One year on – Still living Fat Free!

It’s exactly one year since I posted my first blog about my ‘tummy troubles’. My ramblings about my digestive dysfunctions have had nearly 9000 views over the last 12 months which is just astonishing to me! Hopefully I’ve provided some answers or given a new perspective to people looking for help with their own digestive problems.

I’ve found out so much more about what could be causing my symptoms (fat intolerance, eggy burps) over the last year. I’ve had a few theories, tried out a few different experiments – some worked, others not so much (My Trial with Symprove). In general life I am fitter than I’ve been in a long time – maybe ever. Exercise helps a huge amount with my symptoms. Here’s a Tara Stiles yoga video which is great for easing that over-full feeling.

I’ve discovered over the last year that coca-cola can be a medicine for helping to move stuck food through your stomach. The first instinct when you feel sick is to take antacids but if you have bile reflux the problem may be that your stomach is not acidic enough because bile is neutralising the natural stomach acid required for normal digestion. A small drink of cola may be all you need to feel fine – antacids could be making things worse! I still occasionally get acid reflux as well and take an antacid but only the burn in my throat is particularly uncomfortable.

In the last year I’ve also learned more about the ‘second brain’ we have hiding away in our digestive system. Our Enteric Nervous System controls all the different aspects of digestion and is almost entirely independent of our ‘first’ brain. This is why it is so very difficult to diagnose stomach disorders. Any number of things can be wrong yet because our stomach and our brain do not talk to each very well our only indicators of a problem are nausea or pain. There’s a lot of research about how our food intolerances can effect our mood. It is so common for people to blame digestive disorders on depression or stress but what if it is the digestive disorder that is causing the feelings of depression or stress? I’m reading up even more and planning to post about our second brain soon.

My diet is still very low in fat and that continues to keep the particularly bad episodes at bay. My last one was in February the day after stealing a pizza crust from my husbands dinner plate. The pizza crust was delicious but definitely not worth the result. Times like that renew my resolve to fight to be healthy and live a good, happy life not chained to the bathroom! I still get waves of nausea, bloating, sensation of fullness and ‘traditional’ IBS-D symptoms on a daily basis but they are eased by keeping portion sizes small and avoiding those foods which I know trigger my symptoms. Everyday I discover something new and everyday I get closer to finding that perfect balance to keep my digestive system calm and functional permanently. Thank you for reading!

What causes Eggy Burps?

When I have a really bad episode coming the first sign is eggy, sulphurous burps. For me these eggy burps are always followed within minutes or hours (each episode varies) by excruciating upper abdominal pain then sometimes by vomiting and always by diarrhoea. I have mentioned eggy burps to every doctor I’ve seen over the years and never had an explanation of why these occur or how to stop them. Even the more verbose doctors who, quite frankly, loved the sound of their voice were more keen to explain to me the technicalities of bowel innervation than why I was belching pure rotten egg stench. I’ve had various theories and none seemed to fit completely. I have repeatedly searched the Internet – never the most reliable source for symptom analysis – and found various herbal remedies and personal accounts which do little to shed light on the physiological processes involved.

Bacterial infection is the most common cause of eggy burps but the effects are short term, gone after the immune system or antibiotics evict the bad bacteria. Having an extremely high protein diet (bodybuilders beware) is frequently associated with eggy burps. Infection with the Giardia parasite is another increasingly common cause. There are a lot of people that believe these repeated symptoms of eggy burps, stomach pain and diarrhoea are as a result of one initial Giardia infection (giardasis) that somehow recurs or left damage in the digestive system in its wake.

I know the awful egg smell comes from hydrogen sulphide being produced somewhere in the digestive system and bubbling it’s way up and out through your mouth. Hydrogen sulphide (or sulfide) can be produced by the bacterial breakdown of organic matter in the absence of oxygen – anaerobic digestion. So what causes an environment in your gut where anaerobic digestion takes over the usual digestive process?

It seems to me that anaerobic digestion could be encouraged in a stomach that does not empty properly. I have found that my symptoms are worst if I eat food that contains too much fat. In a previous post I discussed how eating fatty foods could cause biliary colic type symptoms due to irregular spasms of the bowel. If these irregular spasms also cause the stomach to have delayed emptying or even completely prevents emptying at times then this could explain the bad smells as well. Fat is difficult to digest and has a slow transit time through your digestive system. If you had a digestive dysfunction (gastroparesis, gastric stasis) where food passes more slowly than usual through your gut then food that passes even slower would effectively get stuck and begin to stagnate. If you have ever collected up your food waste for separate disposal to your other household waste (think green) then you’re aware certain foods begin to smell very strongly quite quickly and others just decompose without much fuss. Imagine this process occurring in your stomach. It’s a big bag we’re pouring food and drink into regularly throughout the day – if that food gets stuck it’s going to start to smell and smell bad. This theory for me explains the ‘delayed reaction’, why if I sneak a bit of my husbands pizza crust one evening after dinner then I don’t get the eggy burps until the following afternoon. The pizza crust is still there along with a rancid soup of partially digested foods. The stomach reacts to evict this noxious concoction as quickly as possible – if it can’t go down then it comes up! If some does make it’s way down into your intestine then in those with an already sensitive, ‘irritable’ bowel it passes out extremely quickly. So slow stomach transit time is followed by extremely rapid exit time!

