The Gut Detective's guide to diarrhoea
As you can imagine, I see quite a few clients with diarrhoea as a gut health specialist. Although it can be caused by numerous conditions, the one thing all sufferers have in common is the frustration they feel when it refuses to go away. It is normally at this point that they will come to me looking for answers.
There is a checklist and flowchart that I work through to help narrow down the cause of chronic diarrhoea, and pathology reports are very useful in this process. The sort of tests that can help include...
Routine lab tests: Full blood count, serum electrolytes, liver function tests, calcium, phosphorus, albumin, thyroid-stimulating hormone, vitamin A and D, Folate, Iron, & B12 levels, International Normalised Ratio (INR) or Prothrombin time (PT), erythrocyte sedimentation rate, C-reactive protein, and serologic testing for Coeliac Disease.
Routine stool studies: Stool sample analysed for ova and parasites, electrolytes, fat, occult blood, and leukocytes or lactoferrin; stool culture.
Why would a nutritionist need to see these? We unfortunately don't often have the pleasure of working directly with GPs, and we certainly don't have access to patient medical records. Being able to see the 'big picture' is important because gastrointestinal disorder symptoms overlap. Any recent test results clients have can therefore be invaluable.
Irritable Bowel Syndrome for example, can only be formally diagnosed by a GP or gastroenterologist. If you suspect you may have it, discuss it with your GP first, then come and see me after your diagnosis so I can help you implement the Low FODMAP diet. Otherwise you might be unnecessarily restricting your diet, which can lead to nutritional deficiencies. This is a good example of why we shouldn't just 'Dr Google' it.
Clients don't often have endoscopy, biopsy or colonoscopy results before they come to me, which can easily locate gastrointestinal inflammation or enzymatic deficiencies. So I have to be aware of gastrointestinal symptoms and what their causes might be. Being a nutritionist is a bit like being a detective. The difference between us and GPs or gastroenterologists, is that we use food as the main component of your treatment plan - a food prescription if you will!