Abdominal pain

[Greg1977]

Hi all, I’m new here and after lots of tests apparently I have IBS! The worse bit I get is serious abdominal pains quite a lot and it is tender to touch as well just under my right ribs! Any advice as haven’t tried much yet and doctors haven’t given advice! Cheers, Greg

[Hidden]

Same here very similar symptoms. I am trying various thing. Diet reduced dairy. Omeprazole and buscopan

[fusspot1]

Try Buscopan

[one-n-den]

Hi Greg,

Sorry to hear that the doctors aren’t offering much advice. IBS can be a bit of a ‘Cinderella condition’ and/or what’s left when other diagnoses have been ruled out.

However, while you may have IBS, severe pain and tenderness under your right ribs sounds like a gall-bladder problem, potentially gallstones. I have had IBS for 40+ years, but had gallstones three years ago and the pain is totally different and in a different location.

IBS pain tends to be low down in your abdomen and ‘sharper’ than the dull, but strong pain of gallstones.

I take Colpermin when I get IBS pain, but I’d really try to get gallstones ruled out for that upper-abdominal pain.

Have you had an ultrasound scan? That would usually reveal or rule out gallstones.

Hope that helps!

[Stuart24]

Hello, I wouldn't rule out anything as it is for your doctor to do that but if it's diagnosed as IBS this is my general response to help people find a baseline. First, go to the doctors and get yourself checked for intestinal infections, and whatever other tests they want to do. Most people find they are all clear, and that IBS is a condition brought on by our modern diet, freely accessible food, sedentary lifestyles and usually a trigger of a temporary infection. After 27 years of suffering with IBS I have found that the long-term solution that actually works is all about vitamins, periodic fasting and knocking out a few toxins that are freely dished out by the food industry. You are effectively the manager of a “food nutrient extraction factory”, I know that is obvious, but I have found that IBS is not about medicines, but about changing the way you run the factory, and learning how to get the best performance out of the factory.

This is based on some excellent publications, and also by observing how healthy people live. But, if you are all clear from the doctor’s, then the first thing to sort out is your vitamins and the timing of your eating and fasting periods. An incident of food poisoning or infection can start you on a cycle that you need to make a really concerted effort to break out of. IBS causes vitamin deficiencies which are practically impossible to overcome in most people’s diets, especially because you are probably eating selectively to manage your symptoms. Your vitamin levels affect the health of your intestines, and the health of your intestines affects your vitamin absorption, so it is a vicious circle that you have to break. If your farts really stink like something died, then this is because partially undigested proteins are making it through to your large intestine and the amino acids lysine and arginine being metabolized by bacteria into cadaverine and putrescine which are the compounds that give the smell to rotting flesh! – you yourself are not rotting, and this is just temporary, but it shows that you really need to sort your digestion out.

So, get some really good, expensive, multi-vitamins (ideally constituted for your age) and take them without fail every day before your breakfast. Get a blood test for Vitamin D and get you doctor to judge your supplement level required in IU’s to get you well healthy for Vitamin D. Do not get vitamins with high calcium and magnesium content initially as certainly in large doses these minerals can mess you up as they consume your stomach acid, and you should get enough of these minerals from your diet. Magnesium particularly can give you diarrhoea. If you are on low FODMAPs, go for all lactose free dairy products to boost your calcium. At the same time, sort out your fasting periods immediately. This is normally completely overlooked by GP’s, but is an absolutely essential element for resolving IBS. Your small intestine should be practically sterile, and your stomach acid along with bowel cleaning during fasting (called MMC) will usually do the cleaning. You need to fast for this to be effective, and by that I mean, ABSOLUTELY NO eating in between meals, ideally drinking only water. Imagine that you never washed your dinner plates and just kept putting food on them all the time!, they would be permanently loaded with bacteria. This results in SIBO (Small Intestine Bacterial Overgrowth), which is apparently responsible for 85% of IBS cases, but is only one of the mechanisms involved. You need to give your small intestine plenty of time free of food for cleaning and maintaining the factory. The modern scenario of have cupboards full of rich foods permanently available day and night is a modern luxury outside of the original human design. Your stomach will sort itself out when you have got control of your small intestine (although if you've got gastritis you'll need to finish a course of omeprazole first), and then your large intestine will improve later as nutrients are more efficiently absorbed from your small intestine. Furthermore, you should be able to avoid future bouts of gastritis as during the fasting periods, your stomach acid is more neutral at nearly pH 4. As a basic program, eat a good breakfast at say 7am (porridge with 50% almond milk or lactose free milk) or what suits you and then a good lunch at 12 o'clock - absolutely no food in between. After lunch, no food at all for at least 5 hours, and eat well again for your evening meal because it has got to get you through the night. No supper or snacks, no food or milk at all until breakfast the next day.

