Functional Focus
Biochemical
Nutrient Deficiencies
Each individual will have a unique set of nutrient requirements based on genetics, diet, lifestyle, their environment etc. Whilst it should be possible for most individuals to satisfy their requirements by eating a healthy diet in reality many whole foods are no longer as nutrient dense as in the past and a diet laden with processed or even ultra-processed foods is likely to deplete nutrients and just over-supply calories.
Examples of nutrient deficiencies that may be associated with certain symptoms and/or conditions and may be picked up in the course of history taking:
- Zinc – white spots on nails, loss of sense of taste, failing sick frequently …
- Iron – hair loss, shortness of breath, low energy …
- Vitamin A – poor night vision, very dry eyes, small bumps on the upper arms…
- Magnesium – leg cramps, nausea, fatigue …
- Calcium – abnormal heart rhythm, numbness and tingling …
- Vitamin C – slow wound healing, easy bruising, loss of collagen …
- Vitamin B12 – fatigue, memory decline, swollen tongue
- Vitamin B2 – cracks in the corners of the mouth, cold sores, headaches …
- Folate – fatigue, anxiety, diarrhoea …
- Antioxidants – accelerated ageing, loss of vision, joint pain
- Fat – dry skin, low immunity, hormonal imbalances …
- Protein – muscle wasting, swelling, mood swings …
Other nutrient deficiencies may require in clinic or laboratory tests to determine.
Enzyme Deficiencies
Although deficiencies in digestive enzymes are common and are environmentally influenced, enzyme deficiencies leading to overt disorders/diseases are mostly rare and inherited. Such deficiencies are often detected via neonatal screening or at a young age with symptoms often being severe, but some may only become apparent in adulthood when a triggering event occurs. These are often termed inborn errors of metabolism (IEMs), a group of disorders which result from defiant activity of a single enzyme in a metabolic pathway.
- Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD) – this is the most common enzyme deficiency which depending on the genetic variation and level of deficiency genetically predisposed individuals range from having no symptoms at all to severe haemolytic anaemia. An obvious trigger is a severe reaction to fava beans, but there are a list of medications and foods that very affected individuals may need to avoid.
- Glucose Metabolism and Glycogen Storage Deficiencies – involve impaired enzymes responsible for converting glucose from food into usable energy for the body or enzymes which breakdown of glycogen (stored sugar) in the muscles and liver.
Urea Cycle Disorders – involve deficiencies in enzymes in the urea cycle, which hampers the conversion of ammonia from protein break-down to urea, leading to elevated ammonia levels in the blood, which acts like a toxin in excess.
The symptoms of enzyme deficiencies are as varied as the functions/conversions performed by the relevant enzymes, but some examples are:
- Developmental delays or in severe cases permanent damage leading to intellectual disability
- Neurological symptoms such as seizures
- Psychiatric symptoms
- Organ dysfunction which may affect the liver, pancreas or impact the optimal function of other organs across the body
- Metabolic imbalances which may be associated with low energy, fatigue or even diabetes
- Digestive complaints including bloating and pain, nutrient malabsorption, diarrhoea and/or constipation
- Musculoskeletal complaints including skeletal abnormalities, growth delays and or muscle weakness
Food Intolerances
On an immunological level, there is a distinction to be made between food allergies (igE-mediated) and food intolerances (IgG-, often along with IgA-mediated). Whilst on an immunological level, these are distinct types of reaction, to those who have symptoms associated with any food-based reaction these may not be immediately apparent and may take some time to figure out which foods or even specific components of a particular food an individual is reacting to.
IgE – is often a more immediate reaction and is often associated with anaphylactic shock
IgG – this is often a more delayed reaction which can take hours or even weeks to unfold
Often food intolerances can be reduced or even reversed by temporarily eliminating problematic foods and using the appropriate method to re-orientate the immune system.
In addition food reactions may occur due to an underlying imbalance (e.g. histamine intolerance), so individuals may be experience symptoms (e.g. hives, headaches, sweating, acid reflux etc.) until whatever is causing the lack of tolerance to certain categories or substances within the offending foods has been addressed. In some cases the intolerance may be linked to other areas explored as part of your journey such as microbial imbalances, enzyme or other deficiencies, toxic load etc.
