The concept of the mind-body connection is fundamental to naturopathic philosophy and treatment; however, it is only recently that this phenomenon has been illuminated in scientific literature. 

The most well researched example of this connection is the intricate bidirectional relationship between the gut and the brain.  Stress and anxiety can have a profound impact on gastrointestinal health and vice versa; the health of the gut influences brain function and mental health. The top down effect of stress and anxiety on gut health is clearly seen when the fight or flight response is engaged, causing an increase in gastrointestinal motility and shutting down digestive enzyme output in favour of supplying energy to the brain and musculoskeletal systems. More recent research also points to the effect that the microbiome, enteric nervous system, mucosal integrity, gut immunity and digested food components play in the maintenance of good mental health. Inflammatory and immune mediated processes originating in the gut can translate to immune infiltration and inflammation of the central nervous system, causing symptoms such as anxiety, mood disorders and cognitive dysfunction. This case provides an example of a straightforward approach to gut and nervous system healing beginning with symptom relief and moving on to tackling the underlying imbalances, addressing drivers and ultimately maintaining a symptom-free picture with the assistance of health promoting behaviours.

Initial Consultation 

A 33-year-old female presented with a 2-month history of lower right quadrant abdominal pain, loose and urgent stools, passing bowel movements anywhere from once every 3 days to 10 times daily. She reported having blood, mucous and undigested foods in her stools. She was not feeling constipated but unevacuated and had daily lower abdominal bloating that was worse towards the end of the day. Additionally, she reported lots of foul-smelling flatulence, some reflux, heartburn and burping.

One month prior she had been admitted to the hospital emergency department for the pain, where a CT scan diagnosed pancolitis. She was referred to a gastroenterologist at this time, who prescribed her a mesalazine enema (which she reacted to with cramping pain and so had ceased using) as well as a probiotic and pharmaceutical pain relief medication which she had not taken.

Since this episode the patient had voluntarily made some dietary and lifestyle changes to help improve her symptoms – i.e. she had ceased smoking and drinking coffee, and eliminated dairy, wheat and sugar. The patient’s symptoms had improved slightly with a change to her diet and lifestyle, but was still an issue.

In addition to these gut issues, she was also experiencing:

• daily anxiety which manifested as nausea, sweating hands and a feeling of impending doom which she attributed to family stress;
• frontal headaches twice weekly, previously treated with paracetamol but ceased as it upset her gut;
• insomnia resulting in 5-6 hours of sleep per night;
• low energy rated 3/10;
• heavy menstrual flow;
• carbohydrate cravings;
• poor memory;
• weight loss.

A physical exam revealed slow nail bed refill suggesting a possible iron deficiency and iris signs indicating digestive inflammation. Her diet was reasonably healthy since her self-prescribed changes; however, water intake was low and a hydrogenated vegetable oil spread was used in place of butter.

Initial Prescription

The initial prescription was aimed at regulating gut transit time, reducing inflammation, healing GIT mucous membranes, calming the sympathetic nervous system and promoting better sleep. A comprehensive stool analysis was ordered which included parasitology and she was referred to her GP for nutritional and hormonal testing.

Treatment consisted of:

• A liquid herbal mixture containing chen pi (Citrus reticulata) 30mL, chamomile (Matricaria chamomilla) 25mL, cinnamon (Cinnamomum cassia) 30mL, rhodiola (Rhodiola rosea) 25mL and ginger (Zingiber officinale) 5mL, to be taken 7.5 mL twice daily with breakfast and lunch;
• A nutritional powder containing aloe vera (Aloe barbadensis) 5.0g, glutamine 2.2g, larch arabinogalactans 2.0g, boswellia (Boswelia serrata) 1.5g, zinc 15mg, vitamin A 750 mcg RE, vitamin D3 500 IU, to be taken twice daily;
• A tablet containing kava (Piper methysticum) 2.8g, zizyphus (Zizyphus jujuba) 3.0g, passionflower (Passiflora incarnata) 1.5g, magnolia (Magnolia officinalis) 1.5g, lemonbalm (Melissa officinalis) 750mg, magnesium 50mg and glycine 100mg to be taken 2 tablets twice daily;
• A herbal tablet containing valerian (Valeriana oficinalis) 1.35g and hops (Humulus lupulus) 360mg to be taken 2 tablets ½ hour before bed
• A probiotic capsule containing Lactobacillus rhamnosus, Saccharomyces cerevisiae and Bifidobacterium animalis spp lactis totalling 22.5 billion CFU to be taken twice daily with food once the stool sample had been collected,
• Along with the following dietary advice:
  • A brown rice congee with lots of ginger to soothe the gut and for anti-inflammatory and carminative action;
  • Chamomile, licorice, peppermint and fennel herbal teas to provide soothing anti-inflammatory and gut healing activity;
  • Consume cooked over raw foods for easier digestion;
  • Avoid hydrogenated oils – switch to coconut butter instead.

