Digestive issues such as chronic constipation, food allergies, malabsorption, and gastroparesis are prevalent in nearly all cases of neurogenic trauma, including stroke sequela, multiple sclerosis (MS), Parkinson’s disease, small fiber neuropathy (SFN), and post-traumatic stress disorder (PTSD). This also applies to adult survivors of childhood trauma. To support optimal digestion under these conditions, targeted supplementation is essential to prevent long-term degeneration and wasting. The cost of one consultation can save you hundreds of dollars otherwise spent on ineffective products, as most clients cannot accurately self-diagnose. While I highly recommend working with a trained clinician for guidance on these issues, these supplements are generally safe to use.
For those already diagnosed with SIBO or constipation, or who have undergone a cholecystectomy, many of these supplements can be taken safely without a prescription. Since the issue of chronic sympathetic dominance has not yet been incorporated into any medical school curriculum, there is a preponderance in alternative medicine to attribute everything to toxicity. Without basic clearance and enzyme support, however, the dozens of single herbs ($$) prescribed by a naturopath will have little to no benefit. The supplement industry can be unscrupulous, with providers often exploiting consumers. I, too, have spent thousands on various products, despite being in the business.
As TCM practitioners, by understanding the various steps in the cascade of the fight-flight-freeze response, we can use targeted supplementation for our patients with neurogenic trauma. Not everyone needs everything, and since these are long-term patterns that will take a few years to resolve, we want to minimize out-of-pocket costs. However, with time and proper support, the gut’s function can be restored. These supplements have been universally beneficial for both myself and my clients, increasing transit time, alleviating constipation or dumping syndrome, and supporting the healing process. For TCM providers new to Functional Medicine, you need more training to recommend these to patients.
For Zang Fu practitioners who favor large herbal formulas, it’s important to recognize that in cases of chronic sympathetic dominance, denervation of the middle jiao—which is parasympathetically derived—means patients must be in a parasympathetic state to effectively absorb these formulas. Many of us cannot achieve this state due to the derangement in the ANS.
Modern supplements are more targeted and ensure efficacy without introducing herbs into what is usually a complex case with many medications. These advanced supplements from reputable sources provide more consistent, effective enzymatic support, leading to better therapeutic outcomes and optimal absorption. Additionally, they eliminate the issue of herb-drug interactions for clients with extensive medication regimens. The idea is to simplify the treatment plan to include only what is most needed, ensuring safety and maximizing therapeutic benefits.
As a TCM provider, I am prohibited from changing or tapering medication. As they improve gastric function, they often reduce their reliance on medications that cause additional issues, further simplifying their regimen and enhancing overall health. This patient-driven approach allows for a more individualized and empowering path to wellness.
Bile Salts, TUDCA
Elevated cholesterol is one of the early indicators of chronic fight-flight or sympathetically dominant states, as well as insulin resistance. Despite the availability of effective treatments like ursodiol or gallbladder flushes to retain the gallbladder, cholecystectomy remains a top surgery in the US. Incorporating bile salts into the dietary regimen of these patients supports better digestive health and overall well-being by improving fat digestion and ensuring better absorption of essential fat-soluble vitamins (Healthgrades) (Home) (Topline MD |) (Specialty Surgical Center).
Cholecystectomy, the surgical removal of the gallbladder, has been associated with an increased risk of developing type 2 diabetes. Post-cholecystectomy, the continuous, unregulated flow of bile into the small intestine can disrupt the digestion and absorption of fats and carbohydrates, leading to metabolic changes that contribute to insulin resistance and type 2 diabetes.
One study indicated that patients who underwent cholecystectomy had a 20% higher risk of developing type 2 diabetes compared to those who did not have the surgery. The risk is particularly elevated in patients who are also obese, as obesity is a known risk factor for insulin resistance and impaired blood sugar regulation (BioMed Central, G & L Surgical).
