Nerd Out: Irritable Bowel Syndrome

My latest assignment for my Master’s in Holistic Nutrition was to write a paper about a gastrointestinal disorder. I chose Irritable Bowel Syndrome, as it ranks up there as one of the most prevalent chronic disorders people experience. If you’d like to nerd out with me, continue reading:

Irritable Bowel Syndrome, or IBS, is defined as chronic inflammation of the large intestine and presents itself through a cluster of symptoms, including abdominal pain, spasms, bloating, gas, and abnormal bowel movements (Lipski, 2012, p.286). Because there is a spectrum within the symptoms (mild to severe), and because the symptoms fluctuate over time, it is often challenging to differentiate between IBS and normal variations of the gastrointestinal tract (Rakel, 2018, p.423). Stress has proven to play an integral part in the flare-up of IBS, providing a psychosocial perspective to treatment (Rakel, 2018, p.423), although some experts prefer to categorize it as a disorder of the gut-brain axis rather than as a psychiatric disorder (Kohlstadt, 2012, 261). A diagnosis is made due to its chronic nature (at least 6 months’ duration) (Kohlstadt, 2012, p.261), by excluding pathology, and including some or all of the symptoms of abdominal pain/discomfort, bloating, and diarrhea/constipation (Rakel, 2018, p.423).

Specifically, the Rome III Criteria for Irritable Bowel Syndrome defines IBS as at symptoms lasting at least three months, with onset at least six months previously of recurrent abdominal pain or discomfort associated with two or more of the following: Improvement with defecation; Onset associated with a change in frequency of stool; And/or onset associated with a change in form (appearance) of stool (Kohlstadt, 2012, p.262). This, with the absence of weight loss, anemia, and rectal bleeding, support the diagnosis of IBS (Kohlstadt, 2012, p.261).

Also prevalent amidst the cluster of symptoms may be nausea, anorexia, hypersecretion of colonic mucus, restless leg syndrome, migraine headaches, chronic fatigue, irritable bladder, and dyspareunia (Pizzorno & Murray, 2013, p.1557). IBS is often seen in patients with a history of sexual abuse and/or sexual dysfunction, fibromyalgia, urinary frequency and urgency, poor sleep, menstrual difficulties, lower back pain, and insomnia (Pizzorno & Murray, 2013, p.1557).

IBS is cited as the most common GI disorder seen in general practice, representing 30%-50% of all referrals to gastroenterologists (Pizzorno & Murray, 2013, p.1557). Women are diagnosed twice as often as men, which might be due to men under-reporting symptoms (Pizzorno & Murray, 2013, p.1557), and is more prevalent in Caucasian persons than others. Early studies demonstrate that IBS patients tend to have an enhanced stress responsiveness that presents higher morning cortisol levels and an inability to turn off the stress response, both which have been shown to increase intestinal permeability and inflammation (Rakel, 2018, p.429).  

There are three subgroups of IBS under which patients are categorized: constipation predominant (IBS-C), diarrhea predominant (IBS-D), or mixed (IBS-M) (Kohlstadt, 2012, p.261).  Risk factors may be environmental, genetic, or both (Kohlstadt, 2012, p.262). Several conditions, including food allergies, infections, poor diet, and metabolic disorders mimic the symptoms of IBS and must be ruled out in order to make the diagnosis.

The etiology of IBS is unclear, although it frequently occurs in concert with Small Intestinal Bacterial Overgrowth (SIBO) and Leaky Gut Syndrome (Lipski, 2012, p.287). IBS can also be caused by stressors to the gut as mentioned above, leading to an over-active inflammatory response in the mucosal tissue of the large intestine (Lipski, 2012, p.288). Parasites and candida overgrowth may also play a role in IBS, and women may experience increased symptoms around their menstrual periods (Lipski, 2012, p.288). Chronic stress, dysregulated immune response, dysbiosis, overconsumption of alcoholic beverages, certain medications such as NSAIDs and birth control pills, and even lectins have been implicated in the chronic inflammation characteristic of IBS (Lipski, 2012, p. 46-47) (Rakel, 2018, p.423).

