Trust Your Gut
UNDERSTANDING GUT HEALTH AS A WAY TO WELLNESS
As part of Balance’s Wellness Workshop Series, Dr. Daila Pravs gave an amazing presentation entitled “Digestive Health as a Pathway to Wellness”. Dr. Pravs brings a unique and impressive blend of expertise in both traditional and integrative functional medicine. She carefully explained that a functional model of medicine is not rejecting the traditional model but rather reshaping the questions asked when dealing with patient symptoms and illness. A functional approach frames questions more in terms of “why” rather than “what”. Utilizing a “why” approach can expand the medical focus beyond symptom relief to better identifying patterns and underlying causes of symptoms.
Dr. Pravs’ focus on digestive health is in part related to how integral she sees digestive health to all aspects of well-being. We have all heard the saying “you are what you eat” but I much prefer Dr. Pravs updated, and more physiologically accurate, version – “you are what you are absorb”. You can be eating all the “right” foods but many factors, including environmental, genetic, and emotional factors, can influence the way those healthy food are absorbed, or not absorbed, into your body.
Digestive health is integral to all aspects of human health and well-being. Gut health impacts the following systems:
With the cardiovascular system, for example, Dr. Pravs mentioned that bacteria in your gut can influence how you absorb certain nutrients and can even turn “good foods” into bad foods that might increase your risk of artherosclerosis (plaque build-up in arteries) and cardiovascular disease. Studies have shown that, among patients with artherosclerosis, the same bacteria in the plaque lining their artery walls was also found at higher levels within their gut biome.1
Both the balance of beneficial and bad gut bacteria and the diversity of bacteria within the gut biome can influence susceptibility to illness. There is more bacterial DNA than human DNA. In our bodies, we have500-1000species of bacteria in our gut biome. The blend of bacteria is different in each person and is determined by many factors, including how we were born, our diet, genetics, stress, and many different environmental factors such as antibiotic use and exposure to toxins. According to Dr. Pravs, our gut biome is well established by the time we are three years old. Yes, three years. Don’t despair, however, because Dr. Pravs was also clear that we can influence the balance of our gut biome and support a healthy symbiosis of the different bacteria in our gut for optimal well-being.
Some Factors That Influence Gut Bacteria:
Type of Birth and Breastfeeding.
Research has shown that during vaginal birth, newborns ingest beneficial bacteria from their mother’s vaginal lining. Similarly, babies who are breastfeed receive beneficial bacteria through their mother’s breast milk.
Overuse of Antibiotics
A five day course of antibiotics can alter our gut flora for up to 4 weeks. Research has shown that an increase in antibiotic prescriptions may be negatively impacting our gut flora.
Toxins in Food
Pesticides and toxins in our food can be absorbed during the digestive process and disrupt the symbiosis of our gut biomes.
Hormones/Birth Control Pill
Dr. Pravs also mentioned that hormone levels, particularly associated with the use of birth control pills, might influence the permeability of our digestive system and, as a result, correlate with some digestive issues.
Eat a plant strong diet high in fiber and low in simple carbohydrates.
However, Dr. Pravs also reminded us that even a “healthy” sounding diet might not be healthy. As she cautioned, “Cheetos are vegetarian, that doesn’t make them healthy”.
Understanding each organ involved in each step of the digestive system helps optimize habits that can influence gut health.
Healthy Habit: Rest to Digest
We were all a bit stumped when Dr. Pravs asked us to name the first organ involved in the digestive system. Our brain sends the initial signals to our stomach to prepare it for digestion, therefore the brain is a critical part of the digestive system. As a result, our psychological state directly influences how nutrients are absorbed during digestion.
As part of mindful eating, we know we should sit down to eat and eat slowly. The physiological reason for this is that you want your parasympathetic nervous system to kick in during eating and digestion. The parasympathetic nervous system, sometimes called the rest and digest system, slows the heart rate, increases intestinal and gland activity, and relaxes sphincter muscles in the gastrointestinal tract. All of which improves digestion.
In contrast, our sympathetic nervous system, otherwise known as our flight or fight system, kicks in when our bodies sense a threat (whether real or imagined). When we experience stress, it is this system that takes over to control bodily processes – it accelerates our heart rate, constricts blood vessels, and raises blood pressure. Furthermore, the sympathetic system redirects blood to our muscles instead of our organs to enable us to flee the stressful environment (are we allowed to run away from our screaming children?). When you eat in this state of mind, blood is not flowing to the stomach (because it is going to your muscles), food is not broken down completely, and is not absorbed as well as it should be. This can mean you are not getting the nutrients from the food but can also mean larger molecules are passing through the digestive system and may cause reactions such as inflammation. So before your next meal, take a few breaths and try to put yourself in the right state of mind before you put anything in your mouth.
