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BACKGROUND
b2ap3_thumbnail_Abdominal-Pain-Is-It-Appendicitis_article_main.jpgI first met Todd* with his wife in October 2016. He had been diagnosed with Crohn's disease (an autoimmune inflammatory bowel disorder) three years prior.  His symptoms included abdominal pain and loose stools with blood and mucous.

During our first visit, I learned that during the time his symptoms began Todd had been under increased stress with an upcoming wedding, a change in employment, and home renovations.

He had originally been treated with sulfasalazine, a common prescription medication for Crohn's, however, the medication made him nauseated and his symptoms were not well controlled. He had been unable to increase the dose as recommended due to side effects.

Todd continued to have frequent loose bowel movements within 15 minutes of eating, often associated with mucus and blood. He was experiencing sharp localized abdominal pain with activity, and the pain was limiting his ability to perform his physically strenuous job as an electrical lineman.

Prior to our first visit, Todd and his wife had already explored holistic options for his treatment. He had tried digestive enzymes, probiotics, and homeopathic remedies without relief. He had also completed a two month trial of a gluten-free diet but was unsure if that made any difference.


INITIAL WORK UP
At our first visit, I ordered a comprehensive laboratory evaluation to screen for:
  • Inflammation
  • Nutritional deficiencies
  • Anemia
  • Hormone balance
  • Candida/Yeast
  • Celiac disease
I also ordered Functional Stool Testing.

While waiting for results, I recommended that Todd begin a four-week Comprehensive Elimination Diet, and provided educational materials and book recommendations for support with this.

Blood testing revealed low levels of zinc, and significant vitamin D deficiency, but was otherwise normal. Functional stool testing indicated significant intestinal inflammation and low levels of "good" gut bacteria.

Recommendations were customized for Todd based on his laboratory results (no more “guessing game” when it comes to supplements):
  • Vitamin D (which supports the immune system response)
  • Zinc carnosine (a key factor in the health of the intestinal lining)
  • Fish Oil (a natural anti-inflammatory)
  • Immunoglobulin powder (derived from colostrum)
  • VSL#3 - A high-dose prescription-grade probiotic (this brand has solid evidence supporting its use in the treatment of Crohn’s)
I also prescribed Low-Dose Naltrexone (LDN), an opioid antagonist that has an outstanding safety profile and has shown promise in the treatment of Crohn’s in both adults and children with minimal side effects.


TWO MONTHS LATER–IMPROVEMENT!
Two months after initiating diet changes, LDN and targeted supplementation, Todd reported his pain improved by at least 50% with some pain-free days and improved energy. While still experiencing blood in his stools, he described it as much less than before.

I recommended he add a glutamine/aloe combination to promote further healing of the intestinal lining.


SIX MONTHS LATER–MORE IMPROVEMENT!
b2ap3_thumbnail_intestines.jpgAt six months Todd reported that he continued to experience significant improvement and was very pleased with his progress. He described his pain as minimal, with only minor flares "nothing like it was before”. He had good energy and stamina and was no longer having any work pain. He had become a “believer” in his regimen of supplements and LDN, having forgotten them on two nights, each time with a symptom flare.

While bowel movements had earlier been improved, he had since noticed increased blood and mucus in his stools, so a low dose of Sulfasalazine had been restarted.

He continued to cautiously experiment with his diet, determining his “trigger foods”.


ONE YEAR LATER
This past fall I was able to meet with Todd and his wife for his one-year follow-up. He reported great energy and stamina, no work pain, and no blood in his stools.

While still on the low dose of Sulfasalazine, it was a dose that did not give him side effects and his symptoms as a whole were nearly resolved. Follow up laboratory testing showed normalized levels of iron, zinc and Vitamin D.

I ordered comprehensive nutritional testing at this visit, which allowed us to customize Todd’s diet and supplement needs. His testing showed a need for B-vitamins, as well as magnesium and enhanced antioxidant support to reduce oxidative stress in the intestinal lining. Based on this testing, I also recommended he begin to reduce the amount of animal protein in his diet, transitioning to plant-based proteins.

In just one year, Todd was able to get much better control of his Crohn’s disease through changes in diet, targeted supplementation, and lower-doses of prescription medications without side effects. He had normalized bowel movements, no blood in his stool, minimal pain and improved energy. I look forward to continuing to work with Todd and his wife to optimize his nutrition, simplify his regimen as he continues to heal, and achieve further success!

*Patient names are changed to protect privacy

Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including many autoimmune conditions. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” (using assessments like estrogen metabolite testing) to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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In one year, this 10-year-old has made significant behavioral improvements, has stopped two of three medications, is no longer experiencing insomnia or constipation, and is thriving at school.  Read today's blog to hear his story!

