Optimal Digestion Blueprint Part V

<—-Part IV  

   Part VI —->

Now, my second discovery was the breath doesn’t lie.

There are four main ways for the body to remove waste, through feces, sweat, urine, and breath.

All of these waste products, when examined, can give us an idea of what’s going on inside the body.

You might have heard the saying, one man’s garbage, another man’s evidence.

Well, just like crime forensic scientists examine garbage from a house to get clues regarding a crime that they might be investigating, the waste from the human body is no exception in revealing what is going on inside.

The breath then opens a window and reveals the overall state of our digestive tract. We know that animals can be trained to smell the breath and that it may indicate serious conditions such as some cancers in humans by perceiving specific odor signatures in samples of urine, sweat, breath, and blood.

Breath as a diagnostic tool has a very long history. It can be traced back to the ancient Greek physician Hippocrates around four hundred before Christ BC, known as the father of Western medicine.

He educated his students on using breath odor to spot patients with liver disease, uncontrolled diabetes, and failing kidneys. Incidentally, he was also Hippocrates was also that said, all disease begins in the gut.

We’ve come a long way since then, and technology allows labs to analyze the byproduct of metabolism and digestion, including that of the microbiome in the gut by way of the breath.

Most of our knowledge of the microbiome comes from examination of the large intestine due to ease of access and from the fecal matter that it produces.

Most of the dry mass of the stool is around sixty percent bacteria, So the diversity and number of bacteria in the large intestine can be measured much easier than that of the small intestine. At one time, it was thought that the small intestine was sterile, free of bacteria.

We now know that that’s not the case. And bear with me for a minute because I’m going to tell you in just a minute what this has to do with the breath.

The small intestine does not have as much bacteria as the large intestine nor does it have as much diversity of bacteria. But there is a certain amount of what is commonly called commensal bacteria.

By now, you know, I like to define my terms. The word commensal, which derives from the Latin prefix com, meaning with or together or jointly, like in the word combine, and the Latin adjective, meaning of the table.

And in its earliest English uses, commensal referred to people who ate together.

It is also where the term commensalism comes from and refers to a type of relationship between two different organisms that eat from the same dish.

In this kind of relationship, neither one benefits from the other or provokes any harm. It is therefore a neutral relationship.

And there are other classes of relationships between organisms in our gut, including mutualism, in which both organisms obtain benefit from one another. And this is more obvious when we look at the bacteria in the large intestine and when we learn about keystone species, a topic outside the spirit of this master class, but one we address in the optimal digestion blueprint.

And then we have parasitism, where one profits from the other by causing harm.

We find this also in the large intestine when we learn about pathogenic bacteria.

So the small intestine does have bacteria, but it is minimal compared to that of the large intestine and it serves a purpose.

Let me show you the difference in the number of bacteria between the first part of the large intestine where the cecum with this appendix hanging right below it and that of the duodenum, the first part of the small intestine.

In the cecum, there is ten to the power of twelve or one trillion colony forming units of bacteria per milliliter.

So a milliliter is around twenty drops. By contrast, the bacteria content in the duodenum, which is where the food from the stomach enters, is around ten to the power of three.

That’s one thousand colony forming milliliters. What a big difference. And this number increases along the length of the three sections of the small intestine with around ten to one hundred thousand in the jejunum and around ten million to a hundred million in the ileum and and then to one trillion in the cecum.

What a difference. Now, to measure or quantify the bacteria in the small intestine will require an invasive procedure through which fluid from the duodenum will be aspirated by way of a tube that is inserted through the nose or the mouth, and fluid is removed and later analyzed.

Not a fun process if you ask me. And then with modern technology, the type and number of bacteria from that sample could be identified and measured. This takes us back to my second discovery where the breath doesn’t lie. You see, earlier, we spoke about the role of the stomach, the gallbladder, the pancreas, and the intestines, the role they play in digestion. And now we’re taking a closer look at some of the key players in the gut, that being the commensal bacteria and the role in digestion.

