Indications that Small Intestinal Bacterial Overgrowth (SIBO) may be the reason for your IBS:
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You have a history of one or more of the following:
-Medication use (opioids, antidepressants, proton pump inhibitors...)
-Surgical procedures
-Travel and getting sick while away
-Food poisoning
-Gastroenteritis/colds/flus

Have your symptoms been worse since any of the above?  Toxins released during infectious processes can slow the migrating motor complex (MMC) which is responsible for regular peristaltic motions.  If the MMC is not functional, then bacteria which reside within the large intestine can retrograde and make their way backward into the small intestine - where. they. do. not. belong.  We absorb our food in the small intestine, and so the bacteria are VERY content to be in this area of the gut - fermenting off of foods and creating symptoms of gas, bloating, cramping, and/or constipation/diarrhea OR BOTH depending on the type of bacteria present - Let's chat if you have #IBS without any answers, or have simply been told to follow a #lowfodmap diet.  I am accepting Ontario patients both virtually and in-office! #gas #bloating #cramping #sibo #constipation #diarrhea

Lower abdominal cramps that suddently make you cringe; you realize you need to go for a #2 to help alleviate the pain? Does this sound like you?

It could be Irritable Bowel Syndrome (IBS). Perhaps you've already been diagnosed with it or know someone who has been.  If you are constipated, have diarrhea, or a mix of both, then you could fit this "category".

The main problem with an #IBS diagnosis is: the underlying cause has not been discovered/addressed - you've simply been labelled.  If you've had imaging/testing done, been diagnosed or think you may have IBS, and haven't gotten the results you've been looking for - it might be time to see a Naturopathic Doctor!  I can test you for SIBO!

I'm accepting new patients virtually via Telemedicine.  I hope you find it comforting to know that you can still seek help and guidance amongst the chaos of #covid_19 - in ways that do not require you to leave your home.  Reach out via the contact form to find out more info/set-up your initial appointment. 

Small intestinal bacterial overgrowth (SIBO) is a term used to describe the end result of movement of bacteria from the large intestine into the small intestine. SIBO is defined as a bacterial population in the small intestine exceeding 105-106 organisms/mL; normally, less than 103 organisms/mL are found in this segment.  SIBO is largely underdiagnosed, but is now becoming more recognized and discussed by mainstream medicine. We all have the ability to become “infected” with SIBO at some point in our lives; there is also the chance of recurrence later on in life when conditions are favorable for these bacteria.

Causes:

The two main predisposing factors to SIBO development include impaired gastric acid secretion (also known as low stomach acid), and small intestine dysmotility. There are many other predisposing factors such as the presence of diverticula, strictures, and recurrent antibiotic or medication use.  Acute or chronic infections can also create the ideal terrain for these bacteria to flourish.

Stomach acid secretion may be diminished or non-existential for a number of reasons: an aging population generally secretes less hydrochloric acid; chronic stress slows down our digestive function; medication use (such as proton-pump-inhibitors) also reduces stomach acid production and this predisposes us to infection.  Adequate stomach acid is important to defend the body against pathogen ingestion and colonization.  Other medications (opioids, prokinetics, anticholinergics) are known to slow GI motility and this can lead to the development of SIBO as well. On the other hand, small intestine dysmotility occurs as a result of disrupted communication between the brain and small intestinal smooth muscles.  This disrupted communication occurs as a result of toxins being released from bacterial infections, where the normal peristaltic motion of the intestinal smooth muscles is disrupted.  Therefore, people with a history of gastroenteritis and/or food poisoning, and who have never been well since then should be tested for SIBO.   Those who get sick or catch a bug while traveling overseas are also good candidates for SIBO testing. Slow GI motility allows bacteria from the large intestine to migrate up into the small intestine, and whatever residual small intestinal bacteria to remain, where they can thrive off of glucose and other energy sources in order to flourish.  As a side note, it is important to mention that food is absorbed within the small intestine; bacteria in the large intestine are quite happy to colonize this segment of the GI tract.

