a “normal” colon: IBS, Hepatic Flexure Syndrome, Slow Transit

This is a normal colon:
CT colon hepatic flexure syndrome

No polyps, no thickness in the walls, reasonable unfolding of all the folds, no restrictions or obstructions, no cancers. Altough its path doesn’t look exactly like the text book examples this is a normal colon.

The doctor will say: “This is normal, there’s nothing wrong with you.”

What he actually means is: “This is within parameters, there’s nothing Very Wrong with you. However we must remind ourselves that this picture does not show its functionality in your normal life, when your colon is filled with food instead of air. But hey, no obvious problems!”

I’m glad that Very Wrong Things are ruled out.

I now look more closely at the picture and I think I can see why the owner of this colon wakes up in a sweat every night. At first I thought the problem was solely at the hepatic flexure. Indeed there is a steep bend, where the colon nearly folds into itself, that’s difficult to manouvre for colon content when the person is lying down.

But now that I’ve experimented for a few weeks I can with 80% certainty say that the problem lies at the beginning of the colon, right where it sprouts from the small intestines.

It’s a bit difficult to see but on the smaller scan on the right you see the person lying on her left side and when zooming in you can see how many bends there are in colon section right after the appendix:

CT-foto-colon-inverse

I inversed the image for more clarity.

From centre bottom going up diagonally to the right is the ascending colon: the folds stack up onto each other. Imagine food stuff traversing these bends. It will need the torso to be upright and move in various directions to create room to navigate this freely.

Theory:

this part somehow collapses when lying down. In the first stage of the night food gets processed by the small intestines (average time 4,5 hours) and gets pushed into this part of the colon. Where it gets stuck. The colon swells.

The large motility movement (BMM) comes by every 1,5 hours or so and cannot shift this food. 4,5 hours after the person lied down this accumulates into a stress reaction, waking her up in a sweat. Lower left abdomen tender and swollen.

Experiment:

avoid food to be there in the night. The person has been eating at different times the past few weeks and has been eating different foods too. Avoiding bulk, fibre and gaseous foods (because this is also the part of the colon where bacteria produce gas and gasbubbles easily block a colonic bend or fold). So that’s a low-residue diet plus FODMAP.

The timing has been important too: eat main meals before 2 in the afternoon. Or: “have dinner at noon.”

Drink a lot after 2 o’clock until bed time. Tea, broth. There has been snacking on low fibre things such as chocolates. A walk every evening is important because being upright and moving about ensures the foods in the ascending colon to move upwards.

Results:

have been satisfactory. Sleep has been longer than the typical 4,5 hours on more nights than ever before! Wake up is now typically after 6 hours (4,5 hours + one more BMM cycle) and most days in a sweat with a filled ascending colon but not too dramatic. It has been bliss! So much more gets done in a day on a 6 hour sleep than a 4,5 hours sleep. The person has Adrenal Insufficiency and can even lower her Hydrocortisone on those days.

Future:

get as many 6 hour nights as possible. Hoping to work towards 7,5 hour night but as of yet no idea how to accomplish that. More movement during the day is one route. Tips welcome.

Some Details:

On days that have dinner-at-noon there is tiredness after dinner. It’s the typical tiredness associated with digestion. After one hour there needs to be lie down for one hour for food to be processed by the duodenum. Resting is important to deal with CFS/ME anyway. Needs rest twice a day.

Protein is needed by 11 o’clock in the morning, especially Choline, which fuels the Parasympathetic Nervous System. Otherwise the person will feel weepy and wired at noon. I’ve got Choline pills and body builders protein powders as a back up.

When B12 vitamin is taken (in mB12 form)  Fosfatidylserine is needed a couple of hours later or pee will smell of ammonia, indicating proteins not being absorbed and used for repairs.

Testosteron is taken twice a week, together with some body builders proteins (l-glucosamine and casein), especially on the morning of a work out (fit20). Feeling very good about it. Strong. Together. Without any of these her muscles will not build. With them the muscles are actively in use when standing or sitting, she’s not merely “hanging off my skeleton” or using fat rolls to lean on. It’s quite a novel feeling and it feels appropriate.

