Updated: Jan 20
One of the most common reasons folks come to see us in both integrative primary care and functional medicine is for gut health, stomach pain, and digestion problems. In this article, I'll go through the 13 most common causes of tummy woes and provide many pearls of what you can do for prevention, healing and relief!
......And without further ado, here are your common culprits!
Autoimmune Gut Disease (Crohn's and Ulcerative colitis)
(Already have a diagnosis? Skip to your section!)
1. IBS (Irritable Bowel Syndrome)
IBS is often associated with recurrent abdominal pain, diarrhea, constipation or both with symptoms such as gas or bloating. Many patients who suffer from IBS may also suffer from dysbiosis (unbalanced gut bacteria), SIBO (small intestinal bacterial overgrowth), underlying food sensitivities or pancreatic insufficiency (lack of digestive enzymes).
Inability to empty bowels (or feels incomplete)
Passing excessive amounts of gas
Urgent need to defecate
Abdominal cramping or discomfort
Enteric coated peppermint oil capsules--1 Cap 3x a day at least 30 to 60 minutes before eating and not to consume the capsule too soon after a meal. IBgard is an example.
L0w-fodmap diet (temporarily) with a nutritionist to guide you
Food Intolerance Testing with your functional med provider via Genova or KBMO labs
Curcumin start at 150mg-200mg a day and gradually increase to around 1500-1800 mg a day
Digestive Enzymes-Take About 10 min before meals. I like Bio-Gest by Thorne or Pure Encapsulations Digestive Enzymes Ultra
Probiotics-if they make it worse, get tested for SIBO--otherwise, choose one with more than 8 strains and more than 50 billion count--I like ReNew Life Ultra; most people will experience looser stools initially for a couple weeks.
Zinc Carnosine 75 mg twice a day, Magnesium 600 mg at night (most importantly for those with constipation dominant IBS)
Increase fiber--if fiber is difficult to tolerate, test for SIBO
L-Glutamine (don't take if you have cancer) maximum dose is 30 grams per day. This is split into 5 grams taken six times per day--such as glutashield powder or enteromend
Bovine Immunoglobulins 5-10 grams a day; I like ImmunoLin or Intestinal Support
Ginger Capsules such as Pure Encapsulations Ginger Extract
Working with somatic therapist and doing vagus nerve healing
Dysbiosis is an imbalance of good vs. bad bacteria in the gut. When your body is in dysbiosis, your health may decline. Your gut bacteria affects immunity, digestive health, and mental health. SIBO (small intestinal bacterial overgrowth) is often a side effect of dysbiosis.
Acid reflux or heartburn
Food intolerance, gas, and bloating
Inflammation and aching joints
Acne, skin rashes, and psoriasis
ADHD or issues with concentration
Anxiety or depression
Bloating (often worse at the end of the day)
Patient feels better on Low FODMAP diet
Patients’ symptoms get better after antibiotic treatment
Feel worse after taking probiotics or eating fermented foods
An uncomfortable feeling of fullness or gas immediately after eating
Comprehensive microbiome/gut testing with functional medicine provider
SIBO Breath Test (Treating SIBO with herbal antimicrobials depends on if the patient is Methane or Hydrogen dominant)
Herbal antimicrobials: Allicin, Oregano oil, Thyme, Lemon Balm, Sage, Oregon Grape, Berberine (taken best in combination such as Candibactin, GI-MicrobX, SIBOtic)
Food Intolerance Testing
Limit Carbohydrates and Sugar (Low-fodmap diet x 12 weeks)
Oil of Oregano capsules for 6 weeks can be helpful for all forms of SIBO
Spore-based probiotics (may not tolerate until SIBO treated)
Motility Agents (for those with constipation or slow stool transit time) with prescription such as LDN, ginger capsules, magnesium citrate 600 mg , 5-HTP (interacts with many medication so caution), artichoke
Increased fermented foods and fiber are critical for dysbiosis after SIBO is treated (often not tolerated until SIBO is resolved)
Daily exercise to move the bowels
Gut healing agents such as aloe, glutamine, slippery elm, marshmallow root (best taken in combo such as GI-Relief or Enteromend)
Prescription antibiotics if necessary
Burning sensation in chest (heartburn), usually after eating, which might be worse at night or while lying down
Backwash (regurgitation) of food or sour liquid
Upper abdominal or chest pain
Trouble swallowing (dysphagia)
Sensation of a lump in your throat
Regurgitation of food or liquids into the mouth
