Primary care doctors are visited for digestive disorders by 35.4 million people annually in the U.S. The stomach is a significant part of the digestive process, essential for the breakdown and propulsion of food. This paper will discuss what the stomach does, the top stomach disorders that are treated with integrative medicine, and how to use functional medicine testing to evaluate them. We'll then discuss complementary and integrative medicine treatments, including diet and supplementation.
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What is The Stomach's Role in The Body?
The stomach is an organ essential to proper digestion and is located in the abdomen. This J-shaped organ has four parts. In the stomach, the cardia is the upper portion that receives food from the esophagus. After the cardia is the fundus, followed by the body, and is the largest portion of the stomach. Following the fundus is the pylorus, which then connects to the small intestine.
The stomach performs the act of digestion in two ways: chemical and mechanical. Chemical digestion is the act of mixing juices prepared by the stomach with food to aid in the breakdown of it. The stomach produces hydrochloric acid and pepsin, a digestive enzyme, which are included in the stomach juices that aid in the breakdown of food. Additionally, the stomach makes intrinsic factor, which is necessary for vitamin B12 absorption later in the small intestine. Mechanical digestion is when the stomach contracts, assisting in the breakdown of food by mixing stomach juices with it and causing the food to be moved from the stomach to the small intestine.
What are the Top Gastric Disorders Treated With Integrative Medicine?
There are many diseases of the stomach that integrative medicine can aid in the treatment of. Here are the most common:
Gastritis
Gastritis is inflammation to the lining of the stomach. The purpose of this lining is to protect the tissues of the stomach from gastric juices, specifically hydrochloric acid, which can damage the tissue. When gastritis occurs, it may cause damage to the tissues of the stomach. Symptoms include burning and pain in the stomach, feeling of fullness, burping and hiccups, nausea, vomiting, loss of appetite, skin conditions like rashes, and blood in the vomit or stool due to bleeding in the stomach. Causes of gastritis can be due to diet and lifestyle, including excessive alcohol intake and high stress. Chronic use of certain medications, including non-steroidal anti-inflammatory (NSAIDs) and corticosteroids, can also cause gastritis. Health conditions like previous injuries, burns, and surgeries can cause gastritis as well. Chronic bile reflux, pernicious anemia, autoimmune disorders, and bacterial and viral infections, including H.pylori, can lead to gastritis.
Gastroparesis
Gastroparesis is a condition of the stomach in which food does not move in a timely manner from the stomach into the intestines. Symptoms of gastroparesis include bloating, pain in the upper abdominal area, nausea, vomiting, heartburn, acid reflux, feeling full after only consuming a small amount, loss of appetite, and unintentional weight loss. Causes of gastroparesis seem to be related to the nerve that controls the muscular contraction of the stomach: the vagus nerve. When there is a problem with the conduction of the vagus nerve, the signal controlling mechanical digestion (contracting the stomach) doesn’t occur. Thus, food remains in the stomach longer than it’s supposed to. Certain conditions can lead to vagus nerve dysfunction, including diabetes, surgeries in the abdomen and throat, eating disorders, connective tissue diseases such as lupus, hypothyroidism, traumatic brain injuries, strokes, neurological disorders including Parkinson’s disease, and viral and bacterial infections.
Helicobacter pylori Infection
The Helicobacter pylori (H. pylori) bacteria is found in the stomach of most people. Many people who have H. pylori may not have any adverse effects. However, some people are susceptible to damage from this bacteria, and habitation of it may lead to gastritis, peptic ulcer disease, and stomach cancer. Symptoms of H. pylori infection may include burning and aching in the stomach, abdominal bloating, gas, nausea, vomiting, loss of appetite, frequent burping, gastroesophageal reflux disease (GERD), unintentional weight loss, black or bloody stools due to bleeding ulcers. One of the main causes of H. pylori infection is hypochlorhydria or low stomach acid. Hypochlorhydria creates an environment perfect for H. pylori in that it allows the bacteria to adhere to the stomach wall.
