Disease Begins in the Gut Flashcards
- You have learned about the THREE MOST FUNDAMENTAL DIGESTIVE SUBTANCES, each of which is synthesized in a different body part. Specify the digestive substance and also where each is synthesized in the body. Acceptable answers are specifically:
● STOMACH ACID (also HCl, gastric acid/juice) from the parietal cells in the lining of the
STOMACH or just the stomach. Also acceptable for this category: the protein digestive enzyme, PEPSIN.
● DIGESTIVE ENZYMES (or Pancreatic Enzymes is acceptable) primarily from the PANCREAS but
also produced by the brush border in the lining of the intestines (either location mentioned is acceptable). Because it also contains several key enzymes, SALIVA (or salivary amylase) is also a suboptimal but acceptable answer.
● BILE which is produced in the LIVER (we will also accept gallbladder IF the comment also notes that this is where stored (vs. synthesized).
- The NERVOUS SYSTEM in the gut is called the ENTERIC nervous system, and this is where more than
90% of the body’s SEROTONIN is produced.
Serotonin has a large effect on motility and peristalsis in the GI tract, and both too high and too high levels of its action in the gut can contribute to symptoms of “IBS”. Too much serotonin may contribute to hypermotility and diarrhea. Too little serotonin may contribute to hypomotility and constipation.
- Name at least five key components of healthy “eating hygiene” that will typically help our clients and patients to have optimal digestion and absorption of nutrients into their unique body. Acceptable answers must include five of the following (exact verbiage not necessary):
● Mindful breathing. Oxygen is a key component of cellular energy production, including those cells throughout the GI tract. Many people inadvertently breathe shallowly and perhaps more rapidly while eating.
● Chewing thoroughly. The only part of digestion that we can fully control voluntarily. This also directly helps with slowing a meal and encouraging more mindful breathing.
● Eating while in a relaxed, parasympathetic nervous system mode. Acceptable answers might include: Eating in a comfortable, sitting position, prayer before the meal, eating outdoors or in natural surroundings, or eating without TV/Technology distraction.
● Eating slowly enough to give the body time to secrete appropriate digestive juices as well
as signal natural satiety via hormone secretion (remember, this can take ~20 min). Eating quickly is a common cause of over-eating and then post-meal indigestion discomfort and fatigue.
● Not overconsuming water or other liquids while eating. This recommendation should not be over-interpreted as a general discouragement to consume liquids during meals. Excessive water intake, however, can significantly dilute stomach acid and cause indigestion, an early sense of satiety, and other low-stomach-acid symptoms.
● Not consuming very cold liquids or overly alkaline water while eating.
● Not overconsuming food during a single meal and overloading the GI cavities and digestive capabilities.
● Focusing on the meal and not multitasking. This allows us to savor the meal more thoroughly and give the brain the entertainment it seeks (e.g. flavor, aroma, textures), helping us to more naturally eat the amount of food that the food actually needs.
● Food combining. This is a more esoteric concept of eating hygiene that not everyone needs. Separating heavy starches and carbohydrate foods (e.g. beans and rice) from animal proteins (e.g. 4oz of salmon), for example, may prevent the fermentation (gas release) from carbohydrates while proteins are being digested in the stomach.
- Name five relatively common contributing root causes of constipation (challenge yourself: add
5 more answers for a total of 10). Acceptable answers must include five of the following (exact verbiage not necessary):
● Poor eating hygiene, or insufficient chewing or eating quickly.
● Too much sympathetic nervous system activity. Stress!
● Insufficient magnesium.
● Excessive vitamin D intake.
● Insufficient or lack of movement, exercise, or physical activity.
● Insufficient hydration. This is a place where plain, clean water can have a dramatically different effect than other beverages e.g. tea, even herbal tea, as their osmotic behavior in the body is different.
● Some medications and supplements e.g. opioid painkillers, calcium supplements, antacids, some hypertension drugs in some people, most iron supplements.
● Withholding behavior. Not taking time for bowel movements or ignoring the urge.
● Low thyroid function.
● Low adrenal (or cortisol) function.
● Insufficient enteric serotonin production. Answers regarding the upstream dynamic that causes this are also acceptable e.g. low amino acids, insufficient Vitamin B6, intestinal epithelial damage from microbial overgrowths or toxicity (e.g. mold).
● Insufficient intake of healthy fats as natural lubrication in the intestines.
● Insufficient fiber intake.
● Unaddressed food sensitivities or intolerances e.g. dairy foods.
