[Kellie2003]

I was just wondering what you guys do to manage this type of IBS? What meds, diet etc? What are your thoughts regarding the cycle of IBS? Any feedback would be appreciated

Thanks

 

[erin5983]

I was originally diagnosed with C but it's a mix between the two. I tried Zelnorm hoping it would help with the daily C problems and it didn't, just made everything D, all the time, so I went off it. I've really had to regulate my diet. Nothing too greasy, nothing too spicy, and anything tomato-based usually bothers me. Italian food really does me in. The way I get through my weeks is by eating basically the same foods. I eat a lot of bland foods and try to carry Immodium whenever I leave the house. I usually feel okay, but today I had two D attacks, and nothing really triggered it, so...go figure. Maybe it will just take forever to regulate

. I'm always glad to find another person with C and D since we're not as common around here. I mean, not glad, since it's awful that you have it too, but nice to have someone else who understands. PM me if you've got any other questions.

 

[kac123]

I'm an alternater - i'm more C than D most of the time (I have recently picked up a bug of some sort that just won't seem to go away!). I've found that if i can control the C than I can typically prevent the D. I use Citrucel as a fiber supplement to get some control over the C, and if i'm in a "C-spell" then i take a little more fiber per day until it is fixed. The other thing that I do is to try not to 'over-react" to one symptom or the other. Meaning that if i am hit with a spell of D i prefer to take something mild like peptobismol instead of immodium which is stronger - I've found that it takes longer for me to break out of the C cycle that it causes. I know that this won't work all the time because there are times that i HAVE to be able to function without worrying about the D, but for everyday use that is my approach. I use Bentyl for pain control, and I use hypnotherapy (in the form of Mike's tapes) for control over stress and anxiety which are huge triggers for me. In fact, hypnotherapy is the best thing i've ever done in terms of getting more control over my IBS and I highly recommend it. Thats how i deal with this - hope it helps a little and that you are feeling well today.-Kac

 

[sadone]

i was also originally diagnosed as ibs-c, but over the past few months, i've had more and more 'run-ins' with d...i find that too much sugar can bring the d...as well as yogurt...i tried the acidophulus pills at one point and oooh boy--really bad D.dairy screws with me either way...either makes more c or more d...it is really hard to tell what foods are causing what cuz this d thing is still quite new to me...but i'll let you know if i have a break through! haha.good luck.

 

[lyonskitten]

Hi, I also suffer from alternating d/c. I have suffered with this for going on 19 yrs. now. As of yet I still have not found anything that has worked for me. My doctor is sending me for more test just to make sure it is still only the IBS that is plaguing me. I wish I could be of more help but at least I can tell you that you are not alone in this. Hope you have better luck then I did.

 

[eric]

Pain predominate d and c alternator for thirty years and Mike's tapes were the best thing I have ever done for my IBS.After years and years of meds and otcs and little to no relief. It was and has been amazing.

 

[eric]

The c and d is thought to be caused by serotonin release in cells in the gastro tract that release it to start contractions.To little c and to much d and alternating both.

 

[bonniei]

How can people have both too much serotonin and too little srotonin,eric?

 

[eric]

