I know there are several out there who have talked about how they feel as if bathroom issues are ruling their lives, so I figured it was time to start talking in earnest about what can be done for this. But before we go there, I think I need to back up to the beginning just a bit.
There is great urban legend out there that says that DS = butt glued to the toilet. I’m sorry, but that just really isn’t so. And if it is, then something is NOT right. So if that’sbeen your understanding and you’ve decided that you’ve just got to live with it, can I just encourage you to take a minute and do some careful examination of some basic choices in your life to see if we can’t find a better quality of life for you? Okay? Seriously – it’s not supposed to be like this, and if it is – I kid you not, there is something wrong going on.
First of all – let’s define diarrhea. I know, seems obvious – but until I worked for GI doctors, I really had no idea what the definition of it was. So here we go!
Diarrhea is watery – there is no form. There is no waiting if you have the urge. It is no respecter of time or place. It is in control.
Here are some excellent references that everyone should read:
Next, if you are a newbie – i.e., less than three months post-op, and feel like every BM is essentially pudding consistency and wonder if that’s diarrhea, then the answer to your question is this: NO. Those are pudding poops, and that’s normal early out. In fact, that may be normal for more than early out. I’m six years post-op and I still have some pudding poops. (Hooray – that means the surgery is still doing it’s thing!)
There are things that can cause diarrhea – for anyone! And there are things that can definitely tip a DS’er in that direction. The problem with all of this – you have to factor in the basic detail that every person has a unique physiology. So for one person – lactose may be the big enemy. For someone else – it may be simple sugars. Both instances may be true for a normie, but for some DS’ers it’s even more true.
When I talk to a DS’er who has having bathroom issues that involve more than a few trips to the toilet for a BM daily, I immediately want to know – are you doing the basics? They are:
- Minimum of 64 oz of non-sweetened (artificially or otherwise) fluids daily, with the goal of doubling that consistently
- 90 to 120 grams of protein daily
- 30 to 35 grams of dietary fiber daily
- Sufficient fat intake – and good for you fats are important!
- Taking all of my vitamins daily (See http://www.bodybybaltasar.com/DS_vitamins.pdf if you’re not sure about vitamins.)
- Getting my labs done consistently
If you’re doing the basics, then it’s time to start looking at whether or not you need to tweak some stuff.
First and foremost, it’s really important to understand that chronic dehydration can and will feed chronic diarrhea. The problem being that there is some urban understanding that you should just throw any fluids at dehydration and everyone will live happily ever after.
Unfortunately, not so. Some people find that sugar (whether it’s high fructose corn syrup – which is in a LOT of drinks, or other forms of regular sugar) can actually cause the problem to be worse – or at least enable it to continue on. There are also folks who find that artificial sweeteners actually cause problems for them. The only way you’ll know one way or the other for either regular sugars or artificial sweeteners is to do some little cause and effect trials.
Next, you gotta be realistic about the fact that human beings are not designed to consume massive amounts of sugar. I know – everyone wants tons of license with no repercussion – but sorry, that’s not real life. If you are consuming LOTS of sugars I have two thoughts:
one, are you getting enough protein in? cause if you’re not, your body may be asking you for a quick fix to it’s basic need for a good consistent intake of protein; and second, are you dehydrated? Cause if you are, you may be answering your body’s basic thirst with a quick pop of something in the mouth that gives you a brief warm fuzzy in exchange forwhat it really needs – to be hydrated.
Basic fact: Sugar feeds the BAD bacteria in the gut. It not only CAN, but in most folks WILL cause a serious imbalance that CAN and WILL cause looser stools.
That’s why so many folks find that probiotics are SO helpful. They restore the balance of good and bad bacteria in the gut. Not making a change in your sugar intake, however, will not help you – probiotics can only do so much. You’ve got to accept the fact that shooting yourself in the foot will not make you a better marathon runner.
Next, dietary fiber is your friend! If you are not getting in enough dietary fiber, you will have bathroom issues. Not just because the dietary fiber increases the bulk, but because dietary fiber is rich in vitamins that you need to have healthy flora and fauna in your gut!
