Looking for advice...Gas and Constipation issues

[Mickens]

Hello all, I'm a lurker that's been reading the boards for a while and post occassionally.

I'm almost 11 months post op, HW:478 SW:433 CW:230ish.  So i'm very pleased with the weight loss.

I apologize if this is long and drawn out but gas/flatulence/bloating overall intestinal discomfort has been pretty constant since immediately after the surgery.  I like most people got bad nutritional advice from my surgeons office.  I found boards like these and talked to other ds'ers for advice and guidance.  I've been very diligent about my eating habits. High Protein/High Fat/Low Carb(to the point of almost No Carb),.  About 4 months ago I noticed no matter what I ate, I would become gassy(loud,long,very odorous flatulence)  I met with my gastro and pcp, they told me to do an elimination diet, which i had already been doing but decided to start from scratch, food diary, hardcore elimination diet, cutting out carbs completely, eliminating dairy etc... It helped a little bit but the gas was still there.  So they put me on Xifaxan which did nothing.  Then they put me on Flagyl which definitely helped with the odor of the flatulence, the gas never eased up.  

Ive tried so many things over this past year, every brand of simethicone you can think of, Charcoal caps, acid reducer,Lactaid, I exercise 3 to 4 times a weeks, I only drink water, I only eat my protein via food(Meat and Nuts) it's hard to me to eliminate anything if I'm gassy at all times. I know you all don't know me but I'm not lying when I say I'm not eating carbs.  I'm just too afraid to.  I will add I get at LEAST 125g of protein a day.  I follow Vitalady's regimen to the "T" 

I have a very open minded gastro doctor and we are working together to try and figure this out.  I'm asking anyone of you out there what the next steps I should take are?  I understand everyone has gas and I knew farts/stinky gas were a possible complication of this surgery, but to me this is getting out of hand and affecting my way of life, as well as my job.  If it was a fart here and there i could live with it, but as I said before it's constant.  I would say I average about 3-5 farts an hour.

On top of that, I'm also dealing with constipation,(roids and fissures as a result) I've read previous threads about the subject so I'm implementing alot your advice.  Even with all the fat I eat(Mainly Butter and nuts) I still brick up.  I'm currently taking miralax twice a day and 4 stools softeners a day. I take mag ox with my calcium  Is that normal? Should it really be that difficult to get my poop that soft? Sure I can give myself an enema and "lube the shoot" and whatever other techniques are out there but I don't want that to have to be a daily occurrence, it's fine if it works for others but I don't wanna live like that.  

In the end I'm not at the regret stage,  I know the ds has saved my life and I'm grateful for it. I've lost almost 250lbs in less than a year and a half!!!
I'm just at a point of frustration and annoyance and I'm looking for any advice as to what my next steps should be because although I like my doctors i know their knowledge of the ds is very limited but are very willing to learn, I look to the vets for some guidance.  


Thank you for reading and have a great Holiday

Matt
   

[newyorkbitch]

Dec 24, 2014 6:06:08 GMT -5 Mickens said:

Hello all, I'm a lurker that's been reading the boards for a while and post occassionally.

I'm almost 11 months post op, HW:478 SW:433 CW:230ish.  So i'm very pleased with the weight loss.

I apologize if this is long and drawn out but gas/flatulence/bloating overall intestinal discomfort has been pretty constant since immediately after the surgery.  I like most people got bad nutritional advice from my surgeons office.  I found boards like these and talked to other ds'ers for advice and guidance.  I've been very diligent about my eating habits. High Protein/High Fat/Low Carb(to the point of almost No Carb),.  About 4 months ago I noticed no matter what I ate, I would become gassy(loud,long,very odorous flatulence)  I met with my gastro and pcp, they told me to do an elimination diet, which i had already been doing but decided to start from scratch, food diary, hardcore elimination diet, cutting out carbs completely, eliminating dairy etc... It helped a little bit but the gas was still there.  So they put me on Xifaxan which did nothing.  Then they put me on Flagyl which definitely helped with the odor of the flatulence, the gas never eased up.  

