gut health2

The 5Rs: Rebalance

Christine Stubbe, ND
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The Rebalance phase was added to the 5R approach for restoring gut health as researchers and practitioners recognized the importance of lifestyle influences on the gut. In particular, the focus in this phase of the 5R cycle is on lifestyle management, including reducing stress, improving sleep, and increasing movement.

Stress: a universal trigger

According to Dr. Mark Hyman, 95 percent of all illness is caused or worsened by stress!

There are 2 branches of the nervous system: sympathetic and parasympathetic. The sympathetic branch is known as the “fight or flight” system (some people are now adding “freeze”), and the parasympathetic branch, “rest and digest”. It is important to have these two branches of the nervous system so we can appropriately respond to our environment. The problem most people deal with, is the stress of life becoming chronic stress, constantly activating that sympathetic fight or flight response, versus the rest and digest response. Dr. Neil Neimark, MD writes a comprehensive description of the fight or flight response and its effect on the body.

Essentially, our response to the environment gets converted into molecules. The “molecules of emotion” or “information substances” circulate throughout our body and can affect our mind, emotions, immune system and digestion. Cortisol is a hormone produced by the adrenal glands in response to a stressor, and epinephrine/norepinephrine commonly known as adrenaline/noradrenaline, are neurotransmitters released from the adrenal gland. Adrenaline is the quick response, whereas cortisol is slightly slower in its release. Once they reach their destination, they have an effect, and chronic exposure to these stress-induced substances can lead to chronic degeneration.

The word stress is usually associated with psychological distress. The body also experiences stress from physiologic triggers: skipping meals and letting blood sugar drop, extreme exercise, lack of sleep, and fighting chronic infections- all of these things can also raise cortisol levels.

Stress and the gut

How is it, that stress affects the gut? The hormones and neurotransmitters secreted during the fight or flight response have the effect of decreasing digestion. During times of stress, blood is shunted away from the digestive tract, because digestion is not priority in times of chaos and crisis when one should be fleeing. Dr. Amy Myers, MD explains that, when your stress response kicks in, your digestive system shuts down. If you’re running from a predator, you need blood flow concentrated in your limbs for fleeing and your brain for problem solving, not in your gut for digesting your lunch.” We are operating in survival mode more often than not and this effect leads to chronic wear and tear on the body.

Dr. Myers also says that under chronic stress, your body continuously cycles through periods of high inflammation, which can damage the gut lining, and a suppressed immune system, which leaves your gut vulnerable to pathogens you might be ingesting.” So the immune defenses are down, allowing for invaders to come in and cause damage.

The picture above shows that effect of stress on the gut physiology results in: alterations in gastrointestinal motility; increase in visceral perception; changes in gastrointestinal secretion; increase in intestinal permeability; negative effects on regenerative capacity of gastrointestinal mucosa and mucosal blood flow; and negative effects on intestinal microbiota.1

The gut-brain connection

We’ve all heard the phrases related to emotion like “gut feeling”, “gut instinct”, “trust your gut”, “what is your gut telling you?”, or “butterflies in the stomach”. Why? Many people might view the brain and gut as two distinct organs that since not adjacent to each other, really have little relation. The brain, part of the central nervous system which includes the brain and spinal cord, has many functions and is thought to be the central command, controlling the rest of the body. This control happens via nerve connections, and molecules such as neurotransmitters and hormones that are sent via chemical signals that circulate in the bloodstream to reach their target organs. The brain sends out information and receives information via these routes. The gut has its own enteric nervous system that sends out similar information and communicates with the brain and the rest of the body. The process is bi-directional, explains psychiatrist Dr. Kelly Brogan, MD, where the vagus nerve is the primary line of communication between the systems and that inflammatory molecules are messengers.

This fascinating connection has led researchers to study the role of the GI tract in psychological diseases such as depression, anxiety, autism, schizophrenia and others. In fact, there is a specific protocol, called the GAPS protocol, where GAPS stands for Gut and Psychology Syndrome. Dr. Natasha Campbell-McBride, MD, creator of the GAPS protocol, says “The purpose of the treatment is to detoxify the person, to lift the toxic fog off the brain to allow it to develop and function properly. In order to achieve that we need to clean up and heal the digestive tract, so it stops being the major source of toxicity in the body and becomes the source of nourishment, as it is supposed to be. As more than 90% of everything toxic floating in our blood (and getting into the brain) comes from the gut, healing it will drop the level of toxicity in the body dramatically.” Here we can see the importance of the 5R approach in having a healthy mind.

How is the gut the “second brain?”

