Author

Robynne Chutkan, MD

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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,…

Hilary didn’t have a history of lots of antibiotic use in the past, but she was a picky eater in childhood who avoided fruits and vegetables like the plague. She was now in her thirties and in good health until a case of severe gastroenteritis, with nausea, vomiting, fever, and dehydration led to a five-day hospitalization. The cause of the gastroenteritis was never identified, but because she had a fever, while in the hospital she was treated with two different intravenous antibiotics and discharged on an additional ten-day course of oral antibiotics. Hilary felt better by the time she completed the antibiotics, but three months after the hospitalization she developed mushy stool that she described as having an oatmeal consistency, as well as severe bloating. Upper endoscopy and colonoscopy were unrevealing, and biopsies were negative for celiac disease, microscopic colitis, or any other abnormalities. A month later Hilary was prescribed…

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…