Backflow of stomach acid into the esophagus (acid reflux)
Chest or abdominal pain
Feeling full soon after you eat
Shortness of breath
If you have nighttime acid reflux, you might also experience:
An ongoing cough
Inflammation of the vocal cords (laryngitis)
New or worsening asthma
Chew food sloooowly until is it near-liquid consistency to activate amylase digestive enzyme in your saliva and help start the digestion process
Get checked for a hiatal hernia and SIBO, common causes of heartburn
Treat SIBO if present
Repair hernia if possible
Get checked for H. Pylori bacteria and treat if present
Marshmallow, slippery elm, aloe vera, and DGL (such as GIRelief by Thorne)
Go on a GERD diet: limit spicy and fried foods, peppermint, carbonated beverages,
Small meals more frequently instead of large meals
Go for a walk after eating, don't eat before laying down
Work with provider to lose weight-obesity highly associated
Trial of apple cider vinegar or HCL tablets (with your provider's guidance)
600 mg of magnesium at bedtime
Zinc Carnosine 75 mg twice a day
L-glutamine (avoid if you have kidney disease, liver disease, type 1 diabetes, seizures or Reye's syndrome)
Decrease stress-consider adaptogens such as holy basil and rhodiola and yoga/meditation practices
D-limonene such as brands Yarrow, Life Extensions, Orange Burps & Wellness Resources
4. Autoimmune Gut Disease/Irritable Bowel Disease (Crohn's and Ulcerative colitis)
Crohn's disease is a type of inflammatory bowel disease (IBD). It causes swelling of the tissues (inflammation) in your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and malnutrition.
Ulcerative colitis is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine, also called the colon, and rectum. In most people, symptoms usually develop over time, rather than suddenly.
Symptoms of Crohn's:
Abdominal pain and cramping.
Blood in your stool.
Reduced appetite and weight loss.
Pain or drainage near or around the anus due to inflammation from a tunnel into the skin (fistula)
People with severe Crohn's disease may also experience symptoms outside of the intestinal tract, including:
Inflammation of skin, eyes and joints
Inflammation of the liver or bile ducts
Iron deficiency (anemia)
Delayed growth or sexual development, in children
*High frequency of vitamin and mineral deficiencies
Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it occurs. Signs and symptoms may include:
Diarrhea, often with blood or pus
Rectal bleeding — passing small amount of blood with stool
Abdominal pain and cramping
Urgency to defecate
Inability to defecate despite urgency
In children, failure to grow
*High frequency of vitamin and mineral deficiencies
Low-Fodmap/Elimination Diet with functional nutritionist
Gluten and dairy free diet
Extra fiber (not during flare) such as SuperGut Fiber Mix
Sodium Butyrate or butyric acid
Curcumin (1,000 mg twice a day for 2 months)
Omega 3- Fatty Acids
In-Depth nutrient testing
Magnesium, iron (if needed based on labs)
Comprehensive functional gut /microbiome testing with functional provider
Food Intolerance Testing
Ox Bile (Allergy Research Group or BioGest by Thorne)
GI Synergy (Apex Labs)
GastroFiber (Standard Process)--for those who don't get enough fiber in diet
GI Relief by Thorne
Super Digestive Enzymes (Life Extensions) or BioGest (Ox Bile + Enzymes) by Thorne
Wormwood Complex (Standard Process) or SedaCrohn® 500 mg 3x daily (during flares or up to 10 weeks intermittently for symptoms)
Andrographis paniculata (Acanthaceae)
Boswellia serrata (Burseracea/Indian frankincense)
Cholacol (Standard Process) for constipation and/or indigestion (contains bile salts)
Probiotic such as RenewLife Ultra or Prescript Assist 2 caps/day
L-Glutamine 500 mg 2x/day (Thorne),
Vitamin D3(Thorne)-dose determined by blood levels
B Complex #12 2x/day (Thorne)
Regular daily exercise to increase gut health and motility
Saccharomyces boulardii by NOW or Pure Ecapsulations (IF yeast present in stool testing)
Avoid potential triggers:
Sorbitol, xylitol, or other sugar alcohols
5. Pancreatic Insufficiency
A condition when the pancreas does not make enough digestive enzymes. Without the proper amounts of digestive enzymes, patients struggle to break down foods and absorb nutrients properly. As a result, the food that passes through your intestines is not entirely digested and can lead to bloat, gas, loose stools, and, eventually, malnutrition. Your providers can easily check a pancreatic elastase level to aid in the diagnosis.