BACKGROUND

I first met nine-year-old Luke* and his mother in late 2016. Luke had been diagnosed with a variety of psychological and neurological disorders, including ADHD, PDD-NOS (pervasive developmental disorder-not otherwise specified), Anxiety, OCD (obsessive-compulsive disorder), ODD (oppositional defiant disorder), and a sensory processing disorder.

b2ap3_thumbnail_boy-attacked.jpg

Since the age of five, Luke had been evaluated and treated by a variety of psychologists, psychiatrists, neuropsychologists, and pediatricians, as well as a number of occupational and physical therapists. By age nine he was on three different prescription medications for mood and attention.

At that first visit, Luke’s mom described him as "consistently inconsistent". She illustrated a child who on one day would appear happy, calm and content, while the next day appeared ”tormented" by irritability, anger, hyperactivity, impulsiveness, and anxiety.

I also learned that Luke had suffered from both chronic interrupted sleep and lifelong constipation. At times he would go 5–7 days without a bowel movement, and his mother would notice worsening behavior during these times. Complicating matters, his multiple psychiatric medications only seemed to worsen both his sleep and constipation.

INITIAL WORKUP AND RECOMMENDATIONS 
After hearing Luke’s story and performing an examination, a comprehensive laboratory evaluation was ordered which included testing for:
  • nutritional deficiencies
  • inflammation
  • blood levels of heavy metals
  • thyroid function
  • food allergies and sensitivities
  • micronutrient testing
  • functional stool testing
Prior to our first visit, Luke's parents had already implemented changes to his diet by eliminating additives and preservatives, most processed foods, sugar, soy, and conventional dairy products. I asked them to expand upon this and completely remove gluten from his diet.

FOLLOW UP AND PLAN 
I met again with Luke and his mother in early March 2017 to review the results of his testing. With the exception of low Vitamin D, Luke’s blood lab results were overwhelmingly normal. His stool testing, however, was not.

Luke’s functional stool testing revealed several abnormalities, including:
  • poor digestion, with evidence of high levels of protein and fat in his stool
  • bacterial dysbiosis, an overgrowth of “bad” bacteria in the gut
  • low microbial diversity
I recommended they add both fish oil and vitamin D with specific dosing recommendations given. We also initiated a protocol to rebalance his gut which included:
  • continued food restriction, avoiding gluten and other inflammatory foods
  • chewable digestive enzymes with meals
  • pharmaceutical-grade probiotics
  • an herbal blend to reduce the overgrowth of “bad” gut bacteria while still promoting the growth of “good” gut bacteria
TWO MONTHS LATER - PROGRESS! 
Off one medication and behavior improved!

Luke’s mother and I followed up via email in May after completing the herbal gut protocol. I was thrilled to learn of the progress that Luke had made! He had been off of Concerta (a medicine for hyperactivity and attention) for 2 months and was experiencing less behavioral problems. I advised them to continue the probiotics, enzymes, fish oil and vitamin D, and we added magnesium.

A FEW MORE MONTHS - MORE PROGRESS!
Off two medications, sleeping well and regular bowel movements!

b2ap3_thumbnail_GUT.jpgBy August 2017 Luke was down from three to only one medication. His mother reported that he was sleeping well and was having daily well-formed bowel movements! While Luke was still often impulsive and defiant, overall significant behavior improvement had continued since his initial visit.

In November Luke’s mother and I touched base after he had been back in school. She reported that he was “loving school” and was excited to report that he had not had any behavioral or academic problems. His anxiety and impulsiveness had improved. and his mother commented that “he looks really healthy”.

ONE YEAR LATER 
To follow up our gut protocol, we repeated Luke’s Functional Stool Testing, as well as a Urine Organic Acid Panel (which can give us a wealth of information without another blood draw). His stool testing had significantly improved, with better microbial diversity however he continued to show signs of poor digestion and bacterial levels, while much better, were still trending toward imbalance.

Using this follow up information we were able to “tweak” his current program, adding back digestive enzymes (which had been phased out), and repeating a one-month herbal program to further balance gut bacteria. We also added back L-glutamine to further heal and strengthen his small intestinal lining.

His diet restrictions have loosened slightly, but key concepts remain in place, including a whole food diet, and keeping sugar and processed foods to a minimum. They have identified significant gluten intolerance with increased anxiety and agitation, as well as a slightly less pronounced sugar intolerance.

Through the use of a thorough history, appropriate laboratory testing, and evidence-based Functional Medicine protocols, Luke has made significant behavioral improvements, has stopped two of three medications, is sleeping well, having regular bowel movements and thriving at school. I look forward to seeing his progress continue over the years to come!

