Think about the last time you saw a new GI patient. What does your intake appointment look like?
You probably cover the basics—medication history, drug and alcohol use, history of infections, etc.—to narrow down or eliminate certain causes or conditions. You probably order certain labs and have some bloodwork done. And you may even do a quick check for hypermobility.
But according to functional gastroenterologist Dr. Steven Sandberg-Lewis, you might still be missing a key driver of gut issues: traumatic brain injury (TBI).
Research has revealed that, for many patients, head trauma is directly linked to GI conditions. In our latest Kharrazian Institute Master Class, How to Think Like a Functional Gastroenterologist, Dr. Steven Sandberg-Lewis goes into detail about why this is the case and what to do about it. He brings over four-and-a-half decades of clinical experience to the table that will help you improve your practice’s standard of care.
TBI’s Impact on the Gastrointestinal Tract
Traumatic brain injuries, even those from decades ago, can wreak havoc on gut motility and function. This is due to the fact that TBIs can disrupt the brain-gut axis, triggering a cascade of issues.
One reason for this disruption has to do with the body’s natural response to stress. When the brain experiences a TBI, it triggers the release of catecholamines, a stress hormone that also impairs gut motility and compromises mucosal blood flow.
This disruption to the gut-brain axis can also lead to intestinal hyperpermeability (a.k.a. leaky gut). Leaky gut happens when the tight junctions between the gut’s epithelial cells loosen, allowing bacteria and toxins, along with undigested food particles, to migrate into the bloodstream. And according to studies like this one, without adequate treatment, TBI-induced intestinal hyperpermeability can “lead to bacterial translocation, sepsis, and eventually multi-system organ failure.”
Moreover, when the brain suffers an injury, it releases damage-associated molecular patterns (DAMPs), triggering a systemic inflammatory response. This inflammation propagates downward to the gut, further contributing to gut dysfunction. (DAMPs have also been linked to rheumatoid arthritis, osteoarthritis, atherosclerosis, and even neurodegenerative disorders.)
Identifying unique, effective tools to integrate into your practice can be one of the most challenging aspects of care. In our newest Kharrazian Institute Master Class, How to Think Like a Functional Gastroenterologist, Dr. Steven Sandberg-Lewis provides a time-tested clinical model to handle complex GI cases. In addition to learning more about the link between the brain and gut health, you’ll learn how to better address chronic inflammation, how to create effective treatment protocols for patients with constipation, and much more.
TBI and the Vicious Cycle of Inflammation
Once TBI-caused inflammation starts, it can cascade into an ever-worsening health crisis if not checked.
As mentioned above, patients who have experienced a traumatic brain injury are at a greater risk of leaky gut. And with leaky gut comes bacterial translocation—the “leaking” of gut bacteria into the bloodstream via loose epithelial junctions. These now-harmful bacteria trigger a systemic immune response in the body, crossing the compromised blood-brain barrier to promote more inflammation.
Likewise, short-chain fatty acids (SCFA) in the gut are crucial for maintaining the integrity of the gut barrier. Yet when gut dysbiosis occurs after a TBI, the resulting changes to the microbiome can reduce the number of SCFA-producing Lactobacillus and Bifidobacterium. Reduced SCFAs diminish the body’s anti-inflammatory signaling and further compromise the integrity of the blood-brain barrier.
Gut dysbiosis resulting from TBI has yet other downsides. For example, the now-damaged gut microbiome can struggle with metabolising tryptophan (a serotonin precursor), instead shifting this metabolism toward the kynurenine pathway. When this pathway is overactive, it can lead to further inflammation and the accumulation of neurotoxins.
If you want to learn more about the connection between TBI and the gut—and unlock many other pearls of wisdom from Dr. Steven Sandberg-Lewis’s four-decade-long career—click here to register for How to Think Like a Functional Gastroenterologist.
Treating Gut Patients Who Have Suffered from TBIs
Given the link between traumatic brain injury and GI issues, addressing any TBIs—or even potential TBIs—in your GI patients could be the key to finding answers for your toughest cases.
