My Drs are baffled

[lyndacarol]

I am glad to hear you are moving away from wheat products (I will have to look for those gluten-free pretzels.). Be aware that very sensitive people can be negatively affected by the smallest amount of gluten (and gluten is EVERYWHERE – in toothpaste, and even teabags!).

Since insulin is very corrosive, I suspect that it may contribute (alone or in combination with gluten) to damage inside your intestines. Also, I know that insulin thickens and stiffens the smooth muscles, such as sphincter muscles. This action of insulin may have led to the need for your two sphincterotomies. In fact, this effect on a sphincter muscle may be part of your current reflux problem.

I am glad to hear that your doctors are cautious. I hope they can rule out this possibility of excess insulin in your bloodstream before they proceed with surgery. I know you are tired of so many blood tests, but I think the fasting blood insulin test is a VERY important place to start.

[Lorielynnjackson]

Hi Lyndacarol, thank you for that explanation, it does sound logical to me, and I will ask for that test when I see them. Why would my body be producing too much insulin, or my ovaries too many follicles( which is why I had to have them drilled when I had the hysterectomy), ... Seems like my body is in hyperdrive? What controls those functions... This is why I am wondering at a larger picture... But you are correct, the pain in my back, pain in my left side, and I have been wondering because a lot of my problems seem to revolve around sphincters not working properly. Would this also give me pain and tachycardia and high blood pressure after eating? What is the treatment for this? Would they have to check my pancreas for cysts and whatnot? I will look at your paper this evening, thank you for your thoughts and advice.
Lorie

[lyndacarol]

Why would my body be producing too much insulin, or my ovaries too many follicles( which is why I had to have them drilled when I had the hysterectomy), ... Seems like my body is in hyperdrive? What controls those functions... This is why I am wondering at a larger picture... But you are correct, the pain in my back, pain in my left side, and I have been wondering because a lot of my problems seem to revolve around sphincters not working properly. Would this also give me pain and tachycardia and high blood pressure after eating? What is the treatment for this? Would they have to check my pancreas for cysts and whatnot? I will look at your paper this evening, thank you for your thoughts and advice.

Lorie, there are several reasons your body may produce too much insulin.

#1 Women's bodies produce excess insulin when they are pregnant in order to develop and put weight on the fetus. I suspect that in some women the pancreas does not return to producing the appropriate amount (for just the woman's needs) after the baby is delivered.
#2 A person may have a tumor in the pancreas, called an insulinoma (either benign or malignant), which produces excess insulin. After my first insulin test found a high level, I was checked for this by a CT scan (I was not found to have an insulinoma.); I believe ultrasound can alternatively be used.
#3 Pancreatitis or inflammation of the pancreas causes increased insulin production.
#4 A diet that puts lots of glucose/blood sugar into the bloodstream will cause a spike in insulin.
#5 A high cortisol (the "stress hormone") level increases blood sugar; and therefore, leads to higher insulin level. (Corticosteroid drugs, like prednisone, Solu-Medrol, act the same way.)
#6 There are lots of substances, like trans fats, gluten, MSG, BPA, etc., that increase the blood sugar, and ultimately increase insulin levels.
There are probably many other reasons for the pancreas to produce too much insulin, which are unknown to me.

By the way, excess insulin (a.k.a. hyperinsulinemia) occurs with obesity, type II diabetes, polycystic ovarian syndrome (PCOS); the most common explanation is that obesity causes the other two conditions (type II diabetes & PCOS), but I think it is the INSULIN that causes all three – just my opinion.

There is no medication available to reduce an excess insulin level; a diet that is low in all things that might elevate blood sugar (and therefore insulin) is the only accepted treatment.

[jimmylegs]

for starters, here are some possibly relevant research titles that have appeared in the ongoing discussion here at TiMS over the last few years

The Association between Magnesium Intake and Fasting Insulin Concentration in Healthy Middle-Aged Women

Magnesium Deficiency Is Associated With Insulin Resistance in Obese Children
"Serum magnesium was inversely correlated with fasting insulin ... and positively correlated with quantitative insulin sensitivity check index ... Dietary magnesium intake was significantly lower in obese children ... Dietary magnesium intake was inversely associated with fasting insulin

Associations of serum and dietary magnesium with cardiovascular disease, hypertension, diabetes, insulin, and carotid arterial wall thickness: The aric study (1995)

Magnesium and glucose homeostasis

Studies on the development of an insulin resistant rat model by chronic feeding of low magnesium and high sucrose

Magnesium sulfate attenuates increased blood-brain barrier permeability during insulin-induced hypoglycemia in rats

Separate effects of Mg2+, MgATP, and ATP4- on the kinetic mechanism for insulin receptor tyrosine kinase

Copper, Zinc, Manganese, and Magnesium Status and Complications of Diabetes Mellitus

and some previous related discussion:

"I agree with your logic. However, it doesn't seem to work for me. I have taken zinc and magnesium supplements for years and my insulin levels remain elevated. (Granted, I haven't had testing..."

