Exclusive Dr. Hyman+ Functional Medicine Deep Dive: Gut Health

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Welcome to another deep dive episode. My name is Dr. Padi Murdhamati. I'm a licensed naturopathic doctor and Functional Medicine Certified Practitioner and today I'm going to be doing a talk for you on naturopathic approaches to gut health. So I hope you enjoy it. Before we begin, I think it's very important to understand why gut health is important. As Hippocrates once said, all disease begins in the gut. So it's important for us to pay attention to the gut of our patients if our goal is to improve their health because dysregulation in the gastrointestinal tract can have profound impacts on other areas of health. So what is gut health important for? The most obvious one is digestion and absorption of nutrients from food, but there are many other aspects of health that gut is important for. First we know the microbiome is involved in various things. It's involved in detoxification, the microbiome influences blood sugar control, it even has a connection with the brain through the gut-brain axis. The gut is also closely connected to the nervous system through the vagus nerve and the gut also influences inflammation and immune health through the GALT or the gut-associated lymphoid tissue. Let's review the lay of the land of the digestive system to understand its structure a little bit more. Digestion begins in the mouth. with chewing and with the production of saliva. And saliva has something called salivary amylase, which is helpful in the breakdown of carbohydrates particularly. When we eat food, food first enters the stomach where it is broken down by stomach acid. From there, the food enters the small intestine where it is broken down further and absorbed. This is done by digestive enzymes which are located in the small intestine and they are produced by the pancreas. Water and some vitamins are absorbed in the large intestine so there is some degree of absorption that happens there as well. What are some key functional roles of the gut? This is important for us to review. As we mentioned earlier, the gut is important for the digestion and absorption of nutrients. but there are many other factors that impact the role of the health, the role of the gut, I should say. We all have heard of the term intestinal permeability or hyperpermeability. The term that's thrown around loosely is leaky gut, and that's simply when the cells of the gastrointestinal tract, those enterocytes, they become leaky. They develop holes, they're no longer tightly sealed, and undigested food particles, LPS, and other things enter circulation that shouldn't enter the circulation. Other aspects of the gut that play important functional roles are the gut microbiome, microbiota, or dysbiosis that can impact health in a negative way. We know the gut is closely related to immune function and inflammation. The gut is intricately related to the nervous system and the gut also plays an important role in the elimination of waste as well as detoxification, things that we will touch on a little bit further. So what are some conditions associated with an unhealthy gut? First of all, there is dysbiosis. Dysbiosis simply refers to the state of microbial imbalance related to the gut ecosystem or the bacteria within the gastrointestinal tract. When there is an overabundance of pathogens and/or a deficiency of beneficial bacteria, this is what we refer to as dysbiosis. And dysbiosis can result in nutrient deficiencies, inflammation, and other digestive disorders. What are some symptoms of dysbiosis? Well, symptoms can include bad breath, bloating, constipation, diarrhea, and abdominal pain, just to name a few. Moreover, SIBO is a condition related to dysbiosis, because SIBO is simply when bacteria in the small intestine overgrows. And this condition can happen when there is high amounts of bacteria that have moved up from the large intestine up into the small intestine. And symptoms of SIBO can include abdominal gas, bloating, constipation, as well as diarrhea. Another condition associated with an unhealthy gut is leaky gut. As I mentioned, this term is also referred to as intestinal hyperpermeability. The intestinal lining covers more than 4,000 square feet in surface area. That's a lot of surface area. And there are tight barriers that control what gets absorbed into the bloodstream from the gastrointestinal tract. And an unhealthy gut lining may have cracks or holes in it which allows partially digested foods, toxins, as well as bacteria to penetrate and enter circulation leading to inflammation and setting the stage for a whole host of problems. And this could result in problems not only in the digestive tract but in other areas of health. So what are some other areas that gut health is important in? Well, gut health is actually very involved in sleep. In fact, gut health is connected to our sleep quality and the regulation of the sleep-wake cycle. And an unhealthy gut can contribute to disturbed sleep as well as insomnia. Next is the connection between gut health and immune function. Because 70% of our immune system is located in the gut. and an imbalance in the gut or the microbiome perhaps can relate to imbalances in the immune system because the bacteria within our gut, the microbiome as I mentioned, is closely related to our immune health. And disruption of bacteria within the gut can lead to problems including autoimmune disease, allergies, digestive disorders, and much more. What about gut health and the mood? Well, this is a hot topic because the gut is often referred to as the second brain by many. This is because the vagus nerve connects the gut and the brain and it allows the influence of the gut on the brain and vice versa. It is a bidirectional communication that happens with the gut to the brain. In fact, what the research demonstrates is that an unhealthy gut is associated with depression, anxiety, and other mood disorders. And what's important to know is that the majority of our neurotransmitters in the body that play an important role in mood are actually produced in the gut. What about gut health and skin? Well, gut health can have a significant impact on skin health because certain microbes in the gut cause inflammation, causing skin problems, like acne, eczema, and psoriasis. And imbalances in the microbiome can result in skin infections. So when it comes to skin health, dialing in the digestive tract and the gut, the microbiome