Have you ever been so deep in the “what the hell can I eat?” weeds that you can’t even see the light of day?
Did you see me while you were there?
Because that’s where I landed several years ago when I first learned about my food sensitivities.
I was way down there slowly plodding through the process of discovering my issues and how to address them. When I really searched, I found answers that made sense, but the clinician in me felt compelled to find clinical evidence to support the information. So it took me a while to understand why I was so sensitive to certain foods, and to grasp how my past medical and diet histories – which by most standards were quite healthy – were probably part of what started me down this road long ago.
Granted, this was over 7 years ago and the only reference I had to pull from was my very conventional nutrition and medical experience, where formal nutritional therapy protocols for autoimmune disease did not exist. (They still don’t, by the way.) This was also before the root cause of my problems – intestinal hyperpermeability, or a “leaky gut” – gained more recognition and exposure.
Seven years ago, “leaky gut” was only truly acknowledged in more alternative settings, and only recently has more conventionally accepted terminology come along. Today, you will hear “leaky gut” referred to as a disrupted “microbiome”, or “dysbiosis.”
Starting To Put the Puzzle Together
I began by trying to figure out what I did know, so I could then fill in the blanks that were left. Sort of like working a puzzle by gathering pieces with a flat edge first to create the border, then tackling the trickier work on the interior. What I understood was that certain proteins (like gluten and casein) were causing inflammation in my body, and that this inflammation was related to the joint pain and fatigue I experienced from my rheumatoid arthritis. But what was actually creating this mess was a little harder to pinpoint.
Perhaps you’ve struggled to put the pieces together as well.
Or, maybe you’re where I was, so consumed with wondering how these more progressive concepts of chronic inflammation, food sensitivities and the now constant references to your “gut” are related to your long-term health, that you can’t even motivate to take the puzzle out of the box.
Admittedly, we aren’t painting a very pretty picture here. Anything that can be described as “leaky,” especially when you relate it to digestion, is probably not the sexiest topic. But these concepts are imperative to almost everything we’ll discuss, and sadly, are often ignored in discussions surrounding prevention and treatment for many common ailments.
And I’m all about context. I like seeing where things lie, and why. Without context, I find it really difficult to not only understand concepts, but to internalize them. And without fully understanding the underlying causes and ramifications, I find it hard to have the motivation to make big behavioral changes – like what I eat.
So let’s open the box, spill the pieces, and get to understanding what we’re dealing with.
Macro on the Micro(biome)
Your microbiome is loosely defined as the community of microorganisms or microbes (beneficial and harmful) that share our body space – on our skin, in our mouths, noses, throats, lungs, guts and urinary tracts. The microbiome as a whole is the source of intense, on-going research with projects like The Human Microbiome Project launched by the National Institutes of Health (NIH) in 2008 (which was one year AFTER my issues started). While they have not yet been able to correlate specific microbes with specific diseases, researchers from the project have acknowledged:
“What is clear…is that the microbiome is probably an important factor in many diseases, a factor that has been neglected in the past.”
The American Academy of Microbiology estimates that our bodies have almost three times the amount of bacteria making up our microbiome (about 100 trillion) than we do human cells in our entire body. But, don’t let this fact cause concern (that will come later). The harmful, pathogenic bacteria (e.g. “coliform” bacteria like E. Coli, yeasts, fungus, parasites) are the ones we have been so focused on in the past. But most of these bugs, like Lactobacillus and Bifidobacter, are actually beneficial or “commensal” bacteria.
Ideally, we have a strong, working relationship with the friendly bugs.
Through our diet we provide the nutrients to feed these beneficial bacteria, and in turn, they keep our immunity in check, make certain vitamins, regulate our metabolism, and assist in gene expression, digestion, and many other processes that we are continuing to learn about.
It’s a win/win. Or, at least it should be.
The Guts of the Matter
Our digestive system is the foundation for wellness and immunity, having the highest concentration of immune cells in our entire body. It was Hippocrates who first said “All disease begins in the gut.” The guy has a pretty good reputation, so I don’t take his proclamation lightly. And though this wise, founding father of medicine first realized this over 2,000 years ago, most people seem to be surprised to know that a digestion (or “gut”) issue could be the culprit for a variety of symptoms outside of the expected gas, bloating and poop issues.
So, while the microbiome as whole is a fascinating and timely topic, we are going to stay focused on the micro demographic of bugs in our digestive system. Not only does it house about 80% of our immune cells, 95% of our serotonin, 90% of all neurotransmitters also take up residence there as well.
