NMT150 Week 10 IBS AY2223 PDF

Putting it Together - Week 10 NMT 150 - IBS Dr. Ellen Wong, ND - Toronto Campus  Learning Objectives Discuss the treatment approach for chronic conditions...

Putting it Together - Week 10 NMT 150 - IBS Dr. Ellen Wong, ND - Toronto Campus  Learning Objectives Discuss the treatment approach for chronic conditions and weighing symptom management versus root cause treatment Practice using electronic resources to support design of management plan Practice creating a treatment plan that: Is comprehensive with evidence-informed rationale Meets requirements of informed consent Balances patient wants that may differ from doctor’s Incorporates dietary, lifestyle and natural health products (with rationale for selection) based on patient’s needs and lifestyle Picture: decorative, woman's hands typing on laptop Picture: decorative, various plants in leaf an powder form Therapeutic Order Considerations Small Group Discussion How might you interpret the therapeutic order in this case? Discuss in groups of 4-5: 15 minutes Therapeutic Order Considerations This conversation can be applied to almost all chronic conditions within the naturopathic world Will depend on the severity of patient presentation, patient lifestyle and their needs and wants Find balance between addressing underlying causes and managing symptoms Will require having honest conversations about the nature of chronic condition (IBS) May take a while to manage May take a while to figure out triggers Does patient have any upcoming situations where her fluctuations symptoms will cause stress Picture: decorative, woman holding paper faces, orange coloured one smiling, pink one indifferent, green one in discomfort Diagnosis Considerations Picture: decorative clear brain with multicoloured paint spraying out of the top Diagnosis Considerations IBS is a diagnosis of exclusion What conditions might you rule out? ROME IV criteria Hot Topic: Food sensitivity testing Why is it so controversial?  Picture: decorative, group of students talking at table with books and laptop Small Group Discussion How might you explain this to a patient in a way that is easy to digest AND respects that this is something the patient specifically wanted to do? Practice explaining to a patient in pairs: 10 minutes Picture: decorative, green pill and orange pill, cut open kiwi and orange Symptom Management Considerations Picture: decorative, group of young adults smiling at each other and talking Small Group Discussion Let’s pretend the patient says they 1st want to manage their symptoms Design a treatment plan using dietary, lifestyle and natural health products (with rationale for selection) based on patient’s needs and lifestyle Discuss in groups of 4-5: 20 minutes  Picture: decorative, various vegetables and fruit, nuts and seeds, meat and eggs Symptom Management - Dietary Low FODMAP diet PMID: 20659225, PMID: 28625832, PMID: 27725652, PMID: 29159993 What are some things that would be important to share with the patient when you remove foods from their diet? Side effects? Benefits to treatment? Pro: eliminates symptoms in a lot of patients, rapid response (2-6 weeks), the diet is the test, no fee, no waiting for results Cons: less effective in IBS-C, unlikely to maintain long- term, nutrient deficiencies, social isolation History of disordered eating? Picture: decorative, man with face on laptop and a large rock on his face to represent stress Symptom Management - Lifestyle Stress management What is the cause of stress? Co-management of anxiety and/or depression Side effects? Benefits to treatment? Picture: decorative, peppermint leaves Symptom Management - NHP Peppermint Oil - abdominal pain, “cramping”, QOL PMID: 26721531, PMID: 19507027, PMID: 17420159 Why is QOL important? “A majority of patients would give up 10–15 years of life expectancy for an instant cure for their condition” PMID: 11346322 One of the most common reasons for work or school absenteeism, second only to the common cold People with IBS miss 3-4 times as many workdays annually as the national average of 5 days Side effects? Benefits to treatment? Picture: decorative, spoon with various pills in it Symptom Management - NHP Bifidobacterium (or L.plantarum 299v or mixed strain probiotics) - reduction of symptoms - severity of pain, distension, dissatisfaction with BM, IBS interference in life Study issues: variability of strains and doses methodology industry based studies short-term magnitude of overall benefit in positive studies is modest Side effects? Benefits to treatment? Post-Abx IBS Picture: decorative, glasses on top of a notebook, and other table top decor (candle and plant) Chronic Management Considerations Picture: group of students gathered together at desk all looking at one laptop Small Group Discussion Design a treatment plan using dietary, lifestyle and natural health products (with rationale for selection) based on patient’s needs and lifestyle Discuss in groups of 4-5: 20 minutes  Picture: decorative, french fries, onion rings, ketchup, soda, cheeseburger with lettuce Chronic Management - Dietary Assuming we removed some food, how long do we do this for? When can we re-introduce it? Wheat products (30% reduction? PMID: 26096570) Dairy (lactase persistence - PMID: 30388735) Fried food Beans and legumes Caffeine: tea, coffee, and other caffeinated beverages Packaged and processed foods: chips, cookies, pretzels, and processed meats Artificial sweeteners and sugar alcohols, chocolate Alcohol Cruciferous vegetables: broccoli and cauliflower Garlic and onions Cultural & lifestyle considerations Sauerkraut - PMID: 30256365 reduction in the total IBS-SSS score Picture: decorative, wooden hand holding lit candle Chronic Management - Lifestyle Hypnotherapy - PMID: 24901382 CBT - PMID: 30971419 Meditation + CBT - PMID: 36362745 Decrease symptom severity and QOL Journalling - PMID: 33826992 deepest thoughts and feelings about their IBS - reduce self-rated pain and healthcare utilization Picture: decorative, Japanese zen garden with path of rocks Chronic Management - Lifestyle Management of anxiety and/or depression Anxious trait IBS responds better to CBT Stress management: identifying stress origin Cause disrupt gut flora the same way antibiotics can, just not the same immediate level Do not ignore stress management Do NOT ADD TO THEIR STRESS Hormonal influence? Stats Canada: Among women, IBS is most prevalent during menstruation years, most severe after ovulation & before menses Women with IBS are 3x more likely to receive a hysterectomy than women without IBS Picture: decorative, various jars and containers of supplements and powders Chronic Management - NHP Vitamin D - esp if low Vit D levels Psyllium fibre Consider iron deficiency - menstruating women, vegan / vegetarian, athletes Picture: decorative, garden with various coloured flowers, and trees, winding path and mountains in the distance Chronic Management - Other Acupuncture - results are heterogenous; frequent sessions needed, symptoms may return after cessation of treatment Exercise - r​​esults are heterogenous; may improve symptoms and QOL effect on mood related concerns