Updated: Jan 19
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)
Slow weight loss (with medical supervision /assist if needed)-obesity is highly associated with gallstones (rapid loss makes worse)
Low-inflammatory diet (work with functional nutritionist)
Avoid gluten, processed foods, high cholesterol /triglycerides, sugars
Avoid high fat foods
Increase fiber intake
Lecithin/phosphatidylcholine, choline, methionine, and glycine
Vitamins C and E
Bitter Herbs: globe artichoke, milk thistle, dandelion root, ginger, greater celandine, barberry, yellow dock, turmeric such as in Gaia or Flora Sweetish Bitters, Badass Bitters, Floradix Herbal Bitters, Urban Moonshine
Bitter Foods: radicchio, chicory, arugula, lemon, grapefruit, lime, and cranberries
Enteric Coated Peppermint Oil Capsules such as NaturalFactors, NOW, or Integrative Therapeutics
D-limonene such as brands Yarrow, Life Extensions, Orange Burps & Wellness Resources
Avoid inflammatory fats such as corn, safflower, sunflower, soy and vegetable
Digestive Enzymes such as BioGest or Purse Encapsulations
Biles Salts such as Cholacol by Standard Process or BioGest by Thorne
Increase natural anti-inflammatories such as flax, chia, salmon, vit D, curcumin, berberine, quercetin, bromelain
Decrease animal-derived cholesterol intake (meat, dairy, too many eggs)
Get your estrogen checked and balanced
Get daily exercise
Check for and treat SIBO, common with stones
Inflammation of the pancreas. The pancreas is a long, flat gland that sits tucked behind the stomach in the upper abdomen. The pancreas produces enzymes that help digestion and hormones that help regulate the way your body processes sugar (glucose).
Pancreatitis can occur as acute pancreatitis — meaning it appears suddenly and lasts for days, or as chronic pancreatitis, which is pancreatitis that occurs over many years.
Mild cases of pancreatitis improve with treatment, but severe cases can cause life-threatening complications.
Acute pancreatitis signs and symptoms include:
Upper abdominal pain
Abdominal pain that radiates to your back
Tenderness when touching the abdomen
Chronic pancreatitis signs and symptoms include:
Upper abdominal pain
Abdominal pain that feels worse after eating
Losing weight without trying
Oily, smelly stools (steatorrhea)
Pancreatitis occurs when digestive enzymes become activated while still in the pancreas, irritating the cells of your pancreas and causing inflammation. With repeated bouts of acute pancreatitis, damage to the pancreas can occur and lead to chronic pancreatitis. Scar tissue may form in the pancreas, causing loss of function. A poorly functioning pancreas can cause digestion problems and diabetes. **NOTE: It is important to get conventional medical treatment for pancreatitis as soon as possible. A severe attack can be life threatening if left untreated.
Important: Mild attacks of acute pancreatitis often improve on their own or with dietary and lifestyle changes like stopping alcohol intake and temporarily limiting oral intake to rest the digestive tract and pancreas. More severe acute cases of pancreatitis may require urgent medical attention. If gallstones block the pancreatic duct, a surgical procedure to remove the stones may need to be performed.
Conditions that can lead to acute pancreatitis include:
Gallstones--block the duct of the pancreas (most common cause for acute)
Frequent Alcohol Consumption/Binge Use: most common cause of chronic)
High triglyceride levels in the blood (hypertriglyceridemia)
High calcium levels in the blood (hypercalcemia), which may be caused by an overactive parathyroid gland (hyperparathyroidism)
Infection-including mumps, hepatitis, and mono
Injury to the abdomen
Certain drugs, including azathioprine, sulfonamides, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and antibiotics such as tetracycline
Endoscopic retrograde cholangiopancreatography (ERCP), a procedure used to treat gallstones, also can lead to pancreatitis.
Note: Although herbs should never be used alone to treat pancreatitis, some herbs may be helpful along with conventional medical treatment. Tell your physician about any herb or complementary therapy you may be considering. Many herbs can interfere with certain medications. Speak with your medical provider first.
Eat a low-inflammatory diet such as the Mediterranean diet or Pegan Diet.