"OK so each solaray magnesium pill delivers 100 mg of elemental magnesium. the serving size for 'solaray magnesium glycinate 400mg' appears to be 4 pills. so, the supplement is currently delivering 25% of your daily magnesium needs. you might want to experiment with a couple more of those per day and see how you feel. perhaps there will be a response in fasting insulin."

"I have checked the Solaray magnesium bottle again. You must be correct – the recommended dose is 4 pills per day. I am now taking 4 per day."

[jimmylegs]

and wrt sphincters

The Physiology of the Common Bile Duct: A Singular Observation (1933)
"The magnesium sulphate must have relaxed some spastic sphincter in the intramural portion..."

The effect of magnesium sulphate upon the sphincter of oddi of man (1942)

THE BEHAVIOUR OF THE SPHINCTER OF ODDI IN HEALTH AND DISEASE (1961)
"situated at the confluence of biliary and pancreatic streams, it is able to influence the function of either system" "The only known substances which relax the sphincter are amyl nitrite, nitro- glycerine, magnesium sulphate and egg yolk."

[jimmylegs]

google scholar results on magnesium and hypertension (one of the results is already listed above wrt insulin)

http://scholar.google.ca/scholar?q=magn ... _sdt=0%2C5

[jimmylegs]

Altered Trace Mineral Milieu Might Play An Aetiological Role in the Pathogenesis of Polycystic Ovary Syndrome
http://link.springer.com/article/10.100 ... 012-9592-5

Vitamin D-associated polymorphisms are related to insulin resistance and vitamin D deficiency in polycystic ovary syndrome
http://www.eje-online.org/content/164/5/741.short
"25-Hydroxyvitamin D (25(OH)D) levels showed significant negative correlation with IR and positive correlation with insulin sensitivity (P<0.05 for all) in PCOS women."

Zinc Depletion Causes Multiple Defects in Ovarian Function during the Periovulatory Period in Mice
http://press.endocrine.org/doi/abs/10.1210/en.2011-1599

[Lorielynnjackson]

Hi, jimmy, and wow. Thank you for the research, but I have a questions? Are are these factors similar in people with MS? Can you give me the layman's explanation for these tests and articles? Or is this just general research about the effect of these nutrients on the body? In regards, to the sphincter of oddi, the conclusion from gastro was the the sphincter had spsmed, withholding it's bile, never completely emptying which cause sphincter of oddi disorder 3( the one with no blood tests, just symptoms) and caused the gallbladder to die. It kept spasms after they removed my gallbladder, and was cut wide open dumping excess bile in an already bile abundant location. My tummy was full of bile from the first day I saw this dr, from endoscopy 1. They keep checking me for gastric emptying convinced I have a form of gastroparesis... But tests keep coming back normal. They say bile salt diarhea, and gave me stuff for it, but then I don't go to the potty for days... Which is very uncomfortable, and actually makes me sicker. Last night I had a bad experience, which happens every so often. I made some sweet potatoe chicken soup, and ate about a 1/4 of a bowl, within 1/2 an hr, I felt like I was on fire, then sweating,Then my heart rate skyrocketed..to 120. Then the pain epigastric, some left side pain, nausea, and the feeling of regurgitation came. Took about a 1/2 hr for it to pass. When it passed I was sore in the regions I mentioned and tired. Every day, every time I try to eat, a decent meal. This. Drs telling me to eat small meals but then symtpms all day every day. Did I mention I'm ravenously hungry? :)I woke up refluxy today too, so maybe the stomach is still wrapped properly and valve doesn't work, or surgery failed, or hiatal hernia back. It also does not seem to be getting better, if anything the hiccups are gradually stronger, nausea is strong and more frequent, pain is a little stronger, so it seems progressive or a problem getting worse... Probably the one ihve had since beginning. Cat scan shows normal pancrea, if there was a similar problem with pancreas and inflammation would it show on cat scan and blood tests, or would it be like sphincter of oddi, where no tests prove anything but when the dr goes in you can see its wrong? Or like the gallbladder that died and no tests backed it up (other than hida)... Other than symptoms...?

[jimmylegs]

hi there nutrient deficits and imbalances are linked to all sorts of different conditions.

the research is posted to underscore the amount of academic effort that has been spent on understanding the implications of nutrient deficits on things like insulin status, sphincter spasticity, hypertension, and POCS. what I've posted is the tip of an enormous iceberg. it just goes on and on and on and on.

this kind of info is, imho, rather irresponsibly and excessively glossed over in modern 'health care'.

magnesium is low in lots of people for a variety of different reasons, right down to conventional agriculture practices.

mag depletion can manifest in ridiculous numbers of different ways depending on the complex interactions between genetic environmental and lifestyle factors. you could probably line up hundreds of people each with a separate complaint with the common denominator being low magnesium. same thing with zinc. pretty much with any nutrient that starts to slide, it's can look different in each person because nutrients don't support single functions in the body.