In a normal functioning digestive system the stomach emptying process begins within about 20-30 minutes of eating a normal meal and the stomach is mostly emptied after about 3 hours. The higher the fat content the longer the emptying time, if the meal is less solid (i.e. soup) then transit time will be faster. So is the solution simply to eat less – or just soup? I’ve found from my experimentations with food that only eating soup does not help as much as would be hoped. A lot of soups you can buy in the shops or restaurants are very high in fats, plus the liquid state does not stimulate the stomach enough to begin emptying. Smoothies also tend to include hard to digest fruit skins and other indigestible fibres plus fruit acids. Small snacks are not large enough to stimulate the stomach to begin emptying. Large fatty meals are too much for the stomach to process efficiently resulting in stinky ‘leftovers’. I’ve also experimented with probiotics in the hope that introducing ‘good’ bacteria’ would prevent the proliferation of ‘bad’ bacteria which could create the environment where hydrogen sulphide is produced. Unfortunately my experiments did not produce definitively positive results for but it may work for others!

The best ways I’ve found to prevent eggy burps are:

  • to eat regular small meals (i.e. risotto)
  • avoid hard to digest foods (e.g. fats, insoluble fibres, fruit skins, any meat except chicken and turkey)
  • try not to eat any later than 4 hours before bedtime
  • exercise regularly to physically assist movement through the bowel

My Trial of Symprove – a promising probiotic treatment for IBS

There has been talk in the press in recent months of a probiotic drink called Symprove which has apparently been shown in clinical trial to  reduce symptoms of IBS in half of the participants. I have not been able to find an official write up of this clinical trial but it is registered with Current Controlled Trials. The main difference between this probiotic and all the hundreds of others currently on the market  is that that Symprove is dairy and gluten free so removes two common IBS triggers from the delivery system.

After such a promising write up I thought I might give it a try. I’m not one who goes for any fad diet or radical treatment without first having solid evidence but the theory appears sound and I doubt it can make my symptoms worse. Plus it sounds much more appealing than faecal transplant!

I am not here to advertise, nor am I being sponsored in any way to write this I just wanted  to share my experiences of trying Symprove for the first time.

Day -2 – My parcel of Symprove had unfortunately arrived while I was out and so was taken back to the parcel collection depot where I was not able to collect it for 48 hours. I am hopeful that in this time it was not stored on a radiator!

Day -1 – The night before my first dose of Symprove was the worst in a few months, I awoke at about  2:30 with stomach pains, nausea and diarrhoea and spent the rest of the night in the bathroom. So my motivation to try Symprove and for it to work was high.

Day 1 – My lovely husband went out for me to pick up the parcel so I could finally try my first dose of Symprove. I can honestly say that it is the most foul thing I have ever tasted! It tastes like liquid yeast. Unpleasant but you only have to drink 1ml per kilo of body weight so not a massive dose and only once a day. My husband helpfully pointed out that anything that tastes that bad must be good for you! There was no magic instant disappearance of symptoms but that is of course to be expected. There was some yeasty reflux throughout the afternoon but no apparent adverse effects although I was still quite sore and nauseous from my bad night.

Day 4 – I’m getting into the routine of waking up and having my shot of Symprove first thing before breakfast. There is still no dramatic difference in my symptoms. My stomach pains, diarrhoea and nausea are settling down at their usual pace after a bad episode.

I’ll continue to update this post regularly with my experiences. Please feel free to share if you’ve tried Symprove.

16th November 2012

One month – So after a month of drinking Symprove every morning I am definitely not ‘cured’ but there has been some improvement, enough for me to want to continue. In the last month I’ve had two episodes of fairly severe symptoms involving diarrhoea and some nausea but no vomiting and not the worst kind of upper GI pain. The worst of my ‘episodes’ have been very rare this year anyway because of the balance I’ve found in diet and medication. The most recent bout of diarrhoea I have theorised may have been triggered because it was a ‘treat’ day in honour of my husbands birthday and although I didn’t eat much fat as per my usual diet I ate much more sugar than usual. This may have disturbed the new gut flora causing them to bloom or react adversely in some way thus causing the stomach upset. Since going back to my usual diet my symptoms have settled again. In the first couple of weeks I actually noticed a slight increase in lower left side bowel cramps but this in general has settled down now.

