A new study, published in the European Journal of Clinical Nutrition, demonstrated a connection between diet, and stool pH and bacterial levels in adults.¹ The researchers studied stool samples from vegetarians, vegans, and omnivores. They found lower levels of potentially pathogenic bacteria, like E. coli, in people consuming the vegan or vegetarian diets. What they also found, in conjunction, was a decrease in stool pH level with decreases in consumption of animal proteins. Those on the omnivore diet had a stool pH of 6.9; those on the vegetarian diet (which included dairy and eggs) had a stool pH of 6.6; and those on a vegan diet (no animal proteins) had a stool pH of 6.3.

The higher pH in the omnivore diet is explained in part by an increase in the production of alkaline metabolites by enhanced growth of the protein-digesting putrefactive bacteria in the gut. That’s right—a diet high in animal protein promotes increased putrefying activity of gut bacteria, raising the pH of stool and making products like putracene, cadaverine, and nitrosamine, which could lead to colon cancer. Diets lower in animal protein and—this is key—higher in fiber promote gut bacterial activity that produces more acid via production of the beneficial short-chain fatty acids (SCFAs) butyrate, propionate, and acetate, promoting a more acidic environment in the gut.

The change in pH levels explains why potentially pathogenic bacteria were increased in the higher pH (more alkaline) stools of people consuming an omnivorous diet. Lower pH ranges do not support the growth of potential pathogens, which thrive in the higher pH range over 6.5.^2,3 So I say, stay alive under 6.5!  

Here is a major point. The lower pH may be mainly a biomarker indicating the production of the SCFAs, particularly butyrate. Butyrate is a major fuel for the colonocytes, and is critical for optimum colon health. Butyrate also affects nuclear transcription in a positive way. In other words, when colonic cells are under attack from absorption of free radicals from fecal material (more likely to happen with chronic constipation), the nucleus, under stress, sends a message to the cell: either commit suicide (apoptosis) or produce more damaged cells (cancer).  Butyrate is more likely to promote apoptosis, preventing cancerous cells and allowing new cells to come in and maintain a healthy colon lining.

However, we must always remember everything is a question of balance.  All of the SCFAs including butyrate come from the fermentation of soluble fiber from plants by commensal bacteria. Too much fermentation with too low of a pH (or too much acid) can damage the colonic lining creating increased permeability problems leading to numerous problems including immune imbalances which can have total body effects.

The researchers also found a decrease in levels of Bifidobacteria and Bacteroides in the people on a vegan diet. This is in contrast to other studies that have found increases in Bifidobacteria, and seems an anomalous finding, since high-fiber diets support the growth of Bifidobacteria, while suppressing the growth of potential pathogens. Perhaps a closer look at the diets would be in order. Many vegetarians and vegans eat high amounts of refined carbohydrates, and too much fats and oils which do not promote healthy Bifidobacteria levels.

The researchers state, “In addition to age, gender and diet, factors such as microbial interaction, food transit through different intestinal compartments with different bacterial colonization density, availability of nutrients, colonic supply, sulphate and bile acids, and bacterial adaptation may all be involved in the composition and activity of colonic microflora. This may help in understanding the lower abundance of Bifidobacteria and Bacteroides species in vegans and vegetarians, which was not linked to stool pH.”

At any rate, all diets—vegan, vegetarian, and omnivore—will benefit by adding probiotic-rich foods along with supplements to help replenish levels of the beneficial Bifidobacteria and Lactobacilli. These bacteria, along with a high-fiber diet high in vegetables and fruits, help to lower the pH in the intestines by producing the nourishing SCFAs.

Incidentally, this topic can confuse the message of the benefits of a high-alkaline diet. You may have heard that a diet high in animal protein, sugar, and refined carbohydrates creates acidity in the body. Yes, these foods do lower urine and salivary pH levels, which are thought to be associated with bone mineralization, a process that helps neutralize acidity by pulling alkaline minerals from bone.  Chronic low grade acidity (metabolic acidosis) also causes excess loss of calcium, magnesium and potassium in the urine. Diets high in vegetables and fruits, on the other hand, produce more alkaline urine and saliva levels, which is associated with reduced bone loss and reduced loss of minerals in the urine.⁴ These variabilities in optimum pH in different areas show the body’s ability to change based on local environment and physiologic and biochemical requirements.

