Help me figure out what's going on with my butt

February 7, 2014 1:54 PM

Is there a scientific, non-woo, non-exclusion diet based way to test for food intolerances? Lots of snowflake details and some TMI inside.

Over the last year or so, I've developed some IBS-type symptoms (bad gas, bloating and diarrhoea, with some acid reflux & nausea, some cramping, and feelings of fullness way past the point that I should be feeling full). It's really irritating, as I used to have a cast-iron stomach. I saw my GP about it and she was worse than useless (she said "IBS usually occurs in anxious and obsessional people", gave me a pointed look and moved on).

Cutting out certain foods (specifically broccoli, cauliflower, bell peppers, cabbage and cabbage-like foods) tends to keep the worst of it under control, and massively reducing the amount of wheat I eat (and cutting down portion size in general) has helped with the feelings of excessive fullness - but I'm still getting attacks when I don't eat any of these things, and I can't figure out the cause.

Is there anything kind of test that can tell me what I should avoid? I've had some success with cutting out really obvious culprits (the last time I ate a small bite of bell pepper by mistake, I had around twelve bowel movements the following day and near-constant gas - as soon as I'd pass some, it was like I could feel myself immediately inflating again), but I'm wary of doing a full-on exclusion diet for several reasons, including that we get free lunch at work and it's really hard to have any control over what I'm going to get to eat, plus I have a history of disordered eating and don't want to end up down that path again as a side effect of cutting stuff out to see what's causing this. I'm already getting aversions to certain foods that I fear are going to make me sick, and I'm really nervous about this getting out of hand.

I already avoid a lot of the foods on the IBS trigger lists - no alcohol, carbonated beverages, coffee (or caffeine in general), meat, etc., and not a lot of really fatty or fried foods. I generally drink soy rather than cow's milk out of taste preference, but haven't seriously investigated cutting down on dairy as cheese is one of my biggest weaknesses. I've been vegetarian for around eight years now, and I really love vegetables - but the diet of broccoli and bran that had been working for the last seven or so now seems to be hurting me.

In general, I seem to get way more attacks when I've eaten out or eaten at work - when I've prepared the food (or my SO, who I live with, has), it very seldom makes me sick. It's been a huge issue this week as I'm travelling on business and have been eating out for almost every meal. I feel so bad right now that it's almost like food poisoning, but I'm pretty sure it was something I ate last night.

My bowel movements (I'm so sorry) are generally very loose, and sit somewhere on the colour spectrum between green, yellow and orange, with plenty of undigested plant matter in there even though I try to be careful about the amount of insoluble fibre I eat.

Does anyone have any idea how I go about finding a more definitive list of the stuff I should be avoiding? Is there a test? Should I be cutting out more things to see if that helps, or trying a full exclusion diet or a FODMAP diet? It's getting to the point where it's impacting on my quality of life, and I just don't want to be the guy with a bunch of nebulous food-based intolerances. I'd like to be able to eat without having to worry that it's going to make me feel awful all the next day (or longer).

I don't have a lot of money at the moment as we just moved, and my experience dealing with this through the NHS (I'm UK-based) was terrible, but I would be prepared to pay for a couple of hours with a nutritionist/dietician if that's something that might help.

Any and all advice gratefully received.

posted by terretu to Health & Fitness (31 answers total)

Try cooking your food more thoroughly? Raw or partially-cooked vegetables can trigger this sort of thing when the same veggies cooked to softness might be fine.
posted by Holy Zarquon's Singing Fish at 2:01 PM on February 7, 2014

I would strongly suggest seeing a gastroenterologist first. It's entirely possible that what you're experiencing is due to food intolerances (and a GI doc can advise you on that score, as well, and probably can refer you to a nutritionist as necessary), but it's also just as possible that it's due to other medical issues.
posted by scody at 2:02 PM on February 7, 2014 [10 favorites]

(Also, I'm not sure where you are located, but if you are in L.A. and want a referral to a good GI doc, let me know. I will be happy to refer you to my gastroenterologist, who totally took care of me after another GI doc blew off my symptoms for a few years as IBS/just being high-strung/etc.)
posted by scody at 2:05 PM on February 7, 2014 [1 favorite]

First, under melted (as my phone would have it) or unfermented soy is difficult to digest. So there's that.

