Pillars of GI Health

How Macronutrients Affect GI Health

Carbohydrates

Carbohydrates are one of the most important sources of energy for your body. Carbohydrates are considered simple or complex depending on their chemical structure. Simple carbohydrates include sugars found naturally in food, as well as sugars added during food processing. Complex carbohydrates include whole grains, vegetables and legumes, all of which are good sources of fiber. Both complex and simple carbohydrates are processed in the body and turn into glucose, which is used as energy.

Dietary Fiber

Fiber is a substance found in plant food and cannot be broken down in the GI tract. Fiber is passed, intact, through the GI tract and makes up part of the stool. The two types of fiber, soluble and insoluble, are both important to a healthy diet. Fiber increases satiety, or the feeling of fullness, which can aid in healthy weight management.

Soluble fiber retains water and turns to gel during digestion. It also slows digestion and nutrient absorption from the stomach and intestines. Soluble fiber can be found in foods such as oat bran, barley, nuts, seeds, beans, lentils, fruits, and many vegetables. Soluble fiber plays a role in slowing down the absorption of fat and sugars, which can help reduce cholesterol and balance blood sugar levels. Insoluble fiber speeds the passage of foods through the stomach and intestines and adds bulk to the stool.

Insoluble fiber is usually found in foods like nuts, seeds, whole grains, vegetables and wheat bran. Insoluble fiber is effective for the treatment and prevention of constipation and of digestive disorders like irritable bowel syndrome.

Protein

Lean proteins are vital to a healthy diet, and can even increase satiety and promote weight loss. Meat, poultry, fish, beans, peas, eggs, nuts and seeds supply many nutrients, including protein, B vitamins, vitamin E, iron, zinc, and magnesium. Proteins function as the foundation for bones, muscles, cartilage, skin, and blood. They also play a major role in building enzymes, hormones and vitamins.

Creating an Ideal Meal

One of the healthiest dietary patterns comes from the Mediterranean region. The Mediterranean diet consists of a high intake of olive oil, nuts, seeds, fish, plant proteins (legumes and lentils), fruits, non-starchy vegetables, herbs and spices, moderate consumption of wine, and dairy (mostly in the form of yogurt and cheese).

The Mediterranean diet also consists of minimal meat consumption, particularly red meat, refined carbohydrates, sugars and processed foods—foods that have been shown time and time again to have harmful effects on the body.

Following a Mediterranean diet is a simple way to select healthy foods and avoid harmful foods that can negatively affect the digestive system. This will also help ensure the foods you consume consist of the most beneficial macronutrients (fats, proteins, carbohydrates) and micronutrients (vitamins, minerals, antioxidants).

Another element of the Mediterranean lifestyle includes eating meals in a relaxed, family-style atmosphere. Rather than rushing through meals or grabbing food on the go, mealtime, particularly dinner, is a time to slow down, laugh and reconnect. Taking the time to relax and digest food properly also supports GI health. For the past 50 years, scientists have studied the eating patterns of people native to the Mediterranean region and found that they are associated with long, healthy lives with minimal chronic disease.

Herbs and Spices that Promote Digestive Health

Many herbs and spices naturally have anti-inflammatory, detoxification and antioxidant properties. Historically, herbs and spices have been considered priceless for their flavor-enhancing and health-promoting benefits. Incorporating fresh herbs and spices into salads, soups and other dishes can provide anti-inflammatory and antimicrobial properties and enhance digestion. The table below outlines some of the healthpromoting properties of various herbs and spices you might consider incorporating into your meal planning.

The 4R Approach to Managing GI Dysfunction

Your health care provider has many tools to assess and treat GI dysfunction. One of the popular functional medicine approaches for GI-related conditions is the 4R approach: Remove, Replace, Reinoculate and Repair. The Remove step restricts toxic, pro-inflammatory and potentially allergic foods from the diet, and eliminates harmful organisms. The traditional approach is to add a prescription medication to the body, but often the best medicine for our GI tract is in elimination and allowing the system to rest. After the critical Remove step, your health care provider can then help you address the need to Replace with digestive aids, Reinoculate with probiotics, and Repair a damaged GI tract.

