Irritable Bowel Syndrome: Managing Weight Loss and Bloating Challenges

Irritable Bowel Syndrome (IBS): Dietary bloating, weight loss to underweight?

Irritable Bowel Syndrome: Dietary Bloating, Weight Loss to Underweight
Hello Doctor, I have been seeking medical attention for over a year and have consulted many doctors.
As of January 19, 2021, I had a peptic ulcer and duodenal ulcer last year, for which I took gastric medication (such as H2 blockers) for nearly a year, stopping in November of last year.
It has now been over two months since I stopped taking the medication.
The reason for my inquiry is that during the period from August 15, 2020, to December 7, 2020, my BMI dropped from normal to underweight (from 72 kg at 183 cm to 61 kg), resulting in significant thigh muscle atrophy.
Due to the abnormal weight loss, I went to a large hospital (medical center) where various tests were conducted, including gastroscopy (no Helicobacter pylori), CT scan, colonoscopy, and blood tests, all of which showed no abnormalities, confirming a diagnosis of Irritable Bowel Syndrome (IBS).
Currently, I am taking Dicetel (100 mg three times a day) along with enzymes and probiotics (Bifidobacterium, taken regularly with meals for the long term) to alleviate bloating.
The enzymes were prescribed because fatty meats are difficult to digest (and they have indeed been helpful).
Additionally, I take one Ambien (50 mg) at bedtime due to insomnia, which is also a reason for my weight loss, as my neighbors are quite noisy, and I tend to be a more anxious person.
I started taking it in December 2012.
Previously, I was also diagnosed with IBS at a local clinic and took one Subitram at bedtime for three months (from August to November).
I have no history of mental illness and have served in the military without issues.
This is the first time I have been prescribed such medication to assist in treating IBS.

The ongoing weight loss is likely due to two main factors: bloating from consuming fatty meats, leading to discomfort, and insomnia.
From December 7 to January 11, my weight returned to the lower end of the normal BMI range (from 61 kg to 64.5 kg, stabilizing at 64.5 kg for three weeks).
However, in the past week, I have eaten a bit less, and my weight has slightly decreased (to 64.15 kg).
Every time I eat, if I consume too much fat or meat, I experience bloating and a feeling of indigestion.
Even after 4-5 hours, I still feel bloated.
However, if I avoid fatty meats, my weight drops to a dangerous level.
For example, I can digest pan-fried sea bass relatively well, but salmon is harder to digest, and chicken thighs lead to excessive stomach acid and gastroesophageal reflux.
If I only eat easily digestible sea bass, my weight will inevitably decrease (this is the conclusion I have reached over the past three to four months).
I previously spent three months eating only boiled sea bass, which resulted in weight loss.
Even when I switched to fried eggs and fried sea bass, along with one bottle of Ensure per day, my weight still decreased.
It seems that sea bass and eggs are not sufficient? I have supplemented with Ensure, but if I drink too much, it triggers IBS and causes diarrhea (eating too much also leads to IBS-related diarrhea).
Additionally, I stand and move slightly for two hours after each meal to avoid acid reflux and aid digestion.
However, I am still too weak to exercise outdoors (most of the time it is too cold), but I try to sit by the window to get sunlight (if available) and do light indoor exercises (not too vigorous, just slight movements).

My question is: every meal feels like a challenge for me, and over time, it has become exhausting.
I wonder if you have any suggestions? Despite my efforts to eat, I still cannot seem to break through the weight barrier of 65 kg.
Could there be other issues affecting this? I cannot eat an additional meal because I feel like my gastrointestinal tract has not fully digested what I have already consumed (bloating? or a sensation of fullness in the stomach, excessive stomach acid?), and if I force myself to eat more, I end up with diarrhea.
I find it incredible and perplexing that a peptic ulcer, which is not very severe, could lead to such serious consequences.
I have already resigned from my job to recuperate for over half a year, yet I have not seen significant improvement.
Although I do not have urgent financial pressures, I hope to recover soon.
Am I truly only dealing with IBS? If there are other possibilities, please let me know.
Thank you! If you have any dietary recommendations, please share! Additionally, I am concerned that taking Ambien will lead to dependence, and that I won't be able to sleep without it in the future.
Is that a possibility? Thank you!