Rather than a roll your own elimination diet,if you can afford to see a ddietitian and work with them. They may want to try other things before going to an elimination diet.

The people I know who have calmed their roiling guts by this route have found odd
Culprits.

My dad had to cut out a variety of foods for ... a year or so and then he was able to slowly reintroduce them over about six months.
posted by Lesser Shrew at 2:07 PM on February 7, 2014

You need to see a gastroenterologist (GI specialist).
posted by radioamy at 2:15 PM on February 7, 2014

What I would describe as the same symptoms in my (vegetarian) case, plus iron deficiency, were found by a gastroenterologist to be celiac disease.
posted by Radiophonic Oddity at 2:16 PM on February 7, 2014

If you're eating at restaurants the food is often much higher in fat content that food you'd make for yourself. I know someone who gets like that after a high fat meal.

Go back to your GP and don't accept the brush off and keep going back until they help you or can refer you to someone who will. Also don't accept an IBS diagnosis until everything else has been ruled out.
posted by missmagenta at 2:26 PM on February 7, 2014 [1 favorite]

Do you cook with vegetable oil at home? This is a stab in the dark, but that is often the secret ingredient that is in practically everything you would eat on the road but many people never use at home.

I agree it's worth trying to get to a GI.
posted by telegraph at 2:35 PM on February 7, 2014

How is your gallbladder? Any history in the family?

I agree, go checked out at the doctor's. This is not something we can solve here.

Personally, I'd go on a bit of a diet in the meantime just to calm the digestive system down - eating only food that is easy to digest.
Broccoli, the entire cabbage family actually, onions, leek, olives, mushrooms, bell pepper, cucumber, legumes, avocados, nuts and fats (dairy with high fat content as well) are all rather not advisable right now. Avoid food that is fried or has a lot of spices.

Rather go for (steamed) veggies like carrots, fennel, tomatoes and zucchini. Rice is good. Lettuce is fine as well.

Hope you feel better soon!
Don't put off that appointment.
posted by travelwithcats at 2:35 PM on February 7, 2014

Oh, while I agree that your doctor made an unprofessional and frankly stupid remark, try not to per-diagnose yourself. Go in and describe your symptoms and their duration without assigning them to one illness or the other. Docs have to mentally run through a lot of options- usually starting from the worst case scenario - to determine what it is you really have. Don't throw them off the course!

If there is no improvement after a while, sure, tell the doctor about your own research and what tests you want etc. But start out by simply stating the facts.
Good luck!
posted by travelwithcats at 2:45 PM on February 7, 2014 [1 favorite]

I know you said you're not interested in an exclusionary diet. However, I have had similar symptoms to yours and recently did the Dr. Oz (I know) elimination diet, and found it easy to do - it's not super-duper restrictive (only five days - watch the video to get the full scoop) and I liked that it focused on the most common culprits. And, I realized that I've felt so much better when I don't have corn, eggs or onions - staples I've relied on my whole life (and which are used in a lot of restaurant cooking).

Good luck to you - I too wish there was an easy scratch-test kind of evaluation for food intolerances!
posted by hapax_legomenon at 3:07 PM on February 7, 2014

We went to a naturopath in our area who wrote us a lab slip for bloodwork that would determine food allergies. It tests for all sorts of foods, from various meats to various vegetable and fruits, and more. Our impetus for getting the test was not IBS symptoms, but the dr. suggested that some other health problems were being exacerbated by inflammation in the body, which could be caused by food allergies.

I'm still waiting for mine to come back, but we were surprised to find that my hubby is allergic to yeast - both baker's and brewer's. Cutting those out has made a big difference for him. Going gluten-free and dairy-free has made a big difference for each member of our family.