Allopathic approaches to IBS focus on three main therapies: increasing fiber in diet, probiotics, and antibiotic therapy (Rifaxamin), especially if SIBO is indicated (Lipski, 2012, p.287) (Rakel, 2018, p.430). Another pharmaceutical, oral Cromolyn (brand name Gastrocrom), is used to control the release of GI-irritating substances from mast cells in the GI tract (https://www.mayoclinic.org/drugs-supplements/cromolyn-oral-route/description/drg-20063181).  And with the mind-body connection to IBS, tricyclic antidepressants and selective serotonin reuptake inhibitors are an option for patients with IBS-D (Rakel, 2018, p.430).

For IBS-C, a diet high in fiber (25-30 grams per day, preferably insoluble fiber such as in oats and psyllium), and low in fat help with stool bulking and intestinal motility (Kohlstadt, 2012, p.272).  Pharmaceuticals such as 5-hydroxytryptophan (5-HTP), Lubiprostone, Tegaserod, and Renzapride may be indicated soften the stool and relax the gut. (Kohlstadt, 2012, p.265) (Pizzorno & Murray, 2013, p.1560).

Anticholinergic agents are used to reduce abdominal cramping and smooth muscle spasms (Kohlstadt, 2012, p.266). Peppermint oil is gaining traction in the allopathic medical community as another option for relaxation of the smooth muscle in the GI tract as well as for mediation of other symptoms (Kohlstadt, 2012, p.266) (Pizzorno & Murray, 2013, p.1560).

Broad-spectrum probiotics are recommended to repopulate the intestinal microbiome with optimal rather than pathogenic gut microflora, decrease fermentation, and stimulate proper immune function (Rakel, 2018, p.427) (Pizzorno & Murray, 2013, p.1559).

Antibiotic therapy, specifically Rifaxamin, has been found to significantly improve IBS symptoms, especially in IBS-D patients and those with comorbid SIBO (Rakel, 2018, p.430).

All types of IBS may benefit from Cognitive Behavioral Therapy and/or hypnotherapy to help with accompanying anxiety and depression (Kohlstadt, 2012, p.271).

The above-mentioned approaches are based on an extensive medical history, including frequency of abdominal pains, gas, bloating, constipation, and/or diarrhea. Lab tests may include a comprehensive stool analysis, complete blood count, erythrocyte sedimentation rate, free thyroid T3 hormone levels, and antiendomysial antibody testing for celiac disease (Pizzorno & Murray, 2013, p.1557).  The enzyme-linked immunosorbent assay (ELISA) allergen challenge test or the ELISA IgE/IgG4 test are sometimes used to detect food allergies (Pizzorno & Murray, 2013, p.1558).

IBS-D type symptoms may indicate a panendoscopy with duodena, colonic, and terminal ileal biopsies to rule out celiac disease, inflammatory bowel disease, and colitis (Pizzorno & Murray, 2013, p.1557). Additional stool testing for eosinophilic cationic proteins may be indicated if food allergy is suspected (Pizzorno & Murray, 2013, p.1557). Finally, screening for occult fecal blood, flexible sigmoidoscopy/colonoscopy are also options to rule out other causes (Pizzorno & Murray, 2013, p.1557).

Integrative approaches take a broader approach to diagnosis and treatment. Assessments such as a health history questionnaire are combined with a comprehensive discussion and/or physical assessment, and include all of the inclusions and exclusions as a diagnostic tool as listed previously. Family medical history is noted, as there may be a genetic link (Rakel, 2018, p.423). A food journal and dietary history is collected to detect possible food sensitivities, intolerances, and allergies (Lipski, 2012, p.288-289), as well as helps determine detrimental dietary choices and eating patterns.

Breath tests, including the SIBO breath test (or the Hydrogen-Methane test), the Lactose-Intolerance/Lactose Malabsorption test, the Fructose Intolerance/Fructose Malabsorption test, and/or the Sucrose Intolerance/Sucrose Malabsorption test are utilized to detect gut sensitivities to sugars, and are especially indicated if leaky gut or SIBO are suspected (What is Irritable Bowel Syndrome, 2019, https://www.commdx.com/)  (Lipski, 2012, p.289) (Kohlstadt, 2012, p.272). Organic acid testing is also a possibility, providing an evaluation of intestinal yeast and bacteria (Lipski, 2012, p.289), and an HCl challenge test can detect decreased gastric acid production (Rakel, 2018, p.430).

