Gastrointestinal symptoms

• appetite, loss of
  • foods to help you gain weight
  • weight change
• bloating and gas
• constipation
• diarrhea
• liver and gall bladder
• rectal
  • anal fissures
  • bleeding
    • Patient experiences
  • hemorrhoids
• upper gastrointestinal symptoms
  • nausea and vomiting
  • stomach and esophagus
• yeast infection and gluten sensitivity

From: Dr Trevor Marshall Date: 2011-12-30 12:11:50

Most of our members have problematic GI tracts :) It is at the forefront of dealing with pathogens coming into our body, and is the first to fail when the immune system is weakened by the Th1 microbiota.

J Nutr. 2011 May;141(5):769-76. Epub 2011 Mar 23. Regulation of tight junction permeability by intestinal bacteria and dietary components. Ulluwishewa D, Anderson RC, McNabb WC, Moughan PJ, Wells JM, Roy NC. Source Food Nutrition Genomics Team, Agri-Foods and Health Section, Palmerston North 4442, New Zealand. Abstract The human intestinal epithelium is formed by a single layer of epithelial cells that separates the intestinal lumen from the underlying lamina propria. The space between these cells is sealed by tight junctions (TJ), which regulate the permeability of the intestinal barrier. TJ are complex protein structures comprised of transmembrane proteins, which interact with the actin cytoskeleton via plaque proteins. Signaling pathways involved in the assembly, disassembly, and maintenance of TJ are controlled by a number of signaling molecules, such as protein kinase C, mitogen-activated protein kinases, myosin light chain kinase, and Rho GTPases. The intestinal barrier is a complex environment exposed to many dietary components and many commensal bacteria. Studies have shown that the intestinal bacteria target various intracellular pathways, change the expression and distribution of TJ proteins, and thereby regulate intestinal barrier function. The presence of some commensal and probiotic strains leads to an increase in TJ proteins at the cell boundaries and in some cases prevents or reverses the adverse effects of pathogens. Various dietary components are also known to regulate epithelial permeability by modifying expression and localization of TJ proteins. PMID: 21430248

I learned to have some control over the hyper-acidity problems with the following measures: Keeping carbs lower - especially in the evening. Keeping citrus, spicey and tomato based foods lower, and sleeping with a large pillow.

When the symptoms became really bad, I found the acid was controlled very well with famitodine (available as Pepcid AC) and ranitidine (also available over the counter, but I can't recall the name). These drugs take about 1/2 hour to take effect, but reduce stomach acid by about 70% for many hours. They are very effective.

The most potent acid controller I ever used was called prilosec (or, losec). It blocked the proton pump that pumps the acid, with one dose reducing stomach acid by about 90%. At my worst, two of these still could not get my acid under control.

I found that calcium based products or foods, provided immediate relief (by neutralizing stomach acid), but often resulted in a rebound effect (or, even more acid a couple hours later).

~DaveW

What should I do for my throat, esophagus or stomach problem?

Symptoms related to the upper gastrointestinal tract are very common in Th1 diseases. The first suspect when symptoms exacerbate should be DThomas and Aunt Diana have reported hoarseness.

Nausea/vomiting

If nausea is accompanied by cardiac symptoms, see When should I be concerned about cardiac symptoms?

Avoid foods that seem to be causing nausea. Check any meds you are taking for palliative reasons, especially pain medications to see if nausea is a side effect. Do not take Benicar on an empty stomach if it is followed by nausea.

If the nausea lasts only a few hours, you may avoid eating and continue to sip on fluids. If the nausea lasts for more than a few hours, it is important to find food and fluids you can tolerate so you maintain your nutrition and don't become dehydrated. Most people find eating small, frequent bland foods is best. You may prefer food and fluids at room temperature. Avoid greasy, fatty, fried and spicy foods. Avoid coffee, caffeinated drinks, alcohol and acidic drinks (orange or grapefruit juice). Avoid foods with lots of fiber (bran, raw vegetables, fresh fruits, high fiber vegetables such as broccoli, corn, beans, cabbage, peas, cauliflower), whole grain cereals and bread.

There are behavioral therapies and techniques that can also prove helpful in combating nausea and vomiting, including:

Acupressure Acupuncture Biofeedback Distraction Therapy Hypnosis Relaxation Visualization/Imagery Rhythmic breathing If nausea seems to be related to weaning from steroids, follow the weaning guideline to mitigate withdrawal symptoms.

Nausea due to immunopathology may be relieved by adjusting MP meds. If this is ineffective, you may try OTC palliation and is that is ineffective, ask doc for a prescription antiemetic (you may need one of the new more effective meds developed to treat the nausea related to chemotherapy).

