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Tag: gut health

Categories Gut Health, Advice, Health, Nutrition

Is SIBO the Cause of Your IBS?

Author Amber Hudler Posted on

Do you struggle with gas, bloating (that gets worse as the day goes on), distention, pain, or chronic IBS? Have you ever stopped to question the root cause? It could be SIBO.

What is SIBO?

Small intestinal bacterial overgrowth (SIBO) is an overgrowth or accumulation of bacteria in the small intestine (SI). Normally, we want a diverse amount of healthy bacteria in the large intestine (colon) but not in the small intestine. The overgrowth in the SI can cause discomfort and a host of other symptoms. Current research indicates that more than 75% of patients with IBS also have SIBO.

What causes SIBO?

  • Low stomach acid (hypochlorhydria) – Stomach acid kills bacteria
  • Compromised motility (gastroparesis, Parkinson’s, scleroderma)
  • Intestinal permeability (leaky gut)
  • Compromised gallbladder
  • Age
  • Food poisoning
  • Traumatic brain injury (TBI)
  • Chronic use of NSAIDs, Antibiotics, or opioids
  • Hypothyroidism
  • Liver dysfunction
  • Chronic pancreatitis
  • Ehlers-Danlos syndrome
  • Intestinal surgery
  • Fistula
  • Genetics
  • Stress

What are signs and symptoms of SIBO?

  • Bloating
  • Diarrhea, Constipation, or a combination of the two
  • Cramping
  • Nausea
  • Pain
  • Reflux
  • Rosacea/Eczema/Psoriasis
  • Migraines
  • Depression
  • Fatigue
  • Weight loss/gain

How do you test for SIBO?

You can test for SIBO using a breath test. Breath tests can be done at your doctor’s office or at home. A brief fast is required (24-48 hours) in which you eat certain foods such as chicken and white rice. During the test, a lactulose or glucose solution is consumed. Once consumed, you will be asked to breath into a bag in intervals for up to 2 hours.

What are the different types of SIBO?

  • Hydrogen dominant
  • Methane dominant
  • Hydrogen sulfide dominant

During testing, different levels of hydrogen and methane gas in the breath will be measured. If there is a rise in either hydrogen or methane at the 90 minute mark, SIBO is present. For hydrogen, a rise in >- 20ppm is indicative of SIBO. For methane, a rise in >- 10ppm is indicative of SIBO

How is SIBO treated?

  • Antibiotics such as Xifaxan/Rifaximin or neomycin
  • Herbal microbials
  • Dietary intervention
  • 5R Gut Protocol

What is the best diet for SIBO?

There are many different diets that have been studied and implemented to help support a patient with SIBO. These include Low FODMAP, the Specific Carbohydrate Diet (SCD), a Bi-Phasic diet, and an Elemental diet. By far the most well researched diet for SIBO is the low FODMAP diet. It is also the most flexible and least restrictive diet of those mentioned, so this is the diet I recommend starting with. Many individuals with SIBO develop food sensitivities, so it is common that by the time they come to see me, they are already avoiding a number of different foods because they have become intolerant to them. The goal with dietary intervention is to implement a diet that will support the treatment phase (when you are taking antibiotics or microbials) and allow you to have a well balanced diet that provides you with adequate calories and nutrition. With any SIBO diet, your goal is to do this temporarily  (on average 6 weeks) until you start to feel better.

If you want to learn more about SIBO or if you have been diagnosed and are looking for dietary support and counseling, contact me here.

Photo Image by Анастасия Гепп from Pixabay

Categories Advice, Food, Gut Health, Nutrition, Sleep, Stress

Nutrition for Chronic Fatigue Syndrome: 10 Steps to Improve Your Energy

Author Amber Hudler Posted on

Chronic fatigue syndrome (CFS) or Myalgic Encephalomyelitis (ME) affects millions of individuals each year.  It is generally defined as extreme fatigue that lasts for six months or more and does not improve with sleep or rest.

Individuals suffering from CFS may find it difficult to participate or engage in physical activity, and may struggle with concentration, memory, or the completion of mental tasks.

While no laboratory test will diagnose CFS, there are a few theories about what contributes to it. Certain viruses, hormone imbalances, a compromised immune system, as well as high levels of chronic stress are all possible considerations.

