Gut Health - its role in early identification, prevention, and treatment of chronic diseases

It is well known that chronic diseases are the leading cause of illness and disability in the western industrialised world - in fact, they affect more than half the population and cause 7 out of every 10 deaths. People with chronic health conditions are the most frequent users of health care, accounting for more the majority of health care costs.

Many common patient symptoms, e.g., gut pain, fatigue, general aches and pains, headaches, and loss of appetite, could equally well reflect one of several chronic conditions, often making diagnosis and treatment difficult. Available therapies generally target the symptoms without getting to the root cause and truly effecting a cure. Functional medicine clinicians utilise a number of tests to seek out the root course.

Why Gut Health?

Poor gut health is at the heart of many chronic conditions and a healthy gastrointestinal (GI) tract is vital to our overall wellbeing - indeed, our very survival. GI symptoms are among the most highly prevalent of chronic health complaints but are also largely hidden and the least understood. Sedentary lifestyles and standard Western diets do little to support this neglected organ system. Studies suggest that irritable bowel syndrome (IBS) or related symptoms account for 10–20% of primary care clinician visits and up to 20% of GI outpatient clinic time.

Symptoms of Irritable Bowel Syndrome:

• Abdominal pain/cramping
• Diarrhoea
• Constipation
• Bloated feeling
• Gas
• Indigestion
• Burping
• Loss of appetite
• Blood or Mucus in the stool
• Nausea
• Anxiety

In spite of suffering debilitating symptoms, interestingly however, only 30% of individuals with IBS consult a clinician about their symptoms. This may reflect patients’ tendency to tolerate symptoms that are episodic and variable, to be reluctant to discuss IBS symptoms with their doctor, or to self-medicate, given the large amount of over-the-counter drugs that claim to offer symptom relief. Unfortunately, unguided use of such medications can compound the problem while temporarily masking a symptom of something more serious.

Many sufferers simply adjust to their 'new normal' of chronic abdominal pain/discomfort, acid reflux, diarrhoea, constipation, gas, and bloating, however these symptoms are not normal!

Irritable bowel syndrome, like so many chronic conditions, is actually a symptom of an underlying issue, not a disease in and of itself, properly diagnosing IBS can be challenging. It is often considered to be a functional bowel disorder caused by stress, with no clear aetiology/cause.

Clinicians can be frustrated by the lack of specific biomarkers, reliance on clinical symptoms for diagnosis, and overlap of symptoms with those of organic conditions. Patients with this disorder greatly desire effective therapies, but without the necessary tools to personalise diagnosis, treatment is often trial and error—at best giving temporary relief—with patients typically returning once symptoms recur.

Stool tests help one develop a solution that will help get to the root of the matter, transforming the clinician-patient relationship in the process, for dramatically improved health outcomes.

In the healthy state, the single- cell-thick intestinal mucosa forms a barrier which allows properly digested nutrients to enter the bloodstream but not pathogens, toxins, or undigested food. IBS is often linked to increased permeability of the intestinal mucosa. Here, the epithelial cells become inflamed and release the tight-junction regulator protein zonulin, triggering the disassembly of the tight junctions and allowing pathogens, toxins, and undigested food to enter the bloodstream.12.

This can lead to an improperly controlled immune response and chronic inflammation, negatively affecting metabolism and multiple organ systems.

Uncover the root cause of symptoms with a gut health assessment

The gut comprises one long tube from mouth to anus that separates the blood and internal organs of the body from luminal pathogens and other harmful substances that we ingest along with our food. The digestive tract has a surface area of 100–130 square feet and, in order to fulfil its protective barrier function, houses two-thirds of the body's immune system. The gut is home to trillions of bacteria and other microbes (collectively, the gut microbiota) that support digestion and absorption of food, regulate the integrity and function of the gut lining (mucosa), train and modulate the immune system, and communicate with the brain about energy uptake (via hormones and neurotransmitters) that affects mood and overall well-being.

In the healthy state, this intricate ecosystem maintains a delicate balance to protect the body against infection while preventing tissue-damaging immune overreactions and inflammatory responses to numerous bacterial and food antigens. Disturbance of this homeostatic coexistence in the gut is associated with many chronic diseases, at least partly stemming from GI inflammation/immune system dysregulation triggered by infections, maldigestion/malabsorption of food, microbiota dysbiosis, and/or intestinal permeability.

A gut health assessment can uncover the root cause of GI imbalance

A recent explosion of scientific research worldwide, including the Human Microbiome Project (HMP), is providing new insights into the importance of the gut as the “gateway to good health” and giving new meaning to the phrase “you are what you eat.”

In fact, most functional GI disorders, including IBS, comprise a number of different, often treatable, conditions that can be diagnosed or ruled out with the use of serum and faecal biomarkers.  Such biomarkers give important clues into the underlying causes, e.g., inflammation, intestinal dysbiosis, celiac disease/gluten sensitivity, maldigestion/malabsorption of food, inflammatory bowel disease (IBD), food allergies or other immune dysregulation, and bacterial/fungal/parasitic/viral infections.

This information is critical to being able to effectively treat the disorder and restore the patient (and their gut) to a state of health, by means of dietary interventions, specific supplements, medications, and/or more targeted tests.

