GI Guide

Gut Health Information

A food allergy is an immediate response you get every time you eat a certain food, i.e., break out in hives every time you eat shellfish. By the time we're adults most of us have figured out our food allergies. Food sensitivities involve a different part of the immune system. They can be dose-dependent, meaning you are able to eat a little of the food and be ok, but eating more than a certain amount causes symptoms. Food-sensitivity reactions can show up 2–3 days later, making it harder to identify the culprit.

No, you can have something called “non-celiac gluten sensitivity.” This means that you may have symptoms similar to those with celiac disease but don’t meet the diagnostic criteria. Gluten sensitivity shares many symptoms with celiac disease but people with non-celiac gluten sensitivity can have many non-GI related symptoms, such as headache, “brain fog,” joint pain, numbness in the legs and arms, skin rashes, eczema, and mood and behavioral imbalances. Symptoms typically appear hours or days after gluten has been eaten.

IBS is a diagnosis made, generally by a gastroenterologist, when all other GI conditions have been ruled out and you are still suffering from diarrhea, constipation, bloating, gas, and abdominal pain. Sometimes you may be prescribed medications to manage symptoms or told to follow a special diet. However, IBS usually has one or several underlying causes, including food sensitivities (gluten and dairy are common), low stomach acidity, parasites, or a condition called Small Intestinal Bacterial Overgrowth (SIBO). Research shows that up to 80% of IBS cases are actually SIBO.

Depending on the root cause, there can be some common food triggers. But working with a dietitian or functional medicine practitioner can help fine-tune which dietary changes need to be made for the best results. Removing gluten, dairy, and some foods that are high in fermentable fibers — like cauliflower, asparagus, garlic, onion, and apples — may help relieve some of the symptoms. However, for full resolution, the underlying cause must be addressed first. 

Depending on what the cause is it may or may not. If stress or anxiety is triggering GI issues, then through mindfulness techniques it may resolve on its own. However, if it is a food trigger or gut bacteria imbalance, interventions must be implemented to bring the GI tract back into balance, and until the triggers are removed you will likely continue to struggle with some level of discomfort. The good news is that as long as all other severe medical diagnoses have been ruled out by your doctor, IBS symptoms can usually be managed with nutritional and supplemental interventions.

To increase your chances of falling pregnant, you need to create an environment that will support a new life. Reducing inflammation is key. When choosing foods, eat as many organic fruits and veggies as possible, ideally limiting fruit to no more than 2 servings a day, and consuming 8–10 servings of veggies daily. Meats should be organic and pasture-raised/grass-fed whenever possible as this will decrease your exposure to inflammatory fats and chemicals. Eating enough fat is important — get fats from healthy sources like avocados, nuts, seeds, olive oil, and fatty fish — 2-3 tbsp per meal is a good start.

Yes, highly refined sugars and carbohydrates should be limited or avoided when trying to get pregnant. The blood-sugar balance will influence your hormonal balance, so avoid foods such as white-bread products, pastries, cookies, cakes, candy, sodas, juices, jams/jellies, white rice, and pastas. You should also avoid highly processed foods that have a lot of fillers, food colorings, and added preservatives — if you can’t pronounce the ingredient or know what it is, put the product back on the shelf.

Most often, infertility has its roots in one or more of these areas:

  • digestive function and gut health
  • detoxification
  • blood-sugar and insulin imbalances 
  • adrenal health or stress management

Inflammation and oxidative stress underlies these 4 areas so working holistically to optimize them will lower the body’s overall inflammation, maximizing chances of conception. Nutrition is key because every single area depends on nutrients. Typically when I formulate a specific plan for you, we’ll first want to address gut health, detoxification and blood sugar because focusing on these areas will improve egg and sperm quality, balance hormones, increase chances of implantation and embryo development, reduce the risk of miscarriage, and optimize birth outcomes.

SIBO stands for Small Intestinal Bacterial Overgrowth. It’s not an infection or an overgrowth of pathogenic bacteria, but of normal bacteria in the wrong spot. In a normally functioning digestive tract, the bulk of bacteria reside in the colon, the rest of the GI tract is relatively sterile. When there’s a motility issue, for any number of reasons, that prevents bacteria from being moved through the GI tract, then you can get a stagnation or backflow of bacteria into the small intestine, causing an overgrowth. This leads to gas, bloating, distension, abdominal pain, diarrhea, constipation, reflux, and nausea.

