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.

Low Energy? What blood work an ND may want to see.

If I was to ask you to rate your energy on a scale of 1-10 (10 being great) what would you say? If you said lower than 5/10, even after a good nights sleep, it is something that should be addressed.

I like to review blood work first when fatigue is a concern, as a few common nutrient and hormone deficiencies can be the culprit. The reference ranges I refer to may be slightly different than your MD for a few reasons.

1. I want to optimize your levels to sustain better energy.

2. I am referring to the newest reference range recommendations that will hopefully be reflected in blood work soon.

3. I see results when patients levels reach a certain level.

So what blood work do I like to see and what levels should they be at? This may vary slightly depending on someone’s health history.

• Vitamin B12 - This should be above 200 pmol/L, ideally above 450 pmol/L.

• Ferritin - You have iron deficiency anemia if your ferritin level is below 30 ug/L. Unfortunately, this is becoming more and more common in today’s society. A full iron panel is not often needed.

• TSH - Your thyroid stimulating hormone should be between 0.8-2.5 mIU/L. This can fluctuate during times of stress or hormone changes. Medication is not often needed until the level gets much higher, however supporting adrenals (stress hormones) and the thyroid gland if out of this range can help.

• Morning Cortisol - Between 7-9am your level should ideally be between 450-550 nmol/L. Cortisol is an essential hormone that plays many important roles, including regulating your body's stress response. If it is low you are most likely suffering from burnout!

There are several reasons why someone may be deficient in any of these and it is important to address the cause as well as supplement for the deficiency.

Take a look at your most recent blood work. What are your levels like? I’m happy to help improve them and ultimately your energy!

Welcome Dr. Paige!

If you have come to the clinic in the past year or so, you may have seen or heard of my lovely associate Dr. Paige Weatherbee-Sakr! She started during my second maternity leave and has continued seeing patients on Wednesdays since. She will be at Symmetry for the foreseeable future, so it is probably time to introduce her properly! She is a great asset to the team. I want to highlight that she is completing a Mental Health Fellowship this year as this is an area of interest to her in practice as of late. I’ll pass it over to Dr. Paige to tell you more about herself.

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Hi my name is Paige and I am a Naturopathic Doctor working at Symmetry Wellness Centre with Dr. Karen! Some of you may have met me while I was covering for Dr. Karen’s second maternity leave. For those of you who did not, I figured I would share a little about myself, so you know who I am if I pop up in the blog or in her office!

I started covering for Karen in May of 2023 and have found myself continuing to work in her office on Wednesdays at Symmetry Wellness Centre in Burnside. I am also certified in IV therapy like Karen and so I provide 1:1 visits as well as IV care in the office.

When I am working, I like to work from a place of addition – whether that be food, sleep, habits or water - my goal is to make sure you are getting enough! I do this through a lot of listening, a lot of helping people with introspection and leaning on the tools at our disposal – IVs, Botanicals, Nutrition, Nutraceuticals, Exercise, Counselling and Diagnostics.

I am also interested in research and how we blend that with clinical experience, specifically in the world of mental health and the digestive system. With this interest, I am also currently pursuing a year long program to improve my grasp on the research around mental health support and Naturopathic medicine. I hope to be able to share the fruits of this program in 2025!

When I am not in the office, I can be found in the kitchen (since I love food), in the woods (since I love to geocache and hear the birds), Watching shows or in a book (since I love science fiction and fantasy), or just spending time with loved ones (since I am a wife/sister/daughter/aunt/dog + cat mom).

I hope you find as much joy as I do both professionally and personally! Hope to see you in Dr. Karen’s Office soon!

Heart rate variability - A valuable tool to track well-being

A healthy heart does not beat like a metronome, but actually changes its rhythm with each heart beat. The constant variation between each beat is called your heart rate variability (HRV). This is something I have been speaking about to several of my patients recently, as more people have smart watches and other health tracker apps that can measure this.

What affects HRV?

There are certain situations that result in a higher HRV and other situations resulting in a lower HRV, reflecting your hearts ability to respond to different situations. This ultimately reflects how your nervous system is responding. HRV can react to stress and/or illness before resting heart rate, which makes it one of your body’s most powerful signals—providing useful insights into your stress levels, recovery status, and general well-being.

Generally a lower HRV is associated with your “flight or flight” response, stress or illness. A higher HRV is associated with your “rest and digest” response, general fitness and good recovery. It is amazing how we can track how just a 5 minutes meditation exercise can improve your HRV.

There are some things we cannot control that affect HRV such as age, hormone cycles, illness and amount of stress we have. However, to improve HRV there are things we can control such as sleep routine, alcohol and caffeine intake, how we manage stress and fitness level.

Tracking HRV

A high or low HRV is relative to each person. It is therefore best to track your own HRV over time and generally aim for a higher level, or track what improves it and decrease it, instead of comparing to others. It can range from 20 to above 150 depending on the tracker. Also, sometimes it is ok to see a lower levels for a short period of time, eg. during a strenuous activity where our nervous system is working hard to increase our heart rate. It is then how we recover that matters.

HRV fluctuates often throughout the day so is is helpful to track it in a controlled setting like sleep. However, some trackers, like the smart watch may limit this if you don’t want to wear it at night.

I see a lot of digestive issues, fatigue, insomnia etc in my practice and it almost always has a component that connects back to the nervous system. If we can help manage our stress response and improve HRV, that can help us tremendously over time. Ultimately, you don’t NEED to track HRV to check in with how you are doing overall. However there are some pretty neat tools out there now that can track things like HRV that we can use to our advantage.

Thoughts? Check in with me if you have questions.

Dr. Karen