| Food Intolerance or Disturbed Gut Function?
Many people suffer daily with digestive upsets, from mild discomfort to severe symptoms of pain and bowel frequency that see them house bound.
Up until recently most upper digestive complaints such as indigestion and heartburn have been treated with anti acid medications such as proton pump inhibitors (eg Nexium and Somac) which have long term side effects such as poor bone mineralisation and bowel cancer due to inhibition of correct digestion in the stomach.
Lower digestive distress (bloating, pain, alternating constipation and diarrhoea) are commonly labelled Irritable bowel syndrome (IBS) and suffers may be told it is all in their head or recommended anti depressants if no reason for the symptoms can be found.
Naturopaths will commonly identify food intolerance and gut dysbiosis (imbalance of good and bad gut bacteria) as a cause, however it appears that gut dysfunction may precede these in some cases. Discovering the true cause and addressing these with evidence based natural medicines is helping many people recover their normal digestive function.
This article is about how you can help heal your gut problems, covering the following
- What is food intolerance
- What is disturbed gut function
- Which came first?
- The nervous system and the gut
- Addressing the cause
- Supporting normal gut function
- How to determine food intolerance
Treatment of functional gastrointestinal disturbances rests fundamentally on the art of medicine in the treatment of the patient and not on the science of medicine in the treatment of the disease.
Wilbur, D.L. 1955 quoted by Ruth Trickey 2012
What is food intolerance - Food intolerance is a pharmacological reaction (like the side effects of a drug) to the chemicals in foods.
How common - Food intolerance is much more common than allergies, affecting babies (through breastmilk), children and adults. Effects are related to dose so in theory, everyone will react if the dose is high enough, and this was confirmed in a study with MSG. People most likely to be affected by nasty food chemicals are those who are most sensitive, and those who consume the highest doses. As additives continue to increase in our food supply every year, we should expect more people to be affected, especially children.
Which foods -, food chemicals most likely to cause problems are artificial colours, natural colour annatto (160b), preservatives, flavour enhancers (the 600 numbers) and some natural chemicals called salicylates and amines. These can be in many different and seemingly unrelated foods. For example, asthmatics are most likely to be affected by sulphite preservatives (220-228) in dried fruit, juice drinks, cordials, wine, sausages, some medications and a wide range of other foods.
Timing - Food intolerance reactions can be delayed up to 48 hours or more, or effects can be cumulative. For instance, children rarely react to the preservative in one slice of bread, but if they eat bread every day - as children do - the effects can build up over a month and fluctuate with no obvious cause. In our experience, parents rarely realise their children are affected by food chemicals until their symptoms improve when nasty food chemicals are removed from the diet.
Dose: -Intolerance reactions to food chemicals are dose-related. Some people are more sensitive than others. In theory, everyone will react to food additives if they consume enough .
Symptoms - Food intolerance reactions can be the same as allergy , itching, swelling, rash, spreading hives, vomiting, diarrhea, breathing difficulties and in the most severe of the allergic disorders, anaphylaxis can lead to collapse and death. By definition, anaphylaxis is an allergic reaction which involves two of the body's systems (eg respiratory and gastrointestinal or skin). Anaphylactic deaths as a result of insect bites or penicillin are usually very quick - within minutes - and due to cardiac arrest, anaphylactic deaths due to food allergies are usually due to suffocation (breathing difficulties).
as well as:
skin (rashes, swelling)
airways (asthma, stuffy or runny nose, frequent colds and infections)
gastrointestinal tract (irritable bowel symptoms, colic, bloating, diarrhea, vomiting, frequent mouth ulcers, reflux, bedwetting, 'sneaky poos', 'sticky poos')
central nervous system (migraines, headaches, anxiety, depression, lethargy, impairment of memory and concentration, panic attacks, irritability, restlessness, inattention, sleep disturbance, restless legs, moodswings, PMT).
Symptoms of food intolerance can come and go and change throughout life.
For an occasional antidote to a food intolerance reaction, try a pinch of soda bicarb in half a glass of water, or half to one Caltrate plain white 600 mg calcium supplement tablet.
Taken from the fedupwithfoods.com.au referencing
Clarke L, McQueen J, et al. (1996). "The dietary management of food allergy and food intolerance in children and adults." Australian Journal of Nutrition and Dietetics 53(3): 89-94.
What is disturbed gut function (Functional Gastro intestinal Disease FGID)
Functional Dyspepsia (Indigestion and heartburn)
Upper gastrointestinal system (GIT) symptoms
· Early satiety
· Post prandial fullness
· Abdominal cramps
· Epigastric pain/upper abdominal discomfort
· Build up of gas causing pain
Lower GIT symptoms
· Diffuse abdominal pain
· Build up of gas causing pain
· Abnormal stool frequency with relief with evacuation
· Feeling of incomplete evacuation
Which can first – intolerance or gut issues?
A ‘two way street” exists between most Functional Gastrointestinal disorders and a range of other insults for example:
IBS frequently exacerbated by food intolerance, while eating an inappropriate food can trigger an attack of IBS
Dysbiosis can be a cause or an effect of IBS
Stress can be a cause of IBS and at the same time, IBS itself is a significant source of stress and altered mood states
Dyspepsia may be caused by a number of foods (food intolerances such as lactose) medication (NSAIDs especially chronic use) systemic disorders and disease of the GI tract. More than 50%of dyspepsia cases are determined to have no obvious cause and are labelled idiopathic or ‘functional’
5 proven causes of functional dyspepsia
· inadequate ability of the stomach to adapt to ingested food
· delayed emptying of the stomach
· hypersensitivity to expansion/distension of the stomach wall
· abnormal small intestine (middle and lower) motility
· changes in sensitivity to fats and acids
Further modified by psychosocial factors and helicobator pylori and other acute gastroinstestinal infections
The brain gut connection
Serotonin is the main neuropeptide affecting gut motility, secretion and sensitivity. Alterations in serotonin signalling is evident in FGID (IBS, chronic constipation, diarrhoea and functional dyspepsia). Stress has a strong association with onset, exacerbation and severity of IBS symptoms. Sustained stress can result in permanent pain, increasing stress responsiveness of central stress circuits. Anxiety exacerbates IBS.