Microbial Imbalances
The majority of people have had some sort of infection be it bacterial, viral, parasitic or fungal at some point in their lives. In some instances, the individual may be asymptomatic and not even realise that they are infected, as the immune system may mount an effective immune response or else the immune response may be dampened for some reason.
Some of these relatively common infections can either survive in the system for many years or else be ‘dormant/latent’ for a number of years often to be ‘reactivated’ years later often in response to a new ‘trigger’ including a new infection (with a new infective agent), nerve trauma, immunosuppression, a toxic exposure, physiologic and physical changes (e.g. fever, lack of exposure to sunlight etc.). Many are associated with specific conditions including autoimmune conditions, certain types of cancer, neurological conditions, congenital diseases, cardiovascular conditions and more.
Viruses –
- Epstein-Barr Virus (EBV)
- Varicella-Zoster Virus (VZV)
- Herpes Zoster Virus (HZV)
- Herpes Simplex Virus (HSV)
- Cytomegalovirus (CMV)
- Covid 19
- Coxsachie Virus
Bacteria –
- Mycobacterium tuberculosis
- Anaplasma phagocytophilum
- Ehrlichia chaffeensis ehrlichia ewingii
- Bartenwal
- Yersinia
- Rickettsia
- Borrelia burgdorferi and borrelia miyamotoi
- Mycoplasma
- Chlamydia pneumoniae
- Chlamydia trachomatis
- Streptococcus pyogenes
Parasites –
- Toxoplasma gondii
- Echinococcus multilocularis
- Entamoeba histolytica
- Leishmania infant
- Taenia solium
- Babesia microti
- Liver flukes (fasciola)
Fungi (and the toxins they produce)-
- Candida species
- Aspergillus species
- Penicillium species
- Stachybotrys chartarum
- Fusarium species
Whilst there are some distinctive symptoms and conditions associated with some of these infections, many overlap between infections and some individuals may have multiple infection both latent and active. Hence an individual’s history, symptoms, potential environmental exposures, basic blood work etc may provide indications of whether testing for infections is warranted.
Environmental
Whilst we all recognise that psychological ‘stress’ potentially impacts our health and most of us are aware that we are living in times of unprecedented levels of exposure to environmental toxins, it is often the invisible stressors that take us by surprise. Unfortunately, many toxins are now ubiquitous in our environment which may leave individuals confused about what is healthy to eat, drink and breathe, so some pragmatic solutions may be recommended based on what is realistically doable for each individual.
Stress
I am not qualified to offer any formal counselling, however, stressors in general and how they may affect an individual’s health picture will be considered and lifestyle recommendations may be made as appropriate.
Emotional stress – this can be due to circumstances at work, at home, within an individuals social circle or beyond.
Psychological stress – this can cover all of the above and extend to bullying (past or present), financial pressures extending to fears and compulsions.
Physical stress – this can be related to a physically strenuous job, shift work or may even apply to leisure- and professional- athletes, particularly in the context of endurance or extreme sports.
Biochemical stress – a range of these are outlined.
Associated conditions may include:
- Anxiety
- Depression
- Insomnia
- Chronic Fatigue and ‘burn-out’ (often associated with adrenal insufficiency)
- Osteoarthritis
- Post-traumatic stress disorder (PTSD)
- Digestive (gastro-intestinal) complaints such as Irritable Bowel Syndrome (IBS)
- Cognitive decline
- Frequently infections
- Tachycardia (rapid heart beat)
Mould Toxicity
Until recent years mould toxicity was poorly understood and the wide-reaching detrimental affects on health were all too often overlooked.
However various studies have investigated the effects of mould toxicity in conditions ranging from stubborn weight gain to autoimmune conditions, neuropathy, chronic pain and beyond.
Mould exposures may be insidious with individuals not making the link between exposures that may have taken place decades prior to falling sick or else the mould is not obviously ‘visible’. Whilst there are abundant mould species that are not harmful to humans and may have medicinal properties, there are a few species that produce toxins in the environment and often within our bodies that cause a wide-variety of symptoms that are often misdiagnosed.
