Microbiome and gut health

Gut issues are a warning sign and when left unmanaged, they pose a risk of chronic health problems. 

If you are following health related news, you probably have seen blogs stating that all gut issues and often all health issues are caused by a “Leaky Gut”. Is that true?

To my opinion, it’s NOT. A Leaky gut may play a role but not always and there are many other factors at play which are often overlooked. Let me explain. 

Proper gut health assessment

For a proper gut health assessment, you need to think of a digestive system as a sort of manufacturing plant where many sequential steps are taking place in order to deliver a final product, hopefully a well-formed poop. Each step along the way plays an important role, therefore when focusing exclusively on a leaky gut as a cause and supplementing with probiotics as a fix, you might miss other important digestive pieces. 

If you see the digestion process as a sequence of events, you can imagine that whenever one step goes wrong - it affects what happens next, as a result affecting the quality of the end product, your poop. 

The gut functions in a top-to-bottom sequence. Issues can take place anywhere along this sequence and if you overlook any one of them, you most likely won’t have good results with conquering your gut issues by applying a standard gut healing protocol. For instance, you will have limited results when you fix your gut with probiotics and herbals while you have low stomach acid or a sluggish gallbladder.

Many different things can cause gastrointestinal challenges so you want to investigate which ones might be affecting you. It will help you to develop a customized plan to address your problem in a smart and strategic way. 

Few common gut issues include:

  • not chewing foods well enough,
  • having suboptimal levels of gastric acid,
  • having a poor bile flow,
  • not making enough digestive enzymes,
  • having a gut dysbiosis,
  • suffering from a too slow or too quick intestinal transit. 

So, if you are struggling with digestive issues, do not exclusively focus on a leaky gut – keep a bigger picture. 

5 common signs of an unhealthy gut 

These are symptoms, not diseases. Nevertheless, they might sometimes be associated with a disease. 

1. Abdominal bloating 

For many of my clients, it is one of the top complaints. It is a feeling of fullness, swelling, tightness, or hardness often described as a “feeling of being pregnant”. It may also be associated with pain, flatulence, abdominal distension, nausea, burping, belching, or gurgles. 

unhealthy gut - abdominal bloating

Causes of abdominal bloating

The cause can be as simple as eating and drinking too fast and too much. We tend to swallow air when eating fast and our digestive system can take-in only a certain amount of food at the time. Overconsumption of starchy foods such as grain products, seeds and nuts can promote bloating as well. A common bloating bomb is having a large pizza with a large dose of coke. Abdominal bloating can also be driven by low gastric acid levels, dyspepsia (indigestion), impaired pancreatic function or bile production, constipation, food allergies, food intolerances, celiac disease, gallstones, SIBO, gut microbiome dysbiosis, Helicobacter pylori infection, parasitic infections, Inflammatory Bowel Disease (IBD), use of medications that influences digestion, hormonal changes, reproductive track issues, or abdominal water retention. People with IBS and SIBO often experience bloating.  

2. Diarrhea

Diarrhea is defined as loose and watery bowel movements and a too fast bowel transit. Then, feces do not stay in the colon long enough for water to be re-absorbed into the body. Diarrhea can be associated with cramps, nausea and vomiting. 

Diarrhea is described as acute when it lasts less than four weeks, as in viral gastroenteritis. It is considered chronic when it lasts four weeks or longer. Everyone experiences diarrhea once in a while, for a couple of days. It’s usually not serious and the problem resolves on its own. 

 unhealthy gut - diarrhea

Causes of diarrhea

Typically, acute diarrhea is a sign that your body wants to get rid of something, could be microbes, parasites, foods or toxins, for example such as during a food poisoning. Then, the toilet is your best friend. It’s an intelligent way of reducing the infectious and unwanted agents. It’s self-limiting and typically will resolve in a couple of days. 

