- Tummy pain
Digestive health is of utmost importance. Why? Your gut is the gateway to optimizing your health. If you are feeling unwell in your tummy and experiencing any or all of the above symptoms, you may not be absorbing nutrients which can lead to low energy. Disturbances in the gut can create increased permeability (“leaky gut”) resulting in inflammation, body aches, and joint pain.
Is it time to fix your gut so you can enjoy all the foods you once did without feeling sick? Let yourself be able to go out without having to landmark the washroom on arrival.
Fun Fact: Did you know that according to the Canadian Digestive Health Foundation, Canada has the highest prevalence of IBS at 18% vs 11% for the rest of the world (1)?
Has your doctor told you that you have ‘IBS’? IBS stands for Irritable Bowel Syndrome. According to the CDHF (2021), it is defined as “a disorder affecting the intestine. IBS involves problems with motility (movement of digested food through the intestines) and sensitivity (how the brain interprets signals from the intestinal nerves), leading to abdominal pain, changes in bowel patterns and other symptoms.” (2)
Often, IBS is a diagnosis of exclusion, meaning it is a diagnosis given to someone when all other tests come back normal and there isn’t any other condition that can explain the symptoms such as cramping, bloating, diarrhea, constipation, pain, mucus in your stool, and incomplete evacuation to name a few. Often, you may be given the low FODMAP diet and told to follow that without digging deeper and getting to the cause.
In comes naturopathic medicine: Seeing a naturopathic (ND) or functional medical doctor (FMD) can help you unravel the root cause of your “IBS” whether it is SIBO (Small Intestinal Bacterial Overgrowth), dysbiosis, food sensitivities, insufficient stomach acid leading to a lack of digestion or something else. Functional testing options can help you and your ND or FMD figure out what is going on. Sometimes your digestive concerns may be actually linked to a hormone imbalance such as thyroid disorder or maybe estrogen dominance or another systemic inflammatory condition.
Set Up An Initial Assessment
We discuss your digestive health concern in great detail as well as a head-to-toe review of symptoms because the entire body is connected. This helps figure out if there is something else going on or it is simply a digestive problem. Necessary physical exam will be conducted as well like your blood pressure, listening to your tummy, and anything else.
You can bring any test results to the appointment with you and/or I can have you sign a release form during the appointment and request it from your doctor.
Functional testing can be offered during this appointment if necessary.
Simple treatment recommendations may be provided on this visit.
Follow-up and Establishing the Treatment Plan
When you come back for a follow-up appointment, we discuss the results from any testing that was done and/or review your symptoms and all the information gathered from the initial assessment to discuss what is going on. I will provide an overview of the entire treatment plan and you will walk away with the first step in the treatment plan so you aren’t too overwhelmed with everything.
Follow-up appointments will be every 3-5 weeks and the duration increases based on symptom improvement. These are check-ins to see how everything is going, if anything needs to be modified, and if we are ready to move on to the next stage of the treatment plan.
Functional testing can be re-ordered or ordered at any point.
Food Sensitivity Testing
Food sensitivities are immune system-mediated reactions to certain foods. The most common are dairy, eggs, gluten, soy, and nuts. A person can develop a food sensitivity at any stage of their life due to a variety of different factors. Usually, a person can develop an immune reactivity to food if there is an increased intestinal hyper-permeability (“leaky gut”) situation and this can arise from repeated exposure to toxins, antibiotics or the use of acid-blocking medication.
Symptoms of a food sensitivity can include: diarrhea, constipation, gas, bloating, acid reflux, low energy, joint pain, muscle pain, migraines, and difficulty losing weight. Food sensitivities are often implicated in autoimmune conditions like Hashimoto’s and lupus.
Food sensitivities are different than food allergies. The latter is often tested for by an MD using a “skin scratch test”. This looks at immediate hypersensitivity reactions to foods (IgE reactions). Since these are immediate, for them to be accurate, they must be done up to 48 hours following the consumption of the tested foods. IgE reactions involve the release of histamine and often present with hives, allergy symptoms, itchy eyes, or anaphylaxis (difficulty breathing, lip swelling).
Food sensitivities are delayed-type hypersensitivity reactions. They involve an immune-mediated IgG response which can last in the body for up to 3 months following exposure to a particular food. These are the reactions that happen when you eat something and feel sick a few days after. There are for types of IgG antibodies and IgG 1-3 are involved in inflammatory reactions in the body where IgG4 is a protective response against any IgE-mediated allergies to keep the inflammation and immune response in check.
The food sensitivity testing Dr. Shah does in her office tests your total IgG antibodies to a particular food that determines foods that are either creating inflammation in the body or showing a tolerance reaction to foods that one is allergic to and may develop hives or anaphylaxis from. This test is done in-office and involves a finger prick to obtain a small amount of blood for the sample.
- There are Basic, Enhanced, and Vegetarian panel options.