● Microbial imbalances in the gut, especially a lack of beneficial, endemic species (e.g.
Bifidobacteria) or microbial overgrowths (e.g. IMO/mixed-type SIBO, Candida).
● Vagus nerve damage or dysfunction.
● Posture or Not sitting properly on the toilet.
● Insulin resistance, hyperglycemia (autonomic neuropathy).
● Excessive progesterone.
- Name five relatively common contributing root causes of diarrhea. Acceptable answers must include five of the following (exact verbiage not necessary):
● Stress. Increased cortisol can increase transit time.
● Poor sleep. Poor sleep can increase cortisol, which impacts transit time.
● Lactose intolerance. With poor endogenous lactase production, microbes will consume available milk sugars, contributing to gas, bloating, and diarrhea.
● Fructose intolerance. This phenomenon has increased with increased use of high fructose corn syrup in the diet.
● Sugar alcohols as sugar substitutes. e.g. sorbitol, mannitol, xylitol
● Microbial imbalances, including parasites, insufficient Lactobacillus spp., Candida
overgrowths, food poisoning, and viral infection in the gut.
● Food sensitivities or allergies.
● Specific medications. Laxatives, SSRIs, metformin, corticosteroids, antibiotics, ACE
inhibitors.
● Excessive magnesium (especially citrate forms) or vitamin C intake.
- The development of multiple, significant food sensitivities, especially to some foods that your client or patient consumes often, usually involves a state of enhanced intestinal permeability (or leaky gut). Insufficient levels of this key vitamin may contribute to this state: Vitamin D.
A key food to eliminate from the diet while one is in this state (regardless of whether it is flagged as an issue on any type of food sensitivity testing) is gluten or wheat.
ENHANCED INTESTINAL PERMEABILITY,
KEY VITAMIN - VITAMIN D
KEY FOOD TO ELIMINATE FROM DIET
GLUTEN OR WHEAT
- List at least five relatively common causes of persistent acid reflux or GERD:
● Hypochlorhydria (or insufficient or low stomach acid or pepsin).
● Stress! Causes esophageal sphincter to loosen and pyloric valve to tighten.
● Poor eating hygiene (e.g. insufficient chewing, eating on the run).
● Overeating.
● Medications (e.g. birth control pills, progesterone, diazepam, NSAIDs).
● Proton Pump Inhibitors or other Antacid drugs (cause lower stomach acid and perhaps lower magnesium, both of which can trigger reflux).
● Magnesium deficiency.
● H. pylori or other microbial overgrowth or imbalance.
● Food Sensitivities.
● Hiatal hernia.
● High intake of foods that may cause spasm or weakening of lower esophageal sphincter e.g. coffee, tea, hot spices, citrus juices, chocolate, mint. (Other similar examples are acceptable).
● Physical impingement e.g. obesity, pregnancy.
● Sedentary lifestyle.
● Hypothyroid and/or hypocortisol or hypoadrenal state.
● Smoking.
● Low saliva formation (or low salivary enzymes).
● Hyperchlorhydria.
● Eosinophilic esophagitis.
- While they can vary dramatically from patient to patient, three of the most common symptoms of insufficient stomach acid (or hypochlorhydria) include:
● Frequent belching, especially soon after a meal.
● Nausea or upper belly bloating (especially within an hour of eating).
● Strong fatigue (after eating or as evidence of downstream anemia).
● Sense of pain or tightness at the base of the sternum (especially within an hour of eating).
● Persistent bad breath.
● Strong sense of fullness (perhaps early satiety with only a small amount of food) after meals, especially high-protein meals.
● Persistent acid reflux (GERD).
● Chronic cough.
● Neuropathy, poor balance/gait, poor memory, poor circulation, frequently feeling cold
(as evidence of insufficient Vitamin B12).
● Gastritis or ulcer or GI pain in the area of the stomach.
● Tendency toward regular GI microbial overgrowths (lower belly bloating or IBS).
● Persistent asthma, eczema, food allergies, food sensitivities (often coincident with low stomach acid).
- Name three important functions of bile which were explicitly covered during your SAFM
coursework. Acceptable answers should include three of the following:
● Emulsify dietary fats in order to increase digestion and absorption or phrased differently, to increase the activity and effectiveness of lipases in digesting dietary fats.
● Increase the digestion and absorption of fat-soluble vitamins.
● Keep microbial balance in the intestines by acting as an antimicrobial.
● Break down lipopolysaccharide (LPS) to reduce likelihood of immune system reactions to excess levels of this endotoxin.
