Dr. Jimenez, D.C., presents how chronic metabolic connections like inflammation and insulin resistance are causing a chain reaction in the body in this 2-part series. Many factors often play a role in our health and wellness. In today’s presentation, we will continue on how these chronic metabolic diseases affect the vital organs and organ systems. It can lead to overlapping risk factors associated with pain-like symptoms in the muscles, joints, and vital organs. Part 1 examined how overlapping risk profiles like insulin resistance and inflammation affect the body and cause muscle and joints pain-like symptoms. We mention our patients to certified medical providers that provide available therapy treatments for individuals suffering from chronic conditions associated with metabolic connections. We encourage each patient when it is appropriate by referring them to associated medical providers based on their diagnosis or needs. We understand and accept that education is a marvelous way when asking our providers’ crucial questions at the patient’s request and acknowledgment. Dr. Alex Jimenez, D.C., uses this information as an educational service. Disclaimer
How The Liver Associated With Metabolic Diseases
So we can look to the liver to find earlier cues of cardiovascular risk. How can we do that? Well, let’s understand some liver biochemistry. So in a healthy liver cell hepatocyte, when you have increased insulin being secreted because there was a meal that required glucose to be absorbed, what you expect if the insulin receptor works is that the glucose would go in. Then the glucose would get oxidized and turned into energy. But here’s the problem. When the hepatocyte has insulin receptors that don’t work, you’ve got that insulin on the outside, and the glucose never made it in. But what also happens on the inside of the hepatocyte is it was assumed that the glucose was going to get in. So what it does is it turns off fatty acid oxidation, thinking, “Guys, we don’t need to burn our fatty acids. We’ve got some glucose coming in.”
So when the glucose is not there, and you’re not burning off fatty acids, very common for people to feel fatigued because nothing is burning for energy. But here is the secondary sequela; where are all those fatty acids going, right? Well, the liver may try to repackage them as triglycerides. Sometimes, they stay in the hepatocyte or get shifted out of the liver into the bloodstream as VLDL or very low-density lipoprotein. You might see it as a high triglyceride shift in a standard lipid panel. So, when all of us are talking about getting a triglyceride level to around 70 as your 8+ goal, when I start seeing triglycerides rising, we wait until they’re 150, even though that’s the cutoff for our labs. When we see it at 150, we know they are shunting triglycerides out of the liver.
So that will happen many times before we find impaired fasting glucose. So look at your triglycerides, fasting triglycerides, as an emerging or early biomarker of insulin dysfunction. So this is another diagram that says that if the triglycerides are being created because the fatty acids are being oxidized, they can stay in the liver. Then that makes steatosis or the fatty liver, or they can be pushed out, and they turn into lipoproteins. We’re going to talk about that in just a second. The body is like, “What are we going to do with these fatty acids?” We can’t try to shove them into places because nobody wants them. To that point, the liver is like, “I don’t want them, but I will keep some with me.” Or the liver would have these fatty acids transported and stuck to the blood vessel walls.
And then the blood vessels and arteries are like, “Well, I don’t want them; I’ll put them underneath my endothelium.” And so that’s how you get atherogenesis. The muscles are like, “I don’t want them, but I’ll take some.” That’s how you get the fatty streaks in your muscles. So when the liver is getting bogged down with steatosis, inflammation occurs in the body and produces this feed-forward cycle inside the hepatocyte, damaging the liver. You’re getting cellular death; you’re getting fibrosis, which is just an extension of what happens when we don’t address the core issues for fatty liver: inflammation and insulin resistance. So, we look for subtle rises in AST, ALT, and GGT; remember that it is a liver-based enzyme.
Hormone Enzymes & Inflammation
GGT enzymes in the liver are smoke detectors and tell us how much oxidative stress is going on. Will we look at HSCRP and APOB to see the output of this liver? Is it starting to dump excess fatty acids through VLDL, APOB, or triglycerides? And how it picks that is just genetics, honestly. So I look for liver markers to tell me what’s going on in the liver as a sign of what’s happening everywhere. Because that might be the genetic weak spot of the person, some people are genetically vulnerable just in terms of their lipid profiles. To that point, we can look for something called metabolic dyslipidemia. You know this as high triglycerides and low HDL. You can specifically look for a ratio; an optimal balance is three and lower. It starts going from three to five and then five to eight, like eight is almost pathognomonic of insulin resistance. You’re just reaching becoming more and more insulin resistant.
As the number increases for that trig over HDL ratio, that is a simple, easy way to screen for insulin resistance. Now some people look 3.0 on this but still have insulin resistance. So there are other tests you do. This is a way to find those who show insulin resistance through lipids. And remember, everybody is different. Women with PCOS could have amazing lipids but could express an increase or decrease of hormones associated with insulin, estrogen, and inflammation. So look for something other than one test or ratio to indicate whether they’ve got it. You’re looking to see what could be the place where we will find the clue.
