LC or not LC? Frustrated with "up in the air" GI d

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JamesEcuador
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LC or not LC? Frustrated with "up in the air" GI d

Post by JamesEcuador »

Hi All

I've viewed this forum quite a lot and it has been very useful to read about similar experiences but I’m a newbie who's finally got the guts (pardon the pun) to post my opening message. Hello everyone and thanks for hearing me out!

I’m a 34 year old ex-pat Brit guy who lives in Ecuador and since I arrived a few years ago I've had stomach problems which progressively got worse since suffering from my first gross bout of intestinal parasites in around 2009. In about 2011, I started realizing that my body reacted after eating wheat products and I went to an allergist who confirmed I had a wheat intolerance which went with my lactose intolerance which I’ve known about and managed for 10 years. I’m not sure if its relevant here but around the same time I also lost my sense of smell progressively over this time and I’m now totally anosmic (can’t smell anything) with the doctors believing it to be caused by chronic sinusitis and nasal polyps. Via a blood test I was also deemed negative for Celiac but showed a high IgG sensitivity. I’m also allergic to grass, dust, cats and dogs but I knew that already.

My allergist recommended that I cut down on wheat but said that perhaps a little wheat in my diet would be OK so up until recently I wasn't over strict with my diet. Over the months, I become more sensitive to wheat/gluten based food and drink – especially to processed food like ready-made fries, bottled sauces, herbal teas as well as some breads and all beers. After consuming these, I sometimes would have reactions which included constant disgusting burping, fuzzy head, trapped gas, horrible abdominal pain, constipation for about 24 hours and then tiredness and body aches that last up to a week or so. Away from these reactions my BMs are pretty much OK. The worse regular symptom I experience is that for the last 6 months, every morning I wake up feeling nauseous and achy/have joint pain which can last all day. For much of the day my stomach is knotty and feels irritated, especially when stressed. At the end of last year I started to lose weight quite quickly (from 70 kgs to 65 in two months) and have had real problems putting it on again. I’ve also now given up dairy since even lactose free food and milk irritated my guts.

So because of all the above, and mostly because of the weight lost, in January this year I went for a second opinion to a GI. I had an endoscopy and was found to have gastritis but again no signs of celiac. A blood test and stool test also confirmed I had giardia parasites which I’ve had treatment for but since I live in a place with poor sanitation will probably not be fully clean of fully until I leave Ecuador. I was also ordered to have a colonoscopy where the biopsy confirmed I was found to have “traces” of lymphocytic colitis. This was particularly weird for me as I thought, well I either do or I don’t have this disease! In the notes to my biopsy it said that a third of patients who test positive for LC are also celiac and that the results of my biposy should be matched with the rest of my patient notes for a proper diagnosis. My doctor couldn't do this and said my case is “complicated” and that he didn’t have enough information to diagnose me one way or the other and recommended that I stick to a gluten free diet as a kind of self-test to verify (or not) the results of my colonoscopy biopsy.

So 4 months GF and DF I do feel a bit better –I’ve put on weight, I have more energy, I feel more alert but I still have this nauseous feeling in the morning with body aches and joint pain throughout the day. My stomach often feels knotty and weak (worse when stressed). I have had setbacks with accidental gluten/wheat poisoning and whenever that happens it seems to set my body and guts (mostly pain rather than D or C) back for weeks. I’d like to test my own body with trying some wheat/gluten but scared about the reactions.

Its frustrating getting medical care here in Ecuador because of my own language limitations and Ecuadorian cultural and medical differences. So the reason for this opening post is that I was wondering if my situation is quite common that a doctor cannot diagnose exactly whether you have LC or CD or not from medical testing. From my research I regularly seem to have lots of the typical LC symptoms but the fact that I don’t suffer with diarrhea and/or constipation (unless I eat food I’m intolerant to) makes me question whether the LC is the answer.

I know I have a dodgy tummy, I know I have food intolerances and other allergies but I suppose what I’ve wanted from a doctor is to give me confirmation that I have something without purely testing my body with reactions to my diet. The grey area I’m in at the moment is the most frustrating - a GF plus DF diet here is incredibly difficult to stick to through a lack of allergy free food available in the stores and I’m not really happy with my up-in-the-air diagnosis at the moment.

