Need advice-Tapering/diet difficulty-continued weight loss

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WhirledPeas
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Need advice-Tapering/diet difficulty-continued weight loss

Post by WhirledPeas »

Hello, long time no chat on here. I very much need testing and diet advice and some encouragement. I switched GI doctors (old one said some things that were very inappropriate and was recommending gallbladder removal). Primary and new GI both at local university in early December advised against it since it was not inflamed and could cause more GI issues for me. Due to my continued weight loss (149 lbs, size 8 before May and this severe flare and now 108 lbs. size 0 - very very skinny) and continued symptoms, wants me to repeat a colonoscopy since the last one was May 2013 when I was diagnosed with MC (LC). Almost 5 years. I told her I wanted to put that on the back burner and she suggested a gastric emptying test (egg white, white wheat bread sandwich with strawberry jam) for gastroparesis/chemical gastropathy (chronic on and off burning in throat, mid chest and stomach) and hydrogen breath test for SIBO (concentrated glucose drink and day before eating only lean meat (turkey) and white rice, broth, etc. No potatoes or veggies. I put those off, but now reconsidering especially the colonoscopy and or gastric emptying test since I'm losing weight every time I go to my primary every 6 weeks. Usually about 3-4 pounds. I miss healthy food and energy. My follow up with GI doc is on March 1st. Need to have a plan before I see her.

I put off gastric emptying test because of concern about having to eat egg whites and wheat white bread. Gluten again and eggs were on my Enterolab list this past May. In 2013, eggs were not on the list and I ate eggs prior to this first severe flare without any issues. It was one of my safe protein foods. I was told I could bring in two slices of gluten free low fiber bread to substitute. If I'm going to do this 7:30am test, I would need recommendation on which brand GF bread to buy. Concerned about hydrogen breath test because of it possibly causing diarrhea which technician said is likely considering my symptoms and the only thing it would do is diagnose and antibiotics would probably be prescribed (?) along with diet recommendations. Relapse rate seems very poor with antibiotics. It seems SIBO diet and MC diet conflict as far as fiber causing possibly more GI distress. Catch 22.

I started Budesonide 9 mg on June 7 and in early December constipation was happening more frequently than before. My diet was limited to turkey tenderloins 98% fat free (baked in generous amount of certified EVOO), boiled salted yellow potatoes and soft carrots and Progresso Classic chicken broth in a box (GF and soy free). In the last few weeks, I've made homemade chicken broth, but expensive considering I can't eat the chicken breasts without loose stools (extra fat since the turkey breast bone in does the same thing). Made beef bone broth made with shank meat that I put aside and bones and skimmed tallow off a few weeks ago and tried for 4 days in small amounts. One shot first few days was okay but when I double it to I had GI nausea issues. I have plenty in the freezer.

So for two weeks I tapered from 9 to 6 every other day to be safe. December 19 down to 6 mg daily and towards the end of the 9 to 6 mg tapering I was still dealing with constipation and ended up having a painful cramping, nausea, gas and belching episode on Christmas late afternoon. I bounced from C (varied: not fully moving my bowels, small to medium amount coming out to nothing for a 3-4 days after cramping episode and eating smaller meals) to semi-formed with some LD and somewhere in between before, but before TAPERING I had more often semi-loose and or formed BMs (more stability) and every 6 weeks I would have a painful episode of cramping, intense gas build up in colon, varied from moderate to severe belching followed by an urgent BM or a few usually in the late afternoon or after dinner. What changed when I went from 9 to 6 mg daily is that I did not tolerate eating carrots (fiber) every day and every meal like before. Now I am only eating carrots on the 3rd or 4th day to see how it goes after having a cramping BM episode last Tuesday night. Today is the 4th day. I've barely had a BM since the episode on Tuesday night. Today is Saturday. Tiny amount once each day if lucky. Adding more olive oil and slowly adding 1/3 c. of carrots yesterday and today. I can easily go from C to semi-formed with LD. It seems I get the choice of eating more carrots and having loose stools/nausea or eating more potatoes and having to deal with C which is okay until it gets uncomfortable and the bloating and gas start up because of the buildup in my system. Delicate balance. I've tried baked chicken and turkey breasts that have bone in and skin on and just the amount of extra meat fat in the breasts without skin brings on nausea and irritable bowel feelings and BMs (multiple BMs and discomfort). That is why I am losing weight because I don't have enough fat and calories in my diet, but the extra fat in roasted poultry causes me to feel bad. I eat 3 or 4 bowls of the "soup" a day every 2 to 3 hours.

