functional medicine, gut health, and depression: a case history

FOLLOW ALONG AS I ADDRESS A QUESTION FROM A PATIENT ON GUT HEALTH AND DEPRESSION

Functional Medicine Gut

Wellcome V0011145

This email is from “Suzie” who came to see me for neurological TOS a few years ago.  My treatment helped somewhat, but certainly not enough to call it successful.  With her permission, I am answering this for everyone to see because I know that lots of people are in similar situations.  To see other CASE HISTORIES just follow the link.

Dr. Russ,
I had the first rib resection for my NTOS on August 22nd. It is better but not 100% – wasn’t expecting 100% anyway I guess.

I was off work for four months. For two of those months I did an elimination diet w/ no gluten, no dairy, no added sugar, etc. – I followed the Vital Mind Reset Diet by Dr. Kelly Brogan.  The first month I still ate white potatoes but she asks you to eliminate potatoes, rice, and legumes so on the second month when her program started I eliminated them. So, I was basically eating paleo – meats, veggies, and good fats! As an example, for breakfast I usually ate her KB Smoothie – I used collagen, nut butter, cocoa powder, coconut oil, and sometimes a raw egg yolk or two. Yes, she called it a fat bomb and the intent was to get your blood sugar stabilized. She stressed eating organic and grass fed & finished meats and non-GMO fed animals that need more than just grass like pigs or chickens.

Sounds good so far Suzie.  Remember that rice and white potatoes are both high glycemic (especially the potatoes) as well as being potential GLUTEN CROSS-REACTORS.  And while some people can eat BEANS AND / OR LEGUMES, not everyone can handle them.  BTW, I am a big fan of PALEO and / or HFLC (KETOGENIC) for people trying to deal with underlying or occult inflammation (there is also some crazy amazing information on scientists using Keto diets to address cancer — HERE).

Honestly, I don’t feel as though my depression improved. I lost weight. The pain in my feet subsided mostly and the tingling in my feet did as well for the most part. It was close to Thanksgiving when her program ended and I DID NOT reintroduce food as I should have. I went back to eating some bad food – I didn’t go strictly back to bad food but I did throw it back in my diet. Sometimes I would eat pizza, or a PB&J sandwich with white bread, or a bakery pastry, etc. I would say I was doing 50/50 – 50% paleo and 50% crap. 

According to the peer-reviewed literature, DEPRESSION is one of the myriad of problems that fall under the category of “CAUSED BY INFLAMMATION“.  Don’t think I’m picking on you, but the whole point of putting in the time and effort to do an ELIMINATION DIET is to at some future time, “reintroduce” foods back so that you can figure out which one(s) you might be reacting against immunologically.  The thing to remember about food sensitivities (I’ll use GLUTEN as an example since it’s common), is that you have to go off of reactive foods totally.  It’s why there is no such thing as a “low gluten” diet — it’s GLUTEN FREE.  And if you click the link, you’ll see why I’m not a fan of most “GF” programs or foods. 

Because I myself am sensitive (whether it’s actually a gluten issue or a FODMAP issue, I’m not totally sure — functionally it doesn’t matter), I have figured out that if I do a cheat day I pay for it.  Severely!  I took a big-time cheat day over this past Christmas break, and it took me a month to get my Gut straight afterwards.  That’s why CHEAT DAYS for people whose only issue is their weight are usually not a big deal, but if you have sensitivities or serious underlying illnesses, you are much more likely to cause yourself extended grief each and every time you cheat.  This is the voice of experience speaking.  Every person has to ask themselves if it’s worth it.  And this doesn’t even begin to address the issue of potentially re-firing addictions (HERE).

I noticed stuff when I went back to foods I hadn’t been eating for the 2 months. I couldn’t always figure out which food it was but sometimes I could. Symptoms I started having were itchy skin, congested nose, watery eyes, sneezing (I have never been a sneezer – in the past if I sneezed I was coming down with a bug). I tried to have chili once – used soaked kidney beans instead of canned – terrible bloating. Potatoes and rice definitely cause runny nose, sneezing, etc. When I would eat pizza or a sandwich it felt heavy in my belly and my guts would just feel off. Sometimes my mouth will hurt on the inside or my lips will hurt. Other than the beans, which causes bloating fairly quickly, it will take a few hours for the runny nose, eyes, sneezing to start. Food intolerances or food allergies??? I have never had seasonal allergies in my life but now when I eat certain things that is exactly what I think people who have seasonal allergies suffer from.

