Dr Dingle's Blog / metabolic syndrome
Treatments for obesity have been shown to reduce pain secondary to weight loss. Intestinal microbiota has been shown to influence obesity and pain sensitivity.
Physiological pain plays a life-essential protective role, while acute or chronic pathological pain indicates a medical problem that needs treatment and imposes a medical challenge. Neurotransmitters, immune cells, and hormones have been demonstrated to contribute in pathogenesis of chronic pain.
Pain threshold is influenced by several factors, including obesity, which alters adipose tissue metabolic and endocrine functions leading to alterations in systemic physiology including an increased release of fatty acids, hormones, and proinflammatory molecules that contribute to obesity associated complications. Studies have demonstrated that obese humans and rats are more sensitive to pain stimuli than normal weighted ones.
Previous studies have demonstrated a relationship between intestinal microbiota and diseases including pain disorders with probiotics having a positive effect.
In this study the mice taking probiotics had a significantly lower sensitivity to mechanical stimulation compared to their corresponding control. The results of this study suggest a protective effect of probiotics on nociception circuits, which propose a direct result of the weight reduction or an indirect result of anti-inflammatory properties of the probiotics.
Potential Nociceptive Regulatory Effect of Probiotic Lactobacillus rhamnosus PB01 (DSM 14870) on Mechanical Sensitivity in Diet-Induced Obesity Model
The intestinal microbiome is a plastic ecosystem that is shaped by environmental and genetic factors, interacting with virtually all of our organs, tissues and cells. One of the most important factors in regulating and controlling our microbiome is the pH or acid level.
While often mentioned in terms of the stomach the pH has a controlling role to play in the health of the whole GI tract from the mouth to the anus and changes in the “normal” pH anywhere in the gut can have large implications on the rest of the GI tract. The pH scale goes from 1 being very acidic to 14 being very alkaline. The level in our blood and tissues should be constantly around 7.36, neutral and the level in our GI trace varies from 1 to 8. We cover this a lot more in our book “Overcoming Illness” which focuses on the role of inflammation, oxidation and acidosis in illness.
After initial breakdown by chewing, food is churned by the smooth muscles of the stomach and is broken down by hydrochloric acid and stomach juices (enzymes). The pH of the stomach is highly acidic, around 1.5 (1.0-2.5) due to the hydrochloric acid which helps to kill harmful microorganisms, denature protein for digestion, and help create favorable conditions for the enzymes in the stomach juices such as pepsinogen. Not to mention sending messages along the GI tract that everything is working well in the stomach. If the pH is too high, say 3 or 4 (more alkaline) then the system does not work and you end up with digestive and health complications. For example, premature infants have less acidic stomachs (pH more than 4) and as a result are susceptible to increased gut infections. Similarly, the elderly show relatively low stomach acidity and a large number of people, more than 30%, over the age of 60 have very little or no Hydrochloric Acid in their stomachs.
Similarly, in gastric bypass weight loss surgery, roughly 60 percent of the stomach is removed. A consequence of this procedure is an increase in gastric pH levels that range from 5.7 to 6.8 (not 1.5) to making it more alkaline and as a result are more likely to experience microbial overgrowth. We see similar patterns in other clinical cases such as acid reflux in which treatment involves the use of proton-pump inhibitors and celiac disease where delayed gastric emptying is associated with reduced acidity and increased disease.
Unfortunately, acid reflux is often wrongly treated as a condition which involves the production of too much acid. It is in fact, the stomach finding it difficult to digest the foods, most commonly as a result not having enough acid to complete digestion and why medications (see later) which further reduce stomach acid have serious and deadly side effects on health, the digestive process and the gut microbiota. Acid reflux affects about 20% of the adult population and is much higher in older people which is consistent with the studies showing lower stomach acid as we age.
 Adbi. 1976; Martinsen et al., 2005.
 Carrion and Egan, 1990.
 Husebye et al., 1992.
 Machado et al., 2008.
 Amir et al., 2013.
 Usai et al., 1995.
