On occasion in clinical practice you will come across patients who, on paper, appear to be 'doing everything right'. They follow a diet that many practitioners strive to achieve, yet, even with all their clean eating, meditation and dramatic shifts in thinking, these patients are unable to feel well.  

Case History

A 24 year old female attended clinic presenting with variety of digestive complaints, including chronic yeast infections, an anal fissure, and alternating constipation and diarrhoea. Although she was currently eating "the best diet" she had ever eaten (plant based with no processed or packaged foods), she complained "of feeling the worst she had ever felt" and was becoming disillusioned. Two years prior to our initial consultation, she had partied hard and travelled throughout Asia, upon her return to Australia, she endeavoured to 'clean up' her diet after a 'big revelation' that her recurrent yeast infections and anal fissure were a direct result of her lifestyle choices.

Treatment

The treatment plan we followed for the subsequent 3 month period focussed initially on identifying and eliminating foods which she found aggravating. We utilised a modified low FODMAP diet to eliminate and re-challenge foods.

In addition to the modified low FODMAP diet, her treatment included Saccharomyces cerevisiae (boulardii) (15 billion CFU per day) and antimicrobial herbs including oregano oil and phellodendron (Phellodendron amurense) to support the balance of intestinal microbiota.

FODMAPs is an acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. These molecules are naturally found in foods and can be poorly absorbed by some people, causing digestive disturbances. For more information on FODMAPs, their detrimental effects, and how to implement a low-FODMAP diet in your practice, see http://shepherdworks.com.au/.

The treatment plan then moved to heal and seal the intestinal lining with a combination including glutamine, licorice (Glycyrrhiza glabra) and turmeric (Curcuma longa). Initially I had concerns regarding the combination of herbs and nutrients due to their FODMAP content, however through manipulating the dose and the use of an additional blend of Chen Pi (Citrus reticulata) (25mL/week) and Chamomile (Matricaria recutita) (35mL/week) taken as 5mL symptomatically, we were able to find a tolerable dose which provided a therapeutic outcome.

Follow-Up

The changes were evident within a matter of weeks of starting our treatment. She initially struggled with the changes in diet, due to her plant based raw food diet. However, her symptoms reduced dramatically and she could understand how eating large quantities of 'seemingly healthy' plant based foods could have significant negative impacts on her gut health. She "could not believe that healthy food like banana and avocado, could cause such massive gut symptoms" and was stunned to see such improvements in such a short period of time. She continues to follow a low FODMAP style diet and happily reports she is now able to tolerate small amounts of banana and avocado without triggering her irritable bowel symptoms. Her bowel motions have normalised, her anal fissure has healed as the trauma to area has now been eliminated and her gut flora balance has been restored and she now no longer suffers from chronic yeast infections.