After years of severe abdominal pain, 10 year-old Parsley Health Pediatrics member, Michael had grown fearful of eating. Not only had it become painful and unenjoyable, but it began to impact his mental health too. Parsley Health pediatrician and rheumatologist, Gabriella Safdieh, MD helped to properly diagnose Michael so he could get back to being a kid again.
I recently had a really interesting case with one of my pediatric members here at Parsley Health that provides a great example of how we can work in conjunction with your child’s pediatrician to provide an extra level of care. When I first met with my 10-year-old patient, he had already been diagnosed with Celiac disease through an endoscopy, but despite eliminating gluten from his diet, he continued to suffer from abdominal pain and irregular bowel movements for several years. He had tried some food eliminations like dairy for brief periods, but no sustained food eliminations. He had also tried some supplements and medications, including PPI’s for possible reflux and probiotics for increasing microbiome diversity, but with only minimal relief from these interventions. He had reached a point where he was afraid to eat because his stomach always bothered him. In addition, he was too small for his age and falling off his growth curve, and was experiencing anxiety and joint pain.
So when he came to Parsley Health, he had a number of goals including eating without fear, to have a digestive system that worked reliably, and to gain weight and grow.
Identifying SIBO symptoms
During my first appointment with Michael and his mother, I started off by getting an in-depth history and past medical history. Doing this always helps me understand all potential triggers that could have led to a disruption in a patient’s health and allows me to eliminate some possible factors that could be contributing to symptoms. I was immediately concerned about small intestine bacterial overgrowth (SIBO), given the frequent bloating and stomach pain, a marker of SIBO symptoms. I was also confident that we were missing a food sensitivity outside of gluten.
Next, one of the Parsley Health coaches who specializes in pediatrics gathered detailed information about his current diet and lifestyle. This was followed by a thorough physical exam.
SIBO breath test
Based on this 75-minute visit with myself and our health coach, I still felt strongly about the possibility of SIBO, so I recommended he complete a SIBO breath test. SIBO is common in children, and unfortunately under-diagnosed. I felt this was the most important test to do given that with a positive test, the treatment involves antibiotics and is specific for SIBO. Additionally, I knew we would look into certain food sensitivities at a later point.
A few weeks later, after he had completed the breath test, I reviewed his results, which confirmed he had SIBO. We treated his SIBO with antibiotics for 2 weeks followed by certain herbal supplements that have been proven to help with SIBO. Using antibiotics followed by the herbals works the best for the eradication of SIBO.
Following up with FODMAP
After he finished the antibiotics and herbals, we worked closely with Michael and his mother to follow a FODMAP-gentle diet as opposed to a regular low FODMAP diet, which includes restrictions specifically of grains: wheat and rye (which he already avoided due to Celiac), vegetables: onion, leek, cauliflower, and mushrooms, fruit: apple, pear, dried fruit, stone fruit, and watermelon, dairy: milk, ice cream and yogurt, and meat/alternatives: legumes. For our pediatric members, we typically make modifications to nutrition plans that suit the specific child’s needs.
We also decided to do some follow-up testing at this point to look for food sensitivities, which I suspected may still be an issue.
Diagnosing digestive issues
Using an IgG food sensitivity test, which involves just a finger prick (I like to keep testing as minimally invasive as possible, especially for kids!), I also diagnosed him with food sensitivities to dairy, eggs, and bananas. A comprehensive blood panel also uncovered several vitamin deficiencies, partly due to decreased food intake since he was afraid to eat and partly due to decreased absorption because of his SIBO.
After eliminating dairy and eggs, getting him on probiotics and glutamine to help his gut continue to heal, and prescribing some nutritional supplements including fish oil, vitamin D, and B-vitamins to help him resolve the vitamin deficiencies, Michael really started to get back to himself again. What is exciting is that his digestive issues have significantly improved and he is feeling more energized – it is extraordinary to see the improvement in just 3 months.
A newfound freedom
Most importantly, Michael is becoming less afraid to eat and he’s more focused on just being a kid. Many kids (and parents) can get consumed by food allergy/sensitivity stress which can be all-consuming. This can lead to increased anxiety, not only related to food but to other aspects of life as well. The reality is that food sensitivities do come with daily thoughts of food preparations, explaining to restaurants/caretakers/friends, leaving parents and children feeling overwhelmed, and it has a large psychological impact. But working with a doctor and health coach that understands this can make a huge difference in a child’s life.
For Michael, we will continue to make adjustments to his plan to continue to reintroduce higher FODMAP foods as he can tolerate them. This is a success story for now, but health is not always linear. We will continue to be there for Michael and his family as they navigate his health journey, including monitoring him SIBO to closely to be sure it stays in remission and rechecking his food sensitivities and vitamin levels as he continues to heal.