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Good post frygirl and I will get back to you on it, but your doing the right things, it might just take time and people have flares that come and go sometimes. I will get back to you and help where I can.
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It is complex, but I think I get the gist. What does this mean in terms of treatment? To reduce stress, of course, but life requires a certain amount of stress. And personally, my symptoms are just as bad now as they were when I was working at a highly stressful job. I believe my baseline for reacting to a perceived stressor is higher than most people's because I've kept that stress level up so high for so long. That's my 'normal', if you will. I'm sure this doesn't help my IBS symptoms, especially in light of the information you provided. As I said, I am working on that, and I do think I am doing a lot of good things to reduce it.
Also, I don't primarily get D, especially since I've cut fatty foods from my diet. On a day to day basis, my complaints vary a lot from being overly gassy, bloated, nauseous, twingey pain to more widespread pain in my abdomen, minor cramping, heartburn, reflux, dizzy, weak, fatigued, a sense of urgency that most often passes with gas only, strong, uncomfortable pressure and nerve sensations in my pelvic region. Can I assume that most, if not all these symptoms are affected by the same process you described in your post?
One thought occurred to me: you said the big brain communicates to the little brain through the vagus nerve. To my understanding, the vagus nerve is also responsible for gastric emptying. It seems significant to me that I have gastroparesis and IBS, both of which involve the vagus nerve. Thoughts?
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As an aside, whenever I eat yeasty foods ( and yeast and yeast extracts is in a lot of foods), I get that gurgling, gassy, bloating, sometimes D effect...pretty well everytime. I see yeast was high on the list. I developed yeast intolerance in the last 15 years or so; figured it out on my own by trial and error. I know I feel better when I don't eat processed foods in general. If a particular food bothers you, don't eat it. Don't wait for any study, or rely another person's experience or opinion to tell you whether it is "safe."
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yeast
#352377 - 11/17/09 10:36 PM
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Thanks Kim - it's interesting that yeast is a problem for you. I do consume a fair amount of sourdough bread and probably some processed things with yeast, so that is a possibility. I've personally had difficulty figuring out what other foods bother me - the symptoms are with me all the time and my diet is so restricted right now. I have to eat something! So I've been hoping to find some other indicators to help me figure out what it could possibly be. On the other hand, I'm not sure if it's unrealistic to expect my diet to fix these symptoms, thus my confusion. Anyway, I appreciate your insight on yeast.
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Shawneric has done an excellent job of discussing Ig test and IBS.
I have read the original article in the journal GUT. Following the article there were two letters from knowledgeable researchers that pointed out that this study had a design flaw. I can post these comments if you would like to read them. In a subsequent paper the senior author of the reported paper wrote that the mechanism by which IgG food antibodies could be mediating a detrimental effect in IBS is unclear; however, there mounting evidence to support a low grade inflammatory process in some patients. It is tempting to speculate that IgG antibodies could be involved in this process but the evidence is not clear.
I find that I have to be cautious about medical studies reported in the press. The only true account comes from reading the original study which can be difficult because the articles are technical and you need to belong to an institution that has a subscription in order to access them.
In January 2009 the American College of Gastroenterology Task Force on IBS released a report An Evidence-Based Systematic Review on the Management of Irritable Bowel Syndrome. You might find Section 2.6 Diet and irritable bowel syndrome on page S17 of some interest. They conclude patients often believe certain foods exacerbate their IBS symptoms. There is, however, insufficient evidence that food allergy testing or exclusion diets are efficacious in IBS and their routine use outside of a clinical trial is not recommended.
Another great question 
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
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Just fyi, but the " low grade inflammatory process in some patients' is seen more in PI IBSers, but also in IBS. This can happen when fighting the intial infection in PI IBS, but the infection goes away and a person is still left with PI IBS which can develop into "classic IBS" and the body not working right and so it thinks there is still an infection going on and keeps sending signals to the mast cells to fight the infection which isn't there. Kindof like an autoimmune responce, which can be driven by the stress of IBS itself, the symptoms themselves and life stressors, both emotional and physical in general. Say you feel a d attack coming on, your brain senses that as a threat to you, a threat to the organism and mounts a responce or even a pain attack. Fear and perceived or real threats can set this in motion. So just a perceived threat can set it in motion also and there are ways to calm this action down.
One thing to note is it is MACROSCOPIC inflammation of specific cells, mainly the mast cells I have been talking about on this thread and why I am saying its so important to learn about them and the process, but some others as well.
This is all so complex, but stress or a threat to the organism launches a chemical reaction that triggers the HPA axis or hypothalamic-pituitary-adrenal axis and the bodies fight or flight, before a person is conciously aware of it even, this sends signals to the mast cells which then degradulate and release histimine, the histimine, is like mild toxin the smooth muscle of the colon and contributes to d and pain. Stress can also reactivate previous inflammation of cells this way as well. This process is called neurogenic inflammation. This is something Dr Wood is explaining on this thread, its very important in IBS.
This is an expert on it all and its not a theory.
Comment from Emeran A. Mayer, M.D. -- In contrast to the common interpretation of the term "stress" as a psychological phenomenon, it should be understood as any real or perceived perturbation of an organism's homeostasis, or state of harmony or balance. For example, in this viewpoint a severe hemorrhage, starvation, extreme temperature, or worry about the unpredictable onset of abdominal pain all qualify as stressors -- some as "physical" stressors, others as "psychological" stressors. The fear to leave the house in the morning without knowing if one can make it to work without having to stop on the freeway because of an uncontrollable bowel movement, or the fear of experiencing uncontrollable abdominal discomfort during an important business meeting are sufficient stressors to activate the central stress system.