Additional factors that can contribute to CFS include:

  • Food allergies /sensitivities
  • Celiac / Non-Celiac gluten sensitivity
  • Hypothyroid / Hashimotos
  • Insulin Resistance
  • IBD
  • Candida
  • Oxidative stress / cell damage
  • Certain medications
  • Nutrient deficiencies
  • Intestinal permeability / Leaky gut)
  • HPA Axis dysregulation / adrenal fatigue)
  • Impaired sleep
  • An imbalance in energy demand vs energy expenditure

Although there is no definitive treatment for CFS, many individuals are able to find relief through diet modification, gut healing, and supplementation. One key factor to consider is mitochondrial support.

The mitochondria are the main energy source or “powerhouse” of the cells. They are found throughout the body. When they are damaged, less energy is produced. By targeting and supporting the mitochondria, individuals often find that higher energy levels can result.   

For those suffering from CFS, it is important to evaluate nutrient insufficiencies related to mitochondrial damage and replete if necessary. A micronutrient test is a great place to start.

The following nutrients are often associated with fatigue and CFS:

  • Iron
  • Copper
  • B Vitamins (especially B12)
  • Vitamin D
  • L-Carnitine
  • Fatty Acids
  • CoQ10
  • Magnesium
  • Potassium
  • Chromium
  • Vitamin A
  • Vitamin E
  • Vitamin C
  • Zinc
  • Glutamine
  • Choline

To help promote restful sleep and provide additional support, the following supplements have shown beneficial effects:

  • L-Theanine – Found in foods like green tea, L-theanine supports healthy sleep.
  • Melatonin – A naturally occurring hormone, Melatonin supports restful sleep and supports mitochondria homeostatis
  • Magnesium – This amazing mineral has many purposes. Magnesium promotes restful sleep, healthy gut motility, stress reduction and is a natural muscle relaxer. If you want to sleep well, include magnesium rich foods to your diet and either an oral or topical magnesium supplement.
  • Rhodiola rosea – A natural adaptogen, Rhodiola has been shown to improve energy levels in those who suffer from CFS.

Finally, look for ways to modify your lifestyle in order to replete your energy stores. I recommend these tips:

  1. Improve your diet – reduce intake of white sugar and highly processed foods. Adopt a whole foods diet with a high intake of fruits, vegetables, lean proteins that include organic poultry, wild caught fish or grass-fed beef and non-GMO whole grains. In addition consider the following types of foods that will supply your body with melatonin, tryptophan (a precursor to melatonin), magnesium, and choline.
    • Eggs
    • Fish  
    • Pistachios
    • Cow’s milk
    • Oats
    • Mushrooms
    • Cherries
    • Black and red rice
    • Poultry (Chicken, turkey)
    • Cheese
    • Seeds (pumpkin, sesame, sunflower)
    • Nuts (Almonds, cashews)
    • Peanuts/Peanut butter
    • Spinach
    • Soy milk
    • Beans (black beans, kidney beans, lima beans)
    • Edamame
    • Avocado
    • Potato
    • Brown rice
    • Oatmeal
    • Wheat germ
    • Brussels sprouts
    • Liver
  2. Identify food sensitivities and intolerances. Work with a qualified dietitian to identify any potential foods that are antagonizing your symptoms. Do a trial elimination with a food journal and analyze your results.
  3. Balance your plate with the correct ratios of complex carbohydrates, proteins, and fats to stabilize blood sugar and promote energy balance. Include protein at every meal.
  4. Be sure to incorporate enough calories to support activity and energy output. If calories are too low to support your level of activity, fatigue will result. Remember that food provides your body with energy and fuel.
  5. Identify sources of inflammation including environmental toxins, and work to reduce them.
  6. Identify nutritional deficiencies especially if taking certain medications such as acid suppressing mediations, lipid lowering, oral contraceptives, anticonvulsants, loop diuretics, and anti-hypertensives. I recommend a Spectracell Micronutrient test.
  7. Strengthen and heal the gut. In addition to removing inflammatory foods, incorporate a probiotic supplement that contains Bifidobacterium infantis, F. prausnitzii, and L. acidophilus.
  8. Improve sleep; Increase daytime light exposure and reduce exposure to blue light / screens especially at night. Strive for 7-9 hours of sleep per night. Consistency is key.
  9. Reduce stress. Consider deep breathing exercises, daily meditation, delegating tasks, asking for help, being out in nature, laughter, journaling, and seeking out a licensed counselor when needed.
  10. Begin a steady exercise program. Aim for a minimum of 30 minutes per day of cardiovascular exercise.

