The Gut-Brain Connection - A BIG Piece of the Puzzle

A few questions for you first - Is bloating your most prominent digestive symptom? Do your IBS symptoms worsen during periods of stress? Do you feel bloated with a certain food one day, but not another day? Do you get bloated even from water? Yes is a common answer I hear but it does not typically indicate any serious damage to the gut, or that you most definitively have SIBO. It could actually be a misfiring of signals from your gut to your brain and back…aka a gut-brain connection issue (or a disorder of gut-brain interaction - DGBI).

Bloating & Distension are Different:

Abdominal bloating and distension are 2 of the most commonly reported GI symptoms. For some they can be chronic and very uncomfortable, but for other it may be infrequent.

But there is a difference between bloating and distension! They can occur together or independently. To get technical, abdominal bloating is the subjective sensation of excess intestinal gas, but without obvious visible abdominal distension. People with bloating may feel a sense of fullness or discomfort. Abdominal distension is the objective physical manifestation of an increase in abdominal girth (aka “looking 6 months pregnant” for some). Unfortunately, because of how the health care system categorizes IBS, the differentiation is not regarded, but it can be very helpful to determine the cause of your IBS.

If you have bloating and/or distension but regular bowel movements, or if you have explored celiac testing, the lowFODMAP diet or SIBO testing and you still have bloating, it would be helpful to explore the idea of a disorder of gut-brain interaction (DGBI).

It's Not "Just in Your Head":

It’s important to understand that a DGBI is not "just in your head." While the brain and gut communicate closely, the symptoms are real and need proper management - these are gut conditions that can be affected by stress and mental health. But they are not just stress and mental health.

Think of your gut as a house and a DGBI as a highly sensitive fire alarm system. Normally, the fire alarm only goes off when there is an actual fire, alerting you to real danger. However, in DGBI, this fire alarm system is malfunctioning. It’s hypersensitive and can be triggered by everyday activities like cooking or lighting a candle, causing unnecessary panic and stress. Just as you would need to fix a malfunctioning fire alarm, DGBI requires a tailored approach to manage the symptoms and improve your quality of life.

What can help?

There are several things we need to explore in order to calm this hypersensitivity and correct a DGBI. Everyone in unique of course so unraveling the trigger and make the correction does need an individual approach. Do we need to start with correcting any imbalance of gut bacteria? Or does daily stress and anxiety have a bigger impact on your gut symptoms. These are things I love to explore with people.

For the Love of Fibre!

Chances are that someone has told you at one point in your life that you need to eat more fibre.

Maybe you tried to do so and you got constipated or you ended up farting a lot! Or maybe you tried decided to give up because it was too hard.

Well whatever the reason, here are a few fibre tips that can help make increasing fibre a little easier on the digestive system!

#1 - Soak your beans!

• Beans aren’t called the magical fruit for nothing! Beans, which can be a great source of fibre, contain a carb called raffinose. Raffinose can be a bit harder to break down in our digestive systems, which means that our gut bacteria get a lovely meal! When our gut bacteria snack on things they produce gas! Now we do need to show them love, but it can be uncomfortable when you get a bout of wind at Sunday dinner over baked beans!

• In order to help reduce the raffinose load a dose of baked beans or bean salad provides us, we need to soak the beans first! They can be soaked for a few hours or overnight. This will help hydrate them and reduce the gas producing raffinose snack without impacting the overall nutrition of the beans!

#2 - Fruits contain fibre too!

• Whole fruits can have more sugar in them than their vegetable counterparts, but wapping in some fruit for dessert or part of snack time can add in some more fibre to your day!

• Notably high fibre fruits include: pears, citrus (eating the whole inside not just the juice), berries, apples, avocado, kiwis, bananas

#3 - Baked goods and ground meat!

• Shredded vegetables like zucchini, mushrooms and carrot can be added to baked goods and ground meat dishes without altering the flavour too much!

• So making meatballs or cooking ground meat for tacos? try shredding in some zucchini or dicing mushrooms to add some extra fibre in!

• Making muffins? try added zucchini or carrot to give not only extra flavour but also extra moisture!

There are tons of ways to make fibre fun! What do you like to do to add more fibre? I would love to know!

Dr Paige

Blueberry Oatmeal Flax Muffins - aka "Mary's Poop Muffins"

I may sound like a broken record to my patients lately regarding fibre intake, however this is such an important component in our diet that most people are lacking in. When it comes to digestive issues many patients of mine are actually avoiding fibre rich foods as it is causing GI distress. They may be on the lowFODMAP diet, recommended to them by their MD or through online research, which is a low fibre diet. This should only be used short term for symptom relief while we treat the root cause, as like I said before fibre is very important for overall digestive health.

Low fibre intake can present as constipation, other digestive issues and even food cravings.