Permeability, or leaky gut issues can also be assessed using a lactulose-mannitol urine test or with positive IgG food antibody testing (Rakel, 2018, p.423).

A comprehensive digestive stool analysis including parasitology is recommended, as candida overgrowth and parasites are often overlooked causes of IBS (Lipski, 2012, p.288).

An elimination diet and subsequent food challenge helps identify triggering foods (Rakel, 2018, p.426). Introducing therapeutic dietary systems (FODMaPs/fermentable carbohydrates avoidance, GAPS, Paleo, low-sugar, dairy-free, gluten-free, lectin-free, caffeine-free, alcohol-free, etc.), based on individual needs often provides symptomatic relief (Pizzorno & Murray, 2013, p.1558, 1559) (Lipski, 2012, p.289) (Rakel, 2018, p.426) (Kohlstadt, 2012, p.269). It is important to note that artificial sweeteners such as sorbitol, maltitol, or xylitol may worsen bloating and diarrhea in IBS patients so should be avoided (Kohlstadt, 2012, p.270-271).

Increasing fiber with psyllium seeds, flaxseed, or hemp seed is recommended, as well as adding a broad-spectrum probiotic that includes lactobacilli and bifidobacteria (Lipski, 2012, p.290). Eliminating dairy foods, sugar, fruit, honey, and maple syrup may ease symptoms (Lipski, 2012, p.289, 290). Prebiotic-rich foods (bananas, artichokes, garlic, onions, etc.) as well as probiotic foods (sauerkraut, kimchee, and kvass, etc.) stimulate and feed healthy GI flora (Rakel, 2018, p.428) (Axe, 2018, https://draxe.com/leaky-gut-diet-treatment/).

Other dietary supplements include pancreatic enzymes, ginger, aloe, Chinese herbs such as Padma Lax and STW-5, glutamine, EPA/DHA fish oil, peppermint oil, chamomile, rosemary, Melissa (balm), valerian, betaine hydrochloride, and calcium-magnesium citrate (Rakel, 2018, p.428- 430) (Lipski, 2012, p.290-291).

Bone broth soothes the gut and provides the nutrients collagen, glycine, proline, and glutamine, as well as easily absorbable minerals and natural anti-inflammatories like chondroitin sulfate and glucosamine (Kresser, 2019, https://chriskresser.com/the-bountiful-benefits-of-bone-broth-a-comprehensive-guide/).

Decreasing the chemical load by eating organic produce, and pastured eggs and meat, allows for optimal healing of the gut. Other nutrient-rich foods include healthy fats like coconut oil, avocado, and the omega-3 fats in fatty fish. Sprouted seeds, fermented vegetables, and adequate hydration round out the list (Axe, 2018, https://draxe.com/leaky-gut-diet-treatment/)

Finally, lifestyle modifications that include more self-care to decrease stress, anxiety, and depression have been shown to decrease IBS symptoms. Mind-body therapies include stress management, relaxation therapy, meditation, hypnosis, journaling, biofeedback, art therapy, acupuncture, and gentle exercise such as yoga, and walking (Rakel, 2018, p.429). Often more effective than medical therapy (Rakel, 2018, p.429), stress reduction strategies tap into the mind-body and gut-brain connection that affects both sickness and wellness. An entire paper could be written on this topic as well, but suffice it to say, a holistic approach to Irritable Bowel Syndrome, including diet, supplementation, exercise, and stress reduction, offers promise to provide not just physical but emotional relief as well.   

References

Axe, J. (2018, July 30). Leaky Gut Diet and Treatment Plan, Including Top Gut Foods. Retrieved May 30, 2019, from https://draxe.com/leaky-gut-diet-treatment/

Cromolyn (Oral Route) Description and Brand Names. (2019, February 01). Retrieved May 30, 2019, from https://www.mayoclinic.org/drugs-supplements/cromolyn-oral-route/description/drg-20063181

Kohlstadt, I. (Ed.). (2012). Advancing medicine with food and nutrients. Boca Raton: CRC Press.

