Common Digestive Disorders
Click on each item to expand the section.
A common disorder occurring as the esophagus transitions into the stomach, that affects 1 in 4 adults in North America. Classically experienced as a burning sensation, discomfort or pressure in the upper abdomen or chest, that may be accompanied by regurgitation of stomach contents. Other indicators may include: chronic irritated cough worse at night, frequent belching, sore throat on waking, bad breath or hoarseness. Typically, symptoms are worse after eating or lying down, and are relieved by antacids.
The discomfort associated with GERD is due to the regurgitation of food that’s been in the acidic environment of the stomach. When acid touches the lining of the esophagus it causes an uncomfortable or burning sensation. A seemingly benign condition, chronic GERD can lead to: inflammation, esophageal erosions and even esophageal cancer.
LPR, on the other hand, is when reflux moves past the upper esophageal sphincter and impacts the areas of the larynx and pharynx. These individuals will have symptoms like: persistent lump in the throat, constant desire to clear the throat, chronic unexplained sore throat, hoarse voice and sinusitis or post nasal drip.
Antacids offer temporary relief by coating the esophagus with a buffer to the acid, or by neutralizing stomach acid. Prescription antacids take this a step further – blocking production of stomach acid. These approaches fail to address any of the causes/contributing factors, and are associated with acute adverse effects (diarrhea, nausea, abdominal pain, headaches) and long-term risks (increased risk of gastroenteritis, stomach or small intestinal bacterial overgrowth, pneumonia, osteoporosis and/or spinal fracture, vitamin & mineral malabsorption).
So instead of relying on antacids, I strongly encourage sufferers to seek naturopathic care – which has highly effective options for treatment that address all of the contributing factors: reducing inflammation, healing the esophageal mucosa/lining & preventing of progression to esophageal ulcers or cancer.
Damage to the cells of the mucosal lining (typically in the stomach or duodenum – the uppermost section of the small intestine) eventually leads to necrosis (tissue death) and ulceration penetrating through the wall of the stomach or intestine. Those with PUD often present with dyspepsia (persistent abdominal pain) that is localized to the upper abdomen, and often tender to touch/pressure. Very dark, tar-like stool is an indicator of severe PUD or bleeding in the upper GIT (gastrointestinal tract). If symptoms are not improved with antacids, and the individual is: male, over 45, has a history of high stress, smoking, alcoholism, COPD, chronic NSAID, aspirin or corticosteroid use, or a low fibre diet, PUD should be considered. Evaluation includes an occult stool test (to examine stool for blood) and endoscopy (microscopic examination) and biopsy/culture for H. pylori bacterial infection.
Conventional therapy focuses on H. pylori eradication using a cocktail of drugs including antibiotics. Naturopathy has highly effective treatments (foods, strain-specific probiotics, herbs, etc) to successfully eradicate H. pylori without many of the side effects associated with conventional treatment. Naturopathy goes beyond H. pylori eradication to promote ulcer healing and offers prevention against recurrence – which is common.
Celiac Disease is an immune-mediated disease of the digestive tract, involving reactivity to all gluten-containing grains (wheat, spelt, kamut, rye, barley – and in some cases oats and corn). Specific protein molecules in these grains resist digestion in the stomach and small intestine – where they do damage to enterocytes (cells lining the digestive tract), and get absorbed into the bloodstream – where the immune system forms antibodies against them and mounts an inflammatory response.
About 1 in 100 North Americans has Celiac Disease – with rates on the rise. Common symptoms include: diarrhea, fatigue, rumbly stomach, dyspepsia, weight loss (failure to thrive in infants), abdominal distension, excessive gas. Red flags: family history, Irish or Scottish descent, female infertility or recurrent miscarriage, evidence of nutritional deficiencies, unexplained iron deficiency. Diagnostic Testing is imperfect and at times confusing (false negatives are common) – seek a Digestive Health Expert to help guide you through the process. Once diagnosed, Intestinal Permeability Tests (available through the clinic) prove useful in monitoring and prevention. In addition to a strict GFD (gluten free diet), naturopathy has a number of highly effective treatment options for improved outcomes.
Gluten Sensitivity may occur in as much as 10% of the general population, and is experienced as symptoms that improve or resolve after gluten withdrawal (and which return after subsequent exposure). It is differentiated from Celiac Disease in that there are no allergic or immune mechanisms, and no intestinal damage seen on biopsy or Intestinal Permeability Testing. Anti-tTG IgA antibody testing will likewise be negative. Common symptoms include: dyspepsia, diarrhea, nausea, vomiting, bloating, gas, behavioural or mood changes, bone or joint pain, muscle cramps, chronic headaches or fatigue, eczema or skin rashes, “foggy mind”.
These three terms are often used (incorrectly) interchangeably.
