Dr. is Trying stuff: Imuran, Mesalamine, and Cholestyramine!

[kmc2016]

Hi. Currently I'm on Lomotil and Budesonide. I have no cramping, and little urgency, but 1-5 liquid bowel movements per day. Had check up explaining this so, dr. added cholestryramine, and mentioned attempting to switch to Mesalamine and if that didn't work switching to Imuran. I said that I think I can live with 5 liquid stools a day and probably wouldn't want the Imuran. Wondering, what are your thoughts on the effectiveness of cholestryamine, mesalamine, and Imuran (not all at once) in comparison with the Lomotil Budesonide combo. She also briefly mentioned upping fiber (I suppose from a bulking perspective) what are your thoughts on that?

[tex]

She also briefly mentioned upping fiber (I suppose from a bulking perspective) what are your thoughts on that?

My thoughts are that your doctor doesn't really understand MC, nor how to properly treat it. Fiber is definitely contraindicated for MC. In a few cases, soluble fiber can be tolerated to bulk up the diet, but that doesn't really address the cause of the diarrhea, it simply helps to increase the volume, by soaking up the water. It makes more sense to eliminate the water by allowing the colon to remove it, the way it was designed. But that means stopping the inflammation that is perpetuating the symptoms (by removing the foods or drugs from the diet that are causing the inflammation).

The cholestyramine is definitely worth a try because many cases of chronic diarrhea are associated with bile acid malabsorption.

If the budesonide doesn't work, mesalamine is even less likely to help.

My opinion of Imuran is that it is a treatment of last resort for patients who are in a position such that they are willing to try to survive without their immune system to help defend them from all types of pathogens and disease. That said, it's relatively effective (provided that you are willing to make the necessary diet changes to avoid your major inflammatory foods). In most cases, it will not allow an MC patient to totally ignore their diet restrictions, so there's definitely a question about whether it's worth the risks that its use imposes. It will usually mask minor diet transgressions, but not major ones.

[kmc2016]

Tex, I think I will try to improve my diet even more, may be try the enterolabs that is mentioned (as maybe some of the things that I think are okay in my diet are not okay), try the cholestryamine and refuse the imuran and probably refuse the mesalamine.

[Gabes-Apg]

Tex, I think I will try to improve my diet even more, may be try the enterolabs that is mentioned (as maybe some of the things that I think are okay in my diet are not okay), try the cholestryamine and refuse the imuran and probably refuse the mesalamine.

I think that is a good plan..

sorry if we have discussed this before and you have answered, are you taking good quality Vit D3 and magnesium?

[kmc2016]

I take vitamin D, 4000 mg, I know my value is in the average range of normal (I used to be very deficient), but magnesium, no don't take any, any dose and brand recommendation?

[tex]

I take Doctor's Best Chelated Magnesium (magnesium glycinate) 500 mg per day, divided up as 300 mg after breakfast, 100 mg after lunch, and another 100 mg after an afternoon or evening snack or meal. This product shows 200 mg on the front label, but that's the serving size dose. The serving size is 2 tablets, so each tablet contains 100 mg. IOW I take a total of 5 tablets per day.

The RDA for magnesium for men is 400 mg. The RDA for women is 300–320 mg, so you might be able to get by with 300–400 mg if your weight is average or below. But keep in mind that IBD patients use more magnesium than "normal" people.

Tex

[Gabes-Apg]

Magnesium

based on lots of people in this group sharing their experience we have found the following;

ORAL TABLET - the safest is Doctors Best Magnesium Glycinate
LOTION - lots here use topical magnesium lotion - Ancient minerals
LIQUID - for a more absorb-able liquid version - Dr Dean ReMag product

with all of these, start on lower dose and work up gradually to full dose, spread the dosage through out the day (especially for oral intake)
The daily requirement for magnesium is about 400mg **ELEMENTAL magnesium per day
if you are deficient, then you may need 600mg-800mg elemental magnesium per day for 8-12 weeks.

I encourage you to read the various posts and discussions about magnesium to see what others have experienced and how to approach.
when you start, you may feel worse before you feel better.. There are quite a few recent ones in the main message board..

**ELEMENTAL - with oral tablet products, double check the fine print on the back of the bottle to check how many tablets are required per dose, for elemental magnesium intake.

hope this helps