Gut Health - Carolina Total Wellness

August 26, 2022November 28, 2022

The Vagus Nerve: Not All Who Wander are Lost

Erica Nelson, MSPH, NBC-HWC

Practical Strategies for Managing Anxiety and Improving Digestion

Who’s the Boss?

They say the mind is a wonderful servant but a terrible master. Are you in charge of your mind and body? Or do you feel like you are at the mercy of your thoughts and feelings (physical and emotional)? This article shares cost-free and drug-free practical strategies to take back control of your physical and emotional feelings and make your mind your servant.

Your nervous system is complicated but you do not need to know all of the details to have a significant impact on its function. In this article you will find a very simple description of how one specific nerve, the Vagus, connects your physical and emotional feelings. You will also learn practical things you can do to reduce anxiety, improve digestion and overall wellbeing.

A (Very) Brief Neuroanatomy Lesson

Starting from the top, the brain branches out from your skull through 12 cranial nerves (and their branches) known as the peripheral nervous system.

Starting from the ‘bottom’ the gastrointestinal ‘mind’ is called the enteric nervous system (ENS.) The ENS has more nerve cells than the rest of the entire nervous system combined (more than 100 million!) and is capable of functioning independently of the rest of the nervous system.

The Vagus nerve is one of the 12 cranial nerves. It connects your brain to your digestive system and vice versa. It sends and receives both motor (movement) and sensory (feeling) signals. Beyond the digestive system, it touches nearly every major organ and plays a role in heart rate, respiration, facial expression, inflammation, sweating, reproduction and more.
Photo courtesy:
www.drarielleschwartz.com

The word ‘Vagus’ comes from the Latin for ‘wander’ but, as Tolkien wisely said, ‘Not all who wander are lost.’ This nerve, and its branches serve as the information super highway in your body and provide the early warning system for threats, internal and external.

Most of these functions are reflexes that happen without you thinking about them to keep you alive. Can you imagine if you had to decide to shunt blood supply from your stomach to your heart and lungs to run from danger? But sometimes the reflexes are not actually helpful in the moment and we are left feeling like our stomachs have minds of their own – because they kind of do. But when we know what the reflexes respond to, we can take steps to trigger a more desirable response.

Toning the Vagus for Stress Resilience

Have you ever felt your mouth go bone dry just as you are about to begin a presentation or performance? Or worse, maybe you feel like you are going to throw up? Or need to go to the bathroom RIGHT NOW. This is your reflexive response to stop bodily secretions and smooth muscle contractions in your GI tract so you can spend your resources elsewhere.

When you perceive a threat, your brain and body make preparations to respond and additional resources – oxygen, fluids, etc. – are diverted from digestion and reproduction until you are physically and psychologically safe again. Your heart rate, blood pressure and breathing increase, your pupils dilate, your mouth may go dry, your muscles may begin to tremble all of these are signs of activation of your sympathetic nervous system.

It is the job of the parasympathetic nervous system, including the Vagus nerve, to restore resources to ‘rest and digest’ once the threat (perceived or real) is passed. Depending on the duration and intensity of the threat, it may take 20 minutes or 20 years to return to a healthy resting state. When left unattended, chronic stress or PTSD can have long-term effects on your physical, cognitive and emotional health.

Techniques to Build ‘Stress Resillience’ and Facilitate the Job of the Vagus Nerve

Daily Habits to Support Stress Resilience:

Cat/Cow stretching with a Lion’s Roar

This exercise lengthens and contracts the Vagus nerve to activate it. Get on your hands and knees on the floor. Begin with a neutral spine and then press down through your hands and knees to arch your back upwards like a cat. Inhale while doing this. Then drop your belly down towards the floor and lift your breastbone forward and up. Exhale loudly while you do this, sticking your tongue out and even roaring like a lion.

Laugh

Laughter really is one of the best medicines. Real laughter is best but even fake laughter will engage the Vagus nerve through contraction of the diaphragm.

Hugs

A warm embrace, ideally 20 seconds or longer, will stimulate the part of the Vagus nerve that runs down your back and can trigger the release of a hormone called oxytocin, known as the feel-good hormone.

Singing, humming, chanting, gargling

The Vagus nerve is connected to your vocal cords and the muscles at the back of your throat. All of these activities activate the muscles around the nerve and can stimulate it. Choose one or more and find time for it each day.

In-the-Moment Strategies to Get Back to Rest and Digest:

4-7-8 breathing

Place the tip of your tongue against the ridge of tissue just behind your upper front teeth, and keep it there through the entire exercise. Exhale completely through your mouth, making a whoosh sound. Close your mouth and inhale quietly through your nose to a mental count of four. Hold your breath for a count of seven. Exhale completely through your mouth, making a whoosh sound to a count of eight. This is one breath. Now inhale again and repeat the cycle three more times for a total of four breaths.

