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Gastroenterology (Expert Forum)
IT SEEMS NOT SO MUCH WHAT I EAT, BUT WHERE I EAT.
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
IT SEEMS NOT SO MUCH WHAT I EAT, BUT WHERE I EAT.
by JPM in CV, Aug 19, 2003 12:00AM
19 Aug 03
Dear Dr. Pho:
Since approximately 1988 I have had diarrhea problems. Until 1995 I figured medical science likely had no solution for me. However, in 1995, during a routine physical, I told a doctor about the symptoms. Another, more pressing issue diverted our attention: Blood tests indicated I was anemic. An occult blood test for my stool was negative. Concerned there might be bleeding in my sigmoid, the doctor had me undergo a flexible sigmoidoscopy; the attending proctologist saw nothing out of the ordinary. The first doctor (the one concerned about my anemia) directed me to take iron supplements; these tended to constipate me and I told her so; she told me to take them anyway. Since I desired to avoid being constipated and since I was quite sure the anemia was diet-related (The doctor never even asked me about my diet.), I stopped taking the supplements. I never again saw the doctor . . . . so the diarrhea issue never again came up.
Simply stated, if I eat only frozen, canned, or otherwise packaged foods, I will never get diarrhea. Also, if I eat prepare-as-you-go (not buffet) food in better (high end) restaurants, I will not get diarrhea. However, if I go to “run of the mill”, chain restaurants or inexpensive “mom and pop” type places, I will very often get diarrhea. Home-cooked meals will generally not give me diarrhea, but sometimes will. Thus, for example, if I eat frozen food section type meat loaf, I will never get diarrhea. If I eat meat loaf in an inexpensive restaurant, I will quite likely get diarrhea. If I eat meat loaf at someone’s home, I probably will not get diarrhea. I have also noticed this phenomenon with steak, prime rib, ham, pizza, seafood, ravioli, omelettes (even those without meat) and other foods. You get the idea, doctor. There is something about inexpensive restaurant food that “bothers” my digestive system. By the way, my friends will eat the same restaurant food and not get diarrhea. What do you think might be my problem?
In 1983 I came back from Mexico with moderate diarrhea; it lasted about 3 weeks. Except for occasionally taking loperamide HCl, I take no drugs. (The loperamide HCL is often ineffective for me. I usually only have one very loose bowel movement, so I generally only take the initial two caplet dose.) Also, I do not smoke, but do moderately drink alcohol nearly every day. I am a 45-year-old, Caucasian, heterosexual, male, 5’ 5”/170 pounds. I have had abdominal surgery. I could eat more nutritiously, but often do not because of my diarrhea problems. Just in case you are thinking that alcohol consumption is somehow responsible for my problems, while keeping in mind that my problems developed in about 1988, note that I drank no alcoholic beverages from mid-1986 to early-1994. Also, drinking alcoholic beverages with “troublesome” foods appears to sometimes, but not always, help.
Thank you, doctor, for your assistance.
Respectfully,
JPM in
Dear Dr. Pho:
Since approximately 1988 I have had diarrhea problems. Until 1995 I figured medical science likely had no solution for me. However, in 1995, during a routine physical, I told a doctor about the symptoms. Another, more pressing issue diverted our attention: Blood tests indicated I was anemic. An occult blood test for my stool was negative. Concerned there might be bleeding in my sigmoid, the doctor had me undergo a flexible sigmoidoscopy; the attending proctologist saw nothing out of the ordinary. The first doctor (the one concerned about my anemia) directed me to take iron supplements; these tended to constipate me and I told her so; she told me to take them anyway. Since I desired to avoid being constipated and since I was quite sure the anemia was diet-related (The doctor never even asked me about my diet.), I stopped taking the supplements. I never again saw the doctor . . . . so the diarrhea issue never again came up.
Simply stated, if I eat only frozen, canned, or otherwise packaged foods, I will never get diarrhea. Also, if I eat prepare-as-you-go (not buffet) food in better (high end) restaurants, I will not get diarrhea. However, if I go to “run of the mill”, chain restaurants or inexpensive “mom and pop” type places, I will very often get diarrhea. Home-cooked meals will generally not give me diarrhea, but sometimes will. Thus, for example, if I eat frozen food section type meat loaf, I will never get diarrhea. If I eat meat loaf in an inexpensive restaurant, I will quite likely get diarrhea. If I eat meat loaf at someone’s home, I probably will not get diarrhea. I have also noticed this phenomenon with steak, prime rib, ham, pizza, seafood, ravioli, omelettes (even those without meat) and other foods. You get the idea, doctor. There is something about inexpensive restaurant food that “bothers” my digestive system. By the way, my friends will eat the same restaurant food and not get diarrhea. What do you think might be my problem?
In 1983 I came back from Mexico with moderate diarrhea; it lasted about 3 weeks. Except for occasionally taking loperamide HCl, I take no drugs. (The loperamide HCL is often ineffective for me. I usually only have one very loose bowel movement, so I generally only take the initial two caplet dose.) Also, I do not smoke, but do moderately drink alcohol nearly every day. I am a 45-year-old, Caucasian, heterosexual, male, 5’ 5”/170 pounds. I have had abdominal surgery. I could eat more nutritiously, but often do not because of my diarrhea problems. Just in case you are thinking that alcohol consumption is somehow responsible for my problems, while keeping in mind that my problems developed in about 1988, note that I drank no alcoholic beverages from mid-1986 to early-1994. Also, drinking alcoholic beverages with “troublesome” foods appears to sometimes, but not always, help.
Thank you, doctor, for your assistance.
Respectfully,
JPM in
Doctor's Answer
by Kevin Pho, MD, Aug 22, 2003 12:00AM
, Aug 22, 2003 12:00AM
If the diarrhea is associated only with certain foods, I would examine the possibility of some kind of malabsorption syndrome. There are many kinds - i.e. to fats, carbohydrates, or protein. Celiac disease can also present this way and should be investigated.
In terms of the next tests, I would consider fecal fat tests and serum tests for celiac disease (which can be done via measuring certain antibodies). Breath tests can also be performed to look for lactose intolerance.
If you haven't had a fully colonoscopy yet, I would consider this. Make sure that inflammatory bowel disease has been ruled out (this should have been done during your flex sig).
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
In terms of the next tests, I would consider fecal fat tests and serum tests for celiac disease (which can be done via measuring certain antibodies). Breath tests can also be performed to look for lactose intolerance.
If you haven't had a fully colonoscopy yet, I would consider this. Make sure that inflammatory bowel disease has been ruled out (this should have been done during your flex sig).
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
seem to be a lot of mucos, wonder if it is connected to the gall bladder?
did you ever get tested for h pylori bacteria?/