A Nutritional Approach to Gastrointestinal Disorders: A Case Report

Abstract

Introduction

This case report reviewed a female client with numerous pre-existing conditions linked to gastrointestinal (GI) dysbiosis and systemic inflammation. Gastrointestinal ailments such as acid reflux/gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), inflammatory bowel disorder (IBD), and increased intestinal permeability (“leaky gut”) are on the rise and growing according to current research. Adjunctive therapies appear safe and are increasing in their use with the management of these conditions.

Case Presentation

A 39-year-old female, currently using H2-Receptor antagonists (H2R), presented with long-standing signs and symptoms of gastrointestinal (GI) ailments. A nutritional approach (ReNew Food Plan) focusing on client education, increased consumption of foods associated with reduced inflammation, and decreased consumption of processed foods was recommended. These recommendations were made to improve intestinal permeability, balance gut microbiota, and reduce reflux symptoms while decreasing dependency on H2-R medications, restoring regular bowel movements, and increasing immune function, including IgA levels. As a result of the adjustments, the client reported outcomes (CRO) indicated a reduction in signs and symptoms of her gastrointestinal (GI) and immune system ailments from severe and frequent to mild and occasional.

Conclusion

The ReNew Food Plan, a “food-first approach” integrated with other interventions, appeared to improve this client’s gastrointestinal (GI) and immune system function safely and effectively. Further studies are needed, especially about the ReNew Food Plan to compare results and show how this specific food plan could work for others.

Introduction

Gastrointestinal (GI) dysbiosis secondary to irritable bowel syndrome (IBS) and food allergies is rising worldwide, including the first few years of life.^1,2 Dietary choices, environmental triggers, and genetics may play a role in GI ailments causing immune system dysfunction and disorders.³ This case report reviews a 39-year-old female who presented with severe lifelong GI disorders and chronic inflammation. The ReNew Food Plan,⁴ a dietary intervention, was the primary recommendation and was augmented with other recommendations for nutritional supplementation and lifestyle modification. Restoring and improving GI function was the primary goal, along with reducing prescription medications, if possible, with a secondary goal of improving immune system function. The client reported safe and effective steady improvements in her overall health. This case report was written according to the CARE health research reporting guidelines.⁵

Timeline

• 2022-02-08

  • The initial visit, part 1: Intake forms (completed online 1/28/2022), were reviewed by MW with a focus on the client’s primary health concerns related to her GI and immune systems. The client was referred to a primary care provider (PCP) and an oncologist and received recommendations for a nutrition program (ReNew Food Plan).

• 2022-02-15

  • The initial visit, part 2: MW completed the review of intake forms. The client’s priorities were reviewed: improve GI, overall health, and immune function. Reduce prescription medications if possible.

• 2022-02-28

  • Follow-up visit 1: Reviewed recommendations and educated the client on their implementation, including obstacles and potential solutions.

• 2022-03-10

  • Quick check-in with the client: No acid reflux or gastroesophageal reflux disease (GERD) symptoms. PCP concurred to reduce this client’s prescription medication, H2-Receptor antagonist (H2-R).

• 2022-03-21

  • Follow-up visit 2: Reviewed recommendations and provided more education on GI health and the recommended plan associated with our dietary recommendations. Abdominal scans were consistent with chronic GI inflammation.

• 2022-04-04

  • Follow-up visit 3: Reviewed recommendations and offered additional education on GI health and the recommended plan associated with our dietary recommendations. The client was offered a transition to a modified Mediterranean diet, which she declined.

• 2022-04-29

  • Follow-up visit 4: Client-reported compliance challenges with the dietary recommendations. Reviewed recommendations and offered support and education.

• 2022-07-17

  • Follow-up visit 5: Client-reported symptom improvement with our dietary recommendations. We also reviewed the recommendation from the MD providers on diet and weight loss.

• 2022-10-02

  • Final visit: Client-reported continued symptom improvement with our dietary recommendations. Updated digestive questionnaire to compare with the intake questionnaire. Symptoms score had moved from severe and frequent to mild and occasional/frequent.

Case Presentation

A 39-year-old Caucasian female with two children presented the following GI symptoms as her primary complaint: acid reflux/GERD, diarrhea, constipation, abdominal pain, gas, and bloating. Further, GI symptoms included excessive hunger, bad breath, nausea, and mouth and tongue ulcers. Other symptoms included bruising and muscle soreness with back pain, eczema, itching, depression-related symptoms- insomnia and fatigue, night sweats, narcolepsy, poor memory, ringing in the ears, hearing loss, and swollen glands.

Medical History. A neuroendocrine tumor (NET) measuring 0.6 cm with clean margins was removed at a recent appendectomy [2022]. The client had also been previously diagnosed with: (1) Celiac Disease, (2) endometriosis, (3) Depression, (4) Narcolepsy, (5) IgA deficiency, and (6) Herpes. Laboratory abnormalities included Alkaline Phosphatase, Glucose, and Monocyte elevation. This client had a long history of GI disorders, using various prescription medications, and dietary supplements.

