The brain gut connection is incredible. For years I suffered with terrible IBS where I would almost always get nauseous after eating and would often need to immediately go to the bathroom. I also had a very difficult time gaining weight. I tried all kinds of drugs - prescriptions to treat nausea, malabsorption, even gastroparesis (slow emptying of the stomach). Nothing worked and a few of the prescriptions were nerve wracking. One was the original synthetic THC medicines that came out in the 80’s. Another one called reglan can give you something called Tardive dyskinesia which is horrible and incurable. All to just be able to eat normally and go to a movie afterwards.
I saw a doctor at one of the major medical centers and he knew my issue immediately. After ruling out a few things via tests, he started me on a small dose of very old tricyclic antidepressant called Nortriptyline. 25mg vs the therapeutic dose of ~150-200mg. It almost instantly stopped my issues. They cannot explain why it works, but he says it helps 2/3 of his fast gut patients without the mood effects or other bad side effects that have made them fall out of favor for newer drugs.
Just the idea that a simple pill can affect the gut by affecting the brain (or is it vice versa?) is really profound and tells us how much more we need to understand in the brain gut relationship.
Would you mind disclosing who the doctor was? I have been dealing with this for years and it's been wreaking havoc on my personal and professional lives. Doctors in my area are not familiar with my condition and don't have a solution. I'm especially tired of the malabsorption, dietary restrictions, sleeping issues, inability to gain weight, edema.. a whole laundry list. Would love to hear your doctor's opinion.
I am not surprised that the brain-gut circuit affects the sympathetic nervous system. I find that when my symptoms start getting very bad my heart rate variability drops basically to 0 (with loud, thunderous heartbeats). When things are good I don't notice my heartbeat whatsoever. Symptoms improve basically when I stop eating.. which is not a treatment plan.
I find it strange that my gastroenterologist does not even contemplate cases involving gut dysbiosis. I ask all of the relevant questions and the answer is "dysbiosis is not something we treat". And he's a gastroenterologist for christ's sake. He literally said to me "Get used to it. Some days you will have good days and some days you will have bad days". Modern medicine for you.
I had similar experiences, but with amitriptyline at the lowest dose of 10mg taken every night. At 25mg I was too drowsy. It drastically improved all of my chronic problems almost immediately - gut problems (IBS-D), inability to sleep more than a few hours, and issues with peripheral nerves.
Amitriptyline has a slight sedative effect compared to nortriptyline, which is good if you suffer problems with sleep, but has slightly more side effects.
I'm in the UK, and a GP at my previous clinic prescribed me this. Your doctor should be able to also, there shouldn't be a need to see a specialist.
Wow that's so interesting. What problems were you experiencing with peripheral nerves? I have also developed these problems recently. I had a colonoscopy where I had to chug a bunch of polyethylene glycol and after that I've had fluctuating levels of numbness (peripheral neuropahy? I am assuming) in both of my hands. I have no idea the pathology here.. electrolyte problems? Docs aren't even investigating.
My GPs seem to think I am insane and that this is all induced by "stress and anxiety" since my bloodwork is for the most part normal—although in the past months it's been teetering on the verge of becoming problematic in some areas. Because of this, they write most of my symptoms off.
Was there something that you said specifically that caused them to prescribe that or it was just after describing your symptoms? I feel like if I go in saying "well I read about this SSRI on the internet"... instead the psych ward is going to be their next prescription for me.
I had those same issues with first numbness, then progressing to sore joints, in the fingers and toes. Then it progressed to sore joints around the body.
It seems that the flare-ups heighten pain sensitivity in the peripheral nerves in addition to the gut problems. My whole body feels 'raw' when it happens.
I have no idea on what the pathology is, but I expect it has a genetic component. It seems that my gut has issues with the self-regulation of certain neurotransmitters.
Over the past decade or more, I've tried nearly all of the other treatments for IBS and none of them work. The peppermint oil capsules were the worse. It was a complete waste of time and you walk around with the smell of toothpaste, at least that's how it felt to me.
You can refer back to some credible information for patients like this here from the NHS -
Amitriptyline is clearly a treatment option for IBS there. Insist on it and your doctor should have no reason to deny it to you unless you have a contraindication.
If you're not in the UK, then there are other sources like this -
>In one trial, nearly 70 percent of patients receiving 10 mg of amitriptyline experienced a complete loss of IBS symptoms compared with 28 percent of those on placebo.
I guess I'm lucky and in that 70%. I hope you are as well. It's such a big effect on my health, I wish I knew how to deal with it sooner.