IBS or SIBO symptoms like gas, bloating, constipation, and diarrhea
Unexplained weight loss (not everyone)
Feeling of fullness
Abnormal lipid digestion causing malnutrition; depletion of lipid-soluble vitamins (A,D,E,K); selenium, zinc, B12, calcium, and iron
Dry skin, brittle nails and hair loss
Edema (tissue swelling)
Fatigue or dizziness.
Feeling cold all the time
Memory and concentration issues
Pancreatic enzyme replacement therapy (PERT)
Digestive Enzymes from Pure Encapsulations or Thorne
Ox Bile (Biogest by Thorne)
Get full nutrient testing and supplement if needed
Avoid Alcohol (can damage an already struggling pancreas)
Check for causes of pancreatic insufficiency such as
Inflammatory bowel disease (IBD)
6. Celiac Disease
An immune reaction to eating gluten, a protein found in wheat, barley and rye.
If you have celiac disease, eating gluten triggers an immune response in your small intestine. Over time, this reaction damages your small intestine's lining and prevents it from absorbing some nutrients (malabsorption). The intestinal damage often causes diarrhea, fatigue, weight loss, bloating and anemia, and can lead to serious complications.
In children, malabsorption can also affect growth, development and behavior.
Symptoms for adults:
Bloating and gas
Nausea and vomiting
More than half the adults with celiac disease have signs and symptoms unrelated to the digestive system, including:
Anemia, usually from iron deficiency (fatigue, bruising, difficulty concentrating, shortness of breath, difficulty exercising)
Loss of bone density (osteoporosis) or softening of bone (osteomalacia)
Itchy, blistery skin rash (dermatitis herpetiformis)
Headaches and fatigue
Nervous system injury, including numbness and tingling in the feet and hands, possible problems with balance, and cognitive impairment
Reduced functioning of the spleen (hyposplenism)
Children with celiac disease are more likely than adults to have digestive problems, including:
Nausea and vomiting
Pale, foul-smelling stools
The inability to absorb nutrients might result in:
Failure to thrive for infants
Damage to tooth enamel
Neurological symptoms, including attention-deficit/hyperactivity disorder (ADHD), learning disabilities, headaches, lack of muscle coordination and seizures
Ask your provider to run a celiac lab panel
Get an endoscopy/colonoscopy with tissue sample (biopsy) to check for celiac
Strictly avoid ALL gluten, rye, wheat, barely and food cooked near/with gluten for at least 8 weeks and note how you feel if you haven't been tested yet
A strict, lifelong gluten-free diet is the best way to manage celiac disease.
Get tested for SIBO, yeast, thyroid disorder, osteoporosis, and pancreatic insufficiency as they frequently co-occur
Avoid lactose (dairy), fructose (fruit), sucrose (honey)-hard to digest with celiac
Work with a functional medicine gut specialist (such as Hearthside Medicine) to optimize gut health and heal damage to gut lining
Consider gut-healing, anti-inflammatory supplements such as probiotics, L-glutamine, ALA, zinc carnosine, GI Relief by Thorne, Omega 3 Fatty Acids, Vit D, bomelaine, quercetin, curcumin, probiotics.
Nutrient dense Foods & Fermented Foods
Get a full nutrient panel to check for malnutrition (common), and supplement as needed, especially Folate, Iron, Vitamin B-12, Vitamin D, Vitamin K, Zinc & Copper
Gastritis is a general term for a group of conditions with one thing in common: Inflammation of the lining of the stomach. The inflammation of gastritis is most often the result of infection with the same bacterium that causes most stomach ulcers (H. Pylori) or the regular use of ibuprofen-like medications. Drinking too much alcohol also can contribute to gastritis.
Gastritis may occur suddenly (acute gastritis) or appear slowly over time (chronic gastritis). In some cases, gastritis can lead to ulcers and an increased risk of stomach cancer
Peptic ulcers are open sores that develop on the inside lining of your stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is stomach pain. In the past, it was thought that stomach ulcers were caused by increased stomach acid. However, up to 50% of patients do not have increased stomach acid and many may have low stomach acid. Low secretory IgA and high calprotectin are commonly found in the presence of ulcers or other inflammatory conditions of the gastrointestinal tract.
