Digestion & GI health

Your gut instincts: natural digestive health for overall wellness

by Marcelle Pick, OB/GYN NP

• If you’ve got digestive problems you have lots of company
• How digestive health supports overall wellness
• Married for life: the intimate relationship between your GI tract and your immune system
• Nutrient absorption supports your “bioenergetic” activities
• When absorption goes wrong
• Improving nutrient absorption
• When you have that gut feeling
• If it goes in, it must come out
• Good digestive health is a reason for celebration!

As a functional medicine practitioner, I know that nothing contributes more to your overall health than digestive wellness. No matter how well you eat, if your digestive system isn’t breaking down and absorbing the nutrients in your food, your body can’t get what it needs to keep you healthy.

Recently I saw a patient at the Clinic who was disappointed with conventional medicine’s approach to wellness. When I asked about her GI (gastrointestinal) health, she said she’d never really thought about it — at all — until she woke up after gallbladder surgery! But it hasn’t always been this way. For centuries, “How’s your digestion?” was the first question doctors asked. Wise practitioners have always known that a healthy GI system is the foundation for wellness. Today, progressive medical professionals are seeing proof that a diverse array of symptoms, illnesses, and disorders can be traced directly to digestive dysfunction, even when they seem unconnected to the gut.

If you’ve got digestive problems you have lots of company

In the United States, at least 70 million people experience digestive disorders. Many more don’t know that their unlikely symptoms (see box) may also be related to trouble in their GI tracts.

Women with digestive problems are often so accustomed to stomach issues that they don’t realize how much better they could feel. They may have learned to live with the discomfort and think that’s just how it’s supposed to be. But over time, functional digestive problems can lead to chronic illnesses that are likely to impair your health even further.

Many of my patients don’t make a connection between the food they eat, either, and how they feel, physically and emotionally. But any factor that affects your GI function is worth looking into, because good digestion promotes optimal health — both physical and emotional.

How digestive health supports overall wellness

A well-functioning GI tract helps ensure a woman’s long-term physical health in three ways:

Immunity. The majority of immune system activity takes place in your gut. Much of the inflammatory immune response you hear so much about starts in your digestive system, generated as a result of what you eat. Immune function is also linked with exposure to unfriendly “foreigners” (xenobiotics) that enter through your gut and how well your immune system manages these outsiders.

Sustenance. The GI system breaks down food into raw materials and energy. But no matter how good your diet is, problems with nutrient breakdown and absorption — or malabsorption — can stir up unpleasant symptoms and may also hint at other, more serious concerns.

Emotional well-being. Emotional health is intricately connected to your GI system by way of the enteric nervous system (ENS). The weird but wonderful ENS helps to regulate digestive function independently of your brain, but there’s plenty of information continually racing back and forth between the two. Think of how your stomach feels when you are anxious, stressed out, or even when you are deliriously happy. This powerful mind-body connection is especially important for recovering and maintaining physical health.

Together, immunity, sustenance, and emotional health are the tripod that supports and stabilizes our overall wellness. Let’s take a closer look.

Married for life: the intimate relationship between your GI tract and your immune system

Your GI tract — all 20-30 feet of it — is lined with a protective mucosal barrier, where any food-based antigens, pathogens, and toxins you swallow are recognized and managed. If that barrier is faulty, unfriendly invaders can gain a toehold — a condition called dysbiosis. Fostering healthy microflora throughout your GI tract is a powerful way to enhance your digestion and preserve immunity. Before birth and continuing throughout life, your immune system “talks” with microbes, distinguishing between beneficial flora (commensal) and pathogens (disease-causing). Beneficial flora can help stem the kinds of overactive immune responses that can lead to allergic reactions. The food you eat, and its pH balance, glycemic load, fiber, and essential fatty acid content all affect the flora in your gut. So does a history of antibiotic use.

If the mucosal lining becomes too permeable, the same “undesirables,” along with undigested food particles, can cross into the bloodstream more readily, a condition known as leaky gut. Functional practitioners believe dysbiosis and leaky gut are among the most common root causes of a wide range of symptoms and complications, many of them serious.

Much of the immune system’s activity in the intestines is mediated by a component of the lymphatic system known as gut-associated lymphoid tissue, or GALT. As the largest lymphoid organ in the body, GALT corrals foreign invaders for inspection so the immune cells can better recognize potentially harmful organisms and substances.

When your immune system is challenged, it initiates an essential — and completely natural — inflammatory response. But when challenges are ongoing or repeated, chronic inflammation is the unwelcome result. In the digestive tract, this sort of low-grade inflammation can unleash unpleasant symptoms. This chain reaction can also lead to sensitivities as “learned” immune responses to certain foods, such as gluten.

