Every year digestive disorders cost Americans over $141.8 million dollars and 70% of Americans have a digestive disease or will suffer from one over the span of their lives. Many people suffer from digestive issues like constipation on a daily basis, while others have more serious issues like irritable bowel syndrome (IBS) or Ulcerative Colitis (UC).

 

The gut includes the entire digestive tract but most of the breakdown and absorption of nutrients and water happens in the stomach, small intestine and the large intestine. The gut is responsible for helping us absorb nutrients from food; absorb water; eliminate waste; and maintain immunity and mood.

 

Did you know that what you eat can disrupt the fragile balance between the good and opportunistic bacteria in your gut?  Eating a diet in refined foods and little fiber feeds the opportunistic bacteria (bad bacteria) that make you sick. When the bad bacteria are in control there is increase inflammation in the gut and this decreases its ability to absorb the nutrients from your food.

Imbalances in the gut flora are caused by highly processed, low fiber diets, medication use (NSAIDS, acid reflux medications and birth control pills) chronic stress, antibiotic use and living a sedentary lifestyle.

 

Digestion

Digestion is the breakdown of food from macromolecules into smaller parts by enzymes, so nutrients can be absorbed. The three macromolecules that are broken down by our gut are carbohydrates, fats, and protein.
Carbohydrates are broken down into simple sugars (glucose) for use by the brain and are stored in our muscles and liver for energy.

Fats are used to repair the lipid bilayer in our cells and help increase the absorption of fat-soluble vitamins like vitamin D, E, and K.

Proteins are broken down into amino acids and amino acids help buffer our blood pH and are the building blocks for nucleic acids. Proteins are also responsible for the structure of our organs, muscles and connective tissue; they also make up our antibodies, hormones, red blood cells and act as catalysts for chemical reactions that occur in the body.

Our digestive system is full of good bacteria that control gene expression, secrete antibiotics, protect us from foreign pathogens, produce vitamins, boost immunity, keep us regular and regulate mood.

The next part of this series will discuss the harmful effects of unmanaged stressed on the gut and how it disrupts the balance between good and bad bacteria.

 

 

Chronic Stress and Gut Health

Have you noticed how your digestion is affected when you are chronically stressed? Do you struggle with stomach upset when you are given bad news or when you feel overwhelmed?

The problem with modern day stress is that it is relentless and this leads to chronic stress and elevated levels of cortisol. High cortisol levels in the body are linked to poor digestion, increased systemic inflammation, insulin resistance, and hormonal and gut flora imbalances.

Stress has a powerful effect on the gut, and we are going to discuss how the gut reacts to communication from the sympathetic and the parasympathetic nervous systems.

Although our bodies are amazing, well-oiled machines, it is unable to tell the difference between stress from a real threat and the daily stressors that trigger the fight or flight response.

 

The Autonomic Nervous System

The body responds to stress by sending information to the brain where it is processed by the autonomic nervous system (ANS). It is a part of the nervous system that is responsible for automatic body functions like breathing, regulation of blood pressure, and heartbeat.

The ANS is also in charge of regulating the sympathetic nervous system (SNS), the parasympathetic (PNS) and the enteric nervous system (ENS). The SNS is responsible for the fight or flight response; the PNS is responsible for the rest and digest response, and the ENS is in charge of digestion, immunity, and mood regulation.

 

 

The Sympathetic Nervous System

The SNS system is responsible for the stress response and it is triggered by everyday stressors and real threats. This system triggers the release of norepinephrine (adrenaline) and cortisol; hormones that help the body release the energy needed to stay and fight or to run from the threat.  The primary function of the SNS is to provide the body with energy to fight or run from a threat.

Distress signals are sent to the brain, where it is forwarded to the amygdala ¹ and processed; it is then transmitted to the hypothalamus. The signal is then relayed from the ANS to the adrenal glands where epinephrine is released.  This hormone are responsible for increasing blood pressure and stimulating the breakdown of glycogen and fats.  The breakdown of fats and sugars release the extra energy needed for fight or flight response by supplying the brain and muscles with the fuel it needs.

 

The Parasympathetic Nervous System

The PNS system helps the body restore and recover from stress;  and it is also responsible for digestion, healing, reproduction, and the regeneration of tissues. It stimulates increased blood flow to the gut, which increases the amount of oxygen-rich blood and aids in the absorption of nutrients.