Kresser, C. (2019, May 28). Bone Broth Benefits: Everything You Need to Know. Retrieved May 30, 2019, from https://chriskresser.com/the-bountiful-benefits-of-bone-broth-a-comprehensive-guide/

Lipski, E. (2012). Digestive wellness: Strengthen the immune system and prevent disease through healthy digestion. New York, NY: McGraw-Hill.

Pizzorno, J., & Murray, M. T. (2013). Textbook of natural medicine. St. Louis, MO: Elsevier.

Rakel, D. (2018). Integrative medicine. Philadelphia, PA: Elsevier.

What is Irritable Bowel Syndrome? (2019). Retrieved May 31, 2019, from https://www.commdx.com/

My Optimal Health/Weight Loss Workshop Explained (Phase 2)

**This is an explanation to my professor of the second module (or phase 2) of my weight-loss, optimal health online program. I’m currently working on my Master’s of Holistic Nutrition from Hawthorn University.**

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Once a client is fully entrenched in Phase 1 of my Fittbodies Optimal Health Plan, I introduce the Phase 2: Boost Immunity formula. In this phase we build on the Phase 1: Alkalize steps with immune-supporting habits, paying closer attention to fasting, sleep, cravings for sweets, and holistic health.

I begin by encouraging clients to eat their meals within a small, condensed window of time, also known as Time Restricted Eating (TRE) (Longo & Panda, 2016). Scaling back the timing of their first and last meals gradually, by 30 minutes a week, allows the client to ease into a longer fasting window without feeling deprived. For example, if a client’s regular breakfast time is 7am and dinner time is 7pm, I would have them begin Phase 2 by taking 30 minutes off each side of their fasting window. They would therefore eat breakfast at 7:30am (at the earliest) and eat dinner at 6:30pm (most days). Of course there needs to be flexibility to accommodate work schedules and social engagements, but the aim is to achieve a longer fasting window 80% of the time. As the client builds confidence in fasting, we will lengthen the fasting window by another 30 minutes for a week. It may not be feasible to scale back dinner as much as it is to put off breakfast, so once a client finds an optimal dinner time for their schedule, preferably 2-3 hours before bedtime to allow for complete digestion, we hold that dinner time and begin scaling back the first meal only. Not only does this way of eating better coincide with circadian rhythms (Longo & Panda, 2016), but it allows the cells to undergo positive metabolic changes (Longo & Mattson, 2014). Ideally, we work up to a 16 hour fast with an 8 hour eating window over the course of weeks to months.

Physical activity is maintained during Phase II, with the challenge of exercising while in a fasted state. Stressing the body occasionally this way encourages hormesis and builds the body’s ability to adapt to stress (Mercola, 2013, https://fitness.mercola.com/sites/fitness/archive/2013/09/13/eating-before-exercise.aspx).

Phase II also encourages clients to eliminate refined sugar and artificial sweeteners and instead use honey, maple syrup, coconut sugar, and stevia leaf for sweeteners. We continue to work on reading labels with emphasis on avoiding products with added sweeteners. If a client has a favorite treat that holds a lot of emotional value for them, we’ll work together to find a healthier version that they can eat without compromising their newfound health. An example of this is my healthy “raw cookie dough” recipe, which is comprised of almond butter, MCT oil, plant protein powder, and bittersweet chocolate chips. I personally eat this, mixed in a small cup, instead of eating the white flour, sugar-laden traditional version, without feeling deprived.

Alcohol is also limited in Phase II, as alcohol metabolizes in the body as sugar. We scale back to consuming only on the weekends, and one-to-two drinks only (Cloe, https://www.livestrong.com/article/435315-the-effect-of-alcohol-on-insulin-resistance/).

