Lower Digestive Issues: 6 Common Problems & Functional Solutions

When we think about digestive issues, we usually focus on upper GI symptoms like heartburn or that annoying bloated feeling after a big meal. But a lot more is happening in our gut, especially in the lower part of our digestive system.

As we hit our 40s, 50s, and beyond, our lower gastrointestinal tract – basically everything from the end of our small intestine to, well, the exit – starts acting up in ways we might not expect. I’m talking about the large intestine (AKA: the colon), the rectum, and, yes, even the anal canal.

Source: Dr. Purushottam Vashistha

These body parts might not be your typical dinner table conversation (although honestly, in my house, they are)…but they’re super important for our overall health.

As we age, this lower part of our gut can start acting up. Maybe you’ve noticed changes in your bowel habits, or you’re dealing with uncomfortable issues you’ve never had before, like irritable bowel syndrome (IBS) or more serious stuff like inflammatory bowel disease (IBD). Maybe you’ve been doubled over in pain, googling what colon cancer feels like, only to be told by your doctor you’ve got a case of diverticulitis. Or maybe eating certain foods you used to be able to handle (like dairy or gluten) is suddenly a no-go.

Trust me, you’re not alone. Millions of people in the United States deal with lower GI problems every day. In fact, it’s estimated that 60 to 70 million Americans are affected by digestive diseases [1].

But why does this happen? And more importantly, what can we do about it?

Let’s start with a quick recap of how digestion works, what your lower GI system is responsible for, and the top root causes of digestive disturbance.

How Your Digestive System Works

Think of your digestive system as a complex assembly line. It starts in your mouth, where chewing breaks down food and mixes it with saliva. From there, the food travels down your esophagus into your stomach, where it’s churned with stomach acid and enzymes. This mixture then moves into the duodenum (the top of your small intestine), where most nutrient absorption occurs.

The lower GI tract takes over from there, focusing on further nutrient absorption, water balance, and waste elimination.

Your lower digestive system includes:

• The remainder of the small intestine (jejunum and ileum)
• The large intestine (colon)
• The rectum
• The anal canal

The jejunum and ileum continue absorbing nutrients that weren’t picked up in the duodenum. The large intestine, or colon, is where most water absorption occurs, turning liquid waste into solid stool. It’s also home to trillions of bacteria that play crucial roles in our health. The rectum stores stool until it’s ready to be expelled, and the anal canal is the final exit point, controlled by sphincter muscles that regulate bowel movements. 

It’s this lower system where many digestive problems occur, especially as we age. Let’s see why…

The Top Root Causes of Lower Digestive Disturbances

As we get older, the lower digestive tract goes through several changes that can lead to discomfort and health issues. These changes include:

1. Decreased muscle tone in the colon, which can slow bowel movements
2. Reduced production of digestive enzymes, affecting nutrient absorption
3. Changes in the gut microbiome, potentially leading to inflammation
4. Weakening of the pelvic floor muscles, which may contribute to issues like fecal incontinence (AKA: accidental pooping)

Some digestive disorders, like irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and celiac disease, can either show up or get worse as we hit midlife. These aren’t just the occasional stomach ache—they can be chronic conditions that need proper attention.

That said, many digestive problems aren’t solely the result of aging. Several other root causes can contribute to lower GI tract issues and chronic digestive disturbances:

Lower GI Issue Root Cause #1: Toxins

Exposure to environmental toxins, pesticides, and heavy metals can disrupt the gut microbiome and lead to inflammation. These toxins can damage the delicate lining of your gut, leading to increased permeability (AKA “leaky gut”). They can also kill off beneficial bacteria, allowing harmful bacteria to thrive and cause digestive issues.

Lower GI Issue Root Cause #2: Nutrient Deficiencies

Inadequate intake of essential nutrients can negatively affect gut function and repair mechanisms. For example, zinc deficiency can weaken the gut barrier [2], while vitamin D deficiency can impair immune function in the gut [3]. Low levels of omega-3 fatty acids can also contribute to increased inflammation in the digestive tract [4]. 

Nutrient deficiencies can also be caused by problematic conditions in the gut, like in the case of celiac disease, where gluten causes the body to attack the villi that line the intestinal wall, affecting your ability to absorb nutrients from food.

Lower GI Issue Root Cause #3: Chronic Infections

Lingering bacterial, viral, or parasitic infections can cause ongoing inflammation and damage to the gut lining. These persistent infections can disrupt the balance of gut bacteria, interfere with nutrient absorption, and trigger an ongoing immune response that leads to chronic inflammation. 