The purpose of the PNS is to restore and rejuvenate the body, and it does the following:

–    Conserves energy

–    Increases intestinal motility

–    Slows heart rate

–    Dilates blood vessels

–    Increases insulin production

 

Digestion is activated by the PNS system and turned off by the fight or flight response. Chronic stress affects digestion by decreasing insulin production; intestinal motility; the secretion of digestive enzymes and reducing blood flow to the digestive system. Reduced blood flow to the gut decreases absorption of nutrients,  increases the risk of leaky gut syndrome, increases inflammation and increases your risk of autoimmune disease.

 

Enteric Nervous System (The Second Brain)

The gut is referred to as the second brain, with good reason and it is responsible for sending and receiving impulses from and to the brain that control digestion.  The ENS receives and sends information from the brain through the vagus nerve ², a cranial nerve and the peripheral nerves that are responsible for controlling the movement of food through the digestive tract.

The peripheral nerves are responsible for the mechanical mixing of food in the stomach and the muscle contractions in the intestines that help move food through the gut.

 

The ENS is part of the ANS and is found in the wall of the digestive tract where it helps you sense threats in your environment and then influences the way your gut responds. It is responsible for stopping pathogens (bacteria and viruses) found in our food from making us sick.

 

The immune cells in the gut prevent the pathogens from our food from crossing the gut by secreting histamine and other inflammatory peptides/chemicals. The ENS detects the presence of these inflammatory peptides and triggers a response to purge the pathogen from the system.

The ENS is also responsible for maintaining the biochemical environment in the stomach and intestines which allows digestive enzymes to do their work.

 

The ENS is made up of over 400 million neurons, neurotransmitters, and neuropeptides that help it communicate with the central nervous system (CNS) and it is also home to over 80% of the body’s immune cells. ³  These neurons are found in the tissues that line the digestive tract and include the esophagus, stomach and the small and large intestines.

The gut is responsible for secreting neurotransmitters that regulate mood (serotonin, dopamine, and glutamate)), control blood flow to the gut (nitrous oxide) and control gut motility (norepinephrine aka adrenaline).

Chronic Stress and Your Gut Flora

Stress disrupts the fragile ⁴  balance between the beneficial and opportunistic bacteria in your gut.  As we covered in Part I of the Gut Health series, beneficial bacteria are responsible for regulating mood, immunity, secreting vitamins and antibiotics; rebuilding the intestinal lining; increasing the absorption of nutrients from food; controlling metabolism and preventing food allergies.

 

Inflammation and the Gut

Psychological stress triggers the fight or flight response which triggers the release of hormones that keep the body on high alert, which leads to physiologic stress. When this happens over an extended period, it leads to decreased nutrient absorption increased the permeability of the gut lining and inflammation.

Inflammation is a response to tissue injury or damage caused by a bacteria or virus, but it can also be triggered by high levels of cortisol that suppress the secretion of hormones that protect the gut.

 

For example, elevated levels of cortisol decrease the secretion of insulin, a hormone,  that allows cells to absorb nutrients in the blood. It also suppresses the secretion of secretory IgA an immunoglobulin that helps protect the gut mucosa from harmful bacteria and viruses.

 

The body will mount an immune response in response to chronic stress and will attack the cells in the lining of the gut.  The damaged intestinal cells (microvilli in the small intestine) release chemical mediators that activate the inflammatory response. Under normal conditions, the immune system uses inflammation to protect the gut from foreign pathogens but extended periods of inflammation damage the gut lining.

 

When the cells in the small intestine and stomach are chronically inflamed, it affects the ability of the digestive system to break down and absorb nutrients. The release of chemical mediators causes blood vessels to release fluid into inflamed tissues ⁴ and this causes swelling.

 

The swelling interferes with the gut linings ability to keep harmful bacteria and large molecules from crossing the gut lining and entering the blood. When large proteins cross the intestinal lining, the body does not recognize these proteins, and it launches an immune response.  An example of this is celiac disease, where the immune system launches an immune response to gluten, a protein found in wheat.

 

 

If the person continues to eat products that contain wheat, rye or barley, the body will continue to attack the gluten and the result is the destruction of the microvilli in the small intestine.

 

Our bodies have created systems that help us react to and deal with perceived stressors and threats in our environment. When the brain perceives a threat, it activates the SNS which send information to the second brain, the ENS in the gut which secretes hormone and neurotransmitters that shut down digestive processes and helps the body focus all its energy on helping us deal with the imminent threat.