is crucial. So when do we suspect digestive dysfunction? These are some of the symptoms that are suggestive of digestive dysfunction. There's bloating or belching following meals, flatulence after eating, a sense of fullness after eating, undigested food in the stool, iron deficiency and anemia, unintentional weight loss, chronic diarrhea, constipation, just to name a few. What I like to do as a naturopathic and functional medicine doctor is to gauge the health of my patient's gut I gave them what is called the GI symptoms questionnaire. This questionnaire allows the patient to score the severity of their symptoms they're having with respect to their gut. And these are some of the things that the questionnaire looks at. Nausea, vomiting, diarrhea, constipation, feeling of being bloated, belching, passing gas, heartburn, intestinal stomach pain, frequent need to clear the throat, food in the stool, mucus in the stool, foul smelling stool, all of these symptoms give us clues with respect to the severity of digestive dysfunction. And once the patient has scored these symptoms, we're able to quantify the severity of their symptoms based on their score and obviously their higher their score, the more severe their symptoms are. So what are some risk factors that increase the likelihood of digestive dysfunction in an individual? While going all the way back to birth, the method of a person's birth can have impact on the likelihood of them having a digestive issue in the long term. Firstly, those that are C-section births or are bottle fed It doesn't give this, the person a chance their microbiome to fully develop, which increases the likelihood of digestive dysfunction down the road. Because the intestines, they're sterile in the womb, right? And so the first place you acquire flora is from the birth canal. Passing through the vaginal canal, it simply inoculates, it colonizes the infant's gut because the vaginal fluid is swallowed at birth and these are the first bugs that colonize the infant's gut. And those infants that are delivered by C-section are at an increased chance to have deficiencies in a species of bacteria called Bacteroides, which are very important for gut health. Then there is breastfeeding. Breastfeeding influences gut microbiome, because it is a great source of bifidobacteria and breastfeeding has been shown to appear to be protective against childhood obesity. Then we have antibiotic use. Unnecessary use of antibiotics can be a risk factor for digestive issues down the line. An average child receives one round of antibiotics per year and has received 10 to 20 courses of antibiotics by the age of 18. Infants given broad spectrum antibiotics before the age of two have a higher chance of becoming obese during childhood. Another risk factor is the standard American diet or the SAD diet. Unfortunately, the SAD diet is high in sugar, fat, processed food, and all of this reduces the biodiversity in the gut microbiome. and what's fascinating is that these changes in the microbiome can happen in as little as 24 hours after eating these foods. Let's spend a couple of minutes talking about the gut microbiome. The gut microbiome is a complex ecosystem of microorganisms. It is composed of viruses, bacteria, and fungi. and it is influenced by nutrition and lifestyle factors like stress. And this microbiome is connected to many aspects of health. A little more information on the microbiome, which is actually fascinating, because the microflora in the gut weighs a total of two to five pounds. And the microbial cells outnumber human cells by a factor of 10. And what's fascinating is that microbial DNA outnumbers human DNA by a factor of 100. So what are some ways that the microbiome serves us? Well, first and foremost, the microbiome plays an incredibly important role in the breakdown of complex carbohydrates. It is important in the production of vitamins and minerals. It is also important in the production of short chain fatty acids, which are very important for the cells of the gastrointestinal tract. The microbiome protects us against pathogens, it influences immune health, it's important in the detoxification process, and it also influences the nervous system. So what does a healthy gut look like compared to a sick gut? Well, when it comes to a sick gut, we see one that is being exposed to a poor diet, dehydration, lots of medication, infection, low enzymes, stomach acid, and imbalanced ecology or microbiome, impaired intestinal permeability, and an imbalanced nervous system. Whereas on the other hand, if we look at a healthy gut, we see proper micronutrient, macronutrient, and phytonutrient levels, proper chewing, adequate digestive juices, enzymes and pH, an intact gut lining barrier, a balanced ecology of bacteria, as well as a balanced nervous system. So what are some causes of poor digestion? Well, poor dietary habits like food selection, meal timing, poor chewing are all causes of poor digestion. Altered bowel transit time, whether too fast or too slow can be a problem. because if it's too fast it could lead to malabsorption and this could be seen in conditions like hyperthyroidism. Then we have villous atrophy which are those brush border enzymes in the finger-like projections in the gastrointestinal tract. They could atrophy, perhaps if there's celiac disease. We have dysbiosis which we've touched on, low levels of stomach acid are a cause of poor digestion, low levels of saliva, bile, and enzymes are causes of poor digestion. We have food allergies, sensitivities, and then there's the pharmaceutical agents, right? Acid blockers, laxatives can all impact the gastrointestinal tract in a negative way. And interestingly enough, travel or frequent flying disrupts the microbiome potentially through stress and then hypoxia or low oxygen can impact digestion as well. At this point, it's important to differentiate between two key terms when it comes to digestive health: mal digestion and malabsorption. Mal digestion simply refers to defective breakdown of nutrients, whereas malabsorption refers to impaired mucosal absorption of nutrients. A common malabsorption is lactose intolerance because those that are lactose intolerant have deficiencies in the enzyme lactase, which is very, very important in the breakdown of lactose molecule.

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Hi everyone. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their Find a Practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.