Yesterday I started pureeing the boiled potatoes and 1/3 c. of soft carrots in blender and heat that up with chunks of baked turkey tenderloins, add 1 tsp. EVOO and a few tablespoons of the meat evoo drippings from cooking the turkey. Hoping it would help me digest better and have less gas which tends to come once I've been C for 3-4 days. No gas pains (yet).

I'm taking D3 5000 mg daily, epsom salt baths every night (2-3 cups in large bath tub), once in awhile I pump some magnesium oil spray on my feet (gives my tummy a mild rash). Methyl B12 800 mcg sublingual drops. I'm not going out as much as I was when I was on 9 mg since an episode keeps me at home for a few days. Have to be near a hot bath to expel the painful gas and near a bathroom. These episodes are happening every week or week and a half and prior to weaning about every 5-6 weeks (along with every other upper and lower GI symptom), but cramping and D is the worst and wears me out even more than usual.

My hair continues to thin. I wash it once a week and a handful of hair always is in the drain filter. Nails are dry despite daily moisturizing. Primary ordered a bone density test which I'm having on Tuesday by the way.

I am concerned about the weight loss and malnutrition/very low energy. My quality of life needs to improve. I am open to any suggestions. I do meditation You Tube breathing exercises before bed every night and sometimes during the day and try to walk in nature when I have the energy and get to music concerts that I LOVE whenever physically possible. Lifts my spirits. And trying to sleep more on the weekends.

Thank YOU for reading this long post. I have been meaning to reach out on here for quite some time. Glad I finally did.

Gratefully,

Wen
1st severe flare 5/1/17 Budesonide started 6/7/17. MC/Gastritis 5/2013; IBS/GERD 2001nobiopsy. Celiac biopsy neg2013. Protonix2001-2006.
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Post by tex »

Hi Wen.

This is not a complete answer — just a few observations.

1. Budesonide is constipating. The dose should be reduced at the first signs of constipation.

2. Except for polyps (in patients prone to developing polyps), repeat colonoscopies for MC patients never find anything new. Never!

3. Brittle hair, dry nails, constipation, and losing weight (assuming you're eating enough calories), are symptoms of a magnesium deficiency. Budesonide depletes magnesium. MC depletes magnesium. A magnesium deficiency prevents vitamin D from working and prevents healing.

Tex
:cowboy:

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 Erica P-G »

I agree 100% with Tex...you are VERY Magnesium deficient.

I hope you get better soon...you need to eat and it almost doesn't matter what at this point....

Hugs
Erica
To Succeed you have to Believe in something with such a passion that it becomes a Reality - Anita Roddick
Dx LC April 2012 had symptoms since Aug 2007
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Post by WhirledPeas »

I've been meaning to reply here for so long.... Always trying to catch up on my limited life, chores, errands, appointments and taking care of myself through the various symptoms that come and go and come back eventually. A pattern. And try to have a social life and catch some music once in awhile which is my inspiration. I'm exhausted afterwards, but it lifts my spirits.

ERICA, Thank you for the hugs. That ONE kind word lifted me up on a hard day...

TEX, thank YOU for the reply and advice. I weaned to 3 mg of Budesonide every other day. I did 3 mg every day for 3 weeks. A week of every other day and then I tried 3mg every two days and that 2nd day without it I had diarrhea. CAN rebound happen that fast? I am back on 3 mg every other day. If I eat fiber (carrots or baked apple) or fat (added EVOO or drippings from cooking the turkey tenderloins too soon after having D or IBS multiple BMs with nausea bout I get broken up cramping BM and or D.)