It almost sounds like a histamine thing, but GRAINS and potatoes actually have low histamine levels.  However, they are both on the cross-reactivity list above, meaning your body reacting against them could potentially cause excess production of histamine.  Also be aware that SIBO (Small Intestinal Bacterial Overgrowth), which is intimately related to FODMAPS (HERE), can cause increased Mast Cell activity (high histamine levels).  But then again, so can both LEAKY GUT SYNDROME and ALLERGIES.  Although there is a specific enzyme (HMT) for breaking down histamine in the CNS, histamine in the gut is broken down by the enzyme ‘diamine oxidase’ or DAO.   What causes diminished levels of DAO?  The very things mentioned in this paragraph, plus certain medications, chiefly ANTI-DEPRESSANTS and the non-PPI drugs used to treat GERD — H2 blockers aka “Histamine Blockers” such as Pepcid, Tagamet and Zantec. 

Other drugs that affect histamine levels via decreasing your body’s production of DAO include BETA BLOCKERS, NSAIDS, and the “biologics” people take for various AUTOIMMUNE DISEASES.  Oh; and yes, antihistamines as well (which I have seen cause back pain in a number of patients).  For the record, among the foods that are high in histamine, many are “healthy”.  These include about anything fermented (including not only alcohol and vinegar, but various probiotic concoctions such as the KKK — Kombucha, Kefier, and Kraut.  Furthermore, healthy green tea acts as a blocker of DAO.

The last month before I went back to work I was eating 50/50 and wanted to lower my dose of cymbalta. I want off thse antidepressants that I have been on for over 20 years. I was on a low dose but it was very hard coming off of this drug. I am no stranger to trying to get off antidepressants. I have been through hell coming off them in the past. I have finally been free of taking cymbalta for about 2 months now but initially I was extremely angry and wanted to be violent. I had a lot of trouble keeping myself in check. The rage from Cymbalta withdrawal has subsided but, as I’ll explain in the next paragraph, I am still very depressed and angry. I am lowering my Burpropion dosage now but I have been on this before and never noticed major withdrawals from this drug.

The problem with antidepressants is that no matter what anyone tells you, they create a reliance on, or addiction to them.  Why?  It all has to do with negative feedback loops. Cymbalta is a SSRI ANTIDEPRESSANT with an added component that also blocks the reuptake of norepinephrine, officially making it an SNRI (Serotonin and Norepinephrine Reuptake Inhibitors).  In my humble opinion as the ‘Village Idiot,’ these are terrible drugs that should probably never have gained FDA APPROVAL

Although I am not an expert on the subject in any sense of the word, the internet abounds with horror stories of coming off of SNRI’s.  When you block the body’s “reuptake” of various neurotransmitters with SNRI’s, you create artificially high levels of said neurotransmitters at the synapses.  The increased levels of neurotransmitters are supposed to, among other things, improve mood and energy levels.  The problem is that when you stop blocking the reuptake of any neurotransmitter, levels of said transmitters plummet.  The result can be a wide array of potentially severe (and in many cases ‘bizarre’) side effects. 

I am honestly not sure of the best way for people to come off of these drugs, although the web abounds with such articles.  For the record, Burpropion (Wellbutrin) is a drug used to treat depression, anxiety, and is used extensively in smoking cessation.  It is known to react with lots of drugs, including antihistamines and antidepressants, not to mention H2 Blockers.

The night before I went back to work I had horrible pain just below my sternum. I debated going to the ER a couple of times that night but didn’t. I did not go to work the next day and the pain subsided after awhile. I hate work. I’ve hated it for a long time. I always hated school. I was not looking forward to going back. Within the first couple of weeks of work I started having bad heartburn although it took me a week to figure out what it was because I’ve only had heartburn a couple of times in my life. I was also getting pretty severe lower belly bloating. Some days I feel like I have a stomach full of acid and others I have pretty constant heartburn. Not every day is the same and some days are worse than others. I started drinking just smoothies – blend of lettuce, carrots, coconut oil, and sometimes beats, in the mornings and also sometimes at nights. Sometimes I feel like I can’t eat anything or have no idea what to eat because everything seems to exacerbate my symptoms. I have had some pretty significant lower back pain start since going back to work too. At first I thought it was from sitting again a lot but I am wondering if it isn’t related to whatever is going on.

Heartburn is usually the result of LOW STOMACH ACID (not high stomach acid), and among other things, can be brought on by various forms of stress (which when maxed, can cause ADRENAL FATIGUE), which also happens to be intimately related to SYMPATHETIC DOMINANCE.  Be aware that the medical community’s solution for GERD is always H2 Blockers or more commonly, the even more dangerous PPI’s I mentioned earlier.  Neither solves the problem, and in truth, frequently causes the problem to become virtually self-perpetuating to the point people cannot live without them.  And not that I need to tell you this Suzie, but going through life hating what you do for a living makes everything — including healing your body and mind — difficult, to say the least.  Unfortunately, I don’t have a simple answer for this.

