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Breakthroughs in Irritable Bowel Syndrome
Irritable Bowel Syndrome or IBS as it’s commonly called, may not be the most exciting topic to read about. But for the 5 million Canadians who suffer from it, learning about breakthroughs in treatment is definitely news worth reading. Medical research has made the connection now between IBS and the microbiome, the immune system and the nervous system. While stress and food intake may confound an IBS problem, breakthroughs in our understanding of the microbes in our intestines are helping to solve the deeper issues that can drive this health condition.
IBS symptoms can include bloating, excess gas and burping, some degree of constipation, diarrhea or both, and often an element of abdominal pain or discomfort. As a naturopathic physician, I regularly treat patients who have been told they have IBS, and that there’s not much they can do about it. The fact is, there are potential solutions to these issues. My first step is to explain that IBS is a diagnosis of exclusion, meaning we must rule out overt infection, cancer, inflammatory bowel disease, reproductive issues and more. Once we’ve done that, we can take steps to find out what is causing that person’s IBS.
Some of my patients respond well to avoiding certain foods, so we usually work to identify food triggers. Some MDs are sharing the research out of Monash University about the FODMAP diet which are foods known to cause IBS symptoms in some people. These foods can provide the fuel to our intestinal bacteria to make gas. But people with a healthy gut can handle those foods just fine, and many FODMAP foods are healthy foods, like broccoli, apples and garlic. If someone feels better on a FODMAP elimination diet, I see that not as a solution, but as a clue that their intestinal microbiome needs work.
By far the most common cause of IBS in my experience is an imbalance in the bacterial lining of the intestines called the microbiome. The large intestine is supposed to have a lot of bacteria and it is normal to ferment the leftover foods there. But the 12 feet of the small intestine are supposed to be relatively bacteria-free. Even if bacteria that is normal to have in the large intestine ends up growing in the small intestine, these bacteria will ferment the normal healthy foods we eat and create gas, intestinal irritation and nutritional issues.
What can cause bacterial overgrowth in the small intestine? There are many factors, but the most common one is a history of gastrointestinal infection. Even a case of traveller’s diarrhea, food poisoning, or viral gastroenteritis that resolves nicely can trigger an autoimmune reaction in about 20% of people. That autoimmune reaction can attack the nerves that stimulate the muscles that cause the sweeping motion inside the small intestine that moves food along between meals. Without this motion, food pools in the small intestine, bacteria can migrate upward from the large intestine, a ‘compost’ is formed, and excess bacteria blooms. Studies of military personal showed that prior gastrointestinal infection was a much stronger predictor of who would get IBS than stress level. Other studies have shown that GI infections can lead to motility disorders in the esophagus and intestines.
Brain injuries are also a potential cause of Small Intestine Bacterial Overgrowth (SIBO). The brain orchestrates the motility of the small intestine, so a brain injury can hamper its ability to coordinate the flushing of the small intestine, allowing a bacterial overgrowth to ensue. Autoimmune disease can also be connected, as well as abdominal surgeries, long term diabetes and more.
Fortunately, there is a specialized test for SIBO that can be ordered through naturopathic physicians. The gold standard test is a series of breath tests that looks for hydrogen and methane gases that have formed in the gut, been absorbed into the blood and are then breathed out. If a test comes back positive, I coach my patients on a four-step program. The first step is to prepare the intestine by opening up the biofilm that the bacteria hide out in. Then we use prescription or herbal antibacterial agents that exclusively target the bacteria in the small intestine. When that phase is complete, patients’ IBS symptoms are significantly better and we work on addressing the underlying cause, which is the motility disorder in the small intestine. There are prescription and herbal “pro-kinetic” agents that rehabilitate the muscles of the inner small intestine so the problem will stay away for good. In addition, we work to heal the intestinal lining to make it more resilient using natural medicines and SIBO specific probiotics.