Wow. Thank you. This is enlightening in ways that you cannot even imagine. For example I thought maybe the gut problems had been causing other complications which resulted in the neuropathy. Now, I can maybe begin to look at the gut issues as the sole catalyst here.
Anyways thank you so much. I will run this buy them and see what they say. Now I have a new path to explore and some new found hope as my options were running out.
Forgot to add that head posture can also cause peripheral numbness. I find that using 2 pillows (to help with acid reflux) overextends my neck and sometimes results in numb fingers in the morning depending on sleeping position.
Hope everything goes well. IBS sucks but what sucks more is that a lot of doctors still treat it as an inconvenience as opposed to an actual illness that deserves proper attention.
Man, I've been taking Trazodone as per this comment for the last week (had some extra laying around), and my IBS-C is basically gone. I've tried everything and this is the first thing that has worked. Thank you so much for your comment; this is a truly life changing paradigm for me. I hope it continues, but I am feeling so much better than I have in a long time. I can't thank you enough.
Ami. also helps with migraines. Foods can also be migraine triggers and should be carefully observed when trying to tackle them. There’s a lot going on there between gut and brain.
I don't know how doctors would feel but maybe it's time to have a system to query more than one doctor for patient's ailments. Instead of waiting to run into the occasional pro that actually knows your issue and fix it with a switch.
No need for moonshot AI just an large aggregative system that let's curious doctor that are very capable in a subfield scan open issues for diagnosis.
The gut has its own nervous system: https://en.wikipedia.org/wiki/Enteric_nervous_system . Usually the effects of antidepressants on the gut are considered an unwanted side-effect, but in your case it was the intended effect.
Author is Michael D. Gershon M.D., chairman of the Department of Anatomy and Cell Biology at Columbia University's College of Physicians and Surgeons at the Columbia-Presbyterian Medical Center in New York City.
Where are you getting your information? Tricyclic antidepressants are generally SNRIs, which definitely do effect the brain. It is true that the gut also has serotonin receptors, so there can definitely be side effects there, but to say that it's the only place where TCAs have an effect contradicts decades of medical research.
> Tricyclics work directly on gut neurology. [The effect you are noticing] [has] nothing to do with the brain [as it is a direct result of the direct effect the tricyclic has on the gut].
I don't know much about brain-gut connection, but just a note: Tardive dyskinesia has some treatment options now (valbenazine is one of the options I'm familiar with). They're not a total "cure" but I've seen the benefits in a few patients when I was in school.
I was prescribed Amitriptyline for post concussion syndrome, and noticed that my IBS basically stopped. I forget the dosage and how long I took it—-perhaps six months to a year—-but after I discontinued it, my IBS didn’t return. Although maybe the concussion knocked things around in a way that fixed it. :)
Have you identified which fodmap group you're sensitive to?
My girlfiend is a professional dietician, is suffering from IBS and has found a pill containing an enzyme that she swallows before eating a certain fodmap group.
It helped her a lot.
Yes she reckons the enzyme works both for FOS and GOS. Things like onions and garlic were an absolute no-go before she found the enzyme. Now she can eat them
She has to take an enzyme pill before each meal that includes this group though.
It's fairly harmless so she doesn't mind, it's just a bit of additional cost on our food.
If you're motivated, you can follow a protocol ("food challenges") to know which group(s) you're sensitive to. The idea is that you have a zero fodmap diet for a few weeks and then slowly reintroduce small amounts from each group and see how you react. It is not an easy task to figure out meals this way and to keep motivation so I'd recommend being helped by a dietician.
To the best of my gf's knowledge, there is no such enzyme for fructose intolerance unfortunately.
Also, if you want to know more about each group and which food is the most problematic in each of them, Monash has a great app for that. You've probably come across it already, otherwise search "Monash fodmap" on your app store. It's great to know if you can have a little bit of something or nothing at all and to educate yourself
Yes I'm in the 'middle' so to speak of that Monash FODMAP diet challenge, and I'm finding some relief but I still need to do a lot of triage, and expand my food options because they're severely limited now.
I'll talk with my doctor to see if I should give that enzyme pill a try.
"One study of 28 subjects looked specifically at whether psyllium husk plays a role in patients with irritable bowel syndrome, discovering that psyllium husk eliminated symptoms"
I have the exact same problem and symptoms and my cheap solution to completely and radically change diets fixed my IBS and lifelong mood disturbances in a week. It's so good that this weekend I had a "bad food" binge and I've spent 5 hours on the toilet and the whole weekend in a sorry state of mind.
