The Gut "Connections to Health & Disease"

For individuals dealing with constipation issues, can using an osmotic laxative help treat and prevent constipation?

Osmotic Laxative

Osmotic laxatives can help treat or prevent constipation by increasing the amount of water in the colon, softening stools, and making them easier to pass. Some osmotic laxatives are used for bowel preparation to help clear the colon before a colonoscopy. They are available over the counter and by prescription and can contain different active ingredients, including polyethylene glycol/PEG, lactulose, sorbitol, magnesium citrate, and magnesium hydroxides.

How They Work

Constipation occurs when stools are irregular and hard to pass, as they are usually hard and dry. An osmotic laxative helps relieve constipation by increasing the amount of fluid in the intestines. They pull water from the colon's wall to the inside, softening stools and making them easier to pass. The term osmotic refers to the movement of fluids through a membrane with the concentration equal on both sides. In individuals with constipation problems, the concentration of water in the colon's wall and the inside of the colon/lumen is balanced but insufficient to compensate for hard, dry stools. This is especially true of those who don't drink enough water. Osmotic laxatives alter the balance with substances like salts, sugars, and other organic compounds to encourage water movement into the lumen.

How Are They Different?

Most laxatives are generally used for the treatment of occasional constipation. Osmotic laxatives work differently because they are used to prevent or treat chronic constipation. Other types of laxatives include:

Emollient

• These are made with a surfactant called docusate.
• Surfactants are substances that draw and spread fats and water.
• Docusate increases the passage of water and fats into stools to soften them.

Lubricant

• These are made with oily substances, like mineral oil, that help the stool slide through the intestine.

Stimulant

• These laxatives relieve constipation by causing the intestines to contract and push out the stools.

Osmotic Laxatives

The common osmotic laxatives are made with different active ingredients that include:

Polyethylene Glycol - PEG

• This organic compound is derived from petroleum and can be safely ingested to manage constipation.
• Available over the counter.
• These include Miralax and GlycoLax.

Lactulose

• This is a type of sugar that is not absorbed by the intestine.
• Instead, the sugar sits and ferments in the intestines, producing fatty acids that pull water into the lumen.
• Available by prescription, including Cephulac, Duphalac, Kristalose, and others.

Sorbitol

• This is also a non-absorbable sugar with activation similar to lactulose.
• Over-the-counter and prescription versions include Arlex and GeriCare.

Magnesium Citrate

• Magnesium citrate is magnesium in salt form combined with citric acid.
• The salts help pull water into the lumen.
• Over-the-counter versions include Citrate of Magnesia, Citroma, and LiquiPrep.

Magnesium Hydroxide

• This milder form of magnesium is sold under the brand Milk of Magnesia.
• Milk of Magnesia is also an antacid and is available over the counter.

Potential Side Effects

As with all medications, there can be potential side effects. Most are relatively mild and resolve independently within a few days. Common side effects include:

• Abdominal cramping
• Bloating
• Nausea
• Diarrhea
• Flatulence

Overusing laxatives can cause dehydration and the loss of electrolytes like sodium, calcium, potassium, minerals the body needs to regulate heartbeat, muscle contractions, and other essential functions. (Tropini, C. et al., 2018) Consult with a healthcare provider to ensure you use any laxative correctly, whether over-the-counter or prescription. For those thinking about using osmotic laxatives, be sure to follow the dosing instructions carefully, avoid complications, and use only when needed. Individuals with chronic constipation should see a healthcare provider so that they can identify the underlying cause. Diet, exercise, and increased fluid intake can improve the condition. Others may require treatments that extend beyond the use of laxatives.

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to create personalized treatment programs. We passionately focus on treating patients’ injuries and chronic pain syndromes. Using an integrated approach to improve ability through flexibility, mobility, and agility programs tailored to the individual. Our providers use Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers if other treatments are needed. Our goal is to relieve pain naturally by restoring health and function to the body.

Poop Testing: What? Why? and How?

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Tropini, C., Moss, E. L., Merrill, B. D., Ng, K. M., Higginbottom, S. K., Casavant, E. P., Gonzalez, C. G., Fremin, B., Bouley, D. M., Elias, J. E., Bhatt, A. S., Huang, K. C., & Sonnenburg, J. L. (2018). Transient Osmotic Perturbation Causes Long-Term Alteration to the Gut Microbiota. Cell, 173(7), 1742–1754.e17. https://doi.org/10.1016/j.cell.2018.05.008

Can incorporating nopal or prickly pear cactus into one's diet help individuals trying to lower blood glucose, inflammation, and risk factors associated with heart and metabolic diseases? 

Nopal

Nopal, also known as prickly pear cactus, is a versatile vegetable that can be added to nutrition plans to increase fiber intake, vitamins, minerals, and plant-based compounds.  It grows in the U.S. Southwest, Latin America, and the Mediterranean. The pads, or the nopales or cactus paddles, have a texture like okra and slight tartness. The prickly pear cactus fruit, referred to as tuna in Spanish, is also consumed. (University of Arizona Cooperative Extension, 2019) It is often used in fruit salsas, salads, and desserts and is available as a supplement in tablet and powder form.

Serving Size and Nutrition

One cup of cooked nopales, around five pads, without added salt, contains: (U.S. Department of Agriculture, FoodData Central, 2018)

• Calories - 22
• Fat - 0 grams
• Sodium - 30 milligrams
• Carbohydrates - 5 grams
• Fiber - 3 grams
• Sugars - 1.7 grams
• Protein - 2 grams
• Vitamin A - 600 international units
• Vitamin C - 8 milligrams
• Vitamin K - 8 micrograms
• Potassium - 291 milligrams
• Choline - 11 milligrams
• Calcium - 244 milligrams
• Magnesium - 70 milligrams

It is generally recommended that most individuals consume 2.5 to 4 cups of vegetables per day. (U.S. Department of Agriculture, MyPlate, 2020)

Benefits

Nopal is highly nutritious, low in calories, free of fat, sodium, or cholesterol, and full of fiber, vitamins, minerals, and betalains. (Parisa Rahimi et al., 2019) Betalains are pigments with anti-inflammatory properties. The variety of fibers creates a low glycemic index (measures how much a specific food raises blood sugar levels after consumption) of about 32, a recommended addition to a diabetes-friendly diet. (Patricia López-Romero et al., 2014)

Compounds

• Nopal contains a variety of beneficial carbohydrates, vitamins, and minerals.
• Nopal has soluble and insoluble fiber, which benefits blood sugar.
• It also contains vitamin A, carotenoids, vitamin C, calcium, and plant-based compounds like phenols and betalains. (Karina Corona-Cervantes et al., 2022)

Blood Sugar Regulation

Research has evaluated regular nopal consumption and supplementation for blood sugar control. A study on blood sugar evaluated adding nopal to a high-carbohydrate breakfast or a breakfast high in soy protein in Mexican individuals with type 2 diabetes. The study found that consuming nopales, about 300 grams or 1.75 to 2 cups before a meal, could reduce after-meal/postprandial blood sugars. (Patricia López-Romero et al., 2014) An older study had similar results. (Montserrat Bacardi-Gascon et al., 2007) Individuals were randomly assigned to consume 85 grams of nopal with three different breakfast options:

• Chilaquiles - a casserole made with corn tortilla, vegetable oil, and pinto beans.
• Burritos - made with eggs, vegetable oil, and pinto beans.
• Quesadillas - made with flour tortillas, low-fat cheese, avocado, and pinto beans.
• The groups assigned to eat nopales had reductions in blood sugar. There was a:
• 30% reduction in the chilaquiles group.
• 20% decrease in the burrito group.
• 48% reduction in the quesadilla group.