They can also make the gut more susceptible to deeper infections, food sensitivities, and even life-threatening diseases. For instance, chronic H. pylori infection, which affects about 35% of the U.S. population, has been linked to various gastrointestinal disorders and may increase the risk of developing gastric cancer [5].

Lower GI Issue Root Cause #4: Stress & Trauma

Chronic stress elevates cortisol levels, which can negatively impact gut health by altering gut motility, flaming inflammation, and disrupting the gut-brain axis. High stress levels decrease blood flow to the digestive system, impede the production of crucial digestive enzymes, and alter the composition of the gut bacteria in your microbiome. 

Trauma, whether physical or emotional, can also lead to long-term changes in gut function through its impact on the nervous system. For instance, it’s estimated that up to 50% of individuals with IBS have a history of early life trauma or abuse, highlighting the significant impact of stress and trauma on gut health [6].

The result of these various root cause factors? Chronic inflammation – which can lead to many different gastrointestinal disorders and even increase your risk of developing more severe conditions like colon cancer.

Understanding these root causes is crucial for addressing lower GI issues effectively. While conventional medicine often focuses on managing symptoms, a functional GI approach aims to identify and treat the underlying causes of digestive problems.

Yes, some digestive issues are inevitable as we age, but many can be prevented or managed through lifestyle changes and targeted interventions, which we’re about to get into.

If you want details on identifying and resolving upper GI problems, pop over here. You’ll find tons more info about bloating, gallstones, leaky gut syndrome, gluten sensitivity/celiac disease, acid reflux, gastroesophageal reflux disease (GERD), and heartburn.

For now, let’s explore 6 of the most common lower GI tract health conditions, why they occur, and the functional health approaches you can take to remedy them.

1. Constipation

What’s happening:

Constipation is when bowel movements become infrequent, difficult, or incomplete. It’s characterized by hard, dry stools that are challenging to pass. Not having a bowel movement daily can be considered constipation, however some experts define it as 3 or fewer eliminations per week (but everyone is different). No matter the official definition, constipation can cause discomfort, bloating, and a feeling of fullness or incomplete evacuation. 

Constipation is one of the most common gut issues—especially in the United States and other Western countries—impacting millions [7]. It can significantly impact overall health if left unaddressed. In recent years, there’s been increasing awareness of how constipation can be a sign of more serious underlying conditions.

My clients love to tell me that I’m obsessed with poop, but from a health perspective, it’s one of the best things you can do! Regular bowel movements remove toxins and waste from the body. So when constipation strikes, those pollutants linger in the body longer than they’re supposed to, making you feel slow, tired, and uncomfortable.

Why constipation happens:

Constipation can have several root causes, including:

Dehydration – Not drinking enough water can lead to harder stools that are difficult to pass. Poop is typically 75% water, so if you aren’t getting enough liquids in daily, it makes it harder to get the poop out (quite literally) [8].

Lack of dietary fiber – A poor diet low in fiber is a common cause of your digestive health problems. Low fiber can slow down bowel movements and make stools harder. Fiber acts as a bulking agent, adding mass to stool and helping it move through the intestines more easily. It also feeds beneficial gut bacteria, promoting overall digestive health. Those on certain diets—like keto or low-carb—tend to get constipated more often since many of their food options are low in fiber.

Hormonal changes – Fluctuations in hormones, particularly during menopause or thyroid issues, can affect bowel function. This is because hormones influence gut motility and water absorption in the intestines. For example, decreased estrogen during menopause can slow down gut transit time and create constipation.

Medications – Certain drugs, such as opioids, iron supplements, and antidepressants, can cause constipation because these medications can slow down gut motility, decrease intestinal secretions, and alter the gut microbiome.

Sedentary lifestyle – Movement helps stimulate the muscles in your intestines, promoting peristalsis (the wave-like contractions that move food through your GI tract), so a lack of consistent physical activity can slow down digestive processes.

Ignoring the urge to go – Maybe you’re on the road. Maybe you’ve got a jam-packed schedule or are distracted by other activities. Maybe you’re one of the many people who physically can’t “go” in public (a condition known as parcopresis or “shy bowel syndrome”). Regularly postponing bowel movements can weaken the signals between the brain and the bowels, creating conditions ripe for constipation.

Neurological conditions – Diseases affecting the nervous system, like Parkinson’s, can interfere with bowel function. This is due to disruptions in the nerves that control intestinal muscles and coordinate bowel movements.

Pelvic floor dysfunction – Weakened or uncoordinated pelvic floor muscles can make it difficult to have a BM. It may surprise you to know that your pelvic floor muscles play a crucial role in the defecation process, helping to relax the anal sphincter and allow stool passage, but it’s true!

