“Eating less, having dinner early, fasting for 12 hours… are three keys to intestinal health”

Lucía Redondo is a doctor and dietitian-nutritionist, expert in psychoneuroimmunology, orthomolecular nutrition and Chinese medicine, and author of the books Natural remedies available to everyone (Comprehensive editorial) and Prebiotic Food (Platform publisher).

After directing the Nutritional Therapy and Integrative Health Unit of the Valencian Digestive Institute at Hospital La Salud (Valencia) for four years, he currently offers online integrative health plans and collaborates as a teacher with several universities. One of her main areas of interest is the microbiota of the small intestine.

–If we have intestinal discomfort and the doctor has ruled out any serious problem, what can we do to feel better? Where do we start
– Many, many patients who have gone through this situation come to our offices: they have visited medical offices, where they have been told that they have nothing, that everything is fine, that there is nothing to do. Some are diagnosed with “irritable bowel syndrome” or that it is all “nerves”. What do we do? First, understand that there is always a lot to do. We can always do something. And also understand that digestive problems do not They are going to be solved with a magic pill, not even if it costs 500 euros.

We can do a little reflection on our body to understand what is happening to us, since when has it been happening to us and what happened when the problem started. Digestive health depends on many factors, we can begin to ask ourselves: how is my diet?, how is my rest?, do I play sports?, do I have contact with nature?, do I have healthy social relationships?, what relationship I have with my close people? Do I have any conflicts that didn’t work out? Am I suffering from stress? Am I taking unnecessary drugs?

It is time to embark on an improvement process. We need to start a path of self-knowledge and change. For this, I recommend that we put ourselves in the hands of a good professional specialized in nutrition and clinical psychoneuroimmunology. I am very lucky to have surrounded myself with great professionals and to have formed an excellent team, with great people, who follow this same line of work.

–It seems that many digestive problems are due to alterations in the intestinal microbiota. One that is being talked about a lot is the SIBO, what is the SIBO?
–SIBO stands for Small Intestinal Bacterial Overgrowth. This is a disorder that was originally defined as an excessive number of bacteria in the small intestine, causing gastrointestinal symptoms. Instead, today we know that it is not a simple excess of bacteria. The symptoms associated with SIBO are actually produced by an alteration –dysbiosis– of the type of microbes that live in the small intestine.

–In fact, there are several types of overgrowth, right?
In recent times, many nomenclatures have appeared that, from the outset, can be a bit confusing. But it is not as complex as it may seem. Let us remember that in SIBO there is, in reality, a dysbiosis, an alteration of microbes. Therefore, depending on the microbes that are overgrowing, several types of SIBO can appear:

“SIBO hydrogen”, where there is an excess of hydrogen-producing bacteria.”SIBO hydrogen sulfide”, where there is an excess of sulfate-reducing bacteria, which produce hydrogen sulfide.”SIBO methane”, where there is an excess of archaea that they produce methane. Since archaea are not bacteria (they are another type of microbe), it would not be correct to call it SIBO. For this reason, the concept of IMO, from the English acronym for “overgrowth of methanogens in the intestine” is used. “Fungal SIBO”, where there is an excess of pathogenic fungi. Again, since fungi are not bacteria, the correct name for it is SIFO, short for “small intestinal fungal overgrowth.”

–How is each type of SIBO diagnosed?
At this point I would like to make an important clarification. Although these four types of SIBO have been described, we must not fall for the labels and protocolized treatments. Although it is not what we want to read or hear, I have to say that, in the event that there is, for example, an IMO (“SIBO methane”), even if we eradicate it, the problem is still not solved. We have to look for the cause and treat it to achieve a lasting improvement over time and avoid recurrences.

In the event that we present symptoms that fit with an IMO, such as great abdominal distension, gas and constipation; then we can consider doing a breath test for SIBO. But, in addition, we have to know everything about this person, to get to the origin of the problem. Imagine we have hypothyroidism which is behind that IMO; until we improve the hypothyroidism, we are not going to solve the IMO. Or imagine that the problems appeared as a result of an emotional conflict, or as a result of taking several drugs, or as a consequence of gastroenteritis, or we dragged it on since we were little. Or maybe what we have is an infection in the mouth that is causing dysbiosis in the intestine. We need to know the whole story of this person.

