Editor’s Note: This article is a reprint. It was originally published November 17, 2024.
Understanding the intricate connections between your immune system, gut health, and overall well-being is a key part of reaching optimal health. I had the privilege of interviewing Dr. Heather Moday, founder of The Moday Center based in Virginia, who has seamlessly integrated functional and integrative medicine into her practice.
Our conversation focused on significant shifts in medical practice, the role of the microbiome, and the value of health coaching in supporting lasting health changes.
A Journey from Conventional to Integrative Medicine
Dr. Moday’s medical journey shows how she came to integrate functional and integrative medicine into patient care.
• She began her career with a solid foundation in internal medicine — Dr. Moday pursued a fellowship in allergy and immunology, spending a decade in private practice addressing allergies, chronic asthma, and immune deficiencies. “I felt that I wasn’t using really all that I had learned, and there was a lot more to learn. It was not holistic enough for me,” she shared.1
• Fellowship with Dr. Weil — This sentiment drove her to search for a more comprehensive understanding of health via an integrative medicine fellowship with Dr. Andrew Weil in Arizona and subsequent certification in functional medicine in 2014.
• Going beyond conventional immunology — This pivotal transition allowed Moday to expand her focus beyond conventional immunology, embracing a holistic framework that considers nutrition, behavior, and environmental factors as components of health. By bridging these disciplines, she now addresses chronic medical issues with a more nuanced approach.
Your Microbiome Is the Heartbeat of Your Immune System
The microbiome — the vast ecosystem of microbes residing primarily in your colon — was a primary focus of our discussion.
• Microbiomes are vital to your immune system — Moday explained how these trillions of microorganisms are not merely passive inhabitants but active participants in training your immune system and maintaining overall health. “(The microbiome) literally trains our immune system, but it also informs and acts as a go-between,” she said.2
• These microbes foster a balanced immune response — Disruptions in the gut microbiome have been associated with chronic inflammation, autoimmune disorders, and metabolic conditions such as diabetes and obesity.3
• We also discussed leaky gut —This is a condition where the epithelial lining of your digestive tract becomes permeable. This increased permeability may allow unwanted substances like endotoxins (lipopolysaccharides, or LPS) and food antigens to enter your bloodstream, which may trigger immune responses associated with autoimmune conditions. Gut dysfunction is a common feature of autoimmune disease.4
Maintaining the integrity of your gut barrier is considered important, but factors such as stress, poor nutrition, environmental toxins, and certain medications may compromise this barrier, which has been associated with systemic inflammation and immune dysregulation.
Your Gut’s Hidden Heroes and the Oxygen Gradient
Your colon maintains a controlled oxygen gradient that is crucial for the growth of oxygen-intolerant bacteria. It’s like having different climate zones within your gut, each supporting specific types of bacterial life.
• This oxygen gradient isn’t static — It requires a constant supply of cellular energy to maintain. If that energy supply falters, more oxygen can seep in, which may suppress your beneficial bacteria. As beneficial bacteria dwindle in numbers, more harmful, oxygen-tolerant species may gain ground, and this imbalance has been associated with a range of other health concerns.
• An overlooked aspect of gut health — Maintaining this oxygen gradient is one of the most important, yet often overlooked, aspects of gut health. It’s not just about what you eat, but about creating the right environment for your beneficial bacteria to thrive. This is where the importance of cellular energy production comes into play. Without it, the system may be less able to support beneficial bacteria.
• What do we have to thank for maintaining this system? — Some of the hardest-working cells in your body — colonocytes and goblet cells. Colonocytes line your colon walls, performing many vital functions. They’re like the bouncers at an exclusive club, deciding what gets in and what stays out. They also play a crucial role in maintaining that all-important oxygen gradient.
• Goblet cells are the maintenance crew — They secrete a mucus that acts as a protective coating, shielding your gut lining from harmful substances and pathogens. Colonocytes and goblet cells form a strong defense for your gut.
The health of these cells is directly linked to your overall gut health and, by extension, your general well-being. When they work well, they help build a strong gut barrier, absorb nutrients, and balance the microbiome. But when compromised, it can lead to digestive and systemic health concerns.5
• The importance of a balanced gut microbiota — This illustration depicts the delicate balance of gut microbiota and its impact on health. On the left, “Eubiosis” shows a healthy gut environment with beneficial bacteria, strong barrier integrity, and positive metabolic outcomes. On the right, “Dysbiosis” illustrates how factors like antibiotics and an inappropriate diet can disrupt this balance, which may lead to inflammation and compromised gut health.