Testing:

Few testing and/or imaging methods will detect the presence of SIBO.  If you're someone who has had a colonoscopy, ultrasound, and stool test with inconclusive answers for digestive symptoms - SIBO testing may be the next step.  The 3-hour lactulose breath test is a common testing method used by Naturopathic Doctors.   Breath samples are collected in test tubes at 20 minute intervals, and the amount of hydrogen and/or methane gas is measured.  The lactulose solution serves as a substrate for the bacteria; hydrogen and/or methane gases are emitted as a by-product.   Hydrogen-producing bacteria are generally responsible for symptoms of diarrhea/loose stools, whereas the presence of methane-producing bacteria generally presents clinically as harder stools/constipation. For most people, it takes 120 minutes for material to pass from the upper GI tract into the large intestine – the first 120 minutes of testing gives crucial information regarding possible overgrowth.

Symptom Presentation:

People with SIBO vary widely in presentation, from being mildly symptomatic to suffering from chronic diarrhea, weight loss, and malabsorption.  Approximately 80% of people who have been diagnosed with the irritable bowel syndrome are infected with SIBO.  Irritable bowel syndrome is classified as a diagnosis of exclusion in those individuals who present with symptoms of abdominal pain relieved by defecation, and irregular bowel frequency and consistency. Those people presenting with widespread pain, as in fibromyalgia, should also be tested for SIBO.  Symptoms of SIBO include but are not limited to: bloating/distension, gas, cramping, nausea, aches and pains, and abdominal discomfort.

Treatment:

There are three sequential phases of SIBO treatment following proper diagnosis: the preparation phase, eradication phase, and the recovery phase.  Each phase serves its own unique and important purpose.   
The preparation phase is important to ensure that the liver’s ability to eliminate toxins, detoxify, and rid the body of bacterial end-product is maximized.  If liver function is sluggish and toxins are not eliminated properly, the individual may feel worse as toxins pool into the system during the eradication phase and become reabsorbed.  This phase is also necessary to ensure the bacteria are effectively targeted during the eradication phase: breaking up bacterial biofilms is an important step in the treatment process. The preparation phase usually lasts for a minimum of two weeks before the eradication phase begins.

The eradication phase involves the use of natural antimicrobials to target the bacteria.  Certain antibiotics may also be used for eradication during this phase.  Natural antimicrobials are rotated on a biweekly basis to ensure bacterial resistance does not occur.  This phase can persist anywhere from 2 to 6 weeks.  The preparation phase is often continued into the eradication phase.

The recovery phase is complex - it involves starving off SIBO remnants; restoring balance/homeostasis within the body: restoring gastric acid levels, stimulating the MMC, and optimizing gut health via repair and colonization with good bacteria.  Diet is very important during this phase only – an anti-SIBO diet starves off any remnants.  The anti-SIBO diet consists of low FODMAPs (foods in which the bacteria do not feed off of: white rice, eggs, white sugar, cashews, oils, meat, and low fermentable veggies and fruits to name a few).  A study shows that 75.6% of the ninety patients who were followed for a period of 15 months, and who were adherent to the diet, noticed symptom improvement. The recovery phase generally persists for 1-2 months.  Restoring balance with probiotics should be done with caution, and prebiotic-containing probiotics are to be avoided. Prebiotics act as an energy/fuel source for SIBO and this can prevent complete elimination.
 
