Inflammatory Bowel Disease (IBD)
Inflammatory bowel disease (IBD) is the general term used to refer to inflammatory diseases of the intestines, including
the major syndromes of Crohn’s disease and Ulcerative Colitis both of which are medically considered to be of unknown
cause.
The diagnosis of inflammatory bowel disease is based upon internal visual examination of the
intestines by sigmoidoscopy, endoscopy, colonoscopy and/or barium enema and by biopsy of intestinal tissue. The symptoms of
ulcerative colitis include intestinal cramping and spasm, the presence of blood and or/mucus in the stool, weight loss, a
sense of urgency and diarrhea.
Crohn’s disease is characterized by repeated bouts of fever and diarrhea accompanied
by right lower quadrant pain, tenderness and the presence of peri-anal disease with abscess and/or fistula formation.
Ulcerative Colitis can best be described as an
inflammatory, ulcerating, pathological process affecting the large intestine (colon) while Crohn’s disease is defined
as chronic inflammation of the small intestine at times gradually moving to the
colon at which point it is referred to as “Crohn’s Colitis”. Crohn’s
disease inflammation generally involves the intestines with areas that are relatively untouched being surrounded by highly
inflamed areas. Ulcerative colitis usually starts in the rectum and progresses upwards to involve varying lengths of the colon.
Medical treatments are similar with nearly the same set of pharmaceuticals being employed
for both. Surgical options vary depending on the diagnosis but include the removal of segments of the small intestine (Crohns)
and/or removal of part or all of the colon (Ulcerative Colitis).
The onset of IBD may be insidious, with some patients experiencing gradually increasing bowel
irregularity with alternating constipation and diarrhea. This may persist for years until one day they experience cramps,
an urgent need to defecate and the release of blood and/or mucus from the bowel. In other cases onset may be sudden with few
preceding symptoms. Experience says that many patients have had other complaints preceding the IBD; symptoms that include
fatigue, allergies, anxiety, depression, and muscle and joint pains. In other words all has not been well for a significant
period of time.
Traditionally a patient will be referred to a gastroenterologist. Current medical protocol
calls for patients to undergo a “colonoscopy,” a procedure in which the physician runs a flexible optical instrument
up through the rectum to examine as much of the colon as possible through visual examination. Colonoscopy will identify the
extent of the damage but not why the damage has occurred. The patient will then
be assigned a title for their disease, (“ulcerative colitis” or “crohns disease”) without knowing
why the problem is occurring.
Despite viewing both conditions as “cause unknown” and using the same basic drugs
to treat both, emphasis has continued to be placed by the medical community on differentiating a patient’s condition
between Crohn’s or ulcerative colitis. Unfortunately for the patient, this commonly results in costly, inconvenient,
repeated, testing by different physicians often going back and forth between the two diagnoses. This is of little benefit
to patients who would be better served by focusing on why they became ill and what steps should be taken to return them to
health. A rationale used for this emphasis on diagnosis by some physicians is that ulcerative colitis can be treated by removal
of the colon whereas this would not be performed in most cases diagnosed as Crohn’s Disease.
Both UC and Crohn’s are observed to start most frequently in young adults between the
ages of 20 to 40 but no age is exempt. In practice I have seen children under nine years of age with diagnosed IBD. The condition
is more common in Caucasians than Blacks and Orientals and is disproportionately high in the Jewish population. Both sexes
are equally afflicted.
Surgical intervention is the ultimate medical outcome for many IBD patients. This occurs when
the individual fails to improve after drug therapies, which is often the case. Nearly one third of all patients with extensive
ulcerative colitis undergo surgery. This commonly involves the removal of a portion of intestines ranging from a few feet to the entire colon. In Crohn’s disease there is often a history of surgeries to remove intestinal
tissues with the patient having additional segments periodically removed as the disease progresses, sometimes repeated until
no more tissue can be taken.
We have had numerous patients come to our office
who had undergone multiple surgeries removing segments of intestinal tissues. The scenario all too often observed is that
any temporary improvements were followed by a continuation of the disease process and a worsening of the condition. This should
not surprise us when we consider that surgery does not build health nor address why the patient had become ill.
