Moodle at CCNM

This talk will involve a 45 minute case description of a commonly encountered presentation of Small Intestinal Bacterial overgrowth in clinical practice. The presentation will review symptomatology, laboratory work up and breath test interpretation, and treatment approaches, including dietary interventions. We will also explore concepts of dietary expansion, following long-term dietary restriction.

Presenters respond to questions from the audience regarding eating a SIBO diet. A mixture of data, clinical experiences and outcomes and case examples are covered.

Disordered eating behaviors can have a profound impact on digestive physiology, resulting in changes to motility, anatomy, digestive secretions, immunologic status, and microbial balance. These changes often lead individuals with eating disorders to develop any number of functional gastrointestinal disorders (FGID), with some studies estimating a 98% prevalence of FGID in patients with an eating disorder (Boyd, et al. 2005). And to make matter more complex, the symptoms of the eating disorder itself can often be indistinguishable from the symptoms of these gastrointestinal disorders, making it difficult for clinicians to identify appropriate treatment strategies. This overlap can present challenges in the setting of a functional GI practice, and poses some difficult questions. How do we appropriately screen for and recognize patients who have eating disorders? How do we ensure that our interventions do not cause harm to these patients? Do we consider dietary modification or other cornerstones of digestive health treatments in this patient population? This presentation will explore these questions, as well as provide useful tools for clinical evaluation, management, and appropriate referrals for patients with disordered eating behavior and diagnosable eating disorders.

Integrative medicine providers, including naturopathic physicians, routinely employ new and emerging science to inform their clinical practice. This practice of early adoption, along with growing interest from the public, has contributed to the explosion in affordable gastrointestinal (GI) microbiome testing marketed to integrative medical practices. These tests are often described as clinically useful tools that can be used to inform treatment of chronic medical conditions, as well as strategies for optimizing general wellness. While these interventions can often be of great benefit to patients, their implementation is not always informed by a nuanced understanding of the limitations of this testing. Commercial microbiome testing in its current form cannot truly nor completely describe an individuals GI microbiome health, except possibly when identifying specific infectious pathogens, nor inform specific interventions (probiotics, prebiotics, etc.) with the accuracy often claimed by the tests themselves, or the physicians employing them. As early adopters, it is our responsibility to not only understand the usefulness of GI microbiome testing, but also its limitations, and ensure that our care is informed by this knowledge. This presentation will review the technology employed in current commercially available microbiome testing and what practitioners should know regarding the limitations of utilizing this technology in clinical practice.NOTE: This talk is not intended to dissuade providers from using GI microbiome tests, but rather encourage thoughtfulness and transparency when utilizing these technologies. I believe that highlighting this discussion in a separate talk (vs combining with a more in-depth review of the technology) will help participants better retain information essential to their PARQ discussions.

Visceral hypersensitivity occurs in up to a third of patients with IBS and Functional Dyspepsia, two of the most common functional gastrointestinal disorders presenting to naturopathic practices. This condition is often overlooked and rarely discussed in clinical context, yet can complicate presentation and often leaves patients with continued symptoms despite "normal" work-up. This presentation reviews the proposed causes of visceral hypersensitivity, its relationship to IBS and FGID, and various treatment approaches, including review of research on pharmaceutical, botanical, manual, and psychological interventions. Review of pharmaceuticals to include classes of SSRI, TCA, 5HT3 antagonists, 5HT4 agonists, GABAnergic agents, as well as Ketotifen & Naltrexone (low dose).