The fibre equivalent of one small clementine is already too much fibre in a day and will cause insomnia. Nuts are being consumed though and but they have to be chew chew chewed.

The colon expert at the hospital said fibre is only needed for colon functionality. If the colon functions (i.e. you have satisfactory bowel movements) than fibre is not needed. Because the problem here is in the ascending colon food has not been dried out yet and hard pellet stools are not an issue. The low fibre diet does not cause very loose stools either. There’s a bowel movement once or twice a day.

I’m amazed at how sensitive the variables are. One clementine, come on!

There is one other thing as important for the sleep as food intake: dust. The bed needs to be changed at least once every fortnight and needs to be vacuumed every third night and sleeping clothes (including hats and scarves) need to be shaken vigorously out of the window every other day.

The last one stumps me. It needs to be both: food and dust. One of the two does not prevent the waking up.

One more detail: the CT colon shows a little bit of food matter left in the steep bend at the Hepatic Flexure. Indicating, because the patient had a very good colon cleaning before the pictures were taking, that this is indeed a second trouble spot in the colon. Food does get stuck here, especially when there’s air trapped. Avoidance of gaseous foods helps with this particular colonic problem. I’ve researched FODMAP and have understood the reasoning behind it (“what do bacteria eat?”). This allowed me to assess potential food items instead of trying to follow the list of this or that person/website.

  • As a rule: stay away from dietitians, they mean well but they do not know enough
  • as a rule: run from from amateurs/celebrities/people who’ve done a course/wrote a book about their experience. They’re in it for the money and their kick for saving humanity.
  • view your doctor’s opinions with some reservations. He’s knowledgable but he’s wearing horse blinders and has blind spots and assumptions (about you, your gender, your age and what “normal” bodily function is).
  • educate yourself. Sherlock the heck out of your thing.

Sherlock Holmes pic by Kevin on Flickr

Fixed the slow colon/ constipation.

So I fixed my slow transit colon and I now regularly use the toilet and deposit healthy, softish, stools in the round porcelain vault.

My clue was this: a scientific case where Crohn’s disease was healed by restoring the balance between gut neurotransmitters Dopamine and Serotonine.

In Crohn, it was assumed and proven in this case, there’s too much serotonin and not enough dopamine. Serotonine speeds up gut motility. By comparison I assume dopamine slows it down and this echoos my experience as a high dopamine person.

This is the scientific study: Amino acid-responsive Crohn’s disease: a case study. A patient of 22 years was healed just by taking in precursors to both dopamine and serotonin in a good ratio.

I mentioned this to my GP and he said that a regular side effect of Anti-depressants is loose stools. AD enhance the levels of serotonine. Serotonine is produced and used in the gut, for about 90-99,9 % of the bodily production.

So I set out to up my levels of gut-serotonin. For this I now take 5-HTP, a plant and precursor of serotonin. Currently I’m taking about 100 mg twice a day. I also stopped eating any and all fibres since I think my case of constipation is definitely not helped by adding fibre to hold the water. I’m better helped with relieving the digestive system of as many burdens as possible. No fibres, no vegetables, no raw foods, no nuts, no tomato skins et cetera.

I also apply the tummy massages I outlined in my previous post, both for the colon and for the Hepatic Flexure. And do the kettlebelling now and again.

I squeeze out lemons and drink the juice. (Acid stomach = better bile? Lemon juice relaxes the gut muscles? The increased salivation is important?  I know there’s a link between adequate saliva production and adequate adrenal function/stress resilience… I don’t know, it just feels good. I can’t say yet what is important in the palette of solutions I’m trying right now. Fresh lemons do seem important. Store bought lemon juice didn’t do the same for me.) I also take 1000 mg vit C. Sometimes twice.

Lastly I only eat proteins twice a day. I don’t eat any more after half past three in the afternoon. I believe the gut -or my gut at least- fares better with rests and pauzes. Not the constant bombardment of food morsels that the five-meals-a-day-brigade advises.