Current Medical (Pharmaceutical) Therapy for Inflammatory
Bowel Disease
Traditional medical therapy for IBD includes corticosteroids, sulfasalazine and its derivatives
and in recent years an increasing number of immune suppressant drugs. Corticosteroids are given orally and through enemas
into the bowel. The most common form is prednisone. Immunosuppressive agents include methotrexate, Azathioprine, 6-mercaptopurine
(6 MP), and Cyclosporine. Remicade, a Tumor necrosis factor alpha blocking drug given by infusion has been employed in recent
years. While these drugs can bring about a temporary abatement in symptoms through suppression of the immune system, they
fail to bring about significant improvement in many cases and all carry with them significant side effects including decreased
resistance to infection, nausea, serious liver damage, lymphoma and other cancers and tuberculosis. These drugs interfere
with fundamental processes of the body and therefore the adverse consequences of taking them should be of little surprise.
Genetics: There is a familial tendency towards IBD. It is estimated that between two to five percent of persons
with IBD will have offspring also so afflicted.
Infection: The chronic inflammatory nature of IBD has led to an ongoing look for infectious agents. No single agent
has been implicated yet there is considerable clinical evidence that the composition of the intestinal bacterial flora has
a significant effect on the disease condition.
Immune Mechanism: Inflammation is a key part of IBD and this implicates the immune system. Studies, however,
that have looked at immune abnormalities see them revert to normal when the disease is in remission. This suggests that they
are part of a secondary phenomenon and not part of the root causes of IBD.
Psychological Factors:
The psychological attributes of IBD patients have been explored extensively. It is common
to find that the beginning of symptoms often follows an emotional crisis of some type. This is true of many chronic disease
conditions and in IBD most likely represents a triggering of the disease process rather than the cause of it in most cases.
More Than Intestinal Diseases
The patient with IBD often has to deal with more than intestinal symptoms. The inflammatory
state of the GI tract afflicts the body systemically. Chronic fatigue, arthritis and muscle pains, allergies, back pain, skin
problems including psoriasis, neck, shoulder, hip and ankle pains, eye inflammation (iriditis), heart disease, extreme weight
loss and other manifestations of gut inflammation are often manifested. There are a variety of reasons for this. With the
poor absorption of nutrients that occurs, a myriad of adverse consequences develop as the tissues become severely limited
in their ability to obtain amino acids, fats, minerals and vitamins from the diet. The IBD patient often starves for nutrients,
despite taking in a fair amount of them. Putting food in the mouth does not assure its delivery to the cells of the body.
The altered bowel anatomy and physiology of the IBD patient may lead to abnormal elevations
of bacteria and the formation of immune complexes resulting in inflammation of the joints leading to joint destruction and
arthritis. Abnormal bowel permeability accompanies IBD leading to a significantly increased tendency to allergies and rheumatologic
disease as foreign materials make their way into the bloodstream. Scientific journals have noted this important relationship
between the GI tract and inflammatory joint disease, yet gastroenterologists and rheumatologists have failed to make practical
application of this information.
“Alternative Medicine”
Understandably many people with IBD look beyond western style medicine for answers in light
of the many dangers and poor record of IBD with medical treatments. A survey of patients with IBD by researchers at the University of Calgary found that more than half of them were using some type of alternative medicine. Practitioners of “alternative medicine” which encompasses a wide diversity of practices, have a variety of treatments
for IBD. These include homeopathic potions, herbal remedies, megavitamin therapies, etc. While most of these are safer than
drugs and surgery, the same fundamental error remains i.e. treating the symptoms of the disease rather than addressing causal
factors and undertaking steps to enhance the general health. What is sorely needed is not “Alternative Medicine”
but an alternative to medicine that addresses the causes of each person’s problems and builds the overall state of vitality.
This is particularly true with the IBD sufferer.
A change in the way IBD is approached is sorely
needed. Attention needs to be turned to two inter-related areas: (1) addressing the specific contributing factors involved
in each patient’s case (2) Supplying the Foundations of Health.
The General Approach for Success:
A successful approach to resolving the symptom complex known as IBD begins by consideration
of the individual causal factors at play. An investigation of the factors contributing to the patient’s problems is
needed. A thorough interview of the patient, focusing on family and medical history along with personal habits should begin
the process. By the end of an extensive patient interview which typically will take from 45 minutes to an hour, the practitioner
should have a basic working knowledge of the patient including the physical, familial, occupational and social background
of the patient. With the addition of the physical examination and appropriate laboratory testing the practitioner should have
some understanding of how the disease has evolved and set out to construct an individualized program addressing the patient’s
needs.