Conclusion:
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SIBO can manifest as IBS and fibromyalgia.  Anyone with a positive history of gastroenteritis, food poisoning, and who has chronic GI upset should be assessed for SIBO.  SIBO can result from low stomach acid, slow GI motility, and dysbiosis (as a result of underlying acute or chronic infections).  SIBO is an under-diagnosed condition but it is becoming more accepted as a cause for symptoms.  The breath test is the most widely used testing method to detect hydrogen or methane gases emitted by these bacteria.  Hydrogen-producing bacteria are responsible for diarrhea-like symptoms whereas methane-producing bacteria are responsible for constipation-predominant symptoms.  It is possible for breath testing to reveal infection with both types of bacteria as well. SIBO treatment is done in a step-wise approach; it is lengthy and requires patience but for those who follow protocol and who see it through often achieve great results.  Speak with your Naturopathic Doctor about testing, and to determine whether or not SIBO treatment is indicated for you - herb and drug interactions do exist.

Hormonal Imbalances: Estrogen and Progesterone

Hormonal imbalance is a common problem many women face.  Women are now, more than ever before, taking on more and more responsibilities - they're caregivers, nurturers, and employed in the workforce to make ends meet.  As a result, we are seeing a rise in stress levels and this is one important reason why hormonal imbalances are becoming more prevalent.  Exposure to xenoestrogens in household products (ie. plastic containers), personal products, and even water supply can contribute to hormone imbalance. Poor dietary choices also contribute to hormonal imbalances; imbalances arise from changes in estrogen, progesterone, and/or testosterone levels:  estrogen may be elevated relative to progesterone, or progesterone may be low resulting in a relatively high estrogen reading. This article will primarily focus on imbalances in progesterone and estrogen.

Causes:

1) Stress:  This is a main cause of hormonal imbalance seen in women of reproductive age. A common term used to describe the result of chronic stress is adrenal fatigue. The adrenal glands sit on top of the kidneys and they produce the stress hormone cortisol.  When we are in a sympathetic nervous system state (the "fight-or-flight" state) our bodies divert all resources toward immediate survival, thus favouring cortisol production; the result is less time and activity spent in the parasympathetic state and this affects our digestion, sex hormone production, etc. Chronic stress leads to changes in hormone concentrations: sometimes referred to as the "cortisol-shunt" or "pregnenolone-steal". In this situation, cortisol production is favoured over the production of the sex hormones; the body's precursors and resources are diverted to produce more cortisol and the sex hormone levels suffer as a result. (1)  Mental and emotional health (including and especially stress levels) is important to consider in clinical presentations of hormonal imbalances. Naturopathic Doctors run saliva cortisol/hormone panels to determine hormone concentrations and to assess for adrenal fatigue.
 
2) Xenoestrogens:  We are exposed to these "bad" estrogens on a regular basis, and these estrogens mimic the effects of the real hormone.  Xenoestrogens are found in medications (oral contraceptive pills), cosmetic and household products, pesticides, and plastics. Estrogenic compounds, such as Bisphenol A (BPA), leech out from plastics during temperature extremes such as freezing or heating. These estrogenic compounds disrupt the body’s endocrine system and impact the concentration of the sex hormone estrogen. (2)  Attempts to use as little plastic as possible can reduce your exposure to BPA and synthetic estrogens:  use glass containers/water bottles, reduce canned food consumption, use plastics with recycling symbols 2, 4,  and 5. (3) Xenoestrogens are more potent than hormones which naturally occur within the body; they mimic the action of estrogen by binding more strongly to estrogen receptors. (1) Chemicals which have estrogenic activity can cause health-related problems such as early menarche in women, as well as increased rates of breast and ovarian cancer. (2)  Other health problems can arise from a reproductive standpoint - heavy menstrual cycles, breast tenderness, and bloating for instance signify an imbalance known as "estrogen dominance" in which the concentration of estrogen is either above normal range, or progesterone is lower than normal resulting in a “relative” estrogen dominance.  
 
