Son of Gastroenterologist diagnosed IBS-A or Bacterial Overgrowthsibo bacterial overgrowth gastrocolic
Posted 13 July 2014 - 09:03 PM
Hi fellow sufferers,
Wanted to share with you my experiences with IBS having had some of the best medical advice in the country.
Since I can remember I have had digestive issues. As a kid I was prone to vomiting after eating high fat food or over-eating. When I was working on my Master's Thesis in my 20's I was having trouble keeping food down. After having an upper Endoscopy in the 70's the doctor deemed I had "sensitive stomach" and told me to stay away from coffee, chocolate, and acidic foods. That worked for a while.
My father (who passed away last year) was a leading researcher in Gastroenterology. Throughout the years I met some of the top doctors in the field and was given treatments that gave me some relief but never fully resolved the symptoms.
My symptoms got worse with time. By my 40's, my most prevelent symptom was the gastrocolic effect after eating. After an innocent lunch of soup and a sandwich I would need to go to the bathroom badly. On a number of occasion this would happen on a ride home from a restaurant and I was trapped in a car. This often ended with disastrous and embarrassing consequences. Then I would be met with abdominal pain. My sleep is often interrupted in the middle of the night and after a bout of D I am left with C for at least a day.
In 1998 my father suggested I meet with Dr. Lin at Ceders-Sinai Medical Center in LA. (He is no longer there). Dr. Lin spent many hours with me giving me a number of tests:
The first one was a hydrogen breath test. After drinking a sugar drink the hydrogen in my breath is measured every 15 minutes for 3 hours. By charting hydrogen levels Dr. Lin could determine when the upper GI bacteria were attacking the sugars.
His theory is that IBS is caused by bacteria leaking into the Upper GI. He believes this is caused by a break down of peristalsis. He calls peristalsis the housekeeper wave. In a normal person the housekeeper starts at the throat and moves through the alimentary canal regularly to keep digestion moving and in one direction. In an IBS patient there is no housekeeper, and bacteria can easily move into the upper GI.
He tested me by giving me a Anthroduodenal Manometry. In this test I had tubes with gauges running through my nose down to my stomach that measured motility. I was monitored for 6 hours and never recorded the Housekeeper wave. This confirmed Dr. Lim's hypothesis that I was missing this important component to one way motility. The bacteria had an invitation to visit my upper GI. Foods could feed the bacteria with no place for the gases to escape.
He gave me a round of Neomycin that killed all my intestinal bacteria and I felt pretty good for about 3 weeks. Of course this treatment would be a terrible way to treat my symptoms for the long term as super bacteria may develop among other problems.
Dr. Lin's main advice was to follow a Japanese diet. Steamed fish/poultry and vegetables (hydrated foods digest easiest) stay away from fats/oils…we all know the drill. Dr. Lin highly recommended staying away from drugs, changing lifestyle was the best way to deal with the symptoms.
I did begin taking Psyllium regularly. It doesn't really stop the symptoms but it does bind the watery stool.
I have tried pro-biotics with no relief. I have tried a number of different brands. I am skeptical of any treatment, something like 80% of people can be cured of IBS with a placebo. Whenever I try a new treatment I keep a diary, note doses, food intake, and symptoms. Dr. Lin feels the problem is bacteria, adding more to the mix will not help.
I have had some luck with pancreatic enzymes. I have a prescription variety (note: they are expensive), whenever I eat at a restaurant where I have no control of the food I take a few before eating. They reduce the gastrocolic effect. I have had my gull bladder and pancreas tested and they are normal. Since i started taking these (maybe 10 years now) I have not had any embarrassing incidents in the car.
I noticed the symptoms are reduced with regular exercise.
I can bring on the symptoms every time by eating French, Italian, Chinese or Tai food (I believe it is the oils). I can find dishes at Mediterranean, Mexican and Japanese restaurants that don't bother me. I am not lactose intolerent but milk fats from dairy or beef bring on symptoms. I tell people I am lactose intolerent.I love cruise ships where i can tell the chefs my diet before traveling and they will make sure I eat right.