Semaglutide side effect – Semaglutide, found in Ozempic and other new weight loss medications, mimics the GLP-1 hormone, which helps regulate blood sugar and slows the movement of food through the stomach. This delayed gastric emptying can improve satiety and aid in weight loss, but it may also lead to constipation as a side effect. In clinical trials, up to 15% of people taking semaglutide reported constipation [9].

How to address constipation:

1. Increase fiber intake – Gradually add more high-fiber foods to your diet, such as fruits, vegetables, whole grains, and legumes. Aim for 25-30 grams of quality fiber per day. This is a vital component of an effective treatment plan for many digestive issues. Pro tip: increase water intake alongside fiber to prevent worsening constipation. You can also add a fiber supplement. I recommend you start at a quarter dose and build up to full dosing. 

2. Stay hydrated – Drink plenty of water throughout the day. Aim for at least eight glasses per day.

3. Exercise at least 30 minutes a day – Physical activity helps stimulate bowel movements, so try to get at least half an hour of moderate exercise most days of the week.

4. Establish a regular bathroom routine – Yes, you can train your poop! Try to have a bowel movement at the same time each day, preferably after a meal when the gastrocolic reflex is strongest.

5. Use proper toilet posture – Surprisingly, the way we sit on a toilet doesn’t give us the best position to poop; what works better is elevating your feet while on the toilet. An easy way to do this is by using a footstool, which creates a more natural squatting position, making bowel movements easier. (BTW, remember those completely unhinged Squatty Potty ads?! That’s exactly what this tip is about.)

6. Try natural laxatives – Prunes, chia seeds, and ground flaxseeds can help promote regular bowel movements.

7. Consider magnesium supplements – Magnesium citrate or magnesium oxide can help draw water into the intestines, softening stools. Of course, always consult with a healthcare provider before starting new supplements.

8. Manage stress – Chronic stress can interfere with digestive function. Practice stress-reduction techniques like meditation or deep breathing exercises each day to get the benefits.

9. Look at your medications – If you think your medications might be the cause of your constipation, talk about it with your doctor. They won’t know your symptoms unless you tell them. Chances are they have some alternatives they can offer to alleviate your constipation struggles.

10. Pelvic floor exercises – For those with pelvic floor dysfunction, exercises to strengthen and coordinate these muscles may help. For example, Kegel exercises can help strengthen these muscles, while balloon expulsion exercises can improve coordination. Both can be beneficial for managing constipation. If home exercises aren’t helping, consider working with a pelvic floor physical therapist.

11. Probiotic supplements – Certain probiotics contain strains, such as Bifidobacterium lactis, which have been shown to help alleviate constipation [10]. It’s thought to be due to their ability to improve gut motility, soften stools, and reduce gut transit time.

12. Avoid overuse of laxatives – While occasional use is fine, regular use of stimulant laxatives can lead to dependence and worsen constipation over time. Overuse can create a condition known as “lazy bowel syndrome,” where the colon becomes reliant on laxatives to function, making it harder to have natural bowel movements.

If constipation continues despite these shifts, or if you experience severe abdominal pain, bloody stool (even a small amount), or unexplained weight loss, call your healthcare provider right away, as these could be signs of more serious conditions that require medical attention.

2. Diarrhea

What’s happening:

Diarrhea is characterized by loose, watery stools occurring more frequently than usual. It’s your body’s way of quickly expelling something it deems to be harmful from your digestive tract. 

When your digestive tract is operating normally, food that’s been processed through the GI tract proceeds to the colon, where water is absorbed from the remaining waste matter until a solid stool is formed. But if not enough water is absorbed, or if the processed food moves through the gastrointestinal tract too quickly, the stool won’t be solid and will get passed in a loose or watery (diarrhea) form.

While everyone experiences occasional diarrhea, frequent or chronic diarrhea can be an indication of an underlying condition and can lead to dehydration if not managed properly.

Why diarrhea happens: 

Diarrhea can have several root causes, including:

Infections – Viral, bacterial, or parasitic infections can cause acute diarrhea. Common culprits include norovirus, E. coli, and Giardia.

Osmotic fluid imbalance – This means a larger-than-normal amount of water in the stool.

Food intolerances or allergies – Lactose intolerance, celiac disease, or sensitivities to specific foods can trigger diarrhea.

Medications – Certain medications, especially antibiotics, can disrupt the balance of gut bacteria and lead to diarrhea.

Inflammatory bowel diseases – Conditions like Crohn’s disease or ulcerative colitis can cause chronic diarrhea.

Stress, anxiety, and trauma – The gut-brain connection means that psychological stress, including unresolved trauma from childhood or any time in your life, can manifest as digestive symptoms, including diarrhea.

