March 23, 2018 at 2:30 pm #855Archived PostsModerator
Female, 61, major bowel issues going on
Hoping you can advise on where I go now with this client. She came to me with major digestive distress. She wakes first thing in the morning (and often has to sleep in a semi seated position – lying flat is uncomfortable). And she needs to open her bowels urgently upon waking up. Energy levels not good (not surprisingly) most of the time. Also lots of issues with reflux, bloating, discomfort after eating. Feeling like bowels are never empty. Experiences episodes of “anxiety” and yet she stands firm that she does not feel anxious or stressed… these episodes have resulted in some checks on heart. She says she feels pretty healthy up until about 4 years ago she became very ill over a weekend with a viral infection. Ended up in A&E with tachycardia episode. Has not felt well, digestively speaking, since then. Also has had a lot of ear and sinus infections. At the moment reports to have a claggy foul taste in her mouth at times.
She has been to see a GI consultant. Her daughter has been diagnosed with EDS after having issues with hypermobility and seizures, but not diagnosed as POTS. It is suspected that my client also has EDS and therefore this may be impacting gut motility. He diagnoses diverticulitis and dysautonomia. Additionally, I suspected SIBO (and interestingly consultant states this also in his notes).Part 2 – In the past couple of weeks, bowels have been a little worse and upper chest pain, numbness in jaw, side of face and left arm – so trip to the A&E. Was suggested this was “oesophagia dysmotility mimicking heart issue”. Suggestion of GTN spray when have pain and also to have a treadmill test. Referred back to GP who “… told unsympathetically probably gastritis and put on omeprazole again twice daily for two weeks. Also to keep a bland diet of rice, pots, mash, white bread etc etc.to avoid upsetting diverticular. Also mentioned claggy throat and feeling of food not going into stomach and that it seems to affect my sinus…clear most of time but throat constricted feel and yuk taste in my mouth. Had a Tuna jacket for lunch and green tea…mouth feels bit stingy/ sore!”
More blood work done by GP.
We have done OAT, SIBO lactulose breath test and a stool test. Plus all the various blood tests doctors have done.
Part 3 – Tried starting with a FODMAPs diet, but she finds it hard to follow. Her mother has been diagnosed with cancer for the second time so she is spending a lot of time taking her mother to various appointments and has had the joy of hospital canteens featuring a lot in her diet lately.
Genova OAT test results: V low Mg, low in B1, B6, B9, B12, and alpha lipoic acid. V high need for probiotics and pancreatic enzymes. Glycine and serine are elevated. Malabsorption, dysbiosis and yeast/fungal overgrowth.
Doctor’s Data CDSA: elevated Sec IgA (271 mg/dL), yeast present in 2 of 3 samples, no ova or parasites, low levels of bifido bacteria.
Breath Trackers Lactulose breath test: positive for SIBO; shoots right up at 20 minutes and stays elevated for full 180 minutes (i.e. not the “double peak” which is often spoken of). More hydrogen than methane.
Part 4 – GP blood tests: folate and D3 ok (I have checked results myself – not going on the “all results are normal” phrase). Ferritin and B12 are in the “normal” range however I would like to see them a little higher. And RBC, haemoglobin, MCHC, MCH and hematocrit all at the low end of “normal” in the given lab ranges. These are results from tests done in 7/2017, 10/2017 and 03/2018. The latest blood work (3/2018) were also done on HbA1C and fasting blood glucose: 42 and 5.5 mmol/l, respectively. Mg also showed “normal” in the latest blood work.
She is being sent to nurse for advice. I would be interested to see how he/she reacts to advices on rice and white bread advice she’s been given by GP.
I am at a loss as what to do next without upsetting the apple cart. Obviously, bowel issues need to be addressed as well as blood sugar control. But nothing we’ve done so far seems to have helped her progress forward at all.
Thanks in advance for any advice or perspective on this.
Posted By Sharon Strahan 23/3/2018
March 5, 2019 at 2:32 pm #856Christine BaileyModerator
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
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