Associated conditions may include:
- Postural orthostatic syndrome (POTS)
- Digestive complaints including malabsorption and deficiencies
- Immune suppression
- ‘Brainfog’
- Headaches
- Seizures (often diagnosed as epilepsy)
- Tremors
- Vertigo and dizziness
- Kidney stones
- Kidney damage
- Chronic pain often diagnosed as fibromyalgia
- Weight gain or weight loss
- Hairloss
- Neurological damage (often diagnosed as parkinson’s, dementia or autism)
- Hormonal imbalances
- Food sensitivities and intolerances
- Endocrine (hormonal) disruption
- Gastrointestinal symptoms
- Lung damage
- Fatigue
- Eye problems
- Vaginitis
- Changes in DNA and associated conditions such as cancer
Heavy Metal Toxicity
These may also be insidious and invisible, in fact, these type of exposures may have occurred in utero with the burden being added to across life, which is why it may be appropriate to explore an individual’s health history from the pre-conception onwards.
There are a variety of heavy metals that can impact human health, below are some common ones which the average person may be frequently and unwittingly exposed to.
Associated conditions may include:
Mercury –
- Eczema
- Blushing
- Dermatitis
- Rashes
- Cataracts
- Peripheral vision loss
- Retinitis
- Brain damage (often diagnosed as Parkinsons)
- Cognitive decline
- Poor coordination
- Ataxia
- Emotional disturbances and mood swings
- Hypothyroid
- Numbness and tingling
- Heart complaints
- Birth defects
- Depression
- Joint pain and poor bone health
- Mania and psychosis (often diagnosed as schizophrenia or bi-polar disorder)
Aluminium –
- Amyotrophic lateral sclerosis (ALS)
- Brain damage (often diagnosed as Alzheimer’s, other dementia or senility)
- Anaemia and other blood disorders
- Lose of appetite
- Colic
- Hyperhydrosis (excessive perspiration)
- Peptic ulcers
- Skin conditions
- Osteoporosis and osteomalacia
- Autism spectrum disorders and learning delays
- Kidney dysfunction
- Mood disorders
- Muscle weakness and pain
- Eye conditions
Lead –
- Birth defects
- Allergies
- Autism spectrum disorders and learning delays
- Behavioural disorders
- Fatigue
- Stillbirths
- Infertility and sterility
- Blindness and cataracts
- Headaches
- Hypertension
- Diabetes
- Convulsions and seizures
- Insomnia
- Psychosis
- Joint pain
- Peripheral neuropathies
- Vertigo
- Nightmares
- Numbness
- Gout
- Menstrual problems
- Gastrointestinal issues incl. bloating and pain
Cadmium –
- Kidney stones
- Low red blood cell anaemia
- High blood pressure
- Osteoporosis
- Low sperm count
- Vertigo
- Headaches
- Cardiovascular problems
- Muscle weakness
- Osteoporosis
- Nausea
- Nerve cell damage
- Cramps
- Low energy
- Smoker’s cough
- Stroke
- Osteo- and rheumatoid- arthritis
Arsenic –
- Headaches
- Fatigue
- Restlessness
- Insomnia
- Drowsiness
- Vertigo and dizziness
- Aches and pains
- Cognitive decline
- Listlessness
- Abdominal pain
- Changes in skin pigmentation
- Skin lesions
- Hyperkeratosis
- Developmental defects
- Diabetes
- Lung disease
- Heart attack
In addition to these common heavy metals, there are a range of minerals and other metals which can be problematic in excess/if an imbalance exists such as copper, iron, thallium, gadolinium, silver etc.
Endocrine (Hormone-) Disrupting Chemicals (EDCs)
When talking about hormones, for most hormone replacement therapy (HRT), steroid usage including hydrocortisol, testosterone injections and the like will be top of mind. However, unfortunately the types of chemicals that affect our endocrine system (hormonal balance) have become omnipresent in our bathrooms, kitchens, wardrobes, cleaning cabinets etc. Not only that, some accumulate over time and have earned the ominous title of ‘forever chemicals’ as they are enter the body easily, but are challenging to remove.
Associated complaints may include:
- Undescended testes in young boys
- Excessive growth of breast tissue in young boys or pre-pubescent girls
- Premature puberty
- Heavy flow and/or irregular cycles in menstruating women
- Fertility issues
- Polycystic Ovarian Syndrome (PCOS) in women
- Acne and other skin complaints
Frequencies
These are part of our daily reality and do not seem to affect all equally and in fact some frequencies such as certain types of music, laser therapies and the like may have a healing effect when applied appropriately. However, a debate has been raging for a number of years as to whether ‘electro-smog’ may negatively impact susceptible individuals with some governments choosing to limit WIFI exposure amongst young children amid concerns and research around early life brain development. In individuals with insomnia, headaches, tinnitus, tingling sensations, even unexplained elevated blood sugar levels etc. it may be useful to take stock of the overall load in the daily environment as a possible contributing factor.