Phase II begins the elimination of grains, including wheat, corn, oats, rye, buckwheat, etc. to see if it makes a difference in the client’s energy levels, mood, and sleep. Processed foods, such as crackers, pasta, breads, cereals, cakes, and cookies are avoided. Limited intake of home-prepared quinoa and black rice is acceptable as they provide fiber while creating less of an insulin response in the body (Goldman, 2018, https://www.healthline.com/health/why-is-quinoa-good-for-diabetes), and (Price, 2019, https://draxe.com/black-rice-nutrition-forbidden-rice-benefits/).

I teach about our toxic exposure to potentially dangerous chemicals in Phase II, and encourage the client to purge their make-up, body-care, and personal-care products and cleaners and to purchase cleaner alternatives. Obsesegens, hormone-disruptors, and chemicals hidden in our daily routines wreak havoc on our bodies, resulting in hormone imbalances, weight gain, and other disease states. A great resource for finding “clean” alternatives is the Environmental Working Group’s Skin Deep database (https://www.ewg.org/skindeep/).

I encourage clients to begin the practice of daily oil pulling as a way to detox as well during Phase II. Oil pulling is an ancient Ayurvedic practice in which a person swishes coconut, olive, or sesame oil for up to 20 minutes a day. It is purported to whiten teeth, reduce inflammation, boost immunity, and kill bad breath, among other things (Axe, 2018, https://draxe.com/oil-pulling-coconut-oil/). Clients start with 3 minutes a day of swishing, working up to 5, 7, then 10 minutes minimum, with coconut oil.

Finally, we work on both quality and quantity of sleep in Phase II. Rest is underrated, in my opinion, and so we work on emotional as well as physical aspects of sleep hygiene. This includes darkening the room for sleep by unplugging clock radios, night lights, or anything else that glows at night; plugging in cellular phones as far away from the bed as possible; using room-darkening window coverings; wearing blue light blocking eyewear at night; and avoiding digital devices for at least an hour before bedtime (Stevenson, 2013, https://themodelhealthshow.com/sleep-problems-tips/.) Moving up bedtime 30 minutes earlier each week is a goal, until a minimum of 7 ½ hours of sleep a night, on average, is reached. Use of a Fitbit or other sleep-tracking device is a great motivator, as sometimes we over-estimate the sleep we get.

There is a lot to this Phase II, and clients are allowed to take it as slowly or as quickly as they need or want. At the fastest, the above steps are implemented over the course of a week and maintained over a month or two before moving on. Those who choose (or need to) take it slower can incorporate one new step every week or two, progressing over the course of 2-3 months.

Individuals may experience some setbacks during this phase, including symptoms of detoxification such as irritability, nausea, fatigue, muscle aches, headaches, etc. Sugar cravings may ramp up before dissipating, and some may struggle with limited alcohol and grain intake. Longer sleep may take time, as will the transition to shorter eating windows, eating the garlic, and exercising in a fasted state. It’s very possible clients will get impatient if results don’t occur quickly enough, or if they regress at any point, so I’ll need to provide lots of support and reminders that this is a lifestyle change that will enable their weight to drop off and stay off over time.

Check-ins, weekly (or more often as needed), videos, and Facebook group support are key to success in Phase II. The initial “glow” of success with Phase I will diminish, and it is possible clients may feel more deprived of the foods and habits they love most during Phase II. Progress in this phase may slow down, or even seemingly stop, so I will need to provide reading materials, hand-holding, and testimonials from other clients to help them stay motivated through these changes.

 

References

Axe, J. (2018, June 02). Coconut Oil Pulling Is the New Flossing (It Stops Tooth Decay, Prevents Cavities, Kills Bad Breath & More!). Retrieved March 16, 2019, from https://draxe.com/oil-pulling-coconut-oil/

Cloe, A. (n.d.). The Effect of Alcohol on Insulin Resistance. Retrieved March 14, 2019, from https://www.livestrong.com/article/435315-the-effect-of-alcohol-on-insulin-resistance/

Goldman, R. (2018, July 23). Why Is Quinoa Good for Diabetes? - Healthline. Retrieved March 14, 2019, from https://www.healthline.com/health/why-is-quinoa-good-for-diabetes

Longo, V. D., & Panda, S. (2016). Fasting, Circadian Rhythms, and Time-Restricted Feeding in Healthy Lifespan. Cell Metabolism,23(6), 1048-1059. doi:10.1016/j.cmet.2016.06.001

