Hello, my friend!

Happy July!

I hope wherever you are, the air is clear and you are enjoying these summer days. If you are dealing with forest fire smoke, I hope you're taking care of your lungs by staying indoors and wearing a mask when outside.

This month's question: Do you ever wonder if you might have a problem with your digestion? Do you struggle to distinguish between normal and abnormal symptoms?

If so, read on. This month, I'll review common digestive symptoms that are often dismissed or ignored (but shouldn't be) as well as some suggested next steps.

What is a "healthy gut" anyway?

The term "healthy gut" is thrown around a lot.

Healthy digestion is defined in gastroenterology circles as the absence of active disease and distressing symptoms that affect daily quality of life.

In a healthy gut, we see:

effective breakdown of food and absorption of nutrients without chronic fatigue or nutritional deficiencies
comfortable elimination that is regular, painless, and with frequency ranging from 3 times weekly up to 3 times daily
absence of persistent bloating, excessive gas, abdominal pain, or chronic heartburn
stools that are mostly soft but formed (not hard, not mushy or watery)

Why does it matter if your gut health isn't perfect?

My opinion is that gut health "perfection" is a bit of a myth. Even the healthiest of people will likely see occasional diarrhea, abdominal pain, changes in stool consistency, or heartburn during unusual circumstances, moments of high stress, or when eating unusual foods.

However, if digestive symptoms occur somewhat regularly or frequently, this could be a sign something is wrong. For example, a person experiencing digestive symptoms at least one day per week for the past 3 months would fit the criteria for a diagnosis of irritable bowel syndrome (IBS).

If ignored, chronic digestive disturbances can cause all of the following:

poorer quality of life
weakened immune function and frequent infections
mental health issues
skin problems like acne and skin rashes
chronic fatigue
poor quality sleep
chronic muscle and joint pain
headaches
recurrent vaginal yeast infections and urinary tract infections
food sensitivities
allergies & histamine intolerance
nutritional deficiencies and anemia
hormone-related symptoms such as irregular menstrual cycles and painful menses

This is just a short list.

It's fairly common for people to struggle with a variety of health problems and never realize the root of the problems lies in their gut! In naturopathic medicine, there's a commonly held belief that "all health ailments start in the gut."

Abnormal Gut Symptoms 🚩

Before we dive in, here are some red flags. If any of these is present, urgent care is recommended:

vomiting accompanied by chest pain or shortness of breath
vomiting longer than 12 hours
blood in the stool or black, tarry stools
digestive symptoms accompanied by high fever
ongoing persistent and severe abdominal pain or cramping
unintentional and sudden weight loss

The following are digestive symptoms many people think are normal just because they are common:

1. Loose or watery stools

Stools should be soft but formed most of the time. Frequent loose or watery stools is not normal.

Someone with loose or watery stools may see their stool normalize from taking a daily probiotic and/or digestive enzymes taken with meals. If these strategies are not helpful, it's best to discuss this symptom with one's doctor, as loose stools can be caused by a variety of different problems.

2. Frequent bloating

Bloating can be defined as a sensation of feeling overly full or pressure or in the abdomen or as abdominal distension. Many people I work with experience frequent uncomfortable bloating. For many people, it's this discomfort or the inability to reliably identify triggers that bring them to my office.

Without knowing anything about what's causing a person's bloating, some simple strategies that may help are:

eating more slowly and chewing well; not eating "on the go"
using herbs between meals like peppermint, ginger, fennel, cardamom, and chamomile
taking digestive enzymes with meals

If these strategies do not help enough, I recommend speaking with one's doctor to find the cause of the bloating. A proper assessment is probably necessary.

See also blog post: How to stop feeling bloated

3. Greasy stools

The greasy sheen or oily film in the toilet bowl is usually fat that has not been digested sufficiently.

If stools are greasy rarely, it may not be concerning–especially if it occurs after eating high-fat meals. However, this can be a sign of many underlying issues including celiac disease, bile duct issues, and pancreatic insufficiency. Greasy stools that persist for more than 2 weeks should be discussed with a doctor.

4. Excessive gas and belching

It's normal to pass gas during the day. Typically "healthy" gas is defined as passing 0.5-2 L gas daily, or about 14 farts daily. In fact, when undergoing abdominal surgery, one of the first positive signs of healing is when you start passing gas normally.