Many stool tests are available assess several broad areas of potential dysfunction:

Microbiota Dysbiosis
Most chronic disease sufferers have a disorder of the microbiota that can be related to the disease pathophysiology.The microbiota is the collective term for all the microorganisms that inhabit the human body; a mixture of bacteria, viruses, fungi, and yeasts. These microbes reside in communities specific to different regions such as the skin, mouth, genitals, and intestines. The human microbiome refers to the genes and genomes of all the organisms that make up the microbiota.

The gut microbiota is vital to our survival and functions to establish and maintain our immune system, fend off opportunistic pathogens, and help extract nutrients from our food. It is key to the structural integrity of the gut lining and preventing inflammation.

Dysbiosis is an undesirable shift in the composition of the microbiota resulting in an imbalance between protective and harmful bacteria that can lead to a plethora of chronic diseases if left unchecked. However, pathogenic bacteria may coexist peacefully with beneficial bacteria if the overall balance of the microbiota is healthy.

A high-fat, high-sugar (standard Western) diet, overuse of common medications (e.g., antibiotics), exposure to certain pathogens, and other factors may induce dysbiosis by affecting the growth of some microbes. Chronic dysbiosis can alter the environment (e.g., pH) in the gut and thus invite pathogenic bacteria, fungi, or parasites to flourish. This can result in lower levels of beneficial short-chain-fatty-acid (SCFA)-producing bacteria, promoting intestinal hyperpermeability (“leaky gut”) and inflammation.

Maldigestion/Malabsorption/Malnutrition
Maldigestion of food can cause the GI symptoms such as bloating, abdominal pain, gas, constipation, and diarrhoea. It can also stem from a variety of problems, including low stomach acid, abnormal GI motility (either rapid or slow transit times), lack of bile acids, and exocrine pancreatic insufficiency (reduced secretion of digestive enzymes from the pancreas). Chronic maldigestion can promote bacterial/fungal overgrowth (small intestinal bacterial overgrowth or SIBO), which can compromise the intestinal barrier, allowing toxins, bacteria, and undigested food particles to enter the circulation and increase risk for food sensitivities, autoimmune disorders, and an overburdened liver.

Malabsorption of nutrients can be a consequence of maldigestion and can also occur when infection or inflammation damages the intestinal mucosa or increases transit times. The resulting nutrient deficiencies can lead to malnutrition and other health complications such as anaemia, skin and cognitive/mood disorders, impaired vision, and osteoporosis.

Gut Inflammation
Dysregulation of the normal homeostatic relationships between the gut microbiota and host immune responses can lead to intestinal inflammation, and evidence suggests that luminal flora may be a central factor in the development of inflammatory bowel disease (IBD). Crohn’s disease and ulcerative colitis are immune-mediated conditions characterised by chronic inflammation of the small intestine (ileum) and large intestine (colon). The pathogenesis of these conditions is multifactorial, but they are generally thought to result from “an exaggerated immune response towards the gut microbiota/toxic luminal substances in a genetically susceptible individual.”

Ulcerative colitis is characterised by inflammation that is limited to the colon—typically the superficial mucosa and submucosal layers, whereas Crohn’s disease involves any part of the GI tract and commonly involves complications such as strictures, abscesses, and fistulas.

Possible triggers may include:

• Microbial overgrowth — microbiota dysbiosis (imbalance) favoring pathogenic overgrowth of bacteria or yeasts can disrupt the intestinal epithelium, causing hyperpermeability
• Certain medications — chronic use of drugs such as antibiotics, aspirin, acid-reducing drugs, or nonsteroidal anti- inflammatory drugs (NSAIDs)
• Food additives and inflammatory foods — gluten, emulsifiers, excess sugar/alcohol consumption, and dairy
• Stress and age

Intestinal Permeability
The intestinal epithelium is the largest exposed surface area of the human body and its ability to act as a barrier against potentially harmful molecules, bacteria, and foreign substances is critical to gut immune homeostasis. The permeability of this barrier is finely regulated by the presence of tight junctions—molecular complexes that seal the spaces between the epithelial cells, guiding passage of select molecules (e.g., nutrients) through the transcellular spaces. The epithelial cells produce mucus and antimicrobial molecules to further protect against noxious or infectious agents.

Breakdown of this barrier can cause a disruption of normal mucosal immune homeostasis that can lead to uncontrolled chronic intestinal inflammation, allowing increased passage of undigested food particles, microorganisms, and their immune-stimulating antigenic products (e.g., lipopolysaccharide) to the circulation. The integrity and function of the epithelial cells themselves can also affect intestinal barrier function; if disrupted, tight- junction components and regulatory proteins will appear in the stool.

Gastrointestinal Bleeding
The faecal occult blood test detects the presence of hidden blood in the stool, which may indicate a benign or cancerous growth, IBD, or other damage to the gut lining.

Gastrointestinal Pathogens 
Intestinal parasites, pathogenic bacteria, and viruses can be a significant source of GI illness. does not manage to clear them or keep them in check, they may start to cause patient symptoms.

Systemic Autoimmunity
What is important to understand is autoimmune disorders which are the number 3 cause of mortality and morbidity in the industrialised western world are often triggered or made worse in genetically susceptible individuals by intestinal dysbiosis and a dys-regulated gut inflammatory response (often with increased intestinal permeability - leaky gut) to stress, toxins, infections, nutrient insufficiencies, and various foods. See separate article on autoimmunity and separate article on leaky gut.

We all  have the potential to lead an active, healthy, happy life free from chronic disease and debilitating symptoms, we just need the health insights to learn how!