The intestine - The body’s underappreciated control center and gut health | DW Documentary

The gut – it's more crucial than we might think.

You can sort of tell the state of someone's gut

from a first glance.

Our gut plays such a vital role.

I really think of it as the body’s control center,

influencing everything else happening within us.

It’s home to trillions of organisms that keep us up and running.

We're living in harmony with these foreign cells:

bacteria, viruses, archaea fungi.

They’re all part of the microbiome.

So we’re basically walking aliens.

The gut can also be a source of stress...

Here, you could go boating.

But there’s a catch: None of the boats have toilets!

For many, discussing digestive problems is taboo.

Millions of people are left alone. Young people especially.

But the gut can also be a motivator...

Switching my diet was a game-changer.

It’s ninety to ninety-five percent vegan now.

What else could we be doing to help our gut?

What kind of a relationship should you have with your gut?

A good one!

You should live in harmony with your gut, like the bacteria do.

If your gut is bothering you, maybe you’re irritating it, too.

My name is Tanja Kühbacher.

I’m a professor of gastroenterology

and the chief physician at St. Marien und Annastifts Hospital

in Ludwigshafen am Rhein, Germany.

My passion is chronic inflammatory bowel diseases –

and that's my field of clinical research.

You could say, the gut is an uncharted ocean.

The microbiome in particular.

But also, our understanding of what we can already do

to help patients. It’s fascinating.

It's what excites me about the gut.

I want to understand my body.

I've only got this one.

I'd like to do my best to keep it healthy for as long as possible.

And really get the best out of it.

I’m Jana.

I’m twenty six, and originally from Bavaria.

I've been studying computer science for the past few years.

I’ve also been working as a model for several years.

I do a lot of sports, and last year I started competing in triathlons.

I’ve set myself a goal:

I'm training for the Ironman 70.3 in Zell am See.

I’m deep in training for that right now,

with a few other triathlons planned in advance.

I’ve always been really interested in nutrition and health –

partly because I have so many food intolerances.

That led me to learn more about the gut –

what it needs, how it works.

The gut’s most important function is nutrient absorption,

which happens in the small intestine.

At five to six meters in length, it’s the longest section of the gut.

With its countless folds and villi,

the small intestine’s surface area measures some thirty square meters.

This maximizes the absorption of nutrients from food.

After that comes the large intestine, about one meter in length.

It’s home to trillions of microorganisms.

A valve prevents them from moving into the small intestine,

where they could cause problems.

In the large intestine, though, they’re extremely useful –

harvesting key metabolic nutrients that have gone undigested.

In in my family, cooking was sacred.

We all cooked together a lot on weekends.

Right now, I’m making hummus from scratch – it’s so easy.

We make it quite often.

I eat something delicious and healthy every day,

something that satisfies me physically and mentally.

I know it has the flavors I want,

and I’ve come to dislike unhealthy foods,

because I know how bad they are for my body.

As the body’s largest immune organ,

the gut can only perform at its best when it’s properly nourished,

and provided with the right conditions.

If I give it the right food and energy at the right time,

I can achieve peak performance.

I think I’m pretty well informed – but what’s my ultimate potential?

Where can I go from here?

Maybe I haven’t reached the pinnacle yet.

That’s why I'm seeing an expert –

they know exactly how things work.

Every time we consume food

– especially the artificial foodstuffs that our bodies

haven’t encountered in the last 5,000 years –

it causes slight inflammation in the gut.

Over time, that inflammation can spread,

and start affecting our energy levels throughout the day.

My name is Jens Freese.

I’m a sports scientist,

psychoimmunologist and neuroimmunologist.

I also studied nutritional science.

I’ve been working on gut-related topics for about thirty years now.

Today, I consult and coach patients –

including elite athletes – on their gut health.

Hello

Hi, great to see you.

Nice to meet you!

I’m hoping this appointment with Dr. Freese

will show me what my body’s missing.

We’re going to test everything – stool, blood –

and see if what I’m eating is actually getting where it needs to go.

I think there’s a lot of room for improvement.

Our gut is so important!

People think, 'Sure, you eat something and stool comes out.'

But really, it’s vital for everything in the body. Everything!

I’m Philipp Stehler. I’m thirty six.

Sometimes people recognize me from television –

I was on the German version of The Bachelorette in 2014,

and on a soap opera – stuff like that.