Healthy Habit: Chew your Food
Ok, Grandma was right. Chewing your food adequately greatly improves the digestive process and helps optimize the absorption of nutrients. We do need to mechanically break down our food in our mouths so our stomach, small intestine and large intestine can do their jobs efficiently. Dr.Pravs pointed out that sometimes it is the simplest changes we make that have the biggest impact.
Healthy Habit: Relax (and maybe skip that second glass of wine)
The stomach is where food molecules are broken down and prepared for the rest of the digestive process. Food is churned and broken down by acid in the stomach. No absorption actually happens in the stomach. There is a trap door at the top of the stomach from the esophagus (and second at the bottom of the stomach leading to the small intestine). The opening of this trap door is influenced by several factors. Alcohol consumption can result in the trap door remaining open longer than optimal. Stress can have a similar effect on this opening. When the trap door remains open too long, acid from the stomach can rise up into the esophagus causing reflux. Just another reminder to “rest and digest”, breath, slow down and enjoy your food.
Organ: Small & Large Intestine
Healthy Habit: “Go” when you have urge
The small intestine is where most of the digestive magic seems to happen. It is here that good and bad food molecules get separated and the majority of nutrients are absorbed into your system. In contrast to the large intestine, it is a relatively sterile environment. When excess bacteria do get into the small intestine (referred to as SIBO – small intestine bacterial overgrowth), symptoms such as bloating, gas, cramping and diarrhea can result. These symptoms occur because the bacteria in the small intestine creates fermentation rather than digestion. SIBO is difficult to diagnose. There is a breath test for diagnosis but it is not used very often. Dr. Pravs mentioned several approaches to re-establishing a good gut biome in individuals with SIBO, including probiotics and nutritional herbal regiments. Of course, the first step in addressing these symptoms is discussing your symptoms with a health care provider familiar with SIBO.
The large intestine is the final step in the digestive process. It is where 80% of the fluid in bowel movements in absorbed and stool starts to form. There are two sphincters at the end of the large intestine. The internal sphincter is autonomic and triggers the initial urge to have to use the bathroom. The second sphincter is external and under our control (thankfully). While we do have some control, Dr. Pravs did explain that it is important not to ignore those initial urges as the longer stool is in the large intestine the more fluid is absorbed and risk of constipation, and increased bacteria, can increase. So, go when you have to go.
Leaky Gut is a hot topic lately. Dr. Pravs outlined the processes through which “Leaky Gut” can develop. (Note: if you are talking to a conventional doctor you should probably use the term “increased intestinal permeability”). Dr. Pravs used the analogy of a brick wall to describe the cell structures lining the digestive system. Gut cells line the intestine, beyond those are lymphatic system cells, and beyond that are blood cells. In fact, the digestive system contains about 70% of our immune cells along the digestive tract. As nutrients are absorbed through the gut cells, they pass through the lymphatic system and into the blood stream. Small gaps in the digestive system, referred to as tight junctions (think of the mortar between the bricks in a brick wall), allow nutrients to pass through. If these tight junctions loosen or open more than they should, they can allow bacteria and toxins to pass through inappropriately which can trigger the immune system to respond. The immune system will then attack these as foreign substances by creating inflammation as a way of protecting our bodies. Inflammation, along with bloating, food sensitivities, fatigue and other digestive issues are common symptoms associated with Leaky Gut.
Interestingly, Dr. Pravs did point out that Leaky Gut is not a food specific sensitivity nor does it constitute a food allergy. It has more to do with factors influencing the process of digestion and the permeability of the lining of the digestive tract. Some foods, for example foods with gluten, can make this disruption worse and therefore should be avoided while re-establishing a healthy gut biome. Gluten has been associated with the opening of the tight junctions between gut cells through the release of the protein Zonulin in the body. This chemical is necessary for the regulation of intestinal permeability but, like most things, too much Zonulin can cause the tight junctions between the gut cells to become too permeable and allow antigens to pass through. It is this process that may explain why the “Western diet”, which is low in fiber and high in carbs, is associated with increased risk of leaky gut syndrome. Heavy alcohol use and chronic stress are two other factors that have been associated with a leaky gut.4
Trying an elimination diet, in which high risk foods are eliminated for two to four weeks, can help identify foods that might make symptoms of leaky gut worse. Most nutritionists, including Dr. Pravs, commonly target 5 groups of foods to eliminate:
Caffeine, alcohol, and added sugar are commonly included on that list as well.