However, the studies were small, and the population was not diverse. so further research is needed.

Increased Fiber

The combination of soluble and insoluble fiber benefits the gut in various ways. Soluble fiber can act as a prebiotic, feeding beneficial bacteria in the gut and assisting in removing low-density lipoprotein (LDL) cholesterol from the body. Insoluble fiber increases transit time, or how quickly food moves through the digestive system and promotes bowel regularity. (Centers for Disease Control and Prevention, 2022) In a short-term randomized clinical control trial, researchers found an improvement in irritable bowel syndrome symptoms in individuals supplemented with 20 and 30 grams of nopal fiber. (Jose M Remes-Troche et al., 2021) For individuals not used to consuming fibrous foods, it may cause mild diarrhea, so it is recommended to increase intake slowly and with adequate water to prevent gas and bloating.

Plant Based Calcium

One cup of nopal provides 244 milligrams or 24% of daily calcium needs. Calcium is a mineral that optimizes bone and teeth health. It also assists in blood vessel contraction and dilation, muscle function, blood clotting, nerve transmission, and hormonal secretion. (National Institutes of Health. Office of Dietary Supplements 2024) Individuals who follow diets that exclude dairy products can benefit from plant-based calcium sources. This includes cruciferous vegetables like kale, collards, and arugula.

Other Benefits

Studies done in animals and test tubes suggest that fresh nopal and extracts may assist in reducing triglycerides and cholesterol in metabolic dysfunction-associated steatotic liver disease or when unhealthy amounts of fat accumulate in the liver. (Karym El-Mostafa et al., 2014) Other potential benefits with limited evidence include:

• Inflammation and pain reduction.
• Body mass index (BMI), systolic, and diastolic blood pressure reduction. (Igho J Onakpoya et al., 2015)
• Positive changes in the gut microbiota and weight loss. (Karina Corona-Cervantes et al., 2022)

Consult a Dietician or Healthcare Provider

Unless individuals are allergic to it, most can eat whole nopal without a problem. However, supplementing is different because it provides a concentrated source. Individuals taking medication to manage diabetes and consuming nopal regularly may contribute to an increased risk of developing hypoglycemia or low blood sugar. Dermatitis has also been reported from contact with the cactus spines. (U.S. Department of Agriculture, FoodData Central, 2018) There have been rare reports of bowel obstruction in individuals who consume large amounts of the seeds found in the fruit. (Karym El-Mostafa et al., 2014) Ask a registered dietitian or primary healthcare provider if nopal can provide safe benefits.

Nutrition Fundamentals

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies that are available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

University of Arizona Cooperative Extension. Hope Wilson, M. W., Patricia Zilliox. (2019). Prickly pear cactus: food of the desert. https://extension.arizona.edu/sites/extension.arizona.edu/files/pubs/az1800-2019.pdf

U.S. Department of Agriculture. FoodData Central. (2018). Nopales, cooked, without salt. Retrieved from https://fdc.nal.usda.gov/fdc-app.html#/food-details/169388/nutrients

U.S. Department of Agriculture. MyPlate. (2020-2025). Vegetables. Retrieved from https://www.myplate.gov/eat-healthy/vegetables

Rahimi, P., Abedimanesh, S., Mesbah-Namin, S. A., & Ostadrahimi, A. (2019). Betalains, the nature-inspired pigments, in health and diseases. Critical reviews in food science and nutrition, 59(18), 2949–2978. https://doi.org/10.1080/10408398.2018.1479830

López-Romero, P., Pichardo-Ontiveros, E., Avila-Nava, A., Vázquez-Manjarrez, N., Tovar, A. R., Pedraza-Chaverri, J., & Torres, N. (2014). The effect of nopal (Opuntia ficus indica) on postprandial blood glucose, incretins, and antioxidant activity in Mexican patients with type 2 diabetes after consumption of two different composition breakfasts. Journal of the Academy of Nutrition and Dietetics, 114(11), 1811–1818. https://doi.org/10.1016/j.jand.2014.06.352

Corona-Cervantes, K., Parra-Carriedo, A., Hernández-Quiroz, F., Martínez-Castro, N., Vélez-Ixta, J. M., Guajardo-López, D., García-Mena, J., & Hernández-Guerrero, C. (2022). Physical and Dietary Intervention with Opuntia ficus-indica (Nopal) in Women with Obesity Improves Health Condition through Gut Microbiota Adjustment. Nutrients, 14(5), 1008. https://doi.org/10.3390/nu14051008

Bacardi-Gascon, M., Dueñas-Mena, D., & Jimenez-Cruz, A. (2007). Lowering effect on postprandial glycemic response of nopales added to Mexican breakfasts. Diabetes care, 30(5), 1264–1265. https://doi.org/10.2337/dc06-2506

Centers for Disease Control and Prevention. (2022). Fiber: the carb that helps you manage diabetes. Retrieved from https://www.cdc.gov/diabetes/library/features/role-of-fiber.html

Remes-Troche, J. M., Taboada-Liceaga, H., Gill, S., Amieva-Balmori, M., Rossi, M., Hernández-Ramírez, G., García-Mazcorro, J. F., & Whelan, K. (2021). Nopal fiber (Opuntia ficus-indica) improves symptoms in irritable bowel syndrome in the short term: a randomized controlled trial. Neurogastroenterology and motility, 33(2), e13986. https://doi.org/10.1111/nmo.13986

National Institutes of Health (NIH). Office of Dietary Supplements. (2024). Calcium. Retrieved from https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

El-Mostafa, K., El Kharrassi, Y., Badreddine, A., Andreoletti, P., Vamecq, J., El Kebbaj, M. S., Latruffe, N., Lizard, G., Nasser, B., & Cherkaoui-Malki, M. (2014). Nopal cactus (Opuntia ficus-indica) as a source of bioactive compounds for nutrition, health and disease. Molecules (Basel, Switzerland), 19(9), 14879–14901. https://doi.org/10.3390/molecules19091487

Onakpoya, I. J., O'Sullivan, J., & Heneghan, C. J. (2015). The effect of cactus pear (Opuntia ficus-indica) on body weight and cardiovascular risk factors: a systematic review and meta-analysis of randomized clinical trials. Nutrition (Burbank, Los Angeles County, Calif.), 31(5), 640–646. https://doi.org/10.1016/j.nut.2014.11.015

Corona-Cervantes, K., Parra-Carriedo, A., Hernández-Quiroz, F., Martínez-Castro, N., Vélez-Ixta, J. M., Guajardo-López, D., García-Mena, J., & Hernández-Guerrero, C. (2022). Physical and Dietary Intervention with Opuntia ficus-indica (Nopal) in Women with Obesity Improves Health Condition through Gut Microbiota Adjustment. Nutrients, 14(5), 1008. https://doi.org/10.3390/nu14051008

For individuals wanting to eat pancakes regularly, are there ways to increase pancake nutrition and lower the calorie and carb counts so they can be included in a balanced diet?

