Gastroinstestinal Flashcards by Sarah Standeven

What is hypochlorhydia?

Low stomach acid
Fasting gastric PH above 3.0
1.5-3.0 is normal

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Hypocholrhydria signs and symptoms

Gas and bloating often less than 30 mins after eating
Heartburn
Full sensation after meals
Foul smelling stools
Diarrhoea
Food allergies
Brittle nails
Nutrient deficiencies (Iron, zinc, folate, B12)

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Hypochlorhydria implications

Reduced mineral absorption
H. pylori and SIBO
Poor pancreatic juice and bile flow

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Natural help for hypochlorhydria

Chew, don’t overeat or drink with meals
Apple cider vinegar (1-2tsp in water before meals)
Zinc and B6
Bitter greens - rocket, chicory, watercress
Herbs - Dandelion, cardamon, fennel

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What is exocrine pancreatic insufficiency?

A deficiency of the pancreatic enzymes needed for normal digestion, resulting in nutrient malabsorption (esp fat)

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EPI symptoms

Bloating, belching, flatulence 1-2 hours after eating
Greasy, floating stools
Drowsiness after meals
Food intolerances

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Causes of pancreatic insufficiency

Chronic stress
Hypochlorhydria
SIBO
Dysbiosis

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Natural help for pancreatic insufficiency

Avoid snacking between meals
Correct stomach acid levels
Diaphragmatic breathing before meals
Use bitters

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What is bile insufficiency?

A condition where bile synthesis and or bile flow is compromised affecting one’s ability to digest, absorb and use fatty acids

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Signs and symptoms of bile insufficiency

Constipation or diarrhoea
Intolerance to fatty foods
Bloating, excess flatulence and cramping

Stool test shows:
Low/absent bile acids
High faecal fats

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Bile insufficiency causes

Low Hcl
Obesity
Oestrogen dominance
Impaired liver function

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Long term bile insufficiency implications

Deficiency of fat soluble vits
Hormone imbalances
Hypercholsterolemia
SIBO

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Natural help for bile insuffiency

Adequate hydration
Avoid processed food
Diaphragmatic breathing
Taurine and choline rich foods

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What is the mucosal barrier?

Mucus covering the entire GIT provides a thick barrier between the immune stimulating contents of the outer world and the multitude of immune cells in the gut wall

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How to support the mucosal barrier

Dietary fibre
Polyphenols (green tea, cranberry, blackcurrant, pomegranate)
Slippery elm, marshmallow, liquorice
Seaweed and algae

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Intestinal junction support

Glutamine
Zinc, vit A and glucosamine
Bone broth (glycine)

Zonulin in stool test

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What is secretory IGA

It resides in the mucosal lining and protects the intestinal epithelium from toxins and pathogenic microbes

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Why is low SIgA a problem?

It increases the risk of infections including SIBO

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How is low SIgA caused?

Emotional/physical stress
NSAID use
Antibiotics

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Increase SIgA by

Vits and D
Saacharomyces Boulardii
Pre and probiotics
Echinacea
Polyphenols

Elimination diet stage 1

Detox

Days 1-2
Increase fruits, veg, healthy fats, water, herbal teas

Remove processed food, chocolate, caffeine

Elimination diet stage 2

Days 3-14

Detox as in stage 1 and also
remove all suspected foods for 2 weeks e.g gluten, dairy, corn, soy, eggs, nuts, beef, pork, yeast, citrus, chocolate, nightshades, chocolate and coffee

Stage 3 elimination diet

Reintroduction (day 15 onwards)

Eat the challenge food 2-3 times a day for 1-3 days
If you get symptoms remove the food and wait for symptoms to disappear before trying the next food
Keep a reaction food out of the diet for 3 months before trying again.

The 5R protocol

Remove - foods, toxins, unnecessary drugs, use microbials if needed
Replace - e.g support bile, pancreatic or stomach acid
Reinoculate - pre and probiotics
Repair - junctions, mucosa and SIgA
Rebalance - address stress, sleep and exercise

What is dysbiosis?

An imbalance in the colonies of the bowel flora leading to a potential disruption in both local and systemic health

Aetiology of dysbiosis

Poor diet Infections Medication use - antibiotics and OCP Stress Low digestive secretions C-section and bottle fed

Dysbiosis and diseases

Atopic disease - lower abundance of bifidobacteria and lactobacilli Metabolic syndrome - less bifido and akkermansia Colorectal cancer - pathogens Neurodegenerative - pathogens

What is SIBO?

An overgrowth of non-pathogenic bacteria in the small intestine. It is the most common cause of IBS (60-70%)

SIBO symptoms

Bloating, abdominal pain or discomfort, constipation, diarrhoea, flatulence

Key clinical indicators of SIBO:

Probiotics and fibre worsen symptoms Chronic low ferritin Post infection IBS A coeliac patient does not improve on a strict gluten free diet

SIBO aetiology

Hypothyroidism Stress Poor oral health Low SIGa Histamine or Lactose intolerance

SIBO diet support

Low FODMAP Specific carbohydrate diet

Anti microbials for SIBO

Berberine, oregano, cinnamon

Other therapeutics for SIBO

Digestive bitters Fasting and meal spacing Lion’s mane

What is IBD?

A group of autoimmune conditions of the colon and small intestine. Crohn’s disease and ulcerative colitis are the most common.

IBD symptoms & complications

Symptoms peak between ages 15-35 Abdominal pain and diarrhoea Urgency to pass stools Rectal bleeding Weight loss Fatigue Colorectal cancer, osteoporosis and anaemia

Crohn’s overview Region, distribution, layers, symptoms, complications

Region: Mostly terminal ileum Distribution: skip lesions Layers: All Symptoms: Crampy abdominal pain (right) & loose semi solid stools Complications: Malabsorption, obstruction, abscess

Ulcerative colitis Region, distribution, layers, symptoms, complications

Region: Colon and rectum Distribution: Proximally continuous Layers: mucosa only (ulcers) Symptoms: Abdominal pain (left) and bloody diarrhoea Complications: Haemorrhage - anaemia

IBD triggers

Medication Smoking Stress Infections Poor diet

IBD diet

Remove inflammatory food Consider low FODMAP or SCD Soups, stews and broths Elimination diet Omega 3 to 6 ratio Green juices for chlorophyll and anti-inflmmatory

IBD natural help

Vit D -tight junctions, support bacteria, regulate mucosal inflammation Fish oils - 4.5g/day for inflammation Herbs - marshmallow root, slippery elm Green tea for muscosal barrier Vit A, zinc, l-glutamine, glucosamine

Naturopathic approach to candidaiasis

1. Elimination and detox: soluble fibre and liver support 2. Diet: go gluten/dairy free, lots of non starchy veg 3. Antifungals and biofilm disruptors: berberine, oregano oil, thyme 4. Predisposing factors: stress, smoking, sleep 5. Nutrient deficiencies: With testing or a multivitamin 6. Microbiome: pre and probiotics

What are gallstones?

Crystalline calculi formed in the gallbladder from a build up of bile components. 80% of gallstones contain cholesterol.

Key risk factors for gallstones

Sedentary Weatern Diet OCP Obesity Alcohol

Natural approach to gallstones

Fibre PUFA Peppermint Vit C

What is gastro-oesophagul reflux disease? GORD

The reflux of gastric juices back into the oesophagus

GORD risk factors

Pregnancy Obesity Fatty foods Medications e.g NSAIDs

Natural approach to GORD

Keep upright after meals or when sleeping Chew well Eat a mediterranean diet Increase stomach acid