So let’s use the word healthy. A healthy person has VLDL that looks to be a healthy normal size in their bodies, and they have normal LDL and HDL. But now look at what happens when you get insulin resistance. These VLDL ls start to pump up with triglycerides. That’s why they’re fattening up. It’s lipotoxicity. So if you start looking at the VLDL three numbers in a lipoprotein profile, you’ll see that that number is creeping up, and there are more of them, and their size is bigger. Now with LDL, what happens is that the cholesterol amount within the top and the bottom is the same. If I pop all these water balloons, it’s the same amount of LDL cholesterol. However, that amount of LDL cholesterol in insulin resistance is repackaged in small dense LDL.
How Does Functional Medicine Play Its Part?
Now we understand that there may be some of you who cannot or do not have access to this testing, or your patients cannot afford it, and that’s why we answered the questions and looked for other clues of insulin resistance and treat the root cause that is affecting the body. Look for signs of inflammation and other overlapping profiles of insulin resistance. The particle number is higher when they’re insulin resistance. So cholesterol is the same, whereas the particle number is more elevated, and small dense LDL is more atherogenic. Treat it because whether or not you have access to knowing the LDL particle, there should be something in your head that says, “Man, even though this person’s LDL cholesterol looks good, they have tons of inflammation and insulin resistance; I can’t be sure that they don’t have higher particle number.” You might assume that they do this just to be safe.
The other thing that happens in insulin resistance is that the HDL or the healthy cholesterol tends to become small. So that’s not very good because the efflux capacity of HDL is lessened when it’s smaller. So we like the larger HDL, if you will. Access to these tests would give you a solid indication of what’s going on with your patient from a cardiometabolic perspective.
When it comes to these tests, it is important to utilize them to determine the patient’s timeline when they have inflammation or insulin resistance in their bodies, affecting their quality of life. However, many people would often express that these tests are expensive and would go with the gold standard of testing for affordability and be able to decide if it is worth it to better their health and wellness.
Look For Cardiometabolic Risk Patterns
So when it comes to cardiometabolic risk factor patterns, we look at the insulin aspect and how it correlates with mitochondrial dysfunction associated with insulin resistance and inflammation. A research article mentions how two mitochondrial dysfunctions can affect the body. Okay, let’s talk about the first issue, which is the quantity issue. One could be endotoxins that we encounter in our environment, or two; it can be genetically passed along from generation to generation. So the two types could indicate that you don’t have enough mitochondria. So that’s a quantity issue. The other problem is it’s a quality issue. You got plenty of them; they don’t work well, so they don’t have high output or at least normal results. Now how does this play out in the body? So out in the periphery, your muscles, adipocytes, and liver, you have mitochondria in those cells, and it’s their job to energize that lock and jiggle. So if your mitochondria are in the right number, you’ve got plenty to energize the insulin cascade lock and jiggle.
Interesting, right? So here it is in summary, if you don’t have enough mitochondria, which is the problem in the periphery, you get insulin resistance because the lock and jiggle aren’t working well. But if you do not have the mitochondria working well in the pancreas, especially in the beta cell, you don’t secrete insulin. So you still get hyperglycemia; you don’t have high insulin state. When this happens, we know your brain should be hurting, but hopefully, it will come together slowly.
Another article mentions that it connects mitochondrial dysfunction with type two diabetes, and poor maternal nutrition can prime it. This one talks about how fatty liver is associated with lipotoxicity, right? That’s that increased fatty acid, and oxidative stress, which, remember, is the byproduct of inflammation. ATP depletion and mitochondrial dysfunction. When this happens, it can affect the liver, which then turns into the fatty liver, and can also be associated with gut dysfunction, which leads to chronic inflammation, elevated insulin resistance, mitochondrial dysfunction, and many more. These chronic metabolic diseases are connected, and there are ways to reduce these symptoms from affecting the body.
Conclusion
When having a conversation with their doctors, many patients know that the same drivers affect a whole host of other phenotypes, all commonly rooted in inflammation, insulin, and toxicity. So when many people realize these factors are the root cause, doctors will work with many associated medical providers to develop personalized functional treatment plans. So remember, you always have to use the timeline and the matrix to kind of help you know where do you start with this patient, and for some people, it might be you’re just going to tweak a little bit of lifestyle because all they’re working on is changing their body count. So it’s one of the blessings of functional medicine that we were able to turn off the inflammation in the gut, which helps reduce the toxic impact burdening the liver. It also allows the individual to find out what works or doesn’t work with their bodies and take these small steps to improve their health.
We hope you have fresh eyes about inflammation, insulin, and toxicity and how it is at the root of so many conditions that your patients are facing. And how through very simple and effective lifestyle and nutraceutical interventions, you can change that signaling and change the course of their symptoms today and the risks they have tomorrow.
