Many thanks for your question regarding your client who experiences a range of digestive symptoms. I note she has already been diagnosed with diverticulitis and dysautonomia and possible gastritis. From the results it also appears that she has SIBO and gut dysbiosis in the large bowel. I am not surprised she is feeling anxious at times in view of the symptoms she experiences.
You mentioned her HbA1C reading is 42 – which is on the high end of what is considered normal. Encouraging her to follow a diet higher in vegetables and protein such as fish and light meats would be appropriate.
It is not also surprising that certain nutrients may be on the low side if she has SIBO and possibly therefore malabsorbing. It may well be in view of her family issues there are motility disturbances which can aggravate the condition. You do not mention whether she has any investigations in terms of gastritis or colon examination – this may be helpful for your client. With SIBO then consider introducing anti-microbials and yes, a low FODMAPs approach may be helpful at this stage. I would certainly avoid gluten and dairy at this stage as well.
As she has diverticular disease there will be certain considerations regarding her diet. Diverticula are small pouches or pockets in the wall of the digestive system, most often the large intestine. When these pouches become inflamed, this characterizes diverticular disease. Diverticula are quite common in older individuals, and often do not cause symptoms. Factors currently known to increase risk of diverticulosis (no symptoms) include advancing age, obesity, and smoking. Factors known to increase risk of diverticulitis include low-fibre diet, sedentary lifestyle, obesity, smoking, alcohol consumption, and use of NSAIDs and pain relievers. Depending on the condition it can be acute or chronic and therefore the intervention may be influenced by the stage of condition. There are a number of considerations which may help your client.
Probiotics – by helping restore the balance of intestinal flora and reduce inflammation in the intestine, probiotic supplementation may be of benefit in both acute and chronic diverticular problems. At this stage in view of the SIBO consider the BioBifido BacT powder which is without inulin or other prebiotics.
Butyrate – in a randomized clinical trial of sodium butyrate in 52 people with diverticular disease, less than 7% of those in the butyrate group experienced diverticulitis symptoms compared with slightly more than 31% in the placebo group.
Krokowicz L et al. Sodium butyrate and short chain fatty acids in prevention of travellers’ diarrhoea: a randomized prospective study. Travel Med Infect Dis. Mar-Apr 2014;12(2):183-188. https://tinyurl.com/ydeda7m8
Fibre – fibre should be only gradually increased in the diet and again at this stage focus on low FODMAPs options. You could also consider supplements of ground psyllium seed husk or apple pectin fibre as well – this may have the added benefit of helping to balance blood sugar more effectively. However, please note, for those recovering from a bout of acute diverticulitis, a low-fibre diet may be advised so it does depend on the stage of the condition and whether they suspect a flare up.
Schaffzin DM, Wong WD. Nonoperative management of complicated diverticular disease. Clinics in colon and rectal surgery. Aug 2004;17(3):169-176. https://tinyurl.com/yanvtg73
Fish oil – this may be helpful in diverticular disease, as these have anti-inflammatory activity. In the same way consider using curcumin – the raised SIgA is an indication that the gut is currently responding to infections / irritations.
Farrukh A, Mayberry JF. Is there a role for fish oil in inflammatory bowel disease? World journal of clinical cases. Jul 16 2014;2(7):250-252. https://tinyurl.com/y76ufr6s
You mention dysautonomia – there are many different forms but if secondary there could be underlying conditions including:
Therefore depending on the type of dysautonomia, she has and severity additional investigations may be required. I presume she has already been tested for coeliac disease.
I would also recommend this client does not eat late at night if she struggles with sleep and digestive issues. Ideally follow time restricted eating and leave at least 12-14 hours overnight of no food. I presume that she has been checked for Helicobacter pylori? If she is sore and experiencing reflux in the evening then again eliminating certain foods from her diet may help – chocolate, caffeine, chili, gluten, fizzy drinks, alcohol etc. She is on a PPPI and as you have already suggested possible nutritional insufficiencies I would recommend a multi vi min for her at this stage.
The following supplements are suggested for you to consider in light of your relevant expertise and intimate understanding of the needs of your client or patient. It is not intended for them all to be taken, but rather just those that you select. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.
Please consider these suggestions in light of the other clinical information pertaining to this individual. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.
Full Spectrum Digest (ARG) – take 1-2 with each meal – to support digestion
Sano Gastril lozenges (ARG) – suck 1-2 around meals or if she experiences soreness. https://tinyurl.com/h3mttmd
Phospholipid Colostrum (ARG) – take 1tbsp three times a day – soothing and healing and anti-microbial support – https://tinyurl.com/zwty66b
Gut Dysbiosis / SIBO
ADP Oregano (BRC) – take 3-4 with each meal – https://tinyurl.com/y9a5xbhr
Caprin (BRC) – take 2 with each meal (anti-fungal)
BioBifido BacT Powder (BRC) – take 1 tsp daily (2 hours+ away from anti-microbials)
Cod Liver Oil liquid (Nordic Naturals) – take 1tsp daily
KappArest (BRC) – take 2 with each meal – https://tinyurl.com/hkubw8y
Multi nutritional support
Aqueous Multi Plus (BRC) – take 1tbsp daily – https://tinyurl.com/kndtebh
I hope this helps with your client
Registered Nutritional Therapist Helen Perks is collaborating with Clinical Education to bring you the first-ever Functional Medicine book club for Practitioners.
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