Yesterday I wrote about SIBO, small intestinal bacterial overgrowth. This occurs oftentimes alongside bacterial dysbiosis. Dysbiosis is an alteration of the body’s microbial community making a shift in the population when primarily good bacteria decreases and bad (or pathogenic) bacteria flourish. In simple terms you have less good and more bad. The balance is thrown off.

How can dysbiosis occur? Overuse of antibiotics, poor diets, excessive alcohol intake, overuse of NSAIDs(aspirin, Ibuprofen), and other lifestyle factors.

Many are more used to calling these instances of dysbiosis by the location of the bacterial community shift or the type of change that is taking place. For instance, we call a dysbiosis in the vaginal cavity a vaginal yeast infection. Or a local overgrowth of yeast in the mouth is called thrush. Other examples are SIBO (dysbiosis in the small intestine), vaginosis, and candida overgrowth.

If you have IBS, chronic bloating, distention and indigestion, celiac, crohn’s, colitis, GERD, obesity, food allergies or heart disease, you may have some intestinal dysbiosis.
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In order to assist in bringing a better balance to your intestines, eating a specific diet and reintroducing the best bacterial communities can improve the above symptoms/conditions. It is also important to take specific protocols for gut healing to avoid dysbiosis in the future. Taking glutamine for gut healing and nourishing yourself with bone broth, and decreasing sugar intake, especially in the form of soda and other liquid sugar can all help with keeping a balanced bacterial community.

Our gut is our bodies largest immune organ, it houses more inhabitants than your body has it's own cells, it helps us absorb all the necessary components for life including water, food, and vitamins, it is your bodies first access point for many invaders and houses the largest surface area of your body. Your gut is so, so, so vitally important- and having a healthy gut can assist in enjoying optimal wellness. We talk a lot about the microbiome that lives in our gut, however, we don't often talk about the cells that line our digestive tract, and the topic of today's blog is an important component of protein that these cells rely on: Glutamine.

Protein is made of amino acids, and glutamine is just one of twenty our bodies require. Glutamine, that amino acid from above is an important "food-stuff" for the cells of the gut lining. 20-30% of the bodies glutamine is used by these cells alone. It is an essential component for the maintenance of gut metabolism, and function especially during periods of trauma or when gut health is compromised. 

If an individual is lacking adequate glutamine they may experience fatigue, weakened immune system, and even chronic inflammation. When gut cells lack the necessary glutamine, cell function decreases, and our first line of defense (in terms of immunity) can become severely compromised. Glutamine supports essential healing processes and works to regenerate and repair the cells of the intestine. 

It is also an important amino acid used for removing toxins from our body - in this way it removes excess ammonia. It is also important in the production of a neurotransmitter known for calming effects on the body and mind in stressful situations (GABA). 

Conditions (or habits) that can compromise gut health and function include:

• Smoking
• Stress
• Chronic inflammation
• Overuse of antibiotics
• Leaky gut
• Environmental toxins
• High levels of sugar intake
• Consuming foods an individual is allergic/sensitive to

Since glutamine is so important, even if you are not experiencing one of the above listed conditions or habits it is important to make sure your body is provided enough glutamine. 

After my most recent post "Nourishing the Gut" a reader wrote in with the following question: so I have read some where that there are certain kinds of fiber that are more beneficial to gut guys. What's the deal with that? 

Let's take some time to talk more about fiber. Fiber is essential for optimal digestive health. It is recommended that we eat 25-30 grams of fiber per day however, the average American eats about 15 grams of fiber per day. That is an "F" in my book. And not F for Fiber, F for FAIL.

Fiber represents a group of carbohydrates or carbohydrate-containing compounds. We tend to classify fiber based on whether it is soluble in water. That is just a fancy way of saying, it absorbs water. Some fibers do, others done. Unlike most carbohydrates, fiber is not digested or absorbed in the small intestine. What does that mean? It means it makes it's way to your large intestine (also known as your colon) fairly intact. Why? Humans lack the digestive enzymes to properly break down fiber. Don't worry, we still need it. This just means, you aren't a cow, who can turn grass or hay into energy. 

Soluble vs. Insoluble

So soluble fiber and insoluble are both very important, they just each provide their own benefits. Soluble is the kind of fiber that decreases blood cholesterol levels, it provides bulk to stool - which is a good thing. This type of fiber is in apples, the pulp in oranges, foods like oats, and dry beans. 

Insoluble fiber remains VERY unchanged as it passes through your small intestine. It helps move contents through your guts. This type of fiber is what you find in the peels of fruits, like that apple from above, it's skin or peel is insoluble fiber. Insoluble fiber is in seeds, it is more often the type of fiber in vegetables and whole grain products, corn and brown rice. 
 
