For My Tummy

Self-Help for IBS

For My Tummy

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You Know You Are Having a Bad IBS Day When . . .

You know you are having a bad IBS day when

You start talking unkindly to the button you are trying to sew onto that winter coat that it’s cold enough for, when it’s really all the fault of the needle.

You know you are having a stressful and bad IBS Day when

You drop and break a perfectly balanced, grooved, weighted glass that knows better than to leap out of your hand and crash to the floor.

So the stress catches up with you, and you know you are having a really stressful and bad IBS Day when

Your IBS-C turns into IBS-D.

November 12th, 2007 Posted by tummyblogger | Blog, humor, general, IBS, IBS-C, IBS-D | 2 comments

Irritable Bowel Syndrome - What to Use Every Day?

In reviewing the questions that people ask search engines, and then get direct to this site, I am seeing a lot of “is it ok to take xyz every day.” The answers are sprinkled through this site, so I wonder whether people find what they are looking for.

In this post I review some of the queries and try out some answers. Feel free to comment by clicking on the “no comment” link, which opens the comment box:

    Is it okay to take laxatives every day?

  • a. By laxative do you mean anything in the laxative aisle of the drugstore? Then read beyond this question for information on Soluble Fiber Supplements, also called “prebiotics.”
  • b. Generally it is not good practice to do this. Over a long space of time you become dependent on laxatives, and you need a larger and larger dose to get the same effect. A diet that avoids IBS triggers, and the simultaneous building up of your intake of soluble fiber supplements (SFS) to the recommended levels will relieve constipation over time. You do not need to have a bowel movement every day; fewer than three per week is a cause for concern. “Cause for concern” is code for “talk to your doctor about this.”
    Is Benefiber okay? Review of Benefiber?

  • When the major ingredient of Benefiber was guar gum, it was okay. At that point Benefiber was a Soluble Fiber Supplement (SFS), which is the kind that helps IBS. Now it is not an SFS, because the makers (Novartis, makers of Zelnorm) changed the main ingredient to maltodextrin.
    What about Fibersure? Review? Take it every day?

  • Fibersure is an SFS, made from chicory root fiber, also called “inulin.” Anything similar that is all inulin–for example, a Walmart store brand, or a Canadian, Indian, Australian, or British product–would act similarly. This is the kind of product in the “laxatives” aisle that you should take every day. In fact, you should take several doses throughout the day to build up to 20 to 30 grams of soluble fiber every day.
  • I don’t receive the queries about Heather’s Organic Acacia Tummy Fiber ™, which is the other brand name Soluble Fiber Supplement (SFS). Like FiberSure, it should be taken every day. Like FiberSure, unlike senokot and similar laxatives, you should gradually build up to a base level of 20 to 30 grams of SFS per day.
    Take Metamucil ™ every day?

  • There are two answers here. First, unless you have a free year’s supply of Metamucil ™ without any additives, don’t take Metamucil ™ for IBS. It has several ways of irritating a sensitive tummy. Second, if you have an otherwise nice doctor who insists that you take a psyllium fiber supplement (PFS), try bargaining with her to take Original Konsyl ™, which is a PFS with absolutely no sugar, sugar substitute, orange coloring, orange flavoring, etc–no additives at all.
  • So the short answer? Don’t take Metamucil ™ every day; don’t take Metamucil ™ at all! If you take Original Konsyl ™ every day, preferably add it to a base of 20 to 30 grams of SFS.

Look for a further post on “every day IBS care.”

September 30th, 2007 Posted by tummyblogger | fiber, general, IBS, Irritable Bowel Syndrome, IBS-D, FiberSure (tm), Heather's Organic Acacia Tummy Fiber (tm), Benefiber (tm), Prebiotics | 4 comments

Irritable Bowel Syndrome - The Three Rules

I have been fixing up the inner workings of For My Tummy. This involved going back over two months of posts, and that gave me the chance to notice that I had posted once on two rules for IBS, here. And then, ten days or so before that, I had posted on the one rule for IBS.

