constipation

When to get help and when to do it alone.

We live in a wonderful time when we can access any information we want with just one easy click of the button.  For example, when I typed ‘gut health’ into Google I got a massive 133 MILLION hits! There is so much benefit to having access to this information, as you can get inspired, cultivate hope and discover some tools to help manage your health. However, having this much information has its down sides and can leave you feeling confused, overwhelmed or can even be dangerous.

In clinic I frequently hear my patients start a sentence with ‘I was reading about…’ or ‘I was Googling the other day and…’ Whilst I love hearing that they are taking an interest in their health, unfortunately the sentence usually ends with ‘now I’m confused’ or ‘I don’t know what to do’.

So, how do you know when you are out of your depth in addressing your health alone and when you need some professional help? To help you decide when you need to close the laptop and pick up the phone, ask yourself these five questions.

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1. Does your diet or supplement provide you with an immediate improvement and/or if you were to stop your treatment, would this effect be long-term?

If not, you have probably been providing yourself with Band-Aid support and not addressing the underlying issue. A great example I see a lot in clinic is constipation. Before coming to see me many patients have developed a dependency on strong coffee, laxatives or supplements to ensure a daily bowel motion. It needs to be understood that constipation is symptom of something else going on(1) and can be tricky to treat. There are many causes of constipation including an imbalance of your gut flora, SIBO (small intestinal bacterial overgrowth)(2) or nervous system issues, such as a side effect from a medication or low intestinal serotonin levels. Did you know 95% of the serotonin in our body is found in our gastrointestinal tract? Having enough serotonin is important because it signals the muscles along our digestive tract to contract and relax. This is called motility and it is necessary for regular bowel movements(3).

 

2. Do you feel overwhelmed, stressed or anxious when thinking about your health?

If so, these emotions may be making your symptoms worse(4).  When your body experiences these emotions, it enters a state of fight or flight which causes our nervous system to tip into sympathetic nervous system dominance(5). Our sympathetic nervous system is necessary for our survival, as we use it when we need to escape danger or act quickly. However, this part of the nervous system inhibits our ability to rest and digest properly(6)(because who cares about digesting when you are running away danger). Experiencing daily stress, anxiety and overwhelm regarding your health may only be making you health worse. How ironic! A proven example of this relationship is stress and its ability to worsen or flare symptoms of Irritable Bowel Syndrome(7). 

 

3. You have a sense that there is something else underlying the issue and are finding it difficult to get the big picture?

The perfect example of this is acne and congested skin. I meet many people that have ‘tried everything’; they have invested a lot of time and money into topical treatments, medications and diets without any improvement. Potentially this is because they are only treating one part of the problem.
Acne and skin congestion is considered a complex multi-system disease, rather a skin condition. Our skin is a huge organ and the health of it is a result of your diet, nutritional status, gut health and gut bugs, nervous system, hormones and immune system (8). So whilst the oral contraceptive pill or antibiotics may help manage your skin (9,10) if you stop these, your skin may go back to where it started. To make an effective long-lasting change in your skin, you need a holistic inside-out and outside-in approach.

 

4. Are you following advice that is supposed to help you and yet you feel worse?

You’ve starting eating healthier and have invested in cupboard full of supplements, yet you feel worse than ever with less energy, stomach pains, poor sleep and your mood has taken a turn. What could be going? It’s no surprise that we are all different - what works for someone may not work for you. A great example of this is if you have an underlying histamine issue. Histamine is a naturally occurring substance that we create in our body and is present in many foods. It is especially high in aged foods including bone broths, fermented foods, kombucha and kefir (11) and in some probiotics, which are readily promoted for gut healing (12). If you have tried any of these and feel worse, histamine sensitivity may be your issue. Perhaps you need the guidance from someone who acknowledges or understands the issue of histamine to help guide you back to health.

 

5. Is integrative medicine a better fit?

That is, are you required to take medications or are you under the care of practitioner who has limited understanding, interest or awareness of the role diet and gut healing plays in our wellbeing? If you answered ‘yes’ and you are trying to make supplement and dietary changes alone, you may be putting yourself in danger. Thyroxine (thyroid medication) is a great example of something that needs to be monitored closely. A change in supplements, medications and diet may alter the dosage needed to keep your thyroid in balance. If these interactions aren’t understood and accounted for, you may start to experience symptoms of thyroid imbalance (fatigue, shakiness, anxiety, gut issues)(13, 14). A practitioner that will consider these interactions is important in ensuring you a safe road to good health.

 

Closing Thoughts

Before you have lost all hope and motivation, spent years of your time and a mountain of money, reach out and get some professional support.  We love that you have taken the initiative in trying to help yourself and we want to be there for you to reach your health goals in a safe and effective way.   

