Dr Dingle's Blog / microbiome
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.
The most important aspect of dysbiosis is that a loss of total microbial diversity which represents the first link in the chain of events leading to the development of local and body wide inflammation. Multiple human conditions have been associated with dysbiosis, including autoimmune and auto inflammatory disorders, such as allergies, cardio vascular, metabolic disorders (diabetes, obesity and non-alcoholic fatty liver disease), various cancers and inflammatory bowel disease such as Crohn's and ulcerative colitis (UC), celiac disease, and neurological disorders including autism.
Once inflammation starts it appears that these opportunistic microorganisms are able to exploit the inflamed environment and expand their numbers to become an even bigger problem.
There appear to be three types of dysbiosis that more often than not, occur together to create the problem. These include (i) loss of beneficial microbial organisms perhaps through the use of antibiotics, (ii) expansion of pathobionts or potentially harmful microorganisms as a result of too much processed foods and (iii) loss of overall microbial diversity. It is likely that dysbiosis encompasses all three of these manifestations at the same time to influence disease.
The challenge is that the Dysbiotic microbial ecosystem can become resilient over time and may become hard to alter. In one study while dieting rapidly reversed the metabolic problems associated with a high fat diet, the dysbiosis in mice after a 4-week high fat diet persisted up to 21 weeks after returning to normal chow diet. It did however change after 21 weeks.
 Milani et al., 2016.
 Chow et al., 2011.
 Baumler and Sperandio, 2016.
 Del Chierico et al., 2012.
 Konig et al., 2016.
 Spees et al., 2013.
 Petersen and Round, 2014.
 Thaiss et al., 2016.
The integrity of our gut and our gut health is so important to our health but has largely been ignored until recently. The mucous membrane absorbs and assimilates foods and serves as a barrier to pathogens and other toxic substances. When this integrity is compromised the permeability of the gut may be altered, gut function erodes and we end up with many health conditions associated with inflammation and leaky gut.
The gut lining is composed of close fitting, thin cells separated by tight junctures, like a thin protein mortar. When the barrier is disrupted the intestines permeability increases allowing larger particles, bacteria, undigested foods or toxins to cross the barrier. This intestinal permeability, called leaky Gut, is linked with virtually all the gut related disorders including ulcerative colitis, Crohn’s disease, celiacs disease, and auto immune conditions including inflammatory joint disease, ankylosing spondylitis, juvenile onset arthritis, psoriatic arthritis, diabetes mellitus type one and primary biliary cirrhosis.
To maintain integrity and normal function of intestine, a delicate equilibrium must be reached between the microbiota and intestinal immune system. In a healthy body the immune system protects us against invasion and controls the commensal microorganisms. In return the beneficial bacteria provide essential nutrients to the gut cells and promote healthy immune responses in the gut.
A healthy microbiome contributes to the maintenance of intestinal epithelium barrier integrity maintaining the tight junctures, promoting intestinal cell repair, and even ensuring a healthy rate of cell turnover. It does this by maintenance of local cell nutrition and circulation and protection against pathogenic microorganisms.
Unlike most other cells in the body that get their energy and nutrients from the blood supply, more than 50% of the energy needs of the small intestine and more than 80% of the energy of the large intestines (where most of our microbiome is) comes directly from the food in the gut. This is not just a one off but with each turning over of gut cells which is over a period of just days, the barrier has to be continually re-established. The end result of this mutually beneficial co-habitation is a symbiotic relationship between the two partners, us and our microbiome. Any change in the relative proportions of the different bacteria alters the subsequent nutrients available and maintenance and protection for the digestive tract. If the right food and conditions are not there for a healthy microbiome then the nutrients are not available for the gut wall and the cells are damaged leading to damage to the integrity of the gut wall and leaky gut. This highlights the importance of eating the right foods for the microbiome to do their job and to maintain optimal gut health.
 Magalhaes et al., 2007.
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.
Irritable or Inflammatory Bowel Syndrome (IBS) affects an estimated 14.1% of the US population and 11% of the global population. IBS is characterized by chronic abdominal pain, gas, cramping, bloating, constipation, and diarrhea. More than one-half of all patients with IBS suffer from depression or anxiety. Missed work, social interactions, and travel are among the top stressors for these individuals. Many studies have shown a compromised gut microbiome to be associated with IBS.
In this study a 53-y-old Caucasian patient had signs of irritable bowel syndrome (IBS; gas/bloating, gastroesophageal reflux), fatigue, and sleep disturbances. He also noted a history of chronic sinusitis, seasonal allergies, multiple chemical sensitivities, and right knee pain (3 surgeries).
Over the course of 6 mo, the patient was treated using an elimination diet, lifestyle modifications, botanicals, and dietary supplements to address the underlying cause of issues. His symptoms decreased and quality of life increased, resulting in the resolution of his IBS symptoms, improved sleep, and increased energy levels.
This case illustrates the usefulness of diet and lifestyle changes to improve and eliminate chronic gut issues.
