Digestive disorders are very common in medical practice. There are three main reasons for evaluating the GI tract:
1) Digestive problems such as gas, bloating, heartburn, diarrhea and constipation.
2) Autoimmune conditions such as psoriasis, lupus, multiple food sensitivities, inflammation, and pain.
3) Non-digestive conditions such as depression, anxiety, neurodegenerative disorders, diabetes, metabolism, obesity, chronic fatigue, and gut-brain axis issues.
The digestive tract affects all of these conditions and symptoms through a variety of mechanisms. Immune dysfunction due to food proteins, autoimmunity directed against intestinal cells, neurodegenerative changes affecting the enteric nervous system and infections. Identifying the underlying mechanism(s) is fundamental to developing treatment and understanding prognosis.
There are many underlying triggers. One of the main contributors is the lack of microbiome diversity. Studies indicate that Americans have the least varied microbiomes in the world. Other studies that look at aging and disability correlate a less diverse microbiome with greater infirmity and lack of independent function. The elderly with diverse microbiome populations function best as they age. A diverse microbiome plays a role in hormone metabolism, production of nutrients and neurotransmitters, detoxification, and activation of bioflavonoids and antioxidants.
Gut health is affected by many factors, including:
● Quality of the food supply. Highly processed foods and genetically modified foods are the main components of our manufactured food supply.
● Exposure to antibiotics -- both directly from treatment for infections or from consuming antibiotic-treated animal products.
● Environmental toxins, substances such as alcohol, and medications such as NSAIDS and aspirin.
One additional point that is sometimes overlooked is that there are some people who will never have their gut issues fixed. There are people with neurodegeneration or degeneration of myelin of their enteric nervous system, and those problems cannot be reversed. These people need to be given reasonable expectations and management support.
The IMNY Solution
As new data develops and as functional testing evolves, we modify our approach to diagnosis and treatment. In the past we relied primarily on the "5R approach": remove, replace, reinoculate, repair, and restore. Although this process is still utilized and helps in many of the more straightforward conditions, we find that many patients do not respond to treatments following this approach. Periodically, we need to step back and review the newest information, take a look at our approach, and adjust.
Currently, we take a hierarchical approach, beginning with the mouth and smell and going through the GI tract, top to bottom. A thorough physical exam is the starting point. Is there adequate production of saliva? Are there dental problems that affect chewing? Is there an absence of bowel sounds, which suggests impaired motility? Is there a loss of sense of smell that can predate neurodegenerative disorders?
In Parkinson’s Disease, loss of sense of smell may precede the onset of tremor by 20 years. But during this time there may be alterations of digestive function which will not necessarily respond to a 5R approach. In such cases we can develop individualized treatment protocols that are targeted to the specific underlying mechanism.
In many non-responders, treatment needs to be directed elsewhere than the gut. The first step is performing a thorough workup before we recommend treatment. This means identifying mechanisms of action and prognosis. Identifying intestinal permeability (leaky gut) requires an understanding the type of IP present and whether it is amenable to treatment. In some cases, we find that the problems cannot be cured but we can develop management strategies that put people into remission and improve quality of life, with the understanding they will have permanent digestive susceptibility and need ongoing care.