My eating pattern is turkey tenderloins baked in olive oil, salted boiled yellow potatoes alternated with white rice every other meal and very soft steamed carrots and Progresso Classic GF Chicken broth (fewest ingredients). In the last week I stopped doing the baked apple to see if I can go past 8-12 days without cramping formed and broken up BMs (sometimes LD towards the end). For 3 days after an "episode", I avoid fiber (carrots or baked apple) and added EVOO or drippings from cooking in it. That stops the D and IBS, but I don't usually have a movement until day #3 or #4 after the D bout which always happens in late afternoon or evening then I start adding carrots (1/4 c. each meal 3 x's a day) and prior eating half a baked apple per day usually as dessert an hour or two after dinner. Baking so long makes it very concentrated and sweet. On that 3rd or 4th day after a bout of D I start cooking the white rice w/ a moderate amount of EVOO again. Typically I have formed BMs sometimes easy to pass and sometimes I have to push. Depends on the day. I've tried eating 1/2 c. of carrots with each meal and that was causing more symptoms at times.

My body is needing more than its getting. I have to try baked grouper (4 oz. filets that I bought frozen) in the next day or so. My new GI doctor's nutritionist wants me to eat fish 3 x's a week or 1 x's a week if it's a fish on the moderate list. NOT that it's a surprise. I am his FIRST MC patient. Of course he gave me a list of soluble and insoluble fibers to help with the constipation, but he doesn't realize how it affects us. It's a delicate balance. He says soluble fiber will help with the D. I have not found that to be true.

These are the things he wants me to try which I'm hesitant to try and want your opinions:

1) ALIVE Liquid Multivitamin and Minerals (LONG LIST of INGREDIENTS, citric acid and fruit juices/veggies). I asked for another option and he emailed back saying he wanted me to try it first. The odds are it won't be tolerated and it's hard trying something knowing you will most likely be more miserable. I have been trying to find a substitute online in capsule form, but each one I've looked at has some drawback with ingredients or amount. Folic acid instead of folate or has too much of something or not enough. ANY suggestions? I need a multivitamin that is easy on the tummy and gut and is MC friendly. All liquid multi vitamins seem to have something in it that "we" try to avoid.

2) ORGAIN VEGAN PROTEIN DRINK (Vanilla): 7 grams of fiber per bottle from pea fiber and a type of soluble fiber that starts with an "i", 150 calories and 1/3 of the calories are from sunflower oil. I have a bottle in fridge which I haven't tried yet. Wants me to drink two of these which is a lot of fiber compared to where I'm at now.

3) MCT Coconut Oil (Sports Research): 1 TBS per day (although I would try 1 tsp first to see how it goes since fat does not always agree with me). This is a new product that he just started recommending to IBD patients, so no experience with it yet. I saw one fellow on here using MCT oil in a post that I read. His symptoms sound so much like mine. I have not tried cooking regular coconut oil yet. The bottle I have has a blurred expiration date so I've been using it for my skin and lips only. It's at least 1 1/2 years old if not older.

I'm still on D3 5000 IU daily, 800 mcg of methyl B12 (sublingual) and need to start taking the Dr. Best 400 mcg of methyl folate with 40 mg absorbic acid. That Vitamin C is what has stopped me from trying it sooner. I know I'm folate deficient per blood test. B12 was at good levels since supplementing.

About magnesium...

