Gut Health Inventory: The North to South Assessment We Use [Facilitated: Episode 3]
- The Facility Denver
- Apr 2
- 15 min read
Understanding the Digestive System: A North to South Approach to Gut Health || At our functional medicine clinic in Denver, Colorado, we use what we call a "North to South Inventory" with every new patient– a comprehensive assessment technique that examines the entire digestive system sequentially from mouth to rectum. This methodology provides crucial insights into why symptoms occur and how they connect to other health concerns.
The digestive journey begins in the mouth, where we first assess chewing habits. Most patients believe they chew adequately until the follow-up question: "Do you drink liquids while eating?" If you use beverages to help food go down, you're likely not chewing thoroughly. We recommend avoiding liquids 30 minutes before and after meals, encouraging natural saliva production through proper chewing. This simple change can dramatically improve digestion as chewing activates the vagus nerve, which transitions the body from a stress state to a "rest and digest" state – essential for optimal nutrient breakdown and absorption.
Oral health evaluation forms the next critical component of the assessment. Bleeding gums, root canals, chronic strep throat, and oral care routines reveal important connections to overall health. For instance, gum health directly correlates with cardiovascular function, with many patients experiencing both chronic gingival inflammation and high blood pressure. We next inquire about sinus and upper respiratory issues – morning congestion, post-nasal drip, blood-tinged mucus – which may indicate chronic biofilm issues or mold exposure affecting the gut microbiome. These hollow, warm, moist passages create environments where microbes thrive, similar to the intestinal tract.
Moving southward, our assessment investigates stomach function through targeted questions about nausea, heartburn, and abdominal pain. The timing, triggers, and characteristics of these symptoms provide important diagnostic clues about stomach acid levels, ulcers, gallbladder function, and pancreatic health. This detailed inquiry helps determine if discomfort stems from insufficient digestive enzymes, structural issues, or nervous system dysfunction, allowing for precise intervention strategies rather than generic solutions.
Bloating represents one of the most misunderstood digestive symptoms. While incredibly common, bloating is not normal. When intestinal distention occurs, a muscle called the ileocecal valve can remain open, allowing bacteria to move from the colon into the small intestine where they produce gases that cause bloating and pain. This bacterial translocation combined with stress, poor chewing habits, and inadequate stomach acid creates the perfect storm for chronic bloating. The practitioners emphasize that bloating signals potential thyroid dysfunction, nervous system imbalance, or specific food intolerances that require targeted intervention.
The final portion of the inventory examines bowel habits and stool characteristics. We challenge the common medical notion that bowel movements ranging from three times daily to once every three days are normal! They observe that constipation contributes to numerous health issues, particularly hormonal imbalances, as the body recirculates partially processed estrogens when elimination is inadequate. Additionally, stool appearance, consistency, and content provide valuable diagnostic information about digestive capacity throughout the entire gastrointestinal system.
This comprehensive North to South approach has proven particularly valuable for patients whose symptoms extend beyond the digestive tract. Many people with migraines, anxiety, skin problems, or fatigue don't initially connect these issues to gut health. However, through thorough assessment and targeted testing, we frequently identify intestinal dysfunction or imbalances underlying these seemingly unrelated conditions. By addressing root causes within the digestive system, patients often experience resolution of symptoms throughout the body, highlighting the central role gut health plays in overall wellness.
Chapter Markers
Episode Transcript
Mitchell: Well, welcome back Week three. Any updates on your end of things, Kate?
Kate: Well, you were asking me before I clicked record and you put the idea of coffee in my head. I have a whole new coffee setup which I'm pretty excited about, facilitated by Mitchell.
Mitchell: Yeah, have you noticed? The gooseneck kettle has changed your brewing experience.
Kate: Having a temperature setting on your kettle makes a massive difference in coffee quality.
Mitchell: And maybe I'm biased because I've spent so much money on this process, but I truly believe that the kettle changes the taste of the pour over.
Kate: No, I think the water changes the taste more than anything.
Mitchell: Water, beans. Of course I use the best quality purity beans, filtered berkey water. I've had the good grinder for a while. The last upgrade was the gooseneck. For me, and maybe I'm just wishing it tasted better, but I think it does the bloom is nicer, yeah yeah, that's what it's all about. Off gas that CO2, right?!
Kate: Whatever you say.
Mitchell: So, what are we talking about today?
Kate: I thought it would be kind of cool to share what we call our north to south inventory of patient history, and these are the questions we go through while we're getting to know someone, and I don't even know if they realize what we're doing until we get a little bit further along the tract, but It's exploring the full GI tract, from mouth to butthole (rectum, thank you)...