The bottom line is, healthy pH levels, whether in the colon or systemic, are found when you eat a high-fiber diet, high in vegetables and fruits, healthy proteins, and healthy fats. Complement this with foods and supplements high in beneficial bacteria, omega-3 fatty acids, and digestive enzymes, and you will be supporting optimal health (which begins in the digestive system).

References

1.  J. Zimmer, et al., “A vegan or vegetarian diet substantially alters the human colonic faecal microbiota.” Eur J Clin Nutr. 2012 Jan;66(1):53-60.
2. J. Adler, “A method for measuring chemotaxis and use of the method to determine optimum conditions for chemotaxis by Escherichia coli.” J Gen Microbiol. 1973 Jan;74(1):77-91.
3. G.R. Gibson, et al., “Prebiotics and resistance to gastrointestinal infections.” Br J Nutr. 2005 Apr;93 Suppl 1:S31-4.
4. B. Dawson-Hughes, et al., “Treatment with potassium bicarbonate lowers calcium excretion and bone resorption in older men and women.” J Clin Endocrinol Metab. 2009 Jan;94(1):96-102.

Leonard Smith, M.D.

Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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Inflammatory bowel disease, or IBD, is characterized by inflammation of the intestines, and is most notably represented as Crohn’s disease, which usually affects the small intestine, but may affect other areas of the digestive tract, and ulcerative colitis, which usually affects the large intestine, or colon.

Two recent studies, presented at the American College of Gastroenterology’s 76^th Annual Scientific Meeting, discovered a connection between IBD and vitamin D status, or with latitude of geographic location at age 30. Latitude has been found to be strongly correlated with vitamin D status, because vitamin D is most commonly obtained through UV sun exposure. Those people living at higher latitudes are more likely to have insufficient vitamin D status; thus, the vitamin D connection to IBD.

In one study, it was found that people who lived in northern US latitudes at age 30 were more likely to later develop IBD. The researchers stated, “This differential risk may be explained by differences in UV light exposure, vitamin D status, or pollution.” The risk of developing Crohn’s disease was 50 percent lower in those people living in southern latitudes at age 30, and for ulcerative colitis, it was 35 percent lower.

In the second study, vitamin D3 supplementation was given to Crohn’s patients with low blood levels of vitamin D. The low-dose group received 1,000 IU daily, and the high-dose group received 10,000 IU daily. After 26 weeks of supplementation, there were differences in vitamin D levels, but more importantly, there was a significant improvement of disease symptoms in the high-dose compared to the low-dose group.

So many conditions are affected by insufficient vitamin D levels. If you do not know your vitamin D level, get it checked, even if you live in the south. Most integrative doctors recommend a vitamin D level of at least 50 ng/dL.

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The gut-brain axis involves the connection of the gut to the brain. This connection goes in both directions—from the brain to the gut and from the gut to the brain. In one way, the gut-brain axis is connected by the vagus nerve—a large nerve connecting the brain to the intestines and other organs. The vagus nerve both sends messages to various organs, and also receives messages from these organs—including the gut—to send to the brain. A new study has established the vagus nerve as a main form of communication from the gut bacteria to the brain.

In an animal model, researchers were able to show that mice fed the probiotic Lactobacillus rhamnosus JB-1 showed less stress-, anxiety-, and depression-related behaviors than did mice not fed the bacteria. Further, the probiotic mice had lower levels of the stress hormone corticosterone, and they also experienced changes in the expression of receptors of the neurotransmitter GABA (gamma-aminobutyric acid) in the brain—highlighting the ability of probiotics to directly affect brain chemistry under normal conditions.

This is an early study that will need to be replicated in humans, but studies like these pave the way for our understanding of the complexities of the gut connection. Did you ever think your gut could have such an effect on your health? If you read my blog regularly, I sure hope so!

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Belly fat, or visceral adipose tissue (VAT), is the fat that accumulates around the organs in the abdomen. It is strongly related to metabolic disorders including insulin resistance, fatty liver and inflammation. Because of the close proximity of belly fat to the intestines, and the ability of gut bacterial toxins to affect inflammation outside the gut, the relationship of increased intestinal permeability, or leaky gut, to increased abdominal fat has been investigated. 

Indeed, previous studies in animals and in people with illnesses like Crohn’s disease¹ and non-alcoholic fatty liver disease (NAFLD), have found a link between leaky gut and belly fat. Until recently, however, no studies had been done in healthy humans. Now the picture is all coming together nicely, as a new study highlights.