You will feel hunger in the fasting periods, but this is doing you good!, and you must NOT respond to it - only with water or black tea. This is CRITICAL. Importantly, when you are feeling better, do not resort to your old ways, you are still recovering, and you need to make a life-style change to have this level of discipline in your eating and continue with it. It takes a few weeks at least, and you need to persevere. You then need to maintain a healthy and consistent way of eating and always keep the vitamins topped to prevent you from relapsing. In a couple of weeks, you should be able to be getting off the low FODMAP diet, and begin mixing back in the higher FODMAPs. Eventually, you can forget about low FODMAPs altogether, depending on how well your small intestine is performing.

The other aspect of IBS is that some food additives are quite simply toxic for you and cause direct inflammation of the colon, allergic reaction of the colon, or they are laxatives that give you diarrhoea that you didn’t realise you were eating. These are to be considered separate to the usual SIBO mechanism that you are dealing with above:

1.) Try to seek out and eliminate “trans-fats”. These cause direct inflammation of the colon, separately to bacterial overgrowth and you will be more sensitive than most because of SIBO and this confuses what is causing you trouble. Chips, hash browns, butter, doughnuts, popcorn and things cooked in cheap or old frying oil as you find in many restaurants and commercial products can give you colon pain directly through inflammation. It usually takes a couple of days to reduce this inflammation, but trans-fats are bad for you in a miriad of ways (cardio-vascular and diabetes), not only by inflammation of the colon. There is evidence that as cooking oil is re-used that the trans-fats increase. So, if you want fried food as a treat, best to do it at home with good oil at a low temperature, and use it only once. Ideally, starches should only be boiled, rather than fried.

2.) E407, or “Carrageenan” – is a high MW galactose food additive derived from a red seaweed, which is only present in small quantities as a thickener, but even at that level it has been shown to be “highly inflammatory to the digestive tract” and associated with IBS, colitis and other GI diseases. There is loads of literature and objections to this substance on the internet. It is present in cheap Crème Caramels, and many other dairy and meat products. After weeks of good health, just one of these products knocks me out with colon bloating and pain. I have found this by trial and error several times. Food tests show that even the food grade carrageenan contains between 2 and 25% of the non-approved “degraded” carrageenan, which is colon damaging and carcinogenic. Some food agencies now prohibit this additive altogether, and it may be responsible for a lot of IBS cases. It may be found in chocolate milk, cottage cheese, cream, crème caramel, ice cream, almond milk, diary alternatives, such as vegan cheeses or non-dairy desserts, coconut milk, creamers, hemp milk, rice milk, soy milk, and particularly processed meat. It is used extensively in cheap meats and is injected even into beef joints – so always get organic or local butcher fresh good quality meat!). It may be labelled as E407 or Carrageenan, but if you’ve got IBS, consider it as highly toxic for you. It may take a couple of days to get over a dose of this.

In the same category is carboxy methyl cellulose (CMC) which is more widely used in the food industry, but has similar toxicology in animal studies, giving inflammation of the colon. However, the jury is still out on CMC to its impact on humans.

