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

Viruses, bacteria, fungi, and protozoa are the microorganisms that naturally live in the digestive tract. Sleep affects gut health and vice versa. A healthy gut microbiota consists of all kinds of microorganisms that produce thousands of compounds and coexist harmoniously. A healthy diet and lifestyle are the biggest factors influencing bacteria variety, and maintaining a varied diet preserves microbiota diversity. Everybody's gut microbiome is different; the more diverse the gut microbiome, the healthier sleep will be. The Injury Medical Chiropractic and Functional Medicine Clinic Team can develop a personalized nutritional plan to improve gut health and sleep patterns.

Sleep Affects Gut Health

Not having a diverse gut microbiome has been linked to autoimmune diseases, Parkinson's disease, and mental health issues like anxiety and depression. Not getting healthy sleep is associated with many diseases and disorders, including:

• Gastrointestinal disorders
• Infections
• Diabetes
• Cardiovascular disease
• Neurological disorders
• Anxiety
• Depression
• Cancer

Changes in sleep patterns influence the central nervous system and the immune system, which affect different organ systems. For example, studies have shown some gastrointestinal disorders, like irritable bowel syndrome - IBS could be associated with increased REM sleep or the fourth part of the sleep cycle when vivid dreaming occurs. In Crohn’s disease or ulcerative colitis, long-term immune response activation can result in poor sleep, insufficient quality sleep, or other sleep problems. The deepest stages of sleep are when the brain and gut communicate to repair the body, restore nutrients, and remove and release toxins.

Sleep Cycle

During sleep, the immune system produces proteins called cytokines that perform functions during the inflammatory response, either by increasing or blocking inflammation, depending on the body's needs. Cytokines help promote sleep, fight infection, or stop inflammation in chronic inflammatory diseases like Crohn’s disease or ulcerative colitis.

• Insufficient sleep significantly alters cytokine production, and infection-fighting cells decrease in numbers when sleep deprived, making it harder for the body to fight infections and lessening protection. This increases the inflammatory response and keeps the immune system on.
• Chronic or long-term immune response activation can result in sleep disturbances or disorders.
• Some disorders include small intestinal bacterial overgrowth and inflammation caused by microbiome abnormalities or dysbiosis.
• The gut barrier function begins to malfunction, leading to bacteria and pathogens leaking into blood circulation/leaky gut, triggering immune responses.

Ways to Improve Sleep

One of the main ways to improve sleep quality and gut microbiome health is to practice healthy sleep hygiene. According to the National Sleep Foundation, individuals should:

Nap Smart

• Naps can be a great way to refresh the mind and body and replenish energy levels during the day.
• Naps don't make up for little sleep at night.
• Keep naps to 20-30 minutes for optimal benefits without disrupting nighttime sleep.

Optimal Sleep Environment

• Comfortable ergonomic mattress and pillows.
• Blackout curtains.
• Temperature between 60 and 67 degrees.

Quit Electronics Before Bed

• The bright lights from phones and screens can make it difficult to fall asleep fully.
• Use an alarm clock with a soft night light and keep the bedroom tech-free.

Create Sleep Routine

• Take a warm shower, read a book, or do light stretches.
• Create a wind-down routine to relax before bed to signal the body that it's time for sleep.

Avoid Caffeine and Alcohol Before Bed

• These substances make it harder for the mind and body to fall or stay asleep.

Food As Medicine

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

Chabé, Magali et al. “Gut Protozoa: Friends or Foes of the Human Gut Microbiota?.” Trends in parasitology vol. 33,12 (2017): 925-934. doi:10.1016/j.pt.2017.08.005

Deng, Feilong, et al. “The gut microbiome of healthy long-living people.” Aging vol. 11,2 (2019): 289-290. doi:10.18632/aging.101771

Gut Bacteria Research: Physicians' Committee for Responsible Medicine. (2019). "Gut Bacteria: Optimize Gut Health With a Plant-Based Diet,"

Ianiro, Gianluca, et al. “How the gut parasitome affects human health.” Therapeutic advances in gastroenterology vol. 15 17562848221091524. 30 Apr. 2022, doi:10.1177/17562848221091524

Lozupone, Catherine A et al. “Diversity, stability and resilience of the human gut microbiota.” Nature vol. 489,7415 (2012): 220-30. doi:10.1038/nature11550

Sleep and Gut Microbiome Study: PLoS One. (2019). "Gut microbiome diversity is associated with sleep physiology in humans.

Sleep Hygiene Information: National Sleep Foundation. (2019). "Sleep Hygiene."

Vaishnavi, C. “Translocation of gut flora and its role in sepsis.” Indian journal of medical microbiology vol. 31,4 (2013): 334-42. doi:10.4103/0255-0857.118870