Darkus Carajo, IBS, Inflammatory Bowel Disease discussed on Free and Inspired Radio
It is function. Often the solution can lie within addressing the function of the organs of the digestive system, those same organs breaking the food down and absorbing the nutrients that eventually interact with the body. In order to investigate this a little bit more, I like to explain to people, especially within a clinical setting that the relationship between food and the digestive system as an equation may be actually missing a variable. So it starts off with food equals symptoms. And when most of the time, it's food divided by the digestive system and the food and digestive systems interaction that actually really equals the symptoms. That's quite a major variable that's missing if I do say so myself. Now, food travels through the digestive system in a step by step fashion that relies on cues from its different components similar to that of a train line. Now, in this episode, I'm really going to try and help you understand what's called a north to south type of system that's been popularized by someone I've trained with doctor darkus carajo. Which basically goes on to explain that each Q or each point in the north to south system or each station in the train line if you like, relies on the cues or stations or signaling from the station before it. So, for example, if the brain represents north in the north to south and the mouth, the stomach gallbladder, pancreas, small intestine, each have a part to play with that journey south through the digestive process. You can start to imagine that the food you're reading is somewhat similar to a train in that it is stopping at each station, but slowly getting broken down and deconstructed into a sum of its parts as that process continues. Now understanding the processes in each of these organs from the brain to the small intestine can actually help you understand why you might be experiencing digestive discomfort after eating and how these functional issues can occur up to two to three hours after eating. And in my mind, this is actually where some of the mystery may be caused in the sense that people can eat meals and not get those symptoms or that negative feedback from the digestion relatively quickly. So that can often mean or often mean that you are end up with quite a foggy idea of what may be causing your problems, which is obviously not what we want. So let's get started on this train line. The vagus nerve helps the brain communicate with the digestive system creating the brain gut axis. So it will start off with the first station in our north to south train line the brain. A lot of people don't often associate the brain with direct mechanical digestion or the digestive process. It's not often that you think about it. In some ways you could think about it in the sense that when you're cooking your food, you have a sensory experience in that you smell the aroma of what you're cooking and that then sends a message to say the food's coming. But to be fair most people don't actually think that their brain may be part of the issue if you like when it comes to daily digestion. But when we're talking about the digestion and the brain you may sometimes heard of the digestive system being labeled as the second brain. This definition is largely down to the highly concentrated amounts of neurons that can independently of the brain affect motility or the journey or food takes from your plate to the toilet and a host of other functions. So the digestion actually works very, very independently of the brain, but in a similar way hence the term second brain. Now the vagal nerve or the vagus nerve is a critical mediator here and very much of a focus for us when we're looking at the brain gut connection. Handling the bidirectional messages between the brain and the digestive system, the vagus nerve makes is the first component of the north to south principal. For example, when the food enters the body via the mouth, it sends a host of interacting signals via the vagal nerve to the brain loaded with information covering amongst other things sensation and nutrition. Whilst our focus here is the journey of the food you eat traveling south, the ascending conversation that travels north up the vagal nerve from the digestive system to the brain plays an essential role and could be a part of how things go wrong. Correcting low vagal tone as referred to in the literature is often a goal in functional digestive disorders, such as IBS and inflammatory bowel disease. Now to put that in a different way, we're focusing on the food traveling south, but remember I mentioned the vague nerve has a bidirectional messaging system. So if you think about it like a major highway, you can go one way or the other. Now with the brain, the brain is receiving messages from the mouth or the organs of the digestion in an ascending fashion as opposed or as well as excuse me. The descending fashion that the brain sending messages to the digestion in response to a Roma and things like that that I mentioned. Now deep breathing, meditation, physical exercise amongst other things can all have a positive effect on this vagal tone. So this is the interesting part about all of this and a theme that you'll often see is that sometimes the solutions to low vagal tone or these types of things that we mentioned aren't actually that sophisticated and maybe things that you can do quite quickly without having to source by or go anywhere, really in the sense of meditation and deep breathing. Now the polymerase research also shows that