I've tried out a few things, that were fun.

I’m living my dream now.

I moved to the countryside with my wife.

I’m the proud dad of a one-year-old son.

We’re getting a big horse farm up and running.

Whenever I imagined where my life's journey might take me,

I always saw it just like this:

A terrace, white fences, horses.

It’s amazing it’s actually happening.

This is where the farm’s going to be, and that’s our home.

We’ve already come a long way.

Two months ago, the grass here was knee-high –

it looked like a jungle.

A lot has changed already.

Around 2011 I was diagnosed with ulcerative colitis;

a chronic inflammatory bowel disease.

My large intestine was removed.

But life's somehow so much better without an inflamed colon.

I’d honestly say I live a pretty normal life.

Ulcerative colitis – along with Crohn’s disease –

is one of the most common severe gut conditions.

Around 650,000 people in Germany live with it,

and that number is on the rise.

Both conditions involve chronic inflammation of the gut's lining.

In ulcerative colitis, only the colon is affected.

The exact causes are still unclear –

genetics, environmental factors, disruptions in the microbiome,

and lifestyle could all play a role.

We see this in the example of people

from regions with traditionally healthy diets

who have adopted more processed, Westernized foods –

like refined sugar, other fats, and carbs.

In those cases we've seen an increase

in chronic inflammatory bowel diseases.

After high school,

I joined the federal police and got into strength training.

I consumed a lot of protein – tons of milk, supplements –

and had frequent diarrhea.

Everyone was lactose intolerant, so I figured I was too...

...but when I started passing blood, it was like,

'Okay, Philipp, this is serious. Blood in your stool is never normal.

You need to go to a doctor!'

After my first colonoscopy, under anesthesia, I woke up to:

'You’ve got ulcerative colitis. It’s a chronic inflammatory bowel disease.

You’ll have to live with it.' I was like, 'Ok.'"

Inflammation can occur

when the protective function of the gut's lining fails.

Normally, it’s a remarkable barrier –

keeping harmful substances out, while absorbing nutrients.

The epithelial layer, with its thread-like protrusions,

maximizes the surface area for the uptake of nutrients.

So-called goblet cells located in the epithelium produce a mucus layer,

which provides a shield.

When this system doesn’t work properly,

it triggers the immune cells under the lining, sparking an inflammation.

The immune system then kicks into action,

releasing pro-inflammatory cytokines– messenger molecules

that say 'So, that’s enough now!

We’ve had enough inflammation; time to stop.'

Normally, things stay in balance,

but with chronic inflammatory bowel diseases,

an imbalance occurs.

The body thinks it needs to create inflammation,

but then it doesn't regulate it anymore.

That leads to an inflammatory response in the body,

which can have effects on every level,

since the gut has such significant influence.

The insidious thing about a chronic inflammatory bowel disease

– like ulcerative colitis –

is that you might feel good for three or four, even six weeks...

Then you have a flare-up.

Severe diarrhea, pain, blood in the stool, and so on.

Every time you get through a flare-up,

you’re essentially symptom-free afterward.

That’s what’s tricky: You tell yourself

'I’ll just get through this, and then I’ll feel OK again.'

All I can only is:

You'd be doing yourself a big favor by taking it seriously.

Don’t ignore things or let them slide,

since it will just get progressively worse over time.

Jana wants to compete in a triathlon,

and she has to train a lot for it.

Today, sports science also focuses on the gut

and its interaction with other organs, like the muscles.

We really can now identify all bacterial species

and microorganisms in the gut.

Our current challenge is that we don’t yet fully understand

what all these microorganisms actually do.

For some, we have an idea; for others, we don’t.

That’s why research in this field has really taken off

over the past ten years.

According to the latest findings,

nearly 3,600 different types of bacteria, viruses, fungi,

and parasites can be found in the gut.

Each person is a carrier for about 300 to 500 of these species,

which weigh a total of roughly two kilograms.

The rule of thumb is: The more diverse the microbiome, the better.

Its exact make-up is highly individual.

It's still being investigated whether the microbiome

begins to form in the womb.

What's clear is that the baby acquires the mother’s microbiome –

at the latest, during birth.

Alright, Jana – let’s take a look at your results.

As far as the stool analysis goes, you’re fit as a fiddle.