Avoid saturated fats, maintain healthy cholesterol levels
Get In-depth nutrient lab testing: suboptimal vitamin A, C, and E, & selenium have been associated with developing pancreatitis. Chronic pancreatitis can also result in malnutrition due to malabsorption of the fat-soluble vitamins A, D, E, and K, and vitamin B12, calcium, magnesium, thiamine, and folic acid. Supplement with provider guidance based on lab levels.
1 - 2 tbs per day of a high-quality omega 3 fatty acid & glutamine: foods naturally rich in L-glutamine include bone broth, grass-fed beef, and cottage cheese.
Avoid alcohol, the # 1 cause of chronic pancreatitis
Take curcumin (turmeric) supplements--I like Qunol
Take a good digestive enzyme 20 minutes prior to eating--such as one from Pure Encapsulations
Frankincense and CBD can reduce inflammation-only use food grade
Avoid medications, such as thiazide diuretics and beta-blockers, that increase triglyceride levels (with your medical provider's blessing of course!)
Take multivitamin daily , containing the antioxidant vitamins A, C, E, D, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium. I like garden of Life and Gaia.
Omega-3 fatty acids , such as fish oil, 1 to 2 capsules or 1 to 2 tbsp. of oil daily, to help reduce inflammation and improve immunity. Omega-3 fatty acids can have a blood-thinning effect and may increase the effect of blood-thinning medications, such as warfarin (Coumadin) and aspirin. I like Nordic Naturals.
Coenzyme Q10 (CoQ10) , 100 to 200 mg at bedtime, for antioxidant and immune activity. CoQ10 might help the blood clot. By helping the blood clot, CoQ10 might decrease the effectiveness of warfarin (Coumadin).
Vitamin C , 1 to 6 mg daily, as an antioxidant. Vitamin C may interfere with vitamin B12, so take doses at least 2 hours apart. Lower the dose if diarrhea develops.
Probiotic supplement - Some clinicians will not give probiotics to severely immunocompromised patients. I like Renew Life Ultra.
Alpha-lipoic acid , 25 to 50 mg twice daily, for antioxidant support. Taking alpha-lipoic acid in the presence of a Thiamine (vitamin B1) deficiency can cause serious health issues. Alpha-lipoic acid may also interact with certain chemotherapy drugs.
Green tea, 250 to 500 mg daily. Use caffeine-free products. Green tea can potentially worsen anemia and glaucoma.
Holy basil, 400 mg daily, for antioxidant protection. Caution: Holy basil can have a blood-thinning effect, and may increase the effect of blood-thinning medications, such as warfarin(Coumadin) and aspirin.
Rhodiola, 150 to 300 mg, 1 to 3 times daily, for immune support. Rhodiola is an "adaptogen" and helps the body adapt to various stresses.
Cat's claw, 20 mg, 3 times a day, for inflammation and immune stimulation. Cat's claw can interact with many medications and may not be safe for patients with leukemia and Parkinson disease. As an immune stimulant, there is some concern that cat's claw may worsen autoimmune disease.
Reishi mushroom, 150 to 300 mg, 2 to 3 times daily, for inflammation and immunity. You may also take a tincture of this mushroom extract, 30 to 60 drops, 2 to 3 times a day. High doses of Reishi can have a blood-thinning effect, and may increase the effect of blood-thinning medications, such as warfarin (Coumadin) and aspirin. Reishi may lower blood pressure, so you should use extra caution if you take blood pressure medication.
Indian gooseberry powder, 3 to 6 grams daily in favorite beverage for antioxidant support. Emblica is a traditional Ayurvedic medicinal plant used to treat pancreatic disorders. It is a powerful antioxidant and one of the richest natural sources of vitamin C. Indian gooseberry may increase the risk of bleeding, especially among people who take blood-thinning medications.
Grape seed extract 100 to 300 mg daily for antioxidant support. Grape seed extract can have a blood-thinning effect, and may increase the effect of blood-thinning medications, such as warfarin (Coumadin) and aspirin, as well as other drug interactions. Speak with your doctor.