Please – EVERY single post-op should read http://www.slrhc.org/healthinfo/dietaryfiber/ – and pay serious attention to the fact that you gotta get good for you food in your body. It takes work. It takes forethought. It takes – yes, that horrible word we all hate: discipline. If you don’t know what dietary fiber is, then look at the content chart on that site. Another excellent resrouce: http://www.nal.usda.gov/fnic/foodcomp/Data/SR20/nutrlist/sr2 0w291.pdf
The cool thing about dietary fiber is that quite a bit of it packs serious protein punch. A 1/4th cup serving of lentils has a ton of dietary fiber and is very protein rich as well!
Now, lest you think, “my bathroom issue is constipation, so I don’t need dietary fiber,” let me just make a point of saying: wrong! If you’re constipated, you DO need more dietary fiber, and more fluids, and probably more fats. But that’s for later.
Next, do you know that some DS surgeons “require” their post-ops to avoid dairy for the first 18 months post-op? Wanna know why? Cause a significant number of post-ops (but no, not everyone) develop lactose intolerance as early post-ops. If you’re not sure what lactose intolerance is, or what it would feel like if you had it, try reading these:
Know what? If you were lactose intolerant BEFORE your DS, you’ll probably be lactose intolerant AFTER your DS. (Although some people report improved tolerance as further out post-ops.) Also, some people who do have issues with lactose intolerance as early postops sometimes find that it lessens as time goes on. It’s not a given, but it’s also not unheard of.
Something to keep in mind: lactose is sometimes places that you wouldn’t think of right off of the top of your head. You gotta pay attention to the details! You gotta read food labels – it’s just basic common sense! This from the NIH web site:
What is hidden lactose?
Although milk and foods made from milk are the only natural sources of lactose, it is often added to prepared foods. People with very low tolerance for lactose should know about the many food products that may contain even small amounts of lactose, such as
- bread and other baked goods
- processed breakfast cereals
- instant potatoes, soups, and breakfast drinks
- lunch meats (other than kosher)
- salad dressings
- candies and other snacks
- mixes for pancakes, biscuits, and cookiespowdered meal-replacement supplements
Some products labeled non-dairy, such as powdered coffee creamer and whipped toppings, may actually include ingredients that are derived from milk and therefore contain lactose.
Learn to read food labels with care, looking not only for milk and lactose, but also for words such as whey, curds, milk by-products, dry milk solids, and non-fat dry milk powder.
If any of these words are listed on a label, the product contains lactose.
Lactose is also used in more than 20 percent of prescription drugs and about 6 percent of over-the-counter medicines. Many types of birth control pills contain lactose, as do some tablets for stomach acid and gas. However, these products typically affect only people with severe lactose intolerance.
SOOOO…. If you are using protein products (powders, shakes, bars, etc.) keep that in mind! Also, people are often terrified that being lactose intolerant means they will never be able to again consume cheese. Remember – there are alternatives available! Some people do GREAT with goat’s milk or sheep’s milk cheeses where they are irritated by cow’s milk cheese. (Also, don’t forget, the harder the cheese, the less likely you are to have an issue with lactose intolerance with it.) Just remember to do any “trials” with some basic controls in place – i.e., don’t consume something that may or may not be an irritant for you around the time you are doing a test to see if goat’s milk cheese is a good alternative for you!
Next, some people are just super sensitive to fats. And it’s an easy thing to want to make a sweeping generatlization and say “all fats are bad” or “all one type of fat or the other” is bad. The fact of the matter is we each have unique physiology and some people tolerate fats poorly all the way around. If that’s the case, respond accordingly – use fats sparingly. Do, of course, give it a good go of trying some alternatives to the fats you use in your day to day life. I.e., if you’ve always used margarine, then try butter. If butter isn’t working out for you, try olive oil. So on, and so forth.
Next, supplements. This is basic stuff, but sometimes we forget it. Calcium citrate – not in company of magnesium – is something akin to quick dry cement in the bowels. So – again – a basic: every post-op needs 2000 mg of calcium citrate daily – AT LEAST. (Of course, labs are the determiner of how much!) Calcium citrate typically comes in a formulation that includes a 2:1 ratio calcium to magnesium, and hopefully has some D3 thrown in there as well. All good and wonderful – unless you are sensitive to magnesium. Some folks are. If that’s the case, you need to try a trial and error between magnesium citrate and magnesium oxide. Magnesium citrate is actually used to specifically move the bowels (more than move – actually clean out!) – ever been given a bowel prep? That’s what it is! You can/will have some benefit from the citrate – particularly if you are one of us who lean more toward the side of constipation as a post-op – but that’s not the topic at hand. (Interestingly enough – magnesium citrate helps support nerve and muscle function. It is also involved in carbohydrate and mineral metabolism and assists in calcium and potassium uptake.)
