7 ms·

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 imm

by Vaslo 6y ago

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.

wittyreference 6y ago
Tricyclics work directly on gut neurology. It’s got nothing to do with the brain.
- droffel 6y ago
  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. https://en.wikipedia.org/wiki/Tricyclic_antidepressant https://en.wikipedia.org/wiki/Tricyclic_antidepressant
  - 55555 6y ago
    The way I read the parent comment: > 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].
    - wittyreference 6y ago
      You read it correctly; thank you for stating it more clearly than I did.
jryan49 6y ago
I have a similar anecdote. Starting an ssri (luvox) cured my ibs.
- muraiki 6y ago
  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. :)
nikkwong 6y ago
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.
- deleted 6y ago
  [deleted]
- starfallg 6y ago
  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.
  - ianai 6y ago
    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.
  - nikkwong 6y ago
epmaybe 6y ago
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.
FreeFull 6y ago
The gut has its own nervous system: https://en.wikipedia.org/wiki/Enteric_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.
- dillonmckay 6y ago
  The Second Brain, according to Michael D. Gershon M.D.
agumonkey 6y ago
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.
- james_s_tayler 6y ago
  That put that in a pitch deck and go get some funding.
  - ianai 6y ago
    Might run into severe ego issues blocking doctors from using such service, but probably not enough to make it infeasible.
    - agumonkey 6y ago
      It's surely one factor. Maybe going subtle and only making a system for 'complex cases' so they don't feel useless.
- doublerebel 6y ago
  The Human Diagnosis Project (YC S12) is something like this. You can see a sample of the cases on their Twitter: https://twitter.com/hdx https://twitter.com/hdx
  - agumonkey 6y ago
    well thanks, even though i'm on HN constantly I never saw that project..
fodmap 6y ago
Are you completely free from IBS (that would be a dream come true for me) or are you still suffering recurrent bursts? I'm still fighting my way out of it. The Low FODMAP diet is helping me, and I have an eye on hypnotherapy as my next step. See https://lens.monash.edu/@medicine-health/2019/06/24/1351605/how-hypnotherapy-is-helping-people-suffering-from-irritable-bowel-syndrome-ibs https://lens.monash.edu/@medicine-health/2019/06/24/1351605/...
- ElKrist 6y ago
  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.
  - fodmap 6y ago
    Thank you for your comment. Is your girlfriend sensitive to galacto-oligosaccharides (GOS)? I know there this enzyme therapy for that problem https://www.monashfodmap.com/blog/new-research-enzyme-therapy-can-help-reduce-symptoms-ibs-patients-sensitive-galacto-oligosaccharides-gos-present-legumes-soy-milk-and-nuts/ https://www.monashfodmap.com/blog/new-research-enzyme-therap... but I haven't try it. I'm sensitive to some GOS but I haven't being professionally tested for them. I did a fructose malabsorption test though, and I tested positive.
    - ElKrist 6y ago
      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
dillonmckay 6y ago
The gut is a second brain, kinda...I have always been fascinated by this book: The Second Brain https://www.amazon.com/Second-Brain-Groundbreaking-Understanding-Disorders/dp/0060930721 https://www.amazon.com/Second-Brain-Groundbreaking-Understan... 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.
1_player 6y ago
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.
amai 6y ago
Did you try https://en.wikipedia.org/wiki/Psyllium https://en.wikipedia.org/wiki/Psyllium ? "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" https://selfhacked.com/blog/psyllium-husk/ https://selfhacked.com/blog/psyllium-husk/ https://selfhacked.com/blog/irritable-bowel-syndrome/ https://selfhacked.com/blog/irritable-bowel-syndrome/
klysm 6y ago
Had a very similar experience with tricyclics - almost immediately stopped all the problems I was having.

by Vaslo 6y ago

wittyreference 6y ago

Tricyclics work directly on gut neurology. It’s got nothing to do with the brain.

droffel 6y ago
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. https://en.wikipedia.org/wiki/Tricyclic_antidepressant https://en.wikipedia.org/wiki/Tricyclic_antidepressant
- 55555 6y ago
  The way I read the parent comment: > 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].
  - wittyreference 6y ago
    You read it correctly; thank you for stating it more clearly than I did.

jryan49 6y ago

I have a similar anecdote. Starting an ssri (luvox) cured my ibs.

muraiki 6y ago
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. :)

nikkwong 6y ago

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.

deleted 6y ago
[deleted]
starfallg 6y ago
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.
- ianai 6y ago
  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.
- nikkwong 6y ago

epmaybe 6y ago

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.

FreeFull 6y ago

The gut has its own nervous system: https://en.wikipedia.org/wiki/Enteric_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.

dillonmckay 6y ago
The Second Brain, according to Michael D. Gershon M.D.

agumonkey 6y ago

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.

james_s_tayler 6y ago
That put that in a pitch deck and go get some funding.
- ianai 6y ago
  Might run into severe ego issues blocking doctors from using such service, but probably not enough to make it infeasible.
  - agumonkey 6y ago
    It's surely one factor. Maybe going subtle and only making a system for 'complex cases' so they don't feel useless.
doublerebel 6y ago
The Human Diagnosis Project (YC S12) is something like this. You can see a sample of the cases on their Twitter: https://twitter.com/hdx https://twitter.com/hdx
- agumonkey 6y ago
  well thanks, even though i'm on HN constantly I never saw that project..

fodmap 6y ago

Are you completely free from IBS (that would be a dream come true for me) or are you still suffering recurrent bursts? I'm still fighting my way out of it. The Low FODMAP diet is helping me, and I have an eye on hypnotherapy as my next step. See https://lens.monash.edu/@medicine-health/2019/06/24/1351605/how-hypnotherapy-is-helping-people-suffering-from-irritable-bowel-syndrome-ibs https://lens.monash.edu/@medicine-health/2019/06/24/1351605/...

ElKrist 6y ago
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.
- fodmap 6y ago
  Thank you for your comment. Is your girlfriend sensitive to galacto-oligosaccharides (GOS)? I know there this enzyme therapy for that problem https://www.monashfodmap.com/blog/new-research-enzyme-therapy-can-help-reduce-symptoms-ibs-patients-sensitive-galacto-oligosaccharides-gos-present-legumes-soy-milk-and-nuts/ https://www.monashfodmap.com/blog/new-research-enzyme-therap... but I haven't try it. I'm sensitive to some GOS but I haven't being professionally tested for them. I did a fructose malabsorption test though, and I tested positive.
  - ElKrist 6y ago
    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

dillonmckay 6y ago

The gut is a second brain, kinda...I have always been fascinated by this book: The Second Brain https://www.amazon.com/Second-Brain-Groundbreaking-Understanding-Disorders/dp/0060930721 https://www.amazon.com/Second-Brain-Groundbreaking-Understan... 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.

1_player 6y ago

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.

amai 6y ago

Did you try https://en.wikipedia.org/wiki/Psyllium https://en.wikipedia.org/wiki/Psyllium ? "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" https://selfhacked.com/blog/psyllium-husk/ https://selfhacked.com/blog/psyllium-husk/ https://selfhacked.com/blog/irritable-bowel-syndrome/ https://selfhacked.com/blog/irritable-bowel-syndrome/

klysm 6y ago

Had a very similar experience with tricyclics - almost immediately stopped all the problems I was having.