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Author Topic: Digestion issues that won't seem to go away  (Read 2042 times)

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Offline decayingsinner

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Digestion issues that won't seem to go away
« on: September 21, 2013, 08:46:10 AM »
This may not be the most appealing topic, but I have had diarrhea since February.  At first I thought it was food poisoning, but that wasn't the case.  I have had the stool test, endoscopy, and colonscopy done, and all have come back just fine.  At my recent visit, my ID doctor suggested I cut dairy from my diet, but that has not seemed to work.  Could it be medication?

Offline Jeff G

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  • How am I doing Beren ?
Re: Digestion issues that won't seem to go away
« Reply #1 on: September 21, 2013, 08:56:52 AM »
Could it be medication?

Does the diarrhea coincide with you starting a new med ?

I had an issue once with some tummy bug and lost a staggering amount of weight . My doctors did all the test you mentioned and many more and never found a single thing . It was explained to me that diagnosing a gut problem can be quite a challenge because of the ability for pathogens or the culprit to hide out in the gut undetected .

Yogurt , probiotics and the Brat diet with lots of Imodium helped until it passed , took over two months .         

Offline decayingsinner

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Re: Digestion issues that won't seem to go away
« Reply #2 on: September 21, 2013, 09:23:13 AM »
Sorry about that, I did forget to mention I have been on Atripla for about 5 years now and my anti-depressants for about 10. 

Offline Jeff G

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Re: Digestion issues that won't seem to go away
« Reply #3 on: September 21, 2013, 09:25:40 AM »
I wouldn't think that the meds is your problem then . I wish there was something helpful for me to add   :-\

Offline sfpvguy41

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Re: Digestion issues that won't seem to go away
« Reply #4 on: September 21, 2013, 11:27:39 AM »
The gut mucosa is badly affected by HIV, and as a result our digestion, even after successful ART and undetectable viral loads, is off.  So maybe this is worth looking into and discussing with your doctor.

I've been looking into this a lot lately to address my own problems. A recent study from UCSF showed definitively that our microbiome is off compared to HIV- folks.
http://www.medicalnewstoday.com/releases/263198.php  They concluded:
Quote
The researchers do not believe that there is a single bacterial species responsible for disrupting the integrity of the gut nor do they propose a specific probiotic bacterial treatment to restore a healthy gut. Nonetheless, Lynch said, manipulating microbial populations is a promising idea.

The problem is, everyone's microbiome is different and there are many different probiotic bacterial strains available on the market...yet even so there are many more yet to be identified and made available as probiotics.  So which ones you take can be a crap shoot, and they may or may not help your specific problem.

Various studies have been done and are being done to determine whether and what probiotics can help us. As this recent study put it:   
Quote
The articles reviewed demonstrate that probiotic supplementation is safe in HIV patients,
but the evidence is conflicting regarding its efficacy in reducing the incidence of diarrhea in this population.
http://digitalcommons.pcom.edu/cgi/viewcontent.cgi?article=1054&context=pa_systematic_reviews  This same study noted that:
Quote
Overall, the adults who received L. rhamnosus and L. reuteri experienced greater resolution of diarrhea than did the children who received B. bifidum and S. thermophilus.
  But this well known study of yogurt probiotics in a study that showed improvements in women with HIV in Nigeria focused on a small group of untreated patients.

From what I've read, unless you are currently immunocompromised, probiotic supplementation is generally regarded as safe, so I'm experimenting with different strains of  probiotics. Florastor has helped me a lot in the past and was recommended by my doctor...it's a pretty common post-antibiotic treatment in Europe.  www.florastor.com

Recently my partner (he's negative) and I had traveller's diarrhea, and this probiotic from Pharmaca literally cleared it up in a day (but you need to take the course of it) http://www.pharmaca.com/Pharmaca-Vitamins-Supplements-and-Herbs/Pharmaca-Probiotic-Ultimate-Blend-24-Billion-Live-Cells-60-Vegetarian-Capsules/520943/6077/Product.  This is a great company, and they have a wonderful list of different probiotics and their effects here http://www.pharmaca.com/projectwellness/2013/04/22/snapshot-different-probiotic-species-and-strains/

