In the last part of the series on digestion, pathophysiology of the colon, elimination, and bacterial overgrowth are discussed. Diet, lifestyle, and supplement recommendations are given regarding the pathologies discussed.

In this post, we are finishing our digestion discussion with pathophysiology regarding bacterial overgrowth and the colon. We will discuss what happens when some of the body’s natural protective mechanisms for bacterial overgrowth, including bile, hydrochloric acid, and enzymes, fail to protect the body leading to bacterial overgrowth in the intestines. We will also talk about some colon pathology, which is the place in the digestive tract where most bacteria live as well as where the final stages of nutrient absorption, mainly water and electrolytes, occur.

It is important to have sufficient hydrochloric acid, enzymes, and bile for digestion, but these components are also part of the body’s protective measures for preventing bacterial overgrowth in the small intestine, or Small Intestinal bacterial overgrowth (SIBO). The upper portion of the small intestine is meant to be relatively free of bacteria because when bacteria are present in this part of the small intestine, they compete with their host for nutrition. When the bacteria or yeast get to the food first, it can lead to fermentation of carbohydrates, which produces gas, bloating, and abdominal distention. 

These bacteria can also break down protein to create vasoactive amines, which can cause inflammation and swelling, as well as increased gut permeability, which can lead to a leaky gut. In addition to decreased digestive juices including hydrochloric acid, enzymes, and bile, SIBO can also be caused by decreased gut motility due to scleroderma, systemic lupus erythematosus, intestinal adhesions, radiation damage, sugar, low secretory IgA, and a weak ileocecal valve. 

Decreased gut motility is most commonly caused by a meal too high in sugar because when blood sugar levels rise too rapidly, it signals the GI tract to slow down. Thus, to support good GI motility, it is important to eat foods low on the glycemic index. To support secretory IgA levels it is important to address food allergies, enhance immune function, and reduce stress because stress is particularly detrimental to secretory IgA. 

Some supplements that can support the body in killing off the overgrowth of bacteria in the small intestine include berberine, garlic, and oil of oregano. These supplements are also effective against candida, a yeast that can overpopulate the small intestine sometimes due to antibiotics disrupting the microbiome. Berberine is a constituent found in herbs such as Barberry, Oregon Grape, and Goldenseal that has anti-microbial and antifungal properties. Our top picks for Berberine include Berberine Thorne, Berberine Integrative Therapeutics, and Berberine Complex Integrative Therapeutics. Our top picks for Garlic include High Allicin Garlic Arcana, Kyolic Garlic Original Formula, and Kyolic Reserve. An option for Oil of Oregano is ADP Biotics. 

Some combination supplements designed to support the body in SIBO include the Candibactin-AR and Candibactin-BR supplements by Metagenics. These are often used together as a treatment but in some cases are used separately. If SIBO has led to leaky gut, some supplements that support the healing of the gut lining include L-Glutamine, L-Glucosamine, DGL, and Aloe Vera. A supplement that contains multiple of these ingredients for leaky gut support is GlutAloeMine Xymogen. This also contains Arabinogalactan, which contributes fermentable fiber to add immuno-stimulators properties, and enhances the production of short chain fatty acids which are the byproducts of “good bacteria” that help to support the gut lining, as well as increases the gut microflora population. Another option that may support leaky gut is RepairVite Apex. For other supplements that may support leaky gut click here.

SIBO can sometimes be very hard to treat and every case is different. If you want a more personalized approach to address your SIBO, consider visiting our consultation page to book a consultation with one of our practitioners. If you want to browse more supplements typically used to support SIBO, click here. 

Our last location of digestion to discuss is the colon. As discussed before, the health of the colon is greatly influenced by the diet, specifically fiber intake. The bulk of the bacteria in the gut live in the colon and the “food” for these bacteria is called prebiotics. Fiber, more specifically soluble fiber, is a term for prebiotics that most of us have heard of. This is why a low fiber diet can influence digestion because fiber feeds the bacteria in the colon.