The Pillars of GI Health

The GI tract is responsible for extracting the nutrients you need to thrive and maintain an appropriate balance of helpful and harmful microbes, while at the same time working with the immune system to prevent the entrance of harmful substances into the bloodstream. The GI tract has four core functions, called the Pillars of GI Health. The health of your digestive system is built upon these pillars and their interrelationship.

Digestion and Absorption

One of the main functions of the GI tract is to digest food and absorb nutrients from it. Digestion begins in the brain, when we see and smell food. Saliva and gastric juices are released while preparing for the meal, well before the first bite of food. This is why it is so important to spend time preparing our food, as this process plays a major role in healthy digestion. When you eat a meal, your mouth, by chewing, physically breaks down large food pieces into smaller molecules. Once the nutrients have passed the intestinal barrier, they enter the bloodstream and circulate to all your cells and tissues. These nutrients work to maintain organ function, energy production, and the growth and repair of new cells and tissues. Ultimately, food and their nutrients provide the energy for every cell in your body.

Different digestive juices are found in various areas of the GI tract. In the mouth, salivary glands release salivary amylase to moisten food and break down starches, helping food move down the esophagus. When food is chewed thoroughly, the body is better able to digest and absorb nutrients.

Digestive en zymes, hydrochloric acid in the stomach, and muscle con tractions of the GI tract all play a critical role in breaking down large food particles into macronutrients (carbohydrates, fats and proteins) and micronutrients (such as vitamins D and B12, zinc, iron and iodine) that are easily absorbed into the body.

Stomach Acid

Many people experience heartburn after eating a meal. Acid reflux, or gastroesophageal reflux disease (GERD) is a common illness that affects 25 to 35% of the US population. Many times, it is not excessive stomach acid causing the problem, but rather decreased stomach acid.

The appropriate amount of stomach acid is crucial for optimal health. Stomach acid is necessary for proper protein digestion and the absorption of vitamin B12 and minerals such as calcium, magnesium, copper and zinc. In addition, stomach acid is a primary defense against food poisoning, H. pylori, parasites, and other infections. Some common symptoms of low stomach acid include:

• Bloating, belching, burning and flatulence immediately after meals

• A sense of fullness after eating

• Indigestion, diarrhea or constipation

• Undigested food in stool

• Upper digestive tract gassiness

When we do not consume enough nutrients, or when our body cannot process those nutrients, maldigestion or malabsorption can occur. Maldigestion and malabsorption can result in low energy, slow metabolism, mental fog, fatigue, and an increased susceptibility to chronic illness. It is vital to have an adequate amount of digestive enzymes in the body to break down food into nutrients. If there is a decrease in enzyme activity, large food particles will not be broken down, resulting in symptoms ranging from indigestion and food allergies to vitamin deficiency.

To improve your digestion and feel better, consider the following methods:

1. Spend more time with food

• Preparing and cooking food is becoming a lost art in our fast-paced world.

• Digestion begins when you see and smell food. Saliva and gastric juices begin while preparing for the meal, well before the first bite. Small appetizers can also be helpful before large meals.

• Chew foods thoroughly. The smaller the food particles and the more interaction with salivary enzymes, the better the digestion process.

• Relax while eating. Reduce the number of times that eating takes place while driving, working, etc.

2. Socialize around food

• In most cultures, eating with others is an important and regular social event—this slows the eating process and increases enjoyment of food.

• Eating alone often promotes poor food choices.

• Eating with others allows for sharing of the cost/time in preparation of foods.

3. Eat regular meals

• Breakfast is especially important in normalizing blood sugar levels.

• Eat healthy snacks throughout the day to maintain energy.

Digestive Aids

In order to evaluate the cause of maldigestion or malabsorption, your health care provider must first rule out poor dietary habits and more significant, underlying conditions. Once these have been ruled out, the most common solution for digestive insufficiencies is to supplement with digestive aids. Digestive enzymes, bile or bile stimulators, hydrochloric acid, or a combination of these components are available as capsules or tablets. These products may be used as temporary aids to overcome deficiencies while other therapies are pursued, or they may be used daily, before meals, to improve digestion.

