ARTICLE
Treatment Strategy
Treatment goals were to follow a naturopathic autoimmune protocol of removing disturbing factors and targeting anti-inflammatory , antioxidant and immune-modulatory mechanisms alongside improved stress adaptation to reduce frequency and severity of UCTD flares and improve energy , mood and quality of life ( QOL ). Longterm treatment goals were to promote gastrointestinal healing , reduce intestinal permeability and support detoxification pathways . Treatment outcomes were to be monitored through changes in pathology markers and patient reported outcome measures ( PROMs ), via GAD-7 and Orebro Musculoskeletal Questionnaires .
Treatment started with a dietary overhaul , removing inflammatory dairy , gluten , sugar , processed foods and alcohol , and limiting coffee intake . An anti-inflammatory diet , emphasising ample antioxidant-rich fruits and vegetables daily and oily fish 2-3 times weekly , was implemented to reduce systemic inflammation and oxidative stress and improve immune modulation . Eating three meals daily to boost intake of nutrients was encouraged . Increasing Vitamin D3 supplementation to 5000IU daily was advised to modulate immune responses , improve gut mucosal integrity and promote musculoskeletal health . Supporting lymphatics to improve immune function and reduce inflammation by increasing water consumption to 2 litres daily , light exercise ( e . g . walking and gentle yoga ), and introducing a dry skin brushing routine was recommended . Flower essences were also prescribed , see Table 3 .
At the first follow-up consultation , inclusion of bitters before meals to improve appetite and digestion was advised and N-acetylcysteine ( NAC ), a potent anti-oxidant and antiinflammatory nutritional supplement generally safe and well tolerated , was prescribed to manage symptoms - Biomedica VegeNAC one capsule twice daily , providing 1180mg NAC daily .
Table 3 . Flower Essence Prescription ( dosage four drops , under the tongue , four times daily )
Bach Flower Essence Elm Gorse Olive Wild Rose Mimulus
Rationale For feelings of stress , anxiety overwhelm , to promote courage and poise For hopelessness and despair , to give faith and hope For exhaustion , fatigue , to promote convalescence , strength and vitality For resignation and apathy , to give passion and motivation for life For fear of flares , to give courage to face life ’ s difficulties
AN ANTI-INFLAMMATORY DIET , EMPHASISING AMPLE ANTIOXIDANT-RICH FRUITS AND VEGETABLES DAILY AND OILY FISH 2-3 TIMES WEEKLY , WAS IMPLEMENTED TO REDUCE SYSTEMIC INFLAMMATION AND OXIDATIVE STRESS AND IMPROVE IMMUNE MODULATION .
Treatment Outcomes
At the first follow-up consultation , improvement in all symptoms except tinnitus was reported . The patient claimed the biggest impact came from removal of dairy and minimising coffee and alcohol , recognising the impact coffee was having on her appetite and alcohol / dairy on her overall symptoms . Bowel motions improved , digestive symptoms were relieved and her appetite improved . A period of high work stress prompted another flare , highlighting the importance of addressing stress adaptation .
At the second follow-up , after NAC supplementation , the patient reported feeling the best she has done since disease onset , having a full six days completely symptom-free . A complete
130 | vol27 | no3 | JATMS