Bowel Acid Diarrhoea

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paganstar
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Joined: Wed Jul 10, 2013 3:52 pm
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by paganstar on Wed Jul 10, 2013 5:04 pm

Bowel Acid Diarrhoea

I control my IBS-D very successfully with the FODMAPs diet plus the further omission of several foods regarded as 'safe' on this diet, but which are not good for me. As you can imagine, my menu is extremely limited and I'm anxious to, at least, extend it even if I can't eat completely normally.

Having recently read about BAD, I'm seeing my GP on Friday 12th in the hope of being able to either get a SeHCAT test or a prescription for Questran. I have 2 questions about this for you:

i) if I have BAD and Questran or a similar treatment is successful in controlling it, would I then be able to eat a regular diet or would it still be limited?

ii) there are several references on the web regarding the use of slippery elm bark, made into a 'gloopy' tea, being as successful in treating BAD as Questran, do you know if this is true?

Many thanks for giving your time.

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Dr Nick Read
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Joined: Mon Jul 08, 2013 2:22 pm
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by Dr Nick Read on Wed Jul 10, 2013 5:22 pm

Re: Bowel Acid Diarrhoea

A low FODMAPs diet need not be a life sentence. If there is also an stress element behind your symptoms then when that is resolved, then you may be able to reintroduce FODMAPs foods. The same applies to Bile Acid Diarrhoea (BAD). BAD is often the consequence of the rapid transit which reduces bile acid reabsorption so is the effect of the IBS as well as a contributory cause. Questran is a very useful treatment, though many doctors would prescribe it without necessarily doing a SeHCat Test - as a trial of treatment. If you are treated with Questran, remember to take it twenty minutes before your meal and titrate it with the size of your meal and the response. I would normally advise starting with 1 sachet before the main meal of the day and half a sachet before lighter meals, but adjust the dose up or down according to the response. But if bowel transit and IBS is being driven by a stressful life, then addressing that may allow you to reduce or stop the dose of questran as well take more FODMAP foods.

Slippery elm becomes a gel in the gut and may also adsorb bile acids but I have no experience in using it and there has been little research on it for IBS-D. .
Dr Nick Read
Gastroenterologist and Psychoanalytical Psychotherapist

http://www.talkhealthpartnership.com/on ... k_read.php

paganstar
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Joined: Wed Jul 10, 2013 3:52 pm
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by paganstar on Fri Jul 12, 2013 10:05 am

Re: Bowel Acid Diarrhoea

Many thanks for your reply.

I have now seen my GP and she has given me a prescription for Questran which she has told me to take as per your instructions. My question now is, in order to prevent constipation, shall I gradually re-introduce some high FODMAP foods back into my diet whilst taking it? I think this is going to be a delicate balancing act.

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Dr Nick Read
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by Dr Nick Read on Mon Jul 15, 2013 4:35 pm

Re: Bowel Acid Diarrhoea

Yes, it is a bit of a balancing act, but I would be inclined to just change one thing at a time. So why not adjust the dose of questran until you achieve relief of diarrhoea without becoming constipated? Then later once you're stabilised, you may want to gradually reintroduce FODMAP foods, especally the ones you think are most implicated, but so you know where you are, I would introduce one at a time, wait a few days before reintroducing the next one. .
Dr Nick Read
Gastroenterologist and Psychoanalytical Psychotherapist

http://www.talkhealthpartnership.com/on ... k_read.php

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