Did you have GI/intenstinal/stomach issues and then fix them? How?
February 16, 2023 5:19 AM   Subscribe

I have had "mild IBS" for a long time, which has slowly gotten worse over time. Past attempts to try and figure out what is going on have led nowhere. I'd like to take another stab at figuring out what is wrong at at least how to manage it better, and am interesting in hearing from people who either got over their issues completely (via some sort of diagnosis, nutritional changes, figuring out an allergy, whatever), or at least figured out a better way to minimize annoyance. Looking for experiences and I guess advice.

I know you're not my doctor. I'm mainly looking for avenues of exploration. I've sort of given up that this can ever get better, but it's pretty annoying and well, I guess I'm willing to look into it again. Even just ameliorating it a bit would be nice...I've definitely become much more of a homebody (and extremely aware of where toilets are at all times, sigh).

Mainly, I am prone to loose stool, and have to take bowel movements like...5-9 times a day, generally once right after I eat, then another time maybe 30-60 minutes after that, and then it sort of varies. Spicy food will generally give me painful diarrhea for the next day.

I'm mainly interested in what people's issues were, and how they solved them, so I can get ideas about what I myself could consider checking out, looking into etc.

I myself am in my mid-30s. I currently live in a place (small Chinese city) where diagnostic procedures are very cheap, but the quality of physicians is on the whole pretty low. That said, before moving here I did see a pretty good GI in the US who did a sigmoidoscopy and didn't see anything, and mainly just suggested I avoid the foods that triggered me the most (spicy food, oily food, overeating...at least that I know of, there could be other triggers!). I am not overweight, but I am not particularly skinny. I have lost some weight over the last ~3 years...but it hasn't really made a difference (though not overeating in a given meal generally does help).

In China I got a colonoscopy (maybe 4 years ago) and it didn't really show anything helpful. There was definitely some inflammation, but there were no signs of crohn's or celiac or anything (and afaik my symptoms haven't been consistent with something like that, but again, the actual quality of physicians I have access to where I live is not particularly great).

Over the last ~5 years, the IBS has definitely gotten worse. My sensitivity to spicy food has gone way up, with even a little spice guaranteeing discomfort in the bathroom (frustrating, as I love the taste! alas). I am in general very attentive about what I eat...not perfect by any means, but I try to restrict my portions, I avoid spicy food, I try to avoid overeating, I try to avoid super oily food (which has seemed to also be a trigger?), and I take a fiber supplement every day (metamucil). It sucks that even doing all this, I still have gotten worse over time...that said, I probably could eat even better, eg eat a lot more vegetables and a lot less meat. I try to eat more vegetables, but my diet is still pretty meat heavy I would say.

I have not looked extensively into any food allergies. I was not lactose intolerant ~6 years ago, but it seems like I have become lactose intolerant. Beyond that, I don't know of any food allergies but of course that doesn't mean I don't have them I guess... Oh I've also gotten super sensitive to alcohol, which also heavily irritates my bowels. I have stopped drinking as a result, more or less completely for the last 6 years. The occasional drinks I have had have reaffirmed that my bowels are sensitive to alcohol.

I will hopefully be moving to Tokyo later this year, so if there are any types of specialists worth seeing, I'm hoping that I can find decent ones there...otherwise if there is anyone in the US that is *really* worth seeing, I can try to line up an appointment for the next time I visit the US...but I think that'd only be worth it if there are more obscure things worth looking into, ruling out, etc. I'm willing to put effort or resources behind trying to make this better, I just have no idea what to do. It seems like it's a sort of "sucks to be you" type of thing that isn't super well understood, but I also haven't looked super extensively b/c every time I've tried it's been demotivating. The experience with the GI in the past was pretty disheartening, as he was basically just like "well, you're better than a lot of people, avoid spicy food and...sorry." But I also have gotten a bit worse in the intervening years (that was maybe 6 years ago), so maybe there'd be more to investigate now, I don't know.

I welcome your experiences and your advice.
posted by wooh to Health & Fitness (22 answers total) 12 users marked this as a favorite
 
Sorry that you're going through this. Quality of diagnostics aside, have you ever had an endoscopy done? I understand that is more the procedure for ruling out celiac (rather than the colonoscopy, for crohns and ulcerative colitis). But I could be wrong.