Since then, I have continued my nightly epsom salt baths with about 2 cups of salt in a medium size somewhat hot bath. And have been spraying 3-4 sprays of magnesium oil on each foot at night then socks on (about 100 mg I think) and when I get dressed the next day since late February. So maybe 200 mg, but I'm sure some rubs off. In the last few days I've tried two sprays on my tummy to see if the rash reappears that I got when I first tried it. I'm tolerating it the last two days, so I will try 4 sprays tonight and wait until my body has cooled down from the bath. I noticed it makes the bottom of my feet exfoliate a bit. It doesn't do that to the top of my feet. I just moisturize my feet extra. It doesn't hurt or bother me. Just an observation. My big toe nails are not as dry as they were in January and February. I left on nail polish for too long after Christmas and that stopped the moisturizers and oils from being absorbed into the nail bed. My nails on my hands are dry but not brittle. Lines through some of them which I had before this severe May 2017 flare mode, but not as much. When I did the magnesium RBC test a good while back it showed slightly elevated levels, but I know those tests aren't effective.

I am at the point where I really need to be pointed in the right direction supplement wise. Maybe the folate will curb the exhaustion that hits me by late afternoon. I get out of breath and am very hungry most of the time and eat every 2 to 2 1/2 hours unless I have appointments out of the house which extends the timing.

Today is Wednesday. It's been a full week since my last episode and last night I had bad gas and belching, but got through it with a hot bath and breathing exercises and had a normal BM this morning. Formed wider than pencils. Medium amount. Usually about the 7th or 8th day after an episode the burning in my throat and stomach gets worse. Have to make sure to eat every 2 hours and time drinking water to get through it.

I probably put this reply off because it's never fun sharing such details and "thinking" about it, but I really do need some guidance.

If you've read this far, God bless you. I feel so alone and frustrated sometimes.

I found out a few days ago that an out of town friend of mine has MC too :-( and has had the same experience as us all with GI doctors. She is on Lialda. I pointed her to this board and the MC Foundation website and newsletter.

Grateful. Thank you for your time and support/advice in advance. I am willing and desperate to get out of this vicious cycle of C and D and heal. It's been a long almost 11 months.

W.

P.S. I don't post much, but when I do it's a long one. ;-)
1st severe flare 5/1/17 Budesonide started 6/7/17. MC/Gastritis 5/2013; IBS/GERD 2001nobiopsy. Celiac biopsy neg2013. Protonix2001-2006.
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Post by tex »

WhirledPeas wrote:CAN rebound happen that fast?
Yes it can.

I'm hoping that someone else can advise you on the supplements, as some of them can be very individual-specific. I think you are right to be concerned about supplements with a long list of ingredients, and protein drinks, especially protein drinks that contain a lot of pea-based ingredients if you are soy-sensitive. If the other (water soluble) fiber source is inulin, some people can tolerate it and some cannot. It's a fructan, meaning that it's composed of chains of fructose molecules.

Tex
:cowboy:

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 WhirledPeas »

tex wrote:
WhirledPeas wrote:CAN rebound happen that fast?
Yes it can.

I'm hoping that someone else can advise you on the supplements, as some of them can be very individual-specific. I think you are right to be concerned about supplements with a long list of ingredients, and protein drinks, especially protein drinks that contain a lot of pea-based ingredients if you are soy-sensitive. If the other (water soluble) fiber source is inulin, some people can tolerate it and some cannot. It's a fructan, meaning that it's composed of chains of fructose molecules.

Tex
Hi Tex,

I forgot to mention that I am eating 3 meals a day (sometimes 4 meals) consisting of a soup with all the things I mentioned most of the time except when I skip the fiber and added olive oil after an episode. As far as calories which you asked about, I'm guessing on an average day I'm about 1,200 calories between the turkey, potatoes, white rice, carrots, olive oil and occasionally baked apple. Sometimes less sometimes more. Less calories the night of the episode (only starch and broth) and for the next 3 days probably 1,000 calories without the added olive oil and carrots until I have a formed BM. I was adding 1 teaspoon extra EVOO to the soup. Now I try to cook the turkey in extra olive oil so I have more drippings. I think my body likes the EVOO better when it's cooked, so I add 1-2 TBS of the drippings which includes meat drippings and water.