Mr. Huang, 30~39 year old female. Ask Date: 2021/01/19

Dr. Chen Shidian reply Gastroenterology and Hepatology

You seem to have a tendency towards anxiety, and it is advisable to seek assistance from a psychosomatic specialist (along with a metabolic specialist to rule out any new metabolic diseases) for management.

Reply Date: 2021/01/19

More Info

Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder characterized by symptoms such as abdominal pain, bloating, gas, diarrhea, and constipation. It can significantly impact a person's quality of life, especially when it leads to weight loss and nutritional deficiencies, as you've described. Your situation is particularly concerning given the significant weight loss and the challenges you're facing with digestion and bloating.

Firstly, it’s important to understand that IBS can manifest differently in each individual. Some people experience more diarrhea (IBS-D), while others may have more constipation (IBS-C), and some may alternate between the two (IBS-A). The symptoms you describe, including bloating after consuming fatty or oily foods, suggest that your digestive system may be struggling to process certain types of food, which is common in IBS.

Your weight loss from 72 kg to 61 kg is alarming, especially since it has led to muscle wasting in your thighs. This indicates that your body may not be receiving adequate nutrition, which can lead to further complications. The fact that you have undergone extensive testing, including endoscopies and imaging, and found no significant abnormalities is a positive sign, but it also leaves the question of what is causing your symptoms.

The medications you are currently taking, such as Dicetel (an antispasmodic) and probiotics, are appropriate for managing IBS symptoms. However, it seems that your dietary choices are still a significant challenge. You mentioned that consuming oily or fatty foods leads to bloating and discomfort, while avoiding them results in further weight loss. This creates a difficult cycle where you are unable to maintain a healthy weight due to the fear of triggering IBS symptoms.

Here are some suggestions that may help you manage your symptoms and improve your nutritional intake:
1. Dietary Adjustments: Consider following a low-FODMAP diet, which has been shown to help many individuals with IBS. This diet involves reducing certain carbohydrates that can ferment in the gut and cause symptoms. Foods high in FODMAPs include certain fruits, vegetables, dairy products, and wheat. Working with a dietitian who specializes in IBS can help you identify trigger foods and create a balanced meal plan.

2. Small, Frequent Meals: Instead of three large meals, try eating smaller, more frequent meals throughout the day. This can help reduce the burden on your digestive system and may alleviate some bloating and discomfort.

3. Hydration: Ensure you are drinking enough fluids, but try to avoid excessive amounts of water during meals, as this can contribute to a feeling of fullness and discomfort.

4. Physical Activity: Gentle exercise, such as walking or yoga, can help stimulate digestion and reduce bloating. Since you mentioned that you are unable to engage in vigorous exercise, even light stretching or movement can be beneficial.

5. Stress Management: Stress can exacerbate IBS symptoms. Consider incorporating relaxation techniques such as deep breathing, meditation, or mindfulness practices into your daily routine.

6. Monitor Your Symptoms: Keeping a food diary can help you identify patterns between what you eat and your symptoms. This can be a valuable tool for both you and your healthcare provider in managing your condition.

Regarding your concern about the medication Anpan (an anxiolytic), it is important to discuss this with your doctor. While some individuals may develop a dependency on certain medications, your doctor can help you find the right balance and may suggest alternatives if necessary.

Lastly, if your symptoms persist despite these interventions, it may be worth exploring other potential underlying conditions with your healthcare provider. Conditions such as small intestinal bacterial overgrowth (SIBO), celiac disease, or pancreatic insufficiency can sometimes mimic IBS symptoms and may require different treatment approaches.

In conclusion, managing IBS can be challenging, especially when it leads to significant weight loss and discomfort. By making dietary adjustments, eating smaller meals, staying hydrated, engaging in gentle physical activity, and managing stress, you may find some relief. It is crucial to maintain open communication with your healthcare provider to ensure that you receive the support and guidance needed to navigate this condition effectively.

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