Part of the workup is identifying what health building
steps the person should take to increase their vitality and restore their health.
This is not the “treatment of disease”. The construction of health is an art and science rarely included in standard
or “alternative” medicine. Health Construction involves the scientific application of the “Foundations of
Health” including sunlight, breathing, proper diet, water, air, sleep, rest, fasting, activity, human companionship,
emotional and spiritual balance, the very factors that connect us tone another and support our well being.
Contributing Causes
to IBD
The Internal Milieu
IBD is most directly involved with the gut interior and this internal environment deserves
our attention. Three inter-related factors contribute to the “internal milieu” of the intestine:
1)
Types of bacteria residing in
the gut lumen
2)
Dietary intake including its
nutrient density and the presence of dietary allergens.
3)
Integrity of the gut barrier
Bacterial Residents in the Gut Lumen
There are over 400 species of micro-organisms that commonly reside in the gut. Their balance
has a profound effect on gut ecology and the patient’s health. Intestinal bacteria have many affects on us including
inhibiting the growth of pathogens, producing noxious toxins, producing and degrading vitamins, supporting or upsetting immune
balance, and protecting or damaging the intestinal membrane. Some bacterial cell walls can initiate immune responses and increase
pro-inflammatory immune materials involved in IBD.
Evidence indicates that IBD patients often have excess gut pathogens (disease producing bacteria).
They may also have an aggressive immune system that over-reacts to normal gut bacteria. Studies have shown that the bacterial
flora balance in patients with Crohn’s disease is typically different than that of a normal gut with a higher proportion
of unfriendly bacteria that can upset the ecological balance of the gut. It has been increasingly recognized
that Probiotic (health promoting) bacteria can help significantly in the control of many intestinal pathogens. The bacteria in our lives and in our guts can have
a remarkable protective influence on our health.
There is solid evidence that administering the right kinds of probiotic bacteria can be of
significant benefit in IBD. Each patient’s needs differ so certain specific properties of bacteria may need consideration
for different patients.
Probiotic bacteria have been shown to counteract inflammatory processes by degrading allergic
materials within the gut, by reducing inflammatory materials from being secreted, by normalizing the gut flora/reducing pathogens and by improving the functions of the gut membrane. Inflammation is central to IBD and therefore
the proper application of probiotics can be highly beneficial. Probiotics may also improve the body’s overall immune
response in significant ways.
Diet/ Dietary Allergens
The human intestinal tract has a surface area equivalent to two tennis courts laid side by
side. This allows a large capacity for absorption of nutrient materials. It also opens the potential for many allergens/antigens
to come into contact with the immune system. Healthy digestion keeps the amount of antigenic materials reaching the bloodstream
to a minimum. With compromised digestion and a damaged gut membrane barrier as commonly seen in IBD, significant amounts of
foreign materials are able to penetrate through and cause allergic reactions that perpetuate the inflammatory response.
The intestinal membrane is only a hair’s width thick and is under constant stress. It
is important that the right nutrients be ingested to maintain an intact mucosal membrane.
Years of poor dietary intake can easily lead to a breakdown in the gut membrane allowing foreign bacteria, bacterial
byproducts and food antigens to crossover the membrane barrier and set off adverse immune responses and subsequent inflammatory
reactions.
Chronic overeating often plays a significant role in creating numerous gastrointestinal problems.
The U.S. population as a group grossly overeats as the widespread prevalence
of obesity in our nation gives clear evidence of. Worsening the situation, much of what is consumed consists of refined flour
and sugar products, hydrogenated fats and an assortment of other “foods” that are fiber, mineral, vitamin and
trace element poor. These unhealthy materials supply little more than calories while affording the body the colossal task
of having to dispose of this huge daily load of antigenic junk. It is little wonder with the ongoing assault our G.I. tracts
take in the U.S. that the gut membrane often becomes disturbed. As a garbage can is made
of our gut the composition of the bacterial flora inside it are dramatically
altered. Weeds flourish rather than flowers in the wrong kind of soil. Likewise, the wrong type of environment fosters the
growth of the wrong types of bacteria. Altering of the internal environment due to overeating on poor foods and other stressors
leads to increased membrane permeability, disturbance of the gut flora, immune
system over activation and as a consequence, an increased chance of setting off an inflammatory response i.e. IBD.
