Gastroinstestinal Flashcards
What is hypochlorhydia?
Low stomach acid
Fasting gastric PH above 3.0
1.5-3.0 is normal
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)
Hypochlorhydria implications
Reduced mineral absorption
H. pylori and SIBO
Poor pancreatic juice and bile flow
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
What is exocrine pancreatic insufficiency?
A deficiency of the pancreatic enzymes needed for normal digestion, resulting in nutrient malabsorption (esp fat)
EPI symptoms
Bloating, belching, flatulence 1-2 hours after eating
Greasy, floating stools
Drowsiness after meals
Food intolerances
Causes of pancreatic insufficiency
Chronic stress
Hypochlorhydria
SIBO
Dysbiosis
Natural help for pancreatic insufficiency
Avoid snacking between meals
Correct stomach acid levels
Diaphragmatic breathing before meals
Use bitters
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
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
Bile insufficiency causes
Low Hcl
Obesity
Oestrogen dominance
Impaired liver function
Long term bile insufficiency implications
Deficiency of fat soluble vits
Hormone imbalances
Hypercholsterolemia
SIBO
Natural help for bile insuffiency
Adequate hydration
Avoid processed food
Diaphragmatic breathing
Taurine and choline rich foods
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
How to support the mucosal barrier
Dietary fibre
Polyphenols (green tea, cranberry, blackcurrant, pomegranate)
Slippery elm, marshmallow, liquorice
Seaweed and algae
Intestinal junction support
Glutamine
Zinc, vit A and glucosamine
Bone broth (glycine)
Zonulin in stool test
What is secretory IGA
It resides in the mucosal lining and protects the intestinal epithelium from toxins and pathogenic microbes
Why is low SIgA a problem?
It increases the risk of infections including SIBO
How is low SIgA caused?
Emotional/physical stress
NSAID use
Antibiotics
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
What is candidiasis albicans?
The most common commensal yeast that asymptomatically inhabits mucosal surfaces
Candida signs and symptoms?
Frequent UTIs
Brain fog
Anxiety and depression
Joint pain
Skin and nail fungal infections
Candidaiasis pathophysiology
Disruption of the host bacterial environment or immune dysfunction can allow candida to proliferate
Candidiasis risk factors
Dysbiosis
High sugar intake
Antibiotic use
High stress
Low SiGA
Candidaiasis testing
Stool: mycology culture
Organic acids test: elevated arabinose
Saliva test: candida antibodies
Blood test: circulating candida antigens
Spit test: saliva sinks or has legs
Naturopathic approach to candidaiasis
- Elimination and detox: soluble fibre and liver support
- Diet: go gluten/dairy free, lots of non starchy veg
- Antifungals and biofilm disruptors: berberine, oregano oil, thyme
- Predisposing factors: stress, smoking, sleep
- Nutrient deficiencies: With testing or a multivitamin
- 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
