Constipation - What moves your bowels?

Regular bowels are an important sign of good health. Our bowels are a primary function of elimination and detox. When this is backed up, we start to use secondary organs of elimination such as your skin, or lungs...which is not ideal. ⠀

Do you suffer from constipation? Check out the bristol stool chart if you haven't seen it before. Constipation could mean daily hard to pass stool, or not going for several days. ⠀

Why are you constipated?

1. There could be an imbalance of bacteria in your gut, aka SIBO, or yeast overgrowth.

2. You could have stagnation of bile from the liver/gallbladder, which is very important to stimulate bowels. ⠀

3. You could have a low fibre diet (but this gets quite complicated for those who have experienced constipation for awhile - due to point #1 typically). ⠀

4. You are not stimulating movement of bowels by moving your whole body. Exercise and twists are key here. ⠀

5. You are STRESSED! If our body is stressed our muscles tighten, including our digestive tract.

What moves our bowels?

1. Get into a routine - We detox during the night for the most part, since our body is at rest, so the morning is when the cycle should be completed, aka a bowel movement. If you wake at the same time each morning, after a good night sleep, your body should start getting into a rhythm and you shouldn’t need extra support. Try it!

2. Try extra support - Try a mug of warm water with lemon. It helps to stimulate liver detox and the warm water gets your intestines warmed up (like a warm up before a big run). Your morning coffee may do the trick as well since it is bitter. Bitters stimulate stomach acid, enzymes and bile secretion, all essential for proper digestion and bowels.

3. Exercise and twist - The simple twist I’m doing above is one way to stimulate the bowels. It’s like wringing out a towel and moves things through. Exercise gets lymph moving, helpful for detox.

4. Hydration - The bowels absorb water to bulk up the stool. This then creates a signal to stimulate a bowel movement. Hydrate with lots of water throughout the day (ideally not ice water, and not just during meals!)

5. Get rid of bad bacteria - Methanobacteria are among those typically high with constipation. Bifido bacteria tend to be low with constipation. These are only 2 patterns I see in practice as it depends on the individual. We ultimately need to eliminate an overgrowth with antimicrobial herbs and a specific diet, then increase the beneficial bugs with supplements or food.

6. Stimulate bile flow - Bile is crucial for proper bowel stimulation. If it is trickling out too often and irritating bowels it can cause diarrhea, and if it is stagnant in the gallbladder (or liver if you don’t have a gallbladder) constipation tends to happen. Simple diet hacks, fibre, cholagogue herbs, and nutrients such as lecithin, and phosphatidylcholine all help to stimulate bile. Cholagogue herbs include milk thistle, burdock, dandelion or artichoke.

7. Relax - I know this is easier said that done but this is key! Deep belly breathing goes a long way to stimulate the vagus nerve ultimately stimulating your bowels.

Questions about constipation? Let me know!

In health & happiness,

Dr. Karen

SIBO - Test Don't Guess

Small intestinal bacteria overgrowth (SIBO) may be more prevalent than we think. Research shows that 50-84% of IBS patients test positive for SIBO. This is with old testing methods that would show many false positives, therefore my assumption is that it is even more prevalent than we think. All it may take for someone to develop SIBO is a bout of food poisoning! That’s it! For some it is more complicated than that.

I have discussed the main reasons someone may have SIBO in a previous post, but let’s jump right into how you accurately diagnose SIBO. In my practice I ask a lot of questions in the first visit. This is because we can gain a lot of clinical information about what may be going on by just getting all the information. A physical exam, specifically an abdominal exam in these cases, is my next step in gathering information. SIBO has a handful of specific symptoms I am looking for which guide my treatment plan. But SIBO also a handful of symptoms that are unique to the individual and can be systemic, for example joint pain, rosacea, hypothyroidism.

Test Don’t Guess

If your symptoms indicate to me that you may have SIBO, before jumping into treatment, it is very helpful to test for it. Not only will this confirm, or deny, a positive result, but it will also guide what type of antimicrobials I’ll use and for how long depending on what the results show. The higher the results, the more rounds of antimicrobials we typically have to do.

The SIBO breath test is the most accurate non-invasive way to diagnose SIBO right now. Research continues to be done to advance our testing methods. The best option is a breath test that is a 3-hour lactulose breath test looking at both Hydrogen (H2) and methane (CH4) levels. This is the type and amount of gas that is produced if you have SIBO. Hydrogen SIBO typically presents as diarrhea (among other symptoms), and methane SIBO typically presents as constipation. The 3 hour test ensures you are testing the entire length of the small intestine, where only a small amount of bacteria should be, not an overgrowth. Stool testing, which we may do for other GI complaints, is only relevant to the large intestine. There is no accurate test yet for a 3rd type of SIBO, hydrogen sulphide. However, there are patterns on the results and patterns in symptoms that may indicate this type. This is not testing for Candida, however it is common for these to present together.

Ultimately if you test positive for SIBO, I treat it. However, 2/3 of patients have shown to relapse post-treatment. There are number of reasons for this but this is why it is always important to treat the patients and not the condition. I aim to treat the root cause along with the SIBO - if we can. Sometimes this isn’t possible depending on the case, so we do are best. It can also take time, and even different circumstances, for example a less stressful job perhaps, to treat the root. 1/3 of cases are luckily non-recurring and the patients feels better quickly and for good. Phew!

All in all, testing is very helpful to me as a clinician if I suspect a bad case of SIBO. It takes the guesswork out of the treatment and ensures a more accurate and quicker treatment result. Treating SIBO is a team effort but the more information we have the better it can be!

Are you interested in getting tested for SIBO? Let me know!

