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  

Celery Juice: Fad or Real?

My attempt at celery juice.

I’ve been asked many times about the 2019 wellness trend celery juice and whether the health claims are actually valid. So I did a little digging to find out if it really is all that it is cracked up to be. Is it the ultimate detoxer? Can it actually cure chronic disease, bloating, heartburn, acne, eczema etc? Let’s break it down.

Pros:

• What I love about this trend is that it is pushing people to first drink more fluids in the morning and eating (or drinking in this case) more vegetables. This is key is my book! I try to get my patients to eat 2 cups of veggies 2x/day so if you can cross a cup or two off your list in the morning that it a bonus!

• Celery is full of vitamins and minerals, especially vitamin K (although not nearly as much as what is in other greens such as kale, spinach or broccoli). Most of its nutrients are still intact in the juice form, except for the fibre, so you are still reaping the benefits if you drink the juice.

• Celery can decrease inflammation as it contains many antioxidants, which decrease overall oxidative stress in our body. This can ultimately decrease chronic disease such as hypertension, cancer and digestive concerns.

• Due to certain non-starchy polysaccharides, especially one called apiuman, celery protects against inflammation in the digestive tract as it improves the integrity of the stomach lining (although only tested in animals). This can lead to decreased bloating, heartburn and inflammatory bowel conditions. This helps in the Repair portion of my 4 R’s in gut health.

• Celery reduces water retention due to phytonutrients called phthalides, ultimately leading to decreased blood pressure or edema/bloating (however only the blood pressure effects have been researched).

Cons:

• Studies on celery, as I have eluded to above, have mostly been on animals only, and not much research has been done. I could not find a study on just celery juice as well.

• The studies on the effects of phthalates for water retention are only on celery seeds, celery oil and celery extracts and not the whole plant (or just juice in this case).

• Finally, some stores are running out of celery!! What are we to do?!

Confusing claims:

• This wellness trend seems to have been initiated by the medical medium Anthony William. He claims all the above pros as well as the ability of celery juice to kill pathogens in the body, which could be causing GI upset, acne, UTIs etc, by its sodium cluster salts. What are sodium cluster salts you ask? I don’t know! He even states that science and research has yet to discover them. He also claims that these sodium cluster salts get neutralized and therefore are inactive if you add anything else (even water or lemon) to your juice and do not drink it on an empty stomach. He may be correct, but as he said this has not be proven or even discovered yet!

Final thoughts:

Is celery juice healthy for you? Yes! Is it a must to incorporate into your morning routine? No.

Although there are several health benefits of celery (the whole plant, not the just the juice), research is lacking on the health claims that have been shared. That said, I don’t see any negatives to adding it to your healthy diet, as long as you are already getting other veggies in your diet including the fibre.

Those that have tried it have told me they have seen great benefits in their digestive system and skin mostly. So it may be worth giving it a shot!

Have you tried 16oz of pure celery juice, first thing in the morning on an empty stomach? I’d love to hear your experience!

In health & happiness,

Dr. Karen

p.s Any other health trends you are curious about? Let me know :)

IBS Diet - Why A lowFODMAP Diet Is Not Advised Long-Term

More and more digestive patients of mine tell me that it has been suggested they go on a low-FODMAP diet (easily fermentable foods) to help/cure their IBS symptoms. Sometimes they are even told to stay on it longterm despite not seeing a big benefit. Unfortunately this is not the best suggestion and can actually cause some long-term side effects leading to worse digestive issues. Only a few digestive condition warrant a low-FODMAP diet, including something called SIBO, small intestinal bacterial overgrowth, and only for a short amount of time. To simplify, SIBO basically means that bacteria have ascending up from the large intestine into the small intestine where they are not supposed to be and cause symptoms such as diarrhea or constipation, bloating, gas, and pain. Yes, many patients with IBS do have SIBO, however it is important to accurately test and properly treat, instead of staying on a restricted diet long-term. We want to treat the root cause, not just decrease symptoms.

A low-FODMAP diet keeps symptoms of SIBO under control simply by starving the bacteria in your small intestines. When they don’t have food, they aren’t able to ferment that food and produce unwanted gas. It doesn’t always solve the problem however. Longterm, this can starve the bacteria in your large intestines that have a beneficial role in our gut and overall health as well as potentially set patients up for reoccurrence of SIBO. Studies have shown that a long-term low-FODMAP diet can reduce the diversity and quality of beneficial bacteria in the large intestine.  