For the patient whose bowel is ulcerated and bloody, the introduction of whole grains, fruits, vegetables and
other complex fiber rich carbohydrates is contraindicated, at least until a period of digestive rest is permitted by a supervised
fast or a planned, limited, dietary to permit the gut an opportunity to initiate healing. In many cases grains should be eliminated
on a permanent basis as their inclusion for many is problematic. Grains may result in food allergy, celiac disease and, particularly
when overused, blood sugar imbalances and disturbances of the intestinal flora
Food Allergy/Antigens
The intestines serve as a conduit for the passage of food allowing for its breakdown, absorption,
and elimination of wastes, yet little attention has been given by medical professionals as to the relationship between I.B.D.
and the intestines reactions to foods that pass through it daily. The typical Gastroenterologist advises the patient to "eat
a balanced diet” assuring the patient (while prescribing a number of pharmaceutical agents) that "diet has nothing to
do with his or her disease."
A food
allergy is an adverse immune response to food. Food allergies typically result in an inflammatory response. The response may
be immediate (one to four hours), or delayed (four to seventy two hours). With
delayed allergic responses a patient might consume a food as few as two to three times per week, yet experience constant discomfort
as the result.
Food allergies may be present at birth or develop over the years. Their genesis may be associated with a number of
factors including the development of faulty digestion, abnormal intestinal flora and impaired intestinal membrane integrity.
In the presence of food allergy, the intestines seek to rid themselves
of the offending materials as quickly as possible. The body produces intestinal spasms to eliminate the offending agent, pours
water into the gut to wash out the noxious material, and secretes mucus to protect the gut lining from the irritating agent...all
typical of the patient with I.B.D. As the irritation continues, exposure to the allergic food(s), can contribute to bowel
inflammation as part of the allergic response.
Any food can contribute to IBD. Cows milk, wheat, and eggs, are particularly common offenders. Every patient, however,
is different. Even foods that are generally benign can on occasion be a problem for an individual. Everyone is unique.
Allergy tests best utilized are blood tests for IgE and/or IgG responses. These are rarely done by medical physicians
who characteristically utilize skin patch testing or IgE. The skin patch test, however, is inaccurate, resulting in many false
positives and negatives.
Other gut related factors to be ruled out in patients with IBD include systemic candidiasis, parasites and upper G.I
tract maldigestion.
Yeast Overgrowth
Candidiasis (yeast overgrowth) has been increasingly recognized as a contributing factor in a number of chronic conditions
including some cases of IBD. Its presence can be identified by the patient history, examination and through specific urine
and stool tests. The use of refined carbohydrates, alcohol, antibiotics, steroids, chronic emotional stress, and lowered immunity
due to factors such as lack of sleep, allergies and over work all contribute to the toxic overgrowth of candida.
Candidiasis needs to be addressed at its source. Giving anti-yeast preparations (whether natural or drug derived) can
be of some temporary benefit but they do not resolve the problem. Causal factors must be addressed and overall immunity improved. This includes avoidance of refined carbohydrates, alcohol, antibiotics, steroids, increased rest and sleep, stress reduction, allergen
identification and removal, and other hygienic measures tailored to the individual to enhance their overall health.
Parasites/ Bacterial Pathogens
Parasites are not a common contributing factor for IBD but stool samples should be taken to assure their absence. More
common are the presence of bacterial pathogens. Stool microbiology samples to check for their presence as well as the numbers
of normal inhabitants of the intestines are often helpful to run. When abnormal flora are found, it is important to determine
what conditions are contributing to this state of affairs.
UPPER G.I. TRACT INDIGESTION
In medical practice the major emphasis in IBD is the intestines where the symptoms are most prevalent. There is a strong
tendency to ignore the body as a whole including areas where the problems are being generated from.
Upper GI disorders can have a significant impact on the lower GI tract and contribute to IBD. Problems originating
from the upper GI tract indigestion that can aggravate and contribute to IBD include:
- Decreased hydrochloric acid flowing resulting in inadequate
breakdown of proteins and resulting bacterial overgrowth/dysbiosis.
