When a patient presented with a 10-year history of diarrhea and debilitating gut health, Michael Smith of Planet Naturopath was ready to set them up for success with a simple approach focused on reducing anxiety.
A slow deterioration
Michael was confident he could help Donna*, a retiree in her 50s who reached out to him in March 2022. “On my intake inform, she described herself as ‘Miserable’,” said Michael. “By the time she found me, she’d been experiencing symptoms for 10 years but said it was slowly getting worse and worse, particularly over the past year. She told me she’d tried everything and was tired of feeling so bad all the time and missed her former vibrancy.
“Donna had also been obese and had lap-band surgery, but that wasn’t the trigger. She recalled experiencing food poisoning about 10 years prior and getting really sick, and that was it; she’d had diarrhea more or less ever since.”
Assessing her history
Michael was somewhat surprised about Donna’s history that in their first appointment.
“She talked me through what she’d tried previously, including taking all of these high-quality herbs and nutrients that I would recommend to patients just like her; they made total sense. But she said while they provided some positive benefits about five years ago, now she couldn’t tolerate any of them.
“She also had a stool test before our first consult that was very comprehensive. It measured things like beneficial bacteria, pathogenic diversity scores, and liver polysaccharides, which is like an endotoxin. Once her results became available, I could see her terrible scores. She had high levels of opportunistic bacteria, like pseudomonas and enterobacter, and really low levels of butyrate-producing bacterias.
“So, it was clear to me then why she was not only experiencing IBS symptoms, including bloating, gas, and reflux, but also migraines, histamine intolerance, and sinus and joint pain. However, diarrhea was her number one complaint.”
A liquid diet
Donna was on an extremely restricted diet that she mainly consumed in liquid form.
“Her diet was very limited and lacking in variety because she was reacting to so many foods, which explained why she had limited microbial diversity. She was liquifying her food to reduce her fiber intake and was mostly drinking raw vegetable juices, as well as a couple of protein drinks.
"Sometimes she would have very small meals of beef, fish, or chicken with a limited selection of cooked vegetables, but would top up her calories and nutrients with the raw juices.”
Michael said Donna was otherwise healthy. “She was a recent retiree who exercised, went to the gym, and did yoga. It wasn’t like taking care of herself was a foreign idea for her. And she knew she needed protein to build her muscle mass. But her quality of life from this type of diet was very low. It was obvious she needed to liberalize her diet.”
After assessing Donna and getting to know her history, Michael started by explaining how her nervous system connected to her symptoms.
“I explained to Donna that her experience was similar to PTSD—like when a person has a traumatic experience such as a car accident and panics every time they have to drive. I said, what’s happening with you is after 10 years of issues, every time you eat you’re getting stressed and your body is in fight or flight.
"I explained we needed to calm her down as she was reacting quickly at every meal—food wouldn’t even reach her intestines; she was just set off within minutes.
“This is why I recommended she give the Nerva program a go. At this first appointment, I didn’t have the results of her stool test yet, but I told her even if it shows you have some kind of bacterial infection, you can't tolerate the supplements I’d normally prescribe and it’s going to be hard for me to help you.
“I explained that Nerva was specifically going to target her gut-brain connection and said many of my other patients have seen improvements from following the program. And that was it; I didn’t prescribe anything else.”
A return to solids
Donna’s breakthrough came five weeks into the six-week Nerva program when she ate solid foods for the first time without triggering symptoms.
“I spoke to her around Week 5, and she was so happy to share she’d tried some hummus with pita bread, which she never would’ve eaten before. She also tried oranges, which didn’t set off a migraine or nausea, though she still had sinus pain. Getting some solid foods into her diet helped with her fiber intake, and even though she was still experiencing diarrhea and some nausea, it had definitely improved. She was just so happy to be eating and not feeling worse afterwards. That’s what mattered to her the most.
“I later suggested she start reintroducing a few more low FODMAP foods and explained these were the least likely to trigger symptoms. When I speak to other patients about a diet like this, many are obviously not keen as it’s so restrictive, but Donna was the opposite! She said, ‘Oh my God, I can’t believe I get to eat all of this!’
“Though one extra thing I did get her started on was a herbal antimicrobial called Biocidin. She added it to her regime and was surprised she could tolerate it. While following Nerva’s maintenance plan, she worked her way up to the full dose of 10 liquid drops per day.
“Once she finished the initial six-week program, she reported more energy, and her stamina was building back up—she used to be a runner and was able to take it up again. Before, there was no way she could do this. By this stage, her diarrhea had improved by 90%, though she still had loose stools.
“She continued introducing new foods. Some things didn’t work for her like gluten, which she started eating when she went away on vacation and relaxed her diet a bit. She came to see me afterwards to get back on track. She returned to a grain-free diet, and during a follow-up she was happy to say everything had settled down more quickly this time.”
A surprising outcome
Michael said the biggest surprise of Donna’s case was the Nerva program's huge impact on her symptoms.
“I got Donna started on Nerva while we waited for her stool test to return. When I reviewed the results, I could see everything was wrong and I was wracking my brain thinking about a plan and her options. Even though I knew she’d already started Nerva, I thought she would come back to me for our next appointment without much having changed. Instead, her diarrhea had improved drastically and she was already trying solid foods. I did next to nothing! All I did was say, ‘Give Nerva a go’, and it made a massive difference. My other patients have said it’s helped, but this case saw the most drastic improvement. She still has a long way to go, but there’s no reason she won’t continue improving.”
Michael Smith is a naturopath at Planet Naturopath.