I'm currently trying a blend of Bifidobacterium (you need to google all these, most can also be bought on Amazon or from iHerb.com online, but it seems the best need to be kept cool and refrigeterated).  There are clinical trials now like these http://clinicaltrials.gov/show/NCT01439841 and I even wrote the good folks at UCSF who said they will do trials.  But all in all, it's a bit of the wild west there now for us in making specific choices.
Labs: (undetectable since 2005)
12/13: 634 cdr, 37.3%, 758 cd8, total chol 183, triglycerides 131
8/13: changed to Edurant from Reyataz
12/12: 828 cd4, 34.5%, 1078 cd8, total chol 192, tri 196
12/11: 787 cd4, 37%, 979 cd8.
9/11: 758 cd4, 38%, 944 cd8, und.
8/11 dropped norvir, incr reyataz to 400 mg
6/11: 621 CD4 CD4% 41, CD8 680! Undetectable. Creatinine and eGFR are ok now.
Switched from Truvada to Epzicom in late April 2011
AGT/AST and creatinine back to normal mid-April.
Cut Norvir from regimen.
Switched back to Reyataz/Norvir late Feb 2011
2/11: CD4 664 34%, CD8 963, diagnosed with osteoporosis, high AGT/AST and creatinine.
12/10: CD4: 676 CD4%: 34 CD8: 1012
Switched from Reyataz/norvir to Isentress 10/10
8/10: CD4: 731 CD4%: 40 CD8: 866
Diagnosed Sept. 2002 started meds May 2005.

Offline buginme2

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Re: Digestion issues that won't seem to go away
« Reply #5 on: September 21, 2013, 01:29:45 PM »
I also use Pharmaca's ultimate probiotic that sfpvguy41 referenced in his post.  It is the best probiotic I have found.  They do require refrigeration.  If you have a pharmaca near you I would also recommend

Offline Miss Philicia

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Re: Digestion issues that won't seem to go away
« Reply #6 on: September 21, 2013, 02:10:47 PM »
I've had digestive issues for over 15 years. I routinely must take both imodium (prescription loperamide) as well as a digestive enzyme, pancrelipase, which addresses a exocrine pancreatic insufficiency (if you google "HIV exocrine pancreatic insufficiency" you can read some studies).

When I take a probiotic I take Jarrow Forumulas Jarro-dophilus EPS which is easy to find on line or at a Vitamin Shoppe chain store. It doesn't need refrigeration.

Bottom line for me however is that long-term daily use of imodium/loperamide isn't going to hurt you.
"Iíve slept with enough men to know that Iím not gay"

Offline aaware72

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"Yes, knowledge is power. Self-knowledge brings mastery of one's body."

Offline sfpvguy41

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Re: Digestion issues that won't seem to go away
« Reply #8 on: September 23, 2013, 02:38:09 AM »
Hey, Bug, I would love to hear more about your experience with the Pharmaca Ultimate Probiotic blend and how it helped you - do you keep taking it or does one course have an effect that lasts a while (technically, are the critters colonizing in us or do they not last?)

This is an area of great interest to me as it is a big problem for me and I think the root cause of most of my HIV-related gut issues. According to Case Adams, PhD in his book The Science of Achieving Digestive health:

"A body with low probiotic populations will wreak havoc with the immune system.  Deficiency dysbiosis ...leads to damaged intestinal mucosa. This can lead to irritable bowel syndrome, food sensitivities and intestinal permeability...this can lead to the entrance of toxins along with larger more complex food particles into the blood stream...which the immune system identifies as foreigners.  The body then launches an inflammatory immune response, leading to sensitization dysbiosis."  It then lists a whole host of things this reaction can cause including (of interest to me): hormonal imbalances and mood swings, diarrhea, reduced sex drive, food and chemical sensitivities, allergies, and various histamine-related inflammatory responses such as rashes and skin irritations."

My Doctor has told me that in his HIV practice he sees a lot of cases of overreactions to allergic stimuli, like mosquito bites and allergies.  But all he does is prescribe antihistamines (a joke for me). AS the USCF researchers just showed different microbiomes in HIV+ ART treated patients with undetectable viral loads, I think we're just a few steps away from being able to address these long term inflammatory problems by rebalancing the microbiome in our guts.

My question is will this take lots of probiotic supplementation, fecal transplants, or what?  I'm 52.  At the rate my gut is giving me problems, I don't want to wait 10 more years for research and find out what other damage long term inflammation will cause.  Everything I read says probiotics aren't dangerous unless you're immune suppressed, and there have been lots of studies showing their benefit in HIV-related diarrhea and improving T-cell counts, and there are ongoing clinical trials to this end now.