SIBO can have many causes but most commonly can be from an episode of food poisoning. Other causes of SIBO can be from abdominal surgeries, underfunctioning thyroid, long-standing diabetes, stomach-acid suppressing medications (PPIs), overuse of pain medications or opioids, head injuries, liver disorders, and motility disorders (like Parkinsons, gastroparesis, etc).

The best way to test for SIBO is by doing a SIBO breath test. This involves drinking a fermentable sugar solution so that the bacteria will ferment and give off either hydrogen or methane gas. If there are bacteria present in the small intestine then the breath test will capture a rise in these gases as the bacteria produce them as a result of their fermentation. Currently, MDs and GI doctors can order tests, but there are several labs that allow RDs to order the breath testing.

SIBO eradication and management involves a comprehensive approach, including herbal supplements and/or prescription antibiotics along with dietary modifications and specific probiotics and digestive support. While SIBO does have a high relapse rate, with proper management and interventions, along with a maintenance protocol to prevent it from coming back, symptoms and discomfort can be greatly reduced. Sometimes manual manipulation such as visceral manipulation techniques can help resolve adhesions and scar tissue which will make the eradication of SIBO more effective.

We have over 100 trillion bacteria inside of us, about 10x as many human cells in the body. So we’re made up more of bacteria than we are human if you think about it. All these bacteria serve a purpose, and every different type of bacteria has a different role — supporting our immune function, making vitamins, regulating our bowel movements, digesting food, and some research suggests helping with weight control, among others. So, supporting our bacteria via the food we eat and not overusing antibiotics are important.

FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols. Basically, these are short-chain fibers that our body does not digest, and instead of being absorbed into your bloodstream, they reach the far end of your intestine where most of your gut bacteria reside.

Your gut bacteria then ferment or “eat” them, producing gases and causing digestive symptoms in some people. These fibers also draw liquid into your intestine which can cause diarrhea and bloating.

Yes, stress has a big impact on the GI tract. It can shut down motility and cause constipation, or speed it up and cause diarrhea and cramping. This is because stress affects the main nerve in our body that regulates GI motility, the vagus nerve. Stress also changes the balance of our good bacteria and can lead to imbalances that negatively affect our health.

It is important that you have at least 1–2 complete bowel movements every day, but up to 3 or 4 can be normal as long as it is not loose or runny. The stool should be soft in consistency and look like logs or snakes, not small pellets.

Functional Nutrition Counseling Questions

Registered dietitians (RD or RDN) must complete 4 years of undergraduate coursework to receive a BS in Nutritional Sciences or a comparable field. This undergraduate degree includes all our nutrition courses as well as science-heavy coursework like biochemistry, organic chemistry, anatomy and physiology, and genetics and biology. Afterwards we complete a 1–2 year internship that rotates through all areas of dietetics: clinical, community, outpatient, and food service management. And thereafter we must study and sit for a national registration examination to become registered.

As a functional dietitian, additional training beyond this coursework is required. I have completed 2 different training courses in functional dietetics over the course of 3 years. 

My approach to patient care also differs as I look at a person holistically and expand upon the RD’s horizon and scope of practice to include alternative therapies that benefit those seeking alternative answers. This can include topics such as nutritional genomics, functional foods, antioxidants, and botanicals. The term “functional” means I will look at how your body is functioning, or dysfunctioning, and will implement more in-depth methods of testing and interventions to identify the root cause of dysfunction. Working with a functionally trained dietitian goes way beyond a simple “eat more vegetables” prescription, but will assess and assimilate a picture that ties in all parts of the body — digestive, cardiovascular, endocrine, psychological, etc- to formulate an individualized nutrition plan for you.

Initial Visit: 
You will be asked to complete several forms prior to the initial appointment for me to go through ahead of time so I can start to piece together your nutrition and health puzzle. This gives me an opportunity to familiarize myself with your case and concerns so that we can be laser-focused during the initial visit. I will ask you clarifying questions and have you expand on your story and health timeline beyond what was gathered on the initial paperwork. This way I can have a clear and in-depth scenario. At the end of the visit, I will link together the different areas of concern and explain their interrelatedness, and then we’ll discuss testing and intervention options. The key is that you and I do this together as I prefer my clients to have an active role in their care. We’ll then set a few goals for you to work on while we wait for the testing results.