Go outside for a walk

This works for a couple of reasons. First, when you are walking, your eyes naturally move side-to-side and trigger a response in your brain that distracts it from threat. Second, you are using up some of the ‘energy hormones’ that were dumped into your system to respond to the threat and may be making you feel ‘jittery.’

Self-massage

Stroke your neck from your ear to your clavicle 10 times on each side. Again, your Vagus nerve is connected to these muscles. Moderately intense massage to the area will stimulate the nerve and help to restore a resting state.

You do not have to be at the beck and call of your body’s reflexes. Choose one or two of the strategies above and integrate them into your day to improve your ability to respond the way you want to – instead of simply reacting – the next time you are faced with a stressful situation.

Call our office and schedule an appointment with one of our health coaches to learn more healthy strategies to reduce and respond to physical, emotional and cognitive stress.

Your Partner in Health!
Erica Nelson, MSPH, NBC-HWC

February 10, 2022February 10, 2022

Long COVID

Susan D. Denny, MD, MPH

Over the past year I have seen an increasing number of patients with symptoms of post-acute sequelae of Covid 19 (PASC), also known as long Covid.

What is long Covid? As defined by the CDC, long Covid is a range of new, returning or ongoing health problems people can experience four or more weeks following SARS-COV-2 (Covid 19) infection. Symptoms can vary significantly by person and can include fatigue, brain fog, memory loss, anxiety, disturbed sleep, joint pain, gastrointestinal symptoms, loss of taste or smell or shortness of breath. Most of the patients I have seen with long Covid suffer from fatigue and brain fog and many have other accompanying symptoms.

In a recent systematic review of 57 studies comprising more than 250,000 survivors of Covid 19, most symptoms included mental health, pulmonary and neurologic disorders which were present 6 months after SARS-Cov-2 exposure. ¹

How many people are suffering from long Covid? Clinical trials have shown anywhere from 31% to 69% of people who have had Covid infection will suffer from long Covid. This is a present and emerging health care crisis with tens of millions of Americans currently suffering and millions more at risk of developing this syndrome. Chances are that you or someone you know has long Covid.

How long does long Covid last? This appears to vary significantly by person. Some clinical trials have shown average length to be about 3 months while others have shown that symptoms may last more than a year. An emerging consensus is that most people have symptoms for 6 months or more.

Who gets long Covid? While some clinical trials show a relationship to acute disease severity, others have shown a significant risk for long Covid even in mild or asymptomatic cases. In other words, it is possible to develop long Covid even if you had no symptoms of acute Covid infection.

A study just published in Cell on January 24, 2001 followed 200 patients over two to three months following their COVID-19 diagnoses. The researchers determined four biological factors that they say are associated with whether a person will develop long COVID.

The first factor is the level of viral RNA in the blood at diagnosis. The second is the presence of autoantibodies—those that attack the patient’s own body. Third is the reactivation of the Epstein-Barr virus, a common virus that most people are infected with and recover from early in life. The last is Type 2 diabetes. Interestingly, the most predictive factor for long Covid was the presence of autoantibodies in the blood. ²

Several other studies have found significant autoantibody levels in patients with long Covid. In one study just published this month, researchers found signals of autoantibody activity that are usually linked to chronic inflammation and injury involving specific organ systems and tissues such as the joints, skin and nervous system in patients with long Covid.³We know that certain viruses can trigger the body’s immune system to begin attacking itself through a process called molecular mimicry. That appears to be a significant source of cellular damage and inflammation in patients who develop long Covid.

Another study published in Gut examined changes in the gut microbiome in patients with long Covid. They found that an altered gut microbiome composition is strongly associated with persistent symptoms in patients with COVID-19 up to 6 months after clearance of SARS-CoV-2 virus. 4

Can long Covid be treated? Yes. While conventional medicine has yet to find a medication to treat long Covid, a functional medicine approach to this illness works well. Addressing the root cause(s) of ongoing inflammation in the body from the viral over stimulation of the immune system is a top priority. Evaluation and treatment of increased intestinal permeability (leaky gut), gut dysbiosis and a disrupted adrenal axis works well to help rebalance the immune system, calm inflammation and improve symptoms.

If you or someone you know is suffering from long Covid, please contact our office to make an appointment with one of our functional medicine providers.