After being fed, those bacteria produce byproducts, or postbiotics, including short-chain fatty acids (SCFAs) such as butyrate, propionate acetate, and vitamins including K and B-group vitamins. Thus, a low fiber diet can impede the production of SCFAs by colon bacteria. 

SCFAs have numerous benefits in the colon including the nourishment of colon cells, anti-inflammatory properties, and protective benefits against colon diseases and cancer. So, one of the best things through diet that can be done to support SCFA production is eating a high fiber diet. This kind of diet is also beneficial for moving food through the digestive tract, giving bulk to stool, and supporting constipation. Foods high in fiber to include in the diet are fruits, vegetables, seeds, and whole grains. A good goal is to get 30 grams of fiber everyday. 

If you are having trouble getting enough fiber through diet alone, you can also supplement with fiber. Some of our top fiber supplements include: OptiFiber Lean Xymogen. TruFiber Master Supplements and Fiber Formula Integrative Therapeutics. Other prebiotic supplements include Biotagen SFI in capsules or powder. You can also supplement with postbiotics such as Ther-biotic Postbiotic SFI and Sodium Butyrate BodyBio. 

A few of the most common pathologies in the colon are Diverticulitis, IBS, and Dysbiosis in colon. We will just have a brief overview of each of these now and these conditions can be expanded upon in future blog posts. 

Diverticula are small sacs caused by the protrusion of the inner lining of the colon into areas of weakness in the colon wall; the condition is called diverticulosis. If the diverticula become inflamed, the condition is known as diverticulitis. Only about 20% of people with diverticulosis develop diverticulitis. Symptoms of diverticulitis include episodes of lower abdominal pain and cramping, changes in bowel habits, and a sense of fullness in the abdomen. Although the cause is not exactly known, it is speculated that it may be due to a low fiber diet and high saturated fat intake. 

The desired outcome of treatment is to address inflammation and to improve motility in the GI Tract. Some dietary interventions include a high fiber diet and avoiding too much fat and red meat in the diet. Some lifestyle recommendations include adequate water intake to prevent constipation, and exercise because lack of physical activity can slow transit time and can lead to constipation. Some supplements that can support diverticulitis include probiotics, vitamin C, and quercetin.

Probiotics can help diverticulitis by altering the gut microbial balance, reducing the metabolism of pathogens, and providing an anti-inflammatory effect to counter the inflammation. Some options for probiotic supplements include Ortho Biotic Ortho Molecular Products, Visbiome, and Ther-biotic Complete SFI Health.  Vitamin C and Quercetin are anti-inflammatory nutrients that can support the body while addressing diverticulitis, which often needs antibiotics to treat. Some options for Vitamin C are Buffered C Powder Thorne, Vitamin C Thorne, and Amla-C. For quercetin, check out Quercetin Phytosome Thorne and Quercetin Pure. For a supplement with a combination of anti-inflammatory nutrients, check out BCQ Vital Nutrients. 

IBS is the most common gastrointestinal disorder with approximately 10-15% of the population presenting with it. It is also largely undiagnosed meaning that many people experience it but do not present it to their doctor to get a diagnosis. The characteristic symptoms of IBS include abdominal pain and distension, more frequent bowel movements with pain, or relief of pain with bowel movements, constipation, diarrhea, mucus in stool, flatulence, nausea, and varying degrees of anxiety or depression. The cause of IBS is still unclear, but it is postulated to be caused by a low fiber diet, food allergies, or stress. 

A few treatment options for IBS include lifestyle, dietary, and supplement options. For lifestyle, it is recommended to exercise in moderation. Light to moderate exercise has shown to be beneficial for IBS patients, but particularly intense exercise can be a contributing factor to IBS and should be avoided. (Sandhaus & Decker, 2024). In one study, patients who engaged in 20-60 minutes of moderate to vigorous physical activity 3-5 days per week experienced a marked improvement in quality of life and reduced IBS severity (Johannesson et al.). Another study showed that thirty minutes of treadmill exercise three times a week for six weeks significantly improved IBS symptoms and improved quality of life compared to the no exercise control group. (Fani et al.). It has also been shown that walking regularly improves symptoms of IBS and it has a positive effect on mood (Shahabi et al.).