probiotics may positively affect their brain. The brain via their activity on the vagal nerve, the positive effect on the brain may also extend to mood and anxiety regulation and decrease cytokines, the chemicals in the body that can cause inflammation. It's definite that I'm going to be doing a full episode on the valuable nerve and how it affects digestion. I think with the element of stress in people's lives, especially over the last few years, looking at the relationship between the brain and the gut in a little bit more depth is such an interesting and insightful experience. So stay tuned for that. I'm going to be trying to put that together over the coming months. Let's move forward in our little train line or our journey south and we're going to be talking a little bit about the mouth. So chewing your food makes a more significant difference to your body's interaction with food than you think. The next station on this train line the mouth is the first stop in mechanical digestion. Just like many people don't go to the dentist as regularly as they should, and if this is you, then please book that appointment. The role of the mouth in the digestive process can be one we take for granted. Now, interestingly, I'm just going to do a little bit on oral health because what a lot of people don't know is that the bacterial environment or the version of the oral microbiome, if you like in your mouth, actually influences the bacterial environment in your stomach. So if you haven't visited the dentist for a little while and got a clean or gotten yourself checked out, this could actually be affecting your digestion, hence why are encourage you to go and get yourself checked with the dentist. If you are a little scared of them, I find dentists generally pretty friendly people and very, very good at their job. So hopefully it won't be as scary as you think. But it will have a huge effect on the bacterial environment in your mouth. Obviously, but also in your stomach which may be causing some of those digestive symptoms. Let's get back to chewing and the mechanical digestion. Chewing and saliva revital components of the digestive and immune processes when it comes to food. Now the mouth may also be the first place that we lose our oral tolerance, which is really important and goes back to whether or not food is actually the problem. So losing your oral tolerance to food can begin in the mouth. After years of seeing vegetable for hubbards in people's digestive exams, it's clear we all including me need to chew our food more. But why? During helps increase your meals surface area volume. Now it sounds to be complicated, but all it does is make it easier to digest and swallow. The more you chew your food the better chance you can, you have to absorb the maximum amount of nutrients. Studies have shown that people who chew less consume more calories. That's crazy, but the difference seems to be between 15 to 50 choose. So that's a pretty big increment of increase if you like. Now the closer to 50 you get the better it is so 50 is 50 choose. Now, you could be one of those people who does count each time they chew, it may not be too awesome at dinner party to do that. But being more mindful of how you're chewing your food may be a nice place to start and not make you seem so strange at a dinner party. Now, the mouth more precisely the saliva is the location of secretory IgA, one of the most critical first responders when it comes to your immune system. You may remember just before that I mentioned that chewing and saliva are actually vital components of the digestive and immune processes. And it's secretory IgA that's the leader in this. Simply secretary IgA helps protect the digestive lining the lungs and the urinary tract from invaders that can cause irritation or infection. Now, we're going to go full on into secretory IgA at some stage, but generally how I explain the role of secretary IgA in patients because we can actually test it through stool exams is that imagine you've got a Lord of the Rings kind of scenario where you have the army approaching the castle. And all of a sudden, the archers appear on the turrets and the arches are always the first to fire when it comes to these kind of scenes in those crazy laws that Lord of the Rings films. Secretory IJ, very much the same. Now, numerous factors influence how much secretary IgA is available in your saliva, stress can inhibit, for example, but the more you chew the higher level of exposure there is to this vital part of the immune system to whatever you're eating. Chewing also makes sure that the antigens that might be tagging along for the ride get exposed to this secretory IgA simultaneously. So if you go back to our little Lord of the Rings example, chewing actually makes sure that the archers can see the totality of who they're fighting and will do totality of who their receiving so to speak when it comes to the small battle that may be going on for a supremacy within the body. I don't want to take that analogy too far, but hopefully it helps you understand it a little bit better. It sounds preposterous but maybe chewing your food more may fix a lot of your long-standing digestive problems. And if you don't try it, how will you know if this isn't the easy solution that's been alluding to you now? The reason for this is because a lot of people don't chew their food and that actually ineffectively mechanically digests your food. So it means that it goes down to one of the most important parts of the digestion. Somewhat unprepared. And when we see that in other ways, you'll