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Handling IBS Without Zelnorm
Well Olly, It's happened again! The sale of an oft prescribed medication, Zelnorm, was temporarily suspended (by the Swiss manufacturer Novartis) after the U.S. Food and Drug Administration asked for more discussion about a statistically significant imbalance in events (such as myocardial infarction, stroke, and unstable angina pectoris) in patients taking the medication compared to people taking a placebo. The data came from more than 18,000 patients that were part of a clinical trial.
While the experts at the pharmaceutical company and the government sort through this, I thought you might want some tips on what you can do to ease your symptoms of constipation IBS without medication. These come from my book, TELL ME WHAT TO EAT IF I HAVE IRRITABLE BOWEL SYNDROME (now being distributed in other parts of the world in Spanish and several other languages):
Constipation predominant IBS often starts in adolescence and may result from excessive colon contractions, which lead to stool dehydration (hard, stiff stools).
HIGH FIBER
People with this type of IBS seem to improve with a high fiber eating plan. The goal is to consume around 30 grams of fiber a day, so many people have to use fiber supplements. If you increase your fiber too fast, you might suffer from bloating and gas. To prevent this, you can use warm tap water enemas along with the fiber supplement (talk to your doctor about this first). Don't forget to drink plenty of water. (Such as 8 or more 8-ounce glasses every day.) Keep in mind one study found that 55% of patients reported that wheat bran made their IBS worse. So keep notes on what is helping you and what doesn't seem to be helping.
SOLUBLE FIBER
Soluble fiber, which dissolves in water and keeps water in the stools, helps prevent hard, difficult-to-pass stools. I personally think of soluble fiber as the gentler fiber. While in your intestines, it holds on to water and forms a gel. Generally people with constipation need both types of fiber, soluble and the rougher tougher insoluble fiber (that has more of a scrubbing action while going through the large intestines).
FIBER TIPS
* Don't have most of your fiber all at once, spread your fiber foods/supplements throughout the day.
* It takes the intestinal tract up to 6 weeks to adapt to a new, higher fiber food plan. But your intestines might never adjust to some foods, such as cabbage or certain beans.
EXTRA HELP
Your physician may add osmotic laxatives (glycerine suppositories for example) or stool softeners if fiber along isn't doing the trick. The use of stimulant laxatives is definitely discouraged.
ABDOMINAL BLOATING
This is a common symptom in IBS, especially if you are constipated. The bloating usually worsens as the day goes on and improves after sleeping. If you are better able to manage your constipation, the bloating may well subside. Reducing the amount of gassy foods in your diet may also help relieve abdominal pain and bloating. Many gas producing foods contain carbohydrates that are not completely digested in the small intestine. By the time they get to the end of the large intestine, bacteria (normally present in the intestines) have digested these carbohydrates and produced gas as a breakdown byproduct.
Beans, peas, cabbage, and some fruits give many people gas. Milk products can cause trouble in people with lactose intolerance or lactose maldigestion. Alcohol and high-sugar foods trigger symptoms for some. The alternative sweetener, sorbitol, can cause gas in some people too. In general... vegetables should be cooked to reduce potential gas production and fruits should be canned in juice or eaten RIPE, when the fruit and skin are soft.
* Avoid gassy foods: Certain fruits and vegetables and dried beans and peas are particular offenders.
* Avoid raw vegetables (including cucumber and lettuce)
* The following vegetables can cause trouble even when cooked: Broccoli, Brussels sprouts, cabbage, cauliflower, cucumber, corn, kohlrabi, leeks, onions, red/green peppers, pimentos, radishes, rutabaga, sauerkraut, scallions, shallots, turnips, chili peppers
* Dried peas, beans and lentils
* The following fruits can cause trouble in some people: Apple, honeydew melon, avocados, prunes, cantaloupe, watermelon
* Other foods/drinks that may cause trouble: Beer, seeds, hard-boiled eggs, soft drinks, nuts, wheat germ, popcorn, spices like chili powder, garlic, hot sauce, curry, and ginger, spicy BBQ sauce.
DON'T FORGET THE POWER OF EXERCISE
Exercise can help those who tend to have bouts of constipation. Exercise stimulates the colon and moving around and using muscles seems to help get things moving in your GI tract. It's a powerful stress reducer too!
~~Elaine
Related Topics: Video: IBS and Fat, Stress, Anxiety and IBS
Technorati Tags: IBS, zelnorm, constipation, fiber, diet, exercise, fda
While the experts at the pharmaceutical company and the government sort through this, I thought you might want some tips on what you can do to ease your symptoms of constipation IBS without medication. These come from my book, TELL ME WHAT TO EAT IF I HAVE IRRITABLE BOWEL SYNDROME (now being distributed in other parts of the world in Spanish and several other languages):
Constipation predominant IBS often starts in adolescence and may result from excessive colon contractions, which lead to stool dehydration (hard, stiff stools).