Mitchell: ..and we catch some other things along the way, like oral health, upper respiratory health, and I think it's a great way to help the person kind of connect with the process of how, if you're having bloating, we've got to talk about the things north of that. If you're having diarrhea, we've got to talk about things north of that. If you're having diarrhea, we've got to talk about things north of that and everything. When we say north to south, essentially what we're talking about is how chewing impacts digestion, which impacts absorption and assimilation and elimination. So you can't suss it out any other way. In our opinion, and I guess the last few years, what we've really figured out is a nice cohesive way is just start at the mouth and work our way down yeah, it's been working well.
Kate:So, we'll jump into it and I imagine the listener can kind of put themselves in the shoes of a patient as we're going through it. But I'll let you kick it off.
Mitchell: So typically, I will ask you do you chew your food? Well, and most people think they do. And then I ask them the follow-up question, do you drink liquids while you eat? And typically if that's yes, why?, “Well, it helps the food go down”.. and that's the first indication to me that you're not chewing your food well. So we really try to delineate, visit one: gather information, visit two: give intervention steps. But oftentimes, this is where I'll come in and say let's pull liquids out 30 minutes either side of your meal, as little as possible, just enough to take any sort of supplements that you take with food, and you'll notice, if you chew enough, you'll make your own water. So that's a clue to me that you're probably not chewing as well as you think you are. So then we'll typically tell you to put your fork down and really experience the first few bites of your meal.
Kate: - or put the burrito down.
Mitchell: Exactly and really be mindful and aware of what it is that's going in your body. I had a professor in college once told me that eating is the most intimate thing we do and we're oftentimes so disconnected from it. It's a means toward an end, it's something on the way to practice, or driving in the car or what have you, but really that becomes you! We're taking the outside world to create our being. We wonder why we have chronic pain or fatigue, but we're eating processed food the whole time. Your body is literally running on shit and it's amazing that the body can actually do that. I wrote a post about that a few years ago. Our body can survive for a long time. Giving it horrible information in the form of the foods we eat, it will get by. If you put a little bit of water in a gas tank of a vehicle, it's not going to run very long, but somehow the human body can withstand years and years of really poor food and you'll still have the lights on.
Kate: All right, I'm gonna put you right back on the railroad tracks here okay….
Mitchell: So, chewing your food is a huge part of it and we won't get into the vagus nerve today. But let's just say, to oppose the stress response, we must chew our food. To divert our nervous system toward a resting and digesting state, we must experience the food that we're eating. This is where I will typically ask about your oral health: bleeding gums, root canals, chronic strep throat.
Kate: As well as your oral care routine. So, we're asking.. are you using antiseptic mouthwashes? Are you using fluoride-based toothpaste? Just some small upgrades we can make in what products you're choosing.
Mitchell: We could do an entire podcast sometime on fluoride: the goods, the bads, the unknowns, anyway. And then this is typically where I will ask you some sinus, nasal, upper respiratory questions. Do you wake up with a bloody nose? Do you get blood-tinged mucus every morning? Do you have post-nasal drip? Are you constantly clearing your throat in the shower in the morning? Do you wake up congested? - That’s a massive red flag to me that there's some sort of chronic biofilm or potentially a mold exposure in the upper respiratory passages. That's a hollow space similar to the gut, where it's warm, it's dark, it's moist and it's very hospitable to microbes. So even when we're starting we say GI north to south, I'm trying to pick up on red flags for potential mold exposure or even chronic strep carriers. We find a lot of people with chronic congestion actually have a pathogen known as marcons. It's an antibiotic resistant staph infection in the upper respiratory passages. So, these are all things as part of my north to south.
Mitchell: I'll ask you about headaches, typically because my ADHD kicks in and I can't move away from the head... And then typically I will ask you do you get nauseous on an empty stomach? That can give us many clues about stomach acid and gallbladder function. From there, we ask “does eating make the nausea go away?” Yes / No, that changes the thoughts in our heads. I typically then go into heartburn or acid reflux,
Kate: and if yes, then I jump in with more questions. What types of food bring on the heartburn? Does the time of day of eating these foods change it? Does amount of eating these foods change it? Does position change it …just getting a little bit more into diet as a cause versus the stomach acid he was mentioning.