While "abnormal" gas is poorly defined, it's worth paying attention if you notice any of the following on a regular or frequent basis:

gas accompanied by painful bloating or cramping
more gas than others in your family
gas that is strongly malodorous
frequent "trapped" gas
seemingly "bottomless" gas that occurs each evening

Unlike bowel gas, belching is considered abnormal if it occurs more than 3 times per week or if the release of gas feels difficult to control. Recurrent or frequent belching accompanied by chest pain, reflux, or stomach pain could point to a problem and should be evaluated.

While excessive gas is not dangerous, it can suggest poor digestion of your food, which can lead to nutrient malabsorption (not to mention discomfort and embarrassment) if not addressed.

A few basic strategies that may help reduce gas, depending on the cause:

Careful and thorough chewing; not rushing through meals or eating on the go
Taking digestive enzymes with meals
Minimizing or avoiding known food sensitivities (ex. dairy)
Avoiding common gas-inducing foods: beans, cruciferous vegetables (broccoli, cauliflower, cabbage, etc)
Avoiding carbonated beverages

If gas persists despite these strategies, it is recommended to discuss symptoms with your doctor.

5. Constipation

Constipation is defined in 3 different ways:

fewer than 3 bowel movements per week
passing hard or dry stool
having a hard time pushing stool out

Chronic constipation is very common and frequently dismissed as "normal" (ex. "my mom has constipation too so it's obviously normal for me"). Chronic constipation is not normal but it is extremely common, and it's been my experience that it's usually quite easy to improve or resolve without permanent use of laxatives.

Constipation can cause further health problems if untreated. Stool and toxins stay in the body longer than is ideal, and this "back-up" frequently contributes to many other health problems including high cholesterol, hormone imbalances, acne and skin rashes, fatigue, joint pain, and more. Constipation also directly cause hemorrhoids and rectal bleeding.

If you struggle with chronic constipation, fibre and probiotics are frequently recommended. If either or both of these make symptoms worse, this could indicate that underlying small intestinal bacterial overgrowth (SIBO) may be a contributing factor. And the good news here is that SIBO is testabl and treatable.

Chronic constipation feels terrible. If you have this issue, I recommend talking to a health care provider to get to the root of the issue and hopefully resolve it altogether.

6. Heartburn

Ever notice how many ads there are for heartburn medications on television? Heartburn is extremely common. It's no surprise. The typical North American diet is quite problematic for the digestive tract!

Heartburn is considered abnormal if it occurs more than twice per week or wakes you up at night. I would say that if heartburn occurs even 1-2 times per month, it's worth exploring the cause(s). The more you understand what's causing your symptoms, the more you can control when they occur.

If heartburn is a common experience, it's recommended to start by avoiding the common trigger foods, which include:

Fatty or fried foods
Spicy foods and citrus fruits
Chocolate, mint, and garlic
Coffee, alcohol, and carbonated drinks

If symptoms persist, a discussion with your doctor can help determine why symptoms are occurring and guide you toward the right treatment. Some doctors will prescribe acid blocking medications and while these may help with symptom management, it is important to know that these medications are intended for a short course and should typically not be taken indefinitely.

FREE EBOOK:

Have you ever wondered if your health problems might be connected to your gut?

Chronic symptoms like low energy, rashes, acne, and hormone imbalances can all be caused by digestive issues.

You might be surprised to learn how even poor immune function and mental health issues like anxiety and depression can be related to gut health!

Read the eBook to learn more!

DOWNLOAD THE EBOOK

How did you do?

After reading through, did you identify with any of the common (but abnormal) symptoms listed above?

If so, it may be time to discuss your symptoms with your doctor.

When you talk to your doctor about your digestive health, some key points to mention are:

How long you've had your symptoms (weeks? months? years?)
How frequently your symptoms occur (daily? weekly? monthly?)
The severity of your symptoms (mild / moderate / severe)
How your symptoms are affecting your life (affecting work/social life? causing pain? embarrassment? fatigue?)
What you've already tried (and how it helped / didn't help)

When symptoms are chronic and persistent, it's time to test. Your medical doctor or naturopathic doctor can help find out the cause of your symptoms through several tests and imaging studies. Once you know why you have your symptoms, you can treat them!

If you would like support getting to the root of your digestive symptoms, feel free to book an appointment. Helping you have a happy gut is my passion and area of expertise!

That's all for this month!

Comments? Questions? Just reply to this email! I'd love to hear what you think!