What is IBD?

Inflammatory Bowel Disease (IBD) is a general term used for a number of similar conditions that affect the gastrointestinal tract, including ulcerative colitis (UC) and Crohn’s disease. In IBD, recurrent inflammation of sections of the gastrointestinal tract leads to tissue damage and the development of painful lesions.  IBD is believed to be a consequence of your body’s inappropriate inflammatory response to intestinal microbes (bacteria and other species that colonise the gastrointestinal tract) when an individual is genetically susceptible.  All layers of the intestine can be inflamed.

In Crohn’s disease the ileum which is the final section of the small intestine, and the colon (large intestine) are typically involved however it can involve any part of the gastrointestinal tract. Ulcerative colitis, on the other hand, involves the colon only. Signs and symptoms of IBD especially in a flare include diarrhoea and urgency, bleeding, weight loss, low appetite, nausea, vomiting, abdominal pain, and even fever. Ulcerative colitis can sometimes also present with constipation.

Other health outcomes related to IBD

Complications and conditions that may arise as a consequence of having IBD may include:

• Joint stiffness and eye inflammation
• Kidney and gallstones
• Fatty Liver
• Osteoporosis
• IBS: even in remission, IBD sufferers can experience IBS (Irritable Bowel Symptoms) as part of daily life such as constipation, diarrhoea, bloating, abdominal pain or discomfort and excess flatulence.
• Small intestinal Bacterial Overgrowth (SIBO) and malabsorption issues of lactose and fructose specifically in Crohn’s Disease
• Nutrient deficiencies: magnesium, iron, zinc, B Vitamins, Calcium and more

Risk Factors of IBD

An interesting fact is that the incidence of this autoimmune disease is rare in developing countries meaning that our western diet and lifestyle has an obvious connection with IBD.

Although it’s not clear exactly why IBD develops in some people, there are several factors that are associated with an increased risk of developing IBD:

• Family history: family history of the disease, especially if someone in their immediate family has IBD, so genetics definitely plays a role.  In Crohn’s disease as an example first degree relatives have a 12- 15 times greater risk of developing this condition.
• Antibiotic use: including exposure in early childhood and recent use.  This leads to Dysbiosis: People with IBD often have far less diversity in the types of microbes found in their guts. This can affect immune function and increase inflammation.
• Birth by caesarean
• Low levels of mucin: Mucin is the mucous substance secreted by cells in the gastrointestinal tract that helps protect your gut lining from bacteria, food particles, and toxins. In IBD, inflammation and antibodies from a dysregulated immune system destroys the mucin, leaving your gut lining susceptible to damage.
• Past gastrointestinal Infection: It’s believed infection (especially when hospitalized) can trigger the onset of IBD.
• Low Vitamin D levels: most likely due to important role in immune health
• Smoking: cigarette smoking increases the risk of developing IBD, particularly Crohn’s disease.
• Appendectomy: Having your appendix removed also increases your risk of developing IBD
• Stress, Anxiety: exacerbates the risk of relapse and flares
• NSAID use (Nonsteroidal anti-inflammatory drugs): increases the risk of relapse flares

Dietary Risk Factors in IBD

• A diet that is high in refined sugar, animal meat & fats, dairy products & high total protein intake
• Low intake of raw fruit and vegetables, wholegrains, and fish
• Low consumption of fibre rich foods
• Formula feeding in early childhood

Naturopathic treatment approaches aim to address the underlying causes of the condition. Whilst some of the above causes (such as family history) can’t be addressed, the strategies in this blog look at addressing some of the other causes, such as diet, restoring healthy gut bacteria species, balancing immune dysregulation, and chronic inflammation, to help you manage your symptoms and improve your daily wellbeing.

Tests that may be required

You are most likely to have been diagnosed by a gastroenterologist via a range of tests that include stool tests to rule out infection as the cause of your symptoms, a colonoscopy, endoscopy, Barium x-ray of your bowel, and CT scans.

As a naturopath, I may also recommend an assessment of the following however it is unique to each individual:

• faecal calprotectin and other inflammatory markers
• Blood tests to assess nutrient absorption issues
• Assessment of bacterial overgrowth

Naturopathic Treatment Objectives

The main focus is on healing the lining of the intestinal tract to reduce disease flares and remission.

Dietary Interventions

This may be done in phases depending on whether you have been diagnosed with bowel motility issues, bacterial overgrowth, or obvious malabsorption issues.

I have specific dietary recommendation for IBD sufferers once I have important information however at some stage in my client’s treatment, suggestions may include the following but will be unique to each individual:

Eliminate or reduce alcohol: it is unknown if alcohol plays a role in triggering disease flares however it is related to worsening pain in some patients.

Lactose free & low Fructose diet: this may be required especially in Crohn’s Disease due to malabsorption of lactose and fructose in some sufferers.  Symptoms of ongoing IBS can be improved.

Low FODMAP diet: may be recommended: depending on bacterial overgrowth status and bowel motility for a period of time.

Increase your intake of fibre and certain prebiotic foods

It is important not to self-prescribe with prebiotic supplements as gas produced may worsen symptoms.

Increase your intake of antioxidants

Antioxidants are important compounds that help to fight oxidative stress in the body. Oxidative stress is a major contributor of chronic inflammation and tissue damage and can trigger immune activation, too. Antioxidants in foods are particularly abundant in fresh fruits, vegetables, herbs, and spices. Fruits and vegetables are also incredibly important sources of vitamins and minerals which are needed for cellular repair and healthy immune function, including vitamins such as A, C, and E, and minerals such as zinc and selenium, which also act as antioxidants in the body.

• Choose fruits and vegetables in a variety of colours each day to maximise the different types of antioxidants you are consuming – many of the antioxidants in fruits and vegetables are what gives the food its pigment.
  • Red fruits and vegetables – contain compounds such as lycopene and anthocyanins: Tomatoes, capsicum, strawberries, cherries, beetroot, radish, chillis, radicchio, rhubarb, raspberries, cranberries, raspberriesOrange fruits and vegetables contain compounds such as beta-carotene: Oranges, capsicum, pumpkin, apricots, carrots, papaya, persimmons, mangoes, sweet potatoesYellow and light green fruits and vegetables contain compounds such as carotenoids: Capsicum, kiwi fruit, corn, pineapple, lemons, cabbage, celery, limes, pears, avocado, fennel, onion, lettuceDark green fruits and leafy vegetables contain compounds such as lutein chlorophyll and zeaxanthin: Broccoli, Brussels sprouts, kale, Pak choy, spinach, silver beet, asparagus, green beans, peas, leeks, artichokes
  • Purple fruits and vegetables contain compounds such as anthocyanins and phenols: Cabbage, grapes, eggplant, onions, plums, blueberries, blackberries
• Use fresh herbs and spices to flavour your cooked foods, or even mix into salads.

Ensure Adequate Protein

Protein is vital for tissue repair and healing however excess animal protein and fats can be detrimental.  For this reason, it is important to carefully develop a diet that has adequate proteins from a range of sources.  Here is a wonderful blog about plant-based protein options.

Reduce Consumption of Inflammatory Foods

As IBD is an inflammatory condition, it’s important to reduce foods that can trigger or worsen inflammation. The foods listed below should be reduced or eliminated from your diet, as they can increase inflammation.

• High sugar foods: sugar, maple syrup, rice malt syrup, cakes, pastries, cookies, chocolate, lollies. Be wary of processed “healthy” treats such as protein balls, protein bars, muesli, and the like. Many of them still contain very high amounts of sugar.
• Trans fatty acids: found in frozen chips, frozen pizza, pastries, fried foods
• Highly refined carbohydrates: white bread, white rice. Instead, choose whole grain and sourdough varieties (proper sourdough, not the type in plastic in the supermarket)
  • NOTE: If you only tolerate white bread and rice, this is okay, but be conscious not to over consume, and choose lower GI, good quality sources). Alternatively, swap some portions of these foods for other carbohydrate sources, such as potato, sweet potato, pumpkin, carrot, and other root vegetables, or even grains such as oats of quinoa.
• Food intolerances: if you have an intolerance to a particular food, it needs to be eliminated completely from your diet. Be sure to read food labels carefully to prevent accidental exposure.

Ensure Adequate Hydration

Adequate hydration is essential, especially when you are experiencing diarrhoea. Without sufficient water, our cells can’t be plump and healthy and aren’t able to function as they need to.

• If you are struggling to motivate yourself to drink enough water, try adding some flavour with sliced lemon or fresh mint leaves. You can even make your own cold brew iced tea by adding a couple of teaspoons of loose herbal tea into a bottle of water and leaving in the fridge overnight. Try making this with nettle leaf tea, which is an excellent source of vitamins and minerals.
• If you are experiencing diarrhoea, you can also try drinking coconut water, which will help you to replace some of your electrolytes as well as rehydrating you. This is a particularly good option if you are not able to eat sufficient food.

Increase your consumption of omega 3 fatty acids

Omega 3 fatty acids are a powerhouse nutrient for reducing inflammation and for helping build healthy cell walls.

• Fish: choose wild caught salmon or tuna, or sardines. Whilst eating the whole food is best, if you are unable to eat fish, you can use a supplement. Keep in mind that many fish oil supplements on the market are of poor quality and may not be providing you with benefit. Fish oil supplements should not smell rancid! It is best to use the fish oil prescribed to you, to ensure you are getting the most out of taking it.
• Vegan options: Omega 3 fatty acids are found in hemp seeds, walnuts, sunflower seeds, chia seeds, and ground flax seeds, and edamame. Vegan omega 3 supplements are also available and are usually algae-based.

During Acute Symptoms

During an acute attack of symptoms, you may need to eat a very simple diet of easily digestible foods – think well cooked stews and soft vegetables with chicken or fish. Some people may require the Low FODMAP diet during acute disease flares depending on their unique disease state.

Lifestyle Interventions

I spend considerable time supporting my clients in this area however some common interventions include

Reduce stress

Stress can worsen inflammation and has been shown to worsen symptoms in IBD. Address causes of stress in your life and seek ways to minimise the stress you deal with on a daily basis – delegate tasks where necessary and prioritise!

• If you don’t already have a regular counsellor or psychologist, look into finding one. Having someone to talk to about the stresses in your life can help you to work through issues and find positive, constructive ways to work through them.  I have some excellent mental health practitioners in my clinic (link here Courtney)
• Daily meditation and yoga have both been found to be effective methods for reducing stress. Sign up for a local yoga or meditation class or try out “Yoga with Adrienne” on YouTube, and the “Insight Timer” app available through your device’s app store.
• Self-care with a relaxing massage, weekends away, a walk in nature will all support the impacts that stress and emotions have on IBD.

Make time for rest each day

Whilst exercise and physical activity is important, rest is equally so, especially during acute flares. Your body is working hard to heal and needs the time and space to concentrate on doing so! Avoid excessive caffeine consumption and ensure no caffeine is consumed after 12pm. Caffeine has a long half-life of 12 hours, so shouldn’t be consumed too late in the day as this will affect your ability to unwind and sleep.

Make sleep a priority

Sleep is so important for reducing day-time anxiety and stress, but it also supports a healthy and balanced immune system.  If you are not sleeping well, you will be provided with additional naturopathic support on how to improve it and you may be prescribed some herbs to help you.  My previous blog article on sleep gives important tips on why sleep is so important.

Herbs and Supplements

Supplements will only be prescribed based on symptoms and blood test results and may include Vitamin D, Zinc, iron.

Prebiotics: specific prebiotic fibres depending on whether you have Ulcerative Colitis or Crohn’s disease may be prescribed to improve your gut microflora and balance your stools.

Specific strains of Probiotics: broad spectrum probiotics are rarely prescribed especially in a bacterial overgrowth.  Specific strains that perform unique functions are better indicated.

Anti-inflammatory herbs: may include bioavailable turmeric, Boswellia, Wormwood in acute and maintenance dosing.

Omega 3 oils: depending on fish consumption in diet

Whether you suffer from Ulcerative colitis or Crohn’s disease, many treatment strategies are similar however there are significant differences especially if Crohn’s is in the Ileum as opposed to the colon.

For support on managing this chronic condition and to reduce flares and quality of life, please book an initial naturopathic consultation with me or book a fact-finding call.  My passion as a naturopath for digestive issues has meant significant study and research combined with specialist mentoring.  My email address is tanya@performanceinhealth.com.au or call the clinic on (02) 8004 5521.

References

Hechtmann, L. (2014). Clinical Naturopathic Medicine. Chatswood: Elsevier Australia.

The post Living with & managing your Inflammatory Bowel Disease (IBD) appeared first on Performance in Health.

I also focus on digestive issues and IBS as a naturopath, and it is certainly an area of health that I am passionate about.  I find that irritable bowel syndrome (IBS) is a diagnosis often via exclusion and once other health conditions have been excluded, IBS is the diagnosis given.    This basically means that the actual cause of your gut distress is not known.  It is important to exclude other causes which is always part of my treatment plan when working with gut related issues. 

When I am supporting someone with an IBS diagnosis, I always consider anxiety as a cause.  In saying this, I always assess for chronic constipation as the cause, slow gut motility, Post Infectious IBS, endometriosis on the colon, bacterial overgrowth in the small and/or large intestine, bacterial dysbiosis, food intolerances & malabsorption conditions and thyroid disease.  I often recommend functional testing to delve more deeply into what is happening for my clients.  Often Inflammatory Bowel Disease, GERD, H Pylori or more may have been excluded by a gastroenterologist. 

I also find that it may be several health-related issues that may create the “perfect storm” of Chronic IBS.

What I do know without a shadow of a doubt is that in approximately 70% of case gut issues drive anxiety and in approximately 30% of cases anxiety drives gut issues however no matter where it starts, one drives the other so you end up in a gut – anxiety – gut- anxiety circuit and treatment must also focus on both for successful outcomes.

Let’s talk statistics about Anxiety Driven IBS.

Both IBS and anxiety are common health issues for adults in Australia. IBS affects around 1 in 5 of us, whilst 1 in 6 will experience an anxiety disorder in their lifetimes. It’s becoming increasingly well established that our mood and our gut health are intrinsically linked and, anecdotally, many of us are all-too-familiar with the gut-churning effect anxiety and stress can have on our bodies. We’ve previously discussed on the blog about the link between gut health and low mood issues such as depression. But what about other mental health conditions? Do these also affect our gut health? Today we look at anxiety and how it can drive IBS – the mechanisms behind this, as well as some simple strategies to help you manage your anxiety symptoms to improve your gut health.

IBS

Irritable bowel syndrome, also known as IBS, is a really common gastrointestinal condition, affecting around 15% of the general population.  IBS is a chronic functional disorder, characterized by recurrent symptoms of abdominal pain and bloating, as well as constipation, diarrhea, or both.  Despite being common, it’s a complex condition that involves a complicated interplay between gut microbiota, diet, pain receptor dysregulation, and mental health. It’s very common for people with IBS to have concurrent mental health conditions, such as anxiety and depression – up to 90% of people with IBS also have one or more mental health conditions. What’s more, IBS symptoms often worsen during periods of acute stress or exacerbations of existing mental health conditions, and treatment for mental health can lead to reduced IBS symptoms. Recent studies suggest that IBS is actually a disorder of a breakdown in gut-brain communication, rather than being a strictly gastrointestinal health condition.

Anxiety and the Gut

Have you ever been anxious about an event and found you suddenly had to go to the bathroom? Or, if you experience an anxiety disorder, do you find that gastrointestinal symptoms are an issue for you? You’re not alone. Anxiety is one of the most common mental health conditions in Australia; many of us have experienced an anxiety disorder ourselves or have seen a loved one go through it. Anxiety causes both psychological and physical symptoms, with gastrointestinal symptoms being some of the most common issues for those with anxiety. Whilst typical symptoms might include shortness of breath, sweaty palms, and palpitations, acute anxiety can also look like:

• Diarrhoea, constipation, or both
• Abdominal cramping or pain
• Nausea, indigestion, or heartburn
• Loss of appetite, or increased appetite

So, what is going on here? There are a few reasons why these symptoms occur.

1. The Enteric Nervous System and The Gut-Brain Axis

The first reason for this link between anxiety and the gut is because both the gut and brain are connected via a system of nerves called the enteric nervous system (ENS), which is also known as the “second brain”, or the “gut-brain axis”. The enteric nervous system controls aspects of communication between the gut and the brain regarding functions such as digestion and gut motility. In fact, the vital functions of the gastrointestinal tract are almost entirely dependent on the enteric nervous system and things quickly fall apart if it is not working properly. Researchers have also found that the ENS may be responsible for some of the mood changes associated with gastrointestinal conditions like IBS. The ENS and gut-brain axis connects the emotional and cognitive centers of the brain with the gut. It is through this link that our thoughts and feelings affect our digestion and vice-versa.