- Impaired motility
- Impaired secretion of sodium bicarbonate
- Impaired disachharidase secretion from the small intestine
(maltase, lactase and sucrase). With decreased disachharidase production, bacterial fermentation which is irritating to the
bowel becomes likely.
Poor secretion of enzymes and/or bicarbonate from the pancreas results in inadequate utilization of nutrients,
microbial overgrowth of undigested food products and bacterial fermentation and/ or putrefaction with many adverse ramifications.
Gluten Sensitivity
Sensitivity to gluten, a protein found in most grains should be checked for. Gluten Sensitivity results in significant
bowel irritation and produces symptoms of IBD. Patients identified with frank celiac disease, a severe sensitivity to gluten,
must avoid all gluten containing products. Some patients do not have full blown celiac disease but still have adverse reactions
to gluten. We have found this to be frequently overlooked.
The Search For Quick Cures
There is a ready market for overnight remedies promising quick relief from the problems of
IBD. Most of these rather useless and sometimes harmful products fall in the category of (so called) "bowel cleansing" products
and food / herbal supplements.
No amounts of colonics, enemas, or "colon cleansers" comprised of herbal derivatives will
prove of long term benefit to the IBD sufferer. “Treating” the bowel rather than addressing the patient’s
overall health is counterproductive. "Colon cleansers" do nothing to address causal factors in IBD and often irritate
the delicate intestinal lining. The same is true of enemas and colonics. Both can also easily contribute to further disruption
of the usually already imbalanced bowel flora.
Fasting
An irritated, ulcerated, intestine needs rest above all else. A properly supervised fast by
a qualified, experienced, practitioner will frequently expedite the patient’s recovery and in some cases is essential.
During the fast, body functions are able to normalize, toxins and allergens are more speedily removed and the tissues have
the opportunity to heal. The fast allows all the body tissues to rest and regain vitality. Following the fast the rested body
is in a better position to appropriate food stuffs and build healthy tissues.
The length of the fast must be determined by the experienced practitioner,
usually lasting between three and ten days. Lengthy fasts, particularly with patients who are debilitated, should be conducted
in house with the patient under the watchful eye of an experienced professional. I prefer, however, in most cases, to use
a series of shorter fasts. Monitoring the progress of the fast through simple lab tests
is supportive of good patient care.
What are the Foundations of Health?
- Whole
Unprocessed Foods – Natural foods from the earth supply us with the raw materials
with which to build and repair tissues. The more these materials are altered by man the less able they are to fulfill their
role in building health. If your food comes in a box, bag or a can you probably should not eat it.
· Contact with micro-organisms. The Hygiene Hypothesis, which is being increasingly championed by public health
experts, gives clear evidence that we require contact with the bacteria of the earth for healthy immune systems and to protect
us from the development of a wide variety of allergic and immune related disorders, including IBD. Our compulsion as a society to avoid dirt and germs at almost any
cost, spraying our living environment with a host of disinfectant soaps bactericidal sprays and veridical washes, may in large
part be responsible for the growing incidence of autoimmune diseases such as ulcerative colitis, Crohn’s disease and
other ailments.
· Sleep
and Rest in adequate amounts The average American is sleep deficient. Whereas we at one time went
to sleep shortly after sunset, in today’s society when the sun goes down the electric lights go on as does the television,
DVD player, computer internet and a host of other inventions that keep us awake late into the night depriving the body
of the rejuvenating sleep their bodies need. The need for adequate rest and sleep is particularly beneficial for IBD patients,
many of whom have a chronic sleep deficit.
· Fresh Air – Air is our most immediate need. Watch people in a crowded room where there
is a lack of oxygen and you will see them begin to yawn, their eyes begin to droop, and to exhibit other signs of fatigue.
We are intended by nature to live outdoors and breathe fresh air on a regular basis as opposed to the indoor lives most people
now lead, in buildings sealed off from the outside world at both work and at home. The IBD patient needs to spend liberal
amounts of time outdoors in the fresh air.
- Sunlight- We are intended biologically
to have regular sun exposure. The sun provides us with many health giving factors including the activation of our endocrine
glands and enabling us to produce Vitamin D. Epidemiological studies have documented that many people in our society lack
sufficient exposure to the sun as evidenced by the increasing amount of rickets that is being observed in the United States. Sunlight also has an important modulating effect on the immune system which
is generally overactive in the IBD patient.