*patient name has been changed to protect privacy

Carin Nielsen, MD Integrative MedicineI use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including both adult and childhood mood and behavior disorders. Rather than focusing solely on the use of prescription medication, consider addressing potential "root causes" of you or your loved one's symptoms, such as nutrition, gut health, toxicities/impaired detoxification, hormone imbalance, deficiencies and more. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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What causes problems with your gut... and what to do about it.

We have a recurring theme this month. It's about our cells and the information we present to them.

Integrative Medicine Leaky GutRemember, our bodies are made up of trillions of cells, and each cell contains a complete copy of our genetic blueprint, which makes us unique. Different parts of our blueprint will be activated in different cell types (muscle cells vs. skin cells).  The parts of the blueprint activated will also change depending upon the information presented to the cell. Food is information.  Many people do not realize that the information our food gives the cells in our body is as powerful, if not more so, than the information provided by prescription medicine.  Let's take this one step further - do you know how one medication may cause side effects in one person but not another?  That is because of our different genetic blueprints.  The same thing happens with the food that we eat.  Depending on our blueprint, the food that we eat will affect us differently.

Recently, I wrote about the gastrointestinal (GI) tract, or gut, and the huge role it plays in our immune system, nervous system, mood and more. I explained how a properly-functioning digestive system works, and also what can go wrong and cause gut imbalance and "leaky gut" - leaking food particles and proteins into your bloodstream that the cells of your immune system don't recognize, activating inflammatory pathways which can lead to many medical problems, including autoimmune disease, eczema, fatigue and more. Today we'll explore the causes behind "leaky gut" and how to repair and rebalance your GI tract.

Causes of "Leaky Gut"

There are many factors that can contribute to your GI tract becoming out of balance, including:
  • Chronic stress and use of over-the-counter pain medications, antacids or PPIs (proton pump inhibitors like Prilosec or Nexium) reduce your stomach acid. Other medications can reduce saliva production.
  • If your gallbladder has been removed you lack the "control switch" on your bile salts. 
  • High intake of sugar, alcohol or genetically modified (GMO) food can break down the protective mucus barrier that lines your intestines.
  • Loss of "good bacteria" from low fiber intake and use of antibiotics may impair digestion and breakdown of food particles and increase growth of "bad bacteria", which along with toxins and irritants can attack and break down both the mucus barrier and the intestinal wall.

Healing your leaky gut.

Identifying and healing your core gut imbalances is one of the most important first steps you can take to promote health and well-being. Originally pioneered by naturopathic physicians, the "4Rs" program of gut repair is used routinely by Functional Medicine physicians to restore health and balance to the GI tract.

The "4Rs" Program

REMOVE - Get rid of what might be irritating your system! Start an elimination diet to remove commonly offending foods. Consider testing for food sensitivities with IgG antibody testing. Identify any abnormal bacteria, yeast or parasites with functional stool testing (I use the "GI Effects" test from Genova Diagnostics) and take appropriate measures to remove them!

REPLACE - Replace any missing factors needed for proper digestion. Working with a functional medicine practitioner can be useful to identify which enzymes or acids are missing. Betaine HCL can be used to replace low stomach acid, digestive enzymes can replace low pancreatic enzymes, and bile salts can be added if needed. The idea is not to remove acid, but rather to support your digestion with the acids and enzymes it needs, giving your gut less work to do!

REINOCULATE - Add back "good bacteria" with a high-quality probiotic blend and promote growth of good bacteria by increasing your intake of fiber and fermented foods.

REPAIR - Promote healing of the GI tract lining by supplying needed nutrients, such as zinc, antioxidants, fish oil, and glutamine.

In my experience, patients generally see positive results in as little as 10 days of this process, with less pain, bloating and stiffness, clear skin, improved energy and mental clarity.


Yours in Health,

Carin Nielsen, MD
www.CarinNielsenMD.com



Carin Nielsen, MD Integrative MedicineI use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. Treating symptoms and chronic disease simply by prescribing medication doesn't address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface" to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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The Functional Medicine TreeMy traditional family practice has evolved into an Integrative/Functional Medicine practice, and my approach to health and healing has changed in many ways. Digestive health and wellness is one of the biggest changes.

Every day, I sit across the table from my clients and talk about the gut. The "gut" we speak of is referring to the gastrointestinal (GI) tract, which is a long tube that starts at your mouth and ends "where the poop comes out" (I have twin 10-year-old sons, so in my house we have many terms for this area).

As a Functional Medicine physician, I often look to the gut first when encountering any chronic medical condition. Why? Because your gut has everything to do with your health. I'm not just talking about symptoms like abdominal pain, bloating or abnormal bowel movements - there are many more symptoms and conditions that occur outside of your gut, yet may be closely linked to GI tract imbalance, including:
  • chronic headaches
  • weight gain
  • eczema/skin rashes
  • asthma
  • depression
  • fatigue/low energy and "brain fog"
  • autoimmune disease (such as rheumatoid arthritis and lupus)
  • chronic sinus problems
  • joint and muscle pain
  • mood swings

Read more about Functional Medicine


Why is the gut so important?

