KIP- Disease Begins in the Gut 101

Question 1

1. Dis-ease often begins in the gut and shows up as dysfunction elsewhere in the body at a later point in time. Over 2/3 of the immune system resides in the gut, assessing the status of our world based on our microbes and what we swallow. Microbial genes affect physiology (and outnumber humans’ genetic material by ~300x).

Question 2

2. None of us have a back-up nutrient pantry in our left butt cheek. Food choices matter. We need essential nutrients from our food, brought in through the GI tract, to run every cell in the body. The GI tract is a major entryway (nutrition, microbes, toxins, hydration) and a major excretion route (waste, toxins, hormones).

Question 3

3. “You are what you eat” is oversimplified. We are what we eat, digest, absorb, convert, and get past the cell membrane. Chronic stress impairs All of these. Chewing well is a critical habit.

Question 4

4. Eating hygiene is powerful medicine and an act of self-care. When in doubt start here (i.e. medicine of smaller meals, eating until ¾ full, slower meals for hormone release and satiety, relaxed state in parasympathetic mode will promote optimal digestive secretions). Simple is OFTEN sufficient. “Doing a stool test” is seldom the most logical first step.

Question 5

5. Grazing on food all day can create microbial imbalance and downstream disease. The Migrating Motor Complex (MMC) cleanses the GI tract, but only when we aren’t digesting food (ideally leave 3+ hours between eating), especially to clear microbial debris. In vulnerable individuals, grazing all day contributes directly to SIBO and other dysbiosis.

Question 6

6. The GI tract has a large concentration of immune tissue (GALT) and nervous tissue (enteric nervous system), all in the same place. This immune-nervous system teamwork in the gut is responding to our environment and communicating to the brain the status of our world (90% of vagus nerve communication goes from gut to brain). Most neurological and mood imbalance also begins in the gut.

Question 7

7. The mouth is the gateway to the gut - and thus the immune system. Assess mouth and dental health. Amalgam dental fillings (which are 50%+ mercury) are toxic. Root canals may create chronic inflammation. Mucous membranes must be well hydrated to allow good immune function.

Question 8

8. Our challenge is to balance nutrient absorption with toxin excretion. Suboptimal gut transit time is a symptom and can promote dis-ease: too fast (e.g. dehydration, mineral deficiency) and/or too slow (e.g. microbial imbalance, retoxification). Most constipation comes from magnesium insufficiency, dehydration, and/or subclinical hypothyroidism/hypocortisolism. Perhaps also insufficient soluble fiber or healthy fats, food sensitivities, dysbiosis, or lack of movement. Most diarrhea comes from stress, lack of sleep, lactose intolerance, medications (SSRI, antibiotics, metformin, corticosteroids, ACE inhibitors), food sensitivities or allergies, or dysbiosis. Serotonin is
   a major player in motility: too little (e.g. methane-producing archaea or ongoing use of SSRI/SNRI)
   or too much (e.g. excessive 5-HTP intake, ongoing use of SSRI/SNRI).

Question 9

9. Sluggish thyroid, sluggish anything - in the GI tract too. Good cellular metabolism is needed for pancreas/stomach (enzymes/HCL), enterocytes (digestion/absorption/gut barrier function), smooth muscle cells (peristalsis/motility), liver/hepatocytes (bile/biotransformation/cholesterol), and immune strength. But we also need strong, consistent GI function to obtain nutrients from food that the cells need to thrive e.g. selenium, iodine, zinc, iron, and liver health to ensure optimal thyroid function.

Question 10

10. IBS is a symptom, not a disease or an ultimate root cause. IBS is usually caused by a combination of factors (e.g. dysbiosis, stress, dysmotility, maldigestion, estrogen dominance, hypothyroid, hypo- or hyper-adrenal state, serotonin imbalance, medications, food sensitivity/intolerance). Often (esp. in women), a combo of poor eating hygiene, subclinical hypothyroid, and insufficient magnesium.

