Weaning Off Entocort

Discussions on the details of treatment programs using either diet, medications, or a combination of the two, can take place here.

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tex
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Post by tex »

:sigh: Bummer, for sure!

For your remission to have deteriorated so steadily, (and for so long), the culprit is almost surely something that you are eating every day. The Pacific broth, for example, should be safe, according to the label. I notice an interesting thing, though. When I was recovering, I tried several "safe" products, that caused me to react, but I never figured out why. They usually contained "organic evaporated cane juice", FWIW.

You say, "I finished the carton a couple of days ago. I've been having D since then." Did you not have D before then? I was under the impression that this problem began at least a couple of weeks ago.

Please don't be embarrassed that your diet may not be 100% perfect, yet. You'll get there. There's no such thing as a drug that brings relief for everyone, every time, either. If your doctor tries to dis the diet, he's living in a glass house, and doesn't realize it. LOL.

I suspect that the magnesium could indeed be a problem, but I don't know enough about that issue to be a good judge of what the odds might be, in your particular case. I can feel your pain. All it takes is one item, to frustrate the best diet in the world. Whenever I was having setbacks, I cut out all processed products, and went back to cooking from scratch. That always worked for me. Whatever the problem is, I sure hope you can track it down, and soon.

Tex
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It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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Post by Gloria »

Tex,
Yes, it seems I'm so near and yet so far from remission.

I had soft D occasionally, but not every day. I've had a gradual deterioration in my BMs over the last couple of weeks. They went from Normans to solid, to soft solid, then to solid pieces, then to D, but not to watery, explosive D. This has occurred over a period of 17 days.

I agree that the problem must be something I'm eating every day, or at least very frequently. That would include fruit, chocolate, rice, almond dream milk, potatoes, pistachios, almonds and an item made from my flour blend (tapioca, potato starch, rice, buckwheat, quinoa, amaranth, and sorghum). I know others have mentioned sorghum and tapioca as potential problems.

I'm at the point where I don't always have an instant reaction to something I've eaten. It seems to take 5 weeks of being completely off Entocort before I begin to react. That's what doesn't make any sense.

For now, I'm back on the Entocort and will likely stay on it for a few months. I don't expect any problems while I'm on it. I don't know if I'll be willing to test going off of it again. It's pretty hard to keep getting my hopes up and then have them dashed. I was pretty discouraged when I wrote this morning. I appreciate your concern - you are always there for all of us. It's pretty amazing that you sacrifice so much time for this board. Thank you for all you do.

Gloria
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Post by susan »

Gloria

When I found this board, I found this thread and read it in awe of your dedication and perseverance.

I have little experience unlike others here that can be of help. I was diagnosed a few months ago and now I'm cutting back on Entocort after only two months because of a very big sinus problem that my PCP thinks may be side effect. After 10 days on 1 pill, my bms are finally starting to deteriorate and I know what's coming, and I'm not sure what to do while I work on the sinuses (currently on antibiotic). So, while I can't help via experience, I just want to offer support and tell you that I sure hear your frustration and discouragement, after all you have done to work on your diet. I really hope you can find the answer that won't mean cutting even more from your diet.

Susan
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Post by Gloria »

Susan,
Thank you for your kind words. I always worry that I'm going to discourage people by relating my experiences, but I want to be honest. I also hope that they realize that I'm an unusual case.

I read your other posts and it looks like you're already GF and DF. Hopefully you'll get the test results from Enterolab soon and will find out your intolerances. I also hope you can go back on Entocort and that it won't exacerbate your sinuses.

Gloria
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Post by tex »

Gloria,

You're right, 5 weeks is a long time for a reaction to begin. It's difficult to visualize any residues of budesonide persisting that long. It would surely be eliminated from the body, (for all practical purposes), in a fraction of that amount of time. Also, that's a long time for a reaction to be initiated, in the event that an "ever-present" food intolerance is triggering a reaction. Maybe I'm looking at this wrong, but to me, that suggests that the "delayed" reaction might be due to accrued damage, that slowly accumulates over time, due to trace amounts of a food intolerance, or even food irritants, in the diet, possibly from multiple sources.

