August 25, 2019 at 3:51 pm #17258Archived PostsModerator
PART 1 (part 2 in comment)
• Female aged 22, height 5ft 4inch, weight 54.4kg
• Primary presenting symptoms plus aims – nausea and vomiting. Started 3 years ago – had daily nausea and vomiting for a year and half. This has reduced to nausea and vomiting episodes occurring every few weeks.
• Other symptoms: 4 bowel movements a day. Pain in lower stomach. Indigestion. Fatigue. Recurrent migraines. Panic attacks. Craves sugar to excess. Low immunity. Extreme bloating after meals.
• Diagnosis – no problem found by medical experts. Seen a gastroenterologist and several GPs. Carried out a gastroscopy, esophageal manometry and biopsies and all normal. All blood tests came back as normal. Blood test for viral infections – all came back normal. Had stool test for H.pylori – nothing detected. No extra help or advice was given.
• Duration for presenting symptoms – 3 years
• Historical health issues – 2009 had Bells Palsy – doctors took MRI or brain and mastoid area and blood test or lyme disease (nothing detected). Was prescribed prednisolone and B complex. She has anxiety – suffers from panic attacks. Has had antibiotics at least twice a year every year for infections.
• Diet – Skips breakfast as too nauseous to eat. Eats on the go. Lunch – chicken and avocado salad from Pret, crisps, pop corn, wraps, sandwiches. Dinner – eats out 4 times a week. High alcohol intake. Dislikes cooking – eats convenience foods, ready meals – gluten free fish cakes. Gluten free pasta and tomato sauce and cheese, nachos, burgers, toast, eggs. She chooses gluten free where she can but will also eat sandwiches etc when she can’t source gluten free food. She has huge cravings for sugar. There is a lot we can change with her diet.
• Current medications – sumatriptan for migraines takes once a month sometimes more.
Your own considerations for relevant antecedents, mediators & triggers – ?dysbiosis, parasitic infection ?possible food intolerance allergy ?undetected viral infection ?gall bladder/liver ?high toxic load
• Your own consideration for specific nutritional intervention – initial protocol
– Take time to sit down and eat each meal. Relax and chew food thoroughly
– Food elimination diet – starting with gluten and diary
– Cook fresh food from scratch each night – simple 3 ingredient meals
– Reduce alcohol consumption
– Ginger and mint to relieve nausea
– Stress reduction techniques
• I feel there is a huge amounts we can do improve with her diet however am uncertain as to what test/supplements would be most beneficial to start with – I feel initially a CDSA with parasitology, and possibly food intolerance/allergy
• Any advice on possible causes and symptoms of chronic nausea and vomiting would be greatly appreciated.
Posted by Lily
August 25, 2019 at 3:52 pm #17260Christine BaileyModerator
Many thanks for your question. Nausea and vomiting can vary from an unsettled feeling in the stomach to the violent action of immediate vomiting.
In some cases people with nausea and vomiting symptoms may have eaten a reactive food (i.e., food containing toxins) or poisoning with a pathogen such as salmonella. However, I presume this was ruled out in view of the previous tests and investigations undertaken. Some chronic low-intensity nausea can occur for a protracted time due to sustained low-level food allergies or problems with food combinations. For this reason you may wish to investigate whether she is reacting to a food – it could of course be gluten as she is still eating some gluten but she could be reacting to any food really in this way.
As she is still experiencing many digestive symptoms I would consider a comprehensive stool test to check for the health of her gut and whether there is any bacterial dysbiosis or parasite present. Interestingly for some people allergies / food reactions can also be associated with migraines. You could consider Cyrexarray 10 panel and for your client to write down for a week her diet, alongside the incidence of her symptoms, so you can see if there are any connections.
If the bloating after meals occurs very quickly after eating then she may experience SIBO and a hydrogen breath test would help to identify whether this is the case.
In other cases I have found that poor liver health and bile flow can contribute to symptoms such as nausea and supporting overall liver health may be merited here. I presume there is no correlation to her nausea and hormone patterns? You mention that it now happens every few weeks so check there is no hormone link here too.
Sumatriptan is a serotonin 5-HT1 receptor agonist (“triptan”). It works by narrowing blood vessels in the brain, which helps to relieve migraine and cluster headaches.
Commonly reported side effects of sumatriptan include injection site reaction, dizziness, vertigo, nausea and vomiting, tingling sensation, flushing sensation, and unpleasant taste.
It is not clear whether the nausea started around the time of the medication but do check whether her symptoms are linked to her current symptoms.
Food wise in addition to IgG reactions migraines can be triggered by other food compounds
Monosodium glutamate (MSG) is a commonly used flavour-enhancer found in some soups and Chinese food.
Nitrites are preservatives found in processed meats such as hot dogs.
Tyramines are natural compounds found in wines and aged foods (e.g., cheeses).
Phenylethylamine is a stimulant compound found in chocolate, garlic, nuts, raw onions, and seeds.
Certain B vitamins, magnesium and herbs like butterbur and feverfew can be helpful to reduce migraines which may be worth considering for your client while you wait for test results.
Diener HC et al. The First Placebo-Controlled Trial of a Special Butterbur Root Extract for the Prevention of Migraine: Reanalysis of Efficacy Criteria. European Neurology. 2004;51(2):89-97. http://tinyurl.com/pqf3u7r
CoQ10 (at doses of 100-300 mg daily) has been shown to be beneficial for preventing and reducing the frequency of migraine attacks among adults.
Silberstein SD. Preventive Migraine Treatment. Continuum (MinneapMinn). 2015 Aug;21(4 Headache):973-89. http://tinyurl.com/p7ee3y5
Condo M et al. Riboflavin prophylaxis in pediatric and adolescent migraine. J Headache Pain. 2009;10(5):361-365. http://tinyurl.com/nh2tnkj
If you consider stress has also played a role then you may wish to consider adrenal testing as well and possibly supporting adrenal health. Check protein is sufficient in her diet in view of the processed / erratic nature of eating patterns. Protein can help balance blood sugar which may also be involved in her symptoms – using the protein formula with nutrients designed to support phase I & II liver detoxification pathways (see below) may be helpful.
If the vomiting has been severe then consider also whether electrolyte balance needs supporting – potassium, sodium in particular. Try sipping coconut water daily – yes ginger tea / cordial can help with some clients to relieve nausea as well as eating little and often.
The following supplements are suggested for you to consider in light of your relevant expertise and intimate understanding of the needs of your 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 patient.
MygranX (BRC) – 1 caps two or three times a day for migraines – http://tinyurl.com/p4ayb3j
Nutri-Clearpowder (BRC) (protein formula with nutrients designed to support liver detox pathways) – start with a low dose and build up slowly.she could sip this through the day – http://tinyurl.com/7rtlnp8
Digestive / Gallbladder support
Beta Plus (BRC): 1 tablet at the start of each meal. http://tinyurl.com/otttdvv.Provides bile salts, digestive enzymes.
Hydro-Zyme (BRC): 1 tablet 10 – 15 minutes before meals. http://tinyurl.com/mzmezk
I hope this helps your client
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