A digestive year from hell

Digestion is a topic that many people don’t like to discuss. Well, I’m going to talk about it because 2020 has been a gastrointestinal (GI) annus horribilis, and yet I’ve managed to come out the other side feeling better than I have in years.

COVID wiped out most of a year of planned travel for us, and saw us move back to Vancouver to spend our travel money renting a place we didn’t want to be in, while not working. So, why not add an array of debilitating symptoms and two scopes to the mix? I’m writing this primarily for my own record, to outline my experiences and some of the steps I’ve taken to gain some control over these conditions. Maybe some of it will be useful to anyone who reads it.

A little history

IBS

The first time I had an IBS (Irritable Bowel Syndrome) attack was several years ago now, an experience which is firmly tatooed on my psyche. I’d taken a week off work and we met my sister-in-law on the first weekend for dinner. I had a double portobello mushroom burger which had a pretty garlicky sauce. For the rest of my week off I had my first IBS flare-up ever. To this day it remains my worst. Hit with rotating gas pain, constipation, diarrhea and a complete inability to eat for most of the week, I was flat on my back or in the bathroom for days and lost about five pounds.

After this episode I did some research and discovered FODMAPs, which are fermentable sugars that can be difficult to digest for some people. When they pass through the small intestine undigested, they ferment in the colon and can produce debilitating symptoms. This led to doing some elimination testing with the guidance of a dietitian. It turned out both portobello mushrooms and garlic are not an option for me, so having them together in large quantities netted a predictable result. Over time I’ve been able to identify several other foods to avoid, both containing FODMAPs and not.

For a while I ate only low FODMAP foods and had tolerable digestion. I say tolerable, because I remained prone to random digestive attacks of varying intensity and symptomatology. However, avoiding all FODMAPs while remaining plant-based is pretty unsustainable so I slowly slipped back into older eating habits and I continued consuming coffee, an often aggressive digestive trigger for me.

It’s not an exaggeration to say that IBS has impacted every area of my life. At times it’s made it difficult or impossible to go running or cycling when I want. It’s caused me to miss more than a few days of work and, at times, when going out I have needed to make sure public washrooms are always within reach. As for eating out, plant-based with IBS means asking questions of servers you’d really prefer to not bother them with. Even when taking all precautions, however, some errant garlic or unidentified irritant has still sidelined me for a day or more at times.

Acid reflux and heartburn

I’ve also had episodes of acid reflux with occasional heartburn for longer than I can remember. Initially it could be attributed to coffee or spicy food consumption, but over time it became more frequent and prominent. Likely the longest term side effect of this condition has been a raspy and often raw throat. This is pretty common, because of stomach acid irritating the lining of the esophagus.

Hemorrhoids

Additionally, in the last decade I developed mild hemorrhoids, likely as a result of my IBS. I had a banding procedure a few years ago, but in the past couple years have been having symptoms again. I’ve never had much itch or pain, so symptoms have mostly taken the form of bleeding and feeling a little blocked. More on that later, but flare-ups definitely complicate the situation for someone who also suffers from IBS, as all the symptoms together can suggest far more serious health conditions.

H Pylori

illustration of H Pylori
Helicobacter Pylori bacteria (CSIR | badgut.org)
I began having symptoms of this difficult-to-treat bacterial infection in late 2019. I would ultimately end up having it through most of 2020, getting a Gastroenterologist consult, going through two rounds of triple antibiotic, PPI and probiotic therapy to get rid of it, and only feel like it was really gone after my digestive system was fully cleaned out and the upper endoscopy it triggered.

For more on my symptoms, treatment and some considerations, read more here.

FIT for a couple scopes

FIT kit image
FIT kit (NPR)
After missing my biennial Fecal Immunochemical Test (FIT) for nearly four years, I got a kit and submitted my sample in June. It came back positive and this triggered a second reason for a specialist consult (and another scope from the other end of my body). Given my “rhoids” a positive test wasn’t a big surprise, but it still created a lot of health stress.

For more on my colonoscopy and endoscopy experience and outcome, and some considerations, read more here.

Denoument and considerations

So, here I am more than a month after my scopes, after a year of digestive hell and a lot of stress about my health. I’ve been given a clean bill of digestive health with no remaining bacterial infection, and not so much as a polyp or ulcer anywhere. Where does that leave me? Oddly, not in a bad spot, right now anyway.

Since I had the scopes, my digestion has felt as close to perfect as I can recall it being, for as long as I can remember. That doesn’t mean it’s going to be this way forever, and particularly with hemorrhoids and IBS, it’s impossible to predict how things will behave for any length of time. However, I can’t remember the last time I felt this good for a month.

