, and you can learn to tune in on these messages from your body!
I consider the gut the foundation of physical and emotional health, and always look to it first when consulting clients. Its role is critical in converting ‘not-self’ to ‘self,’ to absorbing vital nutrients, optimizing immunity and communicating with the nervous system. I have personally been a victim of and witness to many symptoms and syndromes that ultimately tie back to gut integrity, and I’m passionate about spreading that message to others. I believe if you can heal your gut, you can heal your life.
So let’s go through the entire organ system that make up the gut, and how you can optimize the function of each.
1. The mouth: here digestion officially begins both by mechanically (chewing) and chemically (via the amylase enzyme, which breaks carbohydrates into simpler sugars). While the enzyme content can’t really be helped, we can certainly work on the physical grinding action of our teeth.
a. Eating mindfully by taking smaller bites and chewing slowly and deliberately helps reduce particle size of food for easier digestion in the rest of the tract. This also creates more surface area to optimize the chemical reactions taking place in each subsequent organ in the gut.
b. Ayurvedic tradition also focuses on the tongue as an organ that represents the health of the person and his/her digestive power. To help the entire system work better, working topically on the tongue is thought to influence the inner organs. Thus tongue cleaning in the beginning and end of day with a copper or stainless steel cleaner is recommended - by removing plaques visible to us, we can remove the inner plaques as well.
c. Coconut oil ‘pulling’ is also thought to improve the cleanliness of mouth, improve dental hygiene and thus improve the state of health of the gut. To do this: place ½ -1 teaspoon of coconut oil (with or without anti-inflammatory essential oils such as clove, cinnamon and peppermint) in mouth first thing in the morning, and try to ‘thread’ it in between each tooth as if you’re flossing with the oil. Start with the top left corner of mouth, and snake it through to the right, then bottom ending with left (or another sequence of your choice). Finish by swishing, and spitting into trash can (oils can clog plumbing systems!) and continue with brushing as usual.
2. The esophagus: this tube connects the mouth to the stomach, and is separated by the epiglottis from the mouth and by the lower esophageal sphincter (LES) from the stomach. The epiglottis is a little mucosal flap that ensures that food goes down the correct tube - into the esophagus rather than the ‘windpipe,’ preventing choking and aspiration. The LES is a circular group of muscles that opens and closes to make a one-way tract down into the stomach, thus preventing backflow of the acidic content back up the esophagus. Problems can arise when the LES is weakened and the acid escapes, which can erode the mucosa of the esophagus and throat. This is the mechanism for gastroesophageal reflux disease (GERD).
. Foods to avoid in order to prevent weakening the LES: caffeine (coffee, chocolate), alcohol, peppermint (other mints are OK).
a. Not lying down or reclining after meals should ensure the correct flow of peristalsis and prevent reflux.
i. Sleeping with an incline from the waist up can also help keep acid down where it belongs.
ii. For babies with reflux, keeping as upright as possible during and after feeds help.
3. The stomach: here hydrochloric acid (HCl) and enzymes (pepsin) help chemically break down the chewed food particles as well as defend against potential pathogens. The optimal gastric pH level is 1-2. The danger of the pH being too low is eroding the mucosal layer surrounding the stomach, which can cause ulcers and ultimately upper gastrointestinal bleeding - that is potentially deadly. A low pH is also associated with the bacterial overgrowth of Helicobacter pylori (H. pylori), and also with the development of ulcers, though whether it’s a causational or correlational relationship is unclear.
. Typically, a high stomach acid is blamed for symptoms of GERD as described in the last section. That’s why conventional medicine treats this problem by lowering the production of acid (antacids such as calcium carbonate/Tums, or Histamine-2 receptor antagonists such as ranitidine) or shutting off the acid-pump completely with proton-pump-inhibitors (PPIs such as omeprazole). While this does help symptoms, it creates other problems of a high pH: undigested food that strains the rest of the digestive organs, and lowered defenses against ingested microbes. Down the line, suppressing stomach acid can lead to infections, microbiome disruption and a host of other problems such as osteoporosis.
. Alternative treatments of GERD are herbal bitters, a blend of bitter herbs that is thought to bring a downward direction to the digestive process. Bitters also help the liver work better, which produces more bile and enhances digestion and detoxification. Examples include dandelion root, gentian root, and artichoke leaf - taken as a tea/tincture/capsules before meals.
a. Sometimes the symptoms presenting as GERD/ulcers are actually due to low stomach acid, which presents due to a feedback mechanism that lowers the amount of protective mucous lining around the stomach. When the root cause is misdiagnosed, conventional treatment will compound the initial problem. Here are some things you can do to help normalize acid levels:
. Eating smaller meals and chewing mindfully.
i. Taking apple cider vinegar or HCl with pepsin supplement before meals, or digestive enzymes during meals.