Clearly, it’s important to maintain the integrity of the cells that line your digestive tract. In functional medicine, we’ve developed protocols that help repair this delicate lining, restore digestive balance, reset the immune response, and put out the inflammatory fire.

Nutrient absorption supports your “bioenergetic” activities

Nutrient needs vary according to your gender, age, genetics, health history and current status, and individual environment. But the diet we choose to eat is influenced by culture, sensory perception, availability — and habits. If you’ve consumed certain foods your whole life, it can be hard to give them up even if you know they may be unhealthy. But when a food triggers a chronic immune response in your body, you may want to deliberately eliminate that food, even if it’s a favorite. That may be easier said than done, because it’s not uncommon to crave foods that you’re physiologically allergic to! But reducing their hold over you can result in wonderful health benefits.

When you’re digesting food, your body reduces it into smaller chemical forms: proteins and other peptides are broken down into amino acids; carbohydrates are simplified into monosaccharides; and fats are broken down into free fatty acids and monoglycerides. A diet high in plant foods, along with adequate protein and healthy fats, will moderate your digestive metabolism, and help regulate the primary hormones crucial for your survival — insulin, glucagon, and cortisol — resulting in better energy and mood throughout the day.

Your body uses “juices” like these to break down food:

• Digestive enzymes (secreted by salivary glands, stomach, intestines, pancreas). Specific enzymes break down particular proteins, and without them you cannot digest that food or absorb the nutrients contained in it. A common enzyme deficiency (60% of adults!) occurs with lactase, which is needed to digest the lactose in milk products.
• Stomach acid. The stomach’s production of hydrochloric acid (HCl) tends to decrease as we age. Antacids like TUMS or proton pump inhibitors like Prilosec or Nexium accelerate this process and use up critical minerals. Following a pH-balanced diet counteracts this effect.
• Bile. Created in the liver and stored in the gallbladder, bile is a mixture of cholesterol, salts, pigments, water, and minerals and is vital for optimal fat digestion.
• Digestive hormones. Numerous hormones signal hunger (gastrin, secretin, etc.), influence appetite satisfaction, and help regulate digestion.

If your digestive system can’t provide optimal levels of these fluids, you could have trouble with detoxification, as well as maintaining a healthy weight. If so, resolving your GI issues should be the first item on your list for long-term health and well-being.

Taking it all in

Actual nutrient absorption takes place across the surface of the trillions of folds in your intestinal lining — which, when healthy, would spread across an area about the size of a tennis court!

• Water-soluble nutrients, like electrolytes, carbs, amino acids, and some vitamins, cross through the intestine into the bloodstream’s hepatic portal vein, which shunts them to the liver for further processing until they are ready to be absorbed.
• Fat-soluble nutrients, like fats and other vitamins, undergo more complex processes along several different metabolic pathways. The nutrients are mixed, or emulsified, with water and bile, then other acids from the liver and gallbladder are added. Pancreatic enzymes further simplify the mixture, after which the molecules must go through several additional steps. Eventually the lymph fluid (bypassing the liver) moves these simplified fats by way of the thoracic duct into the blood stream and plasma.
• Fiber can be divided into two main types, soluble and insoluble. Most fiber is indigestible, but still essential for slowing the breakdown of carbohydrates and their entry into the blood stream as glucose. Fiber also regulates nutrient-processing “transit time” and serves as the “favorite food” of the beneficial bacteria in the colon, or large intestine.

When absorption goes wrong

Many conditions can cause nutrient malabsorption: celiac disease/gluten sensitivity, lactase deficiency, infection, parasites, chronic diarrhea, and others. If your body doesn’t absorb nutrients well, you could experience nutrient deficiencies or improper absorption — taking in too much or too little of certain nutrients. Possible reasons for poor nutrient absorption include a damaged mucosal barrier, absence of certain enzymes, poor circulation of bile or related acids, defective detoxification or ion transport, or pancreatic insufficiency.

There may be additional complications, such as anemia, gallstones or kidney stones, osteoporosis, malnutrition, or a weakened immune system. Inadequate nutrient absorption can contribute to other systemic problems such as inflammatory joint disease, chronic dermatological disorders, and sensitivities.

If you suspect a problem, there are a variety of tests that determine how well you absorb nutrients. The one used most often is a hydrogen breath test. Other tests for digestive problems look at stool composition and enzyme production, and some involve advanced imaging techniques.