● Regulates pH in the intestines to optimize the action of digestive enzymes and prevent microbial overgrowths.
● Carry the waste product bilirubin and a variety of conjugated toxins from the liver to the GI
tract for overall disposal of wastes via stool.
● Bile salts act to regulate lipid synthesis in the liver, in concert with insulin.
● Helps regulate oxalate absorption from the gut by minimizing binding of minerals to maldigested fats.
● Helps regular blood cholesterol levels by keeping cholesterol in circulation as bile.
● Regulate insulin production and release via secondary bile acids.
- Overall digestive processes can be impaired downstream by root causes found upstream in the body. List at least 8 upstream factors that could negatively impact digestion and absorption.
● Stress - including mental/emotional, dis-ease state, dysbiosis, metal toxicity, crap foods, etc.
● Poor eating hygiene - especially inadequate chewing.
● Crap foods - those that are nutrient poor, inflammatory, or highly processed.
● Alcohol intake - especially excessive.
● Hypochlorhydria - from hypothyroid function, chronic stress, H. pylori, age, inadequate nutrients.
● Inadequate digestive enzymes - suboptimal stomach acid, pancreatic insufficiency, protein insufficiency, chronically elevated blood sugar, chronic stress, and hypothyroid status can impair release of digestive enzymes both from the pancreas and the brush border.
● Bile congestion - lack of nutrients (taurine, B6), elevated estrogen, and dehydration can contribute to thick bile.
● Small intestinal overgrowths (SIBO, IMO, H2S) contributing to excessive gasses that damage villi.
● Uncontrolled celiac disease resulting from immune system imbalance, enhanced intestinal permeability, and molecular mimicry that damages the villi.
● Enhanced intestinal permeability.
● Trauma history contributing to chronic sympathetic nervous system engagement and poor vagus nerve firing.
● Antibiotic use contributing to dysbiosis that turns into a chronic simmering infection.
● Dysbiosis contributing to poor vagus nerve firing.
● Vagus nerve damage.
● Insulin resistance contributing to fatty pancreas and pancreatic enzyme insufficiency
● Certain medications (e.g. NSAIDs, oral estrogen, PPIs, antihistamines, statins).
● Estrogen dominance contributing to increased LDL uptake in the liver from increased cholesterol secretion. Excess cholesterol precipitates out into bile, contributing to bile sludge and gallstones.
● Poor hepatobiliary function/thick bile from toxicity.
● Hypothyroid function suppressing digestive secretions or causing elevated LDL, which can be precipitated out into bile, causing it to thicken.
- Name at least 10 root causes of why enhanced intestinal permeability may occur.
● Small intestinal overgrowths (SIBO, IMO, H2S, fungal).
● Excessive d-lactate or hydrogen sulfide gas.
● Microbial dysbiosis and excessive endotoxins (e.g. LPS).
● Pathogenic microbes.
● Inadequate commensal bacteria, or “isolation from old friends”.
● Use of certain medications, e.g. NSAIDs, oral hormones, chemotherapy, antibiotics.
● Stress.
● Hypothyroid state.
● Insufficient nutrients: Vitamin D, Vitamin A, and/or Zinc.
● Excessive histamines.
● Elevated blood sugar.
● Inadequate nutrients: Vitamins D and A, zinc.
● Chemicals, pesticides, food additives, glyphosate.
● Gluten and zonulin.
● Smoking.
● Processed food consumption.
- Name 3 types of small intestinal overgrowths of commensal bacteria, and the gaseous byproducts they produce.
a. SIBO - hydrogen gas
b. IMO - methane gas
c. H2S - hydrogen sulfide gas
- H. pylori is an endemic bacterial strain in the stomach. It changes the pH of the stomach by making it more alkaline, which can cause the stomach lining to change by thinning. Overgrowths of H. pylori may cause specific symptoms, including: hypochlorhydria and stomach pain (or ulcers or bad breath). When addressing H. pylori, it is important to heal the stomach lining e.g. mucilaginous herbs.
OVERGROTHS OF H. PYLORI MAY CAUSE SPECIFIC SYMTOMPS:
HYPOCHLORHYDRIA
- The 5Rs Healing Order of Operations is a combination of factors to address in order to help heal
the gut. The phases are
1) Remove, 2) Replace,
3) Reinoculate, 4) Repair, and 5) Rebalance.
They often overlap, and only sometimes require antimicrobials. In the Rebalance phase, the client works on determining a long-term maintenance plan of their gut healing gains.