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Food sensitivities: Why you react, and how to identify your trigger foods

Food can be a minefield!

Food provides the building blocks for life, can act as medicine, and is associated with celebrations and our most memorable times, sharing with family and friends.

Yet, food can also be a source of fear and confusion, ill-health, and toxicity in the body. We can spiral into a hole of poor gut health and inflammation, reacting to more and more to foods, still not knowing exactly which foods are triggering us. Some people then end up eating a severely restricted diet and become afraid of food in general.

Common digestive symptoms include bloating, wind and diarrhea. We may not have yet connected the dots between what we eat and seemingly unrelated symptoms such as migraines, joint pain, eczema, fatigue or sinus congestion, and mood disturbances.

Adverse food reactions fall into four causal categories.

  1. Immune system mediated – antibodies and inflammation in response to particular foods
  2. Digestive tract mediated – e.g. enzyme dysfunction such as a lactase deficiency which results in an inability to break down lactose, found in dairy
  3. Gut fermentation mediated – high FODMAP foods may lead to a worsening of symptoms. Read about the Low FODMAP diet here.
  4. Something else in the food e.g. salicylates, oxalates, sulfur, histamine, lectins

This article will explain how immune-system mediated over-reactivity comes about, and how to identify which foods are may be affecting you. My aim is help you understand the reasoning behind the interventions I suggest in my second article (released in the next week or so) on lessening these reactions.

Immune Tolerance

A huge proportion of our immune system lives within the lining of the Gastro-Intestinal (GI) tract. The immune cells that line our GI tract have two critical jobs:

1) Defend us from potentially harmful ‘pathogens’ in our guts (e.g. bacteria or viruses that are a threat)

2) To not react to food that we eat, and the bacteria in our gut. The immune system should actively suppresses a reaction to these.

It turns out that most of the time, the role of the immune system is actually NOT to respond to things. It should only react when there actually is a real threat. This concept of an appropriate response to our food and environment is called Oral Tolerance. Oral intolerance normally develops through a baby’s contact with their parents and breastfeeding. The first 1000 days of life are therefore very important in establishing immunity in general.

If we lose oral tolerance, we can start reacting to foods that we eat, and often we also develop increased intestinal permeability (leaky gut), inflammation, and digestive discomfort. This may progress to the stage where our immune system starts targeting our own tissues and organs (auto-immunity). And so it’s important to work on improving gut health not just to reduce food sensitivities themselves, but also to prevent progression of an auto-immune process.

Testing for Food Sensitivities

The first step you should take when working to lessen food sensitivities is to temporarily remove trigger foods from your diet. We can then work to improve your overall gut health so that you are better able to tolerate foods without an exagerated immune response.

But how do you know all the foods that you are reacting to?

One of the best ways to identify food sensitivities is an elimination diet. An elimination diet involves removing all suspect foods, that may be triggering the immune system, for a limited time (at least 3 to 4 weeks, and up to 3 months). After this period, foods are re-introduced systematically, every two or four days whilst keeping a close eye on your symptoms for a reaction to the food. In that way, we can identify which foods that you are react to. How long you avoid the trigger foods before re-introducing them, and how often you re-introduce them will depend on the severity of your symptoms.

Whereas lab testing only tests how certain parts of the immune system (such as IgG) respond to foods, an elimination diet paints the picture of how the body as a whole responds to the food. This is important as there may be other causes of a reaction other than just IgG antibody reactions.

Eight common foods that are often temporarily eliminated by someone suspecting food sensitivities are dairy products, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat and soy containing foods. Other options include the Functional Medicine elimination diet and the Autoimmune Paleo diet, but both of these diets eliminate more than these 8 foods and so are more limiting in what you can eat.

An elimination diet like this can be empowering but it is also restrictive, mentally challenging and time-consuming. An elimination diet, combined with IgG food reactivity lab-testing, provides the most complete view of food sensitivities. If a strict elimination diet is not possible for a person, then lab-testing alone is still a valuable option.

Ultimately, my goal when I work with clients is to get them on the least restrictive and simplest diet possible that has the biggest impact on their health and vitality. It can be beneficial to work with a practitioner as the foods that need to be eliminated varies from person to person, as does how the duration the food re-introduction phase – it can be quite overwhelming with support!

IgE – Allergic Reactions

In this article, I’m not going to go into detail around allergic IgE mediated, but I am going to focus on IgG food sensitivities. The difference between the two is IgE symptoms develop within a couple of minutes to one or two hours after eating a food and include symptoms such as hives, congestion or swelling of the throat. If you suspect a true allergic reaction to a food, please speak to your GP or contact me for further details on lab testing as I’m not going to focus on true allergies in this article. It is also possible to reduce the severity of IgE reactions, but not typically get rid of them, through nutritional support and Functional Medicine.

IgG Food Reactivity Lab-Testing

IgG antibodies tend to be associated with food sensitivities, and are produced from 3 to 72 hours after a food is eaten. At low levels, IgG antibodies are protective and their production is expected but at higher levels, they are associated with inflammation and typical IBS type symptoms. An IgG-mediated reaction to a food may not be noticed until more than 24 hours after eating a food, and remain in the body for weeks after a reaction is triggered, making identification of food sensitivities difficult without an elimination diet or lab testing.

There are many versions of IgG antibody testing to foods, and this diversity of testing can make choosing the right test confusing and overwhelming. Interpretation also benefits from professional help as the key to real improvement is not to only identify and remove trigger foods from the diet, but also support the gut and immune system so that it’s not so reactive. Our intention should always be to eat as varied and nutrient-rich diet as possible.