Improving absorption

Functional medicine adopts a combination approach for restoring good nutrient absorption. I suggest you work with a motivated functional medicine practitioner to accomplish what’s referred to as the “4 R’s” — plus I’ve added a fifth to the list:

1) Remove. Isolate and remove whatever is triggering the problem.
2) Replace. Put back the nutrients, electrolytes, and fluids you’ve been losing. Consider digestive enzyme supplementation and dietary modification. Use an elimination diet to figure out which foods trigger an immune response.
3) Re-inoculate. Reestablish a healthy balance of gut microflora, especially during and after antibiotic treatment.
4) Repair. Heal and regenerate GI mucosal tissue using nutritional and supplemental support.
5) Regulate. Consider what you’ve been eating to determine whether you could make different food choices that promote better digestion.

This five-step approach has worked wonders for many of my patients with absorption issues.

When you have that gut feeling

Ever wonder why your stomach feels queasy when you’re upset? It’s not your imagination. Your emotions are deeply linked to a sophisticated neural network known as the enteric nervous system (ENS), which controls digestion. The ENS (which some say is part of the autonomic nervous system [ANS] while others think it’s independent) can even operate autonomously from your brain. It’s a lot like your central nervous system (CNS) — the small intestine contains as many nerve cells (neurons) as your spinal cord! But much of the function related to the ENS is still mysterious to us.

The ENS, ANS, and CNS continually exchange information related to gut function and sensory output, while relaying messages to the brain. This explains why just seeing a plateful of delicious food can trigger secretions in your stomach. Sometimes the foods you crave end up interfering with the smooth flow of communication between your gut and your brain. Hormonal and immunological pathways are also involved in the delivery of digestive information to the brain, including details about hormonal shifts and disruptions caused by certain foods.

That lump in your throat and those butterflies in your stomach…

Just about everyone knows from experience that nervousness, tension, or other types of psychological distress can disrupt the digestive system. Emotional stress can set off intestinal inflammation, even in an otherwise healthy person — and if the disturbance is ongoing, the inflammation could become chronic. Even when you’re not upset your gut may get used to behaving a certain way after you eat specific foods. The dietary choices you make when you feel vulnerable or blue are called “comfort foods” for a reason. Patterns of emotional eating are also heavily influenced by the communication between the brain and GI system.

The ENS employs many types of neurons to regulate gut functions, starting with peristalsis and catastalsis, the wave-like muscle contractions that push food through the GI system. The ENS also commands the circular movements that churn up intestinal contents, and initiates the secretion of critically important digestive enzymes.

But our modern lifestyle often “confuses” the sensitive ENS. When you gulp your food down, or stand up while you eat, or when you eat too much or too little, it can disrupt your digestion. Even eating at the wrong time of day can derail normal digestion, with weight gain, absorption problems, reflux, and insomnia among the common symptoms.

What goes in must come out

When I work with patients on digestive issues, I try to help them “connect what they’re eating with what they’re excreting.” It’s just a natural fact: when nutrients are broken down and absorbed, the waste that’s left over must be removed.

No one likes to talk much about excretion, but regular “mass movements” in the large intestine/colon are central to good GI function and overall health. If you don’t leave time for toileting every day because you are too rushed, establish a new routine. That can really help if you have frequent constipation. If you have the opposite problem, the mere act of eating can make you run to the bathroom with diarrhea. In both cases, the ENS is sending signals in response to your emotional input, so take notice.

For healthy bowel function, eat a balanced diet, and avoid eating foods that make you feel bad afterwards. Managing stress helps reduce the sudden gut reactions that create bathroom “emergencies.” And adding more fiber gradually, especially soluble forms found in fruits, vegetables, whole grains, beans, nuts, and seeds, will help regulate your bowel movements.

Good digestive health is a reason for celebration!

I hope you’re realizing that communication in your body does not just flow from your brain down. The two-way messaging between body and mind is especially significant when it comes to gut function, which is influenced by emotional signals, and vice versa. Ask your practitioner to partner with you to improve digestive health as foundational support for your overall wellness. Just conveying this goal can start a worthwhile dialogue.

The speed with which your emotions affect your digestion is proof-positive that the mind-body link is strong — and unbreakable. Keeping the principles discussed in this article in mind, I encourage you to create better digestive wellness with the following suggestions.

• Set a calm, peaceful table for all your meals.
• Allow plenty of time for adequate elimination.
• Eat healthy, balanced meals.
• Choose fiber-rich fruits and veggies.
• Select adequate amounts of — but not too much — lean protein.
• Drink lots of pure water, especially early in the day.
• Stay away from foods that trigger allergy-like reactions or cause digestive after-effects.

You might also consider working with your provider to evaluate the status of your body’s digestive enzyme production and regulation. And I almost always advise women to start taking a good probiotic supplement to improve digestive function.

Think about these guidelines for a few days — then consider starting fresh next week. Your gut function will surely improve, and so will your overall health. Go for it!

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References & further reading on digestion and natural health

 

Original Publication Date: 11/16/2009
Last Modified: 02/16/2010
Principal Author: Marcelle Pick, OB/GYN NP