Another reason to add some of the cabbage family to your daily diet, preferably raw is because of their gut healing properties and how they promote gut health through the gut microbiome. The Brassica family including cabbage, broccoli, brussel sprouts, kale, arugula (rocket), bok choy, cauliflower, collard greens, radish, turnip and others have been recognized for their gut healing and gut health properties for hundreds of years and modern epidemiologic studies have shown a frequent consumption of cruciferous vegetables is associated with lower risk of cancer, especially cancers of the digestive tract, bladder, breast, prostate, and lung. However, only now are we recognizing that many of these benefits are mediated through the microbiome and that their frequent consumption alters the composition of the microbiome.
Cruciferous vegetables are a rich source of glucosinolates a precursor to the Isothiocyanates (ITC), which exhibit powerful biological functions in fighting cancers, cardiovascular, neurodegenerative diseases and gut healing. The Isothiocyanates are a by product of specific plant enzymes (myrosinase) active during chewing or crushing when broccoli is consumed raw or lightly steamed, however, like all enzymes myrosinase is deactivated by cooking and ingestion of cooked broccoli typically provides only about one tenth the amount of isothiocyanates as that from raw broccoli. So to maximize the gut healing, gut health and overall benefits of these foods they are best eaten raw or just lightly steamed.
Instead when cooked cruciferous vegetables are consumed, gut bacteria are mainly responsible for ITC production in the gut. This is highlighted after taking oral antibiotics, the ITC’s availability and uptake decreases after eating cooked cruciferous vegetable. It also appears that there is considerable difference in the ability of individuals, due to individual differences in gut microbial community, to produce the isothiocyanates. Although, the gut community’s ability is altered over just 4 days. In one study feeding raw or cooked broccoli for four days or longer both changed the microbiota composition and caused a greater production of isothiocyanates. Interestingly, a three-day withdrawal from broccoli reversed the increased microbial metabolites suggesting that the microbiota requires four or more days of broccoli consumption and is reversible.
The lactic acid bacteria appear to have myrosinase-like activity and the fermented Brassica food products, such as sauerkraut and kimchi, are particularly rich in Lactobacillus, and a diet rich in Brassica may promote Lactobacillus growth in the colon.
Despite what we are often told the overwhelming evidence shows that Type 2 diabetes is a diet and lifestyle illness. It also shows that when you reverse the conditions that caused it the disease is also reversible.
Type 2 diabetes (T2D) is a chronic disease closely linked to the epidemic of obesity that requires long-term medical attention to limit the development of its wide range of complications. Many of these complications arise from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. Approximately 10% of the population of the USA and Canada have a diagnosis of T2D, and the morbidity and mortality rates associated with it are fairly high. The economic burden of T2D in the USA is $245 billion and around $20 billion in Australia.
This case documents three patients referred to the Intensive Dietary Management clinic in Toronto, Canada, for insulin-dependent type 2 diabetes. It demonstrates the effectiveness of therapeutic fasting to reverse their insulin resistance, resulting in cessation of insulin therapy while maintaining control of their blood sugars. In addition, these patients were also able to lose significant amounts of body weight, reduce their waist circumference and also reduce their glycated haemoglobin level.
These three cases exemplify that therapeutic fasting may reduce insulin requirements in T2D. Given the rising cost of insulin, patients may potentially save significant money. Further, the reduced need for syringes and blood glucose monitoring may reduce patient discomfort.
Therapeutic fasting has the potential to fill this gap in diabetes care by providing similar intensive caloric restriction and hormonal benefits as bariatric surgery without the invasive and dangerous surgery. During fasting periods, patients are allowed to drink unlimited amounts of very low-calorie fluids such as water, coffee, tea and bone broth. A general multivitamin supplement is encouraged to provide adequate micronutrients. Precise fasting schedules vary depending primarily on the patient’s preference, ranging from 16 hours to several days. On eating days, patients are encouraged to eat a diet low in sugar and refined carbohydrates, which decreases blood glucose and insulin secretion.