IOW, you may be so sensitive that while no single item in your diet triggers a reaction, the accumulated effect of multiple, shall we say, "mild irritants", might be enough to slowly add damage to the intestines, until enough damage has accrued that you begin to react, and as the damage continues to build, the reaction slowly intensifies. There are a number of foods in your diet that I had to avoid, while my gut was healing, (for example fruit, almonds, pistachios, and sorghum). They didn't necessarily cause a violent reaction, but they caused bloating, discomfort, irritation, etc. Note that the foods in that list are relatively high in fiber. That suggests that small amounts might be OK, whereas more might tip the balance.

I'm not sure if you are intolerant of corn, (maize), but if you are, sorghum, in particular, is suspect, because maize and sorghum are both grasses, (even though they don't look much like grass, these days), and they evolved from the same ancestors, millions of years ago. They have very similar genetic compositions, and very similar nutritional characteristics, which implies that they may share some similar amino acid chains.

http://www.pubmedcentral.nih.gov/articl ... id=1205233

My time will be amply rewarded some day when I log on and read that you have finally discovered the remaining piece of the puzzle. Until then, we'll continue to search for clues, wherever we can find them.

You're most welcome,
Tex
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It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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Post by Gloria »

I'm not sure about corn. I've been avoiding all forms of it, just to be on the safe side. I didn't realize sorghum was closely related to it.

Your theory about the gradual irritation of my gut sounds plausible. I'm confused about the healing of my gut, though. Is the gut healing while I'm on Entocort? I know it supresses the immune system, but is it still getting irritated? If so, then why do I have normal BMs? It seems that it should be healed after being GF for almost two years, if gluten is the main offender. If I'm not healed after two years, then I may never be healed. I didn't eliminate legumes until last June 30. Do I start counting the healing from that time and not from when I went GF? When can I consider myself healed enough to expand my diet?

I guess with someone like me who has multiple intolerances, these questions are difficult to answer. I'm not even sure which foods are irritants and which are intolerances for me.

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Post by tex »

Gloria,

Healing times are probably different for most of us. I had a fecal fat test at Enterolab, about 2 years and 8 months after adopting the GF diet, which showed that I still had a malabsorption problem. About 10 months later, though, I was able to slowly reintroduce corn and dairy products back into my diet. I tested negative for dairy and soy intolerance, though, at Enterolab. I had cut them out of my diet about a year and a half after going GF, and within a week or so after cutting them out, I was in remission. Maybe they were irritants for me, or maybe I was intolerant to them at the time, I really don't know, for sure. The tests at Enterolab, were not done until I had been avoiding dairy, corn, and soy, for a little over a year. I reintroduced dairy and soy to my diet for a few weeks, just before I submitted the sample to Enterolab, then cut them back out again, but as I said, the test results were negative.

The question about Entocort is a tough one. To be honest, I always assumed that healing could proceed while Entocort was controlling the symptoms, since it's described as an inflammation fighter. According to Dr. Fine, however, that is not the case:
Prednisone and other steroids seem to temporarily reduce the amount of diarrhea in microscopic colitis but they do not resolve the inflammatory process and diarrhea usually returns when the drugs are tapered or stopped.
Now, I'm not sure whether he verified this statement by examining epithelial cell histology of patients using Entocort, or if he merely assumed that to be the case, based on his observation of the return of symptoms following the discontinuance of the drug. If the latter, then I would point out that diarrhea usually returns if the diet is tapered or stopped, also. One would assume that, as a responsible researcher, he verified that claim by examining biopsy samples from patients using Entocort, but I have no way to judge that, since I don't have any information available on it, one way or the other. Here's the article where I found that quote:

http://www.finerhealth.com/Educational_ ... litis/FAQ/

No one truly understands the healing process, IMO. The fact that antibodies can still be detected by stool testing for almost two years after the GF diet is adopted, suggests that autoimmune reactions might still be occurring, to some extent, up until that point, because that is an unprecedented length of time, for antibodies to be produced, in response to an adaptive immune response. Is it not? If any gluten is accidentally ingested, then the clock may have to start over. We understand how the villi of the small intestine recover, after the GF diet is adopted by celiacs, but this is not the same process that occurs when the colon is damaged by inflammation due to intraepithelial infiltration by lymphocytes, (or the small intestine, if it is inflamed by the same process, for that matter). This type of damage seems to be more persistent. We assume that damage caused by other food intolerances, (dairy, soy, etc.), heals more quickly, because the antibody production is not as persistent, after the food is withdrawn from the diet, but we don't know for a fact that this is the case - we can only assume that it is true. As far as I am aware, no one has ever done any research on the healing process involved with controlling the symptoms of MC, nor on the time required for healing to be completed under various conditions.