For more tips like these to or schedule a consultation with me personally, contact me here.

Photo by Abbie Bernet on Unsplash

References:

https://www.cdc.gov/me-cfs/index.html

https://www.health.harvard.edu/a_to_z/chronic-fatigue-syndrome-a-to-z

https://www.mayoclinic.org/diseases-conditions/chronic-fatigue-syndrome/symptoms-causes/syc-20360490

https://www.karger.com/Article/FullText/457918

http://info.spectracell.com/bid/54668/Vitamin-B12-Function-Deficiency-Symptoms-and-Repletion

https://www.ncbi.nlm.nih.gov/pubmed/28219059

https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/

Ferreira, S. 2018. A dietitian’s guide to assessing and treating fatigue.

https://www.spectracell.com

Categories Weight Loss, Food, Health, How To, Nutrition

Intermittent Fasting – Is it right for you?

Author Amber Hudler Posted on

If you are like most people, you’ve heard the buzz about Intermittent Fasting (IF), and you’ve probably wondered if it’s something you should consider. Maybe you’re even confused about how it works or whether or not you’re already doing it. After all, don’t we fast every night when we sleep? I’ve been getting asked a lot of questions about fasting recently so I thought it would be a valuable topic to discuss.

Let’s begin with defining what IF is.

The concept of fasting has been around for centuries, and originated in different cultures due to certain religious practices. Traditional fasting is defined as the abstinence of food or drink. Intermittent fasting is a modified version of a traditional fast. It is defined as a period of time in which you cycle between a period of fasting and eating.

There are different variations to the fasting cycle. Some of the most common ones are:

  • Alternate day fasting (5/2)– This is a cycle in which a person will eat a normal diet for five days and then fast for two days. During the two days, you don’t fast completely, but you severely limit calories. So that might look something like this: Breakfast – Fast, Lunch – Fast, Dinner – 500 calories or less.
  • Complete fasting – This is a fully restricted fast that can last up to an entire day. The other days of the week a normal diet is consumed.
  • Time restricted feeding – This is probably the most popular type of IF. This involves fasting within a certain number of hours per day, and eating within the remaining timeframe. The most common is 12/12 (eating all meals within a 12 hour window and fasting for 12 hours) or 16/8 (eating all meals within an 8 hour window and fasting for 16 hours). The cycle can be repeated as often as you prefer – either every day or just a couple of days per week.

Benefits

Recent studies have reported several benefits to IF. IF has been shown to:

  • Assist in alleviating digestive disorders (IBS, SIBO) 
  • Improve insulin resistance and blood sugar balance
  • Support weight loss
  • Slow the growth of certain diseases such as Type 2 Diabetes, cancer, metabolic syndrome, cardiovascular disease, and obesity
  • Lower inflammatory markers
  • Improve longevity
  • Support cognitive function
  • Improve circadian rhythm (the body’s natural sleep/wake cycle)

Some of the most interesting research has been done in the area of weight loss, cardiac health, and the microbiome.

Weight Loss

The idea behind IF supporting weight loss is due to the notion that IF promotes calorie restriction and a temporary increase in resting energy expenditure. In addition, fasting has been shown to support a decrease in fat mass while allowing the body to maintain muscle mass. The theory behind these findings is that during a fasting period, fatty acids are released from fat cells and enter the liver where they are converted to ketones and used for energy and neurons. However, to date this idea has only been studied in animals, so more studies are needed to determine if it applies to humans as well. Other studies have shown that fasting allowed for a greater loss in abdominal fat and overall fat mass.

Cardiac Health

Alternate day fasting has been shown to have a significant reduction in triglycerides, LDL particle size, inflammatory markers such as CRP and may prove to be a viable option for those who are overweight or obese and suffering from cardiovascular disease.  

Another study found that participants who engaged in time restricted eating (16/8), resulted in a 3% decrease in body weight as well as reduction in blood pressure. The researchers concluded that this type of fasting allowed for weight loss without calorie counting. This type of diet is less restrictive then complete and alternate day fasting and may be easier in terms of compliance.