Those five meals a day are meant to keep your blood sugar level. I know other ways of doing that (see dr. Bernstein: eat nothing that triggers insuline nor any volume bigger than your stomach/fist. Or do a ketonic diet (but at the moment I’m enjoying my slices of white bread with lots of butter and just a hint of ginger jam too much)).

My gut has relaxed.

Suddenly my guts all fit into my pelvic bones. Everything is neatly folded up there. No bloating. I stand taller. Find it easier to sit up straight.

I have more energy.

I’m not sleeping through the night yet. But bodily stress has lessened. I have been sleeping 5 or 6 hours instead of 4,5. When I wake my guts want to move. I think they do not move while I’m asleep, it seems like they are waiting for me to wake. Or they are waking me. I need to do the laying on my right side to assist the Hepatic Flexure. It works. I can hear stuff moving and gurgling. I pass a bit of gas.

I have more energy.

However. The upped serotonine makes MAO A and MAO B work harder. This siphons away Dopamine. I have noticed that my ability to concentrate diminishes on days of high 5-HTP supplementation.

So I’ve taken a new supplement to up my dopamine while I do this experiment with serotonin. This supplement is called Methylphenidate, better knows as Ritalin. Ritalin causes the brain to produce more dopamine. I take 2,5 mg twice per day. Dosage for ADHD is usually 40 mg per day.

I had a big booboo with the doctor about wanting to try ritalin in this context. It’s a new GP, my trusted GP has stopped his practice to focus on orthomolecular science, specializing in the Methylation Cycle (!!!).

The new one didn’t understand one jota of what I was saying. Didn’t try either. All he saw was “a depressed housewife, looking for some happy pills”.  He thought I was on way too many supplements (didn’t bother to notice how low and tailored my dosages are). He suggested I exercise to battle depression. I’m not depressed. I already exercise. Fuck off.

I tried to steer the conversation into engineering territory, explaining how I approached this black box of a disease. How I had figured things out. How I had devised trials, to get more data. I mentioned Methylation Cycle and how messed up mine is due to faulty vitD and vit B12 receptors (I oversimplified things to get a common point of reference).

I asked him if he was familiar with the Methylation Cycle in the mitochondria, as part of the Citric Acid Cycle

All he heard was “Methylalalallablabla” and he proceeded on a rant about how way too many people take Methylphenidate and no one in Spain is taking it and here in the Netherlands everybody and their mum is shovelling pills, all because we want to keep up with Instagram and Facebook and things.

Yeah. It does have the same word in it, “methyl”. But I don’t think it means what you think it means.

So we parted. He did give me a prescription for Ritalin. He was reinforced in his idea that women my age are just sorry people looking for a quick fix. He never got to see beyond his blinders and see that in fact there was a smart engineer sitting opposite him, one with an interesting experience and an open approach to both life and health. Someone who he could have an interesting conversation with about healing and medicine.

Perhaps I’m a depressed housewife too, just like he assumes, I can’t say because I’m living my life from the inside out and have blinders of my own, but I know for a fact I’m also that smart engineer and he never knew.

The ritalin works. But it’s a crude dosage. I easily get hyper. It’s a nice feeling, for sure. I feel alive and productive and I want to dance and run. I do dance and run and try to change gears afterwards and rest (do that stomach massage while I’m resting).

I even started fitness. Powerlifting! Starting very slowly. I’ve been doing Fit20 since March and my core muscles have been build up precisely and with attention. Now I’ve joined a generic gym and do some cardio as warm up and cool down. In between I work on 7 or 8 machines, working on muscles and strength. It’s lovely! Endorphines ahoy! Lyn White from Reverse Therapy would cheer, I’m sure.

In a few weeks I’ll go work with the loose weights, barbells and such. Squat, Push up, Pull up, that sort of thing. It’s something I’ve always planned: weight lifting once I hit 40.

I couldn’t when I hit 40, I was too ill and weak. Now I’m 45 and I’ve started. Thanks to adequate cortisol replacement and now relaxed gut yielding more energy.