I'm sorry, rather than to provide any answers, I seem to have just raised more questions. The problem is, the medical community has defined this disease, and figured out how to diagnose it, and while they have proposed some treatments that sometimes work, and we have discovered that diet changes can bring remission, unfortunately, no one actually understands the details of the mechanism by which healing occurs. We all still have a heck of a lot to learn about this disease. At the moment, far too much of it is speculation, and trial and error. Hopefully, that will eventually change. I'm sorry I can't provide any real answers.

Tex
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It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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Post by RUBYREDDOG »

Gloria, Tex is right, bummer for sure. I really feel your frustration. I have been watching your course to remission closely, hoping that it would be successful and using your experiences as a model for my road to remission. I'm am now in my third week of Entocort and doing fine, so far. Next week I will cut back to 6 mg/day and see how it goes.

I admit, I am discouraged somewhat that you are having problems maintaining remission and in the fact that Endocort probably does not aid in the healing of the gut. That being the case, it may be best suited for people in the early stages of treatment, to help eliminate those horrible explosive watery episodes. Those of us who are closer to remission, but just can't quite get there, may be better off further refining the definition of our irritants through the diet elimination process. IOW Entocort may give us a false sense of security, since it facilitates normal bm's while we are taking it. I know that I have expanded my diet to include a few items that I am not sure about (fruit, almonds, salads occasionally etc.) because I felt that I was healing due to the Entocort and I have not had any negative effect on my bm's.

Just thinking out loud here. Hope you're doing better soon.

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Post by Gloria »

Tex,
Dr. Fine's statement seems correct regarding Entocort not resolving the inflammatory process - that is why most people who rely strictly on Entocort for resolution of their symptoms usually don't achieve it.

I've always felt that Entocort supressed my immune system, allowing me to have mostly normal BMs while I have concurrently fine-tuned my diet to remove the irritatants to my gut. With that theory, one would expect that my gut would become less and less irritated with each food that I eliminate, gluten being the most severe, then dairy, soy, legumes, etc. It doesn't appear to work that way in my case.

My reactions right now are as bad as they were before I eliminated any foods. I made five urgent trips to the bathroom yesterday, had an accident, made a trip to the bathroom at 3 a.m. and am continuing to make several trips today. I upped to 3 Entocort pills today and I rushed a prescription renewal form to my GI's office, because with 3 pills a day, I'll be running out in 8 more days. Hopefully he'll fax the form and the prescription mail order service will send it quickly. Obviously, I wasn't expecting to need this much in such a short time.

I suppose I can reason that I might be having worse reactions if I hadn't eliminated any foods. I'll never know because I don't want to experiment by reintroducing them. I have never had any malabsorption issues according to the Enterolab tests and also according to my weight.

Hotrod,
You wrote:
Those of us who are closer to remission, but just can't quite get there, may be better off further refining the definition of our irritants through the diet elimination process.
That's probably true for most and I thought it was true for me. But the last few days have shown me that I apparently am not closer to remission or I wouldn't be having such a severe reaction. I did change my diet the last several days, but the D just kept coming and getting more frequent. It's as if I haven't changed anything at all.

I've pretty much decided that I've given diet ample opportunity to make a difference, and it has worked, but only in conjunction with Entocort. I expect that I will be on a maintenance dosage of it for the rest of my life. I'm not happy about it, but it seems to be an either/or situation for me. Hopefully I won't need a large dose to keep my symptoms under control. I was on 1 pill every other day for 4 weeks, then 1 pill every three days for 3 weeks and none at all for 5 weeks before I started having problems. That's a total of 3 months with a negligible or nonexistant dosage, and I was doing fine. I don't know if I can remain symptom-free on a greatly-reduced dosage beyond a few months. Time will tell.