Dr. Alex Jimenez, D.C., presents how metabolic connections are causing a chain reaction to major chronic diseases in this 2-part series. Many factors often play a role in our health and wellness. It can lead to overlapping risk factors associated with pain-like symptoms in the muscles, joints, and vital organs. Part 2 will continue the presentation on metabolic connections with major chronic diseases. We mention our patients to certified medical providers that provide available therapy treatments for individuals suffering from chronic conditions associated with metabolic connections. We encourage each patient when it is appropriate by referring them to associated medical providers based on their diagnosis or needs. We understand and accept that education is a marvelous way when asking our providers’ crucial questions at the patient’s request and acknowledgment. Dr. Jimenez, D.C., makes use of this information as an educational service. Disclaimer
How Inflammation Affects The Body
Dr. Alex Jimenez, D.C., presents: So here you have a lean set of adipocytes on the left, and then as they start to plump up with more cellular weight, you can see those macrophages, the green boogies come around looking, saying, “Hey, what’s going on here? It doesn’t look right.” So they are investigating, and this causes local cell death; it’s just a part of the inflammatory cascade. So there is also another mechanism happening here. Those adipocytes are not just getting plumper by accident; it’s often related to a calorie surfette. So this nutrient overload damages the endoplasmic reticulum, leading to more inflammation. What these cells and the adipocytes are trying to do is protect themselves from glucose and lipo toxicity.
And the whole cell, the adipocyte cell, is creating these caps that are trying to say, “Please stop, we can’t take any more glucose, we can’t take any more lipids.” It’s a protection mechanism known as insulin resistance. It’s not just some random thing happening. It is the body’s way of trying to prevent glucose and lipotoxicity. Now that the inflammation alarm is occurring more than just in the adipocytes, it’s getting systemic. Other tissues and organs are starting to feel the same burden of the calorie surfette, causing inflammation and cell death. So glucose and lipotoxicity look like fatty liver when dealing with the liver. And you can also have it just like fatty liver progresses to cirrhosis with hepatocyte death. The same mechanism that’s happening in muscle cells. So our skeletal muscle cells specifically see cell death after inflammation and see fatty deposition.
The best way to think about it is, for example, the cows raised for food consumption and how they have marbled. So that’s the fatty deposition. And in humans, you can think about how people become sarcopenic as they become more and more insulin resistant. It’s the same phenomenon when body tissue tries to protect itself from glucolipotoxicity, causing a local inflammatory response. It becomes an endocrine response when it starts targeting other tissues in the periphery, whether the liver, muscle, bone, or brain; it’s just whatever is happening; they’re in the visceral adipocytes that can occur in other tissues. So that’s your paracrine effect. And then it can go viral, if you will.
Inflammation Associated With Insulin Resistance
Dr. Alex Jimenez, D.C., presents: You’re getting this local and systemic pro-inflammatory response coupled with insulin resistance, returning to this protection mechanism against glucose and lipotoxicity. Here you see how the blood vessels in our arteries get caught in the loop of fatty deposition and cell death. So you’ll see leaky blood vessels and fatty deposits, and you’ll see damage and pro-atherogenesis. Now, this is something we explained in AFMCP for the cardiometabolic module. And that is the physiology behind the insulin receptor. This is known as the lock and jiggle technique. So you have to have insulin lock into the insulin receptor up at the top., which is known as the lock.
And then there’s a phosphorylation cascade called the jiggle that then creates this cascade that ultimately causes the glucose-4 channels to open up the glucose-4 receptors to go into the cell so that it can be then the glucose, which is then utilized for energy production by the mitochondria. Of course, insulin resistance is where that receptor isn’t sticky or as responsive. And so not only do you fail to get glucose into the cell for energy production, but you are also rendering a hyper insulin state in the periphery. So you get hyperinsulinemia as well as hyperglycemia in this mechanism. So what can we do about that? Well, many nutrients have been shown to improve the lock and jiggle things that can improve the glucose-4 transporters coming up towards the periphery.
Anti-Inflammatory Supplements Reduce Inflammation
Dr. Alex Jimenez, D.C., presents: You see these listed here: vanadium, chromium, cinnamon alpha lipoic acid, biotin, and another relatively new player, berberine. Berberine is a botanical that can dampen all primary pro-inflammatory signals. So what precedes these comorbidities often and it’s insulin dysfunction. Well, what precedes insulin dysfunction many times? Inflammation or toxicity. So if berberine is helping the primary inflammation issue, it will address the downstream insulin resistance and all the comorbidities that can happen. So consider berberine as your option. So again, this shows you that if you can reduce inflammation up here at the top, you can minimize many cascade effects downstream. Berberine specifically seems to act in the microbiome layer. It modulates the gut microbiota. It may create some immune tolerance, therefore not rendering as much inflammation.
So consider berberine as one of the tools you can use to support insulin dysfunction and insulin resistance-related comorbidities. Berberine seems to increase insulin receptor expression, so the lock and jiggle work more effectively and improve the cascade with the glucose-4 transporters. That’s one mechanism by which you can start to find the root cause of many of the conditions we discussed when you see paracrine and endocrine glucose toxicity, lipotoxicity organ damage. Now another mechanism for you to consider is leveraging NF kappa B. So the goal is to keep NF kappa B grounded because as long as they don’t translocate, a host of inflammation signals do not get triggered.
