50 Shades of Gut Pain

Today, or rather at 1am last night, as I sat on the toilet for the first time that night, I started to ponder all the different “moods” of my gut. There are so many of them, and I have learned to parse out their different meanings so they are very helpful to me. What I’m not sure about is if I could communicate them to others.

I once sounded like a crazy person in my doctor’s office as I tried to explain that the symptoms I was experiencing (diarrhea, urgency) were not the same as Crohn’s symptoms (diarrhea, urgency) because they came at a different time of day. But this is true–over the course of my life, I’ve learned that a “normal” cranky, inflamed gut means symptoms first thing in the morning. Symptoms at another time of day, to me, mean something else. In this case, it was SIBO.

(A few weeks after that doctor’s visit I passed another SIBO breath test with flying colors, and–as the treatment started working–symptoms returned to normal.)

It’s those finer points of knowing my gut that can mean the difference between a peaceful commute and one where I’m praying with my butt clinched as tight as possible.

Or other things, such as:

  • The fine distinction between a wet fart and a fat, dry fart…before you let it rip.
  • Feeling when stool passes into the descending colon, and how fast it is travelling downward, thus dictating whether you get to walk or run to the bathroom.
  • General inflammation (my ten-year-old self called it “washer machine tummy”) versus a specified area of intestine with, say, an ulcer.
  • Feeling an especially intense bout of the Migrating Motor Complex and distinguishing it from garden-variety cramps.
  • And for that matter, discerning between uterine cramping and gut cramping. I don’t even think my own body can tell that one!

If you’re reading this, and can identify with anything that you’ve read, let me know in the comments below. I’d love to compare notes.

Fiber: Friend or Foe?

When you’re diagnosed with Crohn’s disease and having a hard time, your doctor will often put you on a low-fiber or low-residue diet. Same difference, really. Basically, eat soft, mushy, bland food – and lots of carbohydrates. Rice! Toast! Don’t eat a lot of vegetables!

And honestly, this works. Pre-digesting your food as much as possible helps your gut to rest. Cook your food. Chew your food. (And not in the gross mama bird-baby bird way, eww.)

For me, as I’ve navigated the SIBO/low-FODMAP diet oceans, I’ve sometimes doubled down on this idea, drifting into days when I ate very little plant matter at all. Just meat and fat, and maybe a little fruit or something on the side. It’s very easy to do when the wrong type of sugar sends your gut into a tailspin of gassy diarrhea.

But lest you think I’m going to do an about-face and preach the gospel of high fiber (or even worse, the RAW FOOD DIET), it turns out that eating less fiber is actually better for you. Too much fiber means such things as straining when you poop (no bueno), screwing around with your Nutrient Density QuotientTM, damaging your gut wall, and buying in to poorly-research nutritional theories (and nobody wants to do that now, do they?). TL;DR eat real, whole foods and you’ll get enough fiber.

However, let’s back up to “damaging your gut wall,” Or, as it is called by researchers1, “mechanical stress.” AKA: maybe why our guts hurt so bad after we eat food.

What this means is that fiber damages the cells in your gut, which in turn respond by producing more mucous. This might be good, if more mucous automatically meant better health, but that is unlikely since a common tell for poor gut function is an abundance of mucous in the toilet.

Moreover,

The scientists aren’t certain how many times cells can take a hit, but they suspect turnover is so high because of the constant injury. Potentially caustic substances, such as alcohol and aspirin, can produce so much damage that natural recovery mechanisms can’t keep up. But they doubt a roughage overdose is possible.

My gut can tell you that a roughage overdose is indeed possible. So can my coworkers, based on the day after I ate a raw kale salad with dried cranberries.

Also interesting is that aspirin–banned by my first GI–and alcohol–self-imposed ban due to its gut-destroying properties–are just as bad.

Don’t just take my word for it, though. Let Dr. Eades tell you the whole story.

 


1 Full study at PLOS Biology

Pavlovian Diarrhea

Every since yesterday, I’ve been thinking about the psychological underpinnings of diarrheic urgency. Why is it that I can play chicken with myself all day, but not feel that gotta go gotta go gotta go feeling until I am literally unlocking my door? How is it that most of the time (with a few legitimate exceptions) I can hold it together until the bathroom door is closed?

