The health impacts of floods are numerous. Flood water and its residue is often contaminated with untreated sewage, deceased livestock, industrial waste and household chemicals, and as such, poses a significant health risk to those exposed.^[1] Additionally, mould growth accelerates following an inundation, adding a level of complexity to the already diverse health hazards. One of the common complaints seen following flood water exposure is gastrointestinal (GI) upset. This case study is an example of how contact with contaminated flood water, mud and dust can cause a rapid, and persistent damage to GI and systemic health.

Initial Consultation

A 33-year-old female presented with a 3-month history of severe bloating, foul smelling flatulence and constipation which began the day after she volunteered in a flood clean-up. The bloating was intermittent, occurring every 2 weeks, affected her whole abdomen, and was accompanied by pain that could wake her in the night. She also experienced sharp pain in her lower right quadrant before passing a bowel movement, nausea and pain associated with bloating which was felt in her upper back. Her symptoms are accompanied by fatigue, mood changes and an increase in the duration of her premenstrual abdominal pain.  

A case history revealed:

- A decline in daytime energy from her usual 8/10 to 3-4/10;

- Brain fog experienced as difficulty paying attention to her children;

- Bowel movements every 2 days, some of which smell like ‘old mud’;

- Early satiety;

- Recent intolerance to dairy and alcohol (causes bloating and wind);

- High stress levels rated 8/10;

- Premenstrual pain starting 7 days prior to menstrual bleeding (previously 2 days
   prior);

- Dull headaches occurring all week since gut changes;

- History of gestational cholelithiasis;

- History of childhood asthma – now resolved;

- Difficulty breathing through her nose during exercise;

- Childhood constipation;

- A mostly whole-foods diet with some wheat, but very little dairy;

- Gym 3-4 days per week and very active lifestyle.

Previous testing revealed:

- Ferritin 44 μg/L (25-290)

- Positive Blastocystis species and Dientamoeba species on faecal polymerase
  chain reaction (PCR) test

The relevance of a positive PCR for Blastocystis spp. and Dientamoeba spp. in this case is unknown.  As these are common parasites and considered commensal microbes, it is possible that they were present prior to the patient becoming symptomatic and not the cause of her symptoms. Therefore, treatment was not specifically targeting these parasites.

Current and previous treatment included:

- Magnesium (patient’s own – dose unknown) taken one capsule in the morning.

- Antibiotics (brand unknown) to treat gut symptoms. Treatment was
  unsuccessful and caused a sandpaper-like rash on the patient’s neck and face.

Initial Prescription

The initial prescription was aimed at modifying the intestinal microbiome, improving digestive function and healing the gut lining. Her prescription included:

- Antiparasite Support Tablets, containing Artemisia absinthium (Wormwood)
  100 mg, Stemona sessilifolia (Stemona)1 g, Juglans nigra (Black Walnut Hulls)   
  100 mg and Syzygium aromaticum (Clove Bud) Oil 20 mg. Dosage: 2 tablets
  twice daily for 10 days then stop;

- Gut Antimicrobial Capsules containing Phellodendron amurense (Phellodendron)
   1.6 g, Andrographis paniculata (Andrographis) 1 g, Pimpinella anisum (Anise) oil
   125 mg and Origanum vulgare (Oregano) oil 75 mg. Dosage: 1 capsule 3 times
   daily with meals;

- Vegetarian Digestive Support Capsules, containing Amylase 100 mg, Protease
   55 mg, Lipase 11 mg, Tilactase 16.5 mg, Cellulase 1.65 mg, Bromelains 53.3 mg,
  Taraxacum officinale (Dandelion) root 665 mg, and Zingiber officinale (Ginger)
  333 mg. Dosage: 1 capsule 3 times daily with food;

- Ulmus rubra (Slippery elm) powder. Dosage: 2 teaspoons in smoothie daily;

- Consume herbal teas: chamomile and peppermint (double strength) when
   bloated or with GI pain.

Dietary and lifestyle advice included:

- Add 1 tablespoon chia seeds to food daily;

- Avoid all wheat and dairy until symptoms subside;

- Castor oil packs over liver and uterus to be performed 3 times weekly for 45
   minutes on non-menstruating days;

- Consume bitter foods such as rocket and bitter greens to improve digestion
   enzyme production;

- Include 20 mL apple cider vinegar daily in water or as a salad dressing.

3 Week Follow-Up

The patient reported complete resolution of her bloating along with a significant reduction in the frequency and volume of her flatus, however the smell was still unpleasant and ‘muddy’. She was passing bowel movements daily and had not experienced any nausea or early satiety. The patient reported a reduction in the number of days in which she experienced premenstrual pain to one day prior to her bleed. She also reported an improvement in brain fog, no headaches and noticed that she was able to breathe easier when running. Her energy had also improved to a consistent 7-8/10. The patient had not yet started the castor oil packs and the apple cider vinegar made her feel nauseous, so she discontinued taking it.

Her prescription was continued with the addition of:

- A probiotic capsule containing Saccharomyces cerevisiae 5 billion colony
  forming units (CFUs) and Bifidobacterium longum BB536 1 billion CFUs. Dosage:
  take 2 capsules twice daily away from herbal tablets;

- A nutritional capsule containing lactoferrin 100 mg, iron (from bisglycinate)
  24 mg and ascorbic acid 100 mg. Dosage: 2 capsules every second night before   
  bed;

- Activated charcoal. Dosage: 1 teaspoon in water daily to be taken away from iron
  capsules.

Diet and lifestyle advice:

- Utilise castor oil packs per initial prescription;

- Increase magnesium to 2 capsules daily starting the week prior to menstrual
  period;

- Massage uterine area with clary sage oil during painful days of menstrual period;

- Include warming spices such as cinnamon, ginger, cardamom and cloves to diet
   in the form of a herbal tea.

7 Week Follow-Up

The patient was feeling considerably better. She reported a cessation of smelly flatus and continued daily bowel movements with no bloating or nausea.  She noted an improvement in memory and concentration and further reduction in menstrual pain. The patient was very pleased with her results and as she was mostly symptom free at this point, she chose to discontinue appointments with the condition that she would return if symptoms reappeared.

Clinical Reflections

The body is constantly changing in response to the environment. During natural disasters, environmental changes are rapid and extreme. In this case, the patient was likely exposed to a multitude of toxins and pathogens both airborne and in the residual flood water which resulted in her GI symptoms. The presence of her extra-GI symptoms was a clear example of the far-reaching impact of dysbiosis. Whilst the offending pathogens are unknown, a simple, yet robust microbial modification regime was able to restore balance to the microbiome and provide rapid and satisfying symptom relief.

References

1. Health risks from floodwaters. Carlton, Vic; Environmental Protection Authority Victoria, State Government of Victoria. 2022 [Updated 2022, November 30; cited 2023, December 1]. Available from https://www.epa.vic.gov.au/for-community/environmental-information/water/heavy-rainfall-events/how-to-manage-waste-after-a-flood/health-risks-from-flood-waters#:~:text=Floodwater%20is%20often%20contaminated%20by,and%20skin%20infections%2C%20and%20rashes.