Question 11

11. Remember the 5 R’s of Gut healing: Remove First, Replace, Re-inoculate, Repair, Rebalance (see Slide #12 in Part 2 of DBIG 101). But use a customized approach for each individual person, and remember that stages will often need to overlap one another.

Question 12

12. Hypochlorhydria is common (and often reversible). And can create downstream IBS symptoms and dis-ease (e.g. insufficient amino acids, B12/minerals, dysbiosis, allergies, asthma). Consider poor eating hygiene, age, h. pylori overgrowth, stress (sympathetic nervous system state), hypothyroid or hypoadrenal, or medications. Most chronic acid reflux is low magnesium, a food sensitivity, and stress (poor eating hygiene). Insufficient stomach acid (not too much) or poor bile flow may also be involved when chronic. Acid suppressing medications (PPIs, H2 blockers) prescribed for GERD create hypochlorhydria.

Question 13

13. Hydrate primarily between meals, not during meals. Excessive water during a meal may dilute stomach acid and create hypochlorhydria dynamics. Also consider impact of too many mineral supplements at once and/or baking soda taken too close to a meal (both create excessive alkalinity during digestion).

Question 14

14. 80% of gastric Ulcers are caused by H. Pylori overgrowth. Sometimes a vicious cycle: reduced stomach acid allows h. Pylori to thrive → creates atrophic gastritis → promoting even less stomach acid secretion. Highly contagious - may need to support the entire family. Don’t increase HCl during H Pylori treatment. Remember broccoli sprouts. Other major ulcer root causes: NSAIDs (esp. aspirin) and stress (thins mucous membranes, reduces secretory IgA).

Question 15

15. Look for hypochlorhydria in notably “allergic” people. Allergy may promote low stomach acid
    → Low stomach acid may promote GERD → GERD may promote asthma → Low stomach acid may worsen allergic hypersensitivity, creating a vicious cycle.

Question 16

16. Interconnectedness of Enzymes. Suboptimal stomach acid will impair release and/or function of enzymes (even if release is optimal, pH matters for enzyme action!) in both pancreas and intestinal brush border. Pancreatic enzyme output may be suboptimal in any type of Diabetes. Additionally, chronic stress, hypothyroid, hypoadrenal, dysbiosis, celiac disease, cystic fibrosis, toxicity (bile duct runs through the pancreas, bile brings toxins out of body from the liver via Phase III detox), physical impairment, or chronic inflammation may contribute to insufficient pancreatic or brush border enzyme output.

Question 17

17. Removing the gallbladder doesn’t address root causes of gallbladder disease; it just removes the victim. Go upstream to the liver and assess bile flow (e.g. ALP, GGT, bilirubin,
    ALT/AST). No gallbladder decreases concentrated bile delivery during meals to emulsify fat, leading to poor fat digestion by enzymes, and resulting in fat malabsorption (need fats for cell membrane/neurons/ energy and fat soluble vitamins A, D, E, K, for immune/antioxidant/repair/skin). Bile is also antimicrobial and key for maintaining oxalate balance and a healthy microbiome. Post cholecystectomy often needs bile support with meals.

Question 18

18. Free-flowing bile keeps gallbladder healthy. Need healthy Liver and adequate, balanced ingredients to synthesize bile (e.g. activated B6, taurine, hydration, cholesterol). High estrogen states can concentrate too much cholesterol in bile. Thin bile congestion (e.g. d-limonene, phosphatidylcholine, hydration) before promoting gallbladder emptying (e.g. olive oil, artichoke, bitters). Fatty liver (e.g. insulin resistance, alcohol), high estrogen states (e.g. xenoestrogens, high beta glucuronidase from dysbiosis), and/or hypothyroid can also make bile flow sluggish. Poor bile recirculation can create diarrhea.