Air quality
As it is currently topical, we are all aware of global warming and the association with pollution from cars, acid rain, flatulent cows, air planes, power plants and the like, but very few will give a second thought to their indoor air quality and take stock of possible toxins within the home environment such as:
- Mould on the walls or in the air-conditioning unit
- Paint
- Cabinets
- Flame retardants
- Carpets
- Tile glue and other adhesives
- Kitchen counter tops
- Flooring
- Gas appliances
- Kerosene heaters
- Other building materials
Water quality
In many countries governments take the responsibility of providing clean, running water that is drinkable seriously and yet in many of the developed countries, levels of known toxins can be above the limits considered safe for drinking. Even where this is not the case, there does not seem to be a safe limit for bathing etc when the larger absorptive surface of the skin is exposed.
In addition, the ‘safe’ levels and what is considered a toxin vary significantly, as reflected in the on-going debate surrounding fluoridation of drinking water to improve dental health and prevent cavities – a practice which others consider to be detrimental to thyroid- and brain- health at a minimum.
Some of the ‘drinking water contaminants’ that are still commonly found in developed countries include:
- Lead
- Arsenic
- Nitrates
- Nitrites
- Atrazine
- Glyphosate
- Trichloroethylene
- Tetrachloroethylene
- ‘Forever chemicals’ (Per- and polyfluoroalkyl substances – PFAS)
- Disinfection byproducts of chlorine (e.g. chloroform and other trihalomethanes)
- Microplastics
Not to mention that chlorine can turn into chloride gas when heated in the kettle or the shower, which is then inhaled in a more ‘concentrated’ form.
Epigenetics
According to the American Centres for Disease Control the definition ‘epigenetics is the study of how your behaviours and environment can cause changes that affect the way your genes work. Unlike genetic changes, epigenetic changes are reversible and do not change your DNA sequence, but they can change how your body reads a DNA sequence. While genetic changes can alter which protein is made, epigenetic changes can alter which protein is made, epigenetic changes can affect the gene expression to turn genes “on” and “off”.’
The risk of certain diseases expressing may be reduced, health and performance enhanced by understanding the genetic hand you were dealt and how you might optimise the epigenetic influences such as diet, lifestyle, the composition of the gut microbiome, toxic exposures etc that impact their expression.
A combination of nutrigenomic-oriented genetic testing, testing for latent infections and/or certain toxins as well as telomere testing can be helpful in terms of directing appropriate interventions at an epigenetic level.
Genetics
Genetics are the code we are born with and for a long time they were considered unchangeable, although genetic ‘engineering’ has become a very contested subject. There are various areas of genetics, but one that individuals can easily influence is nutrigenomics, which is primarily concerned with genes that are sensitive to lower or higher intakes of certain vitamins, minerals etc.
Caloric Intake
One area of interest in the research into longevity and anti-ageing over the past few years has been how caloric restriction such as various types of intermittent fasting, autophagy etc. may affect an individuals health span. The science points towards the potential of caloric restriction to induce favourable epigenetic changes via mechanisms such as DNA methylation.
Immune Dysregulation
Research suggest that specific conditions are associated with certain pathogens, which can effect epigenetic changes by influencing DNA methylation and other processes. Several of the infections involved are wide-spread and can survive in the body for years or even decades in an ‘inactive’ (latent and/or lytic state), but may then ‘reactivate’ in response to other environmental influences. Essentially such infections can changes the way the immune system responds, however, progression to a disease state is very individual and appears to depend on multiple other factors. Whilst it is challenging to pick-up infective ‘agents’ in their inactive state, there are specialist labs focused on immune function and certain indicators that can point towards such ‘infections’ as potential targets for holistic intervention.
Some common and well-studied examples are:
Pathogen | Type | Associated conditions (proven or being researched) | Specific considerations |
Epstein-Barr virus (EBV) | Virus |
|
|
Hepatitis B virus (HBV) | Virus |
| |
Human papillomavirus (HPV) | Virus |
|
|
Human Immunodeficiency virus (HIV) | Retrovirus |
|
|
Helicobacter Pylori (H. Pylori) | Bacteria |
| |
Chlamydia pneumoniae | Bacteria |
|
Environmental Challenges
Whilst eating habits and food choices are ‘environmental factors’ that are under the control of the individual, other exposures that can have profound effects not only on the health of the individual, but for generations to come can be made manageable with growing awareness of options to reduce such burdens.
