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Healthy Digestion is a key to great health

Digestive symptoms can be painful, embarrassing and sometimes extremely debilitating. Chronic stress, depression and anxiety have all been closely associated digestive symptoms. The root cause of seemingly unrelated health conditions can often be traced back to digestive problems involving a disruption of the intestinal barrier and resulting autoimmune response. Chronic stress and the imbalance in cortisol can damage the intestinal barrier, leading to;

- Skin rashes such as psoriasis and eczema
- Fatigue
- Muscle aches
- Crohn’s Disease
- Ulcerative colitis
- Celiac Disease
- Hashimoto’s Thyroiditis
- Rheumatoid arthritis
- Alzheimer’s
- Multiple Sclerosis

The link between depression and gut health has been further strengthened via recent research into the role of Psychobiotics and their role on the Gut – Brain Axis. Psychobiotics can be thought of as pro and prebiotics which can provide mental health benefits via the growth of beneficial gut bacteria. Studies have shown that consuming certain psychobiotics can improve depression in as little as 8 weeks as well as improving inflammation and increasing antioxidant status1.

IRRITABLE BOWEL
Irritable Bowel Syndrome (IBS) is the most common digestive disorder and greatly impacts quality of life, in fact sufferers lose on average 73 sick days per year2. Studies have shown that IBS sufferers have a poor quality of life and require more medical intervention than other patients. Findings included3;

- 45% of IBS-D (diarrhoea predominant) patients agreed with the statement “I’m willing to try anything to help manage my IBS”
- 14% of patients reporting they would risk a 1/1000 chance of death to live symptom-free
- Patients reported they would give up 25% of their remaining life (approx. 15 years) to live symptom-free
- 47% of patients with IBS-D stated that they had little or no ability to predict their symptoms on a daily basis.

Our Functional Medicine programs excel at addressing digestive complaints. Unfortunately, many patients I see in clinic believe their symptoms are “normal” and have learnt to live with indigestion, acid reflux, bloating, constipation, diarrhoea, abdominal pain, skin rashes, nausea, excessive belching and flatulence. Perhaps you avoid certain foods or situations that trigger your symptoms, or self-medicate with antacids, over the counter laxatives and pain medication. The underlying causes of digestive symptoms can be easily missed in many cases. Due to the non-specific nature of digestive problems they often go undiagnosed. Many IBS sufferers believe they are not taken seriously, this is one of the reasons why it takes on average 4 years for individuals to receive a definitive diagnosis3.

IBS doesn’t have one specific cause or definitive test unlike Inflammatory Bowel Disease (IBD). There are certain tests which should be considered if you suspect your symptoms are due to IBS. These include;

- Food allergy and sensitivity testing
- CDSA testing for pathogens
- Celiac testing
- SIBO testing

LEAKY GUT
Leaky Gut, also known as increased Intestinal Permeability or Metabolic Endotoxemia is an extremely common syndrome that’s at the core of many chronic health conditions such as Type 1 diabetes, Rheumatoid Arthritis, Multiple Sclerosis, Crohn’s, Ulcerative Colitis, Asthma, Chronic Fatigue Syndrome and Depression4-8. Unfortunately, many health professionals deny the existence of leaky gut.

Irritable Bowel Syndrome (IBS) is one of the most common digestive complaints and affects around 20% of Australians at some point in their life. IBS affects twice as many women than men and is characterized under the ROME IV criteria as recurrent abdominal pain occurring at least one day per week over the last three months. IBS related abdominal pain is related to defecation, associated with a change in frequency of stool and/or a change in appearance of stool. Food sensitivities are a major cause of IBS and leaky gut.

Stress and the role of cortisol is one of the main causes of digestive disorders and leaky gut4,8. Your gastrointestinal system plays a central role in your immune system, in fact 70% of your entire immune system resides in your gut9.  Stress and inflammation can decrease healthy levels of secretory immunoglobulin A (SIgA). SIgA is your principle weapon protecting you from parasites, bacteria and toxins which might otherwise penetrate your gut lining. Glucocorticoids such as cortisol will affect SIgA levels and inhibit your immune system, leaving you prone to developing digestive disorders or even developing food sensitivities later in life. Testing your stress response via the DUTCH test can help develop strategies to improve your immunity, digestive health and energy levels. 

Clinical nutrition and Functional Medicine emphasize healthy digestion as a pillar for good health. The foods you eat through to pathogens such as parasites can prove devastating to your digestive and overall health. The growing evidence around the importance of the human microbiome is becoming clearer.

Dr Clegg incorporates the following functional lab testing;

- Food allergy testing
- CDSA testing for bacterial overgrowth, parasites and inflammation
- SIBO testing
- Microbiome mapping

Food Allergy Testing: There has been much debate around food allergy testing especially food sensitivity testing of IgG antibodies which is not seen as evidence based. As a Clinical Nutritionist, Dr. Clegg prefers testing of IgG together with complement which is far more clinically relevant7. If you have completed an IgG food intolerance test, then it could be worthwhile to undergo more extensive testing which we can offer. The more accurate “gold standard” for identifying food reactions is the elimination – provocation diet11. There are various forms of the Elimination Diet which Dr. Clegg can guide you through.

CDSA testing: A Comprehensive Digestive Stool Analysis (CDSA) with parasitology provides a starting point for pinpointing the causes of gastrointestinal symptoms and chronic conditions, and measures key markers of digestive and absorptive function and inflammation.

