Assessing Chronic GI Complaints (Gut Issues)

Assessing Chronic GI Complaints (Gut Issues)

Gastrointestinal health is a main focus in the field of Naturopathic Medicine. While in school, my instructors frequently said “If you can’t talk about stool, you’re in the wrong school.” I’ve found this to be true since assessing and promoting digestive health is a large part of what we do. If your gastrointestinal tract is not healthy, you’re not healthy. This is where we digest and absorb nutrients from the foods we eat, produce immune cells, produce 95% of our serotonin, nourish our microbiome and eliminate toxins. If things aren’t working well with our digestive tracts, we generally don’t feel well.

Most of the chronically ill patients that I see have some type of gastrointestinal issue. Although that may not be what brings them into my office, it most certainly plays a role in their illness. Common GI complaints include nausea, gas, bloating, heartburn, constipation, diarrhea, slow digestion and pain or discomfort. These could be symptomatic of many different things ranging in severity so a good work up is warranted. I tend to start with a GI Pathogen Screen from BioHealth Laboratory (#401H) to rule out infections as the source of the problem. I have found this test more valuable than a Comprehensive Digestive Stool Analysis in isolating and identifying infections. Infections can be parasitic, bacterial or fungal. Once the infection is identified it can be treated appropriately with medications, herbs, supplements and anti-fungals.

Other things to consider are food allergies and gluten sensitivity. Allergies to specific foods can cause many of the symptoms mentioned above so it is important to identify those potential allergens and remove them from your diet. Food allergy testing is one way of identifying allergenic foods but may not catch everything. An allergy elimination diet is also an effective way to determine if you are reacting to foods. The elimination diet involves removing the most common allergenic foods from your diet for 3-4 weeks. These foods include wheat, dairy, soy and gluten amongst other things. You then reintroduce them back into your diet one at a time allowing three days for each food to bring on a potential reaction. If you note a reaction, whether it is in the GI tract or elsewhere, you should avoid that food.

Sensitivity to gluten can also cause many of the symptoms listed above as well as more systemic complaints. You don’t have to have Celiac disease to be sensitive to gluten. Celiac disease is a complete intolerance to gluten while sensitivity results in a milder reaction. If you have gluten sensitivity, you develop chronic inflammation in the GI tract which leads to structural changes in the lining of the small intestine. These structural changes can reduce our ability to digest and absorb the nutrients from our food. The effects of gluten in someone who is sensitive can be far-reaching affecting many systems in the body. Doing a trial elimination of gluten for 3-4 weeks is a great way to see if gluten may be playing a role in GI issues.

Irritable Bowel Syndrome (IBS) is a common diagnosis when other more serious conditions have been ruled out. IBS is strongly associated with a state of stress, depression or anxiety and often presents as alternating constipation and loose stools. In the book, “The Second Brain,” Dr. Michael Gershon states that our second brain is our enteric nervous system which resides in our GI tract and operates independently of our central nervous system. The enteric nervous system manages digestion through neural circuitry, neurotransmitters and various proteins just like our central nervous system manages the rest of our body. Mental and emotional states have an effect on both of our nervous systems. It has been theorized that IBS is related to an over-abundance of serotonin in the gut. Serotonin starts the process of digestion in the small intestine then is bound up by a particular protein and deactivated. If we are deficient in this protein, too much serotonin remains in the GI tract causing loose stools. Because of the high amount of serotonin, the receptors in the GI tract recede, leading to the opposite effect which is constipation.

SIBO or Small Intestine Bacterial Overgrowth is another common cause of IBS. SIBO occurs when too many normal bacteria have migrated into the small intestine from the colon. The bacteria themselves are not pathogenic but, rather, are in the wrong place. The presence of these bacteria in the small intestine interferes with proper digestion and motility. Some patients present with constipation or loose stools and all will present with extreme gas and bloating. Testing for SIBO can be done with a hydrogen and methane breath test after drinking a solution of lactulose then collecting breath samples every 20 minutes for the following three hours. BioHealth Laboratory offers a SIBO Breath Test Kit (#900) that can be drop-shipped directly to the patient.

When I see a patient who has been diagnosed with IBS, I still try to rule out the above listed possible causes which may not have been considered. If there are lingering infections, food sensitivities or SIBO, these may be contributing to the underlying cause of the IBS. Chronic candida and bacterial overgrowth are more common than we realize and many patients find relief from their IBS symptoms by treating yeast and reducing gut bacteria.

These are just a few considerations when assessing chronic GI complaints. Appropriate testing to rule out treatable conditions is always an important first step. Diagnosis and appropriate treatment of GI disorders can improve the quality of life for those who suffer from chronic yet vague symptoms. Dietary and supplement program are always an option when treating findings on the tests and medication may not be necessary.

Tracy Tranchitella, ND is a Naturopathic Physician at Sunrise Complementary Medical Center in Bend, Oregon. If you would like more information about Dr. Tranchitella and Sunrise Center, please call 951-461-4800 or visit our website at