If nausea is accompanied by symptoms of stomach flu and methods to reduce immunopathology are not effective, maintain hydration for the duration of the viral attack and treating nausea/diarrhea palliatively. You may contact your doctor or pharmacist for advice about palliative medications. Any medications that are not on the list of Medications To Avoid While on the Marshall Protocol are okay to take to relieve intolerable symptoms.

Dramamine, Bonine, Benadryl, Pepto-Bismol, Emetrol, Maalox, etc., are over-the-counter products that often help with mild stomach upset. But often they will not stop vomiting, because they only work in the stomach and intestines while the nausea center of the brain controls vomiting.

Anti-nausea (antiemetic) medications work in the nausea center of the brain and require a prescription, e.g. Phenergan (promethazine), Compazine (prochlorperazine), Kytril (granisetron), Zofran (ondansetron), Reglan, (metoclopramide), Ativan (lorazepam) to name a few. Anti-nausea medications may also be compounded to improve tolerance.

Certain herbs have also been found to be effective nausea remedies.

-Another thing to try is licorice Altoids I know they helped my dad when he was having terrible nausea from his chemo treatments for cancer….he was an MD, so he had access to pretty much anything he needed - and he chose the Altoids! ~Knochen

Prevent dehydration

Maintaining adequate hydration may help to keep symptoms tolerable. This article and this article explains prevention of dehydration and when you should notify your doctor.

Maintain hydration. The following liquids may be tolerated:

water popsicles apple juice decaffeinated Coke clear soup/broth Jello weak herbal tea Koolaid Once clear liquids are tolerated with no further vomiting or diarrhea, gradually add solid foods like rice, applesauce, bananas, toast/crackers without butter, and plain pasta. If these foods are tolerated without the return of symptoms, continue to add bland, low-fat foods such as baked potatoes and white chicken meat.

Seek medical attention if:

-you have been vomiting several times a day for more than two consecutive days or 3 times an hour for more than 8 hours. You may already be dangerously dehydrated. Dehydration can occur in one day if there is serious vomiting and diarrhea. If you are too lethargic to go to the bathroom by yourself, seek immediate medical attention.

-there is blood or 'coffee-grounds' material in the vomit. -you cannot keep any food or liquids down. -you are vomiting and you lose more than 2 pounds a day. -your urine is dark yellow and you are not going to the bathroom as often as you usually do. -you cannot keep your nausea medication down.

Please consult your doctor if you are using aspirin in any form. Aspirin is contraindicated with any bleeding because it prolongs bleeding time.

Sea-Bands help with nausea for some people. They can usually be bought in pharmacies.

Most medications can be taken sublingually if nausea prevents them from being taken orally. In extreme cases, an antiemetic can be given by suppository to relieve the nausea.

Medications may cause gastrointestinal disturbances

Taking meds on an empty stomach may be a trigger; it is okay to take your MP meds with food. Their action may be delayed but its effectiveness will not be reduced.

GI bleeding

NSAID use is discouraged on the MP. Ibuprofen (Motrin, Advil) has some serious side effects (it's hard on the stomach and may prolong bleeding time) so please check with your doctor. It can also cause fluid retention.

Naproxen and naproxen sodium are marketed under various trade names including: Aleve, Anaprox, Miranax, Naprogesic, Naprosyn, Naprelan, Synflex. Like other NSAIDs, naproxen is capable of producing disturbances in the gastrointestinal tract. Addition of a proton pump inhibitor such as omeprazole will prevent this adverse effect.

Since aspirin has serious side effects, chiefly 'thinning the blood' and causing gastric upset, it should be taken only if your doctor says it's okay to take. We do not recommend the routine use of aspirin for its touted preventative characteristics. Other NSAIDs such as Arthrotec may cause you to bleed more easily also. Be sure you know the side effects of all medications you are taking and check with your doctor before you take any medication that delays clotting.

Acid reflux

Gastrointestinal Esophageal Reflux Disease (GERD) is quite common as related muscles/tissues age and inflammation may have a lot to do with that. Medications to reduce stomach acid are some of the most frequently prescribed in this country. The first symptom of acid reflux may be nausea but typically reflux causes epigastric discomfort and pain (heartburn).

Your symptoms of reflux may abate by following a low carbohydrate diet. According to Dana Carpender, who has written several books on lowcarb eating:

“Proteins digest in the stomach, in an acid medium, while carbohydrates digest in the small intestine, in an alkaline medium. This means that eating the two together can trap undigested carbohydrates in your stomach, waiting for proteins to digest - and those carbohydrates can start to ferment in your stomach, leading to indigestion and heartburn. No fun. This is one of the reasons that many people find that reflux clears up on a low carb diet.”

If adjusting MP meds and a low carb diet doesn't work to reduce gastric reflux, it is okay to take medication that reduces stomach acid (e.g. a proton pump inhibitor such as Prilosec) or antacids that provide immediate relief; just be sure to take them 3 hours away from antibiotics to give full chance for adequate absorption of the antibiotic.

