Episode 228: Digestion Troubleshooting with Dr. Sruti Lam-Fletcher

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Gut Health & Autoimmune Health

The connection between gut health and autoimmune disease is very strong. 70% of our immune system lives in our gut. If we have inflammation in our digestive system, that’s going to cause inflammation in our immune system. This connection also goes both ways. If there’s inflammation and autoimmune activity in your body, that impacts digestion as well. Today, we’re going to troubleshoot some of the most common digestive issues, with the goal of supporting our health bodywide. My guest is Dr. Sruti Lam-Fletcher, a naturopath who specializes in digestive health. She’s also an autoimmune warrior herself so understands today’s topic both personally and professionally.

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Show Notes

  • Intro (0:00)
  • Thank You to Our Podcast Sponsor – Luminance Skincare (2:15)
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  • Meet Dr. Sruti Lam-Fletcher (4:06)
    • Dr. Sruti Lam-Fletcher is a naturopath who specializes in digestive and autoimmune health.
    • Originally, she planned to be a medical doctor. She went to medical school in India, and then immigrated to the United States for her residency. Before gaining a residency as an international graduate, she needed to achieve a 99% on her medical boards. It was a very stressful time and she started experiencing gastrointestinal symptoms: gas, bloating, and irregularity. At the time, she dismissed these symptoms as stress-induced Irritable Bowel Syndrome (IBS), but two years later, during her residency, her symptoms worsened to include blood in her stool and GI pain. She got a colonoscopy and was diagnosed with ulcerative colitis.
    • She took a year off from her residency to focus on her health. In addition to changing her diet and lifestyle, she learned about naturopathic medicine. Her personal health journey shifted her career focus. She went to naturopathic medical school at Bastyr University and chose to focus her clinical practice on gastroenterology and autoimmune disease.
  • The Immune System in Our Gut (7:41)
    • One of the reasons gut health has such a strong impact on immune health is that 70% of our immune cells live in the gut. GALT (gut-associated lymphoid tissue) is essential to keeping our body healthy by responding to any pathogens we consume. In addition, the gut microbiome is a huge part of our immune system.
    • It’s a dynamic system, constantly responding to both our environment and our experiences. (Not just food, water, and air, but also exercise and emotions.)
    • Part of our gut’s immune system is the intestinal lining that serves many roles. It helps with the digestion, absorption, and transportation of nutrients. It also acts as an important barrier, keeping dangerous things out of our bloodstream. When this lining becomes permeable, that’s called leaky gut, and it interferes with digestion overall. It can also cause an inflammatory immune response. Leaky gut is considered a precursor to autoimmune disease.
    • Resource Podcasts:
  • Troubleshooting Constipation (14:00)
    • A simple definition for constipation is the body’s inability to have a bowel movement. It looks differently for different people. Severe constipation is having no bowel movement for multiple days. But if you have to strain to have a bowel movement, or the stool comes out in hard pellets, that’s constipation too.
    • For optimal health, bowel movements should happen 1-2 times per day. The stool should be smooth, easy to pass, come out in one go, and contain no undigested food, blood, or mucus. The color should be dark brown, and it should sit on the bottom of the bowl rather than float. That’s an ideal bowel movement.
    • Foundational Solutions: Three things that set the foundation for healthy bowel movements are water, fiber, and movement. For water, divide your body weight in pounds in half. That’s the number of ounces of water you should drink daily. (So, if you weigh 150 pounds, drink 75 ounces of water daily.) For fiber, it’s insoluble fiber that’s the most helpful in preventing constipation. Leafy greens and cruciferous vegetables are good sources. Lastly, when we are sedentary, that can interrupt peristalsis (gut motility). Incorporating movement throughout the day supports healthy digestion. (Resource Podcast: Ep. 155 – Nutritious Movement.)
    • Home-based Troubleshooting: If you’ve tried the foundational solutions and still struggle with constipation, here are three things that are safe to try at home. Abdominal massage helps support gut motility. A Squatty Potty puts your body in a position that makes elimination easier. And the body also likes routine, so consider having a consistent time each day where you try to have a bowel movement…maybe first thing in the morning or after breakfast.
    • Herbs: Ginger and mint are two dietary herbs that not only help with constipation but support digestive health overall. You can simply add these to your meals or drink as a tea after eating. There are also two seeds that are beneficial to chew after a meal: fennel and caraway. And Triphala is an ayurvedic herbal supplement that helps with constipation while supporting health overall. (Resource podcast: Ep.  224 – Ayurvedic Medicine.)
    • When to Seek Professional Help: If you are experiencing chronic constipation where you go three days or longer without a bowel movement and the solutions above don’t help, that’s a good time to seek medical help. Also, if you are experiencing severe abdominal pain, bloating, cramping, or painful bowel movements. Or due to strain, you are developing hemorrhoids or fissures and blood is appearing in your stool. In these situations, it’s important to seek medical help rather than try to address it on your own.
  • Personalizing Probiotics (22:58)
    • Dr. Lam-Fletcher doesn’t recommend over-the-counter probiotics. Everyone’s microbiome is unique, and what helps balance one person’s microbiome may harm the balance of another. So, for probiotics she recommends working with a practitioner who can help you learn more about your unique microbiome needs.
    • Resource Podcasts:
  • Thank You to Our Podcast Sponsor – Adapt Naturals (25:42)
    • Adapt Naturals is a supplement company founded on 15 years of clinical expertise by globally-renowned expert, Chris Kresser. Most supplements are made with cheap, synthetic ingredients, and they’re also poorly formulated. They don’t contain enough of what we do need (or too much of what we don’t). Chris Kresser created a supplement line with the opposite goals.