Integrative Medicine GI TractYour GI tract contains the first line of defense in your body. 70% of your immune system lies in your gut! Every day, when you eat, drink and breathe, you bring various toxins and infectious "bugs" into your body through your mouth and nose. Your gut provides one of the most important and difficult balancing acts of your immune system, seeking out and destroying these foreign invaders (toxins, viruses, bacteria) while ensuring that proper nutrition and micronutrients can be absorbed and assimilated from the foods that you eat.


Your gut is a key factor in regulating your emotional health and nervous system. There is an enormous amount of communication that occurs between your GI tract and your nervous system (which consists of your nerves and brain). The connection between your gut and your nervous system is so strong that scientists have referred to your gut as your "second brain"! Your gut balance can directly affect your mood - 95% of your serotonin (a key neurotransmitter involved in depression and mood) is in your GI tract, and serotonin regulation is a key factor in depression, anxiety, and other mood disorders.

"Leaky Gut"
How GI tract imbalance can affect your entire body

If you used the term "leaky gut" with me 10 years ago, I may have looked at you like you were crazy! As a matter of fact, if you use this term with many of my traditional Western medicine colleagues, they will probably do the same. That is because this is a concept that is not familiar to traditional Western medicine. This is part of Functional Medicine, which involves "getting under the surface" to determine the underlying cause of your symptoms, rather than just treating your symptoms with a medication.

Let me describe "leaky gut" to you the way I described it to my patients in the office. 

A healthy, properly functioning GI tract looks something like this: 
  • Saliva and chewing break the food in your mouth
  • Stomach acid breaks down food particles further, while muscles and nerves work together to keep everything "moving forward" in your intestines.
  • Digestive enzymes and bile salts (from your pancreas and liver) break down your proteins, fats, and starches.
  • Food particles then enter the small intestine. The small intestine has a very important job! 

This is where all of the nutrients and proteins in the food that you eat are absorbed into your bloodstream, while at the same time preventing toxins and infections from being absorbed. In order for everything to work as it should in the small intestine, several things need to be in working order:
  • First, the small intestine has a thick mucus lining that provides protection against toxins, infections, and other irritants.
  • Second, the small intestine contains adequate amounts of "good bacteria". These bacteria work to digest your food and also maintain a balance that prevents overgrowth of "bad bacteria" or other infections.
  • Third, the wall of the small intestine is tight and strong. This wall is what separates the food particles from your bloodstream. If the wall of your small intestine remains healthy and intact, only well-digested small food particles and proteins are let through into your bloodstream. 
So, when everything is functioning properly, your food is digested well, infections and irritants are kept from getting out of control, and small nutrient particles and proteins are entered into your bloodstream where they can find and enter your cells to provide them the nutrition and energy they need.

What happens when the gut becomes leaky?

Integrative Medicine Leaky GutIf your food is not broken down properly, the size and structure of the nutrient particles and proteins presented in your small intestine may be larger and shaped differently. If the integrity of your small intestinal wall is compromised, these larger, different nutrient particles and proteins may be let into your bloodstream.

As we have discussed before, food is information! The food you eat provides information that interacts with the genetic code that resides in each and every cell in your body. By changing the structure and size of these food particles and proteins, you are changing the information presented to your cells, which may activate pathways that promote inflammation.

The cells of your body's immune system are particularly sensitive to this. High inflammatory foods, such as sugar, along with increased "bad bacteria" or toxins in the gut may send a signal to your immune system to be "on alert" for problems. This is followed by the altered food particles and proteins entering the blood stream, causing your immune system to feel under attack! The cells of the immune system activate pathways that increase inflammation. Depending upon your genetic code (or "blueprint", as I like to call it), certain cells may be affected more than others. That is why leaky gut may present with a rash in one person, fatigue and headaches in another, and autoimmune disorders like rheumatoid arthritis in yet another person. Your genetic blueprint determines your susceptibilities.

Common signs of "leaky gut" include:

  • rashes/eczema
  • headaches
  • fatigue and "brain fog"
  • muscle and joint pain
  • weight gain and water retention
The good news - identifying and healing your core gut imbalances is one of the most important first steps you can take to promote health and well-being. We've covered the basics of digestive health and where problems can arise, stay tuned to learn more about the causes of "leaky gut" and what to do about it!

Yours in Health,

Carin Nielsen, MD
www.CarinNielsenMD.com



Carin Nielsen, MD Integrative MedicineI use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. Treating symptoms and chronic disease simply by prescribing medication doesn't address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface" to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
 
 
 
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