Digestive Disorders

Digestive Disorders encompass a large category of symptoms and conditions, so I will highlight the most common issues people face as digestive complaints: GERD, Ulcers, and, Dysbiosis. Our emotional state directly affects our gastrointestinal health. Increased stress and anxiety can trigger gastrointestinal symptoms. Most of these disorders can be managed/treated with lifestyle modifications that include eating a healthy diet, getting adequate exercise, maintaining a healthy weight, decreasing stress, and enjoying restful sleep.

Gastro Esophageal Reflux Disease (GERD)

A common cause of GERD is a Hiatal Hernia (HH). These are often functional in nature, meaning they are not permanent, but are caused by a trigger. Structural HHs are less common, and in some instances require surgery to correct. Hiatal Hernias occur when the lower gastroesophogeal sphincter looses tone and becomes too relaxed, allowing the stomach to protrude into the opening. This allows stomach acids to leak up from the stomach, through the sphincter muscle, into the esophagus. The main symptoms are heartburn, belching/burping, throat irritation/burning, discomfort in the sternum, and/or a persistent cough. Some of the possible causes that may trigger a functional HH include: heavy lifting/bending over, trauma, weight gain, pregnancy, certain foods, increased anxiety, and digestive problems such as enzyme deficiency or biliary dysfunction. Conventional treatment often includes a variety of antacids or acid blockers. These can provide short term relief but do little to address the underlying dysfunction causing the problem. Left untreated, the resulting reflux can damage the esophagus and lead to erosions and/or cancer. Often, a gentle tractioning of the stomach downward during deep breathing can pull the slipped portion of the stomach back to the other side of the valve, resetting the normal muscular function of the valve. This is often dramatic in its resolution of the symptoms when it is appropriately applied. Dietary changes are also often necessary to decrease irritants to the gastrointestinal lining. Melatonin can be useful for some individuals to help increase the tone of the lower gastrointestinal sphincter and to decrease visceral sensitivity.

Hypochlorhydria

Another issue that will produce reflux is a too alkaline stomach, meaning acid production is low. This will slow the digestive process, resulting in a delayed emptying of the stomach contents into the small intestine. This situation requires that you acidify the stomach to increase transit time and take the stress off the valve. High acid content is required for breakdown and assimilation of many nutrients including protein and calcium. Long term use of some antacids has been implicated as a cause or risk factor for future osteoporosis (weak bones). Calcium, protein and other critical nutrients depend on a strong acid in the stomach for digestion and absorption, so it makes logical sense that blocking or neutralizing acid would affect the repair and growth of bone and other tissues. As food moves into the small intestine, the pancreas releases digestive enzymes that are acid neutralizers and the gall bladder and liver release bile, which helps with the digestive process. If the liver and pancreas are stressed by eating bad fats such as trans fats, or refined carbohydrates such as sugar, it can affect the release of these neutralizers and digestion suffers. Often the results are indigestion, bloating, and gas. If you are going to take a digestive aid, it is critical to know whether it would be helpful to use these natural acid neutralizers, such as digestive enzymes or to use an acidifier, such as betaine hydrochloride. The wrong one could make things worse.

Peptic Ulcers

Peptic Ulcers can occur in either the stomach (gastric ulcer) or the duodenum (duodenal ulcer). Ulcers represent a loss of the integrity of the lining of the intestinal tract. They can be caused by stress, NSAIDs, or a bacterial infection of Helicobactor Pylori (H Pylori). The majority of ulcers are from this type of bacterial infection. Stress causes a slowdown of GI function and repair so is often a underlying contributor to ulcerations. NSAIDs such as aspirin, can also lead to ulcerations. They are responsible for over 16,000 deaths per year as a result of damage to the GI tract and bleeding. That is over 40 deaths a day in the US from taking NSAIDS. That is more than all AIDS deaths in this country. Each of these triggers results in an eroding of the protective mucosal lining in the stomach or duodenum. Once the protective lining disintegrates, the stomach acid then burns the exposed tissue and causes pain.

Dysbiosis

GI complaints often involve some infective organism; whether, that is a parasite in the colon or H.Pylori in the stomach. There is often an underlying dysbiosis, an imbalance in the friendly versus unfriendly/pathogenic bacteria that live in the system. Dysbiosis can lead to increased intestinal permeability. This imbalance is an underlying factor in many chronic diseases including Inflammatory Bowel Diseases--Crohn's and Ulcerative Colitis, along with most of the other Autoimmune disorders. Dysbiosis can affect conditions associated with metabolic regulation as well and has been implicated in the development of Type 2 Diabetes, PCOS, etc. Common symptoms may include constipation, diarrhea, gas, bloating, abdominal pain, distension, intolerance/sensitivites to certain foods, and an over active immune system.