In health,

Susan D. Denny, MD, MPH

References:

JAMA Netw Open. 2021;4(10):e2128568. doi:10.1001/jamanetworkopen.2021.28568
Su Y, et al. Cell. 2022;doi:10.1016/j.cell.2022.01.014.
Liu Y, et al. J Transl Med. 2022;doi:10.1186/s12967-021-03184-8.
Gut (2022). DOI: DOI: 10.1136/gutjnl-2021-325989

February 4, 2022February 4, 2022

LENTILS “THE POOR MAN’S MEAT”

Didem Miraloglu, MD, MS

January 6, 2022January 6, 2022

Food and Mood

Blair Cuneo, PA-C

I think about many things this time of the year with seasons changing and holidays approaching. As a functional medicine provider, I consider how changing landscapes not only affect my patient’s physical health, but also their emotional health. This landscape or “environment” of less direct sunlight, more time indoors, increased celebratory food and drink and increased holiday stress has a major impact on mental health for many of us.

Our relationship with food is complex, as is our body’s response to our culinary selections. We hope that our bodies can effectively digest food and absorb its nutritious content, but how do we know if it doesn’t? We hope the foods we are eating are contributing to healthy neurotransmitter production, healthy immune system messaging, but what does it feel like if that’s not the case?

You’d think that your stomach would definitely let you know if any of the above was amiss, but consider this: approximately 30% of us will have a gastrointestinal/gut symptom if there are imbalances in digestion or immune activation, while the majority of us will have a “beyond the gut” symptom first, such as headaches, mood changes, sleep disruptions, fatigue and pain. Thus, the majority of people may not be thinking of a direct relationship between green bean casserole and their anxious or sad days.

Several things need to happen when we eat a meal. First, we need to be in a “rest and digest” state. This signals to the body it’s time to produce digestive acids, enzymes and bile to sterilize the food, break it down and absorb it well. Next, we need healthy proteins that can be broken down by these digestive supports to become the basic amino acids that our body will use as the building blocks to create neurotransmitters like dopamine and serotonin. Neurotransmitters are signaling molecules, providing communication between nerves. The balance of neurotransmitter production, absorption and clearance, affects mental and physical health. Further, this building of neurotransmitters requires cofactors of several micronutrients like zinc, vitamin B6, magnesium and vitamin D.

To cap things off, there can be immune system reactions to foods, allergies and/or sensitivities that are contributing to inflammatory messaging that starts in the gut, but travels “beyond the gut”, affecting our emotional state.

In my practice, I regularly see low levels these cofactors, low levels of digestive enzymes and gastric acid, high stress and of course, the daily challenge in regularly making healthy eating and drinking choices.

In order for a body and mind to be healthy, each of these areas needs to be considered, evaluated and addressed.

While there are objective tests available for providers to check your nutrient and digestive status, there are also excellent lifestyle supports to begin making a shift in your wellness today.

-Eat at regular intervals. It is less stressful for the body when it knows it can count on you to feed it. This also helps the timing of the digestive acids/enzymes release where there are patterns in meal timing.

-Whole foods. Limit processed foods. Head to the refrigerator, before you head to the pantry. Each meal should contain a protein, small amount of fat, and colorful fruits and vegetables.

-Mindful eating, not distracted eating. Try to avoid multitasking while eating. As often as you can, eat at a table, focused on your food and the company that you share. Look, smell, taste and chew well! Even the process of chewing is signaling release of enzymes.

-Connect with your healthcare provider to review your micronutrient and vitamin status. You might discuss multivitamin, magnesium and/or zinc supports and also test your vitamin D to help assign dosing recommendations.

Remember, Food can be medicine! Make sure you use it wisely!

Your Partner in Health!

Blair Cuneo, PA-C

October 22, 2019

What Leaky Gut Is and Why Should You Care

919 why you should care about leaky gut

If you have been researching how to improve your health, you may have heard of leaky gut, also known as intestinal permeability. If that conjures an unpleasant image of your gut contents leaking into the rest of your body — that’s not too far off the mark.

Leaky gut happens when contents from the small intestine spill into the sterile bloodstream through a damaged and “leaky” gut wall. This contamination of the bloodstream by not only partially digested foods but also bacteria, yeast, and other pathogens begins to create a foundation for chronic inflammatory and autoimmune health disorders.

Symptoms and disorders linked to leaky gut include fatigue, depression, brain fog, skin problems, joint pain, chronic pain, autoimmune disease, puffiness, anxiety, poor memory, asthma, food allergies and sensitivities, seasonal allergies, fungal infections, migraines, arthritis, PMS, and many more. Basically, your genetic predispositions will determine how leaky gut manifests for you.

Leaky gut is referred to as intestinal permeability in the scientific research. It means inflammation has caused the inner lining of the small intestine to become damaged and overly porous. This allows overly large compounds into the small intestine. The immune system recognizes these compounds as hostile invaders that don’t belong in the bloodstream and launches an ongoing attack against them, raising inflammation throughout the body. Also, some of these compounds are very toxic (endotoxins) and take up residence throughout the body, triggering inflammation wherever they go.

At the same time, excess intestinal mucous and inflammation from the damage prevents much smaller nutrients from getting into the bloodstream, which can lead to nutrient deficiencies and poor cellular function.

