What’s wrong with my digestion? Why do I bloat so much?
When was the last time you felt really great and didn’t have any bloating, heartburn, constipation or diarrhoea? Are your digestive symptoms affecting the way you feel about yourself and your mood? Have you already been to your GP* and been told that you have IBS and don’t know what to do about it, or have been told to go on a FODMAP diet but given up because it’s so complicated?
The good news is that there is something you can do, with the help of a registered nutritional therapist, to get your health back and feel great again. It’s called the 5R programme that follows the principles of the Functional Medicine Approach, and this is outlined below.
Before explaining what this effective approach is, however, it is important to understand how your digestive system works, aiding your understanding of the 5R approach.
- Most people think that digestion starts in the stomach. Well, it doesn’t! It starts in the mouth – the chewing action helps break down food and begins the breakdown of carbohydrates from an enzyme called salivary amylase.
- Digestion then continues in the stomach, where more enzymes are produced. The pH of your stomach acid is very low, which also helps breakdown protein in your food. It also has a very important function as the low pH can help kill unwanted bacteria and viruses.
- The partially digested food, called chyme, is then moved via muscular contractions called peristalsis into the small intestine, where further enzymes continue their work and bile acids are produced to help breakdown fat products. A lot of food is then absorbed via the gut wall and taken to the liver where it is turned into bio-active molecules to be used by your body, be it for hormone production, immune function, neurotransmitter synthesis, cellular repair and/or protection.
- Lastly, the large intestine has a very important function of housing billions of tiny gut bacteria. Your commensal bacteria contain more DNA that the rest of the cells put together. They play vitally important roles in immune protection and your bacteria also produce large amounts of vitamins, especially vitamin K and biotin (a B vitamin) for absorption into the blood.
The 5R approach involves five key steps: Remove, Replace, Reinoculate, Repair and Rebalance, and each are explained in turn. With the support of a nutritional therapist, you can work out what will be the most effective approach for you. Critically, this approach should pinpoint the underlying cause(s) which can then be addressed or further investigated.
1. What do you need to remove?
- The first step is to remove the factors that are contributing to or causing your digestive issues. These include:
- Foods to which you are sensitive, intolerant or allergic.
- Food low in nutrient value (refined carbohydrates, sugary food/drinks and alcohol).
- Toxins, heavy metals, parasites, bad bacteria, fungus/yeast overgrowth.
2. What do you need to replace?
- Replace refers to replacing factors that may be inadequate or lacking, and these include:
- Hydrochloric acid (stomach acid).
- Pancreatic enzymes.
- Fibre to support transit and general GI function.
- Foods taken out of your diet with nutritious alternatives.
3. What support and/or re-establishment of a healthy balance of microflora do you require to reinoculate your gut?
- These may include:
- Probiotics, prebiotics, synbiotics to obtain a more desirable balance to the intestinal milieu.
- Fibre to support the function of your microbiome.
- Dietary advice to include foods to support your microbiome.
4. Repair refers to providing nutritional support for healing and regeneration of the GI mucosa.
- These may include:
- Nutrients important for GI repair and healing, such as vitamin A, D, C and zinc.
- Interpretation of fatty acid and antioxidant status to allow the use of antioxidants, amino acids and omega fatty acids to restore balance. This aims to reverse inflammation and optimise the immune system.
- Additional antioxidants, such as curcumin to reduce inflammation.
- Foods that contain the above nutrients to support your gastrointestinal tract.
5. Rebalance refers to providing support to reduce stress in your life.
- These may include:
- Mindful eating and better choices (do you ever eat while walking for example/while on your iPhone?)
- Yoga, meditation, breathing, walking.
- Psychotherapy/autogenic training (if some of your digestive symptoms could be caused by current or past stress in your life). Have you ever noticed how your gut reacts to stress, such as a deadline or just before a presentation/important meeting?
As it can be difficult to work out what to do by yourself, consulting a trained nutritional therapist to carry out a dietary evaluation would be a useful and effective step to help pinpoint what support you need and especially if you need to cut out certain foods from your diet (an elimination diet) to see if they are contributing to your symptoms. A registered nutritional therapist will be able to help you by recommending diagnostic testing via the NHS or privately. Furthermore, without specialist advice your symptoms could persist and you may give up with the dietary changes you have made and your digestive problems may remain unresolved for many years to come.
* I always recommend you see your GP if you have persistent digestive symptoms and many nutritional therapists are happy to write to your GP on your behalf. Adopting a combined approach by working alongside a nutritional therapist and your GP is often the best course of action to address your health concerns.