People Need to Know!
Not all nutritionists practice in the same way. Yes, we all absolutely care about nutrients. And most of us care about food as medicine (!). But if you’re a nutritionist trained in Functional Medicine, your approach goes much, much further. Our nutrition staff all have graduate degrees in nutrition, plus advanced training from the Institute for Functional Medicine, which involves advanced laboratory testing, therapeutic dietary plans, and lifestyle interventions. As a result, our interventions are powerful and highly personalized; a one-size-fits-all approach isn’t what you’ll find here.
But what does that really mean? Is it really worth it? Will I see results? At the urging of one of our patients, let’s call him AJ to preserve his anonymity, we are sharing this story. Because, as AJ says, “people need to know!”
AJ was a personal trainer and athlete. He had been high school football player, educated about fitness and wellness and had trained himself and others all his life. AJ asked us to join his care team at the end of March 2017 (age: late 50s); he was also working with a gastroenterologist and primary care doctor. Despite this lifetime of fitness, he was at the time bed-ridden with debilitating fatigue, GI distress, tachycardia (an abnormally rapid heart rate) and more. Just talking to us increased his heart rate to almost 100bpm—not the effect we want to have! His Medical Symptom Questionnaire score (an evaluation of the frequency and severity of symptoms) was 41. Optimal scores are less than 10. AJ had worked with many different doctors, been through a gamut of testing and yet there remained no diagnosis or relief for his symptoms.
The First Steps in Any Functional Medicine Approach
Our first objective with AJ, as with any new patient, was to obtain a full history and try to piece together what brought him to this place. Meeting with Lara and Karen from our nutrition team remotely (all our nutrition appointments are via phone or video conference) allowed him to get the care he needed despite his bed-ridden state. Our functional approach looks at both the physical events as well as the life events such as stress and family circumstances that play a role in overall health and well-being. Like putting together a puzzle, every piece is valuable. This is why we look closely at each individual’s story.
Getting Deeper into AJ’s Story
In October 2015, AJ was eating a vegan diet and training very intensely. As several family members became ill he put his own health on the back-burner and became their primary care-giver. This stress of his family situation took its toll. He was no longer exercising, he was eating poorly (i.e. Standard American Diet with many prepared and processed foods) and not sleeping well. Although his family stress continued, he tried returning to his training in January 2016 but ended up with a pinched neck nerve. This injury resulted in a surgery and heavy reliance on NSAIDS to manage his pain. This seemed to be the beginning of his downward spiral. The combination of ongoing stress, caring for family members, NSAIDs, poor eating and poor sleep landed AJ in bed, trying to work from home and worried not only about his health but about his job security.
Soon after, AJ landed in the ER concerned he was having a panic attack. What followed for AJ was multiple ER visits, endoscopies, colonoscopies, MRIs, stress tests and CAT scans.
All of AJ’s test results were normal; the doctors could find nothing wrong with him!
Despite the lack of diagnoses, AJ was experiencing neuropathy, eating discomfort, gas, bloating, excessive fatigue and tachycardia, even with minimal exertion. He was losing weight and unable to complete everyday tasks like preparing his own meals.
AJ’s physician suspected SIBO (Small Intestinal Bacterial Overgrowth), a condition that can cause many GI symptoms including bloating and gas, and initiated treatment. This did lead to some improvement. He found limited symptom relief with B12 injections but oral B12 had no effect (a red flag for us that he was experiencing some level of malabsorption).
Next Steps for AJ’s Functional Medicine and Nutrition Plan
Looking at all the pieces of AJ’s puzzle, we needed to do a deeper dive to better understand what was going on ‘under the hood’. We recommended a number of tests, including a confirmatory SIBO breath test, a stool test, a food sensitivity panel and an organic acid/nutrient panel. We suspected that intense training and a limited vegan diet* may have led to some nutrient depletions that could have contributed to a compromised ability to make cellular energy in the mitochondria (sometimes called “acquired subclinical mitochondropathy”). Any depletions could be intensified by gut damage from NSAIDs and malabsorption caused by gut dysbiosis and possible ongoing SIBO. Evidence of malabsorption was clear not only in the efficacy of B12 shots (which bypass the gut) but also in his reported history of fatty stools. (Also known as steatorrhea, fatty ‘floater’ stools are one indicator of malabsorption.)