Longo, V., & Mattson, M. (2014). Fasting: Molecular Mechanisms and Clinical Applications. Cell Metabolism,19(2), 181-192. doi:10.1016/j.cmet.2013.12.008

Mercola, J. (2013, September 13). Why Exercising While Fasting Is Beneficial. Retrieved March 14, 2019, from https://fitness.mercola.com/sites/fitness/archive/2013/09/13/eating-before-exercise.aspx

Price, A. (2019, January 30). Why You Should Eat This 'Forbidden' Food. Retrieved March 14, 2019, from https://draxe.com/black-rice-nutrition-forbidden-rice-benefits/

Skin Deep® Cosmetics Database. (n.d.). Retrieved March 14, 2019, from https://www.ewg.org/skindeep/

Stevenson, S. (2017, November 08). Sleep Problems? Here's 21 Tips To Get The Best Sleep Ever. Retrieved March 14, 2019, from https://themodelhealthshow.com/sleep-problems-tips/

Cinnamon Rolls and The Lessons They Teach Us

Ever heard of the Pareto Principle?

It’s a cause and effect theory first discovered by Italian economist Vilfredo Pareto in 1896. It states that 80% of effects come from 20% of causes. Pareto stumbled onto this theory in his garden, noticing that 20% of his pea pods contained 80% of the peas.

What does this have to do with health and nutrition?

What we do when it comes to what we eat and how we move our body can definitely affect our health.

I’d like to suggest that the Pareto Principle is FLIPPED when it comes to health and nutrition.

Here’s how:

If we eat “well” 80% of the time and indulge 20% of the time, our bodies adapt and we shouldn’t suffer too many ill effects of those indulgences. Although the 20% DOES count for a lot, the consistency of the 80% keeps us on the healthy path.

If we exercise 80% of our days and rest 20% of the time, we should be able to maintain a strong, healthy body. Taking some rest days will not diminish our strength, power, or endurance gains. In fact, research has shown that rest days actually ENHANCE our training gains.

If 80% of the time we get a decent night’s sleep, and 20% of the time we stay up late Netflix binging, our bodies will recover. Yes, it’s best to stay on a consistent sleep schedule, but life is fun and sometimes the fun doesn’t start until the kids are tucked away for the night.

You get what I’m saying?

So last weekend was Father’s Day, and the only thing my husband James wanted was homemade cinnamon rolls. Not the healthy kind I’m inclined to make (gluten-free, sugar-free, dairy-free). No. The delicious kind (gluten-full, sugar-full, and ooey-

Here’s a picture of the finished product. Don’t they look fabulous?

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Now here’s what I really want to talk about—THE GUILT.

How many of you would indulge in this delicious treat and then beat yourself up for it the rest of the day? The reality for many people I work with is that they feel “bad” or “weak” when they partake of delicious, unhealthy treats. It doesn't need to be that way.

Here’s the thing—If you eat clean, nutritious, healthy food 80% of the time it is okay to take a bite (or 20 as I did) of something not-so-healthy and “get away with it.”

No guilt. No despair. No, you didn’t ruin your diet. You didn’t undo what you’ve been working so hard for.

You gotta live a little, right?

You just can’t eat like that all the time. Father’s Day comes once a year, so the cinnamon-y and cream cheese-y goodness is okay once a year. (We actually do cinnamon rolls Christmas morning, so that’s twice a year). Once or twice a year won't kill you. It won't even effect you much at all. It's the daily "treats" that are our downfall.

We need to plan out our indulgences so we can make sure that 80% of the time we are making good choices. Birthdays, holidays, and anniversaries can be calendared in advance. Work parties, neighborhood BBQs, and other social events usually give a bit of notice, too.

Plan for them.

Calendar your activities so you can make sure you’re eating and exercising 80% of the time. Then relax and enjoy the other 20%. It’s simple.

The flip side of the Pareto Principle—the 80/20 rule—making sure you’re healthy AND happy for a long, long time. Even if you're a health nut like me.

****Oh, and before I go, I thought you might like the homemade cinnamon roll recipe. 

Yours in indulgence,