In 55 healthy women, intestinal permeability was estimated by measuring urinary excretion of ingested nonmetabolizable sucralose and mannitol. (They measure the ratio of excreted sucralose to mannitol—if the sucralose level is high, it means it leaked through the gut, even though it shouldn’t.) Further, imaging was performed of subcutaneous fat (fat just under the skin) visceral fat, and liver fat. The researchers found that increased leaky gut was associated with increases in both visceral fat and liver fat content in healthy women.² This is important because previous studies have found this in people with illnesses, but it was not known if leaky gut could was associated with belly fat in healthy individuals. Now we have a better picture of this gut connection.

The women in the study had no history of gut disorders, yet some of them still had leaky gut, and those with the worst leaky gut also had the most belly and liver fat. The researchers stated, “The current findings suggest that even without pathologically compromised gut function, intestinal permeability still appears to play a role in visceral adipose and liver fat accumulation.” Importantly, they go on to mention the role that the gut microbiota plays in this picture. Alterations in gut bacteria composition has been associated with metabolic dysfunction,³ and gut bacteria help regulate gut barrier function,⁴ they mention.

They conclude, “Our data suggests that intestinal permeability may be an important part of the link between diet, gut microbial balance, inflammation, and metabolic disorders. The present findings are consistent with the emerging role of gut in metabolic health.”

Abdominal fat has even been considered an organ of its own, due to the many chemicals and hormones it produces, just as organs do. The role of VAT as a contributor to metabolic diseases is possibly the most important factor to consider when trying to reduce disease risk. That the accumulation of this belly fat is related to the gut, and might even originate in the gut, takes our search into the prevention of diseases yet one more step closer to the source. A healthy gut is truly the foundation of total body health.

References

1. Desreumaux P, et al., “Inflammatory alterations in mesenteric adipose tissue in Crohn’s disease.” Gastroenterology. 1999 Jul;117(1):73-81.
2. Gummesson A, et al., “Intestinal Permeability Is Associated With Visceral Adiposity in Healthy Women.” Obesity (Silver Spring). 2011 Aug 18. [Epub ahead of print]
3. Cani PD and Delzenne NM, “The role of the gut microbiota in energy metabolism and metabolic disease.” Curr Pharm Des. 2009;15(13):1546-58.
4. Sharma R, et al., “Molecular modulation of intestinal epithelial barrier: contribution of microbiota.” J Biomed Biotechnol. 2010;2010:305879.

Leonard Smith, M.D.
Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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Renew You Challenge

Let’s start this week off right!

Weekly challenge (I mean opportunity!) to help set you off on the right foot and in the right direction for bringing health to your week. You could even add it to your calendar. Join us!

Many people who have arthritis take non-steroidal anti-inflammatory drugs (NSAIDs) to manage pain. NSAIDs can wreak havoc on the stomach lining, however, so acid-suppressing drugs are often prescribed along with the NSAIDs to help protect the stomach (note the Band-Aid on top of Band-Aid method of medicine here).

The acid-suppressing drugs, or more specifically, proton-pump inhibitors (PPIs), have been found to protect the stomach of people on long-term NSAIDs, yes. But from the results of a new study, it appears that the damage is only displaced further down the digestive tract—to the intestines. So instead of stomach ulcers, intestinal damage occurs, increasing the risk of developing intestinal ulcers, which can be more dangerous and difficult to treat.

The dangers of acid-suppressing medications are many. It’s a topic I’ve touched on before. I’ve even video-blogged about it. So many people are taking these medications long term when they aren’t designed for such use. If your doctor has given you acid-suppressing medications, be sure to inform yourself about the side effects of taking these drugs long term.

This week, if you know someone on acid suppressors for heartburn, open up the dialogue about how dietary and lifestyle factors may be at the root cause of upper digestive symptoms. If you pay attention to what you eat and how you eat, for example, you may be able to make changes that relieve your heartburn. If you know someone on these medications to protect against NSAID damage, they may want to think twice, based on this recent study.

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An interesting study published in the journal Obesity points out that eating more soluble fiber, like that from apples and beans, and moderate exercise will selectively decrease belly fat.¹ The authors don’t seem to know why it is selective to belly fat, and not subcutaneous fat (fat just under the skin). I think one reason would be that the intake of high amounts of soluble fiber promotes growth of beneficial bacteria that produce short chain fatty acids, both of which may control some of the inflammation in the gut. Chronic inflammation causes marked increase in insulin resistance, and therefore, storage of more belly fat. Controlling this inflammation is key, and as we see, can be done by consuming soluble fiber.