3) Poor Dietary Choices/Obesity:  Excess simple carbohydrate consumption leads to the accumulation of fat cells within the body, particularly around the abdominal area.  Fat cells contain aromatase, which is an enzyme that converts testosterone into estrogen.  Overweight women therefore produce more estrogen than the average woman.  Water supply is another source of hormone exposure (people often flush prescription drugs down the toilet instead of properly disposing of these medications at a pharmacy).  A reverse osmosis system can help reduce your exposure to hormones in the water supply. (1)
 
3)  Menopause: Hormone levels decline naturally as we age. The average age for a woman to experience menopause is 50 years old.  Estrogen is the first hormone to decline, and common symptoms of this include night sweats, hot flashes, vaginal dryness and low libido. (4) Pre-menopausal women also experience such symptoms as hormones enter a state of flux. Post-menopausal women are at increased risk of osteoporosis due to the protective effect estrogen exerts on bone health.

Symptoms:

Changes in hormones present with a variety of symptoms: ranging from physical to mental/emotional symptoms. Some women present with an estrogen dominant picture, where estrogen levels are elevated.  Common estrogen dominance symptoms include: breast tenderness, bloating, heavy periods (due to fibroids), cramping (due to endometriosis), mood swings, and depression.  Other presentations of estrogen dominance result from a progesterone deficiency - also known as a "relative" estrogen dominance. (1)   Symptoms of low estrogen can include: vaginal dryness, hot flashes, headaches, insomnia, fatigue, and bone loss.  Low estrogen increases ones risk of cancer and heart disease; natural estrogen is protective against heart disease, and osteoporosis.
 
Low progesterone can present with symptoms of mid-cycle spotting, clotting, long periods (lasting 7 days or longer), and increased risk of miscarriage.  Progesterone is most important during the second half of a woman's cycle (the luteal phase) in order for women to sustain and carry a pregnancy to term.  Following ovulation, the corpus luteum releases progesterone to support the proper development of an embryo. 
 
Naturopathic Management:

The management of a hormonal imbalance depends on symptom presentation, testing, as well as addressing the cause.  Naturopathic Doctors often run saliva hormone tests on specific days of a woman's cycle (ie. day 3 or 21) in order to determine the free concentration of hormones.  It is important to be assessed by your Naturopathic Doctor in order to rule out any emergent conditions & presentations, and to determine the optimal day/timing for your hormone test.
1) Phytoestrogens: These are substances which act like weak estrogens and exert effects on estrogen receptors in the body. Soy and flaxseed are examples of phytoestrogenic compounds.
2) Vitex agnus-castus: This botanical herb helps with boosting progesterone and has hormone-balancing properties. A randomized controlled-trial found Vitex to be helpful in normalizing a shortened luteal phase, and increasing mid-luteal progesterone and estradiol levels. (5)
3) Indole-3-carbinol: This compound is found in cruciferous vegetables belonging to the Brassica family; it gets converted into DIM (di-indolylmethane) and helps support the body’s ability to metabolize estrogens through the activation of detoxifying enzymes.
4) Bio-identical Hormone Replacement Therapy: The use of molecules identical to those produced by the body in order to mitigate symptoms of hormonal imbalance.  These are generally safer to administer and have minimal side effects when compared to hormone replacement therapy.  Bioidentical hormones are synthesized in the lab from a plant chemical extract and are dosed differently depending on age and reason for use.  Speak with your Naturopathic Doctor to discuss available options.
5) Liver support and fiber intake: Supporting the liver’s detoxification and elimination processes is important when it comes to the excretion of excess hormones such as estrogen.  Adequate fiber intake helps bind excess hormones in the system and increases the rate of excretion by facilitating their transportation to the liver.
6) Treat the cause:  Eliminate exposure to xenoestrogens/synthetic progestins, learn how to effectively deal with and manage stressors, exercise regularly and maintain a healthy body weight, and make nutrient-dense dietary choices.
 
 
Conclusion:

Hormonal imbalances can result from poor dietary choices, unfiltered water supply, obesity, xenoestrogen exposure, the use of synthetic hormones, as well as chronic stress. It is important to identify and remove/treat the cause in order to prevent the recurrence or onset of an imbalance.  Testing is a good starting point to determine what sort of imbalance is occurring, as certain symptoms can be indicative of an elevation of both estrogen and progesterone. The next step is to determine whether or not we need to support estrogen or progesterone production, or reduce exposure/encourage detoxification.  Consult with your Naturopathic Doctor before starting on a new supplement regimen to ensure there are no interactions or cautions/contraindications to the treatment.
 

