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Robynne Chutkan, MD

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Lindsay: I saw a compelling study linking the ketogenic diet to reducing inflammation in the gut and improving microbial parameters. I realize you’ve been against keto diets in the past. To me, ketones seem to be beneficial for gut health. Can you elaborate on the study and your take on it? Dr. Chutkan: Lindsay, the study you’re referring to, Ketogenic diets alter gut microbiomes in humans, mice, was published in May of this year and was conducted by researchers at the University of California, San Francisco. Probably the trendiest diet of 2020, the ketogenic diet is a very low carb, high fat way of eating, which keeps the body in a metabolic state called ketosis, in which the body burns fat for energy instead of carbohydrates and transforms fat cells into ketones in the liver, which act as an energy source for the brain. Some preliminary scientific evidence shows that a ketogenic diet may…

These days having a colonoscopy is no easy feat. In addition to the usual inconvenience of a clear liquid diet the day before and a bowel prep to clean you out (thoroughly!), most endoscopy centers now require a negative COVID test a few days before your procedure, and then self quarantine until your procedure is completed. That has lots of people wondering whether the hassle – and risk – is really worth it. Over the last few weeks I’ve spoken with a few patients to help them stratify their risk and decide if a procedure is in the cards.  The first patient I spoke to had ulcerative colitis and was due for her surveillance colonoscopy this month. Patients with ulcerative colitis may be at increased risk for colon cancer depending on how long they’ve had the disease; how much of their colon is affected; and how active their inflammation is. For my patient, although she’d been diagnosed with colitis 14 years…

Kaye was in her mid 60’s with a long history of hypertension, a cardiac arrhythmia that had been stable for several years, and an eye condition that wasn’t well defined but seemed to be progressing. She contacted me via our website to ask if I could help with some constipation she’d been experiencing over the last month. Normally I don’t do telehealth visits for new patients (only follow-up visits for out of town patients), but nothing about the last few months had been normal and she sounded like she was struggling so I agreed to help. Her medical history was complex, and included multiple trips to the Cleveland Clinic for second opinions for her eye problems, as well as several different specialists here in Washington DC. But my part in all this seemed pretty straightforward – stool was stuck in her colon and I just needed to help her come…

Dear members of the Gutbliss community, We hope you and your loved ones are safe during these incredibly challenging times. In this special edition we’ve put together some COVID-19 gut-focused articles, resources and information to help keep you healthy. From the latest research showing that fresh air and sunlight are important factors in combating coronavirus, to the gastrointestinal signs, which may show up before any respiratory symptoms. We also highlight which medications may increase susceptibility, share our homemade soap recipe to help protect you and your family, and discuss at-risk conditions like inflammatory bowel disease. Living dirty during a pandemic may seem counter-intuitive, but exposure to the outside world may actually be just what the doctor ordered – learn how to do it safely with our live dirty dos and don’ts, and check out our dirt/sweat/veg recommendations for promoting a strong immune system. And stay tuned for our series of…

Certain medications could make you more susceptible to contracting COVID-19 and could worsen infection. NSAIDs: You may have already heard that non-steroidal anti-inflammatory drugs (such as ibuprofen and aspirin used to reduce pain, fever, and inflammation) may aggravate coronavirus infection. Because these drugs may affect the immune response, they can potentially elongate the infection time and increase the possibility of complications. While some studies support this line of thinking, the evidence is minimal and more studies are needed. Experts agree that they know very little about how NSAIDs effect coronavirus infection and are looking further into the association. In the meantime, the recommendation is that patients should use acetaminophen (such as Tylenol) to reduce pain and fever.  Corticosteroids: Because of their immunosuppressive characteristics, the routine use of corticosteroids is discouraged during the COVID-19 pandemic. These recommendations are in place because corticosteroids dampen the immune system, hypothetically increasing the risk of…

Sam: I suffer with numerous digestive issues – bloating, constipation, abdominal pain. However, I note that you recommend a plant-based diet. One of the main triggers of my pain are certain vegetable, legumes, nuts and seeds. Protein in the form of white fish and eggs is the easiest on my digestive system. I tried a vegan diet for months and didn’t see any improvement in my reaction to these foods. Do you have any suggestions? Dr. Chutkan: Sam, first, it’s important to get to the bottom of your GI distress. If you haven’t already, taking a close look at your lifestyle and medical history, and working with a healthcare practitioner that values the food as medicine approach, may be helpful. Second, while I don’t have a definitive diagnosis for your distress, I can speak to the symptoms you’re experiencing. As you’ve discovered, the foods that are most beneficial for gut…

A few years ago, a very nice woman named Lucy came to see me about some symptoms she was having. From the beginning she was convinced she had a parasite, and her story is in many ways, representative of the trials and tribulations of figuring out whether that may indeed be the case. Lucy had seen a number of gastroenterologists before me, and reading between the lines of their notes in her medical records, I could see they thought she was a little bit intense. She was a little bit intense, and rightly so. I would have been, too, if my life had been turned upside down by symptoms that no one could explain and that weren’t getting any better. In addition to bloating, she was also having fatigue, upper abdominal pain, nausea, and what she described as “weird” stools. The first gastroenterologist Lucy saw did an upper endoscopy, thinking…

Annette is a patient born in Argentina who I saw in consultation for Crohn’s disease. Like most people from that part of the world, she received the bacillus Calmette–Guérin, or BCG, vaccine against tuberculosis as a child. Since the vaccine is prepared from a strain of live tuberculosis that has lost its virulence in humans, one of the possible side effects is a false positive skin test for tuberculosis, which is exactly what happened to Annette when she was screened for tuberculosis in middle school. As a result of the positive test, she was treated for active tuberculosis infection with three antibiotics for a total of nine months, even though she never had any signs or symptoms of tuberculosis, and an X-ray of her lungs failed to show any evidence of the disease. In her senior year of high school Annette developed abdominal pain, diarrhea, and weight loss. She was…

Tabatha: I have spent years rebuilding my gut after reading your book, The Microbiome Solution. After 4 years of amazing health, I’m afraid of the damage that my next colonoscopy might do to my rebuilt gut microbiome. Should I be concerned and how can I still do my scheduled colonoscopies with the least amount of damage to my gut? Are there other options than a colonoscopy?  Dr. Chutkan: Tabatha, many of my patients, like you, have spent years working on rehabbing their gut microbiome, so your question is a really valid one. Preparing for a colonoscopy requires fasting and cleansing the colon using strong laxatives 24 hours before the procedure. This process can remove many of the microbes that live inside your gut. Let’s take a look at the science: a 2013 study assessed the effect of traditional colonoscopy prep on the gut microbiota in 10 men and 10 women,…