Gut health: Exploring the rainforest within

Imagine a lush tropical rain forest filled with a rich diversity of plant and animal life. This represents the complexity of our gut microbiome, an ecosystem residing in our digestive tract. Scientists are only beginning to unravel the far-reaching effects of gut health.

With surprising roles ranging from influencing our waistline and mood to promoting dental health and a clear complexion, the microbiome is a promising new frontier in medicine.

Increased awareness of how certain foods keep gut flora flourishing has sparked shifts in grocery store shopping and there’s a rising demand for probiotic-powered foods. Here’s what you need to know to nurture your gut microbiome.

Know the difference between probiotics and prebiotics

This dynamic duo has a harmonious relationship in the gut, working together to promote digestive health. Prebiotics are power food for probiotics. Probiotics are beneficial, living organisms that improve our immune system by helping to crowd out bacteria that can make us sick.

In addition, probiotics enhance absorption of nutrients from food and even help make energy-producing B vitamins.

Prebiotics are fibers in food that resist digestion in the upper digestive tract but are used as fuel by probiotics in the lower digestive tract. Probiotics rely on a steady supply of fuel from prebiotics so they can flourish. The best way to ensure that your probiotic population is happy and well-fed is to load up on fiber-rich plant foods.

Top sources of prebiotics include bananas, garlic, onions, leeks, artichokes, asparagus, whole grains and legumes like lentils, beans and peas. Be sure to gradually incorporate these foods into your diet and drink plenty of water to help your digestive system adjust to the increased fiber intake as it helps move things along.

Separate health from hype when shopping

Foods that are cultured or fermented naturally contain probiotics, but food companies are adding probiotics to processed foods such as energy bars and frozen yogurt. The potency of probiotic cultures can be drastically weakened when they are removed from their original source and added into these processed foods.

Kefir
Kefir has diverse probiotic strains that may improve lactose digestion among those who are lactose intolerant.

Sip the champagne of dairy

Cultured dairy products such as yogurt and kefir reign supreme as the most potent probiotic sources. Known as the champagne of cultured dairy because of its slight fizziness, kefir is a low-lactose, creamy drink made by adding “kefir grains” to milk, which cause a very unique fermenting process. 

Originating centuries ago in Eastern Europe, keifer has only recently become commercialized in the United States. While yogurt and kefir both contain beneficial bacteria, kefir hosts a more diverse population of probiotic strains, meaning it could offer added probiotic benefits, such as improving lactose digestion among those who are lactose intolerant.

Check the yogurt container

To make sure your yogurt really does have probiotic power, check for the “Live and Active Cultures” seal. Yogurts that say “heat treated after culturing” on the label mean the yogurt was pasteurized after the live strains were added, which deactivates the beneficial bacteria.

Check sugar content since sugar can work against probiotic benefits. Flavored yogurts that list sugar as the first or second ingredient can pack more sugar than a candy bar.

Choose food over supplements

Think twice before choosing a supplement over food. The journey probiotic supplements make from the lab to the gut is long and full of variables. The best and least expensive option for promoting good gut health is to enjoy foods that naturally contain live cultures.

The truth about gluten sensitivity

It seems like more and more items in grocery stores are popping up with “gluten-free” on their labels. For almost every food containing gluten, there is an equal option that is gluten-free. Even restaurants and bakeries are offering gluten free menu options.

It’s everywhere you look, so it must be healthy, right? Individuals are adopting the gluten-free lifestyle without fully understanding what it means for their health and diet. What exactly is gluten? Is it good for us, or bad? Gastroenterologist Dr. Eamonn Quigley answered these questions, along with others, about the ingredient.

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There are two main groups of proteins in gluten, called gliadin and glutenin.

Q: What is gluten?

A: Gluten refers to a group of proteins (gliadin and glutenin).

Q: What is the difference between celiac disease, gluten sensitivity and a wheat allergy?

A: Celiac disease refers to a clinical disorder where an immunological reaction to gliadin results in injury to the small intestine. The term gluten sensitivity is, in reality, the same as celiac disease and the idea that there are people sensitive to gliadin who do not have celiac disease is highly controversial. The same applies to the term “wheat allergy.”

