Nutrition and gut health can have a profound impact on the body’s ability to heal, and a body that is healing can cause stress and dysbiosis within the gut, leading to dysfunction and breakdowns in other areas and systems of the body. Over a four-week period, Lisa Hannaby has been lecturing on nutrition, discussing the impact of stress, healing, immunity, the microbiome and much more on our patients.
The health of the gut and its ability to absorb nutrients optimally is an integral part of almost every system in the body, including healing, inflammation and performance.
Today I share a few highlights from this fascinating four-part webinar.
A series of webinars
Over the course of four weeks, Lisa Hannaby from Neurish shared four webinars:
- General nutrition
- Nutrition for stressed or competitive dogs,
- Nutrition for healing and immunity
- Feeding the microbiome.
Each of these topics is intricately important to us as Vetrehabbers, and can help us make a difference in the wellbeing of each of our patients.
Nutrition and Digestion
‘You aren’t what you eat, you are what you absorb and utilise.’
To me personally, the digestive system felt very unimportant during the anatomy portions of my studies, and I always brushed over it without paying too much attention. But in the intervening years, I have come to realise its importance in our patients, and have tried to better understand the digestive system. Lisa explained the function of the different parts of the GI tract in the clearest and most concise way I have heard yet, so I would encourage you to watch the webinar for that overview.
We have to realise that if the digestive system is not working optimally, it will not matter what we put into the bowl. Some of the things that can affect the digestive system include:
- Irritable bowel syndrome.
- Low stomach acid production, as a result of anti-histamine use.
- Impaired liver function will affect the digestion of fats and other nutrients.
- Pancreatitis will affect the release of enzymes and hormones that support nutrient absorption.
- Stress will redirect resources from the digestive tract and will change motility.
When it comes to nutrients, the main ones to consider in the dog are carbohydrates, fats and proteins.
Within the world of nutrition, there is an argument about whether dogs need carbohydrates at all. The simple fact is that carbohydrates provide a source of energy. The brain and red blood cells have an absolute need for glucose, which can be provided instantly by carbohydrates.
Simple carbohydrates are absorbed in the small intestine and are available as energy very quickly. Small amounts can be stored in the liver and muscles in a ready-to-use form, while excess is stored as fatty tissue.
Complex carbohydrates are dealt with in the large intestine, and primarily refers to fibre, which is fermented by the microbiome in the gut, providing an essential food source for the bacteria in the gut. If there is no fibre in the gut for the microbiome, microbes will start to eat the mucosal layer of the gut, exposing epithelial cells.
Fats can be in the form of solids or liquids. We need to ensure we include the correct fats in the diet, as certain fats are subject to oxidation. Fatty acids are transported from the small intestine to the lymphatic system and from there into the bloodstream. Including fats in the diet of dogs with degenerative myelopathy is important to slow the degeneration of the nervous system.
Essential fatty acids include Omega 3 and 6, which need to be included in the diet in the right balance or ratio. The Omegas are important components of regulating the inflammatory response, with Omega 3 acting as a COX inhibitor and reducing inflammation.
Fatty acids are essential to maintaining skin health; exclusion from the diet can lead to skin abnormalities and water loss through the skin barrier.
Deficiencies in micronutrients such as zinc, magnesium and Vit B6 can lead to deficiencies in fatty acids.
Fat malabsorption can occur as a result of liver disease, biliary disease, inflammatory bowel conditions or chronic pancreatitis.
Protein forms the building blocks of the body, making a high quality protein an essential component of the diet of a dog that is healing or competing. It is also involved in many physiological and chemical processes in the body.
Micronutrients are essential to the function of the entire body, providing the cells with the compounds they need to carry out specific functions. Micronutrients to consider include Vit A, D, E and K, water soluble Vit C and B complex, minerals including boron, calcium, chromium, copper, iron, magnesium, manganese, phosphorous, potassium, selenium, and sodium, as well as antioxidants.
The real crux of this first webinar for me was that the body is an interconnected structure that requires different compounds derived from nutrients to function optimally. Without these compounds, cells will not be able to carry out their functions; normal processes including healing will be impaired, and systems that need to maintain balance, such as inflammation or the immune response, will be skewed to one side or the other and will not function optimally in the body.
The Impact of Stress
Stress includes any stimulus that disrupts the normal functioning of the body. It is the stimulus required to drive adaptation, strengthening and change in our lives and bodies, including those of our dogs. Our usual perception of stress is that it is a bad, disruptive and destructive thing. Altering our perception and understanding of stress can make a significant difference to its effect on us.
We already have a great understanding of the autonomic nervous system, and how the sympathetic and parasympathic systems balance in the body, the sympathetic mobilising the body and the fight and flight responses, while the parasympathetic system slows us down into a state of rest and digest. Both systems need to function synergistically for our patients to heal and rehabilitate from an injury.
Similarly, we have come to consider cortisol as the ‘bad guy’, when it is an essential part of our bodies, maintaining homeostasis during normal activity and achieving normal cellular and metabolic function. Part of this normal role is to inhibit inflammation by binding to glucocorticoid receptors; when there is a prolonged excretion of cortisol, downregulation or resistance in the receptors occurs, which leads to inflammatory inhibition. Cortisol is also responsible for regulating the stress response, not driving it.
Therefore chronic stress leads to cortisol dysfunction and unmodulated inflammation in the body.
