Functional Dyspepsia

✔️ Do you get full really easily and shortly after eating?

✔️ Do you get full after eating a snack?

✔️ Do you feel like you need to loosen a button on your pants after most meals?

✔️ Do you feel bloated and uncomfortable in the upper belly (ie. Epigastric area) within the hour or two after eating?

✔️ Do you experience diffuse burning in the belly after a meal, unlike the burn of localized heartburn/reflux?

If you notice one or more of these symptoms and they cannot be explained by any known structural abnormalities, you’re likely living with functional dyspepsia. 

We commonly know this as indigestion. 

Functional dyspepsia affects nearly 1 in 5 people and is one of the most common non-structural gastrointestinal concerns. It comes in three main forms including epigastric pain syndrome (EPS), post-prandial distress syndrome (PDS), and a mixed form including both EPS and PDS. 

Epigastric pain syndrome is typically associated with epigastric burning, pain unrelated to the gallbladder, nausea, or belching. 

PDS is more commonly experienced as loss of appetite, early satiety, and epigastric bloating. This is often equated with IBS.

Functional dyspepsia may be due to any of the following suspected mechanisms:

• Delayed gastric emptying

• Visceral hypersensitivity, lowering the local pain threshold

• Impaired barrier function 

• Altered production of acid. Thisincludes either hyperchlorhydria (high stomach acid) or hypochlorhydria (low stomach acid)

• Altered production of digestive enzymes

• Inflammation of the stomach & proximal intestinal tissue due to immune activation or allergies

• Altered gut microbiome, often due to H. Pylori infection

Testing Options: 

Testing often includes screening for celiac, H. Pylori infection, autoimmunity, and thyroid function, the latter of which can disrupt proper GI movement and metabolism. 

Aside from routine bloodwork, functional testing can also shed valuable root cause insight. Food sensitivity testing, food allergy testing, and comprehensive microbiome testing fall into this category. 

Conventional Approach: 

Conventional treatment often includes use of antacids (ie. proton pump inhibitors & H2 receptor antagonists), pro-kinetic agents (see my article here on constipation!), and tricyclic antidepressants.

Naturopathic Approach to Functional Dyspepsia:

Whenever I’m working with someone who lives with persistent indigestion, my goal is to get to the root of the issue. Many people also have overlapping IBS, anxiety, or stress physiology that amplifies symptoms, which is why a combined gut–brain approach typically works best.

Here are a few of my first line approaches:

Digestive Enzymes:

Think of digestive enzymes as the tiny “scissors” that break your food into absorbable pieces. Enzymes are made from your pancreas, stomach, and small intestine, and different enzymes specialize in different macronutrients. For example, lipase helps to break down fats, proteases break down proteins, and amylase turns starches into sugar. 

When enzyme output is low or poorly timed, food can linger in the stomach until properly broken down. This can feel like heavy fullness, pressure, and upper abdominal bloating after even modest meals. 

Digestive enzyme production can be affected by:

• Food quality 

• Chewing and pace of eating

• Mealtime habits

• Stress and state of the central nervous system

• Hydration 

• Regular movement

• Micronutrient status 

• Environmental toxins

• Certain medications and GI conditions (ie. Celiac, pancreatitis)

There are means to support inherent enzyme production but if this proves ineffective, digestive enzymes can be useful in a supplement form. Be sure to talk to you naturopathic doctor prior to supplementing. 

Bitter Herbs: 

Bitter herbs gently “kick start” the digestive process. When bitter taste receptors on the tongue and GI tissue are activated, the body responds by increasing production of saliva, stomach acid, bile, and enzymes. Collectively, this prepares the system to break down food to come, and properly move it along the GI tract. Bitters can beautifully nip sluggish digestion and early fullness in the bud. 

Common bitter botanicals include fennel, burdock, dandelion, gentian, etc. 

Prokinetics:

Prokinetics help to promote movement through the GI tract, and reduce the time foods linger in the stomach before moving onto the small intestine. Please see my article here to learn more about pro-kinetics.