‘Epigenetic marks can be affected by exposure to metals, air pollution, benzene, organic pollutants, and electromagnetic radiation. Chemical and xenobiotic compounds in water or the atmosphere are other potential environmental stressors capable of changing epigenetic status. During embryonic development, the effect of exposure to environmental pollutants seems to have an even more crucial effect on the epigenome and increases the risk of developing disease’ in future generations.
At present extensive testing for epigenetic changes in relation to environmental challenges are only accessible in a research context however, there are various options to test for a range of environmental burdens at an individual level in order to reduce the toxic burden of the individual and lessen the risk of detrimental epigenetic changes being passed on. Some factors may be challenging to capture using laboratory based testing, but may emerge in the course of a consultation.
Some common and well-studied examples are:
Toxin | Sources | Associated conditions (proven or being researched) | Some tests that may be used to assess burden |
Arsenic, aluminium, mercury, nickel, lead, and cadmium |
|
|
|
Pesticides, fungicides, herbicides, industrial chemicals (PCBs, dioxins), plastics, specifically bisphenol A (BPA) and the phthalates |
|
|
|
Pharmaceuticals incl. synthetic estrogen Diethylstilbestrol (DES) and many more |
|
|
|
Human Connection
The potential for social interactions and human connection to promote epigenetic changes affecting health in both a positive and a negative sense have been a subject of research over the past decade, an area that has become particularly relevant as scientists seek to understand the impacts of social isolation during the COVID years.
‘The term social determinant of health often refers to any nonmedical factor directly influencing health, including: values, attitudes, knowledge, and behaviors. Health across the life span is strongly and adversely affected by social disadvantage. Research in epigenetics indicates that alterations in DNA methylation may provide a causal link between social adversity and health disparity. Likewise, accelerated loss of telomeres (the protective ends of chromosomes) is highly correlated with chronic stress including social stress and aging’.
Whereas post-COVID research identified loneliness as having the potential to make epigenetic changes that contribute to the development of diseases related to cardiovascular function, blood sugar management, as well as cancer, pre-COVID research was more focused on the beneficial epigenetic effects and ‘the implications for healthy biological ageing’ of ‘positive social factors‘ such as ‘support from and contact with close others, particularly friends’.
Therefore it is important to consider an individuals health history and story the context of their human connection, as well as family history and future generations.
Human Connection
The effects of social isolation and lack of human connection became acutely apparent during the years of repeated lock-downs and social distancing around the globe, with the potential health fall out still being evaluated across a number of scientific studies. Whilst the links to increased rates of anxiety and depression are clear, tentative links to dementia, cardiovascular health and even ‘all-cause-mortality’ are being researched.
Social Interactions and Relationships
At least two studies reached the conclusions that there are two aspects of human connection that positively influence longevity:
- Healthy, happy relationships
- Social interactions/regular socialising
For most individuals the opposite is likely true for social isolation and unhappy relationships.
Self-esteem
Another aspect of human connection that is well researched and familiar to most is the importance of self-esteem, particularly in the formative years, with studies pointing towards a ‘protective effect against common mental health problems’ when healthy self-esteem is encouraged. On the flip side ‘low self-esteem is a robust predictor of concurrent and future mental health disorders, particularly those associated with negative cognitions and affect as expressed in anxious and depressive symptoms’. Often it is insightful to explore an individual’s formative years in the context of their present day health.
Beliefs
We are all raised with a set of beliefs about the world around us, formed by our friends, family, experiences and other environmental influences. They are often sub-conscious but permeate all aspects of our lives influencing how we behave, interact, vote, our spirituality and so forth. Whilst many of the beliefs we hold allow us to navigate the world without too much deliberation, limiting beliefs can affect our health and may be uncovered in the course of a consultation.
Spirituality
Not every individual is spiritually inclined and seeking a meaningful connection with something bigger than themselves, whilst others ‘trust’ in the wisdom of a higher being and some are continuously contemplating universal themes in search of wisdom and enlightenment. Such connections can significantly influence an individuals health journey and may warrant exploration during the course of a consultation.