· Under
eating – Eating whole foods from the earth is essential in keeping us connected to the earth and in providing us with the necessary
nutrients to produce energy and rebuild tissues. To ingest excessive quantities of food on an ongoing basis, however, is a
great drain on the body. Food eaten in excess, however, depletes the body of energy since digestion is an energy consuming
activity.
· Pure
Water-
The human body is over 75% water content. Water is used by the body for many purposes including assisting in the elimination
of wastes, the distribution of nutrients, cooling the body and making new tissues. Many people do not get sufficient water
and/or do not obtain water free of contaminants or chemicals that are added to the water supply. This places an additional
burden on the body, reduces its efficiency and predisposes the body to a number of health problems including fatigue, which
is one indicator of dehydration.
· Mental
Poise- Ongoing
emotional stress depletes the body of energy, contributing to fatigue and predisposing the body to disease. Connecting with
the earth by going for walks in the forest, in the mountains, along the beaches or in the desert returns us to our ancestral
ways and is one way to smooth away the many mental stressors which have become part and parcel of the modern world.
· Absence
of toxic habits Tobacco, coffee, drugs, alcohol, junk foods all act like poisons to the body. The body in turn must spend energy
ridding itself of these materials, depleting its energy reserves.
· Adequate
activity/exercise and recreation. We are meant to be active. Lack of activity causes atrophy of our tissues making them less efficient
in producing energy.
· Adequate
ties with friends and family. Humans are, like most animals, social creatures with a definite biological need to be connected
to others. Friends, family and pets all can play a vital role in keeping us connected with other living beings of the earth
and provide us with meaningful relationships that are essential for good health.
· Having
a meaningful spiritual orientation. Part of our connection with the earth is connecting with the supreme force that made it. Connecting
with the infinite and communing with it lowers our feelings of loneliness, energizes us and helps bring meaning into our lives.
· Getting
Outside of Ourselves…Having Purpose in Living: It is very easy to become totally self absorbed when an individual has a condition
that so negatively affects every aspect of their life. Realistically attention needs to be given to our illness and we need
to exert effort into getting better. Part of getting better, however, is focusing on those outside of us as well. Becoming
involved in helping others to the extent we are able to as well as having diversions such as hobbies, music, nature study,
art and other uplifting activities helps us to become more balanced.
How very much life has changed! The problems we face today with a variety of health problems including IBD
are certainly at least in part of our own making and therefore require effort on our part for their resolution. A knowledgeable,
doctor who understands these concepts and how to apply them can be very helpful, even necessary in many cases, but essentially
the responsibility lies with each of us. As the cartoon character Pogo used to say: “We
have met the enemy and it is us!”
Getting well from IBD requires hard work. What the patient learns to do when away from the doctor’s office is
of primary importance. We have discussed a number of different factors to be explored as well as general measures that require
the patient’s attention. Recovery will not be found in a pill or a treatment. The patient must make the necessary changes
and work towards improvement, realizing that this takes time and consistent effort. There is nothing the doctor can do to
equal the effort or lack of effort the patient makes.
CASE STUDIES
Case Study I
Patient Presentation:
A forty five year old male entered our office with a fifteen year history of Crohn’s
disease. During this time he had undergone a total of four intestinal resections each time having a segment of his inflamed
small intestine removed. In between operations he was kept on a variety of pharmaceuticals. Understandably, since nothing
had been done to address causes, it was only a matter of a few years each time before another segment of intestine was badly
affected and surgery was again undertaken. When the patient first came to see me his gastroenterologist had told him that
while his intestines were badly inflamed again, surgery was no longer an option since there was not enough small intestine
left to be able to afford removing more of it.
The patient was badly debilitated, underweight, weak, depressed, and pale. He had severe diarrhea
on an ongoing basis. His diet was poor and he had been told by his medical physician that diet had nothing to do with his
disease so that he could eat whatever he cared to. The patient tried to exercise, but found his efforts futile due to his
profound weakness.
His diet was loaded with coffee and refined carbohydrates. Laboratory studies revealed that
his plasma amino acid levels were extremely low although his diet was rich in protein. There was evidence of abnormal bacterial
overgrowth in the bowel, likely due to the massive doses of antibiotics and steroids he had been on over the years. The patient
had extensive muscle spasm throughout the lower neck and upper back region. The
patient was anemic as evidenced through blood work. He was unhappy in his occupation as a salesman.