Complementary and Alternative Therapy for pain associated with pancreatitis include:
Pranayama or breathing exercises
Yoga, which studies suggest can help patients with chronic pancreatitis, significantly improves stress, mood, appetite, overall feelings of well-being, and alcohol dependence.
Traditional Chinese Medicine may help and commonly utilizes:
Licorice root ( Glycyrrhiza glabra )
Ginger root ( Zingiber officinale )
Asian ginseng ( Panax ginseng )
Peony root ( Paeonia officinalis )
Cinnamon Chinese bark ( Cinnamomum verum )
10. Food Intolerance
First, food sensitivities and food allergies are two very different diagnoses.
Food Allergies cause an immediate histamine reaction within minutes to hours of ingested food, and these allergies can be life-threatening. Common food allergens are tree nuts, seafood, dairy, and eggs. Food Sensitivities are more common than food allergies and harder to diagnose because symptoms usually appear anytime within 72 hours after a person has ingested the food. Food sensitivities are not life-threatening but do cause discomfort and, if left untreated, can lead to inflammation in the gut causing many other symptoms; however, they can be remedied with proper nutritional guidance and gut healing protocols. *Food sensitivity symptoms can easily overlap with other common medical diagnoses so get a thorough work up*
Unexplained loose stools or constipation
Gas, cramps, and bloating
Skin conditions (eczema, acne, psoriasis, and dermatitis
Headaches (not caused by tight muscles)
Anxiety or Depression (due to the gut-brain connection)
Vitamin and mineral deficiencies (due to an inflamed small and large intestine)
Anti-allergy: albizzia (stabilises mast cells), baical skullcap (inhibits PG, PAF, leukotrienes, histamine), chamomile, gingko (inhibits eosinophils and PAF), panax ginseng (inhibits histamine), licorice (inhibits histamine)
Immune modulation: echinacea, astragalus
Anti-inflammatory: turmeric (curcumin), ginger, boswellia – Studies show that curcumin has an antihistamine like effect and can target respiratory inflammation. If it helps reduce the frequency and severity of allergic reactions and asthma attacks (1)
Digestive stimulants: gentian, ginger
Repair / soothe gut wall: marshmallow, calendula, slippery elm, licorice, goldenseal, aloe
Vitamin C – inhibits histamine release, anti-allergy, immune, liver and adrenal support
Bioflavonoids (quercetin, bromelain) – stabilises mast cells, anti-histamine
Zinc – immune support, healing and repair of tissues, stomach acid production
Digestive enzymes: to support break down of food proteins
Pre- and probiotic supplement: to support healthy immune and digestive function and promote repair of intestinal lining
Glutamine – repair intestinal lining
Identify / remove allergenic foods via food symptom diary, blood testing or elimination diet
Follow a gut healing protocol, then possibly reintroduce food after 4-6 months at a low dose or on a rotation basis.
Support digestive / liver function: bitter foods (rocket, radicchio, eggplant, lemon, artichoke); enzyme-containing foods (pineapple, papaya); apple cider vinegar and lemon juice with meals
Ideally follow an Autoimmune Paleo diet (AIP Diet) or the Dr. Hyman Pegan Diet. This diet removes the most common allergenic offenders from the diet
Consider avoiding high histamine foods (especially if you are prone to hives) such as leftovers; consider taking D-Hist/ DAO.
Gastroparesis is a condition that affects the normal spontaneous movement of the muscles (motility) in your stomach. Ordinarily, strong muscular contractions propel food through your digestive tract. But if you have gastroparesis, your stomach's motility is slowed down or doesn't work at all, preventing your stomach from emptying properly.
The cause of gastroparesis is usually unknown. Sometimes it's a complication of diabetes, and some people develop gastroparesis after surgery. In some cases it can be caused by damage to a nerve that controls the stomach muscles (vagus nerve).
The vagus nerve helps manage the complex processes in your digestive tract, including signaling the muscles in your stomach to contract and push food into the small intestine. A damaged vagus nerve can't send signals normally to your stomach muscles. This may cause food to remain in your stomach longer, rather than move into your small intestine to be digested.