Physical
Whilst I am not trained to work on a physical level, I am very grateful to the professionals and my clients for helping me to broaden my knowledge base to include and to be able to explain a variety of physical ailments and refer to an appropriate healthcare professional including those below, whilst I focus on diet and life-style aspects.
- Dentists
- Sports physicians
- Myofunctional therapists
- Orthodontists
- Periodontists
- Physiotherapists (neuro-, pelvic health-, musculoskeletal- and pediatric-)
- Osteopaths
- Chiropracters
- Podiatrists
- Craniosacral practitioners
- Rolfing practitioners
- Massage therapists
- Lymphatic drainage therapists
- Accupuncturists
- Accupressure practitioners
- Breathing coaches
Dental
There are a range of different conditions, including those listed below, which most people might consider as a cosmetic- versus a health issue that can impact sleep, oxygenation, pain, immune function and more. These may be touched on in the course of a comprehensive consultation.
A misaligned bite due to:
- Dental- and/or skeletal malocclusion
- Crowded and/or too many teeth (hyperdontia)
- Wisdom tooth removal
- Tooth loss
- Narrow dental arch with insufficient room for the tongue
- Over- or under-bite
- Temporomandibular Joint (TMJ) disorder or TMD
- Neuralgia-inducing cavitational osteonecrosis (NICO)
These are just some of the associated complaints:
- Insomnia
- Snoring
- Trouble breathing
- Obstructive sleep apnoea
- Headaches
- Migraines
- Weakened immune function
- Heart complaints
- Tinnitus
- Dizziness
- Pain
- Musculoskeletal issues
Increased toxic load:
- Dental plaque build up
- Dental amalgams
- Intolerance to dental materials used in restorations
- Dormant infections in root canals
- Dying tissues (necrosis) such as NICOS
These are some of the associated complaints:
- Autoimmune conditions
- Electro-sensitivity
- Chronic cough
- Weight management issues
- Heart complaints
- Neurological issues
- Skin conditions
Musculoskeletal
People tend to go to a physiotherapist, an osteopath or chiropractor for back pain, knee pain, neck pain or recovery from an injury, surgery etc but very few would seek out a specialised physiotherapist for urinary- or fecal- incontinence. Likewise, bunion or callus removal is a popular reason to see a podiatrist, but most would not go to address spinal issues. Often more invasive interventions such as elective surgery and knee/hip replacements can be delayed or even avoided (with the agreement of your medical team) or the outcomes can be improved by taking a Functional Medicine approach and working as
an integrated team.
These are some conditions that may benefit from taking a Functional Medicine approach:
- Carpel tunnel syndrome
- Herniated disk
- Osteopenia/Osteoporosis
- Frequent cramping
- Repeated stress fractures
- Popping or clicking joints
- Urinary- or fecal- incontinence (pelvic health)
- Frequent bedwetting
- Constipation (pelvic health)
- Fibromyalgia
- Odema (swelling)
- Swollen and/or painful joints
- Bursitis or tendonitis
- Bone spurs
- Morning stiffness and/or pain
- Easily fatigued muscles
- Delayed onset muscle soreness (DOMS) in athletes
- Soreness after exercise
- Loss of muscle tone
- Muscle ‘jerking’ when falling asleep
- Restless leg syndrome
Organ
A Functional Medicine approach can form part of a preventative strategy by highlighting organs that are under stress or functioning sub-optimally before irreversible changes occur. Often people are unaware that one or more of their organs is not functioning or have a slightly different structure to others until by chance they have a scan and/or an imbalance finally shows up on a laboratory report.
These are some conditions that may benefit from taking a Functional Medicine approach:
- Liver – non-alcoholic fatty liver disease (NAFLD)/, non-alcoholic steatohepatitis (NASH) etc.
- Kidneys – horse-shoe kidney, complications caused by diabetes (diabetes insipidus), kidney stones, chronic dehydration etc.
- Bladder – interstitial cystitis, tied tubes etc
- Neurological – neuro-inflammation, insulin resistance, dyskinesia, gut motility issues, cognitive decline etc.
- Gastro-intestinal tract – distended colon, hiatal hernia, loose sphincter, dysbiosis, intestinal permeability (‘leaky’ gut), SIBO (small intestinal bacterial overgrowth) and/or SIFO (small intestinal fungal overgrowth) etc.