Also forgot to mention that after the "D" when I skipped two days of the Budesonide 3 mg, I got a bad cold and cough a few days later with yellow congestion that lasted about 8 days. I was miserable. It started with being very cold then a fever which made me not fall asleep until 3am and the next day sore throat and then the cough and congestion came. Not sure if it was related to tapering or not. Amazingly it was my first cold since the bad respiratory infection I had in January 2017 after traveling before this flare on May 1, 2017.

Here is the link for ingredients. Click on the ingredients link... There are three kinds of fiber in this drink.

http://orgain.com/products/21g-plant-ba ... illa-bean/

Do you think I need to experiment and try a small dose of the magnesium you are always mentioning. The second word starts with a "g". Glycinate? Or just keep up with the epsom salt baths and magnesium oil on the feet and stomach?

Is the ratio of B12 800 mcg to Dr. Best Methyl Folate 400 mcg a good one? Has 40 mg ascorbic acid for absorption.

Hoping someone can help me with recommendations for a capsule multivitamin with minerals that isn't too overloaded with ingredients or too high amounts of certain vitamins. Heck, I would take a natural gummy vitamin if there was one on the market with FOLATE instead of folic acid. Anything is better than nothing.

Thank you kindly, good night.

W.
1st severe flare 5/1/17 Budesonide started 6/7/17. MC/Gastritis 5/2013; IBS/GERD 2001nobiopsy. Celiac biopsy neg2013. Protonix2001-2006.
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Post by tex »

A cold can upset our digestion sometimes and cause diarrhea.

That "protein drink" is nothing but a mixture of highly-processed ingredients. I wouldn't touch it with a ten-foot pole. I don't know who it's designed for, but I would be afraid to use it.

I can't tell you what type of magnesium will be best for you. You have to decide what type you want to use. I can only tell you what type I use — magnesium glycinate.

The RDA for folate is 400 mcg. If you need a folate supplement, then you probably need to take at least twice that much in order to correct any deficiency. 800 mcg of B-12 is a mighty small dose but I suppose it would be OK. Most people who take a supplement take 1,000–5,000 IU of B-12. Be careful with ascorbic acid — many of us can't tolerate it very well when we are recovering.

Tex
:cowboy:

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 Erica P-G »

Hi Wen,

I'd stop the protein drinks...I've found they have WAY to many ingredients in them.....stick with your WHOLE foods you mention above, those are winners.

If you want to branch out and try an internal magnesium....I've been using KAL 200mg per tablet magnesium glycinate it is as reasonable in price as the Drs Best but I don't have to take as many tablets to get the 400 or 600 dose I may need on a daily basis.

If you want to continue with external magnesium....the one I found to be extraordinarily good is ReMag Lotion and gives superb magnesium absorption into the skin.

Jarrows B Complex would be a great "multivitamin" for you it has the Folate, B6 (P5P), Riboflavin, etc....remember we don't need EVERYTHING in the multi-vitamin that is on the grocery shelf.....you are getting a good helping of that in your WHOLE foods you are already eating.

800 mcg is less than 1 mg....you may want to re-evaluate that B12. I take almost 3 MG (Milligrams) Methylcobalamin/Adenosylcobalamin as that seems to work better for me. I'm sure Methylcobalamin by itself will be just as satisfactory for you.

I can find all these things at IHerb.com or Vitacost.com and at Dr.carolyndean.com

Do your homework on what you know you need to stay away from and order these individual items when you feel ready. You definitely need more Magnesium....if you are still taking VitD3 then you really need to get at least 400mg of Magnesium in you a day (and that is taking 200mg morning and 200mg evening).

Hugs
Erica
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Post by tasmtairy »

Erica, I was wondering how much Vit D and Mag. I have Drs. best mag 200 mg. I guess I should double that, how much d3. I too am losing weight. Not on budesonide, just mesalamine and diet.

I've researched the protein drinks to help gain weight, but the ingredient list is long with all these fiber powders, but I'm not getting enough calories. After 3 mos, no D, I have had nocturnal incontinence 4 nights this week, out of nowhere.