This means that patients with T2D can reverse their diseases without the worry of side effects and financial burden of many pharmaceuticals, as well as the unknown long-term risks and uncertainty of surgery, all by means of therapeutic fasting.
A short time between eating your last meal and sleep can increase your risk of breast and prostate cancer.
One of the most important factors in regulating our gut health, digestion and controlling our microbiome is the pH or acid level.
While often mentioned in terms of the stomach, the pH has a controlling role to play in the health of the entire GI tract from the mouth to the anus; changes in the “normal” pH anywhere in the gut can have major implications on the rest of the GI tract. The pH scale goes from 1, being very acidic, to 14, being very alkaline. The level in our blood and tissues should be constantly around 7.36, neutral, and the level in our GI tract varies from 1 to 8. We cover this a lot more in our book Overcoming Illness, which focuses on the role of inflammation, oxidation and acidosis in illness.
After initial breakdown by chewing, food is churned by the smooth muscles of the stomach and is broken down by hydrochloric acid and stomach juices (enzymes). The pH of the stomach is highly acidic, around 1.5 (1.0 to 2.5) due to the hydrochloric acid that helps to kill harmful micro-organisms, denature protein for digestion, and help create favourable conditions for the enzymes in the stomach juices, such as pepsinogen. Not to mention sending messages along the GI tract that everything is working well in the stomach. If the pH is too high, say 3 or 4 (low acidity and more alkaline), then the system does not work and you end up with poor gut health, digestive and health complications. For example, premature infants have less acidic stomachs (pH more than 4) and as a result are susceptible to increased gut infections. Similarly, the elderly show relatively low stomach acidity and a large number of people, more than 30%, over the age of 60 have very little or no hydrochloric acid in their stomachs.
Similarly, in gastric bypass weight loss surgery, roughly 60% of the stomach is removed. A consequence of this procedure is an increase in gastric pH levels that range from 5.7 to 6.8 (not 1.5) making it more alkaline and, as a result, more likely to experience microbial overgrowth. We see similar patterns in other clinical cases such as acid reflux in which treatment involves the use of proton-pump inhibitors and celiac disease where delayed gastric emptying is associated with reduced acidity and increased disease.
Unfortunately, acid reflux is often wrongly treated as a condition that involves the production of too much acid. It is, in fact, the stomach finding it difficult to digest the foods, most commonly as a result of not having enough acid to complete digestion. Medications (see my other posts) which further reduce stomach acid have serious and sometimes deadly side effects on health, the digestive process and the gut microbiota. Acid reflux affects about 20% of the adult population and is much higher in older people, which is consistent with studies showing lower stomach acid as we age.
 Adbi 1976; Martinsen et al., 2005.
 Carrion and Egan, 1990.
 Husebye et al., 1992.
 Machado et al., 2008.
 Amir et al., 2013.
 Usai et al., 1995.
Your gut microbiome has an astonishing ability to keep you healthy or ill. The list of diseases that we know of that are linked to the intestinal microbiota grows every day and these diseases are usually complex in terms of both how the disease develops and complications. Having the right balance of good microorganisms in our gut and good gut health is not only essential for good digestion but also in the prevention of or reversing chronic diseases, including.
Poor gut health has been linked with a long list of illnesses including
Asthma and Allergies
Cancers (especially digestive cancers, i.e. bowel and colon and brain tumours)
Inflammatory Bowel Disease including SIBO, Crohn’s and Ulcerative colitis
Cardio vascular disease
High blood pressure
Depression, Anxiety and Stress
Skin health and ageing
Eczema, Dermatitis and Psoriasis
Immune system function including susceptibility and tolerance to viruses and bacterial infections like cold and flu.
Colic, Constipation and Diarrhea
Celiac disease and Gluten and lactose intolerance
The list goes on. For example, even in the area of mental illness we have conditions such as
Depression, Anxiety and Stress
ADHD & Autism
Focus and memory
Learning, mental productivity and cognitive decline. As well as controlling some of our needs and desires i.e. food cravings and appetite, our relationships and our social interactions.
