Tuesday, February 26, 2008

Published in IAACN INSIGHT. Volume 12, Number2


(Official Publications of the International and American Associations of Clinical Nutritionists)

Case History: Elliot B.
  • 42 year old male
  • Weight: 268 lb. Height: 5’ 10 ½”
  • BP 140/90

Main Complaint:
  • IBS – symptoms for 20 years but diagnosed 5 years ago and getting worse.
  • BM: 7 – 8 times/day. Diarrhea, mostly liquid.
  • 1 to 2 x/mo will pass blood with bowel movements if has more movements than usual.
  • Bloating, gas and heartburn.
  • Abdominal pain and gurgling.

Secondary Complaints:
  • Extremely depressed.
  • Very irritable and anxious.
  • Loud noises bother him; he’s startled easily and easily upset.
  • Severe claustrophobia. Never had the problem 20 years ago. - can’t get into a car w/ others unless he’s driving.
  • Can’t drive anywhere unless he knows exactly where the bathrooms are.
  • Sums up his problem as debilitating. Had to quit his job and become a consultant so that he could work from home.
  • He can’t do any hobbies or desired activities.
  • When family went on vacation he would stay in his room.
  • Won’t go outside the house much. - gets worried about leaving home.

History / Family History
  • Had gas pains as a child and thinks he’s always been lactose intolerant.
  • Feels good at 200 lb but currently weighs 268lb; recently gained 20 lb.
  • Drug use: abused drugs in 1980s; underwent rehab for cocaine.
  • Sister who is anorexic and also has drug abuse history.

Current Medical Diagnosis
  1. IBS
  2. Obesity (BMI 37)
  3. Anxiety

Diet Diary
  • Breakfast – fast food
  • Lunch – subway sandwich or tacos – fast food
  • Dinner – fast food or chicken, rice and veggies (at home)
  • Snacks – pretzels, cookies, fruit, crackers
  • Needs coffee to get going in the morning
  • Drinks 3 litres of diet soda/day.
Medications:
  • Lexapro 10 mg/day. 4 years ago was on Paxil, it stopped working so switched to Lexapro.
  • Lorazapan for anxiety as needed for 5 years.
  • Ativan – as needed

Plan:
  • Discover the source of the bowel irritation. Rule out food reactions and infections.
  • After removing any irritants, heal the bowels.
  • Evaluate adrenal function.
  • Educate on healthy diet.

Lab Tests:
  • Stool analysis
  • Adrenal profile – salivary testing
  • Comprehensive blood analysis – fasting
  • Gluten test – blood and saliva

Results of laboratory tests:
  • H. pylori, Clostridium Difficile toxin A and moderate Proteus species were identified.
  • Stage II adrenal fatigue with low afternoon cortisol, low DHEA and very high cortisol : DHEA ratio.
  • Cholesterol – 216
  • Direct LDL – 150 (high)
  • Total Fe binding capacity – 401 (high)
  • Cortisol (blood)– 4.85 ( very low)
  • Hemoglobin A1C – 6.10 (high)
  • Gliadin – borderline in saliva, negative in blood
Treatment:
  • Modified Elimination Diet – eliminating the most common food allergies from the diet for 10 days followed by a reintroduction.
  • Lifestyle and dietary management.
  • Antibiotic therapy to treat H. pylori and C. Difficile infections followed by probiotics.
  • Supplements to support adrenal function, enzymes, B12 injections and sublingual B12 on days not receiving injections.

Current Status:
Best communicated from a report written by the patient after being on the program for 90 days:
IBS ruled my life. I could not go anywhere where I was not absolutely sure that there was a close bathroom. I tried to take over the counter and prescription diarrhea medicine, but it would only last a few hours. Because of my symptoms, I was also on depression medication on a daily basis to "help" me deal with the anxiety that was caused by my IBS. I also suffered from extreme claustrophobia, and could not travel in my car without stopping to go to the bathroom every 20 minutes or so. I would say on a good day I had 6-7 bowel movements and on a bad day 8-9 - every day. I have had IBS for the last 20 years, but this bad, only for the last 2-3 years.
I could not go skiing, running or walking outdoors. Traveling was a nightmare for me and my family. I was always stressed about when I would have to next go to the restroom.
I remember at our first meeting Dr Petersen told me that she could help me, not with arrogance, but with confidence. She showed me pictures of what my insides probably looked like, but explained it in an easy to understand, matter of fact way. Dr Petersen told me I would have to give up eating like I was (eating myself to death, or a certain heart attack), but I could do it gradually.
I was given a diet that included none of the things I had been eating or drinking. It included giving up caffeine and gluten and sugar and aspartame. I had come to the clinic willing to try anything and I knew it would be hard but nothing could have prepared me for the withdrawal from caffeine and sugar. I thought that during the first week I was getting sicker, but I made it through. No real progress on my IBS, but I felt different. We went through blood tests and saliva tests and stool samples. It turned out I had 2 infections in my intestines that were not letting me digest food. The antibiotics at first made me feel even worse, but I was in this for the long haul. I knew I was on the right track because soon I started to feel better. Maybe the IBS was not cured yet, but I had more good days than bad, and I felt better emotionally and physically than I had in a long time. About one week after I finished the antibiotics, I began to lead a normal life. I was only going to the bathroom 3-4 times a day, and the experience was much better. Two weeks later, I had a few days in a row with only 2-3 bowel movements per day. In three days, I had what would have been one of my bad days, but with no anxiety or discomfort.
The side benefit of my gluten free diet is that I am off of my "maintenance anxiety drug". This did not happen because my new doctors told me not to take it, I just forgot to about two weeks ago, and have not had the need for it. Today I got in a car w/ 4 other men and I wasn’t doing the driving. It suddenly dawned on me that I would never have done that before. The anxiety would have prevented me.
I have also lost 18 pounds, which was not why I came here, but is a definite benefit.
It is very difficult to explain the pain and suffering that I went through and that I put my family through with my panic attacks and IBS. I am lucky that they supported me and did not leave me. I feel that I can start to be the person that I am meant to be. My life gets better every day. Maybe everyone is not as sensitive to gluten as I am, but for me it is poison. It is easy to pass up gluten with the great results I am seeing. I asked Dr Petersen if it was just the caffeine that made me so irritable. The doctor explained that for some people gluten is neurotoxic. This was definitely the case for me and understanding that makes it easy to stay on a gluten free diet. I also realized that all of the food that made me sick has gluten in it....bagels, bread, pizza, pasta, sandwiches......I was killing myself while trying to eat healthy. When I had a salad with bread and croutons, it defeated the purpose.
Anyway...that is my story so far. I feel better everyday. I can not thank Dr Petersen enough for helping me change my life.
Sincerely,
Elliot B.
Case study submitted by: Drs Vikki and Rick Petersen, DC, CCN.
HealthNOW Medical Center
1309 S. Mary Ave., Suite 100
Sunnyvale, CA 94087
www.healthnowmedical.com

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