The vagus nerve and its branches can be damaged by diseases, such as diabetes, or by surgery to the stomach or small intestine. Certain medications, such as opioid pain relievers, antidepressants, blood pressure meds and allergy medications can lead to slow gastric emptying and cause similar symptoms. For people who already have gastroparesis, these medications may make their condition worse. Many times this condition occurs after a viral or other infectious illness, but it’s not fully understood.
Signs and symptoms of gastroparesis include:
A feeling of fullness after eating just a few bites
Vomiting undigested food eaten a few hours earlier
Changes in blood sugar levels
Lack of appetite
Weight loss and malnutrition
Factors that can increase your risk of gastroparesis:
Abdominal or esophageal surgery
Infection, usually from a virus
Certain medications that slow the rate of stomach emptying, such as narcotic pain medications
Scleroderma — a connective tissue disease
Nervous system diseases, such as Parkinson's disease or multiple sclerosis
Underactive thyroid (hypothyroidism)--ask your provider to check a full panel
autoimmune diseases/Connective tissue diseases like scleroderma or lupus
Eating disorders including anorexia nervosa bulimia
Amyloidosis, a condition that causes an abnormal protein buildup in organs
Medications that make the stomach empty more slowly
Since gastroparesis can interfere with normal digestion, it may cause problems with blood sugar levels and absorption of various nutrients. Over time, this can lead to complications, including:
Dehydration, especially with ongoing vomiting
Malnutrition due to poor appetite and intake as well as reduced absorption
Bezoars or collections of undigested food that hardens and remain in the stomach and can block food from passing through
Small Intestinal Bacterial Overgrowth (SIBO)
Unpredictable blood sugar changes due to an unstable rate and amount of food passing into the small bowel
Well-cooked fruits and vegetables rather than raw
Soups and pureed foods
Reduced insoluble dietary fiber and fat
Decreasing portions of protein, especially red meat.
Get tested for SIBO--commonly co-exists with gastroparesis
Get tested for blood sugar/insulin resistance with fasting insulin, c-peptide, A1C: high incidence of gastroparesis and diabetes
Try going gluten free and/or low-fodmap diet (temporarily)
Eat mindfully, chew slowly
Eating smaller, more regular meals and drinks
Ensure you are eating sufficient protein and calories
Cook foods until soft and easy to chew, and chew food well
Avoid high fibre foods that may make you feel full, and slow gastric emptying
Avoid high fat foods that slow gastric emptying, except full cream dairy and yoghurt
Avoid fluids within 30 minutes before or after meals
Avoid lying down for at least 1 hour after eating
Avoid carbonated drinks
Meal preparation changes e.g. puree/blending meals or liquid foods
Prepared protein or energy supplements such as Sustagen
Replacing acid (betaine HCl or apple cider vinegar) and enzymes such as papain or bromelain extracts and stimulation of digestion with bitters may help improve digestion for some with gastroparesis.
Avoiding excess animal protein, gluten or dairy or specific food triggers
Eating at least 3 hours prior to bedtime
Vagal nerve stimulation techniques, to improve the gut-brain axis (exercise, deep breathing)
Lifestyle medicine such as stress resilience techniques - meditation, mindfulness, Shinrin-yoku (forest bathing), Yoga, Tai Chi or Qigong
Supplements to restore nutrient deficiencies; improve gastric muscle tone, peristalsis and transit time; reduce nausea and vomiting; specific fibre supplementation to improve gastric emptying; and for mucosal repair e.g. zinc, Vitamin A, Vitamin C, magnesium
Digestive herbal stimulants to improve gastric emptying (used with caution) - such as gentian & ginger and globe artichoke
Anti-pathogenic herbs such as pomegranate husk, garlic, turmeric, berberine if pathogens are implicated
Herbs for anxiety, detoxification, bile production and tone/repair of gastric lining, increase smooth muscle health, as required
Precision probiotics to facilitate a diverse, and healthy microbiome which may contribute to the overall condition of the stomach
Fibre supplementation (prebiotics) to maintain a healthy microbiome, and enhance digestive emptying
Ginger is a natural prokinetic that helps improve stomach emptying to relieve nausea.