So how do we put the puzzle pieces together and come up with rational probiotic supplementation regimens to help get our guts back to semi-normal??  Thoughts?
Labs: (undetectable since 2005)
12/13: 634 cdr, 37.3%, 758 cd8, total chol 183, triglycerides 131
8/13: changed to Edurant from Reyataz
12/12: 828 cd4, 34.5%, 1078 cd8, total chol 192, tri 196
12/11: 787 cd4, 37%, 979 cd8.
9/11: 758 cd4, 38%, 944 cd8, und.
8/11 dropped norvir, incr reyataz to 400 mg
6/11: 621 CD4 CD4% 41, CD8 680! Undetectable. Creatinine and eGFR are ok now.
Switched from Truvada to Epzicom in late April 2011
AGT/AST and creatinine back to normal mid-April.
Cut Norvir from regimen.
Switched back to Reyataz/Norvir late Feb 2011
2/11: CD4 664 34%, CD8 963, diagnosed with osteoporosis, high AGT/AST and creatinine.
12/10: CD4: 676 CD4%: 34 CD8: 1012
Switched from Reyataz/norvir to Isentress 10/10
8/10: CD4: 731 CD4%: 40 CD8: 866
Diagnosed Sept. 2002 started meds May 2005.

Offline decayingsinner

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  • Posts: 274
Re: Digestion issues that won't seem to go away
« Reply #9 on: September 23, 2013, 12:32:44 PM »
Thank you all for the input.  There are definitely a few different products I want to try to see if they provide any help.

Offline decayingsinner

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  • Posts: 274
Re: Digestion issues that won't seem to go away
« Reply #10 on: November 02, 2013, 06:51:27 PM »
I purchased the Jarro-Dophilus Eps probiotic and have been taking it for about a week and haven't noticed any change.  How long should I give it?

Offline Miss Philicia

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Re: Digestion issues that won't seem to go away
« Reply #11 on: November 03, 2013, 08:28:18 AM »
I purchased the Jarro-Dophilus Eps probiotic and have been taking it for about a week and haven't noticed any change.  How long should I give it?

A simple answer -- definitely I'd give it longer than a week but can we discuss a few other things that I'm not clear on since this thread has now reappeared?

If you've had diarrhea every day since February, or 8 months, your doctor should be handling this in a more aggressive matter and/or the patient should be demanding that he/she do so. Is this actually happening every day or just one day a week? I'm still not really clear. If it's daily then forget trying probiotics even though they were suggested here, you need something like a prescription for loperamide.

However, in my mind if it's daily and didn't start when you initially went on meds, and thus it's not med related, you might wish to see a gastrointestinal specialist. We must all remember that things can happen to us that are unrelated to our underlying HIV infection -- just a suggestion.
"Iíve slept with enough men to know that Iím not gay"

Offline decayingsinner

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Re: Digestion issues that won't seem to go away
« Reply #12 on: November 03, 2013, 08:55:57 AM »
Thanks for the reply.  This is happening on a daily ongoing basis. I did see a GI specialist and he ended up doing a colonoscopy and an endoscopy with all tests coming back negative.  I'm really not sure what to do and I'm still paying for the entire procedure even with insurance.

Offline Miss Philicia

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Re: Digestion issues that won't seem to go away
« Reply #13 on: November 03, 2013, 09:28:18 AM »
Then I would suggest at least obtaining a prescription of loperamide and use it daily. You'll have to test around with the dosing. I have to take 2-3 of them twice a day, meaning either a total of 4 or 6.

I have a friend that has a GI issue much worse than I do and he has to take tincture of opium to control it.

As far as the specialist, I just wanted to rule out something like Crohn's disease, etc. but I guess something would have shown up on the procedures he performed, so that's good.

You're other option, of course, is to see if it is indeed your HIV meds suddenly causing this and that means changing your entire regimen. Has this been a consideration yet?
"Iíve slept with enough men to know that Iím not gay"

Offline decayingsinner

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Re: Digestion issues that won't seem to go away
« Reply #14 on: November 03, 2013, 03:14:23 PM »
My ID doctor said this is a possibility for the next step.

Offline tednlou2

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Re: Digestion issues that won't seem to go away
« Reply #15 on: November 03, 2013, 10:50:35 PM »
Just a thought-- are you or were you on a course of antibiotics?  Usually short term is no big deal, but longterm can cause lingering gut issues.  Just a thought.

Offline decayingsinner

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Re: Digestion issues that won't seem to go away
« Reply #16 on: December 22, 2013, 05:57:54 AM »
Just an update....I'm not quite sure why, as I have not changed my diet or lifestyle routine, but all issues within the past two weeks have seemed to stop. 

Offline Tool man

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Re: Digestion issues that won't seem to go away
« Reply #17 on: December 31, 2013, 05:51:50 PM »
Did you ever test for parasites?
I went for years with diarrhea, enough to turn a bottom into a top!
The meds to kill the bugs caused plenty of issues and reinfection usually happened and the process repeated. My husband finally got me meds from Mexico that actually killed the bugs, but it still took almost a year to have normal stools.
Just a thought.

TM
Like I tell my husband, "I would agree with you but then we would both be wrong."

 


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