The Importance of Screening for TBI
Dr. Sandberg-Lewis recommends that the first step is to start screening for TBIs as part of your patient intake process. But this must go further than just adding “Have you ever had a traumatic brain injury?” to a patient questionnaire. Such a limited solution is likely to be ineffective, since TBI often goes undiagnosed; many of your patients may not even know if they have had one.
Instead, ask your patients broader questions like, “Have there been any instances in which your brain may have been shaken?” It’s important to remember that the brain can be injured even without a direct blow to the head. Potential responses to be on the lookout for include:
- Whiplash
- A broken nose
- Blast injuries, particularly for veterans
- Participation in contact sports such as football or soccer
- A broken tailbone (the shockwave can go up the spine and into the skull)
Developing Effective Treatment Protocols for TBI-Related Gut Conditions
Once you have screened your incoming GI patient for a history of TBI, what does an effective protocol look like? In some ways, treatment for TBI-induced GI issues looks similar to any other GI protocol. Probiotics and prebiotics are common tools used to bring the gut microbiome back to health. Changes to the diet to include more fiber and nutrients can also help promote the growth of good gut bacteria.
But Dr. Sandberg-Lewis has found two additional tools that can contribute to gut health, specifically for patients with TBIs. The first is neurofeedback, a form of biofeedback that uses brainwaves to help repair the brain, improve neuroplasticity, and allow synaptic junctions to rewire themselves.
LENS (low-energy neurofeedback system) is a good starting point because it only needs to be done once a week (unlike other forms requiring two or more sessions weekly) and tends to work faster. Dr. Sandberg-Lewis often finds that patients improve within 5–10 sessions.
The second TBI-specific protocol Dr. Sandberg-Lewis relies on is a high-dose fish-oil regimen. For maintenance and prevention against much of the damage from TBI, he advises 3,000 mg of omega-3 fatty acids per day. For more severe, acute brain injuries, he suggests administering 9,000 mg for the first two weeks, then reducing the dose thereafter.
How to Think Like a Functional Gastroenterologist
Screening for traumatic brain injuries can be a game-changer when dealing with complex GI patients. The link between TBI and gut issues has been established, but it is often overlooked in clinical scenarios. Understanding this relationship and knowing how to look for and treat TBI-related gut dysbiosis is key to providing quality care to your GI patients.
This is one of the major points of focus in our latest Kharrazian Institute Master Class, How to Think Like a Functional Gastroenterologist, presented by Dr. Steven Sandberg-Lewis. Dr. Sandberg-Lewis breaks down the key concepts he has learned over a 45-year career to help you and your practice take the next step in care.
Frequently Asked Questions
How does a traumatic brain injury (TBI) affect gut health?
A TBI can disrupt the brain-gut axis, impairing communication between the nervous system and digestive tract. This disruption affects gut motility, blood flow, and microbiome balance—often leading to inflammation, leaky gut, and chronic digestive dysfunction.
Why is the link between TBI and GI issues often overlooked?
Many patients don’t realize they’ve suffered a brain injury, especially if there was no direct blow to the head. As a result, practitioners may not think to screen for TBI when evaluating gastrointestinal complaints, missing a critical underlying cause.
What should practitioners ask to screen for possible TBIs?
Beyond asking if a patient has had a diagnosed TBI, practitioners should inquire about incidents that may have caused brain movement or shock, such as whiplash, a broken nose or tailbone, contact sports, or blast exposure. These events can cause brain injury without obvious symptoms.
How can clinicians support gut recovery in patients with TBI-related issues?
In addition to standard protocols (probiotics, prebiotics, and dietary changes), Dr. Steven Sandberg-Lewis recommends neurofeedback (such as LENS therapy) to promote neuroplasticity and high-dose omega-3 fatty acids supplementation to reduce inflammation and repair brain tissue.
Where can I learn more about treating gut dysfunction linked to TBI?
The Kharrazian Institute’s Master Class, How to Think Like a Functional Gastroenterologist, taught by Dr. Steven Sandberg-Lewis, explores the connection between TBI and gut health and provides practical protocols for managing complex GI cases.
