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Montana Integrative Medicine :: Bozeman, MT

Diarrhea

There are three distinct types of diarrhea: infectious, osmotic and toxic. Infectious diarrhea, as the name implies, is caused by an infection, such as food poisoning. Osmotic diarrhea is caused when water is drawn into the intestines, such as when someone takes high doses of magnesium oxide. There is a class of laxatives called osmotic laxatives that work by pulling water into the bowels. Examples of osmotic laxatives include Malox, Milk of Magnesia and Miralax. A toxic laxative causes diarhea due to toxins accumulating in the bowels. One common cause of this is food allergies.

Interestingly, the symptoms of food allergies and intestinal infections are very similar. Both can cause gas and bloating; post-nasal drip; diarrhea; headaches; brain fog (difficulty processing information); fatigue, difficulty losing weight; and in more severe cases, joint and muscle pain. When a person has irritable bowel syndrome (IBS), which usually means the symptoms of diarrhea, gas and bloating, testing for both intestinal infections and food allergies is crucial for finding and correcting the underlying causes of the IBS.

There are many organisms that can be involved in infectious diarrhea, called infectious gastroenteritis, including bacteria, fungi and parasites. Normally when physicians suspects a parasitic infection an ova & parasite (O&Px3) test is ordered. In an O&Px3 test, a patient provides samples of his or her stool that is evaluated under a microscope by a parasitologist who is literally looking for small parasite eggs or the parasites themselves.

To detect a parasite the parasitologist must rely not just on his or her skills, but also on luck. The parasitologist must be lucky enough to have a stool sample by chance that had a large enough parasite or parasite egg in it to be seen through a microscope. They do not look at every square centimeter of the stool but take samples from the stool to look at. They therefore must also be lucky that the random sample they took had something in it. This test is highly unreliable.

The most advanced testing analyzes stool samples for parasite DNA fragments. This eliminates the role of luck in the process. The stool sample is run through a sophisticated machine and only five cells from an organism are required to detect it. Common parasite infections diagnosed by this technology include hookworm (Necator americanus), whipworm (Trichuris sp.), Strongyloides sp., and Cryptosporidium sp. Additionally, from this one stool sample the tests can detect Helicobacter pylori (commonly called H. pylori) infection in the stomach, bacterial and yeast infections in the intestines, and if your intestines are low in healthy bacteria. H. pylori is a bacterium that colonizes the stomach and is considered a Type I carcinogen, meaning that it causes cancer in humans.

Most physicians will just test for one category of infectious organisms, such as parasites, and not test for any of these other infections, even though the symptoms significantly overlap with a parasite. Parasitic diagnoses are very rare because most physicians are not trained in parasitology. It’s the rare medical school that will expose its students to a six- or eight-week course in parasitology. Most standard medical evaluations do not include a parasite test, and even when they do it’s an extremely insensitive test.

Additionally, when doctors order stool tests, they only do so by specifying whether or not they want it to be tested for bacteria, parasites or fungi. The combination of two of these categories of organisms, or all three, are rarely if ever ordered simultaneously. This is a mistake, since the symptoms of diarrhea caused by infections can be identical. So there are two issues here: (1) doctors are not using the most sophisticated technology to detect parasitic infections, so they miss the majority of the diagnoses, and (2) they do not test for multiple organisms (e.g., bacteria, parasites and fungi), so they get an incomplete picture of the possible underlying cause of the diarrhea.

Case: Diarrhea in a Thirty-seven Year Old Woman

A thirty-seven year old woman had suffered for several months with abdominal bloating and worsening diarrhea. She had seen Dr. Neustadt previously the several years earlier suffering from post-partum depression. She took the MetaCT 400 test at that time and was therefore tested for food allergies. Thus, when she began suffering from diarrhea, a food allergy test was not necessary again, and it could be assumed that she likely had an abdominal infection. She took the microbial stool analysis test, which revealed a rare bacterial infection.

Her results showed:

Aeromonas is a gram-negative bacterium, documented to cause virulent diarrhea. The test showed that this organism was sensitive to natural and synthetic antibiotics. She was prescribed a regimen of Levofloxacin (Levaquin), a potent antibiotic, and her diarrhea, gas and bloating all resolved.

Case: Diarrhea / Nausea / Abdominal Pain in a Forty-seven Year Old Man

A thirty-seven year old man began suffering from diarrhea, nausea and abdominal pain in June 2008 two weeks after returning from Hawaii on vacation. He had already been a patient of Dr. Neustadt's at Montana Integrative Medicine. He had wanted to see Dr. Neustadt first, before seeing the medical doctor, but was forced to go to the medical doctors for what turned out to be inferior, expensive and very dangerous care because his insurance company would not pay for a visit to a naturopathic physician. Please realize, that in Montana, where Dr. Neustadt lives and practices, naturopathic physicians are licensed and have DEA numbers to prescribe controlled substances. But the insurance bureaucracy rations healthcare and predetermines the type of care people can access. Ironically, the insurance companies will pay for extremely expensive medications and surgeries when less expensive, more effective treatments exist, as demonstrated in this and many other cases on this website.

While in Hawaii this patient reported drinking water in the backcountry. Based on that, his medical doctor prescribed Flagyl (metronidazole), a medicaiton that will kill many parasites, including Giardia lamblia. Giardia is a parasite that lives in streams and is passed along via the feces of animals. Ingesting Giardia can cause copious, foul-smelling diarrhea. The medical doctor did not want to wait for the test results for the Giardia and so treated him presumptively with Flagyl. However, when the test came back it showed that the patient did not have Giardia.

This case is important because it illustrates the limitations of the conventional medical approach. If the physician had ordered the NBITC stool test, which tests for dozens of different organisms simultaneously, this patient would have been cured much sooner and a much lower cost.

After the patient did not improve on the Flagyl, he was referred to a gastroenterologist, and underwent an abdominal CT scan and an endoscopy, and prescribed multiple rounds of different medications. All of these measures were completely ineffective because the doctors were really just using a shotgun approach trying to treat symptoms for which they had no idea what the underlying causes were.

By the time he decided to see Dr. Neustadt again, four months had passed and he was still sick and getting worse. His energy was down to less than five out of ten, with ten being best. He said, "I'm getting weaker and am extremely fatigued." Before he was sick he reported that his energy was nine to ten out of ten. He was experiencing migratory arthralgias (joint pain that would move around), post-nasal drip. He denied having any gas and bloating or blood and mucous in the stool. He was having ten to twelve bowel movements a day, and his abdominal pain would range from four to eight out of ten, with ten being worst. He had lost twenty-five pounds of weight and appeared wasted.

The NBITC stool test was ordered, which finally diagnosed the underlying cause of his illness, which, if it had continued put him at increased risk for heart failure. His tests three major intestinal bacterial infections (below).

He was prescribed the proper antibiotics targeted specifically to those organisms, and his diarrhea, abdominal pain and all of his symptoms were cured. The the indirect and direct costs of this patient's procedures, ineffective medications and lost productivity at work, cost at least $30,000 to $50,000, all with absolutely no benefit. In contrast, the simple NBI stool test and conventional antibiotic treatments cost less than $1,000.