Pepto and Imodium questions...

[winter]

How effective is taking pepto bismol for 8 weeks, really? Is there anyone here who has gained remission after completing the 8 weeks of pepto? Did you flare again? If so, how soon after the completion?

Did the pepto immediately stop your diarrhea, or was it a gradual process? Anyone know exactly how the pepto is able to stop the diarrhea in some cases?

I seem to have mild MC in a sense that I do not have diarrhea daily, but more so every few weeks and it is not the copious amount that many people with MC have. Since it does not happen as frequently, do you think it mostly flares due to what I'm eating, or is that just the nature of the disease? What is the typical pattern of flares/diarrhea frequency for someone with MC? I mean, I know it'll vary from person to person, but I'm just curious. Is it usually a daily problem?


I also read that some patients are treated by taking imodium/Loperamide. I'm assuming this does nothing but delay the diarrhea, but does anyone find that they experience remission with using these types of medicines?


Looking forward to your input, everyone.

[Polly]

Hi Winter and

The original study using Pepto Bismol (PB) was done by Dr. Kenneth Fine, an MC researcher. See his website at www.finerhealth.com He found that some with MC did better on PB; however, he quickly abandoned his PB protocol after finding out that the gluten-free diet produced far better and much more lasting remission. He now recommends moving directly to the GF diet. (He has developed the only good lab tests for diagnosing gluten intolerance, using stool samples instead of blood samples).

The active ingredient in PB is bismuth subsalicylate. Not sure how if works, although another heavy metal, zinc, has also been used for diarrhea control. I guess they work similarly. Also, salicylate by itself has an anti-inflammatory effect. Imodium/Lomotil simply delay the diarrhea, as you noted. Some believe that it is not a good idea to keep the diarrhea "in" - that it is best for the toxins to get out, so to speak. They do not lead to remission but can be helpful to control symptoms when needed.

You are lucky to have "mild" MC. My bet would be that it is diet-related, unless you have other risk factors (like long-term antibiotic use, constant NSAID use, HRT, etc.). The most likely food intolerance is gluten, followed by dairy.

Very nice to have you on board! I'll look forward to future chats.

Happy Holidays!

Polly

[tex]

Hi Winter,

Welcome to our online family. Polly has pretty well covered the questions you asked, (with accurate answers, of course, since she is an MD, and she has MC herself). We have found that no one truly understands this disease unless they have it themselves. Dr. Fine, (mentioned in her response), also has MC. So I'll just fill in a few details, to address your specific questions.

How effective is taking pepto bismol for 8 weeks, really? Is there anyone here who has gained remission after completing the 8 weeks of pepto? Did you flare again? If so, how soon after the completion?

Statistically, according to Dr. Fine's research, it's roughly 80 to 85 % effective in bringing remission, but the problem is that many of the other 15 to 20 % are unable to tolerate the treatment without adverse neurological effects. Dr. Fine's research shows that roughly 30 to 35 % of patients who use the treatment, will relapse, unless they adopt the gluten-free diet, when they begin the treatment, and continue following the diet indefinitely, and, as Polly pointed out, he no longer recommends the treatment as the best way to treat MC. (IOW, since the GF diet is necessary anyway, you might as well skip the Pepto). A few members here have tried the treatment, and many of them have been able to gain remission by using the Pepto treatment, however, our cumulative experience, (among members of this board), has been that virtually everyone relapses, unless they adopt the diet early on, and stick with it, meticulously. Otherwise, relapses usually occur anywhere from a few days to a few weeks, after discontinuing the treatment.

Did the pepto immediately stop your diarrhea, or was it a gradual process? Anyone know exactly how the pepto is able to stop the diarrhea in some cases?

Symptoms often begin to improve within a few days of beginning treatment, but some people take longer, (such as a few weeks). No two cases of MC are alike - like snowflakes, we are all different in our symptoms, and our responses to treatment. Like most medications used to treat IBDs, the exact mechanism by which bismuth subsalicylate accomplishes control of symptoms, is unknown. It is known, however, that Pepto coats the mucosa of the intestines, reinforcing the protective function of the mucus secreted by the mucosa, which helps to reduce inflammation, by isolating the epithelia of the intestines from inflammatory agents in the fecal stream. In addition, Pepto-Bismol actually has mild antibiotic properties.