These are all impacted by gut health. Because of the role of inflammation, oxidation nutrition and the many functions of the gut microbiome there is not a health condition that is not influenced by the gut microbiome either directly or indirectly.
Because of the multiple functions of the microbiota dysbiosis can manifest as many and multiple health conditions often termed comormidity or multi morbidity. It is not one disease it manifests as many. For example, large studies have shown the multi-morbidity of eczema, rhinitis, and asthma. Inflammatory Bowel Disease (IBD) patients will also frequently suffer from rheumatologic manifestations, liver multimorbidities and lung, namely chronic obstructive pulmonary disease and bronchial asthma, bronchitis and other chronic respiratory disorders in the adult population, gallbladder disease, heart disease and associated morbidity and mortality, anxiety, stress and depression, as well as arthritis, psoriasis, and pericarditis. In one study of 47325 patients they reported 20 different immune mediate diseases associated with IBD including some of those mentioned above and celiac disease, type 1 diabetes, rheumatoid arthritis, and ankylosing spondylitis.
This evidence strongly shows any health condition will have many layers of disease occurring throughout the body at any one time that are related but not connected at the time of diagnosis.
Arguable the biggest health problem facing us today is gut health rivaling the current obesity crisis and tobacco smoking in its impact on our health. Every health condition is linked to gut health and gut healing either directly or indirectly through inflammation and oxidation. Historically every culture understood this and were involved in extensive practices of gut healing and even our own up until 60 or so years ago. The first thing health practitioners throughout history would do is to start to fix the gut.
Until recently the positive effects of the gut microbiome on our digestive system and health has been severely under rated. Wisdom of Chinese doctors from centuries ago, who somehow knew that the intestines were not merely a digestive organ, but the centre of health and wellbeing. Hippocrates was recorded as saying that all illness begins in the gut. Throughout history from the Egyptians till around 80 years ago medicine and the bowels were frequently mentioned in the same sentence and good health revolved around gut health.
Even today the nomadic Maasai tribes in Africa attribute most illnesses to the effect of “pollutants” that block or inhibit digestion. In these communities the plants are used to cure diseases served mainly as strong purgatives and emetics; they "cleanse" the body and digestive system from polluting substances.
With thousands of studies released each year the gut is known to play a major role in many health conditions including mental health issues, cardiovascular disease, allergies and asthma, autoimmune diseases, some cancers and even diabetes and weight gain. Many of these conditions which are now reaching epidemic proportions have been linked to a dysfunctional gut. Studies have shown a strong link between mental health issues including depression and what is called the gut brain axis. We also know the gut is the centre of our immune system and is strongly influenced by the gut microbiome. As a result the gut has a strong link with allergies and asthma. Peanut allergies for example are not caused by peanuts they are brought about by a dysfunctional gut microbiome.
Antibiotics and many gut medications used for controlling acid reflux have been shown to be devastating to gut health a healthy gut microbiome, as well as many of the chemicals we use around the homes and even the personal care products we apply to our skin. Even our activities either promote gut health and gut healing or harm it. Stress sends messages to the opportunistic (bad) microorganisms in the gut to tell them to start to take over from the good ones. Exercise promotes gut health and healing while no exercise or too much exercise does the exact opposite.
Fortunately, in animal studies we know that many of these conditions can be improved and even reversed if the gut microbiome is repaired. 50% of Parkinson’s Disease has been directly linked with poor gut health while improving the gut microbiome has been shown to dramatically improve symptoms.
The research also shows that while probiotics can be useful in gut healing, repairing the gut microbiome requires an understanding of what encourages a healthy gut microbiome in our diet and lifestyle as well as what causes a dysfunctional microbiome. We now know that all the healthy foods we eat, the vegetables, nuts, seeds, herbs, spices and fruit all feed the gut microbiome which then feeds us and looks after our health. All the studies on healthy diets from the Mediterranean to the original Japanese or the low inflammatory diet (DII) benefit us because they work through the gut to promote gut health and subsequently our health.