“All disease begins in the gut.” – Hippocrates

Friday, July 23, 2010

More from AP and JP: Fatigue, Dehydration, and more.

   Before I start this post, it's important to note that I handle 90% of my symptoms with the Specific Carbohydrate Diet. It took us (both my wife AND me) a long time to accept the lifestyle changes that I needed to make. When you're first diagnosed, or during your first real flare, you're getting a lot thrown at you. I felt like someone was taking away from me everything I enjoyed. I thought, literally, that the rest of my life would be hell.

   Then just as I was getting a handle on things, I started the SCD and it happened again: I felt like the small things I enjoyed, the simple things, dinner with friends, pumpkin pie, good beer, homemade bread were being stolen from me--after more than three decades of enjoying them, it was hard to hear someone suggest that many of those things I enjoyed (like good beer) were the very things that were keeping me sick.

   For a long time, neither of us wanted to hear it. So, when I write, just know it's taken me almost two years to come to terms with my new lifestyle. Every improvement that the SCD, however, has given me has made the transition easier--a light at the end of the tunnel.

   Here's the second in a series of posts from my conversations with AP, about her husband, JP who has recently been diagnosed with Crohn's, but who has been sick for some time. See my first post from AP here.

I've re-arranged the conversation some to make it flow by topic...

My husband and I were just discussing his diet last night. His diet has always been junk. He drinks soda all day long, caffeine, fast food, processed food and junk food. That is it. Aside from the occasional salad he has along with a steak and baked potato meal, he rarely eats any vegetables and he never eats fruit.

   In the beginning of the SCD, my wife and I talked about my diet so much it made us sick. We even had to plan NOT to talk about the diet--especially when we went to see friends. Constant communication with your family, significant other, or housemates (whomever you eat with most often) about the food you're eating and the symptoms you're having (don't be afraid to share with those close to you) is essential.

   JP's diet is horrible, but not all that atypical in the U.S. (though I like to think that's changing...slowly). The chronic inflammation associated with IBD decreases the absorption of essential vitamins and minerals. Decreased transit time in the gut during flare-up further complicates the problem and leaves us in calorie debt too. Even if JP were not sick, his health would suffer from his diet.

In his defense he has always had an aversion to eating. It makes him really tired, and not much ever "sounds good" to him. So he eats whatever seems the most appealing out of the bad. Which is unfortunately never something healthy.

This is not uncommon for people with IBD. We know that eating (especially during a flare-up) increases our symptoms, so we often don't, or don't want to eat--especially when in public or traveling. I also wonder if chronic, widespread inflammation in Crohn's, specifically, could lead to lack of appetite. Certainly chronic illness wears on us mentally which can affect mood, energy levels, and appetite.

He doesn't drink water either. I was secretly hopeful when he got so sick that maybe he would be forced to change some of his habits...

Even if food makes you sick, it is essential to get enough water. This is even more important during flare-ups. A normal person should have about 2L of water per day. A person with diarrhea could need twice that just to break even. Whatever you need to do to get more water, do it. If you don't like water (like JP), then spruce it up! You could do 1 part apple juice (or any juice for that matter) to 9 parts water, or dilute sports drink (not SCD friendly!) with 5 parts water (5:1). I use sparkling water and SCD friendly apple juice, or a dilution of coconut water and tap water (see below).

Unfortunately the doctor seems to basically back him up that he should do nothing to change his diet and rely completely on the medication. The doctor has put him on Asacol and he is beginning to respond. He's having fewer bowel problems but is just as fatigued as always, and I don't think the joint pain has gone yet...

It's interesting to me that conventional GI's advocate that diet has nothing to do with the signs or symptoms of IBD, a gastrointestinal disease. I don't think this is the norm. Most GI's know, for example, that spicy food irritates and exacerbates the symptoms of people with active (read: flaring) IBD. If certain foods can exacerbate symptoms, wouldn't it make sense that certain other foods (or the proper mix thereof) could help to relieve symptoms? Hmmm...

AP later mentioned that JP experiences extreme fatigue. This is common in IBD also. I remember days when I couldn't climb a flight of stairs (I'm a competitive athlete, remember). While there are myriad causes to fatigue in IBD, the most likely (and the ones we have the most control over) are:

         a. Dehydration. Solution, drink water--LOTS of water. You may not want to because either you don't like water (some folks don't) or because water (secretly) makes your symptoms feel worse. You HAVE to drink water. You can use juice to liven it up if you want, but dilute the juice with lots of water. I use an approximate 10:1 dilution with juice, or a 4:1 dilution with coconut water. Coconut water contains four of the 5 major electrolytes and has more potassium per serving than a banana. It is bar none the best natural electrolyte drink out there--and it's far better than conventional sports drinks which are loaded with cheap sugar (which we don't need). One caution: Coconut water in large quantities can act as a laxative in people with IBD, so use it in moderation.

         b. Vitamin and Electrolyte Deficiency. There is a small host of vitamins that either don't get absorbed (like B vitamins in Crohn's), or don't get internally produced (like Vitamin K, in Colitis) when there is so much inflammation. This will be exaggerated with  poor diet. Solution: Take a good multi-vitamin plus Calcium (in the form of Calcium Citrate, it's more absorbable). Freeda makes a good SCD-friendly Multi and B-complex. I take both.

         c. Calorie Debt. When we're sick with that much D, transit time of food is just too fast to be fully absorbed--even in a healthy person. This is a large reason people with flare-ups lose weight so fast.

         d. Anemia. Serious IBD sufferers experience bleeding. This constant leakage can make you anemic. Anemia is a real concern and can cause varying levels of fatigue depending on the severity. See my post on anemia.

Onward to Health

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