Beating IBS with Functional Medicine

For IBS, Leaky Gut, SIBO, Food Sensitivities, Yeast, Gas, Bloating, Refux and Heartburn - by Dr. Teresa Rispoli, ND, PhD., LAc.

Over ten million Americans have been diagnosed with irritable bowel syndrome (IBS). That's 10-20 % of the population. IBS is characterized by a group of symptoms in which abdominal pain or discomfort is associated with a change in bowel pattern, such as loose or more frequent bowel movements or diarrhea, and /or hard less frequent bowel movements or constipation. The most common symptoms are pain in the abdomen (belly), bloating, gas, and constipation or diarrhea, or both. Other symptoms include an urgent need to move the bowels and a feeling of incomplete evacuation. These symptoms unfortunately, come and go over days, weeks, months, or even years. Criteria For Being Diagnosed

The criteria for being diagnosed with IBS , based on the modified Roma criteria:

• Your symptoms must have begun at least 6 months ago

• You have stomach pain or discomfort for at least 3 days a month for the last 3 months

• At least two of the following statements are true: Pain is relieved by having a bowel movement; pain is linked to a change in how often you have a bowel movement; pain is linked to a change in the appearance of your stool.

Abdominal pain is present for at least 12 weeks (not necessarily consecutive, abdominal pain cannot be explained by a structural or biochemical abnormality and has at least two of the following three features: (1) pain is relieved with defecation, and its onset is associated (2) with a change in the frequency of bowel movements (diarrhea or constipation) or (3) with a change in the form of the stool (loose, watery, or pellet-like). There Are Three Types of IBS:

• Some people have constipation (IBS-C).

• Some have diarrhea (IBS-D)

• Some alternate between diarrhea and constipation (IBS-A).
  

Causes of IBS IBS symptoms result from a disturbance in the interaction between the gut or intestines, the brain, and the autonomic nervous system that alters regulation of bowel motility (motor function) or sensory function. Mechanism of IBS Food moving through the digestive tract passes from the small intestines to the colon. The main function of the colon is to absorb water. Muscles in the colon usually contract in a way that pushes stool (waste products) through. In IBS, these muscles contractions may be abnormal. Too many contractions may cause diarrhea. Slowed or fewer contractions may cause constipation. Irregular or intermittent (spasmodic) muscle contractions may cause pain or a feeling of urgent need to move the bowels (go to the bathroom). Researchers suggest that IBS patients have extra sensitive pain receptors in the gastrointestinal tract, which may be related to low levels of serotonin. Decreased levels of serotonin may help explain why people with IBS are likely to be anxious or depressed. Studies show that as many as 94%of IBS patients meet the diagnostic criteria for depression, anxiety, or panic disorder. Many people find that stress triggers their symptoms. Certain foods or eating too much or too little may also cause the colon to overreact. Traditional Treatments Traditional drugs can have devastating side effects. IBS is not a disease; it is a symptom of a compromised gastrointestinal system. Using potentially dangerous drugs to reduce symptoms, while ignoring natural often more effective approaches, is typical of what is wrong with (symptom focused) medicine. Functional Medicine Approach to IBS The key for IBS, like most chronic conditions is to treat the underlying cause(s) of the symptoms. Diarrhea, constipation, gas, bloating, stomach pains, are all warning signs that something isn't working correctly. Focusing on correcting the underlying triggers of IBS symptoms leads to elimination of the problem. I find that IBS usually disappears, or dramatically improves, rather quickly once my patient's correct their poor eating habits (increase fiber, reduce simple sugars, caffeine and junk foods), uncover any hidden food allergies or sensitivities, especially gluten intolerance and dairy, treat parasites, yeast or bacterial overgrowth issues, boost optimal stress coping nutrients (serotonin, magnesium, B-vitamins, etc. restore bowel ecology (prebiotics, probiotics and postbiotics, and optimize their digestive enzymes. The Functional Medicine Approach to Digestive Health: 5R's 5-R Gut Restoration Program in Phases

PHASE 1 - REMOVE:

1. STRESS/Balance Adrenals (take Diagnos Tech’s ASI Test to determine stage of adrenal stress)

2. MICROBES-Bacteria, yeast, parasites (take Doctor’s data CSAP3 test if microbes are suspect)

3. FOOD SENSITIVITIES- Elimination Diet ( take Cyrex Array 10 Multiple Food Reactivity Screen)

4. TAKE DRUGS OR HERBS To eradicate identified pathogens

5. Eliminate GMO foods and xenobiotics

6. Inflammation (Tumeic, Resveritrol, Vitamin D, CBD /Hemp oil PHASE 2 - REPLACE:

1. DIGESTIVE ENZYMES- Plant or brush border enzymes, pancreatin (lipase, amylase, protease), Prescription enzymes

2. HYDROCHLORIC ACID-Betaine HCL 500-3500mg with protein containing meal

3. BILE ACIDS

4. BOTANICALS-Bromelain 1200-2400 MCU, 250-500 mg. taken with meals,

Papain 50,000 usp units/mg. 100-200 mg. taken with meals, Ginger (zingiber officinale), 500-2 grams before meals, Swedish bitters, 1-2 ml before meals.