I have an IBD diagnosis, not IBS, but I think a good GI (ie curious, interested in investigating) makes all the difference. Maybe worth it to try another one?
posted by pepper bird at 6:11 AM on February 16, 2023


When I was first diagnosed with IBS I eliminated as many FODMAP foods from my diet as I could and slowly reintroduced them as I started feeling better. I found that there are a few that will always cause GI distress but the rest I can tolerate pretty well unless I’m in the middle of a flare up.

Can you get tested for SIBO overgrowth? The treatment is an antibiotic and it definitely made a difference in my symptoms.

I personally really like whole psyllium husks as a fiber supplement. The GI doctor who recommended it to me encouraged me to experiment with the time of day I took it to maximize benefits. Have you tried probiotics? Align and Culturelle are the two brands doctors I’ve spoken to love but any foods that contain a lot of probiotics would be beneficial. I would strongly recommend eating more vegetables, my bowel movements inevitably suffer when my diet becomes meat and starch heavy.

It took me years to get my IBS under control so I feel your pain, it takes a lot of trial and error to figure out trigger foods and beneficial dietary changes but it’s doable!
posted by fox problems at 6:12 AM on February 16, 2023 [1 favorite]


I don't have an official diagnosis, but have similar food sensitivities and flares at times. A couple of years ago I had my gallbladder removed, and had more diet issues related to that. So I was prescribed Prevalite (cholestyramine), which binds with the food to slow things down. It's been a great fix all around, and it looks like it's directly prescribed for IBS-D also.
posted by bizzyb at 6:18 AM on February 16, 2023


I had this, cut a lot of processed food out of my diet for other reasons and found that it had the effect of significantly reducing this as well.
posted by corb at 6:20 AM on February 16, 2023 [2 favorites]


Was diagnosed with IBS 30ish years ago. GI docs are typically not nutritionists and will only have suggestions about food. (Dad is a GI doc and admittedly knows zero about food.) My IBS has been mostly under control for about 10 years. Only recently have I really internalized that I literally am what I eat. I now know that these foods will cause symptoms: fried foods, soy (ingredients, soy sauce, and soybean oil which is found in nearly every US commercial salad dressing and many processed foods), very acidic foods, very spicy foods, very fatty foods, wheat, refined sugar & other refined carbs. Basically everything that's highly processed and highly convenient.

I recommend you do an elimination diet. Go back to basics. Make as much of your food from scratch as you're able. If you're able, cut out all processed food and after a while start slowly reintroducing them. Also cut out foods that are known inflammation triggers. Keep a log so you remember what you've tried.

Even if this doesn't solve your problems, you'll have a log of data for the next specialist you see. This will save time in the long run, because they won't waste their time making all these same suggestions about food.
posted by ImproviseOrDie at 6:36 AM on February 16, 2023 [4 favorites]


I found this video from Nutrition Made Simple interesting. Anecdotes, really, but might be helpful for you.
posted by jonrob at 7:07 AM on February 16, 2023


Horrific stress triggered IBS for me in my twenties, and sometimes still does. I could only eat dry toast and apples for a long time. Later I did the elimination diet for migraines and settled into a very limited diet that is like 50% apples, cereal and coffee, with a small rota of safe dishes, and the gut issues largely went away. You have to track this to see what works and what doesn't, and the elimination diet is helpful for ruling out interactions.
posted by dorothyisunderwood at 7:13 AM on February 16, 2023


Yes, I've had similar issues and they improved a lot after I eliminated dairy and gluten from my diet. I never got a diagnosis of anything, but kind of figured out those foods triggered by stomach pain/upset/digestive issues.

Coincidentally, I also lived in China for a while (I am back in the US now). Celiac disease is really not well-known there at all, so it might be hard to get a diagnosis (I worked with American students with celiac who had to avoid gluten and almost no one had heard of this, including doctors in a hospital. Maybe it's better known in really major cities like Beijing/Shanghai)
posted by bearette at 7:16 AM on February 16, 2023


I was diagnosed with IBS some years ago, before COVID-19, and my doctor cheerfully said there was no cure. He also said we would have to deal with my mental health issues first. Now I have read a lot about gut-brain connections, so I'm not sure about that decision, but whatever.
Then I read an article in The Guardian about gut health, and began to follow a high fiber, high fruit and vegetable, and high variation diet, and today, the IBS is gone. Obviously, I studied more about the concepts, I bought a couple of books and found more on the internet. But basically, I try to get 25 grams of fiber and five fruit and veg every day, and 30 different plant foods every week. I have a spreadsheet for each month.

