January 10, 2018 at 10:02 am #996Carolina KingParticipant
Puzzling case of a 29 year old male of African heritage, diagnosed with Familial Adenomatous Polyposis, experiencing overactive bladder/urge incontinence when consuming a plant-based diet.
I would appreciate help on this case. The gentleman experiences frequent urination when eating a plant based diet. Symptoms are mitigated when adding meat and processed foods such as pizzas and burgers. This is obviously a concern with his diagnosis four years ago of F.A.P.
He was first diagnosed with FAP after experiencing an increase in urination which has now become progressively worse (also considering that his mother passed away after succumbing to bowel cancer). Various blood tests, urine tests and ultrasound tests were conducted in which the FAP was diagnosed, but doctors were still unsure if the overactive bladder is connected with FAP. He was subsequently prescribed medication for the overactive bladder which he stopped taking as it didn’t make a difference. He is unsure what analytes were tested for, in all of the tests (apart from coeliac – negative).
He drinks on average 6 glasses of water spread evenly throughout the day (not enough), but when consuming a plant based diet, he will feel the need to urinate at least 6 times in the day, 3 times in the last hour or two before bed, and up to 4-5 times during the night. This is affecting his sleep and so consequently, he has also become very anxious and stressed. He finds that when eating meat and processed foods, the trips to the toilet are reduced by half.
Foods that are a particular problem are black-eyed beans, garlic, ginger, curry powders, chia seeds, citrus, kiwi, banana, and avocados. He also suffers from bloating with these foods as well as nuts. He experiences slight wind and discomfort with leafy greens and the Brassicas. Additionally, he complains of pineapple causing him to feel acidic, and food sitting on his stomach and feeling full very quickly with all foods. Bowel movements are daily, but very strained. I am therefore wondering if his stomach acid levels are too low, or if he could be suffering from SIBO although I have never heard of urinary incontinence being connected with this.
He also mentioned an occasional yellowish cast to the eyes which has never been investigated. Additionally, he is lactose intolerant.
He undergoes a colonoscopy every year to check for polyps. Larger ones are removed but smaller ones remain.
I am unsure whether there are issues with SIBO, a gut infection, leaky gut, food intolerances, or whether the overactive bladder is connected with the FAP.
I have recommended he takes the Flow-Less supplement, but I would of course be very grateful, of further insight into the root causes. Thanks.
Posted by Carolina King 10.01.18
March 6, 2019 at 10:05 am #998Antony HaynesModerator
Thank you for posting this case in our Linked In forum, and for the case details which I have read through carefully a few times.
Before I suggest on what I believe would be a sensible way forward I will provide some summary information about Familial Adenomatous Polyposis (FAP)
FAP is a condition in which carriers require at least annual flexible or
rigid sigmoidoscopy while others prefer colonoscopy, and you report that this man engages in this yearly process. This on-line PDF via the BMJ is very useful on the subject of FAP – http://tinyurl.com/y9hzojxg
I believe that within the case details are sufficient clues to draw some conclusions from, and form the basis of an action plan.
Maldigestion or food sensitivity, or both?
I have met numerous patients who are free of digestive symptoms when they eat processed foods versus a perceived more wholesome diet of wholefood, cooked or raw. In these cases, the process of improving digestion has been the answer, and it has not been a simple nor quick to achieve. Additionally, in this group of patients, it has not been food sensitivity that has played a role in their digestive symptoms, but this needs to be considered too. The presenting antigenic load could easily be all the greater when consuming wholefoods compared to processed foods. Immunoglobulin reactivity to foods, alongside maldigestion, could readily lead to inflammatory cytokines which could trigger the need to micturate.
This man has lactose intolerance, which is the inability to break down (digest) the disaccharide lactose in milk into its two monosaccharides glucose and galactose due to the lack of the enzyme lactase. Given his African heritage, there was a very high genetic predisposition for this being the case, as with other population groups in the world.