I really hope you can get some testing to determine nutrient status, and follow-up specifically with an expert nutrition specialist. in a less severe situation I would be suggesting serum magnesium and serum zinc to start. in your case I think you need to get as many nutrients tested as possible, as soon as possible, and some professional help to restore nutrient levels - possibly via shots (or even transfusion) since your GI tract is in such rough shape. (which really really sucks!!!)

re shorter term solutions, how do you feel when you eat chicken? same thing as with the soup? bummer to hear that didn't go over well.
I was curious to hear what you thought about the other food options I had mentioned, related to iron and zinc. do you think shellfish or red meat would go badly?

and as for getting nutrients in without setting off the GI issues, what did you think about soaking in a nice magnesium sulfate (Epsom salts) or magnesium chloride bath? and I was also curious re your reaction to the idea of trying out some kids gummie supplements.

oops got some students here, bbl

[Lorielynnjackson]

Hi Jimmy,
Sorry its taken so long to get back to you, but I"m sure you were busy with your students.
I will definitely ask to get tested when I see the Drs next, along with gluten sensitivity tests, and my normal barium swallow and I think endoscopy to see if the nissen fundoplication has slipped or is out of place wreaking havoc on my poor body... the Drs have commented that every time they treat me, if there is a minute chance of a bad side effect from that surgery I get it, is this just bad luck or is it my body reacting. And why failure after failure. is this nutrient level too? Not sure what happened with the soup, perhaps I ate too fast... I had salmon this evening with noodles and cooked seaweed, which was ok except for the fact I am now in pain in my epigastric, left side, and back... no nausea, just full quickly (which is normal i guess after the fundoplication), but i have a suspicion that all this bile that is being dumped into my duodenum and backing up into my stomach is keeping me full? perhaps all that bile is putting pressure and inflammation on the new fundoplication? the Drs said that my stomach could handle it, but what if no? Maybe it has cause problems? Had a hard stabbing (felt like a finger poke) into the right side of my sternum, in my chestbone just above my right breast today... took hours to go away and it was pretty severe. I have been getting the spasms that go right across my chest or left side but the right is new? Any ideas? Chicken seems to be ok, steak/pork only in small chewed well (and even then too much hurts) quantities, raw veggies, salad, etc. give me belly aches and anything remotely gassy give me huge build up after the surgery. Shellfish was ok, shrimp seems fine(except for that horrible food poisoning thing). fish seems fine.... i will look into the kids gummie supplements, should I just take the recommended dose, how do I know how much to take?
Another question (sorry to hog your time) Have you seen the FODMAP http://www.med.monash.edu/cecs/gastro/f ... -high.html that they are using to treat IBS? Any opinions? I would gladly try it except that a lot of the allowed foods on the list I cant eat after the fundoplication, and plus they are uncomfortable for me and the unallowed food probably irritate my already irritated bowls... sorry for the TMI. But am curious about the diet, have you studied or heard any feedback on it?
Lorie

[jimmylegs]

hi no problem busy is kind of an understatement hehe!

hope the docs are good to you re test requests! if not, you might consider asking for a referral to a nutrition specialist.

in terms of failure after failure, your body requires nutrients in order to heal. it has to rebuild you structurally from macro- and micro-nutrients and air and water.

if you can't feed yourself, your body has to work with what it can pull from stores in muscles, bones, liver, fat etc. and over time as your stores become depleted, even that source of material could become problematic.

if you were not in good shape nutrition-wise when they first started operating, surgery would only make it worse. there are a bunch of examples in research of magnesium therapy improving response to the trauma of injury and/or surgery.

unfortunately unless the docs have spent some time educating themselves on magnesium assessment, your status will always have looked just fine in the event that anyone ran a test. so, there's no motivation to treat.

zinc is another micronutrient that is essential for healing. again, currently problematic to assess using standard methods, and therefore unlikely to be flagged or treated.

I'm afraid I'm no kind of expert on functional complications related to surgical interventions - I can only comment on the healing process, not what goes on once surgeons start taking pieces out of the puzzle :S

pain and spasm all sounds linked to magnesium status. would be good to assess that first, treat if needed, and then see what kind of situation is left that could feasibly be just the complications from surgery.

if you can, do try to eat a small quantity of beef or liver or salmon or halibut or shellfish (especially oysters/clams if you can, since those are FAR more nutrient dense than shrimp) on a daily basis. chicken is fine too but not quite as nutritious.. do try to infuse those small portions that your system can handle, with as much nutrient density as possible.

re kids vitamins, they're not all created equal - I like Nordic berries the best so far b/c they have the most zinc. the directions on the bottle say how much to take. for Nordic berries it's 4 gummies a day which delivers 8mg zinc (other products only deliver 5 or less).
you can read the product label here: http://www.nordicnaturals.com/en/Produc ... rodID=1411

i'll have a look at the fodmap link and get back to you - send me a reminder though b/c I'm really busy now til Tuesday!