PHASE 3 - REINOCULATE:

1. Probiotics: such as Spore Biotics 2. Prebiotics: inulin, FOS, arabinogalactans 4. Postbiotics: butyrates - Tributyrin-X

5. Fiber: Chia seed, ground flax seed, psyllium 6. Saccharomyces boulardii - if diarrhea

PHASE 4 – REPAIR Leaky Gut and Detox Liver

Repair lining of GI tract with key nutrients needed for cellular healing. 1. Immune support: Whey protein, colostrum. Serum derived Bovine Immunoglobulin 2. Antioxidants: Vitamins- C, E, D, & A-Alpha lipolic acid, Coenzyme Q10 3. Anti-inflammatories: Curcumin, Fish oil 4. Mucosal healing agents: L-Glutamine , N-Acetyl-D-Glucosamine Aloe Vera extract, Deglycyrrhizinated licorice root extract, Slippery elm, Mucin, Marshmallow, MSM, Quercetin PHASE 5 - REBALANCE:

1. Lifestyle change - restore balance

2. Adequate sleep

3. Mindful eating 4. Balanced brain and nervous system-Heart rate variability, heart math, Acupuncture, Yoga, Tai Chi, prayer, and meditation. Food Allergies, Sensitivities and Intolerance Food allergies can contribute to a number of unwanted health conditions, including IBS. Identifying and then avoiding potentially symptom-triggering foods can be extremely helpful to calm GI inflammation while healing the gut wall. Food Sensitivity Related Health Conditions Include:

• Headaches including migraines

• Eczema & psoriasis, skin rashes

• Diarrhea & constipation

• Colitis, IBS, bloating, gas, and stomach pain

• Hyperactivity

• Rheumatoid arthritis and joint pain

• Gout

• Chronic pain

• Edema or fluid retention

• Ear infections

• Anxiety, depression, panic attacks

Food allergies are often considered rare or aren't even acknowledged as a cause of IBS symptoms, by many traditional doctors. Traditional allergists just measure IgE with a skin prick test. This is for immediate allergies. They don't however, measure delayed sensitivities to foods, which account for 95 percent of all food allergies. These delayed responses occur one hour to three days after eating the allergic foods and are measured using a different antibody, IgG 1-4. For this reason, immediate IgE RAST, and skin-prick testing are inferior testing methods in comparison to tests that measure both immediate IgE and delayed IgG sensitivities. Test Food Allergies Using The Elimination Diet Another option for uncovering hidden food sensitivities is to to do a two-four week elimination diet. In this diet you eliminate all common allergy triggering foods, foods with pesticides and artificial ingredients. This can be challenging but if correcting your problem was easy, it would have already happened, right? For the next two-four weeks eliminate:

• All diary products (except butter) including milk, cheese, yogurt, and ice cream

• All corn and related products: corn syrup, popcorn, etc.

• All gluten products: wheat, oats, barley, kamut, spelt, and all flours containg these.

• All soy products (check labels for hidden soy)

• All nightshade foods: white potatoes, peppers, tomatoes, tobacco and eggplant. Nightshades contain a poison similar to belladonna that may cause muscle or joint pain.

Pin Pointing the Allergy-triggering Food

After two or four weeks of totally avoiding the foods listed above, begin to challenge one food group at a time, begging with dairy. For one day only, eat three or more servings of diary while still avoiding the other food groups. Then immediately return to the elimination diet for three days. Remember, most food allergies are delayed reactions and can take up to three days before any symptoms are experienced. Keep a diet journal on hand to record the foods you eat and any symptoms you experience while reintroducing the eliminated foods. After challenging diary (and waiting three days), challenge another food group: gluten, for instance. Have oatmeal for breakfast, a sandwich for lunch, and buttered toast for a snack. Don't eat any other eliminated foods: you are only challenging gluten. Wait three more days before challenging another forbidden food group. If you have a severe reaction, totally eliminate the offending food group for six months. Then slowly reintroduce it back into your diet: Eat one small serving and wait a minimum of four days before eating another. Reactions may be avoided by slowly rotating these foods back into your diet. In the case of mild or moderate reactions, avoid the food group for one to three months (depending on the severity of your reaction) and then begin to reintroduce it. Note: There are some fixed allergens that can never be reintroduced. You should also know that gluten is extremely inflammatory to the gut lining and therefore should be avoided. Dr. Coco's Pulse Test The food listed above re by fat the most common allergic foods. However, practically any food can trigger an allergic reaction. For this reason you might want to dig a little deeper to pinpoint sensitivities to specific foods. Foods can actually be tested by merely tasting them. If a food elicits a rise in the resting pulse rate, this is an allergic reaction. This is because the pulse is controlled by the autonomic nervous system, and stress causes this system to increase blood flow and pulse rate. To use Dr. Coco's pulse test, you must first determine your resting pulse rate: Count your pulse for a fill minute while sitting still. (Sites commonly used to check the pulse are the underside of the wrist and the neck near the Adam's apple. It's best to check your pulse several times throughout the day and to notice if it changes at different times. Is it lower or higher in the morning or at night? To get the most accurate baseline, take your pulse in bed before rising, before breakfast, after breakfast,in the middle of the morning, before lunch, after lunch, in the middle of the afternoon, before dinner, after dinner, in the middle of the evening, and before bed. Your resting pulse is the pulse consistently found before eating, or an average of the lowest pulses most commonly recorded. Keep a food diary and record your pulse rate and any symptoms. Does a pattern emerge? If there is no consistent pattern, there may be too many interfering substances undermining the process. If so, try the elimination diet for four to five days. Along with the obvious elimination foods, foods or chemicals in question should also be avoided during this time. Pulse Testing Foods While sitting quietly, take your pulse. Then challenge this pulse by chewing a small amount of food or food supplement (don't swallow) for a full minute. Liquids can be held and swished around in the mouth. After one minute take your pulse for a full minute. At the end of this time, expel the substance, and rinse out your mouth with pure water, which should also be expelled. Then take your pulse again. If it returns to the resting value, you can repeat the process with other substances. A positive-reaction food or supplement will elevate the pulse above six points. Avoid all such substances for two to three months. For someone who's been on a strict elimination diet for weeks, as rise of only one point may be significant. If other symptoms occur after testing, such as headaches, sore throat, or fuzzy thinking, this is also a positive test, and the food should be avoided for three to six months as well. Severe-reactions foods should be avoided for at least six months. Rotation Diet Once someone becomes sensitive to foods, damage to the intestinal tract has most likely occurred. Repetitive exposure to the same foods may initiate allergic reactions. Left untreated, intestinal permeability (Leaky Gut) and over stimulation of the immune system can create allergies to almost any food. Therefore, a rotation diet helps reduce the chances of developing further allergies and damage to the GI and immune system. On this diet, you rotate (eat non-allergic foods) and rotate each food every 4 to 7 days. So if you eat a carrot (for example) today, you can't eat one for 4 to 7 days, as you are rotating your food groups. These are generally put into food groups, so you cannot eat from a food group more than every 4 days. It might be helpful to consult a nutritionist for help in devising a suitable rotation diet based on food groups. Common Food-Group Items: Grains: wheat, barley, oats, rye, buckwheat, millet, and corn Seeds: sesame,sunflower, and pumpkin seeds Nuts: almond, walnuts, pecans, pistachios, cashews, filberts, Brazil nuts, and chestnuts Oils: safflower, sunflower, soy, cottonseed, coconut, olive, sesame, corn, and peanut Sweeteners: maple sugar, beet sugar, cane sugar, corn syrup, and honey Vegetables: olives, eggplant, tomato, potato, peppers, paprika, sweet potatoes, yams, broccoli, cauliflower, kale, artichokes,cabbage, Brussels sprouts, radishes, turnips, parsnips, carrots, celery, zucchini, Swiss chard, spinach, summer squash, cucumbers, lettuces, onions, garlic, chives, and asparagus