Hormonal changes – Fluctuations in hormones, particularly during the menstrual cycle or menopause, can affect bowel habits. In women, estrogen and progesterone often influence gut motility and fluid balance. For example, during the luteal phase, progesterone levels are high, and some women experience looser stools. Similarly, the hormonal changes during menopause can lead to changes in bowel habits, including diarrhea.

Surgical side effects – Sometimes, advanced interventions, such as having your gallbladder removed, can result in becoming more prone to diarrhea. When the gallbladder is removed, bile flows directly into the small intestine instead of being stored and released as needed. This constant flow of bile can lead to faster transit times and looser stools, particularly after eating fatty meals.

Malabsorption disorders – There are many conditions that interfere with nutrient absorption and can lead to diarrhea, such as celiac disease, pancreatic insufficiency (where the pancreas can’t produce enough digestive enzymes to break down food), or short bowel syndrome (where part of the small intestine is missing or functioning improperly, limiting nutrient absorption).

Overuse or high dosing of vitamin C – High doses of vitamin C can have an osmotic effect in the intestines, drawing water into the bowel and leading to loose stools. This is because the body can only absorb a certain amount of vitamin C at a time, and excess amounts are excreted, often with additional water.

Semaglutide side effect – Semaglutide, the active ingredient in Ozempic and other new weight loss drugs, commonly causes gastrointestinal side effects, including diarrhea. Clinical studies report that up to 24% of users experience diarrhea, particularly during the early stages of treatment, as the drug slows gastric emptying and alters gut motility [11].

How to address diarrhea:

1. Stay hydrated – Diarrhea can quickly lead to dehydration. Drink plenty of clear fluids, including water, clear broths, and electrolyte solutions.

2. Use oral rehydration solutions – These specially formulated drinks can help replace lost fluids and electrolytes more effectively than water alone.

3. Try the BRAT diet – During acute episodes, stick to easily digestible foods like Bananas, Rice, Applesauce, and Toast (BRAT). These foods help firm up stools while providing gentle nutrition.

4. Avoid trigger foods – Common triggers include dairy, fatty foods, spicy foods, and caffeine. Keep a food diary to identify your personal triggers.

5. Consider probiotic supplements – Certain probiotic strains, like Saccharomyces boulardii and Lactobacillus rhamnosus GG, have shown effectiveness in reducing the duration of diarrhea [12].

6. Manage stress – Since stress can trigger or exacerbate diarrhea, incorporate stress-reduction techniques like meditation, deep breathing, or yoga into your routine.

7. Gradually reintroduce foods – As you recover, slowly reintroduce a wider variety of foods, starting with easily digestible options.

8. Use over-the-counter medications cautiously – Loperamide (Imodium) can provide short-term relief but should not be used for prolonged periods without medical advice.

9. Seek medical attention for chronic diarrhea – If diarrhea persists for more than a few days or is accompanied by severe pain, fever, or blood in the stool, consult a healthcare provider.

10. Consider functional medicine testing – A comprehensive gut test will reveal many causes of diarrhea, including bacteria overgrowth, pathogenic bacteria/parasites, viruses, fungus, digestive deficiencies, and inflammation. It can also indicate potential deeper health conditions. For example, a high calprotectin marker on your gut test may indicate Inflammatory Bowel Disease, a common cause of diarrhea, and should be evaluated by a gastroenterologist.

While occasional diarrhea is normal, frequent or chronic diarrhea shouldn’t be ignored. It can be a symptom of various underlying conditions and lead to complications if left unaddressed.

3. Irritable Bowel Syndrome (IBS)

What’s happening:

Many people get confused between IBS and IBD, as they have similar names and symptoms. The key difference between IBS (Irritable Bowel Syndrome) and IBD (Inflammatory Bowel Disease) lies in the nature of the conditions.

Irritable Bowel Syndrome (IBS) is a common digestive disorder that affects the large intestine. It’s a functional disorder, meaning it affects how the gut works without causing visible damage or inflammation. Symptoms include abdominal pain, bloating, and changes in bowel habits (diarrhea, constipation, or both), but there is no physical damage to the digestive tract.

IBD, on the other hand, is a chronic inflammatory condition that includes Crohn’s disease and ulcerative colitis. IBD causes visible inflammation and damage to the intestinal lining, leading to more severe symptoms like persistent diarrhea, bleeding, weight loss, and fatigue. IBD can also increase the risk of complications like intestinal damage or cancer.

In short, IBS affects gut function, while IBD causes structural inflammation and damage to the digestive tract. And unlike other digestive diseases, IBS doesn’t damage the intestines or increase the risk of colorectal cancer.

