Gut Instinct: Grains Of Truth

After more than three years of nagging symptoms and awkward “will there be a bathroom nearby?” planning, my gut instinct told me it was time to get to the bottom of what ailed me. Good news, I’m feeling remarkably better these days. Bad news, why did it take so long to figure it out?

If you’ve been following along, I’ve written about this saga twice before. What A Load Of Crap, published in July 2022, is equal parts diary, detective work, and gallows humor. Many months later, in Getting To The Bottom Of Things, I provided an update on the tests that had been run by both my PCP and a gastroenterologist, all of which were negative. After all that, I had somewhat resigned myself to the minimal improvements achieved through tuning up my diet a bit and mostly avoiding triggers as well as modifying some habits.

Bloating, urgency, and the kind of unpredictable discomfort that makes you plan your outings around bathroom maps were frequent reminders that all was not as it should be.  Some days were fine; others, not so much. Was this to be my new normal? DIY remedies like probiotics, fiber tweaks (hello, chia), and cutting caffeine didn’t help much.

Meanwhile, my GERD got more irksome despite the daily PPI I was taking. I noticed on a 2023 cruise that skipping my usual Greek yogurt seemed to calm things down a bit, so at home, I swapped my long-standing go-to breakfast to oatmeal with a vegan protein powder. Better, but not fixed. Then came a new twist. I began having occasional episodes of elevated heart rate and palpitations. No pain or dizziness, but unnerving nonetheless. Was it related to my gut issues or coincidental? Didn’t know, but I still put off seeking medical care for fear it would simply be dismissed as anxiety. Eventually, these episodes were occurring too frequently to ignore.

The PCP I saw took me seriously (not that anxiety is serious), ordered an EKG, lab tests, a 7-day heart monitor, and later an echocardiogram. Everything looked normal. In the four weeks between my initial doctor’s appointment and a follow-up visit, the frequency of the episodes had escalated and had begun to settle into a pattern of starting while I was eating. So while the negative/normal test results were good news, what was triggering these episodes?

At a follow-up appointment, I asked him if my symptoms could indicate a histamine intolerance (I had been googling), and he agreed that they might. He ordered allergy testing for several common foods (all were negative). Additionally, because histamine can play a role in both stomach acid and flares, he had me switch from a PPI to a higher-dose H2 blocker. Within three days, the heart rate/palpitation episodes had stopped, and my GERD had settled down. (An accidentally skipped dose a few months later confirmed to me that the H2 blocker was definitely doing real work.)

As for the lower-gut drama, I began to wonder if lactose was part of the problem. I tried lactase pills, which worked for a while until they didn’t, so last September I committed to becoming dairy-free. Did it help? Yes, though moderately. I was experiencing less bloat and fewer urgent moments. But there were still “plot twist” days, and while being dairy-free was helpful, it was an incomplete solution to my struggles.

Nearly every day, I still had some level of discomfort that ranged from a feeling of abdominal pressure and gassiness to severe cramping during bowel movements. Even though I was having several BMs a day,  I never passed any blood, had my normal appetite, was not unexpectedly losing weight, and my sleep was not being interrupted. These all gave me a reasonable level of confidence that I wasn’t dying. More or less, I kind of resigned myself to thinking it was just IBS, the realities of life in your 60s, or whatever. Until I just couldn’t deal with it anymore.

At the end of this past April, a particularly bad day convinced me to finally reach out to my GI. After briefing him on my current status, the doctor ordered another round of blood and stool tests to rule out parasites or infections (unsurprisingly, all were negative) and scheduled me for a colonoscopy (also essentially normal aside from a benign polyp or two; biopsies were negative as well). When I asked if he would send in a referral for me to see a nutritionist, he said, “Absolutely”.

By the end of May, the GI’s testing was done, and I still had no answer. It was during the initial discussion with him that I realized I needed to start keeping a daily log of what I was eating and how I was feeling. What I hadn’t realized until reaching out to the GI was that 4-6 loose BMs a day is chronic diarrhea (forgive the indelicacy), so my call to him wasn’t just some hysteria. And while the testing thus far had been negative (which is good), I still needed an answer as to what was at the bottom of my gut problems. Next up at bat, the nutritionist.