Ive tried so many things over this past year, every brand of simethicone you can think of, Charcoal caps, acid reducer,Lactaid, I exercise 3 to 4 times a weeks, I only drink water, I only eat my protein via food(Meat and Nuts) it's hard to me to eliminate anything if I'm gassy at all times. I know you all don't know me but I'm not lying when I say I'm not eating carbs.  I'm just too afraid to.  I will add I get at LEAST 125g of protein a day.  I follow Vitalady's regimen to the "T" 

I have a very open minded gastro doctor and we are working together to try and figure this out.  I'm asking anyone of you out there what the next steps I should take are?  I understand everyone has gas and I knew farts/stinky gas were a possible complication of this surgery, but to me this is getting out of hand and affecting my way of life, as well as my job.  If it was a fart here and there i could live with it, but as I said before it's constant.  I would say I average about 3-5 farts an hour.

On top of that, I'm also dealing with constipation,(roids and fissures as a result) I've read previous threads about the subject so I'm implementing alot your advice.  Even with all the fat I eat(Mainly Butter and nuts) I still brick up.  I'm currently taking miralax twice a day and 4 stools softeners a day. I take mag ox with my calcium  Is that normal? Should it really be that difficult to get my poop that soft? Sure I can give myself an enema and "lube the shoot" and whatever other techniques are out there but I don't want that to have to be a daily occurrence, it's fine if it works for others but I don't wanna live like that.  

In the end I'm not at the regret stage,  I know the ds has saved my life and I'm grateful for it. I've lost almost 250lbs in less than a year and a half!!!
I'm just at a point of frustration and annoyance and I'm looking for any advice as to what my next steps should be because although I like my doctors i know their knowledge of the ds is very limited but are very willing to learn, I look to the vets for some guidance.  


Thank you for reading and have a great Holiday

Matt


   

You need to get up to at least 150g protein every day, at least.

You need to add some fruits and veggies and complex carbs. Long term ketosis is very dangerous. And no wonder you're constipated.

You need to be drinking 64 oz of water every day.

What artificial sweeteners are you eating -in food, as add-ins, etc?

Please keep a very detailed food log for one week and post it here.

[aa]

Are you taking any probiotics?

[Mickens]

Yes I'm currently taking probiotics, I've tried various ones over the last year but as of right now i'm currently taking VSL#3 twice a day as well as floraster.

I do drink water like a madman and get at least 150 ounces a day
No artificial sweets at all
I've tried to introduce complex carbs in the past but to unpleasant results(even more excessive gas) but I will give it another try
I have no problems getting the 150g of protein a day 125 is just the least i'll allow for a day if i'm having a small stomach day

I will keep a write down a weeks worth of food and post it, thanks for the feedback

[newyorkbitch]

How about fruits and vegetables?

Did you try beano? That's helpful for some people.

You really need to get 150g minimum protein every day, no matter what.

What I'm about to say is not going to make you happy, but here goes. Many DSers live with a lot of gas, myself included. And no matter what I eat, or when, I still have a lot of gas. Sure, it gets worse if I eat loads of dairy and carbs…but even when I'm extremely cautious, I'm gassy. You may be one of those DSers for whom gas is difficult to control. I know it is hard, but it is certainly better than life threatening obesity.

[Mickens]

I will give fruits and veggies a try again, seemed like last time they tore me up but maybe things may have changed.

Tried Beano early out, i'll give it another whirl

Yea I'm coming to terms with the fact i'm gonna be a gassy no matter what and yes it's a tough pill to swallow and hopefully it will become manageable over time, but I at least want to see what's out there for things to possibly help. I'll most certainly take a life of ripping ass over being almost 500lbs anyday.

Thanks again

[Simba]

The DS configuration will increase gas/BM quantity, your diet will also change this. I actually dont have an issue with gas rarely if ever, months ago?, I can't remember. I used to be so bloated in the evening, but now my bloating has gone down to almost mothing every since I started on VSL#3DS. It takes about 2 months of taking it everyday to change, but the change is amazing. I have varied my intake, but currently I take about 1/2 packet a day, that has been the single most important change for me. I would be careful with increasing your carbs if you choose to go down that path, if you do go very slowly it can have the potential of making your gas etc significantly worse, personally I would not.