If you find that the brand of calcium is bugging your gut – and there are different variations on that theme – sometimes it’s stomach ache (Citracal is notorious for this!), sometimes it causes gas/bloating/distension (again, Citracal is not unusual to see with these types of complaints) – THEN IT’S TIME TO TRY ANOTHER BRAND! There are LOTS of them out there. BUT – PLEASE – be certain you are choosing Calcium Citrate. It’s the best choice for DS’ers. Honestly. Totally serious.
The product that more people say has made their lives vastly improved with regard to lessened BM frequency is UpCal-D. It’s a powder, it has 500 mg of calcium citrate in one serving (which is awesome!), and it has D3 in it. I like it because it’s so easy to take. I get the little packets of it, open one up – dump it in on my tongue, let it dissolve a bit, and then chase it with a sip of tea or something. It tastes a little bit like pixie stix dust. You can find it at Vitalady or Amazon.com – compare prices – bargain shop. This stuff is worth it’s weight in gold. Thankfully, it’s nowhere near that expensive! (I think we pay $12 for about 120 packets.)
You may need more than 2000 mg of calcium citrate a day to firm things up in the bathroom department. That’s okay. The key is to baby step to the correct amount for you.
Next, accountability sucks – but we all know it’s good for us. That’s why I love
www.fitday.com or www.sparkpeople.com – they are a great place to get a reality check. Do some basic recording of what goes into your mouth – and then also pay attention to what’s going on in the bathroom department. It’s hard to know if the stuff that’s going into your mouth is causing a problem if you don’t know what’s going into your mouth. I know, I know – it smacks of weight watchers – but if it’s going to improve your quality of life significantly, is it worth working past the flashbacks of WW?! LOL! (The answer to that is supposed to be yes, by the way!) Pay attention to the details. If you’re finding that having a Wendy’s frosty is giving you killer gas, distension, bloating, and then a little later on explosive diarrhea – well, folks, there’s proof in the pudding there. (Sorry, I couldn’t help it!)
Next, it’s entirely possible you’ve got a bug going on in your gut that needs medical attention. Get tested for c. diff, h. pylori, and bacterial overgrowth. These are treatable. Why suffer if there’s something that can help – even though it may take a little bit of dedication and work to get there?
Finally, if you’ve tried all of these things and you’re still experiencing frequent BM’s, your labs are showing you to be in malnutrition (and there’s a profound difference between managed malabsorption and malnutrition, folks!), then it’s time to talk seriously with your surgeon and your PCP about whether or not you are in need of a revision. Lest you be panicking right now – it’s not the norm – not everyone goes through this – it’s the exception. It totally and completely as profoundly as possible SUCKS big time that *anyone* has to go through it. BUT, the great news is that those who do find that a surgical response is the best option for them find that it DOES, in fact, make a huge difference and brings hugely improved health and quality of life.☺
All of that being said, we have to be honest with ourselves, as well. I’ve lost count of the patients I’ve talked with who have been suffering horrible bathroom issues, have identified the cause (not at all out of the ordinary for it to be won ton indulgence in sugars – remembering that sugars come in lots of different forms!) and then look me in the eye and say, “I’m not willing to give up the sugar.” To that I have to say, “That’s completely your choice. I can’t make that choice for you.” But if you do make that choice – own up to it. Please.
I guess I need to add one more little snippet here before I close. Everyone always assumes that what it’s like the first month, three months, six months, year – even two years – is what it’s like forever more. That’s sort like saying as a human – my whole life will be just like it was my first two years of life – babyhood and toddlerhood. Yeah, not so much. Things even out with time. Lots of growing up happens over the course of those first few years as a post-op. Figuring out that there are good and bad decisions dietarily AS HUMAN BEINGS – not just DS post-ops – is one of the lessons that happens during that frame of time – hopefully.
Okay – so that’s my book length post for the day! LOL!
Author: Dina McBride