Post infection IBS

[John4202]

I need help. I went to Peru in march of 2016 and came back with a bug. Long story short had 4 courses of antibiotics 2 with flagyl, 1 with cipro at the same time as flagyl, 1 with humatin and finally my naturopath figured it out. I had cyclospora. So 1 more with bactrim. I lost 22 pounds in 1.5 months. Since then I have very bad burning upper abdominal pain 2 - 3 hours after eating and an aching pressure in my right side radiating up to where my gall bladder would be. Further when I eat carbs like bread my stool turns green. I eat no sugar, very little carbs, mostly protein and healthy fats and veggies. I have had every test done, 2 ct's ultrasound, top and bottom end scoped but it all checks out. Anyone out there seen, heard, or dealt with this. The pain is so bad I have spiralled into a depression that has some very dark thoughts. If you've got any ideas I am happy to hear them. Thanks

[patientj]

The green stools might be a symptom of bile acid malabsorption (thesensitivegut.com/2016/02... although it is strange that it only appears when you eat wheat and I think you'd be more likely to have diarrhoea, but worth investigating. As the symptoms occur 2-3 hours after eating, this would be when the food starts to enter the small intestine, and when the bile acids would be released from the gall bladder, so there definitely appears to be something related to this. Do you get any diarrhoea or constipation/any other symptoms, or is it just the pain?

As for the depression and dark thoughts, I'd get on to these straight away. Speak to your doctor about getting on some antidepressants but, more importantly, arranging some counselling/therapy to help out. If you can afford it, you might even want to go private to see a therapist. Prices vary across the country but you will likely be seen sooner and find someone you have a good rapport with.

[John4202 in reply to patientj]

Thanks for the response. No diarrhea,no constipation but a very limited diet right now. I have been put on antidepressants but I keep telling people and doctors if the pain goes away so does the depression as being in constant pain is just exhausting. Curiously if eat before the 2 - 3 hour window it keeps the pain in check.

[patientj in reply to John4202]

Hmm... I wonder. Do you mean that if you eat again before the pain starts you don't experience it? If so, I've got a theory but don't know how to fix it! I think you might be having a problem with peristalsis and bile. Your stomach empties into the intestine after about 2 and 3 hours. Peristalsis is the movement of the gut which pushes the food along, but it can sometimes go backwards (e.g. with vomiting or when some food hasn't been digested). I think that when your stomach empties into your intestines, your intestines might be going into reverse peristalsis, pushing the bile salts back into your stomach, possibly accounting for the pain. When you eat before the pain, your body will initiate peristalsis again, and your stomach will empty into the intestines which will this time be going in the right direction, thereby reducing the chance of bile acids moving backwards.

The green faeces you see when you eat wheat is also interesting. I wonder if some bacteria in your gut are eating the wheat and crowding out other bacteria that would otherwise help to break down the bile so it can be reabsorbed. It would be interesting to know what your blood bile salt and cholesterol levels are.

As for possible solutions... I don't know whether your gut's reaction is neurological or psychological. For instance, your body might be trying to purge all food thinking it will make you ill. From what you say, apart from the wheat I don't think it is dietary related, but it might be an idea to speak to a dietician to try an elimination/low FODMAP diet to see if this identifies any specific triggers. If my theory about the bacteria is right, it could also be worth trying some probiotics to try and rebalance the good and less-friendly bacteria.

I'd be interested to hear how you get on.

[John4202 in reply to patientj]

Yes, just as the pain starts if I eat then no pain. I have thought about the bacterial overgrowth and am taking probiotics and am also using fermented oregano oil as an antimicrobial. Oregano oil on its own is supposed to attack bacteria indiscriminantly but fermented oil is only supposed to attack the bad guys and feed the good guys. I have been very stressed over this whole thing and am working hard to reduce stress as it makes the pain worse when I starts stressing about this whole thing.

[patientj in reply to John4202]

I'm not convinced the fermented oil will be any better - I don't think the antimicrobial ingredients get fermented so they will remain. However, if you're finding it works then that's the main thing.