Mitchell: right, and then the part about oral health. Gum health is an indicator of potential future cardiovascular issues, but it's also the beginning of your GI tract. We have numerous people with chronic gingival inflammation who have high blood pressure, and there's absolutely a mechanism there. So that's again another kind of branch that we can move down to, depending on what the answer to the gum health question is. From there, I typically ask you, and I'll point to my sternum do you get pain here? And I'm just pointing to where the stomach typically is. From there, I typically ask you, and I'll point to my sternum do you get pain here? And I'm just pointing to where the stomach typically is. Does that pain happen on an empty stomach?
Does that pain go away when you eat? Is that pain worse a couple hours after you eat? Have you ever been diagnosed with an ulcer? Have you had an upper endoscopy? Most of our patients have already gone through the gastroenterology workup, so they've had scopes in the top and in the bottom and they've typically gotten a lot of good information already regarding the pathology of those tissues, and so that'll be a part of that conversation as well. From there, we typically ask you, “does it hurt on the front right part of your abdomen after you eat fatty foods? If yes, does it refer to your right shoulder blade? Does it go between your shoulder blades? Do you get pain at the junction between your thorax and your lumbar spine which could point to a pancreatic type of issue?” This is all part of the GI physiology workup, and then we'll get down into the intestines. Bloating. Kate, is bloating normal??
Kate: Bloating is common. Bloating is not normal.
Mitchell:We hear half the people we see kind of giggle about it. And totally think it's normal to wake up with a flat tummy and then two hours after breakfast they look like they're in their second trimester of pregnancy. I hear that more than half the time, I would say, and that's so tragic, because what do I always say? Bloating is not just bloating. When you bloat, there's a muscle, a sphincter that can lay open the ileocecal valve. And when that valve sits open, bacteria can translocate from the colon up into the small bowel, where it turns into alcohol, essentially: producing methane, carbon dioxide, hydrogen, sulfide, things like that, and that's a big trigger of gas and bloating.
Kate:Yeah, the gas that these bugs are producing is what we feel as that distention and pain.
Mitchell: And then couple that with being stressed out while you're eating, you're not chewing your food, you're drinking too much liquids around mealtimes, you've poorly digested the food in your stomach and then now you have these large macromolecules making it out of the stomach into the intestine, where the chronic bloating has allowed bacteria to translocate toward the small bowel, and it's a perfect storm of bloating. So again, your bloating is not just bloating. It's a sign of potential nervous system dysfunction, potential thyroid dysfunction, because thyroid is intimately tied toward digestive function. It can be a whole host of things.
Kate:This is where I can jump in with some nutrition questions around the bloating. So, are there specific foods that are causing the bloating? Is it a specific time after eating that increases bloating, whether that's 30 minutes or two hours after eating? Is it a specific meal, so dinner meal versus lunch meal versus breakfast meal, and does it seem like it is food related in that meal? So if you were to eat your dinner meal at lunchtime, would the bloating be the same? And then other food questions would be oh, again on the specific foods, is it a specific type of carbohydrate that seems to be a culprit, whether that is the cruciferous family, the broccoli, brussels sprouts, something like beans or something like garlic onions? That's a different type of family of fermentable carbohydrates. So that kind of helps with the diagnosis timeline or diagnosis picture of are we dealing with something like SIBO or are we dealing with something more like a nervous system issue?
Mitchell: or is it potentially fungal? Simple sugars bother it, things like that. I also like to infer, or inquire about, gas production. Are you burpy or are you farty? And I think it takes people off guard a little bit sometimes the way I ask questions, but we are trying to get to know you and get to the bottom of how to essentially set up a series of steps to let you change the trajectory of the rest of your life. As goes your gut and goes your stress will go the rest of your entire health picture.
Kate: You know, I really wish we can make an Instagram reel just of the patient face reactions when you ask. So first you'll ask are you farty? And the next question you ask is always what?
Mitchell: What do your farts smell like? And then we get… it's usually, “I don't know, not good”. And then I'm like, does it smell sweet? Does it smell like rotten eggs? Does it smell like the food you ate? Because those give us an idea again. Is this protein maldigestion, like a pancreatic or a stomach acid type issue? Is it carbohydrate maldigestion, like a pancreatic or a stomach acid type issue? Is a carbohydrate maldigestion like a intestinal type issue? Is it fat maldigestion, potentially a gallbladder or a thyroid or a stress issue? All of those actually will somewhat dictate the smell of your gas. That's actually a very important piece of it is what does the gas smell like?
And then typically, from there we will get into pressurization issues. Are you getting hemorrhoids? Are you getting the need to push? Are you constipated? Do you poop every day? It is not normal to poop once every three days. I don't care if when you Google it, it says normal pooping is three times a day to once every three days. No way, no way. We need to.
