Irritable Bowel Syndrome Message Boards | A few questions for Heather (or others who think they know the answer :))

I'm following the IBS diet since a while back but I still need to take loperamide to keep my IBS-D under control. I have read Heather's First Year IBS book and it says there that you might have to try several of the key strategies to get and stay stable, thus implying that just the diet might not help all IBS sufferers. I feel I am probably pretty sensitive to the IF foods, but I think stress is probably the biggest trigger for me. Now to my questions:

1. Is it always better the more SFS you take? I take 4 g before breakfast every day. Before my IBS got bad that was enough to stabilize me, but then it didn't work anymore which was what made me start with loperamide (and go through the tests to get a proper diagnosis). I tried once to increase the dose to 8 g a day (divided in 2 doses) but then it seemed it didn't get better - it was just more of the bad stuff that needed to come out, if you know what I mean...

2. It says in Heather's book that you need to drink - a lot - in order to make the SFS work. Now because I have had a paralysis disease when I was a kid my bladder is a bit sensitive and so if I drank that much I'd pretty much spend the whole day in the bathroom anyway, just empyting my bladder instead. It says on the bottle of my SFS that you should drink one glass of fluid with each dose. But when I talked to the pharmacist about it she said that I should not drink so much because when drinking less the SFS would just absorb the excess water in my bowel system. Kind of a contradiction...

3. I haven't been able to find a SFS in Sweden that doesn't contain an artificial sweetener. There are no ones with sugar either. The one I use now is based on sterkulia and contains the sweetener "sackarin" (in Swedish

). I have been thinking of buying Heather's SFS online but that is really expensive when you don't live in the US plus if you're unlucky you might have to pay duty on it too. I've even approached the leading health store chain in Sweden and suggested that they would import Heather's products but I haven't received the answer from the product manager yet. Any suggestions?

3. In the books it is stressed that everything should be low fat, though I find it the best to neither eat too much nor too little fat I think. I'm just wondering: by your standards - what is considered low fat? Examples of products in Sweden:

*Soy milk (no oil): 2 % fat
*Oat chocolate drink (with oil): 1.5 % fat
*Soy ice cream: 10 % fat
*Oat ice cream: 9 % fat
*Soy cream cheese: around 40 % fat!!!
*Soy yoghurt: 2 % fat

Oh, and it says in the book that cocoa powder is basically fat free. Do you mean that you typically use so little in say a cake that the fat contribution to the whole cake is minimal per serving? Because at least in Sweden the cocoa powder in itself has a 20 % fat content.

I haven't been able to find any soy products marketed as "low fat" at all in Sweden!!!

4. Now a question about functional D vs IBS-D: I think in Sweden they don't really make a difference between the two. Like so many others I got an IBS diagnosis based only on symptoms long before it got bad and I had the necessary tests done. And I think that the GI specialist who did my colonoscopy just wrote functional bowel disease in the letter he sent to me with the results. As far as I can remember from when I read about functional D somewhere on this site, it was stressed that pain was a big difference
between IBS-D and functional D, being present in IBS-D but not in functional D. But I thought pain was not necessary for the IBS diagnosis according to Rome II? Isn't it enough to have 2/3 of pain, change in frequency, change in stool appearance? I used to have stomach cramps associated with D back when I had the occasional attacks, but since I started getting D pretty much every day I find I'm more nauseous than being in pain. It's more a question of un uncomfortable feeling in the stomach.

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I want to learn all the tips and tricks there are to control this, since my fianc� and I are thinking about trying to get pregnant next year. And it's impossible to say if loperamide is safe or not during pregnancy as some of the very limited data available suggest an increased risk for the fetus though it might just be a statistical coincidence because there is so little data, and some say there is no increased risk. And it's a hard desicion to make to stay on it or not. I don't want to risk hurting my future baby, but right now I can't imagine not being on loperamide either - I mean - what if it takes a really long time to get pregnant? And you can't exactly go on sick leave for trying to get pregnant, so... Loperamide is what has (for the most part anyway) made it possible for me to have a "kind of almost normal" life. (Loperamide also helps increase the anal sphincter tonus which is good for me since the paralysis I had when I was a kid has left me with a nerve damaged sphincter, which isn't exactly making the whole IBS-D thing easier...

)

Ooops, long post again... Sorry!

/Ulrika, IBS-D

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