Pancake Nutrition

This high-carbohydrate meal can provide enough energy to fuel a day's physical activity.

Nutrition

The following nutrition information is provided for:

• Two regular pancakes made with white flour - 154g. (USDA Food Data Central. 2019)
• Butter - 1 teaspoon, unsalted. (USDA Food Data Central. 2019)
• Syrup - 1 tablespoon. (USDA Food Data Central. 2019)

1. Calories - 430.8
2. Fat - 18.77g
3. Sodium - 693.9mg
4. Carbohydrates - 55.9g
5. Fiber - .75g
6. Sugars - 8.6g
7. Protein - 8.64g

Pancakes made with whole-wheat flour offer more fiber and protein. The following is nutrition info for two or three whole-wheat pancakes (150g) made from a mix. (Child Nutrition Recipe Box. 2023)

1. Calories - 348
2. Fat - 15g
3. Sodium - 594mg
4. Carbohydrates - 45g
5. Fiber - 6g
6. Sugars - 6g
7. Protein - 12g

Carbohydrates

Pancakes will increase carbohydrate intake. The body uses carbohydrates as a primary fuel source, making them an important nutrient. However, most nutritionists suggest that individuals get their daily carbohydrates from nutrient-dense sources. Pancakes typically don't fall into this category. White flour pancakes do not provide much fiber, and around 60 grams of carbohydrates are consumed in this meal. Substituting whole-wheat flour changes the amount to around 6g of fiber or 20% of the daily recommended value.

Fat

Pancakes can include dairy and eggs and are topped with butter that contributes a significant amount of fat. Pancake mix may contain trans fat. Some brands include partially hydrogenated oils. Health experts recommend that individuals limit or completely avoid foods containing trans fat. If the label ingredient list contains partially hydrogenated ingredients, it is recommended to avoid it. (MedlinePlus. 2022)

Protein

Pancakes may provide some protein, which varies based on the type of flour used. Some brands add protein powder to increase intake.

Vitamins and Minerals

Pancakes and ready mixes are generally made from enriched flour. Enriched foods are those that have had nutrients added during the manufacturing process. In most cases, the nutrients, vitamins, and minerals are stripped away, and then some are added back in during processing. Constantly eating enriched bread products limits diet-friendly fiber and nutrients. The enriched flour in pancakes and added sugar and syrup raise blood sugar levels rapidly and then generate hunger shortly afterward.​

Calories

Total nutrition numbers also depend on serving size. The numbers on the label only apply to a single serving which is just two medium pancakes. Many individuals consume 3-4 medium pancakes and double the amount of butter and syrup as well. This can add up to more than 1,000 calories.

Benefits

Whole-wheat pancakes made with whole-grain flour are more nutritious than pancakes made with white flour and can be a delicious way to eat more whole grains. They can be topped with berries or other fruits for added fiber and nutrients.

Digestion

Whole-wheat pancakes made with whole-grain flour provide significant fiber for healthy digestion. Fiber helps with waste evacuation and has prebiotic compounds that fuel beneficial gut bacteria. (Joanne Slavin. 2013)

Improves Hunger Satisfaction

Whole-grain pancakes taste heartier and include fiber that keeps the body fuller longer than pancakes made with faster-digesting refined flour.

Decreases Risk of Heart Disease

A review of studies examining whole grain consumption and heart disease found that eating whole grains was associated with a reduced risk of heart disease. (Dagfinn Aune, et al., 2016)

Reduces Risk of Obesity

Research suggests that whole grain intake reduces the risk of obesity and could help individuals maintain a stable weight. (Katrina R. Kissock et al., 2021) The fiber will also help keep the fuller longer after the meal.

Helps Prevent Birth Defects

Whole-wheat flour is fortified with folic acid, an important B vitamin during pregnancy. Folic acid decreases the risk of neural tube defects, which can affect the development of the brain or spine. (Centers for Disease Control and Prevention. 2022)

Variations

Nutrients for regular pancakes will vary based on the size.

One made-from-scratch small pancake - 3" across provides:

• 30 calories
• 1 gram of protein
• 5 grams of carbohydrate
• 0 grams of fiber
• 1 gram of sugar

One made-from-scratch medium pancake - 5" across provides:

• 93 calories
• 2 grams of protein
• 15 grams of carbohydrate
• 0 grams of fiber
• 2 grams of sugar

One made-from-scratch large pancake - 7" across provides:

• 186 calories
• 4 grams of protein
• 30 grams of carbohydrate
• 1 gram of fiber
• 5 grams of sugar

Making Pancakes

If pancakes are part of a weekly meal plan, try to keep them lower in sugar, fat, and calories.

1. Make pancakes from scratch without the mix to avoid any trans fats.
2. Use whole wheat flour to get fiber to increase hunger satisfaction.
3. Instead of frying the pancakes in oil or butter, use a quality non-stick pan to reduce fat intake.
4. Use syrup with no sugar.
5. Top the pancakes with blueberries, raspberries, or strawberries.

Eating Right to Feel Better

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

USDA Food Data Central. (2019). Pancakes, plain, prepared from recipe.

USDA FoodData Central. (2019). Butter, without salt.

USDA FoodData Central. (2019). Syrups, table blends, pancake.

Child Nutrition Recipe Box. (2023). Pancakes - USDA recipe for schools.

MedlinePlus. (2022). Facts about trans fat.

Slavin J. (2013). Fiber and prebiotics: mechanisms and health benefits. Nutrients, 5(4), 1417–1435. https://doi.org/10.3390/nu5041417

Aune, D., Keum, N., Giovannucci, E., Fadnes, L. T., Boffetta, P., Greenwood, D. C., Tonstad, S., Vatten, L. J., Riboli, E., & Norat, T. (2016). Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies. BMJ (Clinical research ed.), 353, i2716. https://doi.org/10.1136/bmj.i2716

Kissock, K. R., Neale, E. P., & Beck, E. J. (2021). Whole Grain Food Definition Effects on Determining Associations of Whole Grain Intake and Body Weight Changes: A Systematic Review. Advances in nutrition (Bethesda, Md.), 12(3), 693–707. https://doi.org/10.1093/advances/nmaa122

Centers for Disease Control and Prevention. (2022). Folic acid.

For individuals with stomach issues, can maintaining gut flora balance promote and improve gut health?