We have a lot of people that poop maybe one to two times a week, and my initial three month goal for them is I want you pooping three times a week. Is that ideal? In my opinion, no, but we've got to move things along. A massive subset of people we see are women with what they call PCOS or estrogen dominance. Little do they know. Chronic constipation actually allows you to recirculate estrogens partially methylated estrogens throughout your body. There's an entire chunk of our microbiome called the estrobolome, and it is literally the setup of microbes that help you get rid of things like estrogens, estrogens, whether they are internal or if they are from oral contraceptive or if they are from synthetic forms, from plastics and our food supply. All of that needs to be detoxified, mostly through the GI tract, and chronic constipation doesn't allow that regular final step of detoxification, like the final elimination of it.
And let's say this: Do not do an air quote detox if you're not pooping. No, we have to get phase three elimination happening first from the pooping. I don't leave it there. What does your poop look like? Kate, you'll give them a bristol stool chart sometimes that does help and they'll usually. If they look at that, oh it's a seven, what do you want? A four?
Kate: well, I actually prefer the, the cartoon version of the bristol stool chart. And uh, miss perfect is what we're going for like soft serve ice cream no, no, no, just like a little bit more formed than that, okay.
Mitchell: And does your poop fall apart? Is it small and pebbly? Do you see oil in your stool or in the water? Do you see undigested food? And if you answer corn, I don't care. That's some sort of magic trick that corn tends to do I'm looking at. Do you have pieces of lettuce or beets seeds in your stool? Those are big time hints of potential maldigestion issues up top, depending on what the food you're seeing is. We oftentimes this kind of brings up a point about testing. Everyone wants a stool test. What are the most common people we run stool tests on?
Kate: Not people with digestive problems.
Mitchell:Isn't that crazy. We've figured that out. We can probably solve your digestive issues based on this history. I run a stool test. When you have hormonal problems, skin problems, mental health issues, chronic pain, unexplained fatigue, despite having all the supplements and stress management and circadian rhythm balancing activities, that's when I really migraines. That's when I really get clued in on. Is there a potential parasite going on? We've had numerous patients who come in with anxiety and migraines and what they call perfect GI tracts. They think I'm crazy when I order a stool test and then we find two parasites in a candida or something like that. We treat the gut and their migraines go away. They get off medications.
It's amazing how a history can guide so much of the GI issues. When they're gut-based. It's when they're neurological or body-based that I really feel like I need more information. When we talk about the stools, that kind of ends that part and it's in that last 10 minutes. We've got an idea of their stress, of their feelings around food. We've gotten the idea whether or not they think it's a problem, what types of interventions they've done. We've been able to have a conversation about what types of interventions they've done. We've been able to have a conversation about finding a good biological dentist or potentially doing some sort of nasal microbiome testing. We've really gotten to allow the patient to share their story within the context of the GI tract and that really does open up an entire conversation around what it means to be well. I find that North to South workup helps me keep my train of thought, but it also opens up so many avenues of further exploration or intervention.
Kate: So I think it's been one of the most cohesive ways that we've developed to get to know a person during that initial visit and I love that it keeps you kind of a little bit more on the straight and narrow, because we have this start and stop, we have a trajectory of where we're going through the body and it used to be kind of a let me just pull these questions all over the place. So I love this.
Mitchell: I love this new structure we've added yeah, and I actually learned it from Datis Kharrazhian. He talked a lot about north to south and then we've kind of made it our own where we go more into the upper respiratory issues, the hollow space, organ issues and also the stress based issues. I think it's a great way to just march forward with the person.
So you should have been listening to that and kind of putting yourself there, and I think there's even a few takeaways for you today:
chew your food, be present, avoid liquids during meal times, and bloating is not normal.
Meet The Functional Medicine Team behind Facilitated:
Mitchell Rasmussen, DC, CFMP: Mitchell is a certified functional medicine practitioner with a doctorate of chiropractic at The Facility Functional Medicine Clinic in Denver, Colorado.
Lots of letters behind this name. I went into the field of chiropractic knowing I wanted to practice Functional Medicine. My biggest passion is the immune system. I've focused a lot of post-doctoral education on immunology and clinical applications for chronic diseases like Lyme and other tick-borne pathogens, viral burden, and mold exposure.
About Kate Daugherty, MS, CNS: Kate is a certified nutrition specialist and functional nutritionist at The Facility Functional Medicine Clinic in Denver, Colorado.
I embarked on my career journey in neuroscience, which seamlessly transitioned into further education in human nutrition. Utilizing food as medicine to treat the mind-body connection is truly remarkable. I believe our eating habits nourish our soul just as profoundly as they do our body.
Comments