Man listening to female doctor in office

The 3 Stages of GI Dysfunction

Webinar: “Functional GI Concerns: Understanding and Addressing the Root Cause” with Dr. Daniel Kalish, D.C.⁺

Associated material: PureGI Exclusive, PureGI Brochure

A roadmap to help you understand and support gut health.

WHY FOCUS ON GUT HEALTH FOR ALL PATIENTS?

Complaints related to gastrointestinal (GI) health are highly prevalent in both US and global populations—with one academic survey reporting 61% of Americans experienced at least one GI symptom in the past week.¹

GI complaints are not only common but often present in patients with structurally healthy GI tracts. In these cases, patient complaints are typically attributed to functional GI factors, such as alterations in the gut microbiota, immune function, and central nervous system processing.²

Due to the high rate of prevalence and discomfort associated with GI complaints (e.g., gas, bloating, abdominal discomfort, etc.), there is a great need for practitioners to understand and support functional GI factors—and in turn patient health and comfort.

Dr. Daniel Kalish, D.C.,⁺ founder of the Kalish Institute and practicing functional medicine thought leader, says, “Patient-reported GI complaints don’t manifest overnight. Instead, they develop over months or even years and progress through a predictable series of stages.”

This clinical observation, and a detailed understanding of the latest research, has led Dr. Kalish to this current model for understanding functional GI factors—the Three Stages of GI Function.

STAGE ONE: IMPACT ON MICROBIOME HEALTH & IMMUNE ACTIVITY

The first stage in the Three Stages of GI Function address lifestyle factors such as nutrition, sleep, and stress, which can lead to immune activation and changes in the gut microbiome. In this first stage, patient complaints are typically mild but, if not addressed, may advance.

Nutrition—When a patient complains of GI issues, the first place to look is their diet. Higher intake of animal foods, processed foods, alcohol, and sugar, corresponds to a microbial environment that is characteristic of inflammation, and is associated with higher levels of intestinal inflammatory markers.³
Sleep—Sleep deprivation is pervasive across the country, with the CDC reporting 35.2% of US adults are getting less than the recommended hours of sleep each night.⁴ Animal studies show that chronic sleep fragmentation for 4 weeks affects activities that can influence optimal gut function, such as increased food intake.⁵
Stress—Stress has been shown to alter the composition of the gut microbiota, causing it to skew away from beneficial bacteria towards an unhealthy imbalance.⁶

STAGE TWO: IMPACT IN GI ORGAN & IMMUNE SYSTEM FUNCTION

Over time, prolonged activation of the immune system and shift in the gut microbiome (stage 1) can lead to changes in GI organ and immune system function. Patient complaints may become more diverse or intense at this stage.

Pancreas—Shifts in the gut microbiome have been associated with alterations in pancreatic activity, including enzyme production, which helps to regulate healthy gut activity.⁷
Bile—Microbial changes can also disrupt production and secretion of bile acids, since gut microbiota is integral to their metabolic processes.⁸
Immune—Connections between microbiome homeostasis and optimal immune health are well characterized. Specifically, immune balance can be altered through changes in T-helper cell polarization patterns.⁹

STAGE THREE: IMPACT ON GI MICROBIAL DEFENSES.

Changes in the functionality of GI organs and immune function (stage 2) often influences GI microbial defenses (stage 3). Stomach acid, pancreatic enzymes and bile not only help us digest food but protect us from foreign microbes that we ingest, and a balanced immune system helps the body manage microbes already residing in our GI tract. In stage 3, patients may complain of worsening symptoms.

SUMMARY AND CONCLUSION

Lifestyle factors such as diet, food sensitivities, stress, social isolation, lack of sleep, inactivity and many others can lead to immune activation and changes in the gut microbiome. This is the first stage in the Three Stages of GI Function, when complaints are typically mild but, if not addressed, may advance.

Over time, this prolonged, activation of the immune system and shift in the gut microbiome (stage 1) can lead to changes in GI organ and immune system function (stage 2). In this stage, basic digestive functions can be affected, such as stomach acidity, pancreatic enzyme and bile production, gut barrier integrity and others. Immune balance can also be altered through changes in T-helper cell polarization patterns. Patient complaints may become more diverse.

It is important to note that Three Stages of GI Function is a self-perpetuating process. While lifestyle factors often initiate it, stages 2 and 3 loop back into stage 1, further affecting microbiome health and immune activity.

Dr. Kalish concludes, “In natural medicine, the GI tract is considered the ‘mother’ of the body—meaning, it feeds and heals the rest of the organ systems. A complete workup for any chief complaint must include a thorough GI assessment.”

WORKS CITED

Almario CV, Ballal ML, Chey WD, et al. Am J Gastroenterol. 2018;113(11):1701-1710.
Sperber AD, Bangdiwala SI, Drossman DA, et al. Gastroenterology. 2021 Jan;160(1):99-114.e3.
Bolte LA, Vich Vila A, Imhann F, et al. Gut. 2021 Jul;70(7):1287-1298.
https://www.cdc.gov/sleep/data_statistics.html
Poroyko VA, Carreras A, Khalyfa A, et al. Sci Rep. 2016 Oct 14;6:35405.
Gao X, Cao Q, Cheng Y, et al. Proc Natl Acad Sci U S A. 2018 Mar 27;115(13):E2960-E2969.
Akshintala VS, Talukdar R, Singh VK, Goggins M. Clin Gastroenterol Hepatol. 2019;17(2):290-295
Wang C, Zhu C, Shao L, Ye J, Shen Y, Ren Y. Mediators Inflamm. 2019 Jun 24;2019:7659509.
Zheng D, Liwinski T, Elinav E. Cell Res. 2020 Jun;30(6):492-506.
Iacob S, Iacob DG. Front Microbiol. 2019 Aug 7;10:1676.

⁺Dr. Daniel Kalish, M.D., is a retained advisor for Pure Encapsulations®.