Important features of our CDSA testing procedures include;

1. Infections: Pathogenic organisms (bacteria, viruses, yeasts and parasites) need to be identified via stool testing. It’s important that the technique used to identify infections is accurate. The testing used in our clinic utilizes evidence-based technologies such as MALDI-TOF, PCR and the gold standard method O & P Microscopy from FDA approved facilities.

2. Inflammation: Certain markers in the stool test can identify between Irritable Bowel Syndrome and Inflammatory Bowel Diseases (IBD) Crohn’s and Ulcerative Colitis. Inflammation in the digestive system is extremely common due to poor diet, stress and increase alcohol consumption.

3. Insufficiency: The adage “you are what you eat” needs to be replaced with “you are what you absorb”. Many people have issues digesting, assimilating and absorbing nutrients from the foods in their diet. Malabsorption syndrome due to lactose intolerance, gallbladder problems or hypochlorhydria (low stomach acid) among others can be corrected with diet and supplements9.

4. Imbalance: This area is perhaps the most exciting with regard to digestive health. The human microbiome is an area of health that’s becoming increasingly important. There is still a lot to learn about the microbiome and the influence on one’s health. From a clinical perspective what we do know that’s relevant is the link between certain bacteria and health conditions. Imbalances in the bacteria within your gut has been implicated in conditions such as metabolic syndrome, weight gain, depression and anxiety which will be discussed below.

SIBO testing: Small Intestine Bacterial Overgrowth is often missed in digestive testing as it’s conducted via a breath test as stool samples are not accurate in identifying SIBO. The treatment for SIBO is different to other interventions so it can be important to correctly test for SIBO via a lactulose, glucose and fructose solution when assessing digestive health. Dr. Clegg utilizes SIBO testing which is accurate, safe and evidence based13. Nutritional based protocols have shown positive results in normalizing the lactulose breath test and correcting conditions such as SIBO14. Relapse is extremely common so it’s important to use protocols from someone experienced in this area.

Microbiome Mapping: Our Functional labs in the US have developed techniques that are able to provide detailed information regarding the bacteria that resides within all of us. Certain imbalances in the human microbiota have been linked to15;

- Metabolic syndrome
- Depression
- Anxiety
- Cardiovascular Disease
- Liver Disease
- Diabetes mellitus
- IBD

Healthy digestion is a pillar of good health. 


REFERENCES

1. Akkasheh, G. et al (2015) Clinical and metabolic response to probiotic administration inpatients with major depressive disorder/ A randomized, double-blind, placebo-controlled trial. Nutrition 32: 315-320.  disorder/ A randomized, double-blind, placebo-controlled trial

2. Drossman, D.A. et al (2009) International Survey of Patients with IBS: Symptom features and their severity, health status, treatments, and risk taking to achieve clinical benefit. J Clin Gastroenterol 43(6) 541-550

3. The IBS Global Impact Report (2018) retrieved from:

4. De Punder, K., Pruimboom, L (2015) Stress induces endotoxemia and low-grade inflammation by increasing barrier permeability. Frontiers in Immunology 6(223) 1-12

5. Smyth, M.C. (2017) Intestinal permeability and autoimmune diseases. Bioscience Horizons. 10:1-9

6. Konig, J. (2016) Human Intestinal Barrier Function in Health and Disease. Clinical and Translational Gastroenterology. 7, e196; doi:10.1038/ctg.2016.54 

7. Mu, Q. et al (2017) Leaky Gut as a Danger Signal for Autoimmune Diseases. Frontiers in Immunology. 8(598) 1-10

8. Campos-Rodriguez, R. et al (2013) Stress modulates intestinal secretory immunoglobulin A. Frontiers in Integrative Neuroscience 7(86) 1-10

9. Vighi, G. et al (2008) Allergy and the gastrointestinal system. Clinical & Experimental Immunology. 153(Suppl.1):3-6

10. Vojdani, A. (2009) Detection of IgE, IgG, IgA and IgM antibodies against raw and processed food antigens. Nutrition & Metabolism. 6:22 1-17

11. Vojdani, A. (2015) The Evolution of Food Immune Reactivity Testing/ Why Immunoglobulin G or Immunoglobulin A Antibody for Food May Not Be Reproducible From One Lab to Another. Altern Ther Health Med 21(Suppl.1):8-22

12. Yago, M.A.R. et al (2013) Gastric Re-acidification with Betaine HCl in Healthy Volunteers with Rabeprazole-Induced Hypochlorhydria. Mol Pharm. 10(11): 4032-4037

13. Rezaie, A. et al (2017) Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders- The North American Consensus. The American Journal of Gastroenterology 112:775–784; doi:10.1038/ajg.2017.46 

14. Pimentel, M. et al (2004) A 14-Day Elemental Diet Is Highly Effective in Normalizing the Lactulose Breath Test. Digestive Diseases and Sciences. 49(1): 73-77

15. Wang, B. et al (2017) The Human Microbiota in Health and Disease. Engineering 3(2017)71-82

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Dr. Adrian Clegg

When I began practicing eighteen years ago, people suffering from multiple debilitating conditions had few places to turn to receive the care they needed to get better. As the years have gone by, I began to realise that more and more people were suffering with chronic health problems—feeling tired, depressed, gaining weight, experiencing digestive problems, allergies and a host of hormone issues.

Over the years I have worked with 1000’s of people to help them overcome chronic health conditions using Functional Medicine and AO.
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