Peptic Ulcers
Ulcers are erosions of soft tissue that leave sores. Peptic ulcers are divided into two categories: duodenal ulcers, which occur in the duodenum of the small intestine, and gastric ulcers, which occur in the stomach. Symptoms of gastric ulcers include pain 15-30 minutes after starting a meal due to irritation and inflammation, unintentional weight loss due to pain associated with eating, fullness, bloating, heartburn, burping, nausea, black stools, vomiting black blood, and difficulty breathing. Causes include H. pylori infections, chronic use of NSAID medications, tobacco use, alcohol consumption, and genetics. Although less common, Crohn’s disease, celiac disease, Zollinger-Ellison syndrome, certain cancers, and certain infections, including Epstein Barr Virus (EBV) and Candida albicans infections, can cause peptic ulcers.
Functional Medicine Labs That Can Help Individualize Treatment for Patients with Gastric Disorders
The functional medicine laboratory catalog can be vast and overwhelming. Let's look at some of the top functional medicine labs utilized in the treatment of gastric disorders.
Comprehensive Stool Test
Comprehensive stool tests include markers of digestion, absorption, and gut inflammation and also give great insight into the gut microbiome. The gut microbiome is a collective group of organisms, including bacteria, fungi, and parasites, that live inside our gastrointestinal tracts. We have what's referred to as a symbiotic relationship with these microbes. A symbiotic relationship is one which both parties benefit from. The microbes help us in that we house them and supply them with food. We benefit from the microbes in that they aid in digestion, absorption, and creation of specific vitamins and neurotransmitters, and they have an effect on inflammatory and immune functioning as well as specific hormone metabolism. All of the conditions mentioned, with the exception of gastroparesis, discuss inflammation, and thus assessing the microbiome and inflammation gut markers is warranted. Doctor's Data GI360 test is an excellent choice for a comprehensive gut test that takes a deep dive into the microbiome and inflammation within the gut.
The comprehensive stool test GI-MAP by Diagnostic Solutions is a great comprehensive stool test choice for evaluating H. pylori infections. This test has an entire section devoted to H. pylori and the bacteria's virulence factors. Virulence factors are proteins that aid in adhering the bacteria to its host. Knowing which, if any, virulence factors are present can help to tailor the treatment plan to the patient and increase the likelihood of eradication. Since H. pylori is found in 70% of gastric ulcers and is one of the known causes of ulcers, this test can provide insight into the root cause of symptoms.
Food Allergy and Sensitivity Testing
Food allergy and sensitivity testing should be considered for gastritis. Consumption of foods that the body is reacting to, whether it's an allergy or sensitivity, can lead to immune activation, which in turn can lead to inflammation and irritation within the GI tract, and thus gastritis. Because of these mechanisms, it may also be advised to do food allergy and sensitivity testing in people with peptic ulcers, as the inflammation and irritation can further exacerbate the damage from ulcers. Infinite Allergy Labs offers the 88 Food Antigen IgE/IgG4 & IgG test, which assesses both food allergies and sensitivities and would be a great choice when evaluating the root cause of gastritis.
Micronutrient Testing
Micronutrient testing involves evaluating numerous vitamins and minerals on one test. Micronutrient testing can provide valuable information for those suffering from many conditions, especially gastroparesis. Gastroparesis can significantly affect the way food is digested and absorbed and thus increases the risk of nutrient deficiencies.
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Complementary and Integrative Medicine Treatment for Gastric Disorders
Complementary and integrative medicine treatments for gastric disorders can include dietary recommendations, supplements, and herbs. Here are some of the most common complementary and integrative treatments for gastritis.
Nutrition for Patients With Gastric Disorders
Nutritional interventions are important and can be utilized in many gastric disorders. Let's take a look at the gastric disorders we've discussed and the different dietary recommendations that can be utilized with each of them.
Nutritional Recommendations for Gastritis and Peptic Ulcers
Since damage to the stomach lining is found in both gastritis and peptic ulcers, dietary guidance is similar. Nutrition for gastritis and peptic ulcers may include a high fiber, low inflammatory diet to help heal the stomach lining. Fibrous foods take longer to chew, which allows for the glands in the mouth to release buffering agents into the saliva that protect the stomach lining. Additionally, it is recommended to avoid common food triggers, including spicy foods, alcohol, nitrates, processed sugar and processed foods, and acidic foods, for a period of time in order for the stomach lining to heal.
