What could be wrong with my stomach?

[GIathlete]

Hello,
I am hoping you can help. I am an elite athlete specializing in Ironman Triathlon. I train 20 to 30hrs per week swimming, biking, running and functional strength training. I had a BMD issue a couple of years ago (suffered 3 hip fractures over 2 years) and after seeing 7 different doctors my Primary Care seemed to put a ton of things together and believed I was not absorbing calcium and may estrogen levels were super low and virtually non existent. I was put on Ogestral and Forteo and knock on wood- no more injuries and a BMD increase of 22% in 1 yr. However, I started having what I thought was food allergies. I seemed to grow super sensitive to various foods and couldn't pin point what it was. I thought is was soy and protein isolates. It was mild last year but since Jan of 08 its really become problematic.
My symptoms are:  Severe Bloating-my stomach becomes very distended, it craps in the lower abdominal area, I often get a wave of nausea and really hot. Sometimes the food will come up in undigested chunks. Often I'll have to rush to the bathroom for a bowl movement. I do have frequent bowl movements and oftentimes whole undigested chunks of food will be in my stools. When severe I may throw up rather violently and it'll get into my sinus and cause facial swelling, ear aches and burning esophagus.
I thought I had food allergies or absorption/enzyme/digestion issues. But know one seems to be able to figure it out. My labs are okay except my pancreatic enzymes are higher. Which I have been told by some that is normal for my heavy training volume. I stopped all medications and continue some supplements. I had an ultra sound of my Pancreas, Liver, Kidney and Gallbladder and all was normal. I am on to an endoscopy and muscle tonomitry (sp?) next.
Any help or advice is greatly appreciated.
Thanks!
-Kel
  

[carabeara49]

I'm curious to see how you are doing now. I've come upon your post as I was looking up forteo and candida. I myself, have candida and took forteo a few years back and are wondering if they are related. Hope by now that you are on the mend.

[GIathlete]

This is good information! I am very Thankful for all your help. I am going to get some tests done with a new GI doc and I'll provide him with this info as well! Thanks again!
All the best to you!

[boron]

But again, your symptoms are not from allergies (where a substance histamine is released which causes swelling, itching).

Your symptoms are from nerve irritability, triggered by certain food.

[boron]

What I've been written about nerves above...it's only what it happens behind the scene, you don't need to understand that. I was trying to explain why you get symptoms when you're NOT training so much. It's like a drug withdrawal symptoms: Your intestine becomes irritable, when your body comes in a "resting mood", what your brain may understand as abnormal mood after all this training.

You mentioned Forteo. You started to use forteo to improve your estrogen. Estrogen was probably low because of hard training. So, yes, I agree, stress is a major culprit.

Training = stress >> low estrogen >> Forteo >> digestive problems.

[GIathlete]

Thank you again for the info. The last piece here is very difficult for me to understand. I am not familiar with many of the terms you mention.

I do believe stress is a major culprit. However, I still would have to question the training for triathlon as the main issue. I trained many more hours than I do now in 2005 and 2006. In 2007 I cut back and in 2008 I cut back even more on volume. I did not have this problem in previous years. This has just started after about 1 year of being on Forteo and Chlorthalid.

To me it almost seemed like the Forteo (perhaps it's base) increased my allergies and now combined with stress my stomach is super sensitive.

If you have insight and thoughts on this I would love to hear. Thank you.

[boron]

Hard sporting is stress. Stopping or breaking with hard sporting may again be a stress. People get terrible constipation even when they move their house...But this is vague talking here...

Having problems with estrogen speaks for severe stress.
Food coming into your mouth WITHOUT burning, speaks for reversed gastro/esophageal motility...well, this happens in vomiting and it is controlled by nausea/vomiting center in the brainstem, which is influenced by autonomic nervous system and certain substances/hormones in blood. The gut is almost entirely innervated by autonomic nervous system: parasympathetic nerves (n. vagus) stimulate peristalsis, and sympathetic nerves inhibit it.

Hard training is stimulates sympathetic nerves. When you stop with training, sympatetic tone decreases, what means, that parasympathetic nerves will have more influence. Increased parasympathetic tone causes fast peristalsis (indigested food in stol) and reverse esophageal peristalsis  (food comes into the mouth). This increased ps tone is maybe only triggered by certain food. Someone would call this IBS, but I hate this word, since it doesn't explain much.

In short - you may have periods of irritable bowel. Irritable bowel is mostly irritated by food or stress. It is treated by reducing stress and adjusting diet. The key may be in the second sentence of my first post above.

[GIathlete]

Wow- this is very interesting! Sorry for my delay- I was home in Ohio for the long weekend! Okay...
1. It's actually impossible to take 2 weeks off right now. I have Eagleman 70.3 (1/2 Ironman) June 8th then I race Ironman CDA June 22nd. Now, I will taper for the Ironman, therefore volume will be down for 2 weeks before June 22nd and the week after will be super light! I will gradually build back up volume and intensity though as I prepare for the World Championships in Hawaii on October 11th.
2. Here is some other news- I did not have any real problems now in 5 days! I have been eating steak more and not trying anything new. The last time I was sick was Wednesday from this horrible pizza where I think the owner of the shop used Vegetable Oil from the fryer to saute the veggies- Yuck!!
3. My training has been killer-on track in these past 5 days- 120mile ride/hard transition run and easy swim Friday. Easy bike and 3hr/23mile long run Saturday, 110 steady bike on Sunday and easy bike/run yesterday. So to me- when my training is on- my symptoms are down or non existent. But when i don't get my workout in-things seem to get messed up- like my metabolism or digestive enzymes/acid level get off- from stress? worry? anxiety? Could this be possible?
4. Lastly -what is Candida? how do i get read of it if that is the case? could i have something wrong with my sphincter?

thank you ever so much! hope you had a great long weekend!

