Stomach problems and heartburn are some of the most reasons folks seek care. In conventional medicine, going to your provider for heartburn, bloating or stomach pain often results in a 10 minute appointment, perhaps a quick belly exam in you are lucky to get someone not too rushed, and a prescription for antacids. You may feel okay temporarily, but your symptoms come raging back time after time, leaving you frustrated and wondering what is causing it.
You decide to see an integrative provider because you just aren't getting answers or relief and really don't want to be taking medications if you don't have to.
Your experience from the moment you walk in the door to when you leave is a totally different experience. For one thing, your provider actually sits down and listens to you, rather than standing at their computer by the door, waiting to make an exit. And they explain to you some of the root causes that could be causing your symptoms, rather than just offering a quick-fix symptom suppressing script. You leave feeling empowered that your body is wise and can heal now that you have some knowledge and tools and someone on your team to support your journey.
You now understand that bloating, belching, and heartburn are the symptoms of an underlying cause, your body's way of trying to tell you something needs to change. You've learned during your visit with your integrative NP that the following are some frequent underlying (fixable) causes of your symptoms:
Imbalance of gut bacteria--too much in the wrong location (SIBO) or not enough of the good bacteria
Nutrient deficiencies such as magnesium, B vitamins, vitamin D, zinc
Hypochlorhydria (low stomach acid) from age or medications--yes! Not enough acid can cause problems!
Bacterial or parasitic infection
Food allergies or intolerances
High cortisol levels
Insufficient digestive enzymes
Inflammatory foods and/or gut inflammation
Structural compromise like LES, hiatal hernia, dysmotility etc.
Side effect of other medications you are taking or have taken like ibuprofen
Hormonal imbalances
Acid-provoking foods
Gallbladder or pancreas problems
Chewing habits (fast eating), large meals
Weight, abdominal obesity
Standard American Diet (SAD)
Delayed stomach emptying/poor intestinal motility (for many reasons, including prior viral infection, damage to the vagus nerve, diabetes, and autoimmune disorders)
Insulin resistance
Long-term use of over-the-counter antacids and proton pump inhibitors (used to treat ulcers and acid reflux)--yes this can actually cause and prolong stomach problems! These medications block several key vitamins and nutrients that your body needs to digest foods and balance stomach acid.
Gastric bypass surgery
Chronic stress
Constipation
Gut permeability ("Leaky gut") from exposure to certain medications like birth control, antibiotics, anti-inflammatories or from inflammatory foods and chemicals like glyphosate found in high concentration in most gluten/wheat products.
Other causes that need to be identified and ruled out immediately such as stomach cancer, throat cancer, ovarian cancer, colon cancer--all can cause vague bloating and stomach issues.
While absorbing all this new information is overwhelming, you are excited to finally find a provider that takes the time to educate you and believes in your ability to be a key player in your own healing. You also feel supported when your provider offers you tangible guidance and tools you can immediately start to implement:
Elimination trial: avoidance of acid-aggravating, microbiome-disrupting foods such as gluten, dairy, red meat, carbonated beverages, citrus, tomato, spicy foods, chocolate, alcohol, caffeine (she explains that these foods may not have to be avoided indefinitely, but a strategic 3 week trial period of strict avoidance can help identify which foods are your problem foods)
Food allergy testing
Chewing food slowly & thoroughly to activate digestive enzymes in the mouth--critical first stage of digestion.
Not eating while highly stressed or anxious if possible
Eat smaller, more frequent meals rather than large meals
Avoid large meals before bedtime when being horizontal decreases digestive process
Hormone testing for estrogen, progesterone, cortisol and thyroid-all which play a role in digestion-and then working with provider to balance hormones
Digestive Enzyme testing or taking digestive enzymes before eating; Foods that contain natural digestive enzymes include pineapples, papayas, mangoes, honey, bananas, avocados, kefir, sauerkraut, kimchi, miso, kiwifruit and ginger
Increase fiber-rich, nutrient dense foods to "feed" the "good gut bacteria" needed for healthy gut function and digestion; some people can't tolerate raw foods until the gut is healed more, so they may need to eat cooked veggies instead to get fiber.
Take a probiotic based on microbiome testing so certain strains of bacteria can be added or reduced
Slowly get off medications that are causing more harm than good
Nutrient testing to determine what vitamins/minerals need to be supplemented
Soothe & heal gut membrane tissues with specific herbs and supplements such as slippery elm, licorice (DGL), marshmallow root, aloe vera
Screen stomach, intestines, liver, gallbladder and pancreas with labs, imaging, scopes as indicated to rule out any other serious problems
Zinc carnosine can help repair & strengthen gut lining and gastric structures
Incorporate stress reduction (cortisol lowering) techniques such as deep breathing, mindfulness, yoga. High cortisol "turns off" digestion.