Bonniei, Its is majorly complicated, but here you go. I posted once and lost all the information95 percent of the bodies serotonin is stored in the gi tract. IT is importantly used for the intiation of the peristaltic reflex. Contractions"Pathophysiology of IBSRecent advances have led to a greater understanding of the pathophysiology of irritable bowel syndrome (IBS). Clinical investigations have shown that both motor and sensory functions of the gut appear to be altered in patients suffering from IBS. The enteric nervous system, including 5-hydroxytryptamine (5-HT, serotonin), integrates and processes information in the gut, and is thought to represent a key element in the etiology of IBS.Alterations in motor and sensory functions may cause disturbances in GI motility and increased perception of visceral stimuli (visceral hypersensitivity), both of which make important contributions to the symptoms of IBS. Patients with visceral hypersensitivity are said to experience an exaggerated sensitivity to internal stimuli, such as painful distention in the small bowel and colon. These patients may also experience an increased perception of apparently normal motor events in the gut, resulting in a feeling of abdominal pain or discomfort.The role of serotonin in IBS symptomsApproximately 95% of serotonin (5-HT) is located throughout the GI tract. Serotonin has been shown to be involved in regulating motility, visceral sensitivity, and intestinal secretion.Growing evidence suggests that serotonin subtype 4 (5-HT4) receptors play an important role in the maintenance of GI motor function in humans. Activation of 5-HT4 receptors in the GI tract has been shown to stimulate the peristaltic reflex and intestinal secretion as well as inhibit visceral sensitivity."also important are 5ht3 receptors.This is also one reason why harmless foods can trigger symptoms. The cells are pressure sensitive to ALL stimuli and release serotonin when pressure is applied to them.In d ibs there is more secreted from gut cells and c less secreted. Then also alternating.very important cells are enterochromaffin cells and mast cells and endocrine cells in all this.The new drugs for IBS http://www.aboutibs.org/Publications/serotonin.html It is very complex also and I am still learning about it all.It is also probably not the entire picture in IBS, but very important in the motility patterns and communication to the brain, among other things and the majority of IBS patients presenting to gastroenterologist, effectively demonstrate serotonin dysregulation."Researchers Identify Molecular Aberration in IBS PatientsCharlene LainoOct. 15, 2003 (Baltimore) � Significant alterations in serotonin signaling exist in the gastrointestinal tracts of IBS patients that do not appear in patients without IBS, according to new research. The findings shed light on gut motility, secretion, and sensation, as well as on the clinical manifestations of IBS, said Peter Moses, MD, associate professor of medicine and director of Clinical Research in the Digestive Diseases at the University of Vermont in Burlington. He presented the findings here Monday at the 68th annual scientific meeting of the American College of Gastroenterology. "We're showing a change at the molecular level in the gut," said co-investigator Gary Mawe, PhD, professor of anatomy and neurobiology at the University of Vermont. "Our finding that key elements of serotonin signaling are changed in IBS lends credibility to the notion that IBS is not all in patients' heads, but due to altered gut biochemistry and interactions between the gut and the brain." Researchers already knew that 95% of the body's serotonin (5-HT) is located in the gut and is primarily synthesized by and stored in endocrine cells, Dr. Moses said. That led them to suspect that alterations in serotonin may contribute to abnormal conditions in the gastrointestinal tract, leading to the development of pharmacologic agents that target 5-HT receptors, he said.While the drugs have proven effective in relieving symptoms of IBS, "no one has ever shown cause-and-effect," Dr. Mawe said. "The drugs were developed with the knowledge that serotonin affects gut motility and secretion, but what we didn't know is exactly how they were working." In their current research, the investigators have shown "a significant decrease in the serotonin transporter in cells that form the inner lining of the bowel" in patients with IBS, Dr. Mawe told Medscape. "In the gut, this transporter acts as a sponge to remove serotonin once it is released, and therefore stops its actions. But if you take the sponge away, serotonin that is released stays around longer, and this can lead to changes in motility, secretion, and sensitivity." For the study, the researchers examined tissue from 43 healthy controls, 32 patients with IBS, and 22 patients with inflammatory bowel disease. Each sample was evaluated using immunohistochemical staining, ELISA radioimmunoassay for serotonin content and release, and quantitative reverse transcriptase polymerase chain reaction for measurement of mRNA encoding. The researchers also measured serotonin content, the endocrine cell number, serotonin release, and presence of serotonin transporters (SERT). The study showed that samples from patients with IBS had significantly lower serotonin content � about 70 to 80 pM/mg of tissue compared with about 50 pM/mg in control patients (P .005). Patients with IBS also had significantly higher endocrine cell populations compared with control patients (P .005). Also, SERT mRNA and SERT immunoreactivity were markedly reduced, leading to a decrease in the capacity to remove serotonin from intracellular space once it was released, Dr. Moses reported.However, serotonin release from endocrine cells was not significantly different in cases and controls, he said.The bottom line, according to Dr. Moses, is that "patients with IBS have a deceased ability to remove serotonin once it is released. This tells us for the first time that there is a definitive change in the bowels of patients with IBS.""It's not a matter of too much or too little serotonin, but how the serotonin molecules interact with the receptor," said Kevin W. Olden, MD, associate professor of medicine in the Division of Gastroenterology at the Mayo Clinic in Scottsdale, Arizona."We'll see an explosion of drugs in this area," he said. "Interventions that target serotonin receptors in the brain have revolutionized the treatment of depression and this goes way beyond that."Lawrence Brandt, MD, a gastroenterologist at Montefiore Hospital in the Bronx, New York, agreed and noted two such drugs are already on the market. "The more serotonin you have, the more peristalsis," he said. That's why drugs that activate serotonin receptors, such as tegaserod, help relieve constipation, he said. "Patients with too much serotonin, on the other hand, have diarrhea," Dr. Brandt said. "If we could interrupt that pathway and block it with a serotonin analog, we could help." One such drug, alosetron, is currently available, he said.The selective serotonin reuptake inhibitors that are used to treat depression do not help patients with gastrointestinal disorders because they target a different subtype of serotonin receptors, Dr. Olden said. The study was funded by Novartis Pharmaceuticals, the manufacturer of tegaserod, and one author has received financial support from Novartis. ACG 68th Annual Scientific Meeting: Abstract 20. Presented Oct. 13, 2003."It is very important to realize there are lots of neurotransmitters in the gut and they interact, so this is very complex in itself, but they do not think those receptors are function right. Even though that study was funded by novartis a ton of research has been done on serotonin and IBS and a lot more being domne.But importantly in this they have found the receptors that help to : regulating motility, visceral sensitivity, and intestinal secretion.So its not a matter of how much is in the body, but how its regulating or dysregulating in IBS within certain cells in the gut.I need to emphasize one more time, this is only part of the picture in IBS, but they have known this for quite a few years now.If you want more info read this also.IBS: Improving Diagnosis, Serotonin Signaling, and Implications for Treatment CMEAuthors: Lucinda Harris, MD; Lin Chang, MD http://www.medscape.com/viewprogram/2750