The rules in reverse order are:

  • Never Drink Ice Water
  • Never Eat on an Empty Stomach
  • The Second-Day Rule<

“The Second-Day Rule” needs a little explaining. If you try a new food and have no problems with it on the first day, don’t scarf it up on the second day, thinking “Oh, boy. Now it’s okay to eat xyz!” It will come back to bite you. In other words, some foods–like the IBS triggers–are ok for one day at a time, but not for day-in, day-out use.

Taken together, the three rules make life sound like hard work for people with Irritable Bowel Syndrome. That’s true! I don’t want to coat it with Stevia to make it easier to swallow–actually Stevia would taste bitter if you used it in that way! What I want to do is to give you some sign posts so that what is happening in terms of Irritable Bowel Symptoms, whether constipation or diarrhea or cramps or alternating stuff–so that these symptoms make some kind of sense and potentially can be controlled.

September 12th, 2007 Posted by tummyblogger | Gastrocolic Reflex, IBS, Irritable Bowel Syndrome, IBS Triggers, IBS-C, IBS-D, IBS Diet, IBS Symptoms | no comments

Important Reminder for IBS-D

Please Note
The following point has been at the top of my list for posts for a week or so. I want to emphasize that this reminder from the NDDIC is important for people with IBS-D. If you have bouts of diarrhea, or even constant diarrhea, please heed this:

Replacing Electrolytes

Electrolytes, in addition to fluid, must be promptly replaced after a bout of diarrhea. Soft fruits, fruit juices, broths and soups with sodium, and vegetables with potassium can restore electrolyte levels.

– National Digestive Diseases Information Clearinghouse1

Products
Many use Gatorade ™ to replace electrolytes, those circulating chemicals that keep your body and mind working together. Gatorade ™ is designed to replace electrolytes that are lost through sweating, not the fluid lost from diarrhea. The product that does replace fluid lost from diarrhea is Pedialyte ™(or store brands like it, like CVS).

For Further Information
Ask your pharmacist or doctor for verification: my doctor and pharmacist both said that about a quart a day (one bottle) of Pedialyte ™ is a suitable amount for adults–babies and young children need more.

Discussion
What do you think? Too much to do, to keep track of, or is it useful information?

  1. Quoted in Sidebar, Digestive Health Smart Brief, September 5, 2007 [↩]

September 5th, 2007 Posted by tummyblogger | IBS, Irritable Bowel Syndrome, IBS-D | no comments

Digestive Advantage - IBS Suggestion

This recent post about IBS probiotic Align has a comment from David at Ganeden Biotech, makers of Digestive Advantage ™IBS. They would like me to repeat the review process that I did with Align, using their product for IBS. Their product is widely available in stores, and has one good clinical test of its efficacy.

I am going to respond and thank them. I will have to suggest that I do the review month with their product for Constipation, rather than the one labeled IBS. DA-IBS contains sucralose (Splenda), one of the IBS triggers — at least one of my triggers. Their http://www.ganedenbiotech.com/prod_constipation.html is labeled as using sugar, rather than sucralose.

So, we’ll see. Again, the only compensation is two months of free product. I will also ask for a discount specifically for readers of this blog. They already offer free samples on their web site, although I don’t know how many that would be sent to each customer.

There are some interesting and good reviews of Digestive Advantage ™- IBS on ePinions, which will server for starters.

September 1st, 2007 Posted by tummyblogger | Probiotics, IBS, Irritable Bowel Syndrome, IBS-C, IBS-D, Align, Digestive Advantage - IBS, Digestive Advantage - Constipation, IBS Symptoms | 2 comments

IBS and the Three Nervous Systems

The Second Brain
There is an actual physical finding in Irritable Bowel Syndrome (IBS), that indicates that IBS is not “all in the head.” All in the nerves, maybe, but not all in the head.

The Three Nervous Systembs
To begin with, we need to understand that our bodies have three nervous systems:

  1. CNS - The Central Nervous System
  2. PNS - The Peripheral Nervous System
  3. ENS - The Enteric Nervous System, or the “second brain”

The CNS - Central Nervous System - consists of the brain and spinal column.
The PNS - Peripheral Nervous System - consists of the very long nerves that run along our arms and legs to our hands and feet.
The ENS - Enteric Nervous System - is the nerve tissue that lines our gut = the viscera = (mostly) small and large intestine.