We are now learning that while the brain does control a lot of processes in the body, the gut also “has a mind of its own”. Dr. Josh Axe, DC tells us, the gut is home to the enteric nervous system. Separate from the central nervous system, the ENS is made up of two thin layers with more than 100 million nerve cells in them — more than the spinal cord. These cells line the gastrointestinal tract, controlling blood flow and secretions to help the GI tract digest food. They also help us “feel” what’s happening inside the gut, since this second brain is behind the mechanics of food digestion. 

While the second brain doesn’t get involved in thought processes like political debates or theological reflection, it does control behavior on its own. Researchers believe this came about to make digestion more efficient in the body; instead of having to “direct” digestion through the spinal cord and into the brain and back, we developed an on-site brain that could handle things closer to the source.

But because this second brain is so complex, scientists aren’t convinced that it was designed as just a way to aid in digestion. So while it isn’t capable of thoughts, it does “talk” to the brain in major ways.”

Dr. Kellyann Petrucci, ND, tells us that the gut sends more messages to the brain than the brain to the gut. Dr. Petrucci says, Because the gut is home to more than 90% of the body’s serotonin and about 50% of its dopamine, people suffering from depression or anxiety often experience profound relief when they improve their diets. I’m able to wean many of my patients off of antidepressants and anti-anxiety drugs entirely, simply by getting them to eat healthy, natural foods.”

The Mind Gut Connection by Emeran Mayer e1519250528838

The microbiome and the gut-brain connection

The microbiome is a key player in the gut-brain connection. Dr. Doni Wilson, ND, tells us that, “the bacteria in your gut communicate with the rest of your body by producing substances, triggering inflammatory messages and/or by sending signals via your nerves. If or when the balance of bacteria is disrupted, that has the potential to send a very different message to your nervous system and influence your mood, memory, and focus.”

In an interview Dr. David Perlmutter conducted with Dr. Emeran Mayer regarding his research and book, The Mind-Gut Connection, we learn that microbes in our gut have receptors for neurotransmitters such as serotonin and norepinephrine. This is an example of how the brain communicates with the gut. The bacteria of the gut also produce serotonin (Rountree webinar)

A dysbiosis can trigger alarming signals, but thankfully there are things we can do to correct a dysbiosis as we learned in the “Repopulate” phase of the 5R approach. A special class of probiotics called “psychobiotics” are being marketed to correct microbiome imbalances that result in mood disorders. Neuroscientist John Cryan tells us in a TEDMED video about the gut brain connection and that we really just don’t have enough information yet to prescribe specific probiotics for mood. Stress can also have an impact on the microbiome and an imbalanced microbiome can be a source of stress.

The role of stress in autoimmune health

A scientific article on stress as a trigger of autoimmune disease states, Unfortunately, not only does stress cause disease, but the disease itself also causes significant stress in the patients, creating a vicious cycle.”2 As discussed above, the gut is greatly affected by stress, and we learned that leaky gut can be one of the factors leading to eventual autoimmune disease. Inflammation is another factor that promotes autoimmune disease. Researchers state that, When under stress, cells of the immune system are unable to respond to hormonal control, and consequently, produce levels of inflammation that promote disease. Because inflammation plays a role in many diseases such as cardiovascular, asthma and autoimmune disorders, this model suggests why stress impacts them as well.” This mechanism is explained by the stress hormone cortisol: “prolonged stress alters the effectiveness of cortisol to regulate the inflammatory response because it decreases tissue sensitivity to the hormone. Specifically, immune cells become insensitive to cortisol’s regulatory effect. In turn, runaway inflammation is thought to promote the development and progression of many diseases.”

How stress affects bodies with autoimmune disorder

Dr. Amy Myers, MD lists stress as one of 5 underlying causes of autoimmune disease and says that, “once the autoimmune response is in place, immediate stress only exacerbates it.” It is important for people with autoimmune disease to be aware of their stress triggers and work actively to have better stress management to avoid disease flare-ups.

  1. Konturek PC, Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. J Physiol Pharmacol. 2011 Dec;62(6):591-9.
  2. Stojanovich L,Marisavljevich D. Stress as a trigger of autoimmune disease. Autoimmun Rev. 2008 Jan;7(3):209-13. doi: 10.1016/j.autrev.2007.11.007. Epub 2007 Nov 29.
  3. Curr Opin Clin Nutr Metab Care.2009 Sep;12(5):533-8. doi: 10.1097/MCO.0b013e32832e6776.
  4. The impact of physical exercise on the gastrointestinal tractde Oliveira EP1,Burini RC.

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