The gut also has three quite critical primary functions:
- To digest food and convert it into vitamins
- To absorb nutrients
- To prevent toxins and pathogens from entering the body
Categories of Disruption
Unfortunately, your digestive system and the related processes it is in charge of can be compromised via two general categories. (here’s where we start to get concerned):
The goal for a healthy gut is to have the good, beneficial bacteria outweigh the bad. The good guys act as a physical barrier to the bad. If the good guys get killed off, don’t show up in the first place, or if you consume a diet that feeds your body more bad bacteria, it makes more room for the bad (pathogenic) to take over. This leads the way to a skewed ratio of much more bad bugs to good, aka “dysbiosis.” We’ll discuss the hows and whys in a minute.
- Leaky Gut
The protective lining of your digestive system or gut lumen (the space inside the tube of your intestine that regulates the passage of nutrient particles into your bloodstream), can be damaged by the dysbiosis mentioned above. The lining can also be harmed by various diet and environmental factors. This causes your digestive system to become overly permeable or “leaky,” which is known as having a “leaky gut” or “intestinal hyperpermeability.” And when this protective barrier breaks down, it takes down your entire system with it.
To explain, usually your intestinal wall is woven like a piece of cheesecloth. When it’s “leaky” though, it’s more like a tennis net. This series of openings allows larger, undigested nutrient particles and various toxins and bacteria to jump into your bloodstream before they’ve had time to marinate in the proper digestive juices. Your blood then transports the undigested particles to your liver, which is charged with filtering them; or, they circulate through your body. These escapees are viewed as foreigners by your immune system and trigger an antibody reaction leading to inflammation, putting a huge strain on your entire system.
What Sets It Off
I promised to explain how and why we get into this mess, so let’s dive into the underlying causes of a disrupted microbiome. Keep in mind that some of these things are within our control, and some simply aren’t.
The primary culprits:
|Overuse of Antibiotics||Kills all of the good, commensal bacteria along with the bad. Just one course has been found to permanently alter your gut flora.|
|Birth via C-Section||If baby never passes through the birth canal, s/he skips the critical step of becoming colonized with Mom’s beneficial bacteria and can instead inherit the pathogenic make-up of the hospital flora environment. (Not to mention, the antibiotics mom receives are passed on to baby, further altering the gut flora.)|
|Not Receiving Breastmilk||Breastmilk is a vehicle for protective bacteria as well as other important immunological properties like lysozyme, secretory IgA and leukocytes. They don’t call it “liquid gold” for nothing. Also, the cow milk protein (casein) from formula is damaging to the digestive system.|
|Overuse of NSAIDS (non-steroidal anti-inflammatories)||NSAIDS include ibuprofen, naproxen (Aleve) and many more. It has been well-documented that even short-term use causes intestinal damage and inflammation, and increases intestinal permeability (leaky gut). Ironically (and unfortunately), these are commonly prescribed for autoimmune and other inflammatory conditions, that have at the root of them — a leaky gut!|
|Diet High in Gluten||Gluten is a large protein that is very hard to digest. In addition, when you consume gluten, it causes the release of a protein called zonulin, which unzips the “tight junctions” that hold together your intestinal lining.|
|Diet High in Sugar & Processed Foods||Feeds the pathogenic bacteria (e.g. yeast), allowing them to overtake the beneficial bacteria, aka “dysbiosis.”|
|Use of Proton Pump Inhibitors (antacids)||These include Prilosec, Prevacid, Nexium and many others that work by inhibiting gastric acid production, which can be quite effective for reflux and heartburn (aka GERD) in the short-term. However, they have been linked with many vitamin & mineral deficiencies as well as Clostridium difficile (harmful, pathogenic bacteria) infections and small intestinal bacterial overgrowth (SIBO). Also, it has been shown that it is often a LACK of stomach acid that causes heartburn and reflux (the acid is needed for proper digestion of your food), rather than having too much.|
Other factors involved:
- Inadequate digestive enzyme production (e.g. the genetic deficiency of the enzyme lactase that causes lactose intolerance)
- Exposure to heavy metals and toxins
- Long-term alcohol use
- Radiation or Chemotherapy
- Intestinal Infection/Parasites
I realize it’s a lot to think about.
