General health

Here is a brief summary of the main functions of the gut and the microbiota.

• Digestion and absorption of the nutrients we need to survive! That’s a pretty straight forward one.
• Vitamin B12 and vitamin K are produced in the bowel.
• Excretion of toxins and the normal by-products of the body’s metabolism, such as breaking down old cells or spent hormones. For oestrogen-dependent or sensitive conditions, it is essential that this occurs normally and the oestrogen and other hormones are not re-absorbed from the bowel and then re-enter the circulation.
• Protection from infection and infestation through its mucous barriers, acids and enzymes as well as the gastrointestinal-associated lymphatic tissue (GALT). Around 70% of all the lymphatic tissue in the body is in the GALT which contains B cells that form antibodies and T cells which identify and kills pathogens as well as helping B cells. The GALT can affect intestinal permeability, direct immune cells in response to something detected in the bowel contents, affect whether you develop a tolerance to a substance or an allergy to that substance and when things go wrong, the GALT can even cause direct damage to the bowel wall, like in Coeliac disease.
• Helps teach the immune system ‘tolerance’, and this reduces auto-immune conditions such as Rheumatoid arthritis and Hashimoto’s disease.
• It is an important site in converting largely inactive T4 thyroid hormone into the active form T3 (about 20%).
• It produces and uses about 90% of the body’s serotonin, with the rest being made and used in the nervous system. Serotonin regulates appetite, sleep, memory and learning, temperature, mood, behaviour, muscle contraction, and the function of the cardiovascular and endocrine (hormone) systems.
• The brain and the gut communicate in what is referred to as the ‘bidirectional gut-brain axis’ and it is likely that this communication appears to be managed by our microbiota and is not just about serotonin. For instance, the microbiota determines the gut bacterial toxins and the provision of the nutrient-ingredients to make neurotransmitters (eg GABA and dopamine), change your taste-receptors and stimulate or dampen inflammation and your immune response.
• Bowel function, and especially the microbiota is associated with depression, anxiety and other mental health conditions.
• Inflammation is reduced by ‘good bacteria’ in the bowel as well as elsewhere in the body. Stress can affect the bowel, microbiota, and inflammation and vice versa.
• Helps maintain normal bone composition by absorbing vitamin D and regulating the level of calcium absorption.
• Produces hormones that affects appetite and fat storage (including ghrelin and leptin).
• Microbial fermentation of dietary fibre produces short-chain fatty acids (SCFA) which provide energy for the cells of the bowel, reduce cholesterol, reduce inflammation, protect against cancer (bowel cancer in particular), help maintain a healthy weight and reduce diabetes.  How’s that for over-achieving?
• And if that wasn’t enough, some other areas that the gut microbiota are thought to influence: cognition, memory, MS, Parkinson’s Disease, Alzheimer’s disease and dementia, migraines, allergies, circadian rhythm, gestational diabetes, Cystic fibrosis, obesity, Anorexia nervosa, Crohn’s disease, Ulcerative colitis, non-alcoholic fatty liver disease, asthma, eczema, oxytocin levels, leaky gut and toxins from unhealthy microbiota linked to chronic kidney disease and failure, and the gut microbiome influence the microbiome and glucobiome of a mother’s breast milk.

• age
• hormones
• diet and nutritional status
• where you live
• medications, especially antibiotics
• chronic stress
• infections

• Irritable bowel syndrome
• Leaky gut
• Reflux, GORD (gastro-oesophageal reflux disorder)
• Ulcers
• Coeliac disease
• Inflammatory bowel disease, including Crohn’s disease and Ulcerative colitis
• Food intolerances and sensitivities
• Infections and infestations

Optimal gut function relies on four key factors:

1. The gut lining has to be the undamaged
2. A good balance of gut bacteria
3. Adequate digestive enzymes
4. A healthy fibre-rich diet

You can go a long way to achieving these four factors with the following tips.