5Rs for Restoring Gastrointestinal Health The Institute for Functional Medicine advocates the use of the 5R approach for restoring gastrointestinal health. It involves:

· Remove This includes removing any triggers: food sensitivities, stressful environments, parasites, problematic bacteria or yeast. An Elimination Diet is often used to identify food triggers that may be causing GI symptoms. Concurrent use of herbs or nutraceuticals may also be necessary to remove persistent offenders

· Replace It may be necessary to add nutrients that support digestive secretions: digestive enzymes, HCL, bile acids, B Vitamins, etc. These can be compromised by diet, aging, diseases, medication usage, etc.

· Reinoculate The “good” bacteria can be replenished by eating a prebioitc/fiber rich diet (artichokes, garlic, leeks, onions, chicory, etc.) which provides food for the beneficial bacteria, helping them to grow and thrive.Fermented foods (such as yogurt, keifer, sauerkraut, miso etc.) and supplements that contain active probiotic cultures may also be recommended to help increase the presence of these beneficial organisms.

· Repair It may be necessary to repair the damaged epithelial lining.There are a variety of nutritional supports that are commonly used including: Vitamin D, L-Glutamine, antioxidants (Vitamins A, C, and E), Fish oils, and minerals such as zinc and magnesium

· Rebalance This step is important to ensure lifestyle patterns are changed that may have been an underlying trigger for the dysfunction initially. These modifiable lifestyle factors include a healthy diet, adequate exercise, maintaining a healthy weight, decreasing stress, and restful sleep.

For those interested with some background information, here is a basic introduction to Digestion and Absorption.

Digestion Digestion is the process of breaking down food into smaller units that can be used by the body. Enzymes are used to facilitate this process.

Mouth Digestion begins in the mouth. Chewing releases enzymes that start the breakdown of Carbohydrates (CHO)/starches (salivary a-amylase) and fats (lingual lipase) contained in food.

Stomach After chewing, the bolus of food is swallowed and passes down the esophagus, thanks to muscular contractions, into the stomach. As the food enters the stomach, it causes the stomach to distend. This stretching triggers the release of the hormone gastrin which in turn causes an increase in digestion via increased: hydrochloric acid (HCL), pepsin, and increased motility. The presence of HCL makes the stomach a very acidic environment, perfect for continuing the digestion of proteins (pepsin). A small amount of fats (gastric lipase) are also broken down here in the stomach. The CHO pass through this environment basically unaltered due to the high acidity from the HCL content which inactivates their digestive enzymes. The acidity of the stomach is one of our first lines of defense against foreign invaders such as bacteria or parasites that may be present in foods.

Small Intestines The bolus of food, now called chyme, enters the small intestines (SI). Primary digestion of CHO, Proteins, and Fats occurs in the SI. The hormones secretin and Cholecystokinin (CCK) trigger pro-enzymes and bicarbonate to be released and neutralize the acidic chyme and slow down digestion. Secretin inhibits the release of Gastrin, thereby reducing gastric secretions and decreasing motility. Carbohydrates/Starches/Glucose are further broken down in the SI by pancreatic a-amylase, maltase, sucrase, and lactase. As Glucose enters the SI Gastric Inhibitory Peptide (GIP) is released. This stimulates the production of Insulin and inhibits gastric secretions, motility, and emptying. Proteins are digested via the release of pancreatic pro-enzymes that are converted to protein digesting enzymes in the SI. As Amino Acids and fats enter the Duodenum, CCK triggers the release of Pancreatic lipase and bile from the Gallbladder. Bile, along with Pancreatic lipase, facilitates the breakdown of fats.

Absorption Many nutrients can move directly into absorption such as vitamins, minerals, and water. Nutrients that yield energy, proteins, fats, and carbohydrates/starches, must first be digested/broken down prior to absorption. Absorption can take place along the entire length of the SI.

Small Intestine

· Duodenum This is the site of most digestion referred to previously. Some minerals are also absorbed here, with the exception of the electrolytes: sodium, chloride, potassium.

· Jejunum This is the primary site, 85%, of water absorption. Absorption of CHO, amino acids (broken down proteins), water soluble vitamins, and some minerals (except the electrolytes sodium, chloride, and potassium) takes place here in the Jejunum.

· Ileum Absorption of CHO, Amino Aicds, water soluble vitamins, and fat soluble vitamins can occur in this section. the terminal ileum is the site of Vitamin B12 absorption. Damage to this area of the SI can impair fat digestion and can affect Vitamin B12 production, resulting in deficiency.

Large Intestine Chyme enters the Cecum and signals the Ileocecal Valve (ICV) to close. This prevents material from re-entering the ileum of the SI. Some digestion of fiber occurs in the LI. There is a small amount of nutrient absorption that takes place: water, electrolytes (sodium, potassium, and chloride). Colonic bacteria produce Vitamin B12.