Get answers to the most frequently asked questions about Digestive Rebuilding
Understanding your Symptoms
The Digestive Assessment Explained.
Enzyme and gastric juice insufficiency, sometimes called enzyme insufficiency for short, is responsible for the malabsorption of vitamins, minerals and fatty acids. Without proper levels of enzymes and the gastric juices that activate and deactivate them, the macronutrients in food putrefy, go rancid, and ferment. The results of this incomplete digestion are symptoms such as pain, bloating, gas, and different types of stool. If your symptoms are not properly treated then you are at risk of developing a more severe condition.
What can cause bad breath that is not resolved by oral hygiene support?
Hydrochloric acid (HCL) and pepsin enzyme insufficiencies can cause volatile organic compounds (VOC) to increase causing bad breath.
What can cause constipation after eating protein?
Hydrochloric Acid (HCL) insufficiency can cause reduced motility (peristalsis) 1. Incomplete protein metabolism due to low HCL, intestinal protease, pancreatic and/or pepsin enzyme insufficiency can cause a deficiency in phosphorous in relation to calcium that will cause constriction of the intestinal and sphincter muscles 2.
What can cause frequent heartburn or acid reflux?
If you experience these symptoms more than twice a week, then you have GERD. This may be caused from low HCL and/or pepsin enzyme insufficiency. Your protein may be putrefying causing excess gas to be released and acid splashing up. This can lead to muscle loss and the formation of ulcers.
What can cause intestinal gas (flatulence) that smells really bad (silent but deadly)?
This type of gas is typically caused from incomplete protein metabolism due to low HCL, intestinal protease, pancreatic and/or pepsin enzyme insufficiency. It is like leaving chicken scraps in your garbage overnight.
What can cause excessive belching at the start or during your meal?
Burping is a common symptom experienced after eating fatty meals. It is our opinion that belching may be a reflex of the gallbladder muscle when bile is too thick and/or deficient. This can be somewhat verified when looking at symptom data before and after gallbladder surgery when belching was relieved in a majority of patients postoperatively 4,5.
What can cause prolonged burning (ulcers) after eating?
If you have prolonged burning after eating, then you should get tested for a gastric ulcer. If you have a gastric ulcer, then you most likely have H.Pylori overgrowth 2. Protein metabolism impairment is associated with gastric ulcers and may be why the bacteria were able to proliferate 3.
What can cause pale, light colored and/or yellowish stool?
Bilirubin (red blood cell byproduct in liver) and bile give feces their normal brown color. Therefore, the most common reason for this change in color is the existence of gallstones or sludge in the gallbladder that reduce the amount of bile that reaches the intestines 9,10,11. Cirrhosis of the liver, hepatitis, chronic pancreatitis, pancreatic cancer, a blockage in the pancreatic duct, or cystic fibrosis can also turn the stool yellow and should be ruled out 12. Because of their fast bowel transit time, infants tend to have yellow feces, so there is nothing to worry about 13.
What can cause greasy, floating stools and fat particles (oil slick)?
If your bowel movement is fatty, oily, floats, smells rancid, and is difficult to flush then you are not digesting all the fat you are eating, so undigested fat is seen in the toilet bowl. Talk to your doctor if you see droplets that look like an oil slick, float or stick to the sides or bottom of the toilet bowl making it difficult to flush. This can be a sign of pancreatic lipase enzyme insufficiency and/or bile acid insufficiency 6,7,8.
Why is looking at a history of gallbladder attacks or surgical removal (cholecystectomy) important?
If you are experiencing gallbladder attacks or have had surgical removal of your gallbladder, then you may have liver bile acid insufficiency. This will lead to fat digestion issues and force your pancreas to work even harder making additional lipase enzymes. In fact, even if you have had your gallbladder removed, you may still have many of the same symptoms 17. Only your doctor can see if liver/gallbladder stones are blocking your common bile duct or if your liver is too tired to produce adequate amounts of bile acid.
What can cause frequent diarrhea and fatty stool?
This condition is called Steatorrhea and is associated with a fast bowel transit time, undigested fat and weight-loss 14. This can lead to serious malabsorption conditions and fat-soluble vitamin deficiencies. Only your doctor can tell if your symptoms are caused from pancreatic lipase enzyme, intestinal lactase enzyme, and/or bile acid insufficiency or a more serious intestinal infection 15,16.
What can cause excessive abdominal cramping after eating (not menstrual)?
If you are cramping after eating carbohydrates, including milk products, then you may have pancreatic amylase enzyme and/or intestinal lactase enzyme insufficiency. Around 50% of Type 1 Diabetics and 35% of Type II Diabetics also experience abdominal cramping due to pancreatic amylase enzyme insufficiency 18,19. Tell your doctor about your sugar cravings, energy levels, and ask to test your Hemoglobin A1c.
What can cause excess intestinal gas (not very foul) and bloating?
Fermentation of carbohydrates causes large volumes of non-smelly (loud and clear) intestinal gas. Excess fermentation is caused by pancreatic and/or intestinal enzyme insufficiency 20. Tell your doctor about both the volume and smell of your gas, this can help pinpoint the correct treatment.
What can cause excess brain fog or feelings of anxiety?
The gut contains 100 million neurons – more than the spinal cord. Major neurotransmitters like serotonin, dopamine, glutamate, norephinephrine and nitric oxide are in the gut. The gut also is a rich source of benzodiazepines – the family of psychoactive chemicals that includes such ever-popular drugs as Valium and Xanax. 21 The greatest concentration of serotonin, which is involved in mood control, depression and aggression, is found in your intestines, not your brain. 22 Tell your doctor if you have feelings of aggression, anxiety, and/or depression, as they may be signs of neurotransmitter insufficiency due to mucous membrane issues, protein metabolism problems, and/or bacterial overgrowth.