Why IBS happens:

The exact cause of IBS is not fully understood, but several factors seem to play a role:

Gut-brain axis dysfunction – There’s a strong connection between the gut and the brain. In IBS, this communication may be disrupted, leading to gut motility and sensitivity changes.

Visceral hypersensitivity – People with IBS may have a lower pain threshold for bowel disturbances, making normal digestive processes uncomfortable or painful.

Altered gut microbiome – An imbalance in the types and numbers of bacteria in the gut may contribute to IBS symptoms. Studies have shown that IBS patients often have lower levels of beneficial bacteria like Bifidobacteria and Lactobacilli and higher levels of potentially bad bacteria [13].

Food sensitivities – Certain foods (such as dairy products, gluten, spicy foods, and high-FODMAP foods like onions, garlic, and legumes) may trigger or worsen IBS symptoms in some people.

Stress and anxiety – Mental health can have a big impact on gut health due to the gut-brain connection. Chronic stress can alter gut motility, increase intestinal permeability, and affect the balance of gut bacteria. Additionally, the anxiety and stress caused by IBS symptoms can create a vicious cycle, further exacerbating the condition.

Post-infection – Some people develop IBS after a bout of gastroenteritis. This may be caused by changes in the gut microbiome following the infection or lingering inflammation in the intestinal lining.

Hormonal changes – Many women notice their IBS gets worse during their period. This may be due to fluctuations in estrogen and progesterone levels, which can affect gut motility and sensitivity.

How to address IBS:

1. Identify trigger foods – Pay attention to when your IBS hits. A food diary is a great tool to help you pinpoint which foods trigger your symptoms.

2. Try a low FODMAP diet – This diet, which eliminates certain types of fermentable carbohydrates, has shown significant benefits for many IBS sufferers. In a low FODMAP diet, you’d likely cut out foods such as garlic, onions, and certain fruits like apples for a period of time (say, 4-6 weeks) and then slowly reintroduce them one at a time to identify which ones you can tolerate. The goal of a low FODMAP diet is not to eliminate these foods forever. Instead, it’s to determine which specific FODMAPs trigger your symptoms. Many people are able to reintroduce some or all of these foods in moderate amounts after the elimination phase, tailoring their diet to their individual tolerances.

3. Manage stress – By reducing stress, you can help calm your digestive system and potentially reduce the frequency and severity of IBS flare-ups. Techniques like journaling, yoga, mindfulness, and relaxation exercises can help manage IBS symptoms.

4. Consider probiotics – Certain strains may help alleviate IBS symptoms, particularly Bifidobacterium infantis 35624 [14].

5. Regular exercise – Physical activity can help regulate bowel function and reduce stress.

6. Medications – Depending on your primary symptoms, your doctor may recommend antispasmodics, anti-diarrheal agents, or low-dose antidepressants.

7. Peppermint oil – This natural remedy has shown promise in reducing IBS symptoms, particularly abdominal pain [15]. It may be due to its antispasmodic effects on the smooth muscles of the digestive tract. Peppermint oil is typically taken orally in enteric-coated capsules to prevent heartburn.

8. Stay hydrated – Proper hydration is crucial, especially for those with diarrhea-predominant IBS, to replace fluids lost through frequent bowel movements and prevent dehydration.

9. Consider psychological therapies – Because mental health has such a strong connection to IBS, addressing that potential root cause is vital. Cognitive behavioral therapy and hypnotherapy have shown benefits for IBS management. These therapies can help by reducing stress, changing negative thought patterns, and improving coping skills. A meta-analysis study found that psychological therapies significantly improved IBS symptoms compared to control treatments [16].

10. Explore gut-directed hypnotherapy – This specialized form of hypnosis targets the gut-brain connection. You might be wondering what the heck gut-directed hypnotherapy is, so this is a breakdown of what you might expect in a session: a therapist guides the patient into a relaxed state, then uses visualization techniques to imagine their gut functioning smoothly, like picturing a calm, flowing river. This mental imagery helps reduce stress and improve the regulation of gut movements, alleviating symptoms such as pain and bloating. A study published in the Journal of Neurogastroenterology and Motility found that gut-directed hypnotherapy improved overall IBS symptoms, abdominal pain, and quality of life [17].

IBS is typically a chronic condition that requires ongoing management. While symptoms may come and go, it’s not something that normally “goes away” on its own. However, with proper management, many people can significantly reduce their symptoms and improve their quality of life. 

It’s worth noting that there’s no single definitive test for IBS; it’s usually diagnosed based on symptoms and by ruling out other conditions. However, your doctor may use the Rome IV criteria, a set of diagnostic criteria for IBS, and may perform blood tests, stool tests, or colonoscopy to rule out other conditions.