Friday the 13th (I'm not very superstitious but some people are) - this marks the day I received great news!  I passed both the oral and written portions of the prescribing exam! I will now be expanding my scope of practice in Embrun, Russell, and Ottawa! 

What does this mean for the public?   I can now prescribe high dose vitamin D, administer B12 injections, and prescribe natural desiccated thyroid (NDT) as well as bio-identical hormone replacement therapy (BHRT).  I'll be eagerly learning about these new additions within the next few months! 

If you'd like to schedule your Naturopathic appointment, you may reach out via the contact form or phone the clinic directly.

Yours in health,

Dr. Ashley Kowalski, ND

This blog post has been retrieved from my publication on the following website: naturopathiccurrents.com/index.php/hypothyroidism-what-is-it 

What is it?
Hypothyroidism is a term used to describe an underactive thyroid gland.  Hypothyroidism is further classified according to “type”: subclinical, primary, or secondary hypothyroidism. The main function of the thyroid gland is to regulate the metabolic processes essential for normal growth, development, and tissue differentiation. The thyroid gland can become “sluggish” for various reasons, as we will explore in more depth.  Normally, the thyroid and peripheral tissues convert thyroxine (T4) into its more active form of triiodothyronine (T3).   Thyroid hormone production is influenced by various factors, including: thyrotropin-stimulating hormone (TRH) from the hypothalamus; the levels of thyroid stimulating hormone (TSH) released from the pituitary gland; and the availability of iodine & tyrosine. TSH production is regulated via means of a feedback loop between the hypothalamus, pituitary gland, and thyroid.
Hypothyroidism results in a slower basal metabolic rate (BMR) which ultimately leads to weight gain.  Other signs and symptoms of hypothyroidism include: irregular bowel movements (constipation); low energy; dry skin; hair loss; irritability; mental impairment; cold intolerance; joint/muscle pains; and delayed or absent reflexes, to name a few.  Keep in mind that not every single one of these symptoms will necessarily be present with hypothyroidism.  
 
 
What causes it?
A common cause of hypothyroidism is Hashimoto’s thyroiditis which affects an estimated 5% of the general population, making it one of the most prevalent autoimmune diseases.  It is reported to occur in approximately 10-20% of all women, and less frequently in men. Hashimoto’s is regarded as a disorder of T-cell mediated immunity, with the infiltration of self-targeting T and B lymphocytes in the thyroid gland. Additional autoimmune conditions may be present in those who have a diagnosis of Hashimoto’s, and so it is important to evaluate for co-existing autoimmunity.
Stress can play a crucial role in thyroid dysregulation by triggering the release of noradrenaline, cortisol, and corticotropin-releasing hormone.  These hormones have an inhibitory influence on TSH secretion and suppress enzymes involved in the conversion of T4 to T3.
Poor gastrointestinal (GI) health may also be responsible for autoimmune thyroiditis. Did you know that 70-80% of the immune system is found within the GI tract? Lifestyle factors such as stress, medication/antibiotic use, and poor diet directly impact the integrity and health of the GI tract.  When the GI tract loses its integrity the immune system can ultimately become confused and the body makes mistakes!  In the case of intestinal hyper-permeability, the immune system misidentifies normally harmless antigens (such as foods) as being foreign and mounts immune responses to them.  The protein structure of certain foods resembles that of the thyroid, and cross-reactivity can occur as a result; the body can turn against itself causing an autoimmune reaction.   Also, on a side note, poor GI health will also likely be evident as a result: bloating, gas, irregular bowel movements, heartburn, and abdominal cramps are possible but just some of the symptoms that correlate with poor GI health!