 

After we have dealt with the threat, the PNS system is activated, and it helps restore and replenish the body after the stress response. Since many of us deal with multiple small stressors each day for months and even years the transition between the stress and rest and digest, a response is disrupted, and this leads to digestive system dysfunction.

 

Looking for foods to heal your gut?

 

 

Did you know that many of the over the counter (OTC) and prescription medications that you take can have a harmful effect on your gut?

 

70% of Americans take at least one prescription drug, and this percentage does not include the number of Americans that take OTC drugs.  50% of Americans take more than two prescription drugs and 20% take at least 5 or more prescriptions. The most common medications consumed include opioids, antibiotics, and antidepressants. ¹ With such a large percentage of Americans taking prescription drugs, it is important to be knowledgeable of the side effects of these medications and the effect they have on the gut.

Pain medications and your gut

80% of the opioid supply are consumed by Americans, who make up 5% of the global population and we use 50% of the world’s pharmaceutical drugs and 99% of hydrocodone use. ² Pain medications decrease the natural production of opiates in the body, and this leads to an imbalance in the body’s natural neurotransmitters and hormones.

Opioids are in a class of powerful pain relievers that were created to treat and alleviate moderate to severe pain. Long-term use of opioids has been linked to abuse, an increased risk of addiction and dependency.  Opioids are narcotic pain relievers that include hydrocodone, morphine, and heroin.

Opioids and the gut

If you have ever taken an opiate painkiller like Vicodin, you know that one of the main side effects is constipation.  Constipation is a digestive disorder that is characterized by difficulty emptying the bowels, but this is not the only side effect that opioids have in the gut.

Other side effects include nausea, bloating, abdominal pain and in rare cases paralytic ileus. Paralytic ileus is the inability of the bowel to contract normally and move waste outside the body; this leads to the buildup of food and waste inside the gut. ³

Opioid medications act on the mu and delta receptors that are found in the myenteric and the submucosal plexus. ³ The myenteric plexus is responsible for gastrointestinal contractions, while the submucosal plexus oversees the secretion of ions, mucus, and fluids in the large intestine.  Opioids act by decreasing gut contractions and blocking the secretion of ions and fluids in the large intestine.

NSAID’s and Your Gut

Non-steroidal anti-inflammatory drugs are anti-inflammatory medications that are used to control inflammation in the body.

NSAID use is responsible for 43% of drug-related emergency room visits. Over 100,000 hospitalizations and over 17,000 deaths every year are caused by NSAID use. These drugs act on the lining of the gut, and regular use can lead to inflammation of the gut. ⁴

NSAID’s shut down inflammatory pathways in the body while triggering inflammation in the gut lining.  When the stomach lining is inflamed, it becomes more permeable five which decreases nutrient absorption and increases the risk of infection by harmful bacteria.  Studies have shown that ibuprofen increases the permeability of the gut and can irritate and compromise the integrity of the gut barrier. ⁶

NSAID’s act on the cyclooxygenase enzyme which is responsible for the production of prostaglandins by role converting arachidonic acid to prostaglandin, a chemical mediator that mediate inflammation and pain. ⁷

 

NSAID Mechanism of action

NSAID’s can lead to ulcers in the mucosa of the gastroduodenal mucosa by ⁸

–    irritating the gut lining

–    disrupting the mucosal barrier

–    interfering with the gut repair by decreasing blood flow

–    suppressing the production of gastric prostaglandins

–    inactivating growth factors needed for mucosal defense and repair

 

 

Healthy gut function and sleep

Did you know that many of the chemicals and neurotransmitters that act on the brain have receptors in the gut? The brain and gut produce and secrete endogenous natural opiates and benzodiazepine.¹⁰ The gut bacteria are responsible for sleep and mood regulation, and it controls these functions by secreting hormones that regulate sleep-wake cycles and affect the body’s circadian rhythm.

When there are disruptions in the gut and gut flora, it leads to disturbances in sleep. The gut bacteria regulate the hormones and neurotransmitters that activate the PNS (rest and digestive system). They lower levels of cortisol and increase the release of GABA, a hormone that calms the body and is needed for deep restorative sleep. Your gut bacteria are responsible for producing melatonin, a hormone necessary to regulate your sleep-wake cycles.

