Beat the Bloat

Bloating is quite possibly one of the most annoying digestive symptoms one can experience. Not only is it uncomfortable, it is unsightly and embarrassing. But more importantly, it is a major sign that there is something wrong with the digestive tract. No amount of bloating is considered normal! 

Bloating seems to come in two different forms. The first is your classic “I look like I’m pregnant”, style and the other is “I look fatter for no apparent reason”. Differentiating between types of bloating can help determine what is causing it.

The “pregnant bloat” or what I call “gas bloat”, is normally caused by the fast creation of gas in the intestines. If you tap on your belly, it has a hollow resonance. You may have flatulence or burping later as that gas makes its way out of the intestines. Much of this gas will also be absorbed into the bloodstream and exhaled through the lungs.

To accelerate this gas diffusion process, naturopathic doctors (and wise grandmothers) recommend carminative herbs. Carminative herbs tend to be fragrant because they are high in volatile oils, and include peppermint, fennel, cardamom, caraway, chamomile, and lemon balm. Many of these accelerate gastric emptying and bowel motility, as well as relieve crampy bowels. Fortunately, most carminative herbs are tasty and make wonderful teas. 

For the “fat in the middle” bloat, there is less air involved but often more inflammation. Inflammation is an immune process, and when the immune system rushes into an area, a lot of fluid comes with it. In our joints and extremities this is recognized as swelling, but in the intestines we call it bloating. 

To help relieve this style of bloating, we can still use carminative herbs, but it may also benefit from soothing herbs like licorice, and anti-inflammatories like turmeric, greens, and digestive rest (fasting).

These things can help relieve occasional bloating, they are merely palliative. The challenge is to get the bloating to go away and never come back. To do this, you must understand all the things that cause bloating, and then address these underlying causes.

The first common cause of bloating is insufficient digestive enzymes. We need enzymes to break down the carbohydrates we eat. If they are not properly digested, the carbohydrates feed bacteria, who then make tons of gas as they process the sugars. This style of bloating tends to get worse as the day wears on, and resolves overnight.

Carbohydrates may also feed yeast, which is another cause of bloating. Yeast overgrowth may present with some combination of bloating, constipation (usually), sugar cravings, brain fog, anxiety, waking with a coating on the tongue, and yeast overgrowth in other places, like athlete’s foot or vaginal yeast infections.

Unfortunately, yeast is not the only way that the microbiome, the bacteria that live in your intestines, can be imbalanced. There may also be bad flora residing in your intestines that cause bloating. Klebsiella and citrobacter are two species that can be dysbiotic causes of bloating and inflammation. Lack of good flora is also correlated with bloating, with lactobacillus, streptococcus, and bifidobacterium strains all seen in the research to decrease bloating. Microbiome related bloating tends to feel very random, with a few good days followed by a few bad days. 

Bloating may also happen in the presence of a good microbiome if you are eating foods that you are sensitive to, even perfectly healthy foods like almonds, coconut, or broccoli, are unhealthy if you have a sensitivity to them. Sensitivity means that every time you eat that food your immune system goes after it. This can be a huge source of inflammation and subsequent bloating. This presents very differently from person to person, it may be headaches, fatigue, joint pain, gut pain, high blood pressure, and more.

Some individuals have a good microbiome but it migrates from the colon into the small intestine where it gets early access to sugars before they have been fully digested. This is called small intestine bacterial overgrowth, or SIBO. SIBO is a huge cause of bloating, and it is at its heart a motility issue. It often presents with bloating, cramping, and constipation or diarrhea. It will seem like the person has food allergies, but really it is the carbohydrate types in the food that are the issue, not an immune response.

With all the different causes of bloating, no wonder it is so hard to resolve! The most certain way to figure out bloating is to test for food allergies and sensitivities and to do a comprehensive stool analysis to evaluate all of these causes. Because often, it’s not just one thing, but 2 or 3 that are an issue. For instance, it is very common to have low digestive enzymes and food sensitivities along with some dysbiosis.