4. The small intestine: this is the longest part of the GI, measuring 22 feet (7m) - about 3.5 times of a person’s height! Despite being narrow in diameter, if entirely unfolded and unfurled, its surface area would be about the size of a tennis court - about 2700 sq ft (250m2). The surface area is so vast due to the circular mucosal folds and the fingerlike projections along its walls called villi, and even smaller ones called microvilli. This anatomy allows the small intestine to carry out its physiology: to absorb all the digested nutrients into the bloodstream via tight gap junctions. Remember when I said that technically the ‘gut’ is outside our bodies? Well, the small intestine is what determines what we can assimilate from the outside in. This is a critical role and many problems can arise in this step of the digestive process.
. Intestinal hyperpermeability, or ‘leaky gut’: is a major cause of allergies and autoimmunity, and an array of chronic inflammatory, degenerative and neurological conditions (anything from inflammatory bowel diseases, Parkinson’s disease, depression/anxiety, migraines, autism to coronary artery disease, diabetes and cancer). If the gap junctions are not tight enough, they become ‘leaky’ and allow permeability to bigger particles that normally should not be present in our bloodstreams. This can set off a whole chain of hypersensitivity reactions as our immune cells mark it as a ‘foreign’ and potentially dangerous substance, and begins to eradicate it. Inflammation ensues and the issue becomes compounded if we continue to ingest the offending agent, leading not only to allergies but to autoimmune issues down the line. If the marked molecules resemble any of our endogenous organs, our bodies begin to attack those similar cells as well. The following foods are typical offenders for this type of reaction: gluten, dairy, corn, soy, sugar.
. To heal ‘leaky gut’ we must repair the integrity of the gap junctions. The GAPS (Gut and Psychology Syndrome) diet famously targets this pathology. Collagen has a restoring action here, and can be consumed in the form of food (bone broth, a rich source of gelatin) or supplement (collagen or gelatin are available as powders). An anti-inflammatory diet is also beneficial - consume sources of omega-3 fatty acids (wild caught fish such as salmon, walnuts, chia seeds), grass-fed organic meats, fermented foods, and good-quality fats such as coconut oil. Supplementing with omega-3, turmeric, vitamin D, and evening primrose oil can also help.
a. IBS (Irritable Bowel Syndrome): a group of symptoms with unknown etiology, more prevalent in women and consisting of bloating/gas, abdominal cramps and bouts of constipation and/or diarrhea. In addition, depression and anxiety are common comorbidities, which is related to the enteric nervous system, or gut-brain connection. Treatment often targets the symptoms, but the underlying issues seem to be related to the nervous system and the microbiome. The following tips can help balance the disorder:
. Avoid inflammatory foods and allergens. Try elimination diet by cutting out common offenders, and then add them back in to figure out the culprit. The following is a good place to start:
1. Dairy, wheat/gluten, soy, eggs, caffeine, alcohol, processed foods, sugar, and FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols)
i. Reduce stress by mindfulness practices, such as meditation.
ii. Exercise: may have physical and emotional benefits.
iii. Improve the microbiome with pro- and prebiotics (see section on large intestine).
iv. Other supplements to consider:
1. Aloe vera and L-glutamine (or collagen/bone broth) to help repair gut lining.
2. Adaptogenic herbs to help stress response (licorice is a good choice as it also helps repair the gut).
3. Digestive enzymes or carminative herbs (fennel, chamomile, orange peel) to help with symptoms of bloating.
4. Anti-inflammatory supplements such as omega-3 fish oil.
b. SIBO (Small Intestine Bacterial Overgrowth): a condition where bacteria normally present in the large intestine colonizes part of the small intestine. This causes uncomfortable bloating and gas after eating almost anything, as well as malabsorption of nutrients - due to bacterial fermentation of food particles. The pathology is thought to involve autoimmunity or a physical transplant of the bacteria after some trauma/surgery of the abdomen, or via endometriosis. While conventional therapy aims to kill the excess bacteria via antibiotics (namely rifaximin), there are some other ways to balance this overgrowth.
. In the case of the abdominal trauma pathology, manual visceral manipulation therapy can be very helpful with symptoms.
i. Smaller, more frequent meals seem to be better tolerated.
ii. A general approach to SIBO includes several stages:
1. Phase 1: To ameliorate symptoms, a very restrictive diet should be initiated to decrease the amount of fermentable foods, such as the FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) diet.