Helicobacter pylori infection: occurs in 90% of duodenal ulcers and 70% of gastric ulcers; infection with H.pylori increases risk of ulceration by 2-6 times.
Feeling full after eating a small amount of food
Burning stomach pain
Bloating or belching
Intolerance to fatty foods
Not feeling hungry
Losing weight without trying
Bloody or black stool
Dull or burning pain in belly between your breastbone and your belly button (navel). This pain often occurs around meal times and may wake you up at night. It can last from a few minutes to a few hours. Pain is either better or worse with eating.
Diet of warm soups, ripe banana, stewed fruit, steamed vegetables, brown rice, yoghurt, avocado, potato, porridge.
Avoid raw foods, meat, spicy foods, salty foods, acidic foods
Slippery elm: 1-2 tsp in water 3-4 times daily with food or made into a porridge. Helps soothe and repair gut mucosa
Regulate gastric acidity
Avoid sugar, coffee (including decaffeinated), alcohol, carbonated drinks, refined carbohydrates, acidic foods, fried foods and excessive animal proteins, including dairy foods (dairy will temporarily decrease stomach acid, but this is followed by a rebound increase)
Increase dietary fibre: fibre has been shown to be beneficial in the healing of ulcers, partly due to the increase of transit time. Soluble fibre, in particular, is mucilaginous and can help with coating and soothing the gastric mucosa.
Avoid overeating and frequent snacking
Eat slowly and chew food thoroughly
Protect/repair gut mucosa:
Include glutamine rich foods: beans, brown rice, eggs, fish, legumes and cabbage juice: cabbage juice is high in glutamine; studies have found that 1L daily can facilitate healing of ulcers
Test for & treat H.pylori infection and any other bacterial infections in the gut
Identify food allergies and intolerances: a wheat and dairy-free diet may be recommended-work with a provider who offers food intolerance testing
Licorice (DGL), slippery elm, marshmallow--calming & soothing-I like GI Relief by Thorne
Mucosal repair: goldenseal, calendula, aloe, bilberry
Antacids: meadowsweet, alfalfa
Carminatives: chamomile, lemon balm, fennel, peppermint--calming/soothing
Natural antimicrobials: echinacea, goldenseal, chamomile, barberry, Oregon grape--only use if there is confirmed SIBO and/or H. Pylori (and with integrative provider direction)
Gentle bitters: chamomile, centaury
Nervines: oats, vervain, passionflower--help with abdominal pain
Probiotics – can exacerbate symptoms where bacterial overgrowth is present--treat SIBO first then add in
Zinc carnosine 75 mg twice a day: enhance gut repair
Omega-3 EFAs: reduce inflammation--Nordic Naturals
Curcumin: reduce inflammation--I like Qunol
Vitamin B12 may be indicated in patients with pernicious anaemia or with H.pylori infection--get levels checked
8. Cholecystitis & Gallstones--Inflammation of the gallbladder, a small, pear-shaped organ on the right side of the belly beneath the liver.
Your gallbladder holds a digestive fluid (bile) that's released into the small intestine. The gallbladder plays a vital role in our digestive process by storing bile which helps us break down fats and assists with the absorption of fat-soluble vitamins A, D, E, and K and cholesterol. Excess cholesterol accounts for 80% of gallstones. Gallstones blocking the tube leading out of the gallbladder cause 90% of cholecystitis (infection). The conventional approach involves use of medication or surgery to remove the gallbladder, whereas the Functional Medicine approach looks to treat the root cause. *In severe cases, cholecystitis can lead to severe, sometimes life-threatening complications, such as a gallbladder rupture. It is important to work with a medical provider.
Symptoms may include:
Severe pain in your upper right or center abdomen-- Pain is usually gripping or gnawing, often after a meal, especially a large or fatty one.
Pain that spreads to your right shoulder or back
Tenderness over your abdomen when it's touched
Jaundice (yellow coloration to skin or eyes)
Gas, nausea and abdominal discomfort after meals
Episodic biliary pain in the right upper quadrant or epigastric area lasting 30 minutes to several hours. Episodes may occur daily or every few months
Gallbladder disease results in reduced bile flow into the gut lumen, often causing an increase in small intestinal bacterial overgrowth (SIBO)