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Robynne Chutkan, MD

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Lucia came to see me mainly to confirm that she was following the right path. She had a healthy childhood, but was treated with a year of tetracycline in high school for moderately severe acne. During the year she was on antibiotics she didn’t feel quite right, with frequent nausea, an upset stomach, and cradle cap on the back of her scalp. Cradle cap, also known as seborrheic dermatitis, is a yellowish, crusty rash that’s most common on the scalp of newborn babies, primarily as a result of yeast overgrowth. No one connected the cradle cap with Lucia’s GI symptoms or suggested they might be related to the antibiotics. In her twenties Lucia decided to see a gastroenterologist for her bouts of nausea, which had worsened after she started taking birth control pills. Biopsies taken during an upper endoscopy as part of her evaluation revealed the presence of Helicobacter pylori…

Did you know there’s a right and a wrong way to sit on the toilet? Most people don’t realize that their position when having a bowel movement is key to solving lots of GI complaints like bloating, gas, and constipation. The right position can also help improve more serious GI conditions such as diverticulosis, small intestinal bacterial overgrowth (SIBO), and irritable bowel syndrome (IBS). Squatting is the most natural stance for giving birth and, it turns out, for having a bowel movement. A squatting position helps to straighten the anorectal angle and keeps the knees pressed up against the abdomen, increasing intra-abdominal pressure, which helps to push the stool out. Over a billion people throughout the world don’t have access to toilets and squat over a hole instead. Interestingly, people in countries where squatting is the norm have much less constipation and colon cancer, probably because their diets, like their…

Madeline: I’m wondering if there is a benefit to taking digestive enzymes, especially since I’m over 60. I’ve read that we create less enzymes as we age. I seem to have more gas since either just getting older or maybe it’s menopause. Dr. Chutkan: You are correct Madeline, we make fewer digestive enzymes as we get older, but that’s to be expected. Lots of other things change as we get older too – our bones get thinner, our sex hormone production decreases, our muscle mass declines, and so on. Those things aren’t medical illnesses – rather, a natural part of aging. Digestion changes as we get older and that’s why enzyme production drops. That’s not an illness or “deficiency” any more than menopause is. There are specific instances when people need digestive enzyme supplementation – certain diseases of the pancreas can decrease production of amylase (digests starch) or lipase (digests…

My patient Barbara is a fifty-seven-year-old judge who in the last several years has been very careful about her food: no trans fats, nothing processed, no red meat, organic fruits and vegetables from the farmer’s market, and at least 20 grams of fiber a day. Given her healthy eating habits, she was completely perplexed as to why she was spending the better part of her day in the bathroom. Having a bowel movement had become a full-time job. The morning would get off to a reasonable start: a smallish log right after her morning tea, but things would deteriorate steadily after that with multiple, small, stuttering, pellet-sized poops that looked like rabbit droppings. Each movement was accompanied by an annoying feeling of incomplete emptying. She could feel she had more stool inside, but she couldn’t get it to come out. Invariably, within half an hour, it was back to the…

Jenny didn’t have much in the way of bowel symptoms, just bloating after meals and some constipation. She came in to see me because of severe fatigue, brain fog, thinning hair, and a history of infertility, and she wanted advice on what supplements might be helpful for these problems. As soon as I heard her rattle off this list of seemingly unrelated symptoms, however, I suspected an underlying autoimmune disease. Autoimmune diseases tend to travel in packs, since whatever is stimulating the immune system likely affects multiple organs, and are most common in women. I have lots of patients with autoimmune combinations like Crohn’s and psoriasis, or celiac disease and hypothyroidism. Jenny’s blood work came back showing slightly abnormal thyroid function consistent with an underactive thyroid, which could definitely explain some of her symptoms. So I sent her to my local go-to thyroid expert. He checked some additional labs that…

Watch Dr. Chutkan as she explains the importance of turning around and taking a look! Exploring the connection between what you put in your body and what comes out the other end should be an open conversation, not a dirty little secret. Hard to pass pebbles may be a sign that you need to up your veggie intake; stuck stools may simply need a little more water to help lubricate their passage; and loose stools accompanied by gas might mean your milk drinking days are over. A bounteous, satisfying stool the day after eating a high fiber meal is your body giving you a high five for doing something right. Making these connections between how you’re living and how you’re feeling is a crucial part of being healthy – and turning around to take a look at what’s in the toilet bowl can add valuable information. So how do you figure…

Glenn had been on various antibiotics for cystic acne for seventeen years. His skin would initially respond well, but after a year or two the cystic lesions would return, and his dermatologist would switch him to a different antibiotic. Ten years after he first started taking antibiotics Glenn began to have persistent loose stools and weight loss. He experimented with cutting out dairy and tried to increase his calories, but no matter what he ate, he still had diarrhea and trouble gaining weight. Evaluation of his digestive tract eventually revealed a diagnosis of celiac disease, and he was put on a gluten free diet (GFD), which he adhered to strictly. His doctor reassured Glenn that after a few months on the GFD his diarrhea and weight loss would improve, but two years later nothing had changed. Repeat evaluation showed the signs of celiac disease had completely resolved, and his small…