There’s no acute inflammation.

That's important, because inflammation always saps a lot of energy.

However, there’s room for optimization in other areas –

specifically, there’s a slight shift in your gut’s pH levels.

That doesn’t mean you’re sick,

it just means that the so-called immunomodulating bacteria

have likely decreased significantly.

If we can get these back into their optimal range,

you’ll be able to produce more lactate and butyrate in your gut.

Both are important for keeping your gut strongly anti-inflammatory.

What exactly can I do to improve that?

And get myself out of the red?

You should definitely increase your fiber intake significantly.

So – vegetables, vegetables, salads, salads, and vegetables.

Our fiber intake today is about ten percent

of what our ancestors consumed.

In other words, we should actually be eating ten times more fiber

and roughage than we currently do.

I’d say my main meals already consist mostly of vegetables.

How can I increase it even further?

Should I just increase the portion size, or…?

I’d recommend a prebiotic that you can mix with water

and drink in the morning and midday, or between meals.

Prebiotics are fibers found in vegetables and whole grains.

Or, highly concentrated, in flaxseed or in psyllium husks.

For the bacteria in our gut, prebiotics are a feast.

Probiotics, on the other hand,

are bacterial strains that can have health-promoting effects.

They’re found in probiotic foods like yogurt and kimchi,

or as pills, powders, and drinks.

When I have to go to the bathroom, I just have to go!

I might have five minutes at best to find one;

at worst, maybe just one.

I’m Cari, I’m thirty one,

and I live in southern Germany near Stuttgart.

I’ve been working as a self-employed social media manager since last year.

You probably found me via my Instagram account,

where for two and a half years I’ve been sharing

about my chronic illness:

irritable bowel syndrome, and a related anxiety disorder.

Folks, it’s official: I’m moving to Denmark!

There’s a bathroom for every little rest stop here,

and they’re all super clean.

It’s important to me to be authentic

and show what life is like,

with an illness that’s essentially invisible.

I want to make the sparkly world of social media feel a bit more real.

At school, as far back as elementary school,

whenever something big was happening,

it came with a stomach ache.

After the test or assignment was done, the pain would go away.

During my high school finals, I realized it wasn’t normal.

The exams were over, but I still felt terrible.

I’d have diarrhea up to ten times a day,

even though there was no apparent cause.

I had a colonoscopy and was so sure they’d find something

because I felt awful.

Instead of being relieved when the doctor said

'Your gut is completely healthy, everything looks great,'

I felt even worse.

I thought 'No, no, there’s something wrong with me!

I feel awful!'

I remember sitting there with my mom,

and we didn’t receive any guidance about what to do next.

Many people feel that their symptoms aren’t taken seriously.

Sometimes, they’re dismissed as just psychosomatic complaints.

That means patients might go from doctor to doctor,

maybe getting turned away.

So no one has a complete understanding of their condition.

My name is Miriam Stengel.

I’m chief physician at the Sigmaringen Medical Clinic.

I’m a trained internist and gastroenterologist.

I’ve been working for over twenty years

in the field of neurogastroenterology,

which includes conditions like irritable bowel syndrome

and functional dyspepsia.

About ten percent of people suffer from irritable bowel syndrome.

In Germany, that's roughly eight million people.

Chronic bowel complaints typically present between the ages

of twenty and thirty, with women twice as likely to be affected.

There are three types of irritable bowel syndrome:

One involves constipation,

another alternates between different bowel conditions,

and the third causes chronic diarrhea.

We’ve arrived in Tübingen.

The bathroom isn’t far off, so I really like it here.

It’s definitely very a beautiful spot.

Here, you could go boating.

But there’s a catch: None of the boats have toilets!

I think people who’ve never experienced this kind of anxiety

can’t truly understand what it’s like to think 24/7

about where the nearest bathroom is

and when you’ll need it next.

If you haven’t felt that, it’s hard to grasp.

Something as simple as taking a boat ride for an hour

is a real challenge.

In the beginning, I did a lot of my own experimentation.

Over-the-counter medications, even alternative medicine.

Sometimes something helped temporarily

– for about two weeks –

and I thought 'This is it! This is what I need!'

I was really full of hope.

But then it would all go back to how it was,

and I'd find myself thinking

'Okay, I’m basically incurable. Nothing's going to help me.'