[newyorkbitch]

Dec 24, 2014 21:13:03 GMT -5 Mickens said:

I will give fruits and veggies a try again, seemed like last time they tore me up but maybe things may have changed.

Tried Beano early out, i'll give it another whirl

Yea I'm coming to terms with the fact i'm gonna be a gassy no matter what and yes it's a tough pill to swallow and hopefully it will become manageable over time, but I at least want to see what's out there for things to possibly help. I'll most certainly take a life of ripping ass over being almost 500lbs anyday.

Thanks again

You need some fiber to help with the constipation. Also, eating no carbs longterm, and resulting ketosis, is really quite dangerous.

Try cooked veggies - easier to digest than raw veggies.

What probiotic are you taking?

[caprice]

Hi, Simba,
What's a VSL#3DS?
Thanks,

[Simba]

Dec 25, 2014 7:15:37 GMT -5 caprice said:

Hi, Simba,
What's a VSL#3DS?
Thanks,

Hi Caprice
it is a medical grade food; it is by RX only, probiotic (9.0 X 10e11 CFU), it has 8 different strains of live bacteria which have been chosen and mixed proportionally to optimize GI health. There also have been peer-reviewed journals that state the benefits of using probiotics for enteric hyperoxaluria,which with the DS we have to be concerned about, and was the primary reason I origninally started it. It took me about 2 months or so? But now, I have another benefit, I never get the evening bloating-sometimes it could be pretty awful, and that was independent of food types consumption, but more of a function of the DS (undigested food in the bowel which is a great breading ground for non-beneficial bacteria, hence the reason some take metronidazole-of which I have never taken metronidazole, btw). You could get VSL#3 (4.5 X 10e11 CFU) or if your dr will RX for you, you could get the VSL#3DS. The amount will be trial and error pretty much like anything else with us, I would suggest not starting out with anything higher than 4.5 X 10e11 CFU, that is the VSL#3 strength one capsule/day, or 1/4 to 1/2 packet of VSL#3DS/day. I get the VSL#3DS, my copay is 5$/month.
Merry Christmas!!!!!

[caprice]

Thank you for taking this much time to answer my question.
I'm not in need of it, I'm just frequently stumped by the abbreviations you use, as I have no medical background.
But, I do appreciate your efforts to educate.
Wishing you happy times as well....

[west4thavenue]

Dec 24, 2014 19:47:58 GMT -5 newyorkbitch said:

What I'm about to say is not going to make you happy, but here goes. Many DSers live with a lot of gas, myself included. And no matter what I eat, or when, I still have a lot of gas. Sure, it gets worse if I eat loads of dairy and carbs…but even when I'm extremely cautious, I'm gassy. You may be one of those DSers for whom gas is difficult to control. I know it is hard, but it is certainly better than life threatening obesity.

Hi, Mickens.

I am glad that my surgeon talked to me about this before my surgery 9 months ago.  In fact, he was emphatic in letting me know that gas and foul odor was one of the tradeoffs of having this surgery.  So what newyorkbitch is saying is certainly true for me.  I am just doing the best I can with it.  It's not fun, but the weight loss still trumps the side effects like the gas and hair loss.  It's a hell of a lot easier to manage things when you're alive, right?

Thanks for mentioning that Flagyl helps with the odor.  That's something I haven't tried.

[newyorkbitch]

Dec 25, 2014 13:04:55 GMT -5 west4thavenue said:

Dec 24, 2014 19:47:58 GMT -5 newyorkbitch said:

What I'm about to say is not going to make you happy, but here goes. Many DSers live with a lot of gas, myself included. And no matter what I eat, or when, I still have a lot of gas. Sure, it gets worse if I eat loads of dairy and carbs…but even when I'm extremely cautious, I'm gassy. You may be one of those DSers for whom gas is difficult to control. I know it is hard, but it is certainly better than life threatening obesity.

Hi, Mickens.

I am glad that my surgeon talked to me about this before my surgery 9 months ago.  In fact, he was emphatic in letting me know that gas and foul odor was one of the tradeoffs of having this surgery.  So what newyorkbitch is saying is certainly true for me.  I am just doing the best I can with it.  It's not fun, but the weight loss still trumps the side effects like the gas and hair loss.  It's a hell of a lot easier to manage things when you're alive, right?

