In this episode of IWG Radio, Dr. Nicole Rivera and Clinical Nutritionist Brooke discuss the connection between gastrointestinal trouble and poor sleep patterns. Are you plagued with the inability to fall asleep, stay asleep, or waking up tired and groggy? Take a listen and learn more about how addressing the gut and other systems can help you sleep better!

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Brooke:
Hey there you're listening to IWG radio, the place to be for all of your wellness needs. This is Brooke the clinical nutritionist at Integrative Wellness Group and I'm here today with Dr. Nicole Rivera, functional medicine doctor and we're going to be talking to you a little bit today about sleep and your digestion. The two of those things seem pretty separate and as you might have gathered from some of our previous podcasts what we like to do is take some of these common medical diagnosis or symptoms and we like to bring to you some different approaches to getting better. So Dr. Nicole I would love to have you introduce yourself give us a little background on functional medicine.

[00:01:00]
Dr. Nicole:
Yes, definitely. I am Dr. Nicole working side by side with Brooke here at integrative Wellness Group in Belmar, New Jersey. Being a functional medicine practitioner one of the things that I really strive to do is figure out the root cause of the symptoms that you're currently dealing with. The way that I go about doing that is doing very specific lab analysis in order to just get the big picture, piece the puzzle together with your history, your past hospitalizations, medication use, surgeries, etc. Really give you a general idea of what's going on in your body and what can we do to fix it in a natural way.

Brooke:
[00:02:00]
Right, and I'm glad that you said that specifically fixing it in a natural way because when we talk about something like sleep, we always think that we maybe have some problem going on that it needs a medication, it needs to be fixed. A lot of the times these can clear up on their own through certain supplements, just being able to figure out exactly what's going on. We wanted to talk about that today in relation to digestion. I think that's another fairly common symptom that people have and something that you might be experiencing along with sleep disorders and really how the two are connected.

So lets talk about gut and bacterial overgrowth and yeast in the gut and what's being produced and how that might be affecting our sleep cycle.

Dr. Nicole:
[00:03:00]
Yeah, definitely and just to go off of what you mentioned before is needing or wanting a medication to utilize in order to improve our sleep that's a very understandable thing because if you're not sleeping, you're not healing and you're not really able to function in your day to day. That is definitely something that can start to create a lot of frustration, a lot of anxiety, and we completely understand that and want to support people in every way possible to really figure out the root cause of the sleep issues. It's very unlikely that they are going to creep up for no reason. What we find is we do see a lot of gastrointestinal disturbances that are in association with sleep issues. We're not saying that's the only cause, there definitely is, and we are going to touch on some of those in this podcast, but specifically in relation to the gut.

[00:04:00]
When somebody does develop a type of overgrowth in either the small intestine, the stomach or the large intestine, our digestive tract is very, very large there's a lot of different things going on and a lot of possibilities. If you do have a bacterial overgrowth or you have a yeast overgrowth or even have parasites in different areas of the gastrointestinal tract then that is something that is going to not only create a lot of inflammation within the body, which can definitely start to up your blood pressure. It can make you feel achy. It can make you have brain fog. The other thing that is happening is, these different types of pathogens, you have to understand, these are living organisms and they secrete waste, essentially the same way that we do. The same way that we have stool that we eliminate on a daily basis, these types of pathogens are going to also secrete waste in the event that they are living in your gastrointestinal tract.

[00:05:00]
One of the primary things that we have found through research, not meaning me, but through research in functional medicine and medicine, is that these types of pathogens can let off different types of endotoxins called lipopolysaccharide. The lipopolysaccharide can travel into the blood stream and then start to affect one of the most important organs in our body called our hypothalamus gland. The hypothalamus is pretty much where all of your stimulating hormones for your endocrine system come from. In turn of having this lipopolysaccharide, which is starting to affect your hypothalamus, you might see hormonal issues, which is a separate topic in itself. Then you also might see fatigue and you'll see the fatigue because it's actually going to start to affect the stimulating hormones for your adrenal glands.