People who live with IBS deserve to understand why they have these symptoms and what they can do about it. The goal is to repair the gut once and for all, not just manage symptoms. When we understand and treat the underlying issues, lasting resolution is possible.
Dr. Deidre Macdonald is a naturopathic physician practicing in downtown Courtenay. 250 897-0235 www.getwellhere.com
Buyer Beware of Chemicals in Your Home
There are an estimated 84,000 different chemicals in our environment and 700 new ones are released every year. The majority of these have never been tested for safety. Chemicals that are tested are done in isolation, yet in the real world are bodies are bombarded by hundreds of chemicals and it is the total toxic burden that overwhelms our body’s natural defences. These chemicals enter our bodies every day through food, water, air, health and beauty aids, furniture, clothing and more. Scientific evidence is pointing to chemical exposures as major contributors to cancer, reproductive problems, early puberty, autoimmune disease, Autism, Alzheimer’s disease, Parkinson’s disease and other neurological and metabolic disruptions.
Our bodies have not yet evolved the mechanisms to defend against the assault of modern chemicals. I had a patient who was a very tough military veteran. He had survived the unimaginable and was quite psychologically resilient. But the mosquito coils that he slept with for years in while posted in Germany emitted a potent neurotoxin intended to paralyze mosquitos. Unfortunately the mosquito coils also poisoned his nervous system and was the likely cause of the rare neuro-muscular disorder he developed, and eventually succumbed to. As tough as he was as a person, his physical systems had never evolved the mechanisms to withstand these toxins.
Canadians spend 90% of their time inside, which means we spend most of our daily lives exposed to chemicals found in common household items and dust. We all have of toxins stored in our body and are passing them to our children. Babies are being born with chemicals in their system. In a US study, there were an average of 287 chemicals detected in umbilical cord blood, 217 of which are toxic to the brain and nervous system. At Simon Fraser University, research showed that those babies whose mother’s had the highest concentration of chemicals had a lower IQ at age five.
Some chemical exposure is beyond our control, but we can choose which chemicals are entering our homes through the products we buy. Environmental Defence, a Canadian organization that promotes environmental health, has created a list of the chemicals in consumer products that cause the worst damage to human health. These “Toxic Ten” include flame retardants, parabens, phthalates, petrolatum, silicone (the latter four are commonly found in over the counter skin and hair care products), and perfluorinated compounds (PFC, PFAS – found in water resistant products such as Scotchguard, Gore-tex, Teflon, raincoats, food wrappers, and microwave popcorn bags).
According to Health Canada, flame retardants are found in many consumer products including foam in mattresses, pillows and stuffed toys, in fabrics such as clothing, tents, rugs, and upholstery, and other products like computers, plastics, paint, foam used in construction, glues and more. Health Canada states that the health effects of these chemicals may include effects on development, reproduction and increased risk of cancer. Research has shown that they are hormone disruptors, can alter thyroid function in pregnant women, and can cause neurodevelopmental problems in children (such as lowered IQ, Autism, and ADHD).
Parabens can easily be absorbed through the skin and are commonly found in lipstick and other make-up, skin care products and deodorant. Parabens are strong estrogen mimickers, androgen (male hormone) disruptors, blockers of detoxifying agents in the body, and more. For instance, they are known to disrupt five out of the seven mechanisms cells use to protect themselves from breast cancer.
BPA’s are found in plastic food and water containers, tin / soda can lining, cash register receipts and more. They are known hormone and immune system disruptors, and the newer BPA substitutes may be just as bad. Consumers have demanded the reduction of BPA’s in food packaging and are buying metal water bottles instead of drinking from plastic water bottles. Educated consumer using their buying power will be what moves our society from a toxic soup to a cleaner world.
These household toxins combine to create an unprecedented toxic burden to our bodies, and I haven’t even gotten started talking about pesticides in foods, chemicals in medicines, and the toxins we knowingly ingest in artificial sweeteners, cigarettes, alcohol and drugs. They all adds up. But you can make a difference. Knowledge is power.
