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 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.