Care Plan/Outcome
The patient was initially taken off all refined carbohydrates, coffee, and other irritating
substances. He was put on a light diet of easily digested foods that would not perpetuate bacterial overgrowth with attention
given to his eating habits as well.
After two weeks the patient was placed on a fast lasting a week. The patient was concerned
over losing yet more weight but understood that his already low weight had occurred due to his
problems in digestion and assimilation and that the fast could help greatly in that regard. He completed the fast feeling
"clear headed and refreshed", although the first two days had been uncomfortable, as is sometimes the case. The fast was carefully
broken and the patient found that his cravings for coffee and junk foods had disappeared. While he lost eight pounds during
the fast, this was quickly recovered and within a month the patient not only recovered the weight lost during the fast, but
gained an additional seven pounds for which he was delighted.
Specific amino acid supplements were given temporarily, based on the patients blood studies
and the patient noted a rapid improvement in strength. Probiotics were slowly introduced to help rebuild normal gut flora.
The patient found these helpful. Gradually he was able to begin a mild exercise program and make steady gains.
I counseled the patient on the need to adapt to his occupation or find a new one whereas the
job stress was interfering with his ability to recover. The patient took the advice seriously and obtained another sales position
which proved to be less stressful and more satisfying.
Three years later he remains well, taking good care of himself and following my recommendations
to him which have been altered during his recovery process, almost to the letter. Due to having had so much of his intestines
previously removed, he still has some diarrhea but reports it to be very mild in comparison to what it had previously been.
Case Study II
Presentation/History:
An eleven year old male was brought in by his Mother. She told us that she was coming to our
office as a "last resort", having been referred by another one of our patients. Nine months previously the boy had begun to
experience diarrhea along with weight loss and accompanying fatigue. His pediatrician sent him to a local hospital after a
course of antibiotics failed to produce any results. A colonoscopy was performed, and colon inflammation (colitis) was noted
but no cause could be identified. Due to ongoing weight loss, he was referred to a local hospital where he was given further
testing and another colonoscopy. He stayed there for two weeks undergoing extensive testing, but still no causal factors could
be found. Steroids were administered. An extensive psychiatric evaluation was also conducted.
After two weeks at this hospital the patient was still continuing to have
diarrhea and weight loss, leaving him with a "skin and bones" appearance. The hospital sent him home with the following counsel
to his mother:
1) The patient was in serious condition but there was nothing more that could be done at the hospital. Having ruled
out any organic cause for his problems, they were assumed to be the result of a “psychological imbalance” resulting
from his parents divorce and that he needed to receive psychiatric care.
2) The hospital's registered dietitian advised the mother to give the boy "regular feedings of ice cream and milk shakes,
to help maintain his weight, along with a balanced diet".
3) The child's lack of progress and continued weight loss indicated that his survival was at risk and that re-hospitalization
would likely be needed within the next few weeks to put the boy on intravenous feedings.
Notably, at this point, the child’s hospital and doctor bills totaled over $155,000.00 (one hundred fifty-five
thousand dollars).The patient was very weak and both he and his mother were frightened
by his condition.
After reviewing his case with the boy and his Mother, I ran a battery of functional tests including a food allergy
panel and multiple stool parasitology and microbiology samples.
The stool samples revealed the presence of a protozoan, Giardia lamblia, along with a number of bacterial pathogens
and an almost total absence of healthy bacteria. The allergy test showed a high sensitivity to cow’s milk and other
dairy products.
We advised that the patient be taken off all dairy and put him on a light diet of easily digested, natural foods that
he exhibited no allergic responses to, along with a few nutrient supplements in light of his emaciated condition. Simultaneously,
I referred him to a local medical physician with the results of his parasitology test to receive appropriate medication to
rid him of the protozoa. Probiotics to restore the normal flora were employed. I asked his Mother to make sure that his rest
and sleep hours were increased and that he had regular exposure to fresh air and sunlight.
Outcome:
The patient rapidly improved after the food allergens were removed, he was treated for Giardia, a healthy whole foods
dietary was implemented, probiotics were employed and other health building measures were implemented. Within two weeks his
weight increased along with his strength. His mood rapidly elevated as did his Mothers. He made a rapid recovery over the
next few months and returned to normal weight, strength and activities.