Food Allergy is an acute immune-mediated response. Within minutes or hours of exposure the body mounts a response that typically involves inflammation (hives, itchiness, swelling of throat or lips, etc). Reactions may be severe and require immediate treatment with antihistamines or in severe cases, epinephrine. Food allergies may be detected via IgE skin prick testing done with an allergist.
Food Sensitivity is a delayed hypersensitivity reaction. It is also immune-mediated, but typically less severe and reactions take hours to days to arise. Food sensitivities may be responsible for a wide range of symptoms including skin reactions, digestive symptoms, altered mood or concentration, joint pain and more. They may also contribute to some conditions like IBS and Crohn’s Disease. Food Sensitivities may be uncovered through an Elimination-Challenge Diet or IgG (and/or IgA) blood spot or serum tests.
Food Intolerance is not immune mediated, and refers to a deficiency of specific enzymes required to digest a food successfully. For example, people with Lactose Intolerance lack the enzyme lactase, required to break down lactose – or milk sugar. Symptoms typically include gas, bloating and/or distension, abdominal discomfort, and often cramps leading to urgent loose stool, within 30-60 minutes of consuming the offending food. Many report being able to tolerate small amounts of the food, but reach a threshold that triggers symptoms.
IBS is defined as a chronic functional disorder of altered bowel habits & abdominal pain. Its cause is unknown, and IBS is considered a diagnosis of exclusion – meaning other digestive disorders must be ruled out. There is no accepted biological marker or test that is useful in diagnosis. It is considered the most common digestive disorder in developed countries – affecting up to 25% of adults. IBS may be associated with dysbiosis, GERD, Celiac Disease or Gluten Sensitivity and/or Food Sensitivities. Many sufferers of Crohn’s Disease will have IBS-like symptoms while in remission.
Symptoms typically include: abdominal pain, bloating or abdominal distension, excessive flatulence, diarrhea (>3 bowel movements/day, possibly associated with urgency), and/or constipation.
Risk factors for the development of IBS include: familial history of IBS, acute GIT infections, antibiotic use, stressful life events, anxiety & mood disorders. A comprehensive naturopathic approach offers effective treatment options.
IBD is actually an umbrella consisting of Ulcerative Colitis & Crohn’s Disease – two distinct diseases.
Crohn’s Disease: Affecting 20/100,000 Canadians, Crohn’s has a higher incidence in Western countries, and in those who have immigrated from non-Western countries – suggesting possible links to diet, environment, latitude (think Vitamin D sun exposure) and microbial environment. It manifests as an inappropriate inflammatory response to intestinal microbes in a susceptible individual. Crohn’s causes inflammation to the mucosal lining of the intestines, which can affect the entire thickness of the intestinal wall and cause thickening, narrowing and granulomas (collections of inflammatory immune cells). Crohn’s tends to alternate between active disease and periods of remission.
Primary signs & symptoms include: chronic diarrhea, abdominal pain, weight loss, fever and rectal bleeding. There may also be paleness, abdominal tenderness or masses and extra-intestinal effects like inflammation and pain of the joints or eyes. Many patients will still exhibit IBS-like symptoms regularly in remission.
The following factors significantly increase risk of acquiring Crohn’s: smoking, a highly refined diet high in sugar, a low fibre diet, a diet low in fish, fruits & vegetables, a diet high in animal protein & animal fat including dairy, formula-fed infants & toddlers, low blood levels of Vitamin D.
A referral to a gastroenterologist is necessary for diagnostic testing that will likely include bloodwork, stool tests and colonoscopy with biopsy. Additionally, Intestinal Permeability testing provides a baseline measure of inflammation and damage to the intestine, and is a good predictor of relapse – making it clinically useful every 3-6 months to guide treatment.
A conventional medical approach to Crohn’s focuses on minimizing inflammation through potent drugs like steroids and immunosuppressants. At times these drugs are necessary to induce remission, however, naturopathy has been shown to improve outcomes and remission rates/duration when used concurrently. Additionally, naturopathy emphasizes therapies that are proven to support mucosal healing as an integral part of treatment. Mucosal healing shows: reduced disease activity, longer remission periods, and decreased need for surgery.
Ulcerative Colitis: With an incidence of 10-15/100,000 in Canada, Ulcerative Colitis (UC) has been linked to a Western diet, with rates increasing 11-fold in this demographic over the past 20 years. UC has a gradual onset, followed by periods of active disease alternating with remission. Diagnosis is via colonoscopy & biopsy, with additional tests to monitor like blood work, stool tests and intestinal permeability.
Symptoms classically include: diarrhea with blood, abdominal pain and possibly mucus in the stool. Other symptoms may include weight loss, joint pain, nausea and vomiting.
UC is one of the few diseases that smoking has shown to be protective against. Other risk factors include: antibiotic use, vaccinations, insufficient breastfeeding.
A comprehensive naturopathic approach seeks to include agents to decrease inflammation & inflammatory mediators, increase colonic butyrate production (low in UC), avoidance of exacerbating triggers, healing of the intestinal mucosa and symptom management.