If food allergy or sensitivity testing has been done, a dietary treatment plan customized to the patient's testing results can and should be made. Reducing the intake of food allergies and sensitivities can help to lower inflammation and heal the lining of the gut in both gastritis and peptic ulcers. If food allergy and/or sensitivity testing cannot be completed, an elimination diet may be recommended to discover foods that the patient may be reacting to. An elimination diet consists of avoiding the most common food allergies/sensitivities, including wheat, eggs, soy, peanuts, tree nuts, and shellfish, but it can be tailored to the patient to include suspected offending foods. Elimination usually occurs for 30 days. After that period of time, one food will be introduced every three days. If reactions occur, the offending food will be recommended to avoid for a lengthier period of time, usually three to six months.
Nutritional Recommendation for H. pylori
While no one diet has been sufficiently researched for H. pylori, there is a small amount of evidence that supports a low-nickel diet. The use of this diet, in addition to antibiotic therapy for H. pylori, showed to have higher eradication rates than the antibiotic therapy alone. However, certain nutritional deficiencies have been associated with H. pylori, including vitamins C, E, B12, and iron. Because of these nutritional deficiencies, a whole-foods-based diet, like the Mediterranean diet, is recommended in order to prevent these deficiencies from occurring.
Nutritional Recommendation for Gastroparesis
A low FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) diet may be considered for those with gastroparesis. The “ODMAP” portion of FODMAP are types of short-chain carbohydrates that are considered hard to digest. In patients with gastroparesis, emphasis should be placed on easy-to-digest foods since the digestive process is already impaired, and thus lowering FODMAPs can be helpful.
Top Supplements and Herbs for Patients with Gastric Disorders
Many supplements and herbs can be effective in gastric disorders. Here are a few of the most common:
Marshmallow Root for Gastritis
Humans have used Althaea officinalis, commonly known as marshmallow, for thousands of years for medicinal purposes. Marshmallow contains a substance called mucilage, which can aid in lowering inflammation and soothing the tissues and lining of the stomach.
Dose: 30-40 drops of tincture (liquid form) in water or 6g of dried, powdered marshmallow root in divided doses. Additionally, marshmallow can be found in tea form; several glasses of tea daily is recommended.
Duration: Until retested confirms the condition is stabilized or when symptoms subside
Mastic Gum for H. pylori
The mastic bush, Pistacia lentiscus, has antioxidant, anti-inflammatory, and antiulcer properties, which is why it has been used medicinally for thousands of years. The active portion of the plant is the resinous gum, called mastic gum. Mastic gum has been shown to eradicate H. pylori infections.
Dose: 1-2.8 grams daily
Duration: Up to 3 months
Probiotics for H. pylori
Probiotics are supplements that contain strains of beneficial microbes, with the intention of supporting the gut microbiome. Studies have shown that probiotics can lower inflammation and may assist in the eradication of H.pylori infections. Lactobacillus and Bifidobacterium as well as Saccharomyces boulardii are the strains that have been shown to be the most beneficial in the eradication of H. pylori.
Dose: Saccharomyces boulardii 1,000 mg with concurrent therapy
Duration: 2 weeks
Prokinetics for Gastroparesis
Prokinetics are substances that induce the movement of the gastrointestinal tract. Prokinetics are an excellent choice for gastroparesis since gastroparesis is, by definition, slow or inhibited movement of food out of the stomach and into the intestines. The herbal formula Iberogast, composed of caraway, chamomile, angelica root, and bitter candytuft, has been shown to be effective in the treatment of gastroparesis.
Dose: 20 drops three times per day
Duration: Until symptoms subside or testing shows improvement
L-Glutamine for Peptic Ulcers
L-glutamine is an amino acid that fuels the cells of the small intestine. L glutamine may be effective in the treatment of peptic ulcers. A deficiency of glutamine has been associated with increased susceptibility to ulceration and decreased functioning of the stomach lining. L-glutamine has also been shown to reduce inflammation.
Dose: 5 grams twice daily
Duration: 6-8 weeks
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Summary
The functioning of the stomach is of utmost importance to the body. Without the stomach functioning properly, food may not be digested correctly, and thus, nutrients that the body runs off of may not be absorbed. Various conditions affecting the stomach can be evaluated with functional medicine labs to reveal the root cause of the condition. Complementary and integrative treatments, including nutrition, can be utilized with the goal of full eradication of symptoms in mind.
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