Ask Dr. Casey: Sluggish Digestion & Bloating?
Hi Dr. Casey, I have sluggish digestion with lots of bloating and gas following a meal. I also sometimes feel like I see a lot of my food come out in my stool undigested. Is this normal? Is there anything I can do to help my digestive system out?
- Jessica R
Hi Jessica,
Oh, the wonders of the black box we call the gastrointestinal (GI) system. Sustenance goes in one hole, then comes out another in a different form - and what happens in between is anything short of a mystery (and miraculous). You are not alone in having digestive complaints - it is one of the most common organ systems I see patients come in with difficulties on: reflux, bloating, loose stools, constipation, ulcers, abdominal pain … there’s a lot that can go wrong in transit! Historically, many of the founding thinkers of naturopathic medicine thought all disease begins in the gut. I do agree with this statement to some extent. If your body is not agreeable to the food you are putting into your system three plus times a day, it will begin to try to let you know in the form of signs and symptoms. Understanding why and what is going awry can be frustratingly illusive.
Let’s zoom in on your symptoms as an example. Bloating and gas can be normal symptoms of digestion, but when paired with discomfort or excessive bloating, they can become more worrisome. There are a number of diagnoses that are associated with these vague symptoms and are important to rule out. While irritable bowel syndrome, or IBS, has been a medical go-to since the 1980s or so, it is generally a nebulous catchall that does not have much in the way of actionable steps for symptom improvement. There have been proponents in allopathic and naturopathic medical communities alike to get a more focused diagnosis for better treatment. For example, a 2014 paper from the World Journal of Gastroenterology states, “Association between IBS and [small intestinal bacterial overgrowth] SIBO is definite,” where up to 78% of those diagnosed with IBS also tested positive for SIBO (1). When I am working with patients with vague GI symptoms, I do my best to think about what diagnoses are possible in order to be the most effective with appropriate treatment. While IBS has often unhelpful tips of “stress management” (important, but also good luck in our world!), SIBO and other related diagnoses have a clinical course of possible treatment. So, first things first, Jessica - see if you can find a health care provider who can help you be thorough in diagnosis to best direct possible treatment. Then you can better understand the why behind what is going on and have a better chance of prevention, as well.
So many people have nausea, heartburn, indigestion, upset stomach, diarrhea (cue PeptoBismol …). I think it is multifactorial, but two main points stick out to me. Keep in mind that these are not facts derived from peer-reviewed journals, but my own clinical experience, so please take them with a grain of salt. First, in our current food system we often eat foods that are overly processed or unnatural. Fillers, chemicals, dyes, sugar alcohols can all take a toll if our body is trying to figure out how to break down an onslaught of unnatural perceived nutrients. Paired with pesticides and other chemicals that disrupt the integrity of the absorptive lining of our GI tract, our system is facing a conundrum of foreign substances it is not evolved for. Occasional consumption of such delicious foods is ok, but regular consumption of processed foods can lead to problems further down the line (including higher risk for colon cancer). Things get more confusing when even our own bodies perceive “healthy” or “natural” food as difficult to digest. For example, my own body just can’t stomach bananas well. Everyone does have a unique body chemistry, and slowing down enough to tune into what foods may not agree with you is important and often overlooked. It’s great to bring an objective presence on board for this such as a nutritionist or a naturopath.
Second, many Americans eat in a harried, often stressed state. I am guilty of it too, shoving my lunch over a short break between patients. Whether eating at work or in the car, eating standing up or in an anxious mood, our body’s cue to be in the “rest and digest'' nervous system, called the parasympathetic branch, often isn’t active when we eat our meals because of the state of our nervous system (stressed!). Instead, it is in a version of “fight, flight, freeze,” known as the sympathetic branch. In the sympathetic nervous system, our body prioritizes resources for survival - it is not focused on digesting a meal. It shunts blood away from the GI system to major muscles of motion (to flee/fight) and towards the heart and lungs. Contrast the survival state to the parasympathetic nervous system: salivary enzymes begin the breakdown of food in the mouth, stomach acid gets revved up to help breakdown nutrients, bile flow begins for fat digestion, pancreatic digestive enzymes are secreted in anticipation of the incoming meal, and the rhythmic flow of the GI system, called peristalsis, comes online to move our food down the food tube. How much easier it is for our bodies to break down, absorb and eliminate a meal in this state! This may also be why some of your food comes out whole or partially digested, Jessica - your GI system may not have all parts of the system firing to break everything down. The question is, how to get there?
While we may not be able to always change the state of our nervous system on demand with the set-up of our stress-driven culture, there may still be a backdoor way or two to try and get there when the window to feed ourselves arrives. One technique I personally use for my lunch break is to take herbal bitters before my meal. Herbal bitters have been used for a long time to help prime the digestive system - they help to get things moving along our entire intestinal tract. The vagus nerve, one of our main conductors of the parasympathetic nervous system, functions as a taste sensor at the root of the tongue and continues all the way down our GI system for the entire small intestine and ⅔ of the colon. I was amazed when I learned this in medical school! The theoretical model is when bitters hit the back of the tongue, it perceives “food incoming” and begins to secrete digestive enzymes in the mouth and pancreas, initiates peristalsis, stimulates the release of bile and increases acid production in the stomach. While I may not feel like I am in a parasympathetic state, my body can at least handle my incoming lunch more easily with my digestive system a bit more activated. While timing is best 15 minutes before meals, life isn’t perfect and neither am I, and I am usually taking them a few minutes before I eat my meal. There are various herbal bitter formulas out there, including those with gentian, dandelion, oregon grape, etc., and I have even had patients start meals with bitter food (arugula, dandelion greens) or drink (dandelion root tea). I once had a patient come back and say, “aruGOla - I am now pooping every day instead of every three!”
One last plug, Jessica, and that would be to be current on colon cancer screening. Too many times I have negotiated with my patients on this usually undesired screening, only for a precancerous polyp to be found (or worse). The guidelines recently changed to now begin colorectal cancer screening at age 45 instead of 50 due to increasing prevalence at younger ages. Because the GI system is such a black box of mystery and colorectal cancer is on the rise, I encourage all of my patients to be current for this screening.
In short Jessica, the reason for your bloating and gas could be a myriad of causes and I would suggest working with someone to better understand possible triggers or causes. It’s also important to prime your GI system for eating and be in tune with what foods may not agree with you. GI health can be a journey, but a worthwhile one. Your body is likely trying to tell you something, and I am so glad you are wanting to listen and ask why.
Sources
Ghoshal, U. C., & Srivastava, D. (2014). Irritable bowel syndrome and small intestinal bacterial overgrowth: meaningful association or unnecessary hype. World journal of gastroenterology, 20(10), 2482–2491. https://doi.org/10.3748/wjg.v20.i10.2482