Things just went downhill from there, unfortunately:

The anxiety disorder came along.

As far back as I can remember,

anytime I had a moment where I wasn’t feeling well or was afraid

– and fear is a nasty companion –

my stomach would immediately react.

And vice versa, of course.

It would start rumbling,

and then I’d become even more anxious because I’d think

'I have to go to the bathroom, now.'

It was such a nasty, overwhelming, and burdensome thing.

The point came when I said 'Okay, I need help now.'

My mindset was: You’ve seen the doctor, you’re taking medication.

That’s all you can do.

It's really important that affected individuals find a specialized center.

Today, we’re much better equipped to intervene

in inflammatory processes in a targeted, individualized way.

The great thing is that beyond the corticosteroids of the past,

we now have modern medications;

biologics, antibodies, small molecules.

These allow us to control inflammation over the long term.

Unfortunately, these newer medications are often underutilized.

In 2019, I had severe water retention in my legs,

changes to my skin, and I ended up in a hospital emergency room.

My entire colon was so inflamed,

with dark, black patches of inflammation

that had worked their way in very deep.

Things got very serious, very quickly.

They said 'We need to talk about a colectomy.’

So, removing the colon.

My body had always been a big part of the my self image.

I'd begun building a career in media.

Then suddenly: Colon removal, a pouch out of my stomach.

I resisted it for a long time.

Eventually, though, you switch into survival mode, and say:

'Do what you need to do! Just make me feel better.'

The colon is always removed first,

and then a temporary stoma is created.

The stoma usually stays in place for about three months.

Once everything has healed up, the stoma is removed.

But you need everything

to be as free from inflammation as possible

before reversing the operation.

The worst was going back to the doctor, with the pouch.

He said: 'Now your esophagus and small intestine are inflamed,

and I can’t remove those.'

That was such a blow.

I thought: 'Okay, I’ll try everything now, absolutely everything!'

I read a lot, and completely changed my life

so nothing would promote inflammation anymore.

It was a lot of work.

I’ve been modeling since I was 18, so it’s been a while now.

Over the past four or five years,

it’s become much more intensive.

You're working with your body and your appearance.

You can sense it, when someone is at peace with themselves,

healthy, and fit – you can see it.

I notice it from others, too.

When they say to me 'Hey, you’re glowing!'

It's always during a week when I’ve really focused on my diet,

stayed healthy, avoided going out.

I believe you can really see the difference.

You notice it when the mouth has cracks in the corners,

or the skin looks rough.

Those are signs of deficiencies in vitamins and trace elements,

indicating that the gut isn’t healthy,

or isn't functioning properly.

If there’s any inflammation, for instance,

the gut can’t absorb nutrients effectively.

Then I’ll say 'Let’s check vitamin B12 and iron.'

Supplements have something of a doping effect.

Many patients will say 'Wow, that feels good.'

I’ve already checked out the course terrain

for the Tegernsee Triathlon, which is in about two weeks.

I’m excited –

I did my first Olympic triathlon three or four weeks ago.

I feel pretty fit, with my training right now,

so I’m curious how it will go.

I’ll likely train hard for one more week,

then ease up to make sure my body is well-rested.

If we push ourselves too hard – as many professional athletes do –

it reduces microcirculation to the digestive tract

and puts strain on the gut.

That’s why it’s so important to balance intense physical,

emotional, and mental exertion with proper recovery time.

Jana will notice that the better her gut health is,

the better she can handle higher levels of training.

Right now, I’m actually feeling really good.

I was worried that the fiber I’m eating might be too much –

because my body isn't used to it

and it could have been a strain on my digestion –

but it actually feels really great.

I'm feeling like everything’s much lighter, in fact!

When it's done, it's done!

At first, I didn't find it very tasty, but I’m used to it now.

I really feel like I'm making progress,

especially with running.

I feel like I'm less prone to injuries. Things are happening!

Switching my diet was a game-changer for me.

At that point, I said

'No matter how much I want a steak or cow’s milk,

those will trigger my already inflamed gut.

What else can I cut out?'

Sugar: Huge problem.

The solution was to start cooking everything myself.

Turmeric was another discovery I only made

after getting my gut illness – it’s all the rage now.

We’re especially cautious with Philipp’s gut issues,

making sure we do everything preventively and carefully

to hopefully avoid any problems.