Food intolerances

Food sensitivities and 'allergies' are more appropriately labeled intolerances and members report a wide variety of symptoms and offending foods. Food intolerances may also be linked to the level of soy, chlorogenic acid or genistein in a food.

Many folks report intolerance to alcochol. This may be due to other ingredients in the alcoholic drinks, such as the grains in some beer. See Is alcohol allowed on the MP?

All your food allergies disappear as you recover on the MP. It is important for you all to realize that the worrying about food you are doing is as a result of your Th1 disease. Therefore, it is not helpful to think about these things as food “allergies,” you should think about them as “can't tolerate certain foods.” These days I eat anything I want. I know that my body is not sensitive to any of the foods I used to shun. Once the bacteria had been cleared from my body and mind, the sensitivities to smell, foods, and touch had all gone.

..Trevor..

Frequent hunger

Hunger has often related to fluctuating blood sugar levels. Changing from a low fat diet to a low carb diet should stabilize blood sugar and eliminate frequent ravenous hunger.

Cramps

When I first had bad spasms in the stomach and intestines, I was told to get Dicyclomine 20mg. When I am desperate, this really comes in handy. The pill is small, but I cut it into 4ths. Sometimes even less. Don't need much to stop the pain. Makes me sleepy. ~Lori

Belching, bloating and excess gas formation

Burping (belching, or eructation) can be due to gas-producing bacteria in the digestive system. Eating carbs such as refined sugar, flour and some high-sugar fruits can make digestive gas or belching worse. This article says. “The gas-producing colonic bacteria thrive on foods containing poorly digested carbohydrates (starches and sugars).”

An NIH website says, ” Most foods that contain carbohydrates can cause gas. By contrast, fats and proteins cause little gas.” You may reduce gas by reducing carbohydrate consumption.

Some people have burps and others have gas in the lower digestive system, but the gas produced by bacteria in the gut eventually must escape. This is another symptom of the disease that we would expect to resolve.

Simethicone is an oral anti-foaming agent used to reduce bloating, discomfort and pain caused by excess gas in the stomach or intestinal tract.

Beano is a natural enzyme supplement that can help you prevent gas, bloating, and other digestive problems after eating certain foods

-An occasional acid reducer like Tagamet works well for me. Phazyme is also good at relieving bloating as is good old baking soda in water. ~VEZ R.N.

Patients experiences

-My food 'allergies' have lessened with time. When I react to a food now (I'm in phase 3 MP), I may get sick, but can function. ~Bevin

-Since starting the MP my tolerance for fruits and vegetables is down to almost zero. At first I still tried to eat a few different things in the name of 'variety', but after the stomach pains, nausea and diarhea, I decided that I didn't care what anyone's opinion of “healthy eating” is. So now I only eat what my body agrees with and I'm doing fine. ~Shadowzone

-Braggs apple cider vinegar in water (just a splash) ALWAYS works for my reflux (which causes instant nausea for me). ~xtian1

-Taking excessive amounts of antacids is probably counter-productive, causing the stomach to secrete more acid. As you've discovered, adding more acid (vinegar) actually works better. But use cider vinegar, which seems to have its own healing properties, and take only a teaspoon in half a glass of warm water. Cider vinegar is just a kind of vinegar made from apples. I get it in my local supermarket alongside the other vinegars, but if you can't find it there, it will certainly be in a health shop. It's an old folk remedy for arthritis and all sorts of things - no scientific evidence, all old wives' tales (says the establishment ), but I find it magic for any tummy upsets. But do take care to dilute it well, as it's very caustic. ~Julia

-Limiting the frequency and amount of diazepam (Valium, a muscle relaxant) has eliminated any GERD symptoms for me. I can get away with 1 mg for sleep occasionally but using 5 mg for any reason means sleeping on a wedge for awhile. ~tgritton

-All my life I could swallow the hottest cup of tea due to neuropathy. But I cannot do so now because of esophageal burning. This return of sensation thru immunopathology indicates the healing process is working. Benicar and adjusting MP meds palliates this immune response symptom. ~AB

-My digestive IP is improving immensely. Here is what I have worked out…. I take a digestive enzyme before eating and then about 30 minutes after I eat I take a calcium supplement. The enzyme is improving my digestion and the calcium (which I tested low for in the Fall) seems to stop the burning in the pancreas/gallbladder area. I am barely even sore there right now. The burning sensations continue throughout my body which is not uncomfortable. It took me long enough, but I think I am finally understanding my IP and how to control it. I hope so, at least! ~Juliette

-Phazyme, Titralac, and sometimes good old baking soda to name a few that have worked well for me. If things get too bad for me I have used an occasional Zantac with some good results as well. ~VEZ

-Just a note to tell how I solved my nausea. I was taking my Benicar first thing after rising in the morning, on a completely empty stomach, then waiting 90 minutes for it to digest. This gave me bad nausea. I noticed that I did not get the nausea the rest of the time, after I had my first meal of the day. I changed my schedule so that I ate first thing in the morning, and then took the Benicar halfway between meals the rest of the day. This worked great!. Be sure to allow at least 2 to 3 hours after meals –I allow 3 hours except when my hypoglycemia kicks in, then I wait 2 hours. The pill I take during the middle of the night doesn't seem to bother me since I have my last meal about 3 hours or so before going to bed. I take my last pill just before bedtime. ~Nell C.