Other herbal prokinetic combinations such as bitter candytuft, angelica root, chamomile, and caraway, commonly found in the herbal formula Iberogast,
Strengthen the Vagus Nerve
Depending on the cause of damage or dysfunction, some exercises can strengthen the function of the vagus nerve.
Yogic breathing/pranayama (particularly Alternate Nostril Breath)
Slow, deep, controlled breathing
Visceral manipulation-massage that aims to stimulate the vagus nerve and release tension from abdominal organs
12. Microscopic colitis (lymphocytic or collagenous colitis)
Microscopic colitis is an inflammation of the large intestine (colon) that causes persistent watery diarrhea. The disorder gets its name from the fact that it's necessary to examine colon tissue under a microscope to identify it, since the tissue may appear normal with a colonoscopy or flexible sigmoidoscopy.
Signs and symptoms of microscopic colitis include:
Chronic watery diarrhea
Abdominal pain, cramps or bloating
Some people also report:
Muscle cramps or muscle pain.
Joint pain and stiffness.
Headaches or migraines.
Swollen lymph nodes.
Neurological problems (ataxia).
Causes/Exacerbating factors/triggers may include:
Medications that can irritate the lining of the colon.
Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen
Possibly hormone replacement therapy
Selective serotonin reuptake inhibitors (SSRIs) like Celexa, Paxil and Zoloft
Proton pump inhibitors (PPIs) like Prilosec and Prevacid
Statins, beta blockers and angiotensin receptor blockers may also increase your risk.
Bacteria that produce toxins that irritate the lining of the colon.
Viruses that trigger inflammation.
Autoimmune disease associated with microscopic colitis, such as rheumatoid arthritis, celiac disease or psoriasis. Autoimmune disease occurs when your body's immune system attacks healthy tissues.
Bile acid not being properly absorbed and irritating the lining of the colon.
Age- 75% of people affected are over 50 years old
Those with celiac may have up to 70 times greater risk of microscopic colitis, especially in middle-aged women
Eat a low-fat, low-fiber diet. Foods that contain less fat and are low in fiber may help relieve diarrhea (work with nutritionist to slowly reintroduce critically needed fiber)
Discontinue dairy products, gluten or both. These foods may make your symptoms worse.
Avoid caffeine and sugar.
Discontinue any medication that might be a cause of your symptoms with your provider's supervision
Avoid High-fiber foods like beans, nuts and raw vegetables. Fried and fatty foods, Spicy foods, sugary foods and beverages (including artificial sweeteners)
Gut healing protocol with functional med provider (glutamine, zinc carnosine, probiotics, etc)
Anti-inflammatory diet like the Mediterranean Diet
Identify and avoid food triggers via food intolerance testing and the elimination diet
Consume anti-inflammatories like quercetin, vit D, bromelain, omega 3 fatty acids, curcumin
Get tested for autoimmune diseases
Get full nutrient deficiency testing as deficiencies are common with diarrhea
Stay well hydrated
Intermittent bowel rest with bone broth
A condition where parts of the large intestine form small pouches, very common in countries such as the U.S. where the diet is generally low in fiber. Perforations (holes in the intestinal wall) occur in 15 to 20% of people. Diverticulosis can develop into a more serious condition, called diverticulitis, which occurs when pouches become infected. Some people develop peritonitis, an inflammation of the lining of the abdomen. Peritonitis can be life threatening if left untreated. *If you develop a fever, tenderness or pain in your stomach, or bleeding from the rectum or in the stool, tell your health care provider right away.
