One of the most mysterious and varied health concerns relates to gastrointestinal (GI) problems. What parent can relate to the situation of their child’s vague but nonetheless urgent moan of “my tummy hurts”? Who among us can say they haven’t had some kind of “stomach issue” but the source of the symptoms is unknown?
As an acupuncturist, natural medicine doctor, and health care professional, I treat patients who are presenting with a wide range of symptoms that seem to be linked to GI issues, but are wondering if they could also be related to Irritable Bowel Syndrome (IBS), pancreatic insufficiency, mental health concerns, or something else entirely. There are many misconceptions about intestinal disorders, and even more misinformation about symptoms, that need to be addressed to help people deal with their own GI complaints.
If you have, or have had (but are not sure why):
- Gas and bloating
- Pain and spasm in the stomach
- Diarrhea or constipation
- Pain or sensitivity under the right ribs
- Pain on the back of waistline
- Reflux issues
- Nausea and indigestion
How Digestion Works
Very often, Western medicine doctors don’t discuss everyday lifestyle changes, diet adjustments, natural approaches, and generally how digestion works. Let’s examine the three major components of digestion.
- Digestion in the stomach: The role of pepsin and HCl (hydrochloric acid) in the digestive system is to help break down proteins, which happens in the stomach. Pepsin is an enzyme activated by the presence of HCl in the stomach. It works the peptide bonds of protein, breaking them down into smaller peptide fragments. HCl, on the other hand, provides the optimal acidic environment for pepsin activation and also helps sterilize the stomach by killing bacteria and other harmful microorganisms that may be ingested with food. Together, pepsin and HCl play a crucial role for the digestion of proteins in the stomach before they are further broken down in the small intestine into amino acids with the help of digestive enzymes.
- Digestive enzymes from the pancreas enter the digestive tract into the duodenum, the first part of the small intestine. Digestive enzymes are essential for the breakdown of food molecules into nutrients that can be absorbed and used by the body. Each enzyme is specific for a particular type of food and helps to break it down to simpler components. Examples: amylase breaks down carbohydrates into glucose; protease breaks down protein into amino acids; and lipase breaks down fat into fatty acids and glycerol.
Without digestive enzymes the body would not be able to properly digest and absorb food, which could lead to malnutrition, deficiencies, and other health problems. Digestive enzymes also help to prevent gastrointestinal discomfort such as bloating, gas, and diarrhea. Overall, digestive enzymes play a critical role in ensuring the body can efficiently extract nutrients from food, maintain digestive health, and support overall wellness.
- Bile is a third important component of digestion. It is important for the digestion and absorption of fats in the small intestine. It breaks down large fat globules into smaller droplets (a process known as emulsification), making it easier for lipase to digest it. Fat soluble vitamins A, D, E, and K require fat to be absorbed. Bile helps to digest and absorb those vitamins. Bile aldo helps to eliminate waste products from the body, such as bilirubin, a waste product of red blood cells, as well as other toxins.
Identifying Underlying Causes
With a better understanding of the digestive process, it’s easy to see how complex a system it is, and why identifying any problems can be difficult. But the shortcoming in a Western medicine approach to healthcare is the focus placed on chasing the symptoms, when more attention needs to be given to the causative factors of those symptoms.
Here are a few underlying issues that could be causing confusion or complication for identifying and treating a range of GI problems.
HCl Insufficiency
This condition, also known achlorhydria, is one in which there is a low production of stomach acid. It can cause a number of digestive problems such as:
- heartburn or acid reflux
- bloating and gas after meals
- feeling full quickly
- nausea and vomiting
- undigested food particles in the stool
- nutritional deficiency, especially in iron, calcium and vitamin B12.
Because stomach acid acts as a barrier against harmful bacteria, having an HCl insufficiency can cause bacterial infections in the gut, causing these associated symptoms to develop. There are several reasons why achlorhydria occurs, but the most common are due to aging, usage of certain medications, and as a complication of autoimmune diseases.
Pancreatic Insufficiency
Digestive enzyme insufficiency, also known as pancreatic insufficiency, occurs when the pancreas does not produce enough digestive enzymes to break down and absorb food properly. It occurs as a result of pancreatitis, stress, some medications, and aging. The symptoms commonly associated include:
- abdominal bloating
- cramping and pain
- diarrhea or loose stools, foul smelling (more than usual) stools
- malnutrition.
