Changes in the composition of our bacteria develop as quickly as days to weeks after a change in diet.34 Right now, our understanding of bowel flora remains limited, but it is rapidly yielding to study. I believe that in the next few years we will know with confidence how to assess an individual’s bowel flora status and how to know when it has been fully corrected. In the meantime, the steps required to reestablish what we currently believe represents an ideal composition of bowel flora will be discussed in Chapter 9.
Small Intestinal Bacterial Overgrowth: The Case of the Human Petri Dish
Put a petri dish out in the open air and, over just a few days, it will be ripe with bacteria and fungi. Likewise, mess up the health of the human intestine by allowing undesirable bacteria and fungi to gain an advantage and reducing normal bacterial species, and you have the equivalent of a human petri dish. Such a situation is common, and it’s called small intestinal bacterial overgrowth (SIBO), or dysbiosis, an abnormal overabundance of bacteria in the normally sparsely populated upper small intestine, or jejunum, along with changed species in other parts of the intestinal tract. (Changed bowel flora also occurs in the large intestine and even the stomach and duodenum, but a SIBO or dysbiosis diagnosis is often made by sampling the contents of the jejunum of the small intestine, which is why we have the somewhat misleading ‘small intestine’ label of the condition.)
SIBO has been associated with a number of conditions, including fibromyalgia, irritable bowel syndrome, Crohn’s disease, ulcerative colitis and anatomical distortions introduced by prior bowel surgery.35 SIBO is common in people with coeliac disease, and when ‘normal’ people are assessed for SIBO, up to 35 per cent demonstrate evidence for abnormal intestinal infestations, even if no symptoms are present.36 When SIBO is diagnosed in people with bothersome symptoms, the conventional treatment is to prescribe an antibiotic, such as rifaximin, to wipe out bowel flora, both good and bad. And it works, though it ignores the question of why the SIBO developed in the first place. And, of course, wiping out bowel flora does not guarantee that your intestines will repopulate with healthy bacteria, particularly if the cause of the SIBO remains uncorrected.
The Difficulties of C. difficile
One disturbing trend in the world of SIBO is the increasing incidence of infection by Clostridium difficile, a strain of bacteria capable of inflicting severe damage on the colon. Called pseudomembranous colitis, in its worst form it can involve sepsis (entry of bacteria into the bloodstream) and death.
Ordinarily, C. difficile quietly inhabits the colons of healthy people (or at least what is commonly regarded as healthy) in low numbers, as it competes with other bacteria for nutrients and is suppressed by factors expressed by other species. We know that C. difficile can emerge following the use of antibiotics that indiscriminately knock off bowel flora, good and bad, which of course requires even more antibiotics. More recently, though, C. difficile has proven to be a source of trouble even without a preceding course of antibiotics. Drugs that are widely prescribed to suppress stomach acid, such as Prilosec, Protonix and Prevacid, have been associated with distortions of bowel flora that allow populations of C. difficile to thrive.37 But the reasons why this organism is becoming increasingly aggressive are unclear. Might the distortions of bowel flora caused by grains, changed by agribusiness, play a role? There are no answers at present, but it sure would add up as cleanly as 2 + 2 = 4.
Your Gut is Leaking
Leakiness is a condition that plagues roofs and bathroom taps or is suffered by spy agencies when errant contractors leak classified US security information, but hopefully your seafaring ship, microwave and intestinal tract are free from leaks. For many years, it has been suspected that an abnormally increased degree of intestinal permeability is responsible for triggering diseases such as type 1 diabetes, Crohn’s disease, ankylosing spondylitis, multiple sclerosis and coeliac disease.38 Every day, your gastrointestinal tract must contend with bacteria, fungi and other organisms, bacterial toxins and even larger critters, such as protozoa and insects. It must therefore make millions of ‘decisions’ every day, with each and every meal: What should be allowed passage into the lymph system and bloodstream? What should not?
This tightly controlled system can go haywire. Fragments of gliadin and related prolamin proteins exert direct toxic inflammatory effects on the intestinal lining in anyone foolish enough to ingest grains – effects that can result in abnormally increased intestinal permeability.39 No genetic susceptibility is required for this effect; all testing for coeliac disease or ‘gluten sensitivity’ may be negative in those with intestinal permeability.
In addition to these direct effects, gliadin can also indirectly increase intestinal permeability. While at the University of Maryland, Dr Alessio Fasano discovered that the zonulin protein in the lining of the gastrointestinal tract is a target for the gliadin protein of wheat.40 Once activated, the zonulin protein triggers increased leakiness of the barriers (‘tight junctions’) between intestinal cells, permitting molecules that should be confined within the intestinal tract to gain access to the rest of the body. While the intensity of the effect is variable (depending on the genetically determined form of zonulin), everyone is subject to this effect to one degree or another. Given their structural similarities, the prolamin proteins of other grains exert similar effects.41 The implications of Dr Fasano’s work are huge. His findings mean that the abnormally increased intestinal permeability induced by gliadin and related proteins is the first step leading to autoimmunity, as the body’s immune system is tricked into attacking its own organs in those with genetic susceptibility. In other words, even if you have a genetic susceptibility to rheumatoid arthritis, joint swelling, inflammation and disfigurement may never show unless the process is initiated by consumption of grain proteins. Or, if you have a genetic susceptibility to multiple sclerosis, fatigue, numbness, incoordination and bladder or bowel dysfunction may never appear unless grain proteins cause increased intestinal permeability that allows the genetic susceptibility to manifest. We discuss this distinct pathway that relates autoimmune diseases with grain consumption in Chapter 13.
Venomous, Debauched, and Depraved
If, at the end of this discussion of the gastrointestinal effects of grains, you conclude that grains are not only harmful for bowel health and nutrition but are also a dreadful, nasty, trouble-making collection of bowel toxins, you are empowered with the key to understanding why so many people are plagued by chronic gastrointestinal complaints, regardless of how ‘balanced’ their diet, how vigorously they exercise or how many nutritional supplements they take.
While the gastrointestinal system is ground zero for the human body’s battle against grains, it is by no means the only battleground. We’ll discuss the rest of the battered, barren, land mine-strewn health landscape in Chapter 5.
Grains, Brains and Chest Pains
I couldn’t repair your brakes, so I made your horn louder. Stephen Wright
In the confrontation between grains and the human body, the gastrointestinal tract is directly in the line of fire – but the war certainly doesn’t end there. Let’s penetrate deeper and examine the wounds and scars left by grains as they disrupt, agitate and discombobulate the finely balanced machinations of the human body – joints, skin, glands, respiratory system and brain – leaving no organ untouched. It’s a long chapter with lots of detail meant to show you the astounding scope and frightening severity of the unhealthy human experience that exists because, as a species, we made this terrible decision to consume the seeds of grasses.
Grains