Related FAQs:

Should I take probiotics?

I’m losing weight. What should I do?

What should I do for liver or gallbladder pain?

I have diarrhea. What should I do?

I'm constipated. What should I do?

• f257:

(filelink) LH1953 Lori wrote: Testimonial There seems to be a definite connection with rectal bleeding, and eating garlic. I have spoken to a few members on the MP starting phase 2 who have contacted me. This is also when my bleeding started. Garlic was the trigger food that we all seem to share in common. I know that once this became a symptom for me, I get flair up tissue response with this or spicy foods. Also, drop the Mino down to help with the bleeding. If you are in Phase 2 and this does not help, ask the board about modified Phase 2. Maybe this will help.

• f288:

I’m losing weight. What should I do?

Many people ill with Th1 inflammation have difficulty maintaining a normal weight, especially if they have food sensitivities or gastrointestinal problems.

Some people have reported a weight loss after they have started the MP. One physician wrote: I have seen many patients either initially gain or lose weight in phases 1 and 2.

Immunopathology

Dr. Marshall states, “You need to be aware that some Th1 disease leads to weight loss. For example, anorexia nervosa is a Th1 disease. So if you already had a tendency towards such a thing then immunopathology could exacerbate that tendency. Please see How to lessen symptoms caused by immunopathology

Palliation

As the Marshall Protocol resolves your inflammation, the food sensitivities and gastrointestinal symptoms will decrease. In the meantime, it is okay to use supplements such as milk thistle, probiotics or Rx meds prescribed by your doctor for palliative relief of symptoms to allow you to consume more food.

Exercise and rest

When adjusting MP meds doesn't reduce immunopathology symptoms, ie weight loss, palliative measures may be necessary. Recommend not exercising (fitness doesn't make you healthy) and continue eating high calorie foods.

Rest is a very important part of managing and healing. Limiting activity/exercise will reduce the amount of calories burned. If fatigue prevents you from preparing foods, eat very simply and/or ask for help.

Low Carb and folic acid

Many folks lose weight when they reduce carbs. When weight loss is a serious issue, it's more important to gain weight than avoid carbs so eat what appeals to you. The same is true for avoiding foods supplemented with folic acid…..it's more important to gain weight at this point in your recovery. Continue to avoid foods high in vitamin D.

Nausea

If nausea is preventing you from eating, it's important to palliative the nausea. OTC meds such as Gravol (dramamine) might do the trick. If not, ask you doctor for a prescription antiemetic. Please see What should I do for my stomach problem?

Nutrition

Good nutrition is important to promote optimum body functioning. But when you have a chronic intracellular infection, even if your nutrition was flawless, you would still remain ill. The most important thing you can do to regain your health is attacking the bacteria with the MP.

Please see Food Facts. If your diet is severely compromised, you may need to temporarily supplement with a multiple vitamin product that does not contain vitamin D.

Poor appetite

If your low food intake is related to a poor appetite, it's important to eat foods high in calories on a regular schedule. Watch the clock so you eat small meals 6 times a day and consider it as important as a medication.

-For years I didn't have an appetite; I often only thought to eat when I became weak. Now in recovery, I appreciate my appetite and ability to enjoy food because my senses of taste and smell are improved, along with my digestion.

So my attitude is: if your body is hungry, FEED IT. I now believe that snacks are an important part of our diets, and we should plan them as thoughtfully as we plan our meals. The way I plan is by being selective about what I purchase and keep on hand.

The things I always keep around for snacks are: bananas, apples, oranges, seedless grapes, cheese and nuts. You can eat these easily before bed or if you get hungry during the night. And I will tell you that when I started being hungry between meals and during the night.. I just took that as another sign that I was getting well! It was so different from my earlier years of *no appetite.* I had to keep reminding myself that healthy people have an appetite! ~Belinda Fenter

Anorexia nervosa

Anorexia nervosa is a disease and anorexia means lack of appetite.

Dr Marshall: Anorexia nervosa is a Th1 disease, so please don't let immunopathology drive you in that direction. Have you tried sugar-free chocolate? You need to keep those calories flowing into your body. You will also need to keep an eye on the vitamins and minerals. There are candy bars available in bulk from drugstore.com that have a pretty good basic balance of vitamins. They have Folic Acid (25%), but no apparent Vitamin D. You might look into them. http://tinyurl.com/lvl2u\Tinyurl

See also:

FOOD TIPS

Foods to help you gain weight

Maintaining weight

The Body Mass Index

OBESITY Some Bacteria make you Fat, some Thin

Appetite

• f165:

What should I do for liver or gallbladder pain?