Pancreatic insufficiency can lead to poor absorption of nutrients, especially fat and protein. The treatment for pancreatic insufficiency includes taking digestive enzymes to break down food and absorb nutrients.
Bile Insufficiency
Also known as bile acid deficiency or bile salt deficiency, bile insufficiency occurs when the gallbladder does not produce enough bile, or when the small intestine is unable to absorb bile properly. Symptoms of bile insufficiency include:
- fatigue
- abdominal pain or discomfort
- diarrhea or constipation
- light or discolored stools
- weight loss.
Bile insufficiency can be caused by liver disease, gallbladder disease, Crohn’s disease, celiac disease or gluten sensitivities. Supplementing with fat soluble vitamins A, E, D, and K may be necessary. Replacing bile with bile salts supplements may also be necessary.
Supporting Digestion and Gut Health
There are many ways to support healthy digestion and good balance within the gut, which is just as important as the process that gets your food there. A natural approach involves supporting the digestive system by ensuring adequate production and availability of bile salts, enzymes, HCl, and more. Here are some tips to enhance digestion naturally:
- Consume a variety of nutrient-dense whole foods, like fruits, vegetables, whole grains, and lean protein sources, all of which provide the necessary nutrients for digestive enzymes and good bacteria to function optimally.
- Eat slowly and mindfully, chewing food thoroughly to ensure it breaks down into smaller, more easily digestible pieces. We don’t give our digestive system enough time to release the necessary juices to break our food down when we are distracted or eat too quickly.
- Drink plenty of water to help hydrate the body and prevent constipation.
- Consume food high in natural digestive enzymes, like papaya, pineapple, and kiwi, all of which help break food down.
- Supplement with digestive enzymes and/or bile salts. If you realize certain foods are difficult to digest, or digestive issues occur, these supplements can help.
- Support the production of stomach acid, and thereby the digestion of protein and certain minerals, with Betaine HCl supplements.
Good gut health also benefits from many of these steps, but you can take it further by following these additional recommendations:
- Eat anti-inflammatory herbs and spices to reduce inflammation that damages the intestinal lining, or mucosa. Foods include garlic, ginger, turmeric and those rich in omega-3 fatty acids, like salmon, avocados, and nuts and seeds.
- Consume bone broth, a type of protein rich in collagen.
- Supplement with L-glutamine, a type of amino acid that repairs and maintains the intestinal mucosa.
- Increase your consumption of probiotics, which introduce healthy bacteria in the digestive tract, and prebiotics, which are food sources for the bacteria to help them thrive and support the gut ecosystem.
- Work to manage your stress! Chronic stress can disrupt the brain-gut connection that has shown to lead to inflammation in the digestive tract. Practice stress-reducing activities, such as Yoga, meditation and breathwork.
The body’s digestive system is multilayered, so it should come as no surprise that treatments for any number of the symptoms that can arise may not be straightforward or discernable right away. In my clinic, for example, we use a Bioscan to analyze meridians and organs to determine the source of digestive dysfunction (stomach, small intestine, colon, pancreas, or gallbladder), and then create both short- and long-term treatment plans for a client’s specific issue(s); often such a plan will include acupuncture. It’s important to treat the whole person — body-mind-spirit.
A natural medicine practitioner can also run a comprehensive GI test, evaluate for SIBO (small intestinal bacterial overgrowth), and more, all to develop a complete picture. But understanding how the system works, knowing all the components involved, and exploring underlying causes goes a long way both to tackling GI issues when they occur, or promoting good habits from the start so misunderstanding and misdiagnosis are kept to a minimum.
Helena Amos, M.Ac., L.Ac., is a licensed acupuncturist, European physician and Functional Medicine practitioner with 30+ years of clinical experience combining modern Functional Medicine with the ancient wisdom of Traditional Oriental Medicine. She is Founder/Owner of the Acupuncture and Natural Medicine Clinic in Rockville, MD, and is available for free 20-minute in-office and telehealth consultations. Visit rockvilleacupuncturemd.com for appointments and to see her list of services offered and conditions treated.