So our goal is to keep NF kappa B grounded. How can we do that? Well, we can use NF kappa B inhibitors. So in this presentation of treatment options for any comorbidities related to insulin dysfunction, there are many ways to reduce these overlapping conditions affecting our bodies. So you can directly affect insulin resistance through anti-inflammatory supplements or indirectly help insulin resistance or insulin dysfunction by leveraging things against inflammation. Cause if you remember, insulin dysfunction is what then causes all those comorbidities. But what causes insulin dysfunction is generally inflammation or toxins. So our goal is to address pro-inflammatory things. Because if we can address pro-inflammatory things and nip the insulin dysfunction in the bud, we can prevent all the downstream organ damage or organ dysfunction.
Reducing Inflammation In The Body
Dr. Alex Jimenez, D.C., presents: Let’s move on to the next section that you can leverage or reduce the inflammation and insulin soup damage if you will, that the genes bathe in the body. This is the one you’ll often hear in our presentation, and that’s because, actually, in functional medicine, we help fix the gut. That’s usually where you need to go. And this is the pathophysiology for why we do that in cardiometabolic medicine. So if you have that poor or sad diet, that modern western diet with bad fats, it will directly damage your microbiome. That change in the microbiome can render increased intestinal permeability. And now lipopolysaccharides can translocate or leak into the bloodstream. To that point, the immune system says, “Oh no way, buddy. You’re not supposed to be in here.” You’ve got these endotoxins in there, and now there is a local and systemic inflammatory response that inflammation will drive the insulin dysfunction, which will cause the metabolic disorders that come after that.
Whatever the person’s genetically prone to, it gets clicked on epigenetically. So remember, if you can quell the inflammation in the microbiome, meaning create this tolerant and strong microbiome, you can reduce the inflammatory tone of the entire body. And when you reduce that, it’s been shown that it sets the insulin sensitivity. So the lower the inflammation, the higher the insulin sensitivity related to the microbiome. So surprise, it’s been shown that probiotics are associated with improved insulin sensitivity. So the right probiotics will create immune tolerance. Microbiome strength and modulation occur with probiotics. And so insulin sensitivity is preserved or regained based on where you are. So please consider that as another indirect mechanism or treatment option for leveraging cardiometabolic health for patients.
Probiotics
Dr. Alex Jimenez, D.C., presents: So when it comes to probiotics, we will use them in someone who might also concurrently have irritable bowel syndrome or food allergies. We might pick probiotics over NF kappa B inhibitors if they also have insulin resistance issues. But if they have many neurocognitive problems, we might start with the NF kappa B. So, that’s the way you can decide which ones to pick. Now, remember, when talking with patients, it is important to discuss how their eating habits are causing inflammation in their bodies. It is also important to note that it’s not just a quality conversation; it’s a quantity conversation and an immune conversation.
This reminds you that when you fix the gut by feeding it well and reducing its inflammatory tone, you get a host of other preventative benefits; you stop or at least reduce the strength of the dysfunction. And you can see that, ultimately can reduce the overlapping risk of obesity, diabetes, and metabolic syndrome. We are trying to drive home that metabolic endotoxemia, or just managing the microbiome, is a powerful tool to help your insulin-resistant or cardiometabolic patients. So much data tells us that we cannot just make the conversation about eating right and exercising.
It’s so much beyond that. So the more we can improve the gut microbiota, we can change inflammation signals through proper diet, exercise, stress management, sleep, all the other things we’ve been talking about, and fixing the gums and the teeth. The less the inflammation, the less the insulin dysfunction and, therefore, the less all those downstream disease effects. So what we want to make sure you know is to go to the gut and make sure that the gut microbiome is happy and tolerant. It’s one of the most potent ways to influence a healthy cardiometabolic phenotype. And aside, although it was a bigger thing a decade ago, non-caloric artificial sweeteners do as they might be non-caloric. And so people may be tricked into thinking it’s zero sugar.
But here’s the problem. These artificial sweeteners can interfere with healthy microbiome compositions and induce more type two phenotypes. So, even though you think you’re getting the benefit with no calories, you’re going to increase your risk for diabetes more through its effect on the gut microbiome. All right, We’ve made it through objective one. Hopefully, you’ve learned that insulin, inflammation, adipokines, and all the other things that happen in the endocrine response affect many organs. So let’s now start to look at emerging risk markers. Okay, we’ve talked a bit about TMAO. Again, that’s still a relevant concept here with gut and insulin resistance. So we want to make sure that you look at TMAO not as the end all be all but as another emerging biomarker that could give you a clue about microbiome health in general.
Looking For The Inflammatory Markers
Dr. Alex Jimenez, D.C., presents: We look at elevated TMAO to help the patient recognize that they have changed their eating habits. Most of the time, we help patients reduce unhealthy animal proteins and increase their plant-based nutrients. It’s generally how many doctors use it in standard medical practice. Alright, now another emerging biomarker, okay, and it sounds funny to call it emerging because it seems so obvious, and that is insulin. Our standard of care is centralized around glucose, fasting glucose, to our postprandial glucose A1C as a measure of glucose. We are glucose so centric and need insulin as an emerging biomarker if we try to be preventative and proactive.