Your adrenals are in charge of producing energy but at the same time they are in charge of calming you down and getting you to sleep and allowing you to have restful sleep. Not only are you going to experience some fatigue or lack of energy through your day-to-day, but you're also going to experience issues with sleep. Either falling asleep, staying asleep, everyone is going to be different but it's kind of the double whammy, essentially.

[00:06:00]
Brooke:
Going along with the bacterial and yeast overgrowth there's often going to be some malabsorption problems with certain vitamins and maybe talking and discussing a little more about some of those?

Dr. Nicole:
One of the things that we do here in the event that somebody does have sleep issues, hormonal issues, etc. When we do testing we typically are looking at neurotransmitters. Neurotransmitters are the primary hormones that are helping us to feel good, helping us to calm down when necessary, and then also helping us to get to sleep, essentially. A lot of those neurotransmitters, serotonin I feel like many of you might be familiar with, dopamine is another one, but a lot of these neurotransmitters are going to be very regulated by B vitamins, especially B6.

[00:07:00]
Unfortunately in the event that you have any type of gut issues, especially dysbiosis, then you're typically going to have a lot of issues with the absorption. Some of you can maybe relate to this when you think about taking a B vitamin and then all day you're peeing fluorescent yellow. Typically that is because you are not absorbing it. That could be due to the quality of the supplement you've purchased, but it also can be due to underlying gut issues that are not allowing you to absorb it. In the event of lack of B vitamins, especially the B6, you are going to have a lot of imbalance in these neurotransmitters which can also affect your sleep.

Brooke:
On the topic of neurotransmitters, aren't there specific neurotransmitters that affect the gut?

Dr. Nicole:
[00:08:00]
Definitely, there's two neurotransmitters that are known to specifically affect the gut. One of those is serotonin and then the other one is taurine. Serotonin again some of us are familiar with it because that's the primary neurotransmitter that's going to be supported in the event that maybe we're feeling depressed or having low mood. With serotonin one of the things that people don't understand is 85% of it is actually produced by our gut. In the event that you are having gut issues there's a strong possibility that you are going to deplete much of your serotonin, then that can also lead to sleep issues, but it's also going to lead to mood instability, feeling depressed, just not feeling good in general.

The other element of serotonin is if your serotonin becomes depleted. Serotonin gets converted in the body to melatonin. Melatonin is the primary thing that we know affects our sleep pretty tremendously. If you are lacking the serotonin because of gut issues and then you are in turn lacking melatonin another element that is going to dramatically affect your sleep.

[00:09:00]
Brooke:
B6 is the actually enzyme that is going to be converting that over from serotonin to melatonin, so then it's kind of bringing all these things together. It's kind of like a two way street that the gut issues may cause some malabsorption, but then they may cause depletion of serotonin so we may be having a couple of different things actually going on.

Dr. Nicole:
[00:10:00]
I think that is really important that you said that because that is usually the case. It's usually not one thing. When we are doing the testing and actually looking at people that are dealing with these symptoms, it's not that they just have low serotonin or they just have a B vitamin deficiency. Typically it's kind of a culmination because once gut issues start it's a snowball effect that happens. That's going to start secret that LPS and start to affect the pituitary gland. Then you're going to start to not absorb nutrients very well and maybe become B vitamin deficient. Then you might also become serotonin deficient if the gut issues stick around long enough. It's definitely a cascade that happens, but it doesn't mean that it's a lot of really hard work to fix it. It's just a matter of strategically going about it to re-balance everything and boost these levels back to where they need to be.

Brooke:
Speaking of kind of different things and different areas that you might look at. If we are going to be doing a very comprehensive analysis, what are all of the components that you would really look at? So we would look at the gut.

Dr. Nicole:
[00:11:00]
Definitely, so a stool analysis is going to give us all the information that we need about the gut. It's going to look at yeast, bacteria, parasites, etc. We want to definitely have that information to see if that's an underlying issue. We do want to look at that neurotransmitter panel. I say neurotransmitters, it's a NeuroAdrenal panel. You're looking at the neurotransmitters which are again classified as your feel good hormones, your calming hormones, and then also your stress hormones, cortisol and adrenaline are the primary things we're looking at. We're also looking at the stress hormones which adrenaline is one of the primary ones that we're looking at.

