Happy New Year, happy new you!

Happy New Year everyone! I hope you all enjoyed Christmas (or whichever midwinter festival you celebrate) and new year. If you are reading this then like me you probably find this time of year particularly tough. Here in the UK the main focus of Christmas and New Year celebrations is over indulgence. Eating too much, drinking too much and then slouching in front of the tv. These things all combined is enough to make anyone ill but with me I get very ill. Even after 4 years dealing with fat intolerance the temptation to just have one bite of this, a tiny piece of that can be too much and I end up being sick and in pain while everyone else is being ‘festive’. The combination of feeling ill and the dark, cold weather is a recipe for depression.

I often hear about the link between IBS and depression and I’ve said before I believe it’s a two way street – the bowel influences the mood as much maybe even more than your mood influences your bowel. The fight to remain positive and proactive can seem laughable if you’re feeling exhausted and overwhelmed by your symptoms but it is possible. One of the reasons I started writing this blog is that all of the message boards and forums on IBS were so negative and quite frankly whingey. IBS is a common dysfunction, it varies from person to person in so many ways but your symptoms are not unique, you are not alone. Unfortunately despite being so common there is no consensus on treatment or even how it’s caused. This is where you come in. If you’ve been to the doctor and been checked and scanned and poked and prodded and told there is nothing wrong it’s ‘just’ IBS now it’s time for you to begin to take control of your own condition. Feeling positive about your ability to help yourself is essential. You can feel better and you will. Your bowel is often referred to as your second brain and as such theoretically it can be reasoned with. Nourish it with good food, massage it with exercise, take it out for long walks (well not ‘out’ out but if you take yourself your bowel will surely follow). Treat your bowel with kindness and it will respond.

Life isn’t made better by chocolate or wine – life is made better by feeling well, happy and full of energy.

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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!

IBS or Functional Gastrointestinal Disorder – What’s in a name?

I find it difficult to discuss my ‘tummy troubles’. Which is part of why I started writing this blog. It’s hard to judge how much detail a person wants when they ask ‘so what exactly is wrong with your stomach?’. Do people want to hear about vomit and faeces or do they just want a nice ‘medically’ sounding disease name? I usually begin with saying my stomach just doesn’t work properly. If I say I have irritable bowel syndrome (IBS), which is true, most people associate that with pro-biotic yoghurt adverts with middle-aged women discussing ‘digestive discomfort’ rather than staying up all night on or over the toilet emptying your entire body contents because you unknowingly ate something containing a spoonful of oil. If I mention fat intolerance quite often I get the response ‘ooh that’s good – I wish I had that’. I can understand the response being jokey and meant harmlessly but depending on how ill I’m feeling that day I can take it quite badly (though I have to admit I laughed hard when someone thought it meant I really couldn’t stand fat people).

I was recently asked to fill in a health questionnaire as part of registration to a fitness centre. Most of it was straight forward as these things are but I was stumped by the last question – ‘are there any health concerns your instructor should know about?’. What do I put? IBS as everyone ‘knows’ is just a bit of bloating isn’t it so why list that as health concern? Unfortunately an over-sensitive spasmodic stomach and bowel can be a whole lot more than that. Should I put Functional Gastrointestinal Disorder which is perhaps a more accurate description of my collection of symptoms? The owner of the fitness centre said ‘basically what we need to know is what we would need to tell a paramedic if you passed out’. So I immediately decided to leave the section blank – why would there be any reason that I should pass out so why agonise over the details of the form. I have wondered after the event why I had such trouble with the question? Am I embarrassed to be associated with having IBS even though it so obviously affects my life and is thus one of the things everyone knows about me – I have ‘tummy troubles’. Is it a pride thing? To admit I have a weakness is difficult for me especially one of no known cause that some (not me) believe is entirely psychosomatic.

The Rome III criteria definition for irritable bowel syndrome (IBS) is as follows:

Recurrent abdominal pain or discomfort at least 3 days/month in the last 3 months associated with two or more of the following:
1. Improvement with defecation
2. Onset associated with a change in frequency of stool
3. Onset associated with a change in form (appearance) of stool

So according to the Rome III criteria IBS doesn’t cover stomach symptoms. I would need to include functional dyspepsia:

Functional Dyspepsia
Diagnostic criteria* Must include:
1.One or more of the following:
a. Bothersome postprandial fullness
b. Early satiation
c. Epigastric pain
d. Epigastric burning

and

2. No evidence of structural disease (including at upper endoscopy) that is likely to explain the symptoms
* Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis

and to cover the fat intolerance symptoms I would need to include functional gallbladder and/or sphincter of Oddi disorders:

Functional Gallbladder and Sphincter of Oddi Disorders
Diagnostic criteria
Must include episodes of pain located in the epigastrium and/or right upper quadrant and all of the following:
1. Episodes lasting 30 minutes or longer
2. Recurrent symptoms occurring at different intervals (not daily)
3. The pain builds up to a steady level
4. The pain is moderate to severe enough to interrupt the patient’s daily activities or lead to an emergency department visit
5. The pain is not relieved by bowel movements
6. The pain is not relieved by postural change
7. The pain is not relieved by antacids
8. Exclusion of other structural disease that would explain the symptoms

Supportive criteria
The pain may present with one or more of the following:
1. Associated with nausea and vomiting
2. Radiates to the back and/or right infra subscapular region
3. Awakens from sleep in the middle of the night

So perhaps just to say I have Functional Gastrointestinal Disorder is easier! However as each of these conditions can be explained by erratic bowel spasms then it seems bizarre to give them separate names. My bowel is erratic and unpredictable – irritable in fact!

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

Recommendation: IBS Diary app for Android smart phones

Just a quick recommendation for My IBS Diary an app available for android smartphones. This is a great app for tracking symptoms, medication, bowel movements and food all combined in one diary app that’s easy to use. I am not sponsored by or involved with the company who created this app but I’ve used it and found it genuinely useful. There is more emphasis on emotional feelings than I’d like and there is no option to record vomiting or to specify which area cramps occur however there is a general ‘notes’ section where you can write freely. The data recorded by the app can be downloaded onto your computer and then be used however you wish. Also the icon that appears on your screen is discreetly titled ‘Today’ so any nosey people would be none the wiser as to the status of your bowel!

It’s very common for IBS sites to recommend keeping a food diary and/or a symptom diary but whether it works for you is a personal issue. I would recommend trying it out. It is surprising sometimes when you have a bad day then look back to what you’ve eaten the previous couple of days and it becomes obvious which food has triggered the episode. It is also possible you’ll find out you don’t have any food triggers which may indicate a different condition is responsible for your symptoms. Also there are some foods which are demonised and we are told we should absolutely avoid but keeping a diary may tell you that this food has no effect on you at all. Either way I think more information is always useful and this app is a nice start towards a comprehensive way of recording all aspects of your own particular brand of digestive dysfunction.

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.