Managing this increased risk involves careful monitoring of blood sugar levels, maintaining a balanced diet rich in whole foods, and engaging in regular physical activity to improve insulin sensitivity. Working closely with healthcare providers to adjust diabetes medications as needed is also crucial for maintaining optimal blood sugar control after surgery (G & L Surgical).
One effective approach to managing these issues is the use of bile salts. Bile salts aid in the digestion of fats and improve bowel motility, which can alleviate constipation. The taurine derivative TUDCA (Tauroursodeoxycholic acid) also shows promise in addressing chronic constipation and enhancing fat digestion. For patients who have undergone a cholecystectomy, taking bile salts with meals can significantly mitigate symptoms, much like the prescription drug ursodiol. Because bile salts are caustic, it is important to take them with food to prevent irritation of the stomach lining.
Digestive Enzymes
Enzymes play an essential role in breaking down the food we eat into absorbable nutrients, ensuring optimal digestion and nutrient assimilation. These enzymes, including amylase, protease, and lipase, target carbohydrates, proteins, and fats, respectively, facilitating their conversion into simpler molecules. Chronic Fight-Flight-Freeze responses trigger a cascade of events that inhibit the middle jiao or gut, impairing digestion. Over time, this inhibition leads to hypochlorhydria (low stomach acid), small intestinal bacterial overgrowth (SIBO), and other digestive issues, all traced back to the deficiency caused by chronic stress responses. Supplementing with digestive enzymes benefits individuals with enzyme deficiencies, gastrointestinal disorders, or symptoms like bloating, gas, or indigestion. By enhancing digestion, these enzymes improve nutrient absorption, support gut health, and alleviate digestive discomfort, contributing to overall well-being and vitality.
A common misconception is that digestive discomfort and issues such as acid reflux stem from excess stomach acid. However, as people age, stomach acid production often naturally declines, not increases. This reduction impairs nutrient digestion and absorption, leading to various deficiencies and digestive problems. Using proton pump inhibitors (PPIs) to reduce stomach acid exacerbates this issue by further lowering acid levels, hindering proper digestion, and compromising the integrity of the stomach lining over time. Additionally, much of acid reflux results from partially reactive Moro and Spinal Galant reflexes, which influence the body’s autonomic responses and exacerbate digestive issues. Understanding the true nature of digestive health and the role of enzymes helps in making more informed decisions about managing digestive issues and promoting long-term gastrointestinal health.
For optimal results, I recommend high-quality brands such as Standard Process, Thorne, and Pure Encapsulations. It’s essential not to skimp and opt for the cheapest option; instead, choose a broad-spectrum digestive enzyme. For easy compliance, take a few with your first meal of the day and don’t worry about it thereafter. This approach ensures consistent support for your digestive system and overall health. Most clients can discontinue Tums and PPIs such as Prevacid or Protonix by using digestive enzymes.
Chanca Piedra
Chanca Piedra, scientifically known as Phyllanthus niruri, is a plant traditionally used in herbal medicine, particularly in South America. It is commonly known as the “stone breaker” due to its reputed ability to dissolve kidney stones and gallstones. In addition to its effects on kidney and gallbladder health, Chanca Piedra is also used for managing uric acid levels and gout. It has been helpful in reducing gallstones as well, depending on the type.
Gout is a painful inflammatory condition caused by the accumulation of uric acid crystals in the joints, leading to inflammation and intense pain. Chanca Piedra has been studied for its potential to reduce blood uric acid levels, thereby helping prevent the formation of these crystals and alleviating gout symptoms. The plant contains compounds such as lignans, glycosides, and flavonoids that contribute to its anti-inflammatory and diuretic properties. These properties help promote the excretion of uric acid in urine, reducing its buildup in the body.
Moreover, the antioxidant activity of Chanca Piedra helps protect the tissues from damage caused by uric acid crystals. Its ability to enhance liver function also supports the body’s natural detoxification processes, aiding in the breakdown and elimination of excess uric acid.