You're right - the stress is a really bad exacerbating factor. Have you looked at ways to manage and cope with the stress?

[John4202 in reply to patientj]

I am trying anything and everything. Hypnosis, meditation, cognitive behaviour therapy, councillors etc. It is hard as I am a very outdoors person and not being able to do those things which is my stress release has been very hard. I can't get enough calories in the day to expend on hiking or kayaking so I have been limiting my exercise to easy walks.

[patientj in reply to John4202]

I've got into a (slightly unhealthy) habit of popping a couple of dextrose tablets before I go climbing. I might also have one after a depression-induced nap to help wake me up. Is this something you could perhaps try to help give you a little bit of time out on the water?

[John4202 in reply to patientj]

What is a dextrose tablet? I used to use power gels training and racing triathlon and Cliff bars on the water or hiking but I am not familiar with dextrose tablets.

[patientj in reply to John4202]

Probably the same as a power gel. Pure glucose with a little flavouring. These are the ones I buy: boots.com/en/Dextro-Energy-...

[John4202 in reply to patientj]

Any suggestions for antimicrobial things that leave the good guys alone?

[patientj in reply to John4202]

No, but you could try an alternative approach using prebiotics instead, trying to encourage the growth of good bacteria at the expense of bad bacteria, eventually crowding them out. My knowledge in this area is limited. I know that linseeds can encourage the growth of good bacteria, helping to reduce bloating, but this isn't your problem. Similarly, there's a product on the market (available in Boots) called Bimuno IBAID which selectively encourages the growth of the same bacteria. Taking both of these may also make your symptoms worse initially, and I am also not 100 percent certain of their effectiveness, because if you have got SIBO, the bad bugs could get their fill first.

[John4202 in reply to patientj]

Thats a good idea. I have been eating sauer kraut yogurt and homemade kefir but it has not seemed to make much of a difference.

[patientj in reply to John4202]

Incidentally, reverse peristalsis can also push bacteria from your large into your small intestine leading to small bacterial overgrowth. There is a breath test for this. I think its results can sometimes be misleading, but since you don't have any diarrhoea it might produce a true positive. The treatment for SIBO is antibiotics, but I think your body has had enough of those. You might have to try a few other things by trial and error like changes to diet and use of probiotics to see if they have an effect.

[tiredmum]

My son has post infection ibs after catching cryptosporidium and giardia after a trip to Nepal and India.

A year and a half later he still has diarrhoea about 15 times a day. And suffers with cramps and weight loss. He is now also dairy intolerant.

He has seen a specialist who has told him that it could take 5 years for his bowel to start functioning normally again.

[John4202 in reply to tiredmum]

I hope that is not the case. I can only imagine how frustrating this must be as I have only had 5 months of this.

[notibs]

A bad infection can lead to two possible things causeing your symptoms. Firstly post ilnfectios damage to the intestinal movements and decreased clearing of undigested food and bacteria that lead to small intestinal bacterial overgrowth. You can read about this in a bood by Dr. Pimentael called "the New IBS Solution" (get it online). Secondly a bad infection can overstimulate mast cells which do not settle down after the infection is gone, this is called Mast Cell Activation Syndrome. You can learn about this on the Mastocytosis Society of Canada website or read "Never Bet Against Occam" by Dr. Lawrence Afrin (also online). It can be treated with avoidance of irritating foods, and harmless meds like cromolyn and ketotifen. Let me know if you need more information.

In the meantime, you can take some digestive enzymes every time you eat, and it helps to try herbal,(but very effective)mast cell stabilizers like feverfew, quercetin, curcumin, and boswelia. Take some enteric coated peppermint oil to help with spastic pain. Get checked out to make sure you haven't developed Crohns Disease. Avoid all grains (wheat corn etc) and dairy. I can go into why, but I will just leave that with you for now.

Best of luck. There is lots you can do.

NOTIBS

[patientj]

Just read this article - thesensitivegut.com/2016/09... - while it doesn't properly account for your symptoms, I thought it might be of interest because of your observations about your gall bladder.