Seven Reasons a Brain Injury can Destroy Your Gut!

Seven Reasons a Brain Injury Can Destroy Your Gut

According to the CDC, incidence of hospital visits for traumatic brain injury have increased over the past decade.  It is one of the leading causes of disability world-wide.  You may know that the gut and brain are intricately connected but did you know that many people who experience brain trauma often experience resulting gut issues?   The gut problems come from alternations in the gut-brain axis or the communication network between our intestines and our cerebral matter.   When this delicate network is disrupted, it may result in dramatic gastrointestinal dysfunction, chronic pain or even disability.

According to Dr. Kharrazian, there are seven key ways in which traumatic brain injury can alter GI function, each of which may contribute to your chronic gastrointestinal disorders.

1. Autonomic Dysregulation - this occurs when the autonomic nervous system no longer appropriately  controls things that should come automatically, like heart rate, breathing, and gut motility.   If the system becomes overactive to a sympathetic stimulus the result may trigger a chronic pain loop that is hard to control, leading to abdominal pain.
2. Disorders of visceral sensing and processing - Visceral sensing is the gut's way of telling the brain what is going on.   Sensations in the gut such as temperature, pH, contractility communicate with the brain to notify the body what is happening in the digestive system.  Disruption of these sensing circuits is one of the main factors implicated in irritable bowel disorders (IBS).  Brain injury often contributes to a broken communication network between gut and brain.
3. Increase in intestinal permeability (leaky gut) -  After brain  injury the tight junctions that connect the cells that line your gut often become dysfunctional and allow large molecules to enter from the digestive tract into the blood stream.  Normally these tight junctions are protecting you from the large molecules, such as undigested food particles, bacterial parts or other luminal contacts that could cross over into the blood stream.  We know that the increase in intestinal permeability is a key factor in the development of autoimmune diseases, from Hashimoto's thyroiditis to multiple sclerosis.
4. Compromise of intestinal mucosa - Very commonly after brain injury, there is a compromise in the health of the mucosal lining.  We see this in patients in the Intensive Care Unit (ICU) as well... anytime the body is under massive stress, there is a tendency for the mucosa that lines the gut to atrophy and die.  The changes we see are often immediate and occur within minutes after brain injury, severe trauma or infection.
5. Breakdown of the blood-brain barrier (BBB) - The BBB, as it is affectionately known, protects your delicate gray matter from outside chemicals and inflammatory agents that may cause problems if allowed to enter.  After a brain injury, this barrier is often compromised, allowing massive inflammatory triggers inside the brain where they do not belong.
6. Brain Immune Dysfunction  - The Central Nervous System (CNS) controls much of the immune system and the production of inflammatory signaling molecules, like cytokines.  If there is an injury to the signaling mechanism it may contribute to either over-activation or under-activation of the immune system  This can lead to either immune compromise or autoimmune disease, where the body attacks itself.
7. Impaired gut motility - Sadly we see this as a factor in many disorders such as intestinal dysbiosis and SIBO (small intestinal bacterial overgrowth).   The impairment in smooth muscle contractility of the gut mucosa leads to dysmotility. This dysmotility leads stagnation  and alteration in bowel function and even malabsorption.  Ultimately patients may have very severe symptoms related to this problem of abnormal peristalsis in the gut.

Can see how these many mechanisms of action on the gut after brain injury may contribute to chronic pain and dysfunction, not only in the gut but the immune system as well?  Here's some simple things you can do to ensure you will maintain a healthy gut for life!

So What Can I Do to Maintain a Healthy Gut?

1. Eat a variety of colorful organic and local produce
2. Avoid genetically modified foods and glyphosate which contribute to a leaky gut
3. Take a daily multi-strain probiotic to support your microbiome and immune system
4. Eat prebiotic-rich fruits and vegetables to feed your healthy gut bugs
5. Protect your noggin!  Wear a helmet if you are skiing, biking or doing any activity that involves risk of head trauma
6. Try Restore, my favorite new product to restore gut health and heal tight junctions.  Call Amy at #303-993-7910 if you would like more info....

Although we cannot predict or even prevent a head injury, it's important to realize that if it does happen to you, your gut function may be affected.   Start NOW to take steps to develop a healthy gut microbiome in the meantime!

How to Heal a Leaky Gut, Part II

Did you miss my first Leaky Gut Article?! Read more here

So now you may be wondering if you have leaky gut...