I would also suggest bloodwork to test for MTHFR, whether or not you are positive for it (and it is estimated that around 50% of the population of NA are positive) makes a difference in your digestive health as well.

Best of luck, sorry your GP was such a jackball about it (mine was too).
posted by vignettist at 3:29 PM on February 7, 2014

I would take a two pronged approach: doctors and avoiding eating things that bother you as much as possible. It might help you to keep a food and symptom diary, and it might help doctors you see in the future. Do you have to eat the free lunch at work? Can you pack your own?

I really really hope you see a gastroenterologist and that they screen you for things like celiac and gallbladder malfunction. It'll be worth the long slog through your healthcare system because this is no way to live.
posted by purple_bird at 3:45 PM on February 7, 2014

You might consider a steady intake of probiotics (yogurt / kefir and / or reputable supplements) especially if you've been on antibiotics any time in the last couple of years.
posted by alms at 3:52 PM on February 7, 2014

Getting a comprehensive allergy test (the prick version) revealed a whole bunch of food allergies for me. My symptoms were almost identical to yours, and within three days of eliminating those foods I felt like a whole new person. Visits to a gastroenterologist and a GP had been unhelpful unfortunately.
posted by Mouse Army at 4:55 PM on February 7, 2014

See a gastroenterologist. I have a friend who had been suffering from what she thought was "IBS" for years. She finally saw a GI doc, who did a relatively straightforward test, and diagnosed her with SIBO. One very specific antibiotic later, and she can eat onions again.
posted by hydropsyche at 5:07 PM on February 7, 2014

Oh I feel so badly for you. I know what life like that is like and it can be VERY difficult to get things pinned down. But don't be discouraged if you can help it. With time you can slowly track down the things that bother you and learn ways to keep from having to eat them.

I had a great, very supportive doctor but every test we did came back negative (no celiac, no food allergies, no cancer etc. etc. etc.) and still I felt like crap. What helped me initially was taking a very good probiotic. I used Align (I'm in US so you may not have it where you are). Then I eliminated some of the foods that most people are sensitive to. I can't eat Broccoli at all. I cut out Gluten and felt LOADS better and I had to give up certain dairy (ice cream, cottage cheese, even yogurt). You will be different than me of course, but once you have nailed down a couple big things that you react to, its easier to find the small things. I cut out gluten first. It was a process. I told myself it would take time. It did. I made mistakes and sometimes ordered the wrong things out of habit. When I'm traveling for work, sometimes the only things available have gluten. Travel is the hardest thing but after more than a year of this I have some go-to foods that I take with me and I have a bunch of restaurant chains I know that I can get some gluten free foods that I like. So it gets easier.

Give yourself time to make the change. Don't try to do it over night and go easy on yourself if you make mistakes or have times where you can't avoid certain things. At some point you will look back and realize you have come a very long way, and you feel so much better.

Good luck to you!

PS Having said all that I would definitely go see your doctor first. Tell them you want to rule out other health issues before starting on your own process of eliminating foods. Don't let them poo poo (ha ha) your concerns. If they do, change doctors if you can.
posted by WalkerWestridge at 5:19 PM on February 7, 2014 [2 favorites]

There are breath tests to check for malabsorption / intolerance of fructose and lactulose. My seven year old daughter's fructose malabsorption was diagnosed this way. It is 100% scientific and non-woo, it tests for the presence of breath hydrogen over time after consuming the test carbohydrate after a fast. Same test can diagnose SIBO, as mentioned above.
posted by KathrynT at 5:21 PM on February 7, 2014 [1 favorite]

I wanted to do an elimination diet for FODMAP issues so I went to a dietician (I also have a gastroenterologist and ulcerative colitis, but I thought I might also have some IBS issues). The dietician pulled a book out of her drawer and said, "Oh this is the best guide -- you should just read and follow this. We can have an update appointment afterwards if you like, but this is really all you need." This was the book. By the way, I already had it and my insurance didn't cover my dietician appointment so yeah I was pretty irritated and felt like I had totally wasted my money.
posted by janey47 at 5:47 PM on February 7, 2014 [2 favorites]

We went to a naturopath in our area who wrote us a lab slip for bloodwork that would determine food allergies. It tests for all sorts of foods, from various meats to various vegetable and fruits, and more.

