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Newsletter – IBS case study

IBS: A case study

A 53 year old female came in to see us because of issues with irritable bowel syndrome (IBS). She was “formally” diagnosed five years prior to our visit, but based on her detailed history, was having symptoms that went back as far as her teenage years. She recalled of fluctuations throughout her adult life of both constipation and diarrhea. If she ate rich foods like cream based sauces or soups, she could anticipate explosive diarrhea. But her pattern of predicability began to change in her forties and she became scared to go out in public to eat because too often she would find herself in the bathroom within 15-20 minutes of eating.

She also described periods of constipation as well.

If she ate hard cheeses or peanuts, for example, her bowels would slow to a grinding halt causing cramping, bloating, and gas. At times she could go 5-7 days between bowel movements. She became incredibly frustrated and distraught because of her symptoms. We imagine that while you are reading this you can relate on some level – either you or someone you know has dealt with this pattern of gastrointestinal distress! It can be extremely frustrating and debilitating.

Our patient had been evaluated by several primary care doctors as well as gastroenterologists. By the time she was 45 years old, she had two upper endoscopies (a scope that looks in the esophagus, stomach, and small intestine) and three colonoscopies (a scope that looks at the entire colon). She was told she had mild-moderate inflammation in the lower esophagus and parts of her stomach and was placed on Prilosec- a medication to eliminate production of stomach acid – at age 45. Her colonoscopies were always unremarkable. She was ultimately placed on levsin at age 48 to help reduce the spasms and cramping in her intestinal tract. Despite taking both medications, her symptoms were not well controlled. As you can imagine, her quality of life was sub-optimal and she needed help.

Through our “lens” at Inspire Wellness, IBS as a “diagnosis” does not truly exist.

It is a catch-all name that we call bowel related issues when we cannot identify what is the underlying cause – usually because we don’t look for it! We have many patients labeled with IBS because they present with cramping along with diarrhea and/or constipation. But that label does NOT help the patient in any meaningful way unless we identify root cause of their symptoms and help them to achieve a higher quality of life.

After spending an hour taking a very detailed history, we decided to obtain several tests to better understand the underlying cause of her symptoms. We looked at markers of inflammation since we know that inflammation is a critical contributor to both acute and chronic disease. We also looked for evidence of vitamin and mineral deficiencies. Lastly, we ordered antibody testing for both celiac (a gluten allergy) and candida (yeast). We also felt that since she was taking Prilosec for so long, a disruption to her gut bacteria (microbiome) could be a contributing to her symptoms. Lastly, we obtained a stool test analyzing her gut bacteria and finally a blood test looking for multiple food sensitivities.

Before disclosing results, we should understand the risks of taking medication longterm like prilosec – a drug in the category known as proton pump inhibitors. When these medication first became available, their intended use was for patients who over-produced stomach acid. These medications (including popular brand names such as Nexium, Protonix, and Prevacid) were also found to be helpful in treating a bacterial infection known as h. pylori, which could be an underlying cause of ulcers in the intestinal tract.

But soon doctors began prescribing them for patients with heartburn and before you know it, they became available over the counter. Now, we see countless patients who have been taking these medications for 10 or 20 years!! The consequences of taking these medications longterm include osteoporosis, reduced absorption of vitamins and minerals, kidney disease, and dementia. If you or someone you know is using these medications longterm, please make sure they are aware of the risks – and encourage them to find out root cause so they can try and eliminate their use of these medications.

Getting back to this patient, she returned for her first follow up visit after al testing had been completed. She had several interesting findings. First, her food sensitivity panel revealed high antibodies to eggs, cane sugar, pineapple, banana, almond, soy beans, and gluten. Her stool test revealed multiple issues – she had small intestinal bacteria overgrowth (SIBO). Essentially, bad bacteria invaded her microbiome, disrupting the important functions of our normal gut bacteria. She also had a high levels of candida (yeast) that was acting as a disruptor to overall health.