Can Supplements Make You Pretty

There are some cosmetic issues that respond really well to supplementation, and the beauty industry is trying to get in on that. Want nice nails? Take biotin. Want better skin? Take collagen. Thicker eyebrows? Try a growth serum. Take this 8 question quiz and get all the supplements you need to address your health… the list goes on and on.

Unfortunately it is not quite that simple. How many of us have bottles of product on the shelf that we don’t use because our skin just didn’t like it, or we stopped using it because we didn’t notice any changes? Let’s take a deeper dive into 3 of the most common beauty concerns to help guide your next product selection.

First up are fingernails. The nail exam is one of my favorite parts of new patient physical exams because you can learn a lot about a person just from their nails. One of the most common issues with nails is weak, peeling, or brittle nails. Often, the beauty industry suggests biotin for this. While biotin is an integral component of your nails, it is by no means the only one! 

If you find that your nails peel or are weak, you may actually have a more generalized mineral deficiency. Trace minerals are critical to our health, but are very rarely tested or fortified, and so they are commonly deficient. The most bioavailable minerals are chelates made by Albion labs, and the least bioavailable are the oxide form of the mineral.

A chelate is a mineral bound to an amino acid. Because our digestive tract absorbs amino acids with ease, the mineral is taken up into the bloodstream much more effectively than if it was floating around as a free mineral. Before buying a supplement for nail support, read the label and make sure it has the right form of the minerals.

If your nails are strong but they just don’t grow, that is more likely a thyroid issue and so they won’t be helped by biotin at all. Ridges on the nails are conventionally considered a natural part of aging as the nail thins, but I challenge that assumption and find that it may be from mineral deficiency or from B vitamin deficiency.

The second issue many women supplement for is hair. Over 50% of women will experience hair loss over her lifetime - This is the sort of hair concern that can respond well to supplementation. Thinning hair, very slow growing hair, or hair follicle shrinkage can all be traced back to thyroid function. 

The thyroid is the master gland of metabolism, and so if it is lagging, cells that are the most metabolically active will struggle the most noticeably. You may notice dry skin, thin eyebrows, low energy, and weight gain in addition to your hair loss. In this situation, you don’t need hair support, you need thyroid support and your hair will grow back on its own.

For some women, stress can be a trigger for hair loss as well. However, it doesn’t always correlate exactly with the stressful period. Normally there is a delay of several months, which can make it really hard to track down. Remember that caloric restriction is a stress on the body! Once I had a patient who was experiencing drastic hair loss and she was completely beside herself (understandably). The only change in her life was that she had started a restrictive diet, so when we added in more calories, the hair loss completely stopped!

There is no oral supplement to make your hair instantly shiny, because your hair is dead. You can however, improve its shine over time with hair masks to nourish the scalp and hair follicle. Here  is an example of a scalp nourishing mask. Other things that would be useful for hair quality are omega 3s, protein, and sulfur containing foods.

The last item that women are always looking to work on is skin integrity. Men get wrinkles and they look “distinguished”, women get wrinkles and we look “old”. Not fair! As we age, we lose subcutaneous fat which makes our bony structures more prominent, and there is not much we can do about this besides generally taking care of yourself. Those who age prematurely tend to have had a tough life, emotionally or physically. Antioxidants are helpful here, and something that I like to test if someone is working on overall health or if she is showing signs of premature aging.

For women, hormones actually play an important role in skin health as well. We are all familiar with hormonal impacts on the skin in terms of acne, but it also plays a role in skin aging as well which is most evident after menopause. Balancing hormones and supporting their production in the late 40s and through the 50s can have a positive impact on this transition phase and skin health.

These hormonal changes may be responsible in part for some of the collagen changes we experience as we age. Taking collagen powder doesn’t guarantee that you will make more collagen, but it does at least give your body the building blocks to make more collagen. There is some positive research on particular collagen peptides for skin elasticity and moisture, although there have not been many studies investigating the mechanism.