For more detailed information and scientific studies on the use of Chanca Piedra for uric acid and gout, you can refer to the following sources:
Methylated Bs
Methylation is a crucial biochemical process in the body, impacting everything from DNA production to detoxification and neurotransmitter function. A common genetic variation known as the MTHFR (methylenetetrahydrofolate reductase) mutation can significantly impair this process. Approximately 40-50% of the population carries at least one MTHFR variant, with about 10-20% having two copies of the common C677T mutation. This mutation reduces the enzyme’s function, leading to lower levels of active folate (5-MTHF) and higher levels of homocysteine, which can contribute to various health issues, including cardiovascular diseases and neurological disorders.
To address these methylation defects, it is beneficial to use bioactive, methylated forms of B vitamins, such as methylfolate (5-MTHF) and methylcobalamin (vitamin B12). These forms bypass conversion in the body, ensuring that the necessary methylation processes proceed efficiently. Supplementing with these bioactive forms supports the methylation cycle, enhancing detoxification, energy production, and overall neurological health.
For patients with neurogenic trauma or chronic conditions, ensuring proper methylation through the use of methylated B vitamins can be a key component of a comprehensive treatment plan. By addressing methylation defects, practitioners can provide targeted support that can significantly impact their patients’ recovery and long-term health. This approach helps optimize biochemical pathways and minimize the risk of complications related to impaired methylation (CentreSpring MD) (GeneSight). Just read the label and make sure that B6 and B12 are both methylated, and you’ll be fine.
TMG and Glycine: The Methylation & Inhibitory Duo
While Methylated Bs provide the blueprints, TMG (Trimethylglycine) is the fuel that drives the remethylation of homocysteine, supporting liver health and acting as a precursor to stomach acid. Complementing this is Glycine, a vital inhibitory neurotransmitter. In neurogenic trauma, Glycine acts as a “metabolic brake pedal,” quieting the overactive motor signals that drive spasticity. Together, they help transition the system from a state of threat back into the Ventral Vagal safety required for herbal formulas to actually be absorbed.
The Methylation & Inhibitory Duo: Glycine and TMG
In cases of chronic sympathetic dominance, the body’s “brake pedal” is often worn down. **Glycine** serves as a vital inhibitory neurotransmitter in the central nervous system (CNS), specifically within the brainstem and spinal cord, to dampen the hyper-excitability of motor neurons that leads to spasticity. Beyond its neurological role, Glycine acts as a “methyl buffer,” absorbing excess methyl groups to maintain biochemical balance. Complementing this is **TMG (Trimethylglycine)**, or Betaine. While Glycine clears the path, TMG is a robust methyl donor that facilitates the remethylation of homocysteine in the liver. For the Polyvagal practitioner, TMG is especially useful because it supports the production of gastric acid (as Betaine HCl), addressing the hypochlorhydria and “Middle Jiao” denervation common in neurogenic trauma. Together, they provide the metabolic stability required for the system to shift from a state of “threat” back into Ventral Vagal safety.
Mitochondrial Resiliency: Magnesium and CoQ10
Persistent fight-or-flight responses place an immense “energy tax” on the mitochondria, often leading to cellular hypoxia and eventual Dorsal Vagal shutdown. To prevent this metabolic collapse, **Magnesium** is the first line of defense; it acts as a gatekeeper for the NMDA receptors, preventing the calcium influx that causes neurons to fire uncontrollably and “burn out.” It is essentially the “spark plug” of the cellular engine. To keep that engine running under the stress of sympathetic high-tone, **CoQ10 (Ubiquinone)** is required to facilitate electron transport and ATP production. For patients on statin medications—which block the mevalonate pathway—CoQ10 levels are often decimated, leading to the muscle wasting and profound fatigue seen in chronic neurogenic cases. Supplementing these ensures the “battery” of the nervous system has the voltage required to maintain parasympathetic tone.
