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Center for Integrative Medicine, Fall 2013

Probiotics: Your Cure for Irritable Bowel?

Irritable bowel syndrome (IBS) is one of those perplexing medical conditions. Officially, its cause is unknown. Its symptoms vary. And treatments that work for one person may not work for another.

Symptoms of IBS can include:

  • Constipation, diarrhea or intermittent episodes of each, sometimes alternating with normal stool
  • Abdominal cramps or pain
  • Excess gas
  • Mucous discharge with stool

Sometimes symptoms seem to be aggravated by certain foods or stress. That’s why physicians often recommend dietary changes — avoiding dairy or gluten, for example. They may suggest increasing fiber or physical activity. They may refer patients for psychotherapy to reduce stress or prescribe medications to soothe symptoms.

If you have seen a physician about your symptoms and have not yet found traditional treatment to be successful, a different approach may help.

According to Tanya Edwards, MD, of the Center for Integrative Medicine, the real problem behind IBS — and the real solution — may not be any of the things listed above.

“In my opinion, IBS is due to an imbalance of good and bad bacteria in the intestines,” says Dr. Edwards.

Balancing act

When bacteria are out of balance, there are too many bad bacteria and not enough good bacteria to keep the intestines healthy. Bad bacteria can produce toxins that irritate the intestines, leading to IBS symptoms.

Bacteria imbalance can be caused by:

  • Antibiotics: They get rid of the good bacteria in your gut as well as the bad bacteria that are making you sick. “Sometimes there’s a link between the onset of a patient’s IBS symptoms and their use of antibiotics as a child or young adult,” says Dr. Edwards.
  • Acid-blocking medication: This medicine prevents your stomach from producing the acids used in digestion. But it also prevents your stomach from sterilizing the food you eat before it goes into your intestines. With not enough stomach acid, your gut may become overrun by bad bacteria and yeast.
  • Slow digestion: Undigested food gives bacteria more to feast on, spurring their growth in your intestines.
  • A bad diet: Diets high in processed foods, sugar and saturated fats have been associated with a change in bacteria balance. “Go on vacation for a week and eat lots of processed food, and your gastrointestinal milieu changes,” says Dr. Edwards. “But eat a healthy diet for five days, and you can change it back.”
What works for 95 percent of patients

Regardless of the cause, bacteria imbalance is easy to fix. Dr. Edwards recommends probiotics — good-bacteria supplements available in pharmacies and health food stores.

“Probiotics have helped about 80 percent of my patients who complain of IBS symptoms,” she says.

When shopping for probiotic supplements, look for one that has at least 10 different bacteria species (there are more than 100 in your gut) and at least 10 billion units per capsule, she says.

If probiotics don’t do the trick, Dr. Edwards recommends digestive enzyme supplements. Enzymes help your body digest food better, so bacteria isn’t feasting on it and building up in your intestines. She estimates that using digestive enzymes along with probiotics has helped an additional 15 percent of her IBS patients.

Treating more than IBS

Bacteria imbalance may cause more than IBS. Studies show that bad bacteria may be linked to obesity and cardiovascular disease.

“If you have IBS, why treat just the symptoms?” asks Dr. Edwards. “Why not use a probiotic that actually treats the underlying cause of IBS and may treat other conditions down the line?”

To talk to one of our physicians about alternative treatments for IBS, call the Center for Integrative Medicine at 216.986.HEAL (4325).

Arthritis: Nutrition and Supplement Recommendations

By Christine Spiroch, PhD, PA-C

If you have arthritis, you know that joint pain can limit everyday activities. Arthritis can also make it difficult to work — it’s a significant cause of disability.

More than 40 million Americans have been diagnosed with arthritis. Half as many live with chronic joint symptoms but do not have a formal diagnosis by a doctor.

What you eat matters

Traditionally, physicians have treated arthritis with oral medications and injections to manage symptoms. Here in the Center for Integrative Medicine, we consider another approach: looking at diet.

Arthritis is a disease of chronic inflammation, so we recommend eating anti-inflammatory foods. Rather than add something to the body to mask symptoms, we subtract foods that may cause inflammation in the body.

Foods to consider adding

The following anti-inflammatory foods support and nourish the body and help to “lubricate” our joints:

  • Fish: A key source of Omega-3 fatty acids
  • Healthy oils: We recommend olive oil and walnut oil

Ginger and turmeric can add another anti-inflammatory component to our diet. (They are also available as supplements).

Foods to consider subtracting
  • Nightshades: This food group can aggravate the pain and inflammation of arthritis. It includes tomatoes, white potatoes, eggplant, pepper, paprika and tobacco.
  • Glutens: Just following a gluten-free diet helps many patients experience less joint pain and inflammation.
  • Allergy triggers: When patients test positive for food allergies, we may recommend an elimination diet to help rid the body of common allergens associated with pain and inflammation.

Also, many patients have found these supplements helpful: ginger, turmeric, fish oil, glucosamine, chondroitin, proteolytic enzymes, boswellia and white willow bark.

One size does not fit all

An important but confusing point is that foods that may be good for one body type may be toxic for another. We do not live in a “one size fits all” world.

So it is a good idea to work with your healthcare provider to discuss which foods and supplements may be helpful or harmful to your body. Just as some prescription medications have contraindications and side effects, some supplements are contraindicated for certain medical conditions and with certain medications.

For a consult with Dr. Spiroch or other practitioners in the Center for Integrative Medicine, please call 216.986.HEAL (4325).

Migraine: An Integrative Approach

By Melissa Young, MD

Migraines —severe, debilitating headaches that strike anywhere from several times weekly to just once a year — can be difficult to treat and to prevent. Conventional medicine approaches, which are predominantly medication-based, often fail to relieve symptoms.