And as you remember, we talked yesterday that fasting insulin in the bottom of the first quartile of your reference range for fasting insulin might be where you want to go. And for us in the US, that tends to be between five and seven as a unit. So notice that this is the pathophysiology of type two diabetes. So type two diabetes can happen from insulin resistance; it can also occur from mitochondrial problems. So pathophysiology of type two diabetes could be because your pancreas is not secreting enough insulin. So again, this is that little 20% that we talk about the majority of the people who are getting type two diabetes; it’s from insulin resistance, as we would suspect, from a hyper insulin problem. But there is this group of people who have damaged mitochondria, and they are not outputting insulin.
So their blood sugar rises, and they get type two diabetes. Okay, then the question is, if there is a problem with pancreatic beta cells, why is there a problem? Is the glucose going up because the muscles have insulin resistance, so they cannot capture and bring in glucose? So is it the liver that’s hepatic insulin resistant that cannot take in glucose for energy? Why is this glucose running around in the bloodstream? That’s what this is paraphrasing. So contributing role, you have to look at the adipocytes; you have to look for visceral adiposity. You must see if this person is just a big belly fat inflammatory-like catalyst. What can we do to reduce that? Is the inflammation coming from the microbiome?
Conclusion
Dr. Alex Jimenez, D.C., presents: Even the kidney can play a role in this, right? Like perhaps the kidney has increased glucose reabsorption. Why? Could it be because of an oxidative stress hit to the kidney, or could it be in the HPA axis, the hypothalamus pituitary adrenal axis where you’re getting this cortisol response and this sympathetic nervous system response that’s generating inflammation and driving the blood insulin and blood sugar disturbances? In Part 2, we will talk here about the liver. It’s a common player for many people, even if they don’t have fulminant fatty liver disease; it’s generally a subtle and common player for people with cardiometabolic dysfunction. So remember, we’ve got the visceral adiposity causing inflammation and insulin resistance with atherogenesis, and the liver is like this innocent bystander caught up in the drama. It’s happening before sometimes the atherogenesis starts.
Winter is when most children and adults are prone to catching colds, the flu, etc. The excitement of the holiday season can also take a toll on the body’s neuromusculoskeletal system, leaving the individual more susceptible to illness. Digestive issues such as bloating, cramping, and constipation are also common. Certain supplements can help maintain body, gut, and brain holiday health. Here are a few recommended supplements to take during the holidays.
Holiday Health
To help fill in the gaps from the holiday foods and increase energy, holiday health supplements to consider adding include:
Probiotics
Probiotics are healthy bacteria and microbes that populate the gut or microbiome.
They help digest nutrients, support proper digestion and elimination, and manage appetite and mood.
A quality probiotic supplement supports healthy digestion and immune health.
It can help reduce diarrhea, constipation, gas, and bloating while protecting the immune system against pathogens.
For the most benefits, it is recommended to take a supplement with a high CFU count, diverse probiotic strains, and a delivery method that ensures the probiotics will survive once consumed.
The body produces melatonin naturally, especially at night, since this promotes sleep.
Melatonin is a hormone that helps regulate the body’s circadian rhythm, which makes you feel tired or alert at the right times of the day.
Taking melatonin can help decrease jet lag symptoms.
Consider taking melatonin to help promote healthy sleep.
However, it’s usually only recommended for short-term use, so consult your doctor.
Vitamin D
During the winter, when less sunlight is available, low vitamin D levels are very common among adults.
The body naturally makes vitamin D when the skin is exposed to the sun’s UV light rays; however, most spend nearly all their time indoors once the weather becomes cold.
Vitamin D is responsible for hundreds of reactions related to brain function, hormone production, and immune defenses.
A vitamin D supplement can help maintain healthy levels, which is important for maintaining a strong immune system, cardiovascular and bone health, and mood.
Magnesium
Magnesium is a mineral and electrolyte providing cardiovascular and bone support, improved sleep, healthy muscle and nerve function, and healthy digestion.
A magnesium supplement can help with aches and pains, restlessness, headaches, and constipation.
Vitamin C
Vitamin C intake protects against colds and other illnesses.
It supports healthy immune defenses, healthy nervous system function, antioxidant activity, neuron function, and skin health.
A vitamin C supplement combined with probiotics further helps support healthy gastrointestinal function and absorption.
Chiropractic For Digestive Health
Chiropractic care supports the healthy functioning of the nervous system.
The vagus nerve extends from the brain stem and innervates digestive system organs.
Sympathetic nerves in the thoracic and lumbar regions and the parasympathetic nerves near the sacrum also support digestion.
Decompressing the spine and correcting posture allow room for the muscles to contract, open up the spine to circulate fluids throughout the body, and expand and properly circulate food and waste.