Naturopathic doctors help their patients to prevent and address disease by engaging them in strategies to remove stresses on the body, including the build-up of chemical toxins. We can test you for toxic burden (“CORE” by Genova Diagnostics) and support you in a program to detoxify your home and your body. Next month we’ll talk about steps you can take to reduce your exposure to toxins in your home. Also check out the Toxic Ten Pocket Guide at environmentaldefence.ca.
Gas is No Laughing Matter
While twelve-year-old boys may revel in the sound of their own gas, those plagued by excess gas will find that it is nothing to laugh about. Excessive burping, bloating and flatulence bring distress and discomfort to more people than would like to admit it. Despite the significant problem gas can cause, patients are often told something to the effect of, “Well, you have Irritable Bowel Syndrome, and you’re just going to have to live with it.” I prefer to find and treat the underlying issues which cause gastrointestinal unrest.
Digestive dysfunction on a number of levels can contribute to excess gas. Some people lack adequate stomach acid, or take acid-blocking medication for acid reflux. Indigestion and gas problems can occur due to improper break down of food. Further down, inadequate flow of digestive enzymes or bile can cause food to sit and ferment into gasses. Constipation, diabetes, parasites, helicobactor pylori, multiple sclerosis and other medical conditions can cause excess gas.
Gas results from the production of gas by intestinal bacteria when they digest sugars and other carbohydrates. Imbalances in the bacterial lining of the intestines, called the microbiome, can be a significant source of gas and bloating, as well as Irritable Bowel Syndrome. Immune issues, poor diet, c-sections, antibiotics and acid-blocking drugs can alter the microbiome . In Small Intestine Bacterial Overgrowth, also known as SIBO, excess gas is a key symptom. Also, a common yeast called Candida albicans can proliferate to a level that can cause excess fermentation, leading to gas and other symptoms.
Some people’s gas is attributable to food allergies which can be determined with the help of a naturopathic physician. Celiac disease, or intolerance to lactose, fructose or artificial sweeteners can each result in gas and bloating. It also probably comes as no surprise that beer and other carbonated beverages have the same affect. Lastly, as any vegetarian knows, beans can cause gas, along with the cabbage family vegetables.
In short, don’t let gas get you down. It is often a symptom of an underlying disorder which can often respond well to proper treatment. Anyone who says otherwise, quite frankly, is full of hot air.
Help with Cravings and Stubborn Weight
We all have trillions of bacteria, yeasts and fungi in our bodies, particularly in our intestines. The mix of these microbes makes up our microbiome. New research shows that this microbiome may have more to do with your weight than what you eat. Farmers around the world have long known that feeding antibiotics to chicken and cows fattens them up. Human trials have shown the same thing and scientists now have the research to find out why. Antibiotics, as well as certain dietary choices, change the bacterial lining of the intestines. Those changes allow more calories to be extracted from food. They also increase cravings and appetite by changing hormones. This research gives hope to those who wish to bolster their ability to lose weight. You can change your intestinal microbiome and therefore help your body lose weight.
We now know that our intestinal microbiome affects many important processes, such as digestion, destruction of parasites, mood and brain function, immune system regulation, and prevention of autoimmune diseases. Naturopathic physicians have been working for decades to educate patients about the importance of the microbiome and now scientists around the world are using new technology to understand the microbiome and learn how to foster and protect it.
Why is it that some people seem to put on weight while others lose weight easily? The answer may be that those who lack good bacteria in the intestines seem to extract more calories from food. Recent research shows that thin mice who receive a microbiome transfer from obese mice, gain weight, despite being on a calorie controlled diet. It appears that the microbiome of the obese mice has an increased capacity to harvest energy from the diet.
Another factor in weight gain is the appetite stimulating hormone ghrelin. A healthy microbiome regulates appetite by reducing this hormone. But using antibiotics that alter the microbiome increases ghrelin and is associated with weight gain.