Increase motility of intestines to stop constipation, which contributes to heartburn and bloating--there are herbs, nutrients, and gentle medications/nutrients to help with this such as LDN, magnesium, fiber, increased water, ginger, globe artichoke, caraway
Balance blood sugar to reduce insulin resistance; test for insulin resistance.
Test for SIBO (small intestinal bacterial overgrowth) and treat if present (SIBO is a common cause for bloating and heartburn)
Patient example:
Sarah (name changed for privacy) is 30 year old mom of 3. She comes to see me for concerns of bloating and "feeling 9 months pregnant" by the end of the day. She also sometimes has heartburn and difficulty swallowing pills. Additionally, she is starting to notice that she is reacting more often to certain foods--or at least she speculates it could be foods--she isn't sure. But she is sometimes having hives, indigestion and itchy ear canals and headaches. She alternates between loose stools and constipation.
Over the course of several visits, Sarah and I worked together to uncover and address many of the root causes listed above.
Allergy testing-I referred Sarah to an allergist for testing and did some additional food allergy testing at my clinic. She learned she was reacting to gluten, dairy, and nuts and chocolate--some of her staple foods.
Elimination trial--for 3 weeks, she eliminated all these foods and slowly one at a time reintroduced them to see what she reacted too. She noticed immediately that her symptoms came back when she reintroduced these foods but felt great off them.
Stool studies--we ordered advanced stool studies that look at digestive enzymes, metabolism, types and quantity of gut bacteria, yeast, and parasites. Her results confirmed what I suspected: SIBO causing the bloat and contributing to the heartburn. We treated the SIBO with natural antimicrobials for 4 weeks. She was deficient in some digestive enzymes so we added these for her to take before meals. We also learned from the stool testing that she was deficient in some good strains of bacteria that help with digestion, so once we treated her SIBO, we added back in a specific probiotic with this bacterial strain.
Hormones-we ordered advanced hormone testing and noticed her cortisol was high, which impedes digestion. Her progesterone to estrogen ratio was high, which was likely playing a role in her symptoms as well. We worked together to naturally even out these levels.
Gut healing supplements: She started using DGL (a specific type of licorice), slippery elm, marshmallow root and aloe vera as part of a gut healing protocol.
She started taking magnesium every night, drinking more water, getting daily exercise, and increasing her fiber--now her bowel movements are more normal and she isn't constipated.
Her stool test and some lab work confirmed overgrowth of yeast, which explained her itchy ear canals and sugar cravings and frequent urinary tract infections. Her fasting insulin and blood sugars on labs was elevated, which correlates with the overgrowth of yeast. She eliminated sugars and decreased carbs in her diet and started a supplement to help decrease yeast growth.
Conventional as well a functional lab testing revealed she was deficient in several B vitamins, zinc, vit D and magnesium, all which are needed for digestion, absorption, hormone production, and metabolism. Blood markers of inflammation were high.
Lifestyle: Sarah worked to reduce her cortisol levels with daily mindfulness practices, adaptogenic herbs like ashwagandha that reduce cortisol, and started to eat more slowly and thoroughly. She stopped eating a large meal right before bed and instead at small meals earlier in the day. She swapped her 2 cups of morning coffee for 1/2 cup and nightly wine for a soothing digestive tea. Instead of nightly Netflix, she opted for at least 15 min a night of grounding, calming yin yoga so bring herself out of her sympathetic nervous system and into her parasympathetic nervous system, which turns on the switch for "rest and digest."
Outcome: 8 weeks later Sarah reported to me that her itchy ears were no longer itchy. She wasn't having hives. She wasn't bloated. She wasn't having heartburn, and overall she said "I feel the best I've felt in years." It took a lot of work and patience of Sarah's part. It didn't happen in just 1 or 2 visits. She was dedicated to her healing and saw me 1-2 times a month. If she had gone the traditional route, she'd be on an acid-blocker, which would contribute to long-term digestion problems and nutrient deficiencies. She wouldn't have addressed the underlying causes of her symptoms.
**It is not suggested to abruptly stop any acid-reducing medication as this can lead to "rebound" heartburn; work closely with a trained provider to slowly taper off your medications if you choose this route.
**This blog is for education only and is not to be taken as medical advice.
Need an integrative approach to your tummy troubles, heartburn, bloating? Our integrative primary care practice is accepting new patients and takes most insurances.
Schedule a visit with one of our integrative nurse practitioners today easily online at www.hearthsidemedicine.com or by calling 541-316-5693
We can care for patients in Oregon, California or Washington via telehealth or patients can be seen in our Bend, Oregon clinic.
About our providers: Havilah Brodhead, Marie Mency, Rachel Query are board-certified family nurse practitioners with additional training in integrative medicine.