Elimination and Detoxification

Exposure to the air we breathe, the stress we feel and the food we ingest can add up to over 14 pounds of pesticides, herbicides, food additives and preservatives per year for the average American. The liver, together with the GI tract, is responsible for removing these toxins through a process called detoxification. The function of elimination and detoxification involves removing the unusable portions of the food you eat, as well as toxins. It is essential that both be completely eliminated from your body through urine and stool; otherwise, toxins build up and are stored in your tissues. A good measure of the health of the elimination pillar is how often you have bowel movements on a day-to-day basis. Ideally, you should have two to three well-formed bowel movements per day.

The digestive system is responsible for breaking down food, absorbing useful compounds, and eliminating the rest. A well-functioning gastrointestinal tract, together with the liver, works to remove toxins from the body. Toxins invade the body from three main sources: the environment, personal lifestyle, and the body’s own metabolic processes. Polluted air, prescription drugs, processed foods, and even stress can increase toxins in the body. Eliminating pathogenic organisms (bacteria, viruses, fungi, parasites), toxic burden and negative food reactions can have a profound impact on numerous GI and non-GI-related conditions.

Poor dietary habits play a fundamental role in bowel health and regularity. Lack of adequate fiber and water are the biggest causes of regular constipation. Lack of physical activity can also contribute to chronic constipation. The stool removes many liver-processed toxins, so extended bowel transit times allow these toxins to be reabsorbed.

Detoxification/Biotransformation

When the GI tract is not functioning optimally, additional burden is placed on the liver. When incoming toxins exceed the liver’s ability to remove them, it is termed toxic burden. It is important to periodically restore the body’s ability to cleanse itself and eliminate toxins through detoxification. This is usually accomplished by going through a detoxification program, in which you eliminate food sensitivities from your diet, including alcohol, gluten and sugar. Removing these inflammatory foods from your diet can help alleviate symptoms of mental fog, fatigue, digestive dysfunction, headaches, and food allergies.

The two phases of detoxification, known as phase I and phase II, occur in the liver. Phase I detoxification is responsible for converting fat-soluble toxins, which lodge themselves in your fat cells, into water-soluble substances, which are easily eliminated through the urine. In phase II detoxification, these intermediates become further biotransformed by specific enzymes, called conjugases. These enzymes attach to certain nutrients, such as taurine, glutamine and glycine. Some research has even begun to validate the idea that some chronic neurological symptoms, such as those in Parkinson’s disease, may result from the body’s impairment of detoxification abilities.

Elimination Diet

An elimination diet involves removing potential allergens, toxins or intolerances from your diet for at least three weeks. Afterwards, slowly reintroduce the foods one at a time and monitor your symptoms for possible reactions. If over the next 48 to 72 hours you do not experience any symptoms, you may reintroduce the next food, and so on, monitoring any symptoms or discomfort.

What to Include:

Vegetables: Broccoli, cabbage, cauliflower, onion, Brussels sprouts, watercress, arugula, kale, bok choy, radish, turnip, beans and lentils, garlic

Fruit: Raspberries, strawberries, blueberries, bananas, apples and any other fresh or frozen fruit

Protein: Wild fish, organic or pasture-raised chicken and turkey, grass-fed beef

Plant Protein and Legumes: All except soy

Fats and Oils: Extra virgin olive oil, organic coconut oil, flaxseed oil, sunflower or sesame oil

Nuts and Seeds: All except peanuts

Starches and Grains: Wild rice, brown rice, quinoa, gluten free oats, millet, buckwheat, tapioca

Milk Products: Non-dairy milk such as unsweetened coconut, almond or hemp milk

Beverages: Filtered water, herbal or green tea, sparkling water

Spices and Condiments: Turmeric, garlic, ginger, rosemary, cocoa, pink Himalayan salt

Sweeteners: Stevia

What to Remove:

Vegetables: Canned or creamed vegetables

Fruit: Canned fruit packed in syrup, high sugar or artificial juices, oranges

Protein: Conventional beef, pork, luncheon meats, hot dogs, sausage, bacon, eggs, shellfish