And Serotonin
Serotonin is a neurotransmitter that plays an active role in the activity of neurons in the brain (CNS) and in the gut (ENS) . This activity, to simplify it all, either speeds impulses along the nerve pathways, or (as lack of activity) slows down nerve impulses.

Motility and Serotonin
What do you suppose that would do for motility–the ability of the gut to move its contents along easily, nicely, and calmly to the desired end. That’s right. The role of serotonin and the balanced action of serotonin affects both the speed of thought and the motility of the gut.

“Chemical Imbalance”
Depression is the major chemical imbalance in the brain that reflects an unbalanced serotonin activity. Not exactly similarly, just in somewhat the same fashion, IBS (IBS-C and IBS-D) are in part the result of a “chemical imbalance” of the Enteric Nervous System (ENS), the nerves that operate your gut, which rely on serotonin to transmit signals from one nerve ending to the next.

Balancing Serotonin
That’s why a gastroenterologist (gut doctor) may prescribe a tricyclic antidepressant, not because she or he is treating your head or thinks you are depressed. It is, rather, because he or she wants to give your Enteric Nervous System (ENS) more serotonin to work with for a better-balanced ENS.

August 27th, 2007 Posted by tummyblogger | Medical, IBS, Irritable Bowel Syndrome, IBS-C, IBS-D, Digesting Information, IBS Symptoms | no comments

Fiber 101b - Fiber for Irritable Bowel Syndrome (IBS)

The following material is designed specifically for people with Irritable Bowel Syndrome (IBS). It may be useful to people who have occasional constipation or diarrhea or non-specific tummy pain. As usual, this is not medical advice. It will be helpful to read the Fiber in IBS Glossary, posted two days ago, and you might want to reread the post titled Fiber for IBS 101a.

There are three points in this follow-up post. I will be talking about how the role of fiber in establishing a real comfort level with your tummy. The three points, as questions, are:

  • What does fiber do in your body?
  • What kind of fiber do you need to have that beneficial effect?
  • How much of the right kind of fiber do you need each day?

What Does Fiber Do in Your Body?
As your background reading indicates, there are two kinds of fiber, soluble and insoluble.

    First, insoluble fiber (IF) is bulk, or roughage. It increases the size of the stool as the stool is forming and passing through the large intestine (=large bowel). This is the kind of fiber that many doctors are suggesting you take when they say eat more fruits and vegetables, and take Metamucil ™ or another psyllium laxative/fiber. IF is also the kind of fiber that many many people with IBS have tried and given up on, because it makes things worse.
    Second, Soluble Fiber (SF). Soluble fiber in supplement form (SFS) dissolves completely in water, and when it reaches your large intestine it blends with the contents of your digestive system as it comes from the small intestine, and *there* it forms a gel. I will tell you that the following comparison may gross you out. Still, please read on.
    The gel that’s formed in your large bowel has somewhat the consistency of a tube of toothpaste, and your large bowel squeezes it along until the gel-like stool is eliminated. This is the result of taking a Soluble Fiber Supplement (SFS).

The effect of taking adequate amounts of SFS is very easy passage of formed stools, not too loose and not too hard, dry, or painful. The gel-forming effect of SFS works with the loose and watery stools of diarrhea (IBS-D) as well as with those of IBS-C.

What Kind of Fiber Do You Need to Have that Beneficial Effect?

In order to have the help of fiber to change the nature of the stools you pass, you need adequate amounts of a soluble fiber supplement (SFS) for your IBS-D or IBS-C. Right now in the U.S. the available supplements are FiberSure ™ and Heather’s Organic Acacia Tummy Fiber ™, and perhaps some store brands.

  • FiberSure is pure powderedinulin, made from chicory root. It is also FDA approved for use in treating constipation.
  • Heather’s Organic Acacia Tummy Fiber is pure powdered acacia. It may be classed by the FDA as a “medical food.”
  • Store brands that are still in place that mimic the old form of Benefiber, ™ and have guar gum as their active ingredient. (I have tried to check out a report that Wal-Mart has such a store brand SFS, with no success.)