HIGH FIBER
People with this type of IBS seem to improve with a high fiber eating plan. The goal is to consume around 30 grams of fiber a day, so many people have to use fiber supplements. If you increase your fiber too fast, you might suffer from bloating and gas. To prevent this, you can use warm tap water enemas along with the fiber supplement (talk to your doctor about this first). Don't forget to drink plenty of water. (Such as 8 or more 8-ounce glasses every day.) Keep in mind one study found that 55% of patients reported that wheat bran made their IBS worse. So keep notes on what is helping you and what doesn't seem to be helping.
SOLUBLE FIBER
Soluble fiber, which dissolves in water and keeps water in the stools, helps prevent hard, difficult-to-pass stools. I personally think of soluble fiber as the gentler fiber. While in your intestines, it holds on to water and forms a gel. Generally people with constipation need both types of fiber, soluble and the rougher tougher insoluble fiber (that has more of a scrubbing action while going through the large intestines).
FIBER TIPS
* Don't have most of your fiber all at once, spread your fiber foods/supplements throughout the day.
* It takes the intestinal tract up to 6 weeks to adapt to a new, higher fiber food plan. But your intestines might never adjust to some foods, such as cabbage or certain beans.
EXTRA HELP
Your physician may add osmotic laxatives (glycerine suppositories for example) or stool softeners if fiber along isn't doing the trick. The use of stimulant laxatives is definitely discouraged.
ABDOMINAL BLOATING
This is a common symptom in IBS, especially if you are constipated. The bloating usually worsens as the day goes on and improves after sleeping. If you are better able to manage your constipation, the bloating may well subside. Reducing the amount of gassy foods in your diet may also help relieve abdominal pain and bloating. Many gas producing foods contain carbohydrates that are not completely digested in the small intestine. By the time they get to the end of the large intestine, bacteria (normally present in the intestines) have digested these carbohydrates and produced gas as a breakdown byproduct.
Beans, peas, cabbage, and some fruits give many people gas. Milk products can cause trouble in people with lactose intolerance or lactose maldigestion. Alcohol and high-sugar foods trigger symptoms for some. The alternative sweetener, sorbitol, can cause gas in some people too. In general... vegetables should be cooked to reduce potential gas production and fruits should be canned in juice or eaten RIPE, when the fruit and skin are soft.
* Avoid gassy foods: Certain fruits and vegetables and dried beans and peas are particular offenders.
* Avoid raw vegetables (including cucumber and lettuce)
* The following vegetables can cause trouble even when cooked: Broccoli, Brussels sprouts, cabbage, cauliflower, cucumber, corn, kohlrabi, leeks, onions, red/green peppers, pimentos, radishes, rutabaga, sauerkraut, scallions, shallots, turnips, chili peppers
* Dried peas, beans and lentils
* The following fruits can cause trouble in some people: Apple, honeydew melon, avocados, prunes, cantaloupe, watermelon
* Other foods/drinks that may cause trouble: Beer, seeds, hard-boiled eggs, soft drinks, nuts, wheat germ, popcorn, spices like chili powder, garlic, hot sauce, curry, and ginger, spicy BBQ sauce.
DON'T FORGET THE POWER OF EXERCISE
Exercise can help those who tend to have bouts of constipation. Exercise stimulates the colon and moving around and using muscles seems to help get things moving in your GI tract. It's a powerful stress reducer too!
~~Elaine
Related Topics: Video: IBS and Fat, Stress, Anxiety and IBS
Technorati Tags: IBS, zelnorm, constipation, fiber, diet, exercise, fda
50 Comments:
I wanna know why this has been taken off the market?
How long do you think it will take for zelnorm to come back and how do we know what is going on with it????
It's funny but I never see experts mention to try avoiding bread..particularly white flour bread.
Once I stopped eating bread on a daily basis ( I haven't bought a loaf of bread in 5 years), I experienced a lot less pain. I gave this advice to a co-worker with the same symptoms and she too experienced less pain immediately.
Seriously, one bagel for me and I feel pain immediately.
I rarely eat bread but when I do it usually a mixed grain or wheat bread. However, I would like to know what is there to take that will equal Zelnorm and I am sure the answer is nothing. It has set us back a very long way for those of us that it worked so well for.
I have been off of zelnorm for 3 weeks now. I haven't eaten any food - only veggie juice and milk. I ended up in the ER yesterday. My GI doctor has nothing more to offer me. Does anyone know how to get this back on the market? People with gastroperesis should not have fiber or fat! This is what I have been told at the University of Minnesota and the Mayo clinic. Careful if this is your IBS symtom.
i am so upset that it is off the market.. i tried amitiza it suks, i got a headache, and threw up.. i hope zelnorm comes back soon!!!
Contact your physician and fight for it...I am not sure how but there may be a way to get it via Novartis directly. I don't know how it's covered though...The person i spoke with at the company told me that there may be a way for me to get it if I go thru my doctor. I have 60 tabs left and I am scared to death of what will happen when I run out.