Gloria
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Post by tex »

Gloria,

This isn't chiseled in stone, of course, but if worse comes to worse, I believe that you would probably be able to maintain on one Entocort pill every other day, indefinitely, for this reason: For most people, 8 weeks is the magic number, as an approximate rule of thumb. IOW, of you can maintain remission on a treatment for at least 8 weeks, then it should work indefinitely. That is an extremely low dose, (I'm not aware of anyone who has been able to maintain on less, for the long term). At that rate, long-term use shouldn't cause any side effect issues. Who knows, at some point you might still have a "eureka" moment, and figure out where the problem lies.

I'm not saying that this is the cause of the current problem, but it has occurred to me that, (considering the way that your symptoms have escalated), there is certainly a possibility that some pathogen might be playing havoc with your remission. C. diff comes to mind, for example. After being so successful, for so long, something else certainly may have entered the picture, and upset the apple cart. MC does not make us immune to any other issues that the general population is susceptible to. We sometimes have to remind ourselves that MC is not the only thing that can cause serious D issues. If you are having D, though, without major problems with cramps and general abdominal pain, I would guess that you probably do not have C. diff.

I can't get the sorghum issue off my mind. When did you start using sorghum? If it is 22.2% of the flour mix that you use regularly, then it, (or any other component of that blend, for that matter), could certainly be contributing to your deteriorating condition. You might even be mildly intolerant of two or more ingredients in that flour blend. Anytime we use a product, (even if we make it ourselves), that contains a long list of ingredients, we are magnifying our chances of ingesting an item that is "contaminated". Even if all of the ingredients are safe, (if pure), all it takes is for the manufacturer of only one of those ingredients to slip up, and we are "doomed". If you have any experience with probability and statistics analysis, you should recognize that the odds of an adverse event really begin to escalate, as the number of variables increases. With 7 ingredients in that flour blend, I would be very, very nervous, using it.

Manufacturers slip up, much more commonly, than most of us realize, I believe. Look at McCann's Irish Oats, for example. For many years, they were the darling of the Celiac world, and were held up as a shining example of the purest oats in the world, safe for any celiac diet. How did they earn that reputation? Apparently, simply by claiming that their oats were pure, and no one ever challenged that claim. Then, someone rocked the boat, by deciding to actually analyze the purity of McCann's products, and lo and behold, it turned out that they had some of the most contaminated oats in the industry. They no longer advertise gluten-free oats, of course. Now they say:
Are McCann's Oat products gluten free?

All McCann’s oat products are processed in a dedicated oatmeal mill that handles only oatmeal. In the supply chain between farm and mill, there is a possible cross contamination with other grains, such as wheat and barley but we reckon that the level of non-oat grains to be less than 0.05%. Cleaning equipment within the milling process would remove the vast majority of these grains along with other elements such as stones, straw etc.
http://www.mccanns.ie/pages/faq.html

But that's 500 parts per million, (ppm). Most of the world uses 20 ppm as the limit for gluten-free labeling. As I recall, the random tests found that their products contained around 200 ppm, (more or less) - enough to make a large percentage of gluten-sensitive people very sick, if they ate these products regularly. In the tests that were done, if I recall correctly, plain old Quaker Oats turned out to be much safer than McCann's, and they never even claimed to have pure oats. Anyway, I hope you see the risk - it's not a perfect world, and if we don't use statistics to our advantage, we can become very vulnerable to the risks involved.

Also, if I were in your situation, I would take a very, very careful look at everything that I added to my diet, during that 3 month period of remission. Something was changed, during that time frame, to stymie your progress. At least, that's what I suspect.

Tex
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It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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Post by RUBYREDDOG »

Gloria, I just found one of my supplements has vegetable glaze. This is soy, a no-no for me. So we all must be so careful with our diets. It never hurts to evaluate everything we ingest.

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Post by Pat »

Gloria,

Gosh, I am so sorry you are having trouble. The other times I took Entocort and quit it took 5 or more weeks for it to wear off. I think it must stay in your system a long time. I don't really have any advice as I struggle even with full dose Entocort. Still no Normans after nearly 5 weeks of Entocort and my diet is very restricted. Sounds like good advice from Tex about looking at what you added the that last 3 months. I hope you get it figured out soon. :smile:

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Post by Gloria »

Pat,
It's helpful to know that it took 5 weeks for Entocort to wear off for you, too. I don't know how you are carrying on and working, too. I think about your situation a lot and feel for you.