All of these terms imply that there is an immunological reaction to a component of wheat (i.e. the gliadin fraction of gluten).  A wheat/gluten intolerance refers to individuals that get symptoms when they eat wheat-based products. While the cause of these symptoms is unclear, there is evidence that some of these symptoms may be due to carbohydrates, called fructans, that are also found in wheat, that some people find difficult to digest.

Q: What are the symptoms of someone who suspects they have a wheat/gluten intolerance?

A: They could have any one of a host of symptoms, but most commonly: diarrhea, bloating, or abdominal cramps.

Common symptoms of wheat/gluten intolerance are diarrhea, bloating and abdominal cramps Click To Tweet

Q: What are the symptoms of someone who suspects they have celiac disease?

A: In the past, symptoms of malabsorption such as diarrhea, weight loss, and vitamin/protein deficiency were used to identify someone with celiac disease. Nowadays, many people with celiac disease are detected because of mild anemia, osteopenia, iron deficiency, folic acid deficiency, infertility and other issues, even though they have little or no GI symptoms.

Q: Are there risks/benefits to going gluten-free if you are not allergic or intolerant?

A: There may be benefits, but that has been difficult to prove in large studies. The main drawbacks are cost and the possibility that you could be excluding foods that provide essential nutrients. Always check with your doctor or dietitian.

Q: Is gluten intolerance something someone grows into, out of, or is it for life?

A: If you have a true intolerance, it is permanent.

Q: Besides bread and products containing flour, what other food products contain gluten that consumers may not be aware of?

A: Barley and rye. In principle, oats should not be a problem, but there is evidence that oats may become contaminated by wheat during milling and preparation so many advise excluding oats as well. 

Q: Are there alternatives to foods containing gluten?

A: Yes, countless. There are many great suggestions from patient support groups such as CSA (Celiac Support Association). Find them at csaceliacs.org. Check out these Pinterest boards for more gluten-free recipes:

The gluten-free lifestyle isn’t intended for everyone. Although we may eventually find that there are health benefits to going gluten free, it is best to stick to a well-balanced diet for now. For some, going gluten-free isn’t necessary. However, for others, it’s a necessity. Listen to your body and talk to your doctor or nutritionist about the appropriate diet for your lifestyle.

Reviewed by Dr. Eamonn Quigley

Understanding inflammatory bowel disease

What do Amy Brenneman, an actress in “Greys Anatomy,” Cynthia McFadden, ABC News correspondent, and Shannon Doherty, TV favorite from “Beverly Hills, 90210,” all have in common? All three of these women and million others struggle daily with Inflammatory Bowel Disease (IBD).

Often referred to as the “bathroom disease”, IBD affects more than 1.4 million people in the United States. With no cure and many unknowns, Dr. Bincy Abraham, gastroenterologist at Houston Methodist Hospital, helps others to better understand the disease.

“Most patients who suffer from this disease can be helped by getting early access to care and early introduction of treatment to prevent long-term consequences,” Abraham said. “It is a disease that may be difficult to talk about. However, getting help as soon as symptoms start is better than having the disease get out of control.”

What is Inflammatory Bowel Disease?

IBD is a group of conditions that causes inflammation in the gastrointestinal tract, which plays a key role in the digestion process. IBD is a chronic, recurring condition and primarily includes ulcerative colitis and Crohn’s disease.

This CT scan shows Crohn's disease in a patient's stomach. Image source: Samir (Wikipedia)
This CT scan shows the location of Crohn’s disease in a patient’s stomach. Image source: Samir (Wikipedia)

What causes it?  

There is an increased risk of developing IBD if a family member has been diagnosed with it. However, most cases are sporadic. We know it is not fully genetic because even with identical twins, there is only a 40 percent chance the other will have the disease.

Too many antibiotics during youth could destroy good gut bacteria and increase a person’s risk. Also, according to the hygiene hypothesis, a lack of early childhood exposure to germs and infectious agents could suppress the natural development of the immune system.

Diet may also play a role in causing IBD. Research has shown that individuals that consume more red meat and fats, and have a low intake of fiber, fruits and vegetables may have a higher risk of being diagnosed with IBD.