Here is a quote from the patient
Patient Perspective. “I feel better than ever—even better than in my 20s. I went into this process with a high desire to feel better since my gut symptoms and fatigue began to impact everything I enjoy in life—golf, cycling, and the outdoors, but I was a little hesitant knowing it would involve so many changes. I thought it would be a difficult process, but it really wasn’t once I established my lifestyle, diet, and supplement routines. The hardest part of treatment was going 100% gluten free. Had I known I would feel this good, I would’ve done this long ago. Finding the root causes and making lasting lifestyle changes are the key to health. Working with a knowledgeable practitioner makes all the difference!”
Most people have their own routine and go to the bathroom/toilet the same number of times per day and at around the same time. A person's bowel movement routine is unique to them, and is determined by a number of factors such as diet and what is normal for one person may be abnormal for another. However, stool frequency should be between one and three times a day. If you eat 2 or more times a day you should go at least once a day.
The poo should also be soft and easy to pass but not runny.
The three major ingredients in your feces are water, fibre and microorganisms. If you have plenty of these and still not toileting properly then there may be a physiological reason for low toilet frequency. If your central communication system, your spine, is not in alignment then you may also have some gut problems. I suggest you see and oseotepath or chiropractor. They are not just for back pain. Other critical factors which can have a big impact include the low level of physical activity and or too much stress. Stress can shut down the whole system so do not underestimate the impact it can have on your digestion.
Source. Gut Secrets
If I came home sick from anywhere as a child my mums first question was always, “have you been to the toilet?” I didn’t realize the significance of this until much later and I don’t think my mother even realized what she fully meant. Except that our poo is one of the best and of course the simplest signs of our inner health and therefore our outer health as well. Our poo (feces) can tell a lot about our health and is made up primarily of microorganisms, fibre other undigested materials and water. Living bacteria represent 80% of fecal dry weight. The regularity and frequency also tells you a lot about your internal operating system and the likelihood of you suffering chronic illness. Well, before it may even be diagnosed by modern medical systems. Luckily I learnt this lesson well. Around 2009 I was called over to see my mother as the doctors thought she was dying. When I arrived she was in a delirious state and getting worse. She hadn’t been to the toilet for 10 days in hospital and we were all worried about her. I went into town brought a vegetable smoothie and carried it back to the hospital. I was able to mix in some “super probiotics” (1 trillion) into her smoothie and later which she sipped through the day. The following day, less than 24 hours she had regained her composure. We repeated this twice a day for the week and she walked out of hospital. At this stage the nurses had cottoned on to what we were doing and were asking questions but did not want to take it past that.
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 well being. Hippocrates was recoded 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.
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. While studies of the great apes show they self-medication to control intestinal parasite infections and gut problems across Africa. Chimpanzees (Pan troglodytes) for example, swallow the leaves of certain plant species whole, without chewing to aid expulsion of certain parasites. Swallowing rough or bristly leaves increases gut motility causing expulsion of adult worms, which disrupts the nematode’s life cycle and likely reduces worm burdens.
 Bussmann et al., 2006.
 MCLennan and Huffman, 2012.
 Huffman and Caton, 2001.
Dr Dingle's WA. Gut Healing Tour
Perth May 9
Bunbury May 29
Busselton May 31
Albany June 6
Despite what people may think much of medicine is based on myth. Particularly when it comes to patient care and medication use. One big myth shattered this week is that we don’t have to finish the course of antibiotics. In fac,t the evidence is the opposite and finishing a course of antibiotics may lead to increased bacterial resistance. The one thing it was supposed to stop. However, the over prescription and overuse of antibiotics does contribute to major health problems, especially with all the information coming out on the importance of the gut microbiome and how antibiotics can be so devastating to your microbiome.
Avoiding overuse requires healthcare professionals and the public to be well informed about antibiotic treatment. Public communication about antibiotics often emphasises that patients who fail to complete prescribed antibiotic courses put themselves and others at risk of antibiotic resistance. However, the idea that stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence, while taking antibiotics for longer than necessary increases the risk of resistance. Without explicitly contradicting previous advice, current public information materials from the US Centers for Disease Control and Prevention (CDC) and Public Health England have replaced “complete the course” with messages advocating taking antibiotics “exactly as prescribed.”
With little evidence that failing to complete a prescribed antibiotic course contributes to antibiotic resistance, it’s time for policy makers, educators, and doctors to drop this message.
Since 2006 there has been a large body of scientific evidence showing the gut microbiota is interlinked with obesity and other metabolic conditions including type 2 diabetes. Probiotics are live micro-organisms that confer health benefits to the host and prebiotics are fibers that selectively improve the growth of beneficial gut microbes. Previous animal studies have shown probiotics prevented weight gain, improved insulin sensitivity, as well as reduced endotoxemia and tissue inflammation
In a study of 225 healthy volunteers randomized into four groups those taking the prebiotic with the probiotic or the probiotic alone improved weight. The prebiotic with probiotic group showed a − 4.5% or 1.4 kg difference to the Placebo group, and the probiotic group alone had a − 3.0 reduction in body fat. Changes in fat mass were most pronounced in the abdominal region, and were reflected by similar changes in waist circumference. Both groups also saw a reduction in inflammation.
This clinical trial demonstrates that a probiotic product with or without dietary fiber controls body fat mass and also reduced waist circumference and food intake.