I had an ultrasound done of my gallbladder and kidneys, etc. and nothing abnormal was found. I met with a gastroenterologist last week who did not impress me, but no conventional doctor has other than the doctor I had in Boston for my TOS. I went educated into the appointment with the gastro and asked for tests. He said he thinks it is IBS w/ constipation. I don’t accept it – I want to know why? (I have always been constipated. I didn’t know that because I didn’t realize going to the bathroom once every 3-4 days wasn’t normal). I learned a few years ago after trying to figure out what was wrong with my arm that this isn’t normal. I’d say for the last 4-6 weeksI have only pooped once on my own. The other times I have either done a coffee enema (I know they are not specifically for this) or just a water colonic to go to the bathroom) He also said, “since when is gluten related to depression?” when I mentioned the diet.

I had started taking some digestive enzymes, Duozyme, that Kelly Brogran recommends, but they hadn’t helped. He took one look at them and told me to stop taking them. He ordered an Upper GI and Small Bowel Barium test which I had today. The doctor today that did the initial part of the test when you swallow the barium and he takes the x-rays told me right away that I had significant reflux – the tech said she could see it too – you could see me swallow the liquid and it go down but come right back up. The doctor today told me 2x that he saw major reflux. The gastro doc also ordered a comprehensive metabolic panel and a calprotectin fecal test because my sister has crohns. I insisted on an H. Pylori test. He said they don’t test for SIBO which I think is absolutely ridiculous! I don’t think I would have gotten these tests had I not been persistent. I didn’t like the man. After he suggested it, I told him I had no intention of going on a PPI and he looked at me, shrugged his shoulders, and said, “that’s what we do here”. He told me at around the 30 minute mark in the appointment that he had to go because he had other patients waiting.

Be aware that tests like upper GI, lower GI, ultrasounds, MRI’s, etc, etc, are looking for gross pathology, and not subtle or “functional” problems.  First, there is an intimate relationship between IBS — a known autoimmune disease — and SIBO (HERE).   You can purchase good DIY tests for both SIBO and H. PYLORI (not to mention several labs that do incredible COMPLETE STOOL ANALYSIS).  It’s interesting about the “gluten” comment, because I hear patients complaining of it all the time.  Just yesterday I had a patient with an extremely rare issue (Tarlov Cysts) that she told her doctor that her symptoms improve when she stays away from gluten and sugar.  Her doctor dismissed it out of hand as stupid.  This is the norm because the system of healthcare we’ve created under our current insurance system cannot tell the difference between FUNCTIONAL PROBLEMS & GROSS PATHOLOGY!  I’ll get to the CONSTIPATION momentarily, but isn’t it fascinating that after all this song and dance, “what we do here,” is put everyone on a PPI?

Since I have gone back to work my depression has gotten very bad. Most days I don’t know how I make it through the day. I typically go in the bathroom to sit there and cry at least once a day. I can barely keep it together. My rage during Cymbalta withdrawal HAD subsided but as more stomach symptoms keep coming I have found myself angry/depressed almost all of the time now. I basically hate everyone and have nothing nice to say about anyone. I go from being so mad to bawling. I feel like I am about to explode any minute. I worry that I will lose it and keeping it in check is a full time job that is killing me. I want to snap. I have worked myself up into a mess writing all of this because I am at my wits end about everything…AGAIN…for the millionth time in my life.

I am utterly exhausted with myself and my issues. It took me 4 years to figure out what was wrong with my shoulder and have two surgeries because no doctor would/could help me. I was hoping for a better year – a new start – and the first day of the new year brought the beginning of more problems. I don’t want to spend the money – it terrifies me to now have to spend even more money to try to fix whatever is going on now. I’m still paying for last years surgeries. I am utterly fed up with myself. I feel like I don’t deserve this help – I don’t deserve to spend more of our money to figure out what’s wrong with me.  I hate myself for being sick. I just simply hate myself.

I wish I had all the answers for you Suzie, but I don’t.  What I can tell you for sure is that you’ve got some issues going on with your GUT (probably both LGS and DYSBIOSIS).  Beyond the links I’ve provided today, be sure and look at THIS POST as well as our articles on FMT.   Bear in mind Suzie that you’ll probably need some specialized FUNCTIONAL MEDICINE TESTING as well.  However, for most of you reading this, you can’t really go wrong by starting to tackle your health on your own (HERE).   As is always the case, even though your doctor will probably disagree with you and think you are loony tunes, be sure not to do anything without their express written consent.

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