Chronic diarrhea however, might be the result of food allergies, food intolerances (lactose, fructose, histamine), celiac disease, persistent bacterial & parasitic & viral or fungal infection, Small Intestinal Bacterial or Fungal Overgrowth (SIBO and SIFO), Inflammatory Bowel Disease (IBD), IBS, diverticular disease, gallbladder issues, certain foods and sugar substitutes (sorbitol, mannitol, xylitol), alcohol abuse, malabsorption, overactive thyroid, excessive secretion of fluids by the intestine, or the use of certain medications and supplements (magnesium citrate, vitamin C). Stress is a big factor as well. When you have chronic diarrhea, you are at risk of not digesting the foods well and not absorbing all nutrients well, and you may end up with nutritional deficiencies. 

3. Constipation 

Constipation refers to bowel movements that are less frequent and often associated with dry and hard stools which are difficult or painful to pass. The Rome IV criteria for constipation states that a diagnosis of functional constipation is made when at least two of the following criteria are met for the last 3 months with symptom onset at least 6 months prior to diagnosis:

  • straining on >25% of defecations;
  • lumpy or hard stools on >25% of defecations;
  • sensation of incomplete evacuation on >25% of defecations;
  • sensation of anorectal obstruction/blockage on >25% of defecations;
  • manual maneuvers on >25% of defecations;
  • less than 3 defecations per week.
 unhealthy gut -  constipation

Constipation creates a problem in the large intestine, the colon. The colon’s role is to reabsorb nutrients and water back into our system and to eliminate what we don’t need. Adequate hydration and fiber are the colon’s best friends and essential for its health. Without adequate dietary fiber, the colonic cells (colonocytes) have a difficult time to do their job and to preserve the colon integrity. In addition, your colon is home for gut microbes. The microbes are processing and metabolizing your food and other intestinal content to make various products. The healthier foods (fiber and polyphenols’ rich) your gut microbes receive, the healthier products they will make, including short chain fatty acids (SCFAs) such as butyric acid. The SCFAs are a primary fuel for the colonic cells and are required to nourish the cells and to regenerate them. If the stool is not eliminated in a timely manner, more and harder stool accumulates which adds to discomfort when stool finally passes.  

Causes of constipation

Constipation typically can be a result of the changes in diet or routine (travelling), lack of exercise, low intake of fiber and water (liquids). Fiber absorbs water and causes stools to be larger, softer, and easier to pass. Sometimes, it is caused by a gut dysbiosis or by the use of medications (opioids, iron supplements, antacids that contain aluminum, sedatives, antidepressants, bismuth salts, diuretics, calcium-channel blockers), or by an underactive thyroid, or by neurodegeneration. Interestingly, one of the first symptoms of Parkinson is constipation. Constipation affects women (possible thyroid connection) twice as often as men and is more prevalent as we age (possible neurodegeneration, lack of fiber and less physical activity). Constipation can also occur when you routinely neglect the urge to defecate, your reflex to defecate may be dampened, and accumulated stool may harden as a result, becoming even more difficult to pass. 

4. Heartburn 

Heartburn is a symptom of burning sensation in the middle of the chest and is a common symptom of reflux, a very common gastrointestinal complaint. Reflux or acid reflux, officially called gastroesophageal reflux disease (GERD) is the medical condition, in which stomach content (acid, pepsin) flows back up to the esophagus (the food pipe). 

Reflux of gastric contents into the esophagus is normal physiology, therefore incidents of reflux often go unnoticed. However, when reflux occurs frequently and excessively, it can lead to esophageal mucosal injury and inflammation and persistent symptoms associated with acid reflux. The reflux pain and discomfort can radiate from the lower end of the rib cage to the root of the neck and can be accompanied by the stinging and sour sensation in the throat. Other symptoms of reflux may include hoarseness, cough, and asthma as well as pharyngitis, sinusitis, pulmonary fibrosis, recurrent otitis media, and sleep apnea. Some individuals will also experience bloating, burping, difficulty swallowing, hiccups, or nausea.