Having said all this, and answering the initial question, the SIBO of hydrogen and the IMO (“SIBO methane”) can be identified with a breath test for SIBO. Hydrogen sulfide SIBO and SIFO are more complicated and we must use indirect tests and rely on suspicion based on symptoms.

–You are talking about the microbiota of the small intestine, but there is also the microbiota of the large intestine, right? We always talk about “the microbiota”, but it seems that there are several types.
-Yeah. The microbes that inhabit each place are different, or at least slightly different. Dysbiosis in the small intestine is the one that usually causes food intolerances, abdominal distension and gas that is very difficult to expel. We must always assess the set of symptoms to detect where we suspect the problem, and thus apply the best treatment.

To treat dysbiosis, we propose three phases: cleaning, recovery and maintenance.

–How is the treatment of SIBO? What is the best strategy according to your experience?
–I always say a phrase: “There are as many SIBOs as people are SIBOs”. There is no treatment for SIBO as well, in general. We must observe and understand each person, in order to offer each one what they need. In the treatment, in addition to delving into the causes, we usually consider three phases: cleaning, recovery and maintenance.

We can do the cleaning phase with herbaceous plants, with specific medicinal plants for each person and according to the type of SIBO (only in some cases can we use an antibiotic). We use herbs such as oregano, berberine, mint, black cumin, wormwood, etc. In the recovery phase, it is a matter of restoring the intestinal microbiota, regulating intestinal permeability and the protective mucus layer, digestive secretions and the migratory motor complex (intestinal activity cycles during fasting). We use probiotics and aids such as glutamine, bitter plants or ginger. And finally, maintenance, because there is a great risk of relapse when we treat a SIBO.

– Is it necessary to do a stool analysis to assess how the intestine is?
-From my point of view, no. The malfunctioning of our intestine already gives us signs in the form of discomfort, pain, bloating, gas, diarrhea or constipation. We found out about it. Are stool tests necessary to apply a good treatment? The truth is that in recent years tests that analyze the microbes present in a stool sample have become very popular. I used them myself. But years ago I realized that I was not on the right track.

When I had my patients in front of me, after making a good assessment of symptoms, along with the fecal microbiota analysis, I realized that the treatment I was indicating was the same as the one I would have provided without seeing the test.

There are cases in which it can be justified, there are specific parameters that can give us some ideas, I don’t doubt it, but, from my experience, it is preferable to focus on the tests or analyzes that really provide us with enough information to make the best therapeutic decision.

Keys to Gut Health: Eat Less, Eat Early, and Extended Overnight Fasting

– What are your general tips to take care of ourselves if we suffer from digestive problems or to avoid them?
–As Hippocrates said: “When someone wants health, it is necessary to first ask him if he is willing to remove the causes of his illness. Only then can we help you.” This point is fundamental. And let’s not only think about suppressing the croissant for breakfast, let’s also think about suppressing a sedentary lifestyle or toxic relationships. In addition to reflecting on this, we can start with three tips that will help us feel better and improve the functioning of our digestive system:

Eat fewer times a day, no more than two or three times. Have dinner early. Separate dinner and breakfast at least 12 hours. In this way we favor the activity of the migratory motor complex.

What is the migratory motor complex?
–This concept refers to the cleaning and emptying movements that occur in the stomach and small intestine when we do not eat. These movements do not occur constantly, but there are “waves” every 90 or 120 minutes. Specifically, they are activated when digestion and absorption are ending and the intestine is completely empty. It is usually between two or three hours after having eaten, although it depends a lot on each person.

The objective of these movements is to clean the digestive tract of food remains, digestive secretions, cells and bacteria and other microbes, driving all this content towards the small intestine and then towards the colon. This prevents an overgrowth of bacteria or other microbes in the small intestine (SIBO). It’s our digestive garbage truck.

–To what extent does our mental and emotional well-being depend on the intestine?
– More than a hundred million neurons reside in the intestine. Although they are much fewer than those present in the brain, they are key to our behavior and our emotions. Furthermore, surprisingly, these “digestive” neurons act independently of the central nervous system. In any case, the intestine is in constant communication with the central nervous system. Through the vagus nerve or through the formation of substances that travel through the blood to the brain. I see this a lot in consultation. When the digestive process is not going well, it is very common to feel exhausted or exhausted, without energy, with anxiety, with depression… The good news is that when we manage to improve the intestine, our mood also improves.

–There are many people on restrictive diets for many years because numerous foods make them feel bad, what would you tell them?
-That I understand them. Me too…