Research has examined how dietary choices and introduction of beneficial bacteria may be associated with shifts in microbial abundance, potentially influencing mucus-layer thickness, insulin tolerance, and metabolic profile.6
Mitochondrial Function and Its Role in Gut Health
Mitochondria, often referred to as the powerhouses of the cell, are integral to energy production. In your colon, colonocytes — the epithelial cells lining your colon — rely heavily on mitochondrial energy to perform fatty acid oxidation.
• Origins of the mitochondria — Interestingly, mitochondria themselves are believed to have originated from primordial bacteria through an evolutionary process known as endosymbiosis. While mitochondria are present in colonocytes, bacteria within your gut microbiome do not possess mitochondria and instead survive on glycolysis. This symbiotic relationship underscores the intricate connections between your cellular biology and microbial inhabitants.
• Environmental toxins may affect your mitochondria — However, despite your colon’s naturally low-oxygen environment, modern-day exposure to environmental toxins may disrupt this balance. We’re all exposed to microplastics, excess linoleic acid (LA) from industrial seed oils, and electromagnetic fields (EMFs). These may impair mitochondrial energy production, which is necessary for maintaining your colon’s oxygen-free state.
• What happens when mitochondria are compromised? Colonocytes may be less able to consume the limited oxygen, which can lead to an increase in oxygen within your colon. This shift may create an environment conducive to the growth of facultative anaerobes — oxygen-tolerant bacteria, some of which are pathogenic.
When your mitochondria don’t have enough energy, the colonocytes may not thrive, and the oxygen in your colon may progressively increase. This can lead to a decrease in beneficial bacteria and a rise in pathogenic bacteria.
• Endotoxins, specifically LPS, are another factor in this equation — There’s a significant difference between endotoxins produced by obligate anaerobes and those from facultative anaerobes. The endotoxin from obligate anaerobes is much less pernicious. Meanwhile, pathogenic facultative anaerobes produce more harmful LPS, which may lead to chronic inflammation and contribute to various health conditions, including autoimmune diseases and metabolic syndrome.7
Challenges in Recolonizing Your Gut with Beneficial Bacteria
Delivering oxygen-sensitive bacteria like Akkermansia to the colon presents significant challenges, since many products may not protect the bacteria on their journey through the digestive tract.
• The primary obstacle lies in the fragility of these bacteria — They are highly sensitive to oxygen and require specialized protective capsules to survive the journey through the digestive tract.
• Some available supplements may not deliver live bacteria to the colon — This may limit how well they support the gut’s beneficial bacteria.8
Rather than trying to immediately replenish the gut with live strains, a more strategic approach relies on a two-phase protocol, starting with a pasteurized postbiotic in enteric-coated or microencapsulated form to support the gut barrier before introducing live Akkermansia via delayed-release technology once tolerance is established.
I’m actively funding research to identify and cultivate new species of obligate anaerobes that may produce beneficial metabolites in the microbiome. Genomic analysis has flagged dozens of candidate species. This ongoing research may hold promise for expanding the repertoire of effective probiotics that support a healthy gut environment.
Insulin Resistance, Oxidative Stress, and Metabolic Health
Insulin resistance is considered a widespread issue that can serve as a precursor to more severe metabolic conditions.9 During our discussion, I introduced the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), a simple tool used to assess insulin sensitivity.
• HOMA-IR as a detection tool — HOMA-IR involves measuring fasting blood glucose and insulin levels to provide an indicator of insulin resistance. This method is relatively low-cost and accessible, which is why some clinicians use it to look for early signs of insulin resistance. Moday agreed, noting its utility in her practice and that many people may have some degree of insulin resistance. Talk to your health care provider about whether this testing is appropriate for you.
• The dangers of oxidative stress — Oxidative stress, driven by an imbalance between free radicals and antioxidants, is linked to cellular damage and disease progression. Our conversation highlighted the nuanced relationship between oxidative and reductive stress, particularly in the context of mitochondrial health.
Free radicals, such as superoxide and hydroxyl radicals, are highly reactive molecules that damage cellular components. Antioxidants neutralize these free radicals, preventing oxidative stress. However, I emphasized that in many cases, free radicals are generated from reductive stress, where an excess of electrons leads to the formation of harmful reactive oxygen species (ROS).
• Addressing environmental toxin exposure is a multifaceted endeavor — Moday recommended simple, actionable steps such as avoiding plastic containers, opting for stainless steel or glass alternatives, and minimizing the use of processed foods laden with additives and preservatives.
“You can start with something as simple as not drinking your coffee out of a traditional plastic Styrofoam cup … you can buy a very cheap stainless steel coffee mug and water bottle, and you can drink out of those,” she advised.10 These small changes, when implemented consistently, may help reduce your exposure to environmental toxins and support overall health.