Legumes: black-eyed peas, navy beans, pinto beans, wax beans, string beans, green beans, chick peas, soybeans, Lima, beans, mung beans, peanuts, lentils, and carob

Fruits: lemons, limes, oranges, pineapples, peaches, plums, pears, apples, tangerines, grapefruit, nectarines, bananas, grapes, prunes, papayas, figs, mangoes, kiwi, cherries, apricots, cranberries, strawberries, blackberries, and raspberries

Melons: watermelons, cantaloupe, and honeydew melon

Dairy: milk, cheese, yogurt, goat's milk, cream, butter, and ice cream

Poultry: chicken, eggs, turkey, duck, pheasant, quail, game hen, and goose Meat: beef, lamb, and pork Seafood: fish, shrimp, oysters, clams, mussels, lobster, scallops, crayfish, and crab

Flavorings: dill, comfrey, tarragon, coriander, pepper, cinnamon, mustard, caraway, ginger, vanilla, cocoa, thyme, basil, bay leaf, oregano, alfalfa, rosemary, sage, peppermint, clove, and nutmeg

Fungus: mushrooms, hops, and bakers and brewers yeast

Your Rotation Diet The allergy-testing labs my office recommends will supply you with a specific rotation diet based on your results. If you choose not to test with one of the labs then make your own rotation diet using the food groups listed above.; write out four different breakfasts, lunches, snacks, and dinners. But make sure you're writing three days before repeating a food. Eating out can present a challenge, but I've found that most restaurants are able to accommodate your special needs once you mention your food allergies. Most delayed food allergies resolve themselves after three months of avoidance. Don't fall off the wagon and begin repetitively eating the same foods every day. Continue to rotate your diet to avoid creating new allergies. Sample Rotation Diet Menu: Day One Breakfast: pork bacon or sausage, oatmeal with raisins Snack: almonds and a pear

Lunch: chicken salad, pear, and grapes

Dinner: baked chicken, asparagus, wild rice Snack: popcorn Day Two Breakfast: eggs, wheat toast, orange Snack: apple and cashews Lunch: romaine lettuce with olive oil and vinegar, turkey breast with wheat bread, mustard, tomato, and mayo Dinner: egg omelet with cheddar cheese, broccoli, and onions Snack: cashews and strawberries Day Three Breakfast: cream of rice topped with banana and blueberries; rice milk Snack: tangerine and Brazil nuts Lunch: corned beef on plain rye with sauerkraut and Swiss cheese Dinner: Steak with green beans, baked potato Snack: walnuts, blueberries, and dates Day Four Breakfast: honeydew melon, or cantaloupe, peanut butter on millet bread Snack: pumpkin seeds and sunflower seeds Lunch: baked fish with cauliflower, squash, and zucchini Dinner: lobster, crab cakes, or shrimp salad and olives, artichokes, tomatoes, and yellow peppers Snack: cherries and pistachios Protocol For Treating Allergies

• Uncover any hidden food sensitivities through the elimination diet, Pulse testing, or blood testing. Once uncovered, these foods should be avoided for one to six months, depending on the severity of your reactions.

• Begin a rotation diet as described above to reduce the chances of developing further allergies and to give the immune system a rest

• Treat any Leaky Gut (see more about this below)

Anti-histamine medications like Benadryl or Zyrtec can offer a welcomed relief from allergic reactions, and so can the leukotriene-blocking drug Singular. While these drugs are relatively safe, they do have potential side effects, which are generally mild. I encourage my patients to use the neti pot nasal rinse kit if nasal congestion , runny nose or post nasal drip. Natural Remedies Several natural remedies can be helpful relieving the symptoms of food and seasonal allergies. Below are ones I find most helpful: Tumeric root extract- inhibits enzymes associated with PG-2 inflammatory hormones, major triggers for allergic reactions. Rosemary Leaf extract - helps block synthesis of leukotriene's ( a cause of allergic inflammation) and PG-2 hormones. Singular also works by blocking leukotrienes. Holy basil - boosts natural anti-inflammatory chemicals (PG-1 and PG-3).

Green Tea - is a potent antioxidant and increases the body's own anti-inflammatory activity.

Ginger root - reduces inflammation.

Chinese golden thread - helps regulate prostaglandins; reduces inflammatory PG-2 hormones and boosts anti-inflammatory PG-1 and PG-3 hormones.

Barbary root helps reduce the inflammatory PG-2 hormones and increases the anti-inflammatory PG-1 and PG-3 hormones.

Skull cap - reduces inflammatory chemicals.

