The Gut "Connections to Health & Disease"

Individuals with digestive problems that cannot be diagnosed could be experiencing functional gastrointestinal disorders. Could understanding the types help in developing effective treatment plans?

Functional Gastrointestinal Disorders

Functional gastrointestinal disorders, or FGDs, are disorders of the digestive system in which the presence of structural or tissue abnormality cannot explain symptoms. Functional gastrointestinal disorders lack identifiable biomarkers and are diagnosed based on symptoms. (Christopher J. Black, et al., 2020)

Rome Criteria

FGDs used diagnoses of exclusion, meaning that they could only be diagnosed after organic/identifiable disease was ruled out. However, in 1988, a group of researchers and healthcare providers met to devise strict criteria for the diagnosis of the various types of FGDs. The criteria is known as the Rome Criteria. (Max J. Schmulson, Douglas A. Drossman. 2017)

FGDs

A comprehensive list as described by the Rome III criteria (Ami D. Sperber et al., 2021)

Functional Esophageal Disorders

• Functional heartburn
• Functional chest pain believed to be of esophageal origin
• Functional dysphagia
• Globus

Functional Gastroduodenal Disorders

• Unspecified excessive belching
• Functional dyspepsia - includes postprandial distress syndrome and epigastric pain syndrome.
• Chronic idiopathic nausea
• Aerophagia
• Functional vomiting
• Cyclic vomiting syndrome
• Rumination syndrome in adults

Functional Bowel Disorders

• Irritable bowel syndrome - IBS
• Functional constipation
• Functional diarrhea
• Unspecified functional bowel disorder

Functional Abdominal Pain Syndrome

• Functional abdominal pain - FAP

Functional Gallbladder and Sphincter of Oddi Disorders

• Functional gallbladder disorder
• Functional biliary Sphincter of Oddi disorder
• Functional pancreatic Sphincter of Oddi disorder

Functional Anorectal Disorders

• Functional fecal incontinence
• Functional Anorectal Pain - includes chronic proctalgia, Levator ani syndrome, unspecified functional anorectal pain, and proctalgia fugax.
• Functional Defecation Disorders - include dyssynergic defecation and inadequate defecatory propulsion.

Childhood Functional GI Disorders

Infant/Toddler (Jeffrey S. Hyams et al., 2016)

• Infant colic
• Functional constipation
• Functional diarrhea
• Cyclic vomiting syndrome
• Infant regurgitation
• Infant rumination syndrome
• Infant dyschezia

Childhood Functional GI Disorders:

Child/Adolescent

• Vomiting and Aerophagia - cyclic vomiting syndrome, adolescent rumination syndrome, and aerophagia
• Abdominal Pain-Related Functional GI Disorders include:

1. functional dyspepsia
2. IBS
3. Abdominal migraine
4. Childhood functional abdominal pain
5. Childhood functional abdominal pain syndrome

• Constipation - functional constipation
• Incontinence - nonretentive fecal incontinence

Diagnosis

Although the Rome criteria allow the diagnosis of FGDs to be symptom-based, a healthcare provider may still run standard diagnostic tests to rule out other diseases or look for structural problems resulting in symptoms.

Treatment

Although no visible signs of disease or structural problems may be identified as causing the symptoms, it does not mean that they are not treatable and manageable. For individuals who suspect they may have or have been diagnosed with a functional gastrointestinal disorder, it will be essential to work with a healthcare provider on a working treatment plan. Treatment options can include: (Asma Fikree, Peter Byrne. 2021)

• Physical therapy
• Nutritional and dietary adjustments
• Stress management
• Psychotherapy
• Medication
• Biofeedback

Eating Right To Feel Better

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Black, C. J., Drossman, D. A., Talley, N. J., Ruddy, J., & Ford, A. C. (2020). Functional gastrointestinal disorders: advances in understanding and management. Lancet (London, England), 396(10263), 1664–1674. https://doi.org/10.1016/S0140-6736(20)32115-2

Schmulson, M. J., & Drossman, D. A. (2017). What Is New in Rome IV. Journal of neurogastroenterology and motility, 23(2), 151–163. https://doi.org/10.5056/jnm16214

Sperber, A. D., Bangdiwala, S. I., Drossman, D. A., Ghoshal, U. C., Simren, M., Tack, J., Whitehead, W. E., Dumitrascu, D. L., Fang, X., Fukudo, S., Kellow, J., Okeke, E., Quigley, E. M. M., Schmulson, M., Whorwell, P., Archampong, T., Adibi, P., Andresen, V., Benninga, M. A., Bonaz, B., … Palsson, O. S. (2021). Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology, 160(1), 99–114.e3. https://doi.org/10.1053/j.gastro.2020.04.014

Hyams, J. S., Di Lorenzo, C., Saps, M., Shulman, R. J., Staiano, A., & van Tilburg, M. (2016). Functional Disorders: Children and Adolescents. Gastroenterology, S0016-5085(16)00181-5. Advance online publication. https://doi.org/10.1053/j.gastro.2016.02.015

Fikree, A., & Byrne, P. (2021). Management of functional gastrointestinal disorders. Clinical medicine (London, England), 21(1), 44–52. https://doi.org/10.7861/clinmed.2020-0980

Not getting enough fiber in one's diet can lead to fiber deficiency. Fiber helps support gut and microbiome health. Individuals not getting enough fiber may experience irregular bowel movements, constipation, blood sugar fluctuations, not feeling full/satisfied after eating, or rising cholesterol levels. About 100 trillion microorganisms in the gut are integral to maintaining a healthy immune system. Fiber is the food these microorganisms eat that helps them to do their job. Without the proper amount, the immune system's health may also be compromised.