I’d say, my diet’s ninety to ninety-five percent vegan.

Sometimes a bit of cheese. I wolf down the vegan cheese, too."

Research has shown that certain foods

have anti-inflammatory effects.

Like omega-3 fatty acids from fish, antioxidants from berries, nuts,

and dark leafy greens, or polyphenols from fruits, herbs, and spices.

Fasting regimens also have proven to have positive effects on gut health.

I became more sensitive to myself.

Not that I’m immune to stress, now.

I trust myself to take on work again,

and the pressure that comes with it.

I love working, I want to be successful.

I have that drive in me.

The challenge is figuring out how to reconcile it with my body’s needs.

Sometimes, you just have to treat yourself to a weekend

where you say, 'Alright, it’s time for a break now.

Go to bed, sleep.'

The body regenerates through sleep.

All our cells go through repair processes, and reorganize.

It’s important to find ways to make yourself feel good.

Everyone is different.

In the past, yoga or meditation sounded difficult, to me.

But all these therapies – yoga, meditation, breathing exercises –

have one goal:

To help you connect with yourself, slow down,

take time for yourself, and really focus solely on you.

That’s when the body starts to regenerate.

I started behavioral therapy.

We opened up some unpleasant boxes

that were buried pretty deep.

For the first time,

I realized how closely connected the gut and psyche really are –

that there’s no point in looking for organic causes alone.

Everything is interconnected.

Stressful moments, emotions I don’t release,

issues I deal with internally –

all of this impacts me.

My gut is the first to scream,

'Hey, slow down!' It’s my pressure release valve.

The connection between the brain and the gut

is increasingly being understood.

The gut wall contains more than one hundred million nerve cells,

forming what is sometimes referred to as a 'second brain'.

Part of our autonomic nervous system,

the gut regulates our digestion.

The ‘second brain’ also communicates with our main brain

via the spinal cord, the vagus nerve, and hormones in the blood.

Around ninety percent of information in the body

flows from below to above!

So what is the gastrointestinal tract exchanging with the brain?

Things like appetite, hunger, and satiety regulation come to mind.

But this system also affects our immune system.

It can influence our emotions, our perceptions, behavior,

and other bodily functions.

The better question might be: What doesn’t it influence?

I’m currently on my way to Sigmaringen to see Dr. Stengel.

She’s going to take a closer look at my medical findings.

I’m curious, but trying to keep my hopes in check.

I wish there were a more holistic approach to things –

not always separating the psyche from the body.

I also wish people wouldn’t fall through the cracks

in the system so easily.

There should be a path that doesn’t just end

at a diagnosis of irritable bowel syndrome.

So, you’ve found your way to me. That’s great.

I’ve already received some of your preliminary findings.

So let’s start with you telling me why you’re here today.

It might take a while.

My story actually started thirteen years ago.

I’ve always been the kind of person who had stomach aches,

even as a child.

The symptoms of irritable bowel syndrome are varied

and primarily abdominal, but there are many other conditions

that can cause similar complaints.

Some of these are severe – potentially life-threatening –

while others are less severe.

Most can be treated effectively, if identified early enough.

Small intestinal bacterial overgrowth, for instance,

can cause symptoms –

and is treatable with antibiotics.

Intolerances to substances like gluten, fructose, or lactose

can be managed with dietary changes.

Thyroid dysfunctions, side effects of medication,

or elevated histamine levels can also cause problems for the gut.

And of course – the first priority is to rule out cancers.

Based on my assessment,

I'd conclude that you have irritable bowel syndrome.

Contrary to what you might have heard,

we do have several options to treat IBS.

While a complete cure might be rare,

the goal is to manage symptoms well enough

for you to function comfortably in daily life.

Getting IBS under control

requires a combination of therapeutic approaches.

First, a strong doctor-patient relationship is key.

A second important pillar is symptom-oriented medication.

Have you tried herbal remedies, for example?

Carmentin – a blend of peppermint oil and caraway oil –

is particularly effective for pain and bloating.

Recent studies have shown it working well in the long term.

Nutritional counseling or therapy

is another critical component I'd strongly recommend.

Psychotherapy is also a significant pillar.

We know that people living with IBS

can often also present with depressive disorders.

I know many patients who feel just like you.

You’re absolutely not alone in this.