• Eat your vegetables. No, just eating potatoes won’t cut it.  Aim for at least 5 serves of veges a day and get a variety.  Have salads and stews and dips and smoothies and soups and throw some salad in your wraps and on your sandwiches.
• Drink enough water that your urine is pale yellow; if you are a petite 50kg woman this will be less than if you are a muscular 110kg man.
• Have some fruit, nuts and seeds for nutrients as well as fibre.
• Include wholegrains for nutrients as well as being a great fibre source.
• Avoid sugary foods like soft drink, cakes, lollies, biscuits.
• Include prebiotic and gut-friendly foods. Prebiotics are a type of non-digestible carbohydrate which promote the growth and activity of good bacteria in the gut, and they include:
  • artichoke, asparagus, garlic, green peas, Jerusalem artichokes, onions, leeks, snow peas, tomatoes
  • apples, bananas, nectarines, plums, watermelon, white peaches
  • wholegrains, legumes, nuts and seeds
• Include probiotic foods that contain live beneficial bacteria or yeast, such as:
  • kefir
  • kimchi
  • kombucha
  • yoghurt
  • fermented vegetables, eg sauerkraut
• Move your body.
• Build your resilience and stress management skills.

If you have a condition that requires further management, herbs and nutritional supplements such as glutamine, marshmallow root, zinc, dandelion and prebiotic and probiotic treatment can be very helpful.

The key nutrients required to make thyroid hormones are tyrosine (an amino acid, found in protein foods), iodine, iron, zinc and selenium.

The most important nutrients used in converting T4 to T3 are selenium and zinc.

The key factors that improve cell sensitivity to thyroid hormones are Vitamin A, zinc and exercise.

Factors that can inhibit hormone production by the thyroid gland include: prolonged and/or acute stress, infection, trauma, radiation, fluroride, endocrine disruptors and toxins (eg BPA, mercury, lead, pesticides), gut disorders and auto-immune disorders (of the thyroid gland or other systems, such as Coeliac disease).

The conversion of T4 to the active T3 is essential and conversion can be too low, too high or altered.  Adequate amounts of zinc and selenium are essential to this step.

A small percentage of the conversions produce reverse-T3 (rT3) which is less biologically active.  There is some debate about how important rT3 is, however since it competes with T3 for cell receptor sites, it reduces the effect of T3, and when rT3 is elevated then the areas that thyroid hormones influence are negatively affected.

Factors that increase the conversion to T4 to rT3 include: stress, trauma, low calorie diet, elevated copper levels, inflammation, infection, liver and/or kidney dysfunction.

Once you have successfully made your T4 and converted it to T3, there is still one more step!  The cells around your body need to respond, or be sensitive to, the T3.  Just like with insulin resistance, you can have thyroid resistance, thus having less thyroid effects.

Oestrogen: partially blocks the action of T4, so women make more T4 to compensate.  This leads to larger thyroid glands in women and makes women more prone to thyroid disease.

Cortisol:  when elevated it inhibits the enzyme that converts T4 to T3 and increases rT3.  Higher cortisol levels are also associated with an increased risk of antibody production and the development of Hashimoto’s disease or Grave’s disease

Insulin: when elevated it stimulates an increased production and release of thyroxin binding globulin (TBG).  This leads to more of the T3 and T4 being bound up and not available to the cells.  Insulin resistance is also associated with increased rT3.

Thyroid problems are up to 10 times more common in women than men, and the prevalence increases with age. The more common conditions are as follows.

• Hypothyroidism: most commonly auto-immune (Hashimoto’s disease)
• Hyperthyroidism: most commonly auto-immune (Grave’s disease)
• Thyroid nodules
• Goitre
• Benign or cancerous tumours

Normal thyroid function is essential for normal reproductive function, including conceiving and carrying a pregnancy to term.  There is a complex relationship between hormones of the hypothalamus, pituitary gland, thyroid, ovaries and adrenal glands as well as the gut, liver and immune system and health and fertility is dependent on all these factors working in harmony.

Hypothyroidism is associated with very heavy periods, anovulation, infertility, and if pregnant, it is associated with preeclampsia, anaemia and pregnancy loss.