Leaky gut is increasingly being recognized as a common underlying factor in most inflammatory symptoms and disorders.

Medicine finally recognizes leaky gut

Conventional medicine has long ridiculed leaky gut information and protocols as quack science and alternative medicine folklore, but newer research now establishes it as a legitimate mechanism. In fact, pharmaceutical companies are even working on drugs to address leaky gut.

Research has established links between leaky gut and many chronic disorders. It’s good this long-known information is finally being validated in the dominant medical paradigm as the gut is the largest immune organ, powerfully influencing the rest of the body, as well as the brain.

Current studies link intestinal permeability with inflammatory bowel disorders, gluten sensitivity, celiac disease, Crohn’s disease, type 1 diabetes, depression, psoriasis, and other chronic and autoimmune conditions. Given what we know about the connection between gut health and immunity, it’s vital to include a gut repair protocol in overall treatment of inflammatory and autoimmune disorders.

How to mend leaky gut

Sometimes, repairing leaky gut can be as simple as removing inflammatory foods from your diet. Other times it’s more complicated. Most importantly, you need to know why you have leaky gut. Either way, however, your diet is foundational.

Many cases of leaky gut stem from a standard US diet of processed foods and excess sugars. Food intolerances also contribute significantly, especially a gluten intolerance. A leaky gut diet, also known as an autoimmune diet, has helped many people repair intestinal permeability. Keeping blood sugar balanced is also vital. If blood sugar that gets too low or too high, this promotes leaky gut. Stabilizing blood sugar requires eating regularly enough to avoid energy crashes. You also need to prevent high blood sugar by avoiding too many sugars and carbohydrates. Regular exercise is also vital to stabilizing blood sugar and promoting a healthy gut.

Also, failure to eat enough fiber and produce leads to leaky gut by creating a very unhealthy gut microbiome, or gut bacteria. Our intestines (and entire body) depend on a healthy and diverse gut microbiome for proper function. A healthy gut microbiome comes from eating at least 25 grams of fiber a day and a wide and rotating variety of plant foods.

Other common things that lead to leaky gut include antibiotics, NSAIDs such as ibuprofen, excess alcohol, hypothyroidism, and autoimmunity.

A leaky gut protocol can help you improve your health, relieve symptoms, boost energy, make you happier, and clear your brain fog. Ask my office for advice on improving your well being through a leaky gut diet and protocol.

October 3, 2019

How You Were Born Could Shape the Rest of Your Life

916 microbiome and birth

Whether you’re fat or thin, anxious or relaxed, sickly or resilient — this could all stem from the way you were born thanks to the effects of bacteria in our first few seconds of life. Babies born via c-section are shown to have less desirable gut bacteria, or a gut microbiome, compared to babies born vaginally, who have healthier microbiome “signatures.”

Results from the largest study of the newborn microbiome were recently published. The study found that newborns delivered via c-section lack the healthy gut bacteria found in vaginally delivered babies. Their guts also contain strains of harmful microbes — Enterococcus and Klebsiella — commonly found in hospitals.

In fact, the lead researcher said the levels of harmful hospital bacteria in the c-section newborns was “shocking.” These babies were also deficient in the healthy bacteria that made up most of the guts of the vaginally born babies.

The difference was so profound that he said he can tell you how the baby was born simply by analyzing the bacteria in their stool.

C-section babies missing strain vital for health, weight management, and immune resilience

After several months the gut microbiomes between the two set of infants became more similar with one striking difference — the c-section babies had significantly lower levels of Bacteroides, a strain vital to human health.

Bacteroides are a key strain when it comes to health challenges modern societies face. A number of studies have shown Bacteroides levels are lower in people with obesity. Studies in both mice and humans show that when gut bacteria from thin subjects are transplanted into the colons of obese subjects, most subjects lose weight.

Bacteroides has also been linked with preventing anxiety, and boosting and regulating immunity to prevent inflammatory disorders. This may explain why people who were born via c-section are at increased risk for obesity and asthma.

The study is part of a larger Baby Biome study that is following thousands of newborns through childhood.

Why method of birth affects the gut microbiome

Research suggests that the vaginal canal imparts beneficial bacteria to the infant during birth, while c-section babies are deprived of that and instead immediately exposed to the bacteria of the hospital and the people attending the birth. Studies are underway in which babies born via c-section are swabbed with the mother’s vaginal microbes.

Other factors to consider beyond birth

It may not just be the birth that determines a c-section baby’s poorer microbiome status. Women who undergo c-sections also receive antibiotics, which may transfer to the newborn through the placenta and later through breast milk. These babies also tend to stay in the hospital longer and thus are exposed to more hospital bacteria.

How to develop healthy gut bacteria

Developing good gut bacteria is not neccesarily as simple as taking probiotics. You may also be overrun with detrimental bacteria that need to be “weeded.”