You tend to react to various situations

more strongly through your gut.

That’s simply how you are, and that’s okay.

Thank you so much.

This is the first time I feel like I’ve truly been listened to.

Sorry...

I understand – you’ve endured a lot of suffering.

If you aren’t taken seriously, it really does something to you.

Would you like a tissue?

We’ll keep looking at what’s working, what’s not,

where we might make changes. It’s an ongoing process.

"Hello!"

Hello, Jana. We’ve now received the second sample.

What’s very noticeable is the improvement

in the Enterococcus levels.

Those bacteria are responsible for immune modulation,

and we’re definitely seeing positive developments there.

Okay, that’s great!

"Ten minutes until start!"

The Tegernsee triathlon is an excellent

trial run for my Ironman 70.3.

It’s 1.5 kilometers of swimming, 40 kilometers of cycling,

and 10 kilometers of running.

It’s always a great way to see where I stand,

how much more training I need, and what my weak points are.

Breaking the 3-hour mark would be a dream.

"Three, two, one…"

Jana has a lot of potential to improve her gut health.

Right now, she might only notice minimal effects on her performance

because she’s already doing quite well.

But in elite sports,

where every centimeter and every second counts,

those improvements can make a real difference.

We’ve essentially gone from muscle doping to blood doping,

and now – gut doping.

There have been some very interesting studies,

such as one conducted during the Boston Marathon a few years ago.

Stool samples were taken from elite runners

and transferred to mice.

These mice then showed improved performance.

This suggests that influencing the microbiome

– the collective community of bacteria in the gut –

could potentially enhance athletic performance.

For instance, transferring the stool of fast athletes

to slower ones could, in theory, make the slower athletes faster.

I did it, and today there were also

some really serious triathletes out there –

people who are incredibly strong.

As a beginner, I can’t compare myself to them.

But if I keep training, things will keep improving.

I’m feeling so much better today, strong and motivated.

But it didn’t happen overnight.

I had phases where I had no idea what was wrong.

Then Vanessa came into my life. She gives me a lot of strength.

She tells me I’m more than the illness I live with.

The frustrating thing about this condition

is that you often can’t see it – it’s hidden inside you.

But you can open up. You don’t have to handle it all by yourself.

You can talk about it, and even consider therapy.

Move away from that tough, stoic mindset many men have,

the 'I don’t need to talk about it' attitude.

Talking is crucial –

let it out! It might sound banal or like something adults tell kids.

But there’s truth to ideas like 'Think positive.'

There’s no single person who can help you by saying,

'Take this pill, and you’ll be healthy again.'

You have to take responsibility for healing.

In Italy, in 2022, I posted an Insta story for the first time

– it was awful, completely shaky, and my voice was trembling –

where I admitted that I have irritable bowel syndrome.

I said 'I’m just going to talk about this now.

If anyone doesn’t like it, they can leave.' – but no one left.

In fact, a lot more people started following me.

After that story, so many people wrote to me, saying

'Thank you for saying this out loud.'

It feels amazing not to feel alone.

I had been stuck in my little shell for so long,

thinking I was the only freak.

The gut's a taboo subject.

It’s very different in some Asian countries –

in South Korea there’s an entire museum

dedicated to toilets and stools.

There, they talk about these things openly.

Here, it isn't the case.

As a result, millions of people are left alone.

Young people especially.

We’re capable of a lot more than we give ourselves credit for.

We don’t have to stay in our safe space, at home.

We can go out, and experience things in our own way –

it can be really beautiful.

The gut, with its trillions of organisms,

is the foundation our health is built upon.

So much more than a processing plant for food –

it's the very control center of our well-being.

All the more reason to protect it, and take good care of it.

I believe a healthy lifestyle is the key to good gut health.

That might sound basic, but I think many people

have a great deal of untapped potential for improvement.

When my gut is in balance and my digestion is working well,

I feel incredibly good.

I’m grateful for the small steps forward.

Being able to participate in life a bit more.

So in fifty years I won’t look back with regret.

Food intolerance, allergy, skin condition –

I always start by asking: What’s going on with my gut?

If you’ve ever seen a healthy gut from the inside,

you know how beautiful it is.

The small intestine, with its villi, is remarkable!

You want to preserve that beauty.

Research is so important. The gut is hugely influential.