Ernst, Edzard. “Chiropractic treatment for gastrointestinal problems: a systematic review of clinical trials.” Canadian journal of gastroenterology = Journal canadien de gastroenterology vol. 25,1 (2011): 39-40. doi:10.1155/2011/910469
Govender, Mershen et al. “A review of the advancements in probiotic delivery: Conventional vs. non-conventional formulations for intestinal flora supplementation.” AAPS PharmSciTech vol. 15,1 (2014): 29-43. doi:10.1208/s12249-013-0027-1
Leboeuf-Yde, Charlotte, et al. “Self-reported nonmusculoskeletal responses to chiropractic intervention: a multination survey.” Journal of manipulative and physiological therapeutics vol. 28,5 (2005): 294-302; discussion 365-6. doi:10.1016/j.jmpt.2005.04.010
Peterson, Caroline. “A case study of chiropractic management of pregnancy-related heartburn with postulated fetal epigenome implications.” Explore (New York, N.Y.) vol. 8,5 (2012): 304-8. doi:10.1016/j.explore.2012.06.001
Qu, Liuxin, et al. “Irritable bowel syndrome treated by traditional Chinese spinal orthopedic manipulation.” Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan vol. 32,4 (2012): 565-70. doi:10.1016/s0254-6272(13)60072-2
Back pain is one of the most common reasons individuals go to a doctor, massage therapist, physiotherapist, osteopath, and chiropractor. Various health conditions, some spine-related, others not, list back pain as a symptom. Many of these conditions begin in the stomach or abdominal cavity, which leads to stomach and back pain. Stomach and back pain happening simultaneously, independently, or in combination could be caused by gut problems, back issues, or something completely different. Understanding what causes these two types of pain simultaneously can help figure out a treatment plan.
Stomach Back Pain Causes
Problems in the abdominal cavity and stomach issues can cause back pain and vice versa. Symptoms can also include referred pain when the pain is felt in one part of the body but is caused by pain or injury in another area. Stomach back pain causes depend on the type of condition/s that can include:
Appendicitis
Inflammation in the appendix can cause sudden sharp pain in the abdomen.
It presents mostly in the lower right area of the abdomen but can appear in or spread to other sites, especially the back.
A chiropractic functional medicine team can work with an individual’s primary physician or specialist to develop a personalized treatment plan to alleviate back pain symptoms, re-balance the body, strengthen the musculoskeletal system and restore function.
Inadomi JM, Bhattacharya R, Hwang JH, Ko C. Chapter 7, The Patient with Gas and Bloating. Yamada’s Handbook of Gastroenterology. 4th ed. John Wiley & Sons; 2019. doi.org/10.1002/9781119515777.ch7
Krames E, Mousad DG. Spinal Cord Stimulation Reverses Pain and Diarrheal Episodes of Irritable Bowel Syndrome: A Case Report. Neuromodulation. 2004 Mar 22;7(2):82-88. doi.org/10.1111/j.1094-7159.2004.04011.x
Stephen Norman Sullivan, “Functional Abdominal Bloating with Distention,” International Scholarly Research Notices, vol. 2012, Article ID 721820, 5 pages, 2012. doi.org/10.5402/2012/721820
Weisman, Michael H et al. “Axial Pain and Arthritis in Diagnosed Inflammatory Bowel Disease: US National Health and Nutrition Examination Survey Data.” Mayo Clinic proceedings. Innovations, quality & outcomes vol. 6,5 443-449. 16 Sep. 2022, doi:10.1016/j.mayocpiqo.2022.04.007
Whorwell PJ. Chapter 13, Abdominal Bloating. Irritable Bowel Syndrome: Diagnosis and Clinical Management. Emmanuel A, Quigley EMM (eds.). John Wiley & Sons; 2013. doi.org/10.1002/9781118444689.ch13
The body needs food for fuel, energy, growth, and repair. The digestive process breaks down food into a form the body can absorb and use for fuel. The broken-down food gets absorbed into the bloodstream from the small intestine, and the nutrients are carried to the cells throughout the body. Understanding how the organs work together to digest food can help with health goals and overall health.
The Digestive Process
The organs of the digestive system are the following:
The digestive process starts with the anticipation of eating, stimulating the glands in the mouth to produce saliva. The digestive system’s primary functions include:
Mixing food
Moving food through the digestive tract – peristalsis
The chemical breakdown of food into smaller absorbable components.
The digestive system converts food into its simplest forms, which include:
Glucose – sugars
Amino acids – protein
Fatty acids – fats
Proper digestion extracts nutrients from food and liquids to maintain health and function properly. Nutrients include:
Carbohydrates
Proteins
Fats
Vitamins
Minerals
Water
Mouth and Esophagus
The food is ground up by the teeth and moistened with saliva to swallow easily.
Saliva also has a special chemical enzyme that starts breaking down carbohydrates into sugars.
Muscular contractions of the esophagus massage the food into the stomach.
Stomach
The food passes through a small muscle ring into the stomach.
It gets mixed with gastric chemicals.
The stomach churns the food to break it down further.