Food allergies, toxins, sugar, antibiotics, parasites and stress can wreak havoc with your gastrointestinal system, upsetting the balance in your intestine as well as allowing harmful substances to enter the system. Gas, bloating, diarrhea, constipation or abdominal discomfort may be the first clue that something is wrong with the digestive tract, but did you know allergies
or even lack of energy and fatigue can often be traced to digestive problems as well?

Normally the gastrointestinal epithelium provides a semi-permeable barrier with allows nutrients to be absorbed while preventing larger molecules from crossing into the bloodstream. When this lining becomes inflamed or damaged, then the barrier becomes "leaky". The fallout results in larger, undigested food molecules and other “bad stuff” (yeast, toxins, and all other forms of waste) that your body normally doesn’t allow through, to flow freely into your bloodstream.

Causes of increased intestinal hyperpermeability or "leaky gut":

• Medications (NSAIDS) like ibuprofen and motrin
• Microbial overgrowth or infection
• Parasite infections
• Fungal overgrowth (Candida)
• Ingestion of allergenic foods
• Maldigestion/malabsorption (pancreatic insufficieny or low HCl)
• Radiation therapy or chemotherapy
• Stress
• Aging
• IgA deficiency
• Chronic alcohol intake
• Excessive or strenuous exercise
• Inflammatory bowel disease - Crohn's or Ulcerative colitis

The small and large intestines contains numerous dietary and bacterial products with toxic properties. These include bacteria, bacterial cell wall (LPS), peptides, and bacterial antigens capable of inducing antibodies which may cross-react with human tissues.... when these antibodies react, they may form systemic immune complexes which can circulate and deposit in tissues far away from the gut.

Abnormalities of the gut lining barrier lead to increased uptake of inflammatory molecules and pathogenic bacteria. With inflammation & injury to the gut lininng, mucosal absorption of normally-excluded substances increases dramatically. Intestinal inflammation enhances the uptake and distribution of potentially injurious bacteria and proteins .

Leaky Gut is seen in disorders such as:

• Inflammatory bowel disease (Crohn's & Colitis)
• Inflammatory joint disease
• Food allergy
• Celiac disease
• Rheumatoid arthritis
• Ankylosing spondylitis
• Reiter’s syndrome
• Eczema & psoriasis
• Bipolar, depression and schizophrenia
• Allergies and asthma
• Autoimmune thyroiditis
• Multiple sclerosis
• Autoimmune liver & gallbladder disease

So how do we test for "Leaky Gut"?

Small molecules (glucose or mannitol) readily penetrate cells and passively diffuse through them. Larger molecules such as lactulose are normally are normally not able to diffuse through the cell. If the tight junctions between the cells are functioning properly, they will prevent the lactulose from leaking through. The Intestinal Permeability Test directly measures the ability these two sugar molecules—mannitol and lactulose—to permeate the intestinal mucosa.

Mannitol is readily absorbed and serves as a marker of transcellular uptake. Lactulose is only slightly absorbed and serves as a marker for mucosal integrity (ability of those "tight junctions" to keep out the bad stuff) The test is a 6 hour urine test that compares ratios of the two substances.

For more info:

Genova Diagnostics Intestinal Permeability Assessment
You will need to contact your functional medicine physician in order to order the test.
Now for some treatment options for this leaky gut!

Nutritional Support

1. Glutamine, an amino acid, has been shown to reverse intestinal mucosal damage from various insults. Glutamine is the principle fuel used by the upper intestinal tract to repair and heal.
2. Agents that stimulate protective mucus secretion may also help with the healing. Some common ones I use are marshmallow root extract and deglycyrrhizinated licorice (DGL) extract.
3. Probiotics are essential! Lactobacillus casei, bifidobacter species, and saccromyces boulardii, a beneficial type of yeast are all important to restore gut health.
4. Fish oil can be very helpful in the treatment of intestinal inflammation by decreasing inflammatory prostaglandins. EPA and DHA should be used in the range of 2-4gm daily
5. Quercetin functions as a natural mast cell stabilizer and decrease release of histmine which contributes to inflammation & injury. To be effective, quercetin should be used in powder form and taken 3-6gm daily.
6. Vitamins A and D are critical to supporting secretory IgA function and restoring the mucosal immune system. Ask your doctor for specific doses...