Complications may include:
An abscess (pocket of pus)
A perforation (hole) in the intestine leading to peritonitis, sepsis, and even shock
Fistulas, which may also lead to sepsis
Often diverticula cause no symptoms, although you may experience irregularities in bowel habits. If symptoms do appear, they may include the following:
Abdominal pain, especially after a meal on the lower left side of the abdomen
Either painless rectal bleeding or passing of blood in stool
Irregular bowel movements, including constipation or diarrhea
These factors increase the risk for developing diverticular disease:
Low fiber diet
Advanced age (more than half of people over age 70 have the condition)
Family history of diverticular disease
High fat intake
Lack of regular physical activity
Use of non steroidal anti-inflammatory drugs (ibuprofen), corticosteroids (prednisone), and opiate analgesics (oxycodone, percocet)
What may be needed:
Advanced Stool Testing including markers for calprotectin & Secretory IgA
Abdominal x-ray / barium enema /CT scan / MRI
Prescription meds & antibiotics
Gut rest with bone broth
Daily exercise to move intestines and reduce intestine inflammation
Eat a high-fiber (25 to 35 g per day), low-fat diet that contains lots of vegetables. This diet is also beneficial for overall health, and may reduce the risk of heart disease and cancer.
1 tsp psyllium, ground flaxseed or ground chia added to water daily, gradually building up to 1 tsp twice daily for women and 1 tsp three times daily for men
Increase fluid intake to 2L+ water/day: especially as fibre intake is increased
Decrease intake of commercially raised red meat, refined grains, processed foods
Decrease intake of gluten and dairy (except natural yoghurt) to prevent inflammation in gut
Reduce saturated fat ( such as meat & dairy) intake: appears to reduce smooth muscle contraction in patients with diverticulitis
Avoid whole seeds, nuts, popcorn: may become trapped in pouches
Coconut oil (2 Tbsp/day): anti-inflammatory, antimicrobial, immune support, repairs gut
Chamomile tea: 1-3 cups per day to reduce inflammation and microbial activity
Antispasmodics: cramp bark, wild yam, chamomile
Digestive stimulants: gentian, ginger, agrimony
Glutamine (400 mg, 4 times per day, between meals) is an amino acid found in the body that helps the intestine function properly. DO NOT take glutamine if you are diabetic or have seizures, liver disease, or a history of mania or manic episodes.
Omega-3 fatty acids , such as those found in fish oil, may help fight inflammation. Eat a diet rich in omega-3 fatty acids (Salmon, flax), or take a supplement (Nordic Naturals) .DO NOT take high doses of a fish oil supplement if you are on blood-thinning medication unless supervised by your doctor.
Probiotics -In one study, people who had diverticulitis were more likely to remain symptom-free after 1 year when they were treated with Lactobacillus casei and mesalazine . Some probiotics may not be right for people with severely suppressed immune systems.
Slippery elm is a demulcent (protects irritated tissues and promotes healing). Take 60 to 320 mg per day. Or mix 1 tsp. powder with water and drink 3 to 4 times a day.
Cat's claw is an anti-inflammatory. DO NOT take cat's claw if you are pregnant, have an autoimmune disease, or have Leukemia. Cat's claw can interfere with a variety of medications. Speak with your doctor.
Wild yam. Talk to your provider before taking wild yam if you have or are at risk of having breast cancer, prostate cancer, or any hormonally-influenced condition.
Marshmallow .To make tea, steep 2 to 5 g of dried leaf or 5 g dried root in 1 cup boiling water, strain, and cool. Avoid marshmallow if you have diabetes. Marshmallow can interfere with the absorption of many medications and can interact negatively with lithium..
Licorice can reduce spasms and inflammation in the gastrointestinal tract. DO NOT take licorice for a long period of time, or if you have high blood pressure, heart failure, kidney disease, or hypokalemia (low potassium). Look for "DGL", which means the majority of the blood pressure raising component of licorice has been removed.
Take chewable DGL tablets or mix a spoonful of slippery elm or marshmallow root powder in a small amount of water and drink 1-3 times per day to help soothe and heal an inflamed intestine
Magnesium supplementation can also be very useful for people with constipation
Take prebiotics like FOS powder
Test and Treat underlying SIBO or dysbiosis (imbalanced gut bacteria)
13. NAFLD/NASH/"Fatty Liver"
NAFLD (non-alcoholic fatty liver disease)is now considered to be the most common liver disease in the Western world. Nonalcoholic steatohepatitis (NASH) is liver inflammation and damage caused by a buildup of fat in the liver; fat causes inflammation and damages cells in the liver. Because of the damage, the liver doesn't work as well as it should. NASH can get worse and cause scarring of the liver, which leads to cirrhosis (liver failure). But the disease doesn't always get worse. NASH is the third most common indication for liver transplantation in the U.S.