I can't wait for the day until GPs will try and diagnose digestive and psychological issues with dietary changes that are not just "eat whole grains, plenty greens and less meat" which completely miss the mark.
I've been having symptoms for years that have confounded all doctors I have been to.
About 30 - 60 mins after eating (anything), in addition to bloating and discomfort, I feel the most extremely incapacitating lows. We are talking what I can only assume a depressive episode feels like.
Its like a wave comes over me, I have no joy in my head, no passion, no desire for communication, I simply have to wait for it to pass, and eventually it does, and I feel normal again in a few hours. There is nothing I can do to make it pass earlier. Its as if the food's passage is causing it.
I don't have a eating disorder, ie I like food and comfortable with my body, but really struggle with this. If anyone has had any thing similar I would be very interested in communicating more.
My dad's dad had a sweet tooth, my dad has one, and I do too.
About a month ago I resolved to eating at least 100g of protein per day (1.2g/kg) to see if that wouldn't help me with some recovery and healing. It was a real chore to eat that much. I would eat three eggs and black beans for breakfast to get ~30g, then shoot for 30-40g for lunch and another 30-40g for dinner. I was eating a lot of cottage cheese to make up the extra protein I wasn't getting.
I was constantly so full I lost all desire for sweets. Not eating dessert is effortless, probably in part because I'm beyond satiated.
I tried eating just steaks for a few days, and it absolutely blew my mind (1) how stable my energy was, how energetic I felt (2) how I wouldn't get hungry at all for 8-10 hours. Normally I start thinking about food an hour or two after eating!
The key to a good diet is balance. Too much red meat has equally severe health implications, leading to a higher risk for heart disease, cancer, diabetes, and premature death.[1][2]
Mankind evolved to eat red meat. We developed fire for it. We invented spears and bow hunting for it. It's one of the healthiest foods you can consume, has been part of the human diet for over 2 million years... and besides the noted protein, it contains B12, Zinc, Selenium, Iron, Niacin, B6, Phosphorous and many other valuable nutrients. You can live exclusively off a diet of just red meat and live a long, healthy life. Many tribes do, including the Maasai in Kenya, the Sami in Finland, and the Inuit.
Well if you want to take a retrospective, we also did not consume it every day. We grazed on other things, including veg, fruit and grains, not unlike traditional societies today.
The Inuit don't eat the way they used to, but it was a good deal of fish along with game and berries (ditto for Sami). Their CVD profile has never been reported to be particularly good. Maasai consume mostly milk, and are in a perpetual state of caloric deficit.
We are omnivores. Junk food hacks an instinct to eat dense vegetarian calorie sources. But we will eat anything we can get our hands on, and that seems to start even earlier in the family tree than the hominids.
Meat is a target of opportunity, one that helped us build much larger brains. But it’s not the only thing we’re tuned to eat.
> Mankind evolved to eat red meat. We developed fire for it.
I read somewhere that in some sense minkind devolved to eat red meat. Some gene was damaged, which helped humans to do a marathon activity to track red meat running away (IIRC something to do with an ability of blood to carry oxygen), but humans lost a key enzyme to process fatty acids from red meat. So mankind got more proteins but started to die from heart desease. Probably it was no so bad then because an average lifespan was too short to develop severe symptoms.
Mankind rarely lived beyond 25 until very recently so the long-term effects of high red meat consumption have never been part of the evolutionary equation. There have been numerous long term studies that have found strong links between diseases, esp. heart disease, diabetes, cancer. These diseases take years to manifest normally thus wouldn't have existed then.
Life expectancy being 25 doesn't mean nobody lives past 25. Estimates that low for early humans is skewed by huge infant mortality rates. IIRC living into the 40s or 50s was typical for an early human that survived to adulthood. 60s or 70s not uncommon.
We can't actually tell the age of death of human fossils past the time that wisdom teeth grow in. There's no way of telling whether a fossilized skeleton was 30 at death or 50 at death. Even then, we don't necessarily have a representative sample.
The Sami, as I mentioned, have been studied. They are a tribe of reindeer herders in northern Scandinavia. They eat a diet consisting of almost exclusively reindeer meat. They have lower cancer incidence than Finns (https://onlinelibrary.wiley.com/doi/full/10.1002/ijc.10486).
> They eat a diet consisting of almost exclusively reindeer meat.