2-Week Follow-Up

The patient reported a significant improvement in gastrointestinal symptoms – she was now passing 2 solid bowel movements per day except for 2 days of loose stools when emotionally distressed. She had experienced no blood or mucous in the stool, bloating, pain, reflux or heart burn, and minimal burping, but was still experiencing some flatulence. Sleep had improved to 8.5 hours most nights and she reported no headaches and was feeling much calmer. Her energy was still very low at 3/10 even though sleep had improved. She had increased her water intake, but was noticing some sugar cravings and increased thirst (indicating a possible blood sugar imbalance) and was experiencing significant stress in her relationship since the last visit.

Blood testing revealed low ferritin of 35 mcg/L (optimal range: 20-290 mcg/L), low iodine of 85 mcg/L (optimal range: 50-99 mcg/L – mild iodine deficiency), negative faecal calprotectin and negative gluten antibodies, indicating little or no intestinal inflammation or gluten allergy, ruling out any Inflammatory Bowel Disease or Coeliac Disease.

Her prescription was changed to address these nutritional insufficiencies, and to support her adrenals. Support was also added to manage the heavy menstrual flow, which was likely contributing to low iron stores.  The initial prescription continued with the following change to her herbal formula:

• A herbal liquid containing chen pi (Citrus reticulata) 20mL, chamomile (Matricaria chamomilla) 20mL, ladies mantle (Alchemilla vulgaris) 20mL, schisandra (Schisandra chinensis) 25mL, chaste tree (Vitex agnus-castus) 10mL, ginger (Zingiber officinale) 5mL and gentian (Gentiana lutea) 5mL to be taken 7.5mL twice daily with breakfast and lunch; and also included:
• A herbal and nutritional tablet containing gymnema (Gymnema sylvestre) 3.2g, chromium 223mcg and co factors to support healthy blood glucose to be taken 1 tablet 3 times daily with food;
• A herbal and nutritional tablet containing withania (Withania somnifera) 750mg, codonopsis (Codonopsis pilosula) 500mg, iron (as amino acid chelate) 12mg and cofactors to encourage production of blood cells to be taken 1 tablet before breakfast and 2 before bed;
• A herbal and nutritional tablet containing rhodiola (Rhodiola rosea) 800mg, rehmannia (Rehmannia glutinosa) 400mg, tyrosine 500mg, iodine 80mcg to be taken 2 with breakfast and 1 with lunch.

4-Week Follow-Up

By the 4th week the patient was feeling much better, her energy had returned and was now 8-9/10, and she reported a better outlook on life. Her gut symptoms had continued to improve – she only had loose stools once after eating capsicum, flatulence had reduced, and she continued to have daily, formed bowel movements without blood, mucous or bloating. She was still sleeping well even though she had stopped taking the night time herbal tablet for sleep and had not noticed any sugar cravings or abnormal thirst. Her period was significantly lighter and she only experienced one headache after eating some chocolate.

The results from her CDSA returned revealing:

• Low levels of Bifidobacterium spp;
• Moderate yeast growth;
• No inflammatory markers;
• Low secretory IgA – 41.8 mg/dL (optimal range: 51-204 mg/dL)

Previous supplements were continued and her prescription was changed to address the yeast overgrowth as follows:

• Clove (Syzygium aromaticum) was added to the herbal mixture (in place of chamomile);
• The nutritional powder was switched to one containing glutamine 2.0g, slippery elm (Ulmus rubra) 500mg, pectin 100mg and Saccharomyces cerevisiae 5 billion CFU to be taken twice daily;
• A bowel flora modification protocol was commenced which comprised of:
  • A herbal capsule containing phellodendron (Phellodendron amurense) 1.6g, andrographis (Andrographis paniculata) 1.0g, anise (Pimpinella anisum) essential oil 125mg, oregano (Origanum vulgare) essential oil 75mg to be taken 2 capsules twice daily for 3 days, followed by
  • The previously prescribed probiotic taken twice daily for 4 days, then this pattern repeated for the next 3 weeks;
  • An increase in high fibre foods such as apples, pears, parsnips and whole grains to ensure bacterial die-off by-products were removed effectively;
  • 1-2 cloves of raw garlic squeezed onto food (after cooking) to assist with bowel flora modification.

7-Week Follow-Up

The patient reported feeling great, her gut had been symptom-free except for one bout of loose bowels after drinking a coffee. She was no longer experiencing daily anxiety and her menstrual flow was considerably lighter). She was experiencing an increase in sugar cravings which she linked to less sleep resulting from an upheaval in her family life. The patient ceased attending the clinic at this point due to the extra demands on her time, however was instructed to continue with supplements including the bowel flora modification protocol for another month.

Summary

This case shows how effective herbal and nutritional medicine can be at treating relatively severe symptoms in a short period of time. It also provides an example of the gut-brain connection, with stress and anxiety likely playing into this patients urgent bowel movements with nervous system and adrenal support assisting in her return to health. The two-pronged approach involved addressing her gastrointestinal dysfunction by reducing inflammation, providing the substrates for healing the gut lining and modifying the microbiome, while at the same time calming the sympathetic nervous system, thus reducing its excitatory effect on gastrointestinal motility. In addition, adrenal support helped to reduce the negative effects of chronic stress, which is known to damage intestinal barrier function.  A comprehensive digestive stool analysis is not always necessary when treating a patient and their gastrointestinal system, however, it can, and did in this case, guide treatment and lead to a more comprehensive symptom relief and ultimate recovery of the patient’s good health.