2. The Physiology of Anxiety and Neurotransmitters

The second reason why anxiety and IBS are linked has to do with the chemical changes that occur in the body in anxiety. Physiologically, anxiety is essentially an overactivation of the fight or flight response, also known as the HPA axis or sympathetic nervous system. This means anxiety, like stress, puts our body into fight or flight mode. When the body is in fight or flight mode, “non-essential” functions such as digestion and immune function are suppressed. People with anxiety often aren’t digesting and absorbing their food adequately, particularly when symptoms are bad. What’s more, anxiety leads to altered levels of many important neurotransmitters, which are the chemicals the nervous system uses to send messages throughout the body. When neurotransmitter levels become altered, communication within the nervous system is compromised, as is communication between the brain and the gut via the ENS. Some of the neurotransmitters that are affected include noradrenaline, GABA, and acetylcholine, among others.

Noradrenaline

Noradrenaline, also known as norepinephrine, is a key neurotransmitter in the sympathetic nervous system (the fight or flight mode). It helps us to feel awake and alert and plays important roles in regulating our behaviour, memory, and learning. Anxiety typically causes noradrenaline levels to be higher than normal, which causes a fast heart right, high blood pressure, suppressed digestion, and slow bowels (meaning constipation). However, in periods of acute stress or anxiety, high noradrenaline can actually stimulate the bowels and trigger diarrhoea. In addition, noradrenaline can also cause alterations to the gut microbiota, leading to dysbiosis, which can make IBS symptoms even worse.

GABA

Gamma-aminobutyric acid (GABA) is our main calming neurotransmitter. Not only does it help us to feel calm, it is also important for helping with physical movement and cognitive function. Low GABA levels are typical in anxiety. Unfortunately, low GABA levels causes an increased sensitivity to pain in the gut, one of the most common symptoms in IBS. Low GABA levels can also negatively affect gut motility and the gut’s immune function, too.

Acetylcholine

Acetylcholine is another important neurotransmitter that is altered in both anxiety and IBS. Acute stress and anxiety cause low levels of acetylcholine in the gut and the brain, which leads to inflammation and increased gut motility, causing diarrhoea.

The Role of Gut Bacteria

Of course, we can’t discuss the gut without also discussing the gut microbiota. The gut microbiota is essential for the health of both the central nervous system (brain) and the ENS, because of the important neurotransmitters these bacteria produce, which are utilized by our nervous system. Bacteria in the gut produce not only serotonin, but also GABA, acetylcholine, and even melatonin. Animal studies show that changing the gut microbiota can trigger anxiety disorders and other mental health conditions, further highlighting how important our microbiota balance is. Gut bacteria directly affect the gut-brain axis, too. Bacteria communicate with nerve cells in the gastrointestinal tract, as well as communicating with the brain via the neurotransmitters they produce.

A Self-Perpetuating Cycle

It’s easy to see how the link between gut health and anxiety can lead to a self-perpetuating cycle for those with anxiety disorders and conditions like IBS. Once you are caught in this cycle, it will continue until both the anxiety and the gut aspects of your health are addressed. This is where as a naturopath I often make a significant difference in Anxiety Driven IBS through guiding you towards treatments that will help to address both the anxiety and the gut, to help make sure you are healing both parts of the issue.

Calming Your Anxiety for Better Gut Health

The good news is there are many ways you can start to gain control of your gut health by addressing your anxiety, and vice versa. Below are some great tips for helping to regain your health.

Herbal Medicines for Anxiety

Each person is unique and for this reason there are many herbs that I use for my KPI of Calm energy. This may also include herbs for more restorative sleep as sleep is critical for reducing next day anxiety.  Some of my favourite herbs include kava, withania, rhodiola, passionflower, lavender and more.

Gut calming herbs

Again, this is dependent on medications and what is unique to each client however some of the herbs I may prescribe include chamomile, lemon balm, peppermint.

Use a Quality Probiotic when indicated

Prescribing a probiotic when someone actually has a bacterial overgrowth can worsen their symptoms when working with IBS.  Once an overgrowth has been excluded and reasons for a lack of healthy gut bacteria has been identified then specific probiotics may be prescribed.

A good quality probiotic can be incredibly valuable in re-establishing a healthy gut microbiota for certain people. Certain specific microbial strains, such as Lactobacillius reuteri, have been found to improve gut motility and reduce pain perception in the gut, demonstrating good potential for use in IBS. However, remember that probiotic supplementation does need to be paired with prebiotics and a healthy, plant food-rich diet to ensure sufficient substrate available for bacterial populations to thrive. Unfortunately, many probiotics available on the market are of inferior quality or don’t contain therapeutic doses of specific bacterial strains that are beneficial for conditions like IBS. If you are interested in taking a probiotic, speak with your naturopath to find the right probiotic supplement for you.

Specific prebiotics

Many prebiotics can produce excess gas that worsen symptoms such as bloating and pain however proper prebiotic prescriptions made in line with symptoms can make a huge difference for symptoms and support good bacterial populations to grow.

Vitamin deficiencies and additional needs

Again, each person has different nutrient requirements depending on levels of stress in their lives including career, family, past history and more (which uses up nutrients), diet, lifestyle, and medications.  Important nutrients for anxiety include magnesium, Zinc, Vitamin B, Vitamin C and more.  The wrong magnesium at the wrong dose can worsen looser stools so be careful.

Blood sugar balancing

When supporting my clients with anxiety, a focus is always made around balancing blood sugar levels throughout the day and night as fluctuations can trigger and worsen anxiety.  Having good energy levels throughout the day is also important as fatigue is a trigger for anxiety in many people.

Manage Your Stress

Finding ways to reduce your stress and improve your stress-coping skills can really help with anxiety. Stress management can be as simple as a daily 30-minute walk or starting a mindfulness practice.

Talk it Out

If you experience anxiety, having a professional you can talk to makes a big difference. If you don’t already, consider booking yourself in to see a psychologist, counsellor, or therapist, who can listen to your experiences and help direct you towards helpful strategies to manage your anxiety.  Performance in Health Wellbeing clinic in Sydney’s Inner West have a team of well qualified professionals to help you.

Book in to see me (Tanya Edwards) for Naturopathic support

If you’re struggling to understand where to start, getting some professional guidance is key.  A naturopathic consultation is an extremely thorough investigation which can help you to better understand your symptom picture and overall health as we work together to develop a holistic strategy to help you regain your health.

Treatment will look at what needs to be excluded.  I may recommend a low FODMAP as a temporary measure to reduce gut symptoms as we figure out what is happening for you and herbs to reduce anxiety and gut issues at the same time.  To find out more, contact Performance in Health today.

References

Annahazi, A., & Schemann, M. (2020). The enteric nervous system: “A little brain in the gut.” Neuroforum, 26(1).

Bercik, P. (2020). The brain-gut-microbiome axis and irritable bowel syndrome. Gastroenterology & Hepatology, 16(6), 322–324.

Carabotti, M., Scirocco, A., Maselli, M. A., & Severi, C. (2015). The gut-brain axis: Interactions between enteric microbiota, central and enteric nervous systems. Annals of Gastroenterology, 28(2).

Cherpak, C. E. (2019). Mindful eating: A review of how the stress-digestion-mindfulness triad may modulate and improve gastrointestinal and digestive function. Integrative Medicine: A Clinician’s Journal, 18(4), 48–53.

Gros, M., Gros, B., Mesonero, J. E., & Latorre, E. (2021). Neurotransmitter dysfunction in irritable bowel syndrome: Emerging approaches for management. Journal of Clinical Medicine, 10(15).

Hadjivasilis, A., Tsioutis, C., MIchalinos, A., Ntourakis, D., Christodoulou, D. K., & Agouridis, A. P. (2019). New insights into irritable bowel syndrome: From pathophysiology to treatment. Annals of Gastroenterology, 32(6), 554–564.

Jerndal, P., Ringstrom, G., Agerforz, P., Karpefors, M., Akkermans, L. M., Bayati, A., & Simren, M. (2010). Gastrointestinal-specific anxiety: An important factor for severity of GI symptoms and quality of life in IBS. Neurogastroenterology & Motility, 22(6).

Lee, S., Wu, J., Ma, Y. L., Tsang, A., Guo, W.-J., & Sung, J. (2009). Irritable bowel syndrome is strongly associated with generalized anxiety disorder: A community study. Alimentary Pharmacology and Therapeutics, 30(6), 643–651.

Niesler, B., Kuerten, S., Demir, I. E., & Schafer, K.-H. (2021). Disorders of the enteric nervous system—A holistic view. Nature Reviews Gastroenterology & Hepatology, 18, 393–410.

Popa, S.-L., & Dumitrascu, D. L. (2015). Anxiety and IBS revisited: Ten years later. Clujul Medical, 88(3).

Shrestha, B., Patel, D., Shah, H., Hanna, K. S., Kaur, H., Alazzeh, M. S., Thandavaram, A., Channar, A., Purohit, A., & Venugopal, S. (2022). The role of gut-microbiota in the pathophysiology and therapy of irritable bowel syndrome: A systematic review. Cureus, 14(8).

Windgassen, S., Moss-Morris, R., Goldsmith, K., & Chalder, T. (2019). Key mechanisms of cognitive behavioural therapy in irritable bowel syndrome: The importance of gastrointestinal related cognitions, behaviours and general anxiety. Journal of Psychosomatic Research, 118, 73–82.

The post Is Anxiety Driving your IBS? appeared first on Performance in Health.

Haemochromatosis is a health condition whereby excess iron accumulates in the body (also known as iron overload). There are several ways that iron overload can occur including:

Excessive intake/ absorption of dietary iron

• Most commonly due to hereditary haemochromatosis, a common genetic condition affecting around 1 in every 200 people of European descent
• May also be due to high iron supplementation combined with high intake of iron-rich foods
• Multiple blood transfusions may also contribute

Inadequate excretion of iron

• Blood conditions such as thalassaemia may cause inadequate iron excretion
• Liver damage can reduce clearance of many substances from the body, including iron

Understanding the underlying causes and factors contributing to your haemochromatosis is important for establishing an appropriate treatment strategy. A detailed healthy history in combination with appropriate naturopathic testing will help to establish what is causing your haemochromatosis.

By and large, hereditary haemochromatosis is the most common cause of iron overload due to changes in iron transport and metabolism. This is a genetic condition (mutation of genes) whereby the body doesn’t produce enough of the chemical hepcidin as an example, which is responsible for regulating the amount of iron that the body can absorb. Low hepcidin levels means the body cannot identify when body iron stores have reached sufficient levels and so continues to absorb iron unimpeded. Typically, the body stores no more than 1 gram of iron, but for those with haemochromatosis, 5g or more may accumulate in the body, stored in parenchymal cells in the liver, pancreas, skin, heart, and other organs, in the form of ferritin.

There are 4 main types of hereditary haemochromatosis, which each develop symptoms at different stages in a person’s life

• Type 1 – the most common form – begins in adulthood. Symptoms typically develop between 40 and 60 in men, and just after menopause in women.  Type 1 hereditary hemochromatosis results from a genetic variation to the HFE gene on chromosome 6 and usually involves the C282Y and H63D alleles.
• Type 2 – also known as the juvenile onset form – begins in childhood and symptoms affect normal health and functioning by age 20
• Type 3 – symptoms develop by age 30
• Type 4 – similar in time of onset to type 1

Although the age of symptom onset varies, the treatment for all 4 types of haemochromatosis is the same.

Then there is what is known as Secondary hemochromatosis, and this is linked to an exposure to excess amounts of iron in the body.  This can be attributed to iron transfusions, dietary iron overload via consumption of high iron-containing food or via hemolysis-linked iron overload (destruction of red blood cells). 

Hemolysis-linked iron overload:  Whilst rare, exposure to toxic heavy metals can potentially trigger hemolysis (red blood cell death).  Heavy metal-induced hemolysis is controversial however the increase of free radicals from heavy metal exposure may play a role in disrupting red blood cell membranes.  In addition, heavy metals lead to a depletion of our body’s antioxidants or a disturbance of important enzymes.  This can cause severe oxidative stress-associated hemolysis (red blood cell death) and create hemochromatosis.

Foodborne infections and bacterial toxins can also trigger this hemolysis and be a rare cause of hemochromatosis.

In naturopathy, it is important to understand the cause of your hemochromatosis.  Whether it be primary or secondary, a focus on dietary strategies and herbs and supplements to counterbalance negative impacts on your body are important.

Why is Excess Iron an Issue?

Iron is an essential trace nutrient required for vital bodily functions, including carrying oxygen to every cell in the body via haemoglobin. However, too much of a good thing causes real problems for the body. If left to accumulate to high levels, iron becomes a toxin. Iron toxicity in cells causes oxidative stress, resulting in organ damage. Left untreated, haemochromatosis can lead to significant damage in many different organs in the body, but particularly the liver, kidneys, pancreas, and heart, where iron concentrations are the highest. It can even lead to serious illness, including infertility, cirrhosis, liver cancer, diabetes, arthritis, and organ failure. This is why regular iron studies and screening are important for those with a positive family history of the condition.

There are two types of iron in our diets – heme iron and non-heme iron. Heme iron is found in animal foods, particularly red meats (beef, lamb, kangaroo) and organ meats (such as liver), as well as in poultry (chicken, turkey, quail), pork and game meats, eggs, and dairy. Heme iron is readily absorbed by the body. Non-heme iron is the type found in plant foods. Particularly high sources of non-heme iron include legumes and dark leafy greens like spinach and kale. Non-heme iron is less readily absorbed by the body. This is because heme iron is bound up in other molecules, which the body needs to break down before being able to absorb the iron. Plant foods also contain nutrients and constituents such as oxalates and tannins, which can further impair iron absorption.

Symptoms

Haemochromatosis may be initially asymptomatic for many years. Early symptoms of haemochromatosis include:

• Fatigue
• Weight loss
• Abdominal pain
• Joint pain
• Low libido

In more advanced disease, where iron has accumulated in organs, symptoms may include:

• Jaundice, bruising and upper abdominal pain (liver damage)
• Increased thirst and frequent urination (diabetes or pre-diabetes symptoms due to pancreas damage)
• Heart palpitations, breathlessness, swollen ankles (heart damage)

Naturopathic Testing

Testing is required for establishing baseline iron levels, which can help to direct treatment strategies for management of the condition. Tests that may be ordered include:

• Iron studies including ferritin, iron level, total iron binding capacity (TIBC), and transferrin saturation
• Liver function tests including ALT and AST
• Genetic testing (if hereditary hemochromatosis is suspected but not confirmed)
• Heavy metal testing

Naturopathic Treatment Strategies

The primary goals of naturopathic treatment for haemochromatosis are fourfold:

1. Reduce the intake and absorption of iron
2. Increase the excretion of iron from the body
3. Repair damage to organs and body tissues
4. Increase antioxidant levels

Your GP may request that you have early treatment of haemochromatosis with weekly or twice-weekly phlebotomy/ venesection (similar to blood donation), until stored iron levels are normalised. Ongoing treatment generally involves phlebotomy two to four times a year to maintain safe levels in the long term. The Australian Red Cross Lifeblood has a therapeutic phlebotomy program that enables those with haemochromatosis to donate the blood taken during treatment if eligible. In addition to phlebotomy, diet and lifestyle changes following naturopathic principles will also help you to keep your iron levels in check in the long term.

Nutritional Treatment

This is a large component of the detailed treatment suggestion plan that I Provide to my clients when working with them to reduce iron overload.  Everyone’s plan is unique however it may include the following:

Increase consumption of plant-based meals or consider a vegetarian diet

As discussed above, the majority of iron for most people comes from animal products, especially red meats. One of the best ways to reduce iron overload in the body is to heavily reduce or eliminate meat intake and instead adopt a plant-based diet. This may not mean being completely vegetarian, but instead limiting your meat intake and making swaps for vegetarian protein sources whenever possible.

Avoiding iron supplements

Avoid consuming high amounts of vitamin C rich foods or drinks with meals high in iron

Reduce alcohol consumption

Alcohol increases the absorption of iron.

Reduce consumption of sugary foods

Sugar can increase the absorption of iron.

