For My Tummy

Costco Has Cheaper Align ™ Online — Or Do They?

Thanks to Darlene, who wrote in a comment that she had found Align on the Costco website, for $24.99. The hitch is that they require you to purchase two packages at once. They also tack on a 5% surcharge for non-members. Then the shipping charge for standard shipping is 8.50. Here’s the total:

2 @ 24.99 = $49.98
Shipping & Handling: $8.50
Non-Member Surcharge:$2.50
Order Total: $60.98

Using the AlignGI.com web site to order, and supplying the ALIGNWOM Promo Code, cuts the price from $29.99 on the web site, to $24.99, with free shipping — but no shipping options.

The Costco option is listed on the AlignGI web site, as are some others. The Amazon option is not particularly great, unless you have an Amazon gift certificate — no free shipping, for example.

Also, their website gives explicit ordering instructions that you can take to your pharmacist. If the pharmacy is across the street, as mine is, that’s the simplest.

August 27th, 2008 Posted by tummyblogger | Probiotics, IBS therapy, Align, Online sources | 2 comments

Align for Irritable Bowel Syndrome (IBS) Review: Weeks 7 and 8

Agony of August–NOT
I finished the month of August without my annual bout of extreme IBS, either D or C, and credit the combination of IBS diet and the fact that I was taking the probiotic Align ™ for this amazing difference from the past “agony of August.”

Then, in the beginning of September, I had some C, the result of missing a dose of Heather’s Organic Acacia Tummy Fiber ™. Just goes to show you that all elements need to be in place for your tummy or mine to be on its best behavior.

Elements of IBS Therapy
So, to remind readers of these reviews, to use a probiotic for best effect on IBS, you also need the following daily elements:

• An IBS diet that avoids all triggers, and
• A daily routine that includes increasing amounts of a Soluble Fiber Supplement, up to your stabilization point
• A suitable probiotic

For me, a year ago in July and August 2006 those things were not in place yet, and the probiotics I tried did not work for me. This year, I had both elements in place, and the Align ™ probiotic I reviewed worked great throughout August.

Conclusion of Align ™ Review
Align works as promised, at least on a well-prepared tummy. During the period I took Align ™ I also began to sample some fruits and vegetables, with good success except for broccoli.

The distribution system for Align ™ does not appear to be in place yet, and that affects the credibility of the main source of information, the Align ™web site. For example, the web site has a “sticker” update that says “Now available in pharmacies,” which is not true. There *may* be limited availability in warehouses, if a pharmacist knows to ask and is willing to order it. There is no distribution that has hit the shelves of a large chain pharmacy near me (CVS), in contrast to Digestive Advantage - IBS ™.

Promo Code for Align ™
The promo code to use for a $5 discount when ordering Align from the aligngi.com web site is AlignWOM. Look for a place on the web site called “promo code” and enter it there.

September 6th, 2007 Posted by tummyblogger | Probiotics, IBS, IBS therapy, IBS Triggers, Align, Heather's Organic Acacia Tummy Fiber (tm), Adjuncts, Digestive Advantage - IBS | 4 comments

Sixth Week of Taking Align ™ for IBS

Missing the Pill
This week would have been a very boring, more-of-the-same, post about Align. ™ It would have been, except that on Friday I forgot to take the day’s tablet of Align. It was my second week of taking Align using the 7-day blister packs that come in the new packaging.

Because I had, during this second week, gotten the days on the blister pack properly aligned (I couldn’t resist) with the actual days of the week, I discovered that I had missed a day on Saturday morning, when I still had a caplet marked “Friday,” in my blister pack. “Oh, well,” I thought, it won’t make a noticeable difference. Didn’t I just write a post that said so?”

The Effect of Missing the Pill
I was surprised that I did notice a difference, a distinctive sense of something missing. It’s not that anything terrible happened, or that I had more pain, or anything obvious. Just 15% more sense, for three days, that my tummy was back to struggling for equilibrium. The feeling was really very hard to put a finger on, and nothing I’d go to a doctor about, yet definitely a noticeable feeling.

That barely definable feeling did convince me that Align was actually doing something good for me, that the smooth and mellow tummy I had reported was smooth and mellow, and not imaginary. When I took Friday’s Align caplet on Saturday, I didn’t expect to notice the missed day–it wasn’t a case of a self-fulfilling prophecy.