see that the stomach has a real problem in trying to pick up the slack of that chewing. So in a sense with the saliva, you're not getting the exposure to the digestive enzymes also within the saliva. So that digestive process really is behind in a lot of ways by the time it reaches the stomach. Now the stomach holds the key to preparing the food you eat for absorption into the body. So notice that I've used the term mechanical digestion quite a lot in our conversation so far. The next stop in this area is actually more of an assimilation assimilation based digestion. So it's a little different. The mechanical digestion helps to prepare the food and the assimilation based digestion allows the food to get off the train and hopefully move to different places within the body. Now, for most people when thinking about the digestion, their stomach is the central component and not far off really. Clinically, people point to where they think the stomach is when reporting on their digestive complaints. The stomach is without a doubt a pillar of both the digestive and the immune system. So notice again, as with the mouth, the immune system is very heavily involved in the stomach's role. The gastric juice created within the stomach comprises of digestive enzymes, hydrochloric acid, and other substances such as something called intrinsic factor, which is important for your vitamin B 12 absorption. There are essential for absorbing nutrients. Now would you believe that about three to four liters of gastric juice are produced daily in the stomach to handle those three or four meals a day with your snacks? That's a lot of gastric juice and the process is kind of amazing. I think we're all getting used to the fact that the body really is quite amazing and we just never really notice all these crazy things going on. Hydrochloric acid breaks down food due to its high acidity level. The digestive enzymes deconstruct the protein whilst the musculature of the stomach acts as a cement mixer. I'm sure you've heard that before, to churn the food together so that it can pass through the stomach and into the small intestine. Now, here's where it could go wrong. The level of acidity that the hydrochloric acid reaches plays a critical role in digestion and immune function once again. The acidity of hydrochloric acid plays the role of barrier immunity by killing bacteria that it encounters from food and water. It's important to note that if the PH of the gastric juice doesn't reach a critical point ideally a PH of 1.5 to two, then the inactive enzymes released by the stomach lining have trouble activating themselves and subsequently doing their job. So once again, you have a difficulty in deconstructing the food, which can then cause problems down the line. This acidity also stimulates something called motility, which helps move food move food to the different stations of the digestion. Something particularly pertinent for people experiencing constipation like symptoms. So you're starting to get the idea here that the exposure to enzymes is a really important part of this mechanical digestion. Now medications such as protein pump inhibitors, antacids and non steroidal anti inflammatory drugs can cause changes in this hydrochloric acid secretion and the process we discussed above motility, which once again, if you're having slow bowels is pretty much your focus. And more important consideration in the case of long-term PPI use concerns poor absorption of calcium vitamin B 12 iron and magnesium. Why is this so important? Mainly because these nutrients are actually deficient in a lot of people's diets before the digestion becomes a problem. And this is where sometimes the difference between recommended daily intakes and actual daily intakes has such a huge deficit between both of those markers in the sense that we recommend you have sown so milligrams of magnesium and you go, well, I'm going to go and do that through my diet or supplementation, but then all of a sudden, you've been asked to use a PPI or antacid, for example, and your ability to bring that into your bloodstream will bring the magnesium out of the digestion and into your bloodstream is majorly impaired, leaving you thinking that you're doing the right thing, but once again, unfortunately, the appropriate mineral vitamin isn't getting off the train as you would like it to be. Now, in a clinical setting a large proportion of people have low levels of hydrochloric acid originating from chronic moderate exposure to stress. Interestingly, when you get acute stress, you actually get an increase in gastric juices, but when that stress becomes more chronic. So it's a longer lasting exposure in less intense way, but still intense enough, you start to see a lowering of the gas gastric acid production. Now this is considered to be a protective mechanism to mitigate the stressful situation and the action required to react and respond to that chronic moderate exposure to stress. Thyroid conditions such as hypothyroidism and Hashimoto's can also cause changes in gastric secretions. They believe mainly because of the thyroid's role in the metabolic processes of the body. This connection between the brain and the digestion once again is one of the critical points of interest when looking at our north to south, the train line or treatment method after going through how it works is now easier, hopefully to see how necessary the stomach and its actions are in both triggering cues in the small intestine, mechanically digesting food, deconstructing protein for absorption and the vitamins and