During these, I intend to review lab results, discuss interventions, assess dietary intake and goals, and set a plan and goals for the following visit as a way of working toward your ultimate goal of optimal health. Follow-ups are key to help you stay on track and ensure that I can reassess and modify the course as appropriate for you, so it is an ever-evolving individualized nutrition plan.

This completely depends on your unique situation — everyone is different. At a minimum, most people need 4–5 visits for us to get into a good rhythm and start figuring out their case, but some people need more and some less. Generally I meet with people once a month, but sometimes it maybe every other week, and other times it maybe every 6-8 weeks. Again, because this is about individualization, your plan of care will be customized to your own needs.

I do not bill insurance. In the state of Texas you can submit for reimbursement for my office visits. Just ask me for a superbill and I can provide you with the appropriate codes to send your insurance company. It depends on your insurance plan but most clients will get some sort of reimbursement.

Yes! I can do Zoom visits with you from the comfort of your home or office.

Information About Common Gi Tests

Stool tests are used to look at the digestive function and bacteria balance in the colon, or large intestine. Typically a stool sample/s is collected over the course of 1–3 days and mixed with a solution, then sent to a lab for analysis. These tests will show if there are any pathogens present in the colon, such as parasites, worms, and “bad” bacteria. It also shows if there are very high levels of inflammation in the GI tract, low enzyme production, fat malabsorption, and any immune-system activation in the GI tract.

A SIBO breath test looks for any overgrowth of bacteria in the small intestine which could be causing digestive distress. During this test, you drink a sugar solution and then blow into tubes to capture any gases that are produced by bacteria via fermentation. You collect a breath sample every 20–30 minutes over the course of 2–3 hours.

Sometimes we need to fine-tune the diet and figure out if certain foods are triggering your symptoms. A food-sensitivity test is usually more helpful than a food-allergy test, since food allergies are much easier to identify — you react almost immediately after you eat the same food. A food sensitivity can take several hours to several days to show as a symptom. The Mediator Release Test (MRT) is a food-sensitivity test that goes along with the LEAP (Lifestyle Eating and Performance) nutritional protocol that leads to the most profound results. This is a blood test.

Evaluating micronutrient deficiencies can be an important part of the puzzle. A blood test can identify specific nutrient needs.

A comprehensive blood test, evaluated from a functional nutrition perspective to give more insight into the functioning of your body. Most are markers you have seen before from your doctor, but I like to include several more nutritional markers that are needed to capture the full picture that are often not included in regular blood work.

The adrenals are involved in our fight or flight response to a stressor. Our body does not know the difference between running from a tiger, or dealing with a stressful situation — all it knows is that you’ve switched into survival mode and the adrenals have to respond. The best way to evaluate adrenal function is via a 4-point saliva test with samples taken throughout the day. The goal is to capture the cortisol circadian rhythm (pattern) to better assess how the brain and adrenals are communicating with each other under the element of stress. Adrenal pictures are important when looking at sleep challenges, hormonal challenges, thyroid imbalances, fatigue issues, gut issues, and fertility challenges.

For Health Professionals

I remember how overwhelming it first seemed when I got into functional nutrition. But as you practice more of its principles and stay within the boundaries in which you feel comfortable, you will gain more knowledge and skills to slowly expand your scope. This is also why I offer mentoring, to help close that gap and lessen the learning curve so you can move more swiftly through the process of becoming a proficient functional dietitian — and help more people!

Yes! I have learned organically the ins and outs of the business and I would love to share with you my own mistakes and triumphs — so you can capitalize on the triumphs and avoid my mistakes. I have also worked independently as well as contracted with a functional medicine clinic, so I have seen and worked in both areas of functional practice and can offer you valuable insight.

Of course! Sometimes it is hard to step back and see the big picture with a client, especially when you have been working with them for a while, and so you may start feeling stuck. I love to help RDs take that step back and look at all aspects of the case, and help them get unstuck or change direction in order to optimize their client care. I help with lab-test reviews, supplement adjustments, diet advice, and suggesting alternative modalities.

No. I know everyone is busy so I want to make this as helpful and convenient as possible for you. We can do a structured session on the phone or have a set amount of hours and communicate via email as you need. I just keep track of your time.