Here are some recently discovered points that support the above concepts:

• Eating a high fat and sugar diet decreases the number of beneficial bifidobacteria and increases the number of potentially pathogenic gram negative bacterial species in the gut.
• As these potentially pathogenic bacteria die they release cell wall lipopolysaccharides (LPS) which happen to also be better absorbed through the gut lining when eating a high-fat, high-sugar, low-fiber diet on a regular basis. The LPS molecules easily pass through the epithelial gut lining and hit the gut immune system where they activate white blood cells including neutrophils, monocytes, and macrophages that all then release inflammatory cytokines: TNF alpha, IL-6 and IL-1 beta. These inflammatory cytokines can trigger inflammation in the small blood vessels throughout the body but probably start with the blood vessels in the intestines, causing endothelial dysfunction. This has been proven by measuring a significant decrease in blood vessel wall flexibility within minutes to hours after eating a high-fat, high-sugar meal.²  
• Conversely, supplementing with bifidobacteria and eating a plant-based, high-fiber diet seems to decrease translocation of LPS through the gut epithelial lining and may help prevent the negative effects of high-fat diet induced metabolic diseases.³
• The vascular inflammation in and around the intestinal tract, which is 20 or more feet in length, can stimulate stem cells adjacent to the blood vessel walls (known as stem cell pericytes) to develop into fat cells or adipocytes which accumulate wherever there are blood vessels in the abdomen—that’s almost everywhere!
• The inflammatory fire continues as the abdominal fat, or visceral fat (some people call it VAT) continues to produce more inflammatory cytokines (IL- 6, TNF alpha, etc.) that flow into other blood vessels, stimulating more stem cell conversion into fat cells or adipocytes.
• It is interesting that both vitamin D and stem cells are stored at high levels in abdominal fat. Perhaps the vitamin D is trying to cool down the inflammation and the stem cells are there to respond according to the body’s information: either make fat or something else.  

It makes sense that exercise  was found helpful for reducing abdominal fat. Exercise has many benefits. For one, it produces more adiponectin to help reverse the situation. Adiponectin is an anti-inflammatory hormone made in fat that both decreases inflammation in fat and travels to the pancreas to help sensitize and balance the release of insulin which can help reverse metabolic imbalances.

So it is pretty simple—eat your plant-based, high-fiber diet, supplement with probiotics (including good amounts of bifidobacteria), and exercise moderately on a regular basis.  Then be patient. The accumulation of abdominal fat, along with all the problems caused by this fat, including heart attacks and cancer, is reversible.

1.  Hairston KG, et al., “Lifestyle Factors and 5-Year Abdominal Fat Accumulation in a Minority Cohort: The IRAS Family Study.” Obesity (Silver Spring). 2011 Jun 16. doi: 10.1038/oby.2011.171. [Epub ahead of print]

2.  Plotnik GD, et al., “Effect of antioxidant vitamins on the transient impairment of endothelium-dependent brachial artery vasoactivity following a single high-fat meal.” JAMA. 1997 Nov 26;278(20):1682-6.

3.  Cani PD, et al., “Selective increases of bifidobacteria in gut microflora improve high-fat-diet-induced diabetes in mice through a mechanism associated with endotoxaemia.”

Diabetologia. 2007 Nov;50(11):2374-83.

Leonard Smith, M.D.

Dr. Leonard Smith is a prominent Board-Certified, general, gastrointestinal and vascular surgeon who had a successful private practice for 25 years. In addition to his active surgery practice, he also incorporated lifestyle, diet, supplementation, exercise, detoxification, and stress management into many of the therapies he would prescribe. Many of his patients with cancer, cardiovascular disease, and other serious illnesses did so well under his treatment regimes that he began to devote most of his career to foundational health care and preventive medicine.

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A recent Cochrane Systematic Review, which involves an extensive review of the scientific literature, found that probiotics are effective at reducing diarrhea. The results were similar across all 63 different trials that were analyzed.

A separate review was done for trials involving children with persistent diarrhea. Though only four trials were available for review, results showed that probiotics can reduce the length of time of an episode of persistent diarrhea.