Vitamin C - a natural antihistamine that may reduce symptoms of allergic reactions.

Stinging nettle - reduces allergic rhinitis and hay fever symptoms. It also helps prevent bronchial spasms with asthma. Dosage 500-1,000 mg. three times daily. Quercetin - a bioflavonoid inhibits synthesis of certain enzymes responsible for triggering allergic reactions. Dosage 500-1,000 mg twice daily. Fish Oil - natural anti-inflammatory - can take up to 7,000 mg daily

Yeast Overgrowth Syndrome - Candidiasis An overgrowth in the gastrointestinal tract of the usually benign Candida albicans is becoming recognized as a complex medical syndrome called chronic candidiasis or yeast overgrowth syndrome. As many as one-third of the Western world's population may be affected by candidiasis. Unfortunately, there is no shortcut go getting yeast under control.

Candida Signs and Symptoms Candidiasis commonly infects the ears, nose, and urinary and intestinal tracts. Typical symptoms are constipation, diarrhea, irritable bowel, abdominal pain, gas, bloating, indigestion, skin rash, bladder spasms and infection, and ear and sinus infections. Because candida overgrowth is highly inflammatory to the GI tract and can cause Leaky Gut, there is a plethora of symptoms. Because of this it can it is difficult it diagnose without testing. It's not uncommon for yeast overgrowth to cause or contribute to depression, asthma, fatigue, mental confusion, weakened immune system, allergies, chemical sensitivities, hyperactivity, chronic ear and sinus infections, and adrenal fatigue. Antigens then trigger complex allergic reactions. This might explain why most people with chronic yeast overgrowth develop food, inhalant, and environmental allergies. Allergic reactions can manifest in a variety of symptoms: brain fog, cravings for sweets and carbs, gas, bloating, depression, joint pain, digestive disorders, headache, rash, and breathing problems. Inflammation of the nose, throat, ears, bladder, and intestinal tract can lead to infections of the sinus, respiratory, ear, bladder, and intestinal membranes. In an attempt to arrest these infections, your physician might prescribe a broad-spectrum antibiotic. Such antibiotics promote yeast overgrowth and often contribute additional symptoms.

Causes of Candidiasis The most common cause is medication overuse, especially of antibiotics but also birth-control pills and corticosteriods. These can suppress the immune system and destroy the good intestinal bacteria. A minor increase in intestinal yeast can lead to thrush or vaginitis. However, if yeast overgrowth is left unchecked, more sinister symptoms appear. Yeast can change into an invasive mycellial fungus with rhizoids (tentacle-like projections) that penetrate the lining of the intestinal tract causing Leaky Gut. Leading to increased toxins, disruption of absorption of nutrients leading to nutritional deficiencies. Deficient nutrients lead to reduced immunity and further weakening of the body's defense systems. This can lead to fatigue, more allergies, chemical sensitivities, depression, anxiety, poor memory, brain fog, and digestive complaints. This all sets the stage for environmental sensitivities. As the liver and adrenal glands become chronically overwhelmed, tolerance to the fumes of certain environmental chemicals is reduced: gasoline, diesel, other petrochemicals, formaldehyde, perfumes, cleaning fluids, insecticides, tobacco, pesticides, household cleaners, etc. Treatment of Candidasis Often referred to as the missing diagnosis, candidiasis requires a yeast- free, low-sugar and simple carb, anti-candida diet along with anti fungal medications and natural anti- yeast supplements to produce significant long-term results. Proper treatment requires a comprehensive, multidimensional approach. The antifungals need to be rotated much like the rotation diet mentioned above as the yeast can become resistant. I highly recommend your reach out to a nutritionist that can help guide you on this journey. Die Off and the Herxhiemer Reaction If the correct approach is not followed you might get worse before your get better. This is because when a lot of Candida are killed off during the initial treatment, a sudden release of toxic substances can overload the liver and spill out into the blood stream causing adverse reactions. The body can become extremely acidic. This is called a Herxheimer reaction. This is why I recommend a liver detox for two to three weeks prior to a Candida program. The liver can then handle the extra toxins produced form the die-off. So don't get confused and think the antifungal treatment is causing the reactions. Symptoms can be minimized by taking Alka-Seltzer Gold or 2 tbsp. of baking soda in 8 oz. of water as a buffering (alkalizing) agent tow to three time a day as needed. Patients should stick it out, continue their antifungals for a minimum of three months. If the treatment is discontinued to early, symptoms will return. Protocol For Yeast Overgrowth Treating yeast overgrowth requires a comprehensive, multidimensional approach. Used alone, prescription drugs like Nystatin, Nizoral, and Diflucan or even natural anti-yeast supplements - rarely produce significant results without the following approach. 1. Test for the Problem I test almost all of my patients that present with overgrowth symptoms. Test kits are shipped directly to the patient. The results help direct me in a healing approach since symptoms may have different causes. Remember the GI system is the gateway to chronic illness and our first line of defense. A compromised GI system increases the risk of developing Leaky Gut, allergies, and chronic pain. Therefore, control Candida, bacterial or parasitic infections, heal and seal the gut and brain barriers, improve digestion, replace good bacteria, consider prescription medications short term and follow up with natural remedies, and give your liver extra support. 2. Control Yeast through Diet Begin the Candida Diet, which eliminated the foods that fee yeast. Eliminate all of the following foods for three months: Sugar and simple carbohydrates - are the main preferred food source for yeast, so restricting all forms of sugar is necessary. Avoid refined sugar, honey, maple syrup, fruit juice, milk, white potatoes, corn, processed or bleached (white) flour, bakery goods, muffins, cereals, and anything containing sugar. Avoid ice cream, cake, cookies, and other sweets should be avoided for at least 3 months. Your in this for the long haul so don't cheat! Fruits - should also be avoided, along with fruit juices and sauces. After the one month, try apples or blueberries to see if you have any reactions. Reactions might include, fatigue, depression, aches and pains, rectal or vaginal itching, itching ears or nose, and digestive issues like gas or bloating. Alcoholic beverages turn into sugar so should be avoided, as should malted milk or other malted products.