Most people are getting on average 15g of fibre a day, while the recommendation is 25-35g a day! This is one draw back to easy convenient meals we gravitate towards with our busy lives. Less plants, less beans, less complex carbs that take longer to cook = less fibre.
There are many ways to increase fibre intake, including more plants, beans and legumes, complex carbs, ground flax, chia or psyllium powder. What can you add to your diet this week? It may be one of these delicious fibre rich muffins that really do help you poop!

Examples of healthy fibre rich foods:

• 1/2 cup oats = 4g

• 1 tbsp ground flax seed = 2g; 1 tbsp chia seeds = 6g

• 1 apple = 4-5g

• 1/2 cup lentils - 7g

• 1 medium sweet potato - 3-5g

• 1 tbsp psyllium powder - 5g

Recipe:

Ingredients:

• 1/3 cup butter (or vegan butter)

• 1 cup oats

• 1/2 cup ground flax seed

• 1/2 cup unsweetened apple sauce

• 1 egg

• 1 cup buttermilk (or 1 cup dairy free milk + 1 tbsp vinegar, left to sit for a few minutes)

• 1 tsp baking powder

• 3/4 tsp baking soda

• 1/2 tsp salt

• 1/2 cup brown sugar (optional)

• 1 cup whole wheat flour (or gluten free flour eg. Bob’s Red Mill 1:1 gluten free baking flour)

• 1 cup blueberries

Mix all ingredients in order they are listed. Fill 12 muffin cups using muffin liner. Bake at 375F for 20 minutes.

Do I have a Food Sensitivity? Is it an issue and how to test.

Since I see a lot of digestive issues in my practice I find that food sensitivities are something worth exploring in many. They are quite common and can lead to a variety of different health concerns from digestive complaints, to skin issues such as eczema or psoriasis, to fatigue and joint pain. They are different from severe food allergies, such as an anaphylactic reaction to peanuts that occurs immediately, as they are a more delayed reaction. Food sensitivity symptoms can take up to 72 hours to appear after eating, so a low-grade food sensitivity can be hard to spot. The more severe a sensitivity the quicker and/or more severe you notice the symptom.

What causes food sensitivities?

When we eat foods we are sensitive to it causes the digestive track lining to become inflamed and small “breaks” in the lining occur allowing partially digested food particles to “leak” into your bloodstream, where your immune system sees them as invaders. Your body then produces antibodies (IgG antibodies) which circulate and attach to the food particle. When your body cannot eliminate the antigen-antibody complexes quickly, your immune system mounts a larger response leading to symptoms of chronic inflammation. The more of this food you eat, a higher level of inflammation can occur. So not only can you suffer from local digestive symptoms, it can then cause systemic inflammation.

Damage to the intestinal lining (aka leaky gut) can be caused by several things other than a main food sensitivity, such as gluten. This could be medications including PPIs, antibiotics which disrupt the normal flora in the intestine, overgrowth of other bacteria such as yeast or Candida, other invading bacteria, and high stress causing lower levels of digestive enzymes and blood circulation to the gut.

How do you test for food sensitivities?

The gold standard for food sensitivity testing is an elimination diet. Meaning, you eliminate all the common foods sensitivities such as gluten, eggs, dairy, sugar etc, for 3-4 weeks then reintroduce these foods back in one at a time to investigate what, if any, reaction you have to that individual food. It may be different for different foods, for example, cramping and diarrhea from dairy and bloating and fatigue from gluten.

Another way to test food sensitivities that I do often in my practice is a blood IgG test, testing 96 common food sensitivities with a simple blood prick test. The test is measuring the amount of IgG antigen-antibody complexes produced when your blood is exposed to that food. The higher the level, the worse the sensitivity. I have seen big improvements in patients health when they identify and eliminate their food sensitivities.

Do you have to eliminate foods forever?

Now my goal is never to limit someones diet even more longterm, so I interpret a test result a couple ways.

There may be 1-5 foods that are high on the list and these are generally the true sensitivities, ie - contribute to the leaky gut picture. These foods would be eliminated either longterm or for several months while we heal the gut and address any other contributing factors.

If many foods sensitivities come up, some in moderate levels, it proves there is a leaky gut and systematic inflammation. I advise to limit these foods for the time being and stress the importance of gut healing using probiotics and soothing and healing herbs for the gut. We also may need to explore stress levels, and other systemic bacterial overgrowth contributing to inflammation.

Once we complete a gut healing protocol it is easier to introduce certain foods back into your diet.

Do you have symptoms of a food sensitivity?

If you are struggling with digestive concerns, skin issues, fatigue, joint pain, depression even, and haven’t explored triggers from your diet, I would suggest reaching out to an ND like myself to explore this possibility. As I mentioned above, there may be more to the story that just a food trigger but it commonly has a component in someone health concerns.

Note - If you are noticing digestive concerns triggered by higher fibre foods or the lowFODMAP diet has been suggested and is helpful to you, that may be a different issue all together that we can definitely explore as well.

In health & happiness,

Dr. Karen