Any insights very much appreciated and thank you again for your time to read this long message.

James
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Post by Zizzle »

Welcome James!
You sound a lot like me. I was an international development brat born in France and moved every 2 years throughout Latin America and the USA. Picked up LOTS of GI infections along the way. LC can manifest the entire length of your GI tract, so your gastritis is probably related. LC and gastritis also qualify as Marsh 1 level damage when assessing for celiac disease. It means there is inflammation, but the characteristic villi blunting hasn't happened...YET. If you want confirmation that you should be 101% off gluten, you might want to ask for a blood test (or order your own cheek swab test from Enterolab.com) for your HLA DQ alleles. If you have a DQ2 or DQ8 celiac gene, that combined with your OBVIOUS gluten intolerance, should convince you that cheating is not optional, or you will develop full-blown celiac eventually.

That said, many people with LC don't have celiac genes but are just as gluten sensitive as the average celiac. Regarding the "traces" of LC, many docs don't biopsy the right places, or don't take enough biopsies to arrive at a diagnosis. You're lucky that they found it at all. LC can also have a patchy distribution, so that can explain why not all the biopsies show LC. I once saw the #1 celiac expert in the country, Dr. Fasano, who told me he believed LC was celiac of the colon...

I didn't have too much trouble eating GF in Latin America during my last visit. I stuck to rice, meats, cooked vegetables and corn tortillas and tamales. You just can't eat the processed food.

Welcome to the family and feel free to ask anything!
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Post by Gabes-Apg »

Welcome James

and congrats for posting your story and seeking some advice.

Whether you have a formal diagnosis of LC or not, your symptoms are indicators of digestion issues.
Whether it be LC/CC, Crohns, UC, IBS (the most common used by doctors) alot of the advice given here will help.
(you can call it 'fred' if you wish)

Digestion symptoms mean inflammation, reduce the causes of the inflammation symptoms will go away.
For all digestion issues, removing Gluten and Diary will help big time.
Nausea, fatigue, and joint aches are indicators that you are ingesting something that doesnt agree with you.
after gluten/dairy the most common intolerances are Egg, Soy, Nuts, Fibre.

In countries like the USA, UK, Australia, there are not many GI specialists or General Practitioners that will acknowledge the benefit of diet management for 'Fred'.
There is stool testing by Enterolab that is available via the USA, that will test the major food items and identify if there is an intolerance. There are options for non USA countries to do this, not sure if equador would be covered.

Majority of the people here have a negative blood test for celiac, albeit, eliminating gluten and then trying it again, confirms that we can not digest it.

another topic you may have seen is 'Mast Cells/Histamine', majority of the people on this forum have issues with mast cell/histamine at some stage in their journey.
http://www.perskyfarms.com/phpBB2/viewforum.php?f=74

good luck 'digesting' all the info.
We have a few people here that dont have a confirmed LC/CC diagnosis, they have followed the advice given and minimised symptoms.
Gabes Ryan

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Post by JamesEcuador »

Thank you Zizzle and Gabes for your excellent replies. It's great to finally hear another angle to what I have and from now onwards, "Fred" works fine with me to describe it. Its also a big sigh of relief that my case doesn't sound so uncommon as where I live at the moment, it certainly feels that way! Dr Fasano's theory that LC is celiac of the colon makes sense to me and perhaps that's what my own GI was inferring in a round about way.

I actually live in the Galapagos Islands which is where my Fred problems started. Of course, it is a cool place to live but what you don't see on the nature documentaries is that parts of the populated areas (where I live) have major water sanitation issues which cause health problems. Both the water I wash in and the drinking water is for a lack of a better word, dodgy and riddled with parasites. Before I arrived to the Islands, I didn't have these GI issues. You are right Zizzle that eating isn't so difficult in latin america if you stick to the basics but its not always that easy, mostly because of the lack of choice in the stores. Eating out is also pretty much a no-no for me now due to the risk of cross contamination - I can count on one hand the amount of restaurants who understand catering for allergies and intolerances.

I'm definitely going to try and give eggs a miss - never thought they could make my symptoms worse. For the last few months I've eaten an egg a day for breakfast, mostly because if I don't I get very hungry as I have no access to GF/DF snacks over here apart from fruit and plantain. I've never had an obvious bad reaction but it will certainly do me no harm to try living without eggs for a while.