The Microbiome

Studies have shown that a diverse and healthy gut can be beneficial to maintaining a healthy weight. In certain cases, obese individuals have been found to have higher levels of harmful bacteria in gut, and low diversity of good bacteria. In addition, we are now learning that the gut has its own circadian rhythm. Chronically disrupted circadian rhythm may affect GI function and impair metabolism. Obesity or weight gain can be impacted by circadian rhythm in our microbiome. The microbiome in obese patients require a greater amount of energy, and imbalances can lead to chronic inflammation, dysbiosis, and intestinal permeability all of which can contribute to obesity.

How does fasting come into play? Fasting promotes gut rest, allowing the Migrating Motor Complex (MMC) to work optimally, sweeping debris from the small intestine into the colon and allowing proper digestion and absorption. This can be highly beneficial to those suffering from certain GI disorders and optimizes the ability to have a healthy well functioning gut.

Challenges:

  • In multiple studies, compliance was the biggest issues for participants. For those who engaged in a 5/2 alternate day fast, intense hunger on fasting days was the biggest reason for non-compliance.
  • In addition to hunger, other possible side effects are weakness and fatigue.
  • IF is simply not practical for everyone, since the benefits will only occur with a consistent eating/fasting period over time. If your schedule varies throughout the week, IF may not be a viable option for you. 
  • Due to intense hunger encountered during an 8/16 fast, some individuals report consuming higher amounts of food than normal and higher calorie amounts, which could lead to disordered eating patterns, weight gain, and digestive discomfort.
  • Due to lack of studies, we have no evidence to know what this does to a person’s metabolism long term.

IF is NOT recommended for the following individuals:

  • Those with certain conditions such as hypoglycemia, hypotension, advanced Diabetes, and those with high cortisol/adrenal dysregulation
  • Individuals with a history of eating disorders or those at risk of an eating disorder
  • Individuals who are underweight, or are looking to gain weight
  • Pregnant or breast feeding women
  • Children
  • Athletes

The bottom line:

I prefer the idea of a 12/12 fast. Consume a healthy balanced diet within a 12 hour window, and allow for gut rest and calorie restriction within a 12 hour fast. This seems to make the most sense to me, and allow for the most compliance without feelings of deprivation and intense hunger.

It is also important to understand that IF is not an excuse to go crazy and eat whatever you want during the eating portion of the cycle – a common misconception. Individuals should still strive to maintain a healthy balanced diet, full of lean proteins (poultry, fish, eggs, lean pork and grass fed beef), healthy fats, plenty of fruits and vegetables, and complex carbs (starchy veg, whole grains, beans and legumes).  If you are contemplating IF, talk to a qualified health professional to determine if it’s right for you. If you have further questions about IF, contact me here

Categories Gut Health, Nutrition, Stress

A Nutritional Approach to GERD

Author Amber Hudler Posted on

The incidence of Gastroesophageal Reflux Disease (GERD) has dramatically increased over the last few decades. I know I see a lot of it in my practice. This blog post will help you to understand the most common causes of reflux, dietary factors that contribute to symptoms, and some helpful tips for management and prevention.

 

GERD is most often caused by the flow of gastric juices (stomach acid) up the esophagus, which can result in a burning sensation, pain, or discomfort often referred to as heartburn. The condition typically intensifies following a meal and when lying down. While some individuals may suffer from occasional cases of heartburn that are easily resolved with over the counter medications such as antacids, GERD is more of a chronic condition. GERD can place individuals at a higher risk for swallowing difficulties, esophageal inflammation, ulcers, and certain cancers.

GERD is frequently associated with abnormalities or a decrease in pressure of the lower esophageal sphincter (LES). Your LES is a valve that controls the flow of food from your esophagus into your stomach. Normally this valve should close tightly, keeping hydrochloric acid and gastric juices in their rightful place – your stomach – so that they can help you digest your food properly. When the LES is compromised, the valve does not close fully, or it opens too often, and stomach acid will creep up into the esophagus as foods are being digested.

GERD can also be associated with muscle contractions known as gut motility. In a healthy gut, foods are normally pushed through the GI tract from the esophagus into the stomach, from the stomach into the small intestine, and from the small intestine into the colon. However, when the gut is impaired, these contractions can become compromised and cause a disruption in the digestive process.