Mold and yeast or fungus containing foods are to be avoided. These include peanuts, dried fruits: raisins, dates, prunes, vinegar, pickled vegetables, sauerkraut, relishes, green olives, vinegar-containing salad dressings, catsup, mayonnaise, and pickles, relishes

Dairy products should be avoided

Certain vitamin and minerals - if purchased at a drug store are contaminated with yeast. Look for yeast-free products. Also some B vitamins are derived form yeast-fermenting process.

What Can I Eat on the Candida Diet?

• All non-starchy vegetables

• All meats, beef, chicken, clams, crab, eggs, ham, lobster, salmon, shrimp, turkey, veal, all game (birds and animals). Limit nuts and seed like walnuts, cashews, almonds, and sunflower seeds and pumpkin seeds.

• Cold-pressed non-hydrogenated oils are encouraged. Use extra virgin, cold pressed organic olive oil on your salads or vegetables add a little lemon juice if you desire.

• Butter if fine, no margarine.

• Sweeteners - use only stevia or xylitol.

After at least three months, gradually reintroduce other forbidden foods. Go easy! Remember how hard it is to get rid of yeast overgrowth, and don't sabotage your efforts with yeast-feeding foods. 3. Treat Intestinal Permeability (Leaky Gut)

A Leaky Gut left uncorrected will sabotage your attempts to eliminate yeast overgrowth once and for all. I have found that healing intestinal permeability is often the crucial step in ridding a person of persistent yeast infections. This is why I check for leaky gut in all my patients. 4. Improve Digestion It is important that you digest your food into small particles that wont trigger an immune response. Also since yeast can't live in an acid environment, a healthy level of stomach acid helps deter yeast growth. So patients on acid-blocking drugs increase their risk for developing yeast overgrowth. Follow the instructions on using digestive enzymes and Betain hCL with Pepsin.

5. Replace Good Bacteria Bacteria such as Bacillus, Lactobacillus acidophilus, L. bulgaricus, L. catnaforme, L Fermentum, and Bifidobacterium bifidum normally inhabit vaginal and gastrointestinal tracts; help digest, absorb, and produce certain nutrients; and keep potentially harmful bacteria and yeast in check. Always use these probiotics to replace them when taking antibiotics, but not at exactly the same time of day. L. acidophilus has proven to be effective in treating irritable bowel syndrome, H pylori, diarrhea, and colitis as well as yeast overgrowth. Unfortunately, yogurt doesn't contain enough of the good bacteria to help colonize the colon.

You will need to take probiotic supplements with 25 to 50 billion organisms or CFU's. Some extremely resistant yeast infections may need continuous probiotic replacement therapy. 6. Supplement with Natural Remedies Most of our patients start with prescription antifungals medications for about two weeks and then switch to herbal antifungal supplements along with the anti-candida diet for three months to knock back the overgrowth. Caprylic acid - is a naturally occurring fatty acid and a potent antifungal. It should be enteric-coated, timed release capsule. Dosage: 500-1,000 mg three times daily with food. Berberine or Barberry (Berberis vulgaris) has a wide range of antimicrobial properties. It is a proven herbal medicine used successfully to treat fungal, bacterial, and parasitic infections. Dosage: Standardized extract (4:1) 500 mg. three times daily with food.

Garlic (Allicin) - has been shown to be more potent than Nystatin for Candida albicans. Dosage: Standardized 1.3% allicin 600-900 mg. three times daily with food. Goldenseal (Hydrastis canadensis) is another plant that contains berberine. Dosage: Standardized extract (4:1) is 250-500 mg. three times daily on an empty stomach.

Oleic Acid - the major component of virgin olive oil, hinders conversion of candida into its more harmful, invasive form. Use olive oil abundantly on veggies, & salads.

