Gastrointestinal symptoms are incredibly prevalent worldwide. A large-scale, multinational study found that over 40% of people worldwide have at least one functional gastrointestinal disorder (FGID), characterized by disruptive chronic and recurrent gastrointestinal (GI) symptoms without observable changes to GI anatomy (11). An estimated 11% of Americans experience chronic digestive issues, with the prevalence as high as 35% in those over 65 (12).
The presence of GI symptoms and the necessity of medical care substantially impact physical, emotional, and socioeconomic burdens related to overall health. Additionally, while a conventional approach to management may be required in some instances, many of the commonly prescribed medications for GI symptoms and diseases are associated with adverse GI effects (13, 14). Implementing complementary and integrative approaches may help alleviate symptoms, support quality of life, and manage GI side effects.
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Function of The Gastrointestinal Tract
The digestive system, composed of the GI tract, salivary glands, liver, gallbladder, and pancreas, functions to digest and absorb ingested nutrients and eliminate waste products from the body. The following organs make up the GI tract:
Mouth
Digestion begins in the mouth through the mechanical forces of chewing and the chemical actions of salivary enzymes. The mixture of food with saliva begins the breakdown of starches and lubricates the food to make the transition through the esophagus easier. (15, 16)
Esophagus
Involuntary esophageal muscle contractions propel the food bolus into the stomach. The lower esophageal sphincter (LES) relaxes, allowing food to pass from the esophagus into the stomach. (16)
Stomach
Acid and digestive enzymes in the stomach mix with food to continue the chemical breakdown of carbohydrates and proteins. The final result is a mixture called chyme, which is slowly emptied by the stomach into the small intestine. (15, 16)
Small Intestine
Digestive enzymes produced by the small intestine and digestive accessory organs continue to break down the chyme into absorbable nutrients. Nutrients are absorbed through the semipermeable small intestinal wall into the bloodstream. Peristalsis pushes chyme through the three portions of the small intestine (duodenum, jejunum, and ileum) until it reaches the ileocecal valve and transitions into the large intestine. (15, 16)
Accessory Organs
Digestive enzymes and juices produced and secreted by the liver, gallbladder, and pancreas into the small intestine act to digest carbohydrates, fats, and proteins into their absorbable building blocks. (15)
Large Intestine
The large intestine is primarily responsible for absorbing water and propelling digestive waste to the rectum for elimination. The large intestine also houses the intestinal microbiome, responsible for further digestion and synthesis of nutrients, immune system modulation, and production of signaling molecules. (15, 16)
Rectum
The rectum is the final portion of the large intestine. It stores stool until it is evacuated through the anus during a bowel movement. (16)
Common Gastrointestinal Disorders
Digestive issues affect 60-70 million people, accounting for almost 50 million outpatient care visits annually. Per the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the most common digestive issues include:
- Foodborne Illness & Non-Foodborne GI Infections. Prevalence: A combined prevalence of 211 million
- Gastroesophageal Reflux Disease (GERD). Prevalence: 66 million people experience weekly symptoms
- Chronic Constipation. Prevalence: 63 million
- Gallstones. Prevalence: 20 million
- Peptic Ulcer Disease (PUD). Prevalence: 15.5 million
- Irritable Bowel Syndrome (IBS). Prevalence: 15.3 million
- Hemorrhoids. Prevalence: 75% of people over age 45
- Abdominal Wall Hernia. Prevalence: 3.6 million
- Liver Disease. Prevalence: 3 million
- Pancreatitis. Prevalence: 1.1 million
Common Gastrointestinal Symptoms
The 2019 National GI Survey audited 71,812 individuals to determine the prevalence of GI symptoms in the American population. The study concluded that 61% of Americans experience at least one GI symptom weekly. According to this survey, the most commonly experienced symptoms were heartburn/reflux (30.9%), abdominal pain (24.8%), bloating (20.6%), diarrhea (20.2%), and constipation (19.7%), nausea/vomiting (9.5%), difficulty swallowing (5.8%), and bowel incontinence (4.8%). (17)
The ACG notes that indigestion, belching, and flatulence are also common GI symptoms.
Possible Causes of Gastrointestinal Distress
The development of gastrointestinal issues and symptoms is multifaceted, including factors such as genetics, diet and exercise, dysbiosis and infection, hormonal imbalances, immune function, GI dysmotility, and stress.
Top Functional Medicine Labs Used for GI Complaints
Functional medicine providers will commonly use specialty labs to help identify potential contributors to GI symptoms. The results from these tests help practitioners personalize management strategies. Below are some of the most commonly used GI labs in functional medicine:
Comprehensive Stool Test
Comprehensive stool tests are useful for assessing gut health, especially for those experiencing chronic discomfort associated with gastrointestinal issues. Imbalances in the microbiome and inflammation can lead to gastrointestinal symptoms such as bloating, abdominal pain, and irregular bowel movements. These tests analyze various markers of gastrointestinal health, including digestion and absorption, inflammation, potential immune function, imbalances in the microbiome, parasite presence, and markers like zonulin, and many also test for overgrowth of candida.
Food Sensitivity Testing
Food sensitivity symptoms can easily overlap with other common medical diagnoses. Therefore, it’s vital to rule these sensitivities out while looking for contributing factors. The most common symptoms associated with food sensitivities are gastrointestinal complaints. Based on the results of the testing, practitioners can personalize an elimination diet for patients to help manage GI symptoms.
Candida Testing
Candida can overgrow for many reasons, but one of the most common reasons is dysbiosis (imbalance of the good vs bad gut bacteria). The health of your digestive system relies heavily on the good bacteria that live in your gut to keep bad bacteria and fungi in check. Once your gut microbiome is disrupted, candida can quickly multiply, potentially contributing to digestive problems.