Dietary recommendations for IBS include a low FODMAP diet, increased fiber intake, elimination diets, and avoidance of trigger foods. Supplements that are useful for IBS include probiotics and ginger. Probiotics are one of the main supplements used in IBS since alterations in the gut microbiome can cause or exacerbate IBS symptoms (Sandhaus & Decker, 2024). To view our selection of probiotics, click here. Ginger is another supplement that has shown to be effective against IBS. It may improve constipation by stimulating the activity of the migrating motor complex, which is the nerve and muscle complex that promotes peristalsis and elimination (Deloose et. al). One of our recommended ginger supplements is Ultimate Ginger Complex Arcana. 

The human GI tract is home to over 500 different species of microflora. The type and number of bacteria can determine health and disease in the body. A state of altered bacterial flora in the gut is known as dysbiosis. The major causes of dysbiosis include a high protein, sugar, and fat intake, a low fiber intake, food allergies, lack of digestive secretions, stress, antibiotics, decreased immune function, malabsorption, intestinal infection, and altered pH. 

Ways to support a healthy microbiome in the gut are to follow the recommendations in previous posts for addressing proper digestive secretions, which are part of the body’s natural defense against bacterial overgrowth, eating a diet high in fiber, moderate in protein and fat, and low in sugar, and managing stress. Additionally, you can supplement with probiotics and prebiotics to feed the probiotics to support a healthy microbiome. Click here to see a list of our probiotic and prebiotic supplements. 

The last part of digestion includes elimination. The two most common problems with elimination are constipation and diarrhea. Rather than going too in depth on both of these broad topics in this post, we will just discuss some diet, lifestyle, and supplementary measures that can support constipation and diarrhea. 

Some factors that can cause constipation are a low fiber diet, inadequate fluid intake, lack of physical activity, medications, milk, IBS, pregnancy, laxative abuse, and ignoring the urge to have a bowel movement. Some diseases or conditions that can cause constipation include stroke, multiple sclerosis, low potassium stores, diabetes, kidney disease, hypothyroidism, pituitary disorders, diverticulosis, IBS, and colon cancer. 

To support the body in constipation, it is important to consume fiber, drink enough fluids, and exercise. High amounts of dietary fiber can increase frequency and quantity of bowel movements, decrease stool transit time, decrease absorption of toxins from the stool from the stool, and can prevent certain diseases in the GI tract. The recommended amount of fiber to aim for in a day is 25-35 g. If you can get more that is great, but at least shoot for this range. See above for recommended foods and supplements to add fiber into your diet. 

Fluid intake is also essential to prevent and address constipation because the stool needs hydration to help it pass through the colon. A good goal for water intake is 64 ounces daily. To increase hydration, you can also add electrolytes to your water. Some of our favorite electrolyte powders are Catalyte Thorne, ElectroPure Hydration Designs for Health, and Electrolyte/Energy Formula Pure. You can also add mineral salt and a squeeze of lime or lemon to warm water, which is known as “Ayurvedic Gatorade”, to get electrolytes. 

Exercise is also key to maintaining good bowel movements. Regular physical activity may strengthen abdominal muscles and stimulate peristalsis, which are the muscular contractions that move stool through the GI tract. Some exercises to try include walking, jogging, dancing, swimming, or picking up a sport. 

Some supplements that can support the body in constipation are fiber supplements, click here to view the selection. Bulk-forming laxatives such as psyllium husk absorb water to form soft and bulky stool, which helps with the normal contraction of intestinal muscles. We recommend Organic Psyllium Husk Powder Metabolic Maintenance. Magnesium citrate can also be helpful for constipation. Magnesium citrate is an osmotic laxative, meaning it pulls water into the intestine to soften stool, making it easier to pass. Our recommendations for Magnesium Citrate are Pure, Metabolic Maintenance, and SFI Health. 