Another factor to consider is hypochlorhydria or low stomach acid. While it may sound counterintuitive, having too little stomach acid can disrupt natural digestion, causing food to remain in the stomach longer then it should. This can cause major discomfort for many individuals including reflux-like symptoms.

Consuming foods that weaken the LES (see list below), along with increased stress, anxiety, and gut dysfunction, can make the symptoms associated with GERD occur more frequently and at a higher intensity.

 Common causes of GERD include:

Overeating / Obesity (puts pressure on the stomach)

Smoking (relaxes the LES)

Ingestion of the following trigger foods (weakens the LES):

  • Alcohol
  • Soda / Carbonated beverages
  • Coffee / Caffeine
  • Chocolate
  • Fatty / Greasy / Fried foods
  • Spicy foods
  • Acidic foods (tomatoes, orange juice, citrus fruit)
  • Peppermint / spearmint
  • Onions / garlic
  • Sugar

Stress (impairs gut motility)

Use of certain medications (NSAIDS, calcium channel blockers, Bisphosphonates)

Additional considerations include:

  • Bacterial overgrowth such as H. pylori, SIBO or yeast
  • Celiac Disease
  • Hiatal Hernia (stomach pushes up through the diaphragm muscle)
  • Food sensitivities / Allergies
  • Chronic constipation
  • Micronutrient deficiencies (from use of GERD medications) such as zinc, B12

When reviewing this list, you may find that few or many of these items pertain to you. The list of trigger foods is a general one, and not all foods listed will trigger symptoms in all individuals with reflux. But it is important to know which ones exacerbate your particular symptoms and to avoid those whenever possible. This will allow your esophagus to heal and will help to avoid the pain and discomfort associated with this condition.

Conventional treatment and management of GERD often involves:

  • Weight loss (when appropriate)
  • Continual avoidance of trigger foods
  • Eating smaller meals
  • Raising the head of the bed
  • Use of certain medications such as antacids and acid-blocker drugs such as Proton Pump Inhibitors (PPIs)
  • Avoidance of eating within 2-3 hours of lying down or going to bed
  • Avoidance of tight clothing that can put pressure on the LES
  • Avoidance of certain exercises that can put pressure on the LES such as sit-ups, inverted yoga poses, and certain forms of heavy lifting

Additional recommendations that can help include:

  • Slowing down at meals
  • Sitting at meals (avoid standing)
  • Taking smaller bites
  • Chewing food thoroughly. This can actually increase saliva production which can help support the integrity of the esophageal mucosal barrier, which is often impaired in reflux patients.
  • Consume meals that are lower in fat
  • Consume meals that are lower in carbohydrates (to help maintain a healthy weight)
  • Consume fermented foods (to support a healthy microbiome)
  • Avoid consuming large amounts of fluids with meals
  • Begin a routine of gargling at night to stimulate the vagus nerve (supports healthy digestion)
  • Stress reduction / Lifestyle change
  • Regular exercise

There are several types of supplements that can support GERD naturally and can help avoid the harmful side effects of PPIs. These include:

  • Deglycyrrhizinated licorice(DGL)
  • Limonene (extracted from citrus fruit peel)
  • Zinc Carnosine
  • Magnesium Citrate or Glycinate
  • Aloe Vera
  • Slippery Elm
  • Marshmallow
  • Glutamine (to heal)
  • Probiotics (to balance the microbiome)
  • Digestive Enzymes
  • Ginger
  • Iberogast (for motility)

It is always important to work with a qualified healthcare practitioner to receive a proper diagnosis for reflux and to identify the root cause.

In addition, many people find it valuable to work with a dietitian to help control their diet, which will make it easier to manage reflux and its related symptoms.

Common dietary approaches that I recommend in practice:

  • Identify and avoid trigger foods
  • Avoid processed foods and those high in refined sugar that can impair gut integrity and motility
  • Identify and support any nutrient deficiencies
  • Practice the key principles of eating properly (slow down, chew your foods, do not overeat)
  • Dietary support of Hypochlorhydria if present
  • Dietary support of bacterial infections if present
  • Incorporation of fermented foods and probiotics to heal the gut and support your microbiome
  • Stress reduction each day

 

Sources:

Gaby, Alan R., MD. Nutritional Medicine. Alan R. Gaby, M.D., 01/2011. VitalBook file.