Perhaps most important is whether your diet supports a healthy gut microbiome.

What the gut microbiome needs most is an ample supply of vegetables and fruits on a regular basis in a wide, ever changing variety. Eating a diverse and abundanat array of plant foods will help create a diverse and abundant gut microbiome.

Ask my office for more advice on how we can help you improve your gut microbiome and overall health.

July 10, 2019

Gut Problems Can Have Different Root Causes

903 gut disorder root causes

In the world of functional medicine, it has long been known that gut health is paramount to the health of the rest of the body. For decades we didn’t fully understand why, although we knew the gut was the seat of the immune system and chronic inflammation. Now with the gut microbiome renaissance underway, we also understand how integral gut bacteria is to health.

As such, addressing gut health has always been one and continues to be one of the first steps in managing a chronic inflammatory or autoimmune condition. However, people tend to fall into the trap of thinking everyone needs to follow the same gut healing protocol, wondering why it works for some and not others.

As it turns out, repairing gut health is not a one-size-fits-all approach. There is not just one diet, one type of probiotic, or one gut healing powder that works for everyone. Although there are some basic foundations to gut healing — remove immune reactive foods, keep blood sugar stable, and create a healthy gut microbiome — the truth is you still need to know why your gut health deteriorated in order to address the root cause.

Examples of root causes of poor gut health

For example, a number of patients can come in with a complaint of constipation. While laxatives may help the patient, it is nevertheless important to understand why they are constipated in the first place. This goes for any digestive complaint and not just constipation.

Here are some different reasons why a person can develop a digestive complaint such as constipation:

A past brain injury has dampened activity of the vagus nerve, which carries communication back and forth between the gut and the brain. This slows down motility of the intestines and causes constipation.
The gut’s nervous system, called the enteric nervous system, has degenerated significantly due to chronic gut inflammation from immune reactive foods, too many sugars and junk foods, chronic stress, gut infections, or brain degeneration. Intestinal motility depends on a healthy enteric nervous system, and constipation develops.
Small intestinal bacterial overgrowth (SIBO) releases gases that shut down motility.
Medications impact intestinal motility and cause constipation.
Dysautonomia, a dysregulation of the central nervous system, prevents the body from getting into the “rest and digest” state that allows for healthy bowel function.

A one-size-fits-all gut protocol can completely heal one person, create improvement in another, do nothing at all for a third, and perhaps make another even worse.

It’s also important to screen for more serious conditions. These can include gastric ulcers from an h. pylori infection, intestinal permeability — or leaky gut — from damage to the microvilli of the small intestine, inflammatory bowel disease, ulcerative colitis, or Crohn’s disease. Knowing whether these conditions are an issue also impacts how you manage gut health.

Also vital is knowing whether gut autoimmunity is the root cause of your gut issues. You can test for this through Cryex Labs. If so, this changes your expectations of your outcomes and how you evaluate your progress. Autoimmune disease occurs when the immune system erroneously attacks and destroys tissue in the body. Eventually this leads to symptoms and breakdown of function.

Although autoimmune disease cannot be cured, it often can be dampened or driven into remission for long periods of time. However, unpredictable flare ups also happen, and the person with gut autoimmunity must have realistic expectations in order not to feel demoralized if their symptoms flare and recede. Also, there is still much we don’t know about autoimmunity. For some people it’s easy to manage and for others it’s a constant battle. In these cases, the goal can be as simple as “more good days.”

This is an overview of why common gut-healing protocols work gangbusters for some people and little to not at all for others. Our digestive system is one of the most fascinating, complex, and influential systems in the body. The more scientists learn about it, the more apparent it becomes that gut health largely determines the health of the rest of the body, including the brain.

This is why we are seeing so many chronic health conditions in modernized societies that subsist largely on industrialized agriculture and food processing. The commercialization of cheap, processed, chemically laden, and highly sweetened “foods” largely void of produce has inflamed and damaged the digestive tract, decimated the gut microbiome (some researchers call it an extinction event), and ravaged the brain in today’s modern populations.

Fortunately, functional medicine excels when it comes to repairing and maintaining gut health. Ask our office how we can help you.

June 8, 2019

New Study Links PPIs to an Earlier Death

If you struggle with heartburn or acid reflux, you just pop some pills for that, right? Turns out regular use of drugs to treat heartburn, acid reflux, and ulcers can lead to an earlier death. These disorders are some of the easier to manage using functional medicine protocols, so it’s unnecessary to risk shortening your lifespan through chronic disease when you can enjoy improved health instead.

A recent study found that chronic use of proton pump inhibitors (PPIs) is linked to an increased risk of death from cardiovascular disease, kidney disease, and upper gastrointestinal cancer. The degree of risk increases with duration of use, even if you take low doses. Other studies have linked PPIs to dementia, bone fractures, and pneumonia.