Diarrhea often occurs as a result of infection by many different organisms. This results in a big imbalance in the ratio of good to bad bacteria, so probiotics, (also known as good bacteria), are sometimes recommended as a way to repopulate the gut and bring balance back to the intestines. Indeed, if the Cochrane Review is confirming this, you can’t get more mainstream than that. 

More research needs to be done on specific strains of bacteria and on preventing the progression from short-term to persistent diarrhea. But probiotic therapy can be used safely in addition to rehydration fluids, which are also given during diarrhea treatment.

Diarrhea can be a serious condition. If you are experiencing an episode of diarrhea, talk with your doctor about taking probiotics to help rebalance your gut.

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Probiotics are now being considered for use in treating many digestive (and even non-digestive) health conditions and diseases. Two such diseases in which probiotics have been studied are the inflammatory bowel diseases ulcerative colitis and Crohn’s disease. These conditions involve chronic inflammation of the intestines. Crohn’s disease primarily involves the lower small intestine, but may involve the entire digestive tract. Ulcerative colitis involves the rectum and large intestine, or colon (hence the name colitis—meaning inflammation of the colon).

A recent double-blind, randomized, placebo-controlled study found that in addition to standard treatment, a high-potency, multistrain probiotic improved symptoms. Equally important, it also improved appearance of the colonic mucosal lining in patients with relapsing mild-to-moderate ulcerative colitis compared to those patients only receiving standard treatment.

This is the strongest study to date on probiotics for ulcerative colitis and joins a growing body of evidence for their beneficial effects. Because ulcerative colitis is a serious disease, effective treatment is important. If you have ulcerative colitis, talk to your doctor about using probiotics. Want to learn more before you do? Tune in for my PBS Special The Road To Perfect Health, now airing on your local PBS station.

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Our friends at Nutraceutix were just honored with the 2010 Technology Innovation of the Year Award from Frost & Sullivan, a global research firm that recognizes best-in-class practices and achievements in many industries. They won for their patented LiveBac process, which when combined with Bio-tract® delivery system, helps ensure that Renew Life’s FloraSMART™ line of probiotics are delivered right to the intestines where they are most effective.

Why the standing ovation? Well, probiotics are only effective if they can withstand the harsh conditions in the stomach to be absorbed in the intestines. Once in the intestines, they can help replenish helpful bacteria as well as strengthen immunities and support overall digestive health. Bio-tract technology is an advanced delivery system that creates a protective natural gel around each probiotic caplet to protect it from gastric acid, thus delivering more active probiotic cultures to the intestines over an optimal time frame.

And that means better overall digestive health! After all, 70 percent of the body’s immune defenses reside in the intestines. If the probiotics can’t make it there, they can’t do much good. If delivered intact where they can work their magic in the intestines, they can lead to optimal digestion, bowel regularity, and overall well being.

Hats off to Nutraceutix for building a better way to manufacture and deliver probiotics. Renew Life and our millions of customers thank you daily!

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“Renew You” Challenge – Be a part of my Weekly Challenge to help set you off in the right direction for bringing health to your week. So this week I wanted to challenge the way you eat. 

Heartburn, indigestion, gas and bloating. At one time or another you’ve probably experienced a bout of post-meal discomfort that had you thinking, “What on earth did I eat that just isn’t sitting right??” Well, guess what? You were on the right track.

Most of the time things like heartburn and upset stomach can be prevented just by being choosy about what we put on our plate, since a lot of foods have natural components that can help our digestive system do its job. That’s right—Mother Nature knew what she was doing, folks!

Yogurt and cottage cheese, for example, contain probiotics that help keep your digestive system in balance and promote regularity, and so do fermented foods like kefir, sauerkraut, miso and tempeh.

Raw fruits and veggies contain powerful enzymes that work to break down all kinds of foods like carbohydrates, fats, sugars, and dairy foods, and they also help your body absorb nutrients. Papaya and pineapple, for example, contain an enzyme called papain that is especially helpful for digesting protein in the diet.

And—no surprise here—fiber is also important for healthy digestion. A good blend of soluble and insoluble fiber from fruits, vegetables, whole grains, legumes and nuts helps keep food moving through your intestines and promotes regular, healthy bowel movements.

So this week I want you to really pay attention to your meals and try to choose foods that benefit your digestive system rather than those that work against it. Steer clear of high-fat, sugary and processed foods, and load up on easy-to-stomach foods like fresh produce, whole grains, and probiotic-rich yogurt and fermented foods—your belly will thank you!

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