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    • Use the code HELIX to save 15% off your order. Shop here: AdaptNaturals.com/Helix.
  • Troubleshooting Diarrhea (27:40)
    • The Bristol Stool Chart is commonly used in medical offices to classify bowel movements on the spectrum of constipation to diarrhea. Type 4 on the chart is the ideal stool. Types 5-7 are considered of diarrhea. Type 5 is a formed stool that disintegrates in the toilet. Type 6 is bowel pieces that are often discolored and show undigested food and/or mucus. Type 7 is stool colored water.
    • Common Causes: Diarrhea is a mechanism of action where the body eliminates something that is harmful. One example is food poisoning. In that circumstance, diarrhea is beneficial. It’s getting the toxin out quickly. So long as it’s short-lived (24-48 hours) and there are no other symptoms, Dr. Lam Fletcher wouldn’t interfere. Let the body do its job. When does diarrhea require intervention? When it is accompanied by one of the following symptoms: abdominal pain, fever, blood in the stool, foul smells, green coloring. Those can indicate an infection, parasite, virus, or fungus that requires medical help to eliminate. The other time it’s a problem is when it becomes chronic, even if it’s not accompanied by other symptoms. Chronic diarrhea causes dehydration, electrolyte losses, nutrient deficiencies, and can lead to health problems bodywide. It’s not something that should be ignored. Food sensitivities can be a root cause of diarrhea. Antibiotics can be a cause as well.
    • Home-based Troubleshooting: Hydration is essential. Drink plenty of water. Also drink electrolytes to replenish their losses. When it comes to food, pureed food is easier to digest, so blended smoothies and soups will give you more nutrition during this time. Soluble fiber can also help solidify stool. Any foods with pectin (apples, carrots, pears) are beneficial, especially if they’re cooked. A classic diet for diarrhea is BRAT (bananas, rice, applesauce, toast). Those are considered easy-to-digest foods that help solidify stool. A paleo variation by Dr. Sarah Ballantyne is soup, coconut water, applesauce, broth, and bananas.
    • Supplements: Saccharomyces boulardii is a beneficial yeast that often helps with diarrhea if it’s caused by a microbiome imbalance. Digestive enzymes can also be helpful in breaking down food so you can absorb as much nutrition as possible.
    • When to Seek Professional Help: As noted above, anytime diarrhea becomes chronic or is accompanied by other symptoms, it’s important to seek medical help because long-term diarrhea can damage health in many ways.
  • Troubleshooting Gas and Bloating (39:42)
    • Common Causes: Gas and bloating often coincide with other digestive problems like constipation, diarrhea, and irritable bowel syndrome (which often alternates between constipation and diarrhea). The bloating is caused by fermentation within the digestive tract. Some fermentation is a natural part of the digestive process, but an overabundance of fermentation can lead to very uncomfortable symptoms. Sometimes this happens because we aren’t digesting our food properly. Sometimes it’s an overgrowth of pathogenic bacteria leading to an overabundance of gas. Sometimes it’s caused by SIBO (bacterial overgrowth in the small intestine).
    • Foundational Solutions: Chew your food well, avoid drinking large amounts of water during meals, and eat mindfully rather than multi-tasking during meals. This releases digestive enzymes and also activates the parasympathetic nervous system which supports digestion. Also prioritize whole foods over processed foods in your diet, and minimize sugar intake. That supports a healthy microbiome.
    • Supplements: Many of the same herbs recommended above help with bloating and gas as well (ginger, peppermint, fennel, and caraway). Digestive tonics like Swedish bitters can also be helpful. And any bitter herb can aid digestion; dandelion tea is one example.
    • When to Seek Professional Help: If you are experiencing chronic gas and bloating, it’s important to find the root cause. It might be a gut infection, a food intolerance, or another inflammatory or disease process.
  • Troubleshooting Acid Reflux (47:55)
    • A natural part of our digestive process is the release of hydrochloric acid in our stomach to break down the food we eat. When our body struggles to break down food, it produces more of that acid which can lead to acid reflux (where some of the acid leaves the stomach and flows back into the tube connecting your stomach and mouth). Acid reflux symptoms vary from person to person. It might be a burning sensation in your chest or esophagus (heartburn). But it can also manifest as excessive burping or coughing.
    • Common causes: Acid reflux happens when we eat foods that are difficult to digest, or large quantities of food that require more acid to digest, of certain foods that we may be sensitive to (like spicy foods, dairy, deep-fried foods). Not everyone is sensitive to these foods, but some people are.
    • Foundational Solutions: Some of the same advice for preventing gas and bloating also applies here. Chew your food well, avoid drinking a lot of water during meals, and eat mindfully. Also assess the foods you’re eating, and the frequency that you’re eating. Our body is designed to have breaks between meals to complete the digestive process. If you’re grazing throughout the day, digestion never completes, and acid reflux (as well as other digestive problems) are more likely.
    • Home-based Troubleshooting: Apple cider vinegar is a wonderful digestive tonic. Put 1-2 Tbsp. in a small glass of water and drink it before your meal. This helps break down the food you’re about to eat and stimulates healthy digestion.
    • When to Seek Professional Help: If your symptoms are chronic (daily heartburn, nightly coughing) it’s important to seek help. Chronic acid reflux can damage the mucosa of the esophagus and cause ulcers, as well as increase the risk of cancer.
  • Outro (53:26)
    • You can connect with Dr. Sruti Lam-Fletcher through her website: Sapphire Healing Center. She is accepting new patients and is licensed to practice naturopathic medicine in the state of California. Outside of California, she offers health consultations via telehealth.
    • Eileen (your podcast host) is the author of multiple books, written to help people thrive with autoimmune disease. Learn more on the Books Page.
    • If you like this podcast, follow or subscribe through your favorite podcast app. You can also subscribe to Eileen’s monthly newsletter.
    • Check out the entire archive of podcast episodes.

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