Common brands of PPIs include Prevacid, Prilosec, Nexium and Protonix.

The study looked through the medical records of more than 200,000 people over 10 years. They found those who took PPIs had an almost 20 percent increased rate of death over people who took other types of acid-suppressing drugs (unfortunately, they did not compare death rates to people who took no acid-suppressing drugs). This applied to both prescription and over-the-counter PPIs.

What’s even more alarming is that researchers found more than half the people taking PPIs had no medical need for the drugs and PPI-related deaths were more common in this group.

Why you should address the root cause of your acid reflux or heartburn instead of taking acid-suppressing drugs

It’s assumed overly high stomach acid causes heartburn and acid reflux, but in most cases it’s due to low stomach acid. Stomach acid is vital to the health of the body in its role of digesting foods, in particular meats. When stomach acid is too low your stomach is unable to properly digest foods. Your small intestine does not want to accept improperly undigested food — this will damage its lining and contribute to intestinal permeability, or leaky gut. The low pH of the stomach acid prevents the valve to the small intestine from opening and, as a result, the contents of the stomach shoot back up into the esophagus.

Although the food is not acidic enough to gain entry into the small intestine in a timely manner, it is too acidic for the delicate tissue of the esophagus, which it burns as it shoots back up toward your throat. The extra time the food spends in your stomach also causes it to putrefy, causing that acid stomach sensation, or the feeling of having a brick in your stomach. Some people quit eating meat not because they want to be vegetarians, but because eating meat makes them feel sick.

Low stomach acid contributes to digestive issues throughout the rest of the digestive tract. As undigested food travels into the intestines, it causes inflammation and damages the lining of the intestines. This leads to intestinal permeability, or leaky gut, a condition in which the lining of the small intestine becomes inflamed and leaky. Leaky gut allows undigested foods into the bloodstream, yet prevents micronutrients from passing through because of the inflammation. Undigested foods in the bloodstream trigger inflammation throughout the body.

Stomach acid serves another useful purpose in that it kills bacteria, fungi, and other pathogens that may be in your food, preventing them from getting into the digestive tract and the bloodstream. When stomach acid is low, you lose this additional layer of protection.

Sufficient stomach acid also prevents food sensitivities. Undigested food particles trigger the gut’s immune system to become over burdened and over reactive. This causes the immune system to start reacting to more of the foods you eat, creating immune reactions that become food sensitivities. This is called losing oral tolerance, and it can be a primary cause of food sensitivities and other health issues.

Symptoms of low stomach acid

Heartburn
Acid reflux
Indigestion
Stomach ulcers (low stomach acid raises the risk of an pylori infection, which causes stomach ulcers)
Nausea
Belching after meals
Hiccups after eating
Constipation
Diarrhea
Undigested food in stools

What to do for low stomach acid

You can help support your stomach acid by taking betaine hydrochloric acid (HCl) capsules. Take HCL after you begin eating a meal with meat or protein. How much do you take? Keep increasing your dose until you feel warmth in your stomach, then cut back down to the previous dose. You may need quite a bit in the beginning but then find you need to gradually lower your dose over time.

If you feel intense gastric burning with even one capsule, it means you may have ulcers and an H. pylori infection that can be treated with nutritional compounds.

Ask my office for more advice on how to manage your heartburn, indigestion, or acid reflux, and how to improve your overall health by improving your digestive health.

April 15, 2019May 20, 2019

Integrating Fiber Needs (Prebiotics) Into a Modern Diet

Although the produce section at the grocery store may look vast, it only represents a fraction of edible, nutritious, and tasty plant foods. It’s estimated there are more than 20,000 species of edible plants, and that we only eat about 20 to 50 of them. As a result, this may be playing a significant role in the rapidly declining health of westerners. Our gut bacteria, or gut microbiome, is a foundation to our health, and healthy gut bacteria depend on a diverse and ample array of vegetables.

Ancient humans harvested wild fruits, nuts, and seeds that varied with the seasons. They also dug up underground roots and stems. Studies of the Hadza people, in Tanzania, one of the last remaining hunter-gatherer populations left on the planet, gives us additional insight into the human microbiome and health.

The Hadza have one of the most diverse gut microbiomes on the planet; Americans have the worst. The Hadza gut microbiome diversity is about 40 percent higher than that of the average person in the United States.

Americans consume an average of 15 grams of fiber a day, most of it coming from grains. The American Heart Association recommends eating 25 to 35 grams a day. Some microbiome authors suggest even higher amounts — at least 40 grams of fiber a day.

In contrast, the Hadza consume about 100 to 150 grams of fiber a day, with the average Hadza person eating almost 600 species of plants that vary with the seasons. They suffer almost none of the same diseases that have come to characterize the average American — obesity, diabetes, autoimmune diseases, and cancer.