Inflammatory response and infections can influence visceral perception, secretion and motility
Microbiota (probiotics) play a central role in intestinal immunity via maintenance and function of intestinal epithelial cells. Psychological stress reduces number of lactobacilli and increases growth of pathogens
Clinically proven Natural medicines
Database search engines found on: Medline, Ovid, EBSCO, PubMed, Science Direct, Springer Link, Google Scholar
Any published peer reviewed scientific articles that investigated FGID (IBS or FD) treatment with western herbal medicine, Chinese herbal medicine and dietary interventions
Animal and in vitro studies were excluded
Of 60 trial found, ones with placebo controlled trials were selected – noting a high placebo response rate in FGID
- Singles species
§ B. Infantalis 35624 (IBS-D)
§ E. Coli DSM 17252
§ L. acidohilus SDC 2012 and 2012-05-10
§ L. rhamnosus GG, L. rhamnosus LC705, Bifidobacterium breve and Propionibacterium freudenreichii species sheranil JS
§ Bifidobactrium bifidum BGN4, Bifidobactorium lactis AD011, L. acidophilus AD031 and Lactobacillus casei IBS041
· Peppermint oil
· Psyllium fibre
· Banana powder – increases mucus secretion and exerts an acid neutralising capacity.
· 1 kiwi fruit 2 x day
· Single herbs for FGID
- globe artichoke,
- lemon balm,
- Iberogast complex
Addressing the cause
· Enteric nervous system (ENS) dysfunction
o Disordered motility
o Visceral hypersensitivity
o Disturbance in secretory function
· Central nervous system (CNS) disturbance
o Brain gut interactions
o Brain gut neuropeptides
o Psychosocial factors
o Stress induced adrenal and ANS response
· Food intolerance and allergy
· Dietary indiscretions
o Overeating, poor food choices, poor eating habits
· Immune dysregulation
o Autoimmune and local immune response
· Dysbiosis and parasites
· Leaky gut syndrome
· Adjacent organ distress
Improve bowel regularity
Have lemon juice first thing
Then go for a walk
Have a coffee or dandelion coffee
Sit on the toilet
What you eat
Eat regular simple cooked meals, steam ,braise, grill or bake,
Focus on what you can eat, rather than what you can’t
If poor digestion try cooked foods and white protein,
Warming spices cinnamon, cardamom, coriander, cumin and ginger
Stimulate regular evacuation with fibre and stimulants
Regular morning toileting after eating and/or drinking to stimulate the gasrocolonic reflex
How you eat
At the table with friend or family (associated with increased longevity)
Regular meal times and limit eating in between
Rest time for the GIT to experience normal hunger response
Small to moderate serves in keeping with exercise and age
Away from TV, computer and phone
Consider ill effects of nutritional supplements ie
Calcium can cause constipation, bloating, flatulence
Magnesium can cause diarrhoea
Glucosamine can cause upper GIT upset, diarrhoea
Chondrotin can cause upper GIT irritation
Fish oils can cause indigestion, diarrhoea, flatulence
B vitamins can cause upper Git irritation esp B3
Zinc can cause upper GIT irritation (nausea)
Vitamin C can cause diarrhoea, ascorbate can aggravate Gastro oesophageal reflux disease (GORD)
Heartburn and Reflux
Note there is an increase in fracture risk in those older adults taking proton pump inhibitors (PPI) for the treatment of reflux (GORD)
soaked chia, chamomile and lemon balm tea
reduce smoking and alcohol
elevate head of bed
smaller serving sizes and eat earlier
slippery elm powder, grated apple and yogurt before bed
Try seed breakfast –
· 2-3 tbsp seeds and nut (linseeds, almonds, pumpkin seeds, sesame seeds, sunflower seeds mixture (ground individually to coffee ground texture)
· 1-2 tsp psyllium or slippery elm powder,
· ½ cup plain (unsweetened), organic or biodynamic or raw yogurt with live cultures,
· grated raw apple or stewed apple, pears or plums or berries, in winter may be added to cooked oatmeal, rice or quinoa porridge
Chamomile, peppermint and lemon balm tea 6 mugs daily 3 tsp per mug
Off wheat and dairy (common aquaired intolerance0)
Slippery elm powder
How to determine food intolerance
Many health problems and symptoms begin in the gut and are mediated by our response to food and food antigens. Keeping a food diary can be a helpful place to start especially for food with an immediate reaction. However some foods have a delayed (up to 49hr later) reaction, this can be harder to identify. Some food reactions such as those to salicylates are threshold related so you can consume some food containing them, however once you reach your threshold symptoms appear, again this can be confusing when trying to identify what is causing the problem.
Blood testing for immune responses can be helpful.
Healthscope pathology offer a 93 food panel which rates reactions from mild to severe, cost is approximately $380 or 40 foods $260 or 5 foods $100
RAST blood test covers house dust, grass, wheat, Moulds animals, IgE and eosinophil counts so is more appropriate for inhalant allergies rather than dietary issues.
IgG blood levels are helpful but often not as useful as a elimination diet with challenge
Food intolerance Diagnosis issues
Many false positives and negatives
Food tolerance can improved or exacerbated by other foods, ie fructose is absorbed better in the presence of steroids, protein and sucrose
Fructose absorption is poorer on a low GI diet and with stress or inflammation