Still, I’ll be fine tuning the ritalin-dosage. 2,5 mg is too much in one go, I get too hyper. It’s the same kind of hyper I feel when I eat something fried in vegetable oil. It’s some sort of feverish greed. It feels as hippetyhop as having a little caffeine but with caffein I just get very chatty and fast-brained. With ritalin/vegetable oil I also get a feverish glance in my eye (and brain).

Estrogen-hype is different yet again. There it’s more Popeye-bam!bam! Rosie the Riveter. And lots of energy. I suppose its testosteron related. Of which I scored very low at the last blood tests by the way. I now have a DHEA supplement which converts into estrogen and testosteron, courtesy of your own body to chose how much of which. I do need more testosteron because I need to build up muscle. It’s a weird sensation to work my muscles in the gym but not have the building blocks to actually build them. Strange indeed.

For all HRT it’s: go low, go slow. So I’m just taking a little dab of DHEA every few days. In a few weeks there’s a whole battery of blood tests again. Before that I am to meet my new GP, a woman. I’ve prepared an introduction to my case. I won’t be hood winked by a biased GP again. I hope.

In the mean time: colon is happy! I am happy.

There’s more amplitude between activity and rest. The ritalin is a bit too high at the moment, I’m adjusting dosage. But it’s not so high that I get dopamine-excess symptoms such as head ache from tyramine rich foods (such as cheese). Although they do tend to come on sooner though but that can also be because I’ve been off tyramine for months if not years now. The system may have grown very sensitive (aka it’s not something I’m very worried about). The other day I had just a few organic corn chips for their salt content (It’s a heat wave over here! I’m very vulnerable to heat wave I found out.) The corn chips were made with olive oil (which are not the vegetable fried oils I meant earlier, those are from commercial shops and fast foods) and I got a splitting head ache afterwards. Olive oil contains tyramine. Same with Mascarpone cheese.

If I get the highs and the rests a bit more under control I’m hoping the sleep will follow too. I now -again- have come back to the notion that sleep is made during the day, just like I learned in the sleep study and the psychologist that helped me as part of that. Relaxing, mindfulness, during the day pays off at night.

I experiment with foods but most make me tired. I long very much for salad and sprouts and I eat them in small quantity. But mostly I eat a slice of white bread with lots of full fat butter (Demeter quality) and a hint of jam. Or a thick slice of white bread (artisanal bread, without sugar. Just flour, water, salt and yeast.) with four or five egg yokes on it, warmed in coconut fat. (I won’t say fried because I like to keep the yoke runny.)

I have a piece of chocolate, 75% or more cacao. But only one or two small bits in a day because I’ve noticed it kicks my adrenals and I will lie awake when chocolate was consumed.

For dinner (at 3.30 AM) I have drumsticks or a piece of steak or 150 grams of minced meat with tomato juice and spices. Or fish with creme fraiche.

I also eat pancakes, with jam or slices of apple. But only one or two a day. Instead of slice of bread or dinner. As a pick-me-up I drink decaffeinated Earl Grey tea with unwhipped cream or full fat milk.

Overall I just don’t eat that much, in volume. I do eat enough in calories, what with the butter and all. I have gained some layers of fat in the past few months. These will disappear now that I’m more active. I’m not worried.

I have found that ritalin/dopamins will keep you going and will take away the desire to eat. This can be a seductive tool in the hands of someone who’s not level headed. I know I have an addictive DNA-characteristic and I feel the appeal. Reverse Therapy keeps me grounded in what’s important. As do the physical activity. I need to go out every day, every morning, to move and to clear away the toxins and cobwebs that have accumulated in my body and mood. My body is helped by mB12 and Phosphatidylserine. I need to pay attention to clearing the junk away properly, now that I’ve kickstarted the methylation process and am egging it on with the ritalin.

So these are interesting times for me. I’m deadly afraid I’m wrecking something and for this I’m monitoring my body all the time which is not good, in terms of relax and trust (Reverse Therapy primary points). I take comfort from the knowledge of and my experience with “Go Low and Go Slow” which has always worked for me up until now. I find that I seldom burden my body beyond what it can clear away in a day. Now that the gut/colon is falling into this rhythm too I get more and more confident. Confident that I am a friend to my body.

I wish my former new GP read this. We could’ve become a team.