On Sunday there were deafening bells going off in my brain. By Monday they were going off in 11 others.
Alessandra: “Holy s#*t this has just ticked so many boxes for a couple of Rx resistant patients. Thank you!”
Tess: “Me too – finally the gut and pain connection explained”
What happened? Well on Sunday, normally my holy day of rest 😉 I was feverishly working on a patient case but far from feeling resentful about my lost day of leisure I was thoroughly enjoying myself and the deafening bells were because I was experiencing a major ‘AHA!’ moment. On Monday I got to share my work-up of the case with the practitioner who’s treating that patient and the rest of their very funky group, during our monthly group mentoring session & suddenly there were bells going off everywhere!
The case goes something like this :
24yo Female with severe pain (rates 7-8/10 daily) since May 2016, in joints & muscles with hips, knees & shoulders worst. Extensive investigation by GP, rheumatologist and haematologist have ruled all the likely suspects out but failed to diagnose the condition. Pain so severe – patient has been hospitalised previously. Other features include fatigue, headaches and migraines.
The treating practitioner, daunted but not deterred, ran a series of investigations including a CDSA as the patient reports severe aggravation from eating fat together with other digestive features. Her CDSA results suggest gross fat malabsorption and that got my mind ticking. Many of us have heard about associations between oxalates and pain conditions such as fibromyalgia but do you know the link with fat malabsorption? High oxalate levels can be ‘primary’, which means genetic (rare) or they can be secondary. The leading cause of secondary hyperoxaluria is fat malabsorption e.g. in IBD, pancreatic insufficiency etc. How?
Normally dietary oxalates only contribute approx. 10% of our total oxalate load in our body but in cases of fat malabsorption this jumps dramatically. Dietary oxalates are normally ‘blocked’ in the gut via binding with calcium – but if you have lots of unabsorbed fats in the lower bowel – these bind the calcum instead and so a much higher proportion of oxalates get absorbed.
While the links between oxalates and fibromyalgia are not currently embraced by mainstream medicine, a condition called oxalate arthropathy is recognised as a rare cause of arthritis caused by deposition of calcium oxalate crystals in synovial fluid and soft tissues. The naturopathic thinking goes that hyperoxaluria at lower levels could produce profound musculoskeletal pain and other symptoms via the same mechanism. It makes sense – especially in cases of gut issues with fat malabsorption & ‘unexpained’ pain.
Carolyn: “Me too – can’t believe it – exactly what’s been happening OMG”
This is why I love my job – when we get to share the light-bulb moments and help so many more patients in the process 🙂
We’re experiencing an influx of enquiries about group mentoring this year, so we are working hard to prepare for 2018 to make sure no one misses out! You can read more about the Rachel Arthur Mentorship Programme (RAMP) here. Please get in touch if you would like to put your name down on the 2018 waiting list and we will contact you first to confirm your position. Keep an eye out for more information in October when we officially open applications for a January 2018 kick-off!