Reply To: 50 yo F with major digestive problems, diarrhea and constipation, reactive arthritis in back
- 50 yo F with major digestive problems, diarrhea and constipation, reactive arthritis in back
- Reply To: 50 yo F with major digestive problems, diarrhea and constipation, reactive arthritis in back
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Thank you for posting this layered case of digestive disturbances and anxiety.
One of my clinical focuses is on these difficult to treat cases, so I do hope to be able to help, as I see these cases every day in my practice.
Well done thus far into seeing the gravity of the cases (her stress and anxiety), as well as constant reinforcement of her need to deal with these in a more productive manner.
In cases like these, I tend to encourage my patients with a wash-out phase. I have them stop all supplements for 1-2 weeks and have them return. During the first visit I explain to them that so many things have been tried, etc., etc, it’s difficult to make sense of what’s going on, as the waters is too murky to see through (they typically like this metaphor). Upon the return visit, they’re usually mentally more calmed down, even if they’re body is still inflamed.
I then typically HIGHLY encourage an allergy elimination diet for a period of 2 weeks. Especially in a case like this, where it’s quite clear that she has a significant dietary component to her issues. She may disagree and/or argue with her, but just pointing out the fact to her, and reminding her, of how much better she felt with certain dietary exclusions, will normally make them more willing to adhere to your suggestions.
Recall that the gold standard for food intolerances and sensitivities is the allergy elimination diet. There are numerous ways to perform this. In my practice, to garner greater patient adherence I have them remove a handful of foods that usually cause problems (soy, citrus, dairy, gluten, corn, nightshades [if pain or autoimmune disease], eggs, artificial food colours, preservatives and sweeteners) for 2 weeks.
Then, one by one, they challenge a food by eating it three times in one day, stopping when and if they have a reaction. If after 3 days they don’t react, they can challenge the next food. During this entire time, they should keep a diary of their symptoms, during both the elimination and challenge phases.
• Sicherer SH. Food allergy: when and how to perform oral food challenges. Pediatr Allergy Immunol. 1999 Nov;10(4):226-34. (http://tinyurl.com/92kcjqd).
• Mayo Clinic Staff. Food allergies: understanding food labels. 4 Jan 2011. (http://tinyurl.com/2acbwp).
I have some patients that are unwilling to do this, for whatever reason(s), so I then encourage an IgG food “allergy” panel (www.gdx.net/uk/product/1). This type of testing is helpful in cases like this as your client will now have empirical evidence, with values applied to the foods, for which she can tangibly see may be causing issues.
When the elimination diet with re-challenge is complete, a new diet plan may be drafted and nutritional supplements instituted.
I would also have you consider the addition of topical castor oil packs – (http://tinyurl.com/m5yppjj), fermented foods and stewed apples.
Fermented foods such as sauerkraut, miso, coconut kefir, coconut yogurt, etc., will provide beneficial flora and l-glutamine.
• Regulatory effects of a fermented food concentrate on immune function parameters in healthy volunteers. Nutrition. 2009 May;25(5):499-505. Epub 2009 Jan 3. (http://tinyurl.com/85mueb4)
• Prebiotic effects: metabolic and health benefits. Br J Nutr. 2010 Aug;104 Suppl 2:S1-63. (http://tinyurl.com/7vuv23m)
• Modification of intestinal flora in the treatment of inflammatory bowel disease. Curr Pharm Des. 2003;9(4):333-46. (http://tinyurl.com/8a6r79r)
Stewed apples at 2-3 apples per day for 3-6 weeks; 1-2 daily thereafter (http://tinyurl.com/64wpvrl) are extremely useful in GI concerns.
As a side note, in cases like this I have found constitutional homeopathy to bear out fantastic results. The premise is that the homeopathic remedy will treat all off her physical, mental and emotional symptoms at once with one medicine.
To directly address your questions, no elevated serum B12 is not an issue. Serum B12 is not a sensitive indicator of B12 status. For example, she could have had a meal the night before the test that was high in B12 and this would reflect in the serum.
My conjecture is that you wouldn’t obtain as much information and momentum from organic acid testing, as you would with the IgG food testing, or stool testing. If you feel stool testing to be beneficial (particularly given her previous positive results), Doctor’s Data has some of the best tests on the market. Do consider either their CSA or Microbiology Profile. These are available from http://www.regeneruslabs.com.
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. 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.
Improve nutritional status and assist with stress/anxiety
• ProMulti-Plus (BRC): 2 caps, three times daily, with food. (http://tinyurl.com/p7g447t).
• Stabilium 200 (ARG): 4 softgels upon waking x 1 month, then 2 caps upon rising thereafter. (http://tinyurl.com/3x35v63).
• Intenzyme Forte (BRC): 1-2 caps, at the beginning of each meal until digestion is strengthened. (http://tinyurl.com/nqj2325).
• Symbiotics with FOS (ARG): 1 heaping teaspoon, twice daily, with food. (http://tinyurl.com/6slz7lb).
o If dairy is an issue, consider Culturelle (ARG): 1 cap, twice daily. (http://tinyurl.com/66yuha6).
• Saccharomyces boulardii (ARG): 2 caps upon rising, 2 before bed. (http://tinyurl.com/35392bw).
I hope this helps and please feel free to keep us posted.
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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