Probiotic and Gut Brain connection

Gut and brain connection is not new to us, but to what extent and how it affects all aspects of our wellbeing or illness that we succumb to is being explored constantly in science.

Gut brain connection is not only the connection of Vagus nerve to the brain, but the bacteria that live in gut, and how its various metabolic products affect brain is another powerful connection.

We note that depression is related to inflammation and genesis of inflammation, for the most part is in gut. The article mentions that we are not at this stage where we can treat depression with probiotics alone. I agree.
That is even more the reason to care for our microbiome in our GI tract. Our lifestyle choices, the food we eat, stress we carry, sedentary or active life we live, relations and community we keep, and allow are body and mind to rest does affect our microbiome. That in turn affects genesis of inflammation through our gut.
This article in Men’s health magazine caught my eyes.

Probiotic and gut brain connection-

Diseases Rooted in Gut Microbiome and what to do about it:

The microorganisms in an environment (including the body or a part of the body) are called microbiome.

Scientists at the Weizmann Institute of Science redid the estimate and found that there are about 39 trillion bacterial cells in the body. They play a profoundly important role in human health and disease, from helping us absorb nutrients, to synthesizing vitamins and breaking down cellulose. We couldn’t survive without this microbial zoo inside us.

Shortly after birth, we are colonized with over 1000 species of gut bacteria. Influences such as vaginal delivery vs Cesarean section, breast-feeding vs bottle feeding, antibiotic use, industrialized processed food, heavy metal toxicity, stress levels, chronic illness and poor dietary choices, glyphosate in non-organic foods all have a profound impact on which bugs are selectively destroyed  leading to further imbalance and disease.

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Diseases Rooted in Gut Microbiome and what to do about it:

Is There Anything Like Non-Celiac Gluten Sensitivity

Systemic Immune Response Discovered</FONT COLOR>

Many of my patients come with completely normal evaluation but have no answer for their symptoms. I came across some information that I thought would be interesting.

Many patients report symptoms when consuming gluten, but are negative for serum markers of celiac disease. This so-called non-celiac gluten sensitivity has been maligned in mainstream medicine for years, but new studies point to the potential mechanisms for this effect.

A recent study investigated immune responses in 80 individuals with non-celiac wheat sensitivity who reported gastrointestinal symptoms after consuming wheat products. The control groups consisted of healthy controls as well as individuals with diagnosed celiac disease. All participants adhered to a wheat-, barley-, and rye-free diet for 6 months. Reintroduction of wheat products led to relapse and measurable increase in symptoms.

The key finding was in the serum samples. The researchers discovered changes in biomarkers for the non-celiac wheat-sensitive group. When these participants consumed a diet including wheat, IgG, IgA, and IgM antibodies were significantly higher than in the healthy control group. On the other hand, IgA reactivity was lower than in the celiac group. Serum levels of markers for systemic immune response (LBP- lipopolysaccharide binding protein-and sCD14 measurements) were significantly higher in the non-celiac wheat-sensitive group than in either the healthy or celiac groups. This systemic immune activation correlated with intestinal epithelial damage (measured with FABP2) in both the non-celiac wheat-sensitive group and the celiac group.1

The study also tested serum samples after wheat, barley, and rye were eliminated from the diet. After 6 months of the restricted diet, all participants had significantly improved biomarkers. IgG, IgA, and IgM anti-gliadin antibodies were reduced, as well as LBP, sCD15, EndoCAb IgM, and anti-flagellin IgG and IgM antibodies. Patients’ self-reported symptoms also declined significantly. The systemic immune activation went down as well, paralleling the decrease in reported symptoms.

Importantly, non-celiac wheat-sensitive patients did not show the typical celiac biomarker profile. They did not have elevated antibody responses to TG2 or deamidated gliadin sequences. Duodenal biopsies did not reveal villous atrophy or mucosal abnormalities. However, non-celiac wheat-sensitive participants did have measurable intestinal barrier defects and systemic immune activation.

Another recent study provided further evidence that reintroducing gluten can lead to symptoms in subsets of patients without celiac disease. A double-blind, placebo-controlled trial with 18 patients tested gluten or placebo added to participants’ regular, gluten-free diet. All participants had lymphocytic enteritis without celiac serum markers, but were positive for HLA-DQ2/8, a significant risk factor for celiac disease. More than 90% of the group who received the gluten challenge relapsed and had to stop the study early; 28.5% of the placebo group relapsed. The relapses in the placebo group were likely due to the nocebo effect. These findings suggest that some patients have non-celiac reactions to gluten and lot of associated symptoms. For other patients, non-gluten components of wheat may be responsible for triggering symptoms in non-celiac gluten sensitivity.

