FAQ #17: How do naturopathic doctors diagnose and treat digestive complaints?
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The AANP and the INM would like to acknowledge Steven Sandberg-Lewis, ND for his contributions to the content of this FAQ. Some of the content for the FAQ appeared in articles by Dr. Sandberg-Lewis in the Naturopathic Doctor News & Review.

The gastrointestinal (GI) system plays an essential role in your overall health. Often, imbalances in the digestive system lead to symptoms elsewhere in the body, including the nervous system, immune system, and skin. Trained to treat the whole person and address the root causes of symptoms, naturopathic doctors (NDs) excel at treating GI conditions. They are often able to get to the root cause of GI complaints that have defied conventional diagnosis, utilizing their meticulous evaluation process and advanced clinical nutrition training.

Known as “the second brain” of the body, the GI system lining houses hundreds of millions of neurons (the enteric nervous system) which manage the digestive process from swallowing to nutrient absorption to elimination.[1] Cells in the gut lining also produce 95 percent of the serotonin in our bodies.[2] The GI system acts as a communication center to the brain. When we’re stressed, scared, or nervous, our brain notifies our gut, and we may experience abdominal symptoms. Additionally, the gut lining houses more immune cells than the rest of the body, defending us against viruses and bacteria.[3]

The health of this complex and essential body system relies on a combination of whole-body variables, including proper enzymatic function, nutrient absorption, microbiota (the body’s natural microorganisms) balance, tissue health, and elimination of waste. The ultimate goal is to have a digestive system that is functioning optimally. Naturopathic doctors will assess whether the GI system is performing at a level of optimal function, essential function, or dysfunction. They employ a comprehensive set of tools in their evaluation, including:

A comprehensive health history. Naturopathic doctors spend between one and two hours in an initial appointment with patients to gather information about physical, mental, emotional, genetic, environmental, social, and other factors that affect the health of the GI system. Often, simply taking the time to sift through deeper details related to symptom onset, food choices, or surgical history can be enough to uncover an unrealized association or cause. Naturopathic doctors will also perform a physical exam.

Targeted labs and tests. Naturopathic doctors have a distinctly large toolbox of evaluation strategies. Tests will be individualized, and may include: stool testing for healthy or disease causing bacteria, yeasts, markers of inflammation, blood, pancreatic enzyme levels, and immune markers. NDs may also order blood tests for food intolerances/allergies, celiac antibodies, hormonal and inflammatory indicators, nutritional deficiencies, diabetes indicators, liver function, and more. Naturopathic doctors might also take salivary or urinary measurements of stress hormones, toxins originating in the gut, reproductive hormones, and others. Concern for a more serious underlying condition may result in a referral for colonoscopy or other diagnostic imaging work.

In the United States, the top five GI diagnoses are abdominal pain, GERD/reflux, hemorrhoids, constipation, and nausea and vomiting.[4] Naturopathic doctors treat all of these conditions and others including: diarrhea, irritable bowel syndrome (IBS), celiac disease, gluten-intolerance, inflammatory bowel disease (IBD), Crohn’s disease, ulcerative colitis, microscopic colitis, small intestine bacterial overgrowth (SIBO), food allergies, leaky gut syndrome, ulcers, indigestion, gas, bloating, pancreatic enzyme insufficiency, gallbladder disorders, hepatitis, liver congestion, or fatty liver (alcoholic/non-alcoholic fatty liver disease), diverticulosis, and diverticulitis.

Treatment plans are carefully personalized, and may include:

  • A tailored diet based on an individual patient’s needs and condition. Common diets used for GI issues include:
    • Low FODMAP (reduces fermentable carbs)
    • Specific Carbohydrate Diet (SCD) (eliminates most carbs)
    • SIBO specific diet (combines FODMAP and SCD diets)
    • Anti-inflammatory diet (eliminates foods that can cause and/or aggravate inflammation)
    • Elimination/challenge diet (to identify and eliminate food triggers)
  • Identifying and eliminating any dietary triggers (foods that can trigger allergic reactions, non-allergy intolerances, cravings or overeating)
  • Reducing inflammation and optimizing the health of the intestinal mucous membrane
  • Optimizing intestinal motility/bowel movement regularity
  • Eliminating any underlying infection
  • Supporting a healthy microbiome
  • Referral to a specialist when indicated for imaging or advanced care

 NDs spend time empowering patients to make lasting changes, and helping them integrate treatment plans into their lifestyle for greater success. 

[1] https://www.hopkinsmedicine.org/health/healthy_aging/healthy_body/the-brain-gut-connection
[2] http://www.apa.org/monitor/2012/09/gut-feeling.aspx
[3] https://www.sciencedaily.com/releases/2013/09/130916122214.htm

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