I recommend food sensitivity testing that measures the response of your immune system to foods (through a blood sample). It’s important that the test measures the IgG antibody reaction and also something call Compliment which measures actual tissue damage.  By measuring both IgG and Compliment simultaneously, we get a much clearer signal of activation of the immune system, giving more accurate results than other IgG food tests that only measure IgG. To find out about or order the food sensitivity testing I recommend, see here.

It is however important to note that some people, that have a severely impaired immune system, may not be capable of launching an immune response to trigger foods. In which case, IgG food sensitivity testing would be essentially useless.

How to Reduce Food Sensitivities

In the second article in this series, I take a deep dive into what you can do to reduce food sensitivities and improve your oral tolerance.

If you have any questions, I’m always happy to help so please get in touch. To know more about how you can work with me, you can find out more here.


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FREE INTRODUCTORY CONSULTATIONS NOW AVAILABLE – BOOK HERE

Stephen Ward (MSc) is trained in assessing the root cause of chronic health issues through Functional Medicine.

He uses nutrition, lifestyle changes, and nutraceuticals (targeted supplements) to help you achieve your goals and improve your health.

Food Sensitivities: Heal your gut and enjoy food again

In the first article in this series, I introduced you to some of the concepts behind food sensitivities, and how test for your current food sensitivities accurately using lab testing and/or elimination diet. I say current food sensitivities as these reactions to foods are by no means set in stone. By improving the health of your gut and the functioning of your immune system, it is possible to re-gain tolerance to foods and no longer react to them. This article is all about the nutritional strategies to achieve this.

But first, a reality check!

Let’s check in with our expectations before we get started Is regaining tolerance to all the foods you struggle with now even possible? The answer to this question my friends, is my favourite answer of ‘it depends..’

It depends on the person and it also depends on the food.

Something I tell my clients in clinic, is that I can’t say for certain how long it will take you to achieve results, until we get started. Only then can we see how you personally are responding to interventions.. Once we’ve started, we will then have a better idea of what we are working with. Remember, everyone is different!

But in general, it can be much more difficult, or not possible, to regain tolerance to the ‘top allergens’ such as gluten, and easier with foods like eggs and dairy. After working on improving your gut health, it may be that you can eat these foods without issue, or it may be that it only allows you to cheat occasionally and then have only mild symptoms. This varies from person to person!

The Functional Medicine approach

Are you eating like a bird to control your symptoms?

That’s not good for your health or your well-being!

If you have developed reactions to a wide array of foods, avoiding all these foods doesn’t do anything to resolve the underlying causes of your gut issues –  your immune system and gut bacteria will still be dysregulated; In time, this can lead to worsening of food sensitivities, auto-immunity and chemical sensitivities. Eating a more and more restricted diet isn’t the answer and is a path you don’t want to go down..

The question is not how do you avoid all the foods you react to but how do you calm the over-reactivity of the immune system in your gut, as well as heal leaky gut. The goal here is to reduce the hyper-reactivity to a whole range of foods, rather than focus on tolerance or avoidance of individual foods.

The approach I recommend follows a number of steps, which importantly includes addressing the root causes of your loss of tolerance to foods (or to the environment as in the case of chemical sensitivities):

  1. Identify the foods that you are reacting to through an elimination diet and / or lab testing (see my first article in the series for details on how to identify these foods)
  2. Whilst working to improve the health of your gut (step 3), temporarily remove the foods from your diet that provoke the biggest reactions. This removes the ongoing source of inflammation, so that you are not ‘pouring more fuel to the fire’.
  3. Improve the reactivity of your immune system by addressing the root causes of your gut issues and fixing an overly leaky gut 
  4. Reintroduce foods one at a time, re-establishing diet containing a wide range of foods. Working towards eating a diverse range of foods is key to regaining oral tolerance.
  5. Consider re-testing or monitor symptoms

In this article, we are going to focus on step 3 which is the step where we address your root causes of your food sensitivities.

More than a leaky gut diet..

Whilst addressing an overly leaky gut is important part of reducing food sensitivities, it is not the only thing! Healing a leaky gut alone does not reduce the inflammatory response to foods. We need to support our T-Reg and our dendritic cells in order to switch off the inflammatory messaging in our gut (revisit the first article on this series for a detailed recap on this). Any ongoing sources of inflammation will need to be addressed to reduce inflammation. These potentially include

  • Bacterial overgrowth or gut dysbiosis (an imbalance of bacteria in the gut)
  • Yeast overgrowth (e.g. Candida) or SIFO
  • Pathogenic bacteria or Protozoa (parasites)
  • Small intestinal bacterial overgrowth (SIBO)
  • Auto-immunity including IBD
  • High stress or extreme exercise can also be triggers

You may want to refer to my article on the 4 steps to restore gut health to get you started with these issues. Realistically, you will need to work with a practitioner, such as myself, to identify and treat these gut issues.

Dendritic Cells

Dendritic cells are a type of immune cell that sample the environment inside the gut (the gut lumen), providing an inflammatory signal to the rest of the immune system if they find something which they deem to be a threat. It’s vital therefore that they aren’t overly-reactive (like Donald Trump on Twitter!).

Dendritic cells can initiate an inflammatory response to foods in the absence of leaky gut!