Gut Flora Balance

Maintaining gut flora balance is part of optimal digestive health. Gut microbiota, gut microbiome, or gut flora, are the microorganisms, including bacteria, archaea, fungi, and viruses that live in the digestive tract. The type and amount of bacteria present depend on their location in the body which could be the small intestine and colon. This is the storage housing for waste/stool, and the colon comprises hundreds of different types of bacteria, which have specific jobs and functions.

Unhealthy Flora

The more common pathogens are bacteria that can cause illness if left unchecked, including germs like streptococcus/strep throat or E. coli/urinary tract infections and diarrhea. Other common germs found in the colon include: (Elizabeth Thursby, Nathalie Juge. 2017)

Clostridioides Difficile

• C. diff overgrowth can cause watery foul-smelling stools daily, and abdominal pain and tenderness.

Enterococcus Faecalis

• Enterococcus faecalis is a cause of post-surgical abdominal and urinary tract infections.

Escherichia Coli

• E. coli is the most common cause of diarrhea in adults.
• This bacteria is present in almost every healthy adult’s colon.

Klebsiella

• Klebsiella overgrowth is associated with a Western diet that consists of various meat and animal products.

Bacteroides

• Bacteroide overgrowth is associated with colitis, which causes painful inflammation of the colon.

Healthy Flora

Healthy bacteria like Bifidobacteria and Lactobacillus, help maintain gut flora balance and keep the unhealthy bacteria in check. Without healthy flora, the entire colon can become overrun by bad flora, which can result in symptoms like diarrhea and/or illness. (Yu-Jie Zhang, et al., 2015) These protective, microscopic germs have important functions that include:

• Assisting with vitamin synthesis - vitamins B and K in the small intestine.
• Increases immune system function.
• Maintaining regular bowel movements.
• Maintaining a clean colon naturally without the need for colon cleansers.
• Destroying the unhealthy bacteria.
• Preventing unhealthy bacteria overgrowth.
• Breaking up gas bubbles from food fermentation.

Bacterial Dismantling

Whether labeled as healthy bacteria or unhealthy, they are both single-celled organisms that can be destroyed quite easily. Sometimes, it is necessary, like when having to take antibiotics to kill a strep throat infection. However, the antibiotics also kill the beneficial bacteria, which can lead to compounding problems that can include: (Mi Young Yoon, Sang Sun Yoon. 2018)

• Bowel irregularity - diarrhea and constipation.
• Yeast overgrowth - can cause itching, burning around the anus and lead to vaginal and oral yeast infections.
• Dysbiosis - the technical name for a lack of healthy bacteria or a bacterial imbalance.
• Complications for individuals suffering from irritable bowel syndrome.

There are different ways to destroy bacteria including.

• Individuals who need to take antibiotics to cure an infection. (Eamonn M M Quigley. 2013)
• Chronic laxative use.
• Fiber supplementation overuse.
• Prolonged diarrhea - can flush out the bad and good bacteria.
• Stress
• Completing a bowel prep, like those required for a colonoscopy.

Diagnosing Gut Flora Issues

Many times, problems with gut flora will correct themselves, and no action is required. However, individuals facing chronic bowel problems, like colitis or inflammatory bowel disease, may require medical intervention of their colon's bacteria.

• Comprehensive Digestive Stool Analysis/CDSA is a stool test that checks what type and amount of bacteria are present, nutrient absorption rates/digestion speed, and how well food is digested.
• If there is a significant difference in the proportion of unhealthy versus beneficial bacteria, a healthcare provider may suggest taking a probiotic or a live microbial supplement to help repopulate and maintain gut flora balance.

Gut Dysfunction

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Thursby, E., & Juge, N. (2017). Introduction to the human gut microbiota. The Biochemical journal, 474(11), 1823–1836. https://doi.org/10.1042/BCJ20160510

Zhang, Y. J., Li, S., Gan, R. Y., Zhou, T., Xu, D. P., & Li, H. B. (2015). Impacts of gut bacteria on human health and diseases. International journal of molecular sciences, 16(4), 7493–7519. https://doi.org/10.3390/ijms16047493

Yoon, M. Y., & Yoon, S. S. (2018). Disruption of the Gut Ecosystem by Antibiotics. Yonsei medical journal, 59(1), 4–12. https://doi.org/10.3349/ymj.2018.59.1.4

Quigley E. M. (2013). Gut bacteria in health and disease. Gastroenterology & hepatology, 9(9), 560–569.

Viruses, bacteria, fungi, and protozoa are the microorganisms that naturally live in the digestive tract. Sleep affects gut health and vice versa. A healthy gut microbiota consists of all kinds of microorganisms that produce thousands of compounds and coexist harmoniously. A healthy diet and lifestyle are the biggest factors influencing bacteria variety, and maintaining a varied diet preserves microbiota diversity. Everybody's gut microbiome is different; the more diverse the gut microbiome, the healthier sleep will be. The Injury Medical Chiropractic and Functional Medicine Clinic Team can develop a personalized nutritional plan to improve gut health and sleep patterns.

Sleep Affects Gut Health

Not having a diverse gut microbiome has been linked to autoimmune diseases, Parkinson's disease, and mental health issues like anxiety and depression. Not getting healthy sleep is associated with many diseases and disorders, including:

• Gastrointestinal disorders
• Infections
• Diabetes
• Cardiovascular disease
• Neurological disorders
• Anxiety
• Depression
• Cancer

Changes in sleep patterns influence the central nervous system and the immune system, which affect different organ systems. For example, studies have shown some gastrointestinal disorders, like irritable bowel syndrome - IBS could be associated with increased REM sleep or the fourth part of the sleep cycle when vivid dreaming occurs. In Crohn’s disease or ulcerative colitis, long-term immune response activation can result in poor sleep, insufficient quality sleep, or other sleep problems. The deepest stages of sleep are when the brain and gut communicate to repair the body, restore nutrients, and remove and release toxins.

Sleep Cycle

During sleep, the immune system produces proteins called cytokines that perform functions during the inflammatory response, either by increasing or blocking inflammation, depending on the body's needs. Cytokines help promote sleep, fight infection, or stop inflammation in chronic inflammatory diseases like Crohn’s disease or ulcerative colitis.

• Insufficient sleep significantly alters cytokine production, and infection-fighting cells decrease in numbers when sleep deprived, making it harder for the body to fight infections and lessening protection. This increases the inflammatory response and keeps the immune system on.
• Chronic or long-term immune response activation can result in sleep disturbances or disorders.
• Some disorders include small intestinal bacterial overgrowth and inflammation caused by microbiome abnormalities or dysbiosis.
• The gut barrier function begins to malfunction, leading to bacteria and pathogens leaking into blood circulation/leaky gut, triggering immune responses.