From the adrenal aspect one of the primary organs that's in charge of your adrenals is cortisol. We do look at cortisol over the course of the day. We actually do four saliva samples throughout the day in order to look at where the cortisol is morning, afternoon, evening, and bedtime. This gives us a lot of information about ... Having an overabundance of stress hormone, but at the same time blood sugar instability. The blood sugar instability can play a role in the gut and then the gut can play a role in the blood sugar instability. Again, there's so many things that are interconnected here. The neurotransmitter and the adrenal panel is very important to piggy back off of looking at the stool analysis.

[00:12:00]
There is other testing in the genetic world that we will do. Primarily if somebody's neurotransmitter panel comes back and things are all over the map, we have a bunch of things that are super elevated and other things that are practically zero. We always want to consider is there something genetic that is influencing this. What I mean by this is, I really want to create clarity, because I feel like we live in a world where they are trying to advance genetic testing and their almost doing the testing to brand us, to say eventually you will get this diagnosis because you are predisposed genetically.

[00:13:00]
When we do genetic testing we don't do it for that reason. We pretty much say if there's ten steps to make serotonin, because of your genetic makeup maybe step three needs some support. You support step three and then the pathway works again and you make the serotonin appropriately. It's kind of looking at where's the kink in the chain and what support do you need because genetically certain pathways don't work as well as others. We will go down that road if necessary. Again, more if the neurotransmitter are all over the map and it's just a further way of supporting people and allowing them to get sleep and get restful sleep.

Brooke:
I think it's important that you mention the genetics too and how you can support them based on their own personalized genetic plan. I think it's helpful for the healing phase, but it's also really helpful for the maintenance, and moving forward and making sure that people aren't going back to ... we fixed a problem and now it is coming back again. I think that that always makes people feel a little bit better when they hear about genetic testing is that it's good to know because now we can support you and we can support you for the long term.

Dr. Nicole:
[00:14:00]
Before I did genetic testing people would kind of come to a close with the program and they would feel really, really great, but they also were terrified about going backwards. They would be like "what are my top things that I need to do? What are my top things I need to take supplement wise and what are my top things that I need to continue from the dietary standpoint?". Until I did genetic testing I couldn't really tell them that. Now having you're actually blueprint for your body it's going to give me the information to say you need to be on a B complex. You need to maybe take more glutathione than the average person. You need to take more vitamin D than the average person. These are certain foods that your body does really well with and these are certain foods that your body doesn't do well with. It's amazing for the maintenance part of our program.

Brooke:
[00:15:00]
Before we come to a close I know we briefly mentioned in the beginning of the podcast talking about medications and how that's usually a band-aid idea or a band-aid fix all for this type of scenario when people are having sleep disturbances. Can you elaborate a little more on why they might prescribe certain medications in this event?

Dr. Nicole:
[00:16:00]
Typically I know that a lot of times they are actually recommending antidepressants or SSRIs which are essentially supposed to boost serotonin levels in order to help with sleep, but again it's ... So there's two parts with this. With the serotonin the goal of putting you on the antidepressant is to boost your serotonin levels in order to hope that that will eventually convert into melatonin and then that will help you sleep. If you have a deficiency in B6 or you have issues genetically with producing something called SAMe, that will not allow you to convert your serotonin into melatonin. Which leaves you with a bunch of built up serotonin and virtually no melatonin and you're not going to see your sleep improve or you see it improve for a short amount of time and then you hit a plateau and you kind of go backwards.

[00:17:00]
The other thing with SSRIs is it's a reuptake inhibitor. What that means is the gland in the brain makes your serotonin, your neurons pick up what it needs, whatever is left over gets sucked back into the gland that made it. With the SSRIs you shut down the recycling mechanism so none of the extra serotonin gets sucked back in, it kind of just sits. The idea is hopefully now that its available, now more neurons will pick it up. But what happens is if you continue to use this your body pretty much says "Why is that there? Why is there extra serotonin there again? That's not supposed to be there". Your body will start to send in a fleet of enzymes to actually break down the excess serotonin, again because it's not being used. This is one of the reasons why the antidepressants have a short lived effect. Once your body kind of catches wind of what is happening it will send in a fleet of enzymes to destroy the extra serotonin, because essentially it's not supposed to be there. This is also why it might lose it's effect, but you might be switched to a different medication, or you might add a medication, etc.