This is important as it means even fixing a leaky gut, doesn’t necessarily mean the inflammatory response in our gut will develop normal tolerance. It may take extra work to support the Dendritic cells and T-Reg cells in our gut, as well as the spleen and liver!

dendritic cells sample antigens from the gut lumen

A key process in the loss of oral tolerance is the development of over reactivity in dendritic cells. These long armed cells sample the contents of the gut, and determine whether the immune system should respond to the proteins they find. We can balance the function of dendritic cells by

  1. Digest your food well
  2. Increasing protective secretory IgA

Digest your food well

If foods arrives in our gut, through our mouth and stomach, and hasn’t been appropriately broken down, it is more likely to activate our dendritic cells, and the immune system.

So how do you ensure foods are appropriately digested?

Well, digestion starts when we think about food, when we see and smell something appealing. Then our hormonal and nervous system trigger the release of stomach acid (hydrochlocic acid – hcl) and digestive enzymes, and blood flow (i.e. energy) is redirect to digestion. This happens best when we eat and are relaxed, at ease, and particular when eating in a social situation. Taking a few deep breaths before eating, using 4-7-8 breathing for example, can help to move our body to a relaxed state, and directing energy towards digestion.

It’s also vital that we chew our food really well before swallowing it, usually around 20 to 30 times. A useful image to keep in mind is that food should not be recognisable as the original food by the time we have chewed it and then swallowed it. One yourself indication that you aren’t doing this well, as recognisable food in your stool! I have a short course on optimising your digestive processes that is a great way to focus in on these fundamental requirements for gut health.

If, after focusing on eating your food in a relaxed state and chewing your food well, you still have the signs of low stomach acid, supplementing with HCL and high quality, broad spectrum digestive enzymes may be needed whilst you work on improving your gut health.

Secretory IgA (SIgA)

One of the ways our dendritic cells are protected from over-activation by the contents of our gut is through a natural layer of mucus that lines our gut. This mucus contains a protective immunoglobulin called secretory IgA (SIgA). The intestinal cells produce about 2-3g of SIgA every day and production tends to peak in childhood and start to declines with old age.

Many people think of mucus as being mainly in the nose and sinuses, but there is actually much more in the gut. This sticky mucus lining of the gut protects against gastro-intestinal pathogens like bacteria, viruses, fungi, toxins and food particles.

Essentially, SIgA antibodies bind themselves to the nasties, trapping them in mucus and stopping them from reaching the gut lining, and so SIgA protects our dendritic cells from over activation

These antibodies also ‘tag’ foods as acceptable by the body, suggesting why SIgA is an important part in maintaining tolerance to foods and avoiding progressive food reactions. 

Low SIgA is common in people with adrenal fatigue or who are combating an infection of some sort, particularly a Candida overgrowth. Signs of low SIgA can include cracked dry lips and skin, eczema, psoriasis, acne, chronic infections and accutane or steroid use. SIgA levels can be tested as part of a stool test such as GI Map or GI 360.

In most cases, you can think of the infection as dragging the SIgA down. The bacteria, yeast, or viral overgrowth (or all three – eek!) may need to be resolved and adrenal and thyroid issues addressed (are you constantly under emotional and psychological stress?), and detoxification pathways supported in order to see a change in SIgA.

In other more simple cases, I see a boost in SIgA from nutritional strategies that focus on pre and probiotics (including Sacchromyces Boulardi) with targeted minerals, vitamins and fatty acids. We know Vitamin A and D, Zinc and glutamine support SIgA and so it makes sense to optimise or supplement these nutrients.  

T-Reg Cells

Dendritic cells surround foreign proteins and transport them to the lymphatic system. There, they present the protein to T-Reg cells. It is the T-Reg cells that determine whether the immune response should launch a response of activation or tolerance. We need healthy T-Reg cells in order to distinguish between friend and foe and to not launch an overly zealous response to food. If a response is initiated, B cells within the immune system start to create antibodies to the proteins found in that food. This overactive immune response is a large part of what we experience as food sensitivities.

The good news is that we can support out T-Reg cells through nutrition and lifestyle. So, a key focus in our approach is to enhance the ability of our T-reg cells to distinguish pathogens. 

Short chain fatty acids (SCFAs) and Fibre

One of the best interventions we can make to support out T-Reg cells is to feed them more fibre. Fibre comes from plant based foods and so I recommend eating a diverse range of vegetables and berries, and to constantly switch the vegetables that you eat. This supports a diverse range of healthy gut bacteria, which in turn, metabolise plant material to make SCFAs. SCFAs help regulate T-Reg cells and reduce inflammation.

This is why I ask my clients to not eat only the same well-tolerated foods over and over again, even if test results show that they react to certain vegetables. Of course, if you have a noticeable reaction to a particular food, you probably want to remove it from your diet whilst you are working on repairing your gut. But it really is crucial, that you work on expanding your diet, eating new foods. It is only by doing this that you can regain tolerance to a wide range of foods.

If you tolerate FODMAPs, hummus and stewed apples are particularly good sources of fibre for the gut. Supplemental fibre choices (again if tolerated) include FOS, inulin, psylium, oat bran, beta-glucans, resistance starch,  and arabinogalactin. If you can’t tolerate fibre right now, due to SIBO or IBS, you can also add to your natural SCFA production with supplemental SCFAs, such as Butyrate.

Vitamin D is also critical to dendritic and T_Reg cell function, and helping prevent leaky gut. Test your levels to ensure they are optimal.

Bisphenol A (BPA), typically found in plastics, has been identified as a risk factor in the development of food allergy and food intolerances. A study in 2014, found that childhood exposure to BPA was linked to food intolerances later in life (this study was in rats, but is likely also applicable to humans). BPA is thought to play a role in auto-immunity, PCOS, suppressing tolerance to foods and the environment e.g. multiple chemical senitivities.