Plant Protein and Legumes: Soybeans, tofu, miso, edamame

Fats and Oils: Margarine, butter, shortening, hydrogenated oils, canola oil, vegetable oil, corn oil, mayonnaise

Nuts and Seeds: Peanuts and peanut butter

Starches and Grains: Gluten (wheat, barley, rye, spelt)

Milk Products: Cow’s dairy (milk, cheese, cottage cheese, cream, ice cream, yogurt, frozen yogurt)

Beverages: Coffee, black tea, soda, alcohol, energy drinks, sweetened beverages

Spices and Condiments: Ketchup, mustard, relish, soy sauce, barbeque sauce, chocolate, iodized salt

Sweeteners: White or brown sugar, honey, agave nectar, maple syrup, corn syrup, sucralose, aspartame, saccharin, artificial colors, flavors and preservatives

Microbial Balance

The gut microbiome is an ecosystem composed of more than 100 trillion microscopic organisms, with over 500 different strains of beneficial yeast, bacteria and microorganisms that live in the GI tract. It is primarily located in the large intestine, although there are microorganisms housed along the entirety of the GI tract and your entire body. It is one of the most metabolically active systems in your body. These organisms maintain healthy and functional digestion and absorption from the GI tract, protect against pathogens, help to regulate immune function and blood sugar levels, and assist in vitamin production.

The bacteria in the gut microbiome can have a profound effect on the health of the entire body. The microbiome aids in the production of nutrients, including vitamins B and K, but also can affect one’s risk for obesity or metabolic conditions. For example, birth via C-section verses vaginally can have distinct effects on the health of the gut and immune system. Infants born via C-section do not have the same quantity or diversity of bacteria as that of an infant born vaginally. These changes can potentially affect their long-term health by increasing the risk of certain allergic or inflammatory conditions.

It is important to keep beneficial flora in balance and in plentiful supply to help regulate the digestive system and prevent GI illnesses. Many factors, including genetic makeup, weight and environment, influence bacteria in the GI tract. Even harmless bacteria, when in the wrong place in the body, can potentially cause illness.

Bacterial Imbalance

Dysbiosis is any microbial imbalance of the gut microbiome. When the microbiome is disturbed in any way, the body is vulnerable to many GI disorders. There are several types of dysbiosis, including Candida, small intestinal bacterial overgrowth (SIBO) and parasites. SIBO occurs when the bacteria normally found in the large intestine travel into the small intestine. From there, they overgrow and inhibit absorption of specific micronutrients and macronutrients. The result is uncomfortable GI symptoms such as upper GI gas and bloating after a meal. Bacterial overgrowth is most commonly caused by the use of antibiotics, poor dietary choices, chronic stress, excessive alcohol intake, acid-suppressing medications, chronic maldigestion, chronic constipation, or food allergies. The solution for dysbiosis involves colonizing the gut microbiome with healthy organisms and limiting harmful organisms from overgrowing. The best way to repair bacterial imbalance is to create a healthy environment for helpful microorganisms to flourish. Some tips to minimize dysbiosis include:

• Avoid disrupting events: When the balance in the gut is disrupted, it offers the opportunistic harmful organisms and chance to thrive. One of the most common disruptions is the use of antibiotics. Even if taken in childhood or adolescence, antibiotics can have a profound and long-lasting effect in gut health. Individuals who have taken antibiotics have an increased risk for dysbiosis.8 Other disruptions include mental and emotional stress and infections.

• Improve immune system function: Microbial balance and the health of the immune system are interdependent. Approximately 80% of the immune system resides in the gut, and an unhealthy gut can have serious effects on immune health. A healthy immune system can help protect the gut from pathogenic, opportunistic microorganisms.

• Provide the gut with viable healthy organisms: Maintaining microbial balance requires a healthy community of beneficial commensal organisms. This can be supported by adding highly beneficial, although temporary, probiotic organisms. Commercially prepared probiotics have been selected for their ability to grow in culture, withstand digestive juices, adhere to the gut wall, and support gut and overall health.