Systemic immune activation due to food sensitivities is an area of growing concern for patients. As research continues to substantiate the harmful physical effects of food reactions, the personalized diets used by Functional Medicine practitioners will become increasingly important for good patient outcomes.

From Institute for Functional Medicine

Leaky Gut

Leaky gut syndrome, is not generally recognized by conventional physicians, but evidence is accumulating that it is a real condition that affects the lining of the intestines. The theory is that leaky gut syndrome (also called increased intestinal permeability), is the result of damage to the intestinal lining. As a consequence, some bacteria and their toxins, incompletely digested proteins and fats, and waste not normally absorbed may “leak” out of the intestines into the blood stream and generate all sorts of chemical reaction, resulting in to illness.
This one layer intestinal physical barrier of our gut is as large as 2 tennis courts. Like our skin it is the principal interface between body and all what we eat and drink. Other factor that helps with gut integrity is ,gut microflora–microbiome–it helps the barrier by forming healthy biofilm. As shown in illustration below, gastric acid, mucus, some antibodies and enzymes and immunological barrier are all at the to protect our body and blood stream to get exposed to toxins.
Some of the Factors that the alter and damage both these barriers are stress, toxins, inflammation, infection, poor diet, chemicals, heavy metals, and much more, causing leaky gut–intestinal permeability.(fig-1)

Layers of Normal barrier (Fig 1) [with permission from IFM]
Layers of Normal barrier (Fig 1) [with permission from IFM]
As the barrier is compromised that allows foreign material into our body, tissue, blood stream and automatically our body starts the process to eliminate this foreign material. This causes inflammation and upper regulates our own immune system. In that process are body forearms immune complexes, they themselves with the chemical reaction, cause inflammation and damage organs. A lot of times these invading foreign material, antigen often mimics specific protein complex of specific organ( just to give you some examples,) thyroid tissue or joint tissue, resulting in to thyroiditis or arthritis.

Altered Intestinal Permeability
Altered Intestinal Permeability

This increased permeability does not just happen in intestinal tract. As different toxins get access into our body, because of increased intestinal permeability, it affects all membrane interface, such as blood brain barrier giving access to immune complex affecting our brain, resulting in to multiple symptoms like difficulty with memory, confusion, “foggy brain” etc. If it affects kidney it can cause renal problems, if it affects lung, it can cause allergy, asthma, and other conditions.

Healthy Gut
Healthy Gut

There is a great deal of research linking leaky gut and multi organ system failure.
Increased permeability or leaky In itself is not disease, but it is a dysfunction of the lining which in turn increase the toxic burden for body, and the process of dealing with this toxic burden causes myriads of symptoms and diseases.

Alessio Fasano, world leading researcher on celiac disease proposed without increased intestinal permeability (Leakey gut), genetic predisposition and antigenic load (Gluten), alone is not enough to cause celiac disease ( which is one of the autoimmune conditions ). All 3 conditions are needed for autoimmune illness.

Damaged Cell Junctions
Damaged Cell Junctions

Usually one may not think following conditions do not have any common link but they do, partly because of leaky gut being one of the major root causes of these symptoms and conditions (2,3)

Allergies, asthma,
Food sensitivities, and food allergies,
Digestive disorder, constipation, IBS, diarrhea, bloating, dyspepsia, abdominal pain
Arthritis, rheumatoid arthritis, ankylosing spondylitis
Autoimmune conditions , chronic joint pain chronic muscle pain
Hashimoto thyroiditis,
Environment illnesses, multiple chemical sensitivities
Eczema, acne, rash, psoriasis, hives
Fatigue, fibromyalgia, chronic fatigue syndrome
Sleep disturbances,
Fuzzy memory, foggy brain,
Cognitive disorder
Anxiety, depression, mood changes,
Food allergies and sensitivities.

Any one of these symptoms and illnesses can developed depending on your own susceptibilities determined by your own physiology, detoxication ability, genetics, nutrition…

Relatively noninvasive test exists to diagnose increased intestinal permeability. The test is performed by giving patient lactulose and mannitol. These are type of sugars. These sugars are not metabolized by our body so the amount absorbed is excreted in the urine over 6 hours. Because of their differential absorption, their ratio of excretion in the urine helps us determine possibility of leaky gut.

First step in approaching these conditions is to have a thorough knowledge about this condition and tools to approach this illness. Functional medicine approach is systematic way of thinking about your condition and personalized way to evaluate, and help you get to the recovery.