Thanks for mentioning that Flagyl helps with the odor.  That's something I haven't tried.

Don't be so quick to take Flagyl. It is a powerful antibiotic. For reasons I am sure you know, overuse of antibiotics can lead to resistance to antibiotics when you really need them.

I myself am allergic to Flagyl so I cannot use it even if I wanted to. So I use a lot of devrom, bean, lactaid, etc.

[jpcello]

Flagyl is if you have a bacterial overgrowth. It's a very strong antibiotic and should be used sparingly.

For the odor, try Devrom. I use it daily and wouldn't go a day without it. It doesn't do anything for the gas, but I think it helps with odor. It doesn't work for everyone and you must take it regularly. I take 2 pills before each of my three main meals.

[west4thavenue]

Dec 26, 2014 7:16:54 GMT -5 jpcello said:

Flagyl is if you have a bacterial overgrowth. It's a very strong antibiotic and should be used sparingly.

For the odor, try Devrom. I use it daily and wouldn't go a day without it. It doesn't do anything for the gas, but I think it helps with odor. It doesn't work for everyone and you must take it regularly. I take 2 pills before each of my three main meals.

Thanks.

[west4thavenue]

Dec 25, 2014 21:15:28 GMT -5 newyorkbitch said:

Dec 25, 2014 13:04:55 GMT -5 west4thavenue said:

Hi, Mickens.

I am glad that my surgeon talked to me about this before my surgery 9 months ago.  In fact, he was emphatic in letting me know that gas and foul odor was one of the tradeoffs of having this surgery.  So what newyorkbitch is saying is certainly true for me.  I am just doing the best I can with it.  It's not fun, but the weight loss still trumps the side effects like the gas and hair loss.  It's a hell of a lot easier to manage things when you're alive, right?

Thanks for mentioning that Flagyl helps with the odor.  That's something I haven't tried.

Don't be so quick to take Flagyl. It is a powerful antibiotic. For reasons I am sure you know, overuse of antibiotics can lead to resistance to antibiotics when you really need them.

I myself am allergic to Flagyl so I cannot use it even if I wanted to. So I use a lot of devrom, bean, lactaid, etc.

Thank you!

[citizenk9]

Probably for the first year and a half after surgery I had a very disproportionate amount of gas for the carbs I ate. 2 crackers = 6 hours of painful bloating and gas. I had taken probiotics since surgery but never had Flagyl. I know that for me my choices of food contributed to the problem. I don't know if I'm capable of the self-control you have. I didn't have constipation but I'm sure that is a contributor for you. If you can get that to improve I would think it will help with the gas.

It seemed like overnight my issue went away. I had started taking Zypan around that time on the recommendation of a acupuncturist.
www.standardprocess.com/Products/Standard-Process/Zypan#.VJ2GVv8ADA
It is a digestive enzyme which seems to scare WLS people because they fear they are going to gain weight on it. I was still in that bounce around stage of gaining and losing 5 lbs but I was near goal. Not having gas and bloating was worth 5 lbs if that was the reason.

Two months ago I had surgery for a bowel obstruction and I seemed to have gone back to the same issue with gas and bloating. I went to Whole Foods and bought Critical Care probiotics in the refrigerated section.

www.renewlife.com/probiotic-supplements/ultimate-flora-critical-care-50-billion.html?utm_content=Ultimate_Flora_Critical_Care_50_Billion&utm_source=bing&utm_medium=cpc&utm_campaign=NX_TM_Probiotic&utm_term=critical%20care%20probiotics

It's improving slowly and now that I remembered about the Zypan so I'll probably order that as well. I hope you can find some relief!
Cathy

[belle]