minerals absorbed by the stomach. What do you think so far? Do you feel as if there may be elements of your digestive function that are maybe causing your food to not be digested as well as it could be? Maybe that starting to cause some of these issues. I touched on this small intestine there, and we will definitely get to that as another organ of focus. But what about some of the solutions if you do feel like you're harder to maybe isn't performing the way you would like it? One of my favorite ones is just using apple cider vinegar before meals or at least as a morning shot. It can be an excellent place to begin the process of correcting the hydrochloric acid. I think a lot of the time when you do these types of things you're looking to see some positive feedback. And you'll hear me talk about that quite a lot in that. You do need to see some change quite early. And it's not that you don't want to give the time or you're impatient. But if you're looking to feel better, you probably want to do it as quickly as possible. Doing something like apple cider vinegar is a relatively easy way to see whether or not you're actually on the right track. So maybe you have your first little shot of it. And you just feel 30 to 40% less bloated. Sure, it could be a placebo, but also if you do it again and you continue to feel 30% or 40% less bloated, that could be a nice wind, but also give you a sense that maybe some more focus needs to go into the stomach there for you. Supplementally a popular beginning is a combination of something called betaine HCL, pepsin, which is one of the main digestive enzymes in the stomach, but you must be careful if you suffer from a methane dominant small intestinal bacterial overgrowth or constipation dominant IBS is sometimes that B time may aggravate these types of conditions. So once again, if you're unsure of your seaboard status or anything like that, if you start to see that over the first few days of using a supplement with betaine that you're starting to feel a little worse for where then it's probably best to seize that straight away. But look, let's talk about the small intestine, more from a functional point of view because that's our focus for this episode. The small intestine is where nutrients get off the train and absorb into the body. There are a few fun facts when it comes to the small intestine and its role in the digestion. The first is a surprise to most of my patients in that the small intestine is the primary site of nutrient breakdown and absorption. Yes, that's right. It's actually not your stomach sure your stomach does or is involved in some absorption, but the small intestine is the major site. The second form factor is that the small intestine is actually the longest part of the digestion and can measure up to 15 feet long, which is crazy. The small intestine comprises of three parts, the duodenum, which is the upper part of the small intestine receives the manic mechanically digestive food from the stomach and bile from the liver to break down fats and also receives further enzymes from the pancreas to continue the deconstruction of your food. The rest of the assimilation absorption process occurs over the preceding parts of the small intestine, the jejunum, which absorbs sugars amino acids and fats and the ileum which absorbs any of the nutrients not already assimilated earlier in the small intestine in particular B 12, which is a big focus for a lot of people. The small intestine has become a focus of research due to the potential of bacterial overgrowths in the ilium, the lower part of the small intestine. A better understanding of the small intestines role in essential digestion makes it easier to appreciate how important it is to clear any obstacles to its ability to bring nutrients in the body from the food you eat. Now I wanted to touch on this point a little bit mainly because I also hear a lot of people present to me in the clinic and say, I don't think I'm absorbing my food very well. Now, after we've gone through the function of the digestion in a little bit more focus, a lot of the time I believe release the way of interpreted it, people are mentioning the fact that they don't feel as if they're absorbing their food because they have stomach problems. But they may be right in the sense that they're not absorbing their nutrients very well, but it's actually a small intestine issue. Once again, this is where focusing on the function can actually give you some really nice insights into where things might be going wrong. Once again, though, this is where the north south ideology becomes the most appropriate. The gallbladder and the pancreas rely on cues from the stomachs from the stomach's acidity to release bile and pancreatic enzymes appropriately into the small intestine. So if the correct level of acidity isn't achieved in the stomach, this could immediately have a downstream effect on the effectiveness of the small intestine. So once again, you may remember previously or a little bit earlier in this episode that I mentioned that the train line or the other organs in this cascade moving south rely on the cues from the stations or the organs previous. So once again, this is a very clear example of that. Significantly though PH regulation of the pancreatic juice and the bile also affected the digestive process with the pancreatic PH also playing an essential role in its antibacterial action as well. So the pancreas can actually offer a further immune element. Let's take a quick break and we'll bring all of this together and help you understand a little bit.