- Results take approximately 7-10 business days to receive and then we book a follow-up to establish the treatment plan.
A person can expect to remove reactive foods from their diet from anywhere ranging between 3-6 months or possibly longer based on the situation.
The cheaper alternative to the IgG food sensitivity testing is the elimination diet. While cheaper, this does require a good amount of compliance in order to identify any food triggers and can be a lengthy process. The elimination diet, if done carefully and under the guidance of a naturopathic doctor, can help identify both food sensitivities and intolerances.
Comprehensive Stool Analysis
In order to maximize nutrient intake from foods consumed, foods must be digested first in order to be absorbed. Many factors can contribute to improper digestion and absorption such as low stomach acid, decreased pancreatic enzyme secretion, food sensitivities, inflammation, and microbial infections in the gut. Some symptoms can be gas and bloating after meals, diarrhea and/or constipation.
The comprehensive stool analysis is a stool test that not only looks at occult blood in the stools but looks at gut dysbiosis – an imbalance in the amount of good commensal bacteria, pathogenic bacteria, yeast and parasites in your intestine. Stool chemistry markers for digestion and inflammation are assessed as well.
The test can help determine the possible presence of IBD, pancreatic insufficiency, an inability to digest/absorb fat, protein and/or carbohydrates. It also looks at your sIgA level which is the first line of defence in your gut against infection. Short-chain fatty acids are measured and stools are assessed for blood and mucus.
Organic Acid Testing
This is a urine test that measures organic acids, which are products of metabolism in the body. The testing gives you a comprehensive whole-body metabolic profile while testing approximately 70 different markers.
The test has the ability to test for the presence of candida and mold exposure/infection in the body. It can also look for the presence or absence of dysbiosis (an imbalance between good and bad bacteria in the gut). Organic acid testing can identify the presence of Clostridia bacteria. Clostridia bacteria is common to be present in those with behavioural some neurological disorders like Autism Spectrum Disorders and the bacteria can affect dopamine activity.
The test looks at several markers of mitochondrial function. Mitochondrial dysfunction can be present in many chronic health conditions such as chronic fatigue syndrome, fibromyalgia, and autoimmune conditions. Oxalates are another marker on this test which can be elevated in chronic pain conditions and when there are symptoms of joint pain, urinary difficulties, and kidney stones.
Metabolites of the neurotransmitters norepinephrine, dopamine, and serotonin are assessed. Imbalances in these neurotransmitters can be found in mental health conditions (anxiety, depression, schizophrenia, ADHD, and Bipolar disorder, Parkinson’s disease).
Some other markers include B vitamin metabolites to assess for B vitamin deficiencies; Glutathione status (a powerful antioxidant in the body that determines detoxification status); and, amino acid metabolites for errors of inborn metabolism. It also looks as phosphoric acid which helps to determine vitamin D and bone metabolism.
Addressing infections or deficiencies highlighted on the organic acid test has yielded improved gut function, energy levels, improved ADHD and autistic symptoms to name some of the few benefits.
Small Intestinal Bacterial Overgrowth
Small intestinal bacterial overgrowth is a condition that is becoming increasingly common. Unfortunately, many MDs are unaware of this and may establish a diagnosis of IBS instead. It is normal to have some good bacteria in our small intestines, but as the condition implies, it is an overgrowth of bacteria in the small intestine.
Excess bacterial accumulation in the small intestine can happen for numerous reasons including decreased gastrointestinal motility. This can happen from the use of acid-blocking medication, the use of antibiotics, decreased stomach acid, liver/gallbladder disorders, hypothyroidism, high insulin, stress, and other causes. As bacteria accumulate, they ferment sugars and fermentable fibres resulting in excess bloating like maybe that “pregnant feeling”, gas, diarrhea, constipation, acid reflux, heartburn, burping, and, abdominal pain. Fermented foods and probiotic supplements may make you feel worse.
This test involves collecting a breath sample at home which measures the concentration of hydrogen and methane in your breath. This helps to determine the presence or absence of two types of bacteria. Results are returned in 7-14 business days and if positive, a SIBO treatment protocol is implemented that includes gut healing. Some MDs may order a SIBO breath test but often this uses glucose. Our SIBO breath tests use lactulose which doesn’t get absorbed and therefore can react with bacteria throughout the entire small intestine.
- Canadian Digestive Health Foundation (2021). “Statistics” in Irritable Bowel Syndrome (IBS). Retrieved on August 25 2021 from https://cdhf.ca/digestive-disorders/irritable-bowel-syndrome-ibs/statistics/
- Canadian Digestive Health Foundation (2021). “What Is Irritable Bowel Syndrome (IBS)?” in Irritable Bowel Syndrome (IBS). Retrieved on August 25 2021 from https://cdhf.ca/digestive-disorders/irritable-bowel-syndrome-ibs/what-is-irritable-bowel-syndrome-ibs/