In summary, there is a lot we can do to improve our appearance from the inside out! If you tried a supplement to help your hair, skin, or nails and it didn’t work, don’t give up hope! It may be that you just got the wrong nutrients and taking a different approach to the concern could still work!

Depression is Linked to Inflammation

One of my least favorite diagnoses is depression. It is often used as an umbrella diagnosis for anyone that just feels vaguely unwell.  Feelings of worthlessness? Depression. Don’t feel like doing anything? Depression. Appetite off? Depression. All of these very different symptoms are treated the same way, messing with the neurotransmitter levels in the brain. I’m not saying that depression doesn’t exist, in fact I’m arguing for the contrary. I think the current medical approach to treating depression is overly simplistic for such a complex disease with a huge array of symptoms.

Let’s say your dog or cat lost interest in eating and playing one day. What do you do? You don’t call them depressed; you assume they are sick and take them to the vet. Not eating and not being active are called “sick behaviors” because our body shuts down these things when we are sick. It has nothing to do with neurotransmitters and everything to do with inflammation. We do humans a disservice when we automatically assume it’s “just depression” and not sick behavior from inflammation.

Our immune system communicates with molecules called cytokines. Different cytokines have different roles. One cytokine that plays a major role in sick behavior is interleukin-1 (IL-1). It is associated with lethargy, sleep and appetite disturbances. Here is a study that talks more about this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5244798/ 

Furthermore, scientists have researched the connection between poor mood and inflammation without sickness. In one study, the subjects who experienced negative mood for over a week had higher levels of inflammation. So in order to adequately address depression, we have to move beyond neurotransmitters to look at inflammation.

Inflammation is not inherently bad. Inflammation is how our body starts the healing process and how it turns on the immune system. Unchecked inflammation or long term inflammation is where we start to run into problems. Because our body has finite resources, the most immediate needs are prioritized, which in the case of endless inflammation our body ends up drained. Here’s an example of what this might look like.

Let’s say you are allergic or sensitive to broccoli. Everytime you eat broccoli it turns on your immune system and creates some inflammation. If you eat broccoli every day, over time this will wear down your body and may result in fatigue, low motivation, poor mood, and so forth. Inflammation is a process that is supposed to turn on and then off again after the issue has been resolved. This person is not sick, but they still may have the symptoms of being sick.

One of the easiest and most effective ways to decrease inflammation is to change the diet. Some foods like dairy are inherently inflammatory, and so should be avoided entirely while trying to decrease inflammation. Other foods that could be avoided are the most common allergens including wheat, soy, peanuts, and eggs. I always like to do food sensitivity testing as well because sometimes perfectly healthy foods are the issue.

Another simple way to decrease inflammation is to support the immune system. Some viral infections can linger a long time and this low level infection can also drain the immune system. Warts and cold sores are viral in nature and may be a sign that your immune system is not functioning at its best. Other signs include getting sick easily, post nasal drip, and fatigue. Help your immune system work its best by getting adequate sleep, eating a diet rich in zinc and magnesium, and consider using some immune support herbs like lemon balm and echinacea. 

One interesting note is that the brain and inflammation is a two-way street. An emotional disturbance like heartbreak creates an inflammatory state in the body. In fact, broken heart syndrome is heart disease that starts immediately after an emotional trauma. Counselling, which helps with these emotional traumas, may work to decrease inflammation in the body.

These and other tactics to decrease inflammation in the body may improve depression. There are many other natural things that are specific for depression without necessarily addressing inflammation like inositol, magnesium, St. John’s wort, omega 3 fatty acids. Whether you choose these or pharmaceuticals to address depression, I think you are far more likely to have success if you address inflammation concurrently. 

