Surprising Reasons Your Gut is a Mess
When it comes to digestive issues such as acid reflux (GERD) or IBS (irritable bowel syndrome), the natural holistic tends to point the finger at food allergies and sensitivities. Patients will often be given food diaries to identify potential food triggers or a script for an IgG food allergy panel (NOT IgE as that will not identify delayed food sensitivities/allergies associated with digestion). Others might try a variety of diets including low FODMAPS, Specific Carbohydrate Diet (SCD) or Gottschall Diet and Gut Psychology Syndrome Diet (GAPS) recommended by a gastroenterologist or naturopathic doctor or through an internet search. Yes food can definitely be the cause of gut dysfunction and I have seen IBS and acid reflux resolved by eliminating food triggers or recommending diets like FODMAPS and GAPS. However it is important to sometimes look beyond food and towards other factors that might be messing with your gut.
Lack of Sleep
One of my patients, a super busy stressed out college student completing her senior year from a very competitive music program at a top university. She had finally gotten her PMS and menstrual cramps under control thanks to a naturopathic protocol but now was suffering from terrible constipation and bloating despite following a high fiber clean diet. Why was she getting constipation? Sleep deprivation! She was barely getting 5 hours of sleep a night due to a combination of late night study sessions and early morning orchestra rehearsals. When we don’t get adequate sleep per night, our digestion actually suffers. In fact, poor sleep is a big contributor to acid reflux, IBS, and inflammatory bowel disease (IBD). First, our brain and gut are connected via the gut-brain axis with the primary communicator being the vagus nerve. Sleep deprivation affects the vagus nerve’s ability to send signals to our GI tract which governs autonomic functions such as enzyme secretion, peristalsis and operation of the migrating motor complexes (MMCs). The MMCs are responsible for sending “cleansing sweeps” along the GI tract. In particular, dysfunction of the MMCs is largely responsible for small bacterial overgrowth (SIBO). Secondly, sleep deprivation has the surprising effect of altering our gut microbiome, which is the diverse system of microbes living in our GI tract. By changing our gut microbiome, the way we digest and process nutrients in the small and large intestines is affected. Lastly without enough sleep our body produces more proinflammatory cytokines. These cytokines such as tumor necrosis factor can increase inflammation associated with IBD conditions such as Crohn’s and ulcerative colitis. We are sleep deprived when we don’t get enough hours of sleep and/or we don’t achieve enough deep restful delta wave sleep. These requirements change as we age with babies needing about 14-17 hours and the elderly only needing.6-8 hours.
Too Much Alcohol
A few weeks of excessive drinking or even one night out of binge drinking, can leave our digestion majorly out of wack. Even worse if heavy alcohol consumption persists over the years. We might be surprised to learn that excessive drinking is defined as 8 or more drinks per week for a woman and 15 or more for a man. Drinking alcohol can cause acid reflux, IBS, stomach ulcers and gastritis (inflammation of the stomach lining). Alcohol is among substances like coffee and chocolate that can relax the lower esophageal sphincter (LES), which is the sphincter between the esophagus and the stomach. When the LES relaxes, stomach acid can be released into the esophagus creating acid reflux. This is even worse if we have alcohol with a heavy fatty spicy meal a few hours before bed. Alcohol in general is an irritant and can damage esophageal tissues, the gastric mucosa (stomach lining) and the small intestines. Gastric secretions are reduced by alcohol so our ability to breakdown food in compromised. Alcohol also affects our gut bacteria by allowing more bacteria to pass from the stomach into the small intestine. This results in the growth of harmful bacteria that produce endotoxin, which is toxic. To enjoy alcohol in a gut friendly way, women should stick to no more than 1 drink daily and men no more than 2. We should make sure to have at least 8-16oz of water per drink and avoid alcohol too close to bedtime.
Stress and Anxiety
Sometimes we are so stressed out that are stomach literally feels like its tided up in knots or we simply have the runs. In fact, stress and anxiety could be the two biggest contributors to digestive complaints like IBS and acid reflux. This is because during times of stress and anxiety, our sympathetic nervous system (‘fight or flight”) dominates over the parasympathetic system (‘rest and digestion'“). When this happen the vagus nerve sends signals from the brain to the GI tract to slow down gastric secretions and motility while constricting blood supply. At the same time the HPA-Axis (hypothalamic-pituitary-adrenal) is activated releasing CRH (corticotropin releasing hormone) which increases inflammation and intestinal permeability. Prolonged periods of stress and anxiety can also lead to alterations in the gut microbiome. The combination of reduced motility and gastric secretions along with changes in gut bacteria are the reasons why stress can lead to SIBO and can prevent patients from recovering from SIBO.
Hormonal Birth Control
Over the years at my naturopathic practice in New York City, I have seen a number of woman struggle with a variety gastrointestinal issues such as IBS, constipation, and acid reflux as a result of hormonal birth control pills. It might be a shock but just like our ovaries and uterus respond to estrogen and progesterone, so does our gut. Because the estrogen and progesterone in hormonal birth control are synthetic they exert stronger action and possess a longer half-life than their natural counterparts. Hormonal birth control has a negative impact on the gut microbiome because it can increase levels of e coli and candida sp. and can decrease beneficial lactobacillus bacteria. In addition our large intestine has receptors for estrogen and progesterone, which alter the timing and strength of gastric contractions. We need these gastric contractions that create the peristalsis to keep us regular. Synthetic progesterone in particular inhibits the contraction of the smooth muscle of the colon which can result in constipation.. Surprising research has shown that women who take birth control for greater than five years, there is a three-fold increased risk of Crohn’s disease. This could be because ethinyl-estradiol, the form of estrogen found in hormonal birth control, can increase intestinal permeability. Progesterone relaxes the smooth muscles of the lower esophageal sphincter (LES) decreasing tone which allows stomach contents to regurgitate. Studies have shown significant drops in LES pressure after ingestion of synthetic progestins which further aggravates the problem.
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