Case study from an integrative pharmacy
The Pareto Principle: “80% of the effects come from 20% of the causes.”
Vilfredo Pareto was an Italian civil engineer, economist, and sociologist who discovered a distribution curve that he could apply to scientific, social, geophysical, actuarial, and other types of observable events. I propose that we apply this principle to the patients who come to us for consults. Example follows.
When I began my consulting career, I quickly recognized that gastrointestinal dysfunction plagued most of my patients. They complained of bloating, diarrhea, constipation, gas, bad breath, heartburn, itchy anus, cramping, gut pain, foul-smelling BMs, unformed stools, and discolored stool. They were taking PPIs, H2-blockers, antacids, polyethylene glycol, bismuth subgallate, docusate, phosphate enemas, anti-cholinergics, metoclopramide, domperidone (from Canada), and IBS drugs. Some had had major esophagus surgery, gall-bladder removal, or partial and total removal of the colon. Many had suffered for years, some for decades.
Even if their chief complaint was not digestion, when we drilled down I found that they had digestive dysfunction. Why is that? Hippocrates gave us the answer long ago: "All disease begins in the gut." But I noticed that my patient's doctors rarely asked them about their digestion and even fewer did anything to help it.
It is said that 60% of all illness can be cured or vastly improved upon by fixing digestion. And I find it to be true. No matter who comes through my office door, they leave with something to fix their digestion.
Case in point
Let's look at the example of someone I saw today:
60 yo man, 6', 170 lbs. Fair-skinned/Red-headed, Drama teacher. With CC: 1. skin health; 2. digestion. Seborrheic dandruff, eczema on chest, eczema/psoriasis on feet. Family hx of diabetes. He has had bouts of IBS with diarrhea, but that is not a problem today. His wife is gluten-intolerant so he has reduced, but not eliminated, gluten from his diet. The only labs he could find were lipids and an FBS. The lipids were WNL except for an LDL of 138 (which I don't worry about ... more on that later). The FBS was 105 mg%, but he and the doc wrote this off, since his labs were drawn on January 2. I didn't dismiss it: He has a family Hx of AODM. He has troubles getting an erection (he does not have an erection when he wakes up). He is a teacher with 3 years to go to retirement. High school drama: 5 classes/day. 50-70 hour weeks. 2 shows per school year (rehearsals, builds the sets, promotes, coaches, directs, etc.), which consume, basically, half of his school year.
Do you think he is stressed? Do you think he gets enough sun/vitamin D? Do you think he goes to the bathroom when he needs to? Do you think he eats properly?
I didn't think so, and it turned out he didn't. If he ate breakfast, it was coffee and, maybe, cereal. He has only one bowel movement a day. He avoids the sun. Things get better for him in the summer, when school is out.
I explain: “Breakfast is really important. You need to eat at least 30 grams of protein before 9 a.m. It will help control your insulin by stimulating the "anti-insulin" hormone, aka glucagon.
“You may not feel like eating breakfast, because you don't have enough hydrochloric acid production in your stomach. Without HCl acid, sometimes we don't develop the proper levels of hunger in the morning. This happens with advancing age and stress. When you are stressed, you don't produce enough digestive juices. You must chew your food thoroughly before you swallow.
“I am giving you a digestive enzyme with betaine HCl, so you can activate the enzyme pepsin, digest protein, ionize your minerals properly, kill any parasites/bacteria/viruses in the food you eat, and absorb all of your B vitamins/folate.
“Further, when you chew your food and digest it adequately in the stomach, the small intestine and large colon are not going to be overwhelmed with an unfinished job. This will help to balance the 10 trillion bacteria/fungus/viruses in your lower colon. They, in turn, will produce soothing acids (butyric, lactic, propionic, acetic, formic) to regulate C. albicans overgrowth and allow you to correct the "leaky gut" or "dysbiosis" that has caused your irritable bowel symptoms.
“Lastly, by fixing your digestion, we will prevent the translocation of foreign proteins through your one-cell-thick colon wall into your bloodstream. Your immune system will start to calm down [TH-2:TH-1 ratio will normalize], and you'll stop producing auto-immune B-cells that are attacking your skin and causing the seborrhea/psoriasis/eczema. You will digest the gluten protein more thoroughly, possibly reducing its inflammation of the colon.
“This may take six months. In addition, get your 1,25-OH vitamin D level (goal is 50-80 ng/mL); get an HbA1c done (goal is <5.3%); ask your doctor to order an Lp(a), oxidized cholesterol, and find out your ApoB-gene status.”