How much of the right kind of fiber do you need each day?

How much SFS do you need, and how do you get there? How do you change over from Metamucil ™ or FiberCon ™ or Konsyl ™? Do you also need Metamucil ™?

To my way of thinking, you need to gradually add an SFS to your daily routine, while also gradually reducing the amount of any IFS you have been taking. Carrots and apples and other vegetables and fruits that are sources of SF should be switched to steamed or blended forms, with no sugar added.

Basically, you are going for a daily intake of 30 to 45 grams of soluble fiber. That varies from individual to indivual according to size, weight, and age. To find the right amount, you gradually increase your SFS intake until your stools are the kind of softened and formed “gel” that I described above.

If you reach 40 or 45 grams of SF per day, without getting these results, please consult your doctor.

Bottom Line
The bottom line is that in taking an SFS you take it every day, and build up until the amount is adequate for a comfortable, formed stool.

August 23rd, 2007 Posted by tummyblogger | fiber, Irritable Bowel Syndrome, IBS-C, IBS-D, FiberSure (tm), Heather's Organic Acacia Tummy Fiber (tm), Benefiber (tm), Digesting Information | 2 comments

IFFGD- International Foundation for Functional Gastrointestinal Disorders

The AboutIBS Organization
As their URI indicates, the IFFGD is aboutibs.org, an organization and web site devoted to Irritable Bowel Syndrome (and, perhaps, other functional GI disorders). I’ve just added a link to their web site in the sidebar.

Patient Advocates for Irritable Bowel Syndrome (IBS)
The IFFGD organization is, I think, the closest to a “patient-advocacy” group as people with IBS are likely to find. As noted in my post about IBS in England and Wales, we as people with IBS need to be aware of opportunities to impact public policy on our own behalf. That can be, as in last Friday’s post (08-17-07), either through direct input, or as part of a stakeholder organization which is regularly consulted.

Medical Needs Survey
Right now, the IFFGD is conducting an online survey “designed to measure the impact of IBS and the needs of those affected,” their unmet medical needs. There is a signup blurb on their home page along the left-hand side. The survey is very detailed and asks about your experience of IBS, your history with IBS, how it currently affects your life, and the kinds of treatment you have received, and to some extent the kinds of treatment you want.

The IFFGD survey is completely anonymous–I will disclose that I’ve just taken it, with full confidence that someone from the organization reading this could not pick out my survey from others taken today. It takes between 20 to 40 minutes, and is one way to be involved in patient advocacy without

  • disrupting your routine
  • moving out of your comfort zone
  • being identified as a person with ibs

Appreciation
Of course, you don’t get hugs that way, but, well, it’s still a good thing to do. And I’ll give you a virtual hug {x} and a TIA - Thanks in Advance, for completing the survey.

Call for Comments
Comments from those who take the survey are welcome.

August 21st, 2007 Posted by tummyblogger | general, IBS, Irritable Bowel Syndrome, IBS-C, IBS-D | no comments

Yogurt for Irritable Bowel Syndrome - No?

Moderators in one of the IBS Forums often suggest trying Dannon Activia ™. I have not. That’s because lactose is sometimes a trigger for Irritable Bowel Syndrome (IBS)–and lactose is an ingredient in milk and milk products such as yogurt. Of course Activia ™ is a food–yogurt–and not a medicine.

Now comes this FAQ from the Chicago Tribune health reporter Julie Deardorff. On her blog she asks and answers this question about Activia and other probiotics:

Q. What’s the deal with yogurt?
A. All non-heat-treated yogurts do contain live active cultures, which include the bacteria used as starter cultures to make the yogurt [Lactobacillus bulgaricus and Streptococcus thermophilis], Sanders said. “Yogurts may also contain added cultures, including probiotics. A wider range of health benefits have been documented for some of these added probiotic strains,” Sanders said. But “many of the organisms in yogurt cannot survive in the acidic environment of the stomach,” said Sri Komanduri, an assistant professor of medicine in gastroenterology and nutrition at Rush University Medical Center. “In addition, yogurt contains lactose, which can be a potent gastrointestinal irritant and may only add to the patient’s symptoms [if the person is lacatose intolerant].