What is the Microbiome

Did you know you are a minority in your own body? You have more visitors in your body than you have of your own cells, up to 3 times more. These visitors include bacteria, eukaryotes, viruses, fungi, and even archaea and are collectively referred to as a “microbiome”. In exchange for a warm home and food, the microbiome makes vitamin K, helps break down food, modulates our immune system and supports a healthy mood. So obviously the microbiome is super important for health. Disturbances to the microbiome are implicated in many health conditions:

• Heart disease

• Irritable bowel syndrome

• Inflammatory bowel disease

• Depression

• Anxiety

• Asthma

• Acne

• Eczema

• Obesity

• Type 2 diabetes

• Psoriasis

• Rheumatoid arthritis

This is by no means an exhaustive list. How the microbiome can impact such disparate aspects of the body is not completely understood, but we have a pretty good grasp of several mechanisms: immune modulation, neurotransmitter creation and degradation, and synthesis of nutrients.

Whenever I have a patient with an autoimmune disease, one of the first things we do is a stool test to evaluate her microbiome. Why? Well, somewhere around 80% of our immune system resides in the gut-associated lymphoid tissue (GALT), which is a fancy way of saying the immune system’s home base is in the gut. So because the immune system is the issue, we have to go to the source, therefore we look at the gut.

The immune system’s job is to recognize stuff that isn’t part of you, and to attack and destroy anything it finds and identifies as ‘not you”. If you want to calm down the immune system, as in the case of autoimmune disease, you need to identify what is revving the immune system up. For instance, in rheumatoid arthritis, oral bacteria such as Porphyromonas gingivalis (P. gingivalis), Proteus mirabilis (P. mirabilis), and others like Epstein–Barr virus (EBV) and mycoplasma have all been implicated as causal agents. If you want to get to the root cause of rheumatoid arthritis, you look at the microbiome, and so it goes for any autoimmune condition.

The immune system is constantly surveilling the intestines, sorting through what is food, what is friend and what is foe. When the microbiome is imbalanced and you have bad bacteria, the immune system reacts (as it should), but there is often collateral damage. Much like the stuffy nose you get with a cold, the symptoms are from our own immune system, and not so much the invader. If you’re interested in reading more on this topic, here is a great journal article: http://jem.rupress.org/content/216/1/20 

The next big job of the microbiome is to create and degrade neurotransmitters like serotonin and histamine. There are actually lots of serotonin receptors in the GI tract, and it plays an important role in GI motility (pooping daily). But these neurotransmitters also travel up the vagus nerve and can impact brain health, hunger and satiety, and even stress levels. Here’s a cool research article on this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859128/ So whenever I have a patient with any sort of seemingly brain issue, I always ask about digestion.

Lastly, the microbiome impacts our nutritional status. We’ve known for a long time that many B vitamins and vitamin K are made by bacteria. But bacteria are also vital for the proper breakdown of carbohydrates. Bacteria make short chain fatty acids (SCFA) from these carbohydrates, which serve as the main fuel source for colon cells. SCFA’s also prevent heart disease, and should there be a cardiac events, it is less damaging. Bacteria also create amino acids like threonine and lysine, which is important for the immune system. So if you don’t have a healthy microbiome, it doesn’t matter how great your diet is, you will still be missing out on key nutrients.

I’m certain we will discover more ways that the microbiome impacts our health, but even with just the three we talked about, there is still a massive impact on our health. One of the best ways to promote a healthy microbiome is to feed them the proper food. Bacteria love fiber, so a diet high in fiber promotes good bacteria. You can also help reinocculate your gut with good bacteria by eating foods with live cultures, playing in the dirt, and having pets!

Sometimes these easy changes are enough to make a big impact on health, but sometimes the microbiome is so disrupted that we need to do a stool analysis to see what is throwing the microbiome off. It could be anything from yeast to pathogenic bacteria to low digestive enzymes. Once you know what the problem is, it is relatively easy to restore the microbiome to a healthy status, which in turn supports your whole body.