Serving up Subjective Proof
In one kind of clinical trial, the subjects are rotated on and then off — or counterbalanced off and then on — the investigational drug to see whether the same people report different effects for placebo vs. drug.

This was my own small trial along the same lines, and I am, on admittedly small evidence, convinced of the efficacy of Align–and of the irritating quality of those Sunday through Saturday blister packs!

August 23rd, 2007 Posted by tummyblogger | Probiotics, IBS, Irritable Bowel Syndrome, IBS therapy, Align | no comments

Glossary of Fiber Terms Used in Writing about Irritable Bowel Syndrome (IBS)

Terminology Problems
The discussion about appropriate types of fiber in the therapy of Irritable Bowel Syndrome is hampered by a number of misconceptions about fiber. What has been holding me up in writing a simple Fiber 101b post, the second part of the primer on fiber, has been the need to explain several distinctions among types of fiber, that is so much of what I mean when I say fiber.

These are some the terms used on this and other sites:

• Dietary Fiber
• Insoluble Fiber (IF)
• Soluble Fiber (SF)
• Soluble Fiber Supplement (SFS)
• TV ads for “Fiber”

Putting the explanation of terms into an article, I think, will make your eyes glaze over. That will happen if what I say is in conflict with what you know. So, this is the fiber glossary, the words and terms for talking about fiber. Some of what is on this page will be new to your understanding of fiber.

Glossary

Fiber

Not a specific term. It doesn’t describe the food, or the supplements, that supply fiber. It may be used to describe a daily amount of fiber.

Dietary Fiber

This is more specific. It is part of the break down of the carbohydrates count in a nutrition label. The other part of the carbohydrate count is sugars. Dietary fiber contributes only a small amount of energy/calories, because it is the residue from plant foods.¹ Recommended daily allowances are talking about measurable totals of different kinds of dietary fiber.

Soluble Fiber (SF)

Soluble Fiber comes from plants that are sources of gums used in the preparation of foods, as thickeners, for example. In Heather’s system of Eating for IBS, soluble fiber is also starches that are found in rice, potatoes, and sweet potatoes, and are useful to put the gastrocolic reflex to sleep before eating a (more-or-less) regular meal.

Soluble Fiber Supplements (SFS)

Soluble Fiber Supplements are commercially available varieties of the first kind of SF above, the plants that produce gums that dissolve completely in water. Some examples are guar gum used in the old Benefiber ™, acacia gum used in Heather’s Organic Acacia Tummy Fiber ™, and inulin from chicory root, sometimes used as a sweetener, and the only ingredient in FiberSure ™.

Insoluble Fiber (IF)

This is plant materials–fibers–that do not dissolve in water. Insoluble fiber is what used to be called “roughage.” It is usually what we understand doctors to be saying when they say “Increase fiber.” My bad example is Metamucil ™, which is made from psyllium (a kind of seed) husks. They add bulk to the stool, hastening its movement through the intestines. Bran and various crunchy, rough cereals are sources of insoluble fiber (IF); also raw vegetables such as carrots. The skins and seeds of fruit and vegetables are other sources, as are nuts. This is what doctors still give as the kind of stuff to eat as part of a “high fiber diet.”
None of these things is easily tolerated by a person with IBS.

TV Ads for “Fiber”

In the United States there is an ad for FiberCon caplets, ™ which are “Calcium polycarbophil 625 mg equivalent to 500 mg polycarbophil.” Their labeling suggests that the caplets should not be used more than 7 days without a doctor’s approval. The ingredient is the same as that in Equalactin ™. The interesting point is the way the ads play on the popular conception of a “high fiber diet,” and suggest that such a diet is impossible to follow because we’d be eating fiber all day. So, why not take their caplets? Well, because polycarbophil is a “bulk-forming” laxative–roughage, or IF–and may give some problems to people with IBS.

NOTE
In the past, in the archived posts on this blog, I have used SF and SFS interchangeably, meaning supplements. Heather’s site also has used the terms interchangeably in the past, in the meaning of both supplements and the soluble element of starches such as rice and potatoes, and bananas.
Neither of us is technically wrong, just different. SF, including both starches and SFS, is PREbiotic, a growing medium for the good bacteria that we call PRObiotics.