It is also responsible for the secretion of serotonin, a neurotransmitter that is found in abundance in the gut. Serotonin helps regulate mood and prevents depression. Disruption of the gut flora caused by chronic stress and persistent activation of the sympathetic nervous system (SNS) which leads to imbalances in your microbiome and hormones.

 

Sleeping pills and your gut

Sleeping pills enhance the inhibitory effects of gamma-aminobutyric acid (GABA) which has a sedative effect that (over a period) leads to the overstimulation of the GABA receptors. ¹¹ Overstimulation of the GABA receptors leads to an increase in anxiety, depression, and insomnia.

50% of Americans suffer from insomnia; insomnia is a condition where people have difficulty falling asleep or staying asleep. ¹² Sleeping pills were created to help you fall asleep, but they have harmful long-term effects that include: the worsening of heartburn, diarrhea, constipation, stomach pain, anxiety, depression, and insomnia.

People who take sleeping pills have a higher risk of developing upper respiratory tract infections like sinusitis and pharyngitis. Chronic sleeping pill us also in increases the risk of death by car accidents 50% due to drowsy driving.¹³

 

Sleeping Pills and GERD

Sleeping pills act on the GABA receptors in the gut by decreasing gut motility which causes constipation. It relaxes the stomach sphincter which allows the contents of the stomach to enter the esophagus and causes and aggravates gastroesophageal reflux disease (GERD).¹⁴ GERD increases the risk of esophageal cancer¹⁵ due to the harmful effects of stomach acid on the esophageal lining.

 

Proton pump inhibitors and your gut

Proton pump inhibitor (PPI’S) are used to treat ulcers and acid reflux by blocking the action of the proton pumps in the gastric parietal cells which lower acid production in the stomach.

The proton pumps are found in parietal cells in the stomach, and they secrete acid that is used to break down and absorb nutrients from food; protect the body from harmful bacteria in our food and displaced bacteria from the mouth. ¹⁶ Each part of our body has its unique bacterial community, and the body has barriers and ways to keep these bacteria out of other areas and one way the body keeps harmful bacteria out by secreting acid

Proton pump inhibitors lead to nutritional deficiencies, an increased risk of infection and metabolic disorders. Long-term PPI use leads to deficiencies in iron, vitamin B12, magnesium and increases the risk of fracture, bacterial overgrowth, community acquired pneumonia and Clostridium difficile. ¹⁷ The use of PPI’S increases the risk of Clostridium difficile infection by 65% by decreasing the acid in the gut. Low acid levels in the stomach disrupt gut flora and allow pathogenic bacteria to take over the gut. ¹⁷

 

Birth control pills and the gut

Birth control pills (BCP) are responsible for disrupting the microbiome, creating hormonal imbalances and nutrient deficiencies.  The use of BCP’s depletes many antioxidants, vitamins, nutrients that are needed for good health. They deplete coenzyme Q10, vitamin E, vitamin B6, zinc, selenium, phosphorus, and magnesium.¹⁸ Vitamin B6 is necessary to produce serotonin and gamma -aminobutyric acid (GABA), hormones that are required for mood regulation and sleep.

BCP’s increase levels of epinephrine and norepinephrine, hormones that are released during the fight or flight response. Since the BCP’s deplete antioxidants, they put the body under oxidative stress which causes inflammation in the gut. ¹⁹

The pill leads to a synthetic hormone and these pills increase levels of thyroid and sex binding hormones which leads to hormone imbalances. ²⁰ The thyroid is responsible for regulating metabolism, and it does this by secreting thyroid hormones. Binding of the thyroid hormone leads to low levels and can cause constipation, diarrhea, changes in the sleep pattern, insomnia, fatigue and weight gain.

An increase in sex binding hormones leads to increased binding of testosterone; low levels of testosterone are responsible for decreased sex drive, difficulty losing weight, fatigue and tiredness, depression, anxiety, and an increased risk of fracture.

Common side effects include bloating, insomnia, depression, an increased risk of blood clotting, high blood pressure, cancer, and gallstones. ²¹

 

Antibiotics and your gut

Widespread use of antibiotics in agriculture (to fatten up livestock and the people that eat them), personal care products and the overuse of antibiotics in health care have led to many antibiotic resistant strains of bacteria like Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA) and community-acquired pneumonia (CAP).

Antibiotics are used to treat a variety of different bacterial infections; the problem is the fact that due to overuse many bacteria are now resistant to antibiotic therapy. Antibiotics kill all bacteria in the gut (good and bad) and disrupt the microbiome and leave the gut susceptible to harmful bacteria. When the microbiome is disrupted, it leads to increased inflammation, gut dysfunction, and hormone imbalances.