When we consume food our body has two options: burn the fuel to create energy, or store it for later use. In our modern diets we are overconsuming nutrients, especially carbohydrates, causing a surplus that our body stores for future use. The liver is involved in this storage process by taking the excess nutrients and packing them up to be stored in our fat cells. The liver holds on to some of these fat cells -- but if it stores too many the liver starts to become infiltrated by them – this is how fatty liver disease starts. This is often why we see NAFLD develop in people who are overweight, who have diabetes, or who have high cholesterol.
Things that put people at risk for NASH and for liver damage include:
Insulin resistance and type 2 diabetes.
High cholesterol and high triglycerides.
Metabolic syndrome (pre-diabetes)
Polycystic ovary syndrome
Underactive thyroid (hypothyroidism)
Underactive pituitary gland (hypopituitarism)
Body fat concentrated in the abdomen
You may have no symptoms in the early stages of NASH. Most people who have NASH feel fine and don't know that they have it. However, it can be detected in blood work as elevated liver enzymes, elevated fasting blood sugar, high triglycerides/cholesterol, and on liver ultrasound or other imaging. As NASH progresses and liver damage gets worse, you may start to have symptoms such as:
Fatigue (feeling tired all the time)
Weight loss for no clear reason
An ache in the upper right part of your belly
It may take many years for NASH to become severe enough to cause symptoms, thus it is important to go in for your annual wellness exam and screening blood work.
Possible signs and symptoms of advanced NASH and advanced scarring (cirrhosis) include:
Abdominal swelling (ascites)
Enlarged blood vessels just beneath the skin's surface
Yellowing of the skin and eyes (jaundice)
Yellow discoloration in the skin and eyes (jaundice)
Loss of appetite
Swelling in your legs
Spider-like blood vessels on your skin
Hands down, the #1 most important this is weight loss and blood sugar regulation
Consider working with a nutritionist
Avoid inflammatory fats, add-in anti-inflammatory fats
Vit A, Vit D
Inositol- Doses range from 500mg up to 4g daily (in divided doses.)
COQ10 -Recent studies have found that taking 100mg per day of CoQ10, for as little as three weeks resulted in reduced liver enzymes & inflammation; CoQ10 is well known to help balance the cholesterol patterns typically associated with NAFLD.
Resveratrol-Found in red wine, grapes, berries, and nuts, resveratrol helps to improve insulin sensitivity and tolerance to glucose, while also helping to reduce cholesterol levels and inflammation.
Berberine- lowers cholesterol and improves blood sugar levels by improving the body’s sensitivity to insulin. A meta-analysis found that berberine taken for 2-4 months improved cholesterol levels, insulin resistance, liver enzymes, and degree of fatty liver in patients with NAFLD. Doses range from 500-1500mg per day, and digestive discomfort can be a common side effect.
Milk Thistle-reduces inflammation and fibrosis in the liver, while stimulating liver regeneration and exerting powerful antioxidant activity. It is a powerhouse liver support, and studies have shown significant benefit in treatment of fatty liver. Dose of milk thistle is typically standardized to silymarin content ( 70 to 80% silymarin) , ranges from 180mg to 500mg daily.
Curcumin-has been found in multiple studies to reduce fat accumulation around the liver (steatosis), reduction in liver enzymes, reduction in body weight and waist circumference
Probiotics-- In 2019 a meta-analysis of the available research on probiotics for fatty liver found that they could significantly improve liver damage, reduce liver enzymes, improve triglycerides and cholesterol levels, reduce insulin resistance, and decrease liver stiffness. Supplements containing Lactobacillus, Bifidobacterium and Streptococcus strains performed the best
Omega 3s - powerful anti-inflammatories and can also help to improve insulin sensitivity, reduced serum triglycerides, lower liver enzymes
Antioxidants-- eating lots of fresh fruits, vegetables, and whole grains.
