“Bad digestion is the root of all evil.” Hippocrates.

As physicians we’ve known for a long time the importance of gut function as it relates to health. However, as technology and understanding in science improves by leaps and bounds in other areas of the body the gut seems to be frequently ignored. Physicians fail to consider the gut as the root cause of common ailments such as autoimmune disease, psychiatric disease, neurodegenerative disease and inflammatory conditions. Gut function tends to be ignored until it deteriorates to the point that the gut itself becomes diseased with symptoms of irritable bowel syndrome, ulcerative colitis, Crohn’s disease and more. Evaluation of gut function can not only help heal disease but identification of early dysfunction can prevent tremendous suffering yet this screening is rarely done in traditional western medicine.

The gut is faced with a tremendous task. It processes between 3 and 7 billion tons of food throughout a human lifetime. That food is broken down through the process of digestion and contains not only critical nutrients but also potential toxins. As the nutrients are pulled from food into the body the remaining proteins and waste are kept on the inside of the gut and eventually passed. This filtering process is both critical and complex. The cells responsible for this vital function exist in a single layer throughout the entire gut. Together this layer is so massive that it would cover a tennis court is stretched out. Each cell is held together internally and to it’s neighbor by unique proteins. These proteins though are susceptible to damage from a number of potential sources both from within the body and from externally. When damaged the remarkable layer of cells starts to break down and allows the things that are supposed to stay out inside. Once inside these potential toxins are exposed to our immune system and havoc ensues.

The immune system has developed in step with the gut to accommodate the task at hand. 80% or more of the mass of the immune system lives just inside the cell layer that filters and processes our food. It stands guard to protect us from the numerous assaults that occur on a daily basis. However, when the system get’s overloaded, has genetic weakness or is dysfunctional from other causes the protective blanket fails and the toxic load filtering through can result in activation of the immune system with a variable response. Chronic inflammation is nearly universal but other diseases such as autoimmune, neurodegenerative and psychiatric effect people with unique genetic and environmental susceptibilities. These diseases generally occur long before gut pain and symptoms drive patients to see a specialist.

Identification of the reason for failure of the membrane lies at the heart of the art in treating dysfunction. Testing to understand which of two main pathways the system can fail will lead me down the road that identifies the root cause. These root causes can be chronic stress, adrenal dysfunction, food intolerance, parasite infection, mold exposure and more. A comprehensive approach is required to identify and rectify these issues. Once identified an optimized intervention including a discussion of the pillars of lifestyle are required. Appropriate nutrition, the right amount of exercise, optimized sleep and stress mitigation must be implemented. A functional approach to gut healing requires removal of offending items, replacing what’s missing, reinoculate with better bacteria, repairing the barrier and rebalancing the nutrients supporting the microbiome. This is not easy but it can be simple. It does however take time.

Our traditional health care system has little patience. The above plan cannot be implemented in a primary care 7 minute visit. Concierge doctor’s rarely have the functional knowledge to identify and even more rarely have the skill set to tackle this challenge. Picking the right provider is fundamental to your success. You must be an advocate for yourself, be willing to invest in your health and follow through with the lifestyle changes required. Success is imminent with the right approach but first you must identify the problem.

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