In no particular order, what follows are a few things I’ve tried and considerations if you’re unfortunate enough to have any of these conditions.

IBS

If you have chronic constipation and/or diarrhea, gas or other IBS symptoms, consider some of the following things. IBS triggers can be very individual, but the things I outline below are first line thinking and helped me. These are probably the most important things I’ve considered, with the greatest impact on my digestive health. Most importantly, talk to your doctor about your symptoms and get things properly diagnosed, or eliminated as the case may be.

FODMAPs – Monash University has been researching and testing the issue for years and has a very useful app (iOS/Android) that allows you to look up many common foods. It tells you which FODMAPs are in what foods and how much should be safe, or not. First, though, I’d strongly recommend doing a proper FODMAP elimination/reintroduction diet. If you do it properly, you can pinpoint trigger foods, because low-FODMAP is not supposed to be a long-term diet. Also, with FODMAPs quantity kills. Sometimes you can tolerate 1/4 cup of something, but not 1/2 cup. You need to use trial and error.

Probiotics – I never bothered with them for the longest time. As a very specific probiotic was required during my antibiotic regimens, I’ve simply kept taking one in the time since. It has definitely seemed to help.

Garlic – A lot of people don’t realize how hard garlic can be on digestion, and it’s so common as a food additive that it can be difficult to eliminate. I’ve been avoiding garlic for quite some time, but I know I’d been slipping recently previous to this past year. Since we returned from Australia, I’ve been really strict in terms of labels and asking when we’ve gotten takeout. If you really miss garlic and want the taste, you can prepare garlic-infused oil. I know garlic is my first true kryptonite.

Lactose – When I say I’ve been mostly plant-based for years, the exception has been some dairy, mostly in the form of coffee cream or occasional cheese. When I elimination-tested it, my results were inconclusive, but I’ve been completely off lactose for a couple months now.

Coffee – It’s not a trigger for everyone, but its laxative properties are well-known. It’s probably the one thing I miss more than anything else, and I hate it black. So, like lactose I’ve also been completely off it now for a couple months. It’s quite possible that coffee + lactose is my second true kryptonite.

Beans – In truth most beans and legumes are flagged for FODMAPs, but they each affect people differently. Through trial and error I’ve found the beans I absolutely must avoid are black and kidney (a shame, because I love black beans in particular). Chick peas seem to be fine and we make homemade hummus without garlic. I avoid soft tofu out of caution, but don’t have any problem with firm. Thankfully, tempeh is great and it’s my favourite soy based protein.

Imodium and Milk of Magnesia – I’ve never been one to take drugs for constipation or diarrhea, mostly because I’m afraid of them swinging the pendulum too far the other way. However, I started using both of these a month or two before the scopes, when my symptoms were really bad. A couple tablespoons of MoM is all I typically need to get a traffic jam gently moving again, and the quick dissolve Imodium tabs have been very effective at stopping excessive traffic. I’ve only used both of them a couple times, but they’ve worked like a charm.

I’m also in the process of determining which other foods, particularly nuts, grains and seeds, are triggers. I don’t want to just skip huge groups of foods. I’m avoiding pistachios and cashews for the moment, based entirely on the Monash app, but I plan to test them because cashew cheese sauce in particular, is one of my favourites. Luckily I don’t find many fruits or vegetables cause me problems and I don’t seem to have any fructose or polyol issues.

Stress

Despite whatever may have actually been happening in my digestive system, I suspect stress has played a role in my symptoms being so bad this year. Stress about COVID, stress about losing our year of travel, stress about my wife finding suitable work again, stress about all the stuff going on in my body … just a bunch of fucking stress. Plus, try as I might to kick concerns about my health to the back of my mind, they were a preoccupation and really had been since I received the positive FIT result, given all the other symptoms I was experiencing. I wouldn’t say I’m doing a lot about this specifically, but I’m back to meditating for 20-30 minutes before bed for now and doing yoga frequently.

Aside from all the other benefits exercise provides, it’s also great at busting stress. So, whether you’re trying to fight sitting at a desk all day, get better sleep, feel better or lose weight, just make sure you’re exercising. It’s always been part of our lives, but I’m trying to ensure I’m running or cycling every day now.

Final word

Just like I can’t completely explain why everything got so bad in such a short period of time, I can’t completely explain why things have been so good since the scopes. Luck may have a little to do with it, and for all I know the H Pylori was affecting more than just my gut. I’m absolutely sure that being more careful with what I’m consuming is playing a very large role in things, too. For example, in my case coffee causes stomach acid reflux, contributes to heartburn and can give me the runs. Much as I like drinking it, I’m preferring a happy gut.

All of this also tells me that digestive health is a holistic system and not just one thing, with a magic bullet fix. Like most things in life.

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