Eat Plenty of Antioxidant-Rich Fruits and Vegetables

In order to protect the liver and other organs from the oxidative stress caused by iron overload, we need to be consuming plenty of antioxidants in the diet.

Reduce the burden on your Liver

Due to the excess iron in your system that needs to be processed and excreted, the liver is very hard at work and may become burdened by additional stressors from toxins in your daily environment.  Naturopathic guidance on how to reduce this burden with dietary and lifestyle suggestions plus liver protective and nourishing herbs is always a component of the treatment suggestion plan.

Supplements and Herbs

Each person’s health situation is unique, and a tailored treatment plan would be devised for you, however some of the common herbs and supplements that may be required for you include the following:

Magnesium and Zinc

Both Magnesium and Zinc compete for absorption with Iron.

Fibre Supplement to bind to iron

Antioxidant Supplements to help boost antioxidant levels to combat tissue damage from iron overload.  

Herbal Medicines

Whilst certain herbs aren’t suitable to those with iron overload, there are many wonderful herbs that can be of help in managing haemochromatosis, such as milk thistle, globe artichoke, turmeric, or even hawthorn if the heart is affected.  Herbs to combat fatigue and other symptoms may also be prescribed should this be a symptom.

It is important to understand the cause of iron overload and keep levels reduced so please reach out for an initial naturopathic consultation via the contact tab on my website or book a complimentary fact finding call.  Alternatively, you can email me on tanya@performanceinhealth.com.au.

References

Brissot, P., Pietrangelo, A., Adams, P. C., de Graaf, B., McLaren, C. E., & Loreal, O. (2018). Haemochromatosis. Nature Reviews Disease Primers, 4.

Cooper, J. (2019, September 10). Haemochromatosis. https://advancedfunctionalmedicine.com.au/haemochromatosis/

Haemochromatosis Australia. (2022). Haemochromatosis. https://haemochromatosis.org.au/haemochromatosis/

Hechtman, L. (2012). Clinical naturopathic medicine. Elsevier Australia.

Oh, C. K., & Moon, Y. (2019). Dietary and Sentinel Factors Leading to Hemochromatosis. Nutrients, 11(5), 1047. https://doi.org/10.3390/nu11051047

The post Living with Haemochromatosis and having high iron levels appeared first on Performance in Health.

These days it’s common knowledge that the microbiome – the colonies of bacteria, viruses and fungi that live in our large intestine – are integral to our health and wellbeing and can affect not only our physical but even our mental health. Many people have heard the term “dysbiosis” and understand that an imbalance of microbes in the large intestine can have negative health consequences. However, Small Intestinal Bacterial Overgrowth (SIBO) and also colonic overgrowth remains relatively unheard of by the general population, even as research catches up to the naturopathic knowledge that it is a common issue affecting many of us. So, what is SIBO and how does it occur? In this blog post we take a look into the microbiome, how SIBO develops, and how we can combat this condition using diet, lifestyle, and natural therapeutics.

The Microbiome

The gastrointestinal microbiome is the largest population of microbes in the human body. Approximately 3.8 trillion bacteria reside in our large intestine alone. In fact, the microbiome is made up of roughly ten times as many microbes as there are cells in our entire body. It is primarily composed of different types of bacteria, but also includes some species of fungi and viruses, too. Up to 1,000 different species of bacteria may reside in your large intestine. The microbiome is involved in so many aspects of our health – immune system function, hormonal balance, neurotransmitter function (90% of the body’s serotonin is actually produced by our gut microbiome!) and more. A healthy microbiome relies on overall gastrointestinal health and a good quality diet rich in fibre and fermented foods, which provide both pre- and probiotics to maintain healthy microbial populations.  This community of live species also require a healthy gut, pH and lack of inflammation to thrive and in doing so, benefits the health of your whole body.

What is SIBO?

Small intestinal bacterial overgrowth (SIBO) (which also occurs in the colon (large intestine)in some people), is an excessive and/or abnormal bacterial growth in the small intestine. The small intestine is normally only sparsely populated by bacteria, with small numbers of species such as lactobacilli and enterococci. In some people, there won’t be any bacteria at all in the upper part of the small intestine. SIBO occurs when bacterial populations from lower down the gastrointestinal tract migrate up the gut and colonise the small intestine. These microbes feed on carbohydrates in foods and drinks, producing gases including hydrogen, methane and hydrogen sulphide as a consequence of this feeding process. The bacteria also produce endotoxins as metabolic waste products, which cause inflammation and damage to the intestinal wall, impairing nutrient absorption. Important enzymes and the small, finger-like protrusions (known as microvilli) normally found in the small intestine are lost. Damage to the intestinal lining makes the gut wall more permeable, allowing potentially harmful substances to be absorbed into the blood stream.  It also means that many people will have secondary food intolerances because ethe villi are damaged and the enzymes that live in these villi, literally have no home.  I call them secondary food intolerances, because when the gases are gone, the villi recover, the enzymes have a place to live, and food can now be breakdown down and absorbed properly.  It also means that many people can return to eating these foods again once the overgrowth is cleared.

Causes of SIBO

The body has several defence mechanisms that help to prevent the development of SIBO by creating an intestinal environment that suits beneficial bacteria, while preventing the growth of pathogenic bacteria. Gastric acid in the stomach provides a highly acidic pH, which prevents the growth of certain strains of bacteria, while promoting the growth of others. Likewise, secretions from the pancreas and gall bladder also help to control microbial populations in the small intestine and play an important role in keeping the microbiome populations healthy. The motility of the intestinal tracts also helps to keep food and fluids moving regularly through the gut, preventing stasis. This helps to prevent food sources for pathogenic bacteria being available in the gut long enough for harmful populations to grow. SIBO typically develops because the environment in the small intestine has changed and is no longer able to protect against bacterial colonisation. There are a huge range of potential causes and often there are multiple different factors at play when SIBO develops. Potential risk factors and causes of SIBO include:

Post infectious IBS 

• Food poisoning or infections for drinking water or more can damage the nerves in your gut responsible for proper motility.  Many people who have had Bali belly, food poisoning overseas/in Australia or a terrible gut infection episode often find that their gut has never been the same since.

Medication use

• Proton pump inhibitors (PPIs) are common medications prescribed for reflux, heartburn and managing gastric ulcers, which reduce the acidity in the stomach. Reducing the stomach’s acidity affects the pH in the small intestine too, lowering defences for colonisation from bacteria that thrive in a less acidic environment. Studies show up 50% of long-term PPI users may have SIBO.
• Opioid medications – these drugs delay transit time in the gut, making it easier for bacterial populations to move into the small intestine.

Chronic pancreatitis, poor liver function, non-alcoholic fatty liver disease, gall bladder removal

• Pancreatic enzymes and bile are both important for maintaining gut health. Insufficient levels of either of these secretions can lead to SIBO.

Poor gut motility

• Poor gut motility, such as with chronic constipation or hypothyroidism, means foods that can feed harmful bacteria remain available in the gut for too long. It also means harmful substances meant for excretion can sit in the gut and cause inflammation, worsening symptoms related to SIBO.  Other causes of slow motility can include endometriosis on the bowel, scarring, Inflammatory Bowel Disease and more.

Age (over 75 years)

• With increasing age, motility slows down and the body produces fewer gastric secretions, meaning reduced protection against SIBO.

Stress

• Stress causes huge problems for health and is associated with myriad other health conditions. Anxiety driven IBS can be powerful. In SIBO, it can trigger symptoms by suppressing the normal production of important secretions such as gastric acid. It also slows down motility in the gut, reduces blood flow to the gut and impairs immune function, leaving us without many of the defences that normally protect us against SIBO.

Immune dysfunction

• Conditions that affect the immune system, such as autoimmune conditions, AIDS, and even coeliac disease, can lead to a greater risk of SIBO.

Signs and Symptoms of SIBO

The symptoms of SIBO are variable and often non-specific, which can make diagnosis difficult. There are many other gastrointestinal conditions that can also present in the same way as SIBO. Signs and symptoms of SIBO may include some or all of these:

• Bloating which often gets worse throughout the day
• Reactions to certain foods
• Pain
• Flatulence
• Frequent belching
• Reflux and heartburn
• Diarrhoea
• Constipation
• Nausea
• Fatigue
• Brain fog
• Joint pain
• Signs of malabsorption and nutrient deficiencies, such as iron or vitamin B12 deficiency

Associated Health Conditions

SIBO is a condition that naturopaths have long understood to be a significant contributor to health problems such as IBS. However, it’s only been relatively recently that SIBO has become better recognised by the wider medical community and is becoming more commonly diagnosed. In the past, naturopathic understandings of SIBO as contributing to other health conditions were often dismissed, although advances in knowledge of SIBO have demonstrated that it is, in fact, much more common than previously thought, and is associated with many other health conditions, too. Other conditions that can be associated with SIBO include:

• IBS
• Rosacea
• Dyspepsia
• Coeliac disease
• Inflammatory bowel disease (Crohn’s disease and ulcerative colitis)
• Restless legs syndrome
• Small bowel diverticula
• Pancreatitis
• Hypothyroidism
• Parkinson’s disease, rheumatoid arthritis
• Type 2 Diabetes
• Coronary artery disease
• Past history of abdominal surgery, such as gastric bypass, hysterectomy, or gall bladder removal
• Fibromyalgia
• Non-alcoholic fatty liver disease, cirrhosis

SIBO and IBS

Studies show a correlation between IBS and SIBO. One of the common ways by which IBS and SIBO can be interrelated is through post-infective IBS as mentioned above – that is, IBS that is caused by a gastric illness such as food poisoning. Infection with a gastric pathogen (such as Salmonella or E. Coli) causes an immune response by the body, including the production of antibodies. This ends up causing damage to the nerves that are responsible for gut motility but also to the body’s own intestinal wall, leading to symptoms of constipation or diarrhoea and creating the ideal environment for SIBO.

Nutritional Consequences of SIBO

SIBO can have a number of detrimental effects on nutritional status. As mentioned above when the excess hydrogen and methane gases produce by bacteria destroy villi, absorption and breakdown of foods is impacted, causing digestive symptoms.

Microbes also compete for absorption of important nutrients such as protein, B12, B1 and B3, which can lead to nutrient deficiencies and symptoms of fatigue. Vitamin B12 deficiency can lead to neurological symptoms such as tingling and numbness in the hands and feet, which can progress and eventually become irreversible. The bacteria also metabolise bile salts in the intestines, which are needed for digestion and absorption of fats and the fat soluble vitamins A, D, E, and K, and contributes to symptoms of diarrhoea. Over time, the intestinal damage from SIBO affects mineral absorption, leading to low calcium levels and an increased risk of osteoporosis. It’s easy to see why addressing SIBO is so important to your overall health!

Naturopathic Testing for SIBO

Why is testing for SIBO important? For starters, naturopaths always look to treat the underlying cause of disease, rather than just treating the symptoms. Focusing on symptom management only without addressing the underlying cause would mean there is a good chance of the SIBO returning. In fact, one study found that a whopping 44% of patients experienced a return of symptoms within 9 months of standard treatment. It’s also important to use testing to exclude other conditions that might be causing your symptoms. This is especially important with conditions like SIBO, which often has only non-specific symptoms like abdominal pain and bloating. These types of non-specific symptoms could be due to any number of other conditions. The treatments required for SIBO are different to those for similar conditions such as IBS which may not have bacterial overgrowth at all. Treating the overgrowth and rebalancing the microbiome is the only way to truly alleviate symptoms in the long term and prevent recurrence.

My first focus is via a specific gold standard Breath testing that provides accurate assessment of SIBO and also large intestinal overgrowth. The carbohydrates in the drinks provided are then fermented by the microbes in the small intestine, causing the production of gases such as methane and hydrogen. It is these gases which the breath test assesses for in your exhaled breath.  We know how much gas is produced when normal bacterial amounts are in your gut so calculating an overgrowth is based on this knowledge. I have spent significant time and studies in reading the results from certain breath testing laboratories to ensure correct diagnosis.

In addition to breath testing, other tests that may be required include:

• Full blood count, including to assess for potential gastric infections from your GP
• Coeliac blood testing
• Nutrient status testing of vitamins (A, D, E, K, and B vitamins), and minerals (calcium and zinc)
• Bowel motility test which you can do easily at home

Naturopathic Treatment Options for SIBO

Standard medical treatment of SIBO generally involves antibiotic therapy.  My naturopathic treatment typically last 3 months and uses a multi-pronged approach with herbal antibacterial liquids, motility herbs, herbs for symptom relief such as bloating and pain, a low FODMAP diet to starve bacteria from their food source as we then eradicate them.  It is also very important to treat the cause of the overgrowth, or it will return.

So, lifestyle and targeted nutritional supplementation to address not only the symptoms, but also the underlying cause of SIBO is key. Treatment also focuses on healing any damaged nerves impacting gut motility, healing the gut lining and villi and improving the intestinal environment.

If the above process is done well, a low FODMAP diet which is very restrictive will only be required for 3 months.  I really want you eating FODMAP foods long term as it is very difficult to maintain long-term and it means you miss out on beautiful, healthy foods important for health.  When overgrowth is fixed and we bring the gut back into balance, you won’t produce the extra gas that causes the symptoms and damage meaning you can most likely eat the food you started to react to. 

Below are some examples of key naturopathic treatments. It’s important to speak with your naturopath before beginning any treatments, to make sure the strategies are right for you.

Low FODMAPs Diet in more detail

Utilising a low FODMAPs diet is a highly valuable treatment regime for alleviating symptoms of SIBO and helping to eradicate the pathogenic bacterial colonies in the small intestine. FODMAPs (which stands for fermentable oligo- di-, monosaccharaides and polyols) are specific types of sugars found in many foods which are readily fermented by bacteria in the gut. These foods form a staple source of energy for microbes, and thus can be a source of significant problems for those with SIBO. As the microbes consume and ferment the FODMAPs, they produce high levels of methane, hydrogen and other gases, triggering bloating and abdominal distension, reflux, heartburn, burping, flatulence, constipation, loose stools and discomfort. In fact, this is one of the key pathways by which symptoms of IBS are produced, and a reason why low FODMAPs diets are so commonly used to help with IBS. By eliminating these foods for that 3 month period (may be a little longer if overgrowth is in the large intestine also) from the diet, we are able to “starve out” the harmful bacteria and eliminate them with herbal medicine therapy whilst they are weak.

Some foods that are high in FODMAPs include:

• Garlic, onions, chickpeas, shallots, lentils, kidney beans, cashews, barley, wheat, nectarines, and watermelon are high in oligosaccharides
• Dairy products, including milk, ice cream, cream, yoghurt, and cheeses are high in the disaccharide lactose
• Honey, boysenberries, figs, pears, watermelons, mangoes, asparagus, and dried fruits, are high in the monosaccharide fructose
• Apples, apricots, blackberries, plums, cauliflower, snow peas, and artificial sweeteners are all sources of polyols

As you can see, there are a huge number of foods in the list, which makes the low FODMAPs diet incredibly restrictive. This is why it is a short-term treatment tool only – often around 12 weeks. After this time, foods can be gradually reintroduced. For more information on the FODMAPs diet, see our blog post.

Other Treatment Strategies

Other treatment strategies that might be used include:

• Lifestyle support, such as exercise, to help improve gut motility
• Identifying and removing food intolerances and allergies
• Identifying and treating underlying conditions such as IBD, coeliac disease, endometriosis, or liver dysfunction
• Reducing stress through lifestyle changes
• Dietary changes to support long term microbiome and gut health

Your individual treatment needs will vary based on your whole health picture. If you suspect a bacterial overgrowth may be the cause of your gut issues after reading this blog, please contact me for an initial consultation or fact finding call via the contact tab on the website to arrange further investigations and begin feeling better! 

Although I have a naturopath clinic in Stanmore in Sydney’s Inner West, I work with clients all over Australia via face to face and telehealth to help with this condition.

References

Achufusi, T. G. O., Sharma, A., Zamora, E. A., & Manocha, D. (2020). Small intestinal bacterial overgrowth: Comprehensive review of diagnosis, prevention, and treatment methods. Cureus, 12(6).

Adike, A., & DiBaise, J. K. (2018). Small intestinal bacterial overgrowth: Nutritional implications, diagnosis, and management. Gastroenterology Clinics, 47(1), 193–208.

Bures, J., Cyrany, J., Kohoutova, D., Forstl, M., Rejchrt, S., Kvetina, J., Vorisek, V., & Kopacova, M. (2010). Small intestinal bacterial overgrowth syndrome. World Journal of Gastroenterology, 16(24), 2978–2990.

