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Gut Health Gut Health “All disease begins in the gut” (Hippocrates) Not quite accurate but a significantly profound statement considering when it was said Many chronic diseases are though to originate in the gut Unsurprisingly inflammation is implicated in them Gut Flora Gut flora is crucial to a healthy gut It is estimated there are over 100 trillion microorganisms in the gut (Backhed et. al., 2005) Chris Kresser puts it like this: “The human gut contains 10 times more bacteria than all the human cells in the entire body, with over 400 known diverse bacterial species. In fact, you could say that we’re more bacterial than we are human. Think about that one for a minute.” The Role of the Gut Healthy gut flora is crucial to normal gut functioning The gut plays a role in Immune function Psychological function Providing a barrier between what is inside the body with what is outside Digestion Nutrient absorption Disease linked to gut dysfunction Autoimmune conditions (type 1 diabetes, psoriasis, Coeliacs, inflammatory bowel disease (Crohn’s, Ulcerative colitis), lupus etc.) Irritable bowel disease Alzheimer's (interestingly referred to as type 3 diabetes in this article) Major depression Fibromyalgia and chronic pain Obesity (an emerging area) Non-alcoholic fatty liver disease (NAFLD) What Disrupts the Gut Seed oils Grain Diets high in processed foods (refined carbs, sugar, processed meats and fats) Chronic stress Chronic infections Medications (antibiotics, NSAIDs, birth control) All of these factors are able to change gut flora and potentially increase the permeability of the intestinal barrier Increased Intestinal Permeability aka Leaky Gut “There is growing evidence that increased intestinal permeability plays a pathogenic role in various autoimmune diseases including [celiac disease] and [type 1 diabetes]. Therefore, we hypothesize that besides genetic and environmental factors, loss of intestinal barrier function is necessary to develop autoimmunity.” (Fasano et. al., 2009) Leaky Gut Not all gut bacteria is good The food we eat and our lifestyles play a huge role in which type of bacteria grow in the gut and this directly affects both our physical and mental health Some bacteria in the gut (gram negative bacteria) contain compounds called lipopolysaccharides (LPS) also known as endotoxins (Raetz & Whitfield, 2002) Endotoxins are capable of causing an immune reaction When your gut is inflamed, it increases the permeability of the gut which allows these endotoxins to escape into the blood stream This is capable of stimulating a low grade immune response Leaky Gut It is thought that leaky gut could be the stimulus of diet- induced inflammation Metabolic endotoxaemia is when endotoxin levels in the blood increase up to 2-3 times higher than normal Metabolic endotoxaemia has been shown to rapidly induce insulin resistance and obesity Inflammatory markers also rapidly rise which means an immune response has been initiated Diet plays a role in endotoxin formation Leaky Gut “Placing 8 healthy subjects on a Western-style diet for 1 month induced a 71% increase in plasma levels of endotoxin activity (endotoxemia), whereas a prudent-style diet reduced levels by 31%.” (Pendyala, Walker & Holt, 2012) Many studies have linked long-term high fat diets to increased endotoxin release but these studies failed to restrict the variables and contained refined carbohydrates in them also (thereby nullifying the results/conclusions) It is thought that refined carbohydrates are capable of producing endotoxins and increasing gut permeability Gluten (via the activation of zonulin) appears to be able to increase gut permeability regardless of whether someone has Coeliac disease or not (Drago et. al., 2006; Fassano, 2011) Improving Gut Health Nutritional Plan Glutamine Picking your fibre Resistant starch Prebiotic fibres Low FODMAP (?) Elimination of pro-inflammatory stimuli Increasing anti-inflammatory foods Sugar Excess caffeine Seed oils (omega 6) Processed foods Omega 3 (fatty fish) Fermented foods (prebiotics) Foods rich in antioxidants Hydration Restoring the Barrier Glutamine Glutamine has been the most extensively studied amino acid with regards to its effects on GALT (gut- associated lymphoid tissue) and the intestine. In health, glutamine is categorized as a non-essential amino acid and represents the amino acid in highest proportions in the body. However, during periods of stress and during critical stages of development the essentiality of exogenous sources of glutamine is now well-established to support growth and health in young animals (Ruth & Field, 2013) Glutamine is an important energy substrate and precursor for the production of enterocytes Many immune cells require glutamine to function “In addition to its role as an energy substrate, glutamine is important for intestinal development and function, including maintaining the integrity of the gut barrier, the structure of the intestinal mucosa and redox homeostasis” (Ruth & Field, 2013) Glutamine Foods rich in glutamine: Poultry Meat Seafood Dairy Eggs Think - animal protein Cooking destroys the amino acid so consider also: Raw spinach Dried lentils, peas and beans Cabbage Kale Types of Fibre Lignin Cellulose β-Glucans Hemicellulose Pectins Gums Inulin Resistant starch Classification of Fibre Soluble vs