IBS – A Case Study

Sylvia originally came to see me in May 2009 seeking help with a diagnosis of high cholesterol. With a family history of cardiovascular disease on her paternal side and cancer on both sides of her family tree, she was rightfully concerned for her future health despite being only 30 years of age. High cholesterol is still medically considered a marker for cardiovascular disease (CVD) risk. We do, however, now know that the level of low-density lipoprotein (LDL) in relation to the level of high-density lipoprotein (HDL) is a more accurate measure of CVD risk.

Physically Sylvia is slight and her BMI has never increased beyond 19 (a normal BMI ranges between 20 and 25). BMI (Body Mass Index) is calculated by dividing your weight in kilograms by the square of your height in metres (BMI = weight in kg /height in metres 2). Sylvia maintains her slender frame by actively swimming and playing competitive football and training intensely for multiple days per week. Her skin is without blemish and she can brown easily when exposed to the sun. Her mood is even for most of the month except for the luteal phase of her menstrual cycle when she is prone to anger and frustration. She has been on the oral contraceptive for 7 years.

Sylvia suffers terribly with seasonal hayfever and took anti-histamine tablets regularly until recently. She additionally used a salbutamol inhaler for her diagnosed asthma but has lately switched to corticosteroid medication. She does not tolerate chemicals, perfume, cigarette smoke, animal dander or pollen. Her IgE (markers for classic allergies) indicated numerous positives and she has been diagnosed lactose intolerant. Some of her other concerns were low blood pressure, heartburn, acid reflux, vaginal discharge and bowel movement irregularities.

As a nutritional therapist I am most interested in the food choices of my patients. We are all subject to different lifestyle pressures and may have certain dislikes and aversions that need to be taken into account when making food recommendations based on presenting symptoms. Sylvia completed a comprehensive 7-day dietary diary and indicated that she does not have much of an appetite upon waking. She tends to go to sleep past midnight and wakes in the morning unrefreshed and enjoys a large espresso before setting off for work, which is office based and sedentary. It was additionally evident that she was quite restricted with her lunchtime options as she takes her meals in the office canteen where hot meals are served. She does her best to include plenty of vegetables with her lunch but that which is on offer has been kept warm for an extended period of time and perhaps no longer quite as appetizing as when served freshly prepared. With her long commute she tends to eat dinner quite late, at about 20:00 or later, but she does include plenty of fresh produce. It became clear quite early on that she enjoys a substantial amount of pasta, bread and dry crackers and that there is an inclusion of several items of bovine dairy in her daily diet, despite her being tested lactose intolerant.

In my practice I always discuss non-invasive testing to ascertain the health of the gastro-intestinal tract. Food is assimilated in the gut before it is broken down and the nutrients used for the myriad of metabolic functions in the rest of the body. If the gut environment has been compromised then problems can arise despite choosing the best food sources available. A stool analysis revealed that Sylvia had a very low level of Secretory IgA, an innate immune marker secreted to protect the gastro-intestinal lining. Her alpha-1 antitrypsine reading was also below the expected normal. These readings indicate a diminished activity of the mucosa-associated immune system, which translates into increased gut permeability, commonly referred to as leaky gut. Leaky gut can allow large food particles to cross the gastro-intestinal barrier and trigger an immune response. It is worth noting that undigested food particles are seen as foreign and ‘dangerous’ by the immune system when it enters areas where it is not expected. It was good to have this confirmed because clinically I have assessed that multiple food sensitivities are often the result of leaky gut. Infections of bacterial, parasitic or yeast origin can also give a similar reading, however none was detected in this test.

During an extended consultation we both agreed on an elimination dietary plan to identify additional food triggers and to completely eliminate all lactose containing products as this was already confirmed by her General Practitioner. Due to her ongoing fluctuating bowel movements her consultant recommended Omeprazole, which she continued to take without interruption.

In January 2011 Sylvia was suffering with the most debilitating stomach cramps, which left her without appetite and suffering with nausea. She was rapidly losing weight and her bowel movements have become watery diarrhoea. Her consultant treated her with repeated doses of antibiotics for suspected bacterial infection. Her situation did not improve and I suggested a comprehensive stool test and food intolerance screen. In my clinic I have seen IBS caused by one or more of the following: parasitic/bacterial/yeast (Candida) infection and food sensitivities. A comprehensive stool analysis revealed that she had low levels of the good bacteria, Lactobacillus. Beneficial gut flora protect against infections and play an integral part in the transit time of food through the big bowel (colon). Too few beneficial gut flora may result in constipation. She also had a significant yeast infection, which benefits from the elimination of sugar and refined carbohydrates as a starting point. The test was negative for helicobacter pylori, a common bacteria that can wreak havoc with the delicate balance of the many bacteria residing in the gut.

Her blood food sensitivity screen revealed a few foods that are seemingly innocuous in a person where the gut flora has not been compromised. With the absence of any bacterial infection Sylvia approached her consultant and they agreed that it was futile to continue with her medication. We discussed the importance of eliminating the tested food culprits and introducing a variety of safe foods, both from the screen and the elimination diet previously followed.

Sylvia saw an almost immediate improvement in her symptoms once she followed the agreed protocol. She has not had any debilitating symptoms since March 2011 and even though she still struggles to increase her body weight, she remains active and does not suffer with fatigue. Her cholesterol is well within the normal range and she continues to be vigilant because her family history may unfortunately predispose her to CVD if left unchecked.

This is an example of a patient who first saw me to address her raised cholesterol levels but who turned out to be a classic case of IBS.

This article was published in issue 193 of Positive Health On-Line Magazine in April 2012

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