Fiber is a "prebiotic" food. That just means, it is a food source for the biome of bacteria in your gut. 

Okay, but the question above had to do with our gut guys, the friendly bacteria in our gut that we would like to support. The long and the short of it is this: the fibers that are more fermentable are the fibers these guys feast on. The few that are proven to be very preferential for the microbiome include: inulin (which occurs naturally in leeks, asparagus, chicory, garlic, onions, wheat, oats, and soybeans), oligofructose (bananas, onions, Jerusalem artichoke), galactooligosaccharides (which is found most beneficially in human breast milk, but can be found in dairy products and is often packaged as a prebiotic food right in yogurt). 

Here are a few sources of great foods with a mixture of two of the above fiber types that our "gut guys" love:

• Chicory root: 41.6 g inulin, 22.9 g oligofructose
• Jerusalem artichoke: 18.0 g inulin, 13.5 g oligofructose
• Dandelion greens: 13.5 g inulin, 10.8 g oligofructose
• Garlic: 12.5 g inulin, 5.0 g oligofructose
• Leek: 6.5 g inulin, 5.2 g oligofructose
• Asparagus: 2.5 g inulin, 2.5 g oligofructose
• Wheat bran: 2.5 g inulin, 2.5 g oligofructose
• Wheat flour, baked: 2.4 g inulin, 2.4 g oligofructose
• Banana: 0.5 g inulin, 0.5 oligofructose

***THESE ARE PER 100 grams OF THESE FOODS

This is just a sampling. To keep things simple. It is important that we eat a wide variety of plant based foods to ensure we are giving our bodies adequate sources of fiber. When shopping for any type of bread, look at the fiber, if per serving it is less than 5 grams of fiber, don't waste your money. Eat 2-3 servings of fresh fruit per day, and eat 4-7 servings of vegetables (cooked and raw). Choose brown rice over white, choose whole grain pasta over white, choose cruciferous vegetables like broccoli, brussels sprouts, cabbage, cauliflower, collard greens, kale, turnips, and bok choy. Eating a wide variety of plant based fruits and vegetables will make sure you are eating the types of fiber the microbiome loves. 

WHY DOES THIS MATTER?
We carry around 3 pounds of gut bacteria in our body at any given time. That is as much as your brain weighs. You have GALT cells (gut associated lymphoid tissue) in the lining of your intestines that represents the largest mass of lymphoid tissue in the body, approximately 25% of the intestinal mucosa consists of lymph tissue. The immune responses that start in the gut have GREAT potential to affect all the areas of our body, and inflammation levels. These GALT cells feed primarily on short chained fatty acids, which is what you microbiome is turning the fiber you eat into.

Fiber + Gut Bugs = Short Chain Fatty Acids

Short Chain Fatty Acids + GALT cells = Healthy Immune Response

No wonder we in America are suffering from so many chronic, inflammatory diseases, and autoimmune diseases when we are getting an "F" when it comes to eating enough fiber.

​I will mention if anyone reading this has considered a low FODMAP diet due to IBD, consult your healthcare provider before increasing the fiber in your diet.

I could go on listing the myriad of questions that come up on a daily basis with clients. Gut health is quickly gaining attention both from the public and health professionals, AND WELL IT SHOULD.  There is proven links between the health of our gut (and it's many millions of inhabitants) and risk of cardiovascular disease, immune health, obesity, food sensitivities, and even mental health. You read that right, studies are now showing that there is an increased risk of anxiety, depression, and mood instability with certain changes in gut health.

To be honest, there is more we do not know about our microbiome and gut function (particularly when it is not functioning well) than what we do know. If you ask 5 different Dietitians, Naturopaths, MD's or Yogis how much kombucha you should be drinking, we would all give you a different answer. Some health professionals recommend probiotics, however most don't. The majority will just cite the benefits of yogurt and turn a blind eye to the insane amount of high fructose corn syrup in most of the conventional yogurts found in your grocery store shelves. It is difficult to find a consensus on many of these points. 

In my clinical opinion, we are not doing enough to support healthy guts. We are not nourishing our guts or most times even thinking that we should be. We talk about heart health, eating to prevent cancer, and food allergies, and we spend a lot of effort trying to get skinny in America. As some education reaches the masses, people are spending a lot of money jumping on these new trends of probiotics, fermented foods and drinks, without really understanding what it is that is going on inside of them.

