One of the many places in medicine which our mental/ emotional state is intertwined with the physical is in digestive issues. In fact, the newest research into the gut microbiome reveals that even the smallest constituent elements in our digestive tracts reflect the health of many other organ systems (respiratory, reproductive, cardiovascular, brain, nervous systems, and more). It makes sense that our bodies respond well to an integrative, holistic approach.

Here are some of the approaches I recommend when working with digestive conditions from an integrative holistic lens.

Get more clarity on your condition with more specific lab information

The success of any treatment depends on how precisely you and your doctor understand your symptoms and their cause(s). If you have been struggling with ongoing digestive symptoms but have been left with no explanation despite ’normal’ lab results, or treatment options that haven’t changed your experience, it may be time to seek more specific testing.

Comprehensive integrative gastrointestinal tests, taken in conjunction with other test results and a comprehensive health history, can help clarify specific digestive patterns.

• Is it IBS?

• Or an inflammatory process?

• Or, do you need a closer look at sensitivities to foods and dietary triggers?

• Or, do you have an infectious process such as a parasite, yeast, mold, or small intestinal overgrowth pattern, or other opportunistic infectious pathogens present?

• Or, do you have worrisome symptoms like a major change in bowel habits, unexplainable fatigue, or blood in your stools and need to get in for an urgent work up? (The US Preventative Services Task Force decreased the minimum age for a screening colonoscopy from age 50 to 45 in the past year.)

It can be exhausting and time consuming to struggle through multiple rounds of self-treatment and the guesswork involved in changing your diet for weeks (or months or years in some cases). I highly recommend people to pursue specialized testing with a practitioner skilled in functional and comprehensive gastroenterological tests when something feels off so that clarity and health progress can arrive sooner.

Nourish for your health

For some people, identifying and eliminating specific foods and shifting dietary habits can provide relief of symptoms.

However, perhaps just as many people with chronic digestive issues struggle from avoiding multiple food groups in attempts to resolve symptoms. Some are at risk of developing complicated relationships with food (such as orthorexia), or re-triggering disordered eating patterns, and/or drifting into malnourishment. So, if you’re working with dietary therapies over time, make sure to do this carefully. Getting good information (testing) can help determine the most efficient, nutrient-rich route to healing.

In the meantime, here are a few points about nourishing a healthy gut microbiome:

• Eat the rainbow of high fiber vegetables so that your gut bacteria degrade it into brain- and nervous system-protecting short-chain fatty acids (SCFAs), the mainstay of healthy digestive balance.

• Use less hand sanitizer, avoid unnecessary use of antibiotics including involuntary exposures to antibiotics via soaps, factory-farmed agriculture, and unfiltered water.

• Eat fermented foods.

• When it comes to fasting, a 12-hour fast that happens naturally overnight while you’re sleeping is probably plenty. This is especially true for women’s bodies whose reproductive hormones are more sensitive to the stress of fasting. If you continue to have digestive or other health symptoms despite cleanses and fasting, consider another therapeutic strategy.

• If you are having trouble incorporating plant fibers or fruit sugars in your diet without digestive issues, that may be a warning sign that further investigation is needed.

• Avoid processed foods, fast foods (microplastics! trans fats!), and refined carbohydrates.

Specific foods that worsen symptoms vary from one digestive pattern to the next and from one patient to the next. For this reason, dietary advice should be highly individualized. Know that just because a dietary approach worked well for some one you know, doesn’t mean that it’s necessarily right for you.

Develop a relationship with your stress and work with it

The more we learn about the interconnection between the gut and the brain, the more the research reveals that our digestion is a stress-sensitive process. The digestive and nervous system are co-impacted by microbial metabolites, neurotransmitters, hormones, immune pathways, and yes, stress.

Here are some examples of how stressful events precipitated IBS in various populations.

• Academic overload and a perceived lack of time in medical students led to a significantly higher risk of developing IBS compared to the students who weren’t overloaded. (Pozos-Radillo, 2018).

• Children exposed to various forms of adverse events including physical, emotional, and sexual abuse are significantly more likely to develop IBS over the course of their lifetime. (Sansone, 2015).

As a result of all these known connections between stress and digestion, determining the kind of stress management techniques that work best for each person is a big part of successful care. Some examples might include: therapy or counseling, self-compassion exercises, work-life balance, meditation, hypnotherapy, yoga, or breathwork.

Nutrients and supplements

Nutrients and supplements can make a big impact on digestive healing, but selecting them should happen together with your health care practitioner. (For your consideration: some one with a thyroid condition and IBS, versus some one with hormone imbalances and gallbladder dysfunction, versus another person with undiagnosed bowel cancer might present with some of the same symptoms, but each person needs individualized and appropriate diagnosis and treatment).