Ways to Improve Sleep

One of the main ways to improve sleep quality and gut microbiome health is to practice healthy sleep hygiene. According to the National Sleep Foundation, individuals should:

Nap Smart

• Naps can be a great way to refresh the mind and body and replenish energy levels during the day.
• Naps don't make up for little sleep at night.
• Keep naps to 20-30 minutes for optimal benefits without disrupting nighttime sleep.

Optimal Sleep Environment

• Comfortable ergonomic mattress and pillows.
• Blackout curtains.
• Temperature between 60 and 67 degrees.

Quit Electronics Before Bed

• The bright lights from phones and screens can make it difficult to fall asleep fully.
• Use an alarm clock with a soft night light and keep the bedroom tech-free.

Create Sleep Routine

• Take a warm shower, read a book, or do light stretches.
• Create a wind-down routine to relax before bed to signal the body that it's time for sleep.

Avoid Caffeine and Alcohol Before Bed

• These substances make it harder for the mind and body to fall or stay asleep.

Food As Medicine

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to get in touch with Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Chabé, Magali et al. “Gut Protozoa: Friends or Foes of the Human Gut Microbiota?.” Trends in parasitology vol. 33,12 (2017): 925-934. doi:10.1016/j.pt.2017.08.005

Deng, Feilong, et al. “The gut microbiome of healthy long-living people.” Aging vol. 11,2 (2019): 289-290. doi:10.18632/aging.101771

Gut Bacteria Research: Physicians' Committee for Responsible Medicine. (2019). "Gut Bacteria: Optimize Gut Health With a Plant-Based Diet,"

Ianiro, Gianluca, et al. “How the gut parasitome affects human health.” Therapeutic advances in gastroenterology vol. 15 17562848221091524. 30 Apr. 2022, doi:10.1177/17562848221091524

Lozupone, Catherine A et al. “Diversity, stability and resilience of the human gut microbiota.” Nature vol. 489,7415 (2012): 220-30. doi:10.1038/nature11550

Sleep and Gut Microbiome Study: PLoS One. (2019). "Gut microbiome diversity is associated with sleep physiology in humans.

Sleep Hygiene Information: National Sleep Foundation. (2019). "Sleep Hygiene."

Vaishnavi, C. “Translocation of gut flora and its role in sepsis.” Indian journal of medical microbiology vol. 31,4 (2013): 334-42. doi:10.4103/0255-0857.118870

For individuals looking to improve their gut health, can learning about the supportive digestive organs help with how digestion works and how it can be affected by inflammatory bowel disease/IBD?

Supportive Digestive Organs

Most people are familiar with food movement from the mouth through the esophagus, stomach, small intestine, and large intestine. However, digestion begins in the mouth with the formation of saliva, and the supportive digestive organs provide the necessary fluids to digest food and used by the body. The digestive tract runs from the mouth to the anus in one long, continuous tube. Several supportive digestive organs assist digestion but are not considered part of the digestive tract, including the salivary glands, pancreas, liver, and gallbladder.

Salivary Glands

The salivary glands produce saliva passed through ducts and into the mouth. Saliva is a clear liquid containing various substances important for digestion and the beginning of the food breakdown process (National Institute of Diabetes and Digestive and Kidney Diseases, 2017). Saliva is important to digestion because it aids chewing, contains antibodies, and helps keep the mouth clean. Infections, mumps, obstructions, Sjogren’s syndrome, and cancer are diseases and conditions that can affect the salivary glands.

Pancreas

Behind the stomach is the pancreas, which is important to digestion because it is where digestive enzymes and hormones are produced. Digestive enzymes help break down food (National Institute of Diabetes and Digestive and Kidney Diseases, 2017). The pancreas also creates Insulin, a hormone that helps balance blood sugar levels. Individuals with Type 1 diabetes are unable to make insulin and need insulin shots to balance sugar levels. Individuals with Type 2 diabetes also need insulin because their body is either resistant to insulin or their pancreas does not respond correctly. (American Diabetes Association, 2024) Glucagon is another hormone produced in the pancreas to raise blood sugar when the levels are very low. For individuals who have diabetes, glucagon can increase blood sugar levels too high. Insulin and glucagon work together to regulate blood sugar. (American Diabetes Association, 2024) Some diseases and conditions affecting the pancreas include pancreatitis, cancer, and cystic fibrosis.

Liver

The liver is one of the largest organs. Its functions include creating bile, storing nutrients and glycogen, converting toxins into harmless substances, and/or enabling their removal. Bile is passed through ducts that run from the liver to the duodenum of the small intestine. Blood circulates through the digestive tract and liver, where vitamins and nutrients are processed and stored (Johns Hopkins Medicine, 2024). The liver is also the body's detox organ, helping remove byproducts produced by alcohol and medications. The liver also helps break down old or damaged blood cells and produces substances to help with blood clotting. (Johns Hopkins Medicine, 2024) Diseases and conditions of the liver include cirrhosis, hepatitis, hemochromatosis, and cancer.

Gallbladder

The gallbladder is a much smaller organ located just under the liver. This supportive digestive organ stores bile after it is made in the liver. After eating, the small intestine releases a special hormone called cholecystokinin, which prompts the gallbladder to send bile through ducts and into the small intestine. Once in the small intestine, the bile breaks down the fat from the food. Conditions that can affect the gallbladder include gallstones. Surgery to remove the gallbladder, known as a cholecystectomy, is common. Some individuals may initially need to make adjustments to their diet after surgery. (Johns Hopkins Medicine, 2024)

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop highly effective treatment plans through an integrated approach for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and integrated medicine protocols. If the individual needs other treatment, they will be referred to a clinic or physician best suited for them. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, nutritionists, and health coaches to provide the most effective clinical treatments.

Healthy Diet and Chiropractic

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies that are available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, don't hesitate to contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

National Institute of Diabetes and Digestive and Kidney Diseases. Dis (2017). Your digestive system & how it works. Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/digestive-system-how-it-works

American Diabetes Association. (2024). About diabetes: common terms. https://diabetes.org/about-diabetes/common-terms

Johns Hopkins Medicine. (2024). Liver: anatomy and functions. https://www.hopkinsmedicine.org/health/conditions-and-diseases/liver-anatomy-and-functions

Johns Hopkins Medicine. (2024). Cholecystectomy. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/cholecystectomy

For individuals switching to non-dairy and plant-based diets, can oat milk be a beneficial substitute for non-dairy milk drinkers?

Oat Milk

Oat milk is a dairy-free, lactose-free alternative nearly free of saturated fats, has more protein than most nut-based kinds of milk, adds fiber, and offers a healthy dose of B vitamins and minerals. It contains steel-cut or whole oats soaked in water that are then blended and strained with a cheesecloth or special milk bag that is cheaper to make than almond milk and is environmentally friendly.