BPA is contained in certain plastics, fire retardants, receipts, fast foods, canned food liners and drinks, plastic drink bottles and food containers. Also, you should be aware that other plastics may also have a negative impact on our health – we only now just starting to study the impact of these other forms of plastic on our health..

Liver and spleen

Studies have shown that individuals with liver disease are four to six times more likely to develop an intolerance to gluten, and Celiac disease (the autoimmune reaction to dietary gluten). Our livers can launch an overly zealous reaction to foods in the same way that the immune system in our guts can. If you have food sensitivities and your liver enzymes are raised, you should always work towards restoring the health of your liver as well as your gut.

Leaky Gut

Increased intestinal permeability, commonly known as leaky gut, can be a contributing factor to loss of oral tolerance, but it isn’t the only mechanism involved in food sensitivities!

Mechanism of Intestinal Permeability

With a leaky gut, larger molecules, such as undigested food particles, toxins and micro-organisms, can enter the bloodstream through gaps, called tight junctions, between the cells that make up the gut lining.

The immune system doesn’t recognise these foreign molecules, raises the alarm that an invader is present, and then makes antibodies specific to these molecules. If those macro-molecules are gluten, your body will make antibodies to gluten. If it’s dairy, your body will make antibodies to dairy. A loss of oral tolerance to that food is developing..

A leaky gut can also be associated with a general loss of tolerance to a range of foods. In which case, you may find yourself reacting to more and more foods.

Healing an overly leak gut needs a three pronged approach, a lot of which we have already covered:

  1. Support SCFA production through pre and probiotics and fermented foods (see above)
  2. Support SIgA production (see above)
  3. Supporting the mucosal lining

Supporting the gut lining

You should always start by working on lifestyle factors, such as good sleep and managing stress. Stress and extreme exercise can lead to a leaky gut, and associated issues. 

The foods I tend to recommend for repairing the gut lining include:

  • 30ml Aloe Vera juice daily
  • 250ml Cabbage juice daily (rich in glutamine)
  • 200ml Bone broth daily
  • 500ml of strong homemade ginger tea daily 

Helpful supplements include Zinc Carnosine, L-Glutamine, Butyrate, Vitamin A and D, Colostrum, Flavonoids, and omega 3s.

Food Re-introduction

After you have done the work needed to improve your gut health (and yes, it is work – unfortunately, there isn’t a magic bullet I know of for this), any foods that were removed from the diet are re-introduced systematically. Typically, foods are re-introduced every two or four days whilst keeping a close eye on your symptoms for a reaction to the food. In that way, we can identify which foods you are still reacting to, and may need to continue to limit. How long you avoid the trigger foods before re-introducing them, and how often you re-introduce them will depend on the severity of your symptoms.

Summary

At the end of the day, the aim is to have you eating, enjoying, and tolerating a wide range of foods, particularly plant based foods that provide the fibre for our gut bacteria, but how you get these is a journey which varies from person to person. It’s easy to become overwhelmed and confused by all the information and options, and so I do recommend working with a practitioner, such as myself, through all these steps. Let me know if I can be any help. You may also be interested in the food sensitivity testing service, we offer.

What Really Causes Reflux?

What are Reflux and GERD?

Acid reflux is one of the most common digestive disorders in Australia, affecting 10-15% of the population and is increasing in prevalence. The symptoms can range from mild and annoying to severe and include heartburn, chest pain, regurgitation, and nausea. Long-term reflux has also been linked to increased rates of oesphageal cancer. It’s definitely something you want to avoid!

Gastro-esophageal Reflux Disease (GERD) is a more serious form of reflux. As a side note, in Australia, you may find reference to GORD, rather than GERD, due to the different spelling of (o)esophagus, but we will use the GERD abbreviation in this article.

The conventional medical approach to reflux is to treat the symptoms by consuming antacids or taking acid lowering drugs such as PPIs. Unfortunately, not only does this approach fail to adequately address the symptoms, they can make matters worse…

How your Antacid is Making you Sick

Antacids treat the symptoms and discomfort of heart burn without addressing the underlying cause. As soon as you stop taking them, the discomfort returns. There is little money for a pharmaceutical company when they actual cure a disease (no repeat customers!) and some would argue that this leads to the ongoing marketing of short-term solutions and lack of information around the real cause of health issues such as this.

Furthermore, there are consequences of regularly taking antacids and acid stopping drugs:

  • Increased bacterial overgrowth
  • Impaired nutrient absorption
  • Decreased resistance to infection
  • Increased risk of death by chronic disease

When acid blockers and antacids were first introduced to the market, it was recommended that they were used for a maximum of six weeks. Indeed, they can be useful to provide short-term relief but the problem is longer term that can lead to these side effects.

So what can you do?

The good news is reflux and GERD can easily be treated with some simple dietary and lifestyle changes…

A Symptom is Not a Cause: Not Enough Stomach Acid?

But first, I think it’s important to learn a bit more about why acid-reflux develops…

The idea that too much stomach acid causes reflux and GERD is common in the media and the general public. But the scientific literature centers around the theory that GERD is caused by a dysfunction in the spinchter, known as the lower esophageal valve (LES), which separates the stomach from the lower end of the oesophagus.

Normally, the LES only opens when we eat to allow food to pass into our stomach. It doesn’t matter how much acid there is in the stomach; Acid can not rise up through the LES into the oesophagus when it is closed. But if the LES is malfunctioning, either because of a physical defect or because of abdominal pressure (we’ll get on to this), the stomach acid rises back into the sensitive oesophagus and gives the painful symptoms of heart burn.