 

[Kellie2003]

Hmmm looks like theres not much hope for us alternaters

Has anyone broken their cycle by treating the constipation? I dont get that C'd (have BMs everyday, but always soft and often incomplete evacuation and straining) but my D is often a result of C, my bodys way of cleaning me out. Do you guys have a similar cycle to this?

 

[Kellie2003]

Sorry kac123 i just read that you treat the C to prevent D. I had forgotten

unfortunately my body doesnt agree with much fibre (gad, bloating, distension) I've tried metamucil...but did not help! I always read citrucel is a good fibre supplement and easy to take, but guess what? Its not available here

ohwell im going to have to increase my fibre intake, i'l just have to do it very gradually.Does anyone know what dose i should start off with to ease me into fibre. I am currently having 1 tablespoon of flax seed a day. Im thinking of stopping this as the insoluble fibre may harsh on my system. I just dont know what is exactly causing the pain...particular food or just my IBS in general

 

[bonniei]

eric the research you gave yet does not show how the levels of serotonin can change in a person with in a day. or even the signalling to/of the receptors. Or they would have drugs for alternating which they don't have as rof right now

 

[jrusso11542]

kp2003 My cycle seems identical to yours. I recently bought Eating for IBS and The First Year IBS as recommended from so many on this site. I will let you know the results.

 

[kac123]

Hey KP, Metamucil is evil!

At least for me it is. I always start out a new med/product by taking a little bit of it and working my way up to the "right" dose. With metamucil, even on my small start-off dose I was bloated and gassy almost instantly and I had cramping -- it was horrid. I have tried a few of the other fibers as well but citrucel is my favorite. You could try asking your pharmacy guy if they carry any fiber supplements that are primarily methylcellulose which is citrucels main ingredient. Metamusil is Psyillum so try to stay away from that if it hurts you. Another thing that people use to help regulate constipation is magnesium supplements. I don't know if you regularly take a calcium supplement or not, but if you do try taking one with magnesium in it to balance out the calcium, as calcium is constipating. If you go over to the constipation forum and search for magnesium supplements you will find all sorts of info that may help out until you figure out how to get the right fiber for your body.I hope this helps - the balancing act is not easy and even after 3 years of this I still don't always get it right, but I'm still learning and it will get better! Hope you are well today. -Kac

 

[eric]

Bonniei, I told you it was complicated. "does not show how the levels of serotonin can change in a person with in a day"Its the regulation of it released from the cell receptors. The cells lining the digestive track are pressure sensitive to it release. When released it intiates peristaltic reflex. How is serotonin created in the body?

 

[bonniei]

quote:The cells lining the digestive track are pressure sensitive to it release

It seems its release is dependent on pressure. What is pressure dependent on?

quote:How is serotonin created in the body?

It is a derivative of tryptophan. Foods highest in Tryptophan are Tofu, Most Soy products, Black-eyed Peas, Black and English Walnuts, Almonds, Sesame Seeds, Roasted Pumpkin Seeds, and Gluten flour.

 

[eric]

"What is pressure dependent on?"For one the very act of eating, and hence one reason people attribute the symptoms to harmless foods. Even though specific foods may have their own chemical properties to irritate the gut or stimulate it.Another is emotions.The amount of contractions and pressure is also dependant on the amount of calories consumed, especially fats.The brain also plays a crucial role in all this.

 

[eric]

New drugs�and some respect�for IBS http://www.acponline.org/journals/news/sep03/ibs.htm?hp#body

 

[halliejanemachan]

I am not interested in treating my IBS with drugs. I have suffered for 25 years (I am 36 now) and haven't given up hope. I was doing really well for about a year. As long as I watched what I ate, etc. I did make sure to add extra fibre to my diet. I found sugared mini wheats (no milk) really helped for some reason. Then I decided to get healthy and took flax seed oil for about 4 days. Ever since then (about 4 months) I'm back to where I started. Almost. My GP says to stay away from all of those oils: flax seed, primrose, etc. Bad, Bad, Bad D.