If you considering trying an elimination diet, Dr. Pravs recommended the book, Digestive Wellness by Elizabeth Lipski (https://www.amazon.com/dp/0071668993/ref=rdr_ext_tmb).
Ways to Improve Leaky Gut
Most integrative doctors agree that there are things you can do to either improve leaky gut or more generally create a healthy gut biome5:
Limit your refined carb intake: Harmful bacteria thrive on sugar.
Eat plenty of high-fiber foods: Soluble fiber, which is found in fruits, vegetables and legumes, feed the beneficial bacteria in your gut
Limit the use of drugs: The long-term use of anti inflammatory drugs like ibuprofen contributes to leaky gut syndrome
Take a probiotic supplement: Probiotics are beneficial bacteria that can improve your gut health.
Note about Probiotics. Dr. Pravs did offer some cautionary advice about the use of probiotics. While they can be useful in re-establishing a healthy gut biome, using too much probiotic too quickly can make matters much worse (I believe Dr. Pravs’ exact words were that in can create World War III in your gut). Too much probiotic can cause the “bad” bacteria already in your gut to attack the probiotics and cause inflammation, gas, and bloating. If you do start using probiotics, ease into a regular schedule. Once you have established regular use of probiotics, it is similarly important to maintain some regularity in your use of probiotics to help maintain a healthy gut bacteria balance.
Dr. Pravs mentioned several nutritional supplements that have been shown to improve Leaky Gut syndrome. These include:
Vitamin supplements – particular Vitamin A and D
Natural dietary supplements - ginger, licorice root, and marshmallow root
Each of these are possible ways to address leaky gut symptoms but should only be introduced with guidance from your doctor, nutritionist or gastroenterologist. For each of these possible treatments, there are situations in which they will not be beneficial. For example, although L-Glutamine is a common treatment, for individuals low in Vitamin B, it can have negative side effects.
In determining one’s gut health, Dr. Pravs did say in some situations it is useful to use a micronutrient white blood cell test in order to get a more refined picture of your specific gut biome at the cellular level. This information then allows the exploration of “why” leaky gut has developed – whether it is from lack of access to healthy gut bacteria, non-absorption of nutrients during the digestive process, or genetics. Insurance will cover most of this micronutrient testing.
Dr. Pravs ended her talk by emphasizing that it is possible to rehabilitate an unhealthy gut into a “happy belly”. Once a symbiosis has been recreated within your gut biome, discussions with your health care provider can then focus on how to proceed in the future to ensure optimal digestive health and overall well-being.
She definitely left us with food for thought and an amazing wealth of information to digest. (Sorry, couldn’t help myself).
Valdes Ana M, Walter Jens, Segal Eran, Spector Tim D. Role of the gut microbiota in nutrition and health BMJ 2018; 361 :k2179. https://www.bmj.com/content/361/bmj.k2179/related
Intestinal Permeability and its Regulation by Zonulin: Diagnostic and Therapeutic Implications. Alessio Fasano, M.D. Clin Gastroenterol Hepatol. 2012 October ; 10(10): 1096–1100. doi:10.1016/j.cgh.2012.08.012.
Digestive Wellbeing, Elizabeth Lipski https://www.amazon.com/dp/0071668993/ref=cm_sw_em_r_mt_dp_U_g.sQCb1H3ZGPN
Dr. Pravs' is available as a Primary and Acute Care Physician (for both WOMEN & MEN) and providesSAME-DAY general and acute care such as urinary tract infections, colds, rashes and musculoskeletal concerns.
In addition to serving as a primary, Dr. Pravs has a special interest in:
• Women's Health—including routine gynecologic care
• Digestive Concerns
• Nutrigenomics and Methylation
• Anxiety/Depression & Stress-related Health Conditions
• Migraines and other headaches
• Asthma / Allergy / Eczema
• Metabolic Syndrome / Hypertension/Hyperlipidemia / Diabetes
• Weight Management
• Autoimmune Disorders
• Physician Burnout and Wellness
DAILA PRAVS—MD, ABFM, ABIHM
AMERICAN BOARD OF FAMILY MEDICINE
AMERICAN BOARD OF INTEGRATIVE & HOLISTIC MEDICINE