unhealthy gut - heartburn

When reflux symptoms are severe, chronic and affect the quality of life, a doctor may refer you for a diagnostic testing such as upper GI endoscopy, monitoring Ph, transnasal esophagoscopy or the impedance testing. The results of a medical exam can be helpful in assessing the severity and a possible cause of reflux, and into classifying the heartburn you experience into one of the following categories:

  • functional heartburn, featured by an absence of reflux or excessive sensitivity to acid,
  • reflux hypersensitivity, characterized by the normal levels of refluxed gastric acid which induces heartburn symptoms,
  • non-erosive reflux, characterized by an abnormal amount of acid reflux with no inflammation in the esophageal lining,
  • erosive esophagitis, characterized by the inflamed esophageal lining with eroded spots resulting in ulcers. 

Causes of heartburn

Often, when the lower esophageal sphincter (LES) weakens and relaxes too much, gastric fluids surge up into the esophagus, sometimes causing a painful burning sensation. Poor contraction of esophagus and stomach muscles can also promote reflux

Common reflux triggers include being overweight, being pregnant, smoking cigarettes, having a hiatal hernia, overtraining, overeating, wearing tight-fitting clothes, lying down, bending over, certain medications and supplements (antibiotics, muscle relaxers, blood pressure drugs, ibuprofen, hormones, potassium and iron supplements), Helicobacter pylori gastric infection, low magnesium levels, chronic cough, stress, old age, or sensitivities and allergies to foods.  

Certain foods and drinks can also contribute to reflux by influencing the function of the LES or gastric acid production. For example, many people experience reflux/heartburn complains after alcohol, coffee, caffeine-containing products, cocoa, cola drinks, onions, garlic, citrus fruits, tomato products, high-fat and fried foods. 

5. Poor blood sugar control (hypoglycemia or hyperglycemia) 

You might be surprised to learn that there is a connection between the gut microbes, gut health and blood sugar regulation, according to the latest research. Blood sugar control is a complex symphony of interactions on many levels; genetic, biochemical, hormonal and metabolic level. We know that hormones such as insulin, glucagon and cortisol regulate our blood sugar levels but as scientist continue to study our gut microbiome, they constantly discover new things. We know now that thousands of the metabolites manufactured by gut microbes interact with our body cells and modulate our physiology.

unhealthy gut - poor blood sugar control

Changes in the gut microbiome (gut dysbiosis) were shown to be associated with poorer blood sugar control and with metabolic disorders such as insulin resistance, diabetes, obesity, and metabolic syndrome. The preliminary findings and the logic behind it, is that changes in the intestinal ecosystem can drive inflammation, alter intestinal permeability, modulate metabolism of bile acids and short-chain fatty acids; and that microbial metabolites act synergistically on metabolic regulation systems possibly contributing to insulin resistance. 

People susceptible to obesity are thought to have a gut microbiota that endorses more effective storage and extraction of energy from the consumed diet when compared to the microbial community of non-obese people. Interestingly, gut microbes produce certain metabolites that may affect satiety and insulin resistance.

Studies on the effect of probiotics and prebiotics on blood sugar control and insulin resistance demonstrated that prebiotics and probiotics may have potential to improve glucose metabolism. 

Causes of poor blood sugar control

Poor blood sugar control is mainly driven by a poor diet and poor lifestyle. Diets rich in sugar and processed foods will typically drive blood sugar imbalances, will alter the gut microbiome and impair digestion. The use of medications, antibiotics, chronic stress, poor sleep, sedentary lifestyle and genetics influence both, our blood sugar and our gut microbiome.  

Stay tuned to learn, in my next blog, the ways how to fix these common digestive complaints. 

Information provided here is meant for educational purposes only, and does not constitute medical or nutritional advice or act as a substitute for seeking such advice from a qualified health professional.

Category: Microbiome and gut health icon March 16 2021
Author: Dr Joanna Krzeslak-Hoogland

Being inspired by the effect of nutrition, lifestyle and mind on our health, I am dedicated to help people on their journey to wellbeing.

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