Have you tried simultaneously eating and not eating legumes?

February 6, 2018 9:22 AM

What advice can you give me on living with medication-related diarrhea? Lithium is working great for my brain and really screwing with my digestion: mild stomach cramps and diarrhea on a good day, running to the bathroom a few times in an hour on a bad one. Any tips on coping with this would be great, but in particular I'm wondering if eating differently would help. The thing is, there is SO MUCH ADVICE out there on what to eat when your digestion sucks. ("Eat beans -- they have fiber!" "Avoid beans -- they're FODMAPs!" "Something handwavey about inflammation!" "Probiotics!" "Gluten!" "Veganism!") Is there any real evidence about which of these might help in my situation?

Things to get out of the way:

1. The digestive side effects seem to be here to stay — they've stuck around for multiple months.
2. I still do want to stay on this med if I can. It's been a real ordeal finding one that works, and a lot of the alternatives have worse side effect profiles.
3. We're keeping my blood levels monitored, so this isn't lithium toxicity, just a side effect at therapeutic levels.

A lot of the advice I'm finding on Google for med-related diarrhea is specifically about resetting your gut microbiome with probiotics after a course of antibiotics, which doesn't apply here — lithium isn't an antibiotic. So I'd be especially grateful for advice that isn't antibiotic-specific.

posted by nebulawindphone to Health & Fitness (24 answers total)

Best answer: So the beans/FODMAP/gluten/probiotic/everything else should be off the table here (although honestly, a probiotic couldn't hurt). You know what's causing your issue -- the medication has a known side effect, and unfortunately you've got it. No matter what you eat, you're likely to have the same problem. It's not what you're eating, it's the meds.

Try changing the timing of your dose so it's as far away from mealtime as possible. Are you on an extended release version? If you are, you could ask your doctor if a version that you have to take more frequently would be a possibility so you have more time to digest your food before you take your meds.
posted by erst at 9:35 AM on February 6, 2018

Response by poster: I will be staying on this med at this dosage. That is a decision I have made with my doctor's advice and it is not negotiable.

I am already on the extended release version, and the diarrhea is not noticeably stronger or less strong at any time of day, which makes me think that med timing is not the issue.
posted by nebulawindphone at 9:36 AM on February 6, 2018 [1 favorite]

Are you taking an immediate release or an extended release formulation? When a friend of mine was on lithium, their doctor switched them from the immediate-release to the ER, saying this would help with nausea and also mentioning that the reverse was true for people with diarrhea -- changing where in the GI tract the medication's absorbed can make a difference, so maybe the immediate release would be better for you.

Also, please make sure your electrolyte and sodium levels are where you want them to be! That can be rough with lithium even without the side effects.
posted by halation at 9:37 AM on February 6, 2018

Just to be clear, I wasn't saying you should change your dosage. I was saying if you're on the extended release, you could ask about changing to the non-extended-release kind. You'd have to take it more frequently, but it could allow you to experiment with timing your meals and meds to see if it helps with the gastrointestinal issues.
posted by erst at 9:39 AM on February 6, 2018

Response by poster: (Sorry, erst, the thing about dosage was in reply to something now-deleted.)
posted by nebulawindphone at 9:39 AM on February 6, 2018

Best answer: I've dealt with medication influenced IBS-D and IBS-C (as well as a natural inclination towards IBS-C) and as far as I can tell the answer is "no one actually knows and every body is different." The answer really is try something and see how it goes. As weird as this sounds (because it's usually for constipation) a bulking agent like psyllium might be helpful.
posted by I'm Not Even Supposed To Be Here Today! at 9:41 AM on February 6, 2018 [1 favorite]

Best answer: The reason FODMAPS are off the table as a thing to worry about is because FODMAP is an elimination diet to figure out what's causing diarrhea/constipation/gas/whatever. You know what's causing your diarrhea, so if you had perfect poops before, that's why it's not going to help.
posted by aniola at 9:43 AM on February 6, 2018

Just because digestive disruption is a possible side effect of a medication doesn't mean it cannot in any way be mitigated ever no matter what.

The horrible answer is likely "elimination diet", because you're not going to know until you know. You could probably try a series of mini-eliminations - 4-7 day trials excluding each of the lowest-hanging fruits in turn, so a week without dairy, a week without legumes, if the legumes seem like an issue try cutting all fodmaps for a week. Maybe even start first with a two-week trial with no restrictions but probiotics, emphasis on hydration with electrolytes, a mild fiber supplement, and extremely detailed input/output logging including what time you take all medications (and do you want to add a daily antihistamine to that trial? you might). See where that gets you first before you start cutting things or specifically challenging dairy/legumes/gluten etc.
posted by Lyn Never at 9:47 AM on February 6, 2018 [5 favorites]

Best answer: You might try a week of BRAT to see if you can get some stabilization before you start introducing or eliminating things. I also keep powdered gatorade/powerade around so I can mix it in with water to keep myself hydrated and my electrolytes up.
posted by I'm Not Even Supposed To Be Here Today! at 9:48 AM on February 6, 2018 [3 favorites]

Best answer: So this bowel management guide (link to pdf) is what my husband studied when he was on treatment that could cause bowel disruption. The section on diarrhea starts on pg. 10. The main takeaway was all about timing food vs fiber vs. water, along with a BRAT (bananas-rice-applesauce-toast) diet.