The liver is located in the right upper quadrant (RUQ), mostly tucked up under the lower ribs below the diaphragm. Pain in this area can radiate to the right shoulder or between the shoulder blades (it can be breath-taking for an instant) and may be accompanied by nausea and/or indigestion. Ultrasound may not show any gallstones….it could be due to inflammation only. Avoiding fatty foods may be helpful.

This study shows 1,25-D controls bile enzymes, which may be a reason for gallbladder dysfunction.

“There have been several folks recently who have felt the need to remove their gall bladders. The VDR (and Vitamin D) is closely involved with the bile acids, and with the ability of the liver to clear 'toxins'. I would expect gall bladder problems to, therefore, resolve, as do the other manifestations of Th1 disease. Please take a look at this paper.

..Trevor..

June 07 -Dr. Marshall writes;

“The gall bladder is heavily involved in Th1 disease process because the VDR subfamily of Nuclear Receptors are key to xenobiotic mechanisms in the body.

The VDR superfamily consists of (at least) the VDR, the PXR and the CAR. Of these the PXR (Pregnane Xenobiotic Receptor) is heavily involved in the Th1 disease processes, as it is activated not only by the bile acids, but also by the steroids. Our work has shown that high levels of 1,25-D, such as characterize Th1 inflammation, disable the proper functioning of the PXR.

Your surgeon probably won't understand a word of this I would be happy to chat with him about it

Bottom line - is that a badly functioning gall bladder will most likely become functional again once the Th1 pathogens have been killed off. Ripping out the gall bladder of a Th1 patient, IMO, should be avoided at all cost.

The truth is that I have no idea what the job of the gall bladder is, nor does anybody else. The knowledge about the PXR is only a few years old, one of the results of the sequencing of the genome. Its close relationship to VDR is still being discovered and documented, week by week.

My comments were really meant to make somebody think twice about a surgeon's advice that people can function perfectly well without their gall bladders. They are still telling us Vitamin D is good for us, too.

In your case you will need to keep an eye out for new knowledge as it comes along. My suspicion is that as your body returns to health you will notice the loss of the gall bladder less and less, but that is purely a wild guess on my part.”

Fatty liver

Fatty liver is caused by an imbalance in the metabolism of fatty acids, resulting in an accumulation of lipids (usually in the form of triglycerides) in the liver. This condition is reversible.

A diagnosis of non-alcoholic fatty liver does not necessarily mean the liver is damaged. This article on the American College of Gastroenterology's website says,

“The most common form of NAFLD is a non serious condition called fatty liver. In fatty liver, fat accumulates in the liver cells. Although having fat in the liver is not normal, by itself it probably does not damage the liver.”

Historically, the first report (1963) associating use of tetracyclines with fatty liver disease was the case of a pregnant woman on high-dose IV tetracycline. Similar reports in the 1960's involved pregnant women on high-dose IV tetracycline, often in treating pyelonephritis. So these circumstances were not similar to your own.

We do know that fatty liver is associated with idiopathic disease, inflammation, insulin resistance and obesity, but we see that Th1 inflammation has the same associations. Had you considered that fatty liver might be a manifestation of underlying Th1 inflammation? ~Belinda

Palliation

The first measures taken to reduce pain in the area of the gallbladder should be aimed at reducing immunopathology. See My immune system reaction is too strong. What should I do?

NSAIDs (non steroidal anti inflammatory drugs)

These commonly prescribed pain medications can increase liver enzymes. If pain medication is needed, an alternative should be considered.

Milk thistle

RUQ pain is often relieved with the use of Silymarin/milk thistle which is available in capsules. Milk thistle is made from Silybum marianum seeds. With herbs like this, it's hard to measure the active ingredient amount. Since it all comes from plants, they vary with growing conditions. Some brands may work better than others so you may want to try another if one doesn't seem to help.

For quick relief (especially when the digestive system is not working well), you may try liquid milk thistle drops which are usually available from a local health food store. The drops taste horrible, but you can tolerate the taste in order to get rid of the pain. You can use the drops in addition to the capsules if needed.

Here is a list of milk thistle products.

Fennel tea is not recommended because fennel is thought to have antibiotic properties.