4. Diverticulitis

What’s happening:

Diverticulitis occurs when small, bulging pouches (diverticula) that can form in the lining of your digestive system become inflamed or infected. These pouches are most common in the lower part of the large intestine (colon). 

Source: United Ostomy Associations of America

Diverticulitis can create severe abdominal pain, fever, nausea, and a dramatic change in your bowel habits. Approximately 200,000 people in the United States are hospitalized yearly for diverticulitis [18]. 

Why diverticulitis happens:

Several factors contribute to the development of diverticulitis:

Low-fiber diet – A diet low in fiber can lead to hard stools, increasing pressure within the colon and potentially causing diverticula to form.

Aging – The risk of developing diverticula increases after 40 because the walls of the colon naturally weaken and become less elastic as we age, making them more susceptible to forming pouches.

Obesity – Carrying extra body weight increases the risk of diverticulitis. This may be due to altered gut bacteria, increased intestinal pressure, and chronic low-grade inflammation associated with obesity.

A sedentary lifestyle – A lack of regular movement and exercise is linked with a higher risk of diverticulitis. Regular physical activity helps maintain healthy bowel function and may reduce inflammation in the body.

Smoking – Tobacco use can increase the risk of developing diverticulitis. Smoking can weaken the lining of the colon and impair blood flow to the intestines, making them more susceptible to infection and inflammation.

Certain medications – Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) or steroids may increase the risk. These medications can irritate the lining of the digestive tract and potentially increase the risk of diverticular bleeding.

Genetic factors – There may be a genetic predisposition to developing diverticulitis. 

How to address diverticulitis:

1. Increase fiber intake – Once the acute phase has passed, gradually increase your fiber intake to promote better bowel health.

2. Stay hydrated – Drink plenty of water to help fiber do its job and promote softer stools.

3. Exercise regularly – Physical activity can help maintain bowel regularity and reduce pressure in the colon.

4. Avoid trigger foods – During a flare-up, stick to a clear liquid diet, then gradually introduce low-fiber foods as symptoms improve.

5. Quit smoking – If you smoke, quitting can reduce your risk of developing recurrent diverticulitis.

6. Maintain a healthy weight – Losing extra pounds can reduce your risk of complications.

7. Consider probiotics – Some studies suggest probiotic supplements may help prevent recurrences of diverticulitis. For instance, one study found that a specific probiotic strain, Lactobacillus casei, taken regularly, helped reduce the frequency of diverticulitis episodes in patients by promoting a healthier gut microbiome and reducing inflammation [19].

8. Manage stress – Chronic stress may exacerbate symptoms, as stress can alter gut motility, increase inflammation, and affect the immune system’s ability to fight infections. So, incorporate stress-reduction techniques into your routine.

Contrary to old beliefs, there’s no need to avoid seeds, nuts, or popcorn unless you find they trigger symptoms for you.

Unfortunately, diverticulitis is a condition that can come back again and again. Recurrent cases may require antibiotics or, in severe cases, surgery.

Diverticulitis is a common condition, especially as we age, but it’s not an inevitable part of getting older. While you can’t control all risk factors, many of the lifestyle changes that help prevent or manage diverticulitis—like eating a high-fiber diet, staying active, and maintaining a healthy weight—are beneficial for your overall health, too. 

If you’re experiencing symptoms of diverticulitis, particularly severe abdominal pain or fever, seeking medical attention promptly is crucial. Early treatment can help prevent complications and improve outcomes. 

5. Lactose Intolerance

What’s happening: 

Lactose intolerance is the inability to digest lactose, a sugar found in milk and dairy products. When lactose isn’t properly digested, it can cause uncomfortable digestive symptoms. Interestingly, lactose intolerance is actually the norm for adult humans. Those who can digest lactose into adulthood have a genetic mutation that allows them to continue producing the enzyme lactase. After all, you’re not a baby cow, which is why many people have issues with dairy!

Why lactose intolerance happens:

Several factors contribute to lactose intolerance:

Natural decrease in lactase production – After weaning, most mammals (including humans) naturally decrease the production of lactase, the enzyme that breaks down lactose.

Genetics – Some populations have higher rates of lactose intolerance due to evolutionary adaptations. For instance, Northern European populations tend to have lower rates of lactose intolerance compared to Asian or African populations.

Damage to the small intestine – Conditions like celiac disease, Crohn’s disease, or infections can damage the small intestine’s lining, where lactase is produced.

Age-related changes – Our bodies may produce less lactase as we age, leading to increased lactose intolerance in midlife and beyond.

Premature birth – Babies born prematurely may have reduced levels of lactase, as this enzyme increases in the fetus during the third trimester [20].