Studies show fiber also lowers heart disease risk by binding with “bad” cholesterol to remove from your body. A high-fiber diet also lowers high blood pressure and thus the risk of stroke.

They type of fiber you eat matters too. What gut bacteria need for optimal function are “prebiotic” fibers mixed in with a diverse array of produce.

Prebiotic fibers best feed the healthy bacteria in our guts, thus improving overall health. Good sources of prebiotics include all vegetables but especially:

Garlic
Jerusalem artichokes
Jicama
Dandelion greens
Onions
Peas
Broccoli
Brussels sprouts
Fruits
Beans

Not only do prebiotic fibers help with bowel regularity, they also change the composition of the gut microbiome in a favorable direction. They help strengthen intestinal walls, improve absorption of important nutrients, produce hormones that control appetite, reduce anxiety, and help protect you against chronic disease.

If you’re not used to eating high amounts of plant foods loaded with fiber, don’t double or triple your intake overnight. Your gut may rebel with constipation, diarrhea, pain, bloating, and gas. It takes your digestive system and gut microbiome some time to adapt and be able to adequately digest large amounts of fiber. Gradually increase the amount of fiber you eat by 1 to 2 grams a day over several weeks to give your system time to adjust.

Also, you may have noticed legumes, or beans, are especially high in fiber. It’s tempting to make those a staple in your diet as a result, and if they don’t disturb your health then go for it. However, many people cannot tolerate the lectins in legumes — they trigger inflammation or autoimmune flare-ups. For people with SIBO, small intestinal bacterial overgrowth, they also cause intense digestive issues and inflammatory responses.

Also, some people need to avoid nightshade vegetables because they trigger inflammation, particularly in relation to arthritis. These include eggplant, potatoes (but not sweet potatoes or yams), peppers, tomatoes, tomatillos, hot pepper products (cayenne, Tabasco, etc.), and pepper-based spices. Simply removing nightshades from the diet has brought relief from joint pain for many, especially those with rheumatoid arthritis.

Lastly, some people have gut or immune disorders that make a high-fiber diet inappropriate until they resolve those. Ask me for more information if eating fiber makes you miserable.

What does a high fiber paleo diet look like?

Most people with chronic inflammatory and autoimmune disorders fare best on a paleo diet that eliminates grains and legumes. As grains and legumes are sources of high fiber, what does a high-fiber paleo diet look like?

The recommended produce consumption is seven to 10 servings a day. That may sound like a lot, but one serving is a half-cup of chopped produce, or a cup of leafy greens. Because sugary foods can be inflammatory, aim for veggies and fruits that are low in sugar and unlikely to destabilize your blood sugar.

Therefore, shoot for at least three to four servings of produce per meal – that’s 1.5 to 2 cups of chopped veggies or 3 cups of leafy greens. Or break that up into five meals if you eat more frequently to stabilize low blood sugar.

Ask our office for more ways to support your gut microbiome.

April 1, 2019May 20, 2019

How to Support Optimal Stomach Acid for Good Digestion

842 stomach acid

When we go to the doctor with symptoms of acid reflux, gas, bloating and heartburn, typically the diagnosis of high stomach acid is based purely on symptoms — not a lab test for stomach acid levels — resulting in a prescription for antacids, histamine type 2 receptor agonists (H2 blockers), Proton Pump Inhibitors (PPIs), or even surgery.

For many people, these drugs only worsen the problem.

Antacids reduce stomach acid temporarily, then more acid is automatically produced to bring the stomach back to its intended pH level. This only treats the temporary symptoms and does nothing to fix the actual problem.

H2 blockers block a substance in the body that encourages acid production in the stomach. They work more slowly than antacids and are intended to last for longer periods of time. On the down side, they stop production of pepsin, a digestive enzyme necessary for breaking down protein.

Proton pump inhibitors permanently block an enzyme that tells your stomach to produce acid.

All of these methods are linked to serious side effects and can even contribute to the root causes of continued chronic low stomach acid and other serious health conditions.

5 Ways to test stomach acid levels

Because hypochlorhydria isn’t well known to most patients, many never trace it back to their chronic health condition and they continue to suffer.

The good news is multiple options exist for testing stomach acid levels, which will help you create a clear game plan for remedying the situation at its foundation.

1. Gastric acid secretion test. Highly invasive and expensive, this test is typically done if a patient is diagnosed with a stomach ulcer. It can be helpful to track if anti-ulcer medication is working and to see if material from the intestines is coming back into the stomach.

2. The Heidelberg Stomach Acid Test. Considered the gold standard test for hypochlorhydria, a small capsule with a radio transmitter is ingested to measure the pH of the stomach as you drink a solution with baking soda (reduces acidity). The baking soda will naturally neutralize the HCL in the stomach. If the body does not return it to normal, it’s a sign of hypochlorhydria.