[lyndacarol]

the Drs have commented that every time they treat me, if there is a minute chance of a bad side effect from that surgery I get it, is this just bad luck or is it my body reacting. And why failure after failure. is this nutrient level too? Not sure what happened with the soup, perhaps I ate too fast... I had salmon this evening with noodles and cooked seaweed, which was ok except for the fact I am now in pain in my epigastric, left side, and back... raw veggies, salad, etc. give me belly aches and anything remotely gassy give me huge build up after the surgery.

For whatever reason, some people seem to be more sensitive to complications from surgery. BOTH times my father-in-law had surgery (one for bladder problem, the other for heart bypass) he developed pancreatitis. The work done on you was closer to the pancreas – I still think you could have inflammation of the pancreas.

Diet of protein and fat sources sounds good, but… noodles usually have wheat/gluten (unless you are using rice noodles). Gluten raises your blood sugar; increased blood sugar raises the insulin level produced in the pancreas. You might try juicing vegetables – nutrients would be easier to absorb, giving your system a break.

[Lorielynnjackson]

Hi Jimmy, thank you for your advice, you and lyndacarol have been great, no one has explain things like this to me before, and maybe I can point my doctors in the right direction. Perhaps they are just too close to the situation involving me and my body and its crashes over the last year and a half. I think pancreatic is a good place to start, especially with the last operation. About 7 or 8 yrs ago they did a couple of fasting blood sugars that came back abnormally high, but then I had a couple of normal readings, so we just dropped it. Perhaps this is an old problem, or perhaps there's small cysts or something in my pancreas giving me intermittent issues. (would they have seen that in a cat scan? or ultrasound? Or only a special test?
Jimmy, thank you for looking into the FODMAP for me, so much hype about so many different diets... the only thing familiar I see on there is that fish chicken, gluten free... the longer I look at my problems the more it seems I might have to go gluten free even if there isn't a gluten issue. I love my bread. Pretzels, rice noodles I really like these gluten free, and even choco chip cookie gluten free mix is nice. thanks for the advice on juicing... I don't have a juicer, but it is something to keep in mind if this is going to be a permenant issue for me. Lyndacarol, thank you for sharing about your father in law, perhaps I am just sensitive or perhaps it is a mix of issues, like I am sensitive, plus i don't have the nutirients to heal properly which has messed up my fundoplication causing me other complications... what a mess. I feel like such a mess.... thank you both for your insights... i am truly thankful I found this forum.
Lorie ps. can i enroll in whatever class you are teaching Jimmy? the explanations are just my speed:)

[Lorielynnjackson]

Lyndacarol, I saw your post about nutrients being absorbed into the duodenum and your recommended diet? But I can't find the post anywhere, can you repost for me?
Lorie

[jimmylegs]

no worries lorie
I don't think you'd like the class - unless you want to know how to design studies and put together a research paper

interesting fyi :
Nutrition Support in Acute Pancreatitis: A Systematic Review of the Literature
http://pen.sagepub.com/content/30/2/143.short
"Patients with acute severe pancreatitis should begin EN early because such therapy modulates the stress response, promotes more rapid resolution of the disease process, and results in better outcome. In this sense, EN is the preferred route and has eclipsed PN as the new “gold standard” of nutrition therapy."

not sure that would be 100% applicable in your case... EN means you get the nutrition support via regular eating.. PN is IV.

Evolution of nutritional support in acute pancreatitis
http://onlinelibrary.wiley.com/doi/10.1 ... x/abstract
"no evidence that nutritional support in acute pancreatitis affects the underlying disease process" (the flip side of that is, there's no evidence that it doesn't affect the disease process - just identifies a gap in research)
"... but it may prevent the associated undernutrition and starvation, supporting the patient while the disease continues and until normal and sufficient eating can be resumed"
yep that's definitely important either way.

Micronutrient antioxidant intake in patients with chronic pancreatitis
http://europepmc.org/abstract/MED/15471 ... GAceI80.12
"dietary intake of vitamin E, riboflavin, choline, magnesium, copper, manganese and sulfur was significantly lower than that of controls as well as the Recommended Dietary Allowance (RDA). Dietary intake of selenium and vitamin C was within the limits of the RDA but was lower than that of controls"

hope you can get your hands on some of those Nordic berries - and also get yourself in a nice bath for a magnesium soak