Functional gut disorders are persistent gastrointestinal issues with gut-brain interaction that affect 20% of individuals. These disorders are characterised by abnormal gut functioning and encompass issues like bloating, dyspepsia, fullness after eating, nausea, and irritable bowel syndrome (IBS), including diarrhoea and constipation.
The underlying issues linked to functional gut disorders include dysmotility, an abnormal gut contraction; visceral hypersensitivity, a heightened feeling of sensation in the gut; low-grade inflammation; intestinal permeability or leaky gut; and immune activation of the mucosal gut lining. Stress and psychological issues like anxiety and depression can make functional gut disorders worse through the gut-brain interaction.
Some investigation may be necessary if you present with any of these disorders. Investigations can include but are not limited to breath testing for Helicobacter pylori or Small Intestinal Bacterial Overgrowth (SIBO), testing for food intolerances like lactose or gluten intolerance, fructose malabsorption, or examination of bacterial balance with a gut microbiome analysis.
Naturopathic support for these disorders relies on the 4 R’s of treatment, which are:
1. Remove any irritants
2. Replace any digestive support
3. Reinoculate good bacteria
4. Repair the gut lining
Treatment can be stepwise or combine all four at once, depending on what is best for the individual.
Dietary changes are also helpful and may include excluding certain foods to calm down any inflammation in the digestive tract initially. Excluding gluten or low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diets can be helpful but tricky, so traditional dietary advice can be a good start. This advice includes:
· Eat at the same time every day
· Stay hydrated
· Avoid excess processed food
· Reduce fatty, spicy food and alcohol
· Reduce gas-causing food such as beans and lentils
· Avoid known triggers.
Treatment with probiotics and prebiotics can aid the restoration of the gut. The functions of probiotics include:
· Inhibiting pathogenic bacteria
· Strengthening gut barrier function
· Regulating gut pH, which helps to kill bad bacteria
· Regulating immunity
These probiotic functions help improve the mucosal stress response and intestinal motor function and inhibit visceral hypersensitivity.
Prebiotics are the fuel that feeds the good bacteria in your gut and include GOS (galactooligosaccharides), FOS (fructooligosaccharides), inulin and partially hydrolysed guar gum (PHGG). These prebiotics are fermentable by your good bacteria and produce short-chain fatty acids (SCFAs). SCFAs have many functions, including:
· Modulating motility and transit time
· Influencing and increasing serotonin, which is anti-inflammatory, aids in gut barrier function, electrolyte balance and fluid secretion
· Working directly on smooth muscle
Some prebiotics like FOS and inulin can be reactive in the gut, so using something gentler like PHGG may be better. It is also known for aiding the treatment of constipation in methane-positive SIBO and constipation-predominant IBS.
Treating functional gut issues is a complex process, but the main thing is commitment and readiness for change. Small changes can have significant health outcomes and help you become symptom-free to improve your quality of life.