Why Do So Many People Have Digestive Issues?

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An estimated 70 million people suffer from some sort of digestive issue in North America. Let’s take a moment to slowly digest this. How could this be possible when we have clean water, a steady food supply, and many luxuries others parts of the world lack? I have pondered this question through my whole career in Functional Medicine and as 1 of the 70 million people that suffered from digestive challenges for a large chunk of my life.

To understand why so many of us suffer, it is important to understand how we communicate with our environment. I want you all to do a quick exercise – place your hands on your cheeks. Now slowly follow your cheeks into the inside of your mouth. Your cheeks literally become the inside of your mouth. Then it turns into your throat, esophagus, stomach, small intestine (approximately 20 feet long), and lastly into your large intestine. Then guess what happens? Your large intestine turns into cheeks again – except on our rear-end!

This is called our digestive tract – a large tube that goes from cheek-to-cheek and is technically “outside of us”. It is one of the many ways our body interacts with our external environment and is also how our body protects itself from that same environment. What separates our digestive tract from our blood stream is a razor-thin barrier that is only 1-cell thick. This is your gut-blood barrier and is highly susceptible to damage. When all is working well, this barrier is able to selectively choose what it needs to send into the blood and what needs to stay in the gut. When this barrier is compromised, we arrive at the first factor that can contribute to digestive issues – Leaky Gut Syndrome.

Leaky Gut (a.k.a. Intestinal Hyperpermeability)

Just a few years ago, when I would ask a room full of people if they have heard of leaky gut, I would sometimes get 1 or 2 hands go up. In recent workshops, over half the room will raise their hands. Leaky gut has been in the forefront of research in recent years and has been indicated in the development of digestive issues, inflammatory issues, and even autoimmune disease (1).

One of the reasons for this is that we all make an endotoxin (a toxin made inside of us) called lipopolysaccharide (LPS). It is essentially “bacterial poop” from the trillions of bacteria that reside in our gut (they are just like us – they eat and make waste). We all have pounds of LPS inside of us but it is supposed to stay in our gut. As our gut becomes more permeable (leaky), this LPS actually gets into the blood and can create systemic inflammation and immune stimulation. We call this endotoxemia.

This is especially of concern if you have already made dietary and lifestyle changes but did not feel much of a difference. I’ve always believed that a leaky gut is like a papercut – if you leave it alone, it will heal. However, you could be doing everything right but the next category could be sabotaging your efforts and preventing the papercut from healing.

Gut (Stealth) Infections

When we hear the word “infection”, we usually think of getting a fever or flu-like symptoms. That can be true about many infections but some infections simply make life hard to live. Gut infections are not only a big drain on the person who hosts them but are also seldom tested for and therefore referred to as “stealth infections”. We don’t ever wake up and “feel” this type of infection. These silent pathogens can influence everything from energy levels to stimulating the immune system.

The great news about these infections is that most can be eliminated without antibiotics. I have had numerous cases where an infection such as a bacteria, fungus, or parasite was the “straw that broke the camel’s” back. These infection can also alter brain function through the gut-brain axis – a two-way street that allows the brain to communicate with the gut and vice versa. LPS has also been indicated in several studies as one of the root causes of depression and other disease-based processes (2).

Lack of Testing

As mentioned with the previous post, stealth infections are rarely tested for. Most of the time, when a patient exhibits digestive complaints or symptoms, either no testing is done or most commonly, some sort of imaging technique is performed (ultrasound, x-ray, colonoscopy, endoscopy, etc.). These tests have their indications but for the majority of individuals suffering from digestive challenges, the FUNCTION is what needs to be assessed and prioritized.

Working predominantly with patients that present with gut issues – I rarely see a past stool analysis performed. When we have a patient complete a stool test, the information we get back can be priceless. Learning about the microbiome (our unique collection of bugs that live in synergy with each other all over our body) allows one to implement dietary, lifestyle, and supplemental recommendations that work to balance the gut and create health systemically.

The quality of testing also plays a giant role as many stool tests are (pun intended) “crappy tests”. They involve microscopic testing where human error can factor in and there is poor preservation of samples after collection. Not all stool testing is created equal – I never accept a “clean” test as fact unless it is a highly sensitive advanced functional test.

Lack of Dietary Support

We are not what we eat, we are what we eat and absorb. I have heard time and time again from patients that they have been told – “diet has nothing to do with their health symptoms”. This statement is usually debunked in a very short period of time when patients achieve substantial symptomatic improvement with sometimes minor dietary changes.

Many diets have been studied for digestive support including the Specific Carbohydrate Diet (SCD) and Low FODMAP Diet and both have shown promise both clinically and in patient surveys (3,4). One commonality exists between the many diets – there are foods that can be highly inflammatory for patients with digestive issues. Even before testing, a specific dietary trial is a worthwhile intervention and a temporary elimination of certain foods and foods group can really make differences quickly.

Sympathetic Nervous System Overdrive

An additional point to emphasize is the vast amounts of stress we endure today. Regardless of the situation, whether it’s “normal day-to-day stress” or if our life was in danger, we activate our sympathetic nervous system. The sympathetic nervous system is branch of our autonomic nervous system (think automatic – works without us having to think about it at all times) and it’s main tool is a fight-or-flight response.

When fight-or-flight gets activated, all the blood flow in our trunk (where our heart and digestive organs reside) gets pushed out to your arms and legs to either fight or run. Since you don’t have to eat while a lion is chasing you, digestion simply gets deprioritized.

Where you send blood flow is where you send function and if someone is in constant fight-or-flight because they are in a rough relationship, hate their job, have a stressful commute, live in a hostile environment, or are full of stealth infections, digestive issues are an inevitable endpoint. Unfortunately, many of these stressors are never highlighted along a typical patient journey.

If you or someone you know has been suffering with digestive issues in silence or has been diagnosed with a digestive-based condition like Crohn’s disease or Ulcerative Colitis, there are many areas that are overlooked that can provide life-changing opportunities for healing. If you are looking for answers, I invite you to do a free discovery call with me or attend a free live workshop to learn more about what you can start doing immediately.


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Article References:
  1. Fasano, A. (2019). Zonulin, regulation of tight junctions, and autoimmune diseases.PubMed – NCBI. [online] ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384703.
  2. Maes M, et al. (2019). The gut-brain barrier in major depression: intestinal mucosal dysfunction with an increased translocation of LPS from gram negative enterobacteria … – PubMed – NCBI. [online] ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18283240.
  3. Aleksandrova, K., Romero-Mosquera, B. and Hernandez, V. (2019). Diet, Gut Microbiome and Epigenetics: Emerging Links with Inflammatory Bowel Diseases and Prospects for Management and Prevention. PubMed – NCBI. [online] ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28867793.
  4. Haskey, N. and Gibson, D. (2019). An Examination of Diet for the Maintenance of Remission in Inflammatory Bowel Disease. PubMed – NCBI. [online] ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372922.
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