Since healing Mr. Hungry from IBS/leaky gut, gut health has become a specialty area of practice for me. However, it isn’t just when working with clients that I get asked about gut health. I also frequently get asked about it by people I barely know.  Once someone I meet finds out I’m a Dietitian, they often want to know how to get their stomach feeling better or what I think about dairy, gluten, kombucha, or leaky gut.  

The truth is just about everyone could benefit from some additional support when it comes to GI health. We live in a gut health depleting world where the gut is under constant attack from toxins, chemicals, additives, medications, and more. I mean, we are exposed to over 80,000 chemicals nowadays that weren’t present 50 years ago. This is unfortunate because the function of the GI system impacts our health in many different ways.   The GI system (and skin) is the first defending piece of the immune system, exposed to anything we ingest. It is also responsible for deciphering what is a friend and what is a foe. It does this by interacting heavily with multiple immune-meditated and nonimmune-mediated pathways and mechanisms.  Therefore, there are about a billion potential causes for the same common digestive symptoms, including diarrhea, nausea, bloating, GERD/reflux, constipation, and pain.  In fact, sometimes gastrointestinal symptoms aren’t even present.   Migraines, infertility or autoimmune-related conditions such as fibromyalgia can be related to food or a sign of poor gut health.  

Causes Of GI Originated Symptoms

Allergies, Sensitivities, and Intolerances

Food Allergies are a hypersensitivity of the immune system creating IgE antibodies, which are thought to lead to immediate symptoms.  Often these symptoms are hives, swelling, anaphylaxis, etc.  Most people know their food allergies.  

Food Sensitivities are a hypersensitivity of the immune system which does not involve IgE antibodies.  Instead, they may involve IgA, IgG, and/or IgM antibodies as well as mediators (think of them like text messages), which are inflammatory signals leading to tissue damage and a large variety of symptoms.   

Food Intolerance does not involve the immune system.  Instead, this situation is created by an enzymatic or structural deficiency.  This is the case with lactose intolerance. The body lacks the enzyme lactase, which breaks down the sugar lactose found in milk.  Without the enzyme (or enough of the enzyme) the body can’t properly break it down, leading to unfortunate symptoms.  Fructose Intolerance or malabsorption is also relatively common. This occurs when there are deficient fructose carriers in the small intestine leading to a build-up of fructose and unfortunate digestive symptoms.   However, we can also see people who have an intolerance to high-fat or high-protein foods due to low enzyme production caused by hypochlorhydria (too little stomach acid), often caused by H. Pylori or other gut microbiome imbalances. 

Infection & Microbial Imbalance

Then, of course, there is the potential for there to be an infection, such as small bacteria overgrowth (SIBO), candida (yeast) overgrowth, or a number of other potential pathogens that could be causing digestive symptoms.  Or there could be a microbiota imbalance from the use of antibiotics.  See what is the GI MAP? 

Stress & Autoimmune Conditions

Autoimmune conditions may play a role as well.  Celiac disease is a condition where gluten, a protein found in certain grains, predominately wheat, causes damage to the intestinal wall of the small intestine.  Inflammatory bowel disorders such as Ulcerative Colitis and Crohn’s are conditions of heightened inflammatory response in the GI tract and throughout the body.  Thyroid disorders may speed up or slow down digestion.  These conditions are complex and require a multi-faceted personalized approach to decrease inflammation and promote healing.  In the case of celiac disease, removing gluten is often enough to restore health.  However, often times other food sensitivities have been developed, potentially triggered by the stress of the undiagnosed condition and need to be addressed.  There is no specific UC, Crohn’s, Thyroid, or other autoimmune diets that are widely accepted because each person’s response to food is unique and different.  

Stress does not directly damage the gastrointestinal tract but it does play a huge role.  Think of it like this, genetics load the gun and lifestyle pulls the trigger.  What that means is that every single person responds to stress differently depending on genetic predisposition and lifestyle.  Poor lifestyle choices such as food intake, weight gain, lack of exercise, and stressful life situations (creating stress hormones) create a constant state of stress or inflammation triggering messages.  This may manifest in conditions such as blood sugar imbalances, weight gain, autoimmune conditions, hormone imbalance, digestive disorders etc… Each person will respond to physical, emotional and the general wear and tear of life differently.  

