Naturopathic Approach to Gut Health
Because NDs practice medicine by identifying the root cause of any condition, testing is usually required to determine underlying pathology responsible for issues in a patient’s health. If someone is suffering from digestive complaints, blood testing for food sensitivities and allergies, bacterial or yeast overgrowth via a stool test or even a breath test can be utilized to determine if there are organisms living in the small intestine (where there should not be) or other imbalances implicated in symptom expression. Treatment is then individualized based on the results of the testing. The following are digestive issues that are commonly treated by naturopathic doctors.
As described above, the microbiome is a collection of bacteria that resides in the large intestine of the digestive tract. Unbalanced gut flora is one of the primary drivers of many digestive disorders. The problem can be either an overgrowth of unhealthy bacteria, or an undergrowth of beneficial bugs. Frequently, an overgrowth of yeast is to blame, and the most common symptoms produced are gas, bloating, and diarrhea. Dysbiosis can be diagnosed via a stool test (large intestine imbalance) or a breath test for the small intestine. The naturopathic approach for treatment is a “weed and feed” process. Either herbal or prescription antimicrobials (sometimes alternating with both) are given to kill the bad bacteria (the weeding), and then a probiotic is prescribed to re-populate the gut with good bacteria (the feeding). In this way, the good bacteria are able to crowd out the harmful microbes and proper digestive functioning can be re-established. Prebiotics may also be prescribed. These are substrates that the beneficial bacteria use to grow.
An example of dysbiosis (microbiome imbalance) which has become better understood in recent years is small intestinal bacterial overgrowth (SIBO). SIBO occurs when bacteria inappropriately colonize the small intestine. Because of defective motility of the gut, the bacteria migrate upward rather than staying in the colon where they belong. As with other forms of dysbiosis, the symptoms are abdominal pain, gas, bloating, constipation, and/or diarrhea. The treatment is also comprised of a weed and feed approach (remove offending bacteria and then replace with beneficial ones), with the addition of motility agents that prevent the bacteria from moving upward.
Dietary Considerations for Dysbiosis
Dietary considerations must be taken into account when balancing the microbiome to prevent and treat dysbiosis. Highly processed foods are associated with a less healthy microbiome, particularly a diet high in refined carbohydrates and low-quality fats. These foods have been shown to reduce the biodiversity of the microbiome, resulting in a host of health issues that may be related to the above conditions. A diet high in legumes, fruits, and vegetables are associated with a more diverse microbiome which keeps inflammation at bay and ensures a more properly functioning immune system. 16
Intestinal permeability, or leaky gut as it is commonly known, is a condition that affects the lining of the small intestine. When the intestinal wall comes into contact with inflammatory foods, toxins from food and water, or even metabolites from the above-mentioned bacteria and fungi, this can result in damage to the cells that line the gut. Connections between the cells are referred to as “tight junctions,” because its job is to create a sufficient barrier between the gut and the bloodstream. 17 This is necessary to prevent larger proteins from food and toxins from escaping out of the GI tract and entering the system. If these tight junctions are affected, and become “leaky” and proteins do escape, the immune system identifies them as outside invaders and will launch an immune response, resulting in food sensitivities, allergies, and autoimmunity. 18
Leaky gut is typically addressed by identifying and eliminating food sensitivities, healing the gut lining with supplements such as L-glutamine, and adding anti-inflammatory herbs and a whole foods diet low in processed fats and carbohydrates.
Inflammatory Bowel Disease
Inflammatory bowel disease (IBD), as its name suggests, is chronic inflammation of the gut. Generally speaking, the two most common forms of IBD are Crohn’s and ulcerative colitis UC) and are characterized by symptoms such as abdominal pain, diarrhea, rectal bleeding, and weight loss. 19
While the cause of IBD is not entirely known, research suggests that a genetic component may be present, combined with environmental factors, such as stress and lack of exercise, and of course, the state of the microbiome. 20 Research shows that a diet high in low quality fats, frequent meals of fast foods, high refined carbohydrate intake, and low fiber diets result in a dysbiosis that may exacerbate symptoms of IBS. Dietary recommendations include a low fat, high fiber, diet that excludes potential triggers such as dairy and refined grains. Foods high in vitamins A, D, E, folate, and beta carotene, as well as minerals zinc, selenium, manganese, and iron appear to be particularly helpful. 21
Gastroesophageal Reflux Disease (GERD)
Heartburn, and acid reflux are other names for GERD, which is an extremely common condition affecting approximately 20% of people in the United States. 22 GERD occurs when stomach acid moves upward from the stomach into the esophagus and results in symptoms of chest pain/burning, sour taste in the mouth, sore throat, chronic cough, and difficulty swallowing, and is usually worse at night when lying down. 23 GERD is caused by a laxity of the lower esophageal sphincter (LES), which allows the gastric juices to “reflux” up into the esophagus rather than remaining in the stomach where they belong. GERD is typically diagnosed by symptoms; however, an endoscopy may be ordered to assess for damage to the esophagus or to rule out more serious conditions. 24
Naturopathic treatments include finding and eliminating food sensitives, body work to tonify the LES, and supplements/ herbs that are soothing and healing to the upper digestive tract (see below).