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!

Detoxification

The focus of this article is to explain “detoxification”. This is such a buzzword and the issue is that everyone has a different definition of what it means to detox. Some people say detox and they just mean that they aren’t drinking alcohol for a month. Other people say detox and they mean they are only drinking smoothies for a week. And to some people detox means they buy a kit with some supplements that give them diarrhea. We are going to be using the medical (and therefore most correct) definition of “detoxification”.

 In order to understand detoxification, we first have to understand the “toxification” part of that. Think about all the chemicals you consumed today. Did you use chapstick, toothpaste, a cough drop, lipstick, anything that touches your mouth? Check the label and see if there are any chemicals. I guarantee if you used lipstick today then you ate that lipstick today as well.

 Did you put anything on your skin? Any lotion or deodorant? Perfume? What about your clothes? What did you wash them in? Do they smell like fabric softener? Scents can transfer to your skin and you can also inhale them. 

We all think about the obvious chemicals like cleaning products or industrial chemicals, but it’s the every day exposures for most of us that are the issue. But it’s not just chemicals we need to detoxify. It’s also any drugs we take, essential oils, and our own hormones, to name a few. Essentially anything our body wants to get rid of we have to detoxify it.

 Detoxification is the process by which our liver, and to a lesser extent our kidneys, process all of this “stuff” for removal from the body. This stuff includes endogenous and exogenous chemicals, everything from our own hormones to any medicines or drugs we take, the pesticides we eat, and anything we absorb through our skin. 

The way we detoxify is through the liver. Our liver takes the toxins out of the blood stream and packages them up for removal via the bile. This bile is secreted into our intestines and becomes part of our stool. Minor routes of elimination include being processed by the kidneys and excreted via urine, sweating, and exhalation. So this means we have a limited rate at which we can get rid of stuff from our body.

Imaging a bucket with a hole in the bottom. If you put water in the bucket, it will drain out slowly until the bucket is empty. That’s just like our body. If we get a big exposure, our body will clear this exposure steadily until we are back to normal. However, an issue arises when the bucket fills up faster than it can drain. Water starts to flow over the sides of the bucket. This is just like when our body cannot clear stuff from the blood stream fast enough, then we “flow over” and begin to have symptoms.

 The obvious solution here is to make a bigger hole in the bottom of the bucket, or to stop putting so much water into the bucket. The same translates to us: either get better at detoxifying or stop the exposures.

Most of us realize that we should clean up our environment: stop wearing perfume (it’s a neurotoxin anyways), use natural cleaning products and natural body care. Don’t use air fresheners; they’re toxic. This is the easier part of the detoxification equation.

But how do you improve your body’s detoxification rate? Now that takes some science.  Your liver has two steps to packaging up waste products for removal, aptly named phase one and phase two detoxification. Each phase needs certain ingredients to work. So you can start by making sure these things are replete.

There are herbs that are good for the liver and will provide these ingredients as well as encourage the liver to work better. All brassica vegetables, onions, garlic, dandelion, burdock, milk thistle, and nettles are all great liver support.

 Some people are really slow at phase two detoxification. These people tend to be the sensitive ones that get a headache from strong smells or that react to everything or that need only half the dose of a medication. There are certain herbs that will actually speed up their phase detoxification process. But you have to be careful because if you push this process too fast you’ll end up feeling worse. 

I did that to a patient once. I correctly identified that she needed to detox, but we went too fast and she felt terrible. Big black circles around her eyes, body aches, the whole 9 yards. So we stopped for a week to let her recover and then we started detoxing again at a fraction of the speed and she was able to tolerate this much better. Within a few months she was feeling markedly improved and was super stoked to have her energy back. I never made that mistake again.

 Now, let’s say we have the liver working great, but remember, stuff leaves the body through bile and the stool. These systems have to also be in good working order to detoxify the body. If you are constipated, you are not detoxifying well. In fact, if you have any digestive issues at all, you might not be detoxifying your body well because your microbiome, the bacteria that live in you, might be dysbiotic. Dysbiotic flora will sit and undo all that hard work your liver did to package stuff up, and then your intestines reabsorb whatever is not packaged and flagged for removal.

One last aspect that many people overlook is the bile. Bile needs to be in sufficient quantities for detoxification to be efficient. If your stool is not dark brown, you may not be secreting enough bile, which means you are not getting stuff out of your body, and likely not absorbing your fats very well either. Again you need to have the right ingredients to make bile, and there are also some herbs that help, like artichoke and chionanthus. 

So to recap, to clear toxins your bowels must be moving and you need to be secreting enough bile. Your liver must have all the proper ingredients to process stuff for removal and needs to be functioning at a reasonable speed. If any of these is not in place, the body won’t be detoxifying very well, and there will be a build up of toxins eventually leading to symptoms.

When I say someone needs to detoxify, I mean that they need to get stuff out of their body better. We evaluate this entire process trying to determine where the weak link is and address the issue accordingly. Additionally, I recommend everyone do a proper detox once or twice a year. This is a period of time where you place extra emphasis on optimizing this process to make sure your toxic burden doesn’t build up to the point where you are suffering from it.