Hyperthyroidism is associated with very light, infrequent or absent periods, infertility, and if pregnant, it is associated with preterm birth, low birthweight, preeclampsia, and pregnancy loss.

There are many reasons why you might be struggling with fatigue and here are just some:

• poor quality and not enough sleep; sleep apnoea, the dreaded shift work, young children
• chronic pain – it really drains you!
• poor nutrition, especially lacking adequate protein and B vitamins
• anaemia
• overwork
• being unhappy and dissatisfied – at work, in your relationship, where you live….
• stress – financial, toxic workplace, relationship conflicts, caring for (and worrying about) ill and frail family
• lingering infections
• post-trauma and major surgery
• post-viral, e.g Epstein barr virus, Chronic Fatigue Syndrome
• chemotherapy and radiotherapy
• insulin resistance, undiagnosed or poorly managed diabetes
• dehydration
• chronic illnesses, e.g rheumatoid arthritis
• chronic low level inflammation
• depression
• grief
• underactive thyroid
• environmental factors, e.g noise, mould, smoke
• poor gut function and Dysbiosis
• food sensitivities, e.g dairy
• undiagnosed allergies, e.g gluten
• Hormone imbalance, e.g low DHEA, PMS
• cardiac disease
• partying too hard; drugs and alcohol
• some medications
• lack of exercise

Having prolonged and/or severe fatigue typically isn’t just about being tired, but rather involves other symptoms depending on the cause of your fatigue.

Some of the symptoms of prolonged fatigued can include:

• chronic tiredness
• sleepiness, including falling asleep against your will (micro sleeps)
• headaches and migraines
• light-headedness
• sore or aching muscles
• muscle weakness
• slowed reflexes and responses
• moodiness, irritability, short-fuse
• weepy, upset easily
• appetite loss
• overeating, trying to find energy through food
• digestion problems
• lowered immunity, more frequent infections
• relying on coffee or other stimulants to function
• reduced alertness, concentration and memory
• lack of motivation
• depression
• feeling overwhelmed

Having fatigue that isn’t resolved by a couple of early nights can affect all areas of your life and is a significant occupational hazard, relationship stressor, financial stressor and overall downer. Some major impacts include:

• reduced mental and physical functioning
• impaired judgement and concentration
• increased risk-taking behaviour
• trouble making decisions
• reduced ability to do complex planning and problem-solving
• difficulty communicating clearly (expressing yourself and understanding others)
• reduced productivity or performance
• reduced ability to handle stress
• reduced reaction time – both in speed and thought
• struggling to adjust to change
• unable to stay awake (e.g., falling asleep at your desk)
• increased forgetfulness, and decreased ability to recall details
• increased sick time and presenteesim (you turn up but may as well not have as you aren’t able to function normally)
• increased accidents
• the financial, time and emotional cost of multiple medical appointments

Sound familiar?

A lot!  As always, the first step is to really explore your history and identify all of the things that might be contributing to your fatigue.  Where possible, eliminate the cause(s), and where that isn’t possible, aim to reduce their impact.  Then support your energy production. Steps involved include:

• Lifestyle review; what is working, what isn’t, are you getting any exercise (definitely don’t start an intense exercise regime if you have been fatigued for some time, just a short walk and some stretches are likely to be more appropriate).
• Address the cause: treat the anaemia, support thyroid function, introduce a fabulous nourishing diet, ease up on the alcohol etc.
• Counselling and coaching if required.
• Nutrient supplementation may be helpful, eg. magnesium, B vitamins and Coenzyme Q10 for fatigue and stress.
• Herbal medicine to support
  • adrenal function, e.g. licorice and rehmannia
  • energy production, e.g. rhodiola and ginsengs
  • the nervous system and emotional wellbeing, e.g. St John’s wort, skullcap, passionflower and oats
  • immune function, e.g. Echinacea and astragalus
  • cognition, e.g. gingko, rosemary and bacopa
• Mediation and relaxation techniques.
• Really invest in getting good quality sleep. Try these tips for better sleep.