[boron]

From your answers, I can say that you probably 1. have no fat malabsorption 2. no liver disease 3. no gallbladder disease 4. no new allergy, but you obviously have allergy to fish.

5. Burning after throwing up is from the gastric acid.

Now, what?

Is it possible for you to have a break from your athletics, for lett's say two weeks? The food which comes up into your mouth without having heartburn, doesn't speak for gastritis, and food particles in the stool without constant pale stools doesn't speak for malabsorption, so I don't see any physical cause at the moment.  

Your gut seems to be irritaterd from exercise and symptoms triggered by your protein isolates or other food.

Make a break, and try with this diet:
- don't eat foods which come up into your mouth
- drop protein isolates, and have a low-protein diet trial for 3-4 days (reduce meat, dairy, eggs, beans). I'm not saying that proteins cause your problems, but proteins stay in the stomach for several hours.
- Have another trial with low-carb diet for 3-4 days: no sugar, sweets, fruits, starch (potatoes, pasta, wheat). Simple carbohydrates are the food for intestinal bacteria and eventual candida, and they produce gas and thus cause bloating. So, if after low-carb diet, symptoms would improve considerably, it means you may have intestinal bacterial (or candida) overgrowth.

[GIathlete]

Thanks so much for the detailed questions...
1. Stool- varies throughout the day even- I go often- 2 times in the am usually, 1 or 2 more in the day. It's often normal, whole brown. sometimes it is vary dark, often it's lighter and every now and then it's on the light brown to mustard color. I have seen it closer to whitish green before. It sometimes has whole chucks of food in the more normal ones and int he light brown, greenish ones. These are usually not fully formed and more like particles. Some float some do not. It's wild.
2. I drink a lot of water all day as I workout so much- so urine is mostly pale yellow. Never super dar.
3. I never get cramps just below the rib cage. I only have cramps in the lower part.
4. The heat-feel like i'm going to start sweeting and nausea wave-is not like a flushing-more like i just finished a really hard run and then i stopped and the body is still hot and wants to move to cool down kind of feeling -if that makes sense. The bloating comes after eating the food. The face swelling comes after i had a violent throw up.
5. From seafood-yes- my lips blow up, my throat gets itchy then swells closed- but this newer stuff is not like that at all- no lips or throat- it's only burning after I throw up do i get the burning. It's weird. Let's say i ate something and i get bloated and start not feeling good. I could be sitting at my computer and food will just come up my throat and i spit it out. Maybe a good 4 to 6 times this will happen- no burning or acid feeling- then i just gotta go to the bathroom or really throw it all up. Then i feel the burning and stuff. Wild- I know
6. I just turned 30
i hope this can help you help me!
thanks so much!
-Kel

[boron]

OK, some questions:

Would you say your stool is (at least sometimes) pale OR foamy/sticky/floating ?
Have you ever noticed darker urine as usually?
Have you ever experienced right upper abdominal cramps (below the right rib cage)?
This heat after eating, is it like face flushing (or even swelling), or upper chest flushes, and does it ever go with skin itching or throat itching (not burning)?
How old are you?

[GIathlete]

Thank you so much for all the info! Yes- I am a woman:)
I have had low estrogen in the past but I do get regular lab work and things seem to be going well except for high pancreatic enzymes. I am looking into IBS next. I am pretty sure it's not to dairy or wheat. My breakfast consist of a banana, honey bunches of oats w/almonds, wheat germ, skim milk, whole wheat toast w/ natural peanut butter and a tiny bit of honey pomegranate jelly and a little fresh OJ oh and a carnation fat free 25 calorie hot chocolate. I eat that every day after a light workout in the morning. Never-have problems. Lunch is often a healthy whole wheat pizza crust, fresh spinach tomatoes and mozz cheese w/ tomato basil sauce- no problems- its weird stuff that gives me issues- sometimes an ice cream, snack bar, oily stuff etc. I am extremely allergic to all seafood and found that out when i was 18 and almost died. I do avoid it.

any other thoughts with this additional info would be great to hear!! One of my docs thinks it could be acid the other doc thinks it could be related to my sphincter  -so looking for more thoughts and advice!

thanks so much!

[boron]

I guess you're woman.

From your post, it seems like running is seriously ruining your life. Having low estrogene is typical for professional women athletes.

Allergy is likely. Flushing and itching are typical for allergy, also diarrhea and maybe vomiting, but not bloating. Bloating is probably from "something other".

You can only find if it is allergy, if you eliminate ALL suspicious foods (soy, all your protein isolates, all fish, shellfish, peanuts and tree-nuts, and maybe milk, eggs, wheat and corn)  from your diet and then (after a week, if your allergy-like symptoms improve) start adding foods ONE BY ONE BACK every other day and observe, if allergy symptoms re-appear. Allergy is usually to one or two foods, allergy to more than 4 foods is really rare.  
Principle of eliminating diet is described here:
http://www.allhealthsite.com/32/tests-to-find-causes-of-diarrhea/#elimination-diet

The other term, which is NOT connected with allergy, is "irritability to food", known as irritable bowel syndrome (IBS). "IBS triggered by exercise" is known. At some point, intestine "has enough oif stress" and starts to protest. Many different foods can then irritate such an irritable bowel.

Yet another thing is "food intolerance", what includes lactose intolerance - only to dairy products, and "gluten intolerance" or celiac disease, which may both develop at any time in life. Lactose-free diet trial and gluten-free diet trial (like above one with allergens), lasting for a week each, may reveal this. From your symptoms I doubt, you have celiac disease, but you can try with lactose-free diet (simply nothing dairy), since bloating of lower abdomen and diarrhea are characteristic for lactose intolerance.