Sometimes I wonder if I’ve trained myself into a gut-brain pavlovian response.

When I’m going through a rough SIBO patch, like right now, there are times that I have to go to the bathroom ASAP. To counter that, I’ve learned how to tell when it’s “time” and act accordingly. But, as I’ve also adjusted my life into healing mode, my gut has been slowly improving. That means that the signs gradually change — but my reaction to them does not.

So now I’m stuck in a feedback loop where I’m hyper-aware of all my gut rumbles and movement, but where I’ll also run to the bathroom at the slightest provocation, which doesn’t help build up between-bathroom-breaks stamina, and so on.

I hear about athletes like Michael Phelps visualizing their races — imagining every kick, every breath, breaking down every turn and the last final moments of the race.

Instead of focusing on what can go wrong, Phelps focuses on what happens when everything goes right. He’s rehearsed it so many times, it’s ingrained into a click-whirr response. And so when something actually DOES go wrong, he doesn’t have to scramble to recover, he already has a mental tape to fall back on. A winning tape.

I’d wager that this strategy would also work for my feedback loop problem. Imagine a positive outcome: walking through my front door calmly, guts behaving all civilized-like.

I like it.

Playing Chicken With My Own Intestines

The rumble started as I put on my shoes.

I listened closer: not quite drop everything and get to the bathroom levels, more along the lines of polite gas advisory.

It was time to leave. I had to make a decision. I decided to chance it.

Walk to the train stop.

Catch the train.

Transfer to the shuttle bus.

Still good, no issues on my commute. The gamble paid off.

Things changed on my way home, however. Let’s shift into reverse.

Shuttle bus – no rumbles.

Catch the train – now things get a little interesting. Rumbles have reached the descending colon, which usually means it’s time to boogie. I mentally calculate the time remaining on the train vs the amount of time it would take me to get off at the next stop and find a public bathroom vs the severity of the rumbles. Once again, I decide to chance it.

Every few stops, my gut pipes up and reminds me of all it can embarrass me in public.

At this point, I’m committed. I leave the train at my stop, and set out for home at a measured pace. Fast enough to get somewhere, but not fast enough to catch wind or make things move faster.

As I near my front door, the urgency rises – the rumbling starts again – and I start wondering if I can make it. Stick the key in the lock, open the door. One of my roommates is hanging out with her dogs, and I blast past with the “gotta pee” excuse.

I make it to the bathroom just in time.

#hooray

Sugar Propaganda

 

While “Big Soda” might be a bit of a simplification (the problems with nutrition-legislation are much more widespread), research funded by sugar begets sugar propaganda:

Those promoting Big Soda’s view of nutrition consistently claim that chronic disease is “complicated.” Is this true? While all human diseases are “complex” in the sense that they involve detailed and often poorly understood mechanisms in the human body, that isn’t what they mean. Big Soda speaks of the complexity of addressing and identifying the causes of chronic disease. The label of complexity rules out simple treatments like “stop drinking sugar” and makes models of chronic disease based on overconsumption of sugar seem oversimplified and rash. It is true that chronic disease is complex, but Big Soda is using the term to support their false nutrition narrative.

This type of reasoning provides more justification for the toxic mindset that we can’t do anything about our health (we can!) or that our body/genes/disease will always get the best of us (it won’t!). It’s much too complex, Timmy, you couldn’t possibly understand your health issues and how your actions compound them. Your chronic condition is much to complicated to do anything about, Susie, so just lay back and let it eat away at you. Giving up on your health. Giving up on yourself.

License to be sick–exactly the opposite of what they claim to be selling.

Yup…Today Sucked

I’m planning to try out a sauna this week, and had been discussing that fact with a coworker. As we walked out of work this evening, I said:

“You know, maybe I will go to the sauna on Friday instead of Wednesday so that if I crash and burn afterward, it’ll be on the weekend.”

My coworker replied, “Why would you do that? You should just go!”