I’ve found over time the taste of Symprove is not so unpleasant to me, although still far from being pleasant! It seems more like a very concentrated apple juice. One slightly peculiar side effect I have noticed is that my urine sometimes smells of Symprove!

The main improvements have been a settling down of my dyspepsia type symptoms. I had anticipated that this treatment would benefit my lower GI but not for my upper GI symptoms however at the moment it appears the reverse. Perhaps with more time things will change again!

 

11th March 2013

It has been too long since I last updated this post! I completed my 3 month trial of Symprove in January and unfortunately I can’t report any ‘miracle cure’ of my symptoms. I’m not even sure if any slight improvement in my symptoms was down to the Symprove or wishful thinking. I think treatments like these are a great positive start in treatment of IBS rather than simply blaming it on stress but for me I suppose my digestive dysfunction is more complex than a bacterial imbalance or overgrowth of ‘wrong’ bacteria.

I try to remain positive and continue with the things that work for me which are eating a very low fat diet, avoiding insoluble fibre, dairy and alcohol and exercising regularly. I am still not symptom free but I will continue to experiment and hope for the best!

 

Search terms

I was just looking through my stats page at the search terms that are finding this blog and the two most common are fat intolerance closely followed by eggy/sulphurous burps (accompanied with either stomach cramps, nausea, vomiting, diarrhoea/diarrhea).

When I first started searching for help with my symptoms online I remember searching and finding so many pages and pages of results with a massively overwhelming range of diagnoses for my symptoms (including biliary colic (gallstones), pancreatitis and Crohn’s disease). One disease that would come up regularly and I haven’t discussed so far in this blog is giardiasis infection. This is a parasitic infection with the symptoms of eggy/sulphurous burps, nausea, vomiting, stomach cramps and watery diarrhoea that is easily treated with antibiotics but it can only be contracted by drinking contaminated water in places such as Africa, South and Central America, Russia and some areas of Eastern Europe. So if you haven’t been travelling to any of these places within a couple of weeks of your symptoms beginning then it is unlikely this is the cause of your symptoms.

Today somebody searched for ‘why does eating out make me ill’ and I really hope they found some help from my blog. Unfortunately eating out is almost impossible when you have to be careful about how much fat you eat as restaurants tend to pile on the butter and oil. Even items labelled as ‘low fat’ or ‘healthy eating’ can be laden with oil but just not quite as much as other dishes on the menu. I’ve found it’s safest and least stressful to cook for myself from raw ingredients so know exactly what I’m eating.

Why Does Eating Fat Make Me Sick?

I asked this question to various doctors while my symptoms were being investigated and I never got a clear reply. So if you are experiencing pain, sickness, diarrhoea or even just foul breath and eggy burps after eating fatty food then hopefully I can help you to understand why.

Firstly how is fat digestion supposed to work? The majority of fat digestion occurs in the small intestine. When the fat reaches the start of the small intestine (duodenum) it triggers the release of hormones which in turn initiate the release of enzymes from the pancreas and bile from the liver (via the gall bladder and bile duct, see here for an excellent diagram of the digestive system). The healthy stomach is very acidic mainly to assist in protein digestion and to break down or damage any pathogens (germs) that may have found their way into the stomach. However our digestive enzymes are proteins too so they do not work as well in an acidic environment. One function of bile, along with sodium bicarbonate released from the pancreas, is to restore an almost neutral pH to the bowel so the digestive enzymes can function properly. Bile is also essential to fat digestion by making the fat molecules water soluble (emulsification) which makes the digestive enzymes job much easier. The most important enzyme for fat digestion is pancreatic lipase, it completes the digestion process and allows the small intestine wall to absorb the fat molecules.

So this is how the fully functional fat digestion process works but why and how does this process end up causing pain and sickness in some people? If you have had all the tests and scans showing no ulcers, inflammation, gallstones, pancreatitis or other disease then the fault will possibly lie with irritable bowel syndrome (IBS).

The main symptoms of IBS are caused by erratic bowel spasms. If one or more of these spasms occurs in the duodenum it can result in the stomach not being able to drain properly (sometimes known as gastroparesis) leaving an uncomfortable full sensation, bloating, bad breath, nausea, stomach cramps and feelings of ‘indigestion’ (dyspepsia). I have found eating smaller meals more frequently helps with all of these symptoms and low dose (10mg) amitriptyline helps with the discomfort and pain.