Very far from a typical meat diet (quoting from your link):
"The dietary habits of the Sami differ from those of the other Finns. Reindeer meat (low in fat) and fish have been important foodstuffs in the diet of Sami people. Intake of vegetables and fresh fruits has been low, but berries were eaten, especially by the North Sami. Although nowadays dietary habits have become more similar to that of the rest of the population, still more than 90% of male Sami reindeer herders eat reindeer meat at least 3 times a week and almost 50% eat fish at least twice a week. Reindeer meat and fish contain high concentrations of healthy lipids, trace elements (e.g., selenium), minerals and vitamins. Arctic people usually rely on blood, liver or kidneys from animals to obtain adequate nutrition."
All of these types of studies are being debunked: it's not the red meat that's the problem - it's 1) the quality of meat you're eating, and more so 2) the other crap people are eating. The first Carnivore Conference happened last year, and the movement is growing.
Edit to add: Look up Dr. Georgia Ede videos on YouTube for some of this debunking.
Being in a ketogenic state allows your body to have constant access to your fat reserves, so that's where you can get the constant, stable energy from - and any excess calories, say from meat or the other keto foods you're eating will of course store as fat for later use. There's an One Meal A Day (OMAD) movement that's starting, where people are doing intermittent fasting but instead of a 6:18 ratio - 6 hours where people eat, 18 hours not eating - they'll do a 1:23, where they eat all they need in an hour or so.
I don't eat proteins but I do fill my stomach with raw veggies. The desire for sweets is really boredom turned into nutrition. When you're full you barely want anything anymore. Also the less sweet (and processed food which are allegedly heavy on fat and various sugar) you start to feel subtle taste better. Carrots are sweet.. I feel like eating candy, but it's not strong. Even lettuce has some delicacy to it.
There's an irony to our nutrition, we pay for industrial _ _ _ _ that is bad for us then pay for solutions. Just eat basic stuff and go do something fun.
These are interesting comments. My normal diet of mostly starchy carbs leaves me without any cravings for sugary things even if they're just lying around near me. The moment I start eating sugary things I get hungry so fast, not just for sugary things but anything and it's hard to concentrate.
I also have a weird condition where I'll forget to eat to the point of low blood sugar, sometimes drastically so--speech or vision impairment. I've learned to recognize physical changes associated with very low blood sugar (e.g. nausea, feeling hot/cold/sweaty at normal room temp, extreme indecision) to remember to eat. Haven't found a way to stay in a normal middle ground.
You might try the keto diet for a while and see how you like it. There are two ways in which it might help you.
1. Very low carb means your blood sugar never rises sharply, and then your body doesn't over-correct which can lead to that hypoglycemic feeling.
2. Adapting to utilize primarily fat means that blood sugar largely doesn't enter into the equation and urgent eating to raise blood sugar can go away. It usually takes people days to weeks to get adapted and feel back to normal.
It's a pity there aren't many foods with a sugar level that tastes well to people who aren't acclimated to eating sugary things. The food industry has decided it's either no sugar or lots of sugar, so it seems.
Try Korean/Asian markets. I worked with a few Koreans and they thought treats sold in the USA were way too sweet. They had sweet bean curd things that tasted great when I was doing Keto and while it wouldn’t be good to eat every day they were a nice snack sometimes.
It's surprising to look at the nutrition labels for anko/sweet red bean paste. It seems like it'd be a healthy alternative, but it's basically concentrated sugar cake.
I live in Japan. I've eaten plenty of it. It's the health equivalent of cake frosting in Asia.
Make it yourself. Make all of your food yourself. My regular gym routine, which was part of my life for years until a few months ago when I was forced to stop, involved lifting heavy weights followed shortly afterwards by a bowl of porridge. It's a big bowl of porridge and I would put about 2 tsp of sugar in it to sweeten it. I considered this sweet because it was, in fact, the only sugar I was consuming. Now since lockdown I've had to stop my porridge because my muscle was becoming replaced with fat. I've had to lose weight to stay lean. But I've replaced that small amount of sugar I had regularly with other sweet things and noticed that I'm consuming far more sugar now. I've decided to stop completely now. If you consume ready-made things with sugar, it very quickly becomes an addiction.
I saw a doctor at one of the major medical centers and he knew my issue immediately. After ruling out a few things via tests, he started me on a small dose of very old tricyclic antidepressant called Nortriptyline. 25mg vs the therapeutic dose of ~150-200mg. It almost instantly stopped my issues. They cannot explain why it works, but he says it helps 2/3 of his fast gut patients without the mood effects or other bad side effects that have made them fall out of favor for newer drugs.
Just the idea that a simple pill can affect the gut by affecting the brain (or is it vice versa?) is really profound and tells us how much more we need to understand in the brain gut relationship.