With the rise in prescription drug use in the America, it is important to know the effect the medications you take can have on your gut and overall health. Knowing how these drugs work and interact with your gut can help you manage the effects by eating foods that replace depleted nutrients and helping you find ways to support your gut flora while taking medications.

 

 

Healing Your Gut 

 

 

Gut disruption and chronic disease

The gut is intricately connected to the brain and other organ systems; to live a healthy life, we must first guard the health of our gut. Many chronic diseases have been linked to a disruption of the gut microbiome and a decrease in the diversity of the bacteria in the gut. Decreased bacterial diversity in the gut has been linked to poor diet, medication overuse, smoking the use of antibacterial soaps and unmanaged stress.

 

Inflammation and the gut

Under normal circumstances, acute inflammation is one of the ways the body starts the healing process. Short-term inflammation is the immune systems way of attacking viruses and bacteria that have breached the body’s defenses and helping it heal.  On the other hand, chronic inflammation puts the body at a greater risk for lowered immunity and an increased risk of developing chronic diseases like diabetes and cardiovascular disease.

There are a variety of different stressors that can trigger the fight or flight and inflammatory response in the gut.  The most important thing you can do is to reduce the impact and effects of stress by eating whole, unprocessed foods, managing stress, exercising, getting enough sleep and using foods to combat the effects of prescription medications.

 

Stress management

The best way to decrease stress is to activate the parasympathetic system, and that is done best by relaxing.  A quick and easy way you can do this is to practice deep breathing, exercising, talking with a friend, getting a massage or just carving out some quiet time for yourself.

 

Exercise

Exercise is one of the most cost-effective ways to manage stress by decreasing cortisol levels, reducing inflammation in the body and secreting endorphins.  It helps balance mood by increasing the production of serotonin, the feel-good hormone.

Did you know that exercise may change the behavior of the bacteria in your gut?

According to an animal study conducted by Choi et al., the gut bacteria of mice were tested in sedentary and physically active mice. The mice that exercised had increased levels of Lactobacillales and 24 times more Enterococcus calcium than mice that were sedentary. ¹

Another study performed on rats showed an increase in gut diversity in mice that exercised when compared to sedentary mice. ²

Although these studies were conducted on animals, the results are still promising for humans and this is just one of many reasons to fit exercise into your day.

 

Sleep

Getting quality sleep is essential for helping the brain, gut, and body rejuvenate and repair after a long day. Lack of sleep leads to changes in the balance of the bacteria in the gut, hormone imbalances and decreased immunity. The best way to get quality sleep is to avoid electronics at least 3 hours before bed and caffeine at least 6 hours before bed.

Under normal circumstances, cortisol levels are high early in the morning (to keep you alert and awake), and levels fall in the afternoon as melatonin secretion starts to ramp up and prepare the body for bed. Light stops the secretion of melatonin and increases the secretion of cortisol.  Many electronic devices emit blue light that enters our eyes and stops the secretion of melatonin in the pineal gland.

 

Did you know that the gut has 400 times more melatonin than the pineal gland and is produced by cells in the gut?  Melatonin in the gut decreases inflammation and helps keep the beneficial bacteria healthy so they can keep you healthy; any disruption caused by sleep deprivation, unmanaged stress or poor diet can lead to hormonal imbalances and an increased risk of chronic disease. ³

 

Leaky Gut Syndrome

Leaky gut syndrome has been linked to joint pain, brain fog, fatigue, food allergies, eczema, bloating and headaches.

Our busy lifestyles, the overuse of prescription drugs and over the counter medications, diets high in refined sugars and trans fats create holes in the gut lining and allow large proteins to get through.

Think of the gut lining like a bouncer at a club; the bouncer’s only job is to keep undigested foods, bacteria and large proteins from leaving the gut and entering the blood.

Leaky gut syndrome is used to refer to a condition where the gut lining is hyperpermeable. Increased gut permeability increases inflammation in the gut, and allows foreign substances like proteins to get out of the gut and enter the blood. It decreases your ability to absorb nutrients from food by destroying the brush border and decreasing digestive enzymes.

 

The best way to treat leaky gut syndrome is by healing the gut lining, removing foods that trigger inflammation and managing stress.