Compare, D., Pica, L., Rocco, A., De Giorgi, F., Cuomo, R., Sarelli, G., Romano, M., & Nardone, G. (2011). Effects of long-term PPI treatment on producing bowel symptoms and SIBO. European Journal of Clinical Investigation, 41(4), 380–386.

Danau, A., Dumitrescu, L., Lefter, A., Tulba, D., & Popescu, B. O. (2021). Small intestinal bacterial overgrowth as potential therapeutic target in Parkinson’s disease. International Journal of Molecular Sciences, 22(21).

Khalighi, A. R., Khaligi, M. R., Behdani, R., Jamali, J., Khosravi, A., Kouhestani, Sh., Radmanesh, H., Esmaeelzadeh, S., & Khalighi, N. (2014). Evaluating the efficacy of probiotic on treatment in patients with small intestinal bacterial overgrowth (SIBO)—A pilot study. Indian Journal of Medical Research, 140(5), 604–608.

Lee, A. A., Baker, J. R., Wamsteker, E. J., Saad, R., & DiMagno, M. J. (2019). Small intestinal bacterial overgrowth is common in chronic pancreatitis (CP) and associates with diabetes, CP severity, low zinc levels and opiate use. American Journal of Gastroenterology, 114(7), 1163–1171.

Losurdo, G., Leandro, G., Ierardi, E., Perri, F., Barone, M., Principi, M., & Di Leo, A. (2020). Breath tests for the non-invasive diagnosis of small intestinal bacterial overgrowth: A systematic review with meta-analysis. Journal of Neurogastroenterology and Motility, 26(1).

Rao, S. S., & Bhagatwala, J. (2019). Small intestinal bacterial overgrowth: Clinical features and therapeutic management. Clinical and Translational Gastroenterology, 10(10).

Sachdeva, S., Rawat, A. K., Reddy, R. S., & Puri, A. S. (2011). Small intestinal bacterial overgrowth (SIBO) in irritable bowel syndrome: Frequency and predictors. Journal of Gastroenterology and Hepatology, 26(s3), 135–138.

Shah, A., Morrison, M., Burger, D., Martin, N., Rich, J., Jones, M., Koloski, N., Walker, M. M., Talley, N. J., & Holtmann, G. J. (2019). Systematic review with meta-analysis: The prevalence of small intestinal bacterial overgrowth in inflammatory bowel disease. Alimentary Pharmacology and Therapeutics, 49(6), 624–635.

Su, T., Lai, S., Lee, A., He, X., & Chen, S. (2018). Meta-analysis: Proton pump inhibitors moderately increase the risk of small intestinal bacterial overgrowth. Journal of Gastroenterology, 53, 27–36.

Tziatzios, G., Gkolfakis, P., Papanikolaou, I. S., Mathur, R., Pimentel, M., Damoraki, G., Giamarellos-Bourboulis, E. J., Dimitriadis, G., & Triantafyllou, K. (2021). High prevalence of small intestinal bacterial overgrowth among functional dyspepsia patients. Digestive Diseases, 39, 382–390.

Wijarnpreecha, K., Lou, S., Watthanasuntorn, K., Kroner, P. T., Cheungpasitporn, W., Lukens, F., Pungapong, S., Keaveny, A. P., & Ungprasert, P. (2020). Small intestinal bacterial overgrowth and non-alcoholic fatty liver disease: A systematic review and meta-analysis. European Journal of Gastroenterology & Hepatology, 32(5).

The post Are your Digestive issues caused by Intestinal Bacterial Overgrowth – SIBO? appeared first on Performance in Health.

FAs a naturopath practicing in Sydney, I often see patients struggling with functional liver congestion. It’s an issue that is driven by our modern lifestyle, which sees us exposed to an incredible number of toxins in the foods we eat, the products we use, and even the air we breathe. Detoxification is one of the liver’s primary roles, and yet the toxic burden we are exposed to in our day-to-day lives means that for many of us, additional support for the liver may be necessary for optimal health. Thanks to the commercial onslaught of “detox” diets, pills, powders, and teas, the topic of liver health is often fraught with controversy, and it can be difficult to discern what is truly beneficial and what is simply marketing. This blog provides you with education on functional liver congestion – what it is, what are the symptoms, and how it can be managed naturopathically for short-term symptom relief and long-term health.

The Liver

The liver is one of the largest organs in the body and is involved in a range of vital functions, including:

• Detoxifying harmful substances in the body
• Storing and processing nutrients, including carbohydrates, proteins, vitamins and minerals
• Regulating hormone levels
• Producing bile for fat digestion
• Regulating fat and cholesterol levels
• Helps with controlling blood sugar levels

How a Naturopathic Liver Detox Works

Detoxification is a bit of a buzzword these days, but what exactly is it? Detoxification is a normal process that our bodies go through every day to process and remove the waste products and toxins that accumulate in our cells as a result of normal metabolism and exposure to things like air pollutants. Proper detoxification is essential for good health, particularly when we are exposed to so many different types of toxins in our day-to-day lives. Over time, prolonged burdening of the liver with toxins requiring metabolising and elimination can lead to tissue damage and even the onset of further health issues. When the liver is over-burdened with the task of detoxification, it is unable to efficiently perform its other tasks. This is why functional liver congestion can lead to issues with other aspects of liver health, like hormone imbalances.

What are Toxins?

Toxins are chemicals that have a negative impact on our health in one way or another. In modern society we are exposed to a huge range of toxins through the foods we eat, the products we use and even the air we breathe. Examples of ways in which we are exposed to toxins include:

• Pesticides on unwashed fruit and vegetables
• Chemicals in household cleaning products, garden herbicides and household pesticides
• Microplastics in drinking water and foods
• Particles from plastic food containers, including hormone-disrupting chemicals such as BPA
• Pollutants in the air, including heavy metals, car emissions, mould spores, and fine particles
• Heavy metals
• Phthalates, parabens, fragrances, and hormone-disrupting chemicals such as triclosan, found in personal hygiene and beauty products

The 5 Channels of Elimination

Once toxins have been metabolised or neutralised by the liver, they need to be removed from the body. There are 5 different routes through which waste products and toxins are moved out of the body, known as the 5 channels of elimination.

• The lymphatic system removes waste products from individual cells and moves it towards other channels for elimination from the body
• The bowels eliminate waste products in faeces
• The lungs eliminate waste products in the air we exhale
• The kidneys eliminate waste products in urine
• The skin eliminates waste products in sweat

When supporting liver health, it is just as important to be sure we are optimising the health of our elimination channels, to ensure proper removal of waste products. If waste products and toxins aren’t being eliminated from the body efficiently, they can end up back in circulation, creating a perpetuating cycle of liver congestion. The treatment strategies below include ways of supporting these channels of elimination in addition to the liver, for a holistic approach to returning to health.

Signs your Liver is Congested

Signs that your liver may be congested or not functioning optimally include:

• Feeling generally unwell
• Feeling tired in the morning and worse after eating
• Poor concentration or memory problems
• Lack of hunger in the morning or feeling unable to eat breakfast
• Nausea
• Being unable to tolerate fatty foods or alcohol
• Bloating, chronic constipation
• Weight loss, or difficulty losing weight
• Cholesterol issues
• Mood swings, anxiety, irritability
• Itchy skin and skin rashes
• Dry or oily skin
• Yellow skin or eyes
• Muscle pain and weakness
• Headaches or migraines
• Sensitivity to chemicals, smells
• Hormonal issues

How to Detox your Liver as recommended by a Sydney Naturopath

To return to good liver health, we need to follow three key steps:

1. Reduce the toxic load
2. Repair the gut
3. Support the detoxification process
   
   1. Reduce the Toxic Load

Reducing the toxic load of the liver means identifying and removing factors from both the diet and lifestyle that place strain on the liver. This includes not only “toxins” but also certain foods and drinks that make the liver work harder. Factors that increase the liver’s workload (and may need to be eliminated) include:

Foods and Drinks

• Fatty foods and “junk” foods
• Alcohol
• Caffeine
• Pesticides and herbicides on commercially grown foods
• Unfiltered drinking water
• BPA and other hormone-disrupting chemicals in plastic food storage containers
• Food additives and preservatives

Drugs and Toxins

• Pharmaceutical drugs
• Heavy metals
• Inhaled toxins such as cigarette smoke and vaping
• Topical applicants
• Environmental pollutants
• Chemical cleaning products

Other

• Stress
• Sudden weight loss
• Nutrient insufficiencies
• Inflammation, infection

2. Repair the Gut

The gut is one of our primary channels of elimination. Poor gut health can negatively impact liver health by increasing reabsorption of toxins and increasing the liver’s workload. In turn, a liver that is overwhelmed won’t produce sufficient bile for optimal metabolism and won’t be able to adequately process the nutrients that we eat, leading to a vicious cycle.

3. Support the Detoxification Process

As discussed above, the detoxification process includes the work of the liver, as well as the proper functioning of the 5 channels of elimination. There are many things that can be done to help support this process with diet and lifestyle changes. Depending on your health needs, supplements and herbs may also be used to help support the detoxification process.

Dietary Changes

Reduce Caffeine intake

Caffeine should be eliminated if you have decided on a gentle detoxification or significantly reduced from the diet because of the extra work it makes for the liver. Caffeine is found in coffee, tea, chocolate, and energy drinks.

Eliminate Alcohol

As with caffeine, alcohol places additional strain on the liver and should be eliminated from the diet, at least in the short term. Once the liver has improved, you may wish to include alcohol sparingly – one or two glasses of red wine per week.

Eliminate Deep-fried and “junk” foods

These foods place added stress on the liver and should be eliminated from the diet. This includes “fast” food, burgers, hot chips, deep fried foods, cakes, pastries, and highly processed snack foods such as candy bars and potato chips.

Avoid artificial colours and flavours, including MSG

Artificial colours and flavours also increase the liver’s workload. Check the labels of foods you are purchasing – if there are many ingredients that you are unfamiliar with, or the ingredients list includes many different food numbers, it is probably a food to avoid. Both natural and artificial food additives are often listed by their “food number”. Some of the worst offenders to avoid are:

• Colours: 102, 104, 110, 122, 123, 124, 127, 129, 132, 133, 142, 143, 151, 155
• Preservatives: 200- 203, 210-213, 220-228, 249-252
• Preservatives: 280-283, 310-312, 319-321
• Flavour enhancers: 620-627, 631, 635

Eat Plenty of Fibre-Rich Foods

Fibre-rich foods provide plenty of bulk for our stools and help our bowels to function well. These foods are typically also rich in vitamins, minerals and antioxidants that can assist with liver health, too. Fibre-rich foods include vegetables, fruits, and pulses such as lentils and beans. Choose a variety of fibre-rich foods of varying colours each day to maximise the types of micronutrients you are consuming. For vegetables with edible skins, eating with the skin on can further increase insoluble fibre intake – but be sure to choose organic varieties and scrub the skins well before eating. Aim for 5 or more serves of vegetables or pulses each day, and 2 serves of fruit.

• Red fruits and vegetables – contain compounds such as lycopene and anthocyanins
  – Tomatoes, capsicum, strawberries, cherries, beetroot, radish, chillies, radicchio, rhubarb, raspberries, cranberries
• Orange fruits and vegetables contain compounds such as beta-carotene
  – Oranges, capsicum, pumpkin, apricots, carrots, papaya, persimmons, mangoes, sweet potatoes
• Yellow and light green fruits and vegetables contain compounds such as carotenoids
  – Capsicum, kiwi fruit, corn, pineapple, lemons, cabbage, celery, limes, pears, avocado, fennel, onion
• Dark green fruits and vegetables contain compounds such as lutein and zeaxanthin
  – Broccoli, Brussels sprouts, kale, Bok choy, spinach, silver beet, asparagus, green beans, peas, leeks, artichokes
• Purple fruits and vegetables contain compounds such as anthocyanins and phenols
  – Cabbage, grapes, eggplant, onions, plums, blueberries, blackberries

Drink at least 2 litres of (filtered) water each day

Water is absolutely vital for ensuring your body can remove toxins and drinking tap water is not ideal. In NSW, household tap water can contain small amounts of heavy metals like lead and copper, and both bottled and tap water contain microplastics. Although these are only present in very small amounts, using measures to avoid consuming them in the first place reduces the burden on the liver. Using an at-home water filter is an inexpensive way to make sure the water you’re drinking is free from nasties, and as an added bonus, your water will taste better, too! There are a wide variety of water filters available these days, but you don’t need to choose an expensive one for it to be effective. Both bench-top and tap-fitted water filters are readily available from Bunnings.

Thoroughly scrub and wash Fruits and Vegetables before Consumption

To avoid pesticides and other harmful chemicals on your fruits and vegetables, it is best to choose organic produce when possible. However, regardless of whether you have organic or not, it is important to thoroughly scrub and rinse your fruits and vegetables before consumption to remove surface toxins and reduce the liver’s workload.

To clean fruits and vegetables thoroughly, soak hard-skinned products for 10-15 minutes before scrubbing. Fill the kitchen sink with warm water and add 1/3 cup apple cider vinegar. Alternatively, Dr Bronner’s soap can be diluted and used as a fruit and vegetable wash.

Don’t Store or Heat Food in Plastic

Plastic is made of a litany of chemicals, some of which are known to disrupt hormone balance, such as BPA. Plastic food storage containers and cling-wrap can leak these harmful chemicals into your food, especially if you are heating your food in the container or are placing your food into the container when it is still hot. Whilst many plastic food containers advertise as being BPA-free, the majority of them still contain other hormone-disrupting chemicals aside from BPA. Choose glass or ceramic containers to store food in and always reheat foods on the stove. If you don’t want to purchase a whole new set of expensive glass food containers, recycled jars from other foods are a great option! Pasta, pickles, coconut oil, and the like all come in sturdy glass jars that can be readily washed and reused to store food in again and again.

Other tips for safe food preparation:

• Swap plastic cooking utensils with wooden, stainless steel, or silicone types
• Use beeswax wraps as an alternative to cling-wrap
• Choose fresh or frozen fruits and vegetables and dried legumes over canned goods where possible.
• Use a glass or ceramic reusable coffee cup instead of takeaway cups
• Avoid non-stick cooking pans – swap for cast-iron, stainless steel, or ceramic cookware. Always immediately discard Teflon or non-stick cookware that shows any signs of damage

Lifestyle

Exercise Daily

When we are being physically active, our lymphatic system is able to work 2-3 times more efficiently compared to when we are at rest. Physical activity is also important for healthy bowel movements. One of the easiest gentle physical activities is of course walking, and there are plenty of ways to increase your daily activity by walking more. Try parking your car a little further away from work and walking the rest of the way or meet up with friends for walking dates on the weekend.   Hiking in nature is my most favourite recommendation to people!

In addition to walking, it’s important to get some more vigorous exercise in as well. This could include team sports, running, cycling, or even aerobics or dancing classes. Not only will these activities promote healthy lung function, but they also improve detoxification by increasing the amount you sweat.

Use the Sauna

Another method for getting sweaty is by visiting the sauna. Both traditional and infra-red saunas are becoming more common in Australia. Studies show that saunas can be a great tool for helping your body to eliminate heavy metals. However, if you have issues with fainting or dizzy spells, the sauna may not be for you. Check with your GP before using a sauna if you have any health concerns.

Practice Dry Brushing Once a Week

Dry skin brushing is a traditional technique for improving circulation and lymphatic flow in the body, and is also an effective, gentle exfoliator, so it can help with the skin and lymphatic channels. Make it a habit to dry brush before your shower once a week.