The End Result: Leaky Gut/ Intestinal Damage

All this stress and immune reaction on the gastrointestinal system is now leading to symptoms.  When you are to the point that you are feeling gastrointestinal or potentially other symptoms you have likely sustained some damage to the integrity of the gastrointestinal system.  This is known in the functional and integrative medicine community as “leaky gut.”(1-4)  A condition once thought to be “made up” is now well documented in the literature.  Once the permeability  of the cells that line the GI tract are compromised there is the potential for nutrient malabsorption, food sensitivities, and symptoms.  

Why I Don’t Recommend Elimination Diets 

 Recommendations to improve gastrointestinal health, migraines or autoimmune conditions often include recommendations to try and eliminate “common allergens” such as wheat/gluten, dairy, eggs, soy, and corn.  FODMAPS are popular and well document in the literature to be triggers for IBS.  Tyramine and high tyramine foods are known to be common migraine triggers.   I absolutely acknowledge that certain symptoms may relate to certain foods.  However, I don’t consider it “safe”or the best course of action to eliminate food groups, even if you replace the nutrients.  

Missing Undiagnosed Conditions

First, if you eliminate gluten from your diet and feel better, you could very well have celiac disease.  However, since you didn’t get tested you now have to reintroduce it into your diet for up to 6 months in order to get the appropriate testing and diagnosis.  Even if you are okay with just avoiding gluten, I believe since it is a genetic condition you owe the diagnosis to your family members.    Later on down the road, your daughter could struggle with getting pregnant and that be her only symptom of celiac disease.  No one will think to look for it because there is no family history of the disease.  For this reason, if wheat ingredients all rank high on a food sensitivity test and the client has not previously been tested for celiac, I require that they get the testing before eliminating gluten from their diet.  Also, keep in mind that the level of which you need to adhere to a gluten-free diet does change dramatically depending on if you are diagnosed with celiac or gluten sensitivity.  

Unresolved Inflammation

Second, there are thousands of foods and chemicals out there that we could be potentially exposed to.  The body responds to everything it comes in contact with but some things it over-reacts to.  Yes, there are a certain number of foods that we tend to see more often than others.  However, rarely do I see just those foods show up when we actually test for food sensitivities.   Often the body is responding to stress or over consumption of certain foods and therefore losing tolerance to random foods completely unique to the individual.  Remember how genetics create a unique manifestation of inflammation in the body?  Well, they will also create unique food reactions and sensitivities.  The whole name of the game is to squash the inflammation because it is the inflammatory messengers causing tissue damage and symptoms. To do that you can’t just avoid foods that cause you problems.  You have to isolate to foods that are known to be safe and let the immune system calm down (like putting it in a bubble). Once the immune system is calm you can begin food re-introduction and truly know what causes your problems. For instance, for Mr. Hungry yeast/molds are a huge trigger but he would have never known that if he had just started removing things like gluten and dairy.  He would have improved but not fully, so we would have still been guessing.  

Stress

Third, elimination diets are mentally demanding, life interfering, and not as successful as testing.  You can eliminate one food at a time, but since the immune system is still in a heightened state of responding to other food sensitivities that you have not eliminated, you likely won’t become 100% better.  So,  many people spend months removing 6+ foods from their diet and aren’t quite sure if they feel better, or they feel better but not 100% normal.  A less stressful way could be spending 10 days sticking to 25 foods and then systematically expanding the diet. This helps to determine other food reactions, even untested ones, or those that don’t show up on testing such as intolerances.

What Is Normal?

What is normal?  You should be able to comfortably eliminate at least once per day.  You shouldn’t  have symptoms of GI discomfort very often and definitely not more than once per month (nausea, heartburn, fluctuation diarrhea/constipation, bloating, etc.) Frequent migraines, fibromyalgia, low energy and other symptoms may also be a signal that GI health is not optimal.  

What Should You Do?

