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The Guts of good health: Managing the "in-viroment"

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It will surprise no integrative or natural healthcare practitioner that one of the most important keys to good health is a healthy gut. Get the gut right and a remarkable transformation occurs in areas as diverse as fatigue. It sounds simple enough, but in my 30years of practice, nothing has proved more difficult to achieve than a truly healthy gut.

The gut should be self-regulating and resilient, recovering after famine or infection, and restoring normality swiftly to provide us with our nutrition. The gut should serve its master, right?

Maybe that’s where we have gone wrong. We have seen the gut as an organ whose primary job is to nourish its owner. We doctors have failed, until recently, to appreciate that the gut is not only far more complex than we had anticipated, but that its microbiome diversity and balance is a critical factor for the wellbeing of its owner. More than that, like most of biology and ecology, diversity and change over time are critical to normal function and good health.

This translates to good health requiring a variety of fresh foods in season and “winters”, periods of food shortage (especially of the sugars and starches) during which the gut flora reset themselves and increase in diversity at least once a year. This is not an easy thing to do given the availability of high carbohydrate foods all year round and the fact that supermarkets rarely close through winter.

Maintaining health requires high biodiversity of the gut flora, our “in-vironment”, just as a healthy planet requires biodiversity of our environment. Caloric restriction, especially carbohydrate restriction, is critical to building a diverse ecology and a healthy gut.

Restrictive diets work for a while, but lead to progressive dietary restriction which can sometimes verge on obsession, which definitely does not meet the nutritional requirements of a sick person. Each time the diet is restricted or changed, the person feels somewhat better. Moving to organic foods also helps, but does not restore normal gut function. As a result, many clients come to see me with highly restricted diets of organic and biodynamic rare foods that cost them a small fortune. The additional restrictions of salicylates, a natural pesticide found in many plants, can make good nutrition almost impossible.

One lesson, therefore, is that we need to become better at restoring people to a diet that fits the nutritional requirements and does not turn food into the “enemy”. A healthy diet requires that eating be a joyful and pleasurable act, and that the whole body relaxes into this process. Choosing food that does not cause harm is important, but finding a diet that brings joy and pleasure even when the person requires restriction is an art that we all need to learn.

Chewing food well is almost as important as food choice, starting digestion in the mouth. “Fast foods” are also fast because we are swallowing before we even have a chance for chewing and saliva to start the digestive process.

Why have we lost the biodiversity of gut flora required for good health?

One hundred years back, medicine’s main preoccupation was the treatment of infectious disease. The development of antibiotics changed that remarkably, but not without cost both in terms of microbial resistance and alteration of the normal microbial balance in the various cavities of those treated. There are many who suggest

that the long-term cost of antibiotic use is the distortion of gut ecology and that this directly leads to many of our modern inflammatory and degenerative diseases.

I feel that is only a small part of the story and that we have paid too little attention to the dietary changes that have happened over that century, all of which have impacted our relationship with our microbes. New research in areas as diverse as genetics, microbiology and evolutionary biology are converging to a new medical concept of
the gut and our relationship with our microbes. Research is placing a novel framework around observations and management familiar to every good clinician and natural healthcare practitioner.

Our microbiome is the boss of us, not the other way around. Gut microbes outnumber
our cells 10 to 1, wrapped up in between 200g and 800g of “muck” in our noses, mouths, skin, guts and genitals. They provide over 99% of the genetic diversity of “me” – I have around 25,000 of my own human genes, while gut prokaryotes contribute around 3.5 million genes in my own (relatively) healthy gut. My bugs live in biofilms and cover every mucus-secreting surface of my body. There are dozens of my bugs that could kill me stone-dead within days if given half a chance and tens of thousands of species that create an environment that never gives those nasties that chance. My flora transform phenols from plants into useful and non-toxic nutrients, and breaks down many environmental toxins as a front-line defence against pesticides and chemicals in foods.

We all need to relearn the skill of “gardening” our ‘in-vironment’. As practitioners, we need to take responsibility for re-establishing biodiversity and balance of our clients’ microbiome.

The research on prebiotics, probiotics, diets and stress are providing evidence for very familiar traditional interventions that are sustainable, and diagnostic tests that help us predict who will benefit from different dietary approaches.

What we do know is that the gut and its microbiome is critical to health in humans,
and mastery of this in our clients is the key to managing obesity, inflammation, auto-immunity and detoxification. If we serve our little masters well, they will protect and defend us and provide us with everything we need to feel healthy.

Please note: This article is based on the opinions of Dr Mark Donohoe


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Dr Mark Donohoe

Dr Mark Donohoe is one of Australia’s most experienced and best known medical practitioners in the fields of Nutritional and Environmental Medicine. He has a long history working in the emerging field of “integrative medicine”, and continues to bring orthodox and complementary medicine together in his medical practice. He is a regular guest on the FX Medicine Podcast and in 2019 became the host of FX Medicine's newest podcast series; FX Omics - blending genetics into the modern practice of personalised medicine.