Gut Issues - My Approach

What Is This Issue?

When clients come to me with gut issues, they've often been living with discomfort for years. They might have been given a label like IBS (Irritable Bowel Syndrome), but this diagnosis doesn't really explain why they're experiencing symptoms like bloating, gas, abdominal pain, constipation, or diarrhoea. These problems can be frustrating, embarrassing, and exhausting, often dictating what they can eat and where they feel comfortable going.

What many don't realise is that gut issues rarely stay in the gut. I frequently see clients whose digestive problems are connected to seemingly unrelated symptoms like brain fog, fatigue, skin breakouts, hormonal imbalances, and even mood changes. This is because your gut is connected to everything else in your body.

What Is Underlying This Issue?

In my practice, I find that gut issues are rarely a simple case of "just having a sensitive stomach." They are usually a sign that something deeper is out of balance. A crucial point many miss is that SIBO (Small Intestinal Bacterial Overgrowth) often underlies IBS. This bacterial overgrowth is frequently driven by the gut microbiome and diet, creating a vicious cycle if not addressed properly. There are several common interconnected factors at play:

• Impaired gut motility – the muscular contractions that move food through your digestive system aren't working properly, which can lead to bloating and a feeling of being "backed up"

• Bacterial imbalance – when the bacteria in your gut are out of balance, either with too many of the wrong kind or not enough of the right kind, it can cause gas, bloating, and inflammation

• Low stomach acid – stomach acid is crucial for breaking down food and killing off pathogens, so when levels are low, it can lead to poor digestion and bacterial overgrowth

• Intestinal permeability – when the tight junctions between your gut cells loosen, it allows undigested food particles and other substances to escape into your bloodstream, triggering an immune response and inflammation

My Functional Nutrition Perspective

In my practice, I've found that gut issues are often connected to other health problems, which is why I frequently see them alongside conditions like endometriosis, PMOS, and autoimmune diseases. The gut-hormone connection is particularly relevant – hormonal imbalances can contribute to gut symptoms, and poor gut health can in turn worsen hormonal issues by affecting nutrient absorption and increasing inflammation.

The usual medical approach tends to focus on managing symptoms with medications or generic FODMAP dietary advice that doesn't address why the gut is struggling in the first place. While these approaches can provide temporary relief, they don't resolve the underlying factors that allowed the issues to develop. If you don't deal with the environment and diet that are driving the SIBO, it will simply come back.

Stress plays a huge role in gut health. The gut-brain axis is a direct communication pathway, meaning when you're stressed, your gut feels it immediately. Stress hormones like cortisol can slow digestion, alter stomach acid, and negatively impact gut motility, creating the perfect environment for digestive problems to thrive. This is why addressing the nervous system component is crucial for long-term resolution.

When it comes to diet, especially with gut issues and underlying SIBO, we need to take a low-carb approach. The bacteria that overgrow in SIBO feed on carbohydrates, particularly fermentable ones. By reducing carbohydrates, we starve these bacteria of their food source, which helps reduce symptoms and rebalance the gut environment. This isn't just about symptom management – it's about changing the internal environment to make it less hospitable for the organisms that are causing your symptoms.

What I Will Look At

When working with gut issues, I focus on several key areas to understand your unique situation:

Gut Environment

• I'll investigate potential gut infections that might be contributing to your symptoms

• I'll assess your microbiome balance to identify what types of bacteria might be overgrown or deficient

• I'll evaluate your digestive function and nutrient absorption capabilities

• I'll look for signs of intestinal permeability that might be allowing inflammatory substances to escape into your bloodstream

Gut Motility

• I'll assess how well your digestive system is moving things along

• I'll consider factors that might be slowing down your gut motility, such as thyroid issues

• I'll evaluate how your nervous system might be affecting gut motility

Environmental Triggers

• I'll consider potential dietary factors that might be contributing to your symptoms

• I'll assess your stress levels and how they might be affecting your digestive function

• I'll evaluate how medications might be contributing to your symptoms

Hormonal Balance

• I'll examine how your hormones might be influencing your gut motility and digestive function

• I'll evaluate how stress hormones (cortisol) might be affecting your gut health

• I'll assess the relationship between your reproductive hormones and digestive symptoms

Recommended Lab Testing

For comprehensive assessment of gut issues, I recommend the GI Map test as the priority, which provides:

• Detailed analysis of gut microbiome balance

• Identification of potential pathogens contributing to your symptoms

• Assessment of digestive function and nutrient absorption

• Markers for intestinal permeability and inflammation

Additionally, I recommend the DUTCH Plus test to evaluate how your hormones and stress might be influencing your gut function.

Hormone Considerations

Research has shown that hormonal fluctuations can trigger digestive symptoms in many conditions. This is particularly relevant during menopause, when gut issues often get worse due to the dramatic shifts in hormones. Some women notice changes in their digestive symptoms during different phases of their menstrual cycle as well. This connection between hormones and gut health is particularly important to address when working with persistent gut issues.

For sensitive guts, specialised low-carb diets can reduce symptoms while we work on addressing the underlying causes. These diets need to be tailored to your specific situation and are typically used temporarily to give your gut a chance to heal.

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