It’s time for a long overdue gut update. If you remember from my last post, I went to see a gastroenterologist about some IBS-D problems I’d been experiencing.
The gastro send me in for blood tests for: CBC, Amylase, C.Diff, metabolic panel, Creatinine, Giardia, H. Pylori (IgG), Hepatitis, Lipase, and Sedimentation Rate. No results found.
I spent 3 Fridays in the gastro’s office taking Hydrogen/Methane breath tests for lactose intolerance, fructose intolerance, and small intestinal bacterial overgrowth (SIBO). No results found.
I did learn some valuable lessons from this testing though.
Lesson 1: Fasting, Restricted Diet, and White Rice
I was only allowed to eat chicken, baked salmon, and white rice the day before the breath test. This is quite a challenge with my work schedule, so basically I practiced some long fasts with large meals on these days. Rice is also not a normal part of my diet. A pre-testing day might look like:
8:00 am: wake and continue overnight fast
7:00 pm: chicken thighs cooked in chicken broth
9:00 pm: baked salmon and white rice (reheated from frozen)
This protocol alone helped improve my IBS-D symptoms! Why? Perhaps the fast helped reset my GI system? Perhaps the rice added some needed RS to my diet.
Lesson 2: Mindfullness
The second lesson I learned was to hone in on the feeling of my own digestion. After I drank the test mixture for the breath test I started to notice some gurgling and burping. I was of course observing my response closely with a mixture of hope that there would be more of a response. Wouldn’t it be great to KNOW the source of the problem? Even though I didn’t find the source, spending 9 hours this summer noticing this response to food was productive. Coupled with meditation and mindfulness exercises, I am slowly learning to better understand the signals my body is sending me. Taking a few hours off work doesn’t hurt either.
Here are some studies that talk about the effects that meditation and other alternative mind-body interventions can have on IBS-D. CBT and hypnotherapy are both recommended!
- “The effects of relaxation response meditation on the symptoms of irritable bowel syndrome: results of a controlled treatment study”
I never even turned in the stool test. After doing the full metametrix panel, I just didn’t feel like it was worth it. Also my symptoms began to improve.
Colonoscopy / Upper GI Endoscopy
I also never went in for the invasive scoping. After seeing my symptoms improve, I decided to hold off. The gastro made it pretty clear that if I was feeling well, then the test might not show anything anyways. I may still go in for these tests in early 2015. I am still weighing the risk/reward.
Based on this battery of testing, it seems like the main problems with my gut are:
- Yeast overgrowth (as indicated by Metametrix panel)
- Diet (too low in fiber)
I’ll write some more in my next post about my improving symptoms.
When I started down this path of traditional and evolutionary health, I didn’t have a GI problem. As my general practitioner told me when I casually discussed my symptoms last year: “if there’s no pain, then you don’t have a problem”. So when I write about my potato starch experimentation and stool test results, I generally think of these as optimization hacks rather than a serious medical problem.
About two hours into my first Weston A Price Foundation conference, I realized that I might actually have a chronic GI problem. Frequent cycling between constipation and diarrhea. “Shutting down a bathroom” at least a few times a month. A year and a half later, I finally gathered up the courage to see a stomach doctor. My new $0 deductible ACA healthcare insurance plan surely helped build that courage. The meeting went quite well. The gastroenterologist was a riot. Through a moderate Arabic accent he called me “baby” as if having watched Swingers one too many times. “What can I do for you, baby”. “Let’s do this thing, baby.” “DEATH TO TECHNOLOGY” he shouted as I was leaving, unable to figure out his newfangled computer system.
His line of questioning was very simple: What are your symptoms? How many BMs and what type? Alcohol use? Intravenous drug use?
Based on my answers, he thinks I may have some kind of “functional” communication problem between my gut and my brain. The testing he recommends seems primarily to rule out other acute root causes. He figures that I’m not going to die anytime soon from my symptoms but was supportive of my desire to alleviate them.
He thinks “there is a lot we don’t know” and likes some “alternative” ideas.
He wasn’t upset that I am on a gluten free diet, but acknowledged that this could skew some of the tests designed to screen for Celiac. He thinks the Genova testing is “very alternative” but does his own version of the same tests. He thinks the idea of yeast overgrowth is “very alternative” but has used anti-fungals in the past on a patient or two.
He wrote out some “alternative” ideas to tide me over until further testing could be done:
- Try Caffeine and Dairy elimination – One week at a time.
- Use a Probiotic – Ultimate Flora or VSL#3
- Ginger or Fennel tea . Cinnamon. Or Circumin? Hard to read his writing.
- Peppermint capsules.
When he said that his strategy is one of aggressive testing, I was very reassured. This is the approach I would love to take and the main reason that I went to see a stomach doctor in the first place. He’s looking for colitis, celiac, bacterial overgrowth, malabsorption, and inflammation.
He sent me away with many test orders:
- Blood tests for: CBC, Amylase, C.Diff, metabolic panel, Creatinine, Giardia, H. Pylori (IgG), Hepatitis, Lipase, and Sedimentation Rate
- Hydrogen/Methane breath tests for lactose intolerance, fructose intolerance, and small intestinal bacterial overgrowth (SIBO)
- Stool Culture
- Upper GI endoscopy
I haven’t decided yet if I even want to do the scoping. When I pressed him on whether or not the scoping was worth the risk, he said “You take risks every day – you drove here, right?” He is right about that. Not only did I drive, but I was uncharacteristically on my phone almost the entire time checking my email as I rushed between two appointments.
Overall the appointment went pretty well. Having paid quite a bit of money out of pocket to this point for a mix of western and alternative testing, I’m hopeful that insurance will assist with these tests. It will be useful to have a baseline now in case an acute problem is found now or in the future. I set up procedures and appointments a ways into the future as is mandated anyways by his incredibly busy calendar.