Hi
Oh, it's true that gas is the biggest price i have paid for weight loss. Particularly in the world of adult coworkers who are thinly disguised adolescents, I am the subject of laughter and/or scorn. Family has come to live with it, but they dont always understand why i cant make it to the bathroom in time to let it out there.When I am out shopping, I follow the advice of just keep walking. But in church or at someone's house with only a few people present, it is mortifying. devrom didn't help me, mint oil and licorice oil (also recommended) didn't help
This is my top 10 of things I have learned that helped me. I can get down to 2 or 3 farts per day, if I am careful following these "commandments."
1. I cannot eat fast food ever. The eggs are not entirely real eggs, the chicken and burgers are not pure. They mix them with flour or soy extenders that I cannot digest. Eggs I cook myself, burger or chicken from home, no problem.
2. I cannot eat the cheap yogurt, or even the Greek yogurts from the big companies because they thicken them with lotus root gum or guar gum. There is only one brand in my supermarket that does not have these. (A probiotic with a prebiotic in it is a disaster. The prebiotic is essentially indigestible carbs, which spells trouble. )
3. I don't have a problem from salad, but give me broccoli, corn, raw onions or scallions, or green beans...oh,my. I can eat spinach, peas, carrots, cucumbers, and dried beans without too much problem. It's a bit of trial and error.
4. I've become a label reader. So many foods -- and even vitamins--have hidden sugars or sweeteners or additives. I will not buy foods with ingredients I can't pronounce, and especially anything with an ingredient that ends in "gum, or "starch", as in food starch. These just putrify the air later. Frozen entrees are out, for the most part, because the meats tend to be ground up and mixed with other things, even the fish sticks or cakes, but especially the chicken.
5. Small meals and small well chewed bites are less likely to end in gas than large meals and hastily chewed bites. I think of it as helping food be more digestible.
6. Yeast and baking soda are the problems with carbs for me. I can eat pita bread, crackers, or hard toast without creating a cloud. But these are once a week treats. Pasta is a trigger for me, so never again.
7. Soy is out. Permanently. It's a protein, but I can't digest it. I found it in a vitamin, so I had to switch brands.
8. If you read the labels on ice cream, many brands have fillers and additives. I only eat one brand, which has the fewest ingredients.
9. If I have an important meeting, I will take an antidiarrheal drug, like Lotrimin, an hour before. It keeps the colon from moving. It doesn't last long, but I can get in and out without leaving the air a present. But if you have constipation, that's not a good idea.
10. I know it's controversial here, but a "low" enema in the morning gets the gas out at home and it helps create a regular pooping pattern. I also find walking several blocks in the morning gets it out before the office. And, all carbonated drinks, like soda and beer are out because that gas turns into my gas.
I have regretted having the DS at several points in my life. But, when I have regrets, I think of the 150 pounds I lost and have kept lost for 10 years, the diabetes that no longer exists, and the joint pains that went away. It is a trade off, but one that I can live with, but that affects my self-esteem, just not as much as obesity did. I hope someday they can fix obesity without DS, but this was the best option available to me in February, 2005.
I hope these help, but know that with effort, you will find your triggers and be able to reduce the gas from its current level.

[caprice]

Belle,
I am in awe..... that's some attention to detail. I am sorry that you've had to deal with gas to such a major degree, but glad that the pros outweigh the cons for you.
This was a very helpful list.

[Mickens]

Thank you everyone for the feedback, i'm currently taking VSL#3 twice a day(the packets) as well Ultimate Flora Critical care in the middle of the day. I'm going to try and get approval to get VSL-DS covered by my insurance but i'm not holding out much hope. I'll just keep track of my food intake and continue my elimination diet.

Thanks again

[teetster]

Hi Mickens,

Like you, I suffered greatly with gas and bloating for the first three years of my DS, no matter how careful I ate. I did an elimination diet, tried flagyl, etc, nothing worked. The key for me was finding the right probiotic. I tried several before I found the right one for my system. I don't think it's a one and done deal, I think some people respond better to different probiotics.

On another forum, a poster recommended a probiotic called Inner-eco coconut water. I was reluctant to try yet another probiotic, but I did, because I was desperate. It worked like magic.

Please consider trying this one, it is very cheap, like $20 a month, found at whole foods in the refrigerated section. I won't lie, it doesn't taste great, but it was a complete life changer for me as far as gas and bloating after my DS.

I wish you the best with all of this, it can certainly be quite a burden.