I took antibiotics and now my intestines are unhappy
September 15, 2016 11:32 AM   Subscribe

I have had a really rough month, with the worst asthma attack I can remember having, which resulted in a course of steroids and a Z-pack (antibiotics.) Now my stomach is extremely unhappy with me. What concrete, supported-by-actual-science steps can I take to finish recovering?

I felt great on just the steroids, but when the antibiotics were added it all went to heck. My intermittent digestive difficulties (which my doctor doesn't seem to know how to handle) have suddenly transformed into being constantly extremely gassy/bloated, nearly continual cramping, and production of horrifying smells I have never before encountered. There's also painful, acidic diarrhea every time I get near a toilet.

This doesn't seem to have any connection to what I eat: I drank a glass of water and it left me in serious discomfort. Same with crackers and bread and even taking my regular pills. It feels like my gut is simply rebelling against contact with anything at all. Worth noting: this is also how my eczema behaves during a flare-up, in that I have to wear cotton gloves at all times.

The main advice I've seen is about probiotics, but the information on probiotics is confusing - I'm not sure it's likely to do actually do anything, and it's a lot of money to be wasting. There are also a gazillion variables: which brand, how many millions of bugs, which strains or combination of strains, etc. The BRAT/elimination diet strategy doesn't seem to have helped at all; I felt lousy on the days without bread, the days without dairy, and the days without meat. I'm basically swallowing a lot of Pepto Bismol and getting frustrated doing research, in large part because there is a great deal of noise from the Dr. Oz segment of the internet. Honestly, feeling lousy is not improving my ability to be patient with that stuff.

I live in a very small town, so it's going to be a while before I can see a GI pro. I'd like to do some of the stuff that a GI pro would tell me to do. Please advise!

I know there are some older Ask questions on this issue, but I'm sort of hoping that there's better science than there was when those questions were answered.
posted by SMPA to Health & Fitness (23 answers total) 4 users marked this as a favorite
Z-packs make me feel that way while I'm taking them and then slowly my stomach gets back to normal. I always try to eat some yogurt. You can look at the ingredient list on the yogurt to see if it contains active probiotics.
posted by ilovewinter at 11:38 AM on September 15, 2016 [1 favorite]

Yeah, very little of orally ingested probiotics make it to the gut - but some do. The idea is to recolonize your guts with bacteria that will work with you instead of despite you.

Inulin is a soluble dietary fiber; you can't break it down so it'll get into your intestines. The bacteria that works with you can break it down and use it to good effect, typically speeding up the recolonization process.

It can be found next to Metamucil and other laxatives.

For some people, inulin can cause some bloating and gassy-ness but it skews towards CO2 rather than sulfides and methane.

It dissolves into water and is smooth unlike insoluble psyllium husk (Metamucil) and tastes slightly sweet. Follow the instructions on the container.

Yeah, I hate the GI recovery period after being on large amounts of systemic antibiotics.
posted by porpoise at 11:39 AM on September 15, 2016 [5 favorites]

I was on 2 types of antibiotics at the same time, for two different issues, about a month ago. Get Kefir (any flavor that would appeal to you, does not have to be the "Lifeway" brand). You'll find it in or close to the yogurt section - it's like thick drinkable yogurt. Have at least a serving a day - ideally a little in the morning, a little in the evening. And lots of water, too.
posted by raztaj at 11:40 AM on September 15, 2016 [3 favorites]

Pepto is terrible to be using ongoing and probably making this worse. Try to step off all digestive drugs for long enough to let your gut flora recover.

Here's my philosophy on probiotics: they seem to help, and the refrigerated ones seem to help more. Don't go wild, don't spend your kid's college fund, but go to Sprouts or Whole Foods and choose a reasonably-priced refrigerated option if your pharmacy doesn't have one.

I grew up in a small town conservative non-woo non-hippie place with a non-woo doctor who always had us buy Lactinex (pharmacist had it refrigerated but it didn't require a prescription) with antibiotics even in the 70s and 80s, and it was only when I abandoned this practice as a young adult that I found out how hard antibiotics were on your system. That is complete anecdata but there has been a general trend in this direction for a very long time.

If you also want to increase your intake of yogurt, kimchi, and/or sauerkraut, a) probably don't eat all three at once, that seems gross b) do try to enjoy it so you're getting that out of it, at the very least.
posted by Lyn Never at 11:44 AM on September 15, 2016 [1 favorite]

The most recent thing I've heard on the BRAT diet is that, basically, there's no reason to be on it. In recovering from digestive distress, you should mostly eat what you usually eat (as allowed by your appetite).