Probiotics

Probiotics are live bacteria and yeasts that promote a healthful environment in your gut. A probiotic should be thought of as an organism that, when ingested, remains viable in the gut long enough for its metabolic activity to benefit the body in some way prior to its death or removal. The use of bacterial cultures in food goes back several thousand years. Fermented milk products such as yogurt, kefir, buttermilk, cheeses and sauerkraut have traditionally been used as sources of probiotics. Fermenting acts to preserve, as well as add flavor, to foods. Science has attributed many health benefits to the use of these products, especially fermented milk products. Current research finds that bacteria in the GI tract are important for the health and longevity of humans.

The interest in probiotics has grown in the past several decades from use in animals to use in humans, and probiotic supplements are now widely available in capsule, tablet and powder forms. Commercially prepared probiotics may stay viable in the GI tract for 1-2 weeks, or even longer. The most commonly used and researched strains of probiotics are Lactobacillus and Bifidobacterium species, although the spore-based bacteria (Bacillus) and the beneficial yeast (Saccharomyces boulardii) are becoming popular choices for probiotics in clinical practice. Probiotics have proven their efficacy with conditions such as irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO), dysbiosis, inflammatory bowel disease (IBD) and GERD.

Prebiotics

A prebiotic is a non-digestible food that helps feed the beneficial strains of bacteria in the gut. These agents are typically fibers or complex, indigestible carbohydrates like fructoligosaccharides (FOS), inulin or beta-glucans. Prebiotics fermented by Lactobacilli and Bifidobacterium produce beneficial, short-chain fatty acids that promote healthy colon cell metabolism. Prebiotics can also come in a non-fiber form and be polyphenol-based. Polyphenol prebiotics feed the good probiotic bacteria, without gas or bloating symptoms. Also, polyphenol prebiotics provide antioxidant protection to the gut lining and strengthen its mucosal protective layer.

Barrier Function

The GI tract is one of the body’s largest protec tive cell layers, serving as a barrier between the internal body and the external world. Its critical function is to allow nutrients into the body, while preventing harmful substances from passing into the bloodstream. Not only does increased intestinal permeability affect the GI tract, but also the immune, nervous and endocrine systems. There can be many causes of increased intestinal permeability, including poor diet, chronic stress, toxin overload, and dysbiosis. The GI tract houses the majority of the immune system in the body—about 80% is closely related to the GI tract and plays an essential role in barrier function. If this selective barrier function is not maintained, a number of harmful substances may enter the body, triggering immune-related responses such as Crohn’s disease, celiac disease and food allergies. The gastrointestinal (GI) barrier is an intricate and selective barrier that controls and permits the absorption of helpful substances into the bloodstream while keeping out those that are harmful. In healthy people, the barrier is tightly regulated, allowing only important nutrients to pass through the gut, and protecting the body from harmful substances such as toxins, undigested food and pathogens. Since the gut is constantly exposed to food, microbes and chemicals, the GI tract must work continuously to defend itself from these unwanted substances that, if allowed entry into the body, can cause a vicious cycle of inammation. The constant exposure to foreign substances can cause the walls of the intestines to become vulnerable to deterioration and permeability, a condition commonly referred to as leaky gut

Increased intestinal permeability, or leaky gut syndrome, is a condition that occurs when inflammation causes the tight junctions between the cells lining the intestines to widen. Normally, these junctions are very tight, forcing all molecules to pass though the regulated cell membranes of the gut cell wall. Patients with leaky gut syndrome have dysfunctional digestive processes because the intestines lose their ability to filter nutrients and other substances. When this occurs, substances can enter the bloodstream through the loose intestinal junctions. These foreign substances cause inflammation within the intestines and inhibit digestive and immune function. When left untreated, leaky gut syndrome can affect the entire body.

Healing the gut and repairing the gut barrier can ultimately lead to improved health and quality of life. A critical part of healing the gut includes managing inflammation. Inflammation is the way the body handles harmful organisms and irritants and protects the body from their harmful effects. Unchecked, long-term inflammation can have a detrimental effect on the body.

