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Case Studies: Targeting Gut Health in Two Very Different Patient Scenarios
It’s no secret that good gut health is essential for optimal overall health and longevity. The gut is intimately connected with virtually all other bodily systems, and imbalances here could reflect in our whole body. Here we take a look at two case studies where GI imbalances were behind two seemingly unrelated conditions – rosacea (a skin condition) and POTS (Postural Orthostatic Tachycardia Syndrome).
Case 1: 20-year-old Female with Rosacea, Restless Legs, and Bloating
The skin on Lauren’s face was flushed and red, and there was swelling around her nose and below her eyes. When she was younger, she struggled with acne, which led her to be on a few courses of antibiotics and many over-the-counter medications and creams. Although her acne was mainly gone, the rosacea was at its worst. Aside from her skin, Lauren complained of restless legs. Lauren also had loose bowel movements multiple times throughout the day and felt bloated all the time. She denied reflux, burping, and gas. She was constantly eating to keep up with her vigorous workouts for soccer, both on and off-season, and would snack late at night while studying.
Initial Lab work
Small Intestinal Bacterial Overgrowth Breath Test- POSITIVE
Lab Interpretations
Lauren’s lab work pointed to a few concerns. She had functionally low omega, vitamin D, magnesium, and B12 levels. She also had high homocysteine. Abnormal values can indicate a lack of absorption or poor dietary intake. Both vitamin D and omega deficiency can affect the skin. Low magnesium can be one of the contributors to restless leg syndrome.
Lauren tested negative for candida and had a normal thyroid panel. She did test positive for both methane and hydrogen gasses on her SIBO breath test. Both Rosacea and restless leg syndrome have been associated with SIBO.
*Disclaimer* The breath test is only about 65% accurate, as it does not account for all the gasses indicative of SIBO. There are no false positives, but patients can have false negatives.
Interventions
The following interventions were implemented:
- A low FODMAP diet for 4 weeks. At the end of 4 weeks, she was able to add back in foods from the restricted column, looking for any reactions for 48 hours. Keeping track of reactions, she would move on to the next food.
- Along with the diet, Lauren was also given a herbal supplement, with antimicrobial properties, for 4 weeks. At the end of the 4 weeks she discontinued the herbal antimicrobial and started taking a spore-based probiotic and a gut lining support formula (containing glutamine, zinc, vitamin A, various demulcent herbs) for 60 days. This was done to support gut integrity and to approach treating leaky gut.
- After 2 months, Lauren was instructed to switch from the spore-based probiotic to a non-spore probiotic with a more diverse selection of beneficial bacteria.
- Lauren was also advised to snack less throughout the day and eat meals that were richer in protein and calories. This was suggested so that the Migrating Motor Complex (MMC) had a chance to clear out food debris between meals. Lack of clearing can cause issues such as SIBO.
In addition to the above, Lauren was also given the following supplements:
- B complex
- Magnesium glycinate (500 mg daily with dinner)
- Vitamin D (5,000 IU daily)
- Fish oil (2 g daily)
- Adrenal adaptogens formula, which contains a blend of Bacopa, Ashwagandha, Rhodiola, Eleuthero Root, L-theanine, and phosphatidylserine to help her become more resilient to stress.
Follow Up 2 Months Later
Small Intestinal Bacterial Overgrowth Breath Test- NEGATIVE
At the end of four weeks, Lauren’s rosacea was 95% gone, aside from some puffiness around her lower eyes. Her bloating was 100% gone, and her restless leg syndrome was 100% gone. Her bowel movements were no longer loose.
And at the 2 months mark, Lauren’s face was still clear, bloating was still gone, and her restless leg syndrome was also still gone. She noticed she had much more energy and was playing soccer better than ever. Most importantly, she was relieved that her rosacea didn’t return and her breath test was negative. She continued on her gut support for another 2 months and slowly weaned off.
Case 2: 53-year-old Male with Dysautonomia, Fainting Episodes, and Hypervigilance
After having COVID-19, Ben reported persistent throat clearing and excessive mucus production. Additionally, Ben has been dealing with heart rate spikes with standing, fainting episodes, facial swelling, lightheadedness, blood pressure dysregulation, flushing, palpitations, and occasional bouts of nausea. Sleep-related concerns include waking up in the early morning with palpitations, snoring, and feeling unrested. He also complains of chronic congestion.
Ben noticed that certain dietary factors, such as increased consumption of gluten and sugar, appeared to exacerbate his symptoms. He also reports that he often skips lunch, follows a low-protein diet, and snacks on pretzels and chocolate.
Initial Lab work
Stool Test
Tilt Table (+) Postural Orthostatic Tachycardia
- Normal passive HUTT with mild orthostatic increase in HR
- Dramatic increase in HR with SL NTG (Sublingual nitroglycerin) challenge resolving in seconds on supine positioning c/w postural tachycardia.
Cardiovascular Examination
A thorough evaluation revealed Paroxysmal Tachycardia.
Lab Interpretations
Following a thorough functional medicine and conventional medicine evaluation, Ben has been diagnosed with three conditions: mast cell activation, Postural Orthostatic Tachycardia Syndrome (POTS), and Paroxysmal Supraventricular Tachycardia (PSVT).
Mast cell activation involves the abnormal release of chemical substances from mast cells, leading to the aforementioned symptoms of facial swelling, flushing, palpitations, and gastrointestinal distress. POTS refers to a dysregulation of the autonomic nervous system that manifests as lightheadedness, blood pressure fluctuations, and fainting upon assuming an upright position. PSVT is a condition characterized by rapid heart rates originating from the upper chambers of the heart, resulting in palpitations, dizziness, and shortness of breath.