And if you’re like me, you read that list while silently checking boxes of things that related to you. For example, when I was born, I was only breastfed for a few weeks. I grew up, got married, and had two C-sections. I’ve also worked in the NICU and am well aware of the obstacles that can prevent exclusive breastfeeding – whether it’s health issues with Mom or baby. (I myself couldn’t even hold my baby to breastfeed due to the pain I experienced from RA, shackling me to my breast pump for months). It can feel like risk is coming at you from every angle – genetic, environmental, and from what you put into your body. It’s enough to make anyone want to stick their head in the sand.
But keep reading.
As I learned about the contributors to a “leaky gut”, I realized my poor intestinal wall never had a chance. In addition to a genetic predisposition, my medical and dietary history had rolled out the red carpet, inviting environmental triggers to transform my cheesecloth into a tennis net.
To illustrate, during certain periods of my life I endured chronic strep throat (high school) and sinus infections (college), making it impossible to count the number of antibiotic prescriptions I’ve taken over the years. In addition, while growing up, I took at least a few long-term courses of antibiotics for acne. And this doesn’t include the antibiotics I took here and there to fight whatever other issue may have come up. This was all long before I had even heard of the word “probiotic” so it’s safe to say my gut flora was wildly out of whack.
Also, I was not really notorious for my clean eating ways as a kid. Mom would give me money to buy a snack, and each day before high school basketball practice, I purchased and consumed a hearty meal of Cheetos, Reese’s Peanut Butter Cups and Dr. Pepper. Looking back, knowing what I know now, I have to wonder if this stellar diet was in any way related to the chronic infections and/or the acne. Hmm.
But what really makes me cringe is thinking about my refusal to rest a torn rotator cuff – a volleyball injury that occurred the year before I had my daughter (and received my RA diagnosis). I took so much Aleve to allow me to compete that summer, that I ended up with a prescription for Zantac to counteract the stomach pain and acid-reflux I started experiencing (symptoms of a stomach ulcer). How’s that for a case study in how NOT to practice preventative medicine? Never. Had. A. Chance.
If your gut health isn’t on point, your overall health won’t be either. Getting off course compromises your immunity, detoxification process, nutrient status and neurotransmitter balance. In fact, the health of your gut can actually affect gene expression, meaning it can dictate how your genetic dispositions manifest.
Chris Kresser, a highly respected functional medicine practitioner has said, “Genes may load the gun, but environment pulls the trigger.” And one of the biggest factors affected by your environment is the gut microbiome we just talked so much about.
This is especially true in the case of autoimmune disease. If you do have a genetic disposition to an autoimmune condition, and then you find yourself with an ailment like “leaky gut” (whether due to unfortunate circumstances or unhealthy decisions) the combination serves as an alarm, waking those genes and allowing the predispositions to manifest. The environmental toxins and the undigested particles that escaped from your “leaky gut” set up a bullseye on different systems within your body. For example, when your predisposition is rheumatoid arthritis, your joints are targeted. When it is diabetes, your pancreas is targeted. If it is celiac disease, your intestine is hit. When your genes include multiple sclerosis, your central nervous system is the target. Beyond the autoimmune conditions mentioned above, a disrupted microbiome is associated with the following conditions from nearly every system in the body:
- All Autoimmune Disease (rheumatoid arthritis, celiac disease, type 1 diabetes, multiple sclerosis, fibromyalgia, lupus, Hashimoto’s….)
- Allergies & Food Sensitivities
- Inflammatory Bowel Disease (including Crohn’s & Ulcerative Colitis) & other digestive issues
- Skin Conditions (acne, psoriasis, eczema, rashes)
- Stubborn Weight Loss/Obesity
- Mood/Cognitive Function
- Cardiac conditions
- Childhood hyperactivity
- Chronic arthritis treated with NSAIDS
So there you go.
This is one puzzle you aren’t going to want to show houseguests when it’s complete. I don’t recommend going into details about your leaky gut bacteria as an ice-breaker at your next cocktail gathering, as there’s just no easy transition into or out of this topic without getting graphic and possibly kicked out of the party. But social forums aside, it’s critical for you to bravely dive into the information so you can understand the role your gut health plays in your (or your loved ones) overall well-being.
Consider physical symptoms or conditions you may have and what environmental and lifestyle factors might be compromising your health. Then, it’s all about addressing the factors that you can control. A big one: diet. My next post will be chock-full of strategies on how to address what’s going in, and what’s going on because of it. Just think…changing your diet might change your whole life.
For more information about gut health/microbiome, food sensitivities, inflammation and a personalized, step-by-step plan to heal, check out my book, INFLAMED: Discover the root cause of inflammation and personalize a step-by-step plan to create a healthy, vibrant life.
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