Diarrhea can be caused by a viral infection, which makes up 75% of diarrhea cases, lactose intolerance, food allergies, celiac disease, Inflammatory Bowel Disease, and IBS. In addition to addressing the underlying cause of diarrhea, there are a few steps to take to support the body with diarrhea. If the diarrhea is severe or bloody, or if it is a child under the age of six, contact a physician immediately. 

With acute diarrhea, it is importantly to focus on liquids and a BRAT diet of bananas, white rice, apples, and toast. These foods are easy on the digestive system and may slow down the rhythmic contractions of the intestines. It is also important to replenish electrolytes that are lost through diarrhea. As mentioned above, there are electrolyte powders available at our store that can be put into water, or you can use herbal teas, bone broth, and coconut water as well. 

Another thing to support diarrhea is to avoid dairy products. Acute intestinal illnesses can injure the cells that line the small intestine. This can cause a temporary deficiency of lactase, which is the enzyme responsible for digesting the milk sugar lactose found in dairy products. It is recommended to avoid dairy products apart from yogurt with live cultures if the body can handle it while experiencing diarrhea. 

A few supplements that can support diarrhea are probiotics and Berberine. Probiotics have a protective effect against acute diarrheal disease and have been shown to be used successfully in the treatment and prevention of various types of infectious diarrhea. Clinical studies have shown that probiotics can shorten the duration of acute infectious diarrhea and reduce stool frequency. Probiotics can also support antibiotic-induced diarrhea and can also help prevent it. Click here to view our selection of probiotics.

Berberine is an herbal constituent that has been shown effective against acute diarrhea. Berberine has shown to be effective against the majority of common gastrointestinal infections that cause diarrhea; clinical studies have shown Berberine to be comparable to standard antibiotics and sometimes performed better than antibiotics. See the recommended Berberine supplements listed above for our Berberine supplement options.

I know these posts have been a lot to digest, but hopefully they have helped you be more aware of your digestive health and what you can do to improve it. If you need help navigating the supplements mentioned in these posts, please call our friendly staff or stop into the store. 

References 

Brown, Mary Jane. (2021, Oct 11). How Short-Chain Fatty Acids Affect Health and Weight. Healthline. https://www.healthline.com/nutrition/short-chain-fatty-acids-101 

Deloose E, Janssen P, Depoortere I, Tack J. The migrating motor complex: control mechanisms and its role in health and disease. Nat Rev Gastroenterol Hepatol. Mar 27 2012;9(5):271-85. doi:10.1038/nrgastro.2012.57

Fani M, Mostamand J, Fani M, Chitsaz N, Feizi A. The effect of aerobic exercises among women with mild and moderate irritable bowel syndrome: A pilot study. J Body Mov Ther. Jan 2019;23(1):161-165. doi:10.1016/j.jbmt.2018.02.003

Grey, Heather. (2023, Mar 13). 7 Exercises to Help Relieve Constipation. Healthline. https://www.healthline.com/health/chronic-constipation/exercises-to-relieve-constipation#1 

Hechtman, Leah. Clinical Naturopathic Medicine: Second Edition. Elsevier. 

Johannesson E, Simrén M, Strid H, Bajor A, Sadik R. Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. The American journal of gastroenterology. May 2011;106(5):915-22. doi:10.1038/ajg.2010.480

Johnson, Jon. (2023) Does Magnesium Citrate Work for Constipation?. MedicalNewsToday. https://www.medicalnewstoday.com/articles/322588 

Murray, M.T. & Pizzorno, J. (2012). The Encyclopedia of Natural Medicine: Third Edition. Atria. 

Sandhaus, S. & Decker, C. (2024). Irritable Bowel Syndrome (IBS). Life Extension. https://www.lifeextension.com/protocols/gastrointestinal/irritable-bowel-syndrome

Shahabi L, Naliboff BD, Shapiro D. Self-regulation evaluation of therapeutic yoga and walking for patients with irritable bowel syndrome: a pilot study. Psychol Health Med. 2016;21(2):176-88. doi:10.1080/13548506.2015.1051557