But you know what? I know how hydrotherapy has hit me before, and I can’t imagine a sauna being much different. I’ve been seeing signs of SIBO regrowth, which means that if I do a couple rounds of steam heat-slash-cold, my immune system will get to work. And that means a herxheimer reaction, or dehydration, or just plain exhaustion. Who knows, maybe a sauna will produce some new reaction altogether!

The point is, I don’t want to have to deal with the secondary effects of a new treatment option while trying to juggle a very full workload.

The older I get, the more psychic I feel.

Yesterday I wrote about how sometimes knuckling down is the exact opposite of what you should do, but sometimes you have to do it anyway. And I predicted that today would suck.

Well, it did.

I was completely overwhelmed, overloaded, and I’m dealing with it (just like I said).

But today is almost over. Tomorrow is a new day.

Maybe I’ll go to the sauna.

(Lack of) Taking it Easy

I often live with this idea that I need to do everything perfectly. It’s not enough simply to just do it, it must be done well. And that doesn’t apply only to days when I’m feeling good, but it also applies to every day when I’m not feeling great.

Over the years, I’ve learned how to knuckle down (or rather, punch up) and get myself through a tough day. Maybe fatigue has set in like a dull fog. Maybe I’m running to the bathroom every ten minutes. Maybe my gut is cramping so hard that I can’t stand up straight.

That can happen on some days, but it usually comes at a price.

That price may be not leaving bed the next day.

There’s a time and a place to knuckle down, but I’m also learning that it’s okay to do nothing. And not just the “well, I did nothing so by default I’m okay with it because I can’t change it anymore” kind of acceptance, but the “I am doing nothing today because my body needs downtime” kind of okay.

I’m a big fat hypocrite writing a post like this today, however, because my energy was spent at about 4pm but I still came home, and did laundry, and cooked dinner, and worked for an hour, and now I’m writing this post, and after that I’ll rescue my laundry, and then will do a writing assignment for a course I’m taking.

And tomorrow is going to suck!

Which I will deal with…tomorrow.

One day at a time.

Recipe File: Whole 30 Roundup

Back when I first started cracking down on my diet in earnest, I would go through my monthly Bon Appetit subscription and earmark pages that had recipes I could actually eat (or that were easily adaptable). They weren’t the majority, by any means, but it was always surprising at how many I could pull out of a mainstream cooking magazine.

Fast forward to the current year, and the BA staff is now providing that service online! They recently posted a roundup of Whole 30 Recipes That Don’t Taste Like You’re Depriving Yourself.

Leaving aside the massive dig at dietary self-control, the recipe list is pretty on-point for paleo-style cooking inspiration. But like many recipes from people who do not fully understand the theory and practice of the paleo approach, there are a few missteps with ingredients (white potatoes? corn??). Never rely on someone else’s dietary interpretations; always evaluate critically for yourself.

Similarly, if you’re low-fiber or low-FODMAP like myself, most of these recipes won’t work either. BUT — at least it’s a start! There are a few that I can adapt. (Is this adapt-ception? I’m now adapting the paleo-adapted recipes!)

A few that caught my eye:

For now, I’m off green beans…and tomatoes…and almonds…but I’ll dream about that recipe anyway.

Happy Cooking!

Research Alert: PREdiCCt

Looks like some investigators in the UK are looking to identify environmental triggers for Crohn’s and Colitis flares.

Basically, they’re going to sample people’s gut bacteria and given them questionnaires on their diet, lifestyle, and health over the period of 2 years, then attempt to find trends in the data.

This is the kind of study that makes me hate “evidence-based” science, because it is completely backwards. For the most part, we KNOW what those things are already. We don’t need some big data study to tell us what Sarah Wilson chronicles in herself, or what all the success stories at Mark’s Daily Apple point at.

Based on what I’ve talked about with other IBD people, and read about online, there are big triggers (ie, sugar), but then everything else is intensely personal.

And even then, it can be incredibly hard to tell. I once talked with a guy who kept a very detailed spreadsheet of his symptoms, food intake, sleep and then ran a statistical analysis on it. What did he find? Nothing helpful.

I wish these guys the best, but I’m not going to hold my breath that they find anything significant.