Our first priority for AJ’s Nutrition Plan was to focus on gut repair and electrolyte balance. Until we addressed the malabsorption issue, AJ would not be able to utilize the nutrients in his food for fuel and his healing would continue to be undermined. We started AJ on a nutritionally-balanced elimination diet with low FODMAP intake, as well as gut healing bone broths and a tailored GI healing supplement program. An electrolyte repletion formula was recommended to specifically address dehydration and blood pressure issues. Digestive enzymes were added to facilitate food breakdown and nutrient absorption. We utilized Cronometer, an easy-to-use smartphone-based nutrient tracking tool, to track his food and nutrient intake and the detailed reports guided our targeted recommendations for therapeutic foods to support nutrient repletion, healing, and overall wellness.
Making Progress and Seeing Results
AJ began to feel better with the changes we recommended even before test results confirmed he had SIBO. A little over a month after our first meeting, he was out of bed, his energy was increasing, he had gained back 5 pounds and had no problem tolerating a course of SIBO antibiotics prescribed by his gastroenterologist. His gut healing protocol and diet had a significant and quick impact.
By May 2017, after just 8 weeks, AJ was back at work in the office and back to his training in the gym. His energy had “skyrocketed” and his digestion and motility had improved dramatically. He was making time for himself and using meditation to manage stress. Applying a full functional approach had proved incredibly successful in addressing SIBO, restoring his gut health and finally resolving the symptoms that had plagued him for over a year. It was a complete turnaround to the bed-ridden AJ we had met just 2 months prior! No wonder AJ was shouting “people need to know!”.
Rationale for Our Approach
AJ’s first attempt at SIBO treatment yielded minimal results because he lacked key elements in the foundation for healing. Our goal was to build that foundation using the following tools in our functional toolkit:
- An Elimination Diet removing the most inflammatory foods and allowing the gut to rest
- A GI healing protocol including healing foods such as bone broth and supplements to further boost GI repair
- Electrolyte rebalancing to restore hydration status which is vital to absorption, repair and energy production.
- Digestive Enzymes to support absorption and nutrient repletion
- Lifestyle interventions such as meditation and stress management
Antibiotics alone where unable to address AJs condition as SIBO was only one piece of the puzzle. Nutrient depletion and malabsorption meant that he lacked the vitamin and mineral cofactors needed for energy production and healing. Restoring the integrity of his GI tract, improving his ability to absorb and utilize nutrients and working on lifestyle modification were all vital to his recovery.
For inquiring minds and Functional Practitioners, here is a peek at the Functional Matrix that guided our approach to AJ’s treatment:
Working closely with the nutrition team, AJ shifted from his long-time carb-centric eating pattern to a more balanced diet that included sufficient amino acids (protein building blocks) necessary for healing and plenty of healthy fats. Appropriate fats, which he was now able to absorb, have anti-inflammory, GI healing and immune boosting qualities that played an important role in AJ’s turnaround. Seeing the evidence in his own body, helped keep AJ motivated to continue. We then walked him through how to “challenge” with each individual food to root out those foods his body couldn’t tolerate, and to allow him to expand his diet with those foods he could tolerate. We provided plenty of recipes, tips, and support to help him along the way.
We are so pleased to have walked with AJ on this journey and amazed by his transformation. If you want more information about working with a functional nutritionist, come get to know our nutrition team!
*Vegan diets can suit some individuals, but it can be difficult for some to sustain nutrient repletion on a vegan diet without diligent attention. In addition, food sensitivities to commonly-reactive food such as wheat, other grains, and legumes, aren’t addressed on a vegan diet.
This article was written with Karen L. Herb, MS. Karen earned her master’s degree in Functional Nutrition from the University of Bridgeport, CT. Karen’s passion for nutrition sprouted after she began educating herself about food policy and practices. Her background in the legal field gave her a unique perspective on the interplay of scientific evidence and nutritional policies and recommendations. The deeper she delved into evidence-based nutrition, the more passionate she became about promoting a whole food, mind-body approach to nutrition and wellness. Seeking to specialize in functional nutrition she joined Dr. Kara Fitzgerald as a nutrition resident in January 2017 and is working towards her Certified Nutrition Specialist Certification.