Some issues you need to know:
To begin with, your stomach will riot. Go slow, not from 4 grams of fiber to 25 in one week. And even then, there will be rumbling, literally. But don't worry, keep going. Your gut microbiome needs to adjust.
For the first many months, you will experience severe backlash if you don't follow the diet just one day. Don't worry, keep going. One day you will suddenly realize that you can have a mostly-meat day and nothing bad happens, as long as you get back on track the next day.
The scientists recommend intermittent fasting. Nothing big, just skipping either breakfast or dinner a couple of times a week. Obviously you don't need to get 25 grams of fiber on a fasting day. You don't have to fast to make this work, but as I understand it, it speeds up the process.
Fermented foods are good.

I don't know what the challenges to getting enough fiber will be where you are. I found it hard to begin with, but I realized a lot of traditional food here is rich in fiber, and it has worked out OK. I don't think you will struggle to get the 30 different vegetable products a week since seeds, herbs, spices and condiments count as well. Till now, I've had at least ten vegetable products in just this day, and there will be a few more at dinner. What I struggle with is enough fruit and veg, it seems contradictory but one might use a lot of different spices and herbs through a week without eating five whole fruits and vegetables in a day, specially if one is on a budget.

Another thing is that chilled (and reheated) rice and noodles develop resistant starches, which I don't count in my spreadsheet, but are very good for gut health. So fried rice or noodles might be good things.

Peanuts and peanut products are good too, if you aren't allergic.

It took a bit of thinking to begin with, but considering the benefits, I feel it has been worth it.
posted by mumimor at 7:22 AM on February 16, 2023 [7 favorites]


I have IBS, which used to be mild but got much worse after I had a parasite. I recently did a full blown low-FODMAP diet, working with a dietician. I did 3 weeks of strict diet, then a few months where I introduced a food then withdrew it and tried another. It really did help, as did keeping careful notes (my dietician has an app, but I prefer paper). My dietician follows the monash plan, which you can google if you’d like.
posted by Valancy Rachel at 7:53 AM on February 16, 2023 [1 favorite]


The immediate BMs after meals could point to "dumping syndrome," which can be exacerbated by simple sugars and/or eating too quickly. When I was having similar issues, my nutritionist recommended avoiding liquids for 30 minutes before meals until about an hour after - only a few small sips with food. This greatly cut down on the urgent diarrhea.

And seconding a FODMAP trial diet to see if you can rule out what might be triggering you.
posted by writermcwriterson at 8:32 AM on February 16, 2023


I am a person who is on a high-fiber diet -- above 25 grams per day -- and what surprised me at first was just how hard it is to get that much fiber! If you start tracking yours, you may see that you're still at a fairly low amount, even with your supplement. (Many supplements provide a grand total of 4ish grams.) It definitely takes planning for me to be able to hit that number day to day, but doing so has definitely helped me intestinally.
posted by BlahLaLa at 9:09 AM on February 16, 2023 [2 favorites]


I had several years where multiple doctors told me that my GI symptoms were just IBS but as someone with a scientific background I actually looked up the criteria for IBS diagnosis (the Rome Criteria). My symptoms did not meet the Rome Criteria for IBS diagnosis yet every doctor I saw failed to note or mention that and a GI specialist got a little huffy when I asked about it.

I tried so many things - allergy tests, imaging, probiotics from my doctor. Doctors recommended trying a highly restrictive diet where you basically eliminate everything and add foods back into rotation slowly to see if there are any triggers. I tried this twice with absolutely no relief.

Eventually I ended up with a nurse practitioner as my primary care provider. She actually carefully listened to my symptoms and suggested an SSRI. Apparently SSRIs can be very effective at helping with what are called functional GI disorders.

The GI symptoms I had been struggling to manage for a few years got better after a few months on an SSRI and eventually fully resolved. After about a year I stopped taking the SSRI and my gut issues never returned.

More info on GI issues, IBS, and antidepressant medication.
https://www.med.unc.edu/ibs/wp-content/uploads/sites/450/2017/10/IBS-and-Antidepressants.pdf

posted by forkisbetter at 9:40 AM on February 16, 2023 [1 favorite]


Eventually I ended up with a nurse practitioner as my primary care provider. She actually carefully listened to my symptoms and suggested an SSRI. Apparently SSRIs can be very effective at helping with what are called functional GI disorders.