How to address lactose intolerance:

1. Gradually reduce dairy intake – Start by cutting back on milk and other dairy products to see if symptoms improve.

2. Ditch dairy entirely – Consider switching to plant-based alternatives. Nut milks like almond or cashew, oat milk, and soy milk have become increasingly popular and versatile. Many vegan cheese and yogurt alternatives have improved significantly in taste and texture over the years, making dairy lovers much more amenable to the switch.

3. Opt for lactose-free dairy products – If you absolutely must have cow dairy, many brands now offer lactose-free versions of milk, yogurt, and cheese. These products contain the enzyme lactase, which breaks down the lactose before you consume it, allowing you to enjoy dairy without digestive discomfort.

4. Experiment with different types of dairy – Some people may tolerate goat’s milk or sheep’s milk better than cow’s milk because these kinds of milk have slightly different protein structures and fat globules that can be easier to digest.

5. Try fermented dairy – Yogurt, kefir, and some aged cheeses may be better tolerated because the fermentation process breaks down some of the lactose.

6. Get calcium and vitamin D from non-dairy sources – Foods like leafy greens, seeds (especially sesame and chia seeds), and fatty fish can help meet these nutritional needs. For example, a lunch of grilled salmon on a bed of sautéed kale, topped with a tablespoon of sesame seeds and served with a side of roasted sweet potato, can provide a significant portion of your daily calcium and vitamin D requirements.

7. Read labels carefully – Lactose can be found in unexpected places, including salad dressings, protein powders, processed foods, and some medications.

8. Consider a trial elimination diet – Remove all dairy for a few weeks, then slowly reintroduce it to pinpoint your tolerance level.

9. Support overall gut health – Improving your gut health through probiotics (Lactobacillus acidophilus is particularly effective for those who are lactose intolerant) and a balanced diet may help with lactose tolerance over time. Probiotics can help by producing lactase in the gut, potentially improving your ability to digest small amounts of lactose.

10. Try lactase enzyme supplements – These can be taken with dairy products to help break down lactose.

While lactose intolerance isn’t dangerous, it can be uncomfortable and may lead to nutritional deficiencies if not appropriately managed. It’s important to remember that lactose intolerance is different from a milk allergy, which can be serious and requires strict avoidance of all dairy products. Work with a healthcare professional to suss out which one applies to you.

6. Crohn’s Disease

What’s happening:

Crohn’s disease is a type of inflammatory bowel disease (IBD) that causes chronic inflammation of the gastrointestinal tract. Unlike celiac disease, which specifically involves a reaction to gluten, Crohn’s can affect any part of the digestive tract from mouth to anus. However, it most commonly affects the end of the small intestine (the ileum) and the beginning of the colon. This kind of inflammation can lead to abdominal pain, severe diarrhea, fatigue, weight loss, and malnutrition.

Why Crohn’s disease happens:

The exact cause of Crohn’s disease is unknown, but several factors contribute:

Genetic factors – People with family members who have Crohn’s are more likely to develop the condition. Specific genes like NOD2 have been associated with increased risk. A study published in Nature Genetics found that individuals with NOD2 mutations have a 20-40-fold increased risk of developing Crohn’s disease [21].

Environmental triggers – Factors like environmental toxins, smoking, diet, stress, and certain medications may trigger inflammation in susceptible individuals.

Immune system malfunction – The immune system may attack harmless bacteria or food in the intestines, causing inflammation.

Gut microbiome imbalances – Changes in the gut bacteria may contribute to the development of Crohn’s due to the gut lining becoming compromised, fueling inflammation. Studies have shown that Crohn’s patients often have reduced diversity in their gut microbiome and an increase in potentially bad bacteria [22].

Previous intestinal infections – Some research suggests that past infections may trigger the onset of Crohn’s in susceptible individuals. For example, a study found that individuals who had experienced gastroenteritis caused by Salmonella or Campylobacter had an increased risk of developing Crohn’s disease in the following year [23].

How to address Crohn’s disease:

I’ve found over the years that my most successful clients who are able to put Crohn’s in remission are utilizing a combination approach between allopathic and natural medicine strategies. Here’s a list of options you can consider. 

1. Work with a gastroenterologist – If you experience regular diarrhea, abdominal pain, unexplained weight loss, or blood in your stool, you should see a gastroenterologist. They can perform tests like colonoscopies, CT scans, and blood tests to diagnose Crohn’s disease. 