It is an open question as to whether the probiotics you take via mouth make it to the gut. It is certainly plausible to think that a lot of them will be killed by stomach acid, etc, but there is some evidence that a good number of bacteria do actually survive. If I were you, I'd take a daily probiotic (Culturelle is widely available and has the most widely-believed-to-be-helpful bacteria) and eat a fair amount of yogurt with live active cultures (which most have, but you should double check).
posted by Betelgeuse at 11:45 AM on September 15, 2016 [2 favorites]

A friend of mine went to a gastroenterologist for similar problems, and they gave her a list of specific probiotic strains that had been clinically tested and proven to be effective. I only remember one name from the list, which was B infantis (which I remember because the name made me laugh), but when I was having digestive troubles recently I bought some probiotics with that strain in them, and they definitely worked for me. I eat yogurt every day, and antiobiotics can still mess me up; this is a much higher dosage. That's not to say that plenty of others might not help, but I (and some scientists) can vouch for this one.
posted by dizziest at 11:50 AM on September 15, 2016 [1 favorite]

Take the probiotics yes, but wow, calm down your guts first.

Get yourself some Pepto Bismol and take basically as much as the directions will allow. Liquid or chewable. Do this for a few days.
If it's not calmer after 24 hours add in some Imodium.

Anything else that makes your stomach feel calm, go for it.

Once it's calmer then move on to probiotics and other normal foods.
posted by littlewater at 12:13 PM on September 15, 2016

Soo I had this happen to me after a dose of clindamycin. It was bad enough that I went to the emergency room to make sure something else wasn't going on. My regular doctor took a stool sample to check for parasites/c diff (inconclusive results) and put me on Flagyl, which made me feel ten kinds of awful on top of the diarrhea. I also took probiotics, which were expensive and didn't do anything. On top of that I had minor vaginal and oral yeast symptoms which kept getting worse.

Finally I got an urgent care doctor to give me diflucan for angular cheilitis/oral thrush even though he kept insisting that the painful cracks on the sides of my mouth couldn't have possibly been thrush and that my digestive symptoms had nothing to do with yeast. But I stopped shitting 24/7 after two doses of diflucan. Now I'm much more reluctant to go on antibiotics and when I do, I ask for diflucan with it and I haven't had either a yeast infection, angular cheilitis, or oral thrush since.
posted by PhoBWanKenobi at 12:14 PM on September 15, 2016 [2 favorites]

My primary care physician recommended VSL#3, a refrigerated probiotic, which is available at my local Costco at the pharmacy counter. This page lists the types of probiotic strains found in the product. One of the strains is the B infantis mentioned by dizziest.
posted by apartment dweller at 12:17 PM on September 15, 2016 [2 favorites]

It sounds similar to my wife's experience with a persistent c.diff infection. She had been on a z-pack followed by a more powerful antibiotic, and wound up having the same symptoms as you write. She was on a very powerful antibiotic for about two years, and the only thing that wiped it out was a newly developed drug called Difficid (?). Hellaciously expensive, $3000 for a course, thank dog my insurance covered it. Ever since she's been religious about taking a probiotic. She even recognizes that it might just be a placebo, but that's how bad it was for her.

Do try a probiotic, eat a lot of yogurt, get some Preparation H and soft wet wipes, but if it continues, you may need more medical attention.
posted by disconnect at 12:42 PM on September 15, 2016

Seconding, Kefir, buy a flavored one. Drink some a few times a day.
posted by gregr at 1:27 PM on September 15, 2016

I very much second VSL#3, and add a suggestion for Florastor. VSL#3 needs to be refrigerated, and taken with meals. These two probiotics fixed me up, after a year and a half of being (mis)diagnosed with IBS post-antibiotics, though it took a couple months. They're more expensive than the usual grocery-store probiotics/yoghurt/kefir route, but unlike grocery-store probiotics, which I tried for months and which seemed to be about as effective as water, they actually worked! If you're in a small town, you may be able to order them online (Amazon link).
posted by stellarc at 1:46 PM on September 15, 2016 [1 favorite]

The folks over at Science Based Medicine looked at this question in 2013. Read the whole article; it's worth your time, but [spoiler alert], "There’s reasonably good evidence that probiotics, when taken with antibiotics, will reduce the risk of antibiotic-associated diarrhea."