Inflammatory Bowel Disease affects 1.4 million Americans Click To Tweet

What should you look for?  

IBD can cause symptoms that range from mild to severe. They can include:

  • Abdominal pain
  • Diarrhea
  • Bloody stools
  • Weight loss
  • Nausea and vomiting
  • Anemia
  • Fatigue

It is important to note that not everyone who has IBD suffers from these symptoms. These signs are also not specific to IBD either; people with irritable bowel syndrome (IBS) can also suffer from abdominal pain, diarrhea and nausea. However, the more alarming symptoms, such as bloody stools, weight loss and anemia, are signs a patient should get evaluated soon.

How to treat it?

If untreated, inflammation can damage the GI tract, making it harder to manage. There are many different medications for IBD, but deciding which one is best depends on multiple factors, such as:

  • Severity of the disease
  • Severity of symptoms
  • Age at diagnosis
  • Location of the disease

Another important aspect of managing and treating the disease is diet. Most sufferers are deficient in nutrients, so it is important to have a balanced diet. In those that have severe inflammation or Crohn’s disease with a stricture, they will need to follow a low fiber diet. There is also emerging evidence that vitamin D helps not only with bone health, but also helps regulate the immune system.

If medications or maintaining a better diet still does not help, surgery could be another option. However, this is best discussed with the gastroenterologist and a colorectal surgeon, as surgery may not always provide a cure, especially in Crohn’s disease.

To learn more about IBD, visit The Lynda K. and David M. Underwood Center for Digestive Disorders or call 713.441.9770.

Heartburn drugs: The potential for long-term side effects

Modern pharmaceutical drugs are developed with painstaking effort. The way the atoms of synthetic drugs are arranged can be crucial to a drug’s behavior. The nudging of a carbon-oxygen bond as little as one ten-billionth of a meter can make the drug impotent … or too efficient — and toxic. A little organic chemistry here and there can transform a dud into a life-saving miracle drug. Figuring out how to mass produce naturally-occurring drugs has had equally profound impacts on health care.

Yet no matter how effective a drug appears to be, even the world’s smartest biochemists and medical biologists can’t know with certainty a drug’s short- and long-term impacts — how a drug affects all parts of the body 2, 5 or 10 years into the future. There’s simply no substitute for careful, methodical investigation, long after a drug is approved by the FDA.

Some of the most effective drugs have turned out to be generally quite safe when taken daily for decades, like aspirin. Some statins used to control cholesterol levels, on the other hand, have been found to have negative effects on the nervous system and the liver. Long-term side effects don’t mean a drug is a failure, but knowing more about the drug helps patients and their doctors make better decisions about their long-term use.

The group of heartburn drugs known as “proton pump inhibitors” or PPIs, have been called miracle drugs, with some doctors going as far to suggest, perhaps jokingly, that the drugs are so useful, and heartburn so common, that they should be put in the water supply, as fluorine once was. The FDA estimates about 1 in 14 Americans has used PPIs. In 2009, they were the third-most taken type of drug in the U.S., accounting for $13 billion in sales.

But a study last year by Houston Methodist Chair of Cardiovascular Sciences John Cooke, M.D., suggests PPIs might have a surprising side effect — one totally unrelated to controlling excess acid in the gastrointestinal tract. Cooke’s group of Houston Methodist, Stanford University, and Imperial College London coauthors reported to the journal Circulation that PPIs may cause a permanent constriction of blood vessels, which could in turn cause chronic hypertension.

Heartburn drugs may cause a permanent constriction of blood vessels, resulting in chronic high blood pressure Click To Tweet

It was the first study to show how, exactly, PPIs might cause hypertension. Because this work was done in human tissue cultures and animal models, it was a first step. To know whether long-term use of PPIs increases blood vessel tension in living, breathing human beings, studies of a broad swath of regular PPI users is needed.

Cooke said his research group expects to publish some “very important” follow-up findings this year (2014), but stressed such investigations take time. It may be years before we fully know how the short- and long-term use of PPIs impacts cardiovascular health. Until then, the work must continue.