On the initial intake questionnaire, the client revealed that she had a high intake of refined carbohydrates, sugar, and processed foods and a low intake of essential fatty acids. Potential nutrient deficiencies included protein, biotin, zinc, niacin, and selenium. The client’s eczema and yeast overgrowth were consistent with food sensitivities. The client completed the “Digestive Questionnaire”,⁶ with high scores in the following sections: small intestines, pancreas, small intestines (SIBO), intestinal permeability (“leaky gut”), and dysbiosis. The client also appeared to have food sensitivities, enzyme insufficiencies, and GI ulcers. Initial recommendations included the ReNew Food Plan and a gluten-free diet that the client received in writing, outlining the steps for the beginning. The client implemented the ReNew Food Plan one step at a time over several weeks, even when events adversely affected compliance - compliance was associated with improvement.

As of October 2, 2022, the client’s current weight was 190 pounds and stable. She was 5’2” tall, with a calculated BMI of 34.7. The client reported that the recommended food plan reduced her symptom scores from severe to mild, as noted below:

• Digestive symptoms - heartburn, diarrhea, and nausea reported as mild and occasional and improved with compliance with our recommendations. Food cravings were rated as mild and frequent.

• Mental health symptoms- mood swings, irritability, and brain fog reported as mild and occasional,

• General symptoms - fatigue, daytime sleepiness, malaise, restlessness, and insomnia- were reported as mild and occasional, (occasionally frequent).

• Musculoskeletal symptoms - joint pain and muscle aches were reported as mild and occasional.

• Other symptoms - eczema, itchy skin, and ringing in her ears reported as mild and occasional.

No adverse effects were reported following our dietary recommendations. Her OBGYN and gastroenterologist encouraged her to lose weight before another pregnancy. She wanted to consult on weight loss options while complying with our recommendations.

Discussion

Education and support to better understand the potential healing properties of food.⁷ Research has studied nutritional approaches geared to improve overall health, normalizing GI function, reducing GI symptoms, and improving the comprehensive immune system.⁸ The use of food as medicine can help maintain long-term compliance for those with chronic diseases.⁹

The ReNew Food Plan was recommended for this client due to its focus on enhancing nutritional support and education while allowing the client to gain knowledge through identifying foods that are triggers for increased inflammation and other symptoms that could result in GI dysbiosis and immune dysfunction.¹⁰ Furthermore, the ReNew Food Plan emphasizes eating whole foods to enhance repair and supports regular GI and immune system functions while reducing food cravings, chronic pain, and fatigue.¹¹ The ReNew Plan also improves cognitive function, mood, and metabolism, promotes a healthier microbiome and sleep habits, and reverses certain nutrient deficiencies for overall well-being.⁶ It begins with a short 2-week elimination period to associate foods with symptoms and adjust the diet.¹⁰ The ReNew Food Plan further follows the recommendations to Remove - toxins, allergens, and stressors; Replace - whole nutrient-dense foods not associated with an inflammatory response; Repopulate - Prebiotic and Probiotic-rich foods and supplements; Repair- foods and dietary supplements such as glutamine, quercetin, etc.; and Restore – lifestyle modifications.⁶ After the elimination reset period, the client reintroduces foods to continue understanding how food has healing properties from the symptoms the client is trying to ameliorate. If a client is only partially adherent to the requirements, the entire plan may fail. In this case, full adherence to the ReNew Food Plan recommendations proved challenging but doable at a slower pace.

All elimination diets have limitations. They are not sustainable long-term and may result in nutrient deficiencies depending on what is eliminated.¹⁰ Furthermore, individuals with previous diets high in sugar, processed foods, alcohol, and caffeine may be more prone to negative symptoms that might affect compliance.

Nevertheless, this client safely implemented this ReNew Food Plan and experienced an improvement in her symptoms once she could follow the plan as it was designed. However, the same results may not occur for all clients. Each person is unique and requires an individualistic blend of nutritional guidance and lifestyle modifications. Additional case reports and clinical research would be helpful to clarify how this approach might be individualized and personalized.

Conclusion

The inclusion and exclusion of specific foods and dietary supplementation could provide a platform for healing this client with various symptoms, concerns, and diagnoses. These nutritional recommendations (ReNew Food Plan) were integrated with supportive therapies without adverse events, offered symptom relief and overall health improvement, and reduced the use of conventional medications (i.e., H2R, and other antiacids). This food plan also offered improvement in her overall health and quality of life. Additional research would help clarify how this approach might be individualized and personalized for other ailments and diseases. This case report looked at how the inclusion and exclusion of specific foods and dietary supplementation could provide a platform for healing this client with various symptoms, concerns, and diagnoses. Our nutritional recommendations (ReNew Food Plan) were integrated with supportive therapies without adverse events, offered symptom relief and overall health improvement, and reduced conventional medications (H2-Receptor antagonists -H2R, and other antiacids). Additional case reports and further research would be helpful to clarify how this approach might be individualized and personalized.

Patient Perspective

I’ve dealt with gastrointestinal issues since my birth. I’ve done every diet imaginable to get “healthy” and feel better. I’ve been to all types of doctors- traditional and homeopathic. The advice and lifestyle plan were spot on. It wasn’t easy, but I began to feel better after two weeks of compliance. It’s not the easiest plan, but it isn’t forever. Using the plan, I’m learning about what my body needs and what triggers it. I am forever grateful.