I am forever experimenting, but so far I have not found a magic bullet aside from being vigilant about what I bring into my system.
Thanks for listening,
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Posted 14 July 2014 - 10:34 PM
Hi. Due to my daughter's issue's at birth, where her small intestine had a little piece removed, I have wondered about possible improper flow of material back up the GI tract where it shouldn't be. She has always been bloated and gassy and she has severe food allergies causing rash and regular but low tummy pain. Her stools are fairly normal now, but used to be pretty loose.
supposing her Housekeeper Wave is damaged in the lower GI - lower third of her illium, what would that do?
And would this test be possible to conduct on a 5 yr old, or even that low in the GI?
All the best
Posted 15 July 2014 - 08:32 PM
My understanding is the housekeeper wave goes the whole length of the alimentary camel starting with swallowing. So they only need to measure a few points south of the stomach to know if its regular. However it is a hugely invasive test and if its positive there is not really anything medical science can do.
That said, and understand I am not a doctor, I do not think that removing a small bit of upper GI would effect motility, in your daughter's case it may have and it would play havoc with digestion. Even if a test determined that's there is a motility issue you're still left treating the symptoms. In my opinion it means finding optimum diet for her comfort. I hope she grows out of it.
Posted 16 July 2014 - 10:37 AM
That has been our hope, that she'll grow out of it. But I just have to wonder about if the housekeeper wave can or cannot just go "halfway"
My other concern is that the illeocecal valve is not all the way open, or all the way closed. The valve is still there, but the section immediately before it was the part where a piece was removed, and so I have to think that if the nerve cluster was damaged, then the muscles that open this valve could be malfunctioning and she is getting fecal bacterial up into the illium, or, the food is being impacted at the site of the valve and only slowly being jammed through, so there is putrifaction or something in that region causing a slight SIBO issue down there in the middle gut....
We've had x-rays show she's sort of gassy and distended with poop, but no one has really done a motility check. A chiropractor did show me once a way to massage the tummy to try to move things through, to open and close things a bit to get the gut moving... but we have never attempted to make this a treatment or used this.....
As to your case, I would say it may be worth having a chiropractor or reflexology person do a check on you, and see if they can get the nerves that operate this housekeeper wave working again. I thought that peristalsis was the same thing, but is the housekeeper wave an ongoing thing?
Either way, the spine and nerves, acupuncture... all that is a possible avenue for you to go into..... This could go all the way back to a bad experience in the birth canal, who knows....
Our chiropractor explained that when a nerve is say about 50% pinched, you may not notice an effect, the organ can still operate at a high level, but if you get down to say 10% you may get to the level of noticing problems. It is worth looking into the main nerves that connect to or start the early housekeeper wave at the stomach.... and giving them a nudge. It just may be possible to get them going from whatever they are now (perhaps less than 5% or zero) up to a slightly functional level.
Posted 17 July 2014 - 10:49 PM
The "housekeeper" is Dr. Lin's colloquial way of saying peristalsis. My father's research focus for 40 some years was study of motility. I grew up with graduate students and colleagues talking GI motility around dining room table. My understanding is that the pulse occurs regularly at least once every three hours in order to flush the system. It also occurs when triggered by ingestion of food. I don't know if it can be an incomplete wave.
I have a back condition and have seen many a Chiropractor. I can't imagine that manual manipulation could correct the condition, though yoga and massage may help move the system around.
The complex coordination of contractions that makes up peristalsis is controlled by a neural network. This neural network running digestion is sometimes referred to as "The Second Brain". This network produces seretonin and other neurotransmitters, and coordinates the functions of digestion with some accuracy. I don't think medical science has fully comprehended the workings of enteric nervous system, and at this point safe drugs that would help with our pathologies are years away.
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Posted 18 July 2014 - 04:06 AM
Stunet, testing is never infallible and this link suggests that the procedure to test the migrating motor complex is so uncomfortable and stressful that it could break the cycle.
So under normal circumstances you might have a fairly normal migrating motor complex.
I believe that it’s very likely that IBS is SIBO but never really seen the point of testing as it’s fairly contentious and I’m not certain the doctors really know what they’re doing. It all comes down to diet anyway.