So how do we encourage the growth of an abundant and diverse microbiome? We need to begin at birth. Babies in the womb are “sterile”. The birth canal provides the baby’s first inoculation with the bacteria he or she will need to digest breast milk. Babies born by c-section, who miss out on that bacteria, may be more prone to weight problems as they age. C-sections are a welcome lifesaver at times but I recommend all my c-section babies be given appropriate probiotic supplements (intestinal microbiome powder) as soon as possible after birth.
Humans given antibiotics are more prone to weight gain, just like chickens. Of course antibiotics are another modern medical necessity in some cases. The benefit of antibiotics is generally perceived to be much greater than it actually is for common infections. There are natural medicines that can strengthen the immune system and fight infection without damaging the microbiome. So try to avoid antibiotics and take probiotics if you can’t avoid them.
The foods we eat also cause our microbiome to adapt and change. High refined sugar diets promote the growth of bacteria that influence ghrelin, the appetite-stimulating hormone. Healthier diets help the healthier bacterial to grow. Cats fed higher carbohydrate diets had kittens which ate more and became fatter. (Since we are finding now that mothers can pass on their microbiome to their children, women are well advised to work on enhancing their microbiome even prior to conception.) A whole food diet that is low in both refined carbohydrates and animal fat promotes the healthiest microbiome thus helping to regulate appetite.
I have found that many patients who had difficulty losing weight have an altered microbiome. They often have related symptoms such as digestive issues, allergies, or depression. There are simple tests that can help determine the state of the microbiome. If needed, I coach patients on how to use low carb nutrition and helpful supplements to re-establish the healthy microbiome. When the microbiome comes into balance, cravings are lessened and weight loss is much more easily attained.
My doctor says my thyroid is normal but…
Every week people arrive at the clinic wondering if their thyroid is okay. They’ve often had their conventional doctor check their thyroid, and are told that everything is fine. However, they aren’t convinced. They feel tired, cold, achy, gain weight easily, have headaches, depression and more symptoms that seem to reflect low thyroid function.
As a naturopathic physician, I offer these patients a full thyroid panel. When we test further, we often find that the thyroid really isn’t working optimally. Why the different in approaches?
Our MSP system only allow conventional doctors to run one test to screen for thyroid problems. Naturopathic physicians prefer a full panel to test for TSH, T4 (inactive thyroid hormone), T3 (active thyroid hormone) and a thyroid antibody called TPO. Often we are able to unveil issues in the complex dance of the thyroid hormones, which can then be treated in a variety of ways, both holistic and pharmaceutical.
Our philosophy is to try to determine if your thyroid is working optimally, not just wait until it is diseased.
Curious about your thyroid? You can book an appointment by emailing back or calling Terry at (250) 897-0235.
Think Straight, Feel Great: The Gut Brain Connection
Have you ever had a ”gut wrenching experience?” Have you felt butterflies in your stomach, or had a “gut feeling?” We all have experienced the influence that our thoughts and feelings can have on our stomach, but research is now showing that our guts can influence our mood, behaviour and thinking more that we had previously realized.
The stomach and intestines are so rich in nerves that the gut’s nervous system, the enteric nervous system, has been called the “second brain.” Surprisingly, there are about 100 million nerve cells in the gut, as many as there are in the head of a cat. Nervous stress can affect digestion from a number of angles including reducing blood flow to the digestive organs, altering secretion of digestive juices, changing gut motility, increasing the leakiness of the intestine and, most importantly, altering the intestinal bacterial lining called the microbiome.
The enteric nervous system also informs our state of mind. “A big part of our emotions are probably influenced by the nerves in our gut,” says Dr. Emeran Mayer, a professor from U.C.L.A. It turns out that the main cranial (brain) nerve for controlling the digestion, the vagus nerve, uses 90% of its fibers to send information from the intestines to the brain. Electrical stimulation of the vagus nerve, a useful treatment for depression, may mimic these signals. The enteric nervous system, like the brain, uses neurotransmitters like serotonin and dopamine. In fact, 95% of the body’s serotonin is found in the bowels. So is there a link between impaired digestive function and mental or emotional disorders? The link is clear in autism and research suggests a link in depression, schizophrenia and more conditions of the mind.