2. Phase 2: Initiate GAPS or SCD (Specific Carbohydrate Diet) protocol to heal the integrity of the gut. These are animal-protein and bone-broth based diets that replace starches and processed foods with nutrient-dense ones.
iii. Supplement with probiotics to restore proper microbiome.
iv. Bitter herbs such as gentian root, dandelion root, and artichoke leaf
v. Some herbs can act as antimicrobials to the excess bacteria, such as oregano, wormwood, black walnut, and berberine-containing herbs (oregon grape root, goldenseal, coptis and barberry).
c. Malabsorption: arises when the small intestine doesn’t absorb the proper amounts of macro- or micronutrients from ingested food. A variety of underlying factors can contribute to this syndrome, such as:
. Damage to the intestine from trauma, surgery or inflammation
i. Congenital birth defects
ii. Parasitic infections
iii. Celiac disease, chronic pancreatitis, Crohn’s disease, cystic fibrosis, SIBO
iv. Certain antibiotics, radiation therapy or drugs that damage lining of gut
v. Lactose intolerance
vi. Insufficient digestion by stomach, or problems with accessory organs (liver, gallbladder, pancreas)
5. The large intestine: the final step of digestion involves reabsorbing all the water and salts that were not usable as nutrients via the small intestine. This water combines with waste material (fiber from food, bile acids, dead cells from intestine lining) to be passed as formed stool. In addition, this is the site of the microbiome - the vastly diverse bacterial colonies that help absorb certain vitamins (such as B12), digest fiber, detox certain substances (such as drugs) and ferment the leftover food matter into passable gases.
. Bacterial colitis (such as Clostridium difficile colitis) is an acute inflammation of the colon that can result from taking antibiotics, which throws off the natural flora of the colon and may make it more vulnerable to be populated by opportunistic pathogens, such as the infamous C. diff.
. The more diverse the bacterial species are, the healthier the body! That’s why taking probiotics can ameliorate many underlying gut and digestive issues, and are an absolute must for someone taking antibiotics. Natural sources of probiotics include fermented foods such as sauerkraut, kimchi, kefir or yogurt. Probiotic supplements should ensure a diverse number of species, including soil-based organisms, and be rotated for best results.
1. Prebiotics (indigestible sugars that feed the microbiome) are also important, and are contained in starchy roots such as burdock, elecampane, chicory and dandelion. Some probiotic supplements already contain this in their formula as ‘inulin.’
a. IBD (Inflammatory Bowel Disease) such as ulcerative colitis (UC) or the more severe Crohn's disease (CD) affect the colon, the major part of the large intestine. As the name suggests, this is an inflammatory condition that erodes the lining of the colon, and is thought to be autoimmune in nature.
. Conventional treatment focuses on an array of inflammation-suppressing medications, ranging from oral tablets to biological injectables, with a variety of mechanisms of action and a host of side effects.
i. Holistic approaches target the hypothesized cause of the immune overreaction, using the same approach as for ‘leaky gut’ (see above). Eating a ‘traditional diet’ of three large meals a day with plenty of good fats (such as cod liver oil and ghee, containing vitamins A, D, E and K2), proteins, and bone broth can also be very helpful in slowing bowel movements and healing the mucosa.
6. The anus: where all the waste matter exits the body as feces.
. Anal fissures are common problem in this area, arising when stool is too hard to pass through the narrow opening. The small cuts and abrasions can form around the anal sphincter, resulting in pain and bleeding upon voiding.
. A topical ointment can remedy the cuts, such as a mild antibiotic ointment (bacitracin or a prescription one like mupirocin). For a more holistic option, herbal oils and salves can be used, such as coconut or castor oil based ones with anti-inflammatory herbs like calendula.
i. To prevent the constipation that leads to the fissure, make sure you’re well hydrated and have plenty of fiber in your diet (fruit and vegetable peels, plums, prunes, beets). In addition, avoid constipating foods like starches or grains, pears and bananas. Conventional stool softeners such as docusate may help, or marshmallow root as a cold infusion or a powder mixed in a drink.
“Difference between small and large intestine.” Children's Hospital of Pittsburgh. UPMC. 2018. Accessed 28 Feb 2018. <http://www.chp.edu/our-services/transplant/intestine/education/about-small-large-intestines>.
Kerr M, Cafasso J. “Malabsorption syndrome.” Healthline.com. 26 Sept 2015. Accessed 28 Feb 2018. <https://www.healthline.com/health/malabsorption>.
“Length of digestive tract.” Viva health. 2018. Online. Accessed 26 Feb 2018. <https://www.vivahealth.org.uk/wheat-eaters-or-meat-eaters/length-digestive-tract>.
“The Enteric Nervous System: The Brain and the Gut.” King’s Psychology Network. Accessed 28 Feb 2018. <http://www.psyking.net/id36.htm>.