Acid reflux and the lower esophagal sphincter

Treating gastroesophageal reflux disease with profound acid inhibition will never be ideal because acid secretion is not the primary underlying defect.

http://www.natap.org/2009/HIV/070409_02.htm

What Really Causes Reflux?

The most common causes of acid-reflux are

  • Food intolerances / triggers
  • Excessive gas production
  • Immune system activation

Most often, these three causes are present together and are connected…

Dietary triggers can include alcohol, dairy, gluten, caffeine, processed foods, fructose, FODMAPs (more on this later). The easiest way to find out if foods are triggering your reflux or GERD is to do an elimination diet where you cut out these potential triggers from your diet.

The Paleo diet is a good option as it removes many of the common inflammatory foods. With a diet like this, you should be seeing some benefit in three weeks or so. If you aren’t seeing the improvement you would like, then that’s telling you that you are not getting to the underlying cause…

Excessive gas may be produced by a bacterial overgrowth in the gut. This gas this causes an increase in intra-abdominal pressure (IAP) which pushes the contents of the stomach, including stomach acid, into the oesophasgus.

But what could be causing the bacterial overgrowth?

One common cause of bacterial overgrowth is low stomach acid. Aaha! Now we we can see a mechanism by which low stomach acid may be contributing to acid-reflux…

At a PH of 3, bacteria in the stomach can only survive for 15 minutes but at a PH of 5, bacteria begin to thrive. And a trial has been conducted which confirmed just this effect. 30 people with GERD were treated with a high dose of Prilosec (40g/day), a PPI that reduces stomach acid, for at least 3 months. 11 of the 30 Prilosec-treated people developed significant bacterial overgrowth, compared with only one of the ten people in the control group.

Now, we know that bacterial overgrowth is also associated with immune system activation as the immune system is activated, including a histamine response, to deal with the threat of a bacterial overgrowth.

The Low-FODMAP diet and probiotics are known to reduce immune system activation and histamine. So if bacterial overgrowth and immune system activation are at the core of reflux for some people, it makes sense that a Low-FODMAP diet and probiotics will be helpful.

Reducing Reflux and GERD in Three Simple Steps

Once food intolerances and physical defects of the LES are ruled out, heart burn and GERD are likely caused by bacterial overgrowth and too little stomach acid. If someone is overweight, working to reduce weight can also be helpful.

So our goal is now to reduce the bacterial overgrowth and increase the acid. This can be done in three steps (and is a similar approach used to regain gut health for reasons other than reflux):

  1. Reduce the bacterial overgrowth and causes of low stomach acid.
  2. Replace the missing stomach acid
  3. Repair the gut mucosal lining, gut immune system and re balance the gut bacteria.

To Reduce the bacterial overgrowth, a low carbohydrate Low-FODMAP diet, together with probiotics is effective. A combination of probiotics, namely Sacchromyces Boulardi, a Lactobacillus / Bifidobacterium blend, and soil based probiotics are likely to be effective for this purpose. You may find the most benefit when combining these three different types. A low-histamine diet can also be trialed.

Replacing stomach acid usually means taking a supplement containing HCL with pepsin or another acid stable protease. Pepsin in the acidic environment of the stomach breaks down protein so that we can absorb it into our bodies. If the stomach is not producing enough HCL, it is likely not producing enough pepsin and so both should be supplemented together.

For sensitive people that feel warmth in their stomach from 1 capsule of HCL, apple cider vinegar before meals is an option. A program to support the gastric lining for 6-8 weeks may be necessary (speak to me about this).

After a period of supplementing HCL, many people find that they are then able to reduce their dose..

Note, HCL should never be taken by anyone is using any type of anti-inflammatory medication (e.g. Ibuprofen or other NSAID) or corticosteroids (e.g. predisone). These medications can damage the gut lining and the supplementary HCL could aggravate this, causing bleeding or an ulcer.

Once we have reduced any bacterial overgrowth and any possible drivers of low stomach acid, and then replaced the low acid, we still need to repair the gut.

Repairing the gut means reducing the increased intestinal permeability (leaky gut) which may be present, supporting the gut immune system and re-balancing the gut bacteria. A re-balanced gut microbiome should support gut barrier function, decrease inflammation and balance the immune system and not produce the excess gas associated with additional pressure and reflux.

We can make use of probiotics and nutra-ceuticals to support the intestinal immune system and provide the building blocks needed for the gut to repair itself. Particular foods such as fermented foods, bone broth and soluble fibres can be helpful. Soluble fibres are prebiotics which act as fuel for the good bacteria in our gut. You can read more about repairing the gut in this article.


If you have any questions, I’m always happy to help so please get in touch. To know more about how you can work with me, you can find out more here.


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FREE 30 INTRODUCTORY CONSULTATIONS NOW AVAILABLE – BOOK HERE

Stephen Ward (MSc) is trained in assessing the root cause of chronic health issues through Functional Medicine.

He uses nutrition, lifestyle changes, and nutraceuticals (targeted supplements) to help you achieve your goals and improve your health.


Why are my iron levels still so low?

Iron deficiency is common, especially among women, vegetarians, and anyone who is hypo-thyroid. It can make you feel, tired, dizzy, moody, and cause head aches as the body doesn’t have enough iron to make haemoglobin, the protein in red blood cells that carries oxygen around the body.

This lack of healthy red blood cells is known as iron-deficiency anemia. Resolving this anemia is a crucial first step of any healing program as it robs cells of the oxygen they need to function.

Iron deficiency may explain persistent symptoms in between 30 to 50% of hypo-thyroid patients despite thyroid hormone therapy. Dr. Ruscio recommends testing for ferritin and getting ferritin levels above 100 in such cases.