How to dry brush: Using a soft-bristle body brush, start at the ankles and gently brush the skin in long strokes, working your way up the body and all four limbs. Make sure your brush strokes are all going in the same direction (towards your heart), as this will maximise the circulation benefits. Good quality body brushes are available at many health-food stores, as well as at online stores like biome.com.au

Use Low-Tox Personal Hygiene Products

Personal hygiene products, such as soaps, deodorant, lotions, make-up, and even haircare products, can be a significant source of toxins. These products can contain a litany of harmful chemicals, many of them poorly regulated and prone to contamination with even more harmful substances. Some of the worst offenders that can be found frequently in personal hygiene products include:

• Triclosan: an antibacterial agent that is known to cause liver damage and disrupt hormonal balance. Triclosan is commonly found in deodorants, hand sanitisers, and cleansers. In addition to its ill effects on health, triclosan may also contribute to the development of antibiotic-resistant bacteria.
• Parabens: a widely used preservative in cosmetics that can cause skin allergies, disrupt hormones by mimicking oestrogen, and may even increase the risk of cancer. They are very readily absorbed by the skin.
• BHA and BHT: synthetic antioxidants used as preservatives in many different personal hygiene products. BHA and BHT can cause contact allergic reactions and are classed as a possible carcinogen. They are also linked to organ toxicity and are banned in Europe.
• Phthalates: a class of preservatives found in many different personal hygiene products that can cause hormonal imbalance and impact fertility.
• Sodium laureth sulfate (SLS): a lathering agent (makes soap bubbles) frequently found in body washes and household cleaners such as dish soap. SLS can cause skin irritation and may be contaminated with ethylene oxide, a known carcinogen and neurotoxin.
• Fragrance: sometimes also listed as “parfum” or “perfume”, this is an umbrella term for thousands of different chemicals that are often unsafe and untested – because fragrance recipes are considered to be “trade secrets”, the ingredients aren’t required to be listed on the products. These chemicals may cause hormonal disruptions and allergic symptoms
• Propylene glycol: along with other PEGs (polyethylene glycols) is a hydrating substance that can cause dermatitis and kidney and liver damage. PEGs are frequently used in cosmetics as a cream base for products.
• Coal tar dye: a colouring agent found in shampoos and hair dyes that is a known carcinogen and can be contaminated with heavy metals.
• Formaldehyde: a preservative that is a neurotoxin and known carcinogen.
• Mineral oil: aka petroleum jelly or petrolatum – a “skin smoothing” and moisture-barrier agent that can impair the skin’s ability to eliminate toxins. It can also be contaminated with polycyclic aromatic hydrocarbons, which are associated with cancer.
• Talc: found in baby powder and on condoms, it is linked to ovarian cancer
• Siloxanes: silicone-based products that are used as smoothing agents, particularly in haircare products. They can disrupt hormones, reduce fertility, and are linked to uterine tumours and neurotoxicity.
• Aluminium: used as an antiperspirant agent in deodorants, it is linked to Alzheimer’s disease
  – As a side note – one of our skin’s main functions is to release toxins and regulate our body temperature through (you guessed it) sweating. We need to consider whether using anti-perspirants is working with our body’s natural processes or is causing more harm than good. Natural, aluminium-free deodorants are readily available these days and are a much safer alternative which is why I offer non-toxic yet effective deodorants in clinic.
• DEA, MEA and TEA: chemicals that are used to make products such as sunscreen, lotions, or soaps creamy or sudsy. Can cause eye and skin irritation, and laboratory research has shown high dose exposure can cause cancers in the liver, skin, and thyroid.

Remember that the skin is like a giant mouth, capable of absorbing whatever you put on it. As a good rule of thumb, don’t apply anything to your skin that you wouldn’t also eat. Avoid the ingredients listed above in all personal hygiene products by reading the labels of products carefully and choosing products with shorter lists of ingredients that you can easily identify (avoid long, complicated scientific names!). A good, basic castile soap can be used as a general-purpose cleaner for face, body, and hair, and can also be used in place of household cleaners such as dish soap, and floor wash. Both scented and unscented varieties are available, with the scented versions using natural essential oils instead of synthetic fragrances.

For sunscreens, choose zinc oxide-based and other physical sun blockers, which aren’t absorbed into the skin and generally contain fewer toxic chemicals. Be sure to still read the labels of sunscreen products. Reduce the amount of sunscreen you need to use by following other sun safe measures, such as wearing long sleeves, a hat, sunglasses, and staying in the shade during the middle of the day.

For insect repellents, use citronella-based products. Both sprays and patches are available and are effective at keeping bugs away.

Perfume, make up and beauty products can be full of toxic ingredients.  The small range I have in my clinic ensure that clients have options that are quality and non-toxic.  A range of low-tox products can also found in health food stores, as well as online at sites such as www.biome.com.au and www.floraandfauna.com.au. You can also find more information about safer beauty products and harmful chemicals to avoid at www.safecosmeticsaustralia.com.au

Use Low-Tox Household Cleaners

As with personal hygiene products, household cleaners contain many harmful chemicals, and ingredients are not required to be listed on these products so it can be difficult to know what you are being exposed to. Reduce your exposure to unnecessary toxins by choosing low-tox household cleaners (available at the websites listed above) or make your own. A solution of 50/50 white vinegar and filtered water makes a fabulous general-purpose cleaner – simply fill a spray bottle with the solution, add a few drops of essential oils if you choose to, and you’re good to go.

In place of synthetic home fragrance sprays and candles, use essential oils in a diffuser to gently scent the home. Be sure to choose 100% pure essential oils from a reputable company, to avoid synthetic or contaminated products. If you prefer candles, stick to good quality soy or beeswax products.

Consider your Exposure to Other Household Chemicals

Other sources of potentially liver-damaging toxins include:

• New carpet or furniture
• Fresh paint
• New cars
• Chipboard and other treated timber
• Building materials such as glues, plastics, resin

Consider your exposure to these chemicals and strategies ways to reduce or eliminate your exposure where possible, even if it is as simple as keeping windows open in the home to maximise air flow to air out new furniture or paint or using personal protective equipment when completing home renovations or craft projects. Remove your shoes before entering the home to prevent walking toxins into the home.

Consider your occupational chemical exposure

Do you work in an industry that involves exposure to potentially toxic chemicals? If this is a concern for you, speak with your work’s WHS officer for support in ensuring appropriate precautions are being taken to protect your health.

Herbs and Supplements

There are many wonderful herbs and supplements that can help to support the liver and bring it back to health. However, if your liver is congested and not working well, it is likely that as a naturopath I will start very slowly and gently with these products or may start with diet and lifestyle measures only at first. This is because if the liver is not working well, adding more things to the body for the liver to process may do more harm than good. We want to remove very gently some of the burden on the liver first, before introducing new factors. Remember that these products are not going to do the detoxification work for the liver and aren’t replacing the liver’s function. Instead, their purpose is to support the liver to heal and return to its own optimal function.

Once your body is ready for herbal and supplemental treatment, your treatment regime may include:

• Liver herbs, such as milk thistle, globe artichoke, or turmeric
• Cholagogues and choleretics, including dandelion root and globe artichoke
• Depurative herbs, such as burdock, blue flag, and heartsease
• Tonics and adaptogens, such as withania, rehmannia, Schisandra or bacopa
• Antioxidants, such as vitamin C, quercetin, curcumin, and n-acetylcysteine (NAC)

Gain support from a Liver Health Naturopath in Sydney or Leura

Your liver is one of the most important organs in your body and it must be working optimally for your entire body to work optimally – look after it. I provide liver health consultations for residents in Sydney’s Inner West (Stanmore) and the Blue Mountains. Book a consultation today for naturopathic advice and support for your liver.

The post Liver Health & Detox: Holistic Support from a Sydney Naturopath appeared first on Performance in Health.

What is the Gallbladder?

The gallbladder is a small, pear-shaped organ that lies attached to the underside of the liver. The gallbladder’s primary function is to store and concentrate bile, a fluid produced by the liver, and to release bile into the small intestine during digestion. Because of their shared role in the production and secretion of bile, the function and health of the gallbladder is closely linked to that of the liver, and many of the common health issues of the gallbladder are related to (or worsened by) poor liver function and particularly altered bile secretion.

What is Bile and How is it Made?

Bile is one of our “digestive juices”, a fluid substance that is secreted by the body to facilitate digestion and absorption of vital nutrients. Bile is the primary digestive juice used for digesting and absorbing fats and the fat-soluble vitamins A, E, D, and K. It is typically a dark green to yellow colour and has a thick, sticky texture. It is made up of a mixture of water and various dissolved solids, including bile salts, cholesterol, enzymes, and even waste products ready to be excreted, such as bilirubin (a by-product of red blood cell metabolism). Bile salts are one of the key components of bile. They are produced by the liver from cholesterol via a process known as oxidation.

The human body produces around 1 litre of bile per day. Around 90% of bile is transferred to the gallbladder for storage and concentration, while the remaining 10% is deposited directly into the small intestine from the liver. Just before we start a meal, our bodies enter the cephalic phase of digestion, which is where our bodies become primed for digestion – the onset of salivating is an indicator that your body has entered this phase. It is during this phase that neural pathways signal to the pancreas to produce a hormone called cholecystokinin. This hormone stimulates the gallbladder to start contracting, releasing bile into the small intestine. Bile salts are very efficiently reabsorbed by our intestinal cells and are then transported back to the liver for reuse. About 95% of bile salts are reabsorbed, with the remainder being excreted through the bowels. This recycling of bile salts occurs 6 to 8 times a day, every day, and is known as enterohepatic recycling.

Bile, and particularly the bile salts, are vital for the absorption of fat and fat-soluble vitamins. They emulsify fats so that they can be absorbed, acting like a kind of detergent to break larger fat molecules into smaller droplets. These droplets can then be broken down by enzymes in the intestine, and ultimately absorbed through the gut wall. We know that fats are vital to good health, being used for everything from cell walls to hormones, so it is no wonder that having liver and gallbladder issues can so greatly impact how we feel.

In addition to helping with fat digestion and absorption, bile has other important functions for the body, including:

• Elimination of metabolic waste products and toxins, including bilirubin, heavy metals (lead, mercury and arsenic), drugs and medications, hormones, and chemicals
• Helps to neutralise excess stomach acid in the small intestine, preventing symptoms like heartburn and damage to the intestinal wall
• Helps to kill certain harmful bacteria in the gut, while promoting the growth of beneficial bacteria

Bile and the Gut Microbiota

You may be surprised to learn that bile and the gut microbiota are closely linked, and have a relationship that influences digestion, liver function, and even our immune system. Bile acids act like a modulator of gut bacteria, helping to keep the balance of good bacteria over bad. Special enzymes in certain good gut bacteria can metabolise bile acids. Healthy bile flow promotes higher levels of these bile-metabolising bacteria because they use bile acids as a food source with bile acids also inhibiting the growth of other, harmful types of bacteria. The emulsifying, detergent-like activity of bile acids damages the cell walls of certain bacteria species, keeping population sizes of these harmful bacteria in check.

Health Conditions of the Gallbladder

Gallbladder conditions are increasingly common and can often be related to our modern Western diet and lifestyle.

Gallstones

Gallstones (AKA cholelithiasis), are a very common health issue, affecting up to 30% of Australians over the age of 50. The “stones” in gallstones are formed when bile sits stagnant in the gallbladder, allowing for crystallisation of bile salts. People with high cholesterol are particularly susceptible to gallstones. This is because 90% of gallstones are made of cholesterol. If the liver excretes too much cholesterol into bile it becomes supersaturated, making it much more likely for crystals to form. These crystals bind together to form larger stones which can become lodged in the gallbladder.

Obesity, even when otherwise metabolically healthy, increases the risk of gallstones. Other risk factors for developing gallstones include:

• Being aged over 40
• Being female
• Being overweight, or experiencing a rapid shift in weight (either gaining or losing)
• Having insulin resistance, type 2 diabetes, or metabolic syndrome – insulin increases the production of cholesterol in the liver
• Eating a diet high in calories and high in carbohydrates
• Eating a low fibre diet
• Having liver disease

Gallstones are asymptomatic in the majority of cases, but some people will experience symptoms such as intermittent bloating, pressure, or pain in the upper right abdominal area, particularly after eating fatty foods. This intermittent pain can indicate that a stone may be lodged in the neck of the gallbladder.

Cholecystitis – gallbladder inflammation

If the ducts of the gallbladder become blocked due to gallstones, inflammation (known as cholecystitis) can occur. This inflammation can be acute or chronic, and typically includes symptoms such as abdominal pain, nausea, and fever. When symptoms are sudden and severe, it is considered acute cholecystitis. This almost always indicates that the person has gallstones. Chronic cholecystitis, on the other hand, lasts for much longer and is less severe, but may have periods of acute inflammation and pain (known as biliary colic).

Biliary Insufficiency and Poor Liver Health

Whilst not directly related to the gallbladder, insufficient bile production by the liver can produce similar health issues. Signs that you may not be producing enough bile include:

• Pale stools
• Flatulence and diarrhoea
• Floating, foul smelling stools
• Heartburn (due to lack of alkalising effect of bile salts on stomach acid)
• Symptoms are worse after fatty meals

Bile is an important means of eliminating harmful toxins from the body, so insufficient production can lead to issues with many other health conditions, including menstrual condition like PMS and endometriosis that can be affected by hormone levels.

Testing

If gallstones or inflammation are expected, you may be referred for an ultrasound, as well as liver function tests. Naturopaths often refer you for additional testing, including cholesterol, insulin, and a hormone profile, too. These additional tests can help to uncover what is happening with your health and can unlock information about underlying drivers of your condition, so that an effective treatment strategy can be made for you.

Supporting a Healthy Gallbladder

Treatment of gallbladder issues is always a long-term strategy – there are no quick fixes when it comes to gallbladder health! Likewise, prevention of gallbladder conditions also requires long term healthy lifestyle strategies. Naturopathically, treatment strategies for gallbladder conditions almost always include support for the liver, and it’s easy to see why – the two organs are so closely linked both physically and functionally, so when one isn’t working well, the other also suffers.

Medical treatment of gallbladder issues is often focused on removal of the gallbladder once pain becomes unmanageable. The treatment strategies in this section are instead focused on improving your liver and gallbladder function before reaching this point in your condition. But if you have already had your gallbladder removed, read on – there is a section with tips for optimising health post-gallbladder removal below.

Diet and Lifestyle Strategies

Eat Plenty of Fibre-Rich Foods

Fibre-rich foods are so vital for good health for so many reasons, including for gallbladder health. Insoluble fibre, found in foods such as oats and wheat bran, have been found to reduce the level of cholesterol found in bile, which in turn helps to reduce the formation of cholesterol crystals and stones.

Reduce Saturated and Trans-Fat Intake

Saturated and trans fats have been shown to increase the risk of developing gallstones, so saturated fats should be reduced and trans fats eliminated altogether from the diet.

• Choose lean cuts of meat to reduce your intake of saturated fat
• Eliminate foods that contain trans fatty acids, such as margarine, deep fried foods, commercially baked products like cakes and pastries, and frozen potato products such as chips and potato “gems”

Reduce Intake of Refined Sugar

High intake of refined sugars and carbohydrates increases insulin levels, which prompts the liver to produce extra cholesterol. Excess refined sugar intake has been shown to significantly increase the risk of developing symptomatic gallstones, so should be eliminated from the diet.

When eliminating refined sugar from the diet, be aware that sugar goes by many names! Here are just some of the names you might find on the ingredients list of packaged foods and drinks: sugar, table sugar, white sugar, granulated sugar, brown sugar, raw sugar, syrup, molasses, agave syrup, honey, barley malt, malt syrup. And there are so many more! Always read food labels and choose options that don’t have added sugars and sweeteners.

Don’t Skip Meals

Eat regular, healthy meals and avoid skipping main meals. Fasting can increase the risk of gallstones, as bile sits stagnant in the gallbladder for too long. Aim for 3 main meals and one or two small snacks each day.

Eat Mindfully

As we discussed above, bile release is triggered when we enter the cephalic phase of digestion. You can help to make sure you are in this digestive phase by:

• Sitting at the table to eat (rather than eating on the couch or while driving)
• Using a knife and fork and taking your time to eat and experience your meal
• Avoiding distractions during mealtimes, particularly TV and phones

Maintain a Healthy Weight (or Lose Weight Slowly!)

Gaining weight and being obese are associated with an increased risk of gallstones because of higher levels of cholesterol. Similarly, losing weight very quickly increases circulating cholesterol levels because of the cholesterol being released from fat stores. At the same time, bile may sit stagnant in the gallbladder due to reduce food intake, which allows for crystals and eventually stones, to form. If you wish to lose weight, be sure to seek naturopathic guidance before embarking on a weight-loss plan, as they can help you to develop a gallbladder-friendly plan that will help you to lose weight slowly and steadily – which will also help you to keep the weight off long-term.

Gallbladder Removal –Life After Cholecystectomy

Gallbladder removal is a common treatment for gallstones, but it fundamentally changes your body’s digestive functioning and requires careful dietary management for the long term. Because the gallbladder acts as the storage chamber for bile, its removal means there is no longer a place to store bile as the liver is producing it, so a lesser amount is available at mealtimes. This means less bile overall is available for fat digestion, and a greater reliance on the bile that is injected directly into the intestine from the liver itself. This means your body will not be able to digest and absorb fats the same way it used to. Whilst this doesn’t mean you can no longer eat fats at all, it does mean making some changes to what you eat and how. Post-gallbladder removal, it is also important to support the liver, as the lack of gallbladder places additional burden on the liver to maintain health. Below are some tips for maintaining good health after cholecystectomy.

