Case Study: Gut Health Journey #10

Blog Post by Coach Julie

NCI Certified Nutrition Coach L1 & Certified Mindset Coach
Specializing in Women's Health and Gut Health

I began Phase 4, the reintroduction phase, on July 7th.  With this phase I started 2 new supplements Flora Protect and a supplement called PepZin GI.  These two supplements are to repopulate the gut with good bacteria and to protect the gut barrier and gut immunity.  I will maintain the S. Boulardii with these two supplements and I have continued the peppermint oil.  I am reintroducing foods on a 3 day cycle.  The first day, I will consume half a serving of a certain food.  If I don’t have symptoms, I will continue to day two where I will consume a half serving twice per day.  Assuming there are still no symptoms, I will eat a normal serving on day 3.  Day 4 is a rest day, to make sure that I don’t experience any delayed symptoms.  Sometimes delayed symptoms can occur if you’re experiencing constipation so we’ve built in a rest day to allow any symptoms to subside before we start a new 3 day cycle with a different food.  After the end of the cycle, if there were no symptoms, I have been waiting a week or so and then reincorporating those foods back into my normal diet.  

Since the last update, I have reintroduced: salsa, amino energy (inulin) and alfredo.  All have been a successful introduction. There were no noticeable symptoms with any of those items.

Upon the completion of the 3 day cycle for these remaining foods, I had successfully completed a 21 week reintroduction phase.  I did not have any foods that stood out as terrible triggers for my gut.  I had some questionable issues with garlic, however I believe those to be dose dependent.  This Phase ended on November 29th.   

I have discontinued all the supplements, including S. Boulardii, with the exception of the PepZin GI and Peppermint Oil.  I will be continuing those through Phase 5, the Nexium cessation phase.  

We have now moved onto Phase 5, effective December 2nd.  During this phase, I will move through a minimum 4 week phase where I titrate off of Nexium to discontinue its use.  Long term use of a PPI (proton pump inhibitor) can be very detrimental to your health.  You should be using these PPIs (Nexium, Prilosec, etc) for 3 weeks at the most to treat a temporary flare up.  Long term use of PPIs can lead to increased risk of cancer, risk of fractures, pneumonia, Clostridium difficile diarrhea, hypomagnesemia, vitamin B12 deficiency, chronic kidney disease, and dementia.  If you have been using these medications long term, you should not stop abruptly.  You should use a step down method to gradually decrease your dose.  I have been taking Nexium for over 15 years so the process will take at least 4 weeks, but could potentially last longer.

During this phase, I will continue to take Zinc Carnosine at 75mg every morning on an empty stomach.  I will also continue to take peppermint oil capsules before my morning and evening meals.  Zinc carnosine reduces gut inflammation and helps protect the gut lining, which will be integral while my gut acid levels increase to their normal levels after being repressed for so long.  Peppermint oil soothes the gut and helps prevent cramping and discomfort. I will also be adding in DGL chewables and Betaine HCL.  The DGL chewables will be taken after my morning and evening meals.  3 tablets after each meal.  The DGL chewable is Deglycyrrhizinated Licorice Root.  I have used this supplement in a capsule form earlier in my journey.  DGL is often used to soothe the stomach and support healthy digestion by encouraging mucin production.  The Betaine HCL will be added in as needed.  Betaine HCL helps protect the gut wall and strengthens it throughout the process.  I will be using it as needed should I begin having acid reflux symptoms.

After week one of this process, the withdrawal symptoms started.  Week one consisted of reducing my Nexium to every other day rather than daily.  After about day 4, I began noticing some mild diarrhea and headaches.  I also noticed some weakness and dizziness.  I am also having some reflux which is a most common and expected side effect.  The reflux has been causing some nausea for me.  Based on this, rather than moving to week 2, we decided to repeat week 1 again to see if my body would adjust.  I continued to have symptoms so we will repeat week 1 for a third week to see if my body adjusts to the titration before moving to the next step of the process which will be reducing Nexium to once every two days.

Withdrawal symptoms from a PPI are common, especially after long term use.  Symptoms frequently include acid reflux and indigestion.  There are, however, less common side effects that include: anxiety, depression, diarrhea, nausea, vomiting, constipation, headaches, dizziness and more.

As always, I will provide a case study update in 4 weeks, when I should have completed this final phase if my body responds well.  My body has responded exceptionally well the last few months so I am hopeful this trend continues.