I find this very interesting, since I have also been struggling with mental health issues. BUT, for me SSRIs seriously worsened my gut health issues. So don't do this without good professional advice.
posted by mumimor at 9:46 AM on February 16, 2023 [1 favorite]


Look into rapid gastric emptying—the meal timing tracks and spicy foods are a trigger. In case you haven’t thought to track this, sugar as well as drinking water with your meal are also triggers. A barium swallow test can diagnose it, but you can also experiment at home by following the guidelines: six small meals a day (large meals make it worse), no drinking liquids 30 minutes before or after meals, try to lie down for 20 minutes after eating. Avoid sugar, spicy food, or very hot/very cold foods. And soup, for the same reason as avoiding liquids.

Internet will tell you this only happens to people who have had gastric bypass surgery but this isn’t true, some people just have it for unexplained reasons.
posted by brook horse at 10:22 AM on February 16, 2023 [1 favorite]


Oh, one thing that you probably will be able to find is mushrooms. There seems to be quite a bit of scientific documentation that mushrooms are good for your gut health. And mushrooms are a great 1:1 substitute for meat in a lot of dishes. Eggplant is very good too.
posted by mumimor at 11:08 AM on February 16, 2023


I basically upped my fermented food intake, soluble fiber intake and experimented with different brands of probiotics (everything from the drugstore aisle generics to the fancy refrigerated section at the natural foods store). I liked the Phillips line, but wanted to try lots of different probiotic strains because I had no idea what would work (also I was operating under the theory that diversity in the microbiome would be useful). These days I am much better and don't take a daily probiotic, but I do continue to eat lots of fermented foods and try to increase fiber consumption when I start feeling questionable.
posted by spamandkimchi at 2:58 PM on February 16, 2023 [1 favorite]


I had symptoms like yours for quite a while in my life, with the same diagnosis, though I visited fewer doctors. Mine came on as a long virus issue -- I got a stomach bug and just never fully got better. I'm 99% ok now -- maybe 2-3 bad days a year, mostly during stressful times.

I enthusiastically second mumimor's recommendation for the Guardian diet plan. I had always been a vegan but I felt a lot better once I stopped eating takeout and switched to a very, very fiber-rich, relatively low-fat diet (I just ate a breakfast with 10+ grams of fiber, for example) with a lot of different plants & legumes. I made the change gradually and it took a while before I started feeling normal again. I still have to stay away from certain foods and drinks (diet coke, super spicy foods, foods with a lot of saturated fat), but those restrictions mostly track with how I like to eat anyway, so they're pretty manageable.

I also don't know much about the gut-brain-vagus nerve connection issues, but all of what people are recommending you explore there tracks anecdotally for me -- being happier and less stressed overall definitely helps. But, of course, being sick is stressful, so it's a hard cycle to escape from.
posted by snaw at 4:11 AM on February 17, 2023 [3 favorites]


Re the mentions above of low-dose antidepressants for IBS: there is good evidence of their effectiveness for many people, but unfortunately too often they are prescribed with insufficient guidance on how to taper off them when the time comes. Many people need to reduce much more slowly than doctors and pharmacists tend to suggest in order to avoid serious side effects, as suggested by a good recent article for clinicians on discontinuing them. (And this is true no matter what prescribed dosage you're coming off of. Speaking from direct experience here.)
posted by Creosote at 9:38 AM on February 17, 2023 [1 favorite]


Make sure you get tested for celiac disease before making any big changes to your diet, like low-FODMAP. My doctors thought I had IBS and being on a low-FODMAP diet complicated my diagnosis.
posted by congen at 12:38 PM on February 17, 2023 [1 favorite]


Oh, and a colonoscopy would not tell you if you have celiac disease - the damage is in the small intestine and requires an endoscopy to see. There is a blood test you can have first (though it has an unfortunately high false negative rate).
posted by congen at 12:39 PM on February 17, 2023


My husband has found help by of course avoiding triggers but also lots of fiber pills (like, 2 at every meal and 1 at his nighttime snack) and eating a lot of carrots (more fiber). He eats a pretty low fiber diet aside from the carrots due to other food issues, so more fiber pills has really helped. It may be an easy way to see if adding more fiber helps your problems, which then of course can be switched with food.
posted by evening at 10:39 AM on February 19, 2023


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