Be mindful of fat consumption

• Avoid high-fat meals, as your body will no longer be able to supply sufficient bile for proper digestion of high amounts of fat – that means no keto diet! A lower fat diet is a much better choice for optimal digestion. Aim for no more than 30% of your calories to come from fats. High fat foods will cause abdominal discomfort and digestive issues.
• When you do eat fats, focus on heart-healthy polyunsaturated and monounsaturated fats from sources such as extra virgin olive oil, hemp seed oil, nuts and seeds, oily fish, and avocados. We still need good quality sources of fatty foods in our diet for healthy cells, brain health, and for fat-soluble vitamins A, D, E, and K.
• Eat fats in small amounts throughout the day, instead of eating them all at once. This reduces how much bile is needed for proper digestion.
• Avoid saturated fatty acids, trans fats, and hydrogenated oils such as soybean and canola oil, which can be detrimental to liver health.

Eat plenty of fresh fruits and vegetables

• Aim for 5 or more serves of vegetables and 2 serves of fruits per day, choosing a variety of colours each day to maximise your nutrient intake.
• Fruits and vegetables provide an abundance of vitamins and minerals, as well as antioxidants which are crucial for optimal liver health.
• These foods also provide plenty of fibre to feed healthy gut microbiota. As discussed above, bile is important in maintaining a healthy microbiome, so providing additional support for healthy gut bacteria is important once your gallbladder has been removed.

Utilise bitters before meals

• Bitter foods and drinks encourage the liver to produce and secrete bile into the small intestine, ready to digest our food. Having bitters around 10-15 minutes before sitting down to eat can help ensure our digestive system is primed and ready for optimal digestion and absorption.

Try a small salad of dandelion greens or rocket as an appetiser or mix the juice of a lemon in 250ml of lukewarm water. Alternatively, herbal bitter remedies can be prescribed for a more potent effect.

Herbs and Supplements for Gallbladder Health

Herbs – Cholagogues

Cholagogues can be used to support healthy gallbladder function and prevent health issues, as well as to treat gallbladder conditions. However, they can be contraindicated, especially if there is a history of bile duct obstruction – always seek naturopathic guidance for a herbal prescription. Cholagogues include herbs such as globe artichoke and agrimony.

Herbs – Bitters

Bitters are a wonderful class of herbs that can be used to help with so many health issues. As the name suggests, these herbs contain lots of bitter principles and have a very strong bitter taste. It is the bitter taste of the herbs that gives them their therapeutic effect. Our bodies have bitter taste receptors not only on the tongue, but throughout the digestive system, increasing saliva, enzyme, and bile production. Bitter herbs activate these receptors and improve digestive function, and even shift the body into the parasympathetic nervous system to reduce issues associated with stress and anxiety. Gentian, wormwood, and globe artichoke are all well-known bitter herbs.

Herbs- Choleretics

Choleretics are herbs that stimulate the production of bile in the liver and promote its secretion into the gallbladder. They’re very commonly used for any conditions associated with the liver or gallbladder. Some commonly known choleretic herbs include milk thistle, calendula, and globe artichoke.

Lipase

Lipase is a type of enzyme that helps to break down fats, making them easier to absorb. Supplementing with additional lipase helps to ease the burden of reduced bile on the gastrointestinal tract after gallbladder removal, or when your gallbladder or liver health is impacting bile production and secretion.

Probiotics & Prebiotics

As discussed above, bile is important for a healthy microbiome. When insufficient bile is being produced, either due to gallbladder issues or removal, a good quality probiotic supplement can help support healthy microbial populations in the gut however prebiotics are more appropriate for many people as they are a food source for your own species.  However, it is important to note that many over the counter probiotics available are poor quality and may not provide you with beneficial amounts of probiotics so it is best to seek naturopathic guidance on choosing a probiotic that will be of benefit to you.

References

Boyer, J. L. (2013). Bile formation and secretion. Comprehensive Physiology, 3.

Crawford, M. (2013). Biliary pain work-up and management in general practice. Australian Family Physician, 42(7). https://www.racgp.org.au/afp/2013/july/biliary-pain

Hechtman, L. (2012). Clinical naturopathic medicine. Elsevier Australia.

Housset, C., Chretien, Y., Debray, D., & Chignard, N. (2016). Functions of the Gallbladder. Comprehensive Physiology, 6.

Lammert, F., Gurusamy, K., Ko, C. W., Miquel, J.-F., Mendez-Sanchez, N., Portincasa, P., van Erpecum, K. J., Laarhoven, C. J., & Wang, D. Q. H. (2016). Gallstones. Nature Reviews Disease Primers, 2.

Maldonado-Valderrama, J., Wilde, P., Macierzanka, A., & Mackie, A. (2011). The role of bile salts in digestion. Advances in Colloid and Interface Science, 165(1), 36–46.

Man, S., Gao, Y., Lv, J., Tong, M., Yin, J., Wang, B., Ning, Y., & Li, L. (2022). Metabolically healthy obesity was significantly associated with increased risk of gallstones. European Journal of Endocrinology, 186(2), 275–283.

Tian, Y., Gui, W., Koo, I., Smith, P. B., Allman, E. L., Nichols, R. G., Liu, Q., & Patterson, A. D. (2020). The microbiome modulating activity of bile acids. Gut Microbes, 11(4)

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So, what exactly is histamine?

Histamine is an important molecule in the body that is involved in immune, allergy and inflammation pathways. It is a type of biologically active amine (also known as a “biogenic amine”), a group of many different amino acids that cause physiological changes in the body. There are receptors for histamine spread throughout the body, including in the gastrointestinal tract and even in the brain, as it exerts effects in many different body systems. Its role in the body is complex, and different types of histamine receptors in the body lead to different outcomes, as histamine often plays a regulatory role in different body systems.

One of the main producers of histamine in the body are our mast cells, a type of immune cell that responds to germs and sites of infection by releasing histamine, triggering inflammation and an immune response that helps the body to fight bacteria and other pathogens. Mast cells are also triggered to release histamine in response to allergens (e.g. food, pollen, etc.). It is histamine that causes the classic signs of allergic reaction – watery eyes, itchy skin, and a runny nose – because it causes our blood vessels to dilate. It is also responsible for more serious anaphylactic allergic reactions. In addition to causing the symptoms of allergic reactions, histamine is an important part of our innate immune system, is involved in neurotransmitter release, and may even play a role in ovulation (as well as implantation, uterine contractions, and even lactation). Despite its bad wrap, it is an essential part of our body’s normal functioning. It’s only when histamine accumulates in excessive amounts that issue arise.

As well as being released in response to exposure to allergens, the release of histamine in the body can also be triggered by other factors, including:

Oestrogen

• This is why histamine intolerance symptoms can be worse at certain points in the menstrual cycle when oestrogen levels are higher, such as during ovulation. (For more info on the link between histamine and oestrogen, check out our blog post here.)

Inflammation

• Histamine is one of the molecules released as part of our normal inflammatory response

Gut bacteria

• Certain types of gut bacteria, such as E coli, produce histamine in the gut

Stress

• Histamine acts as a neurotransmitter in the brain. Higher amounts of histamine are released during periods of both acute and chronic stress (which can contribute to feelings of anxiety)

In addition to being made by our cells, histamine is also found in certain types of common foods, particularly fermented foods. The histamine found in foods is due to bacteria breaking down amino acids (from protein) through the process of fermentation. This is why fermented foods and drinks (including beer and wine) can be particularly high in biogenic amines like histamine.  Most people can tolerate eating small amounts of histamine because enzymes in our body are able to break down the histamine in our intestines to be eliminated before it causes harm. One of the main enzymes responsible for breaking down histamine is called diamine oxidase (DAO). DAO is continuously produced and secreted by intestinal cells during digestion to breakdown histamine that is ingested with foods, preventing excess histamine absorption. Whilst we all possess enzymes to break down histamine, there is a limit to how much histamine these enzymes can process, a limit known as “histamine tolerance”. If our bodies exceed this limit, we end up in “histamine intolerance”, leading to excess histamine circulating throughout the body and causing symptoms. Those with low levels of DAO, as well as people with chronic gut issues, are more susceptible to the effects of histamine in food, as their body can’t break down sufficient amounts of histamine before it enters the blood stream. Deficiencies in the micronutrients required for producing DAO (particularly B vitamins such as B6 and vitamin C), as well as gastrointestinal conditions such as Crohn’s disease and even dysbiosis/SIBO, can negatively impact on our DAO levels and leave us at greater risk of histamine overload. Recurring hives and chronic allergic-type symptoms are a sign that your histamine levels are too high (histamine overload) or are exceeding the amount your body can cope with (histamine intolerance).

The Role of Histamine in the Body – Allergies, Hay Fever and More

Whilst too much histamine is certainly an issue for our health, histamine is also a vital part of our body’s normal functioning, and is involved in myriad processes, including normal immune and inflammatory pathways that protect the body from bacteria and viruses. Histamine also plays a role in regulating the function of various immune cells, including monocytes, T cells, and other white blood cells and, as discussed above, is the cause of allergic-type symptoms. However, it’s not all inflammation and runny noses when it comes to histamine’s effects on the body. Histamine is also involved in regulating gastric acid secretion, blood vessel dilation, and can even act on the brain as a neurotransmitter. Histamine can also impact on your menstrual cycle and worsen symptoms of PMS.

Because of the wide-reaching impact of histamine in the body, there are a huge number of conditions that are associated with histamine overload in one way or another, including:

• Chronic allergic-type conditions, such as chronic recurrent urticaria (hives) and chronic hay fever
• Skin conditions including eczema, rosacea and acne
• Asthma
• Gastrointestinal conditions, particularly functional conditions such as IBS, non-coeliac gluten sensitivity and functional dyspepsia
• Menstrual conditions including PMS, Perimenopause, painful periods and endometriosis
• Interstitial cystitis (“Painful bladder syndrome”)
• Neuropathic pain, migraine, headaches
• Certain neurological conditions such as narcolepsy, epilepsy, Parkinson’s disease, Alzheimer’s disease, and schizophrenia

Below we look at the role of histamine in some of these conditions more closely.

Histamine and Eczema

Eczema (or atopic dermatitis) is a really common skin condition that affects children and adults alike. Substance P, a neurochemical associated with pain, is one of the key chemicals which induce symptoms of itching in eczema. Substance P sends a chemical message to mast cells in the skin, triggering the release of histamine and increasing inflammation. The link between eczema flares and exposure to food intolerances or allergies has been well established. Emerging evidence suggests that for some patients, who experience food-related eczema flares but in whom food allergy testing comes back negative, it may be histamine intolerance which is worsening their symptoms. In fact, trials of low-histamine diets in patients with eczema have demonstrated marked improvement of eczema symptoms in as little as one week of dietary change.

Histamine and Rosacea

Histamine acts as a vasodilator, opening up blood vessels and leading to flushing of the skin – one of the primary mechanisms leading to symptoms in rosacea. In those with rosacea, excess histamine-rich foods can trigger rosacea flares and skin redness.

Histamine and Acne

Acne is an extremely common issue particularly in adolescents, caused by an overproduction of sebum (oil) within sebaceous glands in the skin and leading to inflammation and infections within the pores. Whilst there is often an underlying hormonal issue triggering acne, recent research suggests histamine may also play a role, as histamine receptors have been identified in sebaceous glands.

Histamine and Hives

Allergic reactions are one of the most well-known effects of histamine in the body, one of the symptoms of which is hives. Whilst hives can be a reaction to known allergens (such as exposure to poison ivy, for example), chronic spontaneous urticaria is a common skin complaint whereby hives occur without a known trigger. A recent study found that a low-histamine diet was able to reduce symptoms of chronic spontaneous urticaria in 75% of people studied, suggesting dietary histamine may be a factor in many cases.

Histamine and Asthma

In asthma, the role of histamine is even more complex. A study from 2016 showed that people with asthma have an altered gut microbiome, with increased levels of histamine-secreting bacteria in their guts. The study found asthma patients to have higher levels of certain bacteria such as E coli and M morganii, both of which are associated with biogenic amine food poisoning.

Histamine and the Brain

Aside from its role in allergic responses and immune system function, histamine also plays an important role in brain functioning. Both neurons (brain cells) and mast cells produce and release histamine in the brain. Within the brain, histamine acts as a type of neurotransmitter, sending signals to control a range of different bodily functions, including regulating our sleep-wake cycles (higher histamine leads to increased wakefulness), hunger and even regulates the release of certain hormones. Histamine acts to suppress appetite and increase the breakdown of fat within the body – this is part of the reason why some older anti-depressants can cause increased hunger and weight gain, as they block the activity of some histamine receptors in the brain. Histamine also acts to regulate certain hormones, including thyroid hormones, as well as oxytocin and prolactin hormones in breastfeeding mothers. Brain histamine levels have been shown to play a role in a number of neurological conditions, including narcolepsy, Alzheimer’s disease, Parkinson’s disease, epilepsy, and even schizophrenia. Histamine has also been found to play a role in neuropathic pain, headaches and migraines. Although the mechanisms for this role is not fully understood, it is believed that the histamine system within the brain may sometimes be a trigger to the onset of migraines.

Histamine and the Gastrointestinal Tract

As well as influencing hunger, appetite and weight gain, histamine is involved in the digestion of food in the stomach. Histamine is one of the main molecules responsible for stimulating the release of gastric acid by parietal cells in the stomach. Neurons that are sensitive to histamine are found throughout the gastrointestinal system, and elevated histamine receptors within the gut have been found in those with food allergy and even irritable bowel syndrome, demonstrating a link between histamine and these conditions. It has also been speculated that histamine may play a role in a number of other gastrointestinal disorders such as non-coeliac gluten sensitivity.

Diagnosis of Histamine Intolerance

Diagnosis of histamine intolerance is difficult due to a lack of standardised tests to assess for histamine load. Instead, assessing for histamine intolerance or overload through a naturopath is likely to be done via a diet diary and food elimination trial. If you suspect you may be experiencing histamine-related issues, it is important to speak with a naturopath before experimenting with food elimination, to make sure you are well supported nutritionally and are able to effectively assess your histamine tolerance, so long term treatment strategies can be prepared for you.

What are the symptoms of histamine intolerance/ histamine overload?

The symptoms of histamine intolerance are highly varied, but can include:

• Hay-fever type symptoms such as a congested, runny nose
• Allergy-type symptoms (hives and itchy, red skin)
• Bloating after meals, abdominal pain
• Headache, dizziness
• Diarrhoea or constipation
• Asthma
• Painful periods
• Flushing of the skin

You may experience only one of these symptoms, or you may experience many of them. You may also experience these symptoms in conjunction with one of the other conditions discussed above. Because symptoms are so highly varied, histamine intolerance/ histamine overload can often appear to be something else entirely, and studies suggest that some instances of functional gastrointestinal conditions such as IBS and non-coeliac gluten sensitivity may in fact be an intolerance to dietary histamine.

Will taking Anti-Histamines Solve the Problem?

Whilst anti-histamines can help with many issues caused by histamine overload, they have significant limitations, and of course aren’t addressing the root cause of the issue. As well, anti-histamines work by blocking histamine receptors on cells so that the histamine isn’t able to bind to the cell. However, there are multiple different types of histamine receptors on cells, and anti-histamines aren’t able to bind to all the different types of receptors. Anti-histamines also don’t help to reduce the levels of histamine circulating in the body, so they aren’t an ideal solution, although can be helpful in the short term.

To effectively manage histamine overload/ histamine intolerance symptoms in the long term, it’s vital to address the root causes of the issue, including reducing your intake of high histamine foods and addressing chronic stress and gut issues which are leading you to being more susceptible to elevated histamine levels.