The trouble is we don’t all know the drill because there’s a lot of conflicting information on what a good SIBO diet is. I’d agree with your Japanese doctor that hydrated veges with steamed fish / poultry are easier to digest. I’m surprised you found a doctor that recommended staying away from drugs. That’s very good advice.
Did your doctor advise on reducing starches or FODMAPs? Most people find a reduction in symptoms by avoiding bread, pasta, all refined flour goods, chips, crackers etc and filling up on gentle, easy to digest vegetables & fruits. For me, gas from high starch foods and high fibre causes constipation and further symptoms. And the less gas, the easier the evacuation the next morning and the better I am overall.
It’s a tough diet though. I’ve started making bone broths as they’re supposed to heal the colon. And they contain a fair amount of fat so that helps with satiety when you lack starches.
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Posted 18 July 2014 - 04:29 AM
Stu--thanks for all the information you've posted. it's very helpful.
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these are just my own thoughts. for expert medical advice please contact a health care professional.
Posted 20 July 2014 - 10:41 PM
"So under normal circumstances you might have a fairly normal migrating motor complex."
That makes some sense. Its a terribly invasive test. I was sitting up with the tubes through my nose for 6 hours. Dr. Lin swore by it when he administered it, however after he developed the theory of bacterial overgrowth he did not perform that test anymore. He relies on the hydrogen breath test for diagnosis.
Here is an article from Dr. Lin in JAMA:
Abnormal Small Intestinal Motility May Explain SIBO in IBS
Between meals, the interdigestive motility of the upper gastrointestinal tract is characterized by a cyclical pattern of activity known as the major migrating complex (MMC).44 The MMC includes a period of powerful, lumen-obliterating contractions that propagates from the stomach or duodenum distally to the terminal ileum (phase III of MMC or the intestinal housekeeper wave).44 When compared with recordings from healthy controls, the frequency of these intestinal housekeeper waves was significantly reduced in IBS patients,45 which may also explain the abnormal gas retention that is observed in IBS patients.18 The importance of the relationship between abnormal phase III of MMC and SIBO was first described by Vantrappen et al46 in patients with organic gastrointestinal disorders and extended in animal and human studies to the relationship between small bowel motility and gut bacteria47,48; small bowel motility and SIBO49; and small bowel motility, SIBO, and bacterial translocation.50
I did not know about FODMAPs until I read about it here. The way Dr. Lin explained it to me, any foods that make it to the small intestine will feed the bacteria. Fats and Sugars (include carbs) are the worst offenders. An entirely liquid diet will starve the bacteria out of the small intestine after about two weeks. I protein drink (for example) would be absorbed by the stomach long before it reaches the bacteria in the small intestine.
Last time I saw Dr. Lin he suggested I go on a liquid diet for several weeks and that it would provide temporary relief from my symptoms. I declined.
I am very sensitive to fats. Too much olive oil or fried food, and I can be miserable for days. It is difficult to feel full on a low carb diet. Its also really difficult to follow any diet and I often make mistakes and pay the price.
Posted 20 July 2014 - 10:49 PM
Here is another quote about how a liquid diet would stop symptoms:
This is from Dr. Lin's partner, Dr. Pimental http://www.anewibssolution.com/faq.htm
To some extent we have confirmed this concept. In a study we published recently, we were able to completely eradicate bacterial overgrowth and facilitate a dramatic improvement in IBS using a nutritional product from Novartis, called Vivonex™ (see Chapter 6 of the book for full details). Vivonex is an elemental diet, which means the food that it contains is already completely predigested.
Therefore, when a person consumes this product, the food is absorbed so readily into the blood that the food does not travel much beyond the first 2 feet of small intestine (the absorbing area of the gut; the full length of the gut is 15 feet). In the case of bacterial overgrowth where, in most cases, the bacteria are further into the small intestine than 2 feet, the patient’s eating this type of food starves them. The ability to get rid of bacterial overgrowth with this type of diet for two weeks is nearly 90%. The problem is that this diet is very difficult to tolerate even for brief periods of time.