m still working as a nurse in an E.R., and I’m increasingly frustrated how we treat our patients’ illnesses temporarily. A 35-year-old woman suffering for years from ulcerative colitis and ulcers came in with a flare-up of diarrhea and abdominal pain. We did general labs and CT and she was sent home on Zantac. Hard for me to discharge a patient like this, but I have no authority in this setting. How would you have approached this case or can you refer me to a resource on these diagnoses?

But in talking with a lot of ER docs, I realize that you folks are in some ways more aware than anyone else of the shortcomings of the conventional model because you see other people who are falling through the cracks. As your question indicates, many people are now just using the ER as the doctor’s office because they don’t know where else to go to find help. People aren’t just going for serious injuries, traumas, or emergencies; they’re going to the ER to get help with problems that really should be handled by their doctor, not in the emergency room setting, and this is a really good example why. If you’re an ER doctor or a nurse, you’re not going to have time to do the necessary workup and diagnosis and differential diagnosis that you need to do in order to really help these people, much less time to counsel them on diet and lifestyle changes that will be critical to their recovery.

With inflammatory bowel disease, you have more than two considerations, but if we zoom way out, you can look at it like autoimmune disease, so that’s really important to keep in mind because you can’t just look at it like, okay, is SIBO present? Are there parasites? And all of that and look at it from, like, a biological microbial perspective. You have to also consider the component of immune dysregulation.

At the same time, I think in the conventional model what’s often missed is that they only look at it as an immune dysfunction, and then they use immunosuppressive drugs like prednisone, Remicade, or Imuran if it’s a more serious condition, without considering the microbial contribution. We’ve had many patients over the years who had been diagnosed with ulcerative colitis or Crohn’s, and then we do a comprehensive gut workup like I’ve taught you in this course and find that they have two parasites, SIBO, and a bunch of other severe dysbiosis, disrupted gut microbiome, and then we treat all of those things and lo, and behold, guess what? They no longer have ulcerative colitis or Crohn’s disease. The ulceration or inflammation that was observed via colonoscopy disappears, goes away and heals completely. We know this because they’ve had follow-up colonoscopy maybe a year later, and then the GI doc says, “Oh, I guess this was a case of spontaneous remission” even if the patient tells them that, “No, no. We actually, we found these parasites …” and things like that and treated them and that is what sent it away.

Going back to my answer to the earlier question about autoimmune disease, with IBD, you have to do a very comprehensive and thorough workup where you look at all of the potential causes of immune dysregulation. You also do the testing that you’re learning in this course. You look at the gut, stool, and breath testing. Stress and HPA is crucial. I would say stress and HPA axis dysfunction is possibly the biggest issue for people with autoimmune disease, even more than diet and even more than gut health. And then, you’re going to be looking at specific strategies for the gut in terms of diet and lifestyle; it can be really helpful.

One of those if someone is in a flare, like it sounds like this woman was, is the GAPS diet. G-A-P-S, it stands for gut and psychology syndrome. I think we’ve talked about it in the exposome track of the course. I’m not sure if we’ve talked about it yet. If we haven’t, we will. I think I might’ve mentioned it back in the part of the gut course where I covered IBD, but it’s basically a diet without any starch. It’s very similar to a Paleo-type of diet, but it adds a lot more bone broth, fermented foods, and it completely removes any complex carbohydrates, including starch. It’s similar to the specific carbohydrate diet, if you’re familiar with that one. Particularly, the GAPS intro diet is basically just bone broth and meat for the first day or two until the diarrhea subsides, and then you start gradually adding things back in in five stages. The next thing might be very well-cooked and peeled vegetables that are low in insoluble fibers like peeled carrots, peeled squash, or winter squash, like a kabocha squash, and you could even blend that all up.

I’ve had patients who were facing surgery and having, like, 15-plus bloody, watery, mucousy, bowel movements a day who we’ve been able to prevent from having to have that surgery by putting them on a GAPS intro diet and then addressing some of these other causes of autoimmune disease using things like CBD, high doses of cannabidiol or medical cannabis, if it’s in a state where that’s possible. And then even medications like low-dose naltrexone, which I’ve written and spoken quite a bit about. Lyndsey can probably find some material there to link you to. That can really be a game-changer for people with inflammatory bowel disease. In fact, some of the earliest studies that have been done on low-dose naltrexone were done in cases of Crohn’s disease, both in kids and adults. Hopefully that helps get you started. It’s a big topic, but we have covered it and we’ll continue to cover it in the course.