The central stress system involves the release of chemical stress mediators in the brain (such as corticotropin releasing factor), which in turn orchestrate an integrated autonomic, behavioral, neuroendocrine, and pain modulatory response. This biological response in turn will alter the way the brain and the viscera interact, and this altered brain-gut interaction can result in worsening of IBS symptoms. Thus, pain and discomfort, fear of these symptoms, activation of the stress response, and modulation of the brain-gut interactions by stress mediators are part of a vicious cycle which need to be interrupted to produce symptom relief.
The neurobiology of stress is not a theory, but a topic that can be studied in animal models, and one of the hottest topics in drug development for treatment of IBS (e.g., substance P antagonists, corticotropin releasing factor antagonists).
This is an excellent article on it all.
The Neurobiology of Stress and Emotions- IBS
By: Emeran A. Mayer, M.D.
UCLA Collaborative Centers for Integrative Medicine, UCLA School of Medicine, California
http://ibs.med.ucla.edu/Articles/PatientArticle003.htm
The fight or flight responce can make you go.
http://www.thebodysoulconnection.com/EducationCenter/fight.html
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My website on IBS is www.ibshealth.com
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Frygirl, you have a lot going on its a combination of a lot of things, even worrying about foods and what to eat can stress you mentally and physically as well.
Its good your seeing a dietian, as well as the other help your getting, it can be a slower process then you might want but in the end it can help. The CBT can help with this aspect as well.
Don't self diagnose yourself with "yeast syndrome" and eliminate even more foods.
I use to have a problem everytinme I ate popcorn. After the Hypnotherapy I don't anymore. Foods are part of the triggers, but importantly there is more to the conditon then foods themselves,and that is something to keep in mind. You don't want to eat foods that upset you, nor do you want to cut out all foods, because something else is upsetting your gut, like the act of eating itself. If a food constantly sets it off then you saty away from it, but its also important to try them a couple times to see how you do react, so you don't end up eliminating all foods and then get malnutrition. Some foods make your body work right.
I know some IBSers that have also ended up with major food phobias and I mean serious issues.
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Your are getting the gist and that is a good thing, not many people care really, but it is super important. Your making the connections though.
I did not know you had gastroparesis and that is important.
"Gastroparesis also can also result from damage to the vagus nerve, the nerve that controls the stomach's muscles"
A lot of the symptoms your mentioning can be involed in this and IBS. Some just for gastroparesis and some for IBS, but also you have symptoms of upper gi like the reflux. IBS is lower GI mainly of the functioning of the sigmoid colon.
"Other, less frequent effects of gastroparesis are the promotion of gastroesophageal reflux disease (GERD) and malnutrition."
http://www.medicinenet.com/gastroparesis/article.htm
A person can have IBS and Gastroparesis.
" believe my baseline for reacting to a perceived stressor is higher than most people's because I've kept that stress level up so high for so long. That's my 'normal', if you will. I'm sure this doesn't help my IBS symptoms,"
Exactly and its good your working on it, it cvan go a long way and you might find out how tightly wound up a person can get, without realizing it, because it seems normal. Yet the stress hormones flood the body still. The symptoms your are decribing are effected by it all.
The gut brain communicates to the big brain and the big brain communicate to the gut brain via the vagus nerve and there are issues in both conditions so yes its important.
It may also help to explain why you have C and some d better.
The sensation of pain in the gut arises from signaling in the gut via serotonin, which sends a signals up nerve fibers to the brain that a person is in distress or in pain. The chemical itsel doesn't go from the gut to the brain just the electrical and chemnical signaling process.
There are different physical reasons a person can have gastroparesis and that is also important as the above article states. Food digestion itself can be messed up with gastroparesis as well. Even more important to work with a registered dietian.
You are working on something in the right direction for sure, that can help you.
Do you have a good gi doctor and primary care doctor?
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All the dietitian and my GI doctor told me concerning gastroparesis is to keep to a low fat diet and avoid 'roughage' because both of these things slow down digestion. They both also said to eat small meals. All of these things I already do on the EFI diet, so no real changes there. None of my doctors think I am malnourished, they've done some blood tests to make sure. I also take a multivitamin, so my GP told me that's a good insurance policy, especially since I am on a highly restricted diet. My naturopathic doctor wants me to start taking digestive enzymes and possible Betaine HCL to help improve digestion in the stomach.
I use to have incredibly bad heartburn around the clock. I took two types of acid blockers which honestly just made my symptoms worse. Thanks to my naturopathic doctor, who gave me a supplement containing licorce root, marshmallow root, slippery elm, and aloe vera, my tummy is much less irritated feeling these days. She also has me take a teaspoon of lemon juice 15 minutes before I eat each meal, to help digestion. This has also helped.
I'm not sure about the quality of my personal doctors. I changed GI doctors recently because I got brushed off by my old GI doc once she diagnosed me with IBS. My new one is better at listening to me and is the one who ordered the gastric emptying study leading to a diagnosis of gastroparesis. We've discussed medications for both conditions. Since my gastroparesis is not severe, meaning I don't have problems keeping food down, I decided not to take drugs for it because the drug approved in the US has serious side effects. In terms of the IBS, my GI doctor provided a scrip for Bentyl to manage painful spasms when I am in a bad cycle, but I think Heather's peppermints are relatively effective at that without the side effects. He said there isn't much for treating IBS-C. Amitryptiline causes constipation as a side effect, so it doesn't seem like a great option for me.
My GP is really nice and sweet, and she hears me. But again, there is very little she can do to help me. I don't know if these constitute good relationships, but they are the best I've had in all the years I've been seeing doctors about my digestive problems.
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Sounds like your new GI Doc is helping.
I would still ask him what he thought might be the actual cause of your gastroparesis.
I know it must be very hard to have both conditions. Sounds like your making some progress.
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