How gut dysfunction could be the hidden trigger for chronic illness

Exposure to germs is crucial in maintaining a healthy gut and strengthening immunity. Although cleanliness is important, we might have become slightly too obsessed with washing hands frequently since Covid-19, which could compromise your resistance to illnesses, says Dr Raath, a chronic pain management physician.

Professor Mashiko Setshedi, a specialist gastroenterologist and head of the Department of Medicine at the University of Cape Town, agrees.

She explains that although we host microbiomes on our skin, in our oral cavities and throughout our respiratory and genital systems, the gut microbiome is the largest and most significant. 

It refers to the gastrointestinal system and consists of trillions of microorganisms. These include beneficial bacteria, fungi, viruses and parasites which co-exist with us. 

Up to 80% of our immune cells are found in the gut. Once harmful bacteria enters the gut, proteins on the surface of the immune cells recognize them as harmful. This activates the immune system and a complex process is triggered for the infection to be cleared. 

In a healthy gut, many different types of good bacteria are present and through various mechanisms, support the immune system to prevent infection and disease. 

Earlier research has suggested that children who are raised alongside pets show greater resistance to certain illnesses and allergies than those who aren't. This is because they have had more exposure to a larger variety of microbes. Although this theory has since been challenged by some as not giving a full explanation, it could give us a better understanding of how closely the environment and the gut biome are linked.

Babies born through natural delivery receive their first immunity boost from their mother's vaginal bacteria. This usually significantly reduces the likelihood of developing conditions such as asthma, allergies and autoimmune diseases compared with those delivered via caesarean section.

Breastfeeding further enhances a baby's immunity and studies suggest that healthy ageing is linked to a diverse microbiome. 

Illnesses linked to an unhealthy gut

Setshedi explains that an overwhelming amount of evidence now suggests that an imbalance in the gut can lead to myriad illnesses. 

These include autoimmune diseases like multiple sclerosis, rheumatoid arthritis and lupus. Other issues linked to an unhealthy gut include irritable bowel syndrome, inflammatory bowel disease, obesity, certain cancers, chronic fatigue, Type 2 diabetes, and cardiovascular diseases. 

Mental health issues such as anxiety and depression may also stem from gut imbalances. 

The gut and the brain are closely linked through what is known as the gut-brain axis, which enables two-way communication. 

A balanced gut produces important chemicals which regulate mood, emotions and memory function. Serotonin, the feel-good hormone, is a hormone or neurotransmitter that is mostly produced in the gut. If the balance of good and bad bacteria is disturbed it reduces the production of these chemicals and could cause anxiety and possibly depression. 

Keeping the gut healthy

Raath recommends a diverse plant-based diet with moderate portions of fish or chicken. He stresses that we need as much vegetable fiber as possible. Cut out sugar and processed foods and include fermented foods such as red cabbage or kombucha. Antibiotics should only be taken if absolutely necessary. A good probiotic containing live bacteria could help speed up gut recovery after taking antibiotics. 

Advanced treatments for gut problems

Gut screening tests are gaining traction, according to Dr Yvonne Holt, chief medical officer of Next Biosciences. These tests are said to analyze the current state of the gut microbiome and determine its efficiency. From the results and if necessary, a personalized diet can be worked out, possibly preventing inflammation and improving health. 

As a last resort, a doctor could suggest a medical procedure called fecal microbiota transplantation. It is primarily effective in treating severe diarrhea caused by recurrent clostridioides difficile (C-diff). This could develop if you have, for example, taken antibiotics. 

In older people with weakened immune systems, it could be life threatening. The technique involves transferring stool from a healthy donor into a patient's gastrointestinal tract. If successful, it could restore balance to gut microbiota. Setshedi says that for now the Food and Drug Administration has approved this procedure for recurrent C-diff only. 

Raath says that in his experience using synthetic stool as an alternative has been just as effective. The procedures are identical, but the samples differ. A standard mixture that mimics human stool is produced in a lab. A sample is transplanted into the colon with a tube through the rectum. The procedure is comparable to a colonoscopy, but the latter is diagnostic only.  

This kickstarts the recovery of gut microbial diversity. It is further strengthened over six to eight weeks with a microbiome diet and specific live probiotics. This nourishes the good bacteria and restores gut balance. It is then followed by a gut-friendly, fiber-rich diet and probiotics. 

While the long-term effectiveness of such treatments is still under investigation, the emerging research underscores the critical link between gut health and overall wellness. By prioritizing a balanced microbiome, we can take significant steps towards preventing illnesses.