Murray, M. T., & Pizzorno, J. (2012). The Encyclopedia of Natural Medicine, 3rd Edition. New York, New York: Atria paperback.

University of Wisconsin School of Medicine and Public Health. An Integrative Approach to GERD (Gastroesophageal Reflux Disease). (2018)

Mullin, G. E., & Swift, K. M. (2011). The Inside Tract: Your good gut guide to great digestive health. New York, New York: Rodale.

https://www.iffgd.org/motility-disorders.html

Rishikof, D. Health Takes Guts Ebook, 2018.

Hyman, M. 7 Steps to Reduce Acid Reflux. 2018.

https://www.mayoclinic.org/diseases-conditions/gerd/expert-answers/heartburn-gerd/faq-20058535

Categories Gut Health, Health, Weight Loss

Gut Health and Obesity – Is Your Microbiome Making You Fat?

Author Amber Hudler Posted on

If you are like many of my clients, you may be seeking guidance and recommendations for weight loss. I often teach people about the benefits of eating healthy unprocessed foods, getting the proper amount of exercise, reducing stress, and prioritizing sleep as a means of achieving a healthy weight. But what if you are doing all of those things and still not seeing results? What else should be considered? The answer is: your gut.

“All Disease Begins In the Gut”

These were famous words spoken by Hippocrates thousands of years ago, and they still hold true today.

Our gut contains 100 trillion microorganisms known as our microbiome. This vast and awesome environment consisting mostly of bacteria, houses 70-80% of our immune system. It is also where serotonin is produced. Serotonin is a neurotransmitter that is responsible for regulating mood, behavior, appetite, digestion, sleep, memory, and sexual desire. While we want to strive to have as healthy and diverse of a microbiome as we can, we can easily find ourselves in situations where our microbes will become altered or imbalanced.

An imbalance in our microbiome is known as dysbiosis. Dysbiosis occurs when we have low microbial diversity, an overabundance of bad bacteria vs. good bacteria, or pathogens. Dysbiosis typically results from things like poor diet, stress, certain medications like NSAIDS, chronic infections, and toxins in the environment. Dysbiosis has been linked to many chronic diseases such IBS, depression, anxiety, thyroid disease, and autoimmune conditions and obesity.

But how exactly, does bacteria in our gut contribute to our ability to gain and lose weight? Several obesity studies have shown that specific microbes in the gut alter how we store calories and fats. Studies that compared the microbiome of lean individuals to obese individuals have found that the leaner study participants had a wider variety of microbes that break down plant starches and fiber into shorter molecules that the body can use as energy. Studies have also shown that a diet high in processed foods can lower diversity within the gut. Gut bacteria can also alter how we regulate glucose levels and how we respond to hormones that make us feel hungry or full, both of which can contribute to changes in body weight and metabolism.

Simply put, an imbalance in our microbiome may increase our risk of weight gain and obesity.

How do you know if you are at risk?

Digestive issues such as gas, bloating, constipation, diarrhea, reflux, or IBS are all signs that your microbiome is impaired and out of balance. If you are struggling to lose weight, these issues may be a contributing factor. Other signs of gut impair include fatigue, brain fog, depression and anxiety, frequent colds and infections, and autoimmune disease.

What to do about it

Repair your gut – for many this can start with a quality probiotic. Probiotics help to diversify your flora  and keep your gut functioning at its best. I recommend professional grade probiotic supplements along with glutamine or collagen to help maintain a healthy gut mucosal lining . But if you are experiencing any of the issues mentioned earlier, it could require a more extensive gut protocol that includes additional supplements such as digestive enzymes, HCL, Magnesium, herbal microbials, or reflux supportive supplements such as DGL. This may seem extensive, but keep in mind that many of these might be temporary supplements that are needed to reduce inflammation and put you on the road to better health.

If you are struggling with digestive issues and weight gain, it is worth exploring the topic of gut health and working with a qualified health practitioner such as myself, to develop a gut protocol to get you well. Once your gut is repaired you may find it easier to lose weight and maintain a healthy weight longer.

For more information on gut health and nutrition counseling, contact me here