To Decrease Toxic Load:

• Eliminate all known foods that you are sensitive to. This can be determined through a comprehensive elimination diet or IgG/IgE food tests on the blood.
• Avoid alcohol, NSAIDS (ibuprofen, motrin, alleve), and minimize other medications.
• Bentonite clay is a well-known intestinal adsorbent which absorbs numerous toxins, endotoxins and bacteria. Its value in permeability alterations may result from lowering the toxin load in the lumen, thus facilitating repair. I also frequently recommend Upgraded charcoal tabs for the same purpose.
• HCI and digestive enzymes such as plant enzymes, pepsin and pancreatin might help to lessen the antigenic load or toxic molecules being presented on the intestinal lining.

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6 Signs that SIBO might be the root cause of your IBS

Photo courtesy of www.freedigitalphotos.net

Studies show that over 50% of patients diagnosed with IBS actually have an underlying imbalance called SIBO, or small intestinal bacterial overgrowth. The majority of our gut bacteria should be in the colon. When the bacteria migrate backwards into the small bowel or when there is low stomach acid or poor pancreatic enzyme production, bacteria in the small bowel can overgrow and cause symptoms, such as diarrhea, gas, or bloating.

Six signs you might have SIBO

1. You notice that fiber worsens your constipation
2. You notice an improvement in IBS symptoms when taking antibiotics
3. You feel more gas and bloating when you take probiotics that contain prebiotics
4. You are celiac or gluten intolerant and do not have 100% resolution of symptoms on a gluten-free diet
5. You develop chronic symptoms of gas, bloating, constipation or diarrhea after taking pain medications, like opiates.
6. Your blood work shows chronically low iron or ferratin with no known cause

Top 6 Symptoms of SIBO

1. Abdominal bloating and distention
2. Constipation 
3. Diarrhea
4. Abdominal pain or discomfort
5.  Acid reflux or heartburn
6. Excessive gas or belching

How do I know this isn’t just leaky gut?

While SIBO usually manifests with local GI symptoms, a leaky gut will manifest with systemic complaints that affect the immune system. Keep in mind that is is not uncommon to have both SIBO and leaky gut simultaneously. And very often if you have SIBO for a long period of time, you will develop a leaky gut.

Here are some systemic signs of a leaky gut:

• Multiple food sensitivities
• Skin rashes, acne or rosacea
• Respiratory symptoms, like asthma
• Allergic symptoms or increase in seasonal allergies
• Fatigue
• Brain fog or poor concentration, especially after meals
• Any autoimmune disease
• Joint pain or arthritis
• Headaches or migraines

Remember SIBO can cause leaky gut syndrome but not everyone with SIBO has leaky gut. About half of the patients diagnosed with SIBO will also have leaky gut. Most of the time if SIBO is treated, leaky gut will heal itself!

10 conditions that may predispose you to have SIBO

1. Hypochlorhydria (low stomach acid)
2. Pancreatic insufficiency
3. Decreased motility in small intestine
4. Bowel obstruction
5. Diverticula 
6. Surgical bowel resection or bariatric surgery 
7. Food poisoning (Post infectious IBS)
8. Nerve damage that affects the GI tract
9. Drugs, like opiates 
10. Any disease that slows motility (diabetes, hypothyroid)

Other disorders that may be associated with SIBO

• Rheumatoid arthritis
• Ankylosing spondylitis
• Scleroderma
• Hashimoto’s thyroiditis
• Rosacea
• Restless leg syndrome
• Pancreatic insufficiency
• Liver disease
• Diabetes
• Crohn’s disease
• Celiac disease
• Fibromyalgia
• Kidney failure
• Liver disease
• Diverticulosis

How to Diagnose SIBO

Ask your doctor to order the Lactulose Breath Test (preferred over glucose as it will test the entire small bowel vs. just duodenum). You may also need to check a comprehensive stool analysis and urinary organic acids, which may point in the direction of other dysbiosis but are not directly assessing small bowel bacterial overgrowth

How do we treat SIBO?

1. Diet options

• Paleo diet or autoimmune paleo diet
• Low FODMAP diet
• Specific Carbohydrate Diet
• GAPS Diet
• Avoid all alcohol
• Use caution with probiotics/prebiotics
• Use caution with fermented foods as they can increase histamine
• Homemade Elemental Diet by Dr. Siebecker

2. Antibiotics

• Xifaxan

3. Dr. Jill’s favorite antimicrobial herbs

• Allimed
• Oil of oregano
• Thorne Berberine 500
• Biocidin 

Treating SIBO successfully is not always easy and may involve major dietary changes and medication or herbal treatment for an extended period of time. However, getting the balance of your gut microbes healthy will likely prove to be the most important step in regaining your health and vitality! I know it was in my case… if you haven't read My Story, read more here.

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