It was the second week of June when I had my first appointment with her. By then, I had been keeping an intake/output log for about six weeks. Although I had looked at a couple of apps that were designed for people with IBS, I ultimately decided to keep my log in the note app on my iPhone. For my meals, I recorded the time and what I ate (no quantities or calorie counts, though). For my ‘output’, I recorded the time along with an assessment of the ‘quality’ using the Bristol Stool Scale to assign a number. I also made an assessment of quantity, rating BMs either as small, medium, or large as they relate to my typical experiences. If there was cramping, that was noted as well.

The nutritionist spent about an hour with me, reviewing my “moderate relief but still not great” reality,  the history of my symptoms, and my test results. As she shared options for focused dietary eliminations like the FODMAP diet, she proposed that I first eliminate gluten, as that might get me going in the right direction.  She based this on the consideration that  I was already dairy-free and nothing specific in my input/output log had raised a red flag. My GI had included a note in his referral that I should also reduce harder-to-digest foods like fruits with skin, uncooked vegetables, and the chia seeds that I’d been adding to my oatmeal. Going gluten-free wasn’t presented as a forever-and-ever decree, more like a targeted experiment.

She said that I would need to give it 6-8 weeks, and we should meet again at that point to review my results. In my 30s/40s, I had gone through a couple of gluten-free periods during which I’d notice some minor, although positive, physiological changes, so I wasn’t completely surprised or put off by this recommendation. It’s a lot to wrap your brain around to become strictly gluten-free, though; reading labels, learning which non-bread/baked foods likely have wheat as an ingredient, and finding palatable GF options for bread, crackers, and pasta. Thank goodness for GF Oreos!

Fortunately, my husband was/is fully supportive of this dietary change, as he had been with me going dairy-free. We no longer frequent some of the restaurants we used to regularly, and if we go somewhere new, I’d review the menu ahead of time to figure out my options. It’s nice when a menu includes notations about allergens. Occasionally, I’d ‘pre-eat’ or bring a safe snack if my options were unknown. I was determined to be as strictly gluten-free as possible.

So, how did it go? This is the part where I wish I had a drumroll. After about two weeks of going gluten-free, my gut started to normalize. Bloating, gas, and unpredictable urgency had lessened dramatically. At four weeks, I realized that the daily background noise in my gut was basically gone. Not “I got used to it,” but truly not there anymore. Wow, so that’s how I used to feel.

In the weeks since, I’ve remained gluten-free and plan to continue as so. When I met with my nutritionist again earlier this month, she was delighted to hear of my results. I’d even added back in all of the ‘harder to digest foods’ I was to avoid without any noticeable effect. We concluded that no further eliminations are necessary and that I could do some trial-and-error testing of my tolerance for dairy and/or gluten as I so choose. As time has passed, my gut has continued to improve and stabilize, and I can live with this new normal.

In all of this, I’ve learned that I wasted a lot of time and suffered unnecessarily by not seeking medical attention sooner. It’s a relief to know that I don’t have a life-threatening disease or serious medical condition; I simply needed to make a few dietary changes. I find my input/output log continues to be a valuable tool, as it takes the worry out of having to remember what I ate or how my gut was doing if a new or old problem pops up.

While it took a few years to put all the pieces of the puzzle together, I have answers I can live with. While I don’t know how or why gluten became an issue, I know that it is. I wish I’d gotten here faster/sooner, but I’m grateful to feel like myself again. Reminder, I’m sharing what helped me, not offering medical advice. If your gut is staging its own soap opera, I urge you to not wait and seek the professional care you deserve.

What has your gut instinct told you recently? Have you tried going either dairy-free or gluten-free, and if so, why?  What are some of your favorite GF/DF products or restaurant hacks you can share?

Stay well and let’s keep in touch! Subscribe, follow, friend, pin … there are several options available. I look forward to hearing from you soon.

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Photo credit: MMPerez

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