Thanks again
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Post by Gabes-Apg »

James
I use a Rice Protein Powder (mix with Coconut water and some rice milk) this is fantastic for snacks/meal replacements during the work day.
If things are not available locally, try ordering online. It may seem expensive, but in the long term, eating the right stuff, minimising symptoms is worth it.

Things will get easier, the start is the biggest hurdle.

Eating out is a 'struggle' no matter where you are in the world. Restaurants understand Celiac and gluten free, it is catering to multiple intolerances that they struggle with. as you get to know your safe foods, you will be able to find places and order safe foods out.

Most MC eating plans are very basic / bland at first. no spices, not too many ingredients. As the gut heals then the chance to add items in can occur.
For most, life with minimal symptoms overtakes the tastebuds, as time goes on, the craving for dangerous ingredients fades.

glad you like the name Fred, cause he is kinda with you for life! better to get to know him rather than try and reject him!
Gabes Ryan

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Post by tex »

Hi James,

Welcome aboard. Actually, LC virtually always presents in patches in the intestines, so your GI doc's confusion about your diagnosis indicates his lack of familiarity with the disease. Contrary to what most GI specialists realize, LC can present with GI symptoms that range from diarrhoea to constipation, and virtually anything in between. All of your other symptoms (gas, bloating, nausea, joint aches, etc.) are also very common with LC, (and many doctors do not associate those symptoms with LC.

If you have mast cell issues (which many of us have), taking an antihistamine might help to reduce the nausea, and in many cases, other GI symptoms. Some of us even take a non-drowsy antihistamine in the morning, and a Benedryl at bedtime. Please be aware that if you choose to take Claritin, select the Claritin Redi-Tabs, because the regular formulation contains lactose (at least it does here in the States).

If you should want to verify your food sensitivities, I'm pretty sure that you could send a stool sample to EnteroLab from where you are (provided that you have access to either a Fed-Ex, or UPS, or DHL shipping depot that offers overnight international delivery. Here is a link to the lab that we're referring to. The most popular tests (the most beneficial tests for your money) are the combination of Panel A1 + Panel C1.

https://www.enterolab.com/StaticPages/TestInfo.aspx

When you order tests from them, they send you a collection kit with instructions for shipping the sample back to the lab. EnteroLab also offers the cheapest DNA test in the industry, and it provides more gene results than all of their competitors. In addition to testing for any celiac genes, they also test for all genes that predispose to gluten sensitivity. Of course many of us are able to figure out our food sensitivities without using those tests, so the tests are strictly optional.

And remember that the average time from the onset of symptoms until an official diagnosis of celiac disease is determined is 9.7 years in the U. S. I have no idea what the interval might be in GB, but it is probably similar, because the current celiac disease diagnostic criteria can only detect celiac disease after it is fully developed, and that typically takes many years. IOW, doctors have no way to diagnose celiac disease until the mucosa (the lining) of the patient's small intestine is in shambles, and almost totally unable to absorb nutrients.

By contrast, the stool tests offered by EnteroLab can detect gluten sensitivity as soon as antibodies are being produced in significant quantities, at least several years before the damage reaches the level at which celiac disease can be officially diagnosed by conventional methods.

Again, welcome to the board. You seem proactive, and motivated people get their life back from this disease.

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 JamesEcuador »

Hi Tex

Thanks a lot for your reply. Good to know that my LC symptoms aren't so different to everyone elses. I also never knew that a celiac disease diagnosis can take that long after developing symptoms. I'm only 2.5 years into serious GI problems so no surprise that I showed up negative. Also, celiac and LC, are very rare conditions for people to have in Ecuador which can excuse my Dr's lack of knowledge I suppose,

The EnteroLab option is definitely something I will look into. Overnight international shipping is impossible where I live though so it may have to wait until I get somewhere that offers it (like GB).

Since I posted yesterday, a lot of what I've read has started to make so much sense to give some explanations into how I've felt for as long as I can remember. Thanks everyone!

James
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Post by Leah »

Welcome James. Everyone here has given you great advise and if you want to really understand this disease, you might want to order Tex's book about MC. Just hit the picture of it in the upper righthand corner of this page and it goes straight to Amazon.