My condition keeps getting worse. I'm going to the bathroom every 2 hours now and it's beginning to be explosive watery D. I'm concerned because I have a 2-hour test tomorrow as a follow-up to a recent mammogram. I'm not worried as much about the outcome of the test as I am about having D during the testing. Maybe I should take Immodium.

The last time this happened, I took 2 pills of Entocort and within two days I was improving.

Tex,
I don't have a fever and I don't have pain or stomach cramps, just that icky feeling that you get from having D all the time.

I haven't eaten any products with the flour blend since Friday. I last had nuts on Saturday and I didn't eat any fruit all day yesterday. No chocolate today, but I did eat fruit. The three items I've eaten every day are rice products, Almond Dream milk and potatoes. I haven't changed my diet in the last three months other than the items I mentioned earlier: Pacific broth (twice), tomato-olive bruschetta (twice last week) and the calcium tablets added to my homemade rice milk. I just remembered that I did eat Polar all natural tuna last week for the first time in months, but the label says it contains albacore, water and salt only. Could it be that I've become intolerant to potatoes?

I don't have any idea what to eat tomorrow because everything seems suspect right now.

Maybe I need to see my GI and have some tests done.

Gloria
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Post by tex »

Gloria wrote:The last time this happened, I took 2 pills of Entocort and within two days I was improving.
Which, of course, is pretty strong evidence that something has definitely changed, and whatever it is, it is now confounding the treatment. (Everything happens for a reason).

One of the recent changes that you've made is the addition of a calcium supplement, (Apparently the calcium "project" began in early April). On April 7th, you posted this:
I also think that I feel better drinking the Rice Dream milk rather than the homemade rice milk. I attribute that to the calcium and vitamin D in Rice Dream, however. I just purchased some calcium/vitamin D tablets and probiotics from The Vitamin Shoppe that claim to be free of my numerous intolerances. I'll try them tomorrow with the homemade rice milk and see what happens.
Looking at your subsequent posts, you started experimenting with crushing the calcium supplement tablets, and adding the powder to your homemade rice milk, on about April 15th. On April 22nd, you posted this topic, about successfully blending it into your homemade rice milk:

http://www.perskyfarms.com/phpBB2/viewt ... +rice+milk

Ten days later, you began to fall out of remission. On May 5th you posted:
I haven't seen Norman for a week.
I ain't no TV CSI expert, but it appears that this might be a "smoking gun", of sorts. IMO, either the calcium supplement itself may be causing problems, or crushing it and adding it to the rice milk may initiate some sort of chemical reaction, (two minutes in a blender, set on "high", allows a pretty violent mixing action), that may be causing problems. Or, maybe something else is the problem, but this is the time frame that needs to be carefully scrutinized. Are you still taking the priobotics that you mentioned in the April 7th post?

If cutting out the calcium doesn't bring improvement, I would definitely ask my doctor for a C. diff test, (or two, if the first one shows a negative result).

Tex
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It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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Post by Gloria »

Tex,

I'm much better today. Yesterday I made at least 10 trips to the bathroom. Today I've only gone 3 times and I didn't go during the night. I think Entocort has kicked in. Thank heaven for Entocort!

I also have been suspicious of the calcium being added to my rice milk. It does change the consistency of it and makes it thicker. I made some scalloped potatoes the other night using the calcium-enriched milk and the sauce was a tan color. The next day (last night), it was even darker and unappetizing, so we threw it out. I've pretty much decided that I'm not going to add the calcium powder to my homemade rice milk anymore. I'll still take the capsules because they didn't seem to bother me. FWIW, I started drinking Almond Dream on March 7.

Another realization I had today was that I began taking the generic form of Fosamax (alendronate) once a week, three weeks ago. I had taken Fosamax Plus D two weeks prior to that and had taken it earlier for about two years (part of the time while I had MC) without problems. I had been off of it for about a year before I resumed taking it. One of the side effects is diarrhea, but I never noticed that as a side effect from Fosamax Plus D. Supposedly, the only difference between the generic alendronate and Fosamax Plus D is the 2800 units of vitamin D. It doesn't seem likely that one pill per week would cause problems all week long, does it?

Finally, I experienced similar problems when I went completely off Entocort last November. This time, the D was more frequent and severe and I had to increase the Entocort dosage to three pills before it made any difference. Even today, I'm not as improved as I was after taking 2 pills for 2 days last November, but I am much better.

Gloria
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