Screening:
Your Naturopathic Doctor will screen for signs and symptoms of an underactive thyroid.  She/he will likely order a thyroid panel (possibly including iodine via a 24-hour urinary excretion test) to determine the state of the thyroid gland and also perform a physical exam to assess for nodules or irregularities.  An ultrasound may also be ordered to assess the thyroid when nodules are palpated.  In hypothyroidism, TSH tends to be elevated with T4 and T3 being low. Elevated thyroid peroxidase (TPO) and thyroglobulin (TG) antibodies on lab results signify that the thyroid is being “attacked”.  

Natural approaches to treatment:

1. Dietary interventions:

i) Gluten-free diet: The protein structure of gluten cross-reacts with that of the thyroid.Studies show that patients improve on a strict gluten-free diet.When people removed gluten from the diet, antibody levels decreased and thyroid function was restored.There may also be additional offending foods that need to be eliminated from the diet.
ii) Increase protein intake: this is important as protein is a precursor to both tyrosine and stress hormone production (ie. catecholamines).
 
 
Nutritional interventions:

1. Iodine – a micronutrient required for thyroid function and synthesis of thyroid hormones.  Iodine can be obtained in the diet from seafood, animals products, and fruits like cranberries and strawberries. Dose: aim for about 150 micrograms daily, unless pregnant or lactating: 250 micrograms daily. Meanwhile, a number of studies indicated that moderate or mild iodine excess (> 220 micrograms per 24 hours) is associated with a more frequent occurrence of hypothyroidism – the exact mechanism has not been clarified. A recent study suggested that the apoptosis of thyroid follicular cells seen in hypothyroidism development is likely caused by suppression of autophagy activity which is induced by iodine excess. High doses of iodine should be discouraged in Hashimoto’s.

1. Selenium – a micronutrient that increases active thyroid (T3) hormone production and also modifies the inflammatory and immune response.  In the absence of selenium, reverse T3 is produced (which is metabolically inactive). Selenium is particularly high in Brazil nuts and foods such as tuna and oyster. The recommended dietary intake is between 55 to 75 micrograms daily. Three meta-analyses have confirmed a suppressive effect of selenium supplementation on TPO and TG antibodies.  The patient groups in the latter study were receiving 200 micrograms of selenomethionine.   In order to predict whether a patient with Hashimoto’s would benefit for selenium supplementation, the clinician should first investigate the patient’s iodine status.

1. Vitamin D – Several studies have shown a correlation between Vitamin D deficiency and thyroid autoimmunity.  Vitamin D supplements, especially skin exposure to sunlight, are both effective in reducing thyroid peroxidase antibodies in patients with vitamin D deficiency. Vitamin D has immunomodulatory function.  It is important to get your Vitamin D levels tested prior to supplementation – as it is a fat-soluble vitamin and therefore has the potential to accumulate in the body leading to toxicity in high doses due to the build-up of calcium (hypercalcemia) and possibility of nephrolithiasis.   In those at risk of heart disease, your healthcare provider may also prescribe vitamin K alongside vitamin D.  High vitamin K status is associated with reduced coronary artery calcification, cardiovascular disease, and mortality risk.

Herbal interventions:

1. Withania somnifera: This herb is an adaptogen in that it helps modulate the stress response and also mitigates symptoms associated with stress.  This herb supports the conversion of T4 to T3 and thus is beneficial for proper thyroid function.

