Digestive Health and Probiotics Practitioner Guide

Solutions for Optimal Digestive Health and Function

The gut is considered in traditional Naturopathic philosophy, as the seat of all health. It’s not surprising then, that managing the gastrointestinal tract (GIT) is a key step in managing almost all other body systems.

The gut is a complex system and any dysfunction in the gut can have a profound influence over other body systems. As a result of this complexity, managing digestive disorders isn’t always simple and there are often many contributing factors that lead to, and are a consequence of, GIT dysfunction.

To truly restore gut health, a treatment plan will ideally address each and every one of these six functional layers, which form an interrelated web. As such, imbalances in any one layer can lead to imbalances in the others.

Diet

Food is consumed to not only provide the body with the energy and nutrients it requires; it also has a strong influence on digestive health. For example, a diet high in refined carbohydrates may result in a dysbiotic GIT.

Many people make food choices that are detrimental, whether it is due to low nutrient content, high calories, excessive processing or food intolerances and allergies; a patient’s diet should be reviewed and improved as part of any treatment protocol. Particularly in those patients whose primary condition is digestive, food intolerances should be determined using the Metagenics’ Allergy and Reactivity Reduction Program. A custom elimination diet or low FODMAP diet may be useful. Visit Metagenics Institute to learn more about this program for your patients.

Enzymes

Most food that is consumed contains nutrient complexes that are too large for the body’s cells to utilise. In a healthy system, digestive organs secrete acids and enzymes that break down these nutrients to make them small enough for the cells to use. When digestive secretions are reduced, nutrient absorption is also compromised, betaine hydrochloride and pepsin may need to be prescribed.

Bacteria

What comes first – the chicken or the egg? When it comes to gut function, is it inflammation at the barrier that’s deteriorating the microbial environment; or are dysbiotic bacteria and pathogens driving the loss of mucosal integrity? Both may be at play, highlighting the necessity of also addressing the bacteria level. Probiotics are the ideal way to develop a healthy microbiome and restore digestive balance. This balance can be restored via the use of antimicrobials, good quality probiotics and diet, and lifestyle corrections.

Barrier

There are three main lines of defence in preventing bacteria from penetrating the gut barrier. Firstly, secretory immunoglobulin A (secretory IgA); secretory IgA in the GIT binds to bacteria, and therefore keeps those bacteria in the digestive tract where they can do less damage.

The second line of defence is the mucus. This is a physical barrier between the gut lumen and the epithelium which prevents bacterial adherence to the epithelial cells. Nutrients, such as glutamine, zinc and vitamin A increase levels of secretory IgA and improve mucosal health.

Complex epithlelial barrier functions include nutrient absorption, gut immunity, enteric endocrine signalling and nervous system communication. By continuously resisting dietary, lifestyle, microbial and environmental insults, gut homeostasis may become overwhelmed and lead to gut barrier dysfunction. In gut pathology, epithelium can become physically damaged. Many nutrients are shown to nourish and protect epithelial barrier functions, including glutamine and zinc. Aloe vera and BosPure® Boswellia support epithelial healing via anti-inflammatory action.

Immune

With 70% of the immune system being in the gut, the digestive and immune systems are very closely related. Immune balance is influenced by the gut microbiome and, in turn, gut microbiome is influenced by immune balance. Immune function ought to be considered in treating gut health, as immune driven inflammation in the gut can lead to gut barrier dysfunction.

There are two main approaches in treating this ‘see-saw’. The immune system can be treated with a patient specific immune protocol, and the gut microbiome can be brought back in line with the use of good quality probiotics. Evidence based strain-specific probiotic strains, at the correct researched dose, exert specific actions to either regulate or stimulate the immune system. Lactobacillus rhamnosus (LGG®) modulate immune reactions by interacting with dendritic cells within the gut associated lymphoid tissue (GALT), stimulates the production of regulatory T cells and increases the production of anti-inflammatory cytokines.