ALA: The Universal Antioxidant for Nerve Protection
In the landscape of neurogenic trauma and spasticity, oxidative stress is a constant threat to the myelin sheath and nerve conduction. **Alpha-Lipoic Acid (ALA)** is a “universal” antioxidant, unique in its ability to function in both the fatty tissues of the brain and the aqueous environment of the cells. ALA is essential for recycling other antioxidants like Vitamin C and E, but its primary value in sympathetic dominance lies in its ability to improve insulin sensitivity and mitochondrial energy metabolism. By reducing the “noise” of oxidative stress, ALA helps clarify nerve signaling, preventing the erratic firing and “leaking” of electrical impulses that characterize spasticity. For adult survivors of trauma or those with Small Fiber Neuropathy (SFN), ALA provides a protective barrier that supports the long-term structural integrity of the nervous system.
Pyruvate
Pyruvate is a key player in naturopathic medicine, particularly for its role in driving the Krebs cycle even in hypoxic environments. The Krebs cycle, also known as the citric acid cycle, is a crucial metabolic pathway that generates energy through the oxidation of acetyl-CoA derived from carbohydrates, fats, and proteins. Pyruvate, the end product of glycolysis, is converted into acetyl-CoA by pyruvate dehydrogenase, thereby entering the Krebs cycle.
In hypoxic conditions, where oxygen levels are low, cells often switch to anaerobic glycolysis, leading to lactate accumulation and reduced energy production efficiency. However, pyruvate can help circumvent this limitation. It serves as a substrate for the Krebs cycle, enhancing ATP production even when oxygen is scarce. This makes it a valuable supplement in naturopathic protocols aimed at improving cellular energy production and reducing fatigue.
Naturopathic practitioners use pyruvate to support energy metabolism and improve endurance. It is particularly beneficial for individuals with chronic fatigue, fibromyalgia, and other conditions where mitochondrial dysfunction and energy deficits are prevalent. By enhancing the efficiency of the Krebs cycle, pyruvate helps to maintain cellular function and energy levels, promoting overall health and vitality.
Studies have shown that pyruvate can improve exercise performance, increase fat loss, and provide neuroprotective effects, making it a versatile tool in naturopathic medicine. Its role in sustaining the Krebs cycle under hypoxic conditions further underscores its potential in treating a variety of metabolic and energy-related disorders.
Sources: National Center for Biotechnology Information (NCBI) on Pyruvate and Energy Metabolism
Healthline on Pyruvate Supplementation
Journal of the International Society of Sports Nutrition on Pyruvate
Vitamin D3
Vitamin D3, also known as cholecalciferol, is essential for various bodily functions, particularly in the maintenance of bone health. It is synthesized in the skin upon exposure to sunlight, specifically ultraviolet B (UVB) radiation, which converts 7-dehydrocholesterol to previtamin D3. This previtamin D3 is then transformed into vitamin D3 through thermal isomerization. The liver further metabolizes vitamin D3 into 25-hydroxyvitamin D [25(OH)D], the primary circulating form of vitamin D, which is used to assess vitamin D status.
A significant concern in neurological disease is the widespread deficiency of vitamin D3, exacerbated by multiple factors. One of the primary contributors is the extensive use of statins. Statins, prescribed to lower cholesterol levels, inhibit the enzyme HMG-CoA reductase, which is not only crucial for cholesterol synthesis but also for the production of 7-dehydrocholesterol, the precursor of vitamin D3. As a result, individuals on statins have a reduced capacity to synthesize vitamin D3, leading to potential deficiencies.
Moreover, the use of sunscreen and limited exposure to natural sunlight further diminishes the skin’s ability to produce vitamin D3. Sunscreens, while protecting against skin cancer, block UVB rays necessary for vitamin D synthesis. Additionally, lifestyle changes have led to less time spent outdoors, reducing overall sunlight exposure.
These deficiencies have serious implications for bone health. Vitamin D3 is vital for the absorption of calcium and phosphorus, critical minerals for bone formation and maintenance. Microfibroblasts, which play a role in bone remodeling, rely on adequate levels of vitamin D3 to function effectively. Insufficient vitamin D3 impairs these processes, increasing the risk of osteoporosis and fractures, especially in the elderly population.