 

Whole Foods

One way to decrease inflammation is to eliminate foods that are triggering chronic inflammation; some foods that trigger inflammation include gluten, sugar, processed foods, trans fats, dairy, soy or alcohol.

Eat more whole, unprocessed foods like fruits, vegetables, root plants, and resistant starches. Add healthy plant-based fats found in avocados, flaxseed and chia seeds and swap inflammatory oils (like canola oil) for coconut, and olive oils. Omega 3 fatty acids tone down inflammation in the body, and you can eat fish or take a fish oil or algal-based supplement.

 

Spices

Eating antioxidant rich, anti-inflammatory herbs and spices help counteract the effects of oxidative stress caused by chronic stress, poor diet, and medication use. The most antioxidant-rich herbs and spices include turmeric, cayenne, ginger, cinnamon, cloves, sage, and rosemary have been shown to decrease the inflammation in the gut by acting on genes that trigger inflammation in the body.

 

L-Glutamine

Glutamine has been shown to protect the mucosa in the gut by helping rebuild and repair the gut lining that has been damaged from chronic stress, medication use, and an inflammatory diet.

Chronic stress decreases levels of glutamine in the digestive system.

Glutamine is used as fuel by enterocytes, cells that make up the intestinal lining; these cells form a barrier between the gut and the blood and help prevent foreign molecules from leaving the gut and entering the bloodstream. The enterocytes are responsible for absorbing nutrients from food and helping the immune system filter out harmful bacteria and toxins that enter the gut.

Prebiotics and Probiotics

Probiotics are beneficial organisms that help maintain the balance of microorganism in the gut. Too many harmful bacteria in the gut make us sick and have been linked to chronic diseases, and poor digestive, cognitive and skin health.

The beneficial bacteria help the gut mucosa form a physical barrier that keeps other bacteria and viruses out. We need a very diverse number of organisms in our body to help protect our immune, gut and brain function.

A decrease in gut bacterial diversity leaves you more acceptable to develop chronic diseases and infection. Our gut help helps our bodies absorb, digest and break down the nutrients in our food, produce vitamins, minerals and other chemicals that help keep the gut healthy.

Probiotic foods include fermented foods like kefir, yogurt, kvass and fermented vegetables like kimchi and sauerkraut. Prebiotic foods help replenish your gut with beneficial bacteria after periods or chronic stress, and especially antibiotic and drug therapy.

 

The best way to restore your gut health is to educate yourself on the effects of stress, medication use and poor diet on your gut. The next step would be to take the steps needed to eliminate foods that trigger inflammation; then add whole, unprocessed foods that feed the beneficial bacteria; and then add probiotic and prebiotic foods that will help restore and replenish your gut flora.

 

If you are interested in learning more, sign up for my upcoming Gut Health Webinar on February 17^th.

 

Chronic Stress and the Gut Citations

Cited Articles:

1. Understanding the Stress Response. Harvard Health, www.health.harvard.edu/staying-healthy/understanding-the-stress-response. Date of Access: 15 Jan 2017

 

2. Justin Sonnenburg, Erica Sonnenburg . Scientific American, www.scientificamerican.com/article/gut-feelings-the-second-brain-in-our-gastrointestinal-systems-excerpt  Date of Access: 16 Jan 2017

 

3. Emma Young. New Scientist, Gut Instincts: The secrets of your second brain. www.newscientist.com/article/mg21628951-900-gut-instincts-the-secrets-of-your-second-brain/. Date of Access: 15 Jan 2017

 

4. Chris Kresser. How stress wreaks havoc on your gut – and what to do about it https://chriskresser.com/how-stress-wreaks-havoc-on-your-gut/. Date of Access: 16 Jan 2017

 

Medications and the Gut Citations

 

1. Mayo Clinic. “Nearly 7 in 10 Americans are on prescription drugs.” ScienceDaily, 19 June 2013. <www.sciencedaily.com/releases/2013/06/130619132352.htm>.com

 

2. .The Big Business of Pain. https://www.youtube.com/watch?v=04DxaFvG2Q0 .April 27 2016

3.     Gavril Pasternak, Ying-Xian Pan, Mu opioid receptors in pain management, Acta Anaesthesiologica Taiwanica, Volume 49, Issue 1, March 2011, Pages 21-25, ISSN 1875-4597, http://dx.doi.org/10.1016/j.aat.2010.12.008.