I seem to have mild MC in a sense that I do not have diarrhea daily, but more so every few weeks and it is not the copious amount that many people with MC have. Since it does not happen as frequently, do you think it mostly flares due to what I'm eating, or is that just the nature of the disease? What is the typical pattern of flares/diarrhea frequency for someone with MC? I mean, I know it'll vary from person to person, but I'm just curious. Is it usually a daily problem?

There are several modes of MC reactions. The most common mode is secretory diarrhea on a frequent, daily schedule. This is the one that most GI docs are familiar with, and most GI docs are unaware that other modes even exist. However, some of us, (myself included), have alternating diarrhea, (D), and constipation, (C). My cycles of reactions were very similar to yours, typically consisting of a week or so of seemingly good health, (sometimes with C, sometimes not), followed by a period of aches, pains, migraines, brain fog, sometimes nausea, and always, uncontrollable diarrhea. And then the cycle would repeat itself, over, and over again. While it was happening, I couldn't really tell what, (if anything), in my diet, was causing it. However, after I adopted the GF diet, and also cut out a bunch of other foods, I was able to achieve remission, and I am still in remission, 6 years later. So yes, the flares are due to what you are eating, but they are also the nature of the disease. There is a third mode of reactions, which involves C, (no D), but it is rather uncommon, and most people with that mode of reactions presumably never are diagnosed, anyway, because a GI doc is not going to do a colonoscopy exam on someone just because they're constipated, and people with C are not nearly as likely to ever see a GI doc, anyway, so they will never be biopsied, and therefore never diagnosed. If they see a doctor at all, the default diagnosis will almost invariably be IBS.

I also read that some patients are treated by taking imodium/Loperamide. I'm assuming this does nothing but delay the diarrhea, but does anyone find that they experience remission with using these types of medicines?

You are quite correct, that a few GI docs try to treat MC with motility-reducing meds, anti-spasmotics, anti-depressants which have a side effect of C, etc., but, of course, those virtually never work, since they do nothing to address the inflammation that is causing the disease in the first place. The most effective, (safe), med to treat MC, is Entocort EC. And the absolute safest way to treat it, is by diet modification.

I hope I've adequately addressed your questions. If not, or if you have additional questions, please don't hesitate to ask.

Again, welcome aboard.

Tex (Wayne)

[ant]

Winter!

I am one of those that did the 8 weeks Pepto B before going on to Entercort and a GF, DF, SF diet. (When he put me on Pepto, My GI of course just told me to eat anything I wanted to, which I did). Well, when I started to reduce the dose of Pepto the D returned. Wishing you all the best in your journey to remission, Ant

[hawkeyejulz]

Hi~

I was diagnosed with MC in June 2008. I was put on the pepto treatment for 8 weeks. It wasn't took long after my treatment ended that I had another flare up. However, I didn't continue on with pepto for 8 weeks at a time because I was experiencing ringing in my ears from it. I do take it if I feel a flare up coming on and I will continue to take it until the flare up has passed by.

During my 8 week pepto routine, I was feeling great and my diaherra slowly disappeared. I would definatly give it a try. Good luck!

[Gabes-Apg]

Welcome Winter,

I am realtively new to this MC family (diagnosis Dec 09) reading the posts, discussions and articles on this site the main things i have learnt to try and control the D Demon is that: -
- it is different for each of us, we all have different triggers, the triggers and their intensity can vary depending on what else is happening (other health issues, stress)
- the variety of medication / natural therapy regimes work differently for each person

I am trying to control the demon as naturally as possible (i am using zinc liquid and golden seal) and the only medication i am taking is questran lite which i am in the process of reducing the dose

I use loperimide only if i have to. I agree with Polly re delaying and toxins. The reality for me is that i have no more paid leave left so if i have to be at work and get through 4 hour workshops, and D symptoms are evident then I will use small dose of lopermide, and hence pay the price with constipation and discomfort for 2 days following.

As i am still in the process of determining what my digestion likes and dislikes i have minor relapses about once a week at the moment. in the past 4 weeks of being at work i have only used the lopermide twice to ensure that i am not running to the toilet every 30 mins. I find that i dont have full on D, just softish frequent motions.

I have even started to ponder if they are nervous BM's. the stress of being a meeting/workshop (most of which are males) and feeling self concious about how often i go to the toilet and the fact that i bring my own food and wont eat the catering provided which people question me about. i only seem to have these symptoms on these days.

Anyways..... the long and short is that it is a constant variable. the optimum way to get good long term control is the diet. I am Gluten Free, Yeast Free, Lactose Free. it is a bit trial and error what medications are going work and if they are a long term benefit or just the short term quick fix.