Be careful about big panel testing for food allergies. Both blood and skin prick tests for foods can be falsely positive in 50-60% of people, so you may end up avoiding foods you don't really need to based on the test, and the cost of each food tested adds up. The tests could be helpful if you have a history of a specific allergic response (symptoms typically within two hours of ingestion, occur with hives, and occur every single time it's ingested). However, the food allergy tests do not rule out nor rule in food intolerances.

This is different from the celiac sprue / malabsorption tests which are more reliable. And I agree with the food diary and seeing a physician recommendations above.
posted by slomodinkens at 6:31 PM on February 7, 2014

I assume you're a male, but just in case you're not, you need to see a GYN for a vaginal ultrasound looking for endometriosis or ovarian cancer; bloating, early satiety and abdominal pain are the three things to send you there.

If you're a male, you at least don't have ovarian problems, but you definitely have GI problems and, considering the enormous number of foods that are a potential cause of bowel trouble or food allergy/intolerance, you can't hope to figure it all out without the benefit of a laboratory and a physician who has access to a lab. See a gastroenterologist and possibly an allergist, or maybe there's a gastroenterologist who specializes in food allergies and intolerances - get thee to a doc.

If you can't or prefer not to see a doctor, then buy a bottle of acidophilus capsules from a health food store, but be sure you get the ones that have to be refrigerated. Take three a day for a week and you should see a definite difference.

Don't, however, take a week's worth of acidophilus and then see a GI doc, because your stool samples won't accurately reflect what's going on now - or at least not to the same degree.

You do need a workup though - no way you can figure all this out yourself. I hope you get it all settled - good luck.
posted by aryma at 6:38 PM on February 7, 2014

Your doctor may have been uncouth but not necessarily wrong about anxiety. Anxiety and IBS are linked. The fact that almost any food can set it off suggests it may be anxiety related. Few people have issues with everything. I used to have IBS symptoms which sounded very much like what you describe. They went away when I went on a beta blocker for anxiety and high blood pressure. After I left my stressful job and environment (New York City) I can't remember the last time I had any stomach or bowel problems. I would actually suggest exploring possible anxiety and stress issues before wasting money on food allergy testing.
posted by BabeTheBlueOX at 8:23 PM on February 7, 2014

Also wanted to chime in to say that your doctor sounds like a jerk, but anxiety can really wreak havoc on your stomach.
posted by radioamy at 9:24 PM on February 7, 2014

As far as anxiety and stomach problems go: after observing my daughter's behavior and personality when she is not troubled by gut problems from eating foods she can't handle vs. when she IS so troubled, I am starting to believe that messed-up guts / anxiety and stress equation can go both ways. Your guts are lined with more serotonin receptors than there are in your brain, after all. I will hasten to say that there is virtually no scientific data that supports this hypothesis, but from a sample size of one, the correlation seems awfully strong.
posted by KathrynT at 9:51 PM on February 7, 2014 [1 favorite]

I feel odd mentioning this, because I'm still in a trial stage for it, but since I hit menopause, I've had really similar problems to yours and I never know exactly when it's going to strike, so it's really played havoc on my life. I mentioned it to a friend and she told me about her own experience with it, and that she'd increased her fiber intake by a lot, and that it cleared up for her for the most part. I kind of scoffed, but thought I'd give it a try.

And so far, it's actually helping a lot. I'm not back to premenopause cast iron stomach tolerances, but the diarrhea thing has really decreased a lot. Certain foods have helped, but I've also used a mix-in water soluble fiber powder in drinks and stuff.