Question 19

19. Uro- genitourinary dis-ease begins in the gut? Inadequate oxalobacter species (e.g. low endemic diversity, dysbiosis) and/or sluggish or low bile flow leads to maldigested fats in GI tract and malabsorption of minerals, which results in higher absorption of oxalates (dietary oxalic acid + minerals) from intestines. Excessive oxalates in tissues is a contributing factor in calcium oxalate kidney stones or oxalate crystal build up in pain syndromes (e.g. vulvodynia, fibromyalgia). Need activated B6 to break down oxalates and synthesis of taurine (requires methylation) for optimal bile flow. High toxic load in bile can also promote poor quality, thick bile or poor gallbladder emptying (phase III excretion path from liver).

Question 20

20. What happens in the GUT does not stay in the GUT. Damage to selectively permeable intestinal membrane (e.g. low Vitamin D, gluten and gluten cross-reactivity, NSAIDs, OCP, SSRIs, artificial additives in foods) allows higher immune reactivity to what is in the gut: Enhanced Intestinal Permeability (EIP). There may be major or no GI symptoms at all. Zonulin is not always elevated. Often creates a chronic cycle of inflammation, oxidative damage to tissue, and immune hypervigilance. Dysbiosis (e.g. SIBO, pathogens) can be a key contributor to EIP (e.g. enterocyte damage due to oxidative stress).

Question 21

21. Lipopolysaccharides (LPS) can be a pathway for microbes to promote systemic disease. Alkaline phosphatase and Bile degrade LPS. Cholecystectomy or hepatic-biliary congestion + enhanced intestinal permeability + dysbiosis (even mild) may promote systemic inflammation (e.g. chronic fatigue syndrome) and/or chronic autoimmune dynamics (e.g. psoriasis, rheumatoid arthritis) due to molecular mimicry from LPS of specific species. Always consider bile function in autoimmune disease.

Question 22

22. Food sensitivities may be caused by EIP (but not always). No food sensitivity test is fully comprehensive (tell patients this in advance) all are vulnerable to false negatives/positives. Wait at least six weeks after completion of steroid medication to run Food Sensitivity testing (or other immune system reaction testing e.g. WBC data, globulin, fecal sIgA). An elimination diet or specific elimination is faster, more reliable, & free, but not suitable for everyone. Common contributors to joint pain and inflammation given joints are areas of low circulation.

Question 23

23. Individuals with celiac disease (even with gluten elimination) may struggle with malnourishment and/or insufficient nutrition long-term (e.g. iron, zinc, B6, B12). Gluten cross-reactive sensitivity is common. Support gut healing long term.

Question 24

24. Address a “revolving door” of recurring gut imbalanced by continuing to go upstream.
    Check strength and tolerance of immune system. Chronic stress/anxiety, insufficient nutrients (zinc, D, A), hypothyroid, skewing of HPATG axis (rock bottom cortisol), insufficient stomach acid (part of passive immunity): any of these may be driving immune system dysregulation.

Question 25

25. An imbalance in endemic bacteria (e.g. SIBO) is the most common dysbiosis dynamic in IBS. But only 75% test positive, and not all SIBO yields a positive breath test. Endemic microbes from colon end up in small intestines (poor ileocecal valve function?) feasting on mal-digested food that can cause excessive gas build up, promoting diarrhea (more hydrogen, higher serotonin, greater motility) or constipation (more methane, lower serotonin, slower motility) or an oscillating cycle of both. Address eating hygiene and stop grazing. Recurrence common. Consider role of other root causes e.g. hypothyroid, hypochlorhydria, medications, persistent stress, poor immune function.

Question 26

26. A strong, balanced immune system and diet will maintain a healthy and diverse microbiome without intervention. Antibiotics are overused and completely change the microbiome, often taking many months for a new normal to be established, and can promote fungal overgrowths. But antimicrobial herbs are also often overused. Prebiotics and probiotics can be powerful for some and exacerbating for others. Presence of transient, endemic, commensal, beneficial bacteria can be calming, rebalancing, and priming to the immune system.