So, given the fact that he already has a known problem digesting one type of carbohydrate (disaccharide) it is quite possible that he cannot digest other types of carbohydrate which are found in the variety of vegetarian foods that you describe: black-eyed beans, garlic, ginger, curry powders, chia seeds, citrus, kiwi, banana. There was an exception in the list, being avocadoes, and this may reflect a more widespread inability to digest foods and not simply carbohydrates.
It is possible that he would benefit from a low FODMAPs diet, and perhaps even moreso from the Specific Carbohydrate Diet (SCD) proposed by Elaine Gottschall (https://en.wikipedia.org/wiki/Specific_carbohydrate_diet), although that he has worsening urinary needs after bananas would tend to rule this out as a prime intervention. It is possible that he would test positive to SIBO on a breath test. However, it appears to me that there is a fundamental problem with digestion and its consequent impact rather than a primary gut bacteria imbalance.
With maldigestion and with food sensitivity (immunoglobulin-mediated reactivity to specific antigens in food) and food intolerance (inability to digest a component of food, most often the carbohydrate), there may be degrees of compromise in his gut lining, and the downstream consequence of this is increased irritation on his bladder with an increased need to urinate more often. That the processed food diet halves this frequency is telling. Any test for intestinal permeability imbalances may be of some value to demonstrate this imbalance, but it is also true to say that one might safely assume that there is compromise and pursue other avenues of testing.
There may be value in determining this man’s immune reactivity to foods. Whilst the Cyrex Array 10 offers the most comprehensive assessment, measuring IgA and IgG to a wide range of foods, Cambridge Nutritional Sciences offer a more reasonably priced and accessed IgG-only test. This test can be conducted at home (it is a fingerprick test) and sent in the post back to the lab. FoodPrint 40 is the name of the panel – http://tinyurl.com/ybslrwd3 – which is something I have chosen for selected patients. It is possible to conduct more comprehensive tests at a later date, depending on need.
That there is such an obvious change in frequency of urination when a processed food diet is consumed, this would suggest that maldigestion rather than delayed immune reactivity is occurring.
Summary tests to consider
It is not straightforward to assess for reduced digestive function. The level of pancreatic enzymes are reflected in a comprehensive stool analysis conducted by Dr’s Data – http://tinyurl.com/nuf76dx – with the analyte of elastase being specific for the pancreas. Other analytes include fat stain, muscle fibres, vegetable fibres, carbohydrates. Regenerus Labs in the UK offer this test: http://tinyurl.com/yc97h8e4. In this way, this stool test is something to be considered, although the evidence of maldigestion of some kind already exists.
Blood test for food sensitivities
The finger prick test referred to above is certainly worth considering. (The results need to be put into the context of the patient rather than providing a definitive list of foods to exclude.)
It is of interest to know the degree of any altered intestinal permeability in this man but it does not appear to be a priority test given that one may safely assume that when foods are eaten that are maldigested, or to which there is an immune reaction, that there will be compromised I.P.
With maldigestion there may be an accompanying lack of nourishment for many nutrients. This does not appear to be of prime importance in order to help resolve the too frequent urination but does impact this man’s overall health given his increased risk for colon cancer with his FAP condition.
As the medical experts have already confirmed, it is not known if the frequent urination is directly linked with FAP, and perhaps the lack of ability to digest food is part of a wider syndrome of the condition. In the short term, it may still be very possible to improve digestion and intervene with dietary changes in order to resolve the urinary issues and as a result of this support this man’s overall wellbeing and reduce the risks associated with FAP.
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.
Broad spectrum digestive enzyme
Full Spectrum Digest (ARG) – 1-2 with each meal
Fat digestion support
Beta Plus (BRC) (animal sourced bile) – 1 with each meal – http://tinyurl.com/y7vtqhn2
Intestinal permeability support
IPS Caps (BRC) – 2 caps at start of each meal – http://tinyurl.com/zabzymn
As needed, if effective in reducing frequency of urination
Flow-Less (ARG) – 2-3 with two or three meals a day and at bedtime
HCl Acid support may be needed (to be considered)
HCl Plus (BRC) or HydroZyme (BRC) – 1-2 with each meal – http://tinyurl.com/y73tcovt
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.
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