See also PAIN CONTROL

Members' experiences

-Some time ago, I found a liquid milk thistle that I like quite well. My husband was the one who bought it – thought liquid would work faster/better because of nausea, indigestion from RUQ pain. One liquid dose (one dropper) has 500 mg, but I have no way of knowing how much active ingredient is in there. I just squirted it in the back of my mouth PRN. I used to take two droppers-full twice or even three times a day to control the pain. I rarely use it now, and usually only a dropper or two a day at a time. I can recall that when my left upper quadrant (which I vividly remember as spleen pain, since I used to have an enlarged spleen) followed my RUQ pain, the milk thistle would calm both. Your mileage may vary. I just know that when my liver pain got intense enough, I also ended up with spleen pain and milk thistle stopped that orchestration of pain. ~Belinda

-To share my story, I had a Hepatobiliary Scintigraphy or HIDA Scan for the gall bladder done in October of 2002. I couldn't digest any fats and had some severe digestive problems, nausea, gas and bloating, and shoulder blade pain. They found no obstruction or inflammation - but it was only emptying at 14%. It just wasn't contracting. They just diagnosed it as chronic biliary dysfunction and so, of course they said take it out. I said, I think I can do better. One of the main areas of intense burning I've had on the MP is in the gall bladder/liver area. The burning is pretty much gone in that area now, but was intense in phase 2. I've noticed I'm digesting fats better, have much, much less digestive problems, and don't have the pain in the backing up of the bile in the ducts. Seems pretty clear cut to me that as the MP says, we will find Th1 problems in areas we never had a clue were there. And, I'm so happy I didn't have my gall bladder taken out. My doctor and I are both interested later in the protocol, to redo the test. Bet it will be functioning much better.~Vikki

-I had to have a lap choley almost two years ago (middle of the night emergency ambulance ride to hospital!) When it came out the surgeon biopsied sarcs on the GB and my liver. That was the first clue that I had sarcoidosis. ~Linda Lou

-I certainly have experienced gall bladder symptoms as Herx reactions. ~Greg

• f201:

Sarcoidosis liver studies (filelink)

Whether you realize it or not, you are teaching your doctors a lot. Just remember that your goal is to get well, not to educate the doctors.

As your own patient advocate, you have to be willing to provide the docs with information (such as you already have, on how sarc influences test results) that doctors may not know about, since sarcoidosis is a rare disease. You also have to be able to say no to repeat or continuous testing when you decide it will serve no purpose (i.e.: when it will not change the outcome of the disease or will not change the treatment).

Since you probably want to know more about the hepatotoxic potential of minocycline, take a look at this article, “Evaluation of the hepatotoxic potential of minocycline,” which indicates that *high dose* minocycline can result in elevated AST/SGOT.

Liver involvement is common in sarc patients. Here's an abstract you will want to read, because the authors found 44% of their cohort sarcoidosis patients had liver involvement, and 50% of those had elevated ALT. Course of asymptomatic liver involvement in sarcoidosis: role of therapy in selected cases. Although 57% of the patients received treatment, 52% of those remained unchanged. The authors concluded, “The outcome of patients who receive treatment remains similar, as far as liver function is concerned, suggesting that most of the patients with liver involvement undergo natural remission. Unless the patient has progressive liver dysfunction, it is advisable to monitor liver enzymes periodically and obtain liver biopsies only if clinically indicated. In patients who need treatment, it is reasonable to try options other than steroids in view of severe corticosteroid related complications.”

Here is a new article (Dec. 2006) with several eye-opening statements: Diagnosis and treatment of hepatic sarcoidosis. These authors point out that the mere presence of granulomas (in the liver) does not dictate treatment. And their abstract concludes, “Ultimately, in cases of overt liver failure, liver transplantation is the definitive treatment. Overall, treatment for hepatic sarcoidosis is targeted toward alleviation of symptoms but has no curative potential at this time. Focus should be on discovering the etiology of the disease to target therapy at prevention, not cure.”

It seems that ultimately, the important question (that only you and your doctors can answer) is: how will testing or diagnosing sarcoid involvement in additional organs change your treatment?

~Belinda

• f256:

I've developed rectal bleeding. What should I do?

Folks with inflammation in their gastrointestinal tract, may develop rectal bleeding, hemorrhoids or fissures, especially if this is a symptom they have had in the past. The usual reason is immunopathology and it may coincide with an increase in antibiotics.

Dr. Blaney explained in his conference presentation that many of our systemic symptoms (including those involving digestion) are actually caused by inflammation in some part of the nervous system. See Wisdom of the Gut

The autonomic system controls muscles in the heart, the smooth muscle in internal organs such as the intestine, bladder, and uterus. Here are web sources that will provide background information: http://tinyurl.com/ob8br\Tinyurl http://tinyurl.com/cs2co\Tinyurl

To dampen all intolerable symptoms, see My immune system reaction is too strong. What should I do?

Bleeding

Here is an article that explains the significance of blood in the stool. If bleeding is not too severe, it is unlikely to cause anemia. Be sure not to take any medication that can prolong bleeding time such as aspirin, including herbal products. Please consult your doctor if you are using aspirin in any form. Aspirin is contraindicated with any bleeding because it prolongs bleeding time. If you are concerned do not hesitate to contact your Doctor.

