How do you approach the management of patients who require nutritional restoration in the setting of a presumed functional GI disorder recalcitrant to behavioral medicine and pharmacologic therapies?

It certainly is a very good question if indeed the patient has functional disease; then, for sure, they need more than just my help. They probably need the help of a nutritionist, but even more so, they need perhaps psychiatric medication and the treatment of a behavioral therapist or psychological therapist. Oftentimes, I can tell patients what I think, but there is a stigma to having a psychological disease, so they are quite resistant to it, usually. I try to get the significant others or the family involved, and I often explain to the patient with the family present that if we can’t identify something specific that can be treated, then yes, of course, vitamins would be helpful. In the meantime, even with plenty of water and fluid, they ...

I find a functional patient who may not really have anything organically wrong. It may be psychological, are much more difficult to deal with than patients who have a distinct organic problem. The fact that the patient may have stress, anxiety, panic, depression, time is threatening to them, and they don’t want to admit it, so when I casually suggest not for psychological reasons, but for hormonal reasons, that I consider an SSRI or other Relaxing drug or antidepressant, they get annoyed. If I can ultimately convince them that it’s in their best interest to twerk on a lot of other patients and they should give it a chance, not simply a day or a week, more often than not, it does help them. They can prove to be a difficult class of patience.