Sanders also suspects many yogurts marketed as “probiotics” with added strains don’t contain enough bacteria to be effective or haven’t been studied. “I also bet there are many yogurts that contain probiotics that have little if any efficacy studies done on them,” she said.1

What do you think? Has anyone tried Activia, ™ or do you know someone who has tried Activia? Is the advertising for Activia helpful at all in “normalizing” the tummy problems of Irritable Bowel Syndrome (IBS)?

  1. August 1, 2007 Chicago Tribune Features Blogs - Julie’s Health Blog 7/07 [↩]

August 2nd, 2007 Posted by tummyblogger | Medical, Probiotics, IBS, Irritable Bowel Syndrome, IBS Triggers, IBS food, IBS-C, IBS-D, Digesting Information, Dannon Activia Yogurt | 4 comments

Taking Align for Irritable Bowel Syndrome (IBS)-Week 3

Into the third week with Align
The state of my tummy is degrading a bit. I am thinking that Align offers less probiotic than the NSI 15-35 formula I had been taking.

What do I mean by “degrading?”
I am more sluggish–that is, constipated. Also, I have had something like four episodes of reflux in five days. I’ve “medicated up” with both Ranitidine 150 (Zantac ™ 150)) and Prilosec ™. That means that the cost of using Align has gone up, from no cost trial sample to the cost of Prilosec. I have also added ginger tea from Yogi Tea, to enhance elimination. It has been effective.

Is there still an advantage to using Align?
Align has many advantages, starting with its

  • FDA approval. That means that you will get a consistent product with a lot of quality control along the way.
  • Single small capsule taken once a day — not necessary but nice
  • Lots of online support, at AlignGI.com.
  • Extensive information at various levels, also at AlignGI.com.

In a word, there are advantages to choosing Align.

Related Posts

Fiber for IBS - 101a

Sometimes it seems so simple I take it for granted. There are two kinds of fiber for IBS. One is FiberSure ™, which is 100% inulin and is made from chicory. The other is Heather’s Organic Acacia Tummy Fiber ™, which is 100% acacia fiber, from the acacia gum tree.

These are the fibers that are PREbiotic - see PREbiotics 101. One way you can tell is that they dissolve completely in warm water, leaving either clear liquid you can see through (FiberSure) or a suspension that settles into clear liquid if you don’t touch it for a while–Acacia Tummy Fiber.

I have seen posts uncorrected by the communities on forums (that I’ve recommended in the past) that say something like “I’ve changed to Weetabix–or Shredded Wheat–and I still have problems with IBS-C!” or it might be “Now I have yoghurt crunchies for breakfast, so that’s my fiber, but I still have IBS-D!”

I think there’s a disconnect in communication about your need for fiber if you have Irritable Bowel Syndrome (IBS) in any variety.

What I am talking about, and what Heather’s web site talks about, and what medical sites like the Johns Hopkins Medical Institutions Gastroenterology - IBS are talking about is not changing your breakfast cereal to treat your Irritable Bowel Syndrome (IBS).

We are all talking about

  1. the gradual increase of your daily dietary fiber amount from the maybe 3 gms of fiber to ten times that much,AND
  2. starting to get at least half of that amount in soluble fiber, AND
  3. gradually increasing the amount of fiber, most of it soluble, you have EVERY DAY to the recommended range.

In short, ignore the TV ads for cereals or other products that are “high fiber.”

Most of the time a serving of these advertised high-fiber products has as much as 3 gms of fiber in it. That’s one tenth of what you need in a day. Do you want to have ten servings of whatever it is? With milk, and/or containing wheat, and/or containing citric acid? Are you serious or just playing around?