4. Sigthorsson, G et al. “Intestinal Permeability and Inflammation in Patients on NSAIDs.” Gut4 (1998): 506–511. Print.

 

5. Arrieta, M C, L Bistritz, and J B Meddings. “Alterations in Intestinal Permeability.” Gut10 (2006): 1512-1520. PMC. Web. 25 Jan. 2017.

 

6. Kim Van Wijck; Kaatje Lenaerts; Annemarie A. Van Bijnen; et al. Aggravation of Exercise-Induced Intestinal Injury by Ibuprofen in Athlete. Med Sci Sports Exerc. 2012;44(12):2257-2262.

 

7. Ricciotti, Emanuela, and Garret A. FitzGerald. “Prostaglandins and Inflammation.” Arteriosclerosis, thrombosis, and vascular biology5 (2011): 986–1000. PMC. Web. 25 Jan. 2017.

 

8. Cashman JN. The mechanisms of action of NSAIDs in analgesia. 1996;52 Suppl 5:13-23.

 

9. Perlmutter D. NSAIDS, The Gut, and Inflammation. http://www.drperlmutter.com/nsaids-gut-inflammation/

 

10. Your brain can make its own valium. Popular Science. mawww.popsci.com/science/article/2013-06/your-brain-can-make-its-own-valium

 

11. Gottesmann C. GABA mechanisms and sleep. 2002;111(2):231-9.
12. National Sleep Foundation. What is insomnia? https://sleepfoundation.org/insomnia/content/what-is-insomnia

 

13. Why Sleeping pills are considered the number 1 most dangerous drug? http://www.emaxhealth.com/1/why-sleeping-pills-are-considered-number-1-most-dangerous-drug

 

14. American Gastroenterological Association. “GERD Negatively Impacts Sleep Quality, Results In Considerable Economic Burden.” ScienceDaily, 3 September 2009. <www.sciencedaily.com/releases/2009/09/090901082554.htm>.

 

15. Hong, D. Li, J. Wands, R. Souza, W. Cao. Role of NADPH Oxidase NOX5-S, NF-kB and DNMT1 in Acid-Induced P16 Hypermethylation in Barrett’s cells. AJP: Cell Physiology, 2013; DOI: 10.1152/ajpcell.00080.2013

 

16. Imhann F, Bonder MJ, Vich Vila A.et al. Proton pump inhibitors affect the gut microbiome. Gut 2015; 0:1-9. Doi:10.1136/gutjnl-2015-310376

 

17. Mayo Clinic. “Proton pump inhibitors decrease diversity in gut microbiome, increase risk for complications.” ScienceDaily, 25 November 2014. <www.sciencedaily.com/releases/2014/11/141125074656.htm>.

 

18. Palan PR¹, Strube F, Letko J, Sadikovic A, Mikhail MS. Effects of oral, vaginal, and transdermal hormonal contraception on serum levels of coenzyme q(10), vitamin e, and total antioxidant activity. Obstet Gynecol Int. 2010;2010. pii: 925635. doi: 10.1155/2010/925635. Epub 2010 Aug 9.

 

19. Akinloye O¹, Adebayo TO, Oguntibeju OO, Oparinde DP, Ogunyemi EO. Effects of contraceptives on serum trace elements, calcium and phosphorus levels.West Indian Med J. 2011 Jun;60(3):308-15.

 

20. Panzer C¹, Wise S, Fantini G, Kang D, Munarriz R, Guay A, Goldstein I.Impact of oral contraceptives on sex hormone-binding globulin and androgen levels: a retrospective study in women with sexual dysfunction. J Sex Med. 2006 Jan;3(1):104-13.

21.  Kelly Brogan, MD. That Naughty Little Pill. Birth Control Side Effects. Kellybroganmd.com

 

Heal Your Gut Citations

 

1. Choi J. J., Eum S. Y., Rampersaud E., Daunert S., Abreu M. T., Toborek M. (2013). Exercise attenuates PCB-induced changes in the mouse gut microbiome. Environ. Health Perspect.121, 725–730. 10.1289/ehp.1306534

 

2. Cerdá, Begoña et al. “Gut Microbiota Modification: Another Piece in the Puzzle of the Benefits of Physical Exercise in Health?” Frontiers in Physiology 7 (2016): 51. PMC. Web. 3 Feb. 2017.

 

3. http://www.huffingtonpost.com/dr-michael-j-breus/unlocking-the-sleep-gut-connection_b_8941314.html.