Reducing the Impact of Histamine on Your Health

The good news is there are many strategies for reducing the impact of histamine on your health. Some of the key ways to help reduce your histamine load include:

• Reduce your intake of high histamine foods
• Reduce your intake of foods that increase production of histamine in the body
• Reduce excess oestrogen in the body

Foods that are high in histamine:

• Alcoholic drinks, including wine (particularly red wine), beer and whiskey
• Highly processed or smoked meats such as salami, bacon, hot dogs, and pepperoni
• Fermented foods, such as kombucha, kefir, kim chi, sauerkraut and even vinegar
• Fermented and/or aged dairy products, including yoghurt and aged cheeses like cheddar, parmesan and swiss cheese
• Dried fruits
• Processed and pre-packaged foods, including condiments such as tomato sauce
• Leftovers, particularly once 24 hours or more old
• Coffee
• Fish and seafood
• Beef
• Strawberries, pineapple, citrus fruits
• Avocado, spinach, eggplant

Foods that trigger histamine release:

While these foods themselves do not contain high amounts of histamine, they can trigger the release of histamine in the body when we eat them, so are best avoided if histamine is triggering your menstrual health issues.

• Bananas, papaya, citrus fruits
• Tomatoes, beans
• Wheat germ
• Chocolate
• Walnuts, cashews, peanuts

Foods that block DAO production:

Remember the enzyme that helps to clear histamine? These foods can stop our body from producing sufficient amounts of DAO and should be avoided.

• Tea, including black, green and mate
• Alcohol
• Energy drinks

Foods that Help to Reduce Histamine

• Vegetables: broccoli, rocket, asparagus, Brussels sprouts, cabbage, carrots, cauliflower, fennel, garlic, kale, onions
• Fruits: apples, blueberries, blackberries, cherries, mangoes
• Dairy-free substitutes such as coconut milk and almond milk
• Gluten-free grains such as rice and quinoa
• Eggs

Supplements to Reduce Histamine

• Quercetin: Quercetin is an important micronutrient when it comes to immune health and can reduce histamine by preventing mast cells from releasing stored histamine. Quercetin can be found in a wide range of low-histamine foods, including apples, berries (except strawberries), onions and green leafy vegetables.
• Vitamin C: Vitamin C is also a powerhouse micronutrient for preventing mast cells from releasing too much histamine. Vitamin C is also an important nutrient for the production of DAO, thus helping to boost the body’s ability to break down histamine. Boost your intake of vitamin C with low-histamine foods such as berries (except strawberries), broccoli, capsicum, and rockmelon.
• Vitamin B6: Vitamin B6 is another nutrient important for DAO production. Increase your intake of vitamin B6 by including freshly cooked meats such as kangaroo, salmon and chicken in your diet.
• Various herbal liquid medicines

Other Tips for Reducing Histamine Load

• Purchase your fruits, vegetables and meats as fresh as possible
• Eat foods immediately after cooking
• If you do need to store leftovers, freeze them rather than refrigerating, as this will slow down the production of histamine
• Eat plenty of fibre, which helps to bind and expel excess oestrogen to help naturally balance oestrogen levels
• Avoid inflammatory foods such as gluten, fried foods, and highly processed sugary foods – histamine is released as part of the inflammatory response
• Increase your intake of Brassica vegetables such as broccoli, kale, cauliflower, and Brussels sprouts, which support liver detoxification of excess oestrogen

References

Alstadhaug, K. B. (2014). Histamine in migraine and brain. Headache, 54(2), 246–259.

Barcik, W., Pugin, B., Westermann, P., Akdis, C. A., Frei, R., O’Mahony, L., Smolinska, S., Jutel, M., Hessel, E. M., & Michaolovich, D. (2016). Histamine-secreting microbes are increased in the gut of asthma patients. The Journal of Allergy and Clinical Immunology, 138(5), 1491–1494.

Chung, B. Y., Cho, S. I., Ahn, I. S., Lee, H. B., Kim, H. O., Park, C. W., & Lee, C. H. (2011). Treatment of atopic dermatitis with a low-histamine diet. Annals of Dermatology, 23.

Haas, H. L., Sergeeva, O. A., & Selbach, O. (2008). Histamine in the nervous system. Physiological Reviews, 88(3).

Ito, C. (2000). The role of brain histamine in acute and chronic stresses. Biomedicine & Pharmacotherapy, 54(5), 263–267.

Maintz, L., Benfadal, S., Allam, J.-P., Hagemann, T., Fimmers, R., & Novak, N. (2006). Evidence for a reduced histamine degradation capacity in a subgroup of patients with atopic eczema. Journal of Allergy and Clinical Immunology, 117(5), 1106–1112.

Maintz, L., & Novak, N. (2007). Histamine and histamine intolerance. The American Journal of Clinical Nutrition, 85(5).

Nuutinen, S., & Panula, P. (2010). Histamine in neurotransmission and brain diseases. In Histamine in inflammation. Landes Bioscience and Springer Science + Business Media.

Pelle, E., McCarthy, J., Seltmann, H., Huang, X., Mammone, T., Zouboulis, C. C., & Maes, D. (2008). Identification of histamine receptors and reduction of squalene levels by an antihistamine in sebocytes. Journal of Investigative Dermatology, 1289(5).

Schnedl, W. J., & Enko, D. (2020). Considering histamine in functional gastrointestinal disorders. Critical Reviews in Food Science and Nutrition.

Schnedl, W. J., Lackner, S., Enko, D., Schenk, M., Holasek, S. J., & Mangge, H. (2019). Evaluation of symptoms and symptom combinations in histamine intolerance. Intestinal Research, 17(3), 427–433.

Thakkar, M. M. (2011). Histamine in the regulation of wakefulness. Sleep Medicine Reviews, 15(1), 65–74.

Thangam, E. B., Jemima, E. A., Singh, H., Baig, M. S., Khan, M., Mathias, C. B., Church, M. K., & Saluja, R. (2018). The role of histamine and histamine receptors in mast cell-mediated allergy and inflammation: The hung for new therapeutic targets. Frontiers in Immunology, 13.

Wagner, N., Dirk, D., Peveling-Oberhag, A., Reese, I., Rady-Pizarro, U., Mitzel, H., & Staubach, P. (2017). A popular myth—A low-histamine diet improves chronic spontaneous urticaria—Fact or fiction? Journal of the European Academy of Dermatology and Venerology, 31(4), 650–655.

Worm, M., Fiedler, E.-M., Dolle, S., Schink, T., Hemmer, W., Jarisch, R., & Zubrerbier, T. (2009). Exogenous histamine aggravates eczema in a subgroup of patients with atopic dermatitis. Acta Dermato-Venereologica, 89(1), 52–56.

The post Histamine Intolerance and Reducing Histamine appeared first on Performance in Health.

Constipation is such a common issue among both adults and children, but often goes under treated or ignored. Constipation can greatly impact on quality of life and can also exacerbate other health conditions, so getting to the root cause of the issue is important for overall health. If constipation is an issue for you, read on to discover some of the most common root causes, as well as naturopathic strategies to help improve your digestive health.

What is Constipation?

Constipation means you are either not having a bowel movement or are finding it difficult to pass a bowel movement (or both). Ideally, we should be opening our bowels daily and stools shouldn’t be difficult to pass – that is, we shouldn’t need to strain or spend long periods of time on the toilet to get things happening.

Medically speaking, chronic constipation generally means fewer than 3 bowel movements per week. In reality, however, we should ideally be opening our bowels every single day. Why? Because our bowels are one of our major channels of elimination for getting rid of toxins and waste products that the body doesn’t need. If we aren’t opening our bowels often enough, these waste products sit stagnant in the bowel, causing inflammation. They may even be reabsorbed by the bowel and re-enter circulation, increasing the toxic burden on the body and creating additional stress on organs such as the liver, who need to process these waste products all over again.

Symptoms of Constipation:

• Stools are difficult to pass: Straining or extended periods of time sitting on the toilet are required
• You feel as though your bowel movement was “incomplete” after evacuating (as if there is more to pass but you are unable to pass anything more)
• Stools are hard and may be smaller than usual
• Abdominal pains from trapped gas can also occur

What Causes Constipation?

There are many, many different causes of constipation and for many people their constipation will be due to a combination of causes. Below are some of the major causes of chronic constipation.

Insufficient water intake

Stools are made up of a high percentage of water, which is what keeps the stools soft enough to move through the digestive tract efficiently. If you aren’t drinking enough water, your stools can end up being too dry and hard, which slows down their transit in the bowel.

Insufficient fibre in the diet

Fibre (undigestible carbohydrates in the diet) is found in foods such as vegetables, fruits and legumes. It is vital for healthy bowel movements, as it makes up the “bulk” of the stool, as well as being a food source for the bacteria in the gut, which play a role in normal stool formation and gut function. Having sufficient bulk in the stool triggers the gut to rhythmically contract (a process called peristalsis), moving the stool through the digestive tract ready for excretion. Too little fibre means this process doesn’t occur properly, leading to slower transit time.

Low physical activity

Physical activity also helps to stimulate the bowel to move stools through the digestive tract.

Certain medications and nutritional supplements

Certain medications, including some pain-killers, antacids and anti-depressant medications, are known to increase the risk of constipation. Nutritional supplements containing iron or calcium can also lead to constipation.

Stress and anxiety

The gut-brain connection is a powerful regulator of our health. Stress and anxiety activate our body’s fight-or-flight response, putting us into a state known as parasympathetic dominance. When in this state, our body down-regulates certain biological functions, including digestion, so that it is ready to respond to perceived imminent threats. This means impaired digestion and, as a result, constipation.

Dysbiosis

The bacteria in our guts are important for so many aspects of our health, and it’s not surprising that they play a role here, too. Our gut bacteria are the biggest producers of serotonin in the body, which is not only our “happiness” molecule, but is also important in maintaining normal gastrointestinal function. Dysbiosis and reduced intestinal serotonin levels can lead to poor gut motility and contributes to chronic constipation.

Pregnancy

Hormonal changes in pregnancy lead to the slowing down of the gastrointestinal tract, which aids in absorbing additional nutrients from food as it passes through. The downside, however, is that this slower transit time can lead to constipation.

Pelvic Floor Dysfunction

A weakened pelvic flood may mean there is insufficient muscle tone for you to properly expel the stool.

Other causes:

• Ignoring the urge to pass stools
• Over-use of laxatives – this can lead to reliance on laxatives in order to have a bowel movement
• Medical conditions such as IBS, food intolerances, diabetes, Parkinson’s disease or multiple sclerosis

Constipation in Kids

Constipation is also a common issue for children, particularly between the ages of 2 and 4 when potty training begins. Whilst some children may experience constipation due to slow bowel transit, up to 95% of chronic constipation in children is due to withholding behaviour, sometimes triggered by a previous painful bowel movement. Withholding and ignoring signals to open their bowels means the stool remains in the large intestine for too long and becomes dry and hard, making it more difficult to pass and further exacerbating the issue.

Health Consequences of Chronic Constipation

­Haemorrhoids

Haemorrhoids are swollen, distended veins which can occur inside or outside the rectum as a result of straining to open your bowels. Haemorrhoids can be painful which can worsen constipation by leading to hesitancy and resisting the urge to open your bowels.

Dysbiosis

Dysbiosis (changes to the normal microflora balance in your gut) may be a cause or an effect of constipation. To learn more about the importance of a healthy microbiome and the health consequences of dysbiosis, click here.

Waste Product Reabsorption

As discussed above, when stools sit in the large intestine for too long, the body begins to reabsorb some of the waste products that are meant to be eliminated. This can lead to issues with other health conditions such as hormonal issues like PMS, as excess oestrogen that would otherwise have been neutralised and eliminated from the body re-enters circulation, contributing to continued oestrogen dominance. The recirculation of waste products also puts additional strain on the liver, which may lead to fatigue, headaches and other issues. 

Combating Constipation, the Naturopathic Way

Fortunately, there are many effective strategies for combatting chronic constipation without resorting to harsh laxatives. Check out the tips below from Sydney naturopath Performance in Health for some of the common effective strategies to beat constipation.

Dietary Strategies

Increase your fibre intake:

• Fibre is the undigestible portion of carbohydrates which are important for healthy bowel movements.
• Include a variety of fibre-rich foods.
• Fruits and vegetables of different colours and textures (consider leaving the skin on vegetables such as potatoes and carrots for added fibre, but be sure to thoroughly wash before preparing).
• Legumes, nuts and seeds are also good sources of fibre, as well as being protein-rich foods.
• Fibre supplements, such as flaxseed meal and slippery elm powder can also be used, however they must be taken with sufficient water, or else they may exacerbate the issue. It’s best to discuss this with your naturopath before using.
• If you need to increase your fibre intake, it’s best to increase it slowly over a period of time to prevent bloating and gas issues.

Increase water intake:

• As a rule of thumb, around 2-2.5L of water per day is required for an adult, and more if you’re physically active.
• Increase prebiotic foods.
• Prebiotic foods feed the beneficial bacteria that support healthy bowel movements.
• Foods such as apples, garlic, onions, and legumes are all excellent sources of prebiotics.
• Reduce your intake of low-fibre foods such as meats, eggs, dairy and highly processed foods like white bread, cakes – reducing your intake of these foods makes way in your diet for high fibre foods.
• Lemon juice in warm water before meals stimulates digestion and can help with constipation.
• Eat “bitters” before main meals.
• Bitter foods such as rocket, or even herbal bitters such as gentian, can help to improve overall digestive function.
• If you do wish to try herbal bitters, speak to your naturopath first.

Supplements

Probiotics:

• A variety of probiotics have been shown to help improve bowel function in constipation sufferers.
• Probiotics have also been shown to be helpful for children with chronic constipation.

Magnesium:

• Some magnesium supplements depending on the type have been shown to help in chronic constipation by acting as an osmotic laxative, stimulating the intestines to draw additional water into the bowels.

Herbal medicines:

• Depending on the cause of your constipation which must be understood first, some safe and effective herbs can help to improve constipation alongside other treatment strategies.  It is important that a trained herbalist prescribes these herbs as they must be used appropriately.  Herbs such as Dandelion root, Globe artichoke, Senna, Yellow Dock, Rhubarb, Magnolia, Ginger and Licorice are some of the herbs prescribed.

Lifestyle Strategies

Daily physical activity:

• Aim for 20-30 minutes of moderate intensity exercise every day – a brisk walk (fast enough to break a sweat) is a great place to start.
• Bowel “re-training”.
• Sitting on the toilet at the same time each morning (for example, after breakfast) can help to “retrain” your brain to associate a certain time of day with opening your bowels, helping you to initiate a regular bowel movement. After a main meal is an ideal time for this, as it takes advantage of the body’s reflex system to increase peristalsis when the stomach is full.
• Bowel “retraining” can be a particularly important strategy for assisting in constipation in children, who should be encouraged to sit on the toilet for 5 minutes after each main meal and try to open their bowels.
• Ensuring optimal posture for bowel movements is equally important. A relaxed posture with feet comfortably supported on a foot stool optimises posture for bowel movements – a “squatting” type position is ideal.
• For children with functional constipation, using a reward system and even a daily diary can also be beneficial.
• Don’t ignore the urge to go! Even if you are unsuccessful in opening your bowels, responding to bowel movement queues by sitting on the toilet helps to retrain your brain to respond appropriately to these queues in future.

What About Over the Counter Laxatives?

Over the counter laxatives are often the first port of call for constipation sufferers, however, as discussed above, frequent use of laxatives to initiate a bowel movement can lead to your body relying on these for every bowel movement. Instead, think of laxatives (even “healthy” and “natural” ones) as being for short-term use only. Once the initial constipation is relieved, it’s best to focus on longer term strategies and addressing the root cause of the issue, to prevent constipation from recurring.

To find out more, contact Performance in Health today for an initial appointment.

References

Cao, H., Liu, X., An, Y., Zhou, G., Liu, Y., Xu, M., Dong, W., Wang, S., Yan, F., Jiang, K., & Wang, B. (2017). Dysbiosis contributes to chronic constipation development via regulation of serotonin transporter in the intestine. Scientific Reports, 7.

Dimidi, E., Christodoulides, S., Scott, S. M., & Whelan, K. (2017). Mechanisms of action of probiotics and the gastrointestinal microbiota on gut motility and constipation. Advances in Nutrition, 8(3), 484–494.

Forootan, M., Bagheri, N., & Darvishi, M. (2018). Chronic constipation: A review of the literature. Medicine (Baltimore), 97(20).

Hechtman, L. (2012). Clinical naturopathic medicine. Elsevier Australia.

Koppen, I. J. N., Lammers, L. A., Benninga, M. A., & Tabbers, M. M. (2015). Management of functional constipation in children: Therapy in practice. Pediatric Drugs, 17, 349–360.

Levy, E. I., Lemmens, R., Vandenplas, Y., & Devreker, T. (2017). Functional constipation in children: Challenges and solutions. Pediatric Health, Medicine and Therapeutics, 8, 19–27.