1. Take probiotics
2. Get enough prebiotic fiber
3. Anti-inflammatory & digestive supportive fats
4. Take a multi-vitamin to ensure optimal nutrient intake 
5. Transition toward eating more real food 
6. Decrease your stress, practice meditation and yoga 
7. Avoid Artificial sweeteners (eat more real food)
8. Work on developing a positive relationship with food  
   1. Eat until 80% full
   2. Remove distractions while you eat
   3. Keep records of what you eat

I usually recommend avoiding only one thing outside of your normal routine

9.  Decrease Omega 6 rich oils & totally avoid trans fat –> directly inflammatory.  

What If Those Things Haven’t Worked?

Occasionally, I will recommend additional support in the form of supplements including collagen, turmeric, and glutamine.  However, I will tell you that you will likely not see a great deal of help from them if you are still consuming foods that irritate the gut lining and cause inflammation in the body.  In addition, you could be reactive to something like MSG or turmeric, so if you are, these supplements thought to be healing for the digestive tract may be your kryptonite.  

At this point, you may be tempted to begin removing potential trigger foods from your diet.  This trial and error process would be fine, however, it is likely not just one food that is the problem.  If it was just one food you would already know what it was.  More than likely, it is more than one food you have lost oral tolerance to.  There may be a build-up of chronic inflammation that needs to be addressed by removing the trigger foods and supporting healing.

MRT Testing  & LEAP Programming

After consulting with you about your health history, medical conditions, finding out what you have tried and assessing your mindset around food I often recommend MRT (mediator release testing) and LEAP programming.  The process isn’t right for everybody, though.  The testing and dietary support for food sensitivities will require an initial investment of time, finances, and emotion.  However, the result is finding out exactly what your food triggers are (tested and non-tested) and giving the body a chance to actually heal.  You have to be willing to adhere to only 20ish foods for 7 to 10 days while we let the immune system calm down.  You have to be willing to keep meticulous detail for at least 30 days on your symptoms.  You have to be dedicated to getting better and improving your symptoms.  

However, if you do those things you will save yourself from all the guesswork, frustration, and prolonged state of chronic inflammation. You will also likely end up saving money when you don’t have to spend so much on medications (OTC or prescribed) and doctors visits.

A special note: If you have had your food sensitivities tested before using IgG testing (like what Mr. Hungry did- Alcat, Great Plains or Alletess) that is a great start.  However, as discussed earlier, food avoidance does not heal you.  I learned that with Mr. Hungry, it takes a systematic approach to truly decrease inflammation and improve symptoms in the long term.  Food avoidance only focuses on avoiding the foods that come up high (which actually could be a positive protective response) and not on untested foods.  Furthermore,  IgG antibodies are only one immune pathway and may actually signal a positive response. MRT Testing looks and many immune pathways by looking at the end result: the release of mediators which cause tissue damage and symptoms. (You can read more about that here.) 

Food sensitivity testing is one of the most powerful tools I’ve been able to utilize with my clients.  It has been extremely humbling to help others and my husband finally improve life long symptoms and feel better.  If you are interested in seeing if the testing is a good option for you, please schedule a consult with me via my Hungry Hobby RD website so we can discuss if you are a good candidate.  

Linking up with Amanda For Thinking Out Loud Thursday.

References:

1. Hollander, D. (1999). Intestinal permeability, leaky gut, and intestinal disorders. Current gastroenterology reports, 1(5), 410-416.
2. Sturniolo, G. C., Di Leo, V., Ferronato, A., D’Odorico, A., & D’Incà, R. (2001). Zinc supplementation tightens “leaky gut” in Crohn’s disease. Inflammatory bowel diseases, 7(2), 94-98.
3. Kiefer, D., & Ali-Akbarian, L. (2004). A brief evidence-based review of two gastrointestinal illnesses: irritable bowel and leaky gut syndromes. Alternative therapies in health and medicine, 10(3), 22.
4. Kiefer, D., & Ali-Akbarian, L. (2004). A brief evidence-based review of two gastrointestinal illnesses: irritable bowel and leaky gut syndromes. Alternative therapies in health and medicine, 10(3), 22.