The Gut: A Foundation of Good Health

If you're trying to improve your overall health using diet, exercise, and nutritional supplements, your success is dependent upon an optimally functioning digestive system. You can take a handful of nutritional supplements daily and eat plenty of fruits and vegetables, but without a properly functioning digestive system and adequate enzyme function, you simply will not absorb and assimilate the vitamins and minerals you consume.

First Steps
Digestion begins in the kitchen when your olfactory nerve identifies the aromas of a home-cooked meal. Triggered by your senses, salivary amylase (an enzyme) releases into your mouth, thus preparing your body for the upcoming meal.

Sitting down around the dinner table in a relaxed environment helps to activate your parasympathetic nervous system, which is necessary to orchestrate the chain of digestive events. As you chew, food is physically broken down. Chewing your food thoroughly maximizes the amount of surface area of the incoming meal that will be exposed to digestive enzymes. These initial stages of digestion are critical and directly influence the efficiency of the subsequent steps required to break down and absorb food.

The Long Haul
The next few steps in digestion are vital when it comes to optimizing nutrient absorption. Between the stomach, small intestine, gallbladder, and pancreas, an intricate mix of digestive enzymes and beneficial bacteria work together to break down and absorb food. The stomach requires an acidic environment, while the small intestine prefers a generous supply of bicarbonate from the pancreas to buffer this acid and create an alkaline environment later on down the gastrointestinal (GI) tract. Acute digestive symptoms from pancreatic enzyme deficiencies can mimic symptoms of low stomach acid, or hypochlorhydria. These symptoms may include diarrhea, food sensitivity, abdominal bloating, and gas.

Many people drink too much fluid with meals, weakening or diluting digestive secretions. Ideally, most of your daily fluid intake should be 30 to 45 minutes before or after meals. If you do consume a beverage with a meal, limit it to one glass and be sure to avoid extremely hot or cold beverages, as these can slow down or impair digestion.

Lastly, the key to optimal digestion is adequate elimination. Having complete bowel evacuation every day is important. If the lower end of the digestive system becomes sluggish (constipation) or overactive (diarrhea), digestive function farther up the GI tract will become impaired. If you suffer from mild digestive symptoms such as gas, bloating, diarrhea, constipation, and cramping, consider some basic supplements.

Healthy Bacteria: Probiotics
Our intestines have their own thriving ecosystem with hundreds of different strains of microscopic organisms. There are between four and seven pounds of living bacteria in our intestinal tract-in fact, more bacteria live inside of our gut than there are cells in the body. Thankfully most of these organisms are what we call "good" bacteria, or probiotics. The term probiotics, from its Latin origins, literally means "for life." Probiotics serve many functions including suppressing pathogen growth, replenishing good flora after antibiotic therapy, aiding our bodies in an effort to assist in optimal digestive function, optimizing nutrient absorption, and possibly even helping to prevent overweight and obesity.

Recently, a study published in the journal Nature indicates that the type of bacteria in our intestines may be responsible for the way we store nutrients and utilize them for energy. This suggests that probiotics influence whether we burn or store calories.

Researchers have determined that obese humans and mice have a higher percentage of a family of bacteria called Firmicutes and fewer bacteria called Bacteroidetes. In an effort to determine if the presence of these bacteria actually caused obesity, researchers transplanted Firmicutes into the intestines of lean mice. After transplantation, the mice began to store more calories from the food they ate. The same amount of food actually provided more calories to mice with Firmicutes compared to those without these bacteria, suggesting the need to re-establish a healthy balance of digestive flora.

Probiotics and Antibiotics
A common question is whether to take a probiotic supplement while taking antibiotics or to wait until after the course is complete. Because many women often report an increased incidence of yeast infections during antibiotic therapy, I always recommend that my patients begin probiotic supplementation immediately to protect the integrity of the digestive system. Full-spectrum antibiotics kill off both good and bad intestinal bacteria. It is common for new disease-causing bacteria or yeast to take advantage of this environment and proliferate, which results in infection.

Supplementation with probiotics crowds out bad bacteria and prevents these opportunists from invading the digestive system, especially during cold and flu season when bugs are plentiful. The single most important rule when taking probiotics with antibiotics is to take them at least two hours after antibiotics so they do not interact in the stomach.

Do You Need Enzymes?
If you suspect that you suffer from poor digestion, it is important to distinguish between too much or too little stomach acid and if pancreatic enzyme insufficiency exists. Often gastric reflux disease, a disease we may associate with too much acid, is due to not enough acid. This condition can cause symptoms of burning in the esophagus and indigestion. A simple way to figure out if this is your problem is to perform an apple cider vinegar test.

For one week, combine one tablespoon of organic apple cider vinegar with a teaspoon of honey and an eighth of a cup of water. Consume this mixture 15 minutes before meals. If this relieves your symptoms of indigestion or heartburn, then enzyme supplementation could be an effective treatment. Short-term enzyme therapy can be a helpful way of retraining your body to secrete digestive enzymes optimally.

Pancreatic enzyme supplements will usually include the following: amylase, protease, and lipase, all of which are essential for breaking down carbohydrates, proteins, and fats.

If the test doesn't work and you actually continue to get heartburn, then it is not a result of too little acid (which is the most common problem), but rather too much acid. In this case, avoid fatty foods that increase acid production and use supplements such as slippery elm, DGL licorice, and marshmallow root.

Don't Forget Fiber
We all need a balance of both soluble and insoluble fiber. Total dietary fiber goals should be 38 and 25 grams daily for young men and women, respectively.

Soluble fiber acts as a sponge to sop up unnecessary metabolic waste products to assist the body in their excretion. Effective for helping to reduce cholesterol levels and assist in weight loss, soluble fiber works as a bulking agent. Insoluble fiber acts as a scouring agent to remove debris from small, hard-to-reach intestinal spaces. The two forms of fiber work synergistically to clean out the intestines and form bulky, easy-to-eliminate stool.

Some fiber products can be constipating, bloating, or irritating to the intestines. It is essential to find the one that works best for you. The store that gives you remedies offers a multitude of products in capsules, powders, tablets, and wafers.

Clinically, I find the powders to be most effective but hardest to consume. Fiber supplements should usually be taken with a lot of water. However, it's easiest to consume powdered supplements by adding a small amount of water, stirring, and then drinking quickly. Follow it with a large glass of water. For children, a chewable wafer may be easiest.

Fiber supplements should not be used in place of a fiber-rich diet, which includes naturally occurring insoluble fiber foods such as whole grains, flaxseed, and lentils, as well as soluble fiber foods such as apples, bananas, and oats.

"Microbial Ecology: Human Gut Microbes Associated with Obesity" by R. E. Ley et al., Nature, 12/06  "Dietary Fiber and Coronary Disease: Does the Evidence Support an Association?" by J. R. Lupton and N. D. Turner, Curr Atheroscler Rep, 11/03

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