Citrus seed extract - a broad-spectrum antimicrobial used successfully to treat yeast, bacteria, and parasites. Dosage: 100-200 mg. twice daily after meals Tanalbit - is used to treat yeast overgrowth and parasites. Dosage: one capsule three times daily with food. Remember you have to rotate these supplements; Choose two one before meals and one with food. Take them as prescribed for 4 days then change them. Rotate your foods as well so an not to hinder the immune system if you become sensitive. Know that Candida is very inflammatory to the intestinal lining and can cause multiple food sensitivities that will calm down after the yeast overgrowth is knocked back. We Are Not What We Eat But What We Digest and Absorb The state of our health is largely determined by not only what we eat, but also how well we digest and absorb it. Nutrients are worthless if they can't be broken down and utilized. Think of your GI tract as your gateway into your body. It breaks down, absorbs, and assimilates the foods you eat. These carbohydrates, proteins, and fats yield sugars, amino acids, essential fatty acids, and other life-sustaining nutrients. Our food and the nutritional supplements we take provide the building blocks for manufacturing, repairing, and coordinating the vital biochemical components of each bodily function. But as we'll see, the GI tract can become compromised from various biochemical malfunctions: poor diet, bacteria, yeast overgrowth, stress, age, and prescription medications. Unfortunately even if you eat a healthy diet and take nutritional supplements, your health will suffer if you have malabsorption syndrome, achlorhydria (not enough stomach acid), intestinal permeability, or pancreatic enzyme deficiencies. By improving digestion you get the most from the foods you eat and the supplements you take. You probably don't know it but your GI tract is one of your most important immune and detoxification systems. But it's assaulted on a daily basis by stress, bacteria, yeast, viruses, and toxins contained in the food we eat. So the first place to start in establishing a healthy GI tract is your diet. A poor diet leads to poor health, but the right food choices can make all the difference in how you feel. You Are What You Eat- Diet Matters A typical American breakfast might include nitrate-laden bacon cooked in hydrogenated oils (bad), sugary cereal made with bleached enriched flour, and a glass of orange juice (simple sugar). Lunch might a fast-food hamburger loaded with saturated and trans-fatty acids, pasteurized preservative-rich cheese (containing aluminum), French fries cooked in hydrogenated oils and loaded with fat, and a Diet Coke because ("I'm watching my weight") NOT! Unfortunately, much of our food has been processed, bleached, altered with preservatives, and tarnished with toxins. How the Digestive System Works The digestive system includes the mouth, salivary glands, esophagus, stomach, pancreas, liver, gall bladder, small intestine, and large intestine. Digestion involves the breakdown of food; its movement through the digestive tract;m the chemical breakdown of large molecules into smaller, more readily absorbed ones; and the elimination of waste. Digestion begins even before you take a bite. Just thinking about or smelling food can trigger certain chemicals, including the hormone gastrin, which stimulates the stomach cells. The process of chewing also initiates chemical reactions that prepare the stomach, gallbladder, and pancreases for proper digestion. Foodstuff is delivered from the mouth to the stomach by way of the esophagus, a 10 inch-long hollow organ. The esophageal sphincter works like a gate, opening to receive food and then closing to prevent stomach acid or food from returning to the throat. Food is then pushed into the stomach, where digestive enzymes and gastric juices reduce it to a liquid substance known as chyme. The gastric juices contain hydrochloric acid and the enzyme pepsin. Hydrochloric acid breaks down the predigested food, and pepsin breaks down proteins into polypeptides (chains of amino acids). This acidic environment acts as one of the body's first line of defense, destroying viruses, parasites, yeast, and bacteria. After four to six hours, chyme passes into the small intestine, which is about 22 feet of hollow tubing. The gallbladder secrets bile to help break down fats in the small intestine, and digestive juices continue to do their work. At the end of the small intestine, the broken-down food is absorbed into the bloodstream and finally routed to the liver. The colon receives the leftover unusable chyme and begins to solidify it for evacuation. This semisolid material, known as feces, should produce a bowel movement and be excreted within 36 hours. All of this, by the way, would not be possible without your amazing pancreas. It releases proteolytic enzymes, which the stomach uses to breakdown food. Then it later releases sodium bicarbonate (think nature's Alka-Seltzer) to create the necessary alkaline environment in the small intestine. How Poor Digestion Contributes to IBS Symptoms You might not be secreting enough gastric acid. If you are age sixty or over, listen up. Numerous studies have shown that acid secretion declines with advancing age. And the resultant rise in stomach pH (to more alkaline) can cause many of the symptoms associated with IBS, bloating, gas, and loose or constipated bowel movements. It's been estimated that 50 percent of Americans over the age of sixty suffer from a deficiency in hydrochloric acid. One group of researchers found that 80 percent of those with achlorhydria (low stomach acid) had soreness, burning, and dryness in the mouth, including a low tolerance for dentures. Thirty-four percent complained of indigestion and excessive gas. Forty percent complained of fatigue. gastric-acid secretion is a fundamental process in assuring proper digestion and absorption, as these sections are responsible for stimulating the release of pancreatic enzymes. But you don't have to be a senior citizen to suffer from low levels of stomach acid. If you have symptoms of IBS, I recommend you take digestive enzymes. If you enzyme levels are already sufficient before you supplement with enzymes, your body will adjust just fine. But if your levels are low, you should notice a dramatic improvement in your symptoms with continued use. Remember stomach acid is your first line of defense from bacteria, parasites and yeast. But if your low in stomach acid (achlorhydria), you will have gas, bloating, heartburn, diarrhea, constipation, hair loss in women, rectal itching, nausea, (especially after taking supplements), restless leg, sore or burning tongue, dry mouth, post-adolescent acne, undigested food in the stool, and weak, peeling, or cracked fingernails. Proteolytic enzymes are built from amino acids (protein), so if your are on a vegan diet or have a deficiency in amino acids means a deficiency in the inflammation-and pain-blocking proteolytic enzymes. If you are not getting enough protein, you won't have enough amino acids to build these valuable enzymes. And if you already suffer from malabsorption, you may not be digesting protein. So both pancreatic (proteolytic) enzymes and Betaine with Pepsin are very important supplements when having GI distress. You may be suffering form food allergy, intolerance, or malabsorption. If so, your pancreas is the first organ to suffer. It can become deficient in bicarbonate, and the proteolytic enzymes can be compromised or even destroyed. Without proteolytic enzymes and pepsin the protein goes undigested. And if it's leaked across the small intestines membrane, it can trigger inflammatory reactions, food allergies, resulting in more GI stress. Continuous exposure to food allergens can trigger a cascade of reactions that interfere with the absorption of essential nutrients. Nutritional deficiencies, especially amino acids, create a burden on the body's regulatory system, causing pain, fatigue,low moods, bloating, gas, IBS, migraine headaches, and other health problems. Reflux, GERD, and Digestive Enzymes Proper digestion is the first place to start in correcting IBS and GI disorders. The most obvious symptom of esophageal reflux is heartburn. It occurs after eating and can last from a few minutes to a few hours. It feels like a burning sensation in the pit of the stomach and can move up into the chest and throat. Esophageal reflux occurs when the lower esophageal sphincter malfunctions, allowing the backward flow of acid, bile, and other contents from the stomach into the esophagus. Reflux can result from gastritis (inflammation of the stomach itself), peptic or duodenal ulcers, a hiatal hernia, or even from the chronic use of NSAID's. GED (gastro esophageal reflux disease) can cause esophageal scarring or Barrett's syndrome, a chronic esophageal irritation that causes normal cells to be replaced by precancerous ones. An endoscopy test is used to diagnose GERD. Conventional treatment usually involves H2 antagonists (such as Tagament, Pepcid, Zantac, or Axid) and antacids ( such as Tums or Malox) as the first line of treatment. Proton-pump inhibitor drugs (such as Nexium, Prevacid, or Prilosec) might also be initiated. Are Antacid The Answer? NO! These medications block the absorption of nutrients like zinc, folic acid, B 12, calcium, and iron. not to mention your ability to breakdown your food, so it sits there fermenting creating more gas! This can lead to fatigue, anemia, and depression. Then long term use of these medications can block all stomach acid. Here is Why Your Body Needs More Acid Not Less The esophageal sphincter is stimulated to close by the release of stomach acid. Picture the sphincter as a doorway that separates our throat from our stomach. The door is opened by food we eat and closed by naturally occurring stomach acid release. When there is not enough acid present - because antacids have neutralized them - the esophageal sphincter may not close properly, allowing acid to travel back up into the esophagus and cause heart burn. Ironic, isn't it? Antacids can actually make heartburn worse. The stomach needs acid to breakdown proteins for digestion. No protein digestion means no amino acids. No amino acids, means no neurotransmitters (serotonin, dopamine, norepinephrine, etc.) This can lead to all sorts of problems: Leaky Gut, anemia, fatigue, increased allergies, depression, anxiety, and bacterial and yeast overgrowth. Again, stomach acid is our body's first line of defense destroying viruses, parasites, yeast and bacteria. Protocol For Low Stomach Acid If you are suffering from heartburn, low stomach acid is most likely a problem, Try these solutions rather than antacids: Take a digestive enzyme with each meal.

