New to CC and needing help

ldubois7 · Post by **ldubois7** » Sat Jun 07, 2014 7:41 am

Chris,

It's under the section titled: How Should Microscopic Colitis be Treated

http://www.finerhealth.com/Educational_ ... c_Colitis/

ldubois7 · Post by **ldubois7** » Sat Jun 07, 2014 8:10 am

Chris,

Until your appt. on the 20th, I'd back off the veggies. I couldn't have veggies until a few months ago. They were just too irritating for the inflammation in my gut. I experimented and ate seed butters, like sunflower seed & a little pumpkin seed butter. I also couldn't do broths, so I basically ate venison, turkey, & haddock with a muffin made from sunflower seed butter. I drank some coconut milk and ate cooked blueberries & bananas in the muffin. I can eat a little coconut, too. It took that bland of a diet to allow my gut to heal enough that now I can do almost any cooked veggie in moderation.

Also, eating small meals throughout the day helps!

I also couldn't take any supplements! I took only HCL for low stomach acid and Vit D3.

Keep playing with your diet a bit to see what it is that is not allowing you to start gradual healing.

Chrisdat · Post by **Chrisdat** » Sat Jun 07, 2014 8:39 am

Thanks for the link to Dr. Fine. He mentions Pepto, but not how long to take. I'm on week 5 and wondering when it is prudent to quit. I was slow to respond, and not completely responding, but it is helping. Hopefully I'm not in the 20-39% that relapse.

So far no side effects, thankfully.

I eat cooked, peeled, seeded, carrots, butternut squash, summer squash, and green beans (like my grandmother cooked them, mush!). I will think about eliminating them, all veggies and fruits totally, is a little scary for me. I can't have fish or shellfish due to histamines, so meat only:(

Grain-free. Muffins, do you have recipe? I could try if nut/grain free.

Thanks -Chris

UkuleleLady · Post by **UkuleleLady** » Sat Jun 07, 2014 10:07 am

Chris, can you eat potatoes? Some of us eat the red ones which are different than the white potato. They are soothing and help with weight gain. I found carrots & squashes (orange veggies) to be too "loosening" when I was in the throes of reactivity.

I used to be a vegetarian so it was hard to get over not eating vegetables, but I'm healthier now for it. A little more than year later, I can eat most vegetables again, as long as I don't overdo it.

Also, I am one of those who took several months on entocort before the D really subsided. You might need more time. Hang in there. Good luck with your appointment.

Sincerely,
Nancy

Post by **tex** » Sat Jun 07, 2014 10:59 am

Hi Chris,

First off, here is Dr. Fine's original publication discussing his research trials based on the use of Pepto-Bismol to treat MC:

Efficacy of open-label bismuth subsalicylate for the treatment of microscopic colitis.

Note that the treatment recommendation was/is for 8 weeks, not 6, and the conclusions do not suggest that 8 weeks is the tolerance limit for most people. Tolerance depends on proper functioning of the kidneys and liver, and as long as those functions are normal, toxicity should not be a problem. See the article below for more information.

Chris wrote:How long can I stay on Pepto? My Dr. says indefinitely, but it seems I read 6 weeks. Why only 6 weeks?

Everyone seems to worry about the buildup of bismuth in the body, but IMO, they simply don't understand the pharmacokinetics involved. Less than 1 % of the bismuth in bismuth subsalicylate is even absorbed into circulation.

Bismuth Subsalicylate

Upon oral administration, bismuth subsalicylate is almost completely hydrolyzed in the gastrointestinal tract to bismuth and salicylic acid. Thus, the pharmacokinetics of bismuth subsalicylate following oral administration can be described by the individual pharmacokinetics of bismuth and salicylic acid.

Bismuth

Less than 1% of bismuth from oral doses of bismuth subsalicylate is absorbed from the gastrointestinal tract into the systemic circulation. Absorbed bismuth is distributed throughout the body. Bismuth is highly bound to plasma proteins ( > 90%). Bismuth has multiple disposition half-lives with an intermediate half-life of 5 to 11 days and a terminal half-life of 21 to 72 days. Elimination of bismuth is primarily through urinary and biliary routes with a renal clearance of 50 ± 18 mL/min. The mean trough blood bismuth concentration after 2 weeks oral administration of 787 mg bismuth subsalicylate (3 chewable tablets) four times daily under fasted condition was 5.1 ± 3.1 ng/mL. In another study, the mean trough blood bismuth concentration after 2 weeks oral administration of 525 mg bismuth subsalicylate (as PEPTO-BISMOL® liquid suspension) four times daily was 5 ng/mL with the highest value being 32 ng/mL.

Salicylic Acid

More than 80% of the salicylic acid is absorbed from oral doses of bismuth subsalicylate chewable tablets. Salicylic acid is about 90% plasma protein bound. The volume of distribution is about 170 mL/kg of body weight. Salicylic acid is extensively metabolized and about 10% is excreted unchanged in the urine. The metabolic clearance of salicylic acid is saturable; accordingly, nonlinear pharmacokinetics is observed at bismuth subsalicylate doses above 525 mg. Salicylic acid metabolic clearance is lower in females than in males. The terminal half-life of salicylic acid upon a single oral dose of 525 mg bismuth subsalicylate is between 2 to 5 hours. After a single oral dose of 525 mg bismuth subsalicylate (2 chewable tablets), the mean peak plasma salicylic acid concentration was 13.1 ± 3.4 μg/mL under fasted condition. The mean steady-state serum total salicylate concentration after 2 weeks oral administration of 525 mg bismuth subsalicylate (as PEPTO-BISMOL liquid suspension) four times daily was 24 μg/mL with the highest value being 70 μg/mL.

http://www.rxlist.com/helidac-drug/clin ... cology.htm

Keep in mind that one of the primary risks of taking large doses of bismuth subsalicylate on an extended basis is the development or exacerbation of tinnitus. Note that the salicylic acid metabolite associated with bismuth subsalicylate is the same salicylic acid found in NSAIDs, and this is one of the reasons why Dr. Fine no longer recommends the Pepto treatment as the first line of treatment for MC (he now recommends diet changes as the first line of treatment). This in part is due to his research on mesalamine (which is also based on a derivative of salicylic acid.