Health Coaching Can Provide a Support System for Lasting Change
We also discussed the role of health coaching in facilitating sustainable health improvements. Moday shared her experiences and underscored the importance of personalized support in achieving behavioral and lifestyle changes.
• Addressing lifestyle habits is crucial — While proper health care and nutritional guidance are vital, without addressing sleep, stress, and overall lifestyle, patients often struggle to achieve meaningful results. Health coaches provide the necessary support, accountability, and personalized strategies to help individuals navigate these changes effectively.
• Moday believes health coaching should be integrated into a comprehensive health care approach — By collaborating with health coaches, patients receive a holistic support system that addresses both physical and emotional aspects of health. This collaborative model can improve patient outcomes and support long-term well-being.
We’re developing an innovative app to address this very challenge — Pax. Like Dr. Moday, we recognize the need for practical support in implementing life-changing health practices.
The app is designed to offer guidance and support for people who want to adopt health strategies that can feel overwhelming or complex. Our goal is to make healthy lifestyle changes more accessible. If you’re interested in this app, you can click this link.
The Rise in Allergies — Lessons from Peanut Allergy Trends
Our interview also touched on the rise in food allergies, particularly peanut allergies, and factors that may be contributing to this trend. The hygiene hypothesis proposes that reduced exposure to microbes in early childhood may contribute to an underdeveloped immune system, which could increase susceptibility to allergies and autoimmune diseases.
• The Good Friends Hypothesis — Moday expanded on this by introducing the “Good Friends Hypothesis,” which emphasizes the importance of maintaining a diverse and beneficial microbiome through appropriate microbial exposure. “In the ‘90s, someone came up with the idea that children should not be introduced to peanut antigens until they were 3 or 4 years old. But that was problematic,” she said.11
• Research on early allergen introduction — It has been suggested that delaying exposure to these allergens during critical developmental periods may have inadvertently heightened immune sensitivity in some children. Research has examined whether early introduction may support immune tolerance and lower the risk of allergies.12,13 Talk to your child’s pediatrician before introducing allergenic foods, especially if they have severe eczema or an existing food allergy.
A Holistic Path to Health
My interview with Moday reaffirmed the profound interconnectedness of our immune system, gut health, and overall well-being. By embracing integrative and functional medicine, addressing environmental toxins and incorporating health coaching, we can approach modern health challenges in a more holistic, patient-centered way.
The journey to optimal health is multifaceted and requires a commitment to continuous learning and adaptation. As we advance, the collaboration between medical professionals, researchers, and health coaches will be key in fostering a health care system that prioritizes holistic, patient-centered care.
Together, these insights and strategies may help support your overall well-being and resilience. To learn more about Moday and her integrative approach to medicine, follow her on Instagram at @doctormoday.
Frequently Asked Questions (FAQS) Regarding Gut Health and Immunity
Q: How does gut health influence immunity and overall wellness?
A: Your gut microbiome plays a role in training and regulating the immune system, and disruptions in the microbiome have been associated with chronic inflammation, autoimmune diseases, and metabolic disorders. Researchers have proposed that a compromised gut barrier (leaky gut) may allow harmful substances into the bloodstream, which may trigger immune responses.
Q: What environmental factors disrupt gut and mitochondrial health?
A: Modern toxins like microplastics, excess linoleic acid from industrial seed oils, and electromagnetic fields (EMFs) can impair mitochondrial function and reduce cellular energy. This imbalance increases oxygen in the colon, which may inhibit beneficial bacteria and allow harmful oxygen-tolerant bacteria to thrive, a pattern associated with inflammation.
Q: Why is mitochondrial function so important for gut health?
A: Colonocytes (cells lining the colon) depend on mitochondrial energy to maintain a low-oxygen environment that supports beneficial bacteria. When mitochondria are impaired, oxygen levels in the colon may rise, which favors harmful bacteria and can lead to inflammation and metabolic issues.
Q: What role does health coaching play in long-term wellness?
A: Health coaching provides personalized support and accountability, helping people adopt lifestyle changes around diet, sleep, stress management, and environmental toxin avoidance. Integrating health coaching into health care supports more patient-centered outcomes.
Q: What does research say about early allergen exposure and allergies in children?
A: Research has examined whether early introduction of allergens may support immune tolerance. However, parents should talk with their pediatrician before introducing allergenic foods to their children. The Good Friends Hypothesis proposes that maintaining a diverse microbiome through early, appropriate microbial exposure may help support a healthy immune system.
This article is for informational purposes only and does not constitute medical advice. Consult a qualified health care provider before making changes to your health regimen.