Fiber and Gut Health

Fiber and gut health benefits include regulating the body's sugars, helping to keep hunger and blood sugar in check, helping to maintain a healthy weight, its ability to prevent or relieve constipation, reduce the risk of diabetes, heart disease, and certain types of cancer.

• Dietary fiber, or roughage, is the part of plant foods the body can't digest or absorb.
• It passes through the stomach, small intestine, and colon and out of the body.
• It is found mainly in fruits, vegetables, whole grains, and legumes.
• Soluble and insoluble forms are important to overall health.

Types

Soluble Fiber

• This type dissolves in water to form a gel-like substance.
• It can help lower blood cholesterol and glucose levels.
• It is found in oats, peas, beans, apples, citrus fruits, carrots, and barley.

Insoluble Fiber

• This type of fiber promotes the movement of material through the digestive system.
• It increases stool bulk, benefiting individuals who struggle with constipation or irregular stools.
• Whole-wheat flour, wheat bran, nuts, beans, and vegetables, such as cauliflower, green beans, and potatoes, are good sources.

Benefits

Healthy Bowel Movements

• Dietary fiber increases stool weight and thickness and makes it soft.
• Fiber helps to solidify the stool by absorbing water and adding bulk.
• A thicker stool is easier to pass, decreasing the potential for constipation and other problems.

Maintains Bowel Health

• A high-fiber diet can lower the risk of developing hemorrhoids and small pouches in the colon/diverticular disease.
• Studies have also found that a high-fiber diet can help lower the risk of colorectal cancer.
• Some fiber gets fermented in the colon.
• Researchers are looking at how this can help prevent diseases of the colon.

Lowers Cholesterol

• Soluble fiber found in beans, oats, flaxseed, and oat bran can help lower blood cholesterol levels by lowering low-density lipoprotein or unhealthy cholesterol levels.
• Studies also have shown that high-fiber foods can help reduce blood pressure and inflammation.

Regulates Blood Sugar Levels

• In individuals with diabetes, fiber, particularly soluble fiber, can slow the absorption of sugar and improve blood sugar levels.
• A healthy nutrition plan that includes insoluble fiber can help reduce the risk of developing type 2 diabetes.

Helps Achieve Healthy Weight

• High-fiber foods can be more filling than low-fiber foods, helping individuals eat less and stay satisfied.
• High-fiber foods can also take longer to eat and are less energy dense, meaning they have fewer calories.

Getting More Fiber

Ideas for adding more fiber to meals and snacks:

Fiber to Start The Day

• Choose a high-fiber breakfast cereal with five or more grams of fiber per serving.
• Choose cereals with whole grain, bran, or fiber in the name.
• Add a few tablespoons of unprocessed wheat bran to the cereal.

Add Whole Grains

• Try to make at least half of the grains eaten whole grains.
• Look for bread that lists whole wheat, whole-wheat flour, or another whole grain as the first ingredient, with at least 2 grams of dietary fiber per serving.
• Experiment with whole-wheat pasta, brown rice, wild rice, barley, and bulgur wheat.

Baked Foods

• Substitute whole-grain flour for half or all white flour when baking.
• Add crushed bran cereal, unprocessed wheat bran, or uncooked oatmeal to muffins, cakes, and cookies.

Legumes

• Beans, peas, and lentils are recommended sources.
• Add kidney beans to soups or salads.
• Make nachos with refried black beans, fresh vegetables, whole-wheat tortilla chips, and healthy salsa.

Fruit and Vegetables

• Fruits and vegetables are rich in fiber and vitamins and minerals.
• Try to eat a favorite fruit daily.

Healthy Snacks

• Fresh fruits, raw vegetables, low-fat popcorn, and whole-grain crackers are healthy choices.
• Try for a handful of nuts or dried fruits; however, be aware that nuts and dried fruits can be high in calories.

Moderation

High-fiber foods are beneficial for the body's health.

• Adding too much fiber can promote intestinal gas, abdominal bloating, and cramping.
• Increase fiber gradually over a few weeks.
• This allows the natural bacteria in the digestive system to make adjustments.
• Maintain hydration, as fiber works best when it absorbs water.

Individuals not sure how to incorporate more fiber can consult a nutritionist and health coach to help begin the process.

Gut Dysfunction

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Anderson, James W et al. "Health benefits of dietary fiber." Nutrition Reviews vol. 67,4 (2009): 188-205. doi:10.1111/j.1753-4887.2009.00189.x

Cronin, Peter, et al. "Dietary Fiber Modulates the Gut Microbiota." Nutrients vol. 13,5 1655. 13 May. 2021, doi:10.3390/nu13051655

Fuller, Stacey, et al. "New Horizons for the Study of Dietary Fiber and Health: A Review." Plant foods for human nutrition (Dordrecht, Netherlands) vol. 71,1 (2016): 1-12. doi:10.1007/s11130-016-0529-6

Gill, Samantha K et al. "Dietary fiber in gastrointestinal health and disease." Nature reviews. Gastroenterology & hepatology vol. 18,2 (2021): 101-116. doi:10.1038/s41575-020-00375-4