Iron balance is critical with too much iron leading to oxidative damage, which may be part of chronic fatigue, liver disease, and brain function.

Iron as a supplement should only be taken following lab testing of iron levels in the body. When supplementing or when focusing on foods containing high levels of iron, some people find their levels remain stubbornly low. What’s going on?

What can you do?

If you suspect your have iron-deficiency anaemia, the first step is to talk to your doctor about testing to get confirmation. Excess iron can cause serious health conditions and low levels of iron are never something you should assume without testing.

Improving your iron absorption, and gut health, should be thought of as an important step to increasing iron absorption. Here are some things that can be done:

Inflammation and the gut?

Low grade inflammation is associated with all chronic disease. It can have a wide variety of causes, such as infections, injury, poor diet or toxins, even stress! But one of the most common areas where inflammation starts is in the gut.

When inflammatory cytokines are high (during infection or injury), the liver releases a regulatory molecule (hepcidin) which blocks the absorption of iron. In other words, inflammation blocks the absorption of iron from the gut.

You can read about how to reduce inflammation in our gut here. Inflammation in the small intestine in particular, often found with small intestine bacterial overgrowth (SIBO), is associated with poor absorption by the body of nutrients such as B12, iron, and zinc.

And so we need to consider inflammation of the gut when reflecting on why iron supplementation may not be raising iron levels in the body. This focus on the underlying systems of the body is a cornerstone of what is know as Functional Medicine.

Low Stomach Acid

Low stomach acid (HCl) is an important causative factor of anemia due to iron deficiency. Gastric HCl is important for nonheme iron absorption (non-meat iron sources) as this requires an acidic environment which helps the liberation of iron from food. In this article you can find out how to get an idea of your stomach acid levels with an east to do, at home, test.

Phytates

Phytate is found in foods like whole grains, cereals, soy, nuts and legumes. It binds to minerals such as iron and zinc, preventing their absorption.

While eating some phytates is fine, many of us are eating more than the recommended amount, even those eating a Paleo diet containing a moderate amount of nuts.

But the research has shown eating even a small amount of phytate, at the same time as the source of iron, can decrease iron absorption. This inhibitory effect increases as the quantity of phytates increases. This is what is called a dose dependent effect. This effect can be counteracted by eating a source of Vitamin C at the same time.

Pair iron rich foods with Vitamin C

Iron from animal products, known as heme iron is the most easily absorbed by the body. But all is not lost if you are a vegetarian. Eating a source of Vitamin C along with plant base sources of non-heme iron helps absorption.

Foods high in vitamin C include citrus fruits, dark green leafy vegetables, bell peppers, melons and strawberries. In one study, 100mg of Vitamin C taken with food, increased absorption.

Iron and our Microbiome

Probiotics appear to increase the iron absorbing capability of the gut.

In particularly, a 2019 systematic review of the research found that the probiotic Lactobacillus plantarum 299v significantly increased iron absorption in humans.

Luckily for us, there are several commercially available probiotics containing this strain such as this one (affiliate link).

While we have discovered that some strains of probiotics increase iron absorption, other research is showing that other strains block absorption. And so to have optimal iron absorption from the gut, a balanced ecosystem of bacteria is needed. This means a healthy gut and microbiome!

 

How good is your first line of defense?

I’m talking about the importance of stomach acid! This article will let you know why you should care and I’ll also give you an easy test you can do at home to give you an idea of your stomach acid levels, so read on…

Stomach acid, otherwise known as hydrochloric acid (HCl), plays a pivotal role in the breakdown of food, a healthy balance of bacteria in our gut, and the prevention of small intestinal bacterial overgrowth (SIBO), and so the prevention and treatment of IBS. As it’s becoming widely accepted that a healthy body depends on a healthy gut, this is important stuff for your health.

Many people with reflux also actually have low stomach acid, rather than too much. You can read more about that here.

When we eat food, digestion begins in the mouth through the process of mastication (chewing to you and me) and the release of enzymes, such as salivary amylase which starts the digestion of carbohydrates. Chewing our food sets the digestive process off to a good start!

Food is further broken down in the stomach by HCl (PH 1.0 to 2.5) and more enzymes. This kills harmful microorganisms and helps create favourable conditions for enzymes such as pepsin which helps to break down protein.

Stomach acid

HCl also makes nutrients such as Vitamin B12, Calcium, Zinc, Iron, and Magnesium available from our food..

If the stomach is too alkaline, the system of the digestive tract does not work well and you end up with up complications further along the tract such as SIBO.

Also, it is often a lack of acid in the stomach, not an excess, that causes reflux as food is not being properly digested and is causing acid to flare up into the esophagus.

But the amount of acid produced is also affected by the amount and type of food you are eating, and also how you are feeling!

Pause for a second, and let that sink in …

If you are stressed and eating on the go, your body is likely to be producing less HCl and your digestion just isn’t going to be great, whatever you are eating. A good tip is to take three, deep mindful breaths whenever you sit down to eat, and to eat away from electronic devices or your office desk.

How to Test for Stomach Acid Levels at Home for Free
Now, I’ll show you the simple test you can do from your home with just bicarbonate of soda and water, to give you an indicator of your HCl levels (remember this is just a guide!).If you are taking NSAIDs, Corticosteroids, or have other concerns, please speak to your GP first.

