Digestive diseases affect 60 to 70 million people, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Accounting for 12.7 million emergency department visits, digestive diseases place an emotional and financial burden on individuals. Interest in dietary supplements for the treatment of diseases has become quite popular. According to the Centers for Disease Control (CDC), in 2018, 57.6% of adults reported using at least one supplement. Supplement options for the gastrointestinal tract are plentiful.
This article will discuss various gut healing supplements and functional medicine testing that may aid in figuring out what supplement is right for you.
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Top Gut Healing Supplements Used By Integrative Medicine Practitioners
L-Glutamine
L-glutamine is the body's most commonly used amino acid (AA) and is used in more metabolic processes than any other AA. Good glutamine sources are high protein sources such as red meat, poultry, fish, dairy products, and beans. Glutamine is the primary fuel source for enterocytes, the cells lining the small intestine. Common uses for glutamine include Crohn's disease, gastritis, and Celiac disease. It is also helpful as a mouthwash for cancer patients with mucositis (inflammation and ulcers in the mouth) as a side effect of chemotherapy. Dosages range from 15-45g/day for at least five days.
Zinc Carnosine
Zinc is a trace metal used as a cofactor in numerous metabolic pathways. Carnosine is the product of two amino acids, beta-alanine and histidine, and has antioxidant properties. Zinc carnosine is the combination of the two that aids in healing the damaged mucosa of the stomach and small intestine. Because of the combinations' molecular structure, it has a slow absorption rate in the stomach, allowing a more extended period of time for it to work. Common uses for zinc carnosine include ulcers, Helicobacter pylori (H. pylori) infection, Gastroesophageal Reflux Disease (GERD), oral mucositis (chemotherapy side effect), esophagitis (chemotherapy side effect), small bowel injuries due to aspirin, Ulcerative Colitis (UC) and hemorrhoids. Saturation of absorption of zinc carnosine was seen at >30mg/kg, meaning anything over 30mg is not helpful and will be excreted.
Digestive Enzymes
Digestive enzyme supplements mimic the natural digestive enzymes made by our stomach, pancreas, and small intestine. Aiding in the breakdown of food and the absorption of nutrients, there are different digestive enzymes for the different macronutrients: protein, carbohydrates, and fats. Disorders of digestive enzyme insufficiency include lactose intolerance (lack of enzymes to break down lactose, a sugar found in milk and dairy), exocrine pancreatic insufficiency (EPI) (lack of enzymes produced by the pancreas that aid in protein, fat, and carbohydrate breakdown), and congenital sucrase-isomaltase deficiency (lack of enzymes to break down certain sugars). On the other hand, certain medical conditions can lead to digestive enzyme deficiency, specifically enzymes made in the pancreas. Those conditions include chronic pancreatitis, pancreatic cancer, and cystic fibrosis. Other conditions can lead to hypochlorhydria, or low stomach acid. Dosages of digestive enzymes vary greatly depending on the specific enzyme.
Probiotics
Probiotics are supplements used to support the gastrointestinal microbiome, a collective group of bacteria, viruses, and fungi that live within our large intestines. These microbes aid in digestion and absorption, immune function, hormone production, and more. There are numerous types of microbes within the microbiome. Probiotic supplements typically contain bacteria strains, including Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, Escherichia, and Bacillus. There is currently much research being done on probiotics. Research suggests that probiotic supplements may benefit atopic dermatitis, pediatric acute infectious diarrhea, antibiotic-associated diarrhea, inflammatory bowel disease (IBD) (Crohn's disease and Ulcerative Colitis), irritable bowel syndrome (IBS), high cholesterol, and obesity. There are different types of probiotic supplements containing varying strains and dosages.
Prebiotics
Prebiotics are non-soluble fibers that function to feed the microbiome. This process produces byproducts called short-chain fatty acids (SCFAs). SCFAs can enter the circulation and can induce beneficial effects through the body. Regarding GI health, prebiotics can positively impact the microbiome by increasing the number and diversity of microbes. They can also create fuel for large intestine cells, aid digestion and absorption, strengthen GI permeability, and lower GI inflammation. Prebiotic dosages begin at three grams, with most benefits seen closer to five grams.
Deglycyrrhizinated licorice root
Glycyrrhiza glabra, commonly known as licorice root, has been used for thousands of years as a medicinal herb for various ailments. For the digestive tract, a form of licorice root called deglycyrrhizinated licorice root (DGL) is beneficial for ulcerative conditions and the elimination of H. pylori. DGL differs from licorice root in that glycyrrhizin, an active compound that can increase blood pressure, has been removed.
