Gut Woes

Content notice: This post will talk about poop, so if you are the sort of person who doesn't talk about poop or feels like they should apologize when they do talk about poop, then this post might not be a good fit for you.

After so many years paying close attention to my body's every sensation and recording every food and supplement I ingest, I feel like I am no closer to understanding my gut's whims. I have no confidence that the doctors I have seen have any understanding of them, either. I have been diagnosed with gallstones, IBS, SIBO, MCAS, eosinophilic gastroenteritis, gut dysbiosis, gastroparesis, and "just a bug," all for the same symptom episodes. (I say "diagnosed" with a certain amount of disdain because many of those are descriptions of symptoms followed by no medical curiosity as to their cause.) I have had clear ultrasounds and endoscopies, and the comprehensive stool tests from Genova yield nothing noteworthy except for low levels of beneficial bacteria, although I have not had any testing since the pandemic began.

Each late summer/early fall I post asking some variation of this question because I have a flare this time of year - usually sudden, severe diarrhea for a few days, followed by cramping, and then I'm fine until the following year. I've always suspected that my very seasonal diet has something to do with this, as so many glorious fruits - replete with sugar and FODMAPS - are in season right now, able to inflame folks with SIBO, candida overgrowth, IBS, or possibly parasites.

This season, my flare came somewhat early, and after a predictably-irritating binge on a whole steamed cauliflower and two pounds of grapes. (So good.) Severe diarrhea all day (but feeling fine otherwise - no cramping, nausea, chills, etc.) and rolling my eyes at my folly, chalking this episode up to the high FODMAP content and resolving to be more careful next year. I also switched to a low-FODMAP diet (on top of my gluten-free, plant-based, low-histamine, sugar-free diet) on the theory that if FODMAPs caused the flare, then eschewing them would ease it faster.

For about a week I felt okay, eating a restricted list of foods and prioritizing bland, non-fibrous foods like rice. Then, for reasons I cannot discern, the annual gut havoc took a new turn! I started having very small, formed, mucus-ensconced bowel movements about 3-6 times per day. This has been going on for eight days now, with some days more frequent than others, with plenty of normal, solid morning bowel movements as well. I feel a little rumbling, a little cramping. Appetite is okay, no pain, no bloating, no gas, no odor, no greasy appearance, no odd color, no blood. My body temperature is a little elevated (99.3 versus my usual 97.9) but that happens to me sometimes as menstruation nears, so I'm not sure it's related.

Lots of backstory, I know. So does this ring bells for anyone? Tiny bits of frequent stools with mucus?

Is this irritation or dysbiosis from the day of diarrhea, even though it didn't happen until a week afterward? Is this unrelated, like perhaps a bacterial infection I got by eating a cherry tomato from my garden without washing it first? Do I need to start panicking about Crohn's?

I'm seeing a non-LLMD PCP later. Any suggestion for which tests she can order? (I took a rapid COVID test this morning that was negative. I wish there were at-home test kits for everything!)

I have scaled back my supplements a bit for the present, but when this episode began, I was taking these daily: probiotics (expired), quercetin, bromelain, curcumin, B complex, milk thistle, vitamin D, magnesium glycinate, vitamin C, DHA, ashwagandha, chaste tree, and a medicinal mushroom complex. And these a couple of times per week: selenium, digestive enzymes, digestive bitters, zinc.

Thanks to anyone who took the time to read this!

Certainly not, Coffeeholic! People feel self-conscious posting here about a lot of things, especially bowel habits and menstruation, and often would rather not read about other people's bodily functions. That's totally valid and fine! I actually didn't read that post of yours, but certainly would not judge you or be passive-aggressive about your feelings. I was genuinely trying to warn people not to read further if they don't like reading about poop.

Garzie, I'm sorry to hear how much your struggle with your GI tract. It's such a necessary system, and it's pretty impossible to feel okay without it working well!

The vancomycin and PSC article is quite interesting indeed.

What, if anything, would you say you have found the most helpful? You mentioned Bartonella - do you find that gut symptoms improve when you target Bartonella with antimicrobial treatments? Or do you mainly credit Bartonella with causing the issues in the first place?

Right now I'm brainstorming and planning:
Stop current symptoms - bentonite clay, ginger tea, low-FODMAP diet, increase low-FODMAP fiber
Address possible dysbiosis - black walnut, wormwood, olive leaf, manuka honey, coconut oil, berberine, garlic, no sugar, perhaps rifaxamin or vancomycin
Heal gut lining - DGL, slippery elm, aloe vera, glutamine, glycine, zinc carnosine, fennel tea, B vitamins
Repopulate good stuff - probiotics, prebiotics
Address inflammation - curcumin, quercetin, magnesium glycinate
Bolster biliary tract - digestive enzymes, digestive bitters, TUDCA, milk thistle
Improve nerve signals - yoga, hypnotherapy, limbic system retraining, meditation, massage, stress reduction

I probably won't do all of those things simultaneously. And I have zero idea how to accomplish the stress reduction one at the moment because time to myself is not going to happen in the foreseeable future, but I have to figure something out, because I know it's a big contributor.

there are a host of articles linking prevalence or various gut bacteria to rheumatoid arthritis also

and this recent one in the journal cell finds that the gut membrane barrier is compromised(leaky) in RA - causing bacteria and fragments etc to leak out and trigger inflammation in the joints and presumably other tissues
https://www.sciencedirect.com/science/article/pii/s2666634021001628

given that lyme seems to drive this kind of leaky gut type syndrome - it makes one wonder how many of the systemic lyme symptoms of muscle, nerve and joint pain and deterioration are actually triggered by this mechanism