  1. First thing in the morning drink (in one go) a mixture of 1/4 tsp of bicarbonate of soda mixed in 150ml of room temperature water
  2. Set a timer and measure how long before you belch
  3. Repeat for several mornings to check the results

Ignoring tiny little burps, the test tends to show the earlier you burp, the more stomach acid you have

  • 0-2 Minutes: You have plenty (& possibly, though rarely, too much) HCl
  • 2-3 Minutes: You have about the right amount of HCl
  • 4 Minutes upwards: This may suggest you have low HCl

Other signs of low stomach acid include noticing undigested food in your stool, or feeling overly full after eating a protein rich meal (like it sits in your stomach).

What Next?
If you suspect you have low HCl, you can encourage its production by mixing a teaspoon of apple cider vinegar, or some lemon in about 200mls of water before you eat.

Eating bitter food or drink may also help digestive secretions and prompt HCl production. Bitters include a bitter tonic such as the traditional Swedish bitters, and foods such as rocket, chicory, dandelion (including tea), radicchio, endive, and artichoke.  HCl + pepsin is also available as a supplement if required.  

And if you unlucky enough to already have an ongoing gut issue such as digestive discomfort, IBS, IBD, bloating, leaky gut, or just want to improve your gut health, drop me a message and I’ll see what I can do to help…


Stephen Ward (MSc) is trained in assessing the root cause of your health issues and together, we can work this out. 

Call 0491611043 or BOOK ONLINE.

Alternatively, send me a message and I’ll get back to you ..

How to use the Low FODMAP diet to heal your gut

The Low FODMAP diet is now commonly recommended to ease a range of digestive symptoms associated with small intestine bacterial overgrowth (SIBO) and irritable bowel syndrome (IBS). It works by removing foods that commonly cause digestive discomfort from the diet, allowing the gut to heal. Foods are then re-introduced systematically so that trigger foods can be identified. It may be used as part of a gut healing protocol.

FODMAP is an acronym for:

  • Fermentable
  • Oligosaccharides
  • Disaccharides
  • Monosaccharides
  • Polyols

Eek! So what is that in plain English? These are types of sugar that are poorly absorbed by the small intestine and are fermented by bacteria to produce gas. They can cause IBS type symptoms such as gas, bloating, constipation and diarrhea in some people.


Can a low FODMAP diet help you?

Recent research found up to 86 percent of people with IBS saw improvements in their symptoms while on a low FODMAP diet. It has also been found to decrease inflammation, as measured by histamine in the gut, which may reduce neurological symptoms such as brain fog which may be associated with IBS.

A Low FODMAP diet can help you to isolate the types of foods that are causing your symptoms. Once your GP has examined you for other conditions, such as coeliac disease, this diet can help you get back to basics – I commonly recommend this diet as a first step when working with gut issues. It has not only been shown to help many people with IBS, but may also be helpful for other gut conditions such as coeliac disease, Crohn’s and Colitis. It is recommended that you consult with a health care consultant, dietician or Nutritional Therapist, such as myself, before embarking on a low-FODMAP diet.

FODMAPs can feed bacteria in the small intestine, which should only contain a small number of bacteria compared to the colon. This can lead to Small Intestine Bacterial Overgrowth (SIBO). Whereas in someone with a healthy gut, these sugars will pass through the small intestine until they get to the colon where they will act as a food source for beneficial bacteria that live there.

What is the low FODMAP diet?

The low-FODMAP diet helps you identify the foods that are causing your symptoms – this varies from person to person. You start by removing foods that are high in FODMAPs for 2-4 weeks or until symptoms ease.

There are many foods that are restricted but you have to remember why you are doing this – The long-term benefits far outweigh the difficulty of eliminating these foods for this period. Remember, everyone reacts to these foods differently so the Low-FODMAP diet allows you to find out which foods are problematic for you.

As a qualified Nutritional Therapist, I can guide you through this process, help you with tasty and tolerable alternatives to high FODMAP foods, and guide you through the re-introduction phase and help you to identify other causes of your gut issues

The main sources of FODMPs include (there are other high FODMAP foods not on this list):

Oligosaccharides: Wheat products, vegetables such as onions and garlic, all beans and pulses including chickpeas, lentils and soybean, and inulins added to foods such as certain yoghurts, protein bars, and milks.

Disaccharides: The main one is Lactose and many people are Lactose intolerant. Lactose is not the same as dairy: Cream, hard cheeses and butter contain a limited amount of lactose. Most people with malabsorption can handle 4g of Lactose before they encounter issues, and so a thin spread of butter or a dash of milk may be OK, but a Latte may not.

Monosaccharides: These are simple sugars with excess fructose being the main one. Examples of foods containing an excess of fructose include fruit juices, apples, cherries, watermelon, peaches, plums, nectarines, mango

Polyols: Mushrooms, fruits such as apricots, chewing gum, and added sugar alcohols 

How does the low-FODMAP diet work?

Phase 1 – FODMAP Restriction

Phase 1 is a strict restriction of all high FODMAP foods for two to four weeks, or until symptoms settle. The low-FODMAP diet originated out of research by Monash University and they have developed an app which can be used to know the FODMAP content of various foods. It has proven invaluable to many people.

Keeping track of how particular foods affect you is also recommended. That way, you can more clearly see patterns between what you eat and how you feel.

Phase 2 – FODMAP Reintroduction

During this phase, you methodically re-introduce foods that were restricted in Phase 1. Foods are re-introduced one-by-one and in a specific order. The idea is that at the end of this process you will have a better understanding of which foods trigger your symptoms, and you can continue to eat the ones, you do not react to. This process will take several weeks or months, and I suggest you work through this process with a Nutritionist, such as myself, or a dietitian.

Is this the perfect diet?