A study done on 100 people showed a supplement containing DGL to be 73.2% more effective in H.pylori eradication than the placebo group. Another study analyzed 120 people with H.pylori infection who were given standard antibiotic treatment or antibiotic treatment with licorice. Results showed 83.3% of participants in the standard therapy with licorice had eradication of H.pylori as opposed to 62.5% in the standard therapy group. Another study assessing DGL's effectiveness against ulcers showed DGL to be similarly effective at ulcer healing compared to Tagamet, a standard drug prescribed for ulcers. DGL should be taken in a lozenge or liquid form since a mixture of DGL with saliva may result in the growth and generation of stomach and intestinal cells. Dosages range from 760mg-1,520mg between or before meals.
Marshmallow Root
Althaea officinalis, commonly known as marshmallow root, is another herb that has been used medicinally for thousands of years. Having no relation to the marshmallow food product, marshmallow root contains a soothing substance called mucilage which helps to soothe irritated membranes. Because of this substance, marshmallow root can be beneficial for common colds, sore throats, coughs, indigestion, stomach ulcers, IBD, bronchitis, and asthma. A dosage of six grams per day in divided doses is recommended.
Aloe
Aloe vera, commonly called Aloe, was one of the most frequently used medicinal plants in the 18th and 19th centuries. Widely known for its effect on topical wound healing, Aloe may be effective in internal wound healing, including gastritis, inflammation of the stomach, and GERD. In a study assessing Aloe in the treatment of chronic ulcers, 93% of the group taking Aloe showed improvements in healing as compared to 47% in the placebo group. Aloe can also be used as a laxative, although it is not commonly recommended due to its potency.
A review in the Journal of Gastroenterology and Motility assessed three randomized control trials looking at the effect of Aloe on IBS. After seeing statistically significant improvements in IBS symptoms in all three trials, they concluded that Aloe was a safe and effective treatment for IBS. Dosages in this study ranged from 50-60ml, two to four times per day.
Oil of Oregano
Oregano is an herb used in the culinary space, but it also has medicinal properties, including anti-inflammatory and antioxidant functions. Regarding GI health, oil of oregano can help to eradicate harmful microbes through its antimicrobial actions. A study assessed oil of oregano in the treatment of Small Intestine Bacterial Overgrowth (SIBO). SIBO occurs when microbes from the microbiome in the large intestine move into the small intestine and cause problems. Oil of oregano was found to be as effective as the standard drug treatment, Rifaximin. It was also found to be as effective as triple antibiotic therapy in those in which Rifaximin did not work. Oregano oil is also often used against Candida due to its antifungal properties. Oil of oregano is usually taken in tincture (liquid) or gel capsules.
Functional Medicine Labs to Test That Can Help You Determine Which Gut Healing Supplement is Best for You
The supplements discussed above affected all sections of the GI tract, including the stomach, small intestine, and large intestine. A comprehensive stool test such as the GI360 by Doctor's Data would be a great choice to assess gut health. This test shows markers of digestion, absorption, and inflammation while also showing what the microbiome comprises, checking for harmful and beneficial microbes. It will show SCFA levels, too.
The GI-MAP by Diagnostic Solutions is a excellent choice to evaluate an H.pylori infection as it assesses virulence factors. H. pylori virulence factors give more information about the infection and can give insight into how H. pylori is fighting the host's immune system and if the infection is likely to develop ulcers or cancer.
Many comprehensive GI tests offer the addition of zonulin. Zonulin is a marker of increased intestinal permeability, also known as "leaky gut." Leaky gut causes disturbances in digestion and absorption and also causes system inflammation.
Small Intestine Bacterial Overgrowth, commonly called SIBO, occurs when microbes from the microbiome in the large intestine translocate to the small intestine, where they can cause digestive issues such as bloating, burping, and more. The Triosmart SIBO breath test checks for three different gases that bacteria in the small intestine would produce, confirming their presence.
Summary
Digestive diseases are quite common in America and can cause financial and emotional burdens. Numerous supplements may aid in the healing of the gut with various mechanisms. Some supplements target the stomach, while others focus on the intestines. Some focus on inducing change through the microbiome, while others directly affect the GI tissues. It can be challenging to assess what supplement you may need, but functional medicine testing can help to take the guessing out by providing an in-depth assessment of GI health and functioning.
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