Enteric Nervous System

All GIT functions, including digestive secretion, motility, mucosal epithelial barrier health and gut immunity, are controlled by the enteric nervous system (ENS). The ENS also communicates information from the gut to the brain (i.e. the central nervous system), using the vagus nerve as a conduit between these two systems. This bi-directional communication pathway, known as the gutbrain axis (GBA), maintains GIT homeostasis, as well as facilitating immune and inflammatory control. ENS dysfunction and disrupted vagus nerve signalling have been associated with both gut and systemic inflammatory conditions.3,4

Taking a Holistic Approach

With digestion as the seat of health, treatment that focuses on restoring barrier and bacteria function will result in resolution of the majority of your patients’ digestive complaints and many systemic issues. However, it is essential to take a holistic approach, addressing the specific factors affecting each individual, including poor diet, weakened digestion (enzymes) and imbalances in the immune and enteric nervous systems. Just as the gut is central within our body, and its health is central to our continued wellness, these treatment recommendations may well become central to your practice.

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Supporting Practitioners to be at the Forefront of Probiotic Science

The Human Microbiome

The gastrointestinal tract (GIT) is host to a plethora of microorganisms composed of bacteria, archaea, viruses and eukaryotic microbes, collectively known as the gut microbiome. Humans exist in a symbiotic relationship with their bacterial ecosystem, and the bidirectional nature of this relationship makes individual health inseparable from that of the microbiome and vice versa. The benefits of a healthy microbiome extend beyond the gut and have significant systemic impacts, affecting nutrient metabolism, body composition, cardiovascular health, immunity and neuroendocrine function.

The Microbiome Evolution

Recent estimates suggest 38 trillion bacteria cohabitate with the human host (also called ‘commensals’); the majority of which exist in the GIT. Over 1000 species and many thousands of genetically unique strains have been identified, contributing to a broad and diverse microbiome. It is postulated that healthy individuals typically host appreciable levels of certain ‘core’ bacterial genera; Faecalibacterium, Eubacterium, Clostridium, Blautia, Ruminococcus and Roseburia. Additionally, healthy individuals tend to have higher levels of bacterial diversity. As such, it may seem logical to think that prescribing more probiotic species is better, however this is not the case.

Clinically Effective Probiotics

As probiotic research is evolving, so too is the understanding of their specific functions and the profound impact they have on health. Historically, probiotics were thought to replenish or ‘seed’ commensal bacteria. This, now outdated, understanding suggested that by supplying commensal-like bacterial species, they would take up residence within the gut, where they could proliferate and restore balance to a dysfunctional microbiome by sheer weight of numbers. It is now known this is not how probiotics work. Instead, positive results are gained by introducing particular influential probiotic strains that are able to restore each patient’s unique microbiome by promoting the growth of key commensal groups, but also by improving overall GIT function – not by simply ‘adding to the masses’.

Recent research confirms that probiotic function changes not only from species to species, but also at a subspecies and strain level, highlighting the importance of prescribing only specific strains that have been genetically characterised with proven therapeutic benefits. While condition specific probiotics are appropriate for many patients for microbiome restoration, or to target particular health conditions, all patients may benefit from taking probiotics for microbiome maintenance, and to support their everyday health.

Figure 1: A Healthy Functioning Microbiome

Key:

1. Lactobacillus rhamnosus (LGG®) and Bifidobacterium animalis ssp lactis (BB-12®) help to increase growth of the dominant commensal bacterial families, genera, species and strains.
2. LGG® modulates the quantity, diversity (composition) and function of other bacteria and commensal organisms, producing short-chain fatty acids (such as butyrate), which helps restore a healthy epithelial barrier and tight junction integrity.
3. Saccharomyces cerevisiae (boulardii) (SB) is a beneficial yeast that is able to displace pathogens and reduce antibiotic-associated loss of bacteria by rapidly restoring core bacteria.6,7 BB-12® prevents the growth of pathogenic organisms by secreting antimicrobial peptides to prevent pathogen adhesion.
4. Bind to mu-opioid gut receptors, such as Lactobacillus acidophilus (NCFM®) to reduce gut discomfort.
5. Exerting a binding action to immune receptors i.e. Lactobacillus plantarum (HEAL9), Lactobacillus paracasei (8700:2), Lactobacillus rhamnosus (HN001™).
6. Influencing inflammatory markers via T regulatory cells (Tregs) (LGG®, Lactobacillus paracasei - LP-33®). NCFM® interacts with dendritic cells, which help to modulate the immune response

Scientifically researched probiotics for your patients’ digestive complaints

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