1. 1 Shirley S. Lorenzani, “Dietary Fiber: Its Surprising Range of Therapeutic and Protective Health Benefits,” Good Health Guides (New Canaan, Connecticut: Keats Publishing) 1988. [↩]

August 21st, 2007 Posted by tummyblogger | fiber, IBS therapy, FiberSure (tm), Heather's Organic Acacia Tummy Fiber (tm), Prebiotics, IBS Diet, IBS Symptoms | one comment

False and True Conceptions about Irritable Bowel Syndrome (IBS) Treatment

The following paragraph on Heather’s web site caught my eye:

Irritable Bowel Syndrome (IBS) Supplements
Supplements for the dietary management of IBS can be unbelievably helpful for stabilizing digestion. This is particularly true when they’re used as one of the five key strategies for controlling Irritable Bowel Syndrome (proper diet, stress management, alternative therapies, and prescription medications are the other four).

Soluble fiber supplements, herbs that have medicinal effects on the gastrointestinal tract, heat therapy, probiotics, calcium and/or magnesium, and digestive enzymes are all of proven benefit. Best of all, results are usually felt very quickly - sometimes even immediately (emphasis mine). ((1 from the Help for IBS Website
http://www.helpforibs.com/supplements/))

see also

http://www.helpforibs.com/footer/treatments.asp

Not to throw a wet blanket on your hopes of instant relief–well, yes, I’ll throw that wet blanket after all.

Starting diet change, discovering that indeed there are more triggers than you thought, finding the right supplements, all take time. It took me at least three months. Then, too, probiotics take at least three weeks before they begin to give relief. So IBS treatment in full does not produce rapid results. Yes, parts of a treatment regimen do, such as putting a heating pad on a painful tummy, or drinking fennel tea for gas and bloating. Getting IBS under control, though, takes time.

August 19th, 2007 Posted by tummyblogger | fiber, Probiotics, IBS, Irritable Bowel Syndrome, IBS therapy, IBS Triggers, Digesting Information, Prebiotics, Adjuncts, IBS Symptoms | no comments

How Doctors Think about IBS

Introduction
I had a friend who helped me startup a counseling center.

He was a neurologist, who said something that really stayed with me. He said “When I see a patient for the first time, I know within five minutes what I’ll find on examination, and how I’ll treat the person. The rest is interaction–teaching and listening.”

How can he know within five minutes what is going on with a patient? Here is a quote from a medical review article on IBS that lays it out. Knowing this information, and related information about other disorders and diseases, a doctor — all right, a good doctor — is generally quite clear on what to do next. It’s just that the patient, one of us, is still in the dark.

The Bullet
The doctor is practiced in knowing and reciting back “the bullet” - the briefest possible summary of a disorder or disease, and the briefest possible summary of a patient, his or her complaints and treatment. Here in the opening paragraph of a review article on Irritable Bowel Syndrome, is “the bullet.”

New England Journal of Medicine Article

Irritable bowel syndrome, a common disorder in which bowel habits are altered in association with abdominal pain or dis comfort, has a prevalence of 12 percent among adults in the United States and a similar prevalenceworldwide. By definition, no mechanical, biochemical, or overt inflammatory condition explains the symptoms. Validated, symptom-based criteria for the diagnosis of irritable bowel syndrome are highly predictive in the absence of alarming symptoms such as weight loss, fever, and intestinal bleeding. The pain or discomfort experienced by patients with irritable bowel syndrome often leads to health care use and a decreased quality of life. Diarrhea is a symptom that often leads to medical consultation, since it can be inconvenient and, if associated with urgency, may be accompanied by fecal incontinence, an altered lifestyle (owing to frequent trips to the bathroom), and anxiety. Constipation may be associated with bloating, discomfort, and an altered body image. The quality of life was reported as impaired in people with irritable bowel syndrome who sought medical care but only marginally reduced in those who did not seek medical care. The therapeutic goal is both a reduction in the severity and frequency of symptoms and an overall improvement in the quality of life.¹

How Disappointing
After you’ve gone through various tests beyond a simple blood test, all the way to having a colonoscopy, to be offered a “therapeutic goal” rather than a “cure” is a disappointment. So you may begin to distrust the doctor.

Now
What do you think?

