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

Probiotics Everywhere - What To Really Look For!

At the end of last year I did a talk to local Holistic Nutritionists and it was mentioned that one of the top trends of 2017 was going to be probiotics. Not just those good gut bugs in general, but adding them to all different types of foods. So I was curious to see what the commercial industry was going to come up with next. What I am seeing lately is probiotics in orange juice! FYI - probiotics are not naturally found in juice. To see a benefit you also want a lot more than the 1 billion found in that cup of juice they are marketing. 

Better ways than this to get your probiotics :)

I want to shed a little light on probiotics so you have a little more information when those marketing gurus try to direct their product your way. 

Benefits of probiotics:

There are so many strains of probiotics, which are beneficial bacteria that reside mostly in the large intestine of your gut. More and more research is coming out showing the importance of probiotics on a wide variety of conditions, including all digestive disorders, immune health, anxiety, skin health and even weight loss. In Naturopathic Medicine research is trying to get even more specific in terms of subtypes of strains to treat even more individually. In my practice I prescribe either specific probiotic strains or higher doses of probiotics - 11 billion, 50 billion or even up to 300 billion for issues such as crohns and colitis. Once we have established a healthy community of those good bugs the focus then turns more to food forms of probiotics. These would be naturally fermented foods such as sauerkraut, kimchi, kefir, yogurt or even sourdough. Naturally fermented I say...not orange juice.  

What to look for:

While I am not saying a little fresh juice is bad, it is actually quite delicious at times, it just shouldn't be your primary way of getting probiotics. Therefore when companies claim their products contain probiotics, ask yourself if it is a naturally fermented food and how many billion are actually in a serving. Focus on adding a tbsp or two of naturally fermented foods as mentioned above to your meals, or for a higher dose look for a probiotic containing 10 billion or more with more than 2 strains. 

If you are having digestive concerns that don't seem to be improving with over the counter probiotics or fermented foods consider coming in for a visit to discuss a more specific treatment plan for you! I am always happy to help. 

In health & happiness, 

Dr. Karen 

Time for a little Spring Cleaning

Do you feel as if your bucket is starting to overflow? Are symptoms such as fatigue, skin issues, bloating, chronic pain and mental fog starting to creep up on you? It may be time for you to do a little spring cleaning! 

Spring is a great time to dust off the cob webs of not only our home but our bodies as well. In Chinese Medicine, spring is the time of the liver and the liver is the main organ focused on detoxification. When working properly it helps to filter through our blood and eliminate what isn’t needed or toxic to our body. Therefore we not only have to limit what we expose ourselves to but provide the body with proper nutrients to work optimally. We have all heard the saying “we are what we eat” and that rings very true here. We cannot expect our bodies to feel vibrant and healthy if we feed it sugar and other nutrient poor foods all the time. 

“Eat food, not too much, mostly plants.” - Michael Pollen

The Bucket Theory

If you think of your body as a bucket, when we are born we have an empty bucket - a clean slate. We then get exposed to many things that fill up that bucket and unfortunately modern lifestyle and eating habits expose us to so much more than our bodies are able to handle. This may be stress, unhealthy food, environmental toxins and chemicals, prescription medication, smoking, too much coffee or alcohol. If we are not careful over time our bucket overflows and symptoms occur. This could be high blood pressure, headaches, diabetes, bloating, weight gain, chronic fatigue…you name it. Instead of suppressing these symptoms and jamming it all down, we want to optimize proper elimination and detoxification to create an ebb and flow in the bucket, preventing it from overflowing! We do this by eating nourishing whole foods and focusing on liver and digestive health. It isn’t complicated and when provided with the right tools it isn’t hard! 

When provided with the right tools emptying your bucket can easily be done.

That is where I come in. Every spring I offer a Cleanse, using real food and no fancy footwear, to help bring you back (or at least closer) to your clean symptom free self. I offer tools and resources to show you how to optimize your health with nutritious foods. This year it is a 10-Day Cleanse, from April 26th-May 5th, and all accessible online. No need to change out of our your pyjamas to get started on your health journey. 

What’s all included:

• 10 Day Spring Cleanse package with details, meal plan & delicious recipes - emailed to you prior to Spring Cleanse start date
• Video How To's from my kitchen emailed to you throughout the Spring Cleanse to support the program and inspire you in the kitchen
• Access to the Facebook support group
• 2 Online Q&A sessions with Dr. Karen - April 23rd & 30th
• Optional - Detox-Pro supplement to support cleanse (purchased through my online dispensary on Fullscript)

Want to feel your best this spring? Then what are you waiting for! Join me for a little food fun. 😃 Sign up below to reserve your spot. 

In health & happiness,

Dr. Karen