Bathroom Issues

What is hidden lactose?

Although milk and foods made from milk are the only natural sources of lactose, it is often added to prepared foods. People with very low tolerance for lactose should know about the many food products that may contain even small amounts of lactose, such as

bread and other baked goods

processed breakfast cereals

instant potatoes, soups, and breakfast drinks

margarine

lunch meats (other than kosher)

salad dressings

candies and other snacks

mixes for pancakes, biscuits, and cookies

powdered meal-replacement supplements

Some products labeled non-dairy, such as powdered coffee creamer and whipped toppings, may actually include ingredients that are derived from milk and therefore contain lactose.

Learn to read food labels with care, looking not only for milk and lactose, but also for words such as whey, curds, milk by-products, dry milk solids, and non-fat dry milk powder.

If any of these words are listed on a label, the product contains lactose.

Lactose is also used in more than 20 percent of prescription drugs and about 6 percent of over-the-counter medicines. Many types of birth control pills contain lactose, as do some tablets for stomach acid and gas. However, these products typically affect only people with severe lactose intolerance.

SOOOO…. If you are using protein products (powders, shakes, bars, etc.) keep that in mind! Also, people are often terrified that being lactose intolerant means they will never be able to again consume cheese. Remember – there are alternatives available! Some people do GREAT with goat’s milk or sheep’s milk cheeses where they are irritated by cow’s milk cheese. (Also, don't forget, the harder the cheese, the less likely you are to have an issue with lactose intolerance with it.)  Just remember to do any “trials” with some basic controls in place – i.e., don’t consume something that may or may not be an irritant for you around the time you are doing a test to see if goat’s milk cheese is a good alternative for you!

Next, some people are just super sensitive to fats. And it’s an easy thing to want to make a sweeping generatlization and say “all fats are bad” or “all one type of fat or the other” is bad. The fact of the matter is we each have unique physiology and some people tolerate fats poorly all the way around. If that’s the case, respond accordingly – use fats sparingly. Do, of course, give it a good go of trying some alternatives to the fats you use in your day to day life. I.e., if you’ve always used margarine, then try butter. If butter isn’t working out for you, try olive oil. So on, and so forth.

Next, supplements. This is basic stuff, but sometimes we forget it. Calcium citrate – not in company of magnesium – is something akin to quick dry cement in the bowels. So – again – a basic: every post-op needs 2000 mg of calcium citrate daily – AT LEAST. (Of course, labs are the determiner of how much!) Calcium citrate typically comes in a formulation that includes a 2:1 ratio calcium to magnesium, and hopefully has some D3 thrown in there as well. All good and wonderful – unless you are sensitive to magnesium. Some folks are. If that’s the case, you need to try a trial and error between magnesium citrate and magnesium oxide. Magnesium citrate is actually used to specifically move the bowels (more than move – actually clean out!) – ever been given a bowel prep? That’s what it is! You can/will have some benefit from the citrate – particularly if you are one of us who lean more toward the side of constipation as a post-op – but that’s not the topic at hand. (Interestingly enough - magnesium citrate helps support nerve and muscle function. It is also involved in carbohydrate and mineral metabolism and assists in calcium and potassium uptake.)

If you find that the brand of calcium is bugging your gut – and there are different variations on that theme – sometimes it’s stomach ache (Citracal is notorious for this!), sometimes it causes gas/bloating/distension (again, Citracal is not unusual to see with these types of complaints) – THEN IT’S TIME TO TRY ANOTHER BRAND! There are LOTS of them out there. BUT – PLEASE – be certain you are choosing Calcium Citrate.  It’s the best choice for DS’ers. Honestly. Totally serious.

The product that more people say has made their lives vastly improved with regard to lessened BM frequency is UpCal-D. It’s a powder, it has 500 mg of calcium citrate in one serving (which is awesome!), and it has D3 in it. I like it because it’s so easy to take. I get the little packets of it, open one up – dump it in on my tongue, let it dissolve a bit, and then chase it with a sip of tea or something. It tastes a little bit like pixie stix dust. You can find it at Vitalady or Amazon.com – compare prices – bargain shop. This stuff is worth it’s weight in gold. Thankfully, it’s nowhere near that expensive! (I think we pay $12 for about 120 packets.)

You may need more than 2000 mg of calcium citrate a day to firm things up in the bathroom department. That’s okay. The key is to baby step to the correct amount for you.

Next, accountability sucks – but we all know it’s good for us. That’s why I love

www.fitday.com or www.sparkpeople.com  – they are a great place to get a reality check. Do some basic recording of what goes into your mouth – and then also pay attention to what’s going on in the bathroom department. It’s hard to know if the stuff that’s going into your mouth is causing a problem if you don’t know what’s going into your mouth. I know, I know – it smacks of weigh****chers – but if it’s going to improve your quality of life significantly, is it worth working past the flashbacks of WW?! LOL! (The answer to that is supposed to be yes, by the way!) Pay attention to the details. If you’re finding that having a Wendy’s frosty is giving you killer gas, distension, bloating, and then a little later on explosive diarrhea – well, folks, there’s proof in the pudding there. (Sorry, I couldn’t help it!)

Next, it’s entirely possible you’ve got a bug going on in your gut that needs medical attention. Get tested for c. diff, h. pylori, and bacterial overgrowth. These are treatable. Why suffer if there’s something that can help – even though it may take a little bit of dedication and work to get there?

Finally, if you’ve tried all of these things and you’re still experiencing frequent BM’s, your labs are showing you to be in malnutrition (and there’s a profound difference between managed malabsorption and malnutrition, folks!), then it’s time to talk seriously with your surgeon and your PCP about whether or not you are in need of a revision. Lest you be panicking right now – it’s not the norm – not everyone goes through this – it’s the exception. It totally and completely as profoundly as possible SUCKS big time that *anyone* has to go through it. BUT, the great news is that those who do find that a surgical response is the best option for them find that it DOES, in fact, make a huge difference and brings hugely improved health and quality of life.☺

All of that being said, we have to be honest with ourselves, as well. I’ve lost count of the patients I’ve talked with who have been suffering horrible bathroom issues, have identified the cause (not at all out of the ordinary for it to be won ton indulgence in sugars – remembering that sugars come in lots of different forms!) and then look me in the eye and say, “I’m not willing to give up the sugar.” To that I have to say, “That’s completely your choice. I can’t make that choice for you.” But if you do make that choice – own up to it. Please.

I guess I need to add one more little snippet here before I close.  Everyone always assumes that what it's like the first month, three months, six months, year - even two years - is what it's like forever more.  That's sort like saying as a human - my whole life will be just like it was my first two years of life - babyhood and toddlerhood.  Yeah, not so much.  Things even out with time.  Lots of growing up happens over the course of those first few years as a post-op.  Figuring out that there are good and bad decisions dietarily AS HUMAN BEINGS - not just DS post-ops - is one of the lessons that happens during that frame of time - hopefully.

Okay – so that’s my book length post for the day! LOL!