I’ve been prescribed an antibiotic. Should I take a probiotic?
posted by 26.2 at 1:48 PM on September 15, 2016 [1 favorite]

Call a gastroenterologist, tell them you're having an acute issue, and beg to be seen.
posted by radioamy at 2:46 PM on September 15, 2016

On the probiotics front, they take a while (a few weeks at least) to kick in. My gastroenterologist recommended an OTC brand called Align.
posted by radioamy at 2:47 PM on September 15, 2016 [1 favorite]

If you're going to go the kefir route, I'd make it at home. It's pricey in the store and doesn't have as many beneficial strains of good bacteria. I've been making it at home for almost a year and have seen a complete turnaround after a course of antibiotics that started within days of taking it.

The Good Gut is one evidence-based book by researchers at Stanford that touches on probiotics and specifically discusses kefir, kimchi and sauerkraut, among other fermented foods, as being beneficial.
posted by onecircleaday at 3:13 PM on September 15, 2016

hi this was me since june 20th until last week. my gastro doc said to stop with the yogurt and other dairy-based probiotics, specifically for me because i'm already comically lactose intolerant, but i mention this for you because things that fuck up your gut flora can cause temporary lactose intolerance. the vile terrifying new smells and horribly bubbly gas/cramps thing you mention is a common sign of lactose intolerance. even if you had no cessation of horrors on the non-dairy days it doesn't mean you were as strict about it as you could've been, since lactose and whey are both common additives in things like vitamins, otc medications, rx meds, bread, meat, all sorts of things you would not expect to be full of random unnecessary lactose. just cutting out milk and cheese won't do it if that's the problem.

for me personally what worked is increasing the amount of otc antacids i take every day. she also recommended i try an otc probiotic called Culturelle, which i got on amazon for like $4 and haven't even started taking yet but i'll keep it around just in case.

anyway if you've had previous trouble with GERD or just regular heartburn you might want to try an otc antacid in the mornings and see if that helps with the firepoops.

if you do get in to see a gastro doc be prepared to have to do a stool study which involves horrors unimagined and lots of tiny jars that need poop in them

i hate these jars they are my enemy
posted by poffin boffin at 3:35 PM on September 15, 2016

How long ago did the z-pak end? I totally understand antibiotic related GI issues suck but they should resolve without intervention.

I was on a giant monthly dose of flagyl for about a year, several years back that basically turned me into a diarrhea spigot (lovely visual!) I took lactobacillus and the GI issues quickly resolved. However, I discontinued the med shortly therafter. Not medical advice, just an anecdote.
posted by pintapicasso at 4:15 PM on September 15, 2016

IANYD. Call your PCP and tell them all of this. You should get tested for c diff, which your PCP can test for and treat.
posted by namemeansgazelle at 5:26 PM on September 15, 2016

Are you taking the antibiotics with food?
posted by J. Wilson at 6:53 PM on September 15, 2016

Hopefully you don't have c diff. After two doses of different antibiotics earlier this year, I had the same symptoms as you, plus more - especially increasing nausea. Get tested by a primary care/urgent care center place for c diff - if you have it the sooner you find out the better. I ended up in the hospital from severe dehydration and they put me on flagyl, which ended up solving the problem. It was four months and lots of probiotics later that I could get back to a normal diet including coffee. Both my pharmacist and the ER doc said that so many more people are getting c diff from antibiotics.

If you don't have c diff, coconut water is great for dehydration, kimchi and kraut have probiotics, and kefir is nutritious and full of good bacteria. Cut out the acid and diarrhetic foods but don't go crazy on the BRAT diet, a lot of sources say it's not as good as we thought, because of the sugars.

Feel better and good luck.
posted by perrouno at 11:45 PM on September 15, 2016

Update: I added probiotics, which definitely seemed to help. My sense of taste is still totally out of whack, but I'm much more comfortable. And actually, cheese and chocolate now taste much more like themselves than they did two weeks ago. The specific brand I picked was Phillip's "Colon Health," because it was the closest thing I could find to the list of recommended strains and it had good reviews on the Sam's Club website.

However, my experience probably isn't that helpful for future users running into this question, because my stupid asthma has resulted in a couple of ER trips and several new prescriptions (including lots more steroids) since the day I posted the question. The biggest advice I have is to never say anything like "the worst asthma attack I can remember" because the universe apparently takes that kind of thing as a sort of challenge to its authority.
posted by SMPA at 2:08 PM on September 26, 2016 [1 favorite]

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