Many comprehensive stool tests will test for Candida Albicans overgrowth and help identify possible reasons for the candida overgrowth, such as dysbiosis or inflammatory markers. Retesting a few months into care allows for any modification that may be needed.
SIBO Testing
Small intestinal bacterial overgrowth (SIBO) is a condition that can affect up to 80% of patients with IBS.
Over time SIBO can lead to chronic inflammation & immune conditions and could be putting you at risk for other issues, including poor absorption of food and nutrients.
SIBO breath testing is a noninvasive testing alternative to small intestinal culture to identify SIBO and IMO. A SIBO breath test is performed the morning after a patient follows a restrictive preparatory diet and overnight fast.
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Functional Medicine Alternatives for Natural Support of GI Symptoms
Many patients seek integrative care after a conventional approach to management has resulted in unsatisfactory results. Below are common suggestions provided by functional medicine practitioners to support GI health naturally without pharmacotherapy.
Nutrition and Diet Considerations for Support of GI Health
Functional medicine practitioners will often first turn to optimizing the diet when addressing chronic GI symptoms, understanding that diet influences GI inflammation and the microbiome's health. By shifting away from Western dietary patterns and towards an anti-inflammatory, whole-food diet (like the Mediterranean diet), we can increase the intake of fiber, phytonutrients, vitamins, and minerals known to support the gut barrier and feed the healthy intestinal flora (18).
Alcohol and processed sugars are also known to disrupt gut barrier function, impair immune function, and induce negative changes to the balance of the gut microbiota. Abstaining from alcohol and minimizing refined sugars may help support digestive health and reduce intestinal inflammation.
Functional medicine practitioners often suggest eating 25-35 grams of dietary fiber, but the average American dietary fiber intake is only 17 grams daily. Increasing dietary intake of both soluble and insoluble fiber is important for healthy gut function. High-fiber foods include vegetables, legumes, whole fruits, nuts, seeds, and whole grains. (19)
Supplemental and Herbal Alternatives for GI Support
Deglycyrrhizinated Licorice (DGL) for Heartburn
Standard over-the-counter and pharmaceutical options for heartburn include antacids, H2 blockers, and proton pump inhibitors. Side effects of these medications include digestive symptoms, headaches, nutrient deficiencies, and increased risk of infection.
Licorice (Glycyrrhiza glabra) root is a soothing herb. The whole root contains glycyrrhizin, which can cause elevations in blood pressure. DGL is a prepared form of the herb that does not have glycyrrhizin and is commonly used to support digestive comfort. DGL promotes mucus activity, which acts as a barrier to acid in the upper digestive tract to help maintain tissue health. Some research suggests that DGL may be effective in supporting digestive health. (1, 2)
Peppermint Oil for Abdominal Discomfort
Antispasmodics and antidepressants are routinely prescribed in managing irritable bowel syndrome (IBS)-related abdominal discomfort (3). Peppermint has traditionally been used to support comfort associated with various conditions, including headaches, IBS, and non-ulcer dyspepsia, because of its ability to induce smooth muscle relaxation. Many studies support the use of enteric-coated peppermint oil in supporting comfort in IBS-related abdominal discomfort; in fact, the American College of Gastroenterology (ACG) has updated its IBS management suggestions to include peppermint oil as a potential option for abdominal discomfort. (4)
Ginger for Bloating
Bloating is the sensation of abdominal fullness and tightness, often accompanied by abdominal distension. Often, bloating is caused by increased intestinal gas production and slowed intestinal motility, resulting in trapped gas. Along with dietary modifications, simethicone, antacids, and antidepressants may be recommended as pharmaceutical agents to address bloating.
Ginger (Zingiber officinale) has properties that may support digestive health, including anti-inflammatory and prokinetic effects. Rich in terpenes, phenolic compounds, and volatile oils, ginger acts in the digestive tract to coordinate gastrointestinal muscle contractions and increase gastric emptying, which may help reduce flatulence and bloating. (5)
Magnesium for Constipation
Constipation may be a symptom of magnesium deficiency. As an alternative to laxatives, magnesium, most commonly supplemented in citrate or oxide forms, may help relax gastrointestinal smooth muscles and pull water into the intestines. The net effect of magnesium supplementation is softening stool and promoting fecal transit. (6)
Saccharomyces boulardii for Diarrhea
Saccharomyces boulardii (Saccharo-B) is a probiotic yeast that may support gut barrier function, help manage gut pathogens, and reduce inflammation. There is a large pool of evidence to support the use of Saccharo-B in the management of a variety of inflammatory and non-inflammatory diarrheal conditions, including IBS, traveler's diarrhea, antibiotic-associated diarrhea, and inflammatory bowel disease (IBD). (7-10)
Complementary and Integrative Medicine (CIM) for GI Support
It can be easily overlooked, but lifestyle habits, including sleep hygiene and stress management, profoundly impact gut health and function. CIM modalities targeting the gut-brain axis can significantly influence GI health. Research suggests optimizing sleep can positively impact gut microbiome diversity and composition; healthy adults need at least seven hours of sleep nightly. Similarly, increased stress influences gut function; vagus nerve stimulation exercises can promote healthy stress responses, digestive function, and intestinal motility.
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Summary
Gastrointestinal symptoms and issues affect an overwhelmingly large percentage of the population, contributing to decreased quality of life and economic burden related to healthcare costs. While conventional management options address symptoms, they rarely address underlying contributors, and many pharmacologic agents can cause secondary GI symptoms. A functional medicine approach offers in-depth testing to uncover potential contributing factors. Natural herbs and supplements can be considered as supportive alternatives, and many provide the additional benefit of addressing and correcting imbalances contributing to discomfort.
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