What's going on in your gut?
This article was originally published by Dr. Carl Hangee-Bauer with San Francisco Natural Medicine, which has been a pioneer in providing natural healthcare since their founding in 1989. Now celebrating their 29th anniversary, they are the Bay Area's premier naturopathic medical clinic.
Understanding and dealing with chronic digestive problems can be like alphabet soup. There are so many abbreviations and terms that it can make an already confusing situation even more so.
One of the most common conditions I see at SFNM is chronic digestion or elimination problems. Often patients have been to their primary care doctor and possibly a gastroenterologist without finding answers to their chronic symptoms. Most have scoured the internet looking for solutions, with many trying a wide variety of self-treatments that can be expensive and yield minimal results. Self-diagnosis can be very tricky, and without a solid understanding of the root causes, treatments are often ineffective or incomplete.
As an expert in functional gastroenterology, I have found that taking a detective-like approach yields the best results. Some conditions can be resolved with correct interventions, and others are more suited to improved management with diet, anti-microbial medications or supplements, enzymes, herbal medicines, and correction of gut microbiome imbalances.
This approach involves taking a careful and complete history including the length of time symptoms have been present, current symptoms, past lab tests and examinations, past treatments and so on. It is important to understand what we already know and do not know. I always do a screening physical exam and typically order functional GI tests to investigate potential causes. From there an evidence-based integrative treatment plan can be developed.
Does this sound like you?
The most common scenario I see in my practice goes like this... Digestive problems have been present for a long period of time, months to years, sometimes with a suspected triggering event. The person goes to their primary care doctor who runs some screening tests and may offer treatment based on these. They are likely referred to a gastroenterologist who does more screening tests which may include a colonoscopy, endoscopy or both. The goal is to determine a diagnosis. If inflammation is present, the doctor may determine there is an ulcer or gastritis, inflammatory bowel disease including celiac disease, Crohn’s disease or ulcerative colitis, or even cancer. If all tests are negative or inconclusive, the doctor often diagnoses IBS. Minimal or no treatment is recommended, and the person is left wondering what to do next.
What is IBS?
Where the diagnosis of IBS is often a stopping point for conventional medical treatment, it is always a starting point for naturopathic and functional medicine doctors.
IBS is an abbreviation for Irritable Bowel Syndrome. IBS is the most common digestive condition for which people seek care; it is estimated to affect between 10-15% of people in western countries. It is a functional diagnosis with symptoms that may include gas, bloating, abdominal discomfort or pain, problems with elimination such as constipation or diarrhea, and others. As noted above, IBS is a diagnosis of exclusion—once specific medical conditions are evaluated and no diagnosis is determined, IBS is the usual diagnosis.
Because IBS is a syndrome or a collection of varying symptoms from person to person, there are a number of possible causes for IBS that the naturopathic doctor seeks to understand. SIBO and Leaky Gut are among these.
What is SIBO?
SIBO is short for Small Intestine Bacterial Overgrowth. It is thought to be one of the most common causes of IBS.
The large intestine has an extensive microbial population, called the gut microbiome. estimated to weigh a pound or two in each of us. The small intestine, however, is generally sterile, with no significant microbes resident there. In SIBO, gut microbes migrate into the small intestine and take up residence. These microbes affect proper digestion and absorption of the foods we eat and lead to a variety of symptoms, most commonly bloating and gas.
A very common scenario I see in SIBO patients in my practice is you wake up in the morning feeling fine, and bloating and gas progress during the day after eating and drinking. Sometimes symptoms can be so severe in the evening that people skip dinner or won’t go out with friends due to gas and discomfort. Symptoms settle down overnight, and the next day it starts again.
SIBO is assessed with breath tests where you eat a specific diet for a day, and following that take a packet of lactulose powder on an empty stomach. This substance migrates down the intestinal tract where it eventually meets up with gut bacteria that digest the powder, producing methane and/or hydrogen gas. Every 20 minutes for 2-3 hours the person blows into a small labeled balloon which is sent to the lab for analysis. If gases appear too soon, the diagnosis of SIBO is made.
What is leaky gut?
Leaky gut, or intestinal hyperpermeability, can be due to a number of conditions including SIBO. It occurs when irritating factors in the small intestine, where we typically absorb most of our nutrients, cause microscopic separations between the cells of the small intestine, allowing larger molecules to cross into the bloodstream. These partially digested molecules, usually proteins, can trigger immune responses that may affect digestive health as well as a variety of other immune issues including joint pain, allergy, eczema, fatigue, fibromyalgia and a host of others.
I screen for leaky gut in two main ways. The first is either a blood or stool test for Zonulin. I think of Zonulin like the “glue” that hold small intestine cells together. If it is measured and is elevated, it indicates the body is producing more of it to “patch” leaky spaces in the small intestine. Other times, especially if food allergies or sensitivities are suspected, I screen a wide range of foods with a food antibody test. If I see many reactive foods, I strongly suspect leaky gut is the cause.
Treatments are focused on removing irritating substances such as reactive foods or imbalanced gut bacteria, resolving SIBO, decreasing local inflammation, and supporting proper healing of the gut lining.
A whole person approach...
As you can see, the digestive system is complex, and people experiencing chronic digestive problems often have a number of factors to consider for proper and successful treatments to work. By taking a whole person approach while focusing on the key imbalances and conditions at the root of your symptoms, I find that people who have suffered for years can manage or resolve their chronic digestive problems and improve their health in general.
In naturopathic medicine, we have a saying: “If someone has a number of health issues and digestive problems are one of them, adequately address and treat digestion, and other conditions often will improve as well.”