2. Consider medications – I’m definitely a fan of taking medications where they make sense. Various medications can help reduce inflammation and manage acute symptoms. These may include:

• Aminosalicylates (e.g., mesalamine)
• Corticosteroids (e.g., prednisone)
• Immunomodulators (e.g., azathioprine, methotrexate)
• Biologics (e.g., infliximab, adalimumab)
• Antibiotics (to treat infections or fistulas)

3. Identify and avoid trigger foods – Common triggers include dairy, high-fat foods, spicy foods, and high-fiber foods during flares. These foods can be difficult to digest, increase intestinal inflammation, or cause additional irritation to an already inflamed gut lining. Keep a food diary to identify personal triggers.

4. Explore dietary approaches – Some find relief with specific diets like the Specific Carbohydrate Diet (SCD), which limits complex carbohydrates to reduce gut inflammation and promote healing, or the Anti-Inflammatory Diet, which emphasizes whole, unprocessed foods rich in antioxidants and omega-3s (such as salmon, flaxseeds, walnuts, and leafy greens) to reduce overall inflammation. Work with a registered dietitian who specializes in IBD.

5. Manage stress – Stress can exacerbate symptoms, increasing inflammation and altering gut motility. Practice stress-reduction techniques like meditation, yoga, or cognitive behavioral therapy.

6. Quit smoking – Smoking can worsen Crohn’s disease and increase the risk of complications. A study found that smokers with Crohn’s disease have a 34% higher risk of disease relapse compared to non-smokers [24].

7. Consider probiotic supplementation – Some strains, such as VSL#3 and E. coli Nissle 1917, may help maintain remission. This is likely due to their ability to improve your gut barrier function and modulate the immune response, but consult your doctor before adding them to your routine.

8. Address nutrient deficiencies – Crohn’s can lead to malabsorption. Work with a dietitian to ensure you’re getting the necessary nutrients. Supplements may be needed, especially for vitamin B12, iron, and vitamin D.

9. Stay hydrated – Diarrhea is one of the biggest symptoms of Crohn’s, and it can lead to dehydration, so maintaining proper fluid intake is crucial.

10. Regular exercise – When you’re feeling well, regular exercise can help manage stress and support overall health. Low-impact activities like swimming or yoga are very beneficial because they put less stress on the joints and digestive system while still providing the anti-inflammatory benefits of exercise.

10. Surgery may be necessary – In severe cases or when complications arise, surgery might be required to remove the damaged portions of the digestive tract.

Crohn’s disease is a serious condition that requires ongoing management. While there’s no cure, many people achieve long periods of remission when treated properly.

Taking Control of Your Lower GI Health

Many of these lower GI issues can be effectively managed or even resolved with the right approach.

The key lies in addressing the root causes of your digestive disturbances, not just masking the symptoms. This is where functional medicine shines. Unlike conventional approaches that often treat symptoms in isolation, functional medicine looks at your body as an interconnected system.

Working with a functional health practitioner can be a game-changer for your digestive health and overall quality of life!

Here’s why:

1. Comprehensive testing: Functional health practitioners can access advanced diagnostics your regular healthcare provider doesn’t use. For example, gut microbiome tests, which offer a clear picture of what’s happening in your digestive system. They can reveal imbalances in gut bacteria, the presence of pathogenic organisms and levels of beneficial bacteria, markers of inflammation, and even indicators of intestinal permeability or “leaky gut.” These tests can also show how well you digest and absorb nutrients and identify potential triggers for inflammatory bowel disease or other digestive disorders.
2. Personalized protocols: Based on your test results, health history, and goals, your practitioner can create a custom-tailored protocol designed specifically for you. This might include dietary changes, targeted supplements, stress management techniques, etc.
3. Addressing root causes: Instead of just treating symptoms, your practitioner will work to identify and resolve the underlying factors contributing to your lower GI issues. This could involve healing gut infections, balancing your microbiome, or addressing nutrient deficiencies.
4. Ongoing support: Digestive disorders often require time and patience to heal. Your functional medicine practitioner can provide the ongoing support and adjustments needed as your body responds to treatment.
5. Holistic approach: Your practitioner will consider how other aspects of your health – like hormones, stress levels, and sleep – might be impacting your digestive function. After all, every single system is interconnected. And unlike traditional medicine, which tends to distill problems into specific body parts, functional medicine takes a whole-person, whole-istic approach.

Remember, every person’s gut is unique, and what works for one individual may not work for another. That’s why a personalized approach is so crucial.

If you’ve already had an evaluation with your regular doctor and  you’re tired of dealing with persistent unexplained lower abdominal pain, unpredictable or uncomfortable bowel habits, or other digestive problems, it might be time to explore functional medicine. By getting to the root of your issues, you can not only improve your digestive health and get relief, but also boost your overall well-being.

Ready to take the next step in your digestive health journey? Let’s work together to uncover the real causes of your lower GI issues and create a plan tailored just for you. With the right support and approach, you can enjoy better digestion and improved health in midlife and beyond.