The dose is the poison
Stress, just like overload during exercise, can be incredibly good for us, leading to adaptations that allow us to become stronger when applied in the right amounts. Too little stress has no real effect, while too much stress leads to breakdown. When the right amount of stress is applied, we see optimal adaptation and performance occurring.
When we are trying to unravel how much stress is enough or too much, it helps to think about the different stressors the patient is exposed to. Stress will have a cumulative effect, with the healing response in the body adding to the new environment, adding to the stress and uncertainty of the owner, adding to nutritional deficits, etc. Consider the different compounding factors that might be adding stress to the patient, and consider ways in which those factors can be reduced or minimised.
Rest and digest
The stress response will redirect resources away from the gut, leading to changes in motility – food will either slow down at one point in the gut, or speed up through the gut. This leads to an alteration in the absorption of nutrients, and can cause changes to the microbiome as food remains in the wrong places for too long a period of time.
During stressful periods, our bodies have an increased demand or requirement for nutrients. The reduced absorption coupled with the increased demand can lead to the development of deficiencies quickly.
In her webinar, Lisa Hannaby discusses the different nutrient requirements for dogs that are stressed, as well as the foods that we can advise owners to add to the bowl to support the body in regulating and adapting to stress.
Fueling the competitive dog is a process; it’s not only about providing the correct nutrients on the day of competition. Athletes need bioavailable protein to recover from training and build muscle. Carbohydrates provide an invaluable source of energy to athletes in the build-up to competition. Feeding complex carbs in the days before an event can help the dog build the energy stores they will need on the day, while simple carbs on competition day can provide quick, easily accessed energy. Fats are also essential as an energy source. We need to ensure that fat-soluble vitamins are available in the body.
The Immune Balance
The immune system can be considered in terms of innate immunity and aquired immunity. In her webinar, Lisa Hannaby discusses these two immune systems in depth. Our innate immunity includes our skin, mucous and stomach acid, to name a few aspects. It is the first line of defence for our patients.
Our aquired immunity includes white blood cells – monocytes that develop into macrophages, neutrophils, eosinophils, basophils and natural killer cells. Mast cells and cytokines are additional cells that play an important part in immunity.
The immune system needs to function optimally for our patients to remain healthy. Boosting the immune system is a myth, indicating a misunderstanding of this system. If there is an imbalance in the immune system, an immune-mediated disease can be the result. For example, in an overactive or stimulated immune system, our patients can develop autoimmune diseases and allergies. If the immune system is inhibited, the body is prone to disease from external pathogens as well as cancer.
We want a controlled response from the immune system, not an over-active response.
Many nutrients and foods can be incorporated into the diet to support immune function. Lisa discusses these in depth in the webinar ‘Nutrition for Immunity and Healing’.
In many ways, we have regarded inflammation as something to stop, slow or prevent in our patients. It has been considered a bad thing. The truth is that inflammation is a very necessary part of the immune system, and is essential to the healing response and process.
Dysregulation in the inflammatory process can occur, leading to uncontrolled chronic inflammation. This occurs when the initial inflammatory mechanisms fail to eliminate tissue injury, or when there is an inflammatory burden on the body.
If we change our mindset about inflammation, and consider it a messenger indicating that there is dysregulation within the immune function, we can address it from a very different mindset.
Ensuring the body has the nutrients necessary to firstly regulate the immune and inflammatory response, and then to facilitate and regulate healing – and of course ensuring that the gut is absorbing those nutrients! – will allow the patient the best chance to overcome dysregulation in these systems.
Additional factors that could impair healing include stress and sleep disruption.
Feeding the microbiome
The microbiome has been a much-discussed topic in recent years, and with good reason. The health of the gut, and the bacteria within the gut, have a direct effect on almost every system in the body. There are multiple axes or connections, including:
- Gut-immune axis
- Gut-brain axis
- Gut-lung axis
- Gut-bone axis
- Gut-musculoskeletal axis
- Gut-kidney axis
- Gut-thyroid axis
- Gut-skin axis
- Gut-liver axis
Not only does a healthy microbiome in the gut allow optimal breakdown and digestion of nutrients, facilitating digestion, it is essential to the healthy functioning of all of the above systems. Within the gut, the microbiome contributes to maintaining an intact intestinal barrier, promoting tight junction formation and preventing the leakage of pathogens, toxins or dietary antigens into the bloodstream.
Common causes of dysbiosis in the gut include
- Decreased mucosal immunity
- Antibiotic use
- Intestinal inflammation or food sensitivities
- Undigested food, leading to bacterial overgrowth
- Decreased pancreatic output
- Decreased gastric acid
- Motility disorders due to stress
- Anatomic abnormalities or foreign bodies
- The use of proton pump inhibitors
Lisa goes on to discuss the gut-brain axis and the gut-musculoskeletal axis in more depth; how sarcopenia can be caused by gut dysbiosis and corrected when the gut microbiome is corrected, along with a great deal more.
A food first approach
‘What gets fed, survives.’
Lisa is a great advocate of taking a food-first approach to feeding the microbiome. Prebiotics, probiotics and postbiotics all have a place and can be used in certain circumstances, but when we intentionally support and grow the microbiome through diversity in the diet, we can have a profound impact on the health of this system.
‘We don’t rise to the level of our goals, we fall to the level of our systems.’
Lisa left us with this thought at the end of the webinar series, highlighting that without a functional gut, most of the systems in the body will not function optimally, leaving us many steps behind as we try and facilitate healing, improve performance, or improve function of the musculoskeletal system.