1. 1 Howard R. Mertz, M.D. “Review Article: Irritable Bowel Syndrome,” New England Journal of Medicine, 349:22, November 2003. [↩]

August 19th, 2007 Posted by tummyblogger | Medical, IBS, Irritable Bowel Syndrome, IBS therapy, Digesting Information | no comments

Taking Align for Irritable Bowel Syndrome (IBS) Week 5

Fifth Week–Packaging Issues
I’m into the second four-week sample of Align, the probiotic from Procter & Gamble that has a patented new strain of the “good bacteria.” The big news is that I can’t cope with the “days of the week” blister packaging! I just grabbed one and tore it open at the regular time in my day. It was a Wednesday, and I grabbed a Sunday or a Friday, so of course I couldn’t keep count of how many I had taken. If I had a choice, I would use the vial of capsules.

What this kind of packaging does, though, is underline that Align is something to be taken every single day. It is definitely NOT a medicine that you take when you feel bad and have symptoms. Instead, it is a supplement, to add something that your body needs. In order to be work, you need a constant supply, every day. Okay, so you don’t suddenly feel sick if you miss a day–should I try that experiment, just so I can report on it? If you go away for a weekend and leave your Align (or other PRObiotic) at home, and you have been taking it for a while, it’s no big deal to miss a couple of days.

Stop for Antibiotics?
Taking antibiotics for any reason does kill the bacteria. The jury is still out on whether you take both, or stop the probiotic. This isn’t covered in the FAQ at aligngi.com, the–now slick and glossy and attractive–Align probiotic website. I will look for more information and report back.

Good Week
Otherwise, my tummy has had a good week. So have I. They do seem to go together a lot of the time, don’t they? There is a problem with–take your pick–acid reflux, GERD, heartburn, or erosive esophagitis. This problem is NOT different from taking the NSI PRObiotic. I am now taking both Prilosec and Zantac 150mg tablets twice a day, to manage the whatever-it-is-going-to-be-called.

Coupon Code
Reminder: For commenters on any article who do request it, the promoters of Align have given me a $5 coupon code to distribute. I’m giving it out to blog readers who write in with comments on any post, and let me know that they want the promotional coupon code.

August 16th, 2007 Posted by tummyblogger | Probiotics, Irritable Bowel Syndrome, IBS therapy, Align | 5 comments

Medicine and Irritable Bowel Syndrome (IBS)

“Medicine Has Dropped the Ball on IBS”
I recently read a letter of praise for the dietary method of managing IBS, which is a medically endorsed therapy for Irritable Bowel Syndrome (IBS). In the middle of his self-congratulation, he inserted a slam against “medicine” for not dealing with Irritable Bowel Syndrome (IBS).

The best we have are some risky medicines that can reduce the impact on the body of a seriously “messed-up” large intestine (large bowel). As I read it, these medicines are not something you would want to take, or depend on, forever. Rather, they take a very bad situation–constant constipation or diarrhea–and improve the problem to the degree that good dietary control and use of the full daily amount of fiber can take effect. These medicines are not “magic pills” for IBS.

Slams
I see slams, such as I mentioned above, all the time from people with IBS, and would like to offer a gentle, general correction.

IBS Is Functional
The nature of Irritable Bowel Syndrome (IBS) is that it is a “functional disorder.” That means that doctors can identify a symptom picture and some of the physical elements that produce that symptom picture. So far, so good. Medicine is (sort of) in our corner, here.

Just Like Everyone Else
But what we who have IBS often want to know is why no one is working on a magic pill that would attack the cause or causes of Irritable Bowel Syndrome (IBS). The magic of the magic pill is that we would then be able to eat anything and everything, just like everyone else.

The wish of people with disabilities is to be as normal as possible, to use a cane rather than a crutch, to use a crutch rather than a wheelchair, to have people talk to the person in the wheelchair, rather than the person pushing the wheelchair. In the same way, people with Irritable Bowel Syndrome (IBS) want to live in a way as close to normal as possible.

Medicine Offers Crutches, not Cures
What medicine offers, so far, is crutches. Immodium ™ and Miralax ™, Kaopectate ™ and Metamucil ™. We get wise to them. We know they are not giving us a cure, only a crutch to get by on.

It is so frustrating! Yet there is no identified single physical mechanism that could be regulated by a magic pill. An adequate amount of (soluble) fiber daily comes closest. The research results on enteric-coated peppermint come very close also.

The question Why don't we want to hear that? Why do we still want that magic pill that sets everything right? Since serious and consistent dietary change and an increase to an adequate and regular amount of soluble fiber every day work so well for people who try it, why do we still say that medicine has let us down?