Assessing Chronic GI Complaints
Gastrointestinal health is a main focus is the field of Naturopathic Medicine. In class we were told that “If you can’t talk about stool, you’re in the wrong school.” We found this to be true since assessing and promoting digestive health is a large part of what we do. If our gastrointestinal tract is not healthy, we’re not healthy. This is where we digest and absorb nutrients from the foods we eat, produce immune cells, house 95% of our serotonin and eliminate toxins. If things aren’t working well with our digestive tracts, we generally don’t feel well.
Most of the chronically ill patients that I see have some type of gastrointestinal issue. Although that may not be what brings them into my office, it most certainly plays a role in their illness. Common GI complaints include nausea, gas, bloating, heartburn, constipation, diarrhea, slow digestion and pain or discomfort. These could be symptomatic of many different things ranging in severity so a good work up is warranted.
I tend to start with a comprehensive stool analysis to rule out infections as the source of the problem. Infections can be parasitic, bacterial or fungal. Once the infection is identified, it can be treated appropriately with medications, herbs, supplements and anti-fungals.
Other things to consider are food allergies and gluten sensitivity. Allergies to specific foods can cause many of the symptoms mentioned above, so it is important to identify those potential allergens and remove them from your diet. Food allergy testing is one way of identifying allergenic foods, but may not catch everything. An allergy elimination diet is also an effective way to determine if you are reacting to foods. The elimination diet involves removing the most common allergenic foods from your diet for 3-4 weeks. These foods include wheat, dairy, soy and gluten - amongst other things. You then reintroduce them back into your diet one at a time allowing three days for each food to bring on a potential reaction. If you note a reaction, whether it is in the GI tract or elsewhere, you should avoid that food.
Sensitivity to gluten can also cause many of the symptoms listed above as well as more systemic complaints. You don’t have to have Celiac disease to be sensitive to gluten. Celiac disease is a complete intolerance to gluten, while sensitivity results in a milder reaction. If you have gluten sensitivity, you develop chronic inflammation in the GI tract which leads to structural changes in the lining of the small intestine. These structural changes can reduce your ability to digest and absorb the nutrients from your food. The effects of gluten in someone who is sensitive can be far-reaching, affecting many systems in the body. If I suspect a gluten sensitivity in someone, I will either run a salivary or blood test to look for elevated antibodies against gluten or simply have them avoid gluten for 4-6 weeks and then see how they feel.
Irritable Bowel Syndrome (IBS) is a common diagnosis when other more serious conditions have been ruled out. IBS is strongly associated with a state of stress, depression or anxiety and often presents as alternating constipation and loose stools. In the book, “The Second Brain,” Dr. Michael Gershon states that our second brain is our enteric nervous system which resides in our GI tract and operates independently of our central nervous system. The enteric nervous system manages digestion through neural circuitry, neurotransmitters and various proteins just like our central nervous system manages the rest of our body.
Mental and emotional states have an effect on both our nervous systems. It has been theorized that IBS is related to an over-abundance of serotonin in the gut. Serotonin starts the process of digestion in the small intestine, then is bound up by a particular protein and deactivated. If we are deficient in this protein, too much serotonin remains in the GI tract, causing loose stools. Due to the high amount of serotonin, the receptors in the GI tract recede, leading to the opposite effect, which is constipation.
When I see a patient who has been diagnosed with IBS, I still try to rule out the above listed possible causes which may not have been considered. If there are lingering infections or food sensitivities, these may be contributing to the underlying cause of the IBS. Chronic candida is more common than we realize and many patients find relief from their IBS symptoms by treating the yeast.
These are just a few considerations when assessing chronic GI symptoms. If symptoms are severe and longstanding, it is also important to be assessed by a gastroenterologist who can appropriately order additional diagnostics.
Tracy Tranchitella, ND is a Naturopathic Physician at Stillpoint Center for Integrative Medicine in Murrieta. If you would like more information about Dr. Tranchitella and Stillpoint Center, please call (951) 461-4800 or visit our website at www.mystillpoint.com