The Gut Disorder Epidemic
Updated: Jul 1
There is an apparent epidemic of a variety of gut complaints and they seem to be more common in women than men. Discussions of these things is rife on social media where all sorts of elimination diets, self-medication and lifestyle modifications are being tried. The symptoms are varied as are the assumed diagnoses. Common symptoms are pain, boating, gas retention, and alternating episodes of constipation and diarrhoea. Assumed diagnoses are all sorts of food intolerances for which the most commonly blamed are wheat and gluten. "Leaky Gut" generates 3.5 million hits on Google. Another epidemic diagnosis is SIBO (small intestinal bacterial overgrowth, 6 million hits on Google) which is associated with increased bloating and pain soon after a meal. Also epidemic is Irritable bowel syndrome (IBS) diagnosed by symptoms of colicky pain and diarrhoea alternating with constipation and is estimated to affect 12% of the world population. All of these things have been increasing over recent decades and they are also increasing in developing countries experiencing Westernization trends. A much more serious condition of Inflammatory Bowel Disease (IBD) is increasing as well especially in younger subjects. In fact IBD is 16 times more common in those with IBS and tends to occur 2 to 3 years following symptoms of IBS. Leaky gut is thought to precede the development of increasingly prevalent autoimmune disorders: celiac, T1diabetes, rheumatoid arthritis, asthma, multiple sclerosis, etc. so it is vitally important to get to the bottom (pun intended) and sort out these functional gut disorders.
As with all epidemics there has to be a novel common cause such as a new infection or an environmental or behavioural change. I believe the “Fiber Gap” is the most likely explanation for this epidemic and there is a lot of evidence why this might be so.
Firstly the progressive deficiency of fiber from the Western diets is an undisputed concern. Barely 5% of the population actually achieves the recommended daily amounts of 24 to 30g a day, which is most likely much less than the optimal amount anyway.
Fiber functions as a prebiotic that feeds beneficial microbes, increases the diversity of the gut microbiome, and provides substrate for production of short chain fatty acids that are essential for the nutrition and function of the cells lining the gut, especially the intestinal epithelial cells of the hind gut. There are most likely many other ways the microbiota benefit the host but the vitally important role of the short chain fatty acid, butyrate is the best researched. Butyrate regulates intestinal permeability (leaky gut) directly and indirectly by increasing hormones (GLP1 & 2) maintaining the gut barrier, remember this barrier has the surface area of a tennis court and has to renew itself every 3 days, mind boggling! The colonic epithelial cells live for just 3 days, 10 billion colon cells must be generated every day and the energy for all this activity comes from butyrate. Furthermore, the cell signalling role of butyrate guides the differentiation of intestinal stem cells into their many different functional cell types.
Butyrate makes up 5% of the fat in butter and that’s where it gets it’s name but by far most of the butyrate our bodies need and use everyday is produced by beneficial gut microbes from fiber. Microbes have enzymes that breakdown fiber to glucose and microbes use glucose as an energy source. In the absence of oxygen such as the situation in the contents of the hind gut, microbes produce hydrogen, carbon dioxide, acetic acid, butyrate and other organic acids.
As you can see from the equation one glucose molecule has the potential to produce of lot of gas. So, let’s clear up this issue of gas being a bad thing, on the contrary producing gas is essential for a healthy gut. Another thing, hydrogen has significant health benefits and is gaining popularity as a medical treatment for all sorts of inflammatory conditions. However, gas production can be a problem on top of sluggish gut motility, or a blockage caused by constipation. Here lies the conundrum, the cure for these gut disorders usually increases the severity of the symptoms before it can improve them. But a low fiber or low FODMAP diet is probably the worst thing you can do in the long run. Best introduce and increase fibre and prebiotics gradually if they make your symptoms worse initially.
Why on earth it’s not common knowledge when it is difficult to understate the importance of BUTYRATE to the structure, function, health and fitness of the colon (aka: hind gut, large intestine). The function of the large intestine reflects on the small intestine too, and very relevant for our current epidemic of SIBO. The large intestine contains trillions more bacteria than the small intestine which are separated by the highly functional ileo-cecal valve. This valve allows liquids to be injected into the cecum but not allow reflux of the heavily contaminated cecal contents into the small intestine. The function of the ileo-cecal valve is compromised in the absence of butyrate and therefore allows SIBO to progress by retrograde entry of sh1t into the small intestine.
IBS, IBD, SIBO and Leaky Gut are increasing problems and may lead to serious illness. Fiber/prebiotic deficiency is a fact. Fibre was considered nonessential nutrients in the past, is now considered to be necessary to maintain an optimally functioning gut, adequate levels of immunity and suppress inflammatory and allergic responses. Best first step to try is fix your fibre gap but stick with it as the symptoms might get worse before they get better. Oh and yes, intestinal gas is not a disease.