And yeah, that's a really jerky response from a doctor. It might be worth reminding her that she works for you. I'm going through something similar and I'm trying to remind myself of that (my regular doc is aces, but her temporary fill-in not so much). I also wanted to say that if you are female, those could be very important signs regarding your girly plumbing and worth looking into.
posted by emcat8 at 11:09 PM on February 7, 2014

Response by poster: Thanks everyone, this is very helpful! For clarification, I'm mid-20s, UK-based and a lady. It looks like I'll be making a trip to the doctor as soon as I get back home - the fact that I've just moved to a new town means I should be able to see a different doctor, and I'll be much firmer about getting some answers rather than just letting them brush me off.

If anyone's got anything to add, keep it coming - I appreciate all the advice!
posted by terretu at 11:17 PM on February 7, 2014

Yeah, another vote for gastroenterologist. I mean, yes, you could have IBS, and you could have anxiety. BUT you need to rule everything else out before you assume it's that, because there are some much more serious possibilities that would need to be addressed right away. At the bare minimum, they should have solid reasons to rule out celiac, inflammatory bowel disorders, colon cancer, gallbladder, infection, parasite, etc, etc.

When you see the doctor, this is what I've found helpful for being taken seriously:

-Be very specific about your symptoms. It's easy for a doctor to brush off "I'm experiencing loose stools" because really, who doesn't from time to time. "I am experiencing diarrhea up to twelve times per day. I have identified several trigger foods, but the overall prevalence does not drop below five times per day and an average day includes at least 30 minutes on the toilet. This is affecting my daily life." Much harder to brush off.

-Mention any seemingly-unrelated symptoms -- you're not a doctor and you may not know what's related. Swollen tongue? Mouth sores? Low-grade fevers? Fatigue? Weight loss or weight gain? Yeast infection? Mention it all.

-Read up on the Rome criteria and focus on anything that doesn't fit IBS -- not in a "I can diagnose myself better than you" way, you're not trying to second-guess the doctor. But be aware of any symptoms you have that aren't consistent with IBS, and mention them specifically. "Gut pain" is consistent with almost anything. "Gut pain that wakes me from a sound sleep" is NOT supposed to be consistent with an IBS diagnosis.

-Be pleasant and positive in your affect, and treat the issue as something serious but solvable. Don't dwell on the fact that the last doctor dismissed your concerns. (It's unfair, but doctors may be prejudiced by your report of what other doctors have said, and by the feeling that there isn't a solution to your problem.)

-"This is significantly impacting my daily life." In my experience, these are the magic words.

I'm sorry you're going through this -- I know how frustrating this kind of thing can be. I hope they take you seriously and get you on the road to recovery.
posted by pie ninja at 4:48 AM on February 8, 2014 [3 favorites]

Also, forgot to add! Mention any family history you may have. If you have any family history of colon cancer or anything related to it, DEFINITELY mention it. It generally makes doctors take these symptoms more seriously -- as it should.
posted by pie ninja at 4:49 AM on February 8, 2014

I don't think a dietitian is going to be able to diagnose any serious underlying problems - you really need to have a medical professional check out your symptoms since they are so negatively impacting your life. Celiac disease, for example, can only be diagnosed via biopsy. Some of the symptoms and food reactions you describe are very similar to two people close to me, and in both cases they ended up having their gall bladders removed. So I recommend that you go back to the doctor (probably a different GP than that one who previously dismissed you). Best of luck!
posted by Oriole Adams at 11:34 AM on February 8, 2014

You might consider keeping a daily log of your inputs and outputs. At the very least, you'll be able to qualify your symptoms better to the doc. Maybe it'll also help identify some additional triggering behavior.
posted by RobotVoodooPower at 4:36 PM on February 8, 2014

(+1 to everything pie ninja said - this is excellent advice.)
posted by kxr at 3:25 PM on February 13, 2014