Mori, S., Tomita, T., Fujimura, K., Asano, H., Ogawa, T., Yamasaki, T., Kondo, T., Kono, T., Tozawa, K., Oshima, T., Fukui, H., Kimura, T., Watari, J., & Miwa, H. (2019). A randomized double-blind placebo-controlled trial on the effect of magnesium oxide in patients with chronic constipation. Journal of Neurogastroenterology and Motility, 25(4).

The post Living with Chronic Constipation: a Naturopathic approach to healing appeared first on Performance in Health.

Introduction

Mental health is an incredibly important issue affecting a significant number of Australians – nearly 1 in 2 Australians will experience a mental health disorder in their lifetime. Whilst external factors such as stress and environment of course contribute to poor mental health, Changes in our physical health can also impact our mood and may even contribute to or worsen mental health conditions. The importance of our gut microbiome for gastrointestinal health is something that is well established – many of us are aware of the benefits of probiotics for supporting healthy digestion. But how does our microbiome affect other areas of our health, such as our mood? There is growing evidence to support an important link between our microbiome and our mood – the microbiome may have an important role to play in not only helping us to feel happier, but even for helping to support those with mental health conditions such as depression, insomnia, and anxiety. In this blog, we examine the link between our gut, microbiome, and mood, and look at ways to support a healthy gut from a naturopathic perspective.

The Microbiome and The Gut-Brain Axis

The term “microbiome” or “gut microbiota” refers to the trillions of bacteria and other microorganisms that naturally live inside our intestines. We each have around 100 trillion bacteria, made up of approximately 100 different species, living inside our intestinal tract. The exact composition of each of our microbiomes is individual and depends on a range of factors, including genetics, geographic location, diet, and the use of medications, such as antibiotics.

One of the key connections between our microbiome and our mental health is through the gut-brain axis, a two-way communication pathway between our brains and our intestinal tract. This communication highway is mediated by the Vagus nerve, a large nerve that runs up through the centre of the abdomen. Microbes are able to send signals to the brain by directly and indirectly stimulating the Vagus nerve in various ways, but particularly through their ability to produce chemical messengers that send signals to the brain via this nerve. Certain bacteria inside our intestines produce significant amounts of neurotransmitters that are important for our mental health, including serotonin (the “happiness” molecule). In fact, 90% of our body’s circulating serotonin is produced not in the brain, but in our guts by intestinal bacteria, so microbes are playing a bigger role in your mood than you might think! Other important neurotransmitters such as dopamine, noradrenaline, GABA, and acetylcholine, can also be produced by intestinal bacteria. These chemicals play important roles in regulating our mood, anxiety, and even cognitive function.

Our intestinal microbes also influence inflammation levels inside the gut, as well as maintaining normal intestinal wall integrity (i.e. they help to prevent “leaky gut”). This is important, because both inflammation and leaky gut syndrome have been associated with mental illnesses such as depression. Changes in the make-up of the microbiome can lead to an increase in the production and release of inflammatory molecules called lipopolysaccharides. These and other inflammatory molecules send signals via the Vagus nerve up to the brain, causing changes in the brain that can induce symptoms of depression and anxiety.

So, how is the microbiome involved in specific mental health conditions?

Microbiome and Stress

Our microbiome influences how we perceive and react to stress in our lives. Stress leads to changes in the microbiome and can contribute to “dysbiosis” (an unhealthy imbalance of microbes in the gut). Animal studies have shown that a healthy gut microbiome actually helps to regulate our fight-or-flight response (also known as the HPA axis), meaning we are better able to cope with stressors in our lives when our microbiome is healthy.

Microbiome and Depression/ Anxiety

Inflammatory chemical messengers from bacteria have been shown to trigger symptoms of both depression and anxiety. Several studies have found that the types of intestinal bacteria present in the guts of people with major depressive disorder differs to that of the general population. However, there currently isn’t any consensus on any single bacteria that may be causing this link.

Microbiome and Insomnia

Recent research suggests that changes to the microbiome may play a role in insomnia, too. Studies have shown that interfering with normal sleep patterns (such as during shift work) can trigger changes to the intestinal microbiome. Another interesting role of the microbiome in influencing our sleep is in relation to our circadian rhythm, the internal clock that helps us to be awake and alert in the day, and sleepy at night. Studies on the microbiome show that the microbes within our intestines also follow a day-night pattern, fulfilling different functions depending on the time of day or night.

Supporting Your Mood and Your Gut Health

What can you do to help improve your mood and support your gut health? The following provides some tips on supporting both your mental wellbeing and your microbiome.

Eat a healthy diet:

• Certain dietary patterns, such as the Mediterranean Diet, have been shown to improve mental health and also provide lots of the types of foods that are good for supporting a healthy microbiome, too
• Reduce your intake of foods that preferentially feed unhealthy bacteria species – these foods include high sugar foods like cakes, lollies, and soft drinks, as well as foods high in trans fatty acids such as deep-fried foods
• Eat plenty of fibre-rich foods such as fruits, vegetables and wholegrains – Our “good” bacteria feed off of the complex carbohydrates found in these foods
• Our blog on feeding and nourishing your microbiome might also provide important tips https://www.performanceinhealth.com.au/2020/06/11/microbiome-family-gut-health/

Supplement with a high-quality probiotic:

• If you have recently taken medications such as antibiotics, have had a digestive issue such as diarrhoea, or have been through a period of significant stress, your microbiome may well benefit from a boost with a probiotic supplement
• Studies show that supplementing with probiotics can help to improve your mental health. Probiotics have been shown to increase serotonin levels, and clinical trials have shown that just 8 weeks of supplementation can cause marked improvement in symptoms of patients with depression. Other studies show that they are even effective when used in combination with prescribed anti-depressant medications
• The quality of probiotic supplements available on the market varies significantly, so it’s a good idea to discuss your needs with a naturopathic practitioner before beginning supplementation. Naturopaths are able to make recommendations to suit your individual health needs and ensure you are using a quality supplement that will benefit your health due to their extensive studies in this particular field.

Reduce your stress levels:

• As we’ve seen above, stress can affect our microbiome and our mental health, so reducing stress levels where possible is an important strategy for supporting mental wellbeing.
• Regular meditative practices such as yoga and mindfulness are well known for their stress-relieving abilities – check out your local yoga studio, or look into the many free apps that are available if you’d prefer to practice solo
• 20-30 minutes of daily exercise (such as a brisk walk through the neighbourhood) can also help to reduce stress
• Consider seeking the help of a counsellor or psychologist if you feel your stress would be better managed through talk therapy

Consider using herbal medicines:

• Bitter herbs such as gentian can be used before main meals to help improve your digestion and improve the pH in your intestines, which will help to help keep good bacteria happy
• Depending on your specific health needs, herbs such as liquorice, calendula, and chamomile might be beneficial by helping to soothe and heal any inflammatory damage in the intestines caused by dysbiosis
• As always, it is important to seek expert guidance from naturopathic practitioners before using herbal medicines. As a trained herbalist, a naturopath can assess your needs and create a unique blend that will work to best support your healing journey

It is important to remember that everyone’s digestion is unique.  In working with many individuals with Irritable Bowel Syndrome (IBS), strategies to build a balanced microbiome may be more complicated initially and may require a restriction on certain prebiotic foods and low FODMAP food sources.  For this reason, seeking one on one guidance is always recommended.

References

Australian Institute of Health and Welfare. (2021). Mental health. https://www.aihw.gov.au/reports/australias-health/mental-health

Bravo, J. A., Forsythe, P., Chew, M. V., Escaravage, E., Savignac, H. M., Dinan, T. G., Bienenstock, J., & Cryan, J. F. (2011). Ingestion of Lactobacillus strain regulates emotional behaviour and central GABA receptor expression in a mouse via the vagus nerve. PNAS, 108(38), 16050–16055. https://doi.org/10.1073/pnas.1102999108

Clapp, M., Aurora, N., Herrera, L., Bhatia, M., Wilen, E., & Wakefield, S. (2017). Gut microbiota’s effect on mental health: The gut-brain axis. Clinics and Practice, 7(987).

Desbonnet, L., Garrett, L., Clarke, G., Bienenstock, J., & Dinan, T. G. (2008). The probiotic Bifidobacteria infantis: An assessment of potential antidepressant properties in the rat. Journal of Psychiatric Research, 43(2), 167–174. https://doi.org/10.1016/j.jpsychires.2008.03.009

Du, Y., Gao, X.-R., Peng, L., & Ge, J.-F. (2020). Crosstalk between the microbiota-gut-brain axis and depression. Heliyon, 6. https://doi.org/10.1016/j.heliyon.2020.e04097

Hechtman, L. (2012). Clinical naturopathic medicine. Elsevier Australia.

Li, Y., Hao, Y., Fan, F., & Zhang, B. (2018). The role of microbiome in insomnia, circadian disturbance and depression. Frontiers in Psychiatry, 9.

Li, Y., Zhang, B., Zhou, Y., Wang, D., Liu, X., Li, L., Wang, T., Zhang, Y., Jiang, M., Tang, H., Amsel, L. V., Fan, F., & Hoven, C. W. (2020). Gut microbiota changes and their relationship with inflammation in patients with acute and chronic insomnia. Nature and Science of Sleep, 12, 895–905.

Limbana, T., Khan, F., & Eskander, N. (2020). Gut microbiome and depression: How microbes affect the way we think. Cureus, 12(8). https://doi.org/10.7759/cureus.9966

Liskiewicz, P., Kaczmarczyk, M., Misiak, B., Wronski, M., Baba-Kubis, A., Skonieczna-Zydecka, K., Marlicz, W., Bienkowski, P., Misera, A., Pela-Wysiecka, J., Kucharska-Mazur, J., Konopka, A., Loniewski, I., & Samochowiec, J. (n.d.). Analysis of gut microbiota and intestinal integrity markers of inpatients with major depressive disorder. Progress in Neuropsychopharmacology & Biological Psychiatry. https://doi.org/10.1016/j.pnpbp.2020.110076

Morkl, S., Wagner-Skacel, J., Lahousen, T., Lackner, S., Holasek, S. J., Bengesser, S. A., Painold, A., Holl, A. K., & Reininghaus, E. (2020). The role of nutrition and the gut-brain axis in psychiatry: A review of the literature. Neuropsychobiology, 79, 80–88.

Nikolova, V., Zaidi, S. Y., Young, A. H., Cleare, A. J., & Stone, J. M. (2019). Gut feeling: Randomized controlled trials of probiotics for the treatment of clinical depression: Systematic review and meta-analysis. Therapeutic Advances in Psychopharmacology, 9.

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Oligosaccharides

Oligosaccharides such as fructans and galactooligosaccharides (GOS) are found in a range of foods, including nectarines, watermelon, artichokes, garlic, onions, chickpeas, kidney beans, lentils, pistachios, cashews, wheat, barley, and rye. Inulin is a common example of an oligosaccharide.

Disaccharides

The main disaccharide in the FODMAPs diet is lactose, commonly found in dairy products like milk, ice cream, yoghurt, and soft cheeses such as ricotta and cottage cheese. Lactose intolerance is very common, as around 65% of adults do not produce sufficient amounts of lactase, the enzyme required to breakdown lactose in the digestive tract. In the majority of cases, this is largely down to genetics – we simply produce less and less lactase as we age.

Monosaccharides

The main monosaccharide the FODMAPs diet is concerned with is fructose. Whilst we are able to digest fructose, there is a limit to how much can be broken down at once – this is why eating too much fruit in one sitting can cause loose bowels. Although fructose is found in most fruits, it’s only foods that are especially high in fructose that are of concern. These are foods such as honey, apples, boysenberries, figs, mangoes, pears, watermelon, asparagus, artichokes, and dried fruits.

Polyols

Polyols are a type of sugar called a sugar alcohol. They are found in some fruits and vegetables, such as apples, apricots, blackberries, plums, cauliflower, mushrooms, and snow peas, but are also found in high amounts as artificial sweeteners in processed foods. Some of these, like xylitol, sorbitol, and mannitol, you may recognise, as they are frequently used in “low sugar” foods.

As you can see, the list of foods containing FODMAPs is quite extensive!

How Do FODMAPs Affect Health?

FODMAPs and the foods they are found in aren’t inherently bad for our health – it’s a matter of individual tolerance. Whilst some people can consume these foods in relatively high amounts, others have a lower threshold, usually to one or two FODMAPs in particular, and need to eat less of these to avoid symptoms. So how exactly do FODMAPs cause symptoms? FODMAPs move slowly through the digestive tract, accumulating water and fermenting. The high amount of water in the gut combined with gases like hydrogen and methane that are produced by fermentation causes bloating. This bloating stimulates receptors in the digestive tract, causing abdominal pain.

However, there is more to the story than just bloating, with high FODMAPs diets being implicated in inflammation, dysbiosis, and even leaky gut. Whilst FODMAPs don’t cause inflammation directly, eating them in too high amounts can lead to inflammation by triggering changes to our intestinal microbiome, an issue called dysbiosis. Studies on mice have shown that high FODMAPs diets allow “bad” bacteria to proliferate by providing too much food for them. These bad bacteria produce harmful substances called lipopolysaccharides, which trigger inflammation and damage the lining of the gut. This damage, also known as “leaky gut”, leaves us at risk of absorbing harmful substances from the gastrointestinal tract. FODMAPs have also been shown to increase histamine levels in the gut by feeding bacteria that produce histamine and activating mast cells. Histamine triggers inflammation and acts as a signalling chemical, causing pain signals to be sent to the brain.

It’s important to remember, however, that many of the foods that are high in FODMAPs are not inherently bad! Each individual has a unique tolerance limit for foods, and that is true here, too. Eating a diet that is too high in FODMAPs for your individual tolerance is the issue, more so than it is the foods themselves.

What Other Conditions Can Lead to an Intolerance in FODMAPS?

In order for carbohydrates found in some FODMAPs to be properly digested, the “brush border” of the small intestine must produce specific enzymes. If the brush border and the villi are damaged, then you will not properly produce these enzymes and the space usually available for absorption into your body is reduced.  This means that less food is absorbed and more stays within your small intestine, providing more fuel or food sources for bacteria to feed on.  Conditions that can cause small intestinal brush border damage include Celiac Disease, Endometriosis, Crohn’s disease, Food allergies and intolerances, infections such as Helicobacter pylori, giardia and more.  In addition, certain medications are known to damage this brush border.  Due to this, often when the small intestinal wall and brush border is healed and the initial causes are removed, FODMAP’s can return to the diet.

What Conditions are Helped by a Low FODMAPs Diet?

Irritable Bowel Syndrome (IBS)

IBS is the condition most commonly associated with FODMAPs and the majority of FODMAPs studies have focused on its relevance to IBS. Extensive randomised controlled trials have demonstrated that the FODMAPs diet can help to reduce IBS symptoms, as well as reducing inflammatory markers that affect the lining of the digestive tract.

 

Inflammatory Bowel Diseases

Inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis are chronic gastrointestinal conditions that involve significant inflammation in part or all of the digestive tract, leading to leaky gut, ulceration, abdominal pain and diarrhoea, and can have a significant impact on quality of life. Low FODMAPs diets have been shown to reduce symptom severity and improve quality of life for patients with these conditions.

Dysbiosis and SIBO

As discussed above, FODMAPs affect the intestinal microbiome by providing food sources for certain types of bacteria, which can tip the balance of bacteria towards more harmful bacteria types as well as produce an overgrowth of healthy species.

Non-Coeliac Gluten Sensitivity (NCGS)

NCGS is a condition where ingestion of gluten-containing foods triggers symptoms such as abdominal pain, nausea and diarrhoea or constipation, without the autoimmune pathology associated with coeliac disease. Evidence suggests this condition may also be triggered by certain high FODMAPs foods for some individuals, and a recent study showed that a low FODMAPs diet helped to reduce inflammatory markers in patients with NCGS.

Endometriosis

Endometriosis is a complex, painful condition associated with autoimmune factors, whereby the body transplants endometrial tissue into areas outside of the uterus. Using a low FODMAPs diet as part of the treatment strategy for managing endometriosis has shown promise, because of the way it is able to reduce inflammation and visceral pain.

Histamine Intolerance

As discussed above, excess FODMAPs in the diet leads to increased histamine levels by activating mast cells and feeding bacteria that produce histamine. Reducing FODMAPs in the diet can reduce histamine levels by up to eight-fold, improving symptoms for patients with histamine intolerance.

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