 
Hypothyroidism can result from an autoimmune attack, poor digestive health, nutritional deficiencies, as well as adrenal fatigue.  Common approaches to treatment include: eliminating food sensitivities and healing the GI tract; modulating the immune system and decreasing inflammation (in the case of Hashimoto’s); nutritionally providing the precursors necessary for thyroid function; and supporting the adrenal glands to reduce the impact of stress on the endocrine system.  Naturopathic medicine addresses thyroid issues with diet, nutritional supplementation, and herbal medicines.  **Consult with your Naturopathic Doctor before self-diagnosing and initiating treatment for thyroid issues.**

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My article below has been published and retrieved from the Naturopathic Currents website:

What is the Digestive System?The gastrointestinal (digestive) system is complex. The process of digestion follows sequential steps and must function properly in order for the body to get the nutrients it requires for optimal health. Digestion begins in the mouth: Salivary enzymes help degrade food, and teeth aid with the mechanical breakdown. The food bolus then passes down a muscular tube called the esophagus, which transports food from the oral cavity to the stomach. Here, various enzymes and secretions such as hydrochloric acid break down food particles even further. As soon as food leaves the stomach, it enters the small intestine. Most nutrient absorption takes place in the small intestine, whereas waste is formed and stored in the large intestine. The pancreas also plays an important role in secreting digestive juices and enzymes into the small intestine in order to help break down food into smaller molecules that can be absorbed. The digestive system is not only responsible for the digestion and absorption of nutrients from food, but there are many other health benefits noted for having a healthy, functional digestive system.

The Digestive System and Overall Health/WellbeingDid you know that approximately 70% of the immune system is located in the gut? The importance of the gastrointestinal system is testified by the huge amount of immune cells that reside within it. Gut-associated lymphoid tissue (GALT) is the prominent part of mucosal-associated lymphoid tissue (MALT) and represents almost 70% of the entire immune system; in the lamina propria, there are about 80% of all plasma cells responsible for IgA antibody production. The gastrointestinal system therefore plays a central role in immune system homeostasis. It is therefore important that the gut is healthy and functional in order to defend against invaders.
Meanwhile, the digestive system produces approximately 95% of the body’s serotonin. Serotonin is involved in mood regulation. People who have compromised digestion may therefore also complain of irritability or display signs and symptoms of anxiety/depression.

Causes of Poor Digestive HealthMultiple factors contribute to poor digestive health. Physicians must consider physical health, but also look at possible mental/emotional causes as well.
Poor Diet: Unhealthy eating habits can contribute to symptoms of gas, bloating, abdominal discomfort/pains, and change in frequency and/or consistency of bowel movements. An unhealthy diet is also a significant contributor to a variety of health conditions we see today, including but not limited to diabetes, metabolic syndrome, and hypertension. Processed, refined foods contribute to inflammatory processes within the body. What we put into our bodies is important—foods can affect mood as well as immune health.
Stress: The state of our emotional/mental health powerfully influences gut function and flora—the mind/body connection is important. The relationship between environmental or psychological stress and gastrointestinal distress is complex and bidirectional: stress can trigger and worsen gastrointestinal pain and other symptoms, and vice versa. The digestive system has an enteric nervous system which controls peristalsis—the movement of materials through the colon. Under constant stress, blood is diverted away from the digestive tract; as a result, food is not digested, and we do not assimilate nutrients properly. Lack of blood flow affects gut motility, gastric secretions, and mucosal permeability. We often recognize the mind-gut connection as a “gut feeling” which ranges in presentation from butterflies in the stomach to anxiety-induced nausea.
Medication/Antibiotic Use: Some prescription and OTC drugs negatively impact the population of beneficial bacteria in the gut. The intestinal tract has a relative ratio of good and “bad” bacteria—medications (such as antibiotics) can wipe out the population of good bacteria. This leads to a predominant population of “bad” bacteria which increases the risk of infection, toxin buildup, inflammation, and allergies. The bacterial flora is disrupted by antibiotics, infection, chemotherapy, and radiation. This disruption has profound effects on the protective barrier and results in overgrowth of pathogens and the invasion of toxins.
Low Stomach Acid: Hydrochloric-acid production tends to decline with age. Hydrochloric acid is important for digestion to occur in the stomach. Insufficient levels of stomach acid can contribute to symptoms associated with digestive upset, such as bloating, gas, indigestion, belching/flatulence, a sensation of fullness after eating, acne, and rosacea.
Intestinal Hyperpermeability: When the epithelial barrier of the intestine is breached, food particles and other substances “leak” through and enter the bloodstream, triggering immune responses and possibly contributing to the development of autoimmune disease. When someone presents with an autoimmune condition, it is important to assess digestive health. Many factors such as gastrointestinal infections and stress appear to increase intestinal permeability. Symptoms of intestinal hyperpermeability include abdominal pain, joint pains, brain fog, gas, indigestion, mood swings, skin conditions, and changes in bowel frequency/consistency.
Food Intolerances/Allergies: These are highly individualized and vary from one person to the next. These foods cause inflammation in the intestinal lining and compromise the integrity of the mucosa. Food allergies are generally more severe and involve IgE-mediated antibody responses. On the other hand, food intolerances are IgG-mediated and cause delayed symptoms. Talk to your naturopathic doctor about ways you can assess for food sensitivities and about how you can heal the intestinal tract. Signs and symptoms of food intolerances include, but are not limited to, bowel changes/irregularities, skin conditions (e.g. eczema), headaches/migraines, fatigue, irritability, brain fog, and joint pains.