However, my husband's GI doc is not your GI doc.
posted by muddgirl at 10:04 AM on February 6, 2018 [1 favorite]

The most frustrating thing about digestive issues is that there's no magic bullet, and it is different for everyone. Elimination diets are the way to go. However, the closest thing to a magic bullet will be your fiber supplement (my doc always recommends Metamucil). Absolutely start there first, and hopefully it will give you some relief even at the onset. But make sure you ramp up slowly, if you aren't used to a high-fiber diet! Then you can work on figuring out your diet.
posted by backwards compatible at 10:04 AM on February 6, 2018 [3 favorites]

Lots of people recommend the app Cara for tracking digestive symptoms. It might help you correlate any foods, timings, etc.
posted by purple_bird at 10:28 AM on February 6, 2018

Start with using OTC things to calm down your system - that might be pepto bismol or Metamucil or something else. You might need to experiment a bit. Keep yourself eating easy safe things for a while once you are stable and slowly get back to a more varied diet.
Kind of pretend you have the stomach flu for a while, because you kind of do.
I think it’s going to be the Metamucil stuff for the long run but get yourself stable with the pepto and Imodium kinds of remedies to start.
posted by littlewater at 10:28 AM on February 6, 2018 [1 favorite]

I've had some luck with enteric-coated peppermint oil capsules. There is actual peer-reviewed science to support this for IBS (one of many articles here). I know this isn't IBS, but I have similar issues because of chemotherapy, and so far, it is the only thing that's helped. It took a few weeks to make a difference, and it's not 100%. But it's about 80%, which is a huge improvement after months of dietary changes that didn't help at all. I use IBgard, but I don't really know anything about brands. I just read Amazon reviews and chose that one.

Peppermint oil in large amounts is dangerous, so if you decide to try this, don't take more than the recommended dose.
posted by FencingGal at 10:40 AM on February 6, 2018

When I had this issue (9-month course of antibiotics...blerg) my doctor said metamucil or similar fiber supplement, and more dietary fiber like leafy greens and whatnot. After the treatment I was able to take probiotics...they would have interfered with my treatment but should be fine with yours.
Also: eliminate all things greasy/fried/fatty, reduce the amount of starches in your diet, and cut your meat consumption in half or more. You should be replacing those things with the equivalent of a head of lettuce or a bag of kale. Every. Day.
posted by sexyrobot at 11:24 AM on February 6, 2018

It is entirely possible that either going on a low fiber diet OR supplementing with fiber might help. You could try both ways and see if you notice any difference (give it a couple days to let your digestive system adjust).

If you want to try adding fiber Citrucel is pretty gentle on the tummy.
posted by lydhre at 11:44 AM on February 6, 2018

Best answer: I took lithium (extended-release) for 13 years, and ran into the same issue when 1- eating foods that my gut hated and/or 2- I let myself get dehydrated.

To truly fix the issue, I had to go on an elimination diet to see what did and did not work for me, and I also had to add a lot more salt and electrolytes to my diet than you'd expect a normal person to eat. Gatorade, pickle juice, pedialyte, and salt tablets became load-bearing pillars of my diet. The doctor-supervised elimination diet is a trial of boredom, but it's worth doing.

Hang in there. FWIW, things got much better after the first year.
posted by culfinglin at 12:08 PM on February 6, 2018 [1 favorite]

Be careful with things like kale and broccoli until you are super duper sure they don't make any of your situations worse. The more cooked they are they better they are, but when my system is out of whack it gets pretty awful. I sadly can only eat the heartier things from that family when my digestion feels about as good as it can get for me.
posted by I'm Not Even Supposed To Be Here Today! at 12:35 PM on February 6, 2018

When I take a lot of magnesium it can have that effect on me. But I can take a lot of magnesium without adverse effects if I also eat a lot of linseed. That would be a cheap and easy thing to try. I just add some to my smoothie ingredients before I blitz them in my nutri bullet.
posted by koahiatamadl at 12:47 PM on February 6, 2018

I think this is a job for a nutritionist who knows what might conflict with your meds.
posted by theora55 at 1:39 PM on February 6, 2018

Psycho-active medications can affect the motility of your gut, just as stress can. Changes in gut motility can also affect your gut flora or even cause an overgrowth of bacteria in your lower intestine. I have been doing the low FODMAP diet for a few months and my IBS symptoms have improved a lot! It turns out I am not over-sensitive to any of the foods I eliminated but I am slightly sensitive to all of them. I didn't used to be. Things change in your gut. The low FODMAP diet is tedious to follow but it can't hurt to try, given the severity of your symptoms.
posted by mai at 5:00 PM on February 6, 2018

There are daily medications which work for ibs, I've tried some with varying success. What has worked wonders for me is a low dose of aventyl, an older tricyclic antidepressant (I think. Don't have it on me). My GI issues are not yours, but if it's seriously affecting quality of life, you can talk to your dr about adding something to your daily meds. I also take a probiotic, and I have no idea if it works. (And after a modified elimination diet, I cut out beans and most lactose ). IBS is basically a diagnosis of "we dont know what causes this, let's figure out how to help your symptoms" so it may be a good framework to work with.
posted by Valancy Rachel at 5:47 PM on February 6, 2018

Peanut butter Clif bars will reliably plug things up. Both nuts and energy bars (clif in particular) are things I have to avoid for the other side of the issue, so maybe they can help you.
posted by Dashy at 7:02 PM on February 6, 2018

I have diarrhea periodically -- sometimes tied to medication, and sometimes I think I think as low-er key form of IBS-D. Taking an anti-diarrheal (loperamide specifically) helps me, even just half a pill sometimes if things are a bit off.

I try not to take it all the time, but from what I've read there's nothing dangerous about taking it somewhat frequently if it helps mitigate symptoms -- though obviously talk to your doctor.
posted by kylej at 8:05 PM on February 6, 2018