The food is then squeezed into the first part of the small intestine, the duodenum.
Small Intestine
Once in the duodenum, the food mixes with more digestive enzymes from the pancreas and bilefrom the liver.
The food passes into the lower parts of the small intestine, called the jejunum and the ileum.
Nutrients are absorbed from the ileum, lined with millions of villi or thread-like fingers that facilitate the absorption.
Each villus is connected to a mesh of capillaries, which is how nutrients get absorbed into the bloodstream.
Pancreas
The pancreas is one of the largest glands.
It secretes digestive juices and a hormone called insulin.
Insulin helps regulate the amount of sugar in the blood.
The liver has several different roles that include:
Breaks down fats using bile stored in the gallbladder.
Processes proteins and carbohydrates.
Filters and processes impurities, medications, and toxins.
Generates glucose for short-term energy from compounds like lactate and amino acids.
Large Intestine
A large reservoir of microbes and healthy bacteria live in the large intestine and play an important role in healthy digestion.
Once the nutrients have been absorbed, the waste is passed into the large intestine or bowel.
Water is removed, and the waste gets stored in the rectum.
It is then passed out of the body through the anus.
Digestive System Health
Ways to keep the digestive system and the digestive process healthy include:
Drink More Water
Water helps the food flow more easily through the digestive system.
Low amounts of water/dehydration are common causes of constipation.
Add More Fiber
Fiber is beneficial to digestion and helps with regular bowel movements.
Incorporate both soluble and insoluble fiber.
Soluble fiber dissolves in water.
As soluble fiber dissolves, it creates a gel that can improve digestion.
Soluble fiber may reduce blood cholesterol and sugar.
It helps your body improve blood glucose control, which can aid in reducing your risk for diabetes.
Insoluble fiber does not dissolve in water.
Insoluble fiber attracts water into the stool, making it softer and easier to pass with less strain on the bowels.
Insoluble fiber can help promote bowel health and regularity and supports insulin sensitivity which can help reduce the risk of diabetes.
Balanced Nutrition
Eat fruit and vegetables daily.
Choose whole grains over processed grains.
Avoid processed foods in general.
Choose poultry and fish more than red meat and limit processed meats.
Cut down on sugar.
Eat Foods with Probiotics or Use Probiotic Supplements
Probiotics are healthy bacteria that help combat unhealthy bacteria in the gut.
They also generate healthy substances that nourish the gut.
Consume probiotics after taking antibiotics that often kill all the bacteria in the gut.
Eat Mindfully and Chew Food Slowly
Chewing food thoroughly helps to ensure the body has enough saliva for digestion.
Chewing food thoroughly also makes it easier for nutritional absorption.
Eating slowly gives the body time to digest thoroughly.
It also allows the body to send cues that it is full.
How The Digestive System Works
References
GREENGARD, H. “Digestive system.” Annual review of physiology vol. 9 (1947): 191-224. doi:10.1146/annurev.ph.09.030147.001203
Hoyle, T. “The digestive system: linking theory and practice.” British journal of nursing (Mark Allen Publishing) vol. 6,22 (1997): 1285-91. doi:10.12968/bjon.1997.6.22.1285
Martinsen, Tom C et al. “The Phylogeny and Biological Function of Gastric Juice-Microbiological Consequences of Removing Gastric Acid.” International journal of molecular sciences vol. 20,23 6031. 29 Nov. 2019, doi:10.3390/ijms20236031
Ramsay, Philip T, and Aaron Carr. “Gastric acid and digestive physiology.” The Surgical clinics of North America vol. 91,5 (2011): 977-82. doi:10.1016/j.suc.2011.06.010
Fermentation is a process where bacteria and yeast are used to break down foods. The fermentation process has been around for centuries and was initially produced to preserve foods, improve flavor and eliminate toxins. Research has found that eating fermented foods can also increase the beneficial bacteria/probiotics in the gut. Functional medicine practitioners recommend these foods for their health benefits, including improved digestion, increased immunity, and weight loss and maintenance.
Fermented Foods
Fermented foods and beverages undergo controlled microbial growth and fermentation in which microorganisms like yeast and bacteria break down food elements like sugars/glucose into other products like organic acids, gases, or alcohol. The process gives fermented foods unique taste, aroma, texture, and appearance. There are many different types of fermented foods, including:
Whole foods like vegetables, fruits, cereals, dairy, meat, fish, eggs, legumes, nuts, and seeds can go through fermentation. These foods are nutritious in their original form, but through fermentation, they can provide probiotic and prebiotic health benefits.
Probiotics
Probiotics are live microorganisms that benefit the gut by creating a more favorable digestive environment. This helps:
Digest food easier.
Support a healthy immune system.
Support organ health – lungs, reproductive organs, skin.
Improves mood.
However, not all fermented foods contain probiotics, especially commercially produced foods that are pasteurized, killing bacteria and their associated health benefits.
