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AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS Why is gastrointestinal health so important to my patient? Gastrointestinal health, often simply called ‚gut health‛, is central to physiologic balance and wellness.(9) The gastrointestinal system is responsible for a wide variety of metabolic, nutritional, and detoxification processes.(10) Furthermore, the bacteria located within the intestines are intimately involved with our metabolic functioning. The 100 trillion bacteria living within our intestinal system contains more genetic material than the human body and performs more metabolic processes than our liver. The gut environment can be viewed as another organ system. Approximately 70-80% of our immune system cells are located around the gastrointestinal system and there appears to be a close relationship between the immune system and the gut flora. There is evidence that these bacteria play a role in immune modulation and recognition of ‚self‛ that occurs during the early years of extrauterine life.(14) Containing over 1000 species of bacteria, yeast, and parasites, the balance of these living organisms can support nutrient synthesis, detoxification, and immune balance or set the stage for inflammation and intestinal hyperpermeability.(11)The food that we eat is also food for the organisms living within our gut and our food choices influence the balance of bacteria.(8) Eating right is hard. Even people with chronic disease tend to believe that they eat normally; however, few people eat in a manner that is physiologically sound. We often eat highly processed, nutrient poor foods rapidly under higher stress conditions (think drivethru!) which sets the stage for inadequate digestion, malabsorption, and chronic disease.(12,13) Digestion, although not the focus of this primer, plays such a significant role in gut health, the intestinal biome, and ultimately the function of our immune system that it deserves a brief discussion. Proper digestion takes time and preparation. This includes eating foods that our body can digest, with reasonable nutrient, fat, fiber, protein, and carbohydrate intake; preparing food properly, in a low stress environment, allowing for production of stomach acid and pancreatic enzyme synthesis. Taking the time to thoroughly chew the food, in reasonable portions, with 74 plenty of time between bites will allow the bolus of food time to be broken down within the stomach. As you can see, proper digestion requires real food and time to prepare and eat the food. Food choices, eating habits, digestion, the gut flora, and elimination all influence the integrity of the gut, preventing or setting the stage for food sensitivity, and ultimately immune dysfunction, inflammation, and chronic disease.(10,11) How does Food Sensitivity impact gut health? 2012 The development of food sensitivity is the end result of multiple inter-related chronic problems of the digestive tract, such as poor digestion, abnormal bacterial growth within the gut, and chronic gut inflammation. In other words, gut problems precede the development of food sensitivity. However, determining and removing foods that cause inflammation can be an important part of breaking the cycle of chronic inflammation. Isn’t Food Sensitivity just an allergy? All allergy and most sensitivity or intolerances to food are mediated by the immune system. Lactose intolerance, which is due to an enzyme deficiency, is an example of a non-immune mediated food intolerance.(27) Most clinicians think about the production of IgE antibody when they encounter allergy type symptoms and when they are considering food as a potential source of disease. IgE is an antibody produced by the B-lymphocyte, part of the acquired arm of the immune response. IgE is responsible for causing the release of histamine from mast cells and histamine mediates the allergic symptoms of swelling and redness. IgG is another form of antibody responsible for long term immune memory. For instance, IgG is formed after the acute phase of a viral infection, preventing reinfection upon further exposure. Immunotherapy (‚allergy shots‛) can help us understand the function of these antibodies in a practical way. Immunotherapy is an effective means of reducing the symptoms of allergy by chronically
AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS exposing the immune system to the allergen. The allergy reaction is mediated by IgE antibody. After repetitive low dose exposure to the allergen, the immune system can become tolerant to the allergen by shifting immunoglobulin production from IgE (which drives the allergy symptoms) to IgG. As IgG levels increase, allergy symptoms decrease.(1,16) In this setting, it appears that the presence of IgG against an antibody signals that the body does not view the antigen as a problem. In regards to food allergy and sensitivity, there are many IgG tests against food antigens. In light of what immunotherapy has taught us about the role of IgG in allergy, this calls into question whether the use of IgG testing would actually correlate with clinical symptoms and pathology. In fact, it could suggest that the presence of IgG to a specific food antigen may be protective, or at the very least simply indicate exposure tothe food.(35) Food sensitivity may have more to do with the inflammation that results from activation of the innate immune system, rather than IgG antibody production against food. The blood test called the ‚antigen leukocyte cellular antibody test‛ (ALCAT) can determine which specific food antigens activate the immune system, leading to a downstream inflammatory process.(18,19) Studies also suggest that chronic activation of the innate immune system may be an underlying cause of chronic disease, such as Metabolic Syndrome and other degenerative diseases.(2,3,17) Basic Physiology Gut structure and Digestion The gastrointestinal tract starts at the mouth and ends at the anus. Although it traverses the body cavity, the contents of the intestinal tract remain EXTERNAL to your tissues. Similar to your skin, this serves a similar protective and functional role. You can literally control what enters your body because you can choose what to place into your mouth. Individuals can have profound control over their health and wellbeing by exerting control over their diet. As discussed previously, digestion begins at the mouth, requires proper chewing of food, stomach acid, 75 2012 pancreatic enzyme production and bile acid secretion. Heart burn is often a symptom of poor digestion, not of too much stomach acid production. Proper digestion will minimize the exposure of the lower gut to whole food particles, which may set the stage for the development of food sensitivity. Mechanical breakdown of the food and aggressive mixing with salivary enzymes within the mouth begin the digestive process. This process also triggers hormone release, signaling the other areas of the digestive tract to prepare their digestive processes. Stomach pH lowers during the process of preparing to eat, typically from a basal pH of 3-4, down to a pH of 1 when food is ingested. This allows for the optimal functioning of enzymes, bacterial killing, and digestion of proteins. The stomach mixes the food and dispenses it into the first portion of the small intestine called the duodenum where pancreatic enzymes and bile are introduced, as well as bicarbonate to neutralize the acid. This substance is called chyme, and nutrients and minerals are extracted from it as it passes through the small intestinal tract. Chyme passes into the large intestine through a ‚oneway valve‛ where water is extracted and large numbers of bacteria act upon it to further digest it. This material acts as a food source for the bacteria as well, promoting the growth and development of the proper balance of gut flora. The foods we eat are a nutrient source for the bacteria that live within our GI tract. They essentially consume what we consume. Proper digestion ensures optimal breakdown for utilization by the gut biome.(7) The Immune System and the Gut Innate and Acquired Immunity To truly appreciate food sensitivity, we must understand some basics of the immune system and comprehend the complex, multi-layered, neuro-endocrine-immune system. The ‚innate‛ immune system is a branch which reacts to a foreign antigen or substance. It does not require prior education or exposure to that substance. The ‚acquired‛ immune system responds to substances previously learned to be foreign.
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