Addressing vitamin D3 deficiency involves a combination of dietary intake, supplementation, and safe sun exposure. Foods rich in vitamin D, such as fatty fish, fortified dairy products, and eggs, along with vitamin D3 supplements, can help maintain adequate levels. However, it is essential to balance sun protection with sufficient exposure to sunlight to support natural vitamin D3 synthesis.
Sources:
National Institutes of Health (NIH) on Vitamin D
Mayo Clinic on Vitamin D3 and Health
Harvard T.H. Chan School of Public Health on Vitamin D
A Note on the “Fragile Ecosystem”: Why Professional Guidance Matters
While these supplements are powerful tools for recovery, they must be applied with extreme precision, particularly for those in a Dorsal Vagal Freeze state—such as those navigating Long COVID, post-chemotherapy recovery, or late-stage neurological conditions like MS. In these “fragile ecosystems,” the nervous system has opted for shutdown as a survival mechanism. Introducing aggressive mitochondrial support or potent methyl donors too quickly can overwhelm a system that lacks the “clearance” capacity to handle the metabolic shift. This often results in paradoxical agitation, increased spasticity, or deeper exhaustion. Working with a practitioner trained in functional chemistry is essential to ensure we are not just throwing fuel on a fire that the body is trying to put out. The goal is to gently “resuscitate” the cellular metabolism without triggering a defensive flare, ensuring that your investment in your health is both safe and effective rather than a costly source of further dysregulation.
References:
- Dennis Thompson. (2024). Lifestyle Changes May Slow, Prevent Alzheimer’s in People at High Risk. HealthDay. Retrieved from HealthDay
- Dr. Berg. “Ox Bile Benefits: Eight Reasons to Use Bile Salts.” Retrieved from Dr. Berg.
- Fix Your Gut. “Bile Reflux, Weak Pyloric Sphincter, and How to Improve Fat Digestion.” Retrieved from Fix Your Gut.
- Genentech Press Release. (2022). Alzheimer’s Prevention Initiative and the API ADAD (Colombia) Trial. Retrieved from Genentech
- Healthgrades. “10 Most Common Surgeries in the U.S. | Estimated Surgery Cost.” Retrieved from Healthgrades.
- Heralded Alzheimer’s drug works — but safety concerns loom. (2023). Nature. Retrieved from Nature
- Johns Hopkins Medicine. “Common Surgical Procedures.” Retrieved from Johns Hopkins Medicine.
- Leggett, H. (2022). A rare mutation protects against Alzheimer’s disease, Stanford-led research finds. Stanford Medicine News Center. Retrieved from Stanford Medicine
- Mayo Clinic Connect. “Do bile salts help with digestion and SIBO? Any downside to them?” Retrieved from Mayo Clinic Connect.
- Nature Editorial. (2021). Could drugs prevent Alzheimer’s? These trials aim to find out. Nature Medicine, 27, 1187–1196. doi:10.1038/s41591-021-01457-y. Retrieved from Nature
- Pryor, Karen P.P. (ND). 2-Day Advanced Course: Primitive Reflex Integration. PESI. Retrieved from PESI
- Specialty Surgical Center. “What are the Most Common Outpatient Surgeries?” Retrieved from Specialty Surgical Center.
- Suzanne Leigh. (2023). Can Health, Lifestyle Changes Protect Elders from Alzheimer’s? UC San Francisco. Retrieved from UC San Francisco
- Topline MD. “6 Most Common Surgical Procedures in the US.” Retrieved from Topline MD.
- UsAgainstAlzheimer’s. (2024). CNN Documentary Highlights Lifestyle Changes You Can Make to Combat Alzheimer’s. Retrieved from UsAgainstAlzheimer’s
- CentreSpring MD. “MTHFR: Half the Population Has This Genetic Mutation—Here’s What It Means For Your Health.” Retrieved from CentreSpring MD.
- GeneSight. “MTHFR Gene Mutation.” Retrieved from GeneSight.