Prebiotics
Prebiotics are food ingredients that the microorganisms like gut bacteria consume to grow and live, leading to improving the digestive environment. These include:
Milk
Honey
Tomato
Garlic
Onions
Asparagus
Wheat
Barley
Rye
However, most fruits, vegetables, and legumes contain prebiotics.
The Benefits of Fermented Foods
Fermented foods’ health benefits include reduced risk of:
Diabetes
Inflammation
High blood pressure
Cardiovascular disease
Obesity
They have also been linked to:
Better weight management
Improved brain activity
Increased bone health
Faster recovery after exercise and physical activity
There are currently no official guidelines regarding how often individuals should eat fermented foods. It is recommended to consult a nutritionist or dietician to figure out the best nutrition plan for the individual and their needs.
The Science
References
Aslam, Hajara, et al. “Fermented foods, the gut, and mental health: a mechanistic overview with implications for depression and anxiety.” Nutritional neuroscience vol. 23,9 (2020): 659-671. doi:10.1080/1028415X.2018.1544332
Dimidi, Eirini, et al. “Fermented Foods: Definitions and Characteristics, Impact on the Gut Microbiota and Effects on Gastrointestinal Health and Disease.” Nutrients vol. 11,8 1806. 5 Aug. 2019, doi:10.3390/nu11081806
King, Sarah, et al. “Effectiveness of probiotics on the duration of illness in healthy children and adults who develop common acute respiratory infectious conditions: a systematic review and meta-analysis.” The British journal of nutrition vol. 112,1 (2014): 41-54. doi:10.1017/S0007114514000075
Kok, Car Reen, and Robert Hutkins. “Yogurt and other fermented foods as sources of health-promoting bacteria.” Nutrition reviews vol. 76, Suppl 1 (2018): 4-15. doi:10.1093/nutrit/nuy056
Parker, Elizabeth A et al. “Probiotics and gastrointestinal conditions: An overview of evidence from the Cochrane Collaboration.” Nutrition (Burbank, Los Angeles County, Calif.) vol. 45 (2018): 125-134.e11. doi:10.1016/j.nut.2017.06.024
Şanlier, Nevin, et al. “Health benefits of fermented foods.” Critical reviews in food science and nutrition vol. 59,3 (2019): 506-527. doi:10.1080/10408398.2017.1383355
Nutritionists are medical professionals in food and nutrition and work one-on-one to develop an optimal nutrition plan for their body type, age, and health conditions. They explain the right foods to eat, how different foods impact the body, and what foods to avoid. Individuals can benefit from working with a nutritionist to help achieve a healthier lifestyle through education and healthy choices.
Working With A Nutritionist
Nutritionists work with individuals to enhance their knowledge about general nutrition, food, and health. Their focus is on food behavior, which includes developing and implementing meal plans to improve the individual’s or family’s nutrition. Nutritionists work in:
Clinical settings – hospitals, nursing homes, long-term care facilities, fitness and health, and chiropractic clinics.
Government – local health departments.
School districts – regarding school nutrition standards.
Private business – independent work in combination with other medical professionals.
Research – with various health and/or sports organizations.
Benefits
Working with a nutritionist will determine what factors are challenging an individual’s eating habits and triggers and find ways to overcome those barriers. Benefits include:
Nutrition plans are based on nutritional needs, current health, and lifestyle.
Nutrition plans cut down on grocery bills.
Shopping with a specific list cuts down on the extra foods being purchased.
Proper nutrition can help manage chronic diseases like diabetes and heart disease, combined with a primary care doctor or specialist treatment.
Nutritionists can help individuals dealing with food allergies or who have been diagnosed could require a diet change.
Nutritionists can help motivate when struggling to maintain a healthy lifestyle.
Responsibilities and Daily Activities
Nutritionists help individuals reach various goals, like weight loss, healthier eating habits, and stress management, and can be responsible for the following:
Evaluating health needs.
Screening for nutritional risk.
Discussing nutrition and eating habits.
Providing educational resources.
Developing personalized nutrition plans.
Talking about nutritional issues with individual families.
Discussing nutrition plans with primary doctors and other healthcare teams.
Equipping individuals with food behavior modification tools.
Adjusting plans as needed.
Monitoring progress.
Treating conditions and disease management through nutrition.
Functional Nutrition
References
Carrard, Isabelle et al. “Un outil pour évaluer les comportements alimentaires: ESSCA” [A tool for assessing eating behaviors: ESSCA]. Revue medicale suisse vol. 12,511 (2016): 591-6.
Golan, M, and A Weizman. “Reliability and validity of the Family Eating and Activity Habits Questionnaire.” European journal of clinical nutrition vol. 52,10 (1998): 771-7. doi:10.1038/sj.ejcn.1600647
Greenwood, Jessica L J, et al. “Healthy eating vital sign: a new assessment tool for eating behaviors.” ISRN obesity vol. 2012 734682. 22 Jul. 2012, doi:10.5402/2012/734682
Kelley, Claire P et al. “Behavioral Modification for the Management of Obesity.” Primary care vol. 43,1 (2016): 159-75, x. doi:10.1016/j.pop.2015.10.004
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