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Robynne Chutkan, MD

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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…

Did you know that small intestinal bacterial overgrowth (SIBO) is often mistaken for acid reflux? In my practice, at least half the patients who come in with a reflux diagnosis are actually suffering from SIBO. Why is the mistaken diagnosis so common? The symptoms of the two conditions are very similar and even identical in some cases. Burning upper abdominal pain that can feel like acid reflux is one of the commonest manifestations of SIBO. High levels of gas produced by bacteria in the upper GI tract can cause the lower esophageal sphincter to open inappropriately, mimicking acid reflux. To further complicate matters, acid suppressing drugs like proton pump inhibitors (PPIs) are a common cause of SIBO, but since SIBO symptoms are often misdiagnosed as acid-reflux, PPIs are frequently used to treat SIBO, perpetuating the cycle of symptoms. So how can you tell the difference to gain a proper diagnosis?…

Susan: In mid-2008, I had a severe food poisoning incident with lots of diarrhea and vomiting. Later that year, I broke a toe and took Advil every day for a month. In October 2009, I started having problems being regular with my digestion. I saw a physician who gave me a course of antibiotics and proton pump inhibitors (PPIs). After taking them I was still experiencing abdominal pain and bloating. Dr. Chutkan: An episode of food poisoning can be the triggering event for small intestinal bacterial overgrowth (SIBO) because the gut flora is thrown out of balance. The pathogen crowds out a lot of the beneficial gut bacteria, and even after the infection is over people are often still symptomatic because their healthy gut bacteria remain depleted and other species start to overgrow. Non steroidal anti inflammatory drugs (NSAIDs) like Advil compound things because they make tiny holes in the intestinal…

Allen: I experience constipation and bloat more than I feel regular and normal. I lead a pretty healthy lifestyle, with the exception of enjoying a few alcoholic beverages and eating out on weekends. I have a very well rounded diet filled with veggies, fruits, grains, and protein. I exercise 5-6 days a week. I avoid dairy as much as possible and eat red meat once a week at most. I drink a tablespoon of Metamucil every day and take a magnesium citrate supplement (200 mg). It helps, but does not seem to be a cure. Taking probiotics didn’t seem to do much either. I’m extremely frustrated and it’s causing a lot of unnecessary stress in my life. Should I see a gastroenterologist? Dr. Chutkan: Allen, bloating and constipation are probably the two most common complaints I see in my practice, so you’re not alone! And while some may believe these are…

Recently diagnosed with esophagitis and reflux, my doctor recommends I take proton pump inhibitors (PPIs) for the rest of my life, but I’d prefer to use alternatives, such as a healthy diet, exercise and stress reduction. Is this possible? -Dan Dr. Chutkan: Dan, you’re on the right track in being cautious of lifelong PPI use. Stomach acid is one of the most important components of digestion, and when you block stomach acid for extended periods of time with these drugs, you put yourself at risk for suboptimal digestion of minerals like calcium and magnesium, as well as an increased risk of infections like Clostridium Difficile and pneumonia. While PPI’s are one way to treat reflux and esophagitis (inflammation of the esophagus), there are lifestyle modifications that can be really useful in managing symptoms, independent of PPI’s and their adverse side effects. These lifestyle practices include: Eat five to seven small meals to avoid overfilling your stomach.Exercise regularly…

Did you know that it may not be what you’re eating, but what you’re not eating that’s causing your GI distress? Most of us embark on dietary changes by omitting the culprits we believe cause us harm. Whether it’s gluten, dairy, processed sugar, or alcohol, our main focus is usually on subtracting the “bad” from our diets, rather than adding in the “good”. Even my SAD GAS diet encourages omitting those things that most often cause bloating and inflammation – soy, artificial sweeteners, dairy, gluten, alcohol, and sugar. While this subtraction can be an important and necessary step in healing, it’s not the only step, and it may not actually be the most important change to promote gut and microbial health. As a gastroenterologist, I’ve come to realize that in many cases, it’s not what you’re eating, but what you’re not eating that can be at the root of your symptoms. For example, the patients…