In health & happiness,

Dr. Karen

3 Causes of SIBO That Have You Suffering

Irritable bowel syndrome has been a diagnoses of exclusion for many years. If the symptoms are severe enough you are referred for a colonoscopy or an endoscopy, and if tests are clear you are given the diagnosis. If the symptoms are mild enough, no testing is done and the diagnoses is given. This is an umbrella term however. In my practice I see varying causes of IBS since we are looking at the root cause. SIBO, or small intestinal bacterial overgrowth, is one very common cause of IBS. MDs do not have access to other GI tests like a SIBO breath test, or lack knowledge that SIBO is something that can be treated. I see many people with irritable bowel syndrome that show typical signs of SIBO. We test for it and treat accordingly. But WHY do they have it is the big question? 

Symptoms of SIBO

Common symptoms of SIBO are bloating, either with no known trigger food or very predictable trigger foods such as garlic, onion, greens, apples etc, abdominal pain, heartburn, either chronic constipation or diarrhea. Other associated conditions are rosacea, cystic acne, chronic pain, IBD, and even hypothyroidism! The list goes on. This is why I ALWAYS ask you about your gut! 

What Causes SIBO

There are many causes of SIBO that have been shown but I want to point out the most researched and most common causes. One of these may relate to you. 

• Food poisoning - aka bacterial gastroenteritis. This is actually the #1 cause of SIBO. When you get food poisoning your body produces certain antibodies that decrease the motility of your gut. The wave of motility is called your migrating motility complex (MMC) and it is a very important housekeeping function of your gut to clean everything out in the directly of your bowels. When the MMC is disrupted certain “bad” bacteria in your large intestines can ascend upwards into your small intestines and start fermenting foods they aren’t supposed to (aka SIBO). Note - if you’ve had food poisoning once you are more likely to get it again due to the production of these antibodies so please be careful. 

• Stress - This is the most common cause I see in practice. When we have chronic stress our bodies are in fight or flight mode and not rest and digest mode. This leads to a decrease in stomach acid, digestive enzymes and bile production. Stomach acid and enzymes suppress the growth of bacteria and they are also helpful in stimulating the MMC. Stress also affects the enteric nervous system (that gut-brain connection) which stimulates the MMC.

• Abdominal strictures or adhesions - Scar tissue can occur from abdominal surgery, Crohns or Colitis or even endometriosis. The scar tissue then interrupts the proper flow of the gut, aka the MMC. 

As you can see all those causes have an affect on the MMC in our gut. The list does go on unfortunately including issues such as hypothyroidism, opiate use and even traumatic brain injury. 

If you suffer from the above symptoms, have been diagnosed with irritable bowel syndrome but given no treatment, or have digestive issues and have dealt with any of the issue above do not hesitate to get in touch. Let’s get to the root cause of your digestive concerns and help you feel better for good!

In health & happiness, 

Dr. Karen  

Indigestion - To Test or Not To Test

I often see new patients with undiagnosed digestive issues, that they have been struggling with for months, sometimes years. They have seen their GP and given either no solutions, a medication they have to stay on to feel better, or referred to a GI specialist and are waiting for many more months to then be told their scope was clear and you just have IBS! I know this can very frustrating! 

This is where Naturopathic Medicine can come in and be very helpful. We have been trained in the ins and outs of the digestive tract and possible conditions and have had many hours of nutrition training to cater a food plan specific for you. I love treating digestive concerns for a few reasons:

• Time to explain how the digestive tract works 

• Access to GI lab tests that are specific to the patient

• Tools such as nutrition, herbs, and neutraceuticals that can be specific for the patient 

• Most conditions I have found stem from gut health so I can treat skin issues, hormone issues etc by addressing the gut! 

Testing can be an invaluable tool at times and can speed up the treatment process.  I go through the 4Rs in gut health (see post here) with all my patients and usually start with the basics in gut health and/or work with where they are at or how severe their digestive symptoms are, but testing can be very helpful. For example, a recent patient of mine opted to do both the SIBO breath test and the IgG food sensitivity panel during his initial visit so we could gather all necessary information as soon as possible then treat accordingly. On his second visit, we could jump right into the test results, in this case positive for hydrogen SIBO and a sensitivity to a few specific foods, and start antimicrobial herbs specific for his SIBO results. He then saw quick results! I believe we would still have gotten moderate results without testing but with it results happened much sooner and were much better. 

Some GI tests have been criticized in the news as of late but considering the results I see when these tests are included in our clinical diagnoses and ultimately the treatment, I have to disagree with some of their conclusions. A few of the digestive system tests I use are:

• IgG food sensitivity - This is a comprehensive test including 160 foods that you could have an IgG sensitivity to. I always make sure patients are aware that if several foods come back as a sensitivity then we are dealing with a “leaky gut” generally and eliminating the bigger culprits is important as well as a lot of gut healing support. 

• SIBO Breath Test - Many cases of “IBS” are associated with an imbalance in bacteria that cause bloating, gas or bowel movement issues. In the case of SIBO it is an imbalance in the upper GI bacteria and the digestive wave is not functioning correctly. Testing reveals if this is the case, how severe the imbalance is and what type of dysbiotic bacteria is highest. We can then treat more effectively. 

• GI Mapping or Stool Analysis - In more complex cases or if there is a history of parasites and negative scopes, stool analysis is valuable. Among other things his reveals what bacteria, parasite or virus is running rampant in the gut as well as how much inflammation is present. This test is very comprehensive and informative, but it is also more expensive. 

If you have been dealing with digestive issues for awhile with no diagnosis or direction, testing may be of benefit to you. There are many Naturopathic approaches to healing the digestive system and it is one area I love treating. Come visit me! 

In heath & happiness,

Dr. Karen

(Photo credits: 1 - https://www.everydayhealth.com/digestive-health-pictures/lets-hope-its-just-gas.aspx; 3 - www.sibodoctors.com)