Nutrition

Individuals can acquire 27% of daily calcium, 50% of daily vitamin B12, and 46% of daily B2. The nutritional information is for one serving of 1 cup of oat milk. (USDA FoodData Central. 2019)

• Calories - 120
• Fat - 5 grams
• Sodium - 101 milligrams
• Carbohydrates - 16 grams
• Fiber - 1.9 grams
• Sugars - 7 grams
• Protein - 3 grams
• Calcium - 350.4 milligrams
• Vitamin B12 - 1.2 micrograms
• Vitamin B2 - 0.6 milligrams

Carbohydrates

• According to the United States Department of Agriculture, the number of carbohydrates in a cup of oat milk is 16, higher than other milk products.
• However, the carbohydrates come from fiber and not fat.
• Because oat milk is made from steel-cut or whole oats, there is more fiber per serving than cow’s milk, which offers no fiber, and almond and soy, which only contain one gram of fiber per serving.

Fats

• Oat milk contains no fatty acids, no total saturated fat, and no total trans fats.
• The milk does have 5 grams of total lipid fats.

Protein

• Compared to cow’s and soy milk, oat milk has less protein, with only 3 grams per serving.
• But compared to other substitutes, like almond milk and rice milk, oat milk provides more protein per serving.
• This is beneficial for individuals following a vegan or dairy-free diet.

Vitamins and Minerals

• Oat milk contains thiamin and folate, both B vitamins necessary for energy production.
• The milk also has minerals, including copper, zinc, manganese, magnesium, and trace amounts of vitamins and minerals such as vitamin D, A IU, riboflavin, and potassium.
• Most commercial oat milk is fortified with vitamins A, D, B12, and B2.

Calories

• One serving of oat milk, about 1 cup, provides approximately 120 calories.

Benefits

Dairy Milk Alternative

• Dairy allergies are common.
• Around 2 to 3% of children younger than three years old are allergic to milk. (American College of Allergy, Asthma & Immunology. 2019)
• 80% outgrow the allergy, but the remaining 20% still deal with the allergy into adulthood, making dairy alternatives necessary.
• An alternative to dairy milk for:
• Allergies to dairy
• Lactose intolerance
• Following a vegan/dairy-free diet
• Oat milk offers some of the same health benefits as cow's milk, that include:
• Protein to build and repair tissues.
• Maintain hair and nail health.
• Calcium for strong bones.
• Macronutrients like folate help make red and white blood cells.

Lowers Cholesterol

• A review determined that consuming oats and oat products has a profound effect in lowering total and LDL cholesterol levels. (Susan A Joyce et al., 2019)
• The researchers found significant support between oat beta-glucans and blood cholesterol levels, showing that adding oats to one's diet can help lower the risk of cardiovascular disease.

Cancer Fighting Properties

• According to a review of plant-based milk alternatives, oat milk may contain anti-cancer properties and high nutritional value. (Swati Sethi et al., 2016)

Bowel Movement Regulation

• Because a great deal of carbohydrates in oat milk come from fiber, it is also higher in fiber than regular milk.
• Fiber can help because the nutrient absorbs water to regulate bowel movements and decrease constipation.
• Only 5% of the population acquires daily fiber recommendations, making oat milk a healthy option. (Diane Quagliani, Patricia Felt-Gunderson. 2017)

Eco Friendly

• Today the world is more mindful of the environmental impacts of farming. (American Society for Nutrition. 2019)
• Spending on alternative milk has risen, and the consumption of dairy milk has dropped, not only for the benefits and taste but because of environmental concerns.
• Dairy milk uses nine times more land to make one liter compared to rice milk, soy milk, almond milk, or oat milk.

Allergies

• Oat milk is a beneficial alternative for individuals who are lactose intolerant or suffer from any other type of dairy allergy or those who have a nut allergy and can't drink almond milk.
• However, individuals should be careful of intake if they have celiac disease or any type of wheat allergy/sensitivity.
• Individuals can still drink oat milk, but the labels need to be read to make sure the product contains gluten-free wheat.
• Oats are gluten-free, but manufacturers often process them using the same equipment as other wheat products, which could cause a reaction.

Adverse Effects

• Oat milk can contain acidity-regulating phosphates, which are common additives in processed foods and are linked to kidney disease.
• Individuals will want to watch oat milk intake if they are prone to kidney stones. (Girish N. Nadkarni, Jaime Uribarri. 2014)
• Individuals who eat a lot of processed foods might want to rotate with another non-dairy alternative milk to limit phosphate consumption.

Varieties

• Many companies have their own oat milk, which is available at grocery and health food stores.
• Additionally, the milk may come in multiple flavors, including vanilla and chocolate.
• Several companies have also used their milk to create dairy-free ice creams.
• Oat milk is available year-round.
• Once opened, place store-bought oat milk in the refrigerator that will last 7 to 10 days.

Preparation

• Individuals can make their own oat milk.
• Use rolled or steel-cut oats with water, blend together, and strain.
• Place the oats in a large bowl, cover them with water, and soak for at least four hours.
• The next day, drain, rinse, blend in cold water, strain, and whisk.

Functional Medicine's Influence Beyond Joints

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to discuss the subject matter above further, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

USDA FoodData Central. (2019). The Original Oat-Milk.

American College of Allergy, Asthma & Immunology. (2019). Milk & Dairy.

Joyce, S. A., Kamil, A., Fleige, L., & Gahan, C. G. M. (2019). The Cholesterol-Lowering Effect of Oats and Oat Beta Glucan: Modes of Action and Potential Role of Bile Acids and the Microbiome. Frontiers in nutrition, 6, 171. https://doi.org/10.3389/fnut.2019.00171

Sethi, S., Tyagi, S. K., & Anurag, R. K. (2016). Plant-based milk alternatives an emerging segment of functional beverages: a review. Journal of food science and technology, 53(9), 3408–3423. https://doi.org/10.1007/s13197-016-2328-3

Quagliani, D., & Felt-Gunderson, P. (2016). Closing America's Fiber Intake Gap: Communication Strategies From a Food and Fiber Summit. American journal of lifestyle medicine, 11(1), 80–85. https://doi.org/10.1177/1559827615588079

American Society for Nutrition. (2019). Going nuts about milk? Here’s what you need to know about plant-based milk alternatives.

Nadkarni, G. N., & Uribarri, J. (2014). Phosphorus and the kidney: What is known and what is needed. Advances in nutrition (Bethesda, Md.), 5(1), 98–103. https://doi.org/10.3945/an.113.004655

Individuals need to eat more fiber for optimal gut health. Can adding avocado to their diet help improve the gut microbe diversity?

Avocado Gut Support

A diverse gut microbiome is beneficial to overall health. According to a recent study, eating one avocado a day can help maintain the gut microbes healthy, diverse, and balanced. (Sharon V. Thompson, et al., 2021) The researchers observed positive changes in gut bacteria and increased bacterial diversity in individuals who consumed an avocado every day for 12 weeks. (Susanne M Henning, et al., 2019)

Gut Diversity

The gut microbiome refers to the microorganisms living in the intestines. There are around 100 trillion microorganisms, including bacteria, viruses, fungi, and more, exist in the gastrointestinal tract. (Ana M. Valdes, et al., 2018) Having a diverse microbiome means that the body has a range of different organisms that offer various health benefits. Not having enough bacterial diversity has been linked to: (Ana M. Valdes, et al., 2018)

• Arthritis
• Obesity
• Type 1 diabetes
• Type 2 diabetes
• Inflammatory bowel disease
• Celiac disease
• Arterial stiffness
• Atopic eczema

Why Avocados?