Exciting research has emerged on the role of the bacteria in our guts and how it affects the brain. I recently attended the annual national conference of the Canadian Association of Gastroenterologists. Exciting research was presented on what is considered the most important work being done in the field of biology today. The Human Microbiome Project is an international collaboration to map the DNA of the trillions of bacteria that live in the human body. These bacteria are a critical determinant of digestion function, immune function, prevention of autoimmune disease and, as it turns out, mood. Changes in the intestinal microbiome can have profound consequences on our physical and mental health.
For instance, people with Irritable Bowel Syndrome have different wiring in their gut-brain connection. It has long been established that people with IBS have an amplified perception of pain from the intestines. Research now shows that it is their altered intestinal microbiome that is responsible for messing with the nerve signals from the gut.
In animal models, alterations in microorganisms of the intestines have been show to influence brain function including memory and anxiety. Studies on mice show that changes to gut bacteria can actually affect behaviour. If you take the gut bacteria from bold mice and put it into shy mice, the shy mice become bold and vice versa. Mice treated with good bacteria (probiotics) exhibit less anxiety and show changes in the hippocampus of the brain. They have more brain growth factors necessary for learning and higher thinking.
Researchers have found that people with major depression have alterations in their small intestine microbiome. Namely, they show signs of Small Intestine Bacterial Overgrowth (SIBO). My patients with SIBO often have been told they have Irritable Bowel Syndrome and suffer from bloating, constipation or diarrhea, fatigue, fibromyalgia and more. A simple breath test can help diagnose SIBO; with a long term complex treatment regime, relief of both physical and mental symptoms can be achieved.
Antibiotics significantly alter the delicate and complex intestinal microbiome. Not only does this disturbance have an impact on digestion and the immune system, but it has also been shown to affect behaviour. Mice that are given antibiotics are more daring, having lost their natural instinct to hide from predators. Studies have shown that post antibiotic mice have impaired learning. Also, changes in the critical areas of the brain, the amygdale and hippocampus, have been demonstrated with antibiotic use. Since 30% of human newborns are exposed to antibiotics before they even go home from the hospital, and with many more children are given antibiotics in childhood, the implications for brain development and learning are disturbing.
Stress can also alter the microbiome, leaving us more vulnerable to bowel issues, inflammatory conditions and mental effects of these changes. When mice are separated from their mothers at a young age, their microbiome changes and they are more likely to develop inflammatory bowel issues later in life.
There are other digestive factors that have a ripple effect on the brain. Food allergies can activate immune cells called mast cells. These mast cells can release inflammatory chemicals that can have an impact on the brain causing mood, energy, and learning issues. For some people with celiac disease, the autoimmune response to gluten in common bread and pasta products can cause calcifications of brain tissue that can be devastating.
If you are suffering from both digestive issues and mood issues, there may be more of a link that you had previously thought. Treating the digestive issues by correcting the underlying cause may open up doors to improved mood and mental clarity. Naturopathic physicians have a long history of working with patients to enhance the digestive system, through optimal diet, avoidance of food allergies, enhancement of the intestinal microbiome and much more. Don’t let your guts get you down. Take charge of your mental and physical health.
If this sounds like the care that you’re seeking, we’d love to hear from you.
You can book a complimentary 15-minute “meet-the-doctor” visit anytime by calling the clinic. You’ll be able to ask questions, find out how we can help, and see if there’s a comfortable fit with your naturopath.
Book an appointment with Dr Macdonald or Dr. Peters by emailing us or calling (250) 897-0235
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The Macdonald Centre for Natural Medicine
448 10th Street Courtenay, B.C.