By inhibiting the enzyme cyclooxygenase and consequently decreasing prostaglandin synthesis, most NSAIDs are thought to shunt arachidonic acid into a lipoxygenase pathway producing leukotrienes and other hydroxyeicosatetraenoic acids. These substances can produce intestinal inflammation and diarrhea and are thought to mediate NSAID-induced flares of inflammatory bowel disease.1 Although mesalamine inhibits both lipoxygenase and cyclooxygenase in vitro (and should decrease the production of both leukotrienes and prostaglandins), clinical manifestations and results of fecal eicosanoid analysis in our patient suggest that this drug may stimulate leukotriene synthesis as do analgesic NSAIDs and, in turn, lead to diarrhea or intestinal inflammation (or both) in patients with inflammatory bowel disease.

Diarrhea Associated with Mesalamine in a Patient with Chronic Nongranulomatous Enterocolitis

Chronic nongranulomatous enterocolitis, incidentally, is another fancy name for MC. Anyway, my point is, if you know that you are sensitive to NSAIDs, that may have negative implications for longer-term use of bismuth subsalicylate. But it appears that the treatment may be currently helping, so as long as that continues to be the trend, IMO one should never look a gift horse in the mouth.

Tex

ldubois7 · Post by **ldubois7** » Sat Jun 07, 2014 1:47 pm

Nut butter muffins:

1 cup nut or seed butter
1/4 cup honey
2 eggs ( I use flax eggs)
1/2 tsp. baking soda
1 T lemon juice or coconut vinegar

Combine except vinegar. Add vinegar last & pour into muffin tins. I added a few blueberries and only used a couple TB of honey.

Bake 25 minutes at 350.

Or...

http://www.elanaspantry.com/paleo-breakfast-bread/

Or...

http://www.lifeasaplate.com/2011/12/20/ ... ana-bread/

Bananas are better tolerated cooked like this for me. I use pecan butter, flax eggs, and only a small sprinkle of cinnamon due to histamines in cinnamon.

There are other recipes out there that are similar. This allowed my gut to heal where eating veggies didn't for a period of time.

Good luck!!!!

Chrisdat · Post by **Chrisdat** » Sat Jun 07, 2014 2:37 pm

Tex,

Thanks. Exactly information I was looking for. Will help me make the decision on how long to continue Pepto.

Linda,

I think I'll try this recipe. Anything but more meat:) Thanks.

Nancy,

I am sensitive to Nightshades, but would be willing to give red potatoes a try. Tomatoes, peppers and eggplants have been the worst for me, before MC. I could have a bit of potato flesh (not peel). Maybe red potatoes would be worth a try. Like I say, anything but more meat!

Sheila · Post by **Sheila** » Sun Jun 08, 2014 5:36 pm

Chris, many of us rely on "paleo muffins". They are a variation on morning glory muffins and are made with almond flour. Go to the recipe section of the board and you will find them. They freeze well and are a very forgiving recipe. You can put almost anything into them and they are still good.

Sheila W

dfpowell · Post by **dfpowell** » Sun Jun 08, 2014 7:48 pm

Linda,

Where do you get pecan butter?

Thanks,

ldubois7 · Post by **ldubois7** » Mon Jun 09, 2014 4:48 am

Hi Donna!

I make my own pecan butter. I soak the nuts overnight & dehydrate them. Then, I just grind them into butter.

I buy the pecans at Sam's Club.

Gary · Post by **Gary** » Mon Jun 09, 2014 4:54 am

Linda,
From your list of allergies I see you are allergic to dairy. How do you use butter? Thanks!

Gary

Sheila · Post by **Sheila** » Mon Jun 09, 2014 6:33 am

For baking, you can substitute dairy free margarine. In muffins you could try substituting coconut oil. For those of us who can't tolerate dairy or soy, Earth Balance has a dairy free, soy free margarine. I buy it at Whole Foods. You can find soy free mayo made by Spectrum and dairy free, soy free chocolate (large chunks, mini-chips, dark chocolate chips) made by Enjoy Life. Read the labels of everything you buy to be sure there are no ingredients that will make you sick.

Sheila W

ldubois7 · Post by **ldubois7** » Mon Jun 09, 2014 7:44 am

Oppssssss...see below.......

ldubois7 · Post by **ldubois7** » Mon Jun 09, 2014 7:45 am

Hi Gary!

I primarily use coconut oil for my fat in baking. Sometimes I use olive oil. I can't use Earth Balance or other commercial butters because there's too many chemicals in it for me.

My husband uses coconut oil on toast & I use it on veggies, too!

I'm eating as purely as possible and I hope this will allow my body to heal, as it takes so very long!

Good luck! How have you been?

Gary · Post by **Gary** » Mon Jun 09, 2014 7:54 am

I am doing well, thank you. No D for well over 2 mos now, just dealing with having to limit my foods. Got my test results back and I am G,D,E,S intolerant. Still losing weight though. Dropped another 10 lbs. in the last month. I am hoping it is just from the strict diet change.

Gary