• The Institute of Medicine recommends a daily fiber intake ranging from 19 grams to 38 grams per day, depending on various factors like age. (Diane Quagliani, Patricia Felt-Gunderson. 2016)
• Approximately 95% of adults and children do not consume the recommended amount of fiber. (Diane Quagliani, Patricia Felt-Gunderson. 2016)
• Including foods like avocados in a healthy diet can help meet daily fiber requirements.
• Fruit fiber like pectin, has been shown to promote a healthy gut microbiome as well. (Beukema M, et al., 2020)
• Researchers suggest this could be because of pectin's positive effect on beneficial probiotics.(Nadja Larsen, et al., 2018)
• Although further research is needed fiber is believed to help protect the lining of the colon by increasing the bulk and weight of stool and expediting elimination.
• Fiber also adds bulk to an individual's diet and slows the speed of digestion, which makes the body feel fuller longer.

Improved Gut

Individuals can support a healthy microbiota by making small adjustments in their diet, including:

• Eating a variety of fruits and vegetables with the skin, as this is where a majority of the nutrition is.
• Fermented foods like yogurt, kombucha, sauerkraut, kimchi, and kefir.
• Limiting consumption of processed foods, sugar, and artificial sweeteners.
• More whole-grain foods.

Ways to eat more avocados include adding them to:

• Smoothies
• Salads
• Sandwichs
• Guacamole
• If there are more avocados that can be eaten before they overripen, they can be frozen.
• Peel and slice them first, then place them in freezer bags to have year-round.
• They are rich in healthy fat, however, in moderation, they are not likely to contribute to weight gain.

Individuals can work toward having a diverse gut microbiome by paying attention to the foods they eat. Specific foods and dietary patterns can influence the different types of bacterial diversity which can support health.

Smart Choices, Better Health

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Thompson, S. V., Bailey, M. A., Taylor, A. M., Kaczmarek, J. L., Mysonhimer, A. R., Edwards, C. G., Reeser, G. E., Burd, N. A., Khan, N. A., & Holscher, H. D. (2021). Avocado Consumption Alters Gastrointestinal Bacteria Abundance and Microbial Metabolite Concentrations among Adults with Overweight or Obesity: A Randomized Controlled Trial. The Journal of nutrition, 151(4), 753–762. https://doi.org/10.1093/jn/nxaa219

Henning, S. M., Yang, J., Woo, S. L., Lee, R. P., Huang, J., Rasmusen, A., Carpenter, C. L., Thames, G., Gilbuena, I., Tseng, C. H., Heber, D., & Li, Z. (2019). Hass Avocado Inclusion in a Weight-Loss Diet Supported Weight Loss and Altered Gut Microbiota: A 12-Week Randomized, Parallel-Controlled Trial. Current developments in nutrition, 3(8), nzz068. https://doi.org/10.1093/cdn/nzz068

Valdes, A. M., Walter, J., Segal, E., & Spector, T. D. (2018). Role of the gut microbiota in nutrition and health. BMJ (Clinical research ed.), 361, k2179. https://doi.org/10.1136/bmj.k2179

Quagliani, D., & Felt-Gunderson, P. (2016). Closing America's Fiber Intake Gap: Communication Strategies From a Food and Fiber Summit. American journal of lifestyle medicine, 11(1), 80–85. https://doi.org/10.1177/1559827615588079

Beukema, M., Faas, M. M., & de Vos, P. (2020). The effects of different dietary fiber pectin structures on the gastrointestinal immune barrier: impact via gut microbiota and direct effects on immune cells. Experimental & molecular medicine, 52(9), 1364–1376. https://doi.org/10.1038/s12276-020-0449-2

Larsen, N., Cahú, T. B., Isay Saad, S. M., Blennow, A., & Jespersen, L. (2018). The effect of pectins on survival of probiotic Lactobacillus spp. in gastrointestinal juices is related to their structure and physical properties. Food microbiology, 74, 11–20. https://doi.org/10.1016/j.fm.2018.02.015

The digestive system breaks down the foods eaten so the body can absorb the nutrients. During digestion, the unnecessary parts of these foods are turned into waste/stool, which is evacuated during a bowel movement. When the digestive system stops functioning properly due to factors such as diet change, eating unhealthy foods, lack of physical activity/exercise, medications, and certain health conditions, can cause constipation. Constipation occurs when the body cannot have a regular bowel movement. The distention, gas, bloating and not being able to have a bowel movement cause irritability and stress, which can worsen constipation. Incorporating recommended nutrition can help restore regular bowel movements and gut function.

Recommended Nutrition For Constipation

Symptoms like abdominal pain, bloating, and difficult bowel movements are common. Diet and proper hydration have a significant role in digestive health, especially in relieving and preventing constipation. High-fiber foods, prebiotics, and adequate hydration from foods and beverages are essential for healthy bowel movements.

• Fiber is found in whole grains, starches, fruits, and vegetables.
• Soluble and insoluble fiber are important for digestive health.
• Focusing on incorporating high-fiber fruits, vegetables, and whole grains.
• Foods rich in prebiotics like fermented foods are recommended when constipated.

The recommended nutrition for constipation, according to a dietitian includes.

Avocados

• Avocados can be paired with just about anything and are full of nutrients and fiber.
• One avocado contains around 13.5 grams of fiber.
• One avocado will provide almost half daily fiber needs.
• Other high-fiber fruits: pomegranates, guava, raspberries, blackberries, and passionfruit.

Figs

• Figs can be eaten fresh and dried.
• Figs are considered a laxative and have been shown to treat and reduce constipation.
• They contain antioxidants, polyphenols, polyunsaturated fatty acids, and vitamins.
• Other fruits similar to a fig: dried apricots, prunes, and plums.

Plums

• Plums, prunes dried plums are packed with fiber and prebiotics that have a natural laxative effect.
• Sorbitol - a sugar found in plums and prunes, acts as an osmotic laxative that retains water.
• The added H2O makes the stools softer and easier to pass.
• Natural fruit juices, like pear, apple, or prune are often prescribed for constipation.
• Other fruits that aid in bowel movements: peaches, pears, and apples.

Kefir

• Fermented foods like kefir are rich in beneficial bacteria that work to maintain digestive system health.
• It can be consumed on its own or used in smoothies, cooking, and baking recipes.
• Other fermented foods: kombucha, yogurt, sauerkraut, kimchi, miso, and tempeh.

Oat Bran

• Oat bran is oatmeal that has not had the bran removed.
• The bran contains beneficial nutrients including fiber, antioxidants, vitamins, and minerals.
• Oat bran contains soluble and insoluble fiber, as well as beta-glucan/non-starchy polysaccharides.
• All improve the composition of gut bacteria and promote healthy bowel movements.
• Other beneficial grains: oatmeal, wheat bran, rye, and barley.