Natural Treatments to Optimize Digestion:Probiotics/Fermented Foods: These replenish the population of beneficial bacteria in the digestive system, providing optimal defense against pathogens/toxins that contribute to inflammation and infection. The vast majority of the immune system is located in the gut, and beneficial bacteria are crucial for proper immune function. There are many different strains of probiotics, and research suggests that each unique strain comes with its own set of unique health benefits. Fermented foods also contain probiotics; these foods include yogurt, sauerkraut, tempeh, kombucha tea, kefir, and miso soup. Speak with your naturopathic doctor to determine which probiotic is indicated for you.
Oligoantigenic/Anti-Inflammatory Diet: Aim for nutrient-dense foods such as fruits and vegetables; whole, gluten-free grains; and lean hormone-free meats. Avoid refined sugars and simple carbohydrates (white bread, white rice, baked goods…). This diet includes foods that are hypoallergenic in nature. It eliminates adverse food reactions and allows the intestinal tract time to heal. Speak to your naturopathic physician for complete information and to find out ways you can implement this diet into your lifestyle.
Omega‑3s: Omega‑3 fatty acids are known for decreasing inflammation in the gut; they also suppress proinflammatory cytokine production. Cytokines are chemical messengers that coordinate the whole immune system. Omega‑3 fatty acids have been shown to delay the onset and improve the progression of autoimmune diseases by upregulating protective antioxidant pathways.
Glutamine: It downregulates inflammatory mediators in the gastrointestinal system by stimulating the protective stress response in gut cells. Glutamine also helps increase integrity of tight junctions in the small intestine, increases mucosal thickness, decreases permeability, and decreases bacterial adherence and translocation.

Common Digestive ConcernsConstipation--Infrequent bowel movements resulting from slow intestinal motility. When stools move slowly, more water is absorbed from the stools, and this causes them to become dry and hard. People will often experience pain in the rectum during bowel movements, and abdominal pains and/or bloating as the quantity of stool increases.
Diarrhea--Frequent, loose stools as a result of increased intestinal motility. People may experience an urge to defecate, as well as abdominal pain/cramping as pressure builds within. Nutrients are not absorbed properly when transit time is increased, and this can result in malabsorption. Malabsorption over a period of time can lead to weight loss and fatigue. Dehydration is possible after experiencing bouts of diarrhea.
Dyspepsia--An umbrella term for a subset of symptoms. These symptoms include heartburn, abdominal bloating, nausea, early satiety, and/or excess burping/belching.

ConclusionThe digestive system is complex. If any of the organs involved are compromised, digestion becomes impaired. The gastrointestinal system does more than just digest food; it is also involved in mood as well as immune health. There are ways to be proactive when it comes to the health of the digestive system: proper diet, stress reduction, avoidance of medication (if possible), and supplementation all impact the health and function of the digestive system.