Review of other labs:
- Elevated levels of tryptase in blood tests are indicative of an abnormal proliferation and activation of mast cells, supporting the diagnosis of mastocytosis and the need for further evaluation and management of this condition.
- Low levels of vitamin D have been associated with compromised immune health, and some studies have suggested a potential link between vitamin D deficiency and increased susceptibility to anxiety-related symptoms. (2)
- H. pylori, Staphylococcus, and Streptococcus have been identified as potential mast cell activators and contributors to increased histamine levels. (2,3,4) Elevated histamine levels can trigger a cascade of symptoms associated with mast cell activation, such as flushing, palpitations, and gastrointestinal distress.
- Elevated levels of beta-glucuronidase, an enzyme associated with impaired gut barrier function, which can lead to increased levels of circulating histamine.
- Presence of gluten IgA antibodies indicate an immune response to gluten consumption. Gluten sensitivity can contribute to gut and systemic inflammation and permeability, triggering mast cell activation and worsening symptoms.
- Allergy testing revealed allergies to cat and dog dander.
Interventions
The following interventions were implemented:
- Vagus Nerve Exercises: Ben was instructed to incorporate vagus nerve exercises into his daily routine. These exercises, including the salamander, valsalva maneuver, and humming, aimed to stimulate the vagus nerve, which plays a crucial role in regulating autonomic nervous system function.
- Daily Lymph Drainage: Lymph drainage plays an important role in maintaining a healthy immune system and removing toxins, waste products, and inflammatory molecules from the body.
- Nasal dilators and nasal spray: nasal dilators gently expand the nostrils, improving breathing and potentially reducing snoring. The spray moisturizes the nasal passages, removes allergens, and supports a healthy nasal environment.
- Modified Elimination Diet: Excluding gluten and dairy products aims to reduce inflammation, since both are known triggers for immune reactions and gut inflammation.
- This was combined with a low histamine diet due to the presence of mastocytosis, as it helps reduce histamine intake from food sources and minimize the activation of mast cells, thereby alleviating symptoms. This transitioned to a nutrient repletion diet as symptoms continued to improve.
- 2 g Salt/day: In order to manage his Postural Orthostatic Tachycardia Syndrome (POTS), Ben required additional salt intake to help increase blood volume and improve orthostatic tolerance.
In addition to the above, Ben was also given the following supplements:
- DAO (Diamine Oxidase): Ben was prescribed DAO supplementation early on in the protocol. DAO is an enzyme responsible for the breakdown of histamine in the gut.
- Multi-nutrient formula containing vitamins, minerals, probiotics for gut health, omega-3 fatty acids for brain and cardiovascular support, and antioxidants for cellular protection.
- Magnesium supplement that includes multiple forms of magnesium to promote better sleep quality and support the proper functioning of the nervous system and cardiovascular health.
- Ashwagandha, an adaptogenic herb, which may help regulate the stress response system.
- Inositol which has potential benefits in managing anxiety and dysautonomia.
- Vitamin D3 with K2 for immune health and anxiety (vitamin D has been associated with reduced anxiety levels, as it plays a role in the production of neurotransmitters involved in mood regulation).
- Stinging nettle for its potential antihistamine properties, which may help alleviate symptoms related to histamine release, such as seasonal allergies, itching, and hives.
- Quercetin for its potential to inhibit the release of histamine and reduce allergic responses in the body.
Phase 1 Gut Healing Protocol:
- Biocidin: Specifically in its liposomal form, is often recommended for biofilm disruptions due to its broad-spectrum antimicrobial properties and ability to penetrate the protective layers of biofilms, helping to break them down and support the eradication of pathogenic microorganisms.
- Mastic Gum, a resin derived from the Pistacia lentiscus tree, which is often used for its antimicrobial properties against H. Pylori.
- A bovine immunoglobulin supplement that helps strengthen the gut barrier and modulate immune responses in the gut.
Phase 2 Gut Healing Protocol:
- Betaine HCL with Pepsin (Hydrochloric Acid): to support proper digestion and nutrient absorption, following negative H Pylori testing and performing the test for low stomach acidity.
- Herbal formulations containing botanical extracts with antimicrobial properties targeting opportunistic bacteria and rebalancing the gut microbiota.
3-Month Follow-Up
Ben no longer experiences high heart rate episodes, thanks to improved cardiac function and autonomic nervous system regulation. Engaging in regular strength training in a supportive group environment has not only enhanced his physical strength but also provided social support. His H. Pylori has resolved, stress is effectively managed, and a well-balanced diet has stabilized his energy levels.
Key Takeaways
The gut-brain connection provides a fascinating lens through which to understand the complex interplay between our nervous and immune systems, and optimal health. By identifying and treating underlying gut infections, restoring a healthy balance of gut bacteria, and addressing stress, diet and lifestyle, it is possible to alleviate symptoms and forge a path toward greater health and vitality.
Authors Bios:
Dr. Jane Drobin is a graduate of the National University of Health Sciences where she earned both her Doctor of Naturopathic degree and Doctor of Chiropractic degree simultaneously. With her passion for functional medicine, Dr. Drobin treats based on the six principles of naturopathic medicine: -Healing power of nature; -Identify & treat the cause; -Do no harm; -Doctor as Teacher; -Treat the whole person; -Prevention.
With a remarkable career spanning over 22 years, Dr. Arianne Missimer has established herself as an eminent figure in the realm of health and wellness. Her impressive credentials include being an esteemed Doctor of Physical Therapy, a Registered Dietitian, a Registered Yoga Teacher, a Mindfulness Educator, an accomplished author, and a cancer survivor.