This paper from the journal, Nature Immunology, it tells us, so the mammalian gastrointestinal tract, the site of digestion and nutrient absorption, harbors trillions of beneficial commensal microbes from all three domains of life.

Commensal bacteria, which we just defined, in particular, are key participants in the digestion of food and are responsible for the extraction and synthesis of nutrients and other metabolites that are essential for the maintenance of mammalian health.

So bacteria in the small intestine, the commensal bacteria, they release enzymes that breaks down the carbohydrates into simple sugars. Of course, the pancreas also releases enzymes to do that as well, but the bacteria collaborates.

This, fermentation in turn, produces, you know, hydrogen and different gases, methane gases. And the problem comes when the balance between the ones that produce hydrogen and the ones that produce methane becomes alter.

So if we have too many of the ones producing the hydrogen, usually, the person has, more symptoms of, diarrhea type type of symptoms. So sometimes when they identify IBS, they call it IBS type c or IBS IBS type d, the c for constipation, the d for diarrhea. So depending on which type of of microorganism is more abundant in the small intestine, the type of diarrhea or constipation that’s going to be produced by the excessive amount of these particular gases.

So when those silent offenders, those that we discussed earlier, alter the balance of the commensal bacteria in the small intestine, it leads to what is known as SIBO or small intestinal bacterial overgrowth.

Earlier, we identified some of these silent offenders such as stress and antibiotics, excessive use of herbal antimicrobials, anti-acids, infections like H. Pylori, all of which can increase the risk of SIBO or SIFO, meaning fungal overgrowth. And now we have intestinal methanogens overgrowth and and so on. The nomenclature keeps changing as we learn more about the diversity of bacteria in the small and large intestines.

Here is how it works. Just like carbon dioxide, the byproduct of respiration, where oxygen is used by the cells to make energy and the byproduct is carbon dioxide, finds its way to the lungs through the blood to be exhaled in exchange for fresh oxygen.

So do the gases from bacterial fermentation of food that generates hydrogen gas, methane gas, and hydrogen sulfide gas find their way through the blood to the lungs.

And just like a breathalyzer can measure the amount of alcohol that a person may have consumed, the levels of hydrogen, methane, and hydrogen sulfide can also be measured in the breath, and this is expressed as parts per million.

Now, we’re all going to show levels of these gases in our breath since we all have commensal bacteria. But here’s the process. After a fasted night, a baseline test is done.

If the baseline test shows twenty parts per million of hydrogen gas or ten parts per million of methane gas. The test is automatically aborted, and a diagnosis of SIBO is made.

Now, as usual, let me define my terms.

Parts per million.

This means if twenty particles of, for example, hydrogen gas are found in a sample of one million particles of air, or ten particles of methane gas are found in one million particles of air that you exhale into a tube, the diagnosis of SIBO is made. So this is the baseline test.

If the baseline breath test is below the cutoff point, which for hydrogen is around ten to sixteen parts per million or around three to five parts per million of methane, the patient then drinks a premade solution containing a substance that the bacteria can consume or digest with either glucose or lactulose.

I prefer to use lactulose.

Breath samples are then taken for three hours every twenty or thirty minutes apart.

We compared the hydrogen and methane levels in the thirty, sixty, ninety, one hundred and twenty, one hundred and eighty minutes of breath samples apart from each other to the baseline sample that we did before we ingested the glucose or the lactulose.

If any of the post glucose or lactulose samples contain twenty parts per million of hydrogen gas above the baseline, or methane of ten or more parts per million above the baseline, you can be diagnosed with bacterial overgrowth of the small intestine, SIBO.

Breath tests are also used to detect H. Pylori and to see if a patient has lactose intolerance.

It was this SIBO test that helped Carol.

Before, she had digestive problems in her childhood, had constant gas. The breaking point was soiling her pants while in a medium with loose stool.

She had tried antibiotics, anti inflammatory diets, fiber, carnivorous diet, and nothing was working. And when she took our program, the results were less bloating, normal bowel movements, and she got her life back.

So there is a process to this, but first, we have to understand what’s going on underneath the hood. What what are the the nuts and bolts of the whole process?