GOOD LUCK! take care

[ant]

Dear Hawkeyejulz

Glad you posted !! It seems that you have intermittent D. Are you gluten and dairy free or do you just occasionally use Pepto as a treatment?

All the best, Ant

[alclarkson]

I've been taking 2 pepto 3x a day since 5/21. My stomach is still upset and I"m still nauseas. My BMs are still not normal, I can hear everything moving through my intestines and I have copious amounts of gas & bloating. On a good day I may only go once or not at all. It's normally semi-formed pencil D, but gosh my belly is so upset. Yesterday I had a double cheeseburger and shortly after got an awful migraine and awful abd pain and 3 bouts of D. I was sick the entire rest of the day and had to take a nausea medicine. I still have a headache this morning and am SO tired. My 1st guess would be an intolerance to lactose, but I drink milk and dairy creamer everyday and have been fine. I don't know how much longer to stick it out!

[MBombardier]

Andrea, did you have a bun on your double cheeseburger? Your symptoms seems to indicate a gluten intolerance, if so.

[sarkin]

Andrea,

The vast majority of us cannot tolerate casein, which is the protein in milk (lactose, as you probably know, is the sugar). That could definitely cause your symptoms.

The Pepto will only work if you correct the diet (I know, it's hard, because you don't know exactly what you can/can't eat). If you start by eliminating gluten and dairy, and consider a pause from soy and other legumes, you'll have knocked off the top-level culprits. I went totally grain free, as well as gluten free, when I was first sick, because even quinoa (a so-called pseudograin) didn't agree with me.

Basically, the Pepto's job is to heal the damage. If you eat foods that continue to do damage, the Pepto just can't keep up. I started with 8 Pepto/day and got it down to 5, then 3, very quickly.

Also - even if you had that double cheeseburger without the bun, at a restaurant that places buns on the grill for toasting... you were glutened.

I'm a huge proponent of the "when in doubt, cut it out" school of thought. It's actually much faster than eliminating foods one by one while guessing why you still feel awful. Better to feel better, and not have some food you kind of enjoy for a few weeks... even if you discover later you can add it back.

Who knows, there may be some secret ingredient in that nausea medicine, too. Everything you add, increases your risk. Everything you cut out ups your odds of getting your life and health back. That's the way I see it, and how I'm going about it - and I'm eating plenty of great food every day, and never go hungry ;)

Hope you're already feeling better,

Sara

[alclarkson]

Ugh, I would really rather not be gluten intolerant. Guess I've got to start some where.
UGH

[MBombardier]

Gluten is the biggie. Sara is among those on the forum that have my deep respect. Deciding to go gluten-free was like falling off a precipice to me. I couldn't imagine having to deal with the multiple intolerances so many of the dear people on this forum have to deal with. And cutting out everything all at once? No way.

So I went gluten-free, and my body went "Yay!!" for about four months. Then the gluten antibodies had decreased to the point that my body said, "You know, I really cannot tolerate soy..." So out soy went. Now I know I am also intolerant to corn, and rice, which I just challenged, appears not to be my friend either.

I am blessed to be one of the few not to be casein-intolerant, though I am lactose-intolerant. Maybe someday a casein intolerance will raise its ugly head. I don't know.

So, as I said, Sara (and others) just amaze me with how they have totally reformulated their diets, and all at once, some of them, like Sara. I have chosen not to do that. As Gabes says, there is no right way, and there is no wrong way. There is your way, and it's the right way for you.

[alclarkson]

Thanks for all the support. My husband (whole family really) actually went gluten free for about a week and it was very hard. I could not and still cannot believe how many things have gluten.

On the pepto routine, I've noticed increased gas and bloating also more rumbling in my belly- I can hear nearly every movement of my small intestine. Is this familiar to anyone else?

[tex]

On the pepto routine, I've noticed increased gas and bloating also more rumbling in my belly- I can hear nearly every movement of my small intestine. Is this familiar to anyone else?

Hmmmmm. You've been on the Pepto treatment for 10 days now. It might be a bit premature to expect results at this point, but if it's going to help, it should show some benefits relatively soon. The symptoms you describe are typical of an all-out MC flare. If your symptoms are worse now than they were before you started the treatment, then either you've been ingesting more foods to which you are sensitive, than you were before, or you're intolerant of the bismuth subsalicylate, and it's making your symptoms worse.

Tex

[alclarkson]

WEll, my D is definetly better, 1-2xs a day verses 6-7, but these new symptoms are since I started the pepto. Does that make any sense?