The patient: Dan, age 50, a highly successful mid-town Manhattan stock broker with near-constant abdominal pain.
Why he came to see me: After consulting with his primary care physician, he was referred to a gastroenterologist who examined him thoroughly, performed both an upper and lower gastrointestinal (GI) fiberscope visualization, and an abdominal scan. He was told that there was nothing “really wrong with him” and that his symptoms were probably related to the stress of his job and prescribed acid-blocking medication and stool softeners. After about two weeks on the medications, his symptoms failed to improve and he noted that his moods and sleep had become disturbed. He told me that he still suffered severe abdominal pain nearly every day—to the point that he sometimes had to leave meetings early and was reluctant to schedule social engagements for fear he wouldn’t be able to sit through a movie or a nice dinner with a date. Additionally, he found that he began to experience a dramatic increase in intestinal gas that smelled much worse than what he had before the medications. He found me through a fellow trader who had similar problems that had resolved almost completely under my care.
How I evaluated him: Over the course of an hour-long appointment, I reviewed the tests that the GI specialist had performed. Although the findings showed no problems that medication or surgery would directly solve, there were several issues that, when considered together, pointed to identifiable problems… a good explanation…and a course of treatment. We discussed how the stomach needs to make enough acid with meals to make the whole digestive tract work. Besides pulling apart the complex structures of the meal components necessary for digestion, the stomach’s hydrochloric acid helps to sterilize the contents and prevent bacteria and other organisms from growing there. Additionally, the acid helps control the valves that keep the meal from passing through the stomach too quickly or bubbling back up to cause reflux. Even though the acid-suppressing medication that he was prescribed could be useful in giving the digestive system a break and calming irritation in the stomach or allowing an ulcer to heal, he only showed mild inflammation in the upper GI scoping. Besides, these medications should only be used for a maximum of two weeks. The increase in his foul-smelling intestinal gas could be directly related to the acid suppressing medication. When incompletely digested food passes down into the large intestine, the healthy bacteria that we harbor create not only bad gas but other evil-smelling compounds, some of which can contribute to colorectal cancer. Even though each factor in his bloodwork results was in the “normal” range, looking at the test data all together indicated to me that his digestive problems were causing issues with immunity, liver and kidney function, and inflammation. (The reference ranges provided in lab results are truly only for reference. The optimal measures vary by individual.)
How we addressed his problem: Since he didn’t have an ulcer, I prescribed a digestive enzyme complex (Duozyme manufactured by Karuna) to increase acid in his stomach with his meals and another medication (Gastri-Gest manufactured by Priority One) to calm the stomach and quench any residual acid that may trouble him when the meal had passed through without affecting his stomach’s ability to make its own acid with meals. Additionally, I prescribed fish oil, which contains the much publicized “omega-3 oils,” to sooth the entire digestive tract–particularly the large intestine–and help his mood and cramping. We also agreed that he should add in Glucomannan, a fiber supplement (produced by a number of sources) to help bind and remove some of the residue that was stimulating his ongoing cramping and gas. We discussed how although these interventions would start working quickly, literally within a few weeks, that he might require changes in his diet as well as pharmacy over time. Lastly, I emphasized the need to eat with conscious food choices , have regular meals with a healthy variety of foods and to limit his intake of fluids with meals to help concentrate the acid with meals. I also advised him to avoid coffee and other caffeinated beverages at least until our next visit two weeks later because they can irritate sensitive stomachs.
Why I recommended this treatment: I felt that by supporting normal function of his digestion, rather than suppressing acid production, his abdominal pain would decrease and perhaps would completely resolve. Sufficient acid production in the stomach is not only normal, but essential for digestion and health. In my experience, this intervention works quickly and quite effectively in most of my patients with these issues.
The patient’s progress: I received an email from Dan three days after his initial visit with me wondering if the dramatic improvement in such a short time was possible. I told him that even though the pain had been a constant challenge for him for months that the digestive tract was “extremely forgiving” and that changes even in response to different meals were shown to cause shifts in symptoms within hours to days.
At our two-week checkup, Dan reported that he was almost completely free of the previous symptoms that he had complained about. In this appointment, we focused on dietary changes, such as keeping a diet diary for our review to help sustain improvements in weight loss and stamina and to maintain the health of his digestive tract. We agreed that he would have to keep up with the supplements and dietary modifications for a while and that we should continue our monitoring and office visits periodically to modify things as his improvements continued to stabilize.