What can cause undigested vegetable matter (not including corn) in your stool?
Complex carbohydrates and starches found in many vegetables take adequate chewing, good pancreatic enzyme potency, and balanced levels of bacteria in the colon. If you are experiencing excess vegetable matter in your stool, then you may have amylase enzyme insufficiencies. Tell your doctor how much you chew your vegetables and how fast you need to have a bowel movement after eating vegetables.
Why is looking at history of Small Intestine Bacterial Overgrowth (SIBO) important?
SIBO is a chronic bacterial infection and overgrowth of the small intestine.23 It results from the migration of large intestine bacteria into the small intestine. The overgrowth of bacteria produce excess gas within our small intestine. People also experience abdominal bloating, abdominal pain, constipation, belching, flatulence, and diarrhea.24
1: Chen CL1, Yi CH, Liu TT. Influence of intraluminal acidification on esophageal secondary peristalsis in humans. Dig Dis Sci. 2013 Jul;58(7):1948-54. doi: 10.1007/s10620-013-2584-2. Epub 2013 Feb 8.
2: El-Omar EM1, Oien K, El-Nujumi A, Gillen D, Wirz A, Dahill S, Williams C, Ardill JE, McColl KE. Helicobacter pylori infection and chronic gastric acid hyposecretion. Gastroenterology. 1997 Jul;113(1):15-24.
3: Khachiev GL, Ovchinnikova IV, Tursunbaev A. Protein metabolism in patients with duodenal ulcers and mathematical modeling of its disorders. Ter Arkh. 1985;57(2):26-7.
4: Niranjan B1, Chumber S, Kriplani AK. Symptomatic outcome after laparoscopic cholecystectomy. Trop Gastroenterol. 2000 Jul-Sep;21(3):144-8.
5: P Gharde, P Muntode, D Wagh, M Swarnkar, D S Gode, M Yeola, R Meghe, Y Taneja. A Study of Abdominal Symptoms and Their Outcome after Cholecystectomy: Original Article. The Internet Journal of Surgery. 2013 Volume 30 Number 3.
6: Fieker A, Philpott J, Armand M. Enzyme replacement therapy for pancreatic insufficiency: present and future. Clin Exp Gastroenterol. 2011:4:55-73. 2. Keller J, Layer P. Human pancreatic exocrine response to nutrients in health and disease. Gut. 2005;54(suppl VI):vi1-vi28.
7:Domínguez-Muñoz JE. Pancreatic enzyme therapy for pancreatic exocrine insufficiency. Curr Gastroenterol Rep. 2007;9(2):116-122.
8: Adam S Cheifetz; Alphonso Brown; Michael Curry; Alan C Moss (10 Mar 2011). Oxford American Handbook of Gastroenterology and Hepatology. Oxford University Press. p. 234. ISBN 9780199830121.
9: Barbosa, M. R. (2013). Chemical composition and formation of human feces—problems and solutions of large mergers demographics in developing countries. Retrieved from http://ehr.cset.jsums.edu/10cd/OralPdf/Oral%2039.pdf
10: Celiac disease. (2015, April 10). Retrieved from http://www.celiaccentral.org/Celiac-Disease/21/
11: Diarrhea. (2013, November). Retrieved by http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/diarrhea/Pages/facts.aspx
12: Sources of infection and risk factors. (2012, July 13). Retrieved http://www.cdc.gov/parasites/giardia/infection-sources.html
13: Picco, M. (2012, October 12). Stool color: When to worry. Retrieved from http://www.mayoclinic.org/stool-color/expert-answers/faq-20058080
14: Fine KD, Schiller LR. AGA technical review on the evaluation and management of chronic diarrhea. Gastroenterology. 1999;116(6):1464–1486. [PubMed]
15: Lactose Intolerance Fact Sheet. Retrieved by http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/lactose-intolerance/Pages/facts.aspx
16: Viral Gastroenteritis Fact Sheet. Retrieved by: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/viral-gastroenteritis/Pages/facts.aspx
17: Freud M, Djaldetti M, deVries A, Leffkowitz M. Postcholecystectomy syndrome: a survey of 114 patients after biliary tract surgery. Gastroenterologia. 1960. 93:288-93. [Medline].
18: Hardt PD, et al. and the S2453112/S2453113 Study Group. High Prevalence of Exocrine Pancreatic Insufficiency in Diabetes Mellitus. A Multicenter Study Screening Fecal Elastase 1 Concentrations in 1,021 Diabetic Patients. Pancreatology. 2003;3:395-402.
19: Hardt PD, et al. Is Pancreatic Diabetes (Type 3c Diabetes) Underdiagnosed and Misdiagnosed? Diabetes Care. 2008;31(suppl 2):S165-S169.
20: Gas-related complaints. The Merck Manuals Online Medical Library. www.merckmanuals.com/ professional/sec02/ch008/ch008d.html. Updated October 2007.
21: Gut Reaction: The Vibrant Ecosystem Inide the Human Gut Does More than Digest Food, by Sarah C.P. Williams, Howard Huges Medical Institute Bulletin, 14-17, August 2010.
22: Bravo JA1, Forsythe P, Chew MV, Escaravage E, Savignac HM, Dinan TG, Bienenstock J, Cryan JF. Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. Proc Natl Acad Sci U S A. 2011 Sep 20;108(38):16050-5. doi: 10.1073/pnas.1102999108. Epub 2011 Aug 29.
23: Small Intestine Bacterial Overgrowth. Retrieved by: http://ndnr.com/pain-medicine/small-intestine-bacterial-overgrowth/
24: Nutr Clin Pract. 2013 Jun;28(3):289-99. doi: 10.1177/0884533613485882. Epub 2013 Apr 24.
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