Incorporating Gut-Beneficial Foods

How to incorporate recommended nutrition gut-beneficial foods into a regular menu:

Smoothie

• Use kefir or yogurt as a base then balance it out with fiber-rich fruits like mango, blueberries, and kiwi.

Snacks

• Diversify snacks with a plate of fiber and prebiotics.
• Nuts, cheese, crackers, fruit, and a yogurt or avocado dip.

Oatmeal

• Try oat bran to increase fiber.
• Sprinkle a serving of flaxseeds, chia seeds, or hemp seeds for added fiber and healthy fats.

Parfait

• Yogurt parfaits can maximize nutrients, flavor, and textures in a bowl.
• Layer up on a favorite yogurt with granola, nuts, fruit, and seeds.

Grain Bowl

• Fiber found in whole grains and seeds like barley, farro, and quinoa, helps promote healthy digestion.
• Make a bowl with a grain base, then top with a protein, fresh or grilled veggies, avocado, and dressing.

Talk with a registered nutritionist or other healthcare provider to discuss recommended nutrition plan options.

Balancing Body and Metabolism

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Arce, Daisy A et al. “Evaluation of constipation.” American family physician vol. 65,11 (2002): 2283-90.

Bharucha, Adil E. “Constipation.” Best practice & research. Clinical gastroenterology vol. 21,4 (2007): 709-31. doi:10.1016/j.bpg.2007.07.001

Gray, James R. “What is chronic constipation? Definition and diagnosis.” Canadian Journal of Gastroenterology = Journal Canadien de Gastroenterology vol. 25 Suppl B, Suppl B (2011): 7B-10B.

Jani, Bhairvi, and Elizabeth Marsicano. “Constipation: Evaluation and Management.” Missouri medicine vol. 115,3 (2018): 236-240.

Naseer, Maliha, et al. “Therapeutic Effects of Prebiotics on Constipation: A Schematic Review.” Current clinical pharmacology vol. 15,3 (2020): 207-215. doi:10.2174/1574884715666200212125035

National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms and Causes of Constipation.

National Institute of Diabetes and Digestive and Kidney Disease. Your Digestive System and How It Works.

Sinclair, Marybetts. “The use of abdominal massage to treat chronic constipation.” Journal of bodywork and movement therapies vol. 15,4 (2011): 436-45. doi:10.1016/j.jbmt.2010.07.007

Having a healthy microbiota is essential for the immune system’s proper function. In addition, gut health is a crucial mediator for thyroid function, as intestinal diseases commonly overlap with thyroid conditions. Indeed, conditions such as Hashimoto’s thyroiditis (HT) and Graves’ disease (GD) commonly coexist with Celiac Disease (CD) and Non-celiac wheat sensitivity (NCWS). Furthermore, these conditions can be linked to the common root causes: Intestinal permeability and dysbiosis. 

The role of microbiota and thyroid health:

Intestinal bacteria have coexisted in a perfect balance with humans throughout centuries. Indeed, this symbiotic dependence plays an essential role in determining the health or disease of the patient. Furthermore, many factors tend to influence these conditions; birth delivery and breastfeeding can affect the diversity of bacterial strains at a young age. 

In addition, dietary intake, fiber, genetics, environment, diseases, and the constant use of antibiotics may determine our bacterial diversity and growth. Consequently, an impaired bacterial can impact the synthesis of many vitamins such as vitamin K, folic acid, vitamin B2. B3, B5, B6, B7, and B12. Ultimately, reduced synthesis of these vitamins will result in impaired immune response and deranged metabolic functions.

How does gut health influences immune reactions:

Gut microbiota is a crucial influencer of the innate and adaptive immune system, as it is fundamental for gut-associated lymphatic tissue (GALT). Indeed, GALT is an essential factor in developing tolerance to self-antigens, as it modulates its toll-like receptors in the intestinal mucosa.

Furthermore, dietary fiber and the short-chain fatty acids (SCFA) derived by microbial metabolism positively correlate with the number of regulatory T-cells. Consequently, these mediators improve immune tolerance and reduce inflammation, explicitly lowering the concentration of proinflammatory Th-17 cells. Additionally, a higher concentration of SCFA is correlated to stronger intercellular tight junctions, which result in lower pathogen translocation.

Vitamin deficiency, immunity, and gut health

A growing number of research studies describe the cross-reaction between autoimmune conditions like Celiac Disease (CD) and autoimmune thyroid disease. Indeed, in CD’s physiopathology, gluten triggers a chronic inflammatory response, leading to villous alteration, digestive enzyme deficiency, and deprivation of brush-border proteins. 

Consequently, the enzymatic deficiency affects iron absorption, decreasing heme-dependent thyroid peroxidase (TPO). Furthermore, this produces a chain reaction that leads to dysregulation of triiodothyronine (T3) and thyroxine (T4).

Also, lower folate, Vitamin D, vitamin B12, zinc, and magnesium levels are common in patients with CD. The role of these vitamins on immune system regulation is pivotal, and it is considered the common denominator to explain the coexistence of CD, Hashimoto’s Thyroiditis, and Graves disease. 

Clinical applications

Vitamin supplementation has been featured in a large number of studies with the aim of treating autoimmune conditions. 

Vitamin D supplementation is linked to immunoregulatory properties, primarily because Vitamin D receptors are expressed by immune cells like lymphocytes and antigen-presenting macrophages. In addition, immune cells are capable of vitamin D synthesis and promote the differentiation of naive T-cells. 

Nowadays, we have vitamin shops that carry a wide variety of supplements and products. Choosing the right supplement can be easy if we know what we should be looking for, and this guide can help you understand how you should select your supplements.

Autoimmune diseases are difficult conditions to manage and control. The medical-nutritional treatment of these conditions relies on an in-depth assessment, including micronutrient deficiency tests, comprehensive gastrointestinal labs, and a symptoms questionnaire. Following this assessment, nutritional intervention is crucial to replenish vitamin deficiencies with supplementation. In addition, treating the gut is essential to ensure vitamin absorption and symptom improvement. – Ana Paola Rodríguez Arciniega, MS

Bibliography

Starchl, Christina et al. “Celiac Disease, and the Thyroid: Highlighting the Roles of Vitamin D and Iron.” Nutrients vol. 13,6 1755. 21 May. 2021, doi:10.3390/nu13061755

Knezevic, Jovana et al. “Thyroid-Gut-Axis: How Does the Microbiota Influence Thyroid Function?.” Nutrients vol. 12,6 1769. 12 Jun. 2020, doi:10.3390/nu12061769

Additional Online Links & Resources (Available 24/7)

Online Appointments or Consultations: bit.ly/Book-Online-Appointment

Online Physical Injury / Accident Intake Form: bit.ly/Fill-Out-Your-Online-History 

Online Functional Medicine Assessment: bit.ly/functionmed

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*