I think I will double the Mag and D3. I cook all meats in crock pot with soy free beef broth, I did add peeled red potatoes instead of rice. I want to add more foods, but will hold off till the D goes away.

Thanks,
Terry
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Post by tex »

Terry,

Be careful about adding magnesium if you're already having D. Too much of the wrong kind of magnesium can cause D. Calcium depletes magnesium. Calcium is constipating.

That said, you shouldn't have any problem with the doses of magnesium you're talking about, but if you're already having nocturnal D, you might be very sensitive to magnesium, especially increasing the dose.

Also, read the back label on the magnesium bottle. You will discover that for Doctor's Best Chelated Magnesium, 200 mg is the dose, not the amount of magnesium in each tablet. Each tablet is 100 mg, 2 tablets is the dose. The front label is very misleading.

Tex
:cowboy:

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 tasmtairy »

tex wrote:Terry,

Be careful about adding magnesium if you're already having D. Too much of the wrong kind of magnesium can cause D. Calcium depletes magnesium. Calcium is constipating.

That said, you shouldn't have any problem with the doses of magnesium you're talking about, but if you're already having nocturnal D, you might be very sensitive to magnesium, especially increasing the dose.

Also, read the back label on the magnesium bottle. You will discover that for Doctor's Best Chelated Magnesium, 200 mg is the dose, not the amount of magnesium in each tablet. Each tablet is 100 mg, 2 tablets is the dose. The front label is very misleading.

Tex
Oh you are correct Tex, thanks, guess I'm not taking too much then.
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Post by Erica P-G »

HI Terry,

I've been gauging my VitD3 on the basis of 5000iu for every 200-300 mg of Magnesium.....so one VitD 5000iu and then spread out 400-500 Mg Mag a day.....if taking 10,000 iu then spread out 600-700 Mg Mag a day.

Another way to gauge that may work better for someone is take your weight and multiply it by 2.5mg, 3mg or 3.5mg and that is about spot on for your weight and what it will support Magnesium wise. Take that amount with 5000 iu VitD3 and you will be ok. There is some fluctuation in how much to recommend because everyone's body types are different when it comes to amount of daily requirement of magnesium.

Sometimes the higher end Magnesium amounts will create more D for people who are in the beginning stages of healing, so external magnesium should be used in lieu of some of the internal magnesium.

I had night bathroom trips until I got quite a bit of healing under my belt....I will get one occasionally even now if I get into something food wise or a stressed situation (those take time to hit me, but when they do, I know why it happened).

My body still likes to play the hormone game so I will get a few bad days and nights every month....I just factor that into my livelihood at this point.
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Post by tasmtairy »

Erica P-G wrote:HI Terry,

I've been gauging my VitD3 on the basis of 5000iu for every 200-300 mg of Magnesium.....so one VitD 5000iu and then spread out 400-500 Mg Mag a day.....if taking 10,000 iu then spread out 600-700 Mg Mag a day.

Another way to gauge that may work better for someone is take your weight and multiply it by 2.5mg, 3mg or 3.5mg and that is about spot on for your weight and what it will support Magnesium wise. Take that amount with 5000 iu VitD3 and you will be ok. There is some fluctuation in how much to recommend because everyone's body types are different when it comes to amount of daily requirement of magnesium.

Sometimes the higher end Magnesium amounts will create more D for people who are in the beginning stages of healing, so external magnesium should be used in lieu of some of the internal magnesium.

I had night bathroom trips until I got quite a bit of healing under my belt....I will get one occasionally even now if I get into something food wise or a stressed situation (those take time to hit me, but when they do, I know why it happened).

My body still likes to play the hormone game so I will get a few bad days and nights every month....I just factor that into my livelihood at this point.
Thanks Erica!
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Post by brandy »

I have not used them but some members use Freeda vitamins.

I found when I had WD I could not tolerate any oral supplements. It was only by eliminating oral supplements for 3-4 weeks that I started improving.

I am in remission now but products with long ingredient lists cause me issues.
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Post by brandy »

I get D from ascorbic acid.
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