I am one who takes an Allegra in the am and a Benadryl in the pm. You never know, it might help.

With the parasite thing, Im' surprised you don't have major D. maybe your C dominant MC is making the difference. You also obviously have leaky Gut ( Look it up). the symptoms to the rest of the body is a good indication. Healing it is the only way to get better. Like everyone else has said, try to eat as plainly as possible. Fruit and sugars can cause a lot of problems also. After over two years of healing and being able to add many foods back into my diet, I STILL can only eat a very small quantity of fruit ( or sugar) at a time. Try to stick to fish, meats and maybe rice for a while.

Good luck
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Post by Zizzle »

James,
My most common breakfast on the run is a microwaved ripe plantain (cut the ends off and slice halfway through the middle but keep skin on), smashed with coconut oil and lots of cinnamon. It's so soothing to me, and more agreeable to me than bananas.

If you have access to fresh coconuts, you should drink the water for the excellent electrolytes and blend the white inside to make coconut milk.

Other tummy-friendly fruits include sapote, guanabana, papaya, maybe pineapple....my mouth is watering! :smile:
1987 Mononucleosis (EBV)
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2009 Lymphocytic Colitis
2010 GF/DF/SF Diet
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Post by JamesEcuador »

Hi Leah

I do have bouts of D on occasion but never more than 3-4 a day. I find the parasites more clog me up. Sorry for my ignorance but what do you mean by "maybe your C dominant MC is making the difference"? I never have really bad C but equally I'm never satisfied with my BMs if you know what I mean - always feels like I'm not empty enough. In April I returned to England for two months and within a few days my BMs were as normal as they have ever been. Then when I returned, my unsatisfying BMs came back within a few days which made me realise how my environment here is affecting my guts.

I've just seen that Tex's book is available on Kindle (difficult to get Amazon to deliver to Galapagos) so definitely going to invest!

All I really eat now is fish, rice and a lot of plantain. A bit boring but so far, no problems. And Zizzle, we have lots of lovely coconuts here on the islands so looking forward to adding more into my diet :grin:
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Post by Gabes-Apg »

James
if there is more C than D, I can recommend taking high doses of Magnesium, Vit C, and Zinc.
this helps reduce the inflammation, helps motility, and also helps histamine/mast cell.

The other totally good value option to improve wellness, is Vit D3 supplementation.
It helps reduce inflammation, gets your cells healthy, and you need good levels of Vit D3 to absorb other nutrients.

Given the water issues, you might want to research Olive Leaf Extract. (liquid or tab)
it might help your body cope with the dodgy water
Gabes Ryan

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Post by tex »

James,

I'm sure that Leah's comment about your C dominant MC possibly making the difference, was intended to relate to the fact that C-predominant MC can turn a situation where others would have to deal with D, into an almost normal BM.
James wrote:I never have really bad C but equally I'm never satisfied with my BMs if you know what I mean - always feels like I'm not empty enough.
Tenesmus (a feeling of incomplete voiding after defecation) is a commonly reported symptom among many MC patients.

The fact that your BMs are normal in England, certainly highlights the fact that something in your diet in the Galapagos Islands is having a major impact. :shock:

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 Zizzle »

Tex,
Is there evidence out there that a chronic low-grade bacterial or parasitic GI infection like giardia or amoebiasis can cause the histological changes seen in MC?
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Post by Leah »

That's exactly what I meant Tex. thank you. James., I hope the plantains aren't binding you up. I know that bananas do that to me…… and you probably don't eat them while in England. ….. something to think about.

Leah
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Post by tex »

Zizzle wrote:Tex,
Is there evidence out there that a chronic low-grade bacterial or parasitic GI infection like giardia or amoebiasis can cause the histological changes seen in MC?

Sure. The primary diagnostic criterion required for a diagnosis of LC is increased infiltration of T cells into the epithelium of the colon. And even though the histology of the small intestine is ignored when diagnosing LC, for most of us, the same T cell infiltration also occurs in the small intestine (when LC is present).

And yes, the immune system's primary defense mechanism for dealing with both Giardiasis and/or amoebiasis, appears to be increased T cell infiltration into the epithelium of the intestine. So obviously such infections can easily trigger an MC episode (or be mistaken for an MC episode).

Good catch.

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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