By Rachel Larsson

BHSc (Naturopathy), BPH (Nutrition)            

Are prebiotics good or bad in SIBO?

Since my previous blog about IBS and SIBO I have had so many questions from my patients wanting to know more about SIBO. What stands out to me the most is a confusion around what to eat, with the most common questions surrounding prebiotic, fibre rich foods and if they help or hinder SIBO.

 

What is a prebiotic food and what does our gut do to it?

A prebiotic is a non-digestible food ingredient that it is not broken down or absorbed in the higher parts of our gastrointestinal tract(1). There are a lot of foods with prebiotic properties including chickpeas, legumes, leeks, rye bread, garlic and cashews(2). They play a special role in our health - they act as food to our gut's good bacteria, increasing their numbers (lactobacilli and bifidobacteria(3)) and improving our overall health(1).  

 

Why do these healthy foods cause discomfort?

In SIBO, the overgrowth of bacteria causes inflammation and hurts your gut wall affecting your ability to breakdown and digest food. The bugs themselves play havoc with your own enzymes and body processes. For example there is loss/decrease in an enzyme called disaccharideses, which is important for breaking down carbohydrates and sugars. This means that any food, like a prebiotic food that contains fructose, lactose and sorbitol, may not be digested properly, resulting in those uncomfortable symptoms you experience(4).

 

Treating SIBO… with prebiotics?!

You may notice that some of the foods that cause your discomfort are also considered to be high FODMAP foods. FODMAP describes a group of of short-chain carbohydrates and sugar alcohols comprising of fructose, lactose, fructo- and galactooligosaccharides (fructans, and galactans), and polyols(5).

To provide symptom relief from SIBO we may suggest avoiding these high FODMAP prebiotics foods (looking at you apples, onions and garlic!) for a short period of time. It is really important to know that excluding these foods long term is not the answer and will not fix SIBO(6). A healthy gut is dependant on you eating a fibre rich, highly diversified diet so restricting these foods for a long period of time will only worsen your situation and increase your sensitivity to more foods(7). It's not uncommon that we see patients tolerating only a handful of foods and it's best to avoid this! 

Garlic, a wonderful prebiotic food.

Garlic, a wonderful prebiotic food.

As part of our treatment for SIBO we use certain types of prebiotics in combination with probiotics and specific antimicrobials (bug killers). These types of prebiotics have beneficial roles in our gut health that are important for restoring your gut health.

The following are four common prebiotic supplements on the market, three of which we use regularly in the treatment of SIBO. The fourth is not advised!

1. Lactulose

Lactulose is made up of two sugars, galactose and fructose, which is not broken down or absorbed in our small intestine. Lactulose increases our good bugs like bifidobacteria(8) and decreases the bad ones like clostridia(9). It is generally well tolerated, however you can take too much of it and end up with loose bowels(8)

2. Partically Hydrolysed Guar Gum (PHGG)

PHGG is a natural water soluble fibre that has been broken down by an enzyme to make it smaller and to decrease the amount of galactomannon (10). PHGG increases the good bugs Bifidobacterium and Lactobacillus species and decreases nasty waste products such as ammonia(11). PHGG can also give softer stools to assist constipation(12). Studies also show that PHGG in combination with an antibiotic to treat SIBO was more useful in eradicating SIBO compared with the antibiotics alone(13), how amazing!

3. Galacto-oligosaccarrides (GOS)

GOS is formed by breaking down lactose, a common sugar found in dairy. GOS is known to increase the good bugs bifidobacteria and reduce the bad bugs, clostridia and bacteroides. Another benefit of GOS alone or in combination with a probiotic is that it can support our immune system. GOS used in its recommended dosage range is well tolerated. Again, too much of a good thing can lead to problems; abdominal discomfort, cramping, flatulence and diarrhoea(14)

4. Inulin

Inulin is beneficial to out gut because it supports our good bugs bifidobacteria. However, because it is made up fructans(15), it can be really uncomfortable to consume if you have SIBO. Studies have found inulin increases flatulence, rumbling, stomach and gut cramps, and bloating(16). So best to avoid this one! 

Take home messages

Prebiotics are very powerful and beneficial for SIBO. But remember, not all prebiotics are the same.

If certain foods are causing you pain, bloating, constipation, or diarrhoea, this is your body communicating to you that your digestion system is struggling. Ironically the foods that cause discomfort are the same foods that are important to your health. Instead of excluding these foods, we need to improve your digestive system so you can tolerate these and improve your health in the long run. This can be impossible to navigate by yourself so get a professional on board to help correct your bugs, restore your gut wall and find the diet and fibre that is right for you.

After this, you may even be able to handle eating delicious lentils, onion, garlic and apples!

By Rachel Larsson

BHSc (Naturopathy), BPH (Nutrition)