3.) E338, E339, E340, E341, E450, E451 and E452, are phosphates or polyphosphates of different elements. Natural phosphates are essential for life, and your body is full of organically bound phosphates, however, free ionic phosphates have several problems. Firstly, they are laxatives and will give you diarrhoea (sodium phosphate was once used to prepare patients for colonoscopies!). Secondly, they are associated with cardiovascular disease and accelerated aging. Since the 1990’s we are now exposed to twice the amount of added phosphate in foods, and this is bad. There are calls to have added phosphate labelled on products as a health warning. Particular culprits are mass produced sausages and processed meats (another reason to go to your local shop butcher), some cheeses, and cola (both diet and normal).

4.) Aspartame and other sweeteners definitely have a negative role to play in IBS, and for some people this can entirely be the problem, if they are otherwise under control. As with the other toxins above, your ability to cope with them varies on a spectrum. If you look at some of the work of K.J. Mielke, many of these additives can be allergens or “pseudoallergens” and with time you can develop a reaction to them. There are many different possible causes of IBS, and one person’s solution may not be another’s because of the allergies that you may or may not have developed, plus all other factors in play. Personally, these don’t affect me (yet!), but I respect that that could change at any time, and I am vigilant for it.

Red meats generally take a long time to digest, and also contain some trans-fats, but are usually tolerable. Only have them once a day, and just a light salad to go with them, not a load of starchy food or grains, as they have long digestion times. Ideally, you don’t want carbohydrates being held up in transit with heavy meats.

There is a lot of support for L-glutamine to help with repair of your intestinal lining; this means buying 500g of the bodybuilder powder type and having a couple of tea-spoons of this a day, one before breakfast and one just before you go to bed, and you can have this in a light cordial drink.

Other positive things you can do is to start doing some exercise if you don’t already, as this will really help with your gut motility, and your general health. Crucially, hard exercise burns up adrenalin which will also help get your anxiety under control. A friend of mine says that “adrenalin that is not used by your muscles goes to your guts” and there is probably some truth in this.

Dealing with Flare-ups

First thing is, fix your SIBO as described above. But if you are on top of your SIBO, then a bowel toxin usually hits you 5 to 8 hours later as the food gets to your large intestine. The first line of attack is ibuprofen which is far more effective than paracetamol for bowel pain, and I find that 200 mg alone is enough. Second, a couple of Buscopan will stop the cramps. Third, have available some linseed (seeds) and natural aniseed (Star Anise), and make the following tea: in a saucepan, add 1 teaspoon of linseed, ½ to 1 anise star, 1 teaspoon of sugar, a squirt of lemon juice (bottled is fine), and one mug full of water. Boil to simmer for 3 to 5 minutes, then sieve off the hot liquid back into the mug. This is a very effective remedy that I have used countless times, it really does help. The reason that it helps (anecdotally) is that the “gooey” linseed extract coats the intestinal lining. There may be some truth to this, as some propose that the mechanism of inflammation is a chemical attack on the mucus lining of the intestine which then allows food particles be exposed to the more delicate tissues underneath, causing inflammation. The linseed goo would provide a temporary replacement to the mucus lining, preventing further inflammation.

A lot of this was taken from the inspirational paper “Treatment and Management of SIBO — Taking a Dietary Approach Can Control Intestinal Fermentation and Inflammation, by Aglaée Jacob, MS, RD; Today’s Dietitian; December 2012, Vol. 14 No. 12 P. 16”, and several other papers, but it does fit exactly with what I have experienced. Please reply if this works for you.

[juniepoonie]

Thanks for all the interesting info Greg I’m waiting for my 3colonoscopy an lst sibo test after 18yrsof this illness. I’m lowfod map only drink lactose free no sweetners but live in oven chips very little veg or fruit take vit d but have thought l need good multi vits also