In the meantime, here are a few important supports that can support the digestive system healing in a wide variety of conditions:

• Probiotics: The selection of probiotics is vast these days because we know more about the gut microbiome than we ever have before. So, saying that you are 'taking probiotics’ is a little bit like saying you are ’taking medicine’ — the word ‘probiotics’ is referencing a whole category of therapy. The specific species and the metabolites they produce influence metabolic balance, weight loss, cancer, cardiovascular disease, periodontal disease, and mental health. Seek out strains and complexes specific for your health issues.

• Postbiotics: Research shows that supplementing the metabolites of healthy probiotic species may have longer lasting positive effects on gut health than probiotics, whose effects taper off nearly as soon as you stop taking them. Check in with your doctor about postbiotics (also known as short chain fatty acids). (van der Hee, 2019)

• L-Glutamine: This amino acid is like food for the intestinal cells, allowing the gut lining to replenish and rebuild itself and heal intestinal permeability issues. (Zhou et al, 2019).

• Digestive Enzymes: Optimizing the initial portions of digestion — sometimes referred to as ‘upper gate digestion’ — can improve symptoms further down the digestive process such as bloating, abdominal pain, dysbiosis (an imbalanced gut microbiome), or irregular bowel movements. Depending on the diagnosis, some people do better with digestive enzyme support for the stomach, exocrine pancreas, gallbladder, or broad spectrum.

Engage embodied therapeutic care

Research is finally starting to reflect the wisdom that our bodies have long reflected: our emotions, stress, and digestive symptoms are intricately connected.

For this reason, if you have chronic digestive issues, it can be important to receive a form of body-centered therapeutic care that helps you with your specific experience (stress, abdominal tension/discomfort, bloating, GERD). There are many options in this realm; it’s best to notice what works for you:

• Acupuncture can have a direct gastrointestinal effect by altering GI motility and pain perception. (Yaklai, 2021)

• Visceral manipulation reduces symptoms of IBS such as distention, pain, and abdominal hypersensitivity. Visceral manipulation is a French form of osteopathy or gentle hands on work known to help people with wide array of digestive patterns including IBS, gallbladder dysfunction, hiatal hernia, GERD, colic, or other chronic digestive patterns. (Attali, 2013)

• For some people, therapeutic massage or bodywork can help relieve anxiety and stress that manifests as abdominal tension or symptoms.

• A 2020 study in Frontiers in Neuroscience showed acupuncture helped improve neural connections in the gut-brain axis, relieved IBS symptoms, and improved quality of life. (Kai, 2020)

It bears mentioning that no two practitioners are exactly the same even if they are offering the same techniques or services. This is both an extremely human as well as a frustrating part of navigating the world of alternative and complementary healthcare. It’s best to listen to your ‘gut’ feelings and work with practitioners that you resonate best with.

References

❍ Attali, T, Bouchoucha, M, Benamouzig, R. Treatment of refractory irritable bowel syndrome with visceral osteopathy: short-term and long-term results of a randomized trial. J Dig Dis. 2013;14(12):654-61.

❍ Kai, M, Yongkang, L, Wei, S, Jianhua, S, Jing, L, Xiaokun, F, Jing, L, Zhongqiu, W, Daoqiang, W. Brain Functional Interaction of Acupuncture Effects in Diarrhea-Dominant Irritable Bowel Syndrome. Front. Neurosci. 2020;14. https://doi.org/10.3389/fnins.2020.608688)

❍ Pozos-Radillo, E, Preciado-Serrano, L, Plascencia-Campos, A, Morales-Fernández, and Valdez-Lopez, R. Predictive study of academic stress with the irritable bowel syndrome in medicine students at a public university in Mexico. Libyan J Med. 2018;13(1):1479599. doi: 10.1080/19932820.2018.1479599

❍ Sansone, R, Sansone, L. Irritable Bowel Syndrome: Relationships with Abuse in Childhood. Innov Clin Neurosci. 2015;12(5–6):34–37.

❍ van der Hee B, Wells JM. Microbial Regulation of Host Physiology by Short-chain Fatty Acids. Trends Microbiol. 2021;29(8):700-712. doi:10.1016/j.tim.2021.02.001.

❍ Yaklai, K et al. The Role of Acupuncture on the Gut-Brain-Microbiota Axis in Irritable Bowel Syndrome. Am J Chin Med. 2021;49(2):285-314. doi: 10.1142/S0192415X21500154.

❍ Zhou, Q, Verne, ML, Fields, J Z, Lefante, J J, Basra, S, Salameh, H, & Verne, GN. Randomised placebo-controlled trial of dietary glutamine supplements for postinfectious irritable bowel syndrome. Gut. 2019;68(6), 996–1002. https://doiorg.liboff.ohsu.edu/10.1136/gutjnl-2017-315136