Yes this diet can reduce symptoms IF you have IBS/SIBO, however dietary changes alone are often not enough to treat. We want to actually eliminate the bacteria vs starve them into a dormant state. A low FODMAP diet (or similar low carbohydrate diet) is only one portion of my SIBO protocol and should only be used for about 6-8 weeks in the final phase, or short term at the beginning to lessen symptoms. As mentioned, my main goal is to eliminate the unwanted microbes with antimicrobials. This phase does not happen for long as well, only about 6-8 weeks typically.

In the long term, we want to eat FODMAP foods to feed the beneficial bacteria in the large intestines. We also want to keep our diet as diverse as possible to allow greater nutrient density and get a wider variety of nutrients. 

My last point is that SIBO is often a symptom of a deeper digestive problem, therefore after properly treating this condition we then address the root cause, which could be low stomach acid, gallbladder issues, intestinal motility issues, scar tissue, stress and so on. 

Therefore if you have been advised to start a low FODMAP diet, or have been on it for even a few months already, please consider seeing a Naturopathic Doctor like me to consult on whether this is the right treatment path for you, to get tested for SIBO, or to help get to the root cause of your digestive concerns. 

Any questions? I'm happy to help!

In health & happiness,

Dr. Karen

Digestive Health - Where is the pain?

When someone tells me they have stomach pain I always ask them to point to where the discomfort is, since we tend to use that reference loosely. The abdomen is complex with lots of parts (remember the game Operation?!) therefore pointing to the area of pain gives me the best reference of which area or organ is the actual issue. 

I continue to see a lot of digestive concerns in my practice and treat it differently depending on the area of discomfort. An abdominal exam also gives me an idea of what to treat…something that many of my patients claim no one has done yet throughout their years of abdominal complaints! 

So where is your pain?

Let’s go through the main areas of the abdomen along with the common issues in those areas. This is quite simplified, however it may help you zone in on the true cause of your concern and possible treatment options.

Upper abdomen: 

• Esophagus 
• Stomach

Common concerns:

• Heartburn, reflux, GERD - Pain in the upper chest or under ribs in the middle is typically due to low stomach acid instead of high stomach acid (refer to this blog for a full explanation if your mind is blown!), creating a weak lower esophageal sphincter (LES). We want to strengthen the sphincter, sooth the stomach and ultimately increase stomach acid.
• Food feeling heavy or sits there - This is a common symptom of low stomach acid, or silent reflux.
• H.pylori - This bacteria has run rampant in your stomach and is now causing damage. It is treated with triple or quadruple antibiotic therapy along with natural remedies to sooth and protect the stomach lining. Some options are DGL, marshmallow root, melatonin and even broccoli sprouts.

Middle abdomen:

• Liver
• Gallbladder
• Pancreas
• Upper intestines 

Common concerns:

• Gallbladder insufficiency - Is there a mild pain under your right lower ribcage, worse when eating fat or fibre? When the digestive juices (HCl, bile, digestive enzymes) are not stimulated properly there is stagnation in the liver/gallbladder causing issues. We need to stimulate bile production and release with bitters, choline or other herbs. 
• Gallbladder stones or sludge - Prolonged stagnation eventually creates stones or sludge. People on an oral contraceptive pill, taking a heartburn medication such as Nexium, or have a history of parasites have a higher risk of creating stones. We need to be more careful with treatment in this case.

Lower abdomen:

• Lower intestines/colon 
• Appendix 
• Uterus/Ovaries 

Common concerns:

• SIBO (Small intestine bacterial overgrowth) - To put it simply, bacteria that should only be in your large intestines has ascending upwards into the small intestine. There are several causes of SIBO to long to discuss here. Symptoms could vary from bloating and heartburn, to chronic constipation and/or diarrhea. Getting tested with your ND is helpful.
• Constipation - If SIBO is not the root cause, common reasons for constipation would be lack of routine, bacteria imbalance, magnesium deficiency, lack of fibre in the diet or even dehydration. 
• Chronic bloating - The more common reasons for chronic bloating are food sensitivities, bacteria imbalance, or SIBO. A simple detox or elimination diet can do wonders in decreasing bloating at times.
• Endometriosis - Do you have disperse pain, worse during your menstruation? Endometriosis can cause scarring and adhesions within the abdomen leading to more pain during certain times of the month. These cases require more extensive testing and treatment. 

These concerns are covering the more common and simple causes of digestive complaints. I suggest consulting with a Naturopathic Doctor like myself to help with correct treatment or with support for more complex cases. 

In health & happiness,

Dr. Karen