Finally, her blood tests revealed elevated c-reactive protein and insulin – both markers used to identify inflammation in the body. In addition, she had elevated antibodies to candida, confirming what we already knew from her stool test. Her vitamin D level was extremely low at 18 (should be 60-80) along with sub-optimal B vitamins. Lastly, and most concerning, were her celiac antibodies. All four antibody markers were elevated. We sent her back to the lab for genetic testing and found that she had did indeed have a genetic risk for celiac. Remember folks, just because you have a gene does NOT mean it has to be expressed. But in this case, what was turning her gene on was her consumption of gluten – found in common grains wheat, barley and rye.

We had quite a bit to work on but my patient felt somewhat relieved that we had actually found issues that could be contributing to her overall symptoms and poor quality of life. We developed a treatment plan together – first focusing on eliminating the foods that could be contributing to inflammation. In addition to avoiding the all things gluten and the other foods on identified on the sensitivity panel, we asked her to avoid all cow’s milk. Despite not having elevated antibodies to cow’s milk, it is still one of the top contributors to inflammation in the body. And we did not want her adding fuel to the fire!!

In addition, we started with vitamin D3 taking 50,000 units twice weekly. She tarted a B-complex daily along with a daily multi-vitamin. To reduce inflammation, we started her on 2,000 mg daily of fish oil and 1,000 mg daily of turmeric. In order to deal with the multiple infections discovered on her stool test (bad bacteria and yeast), we started an herbal remedy that can eradicate both bacteria and yeast in the GI tract and started her on a good quality probiotic to take once daily.

In addition, we agreed to exercising four times per week for a minimum of 30 minutes each time and deep breathing exercises daily to help reduce stress. She did not have any issues with sleep – thankfully!! Finally, the last pillar to focus on was loving kindness. By focusing on the positives in the people we meet and being open hearted, it can truly help the body and mind function at a higher level (simply think about how much stress you feel when you think about someone you dislike – it really can have a negative impact on health).

After two months of treatment, she came in for a follow up visit smiling and in a great mood. She was completely off of the prilosec and levsin and her bowel movements had all but normalized – going 1-2 times per day inn a predictable pattern. She was no longer afraid to gout out to eat as long as she stayed focused on avoiding those foods that contributed to her symptoms. Ultimately, she stayed on the herbal treatment for 6 months before we discontinued it altogether. She reduced her vitamin D3 to 50,000 units once weekly but has maintained the other supplements. She feels great and has seen a dramatic improvement in her overall quality of life.

Please remember, the body is incredible at restoring itself back to balance – until it no longer can. Once it is out of balance for a sustained period, that is when symptoms can become chronic. If you or someone you know suffers from chronic medical issues, please seek out a doctor that can help identify root cause. The doctors at Inspire Wellness are here to help all of us achieve the highest quality of life.

Our Favorite Supplements

Digestive Enzymes or Bitters taken ~ 10 min prior to meals, find one with ox bile if you no longer have your gallbladder to help release bile into your gut (the gallbladder is actually a very useful organ- don’t rush to have it taken out;)

Activated Charcoal taken ~ 1 hour after a meal that you know is loaded with inflammatory foods and pesticides (may affect mineral absorption and cause constipation so don’t take it all the time!)

Curcumin taken 1-3 x day to help lower the inflammation in your gut (and all over your body)

GI Revive or Glutashield taken 1-3 x day to help the lining of the gut heal

(Check out our personally recommended supplements here: )

Our Favorite Recipes

Gut healing smoothie recipe-
Unsweetened hemp milk
1/2 c Blueberries
1/3 banana (add more for sweetness)
Spinach or kale (fair warning – we tried arugula and had a tasty lawn flavored smoothie)
GI Revive powder (or similar)- 1 scoop
Vanilla Bone broth protein powder (1/2 scoop)

Let us know if you have any favorite smoothie recipes!

When we put our thinking caps on and try to uncover root cause, you – the patient – can ultimately achieve a higher quality of life. If you or anyone close to you suffers from any chronic issue (including IBS) and wants to work on reversing the underlying problems, come see us at Inspire Wellness.

Dan NeidesJessica Hutchins
Inspire Wellness
Functional Medicine Cleveland
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