Why are these symptoms worse when fat is present? This could be the result of ‘bile reflux’. Bile is only released in the presence of fat in the duodenum and bowel spasms may push this bile into stomach. Bile is not normally present in the stomach so this upsets the normal digestive process. There are some reports that bile can damage the stomach lining resulting in symptoms of gastroenteritis (gastritis) or worse lasting damage but I do not believe these have been scientifically verified and should not be something to worry about. Bile acid sequestrant medication can help with these symptoms. Bile acid sequestrants include: Cholestyramine (Questran) , Colesevelam (Cholestagel in Europe, Welchol in the USA) and Colestipol (Colestid, Colestipid).

The worst symptoms I get after eating fatty foods are extreme stomach pain (usually occurring in the night or very early morning), vomiting and diarrhoea match closely those of biliary colic. Biliary colic is the pain resulting from gallstones blocking one or more of the ducts leading from or to the gallbladder causing it to distend. So it is possible that the bowel spasms somehow prevent draining of bile from the gallbladder into duodenum causing the gallbladder to painfully distend. In a similar way bowel spasms could mimic pancreatitis as bowel spasms could prevent draining of the pancreas via the pancreatic duct into the duodenum. Both amitriptyline and bile acid sequestrants help to control the diarrhoea but the best treatment I have found to prevent these extreme episodes is to eat a very low fat diet. I have not found any medication that helps, even powerful painkillers do not control the pain it is simply a matter of waiting it out. Unfortunately there is no ‘cheat day’ on this diet even one sneaky chocolate bar would result in a really bad night. For more information on my diet see here.

My Experience with Irritable Bowel Syndrome (IBS)

This month is IBS Awareness month and because of this so I have been inspired to write about my experiences.

I was first diagnosed with Irritable Bowel Syndrome (IBS) when I was about 11. IBS is a condition where erratic bowel spasms cause many different gastrointestinal symptoms. My particular brand of IBS is known as IBS-D as my main symptom was diarrhoea, along with painful bowel spasms. Stress is definitely a trigger, but I also just had good days and bad days that seemed to me to be unrelated to stress and became just one of those things I dealt with in life. Diet changes and medicines didn’t really seem to make much difference in any significant way. In December 2009 (aged 31) I woke in the night with severe stomach pain and the most awful sulphurous (eggy) burps followed by vomiting and diarrhoea. This persisted for a few days then went away so I dismissed it as a stomach bug. Then at Christmas I experienced the same symptoms again, then a month later again, then two weeks later and so on and so on. Various visits to doctors, referrals and scans later I got no help, advice or support just doctors with concerned expressions suggesting another scan they could try. Meanwhile I just kept losing weight and was getting desperate so I turned to the Internet for help. I found out, unhelpfully, that my symptoms matched several conditions which is what you get when you search medical conditions on the Internet! Though I came away with the novel concept of fat intolerance – something I’d never heard of before. I immediately became more aware of the fat content of what little food I was able to eat and cut it down as much as possible. I found I didn’t get the night time pain and vomiting though the daily diarrhoea, stomach cramps, bloating and discomfort were persisting so my weight was still dropping – although more gradually. Finally after all scans showed no abnormality or disease a doctor suggested that all of my symptoms may be a part of IBS. This at first seemed ridiculous to me, but I have since read this:

“The erratic intestinal spasms associated with irritable bowel syndrome, or IBS, may delay the emptying of food from your stomach (sometimes known as gastric stasis or gastroparesis). In gastroparesis, food sits undigested in the stomach for extended periods of time rather than passing directly into the small intestine. Increased random movement in the small intestine after eating may cause the stomach to empty too slowly. This interruption in the normal passage of food and fluids from your stomach may result in upper abdominal pain, heartburn, nausea, vomiting or an abnormal sense of fullness after having eaten only a small amount. The intestinal spasms that contribute to gastroparesis may also cause diarrhoea, nausea, abdominal cramps and bloating in some people who suffer from IBS.

Changes in your diet may help you manage gastroparesis and control the altered digestion and bowel patterns associated with IBS. Eating six small meals each day rather than three large meals may help food pass more easily through your stomach. By avoiding fatty foods, which slow digestion, and high-fibre foods, which are more difficult for the stomach to process, you may digest foods more efficiently.“

I found when I searched online for anything to help that there are so many people out there with the same symptoms I have. For as many people feeling these symptoms there are as many different diagnoses. The human gastrointestinal system is as individual as a fingerprint, hugely complicated and poorly understood. So until medical science catches up with IBS I take daily medication (anything between 1-10 tablets a day) exercise regularly and carefully control my diet to minimise my symptoms. My intention with this blog is share my experiences, fat free recipes, exercise ideas and anything I’ve found over the years that helps my symptoms with the hope that it’ll help someone else too.