insoluble Fermentable vs non-fermentable Some fibres will ferment in the gut and provide food for gut bacteria Prebiotic fibres Soluble dissolves in water whereas insoluble does not dissolve in water All prebiotics are fibres but not all fibres are prebiotic Promote the growth of healthy gut bacteria (Jerusalem artichoke, chicory root, garlic, raw bananas) Resistant starch a third type of fiber that provides the benefits of both insoluble and soluble fibers The term “resistant” refers to this starch’s ability to resist digestion Instead, it passes to the large intestine where it produces the same effects of soluble and insoluble fibers Effect is especially significant when the starch is cooked then cooled Veggies high in soluble fibre Carrots Winter squash Summer squash (especially peeled) tarchy tubers (yams, sweet potatoes, potatoes) Turnips Rutabagas Parsnips Beets Plantains Taro Yuca Source: ChrisKresser.com Veggies high in insoluble fibre Greens (spinach, lettuce, kale, mesclun, collards, arugula, watercress, etc.) Whole peas, snow peas, snap peas, pea pods Green beans Kernel corn Bell peppers Eggplant Celery Onions, shallots, leeks, scallions, garlic Cabbage, bok choy, Brussels sprouts Broccoli Cauliflower Improving tolerance to insoluble fibres Remove stems and peels Dice, mash, chop, grate or blend Cook completely These will assist the body in digesting them We don’t need 6-8 serves of veggies a day and this recommendation can further aggravate people with an inflamed gut Prebiotics Prebiotics were first defined as “nondigestible food ingredients that beneficially affect the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon, thus improving host health” [2]. This definition was later refined to include other areas that may benefit from selective targeting of particular microorganisms [3]: “a selectively fermented ingredient that allows specific changes, both in the composition and/or activity in the gastrointestinal microflora, that confer benefits.” (Slavin, 2013) Classification of a food ingredient as a prebiotic requires scientific demonstration that the ingredient: Resists gastric acidity, hydrolysis by mammalian enzymes, and absorption in the upper gastrointestinal tract; Is fermented by the intestinal microflora; Selectively stimulates the growth and/or activity of intestinal bacteria potentially associated with health and well-being. Probiotics Probiotics are live bacteria and yeasts that are helpful in maintaining a healthy gut flora “Brenner and coworkers conducted a meta-analysis in 2009 that included 16 randomized controlled trials evaluating the efficacy, safety, and tolerability of probiotics in IBS patients. B. infantis 35624 was the only probiotic that showed any significant benefit in the composite symptom score of IBS patients. Bifidobacterium likely has a beneficial effect in the symptom relief of IBS either as a single agent or in combination with other probiotics, though the available data are inadequate and further well-designed trials are still needed” (Aragon et. al., 2010) Probiotics vs Prebiotics The combination of the both provides the best result Evidence exists that probiotics/prebiotics assist in Reducing inflammation (Lescheid, 2014) Weight loss (Angelakis et. al., 2013) Reducing anxiety and depression (Messaoudi et. al., 2011; Luna & Foster, 2015) Lowering small dense LDL (Davy et. al., 2002) Reducing blood pressure (Khalesi et. al., 2014; Dong et. al., 2013) Improving immune function (King et. al., 2014; Ozen, Sandal & Dinleyci, 2015) Improving skin health (Baquerizo, Yim & Keri, 2014; Bowe, Patel & Logan, 2014) Reducing/preventing allergies (Kuitunen, 2013) Resistant Starch 4 Major Types Type 1 is found in grains, seeds and legumes and resists digestion because it is bound within the fibrous cell walls. Type 2 is found in some starchy foods, including raw potatoes and green (unripe) bananas. Type 3 is formed when certain starchy foods, including potatoes and rice, are cooked and then cooled. The cooling turns some of the digestible starches into resistant starches via a process called retrogradation. Type 4 is man-made and formed via a chemical process. Resistant Starch The main reason why resistant starch works, is that it functions like soluble, fermentable fiber. It goes through the stomach and small intestine undigested, eventually reaching the colon where it feeds the friendly bacteria in the gut positively effecting number and type When the bacteria digest resistant starches, they form several compounds, including gases and short-chain fatty acids, most notably a fatty acid called butyrate Butyrate is actually the preferred fuel of the cells that line the colon Butyrate suppresses inflammation in the gut and other tissues (thereby aiding in the prevention of colon cancer) Butyrate Increases Resistance to Metabolic and Physical Stress (Guyenet, 2009) Healing the Gut Game Plan Intermittently fast Remove all pro-inflammatory foods and increase anti-inflammatory foods Eat fermentable fibres (e.g. sweet potato) Consume resistant starch (e.g. potato that has been cooked then cooled) Include fermented foods such as kefir, yogurt, kombucha, sauerkraut, kimchi etc. Take a probiotic intermittently (i.e. 1 week of every month) Get tested for and treat any intestinal parasite Manage your stress levels Exercise Get enough sleep Hydrate!! (reduce caffeine intake)