Here is an article which explains hemorrhoids and your options for treating them.

Prevention

To allow any inflammation and trauma to heal, promote regular evacuation and prevent constipation see I'm constipated. What should I do?

See also I have diarrhea. What should I do?

In those who have a high level of immunopathology, exertion or exercise (even as gentle as walking) can increase pressure on sensitive tissues and may cause rectal bleeding.

Palliation

For further temporary relief of any intolerable symptoms, contact your doctor or pharmacist for advice about palliative medications. See Medications to Avoid While on the Marshall Protocol.

One Member reports that Benadryl helped.

You may use Rx steroid ointments sparingly.

If necessary, ask your Doctor for pain medication. See Pain Control

See how One Member dealt with rectal bleeding and here

These members have dealt with this symptom and have agreed to be available for support via email or private message:

LH1953 (Lori) Zackone (Fred) Aunt Diana

-It may be better to get cream instead of a suppository from your doctor, it might be easier on the tissues. Also be very careful if Nitro-Bid (nitroglycerin ointment 2% ) is ordered by your doctor. This was given to me by a rectal doc to try and constrict tissue for swelling. I applied a VERY tiny amount and immediately fell to the ground. ~Lori

When having a flare, pull back antibiotics till it gets better. Take extra Benicar. Use cream form of any medication, not suppository as this is too painfull to use. (adds more pressure) I use sparingly using gloved finger (using a Q-tip may be less irritating to the tissue) to apply to location only where the flared tissue is: RX, LidaZone HC Cream. This has lidocaine HCl 3% and Hydrocortisone Acetate 0.5% Zinc ointment may soothe the tissue without cortisone. Watch diet, avoid spices/garlic. ~Lori

-My doctor recomended a great medicine for the fissure, named sufrexal P, it has ketanserine and it is from janssen lab. It heals the fissure and has benzocaine which numbs, doest burn and doesn´t make toxic things, maybe you want to google it. It made me better in four days!!! ~Marion

-I found the best thing for the botom pain and bleeding was K cream or sudocrem which is zinc based. ~Patrickburke

-Well …. there was one herx that I could have lived without. But it is gone now.«< that was the flaming butt herx. Basically, very much flaming and burning during, and then again several hours after … erm ….. evacuation. There was blood coming up on the toilet paper, but no bleeding seperate from the erm …. evacuation. Benadryl was the only thing that helped with the pain (as needed) ~MarkN

Sitz bath

-The use of a “Sitz Bath” soothes the tissue in the rectal area. This is a device that fits on top of the toilet. You lift the “seat” up then place it on the rim. This is a quick fix instead of having to fill the bath to get temporary relief. It can be used as often as needed with warm, not scalding water. It can be purchased at the pharmacy. Ask them to order it for you, or go to a surgical supply store. Some come with a bag to fill it, I just fill at sink, then put on toilet, when done, dump it down toilet. Very neat and convenient! ~Lori

Cold to shrink hemorrhoids

-After a colonoscopy with prep last week I had a hemorrhoid flare. It was painful and my father suggested placing an ice cube on the site while holding one end with a papertowel. When I get tired I just drop the ice cube in the toilette and discard the papertowel (don't want to clog the toilette with the paper towell.)

Any way the proceedure is fast painless and it shrunk the hemorrhoid by 3/4 and left me with no pain, the first try! If I feel any discomfort I repeat the process, the most has been 3x daily. It worked when steroid cream didn't and is better for compliance with the MP.

Now I just have a tiny protuding hemorrhoid that doesn't hurt and doesn't require meds and ithis technique is easy to do. Feel free to pass this info on if you think it migh help others. ~Kelly Well

J Inflamm (Lond). 2011 May 3;8:11. Always one step ahead: How pathogenic bacteria use the type III secretion system to manipulate the intestinal mucosal immune system. Vossenkämper A, Macdonald TT, Marchès O. Source Centre for Immunology and Infectious Disease, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London, UK. a.vossenkaemper@qmul.ac.uk. Abstract ABSTRACT: The intestinal immune system and the epithelium are the first line of defense in the gut. Constantly exposed to microorganisms from the environment, the gut has complex defense mechanisms to prevent infections, as well as regulatory pathways to tolerate commensal bacteria and food antigens. Intestinal pathogens have developed strategies to regulate intestinal immunity and inflammation in order to establish or prolong infection. The organisms that employ a type III secretion system use a molecular syringe to deliver effector proteins into the cytoplasm of host cells. These effectors target the host cell cytoskeleton, cell organelles and signaling pathways. This review addresses the multiple mechanisms by which the type III secretion system targets the intestinal immune response, with a special focus on pathogenic E. coli.

PMID: 21539730

[The ]gut microbiota affects various charac- teristics of the host (fat storage, obesity) [28,32,33] and intestinal disorders such as the irritable bowel syndrome, inflammatory bowel disease and colon cancer [34-36].

