July 12, 2014 at 5:46 am #8652Archived PostsModerator
I first saw this 50 year old woman in May last year. Suffering from major digestive problems, diarrhea and constipation, reactive arthritis in back (reiters syndrome), extreme depression and tiredness. Took Citalopram and other anti-depressants on and off from the age of 16. Diagnosed IBS in 1989 and given colofac and mebeverine but they never worked. Stopped taking lactose which helped to cure IBS in 1998/9.
At this time she could not eat anything without problems and was eating only meat and broth, brown rice and vegetables, fruit. Had a real tea problem, drinking 6-8 a day. She has a real problem with compliance dietary wise – I think a big par oft why I cant get her on track. Very anxious person and very frustrated from feeling unwell for years. On a few occasions pretty rude to me. She had been working with a practitioner but came to see me for testing advice. I advised her to remove dairy and gluten for a short period of time until I saw her again. I also gave her some probiotics.
No other supplements recommended just advise about reducing inflammation through diet and fermented foods. I ran a stool profile – positive for H pylori, yeast/fungi (+2), blastocystis hominis, other possible parasites (taxonomy unavailable), low SCFA, high tryiglycerides, LCFA’s and total fat Organix profile – so much to note here, fatty acid, carbohydrate metabolism affected, energy production, b complex need, methylation issues, neurotransmitter, detoxification, intestinal bacterial overgrowth, clostridial species.
I recommended GI Mirbobix and oil of oregano with a course of probiotics and s boulardi afterwards. Along with B Complex for detoxification, vitamin C, CoQ10 and fish oil. Lots of advice about detoxification in the diet. Also recommended digestive enzymes to help with fat digestion. I had lots of emails and texts saying she had lots of skin problems, eczema that drove her mad, eye infections. I recommended she slowed down so she could let her body detox. She was always on the go.
Also again, detoxification advice in the diet. On a few occassions we cut down on dosages until she was feeling well again. Saw her for follow up in October. Digestively she was a lot better but she had slipped gluten and dairy back in the diet and wondered why she didn’t feel good. So I used the session to talk about diet again and importance of compliance. Follow up in November and stomach and bowl was good, back pain gone. But lots of flu symptoms that had been ongoing for many months. Toxins coming out of the body? Follow up January still a problem, slipping into bad eating habits – no consistency and lots of stress from the family.
Same advice given re diet and also stress management advice. She has now contacted me after 7 months to say that she has elevated B12 – is this a problem? Colonscopy and Endoscopy reported inflammation in duodenum and esophagus which she was given antibiotics for. H Pylori negative. Told to eat no acidic food or legumes.
The antibiotics didnt help and she is taking omeprazole to manage her symptoms of stomach pain and burning in the chest. She tried glutamine by her own choice but it gave her severe stomach pain. Probiotics she feels causes more problems as she did some research and tells me that SIBO and probiotics are not compatible – makes it worse. Doctors tells her they wont help as her symptoms – they are diet and stress related. She cannot tolerate HCL, apple cider viniger or lemon juice – so I suppose that is high acidic levels as oppose to low in this case? Paleo diet not working for her – as too fatty, causing discomfort.
She has contacted me about re testing organix specifically.
I’m at a loss as to what to recommend now or where to go with this patient? I dont know if retesting is right – she still seems to need to do some work.
I think her main problem is stress and I have tried to refer her to some form of stress management practitioner but she is not seeing the importance.
She’s under the impression she can do a month of elimination and then go back to eating poorly again. How can I help her to see that she needs to make significant long term dietary changes to keep her symptoms manageable and reduce stress?
I’m at a loss what to supplement with as everything seems to cause digestive problems.
May 12, 2019 at 5:48 am #8656Todd A. Born, ND, CNSModerator
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.
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