“DIARRHEA HAS CONTROLLED MY LIFE FOR DECADES!”

My 50 year old patient related the following history:

“The diarrhea started in my teens and has dominated my life. It got worse when I went away to college, stress was my first trigger, final exams, a date, then almost anything could trigger it. Imagine trying to find a toilet at a Big Ten football game. I knew I was going to have to leave school if I couldn’t get this under control. My parents arranged a gastroenterologist over winter break. Got scoped at both ends. Everything was perfect.”

“You have irritable bowel syndrome,” he said. “You’re too stressed. Just calm down.” 

“Well, at least I didn’t have ulcerative colitis or Crohn’s Disease (which my parents dreaded) or ‘the Big C’ (which for some ungodly reason, I dreaded). And he gave me the first of many prescriptions that really didn’t do much of anything except a bunch of side effects like drying my mouth or bloating. I tried eliminating different foods–no effect. Got tested for food allergies–nothing.

“And now I’m fifty. A second gastroenterologist a couple of years ago, diagnosis-wise, agreed with the first. Irritable bowel syndrome! Would you believe it actually got worse in the past few years. The Black Friday Sales are this week, and I know exactly where each restroom at Nordstrom’s, Macy’s, and Bloomies is located.”

“Oh, one more thing. My IBS went completely away every time I was pregnant. Three pregnancies. Twenty seven months of peace.” 

“I can’t help you with another pregnancy,” I answered unhelpfully, “But let me tell you a bit about IBS and give you some suggestions that might help.

First, you’ve got a very common ailment, estimates as high as 15% of Americans are suffering along with you. It’s not really a “disease”. Examined under a microscope your large intestine, a/k/a your colon, would look perfectly normal. By far more women get this than men, and IBS frequently runs among women in families. 

Second, the key to understanding IBS lies in an understanding of the brain chemical (a/k/a neurotransmitter) serotonin. The best way to think of serotonin is as your “factory-installed stress buffering system.” A woman’s level of serotonin is only 25% that of a man, so women are far more vulnerable to stress related emotional diagnoses like anxiety and depression. As such, women are far more frequently prescribed the many medications that raise serotonin in the brain, the SSRIs like sertraline, citalopram and escitalopram.

Now, the important part.

Although we think of serotonin as a brain chemical, fully 90% (!!) is produced in your gut. In other words, your intestines act as your “brain outside your skull”. The sensation of “having a gut feeling” or “getting the sh-t scared out of you” is quite real.” 

Third, also pretty important with regard to women. Your serotonin is linked to wherever your estrogen happens to be in your life. When you were pregnant, your estrogen was super-high, which is why you had morning sickness. But this high estrogen pulled up your serotonin to new peaks and your IBS went away. Given the endless vagaries of women and their hormones, if you look back on your life when you were cycling regularly, your IBS was worse during the week before your period. During those PMS days, your estrogen fell, and like the second car of a two car roller coaster, your serotonin stress buffer fell as well. You might have a terrible week: diarrhea, irritability, headaches and then you get your period and Lo! Things improved. 

But now, entering menopause, the relentless decline of your estrogen (sorry, this happens) and your serotonin and your IBS seems to be worsening.

I actually wrote a book on all this called, “The Triple Whammy Cure,” the Three Whammies women suffer from being, ‘stress’, ‘serotonin’, and ’hormones’.

Now, onto your diarrhea. Yours is severe enough and sufficiently interfering with your joie di vivre (especially with the Black Friday sales, holidays coming up and all) that ‘going all natural’ is simply not going to cut it.

The only diagnostic test I’d really like to see (and you may have had this already and if so, let me see a copy) is a Comprehensive Stool Digestive Analysis with check for Parasites. Several companies offer this, almost always out-of-pocket (about $350). Can start treatment awaiting test results.”

Prescriptions

Lomotil, now in its 65th year of being used for both acute and chronic diarrhea. Usually covered by insurance, but if not 90 tabs cost $40 at CVS (oddly $110 at Costco). Usually 2-3 a day keep diarrhea in check. 

An antidepressant (like sertraline or Prozac) will raise your intestinal serotonin. If you are reluctant to go the antidepressant route, see Supplement List below.

If menopause symptoms become severe along with your IBS, starting Bioidentical Hormone Therapy may actually help both. 

Supplements 

IBSynergy (Designs for Health) specifically designed for gut motility issues, Dose: twice a day

Peppermint Oil Capsules (Nature’s Way) Dose: twice a day (also drink peppermint tea and ginger tea)

Psyllium Fiber (like Metamucil) Dose: one scoop daily 

Xymogen Probiomax (high potency probiotic) Dose: one packet daily

Diet 

The commonest diet beneficial response is following the rather difficult low FODMAP program which eliminates of variety of fermentable sugars. Most patients, myself included, find this intolerable. You can try a simplified version here. If nothing happens, just avoid foods that trigger your symptoms.

For help with any of this, schedule with a WholeHealth Chicago practitioner at any of our locations. For supplements, go to our website, click the apothecary tab and order from Fullscripts for our practitioner discount. 

Be well,
David Edelberg, MD