Digestive disturbance can be a common complaint in any age group, but the typical 50-80 year-old patient that I see doesn’t present to me with mal-digestion as the reason for his or her visit. Instead, as we begin to complete our interview with a standard “review of systems,” an important part of a health intake where we make sure there are no other symptoms or health disturbances, my patient will usually add, “Oh, yes, I have frequent digestive disturbance, but it has been that way for years, and all of my doctors say there is nothing wrong.” It seems even the majority of patients who were diagnosed with IBS (Irritable Bowel Syndrome) or IBD (Irritable Bowel Disease) were at some point along the path sent away with no options for treatment. IBS and IBD are frequently characterized by loose stools, or intermittent constipation with loose stools; symptoms that, surprisingly, are extremely common. Even more surprising is that, for many, there are options for treatment that are relatively easy – you just might not have heard of them.
In every type of medicine, the first step in treatment is to rule out a common cause of illness, including bacterial and parasitic infections, celiac disease, ulcerative colitis, and a handful of other instigators in digestive disturbance. Unfortunately, once that checklist has been completed and no diagnosis found, many patients find themselves on their own, treating their digestion like a minefield, fruitlessly cycling through digestive aides and medications that don’t help them very much. If you have found yourself in this position, it may be beneficial to give “the four R’s” of digestion a try. The four R’s are an integrative and functional medicine pearl of wisdom that any provider should easily be able to lead you through.
The First R: Remove
Step one is to remove anything that might be irritating your digestive tract, so that it can begin the process of healing. Although bacteria and other invaders would fall into this category, the culprit for most long-term sufferers is some sort of food. Most patients with IBS have a short list of foods that they know are problematic, and consistent avoidance of these can be a good start. Even better is to have a food sensitivity test to detect reactivity. This is not a skin-prick test, but instead measures for delayed reactivity and is done through blood-work. It is primarily performed by naturopathic, integrative, or functional physicians, and is a good reason to seek out naturopathic or other alternative care. Alternatively, any physician can lead you through an elimination diet, where common allergens such as dairy, wheat, soy, and eggs are removed, and then slowly re-introduced to account for reactions in your digestive tract.
The Second R: Repair
Once you have decreased ongoing damage to your digestive system by the removal of offending agents, it is often necessary to repair the damaged organs. One common approach includes the use of an amino acid known to “feed” the enterocytes (the cells that line the gastrointestinal tract). Over time, enterocytes are susceptible to damage caused by inflammatory processes, and as a result, they can actually begin to push apart, leaving wider spaces between them. These spaces allow for the passage of food particles into the bloodstream that are too large for the immune responders in the bloodstream to recognize. As a result, the immune system will often mount a response to the “foreign invader,” which then leads to more inflammation, digestive disruption, and even delayed systemic effects such as skin rash, headaches, and congestion. This process, known as “leaky gut,” can be the cause or the effect of food allergies, and could be the reason that we see food allergies at a higher rate than ever before. It also may be why people develop food allergies that they never had before. L-glutamine (usually at 1-5 grams per day), is the nutritive to feed the enterocytes, allowing them to plump up and push back together, so the space for absorbing food particles is no longer “leaky.” Another treatment option is to use a family of herbs known as demulcents to provide a thick, protective coating to the GI tract. Deglycyrrhizinated licorice (regular licorice can spike blood pressure), Althaea officianalis (marshmallow), and Ulmus fulva (slippery elm) are common options. Although demulcents are safe for over-the-counter use, it is always ideal to have your physician oversee any use of herbs or nutrients.
The Third R: Replace
For many, the removal of offending agents and even the repair of tissues isn’t enough, and we must also “replace” components of digestion that are not working well. This is usually done with the addition of digestive enzymes, typically a combination of plant enzymes, amylase, lipase, or hydrochloric acid. Bile salts, or ox bile, are often required for those who have had their gall bladders removed for the proper digestion of fats in particular. Digestive enzymes ensure that you are able to digest your food into smaller pieces, therefore decreasing the likelihood of the absorption of large food particles (leaky gut) and the subsequent systemic reactions as well. Many also find the digestive enzymes work well to decrease symptoms of reflux, gas, and bloating, as they speed the upper digestive process, readying food more efficiently for the lower digestive process.
The Fourth R: Re-inoculate
The idea to re-inoculate, or replace, good bacteria in your system has gotten a lot of good press lately, and rightfully so. The use of antibiotics, many other medications, and even digestive disturbance alone can all lead to a decrease in normal bacteria or flora. Such disruptions can leave fertile grounds for not so helpful disease causing bacteria or yeast to thrive. With any gastrointestinal treatment, the inclusion of good bacteria (called probiotics) should take place, to ensure that as bacteria are “removed,” what takes their place is helpful bacteria and nothing else. Many IBS sufferers find that probiotics alone allow for a dramatic improvement in their digestion. You can use probiotics in capsule or powder form (pick a refrigerated version with a billion of acidophilus and bifidobacterium, at least), or you can take smaller amounts in yogurt (stick with the plain or natural yogurts as those touted to be higher in probiotics usually also have high fructose corn syrup or sugar substitutes in them that should be avoided).
Digestive disturbance in general, including reflux, gas and bloating, IBS symptoms, and food sensitivities are too common, and as a medical community, we should be working to investigate why these complaints seem to be increasing. In the meantime you can decrease your symptoms, leave the minefield of a sensitive stomach, and hopefully return the function of your digestion back to its normal state simply by tending to the four R’s of digestion: remove, repair, replace and re-inoculate.
Take Care and Stay Healthy,
Dr. Amy Whittington