If you've been taking Nexium, Previcid, Prevpac, Prilosec, Propulsid, Reglan, or Zantac for over three months, then you may have to stay on the medication as you begin the digestive enzymes. And if you've had upper GI scan that shows you have some esophageal erosion, then you'll most likely need to stay on the antacid medications. But most of my patients have found that they don't need these prescription medications once the start taking a good high potency digestive enzyme. Still, don't discontinue any prescription medications without consulting your medical doctor first. Consider supplementing with Hydrochloric acid (HCL) and Pepsin if the problem persists. If this makes your heartburn worse, then you probably have enough stomach acid. Stop supplementing the HCl, but continue using digestive enzymes. Take the Betaine HCl and Pepsin before your meal, before your first bite, then take the digestive enzymes just after you've eaten. Pay Attention to Your Diet Avoid foods that can relax esophageal sphincter and make heartburn, reflux, and GERD worse. These include fried, spicy, or fatty foods, carbonated drinks, citrus fruits, peppermint, chocolate, coffee, tea, alcohol, tomatoes, garlic, and onions. Avoid lying down for at least three hours after you finish eating. When you do lie down, try elevating the head of your bed about six inches (to facilitate keeping the gastric contents in the stomach). Try eating smaller meals, and more frequently (perhaps four or five meals in a day). Supplementing with Hydrochloric Acid Adequate protein intake, digestive enzymes with pancreatin, and a relaxed emotional state can increase stomach acid production, but supplementation might also be necessary. Follow the guidelines below. Don't take HCL if you've been diagnosed with a peptic ulcer. And since HCl can irritate sensitive tissue and corrode teeth, take it in capsule form only, and don't empty capsules into food or beverages. I recommend that you take pancreatic enzymes along with the HCl. 1. Take one Betaine HCL with Pepsin capsule 500-650 mg. of hydrochloric acid and 100-200 mg. of Pepsin, at the beginning of your meal. Continue taking one capsule with each meal for the next five days. 2. After five days, increase your dose to two capsules with each meal. Continue this dose for five days. 3. If you are experiencing no side effects (such as warmth, fullness, or other odd sensations in your stomach), increase your dose by one capsule at your next meal. 4. Establish a comfortable pre-meal dose (five capsules or fewer), and continue at that level. As your stomach regains the ability to produce an adequate concentration of HCL, you will probably require fewer capsules. Listen to your body, and reduce your dose as necessary. You can also reduce your number of capsules at smaller meals. 5. Be consistent. Individuals with low HCL and pepsin typically don't respond as well to botanicals and supplements, because they have a harder time breaking them down. So to maximize the benefits, keep up the HCL supplementation. If you continue to have heartburn even after trying these recommendations, get tested for GERD and H. Pylori (a bacteria that causes ulcers). As always, talk to your medical doctor before discontinuing your prescription medications. Stress and Nutritional Deficiencies We're all born with a stress coping "savings account" filed with chemicals - such as hormones, amino acids, and nutrients - that can be deposited and then withdrawn when needed. Depending on our genes, some of us have large accounts, and some of us have smaller ones. The more stress we're under, the more withdrawals we make. If we make more withdrawals than deposits, we get overdrawn, and poor health quickly follows. Chronic stress quickly zaps our reserves. Although some patients bankrupt their reserve accounts with one overwhelming event, most experience a series of stressful events over the years. These events typically involve stressful jobs, marriages, family dynamics, surgeries, illnesses, loss of a loved one, divorce, financial failure, etc. Many of my patients can remember the day their account went belly-up. It might have been after a surgery or following the loss of a parent. Whatever happened, the person was never the same from that point on; he/she couldn't get well. patients with IBS have depleted their stress-coping vitamins, minerals, and nutrients, which not only leads to IBS but also prevents them form beating IBS. It is a vicious cycle that can only be broken by taking adequate amounts of essential vitamins, minerals, and essential amino acids. Deficiencies in key vitamins, minerals, and hormones will create the perfect environment for developing IBS. One of the keys for overcoming IBS is replacing these stress coping nutrients; magnesium, B-vitamins, and serotonin in therapeutic dosages.