This test provides a graph showing your specific stomach response to the baking soda challenge, and can help determine if you have hypochlorhydria, hyperchlorhydria (high acid), or achlorhydria (complete lack of acid). At a cost of about $350, this test is not covered by most insurance plans.

3. CBC and CMP. These are common factors on a metabolic blood panel, typically covered by insurance. A skilled clinician can diagnose hypochlorhydria by taking into account these lab results in combination with your symptoms.

4. Betaine HCl challenge. An at-home test considered to be quite reliable, however false positives are possible, so it’s recommended to repeat the test three times. The betaine HCl costs about $20. If you have low stomach acid, you can then take it to help restore your HCl levels.

Buy Betaine HCl with pepsin.
Eat a high-protein meal containing at least 6 ounces of meat (veggies are allowed with this).
In the middle of the meal (not the beginning) take one betaine HCl pill.
Finish the meal and observe what happens.

Possible outcomes:

1. You notice no symptoms. This is likely a sign of low stomach acid.

2. Indigestion. Burning, heat, or heaviness in your chest likely indicate adequate stomach acid levels.

It is recommended to repeat the betaine HCl challenge two or three times to confirm your results. Three positive tests are a good indication of low stomach acid.

False positives are possible if:

You consume too little protein. A low protein meal doesn’t require much acid, so the betaine HCl can cause too much increase in acid.
You took the capsule before the meal, which can cause indigestion.
You have esophageal sphincter dysfunction. A hiatal hernia or poor esophageal sphincter tone can cause increased indigestion symptoms. Rule this out with a medical exam if you suspect it.

5. Baking soda stomach acid test. While not as accurate as the above tests, this is a free at-home test you can use to get an indication of your stomach acid levels. The results can vary from person to person depending on interpretation of the results. Some use it as a baseline measure and to track changes over time.

First thing in the morning, before eating or drinking anything:

Mix ¼ tsp baking soda in 4 to 6 ounces of cold water.
Drink the baking soda solution.
Time how long it takes for a burp to occur. Time it for up to 5 minutes

If you have not burped within five minutes, it may be a sign of insufficient stomach acid. Early and repeated burping may be due to too much stomach acid (do not to confuse this with small burps from swallowing air when drinking the solution). Any burping after 3 minutes is an indication of low stomach acid levels.

Associated tests

Low stomach acid can be associated with other health issues that have far-reaching consequences. If you suspect low stomach acid, ask our office about testing for the following:

B12 levels: Intrinsic factor is a glycoprotein in the stomach necessary for absorption of vitamin B12. When stomach acid is too low, intrinsic factor can’t do its job. This results in vitamin B12 deficiency, which is a serious health concern.

Homocysteine levels: Stomach acid is important for proper absorption of vitamin B12, a key factor in methylation that keeps inflammatory homocysteine at the right levels. When B12 is low, homocysteine elevates.

Supporting healthy stomach acid

Eat protein foods at the beginning of your meal to stimulate the digestive enzymes necessary for digesting protein.

Chew thoroughly. This is one of the most important parts of digestion. Food proteins need to be broken down to be properly digested.

Limit liquid intake during meals until at least 30 minutes after a meal to allow for proper stomach acid production, pathogen sterilization, and protein metabolism.

Stay hydrated between meals to support proper gut motility; this pushes the contents of the intestines out of the body instead of back into the stomach. This is very important for those who are prone to SIBO.

Betaine hydrochloride supplements help support healthy gut function and safely restore normal gastric acidity. (Do not confuse betaine HCl with anhydrous betaine, a methyl-donor nutrient taken to control homocysteine levels.)

Always take the betaine HCL either half-way through the meal or right at the end of the meal. Taking it before a meal may create a false experience of heartburn and can turn off stomach acid production for this meal. Caution: Do not take HCL if you are taking any NSAIDs such as ibuprofen, Tylenol, or aspirin.

HCl with pepsin. Add these to your diet when you consume protein. When you feel warmth in your stomach, that means you are taking enough. Then back it down a notch and monitor your response. Some people need one capsule, others need more as everyone is unique.

Pepsin. Typically used in conjunction with HCl, pepsin is considered very safe when administered to assist digestion.

Digestive enzymes help to break down food proteins. Make sure to get a high-quality blend.

Apple cider vinegar. One tablespoon in a bit of water right before a meal can help with digestion.

Fermented foods such as sauerkraut, kimchi, pickles, pickled ginger, and water kefir contain organic acids, enzymes and probiotics to assist with proper digestion. They are also anti-microbial and fight H. pylori, arch enemy of stomach acid production.

Taking the time to improve your stomach acid levels will make a huge difference in your symptoms and quality of life. Please contact my office for more help.

Category: Gut Health