Vitamin E. Preliminary evidence suggests that vitamin E, an antioxidant, may help some people with NASH.
Betaine. Betaine is a nutrient that reduces homocysteine levels in the body, which are associated with heart disease and are higher in people with liver disease.
S-adenosylmethionine (SAMe). SAMe, a naturally-occurring antioxidant that is involved in many chemical processes in the body, is best known for its antidepressant effects. People with liver disease have low levels of SAMe, and this may in turn lead to low levels of glutathione, a substance that helps the liver rid the body of toxins. Several studies show that taking SAMe may reduce symptoms of liver disease and normalize bilirubin and liver enzyme levels. SAMe interacts with a number of medications, including prescription antidepressants. So ask your doctor before taking SAMe.
Branched chain amino acids (BCAAs). BCAAs, which are involved in synthesizing protein in the body may be helpful
Bupleurum -anti-inflammatory properties and has been used historically to treat liver disorders (not appropriate for pregnant women, people who have bleeding disorders, autoimmune disease, diabetes, or people who will be undergoing surgery)
DGL (special formula of licorice) may be helpful, per some studies
Cordyceps-- A type of mushroom used in traditional Chinese medicine to support the liver.
The Final word:
Where there is one gut issue, there is typically another; for example, most people with heartburn also have SIBO, and most people with SIBO have IBS and most people with IBS have nutrient deficiencies..and so on.....work with a provider who is competent in addressing the overlap of gut health problems. Solving gut issues requires patience from patients and providers alike, so when you go see your provider, be mindful that your tummy woes often can't get fully addressed in one appointment.
For ALL gut health/digestive/stomach issues, the following will almost always help:
Eliminate suspected food allergens, including dairy (milk, cheese, eggs, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. Your health care provider may want to test you for food allergies.
Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
Eat antioxidant-rich foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell pepper).
Avoid refined foods, such as white breads, pastas, and sugar.
Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
Use healthy oils for cooking, such as olive oil or coconut oil.
Reduce significantly or eliminate trans-fatty acids, found in commercially-baked goods such as cookies, crackers, cakes, and donuts. Also avoid French fries, onion rings, processed foods, and margarine.
Avoid coffee and other stimulants, alcohol, and tobacco.
Avoid alcohol-the #1 cause of chronic pancreatitis
Increase your sleep (8 hours per night) to decrease inflammation and cortisol levels
Reduce stress and use techniques such as meditation and mindfulness to manage stress as it arises--stress can cause flares
Drink 6 to 8 glasses of filtered water daily.
Exercise moderately for 30 minutes daily, 5 days a week.
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 can help with coating and soothing the gastric mucosa. If you can't tolerate fiber, you should get tested for SIBO and other conditions.
Avoid overeating and frequent snacking
Eat slowly and chew food thoroughly
Include glutamine rich foods: beans, brown rice, eggs, fish, legumes and cabbage juice
Emphasise antioxidant-rich foods to promote tissue repair: berries, green tea, turmeric, fruits and vegetables
Emphasise anti-inflammatory foods: in cold-water oily fish, berries, nuts and seeds, turmeric, ginger, green tea, olive oil
Consider having the following checked:
A Word On Herbs & Supplements
The content in this article is not medical advise. You are strongly advised to work with a medical provider on the addressed topics before initiating any herbs/supplements.
Herbs, like medications, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. Pregnant and breastfeeding women should never take herbs or supplements unless expressly approved by their physicians.
People with liver disease must be particularly careful because the liver processes almost everything you take. For these reasons, you should take herbs with extreme care, and only under the supervision of a trained medical provider who can cross check your medications and medical history with what you want to take.
About the Author:
Havilah Brodhead is a board-certified family nurse practitioner and owner of Hearthside Medicine Family Care, an integrative primary care practice in Bend, OR. Havilah sees patients in-person in Bend and virtually throughout Washington and Oregon. She is accepting new patients and accepts most insurances. Havilah specializes in integrative & functional gut health and offers functional gut health testing as well as conventional testing. All our providers can prescribe medications, order imaging & labs, and send specialist referrals. Schedule your visit easily online at www.hearthsidemedicine.com