taking a good quality multivitamin and mineral, plus extra Vitamin D, is a good way to ensure you're getting all the nutrients you need to be healthy. Nutritional Therapy For IBS Along with a good optimal daily allowance multivitamin, those with IBS will need to supplement with these additional essential nutritional supplements: Magnesium - is involved in over 300 bodily processes, is particularly important for reversing the symptoms of IBS. It help relax the smooth muscle of the colon, acting as a natural laxative and allowing normal bowel movements. The best form of magnesium for the colon is magnesium citrate. Take it to bowel tolerance (until loose stool are achieved then back down. Start with 500 mg, but those with IBS-C (constipation) may need up to 1,000 mg. or more each day. Now your multivitamin should have at lease 200 mg. magnesium, then add an additional 150-200 mg. a day of magnesium citrate until you have a loose bowel movement. Too much will give you loose stools so reduce by one capsule until bowel movement are regular without diarrhea. IBS, Serotonin and 5-HTP Research has shown that one potential cause of IBS is related to neuroendocrine immune system dysfunction (brain and stomach hormones). This connection is largely mediated by the neurotransmitter, or brain chemical Serotonin. The brain and gut are connected through the neuroreceptors 5-hydroxytriptamine-3 (5HT3) and 5-hydroxytriptamine-4 (5-HT4). These serotonin receptors regulate the perception of intestinal pain and the GI motility (contractions that move food through the intestinal tract). Therefore serotonin controls how fast or how slow food moves through the intestinal tract. In fact, there are more serotonin receptors in the intestinal tract than there are in the brain. So ninety percent of serotonin receptors are in the intestinal tract. Medical science has now determined that how we feel is largely controlled by the foods we eat and how well these building blocks are converted into brain transmitting chemicals called neurotransmitters. Neurotransmitters are brain chemicals that control our moods. You may remember I spoke of chains of essential and non-essential amino acids make up proteins. Many of these amino-acids are converted into neurotransmitters. The brain needs adequate amounts of protein and their amino acids for the production of neurotransmitters. Neurotransmitters are produced from the foods we eat. certain amino acids along with B vitamins, and minerals, produce neurotransmitters. The neurotransmitters that cause excitatory reactions are known as catecholamines. Catecholamines, epinephrine and norepinephrine (adrenaline) are derived from the amino acid phenylalanine an tyrosine. Inhibitory or relaxing neurotransmitters including gaba and serotonin, serotonin is produced from the amino acid tryptophan. Supplementing with 5-hydroxytrryptophan (5HTP), a form of tryptophan, combined with B-vitamins, vitamin C and magnesium, is the source of serotonin. To increase your serotonin levels use 5HTP. In fact, studies show that 5HTP can be as festive as antidepressant drug therapy including SSRI medications. Using SSRI's is similar to using gasoline additive in an empty gasoline tank. Most individuals with mood disorders have been running on fumes (low serotonin or other neurotransmitters) for years. Forget the gasoline additive. Let's just fill the tank back up with serotonin!

To boost serotonin levels I recommend taking the amino acid responsible or making serotonin, known as 5HTP. For patients with IBS-A (alternating between diarrhea and constipation) or IBS-D (primarily diarrhea) should take 300-400 mg. a day with food. Intestinal Permeability: "Leaky Gut" and IBS The father of modern medicine, Hippocrates, said "All disease begins in the gut." Study after study has proven him right showing the role of modern diets, lifestyles, and our gut function play a role in overall good or bad health. Intestinal permeability occurs when the lining of the small intestines becomes permeable (leaky) to toxins that cause chronic inflammation. This permeability allows toxins to leak out of the digestive tract into the bloodstream. This can trigger autoimmune reactions (attack of self tissue) anywhere in the body as they travel in the blood to the body's tissues. Triggers of Leaky Gut The use of NSAIDS, steroids, antibiotics, antihistamines, caffeine, alcohol, and other medications, as well as chronic stress and poor digestion cal all cause "Leaky Gut", as they render the intestinal mucosa permeable to toxins (zonulin) and undigested food partials that create an immune response. Leaky Gut is associated with many illnesses, autoimmune illness included, but individuals with IBS are especially plagued by it! Protocol for Intestinal Permeability Intestinal permeability can be measured by special functional medicine tests from Genova Diagnostics or more current tests called Gut Zoomer from Vibrant America can really pinpoint what is going on in the gut, so you know how to correct it. If you suspect you have intestinal permeability, take the following steps: 1. Keep supplementing with digestive enzymes and HCL if needed.

2. Take probiotics 23-50 billion CFU's daily on an empty stomach for two months. They must me stomach acid resisted or enteric coated to protect them from stomach acid. Also add Mega Spore Biotic 1 daily. 3. Begin the elimination diet to pinpoint food allergies. Pay particular attention to gluten and diary because they are very irritating to the intestinal lining. Or take the Vibrant America Food allergy test. 4. Take 1000-2000 mg. of fish oil a day. Omega-3 fatty acids help repair the intestinal tract and reduce inflammation. 5. For best results you'll need to take high doses of the amino acid L-glutamine, 5,000-6,000 mg. daily along with some additional herbals. L-Glutamine is the primary fuel for intestinal cell function. 6. Soluble fiber is a prebiotic and feeds the probiotic. take 5 - 20 grams daily 7. Postbiotic are the new gut mender. They are made from butyrates a short chain fatty acid that is the end product of microbial fermentation of fiber. the product name is Tributyrin-X by Healthy Gut Company. 8. Colostrum or Serum derived bovine IgG. Heals the gut lining and latches onto foreign toxins and removes them from the intestines. 9. Collagen or bone broth that contains collagen - supports the mucus lining that protect intestinal cells. Once absorbed collagen aids the hair, skin, nails and gut mucosa. Dr. Teresa Rispoli is a Board Certified Functional Nutritionist, ND, PhD., LAc. and specializes in gastrointestinal health issues. She is the founder of Functional Nutritionist Academy where she trains health professionals about Functional Nutrition, she is also the founder of Complete Health Institute located in Agoura CA where she has been in practice for over 30 years.

You can schedule a nutritional consultation by calling 818.707.3126 or contact her at support@functionalnutritionistacademy.com