Reducing the inflammatory burden can be accomplished naturally by:

Gut-Brain Connection

Exposure to stress can result in changes of gut-brain function. Combined with a lack of regular eating, sleeping, and exercising, stress may lead to the development of a broad array of gastrointestinal disorders, as well as cause issues in other areas of the body. The major effects of stress on gut health include changes in motility, digestive secretions, intestinal permeability, mucous production, and bacterial diversity. There are several strategies you can do on your own or in partnership with your practitioner to help control stress and its impact on the gut.

Making Time for Relaxation

Setting aside time to take breaks and relax allows for the body to regenerate and develops overall well-being in the body. Some research has shown that scheduling downtime allows for individuals to have more structure and become more productive throughout the day. Specific to your gastrointestinal system, scheduling time to slow down is beneficial for improving digestion and dysfunction when we are in a constant state of stress.

Mindful Eating

Eating all the right foods is beneficial, however it is important that you also eat those foods in the proper manner. Establishing mindful eating habits can have a positive impact on digestion, elimination and the nutritional impact of food.

• Spend more time with food: Preparing and cooking food allows you to think about and appreciate the foods you are eating. Digestion begins with the sight and smell of food. Saliva and gastric juices begin flowing while preparing for the meal, and even before the first bite. It is important to chew foods slowly and thoroughly. The smaller the food particles, the more complete the digestion process will be. It is also important to relax while eating, which may include reducing the number of times eating takes place while driving, working, etc.

• Socialize around food: In most cultures, eating together with others is an important and regular social event. Social gatherings around food often slows the eating process and increases the enjoyment. Eating with others allows for sharing of the cost/time in preparation of foods, while eating alone often promotes fast eating and poor food choices.

• Eat regular meals: Breakfast is especially important because it helps provide an energy foundation throughout the day. Also, eating healthy snacks throughout the day helps maintain energy balance. It is also a good idea to keep a food diary. A seven-day food diary is a great way to keep track of your food choices and eating patterns so you may track progress.

Centering Practices

Participating in centering practices, such as deep breathing exercises, provide the mind and body an opportunity to achieve a clear and calm state, and overall improvement in digestive wellness.

• Deep Breathing: Diaphragmatic breathing, or deep breathing, is an exercise that contracts the diaphragm. When the diaphragm regularly receives full breaths, its range of motion is increased, and the lowest part of the lungs are able to get a full share of oxygenated air.

Heart Rate Variability/Biofeedback

Heart rate variability (HRV) is a measure of the variation in time between each heartbeat which provides your practitioner insight into the changes between the sympathetic and parasympathetic nervous system. Heart rate variability biofeedback is used primarily by your practitioner to “reset” the nervous system and can help different types of stressors. This process uses sensors attached to your body to measure normally nerve activity in your body. Parasympathetic activity is usually a component in the “relaxation response” in your body. Stimulation of parasympathetic activity by this process may help produce relaxation responses, and help reduce stress effects.

Cognitive Behavioral Therapy

Also known as “talk therapy,” cognitive behavioral therapy encompasses a variety of techniques, which your practitioner may help you identify and change troubling emotions, thoughts, and behaviors. Such stressors can trigger and worsen gastrointestinal pain and other symptoms, and vice versa. Your practitioner can provide a supportive and comfortable environment so that you can freely communicate any concerns or fears that may be causing stress in your body. This one-on-one talk therapy provides a relaxed atmosphere for the development of a comfortable relationship between you and your practitioner.

Conclusion

Chronic gastrointestinal dysfunction can play a profound role in quality of life. Many times, we look at each body system in its own silo, isolated from the rest of the body and its function. We now know that this is not how to enhance wellness. Looking at the body as a whole and identifying the root cause of illness often starts by identifying dysfunction in the gut. Our diet and lifestyle choices, the health of our digestive and elimination processes, our gut microbiome and intestinal barrier health all have an important effect on our overall health.

The human body is remarkably resilient and maintains a metabolic reserve to help protect against disease. Still, the lifestyle choices you make can greatly enhance or decrease optimal function. Ultimately, you hold the keys to your wellness, longevity and vitality.