We have a constant battle taking place in our bellies. We have millions of inhabitants that are all competing for resources. What is that resource you ask? FIBER. Now, I know you are thinking to yourself, fiber? Geez, that isn't sexy, or expensive, or trendy. I know! But, we are spending (in some cases) $40-$100 per month supplementing the bugs that already have found a home in our bellies in the form of pills, foods and drinks we are being told this will help us increase our gut health. This is not necessarily a bad thing, however, if you are starving your helpful, microbial friends of the food they need to survive and proliferate, then it doesn't matter how many of them you shove down the ole' pipe... they won't stand a good enough chance of survival. 

Why is fiber SO important, yes we want these little buggers to survive, but what else is going on here? These bugs have the ability to turn that fiber into short-chain fatty acids, which have been linked to improved immune function, decreased inflammation and protection against obesity. You don't want these guys fiber famished.  What's even worse, is not the die off of friendly bacteria, but when they don't have enough food to eat, they will compete for what is left in their environment that is edible: YOU. When fermentable fiber becomes scarce, studies have shown some microbes will turn to the mucus lining of the gut for food, penetrating a crucial FIRST LINE OF DEFENSE AGAINST PATHOGENS. This opens an individual up to a host of potential infections and increased risk of inflammation. 

Now I'm not saying probiotics, yogurt, kombucha, fermented foods, or other gut promoting efforts are bad, in fact many I employ on myself, my family and in my practice to help individuals. But, if we are not doing the very crucial step of providing the necessary nutrients for our gut community, we are approaching this backwards. So you may be asking yourself, how do I get more fiber? Oh, well I'm glad you asked.

​FRUIT, VEGETABLES, GRAINS (I KNOW), LEGUMES, NUTS, SEEDS. It is great if you can make sure at every meal you are incorporating a few of these items. I promise your gut will thank you.

I find this to be of particular importance with communities that shun grains at this point in time, if you choose not to eat grains, that is fine, however make sure you are upping your fruit and vegetables to compensate for the highly beneficial sources of fiber found in whole grains.

An emerging area of science continues to be the gut frontier. Each of us has living within us more living bacterial organisms than we have our own cells making up our bodies. This ecosystem is largely symbiotic with us, meaning it provides benefits to us humans (as the host) and we provide benefits to these bacteria in the way of a habitat and a constant source of food.

Questions scientists of late are trying to answer include many of the following:

• How many different bacterial strands or types are there? 
• What different roles do the different types of bacteria play?
• Can we leverage the functions of some bacteria to benefit the host?

Certain bacteria are better able to metabolize food that makes it far enough down the digestive track and turn it into usable energy for the host that is absorbed in the large intestine (the colon). Scientists are currently trying to develop populations of these bacterial harvesters and duplicate them to assist impoverished populations that need to get as many calories from their available food sources.  Similarly, People are trying to figure out why bacterial populations differ between obese and lean populations, so that the bacterial profile of lean populations can be used to assist those who struggle with weight to have an easier time losing weight. And so on...this is a huge frontier for science that has keys to helping improve immune health, improve metabolic health, improved bowel health and GI cancer rate, perhaps even energy. 

A recent study from the Journal of Clinical Endocrinology and Metabolism has shown that the connection between gut bacteria (microbiota) populations and the distribution of fat tissue among children teenage populations. This is the first study that I know of to clearly see this. 

"Our findings show children and teenagers with obesity have a different composition of gut flora than lean youth," said the study's senior author, Nicola Santoro, MD, PhD, Associate Research Scientist in the Department of Pediatrics at Yale University in New Haven, CT. "This suggests that targeted modifications to the specific species composing the human microbiota could be developed and could help to prevent or treat early-onset obesity in the future."

The study examined gut microbiota and weight in 84 children and teenagers who were between 7 and 20 years old. The participants included 27 youth who were obese, 35 who were severely obese, seven who were overweight and 15 who were normal weight. Researchers analyzed the participants' gut microbiota. The participants underwent an MRI to measure body fat partitioning, provided blood samples and kept a three-day food diary.

The findings showed an increase in short chain fatty acids circulating in the blood. Short chain fatty acids are something that bacteria can convert undigested food into, then your colon cells absorb them and your blood sends it to other areas in the body, most importantly here, the liver. In the liver these short chain fatty acids can accumulate and be converted to adipose tissue.

There are many questions a study like this brings up, however as a Dietitian, I find this research exciting and compelling that in the years to come we may have additional helps to combat obesity. 

Study Information: ​Endocrine Society. "Gut bacteria differ between obese, lean youth." ScienceDaily. ScienceDaily, 20 September 2016. <www.sciencedaily.com/releases/2016/09/160920130825.htm>.