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Robynne Chutkan, MD

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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…

Rose was in a big hurry when she came to see me. Gallbladder surgery was looming on the horizon based on a test (HIDA scan) that showed a poorly functioning organ, and she needed answers fast. Her symptoms were pretty mild and non-specific: bloating, a feeling of fullness after eating, and vague abdominal discomfort, but as I read through her initial food journal, I tried to maintain a neutral expression. She had been having a cheese Danish with a latte for breakfast, a turkey and provolone sandwich for lunch, and steak, chicken, or cheese pasta for dinner, with ice cream for dessert. Occasionally she’d have an apple for a snack, but usually it was a chocolate bar, cookies, or frozen yogurt. I’ve seen lots of food journals in my time (and mine certainly isn’t always pristine), but Rose’s was Exhibit A for what not to eat if you have a…

I’m trying to lose weight and I keep stumbling upon the keto diet and other low carb options for weight loss. What’s your opinion on diets that limit or completely eliminate carbohydrates? Would it be ok for me to do a 4-week crash keto diet, then slowly reintroduce carbs? -Keri Dr. Chutkan: Keri, growing a good gut garden (aka, protecting and enhancing your microbiome) is my #1 goal with my patients, so I’m always skeptical when I hear about strict diets that restrict or completely eliminate carbohydrates. Here’s why: carbohydrates, including vegetables, fruits, legumes, beans, gluten-free grains like brown rice, rolled oats, millet, amaranth, and quinoa, are the building blocks for a rich and diverse gut microbiome because they’re high in fiber – and act as food for beneficial gut bacteria. And a rich and diverse microbiome, as you probably know by now, is one of the key foundations for…

Anne is a wisp of a woman who’s been terribly bloated and constipated for as long as she can remember. Two tablespoons of psyllium husk (soluble plant fiber that adds bulk to the stool) and one tablespoon of ground flax seed in the morning, followed by two capfuls of a polyethylene glycol osmotic cathartic (a powerful laxative), plus three stool softeners and six prunes at night—and she still has difficulty having a bowel movement. She’s had several visits to the emergency room after nearly passing out from abdominal pain. Each time, the main finding on X-ray was a colon full to the brim with stool. We take a dietary history. Impeccable: she’s quasi-vegetarian and her standard lunch is brown rice, lentils, and kale. She’s two years shy of being the age for colon cancer screening, and given the findings on X-ray, I recommend a colonoscopy to make sure there’s no…

Coconut water is one of the biggest wellness fads in the last 10 years. But is it everything it claims to be: a great source of potassium, magnesium, antioxidants, amino acids, and even cytokinins (a hormone with hypothesized antiaging, cancer-fighting properties), plus low in calories, and an excellent hydration tool? I can definitely speak to the last claim based on personal experience in my gastroenterology practice. Growing up in Jamaica and drinking coconut water right out of the coconut, I was excited when coconut water hit the U.S. market. As a gastroenterologist, I began using coconut water as a form of oral rehydration therapy in patients who struggled to stay hydrated because of diarrhea, which can be a problem for people with inflammatory bowel disease (ulcerative colitis and Crohn’s disease) or in those who’ve had their colons surgically removed because of cancer or disease. While sports drinks are often the…