Brooke:
I think it's interesting too because, and the body will do this in a lot of different ways but, when you start to have an overabundance of something the body goes, "Well I don't need to make that, it's already there" or it might say "I'm already getting that from somewhere else" so it actually shuts down it's own mechanisms and its availability to do that. Over the long-term is it true that something like an SSRI could then shut down some of those mechanisms that actually create the serotonin?

[00:18:00]
Dr. Nicole:
Yeah, because it's like a negative feedback loop. You have all this excess serotonin that is essentially sitting there. Your body gets to a point and goes "Well I don't need to make it, it's there" and so this is the reason why getting off of the medications is so difficult. Because the primary producer of the serotonin almost stops making it. It's like the boy who cried wolf, it's like "oh well you fooled me once, fool me twice, I'm not making it anymore, I'm shutting down".

[00:19:00]
This is one of the things that happens with people that chew gum. If you chew gum all the time and you're body ... You're chewing, your body is thinking you're getting ready for a meal. Your stomach starts to make all this stomach acid to get you ready to digest your food, but you don't actually swallow anything so nothing enters the stomach. So your stomach goes "Fool me once, fool me twice" and then it actually shuts down your stomach acid production. This is when people start to get into feeling indigestion, heart burn, burping. Everyone thinks that's because of high amounts of acid, it's actually an underproduction. Your food is getting into your stomach and sitting there and like rotten essentially because there is no acid to break it down.

Brooke:
Aside from SSRIs which typically are prescribed for depression symptoms, there are obviously medications that are prescribed for sleep disorders. Can you elaborate a little more on what some of those are doing and some of those possible problems with those?

Dr. Nicole:
[00:20:00]
Ambien is a very, very popular one. It's definitely known to have a decent amount of side effects, but with the Ambien, it's primary a GABA agonist. With that being said there's a lot of other ways that you can go in the herbal world that actually really supports as a GABA agonist as well. One of the things you can do is take GABA. You could definitely use things like valerian root, you could use kava. Those are all really great options in the event of trying to go more of a natural route with fixing your sleep issues.

[00:21:00]
The biggest thing I'll say is if you're someone who has been struggling with sleep issues for a long time and you want to run out and buy these different recommendations. Just be cautious with it and I definitely recommend getting testing before you start to mess with your neurotransmitters. You need to understand that neurotransmitters when they become too low, they become a problem, when they become too high, they become a problem. There's a very fine line with keeping your neurotransmitters balanced so that you can feel good and you can feel normal and you can have great sleep. If you go out and start taking the wrong dose of GABA and you are taking it consistently over the course of a couple months you could essentially start to skyrocket your GABA levels and that can start to push you into feeling anxious. I would definitely say get the testing done through a functional medicine practitioner and have the baseline of where you are at and what your body needs. GABA is such a general recommendation, because obviously we talked about so many other things that can be contributing to sleep. It can be anything from the gut issues, to the B vitamin deficiencies, to the serotonin deficiencies, to the SAMe deficiencies. It's really not about everybody needs GABA to fix your sleep.

Brooke:
That's the thing too, without doing the testing and adding in supplements a lot of people tend to have adverse side effects in that you might be taking this to think that it's going to help your sleep but you might end up waking up all night and ending up worse off. It's definitely important to know before you supplement.

[00:22:00]
Dr. Nicole:
Definitely, especially in the herbal worlds like the valerian root and kava are both herbs. And they are very strong, herbs are very, very powerful they can be almost equally as powerful as medication. You definitely want to make sure that what you are doing is supervised by a physician.

Brooke:
As a special bonus for listening we do want to offer you a 15 minute free phone consult with myself. I'd love to talk to you more about anything that you have specifically going on whether it's with regard to digestion or sleep problems and give you more direction on what you can do to start feeling better.

Dr. Nicole:
Thank you so much for listening and we'll talk to you next time.