It would be terrific if we people with Irritable Bowel Syndrome (IBS) could get a lot of our fiber from fresh fruits and vegetables. Sadly, I at least don’t have the nerve to challenge my system with fresh carrots or apples, or GrapeNuts Flakes ™. Oatmeal–mixed soluble and insoluble fiber–works okay after your first dose of soluble fiber (Acacia or FiberSure).

July 23rd, 2007 Posted by tummyblogger | fiber, IBS, Irritable Bowel Syndrome, IBS therapy, IBS-C, IBS-D, FiberSure (tm), Heather's Organic Acacia Tummy Fiber (tm) | one comment

IBS and Doctors

“The doctors don’t know what’s wrong with me, so they say it’s IBS.”
“I’m fed up with the doctors who keep sending me for tests and don’t seem to find out what’s wrong. They don’t know anything more than when they started and they don’t understand that I’m in pain.”

And I read many more similar complaints on the forums.

Medicine starts with the principle “First do no harm.” Now that there are many tests for many ailments, that principle may mean that a doctor does not reach for a prescription pad until after many tests have been done.

Halfway through the testing you say “Do something!” So s/he tells you to start taking fiber, but not what fiber to take, or worse, says “Use Metamucil ™” of which there are many flavors and roughnesses, and citric acid, and artificial sweeteners like Aspartame ™, and perhaps other additives.

This kind of desperation is very familiar to me, since I’ve been going through a series of tests for something else in the past few months. Along the way we found out that I have reduced my cholesterol level from 276 to 167 (fantastic!), that my heart ultrasound and heart stress tests are both terrific, and my liver function by blood tests and ultrasound is normal. In the meantime, I’ve been desperate for the doctor to give me something that helps the primary complaint, of a peculiar kind of fatigue. And I insisted on getting a second opinion, only to find that he agreed with my doctor, on one level, and had a question on another. In the meantime, I continue without any what I would call medical help.

It’s the same situation with developing a diagnosis for IBS. The doctor is not going to prescribe before s/he has ruled out a number of problems.

In an ideal world, once that has taken place, there is one obvious medicine to prescribe that will take care of the problem. If the diagnosis is Irritable Bowel Syndrome, that is not the case. Here is what the ideal doctor will discuss with you when he or she has excluded all the other options and concludes that you have Irritable Bowel Syndrome (IBS).

A. Incidence of IBS symptoms in the general population and its relevance to the patient
B. Gastrointestinal physiology including gastrocolonic response, production of gas, gut sensitivity to certain stimuli, and possible
C. The potential impact of stress in triggering or exacerbating symptoms, with reassurance that symptoms are not psychosomatic
D. Any anxieties, including concerns about underlying disease and major symptoms
E. The need for the patient to accept responsibility for condition management
F. The recognition that no panacea exits, but that therapies can greatly improve quality of life and significantly reduce symptom severity

Well informed patients are more apt to make choices and changes in lifestyle and diet that can reduce the severity and the frequency of their symptoms. It is recommended that physicians discuss new information during patient visits, and build on previous information by disseminating any new educational materials that may have become available since the patient’s last visit.

The source of the above is a paper published on the Gastro-Enterology pages of the Johns Hopkins Institute. The paper describes a number of levels of consideration of the problems of diagnosing and treating Irritable Bowel Syndrome (IBS).

Realistically, your PCP is going to fall short on several counts in the just-quoted lists. I hope that s/he fulfills at least some of them. Where this blog can help is in the last two elements of the above list, which are:

“E. The need for the patient to accept responsibility for condition management [, and]
F. The recognition that no panacea exits, but that therapies can greatly improve quality of life and significantly reduce symptom severity [.]”

“Accepting responsibility for condition management” does not mean that the condition is your fault, or that if it is hard to manage, that you aren’t trying your best to manage your IBS. It does mean that you have a considerable role to play in achieving a greater degree of comfort in living with Irritable Bowel Syndrome (IBS).

Also note that item “F” uses the term “therapies” rather than “treatments.” Does that make a difference? Let me know what you think.

July 23rd, 2007 Posted by tummyblogger | Gastrocolic Reflex, Medical, IBS, Irritable Bowel Syndrome, IBS therapy, IBS-C, IBS-D | one comment