The Low-FODMAP diet can be a life saver for many people and can transform some people’s quality of life and well being within days…

But like anything, there is a downside. When you do a restrictive diet like this, you run the risk of cutting out many nutrient-rich foods and good sources of fibre –  fibre is fuel for the beneficial bacteria in our colon, and is an important part of a healthy diet.

For this reason, and contrary to the belief of many people, eliminating all high FODMAP foods is not a healthful solution. Identifying the particular FODMAPs that trigger your symptoms allows you to include as many healthy high FODMAP foods in your diet as possible. 

What next?

You can, of course, do the low-FODMAP diet and re-introduction on your own, but many people prefer to work with a Nutritionist such as myself to help them identify what they can eat (that’s tasty too!), what they are reacting to, and to guide them through the re-introduction phase. We even have a coaching app for your phone so that I can support you through this process.  

Also, as the diet doesn’t necessarily help you find the root cause of your IBS, a practitioner can help you with testing for a bacterial or fungal overgrowth that may be causing your issues and work with you on other causes of your health issues.

If you’d like to talk me to about the low-FODMAP diet, or your options for working with IBS or other health conditions, please contact me with any questions or give me a call.

What is Leaky Gut? And 12 signs you have one…

Did you know our digestive system has two purposes?

Of course, it allows us to break down food into smaller and smaller particles to be absorbed into the bloodstream and be used by the body. Naturally, we need those nutrients to live!

But also, it blocks larger particles known as macromolecules from being absorbed into the body. These macromolecules include toxins, pathogens, and undigested foodstuffs. This unseen barrier is vital to our long term health and wellness.

Leaky gut, or increased intestinal permeability as it’s known academically, allows the uncontrolled passage of these macro-molecules into the body from the small intestine.

In the small intestine, the epithelial lining itself is only one cell thick. It functions like a cheesecloth with only small molecules intended to pass through the intestinal barrier. As food winds its way through the small intestine, it is broken down into smaller and smaller components until they are small enough to be absorbed through the cheesecloth.

Holes in a net

However, when there is inflammation in the intestine and increased intestinal permeability, larger macro-molecules, pass through the cheesecloth unchecked. It is as if the cheesecloth has tears in it which let the larger molecules through. This is bad news as the immune system recognises these molecules as undesirables and produces antibodies to these molecules, leading to inflammation, and the potential for a host of health issues.

The state of health or the state of disease is the combination between what we are – meaning what genetically makes us the way we’re engineered – and the environment that’s around us. And the gut is the point of entry in which these two elements meet

Alessio Fasano, MD

The gut lining and mucus layer work together

The good news is the epithelial lining is protected by a layer of mucus, known as the mucosal immune system (MALT). While the epithelial lining restricts access to the body of ‘troublesome’ macro-molecules and secretes antimicrobial substances, the mucus prevents unwanted organisms from sticking to the lining. The lining is where the good ‘good’ bacteria live, limiting the colonisation by unwanted organisms.

In healthy states, the MALT provides protection against pathogens but maintains tolerance against non-threatening substances such as food molecules. In other words, the MALT should be smart enough to react to things that may be bad for us, but not react to other things which are harmless (you can read about oral tolerance here). Our microbiome plays a part in training our immune system to react in this way.

Luckily, there are dietary and lifestyle changes, as well as nutrients that can help repair this protective firewall and increase the diversity of our gut microbiome.

It is now recognized that the interface of the individual’s intestinal immune system with their gut microbiome has a critical effect on metabolism and immunity spanning the function of many organs and diseases including cancer, diabetes, arthritis, obesity, anxiety/depression, and autism.

Dr. J.Bland (Founder and PIONEER IN FUNCTIONAL MEDICINE)

How can I tell if I have leaky gut?

While there is testing that can be done for intestinal permeability, the truth is MOST people with a chronic health issue will have some degree of increased intestinal permeability.

And remember, you don’t have to have gut symptoms to have a leaky gut. Leaky gut can manifest as autoimmune conditions affecting the thyroid (Hashimoto’s) or joints (rheumatoid arthritis), mental illness, depression, skin problems like eczema or psoriasis and more.

12 signs you have leaky gut:

  1. Food sensitivities or intolerances – As food particles may enter the bloodstream through a leaky gut, the immune system of a person with increased intestinal permeability may react to a food (especially gluten and dairy). Leaky gut and allergies have been found to be linked.
  2. Poor Immune System Function: Including susceptibility to viruses and parasites
  3. IBS and bloating Particularly diarrhea-predominant IBS
  4. Candida, Parasites and Small Intestine Bacterial Overgrowth
  5. Inflammatory Bowel Disease
  6. Chronic Fatigue – Inflammatory compounds, called cytokines are associated with increased intestinal permeability and can lead to fatigue
  7. Auto-Immune Diseasesread more here including Hashimoto’s Thyroiditis
  8. Polycystic Ovary Syndrome – PCOS has been associated with increased zonulin, a biomarker of increased intestinal permeability
  9. Nutrient Malabsorption – This may be associated with fatigue
  10. Skin issues – such as psoriasis, acne, rosacea, or eczema
  11. Mood issues, Depression, Anxiety, and Mood Swings
  12. Brain Fog and Memory Issues

Now, the good news is intestinal permeability is completely reversible, and the mucosal firewall can be repaired.

Some of the foods that can help include

 

You may also be interested in this article to find out how intestinal permeability is key to the development of an auto-immune disease. If are looking for the steps you need to heal your gut, you probably need to read this article.


Stephen Ward (MSc) is trained in assessing the root cause of your health issues and together, we can work this out.

Call 0491611043 or BOOK ONLINE.

Alternatively, send me a message and I’ll get back to you ..