¹

J Nutr. 2011 May;141(5):769-76. Epub 2011 Mar 23. Regulation of tight junction permeability by intestinal bacteria and dietary components. Ulluwishewa D, Anderson RC, McNabb WC, Moughan PJ, Wells JM, Roy NC. Source Food Nutrition Genomics Team, Agri-Foods and Health Section, Palmerston North 4442, New Zealand. Abstract The human intestinal epithelium is formed by a single layer of epithelial cells that separates the intestinal lumen from the underlying lamina propria. The space between these cells is sealed by tight junctions (TJ), which regulate the permeability of the intestinal barrier. TJ are complex protein structures comprised of transmembrane proteins, which interact with the actin cytoskeleton via plaque proteins. Signaling pathways involved in the assembly, disassembly, and maintenance of TJ are controlled by a number of signaling molecules, such as protein kinase C, mitogen-activated protein kinases, myosin light chain kinase, and Rho GTPases. The intestinal barrier is a complex environment exposed to many dietary components and many commensal bacteria. Studies have shown that the intestinal bacteria target various intracellular pathways, change the expression and distribution of TJ proteins, and thereby regulate intestinal barrier function. The presence of some commensal and probiotic strains leads to an increase in TJ proteins at the cell boundaries and in some cases prevents or reverses the adverse effects of pathogens. Various dietary components are also known to regulate epithelial permeability by modifying expression and localization of TJ proteins. PMID: 21430248

Chronic inflammatory diseases of the intestine, such as inflammatory bowel disease (3) and celiac disease (4), are characterized by a leaky intestinal barrier. In type I diabetes, an autoimmune disease, patients have increased small intestinal permeability (5). The incidence of diabetes can be reduced in diabetes-prone rats by preventing an increase in epithelial permeability (6). Breakdown of the intestinal barrier is also implicated in immune reactions that target organs outside the digestive tract, leading to diseases such as IgA nephropathy (7), nonalcoholic hepatic steatohepatitis (8), and multiple sclerosis in the brain (9). Furthermore, entry of unwanted antigens can lead to systemic inflammatory response syndrome, characterized by a whole body inflammatory state, and multiple organ failure (10).

3. Suenaert P, Bulteel V, Lemmens L, Noman M, Geypens B, Van Assche G, Geboes K, Ceuppens JL, Rutgeerts P. Anti-tumor necrosis factor treatment restores the gut barrier in Crohn’s disease. Am J Gastroenterol. 2002;97:2000–4. 4. Vogelsang H, Schwarzenhofer M, Oberhuber G. Changes in gastrointestinal permeability in celiac disease. Dig Dis. 1998;16:333–6. 5. Damci T, Nuhoglu I, Devranoglu G, Osar Z, Demir M, Ilkova H. Increased intestinal permeability as a cause of fluctuating postprandial blood glucose levels in Type 1 diabetic patients. Eur J Clin Invest. 2003;33:397–401. 6. Watts T, Berti I, Sapone A, Gerarduzzi T, Not T, Zielke R, Fasano A. Role of the intestinal tight junction modulator zonulin in the pathogenesis of type I diabetes in BB diabetic-prone rats. Proc Natl Acad Sci USA. 2005;102:2916–21

Infect Dis Clin North Am. 2010 Dec;24(4):977-93, ix.Influences of intestinal bacteria in human inflammatory bowel disease. Vanderploeg R, Panaccione R, Ghosh S, Rioux K. Source Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada. Abstract Microbes that reside in the human intestinal tract and interact with immune and epithelial cells are strongly implicated as causative or predisposing agents of inflammatory bowel disease (IBD). Recent studies using metagenomic approaches have revealed differences in the fecal and mucosa-associated microbiota of patients with IBD, but it remains unclear whether this is a cause or consequence of chronic intestinal inflammation. A few microbes have been singled out as candidate pathogens in IBD and remain the subject of ongoing study. Complex imbalances in gut bacterial community structure and/or deficiencies in their functional capabilities may be a greater issue in IBD development. A more complete understanding of host-microbiota interactions in IBD is hampered by several remaining but surmountable methodological and technical challenges.

Copyright © 2010 Elsevier Inc. All rights reserved.

PMID: 20937461

From: Dr Trevor Marshall Date: 2011-04-12 10:41:37 Reply: http://www.marshallprotocol.com/reply.php?topic_id=13433

A paper in Vancouver showed that antibiotics change the relative concentrations of GI tract species. The bacteria were not totally wiped out by antibiotics. I imagine the human immune system would also tend to change the flora composition, in time.

FYI –fits my experience – allergy affects gut and bacteria and brain

http://articles.mercola.com/sites/articles/archive/2011/04/12/beware--bacteria-growing-in-your-gut-can-influence-your-behavior.aspx