Migraines last from hours to days, and may cause light sensitivity, nausea, vomiting, visual changes, dizziness and severe throbbing pain on one or both sides of the head.

Uncovering the root of the problem

In Integrative Medicine, we frequently see patients with chronic headaches and migraine. Our approach is to treat the root cause of the problem for each individual instead of the symptoms.

Here are two types of functional therapy that we try:

1. Eliminating dietary triggers

  • Eliminate all caffeine. This includes any over-the-counter or prescription drugs that contain caffeine as well as all coffee, including decaffeinated.
  • Eliminate excitotoxins. Brain-stimulating chemicals such as monosodium glutamate (MSG), the nitrates in deli meats, sulfites (found in foods from salad bars, in wine and in dried fruit) and in artificial sweeteners (especially aspartame, or NutraSweet®).
  • Avoid triggers. Common examples include aged cheeses, fermented or pickled foods, chocolate and alcohol (especially beer and wine).
  • Seek help for an elimination diet. Ask an Integrative Medicine for guidance on eliminating gluten, dairy, egg, corn, yeast, chocolate and alcohol from your diet to determine your specific trigger.

2. Consider functional medicine testing

  • Test for gluten intolerance or allergy. Many gluten-containing foods can cause migraines and headaches. An IgG food allergy panel or celiac panel can determine whether you have gluten intolerance or a gluten allergy.
  • Check the gut for yeast and bacterial imbalances. A specialized stool test may show whether an overgrowth of bacteria, parasites or yeast require probiotics, digestive enzymes, omega-3 fats, medicines or herbs.
  • Look for nutritional deficiencies. Testing levels of magnesium in red blood cells can reveal low magnesium stores — one of the biggest causes of migraines, constipation, muscle cramps and anxiety. Treatment with daily magnesium glyncinate may help.
  • Check for hormonal imbalances. The estrogen in oral contraceptives and hormone replacement therapy can trigger migraine. Saliva testing can reveal estrogen dominance. This can be treated with diet, exercise, herbs, and progesterone.
  • Assess energy production by cells. Imbalances in mitochondrial function can affect energy production, leading to migraine, fatigue, fibromyalgia and muscle aches. Urinary organic acid tests can reveal whether nutrients like riboflavin (vitamin B2) and CoQ-10 may help to reduce or eliminate symptoms.
Herbal therapies for prevention

Herbal therapy, taken under guidance, can also help prevent migraines. We may recommend the following:

  • Butterbur. A small study published in the May 2000 issue of Headache showed that an extract of butterbur root significantly reduced the frequency of migraine attacks among 58 participants. It is important to choose butterbur extracts that are PA-free (free of pyrrolizide alkaloids), standardized to a minimum of 7.5 milligrams of petasin and isopetasin.
  • Feverfew. This herb helps prevent the release of substances that dilate blood vessels.

For many people, a combination of treatments is most effective. In the Center for Integrative Medicine, we may also recommend lifestyle changes, chiropractic care, acupuncture, stress management and massage.

Dr. Young is an integrative medicine physician. To consult her about complementary treatment for migraines or other problems, please call the Center for Integrative Medicine at 216.986.HEAL (4325).

New Integrative Medicine Physician Joins Our Staff

The Center for Integrative Medicine is pleased to welcome integrative medicine physician Melissa C. Young, MD.

Dr. Young is an experienced integrative medicine practitioner who follows the "Food as Medicine" philosophy. She emphasizes a holistic approach to healthcare with a focus on healthy lifestyle choices such as nutrition, physical activity and stress management. Her specialty interests include gluten intolerance, food sensitivities, detoxification, energy restoration, hormone-balancing, migraine and mood disorders.

After graduating from Albert Einstein College of Medicine in New York City, Dr. Young completed an internal medicine residency at Lenox Hill Hospital in New York City and an integrative medicine fellowship at the University of Arizona in Tucson. She is board-certified in internal medicine.

During her seven years of integrative medicine practice in Illinois, Oregon and Kansas, Dr. Young helped to educate medical students and residents about the importance of integrative medicine.

For a consultation with Dr. Young at our Lyndhurst campus, please call the Center for Integrative Medicine at 216.986.HEAL (4325).

Recipe: Chicken Marsala

Here’s an elegant main dish that’s high in protein, low in sodium, and features whole-wheat flour and olive oil.


3 pounds chicken tenderloins, thawed
½ cup whole wheat flour (plus 2 tablespoons)
3 tablespoons extra virgin olive oil, divided
3 cups fresh mushrooms, sliced
¾ cup chopped green onions (about 3 stalks)
¾ cup marsala cooking wine
1 ½ cups low-sodium chicken broth
2 tablespoons lemon juice
2 tablespoons parsley flakes
Kitchen Bouquet® or other browning/season sauce for color (a few drops)

  1. Coat chicken with ½ cup flour. Heat oil in skillet, and cook chicken for about 2½ minutes per side. Place chicken on a platter and keep warm.
  2. Add remaining oil to skillet, and cook mushrooms and green onions, sautéing lightly for 5 minutes.
  3. Whisk in remaining flour, add marsala wine, broth, parsley and lemon juice.
  4. Return chicken to pan and simmer 1 hour or more.
  5. Add Kitchen Bouquet for color.
Nutrition information

Makes 6 eight-ounce servings

Calories: 560
Total fat: 15 g
Saturated fat: 3.5 g
Trans fat: 0 g
Cholesterol: 195 g
Sodium: 400 mg
Total carbohydrates: 18 g
Dietary fiber: 3 g
Sugars: 6 g
Protein: 77 g