The Novartis web site said that they were going to try and make it available to people who are not at risk of cardio vascular side effects. You would have to get on a list with your G.I. physician to continue to receive your medication. I am so scared when I run out of my meds. More Fiber and water do not work, I did it for 10 years! I do know that Novartis is still marketing and selling in Europe.
I have been on Amitiza for 3 days. I have had severe headache and more bloating and constipations. I am discontinuing this med. Any suggestions???
To elizabeth, tx:
Try a visit to our IBS Support Group. The members there might have some suggestions for you.
Thanks!
I have been on Zelnorm for several years and I love it. I didn't realize how much it helped until I had to stop taking it. My husband threw away all my pills after hearing about the recall. I am miserable. My niece has IBS also and her doctor put her on Hyoscyamine it seems to help her. I am going to call my doctor and give it a try. Good luck. I want Zelnorm back
The fact that this medicine even made it to the public really makes me angry. I thought that meds were tested for at least 5 years before the FDA gave the go ahead to place it on the market? My 17 yr. old daughter was placed on this med a few months ago. She started having sharp chest pains last month. She said she felt as though she were having a heart attack. We never even realized that the zelnorm could have been the cause! This medicine should NOT be placed back on the market. I know the you all go through. I have colitis, and there is not one med out there for colitis with diarrhea that will work for me. My daughter has been in the ER a minimum of 20 times since last August with her IBS with Constipation, but even she would much rather have to wait for something else before seeing them put that med back on the market and risk someones life. In the meantime, she is on Protonix for the GERDS and Miralax to help with the constipation. She doesn't have pain-free days every day, but they are still not as bad as they were. Until they come up with a better medication to treat IBS with constipation, we will stick with what we have. If you watched your child go through that type of scare, I think you would think twice before giving it to your own child.
I am really bummed out! I only have 4 pills left and I stopped taking the meds yesterday when I found out....I am already in total discomfort! I am gonna hold on to these pills and if I am desperate, I am taking them. I have never had any adverse effects to this medication and have been on it for a year now. My GI doctor (surprise, surprise) has no suggestions as to what I should eat. Eat bland, they say...that doesn't help! Don't you think it would be a good idea for Dr's to have a list of suggested food choices for their patients?
I know tomato products really bug me, and anything fatty or high fiber....I just want zelnorm back! It is the best!
Having taken Zelnorm for over a year and have had great results with it,now it's gone. For the first time in many years I actualy could leave my house without the worry of my IBS flaring up.
I don't know about you but the risk for me are small compaired to what I have gone through without the Zelnorm. I would rather die from a Heart attack or stroke than become a prisoner in my own home again. Please bring it back.
I have taken zelnorm for two years and it worked miracles for me. I have been off of it for about three weeks and I'm miserable. My doctor recommended Miralax, it helps a little. I also take Oxypowder colon cleanser from time to time, but nothing can replace zelnorm, I pray that they will put it back on the market.
I had just filled a 3 month script of zelnorm when i was told of the recall. Threw them out thinking the amitza would work in the same way. Not happening. I just feel like throwing up all of the time. I won't take any more that for sure.
I've been on Zelnorm for over a year. I don't know what I'll do without it!I don't want to feel like I used to; the bloating,pain,constipation was so bad, I'd have wear a size bigger jeans at end of day. Zelnorm made my life so wonderful. I could travel, eat, enjoy every day. Anybody know how to get it from Europe? How about Canada or Mexico? I'll try anything to have Zelnorm again.
While Zelnorm is a good and effective drug and has been withdrawn from the market because of toxicity, let us not forget that some psychological therapies and probiotics provide relief of equal and greater magnitude.
I too would like Zelnorm to be placed back on the market. I was on it for almost 2 years and loved it - it worked beautifully. Since its recall, my Dr. has put me on Amitiza and I have found it to be inferior to Zelnorm. Although I have had no ill effects, the product simply does not work well and I feel like taking it is a waste of time. I want Zelnorm back!
For those of you who can't live without Zelnorm, like myself... You can get the product without an RX just about anywhere but the US. You need an RX to get it in Canada. You can get 100 pills in Mexico for about 80 US dollars. There is even a pharmacy in the airport in Mexico City. In Sao Paulo, Brasil a package of 30 pills was 50 US dollars. In Zurich, Switzerland a box of 100 pills is 120 US dollars. Frankfurt, Germany you can get 100 pills for about 100 dollars. Not covered by your insurance but if you can't live without it. The US is the only country still living in the dark ages.
I've just run out of my Zelnorm, and my doctor is prescribing Reglan. I haven't seen this mentioned for constipation anywhere on the web, and that makes me a little worried. Has anyone else used this?
Has anyone tried Omega 3 fatty acid Fish Oil supplements? I was at my wits end with the bloating and chronic constipation. I was using OTC laxitives until they stopped helping. I ate lots of fiber 25-35 grams a day, ate a good healthy diet, fresh fruits, veggies, pomegranate juice, green tea, no soda, exercised, and drank lots and lots of water to no end. So just the other day a friend suggested taking Fish Oil supplements. So I did 3 days ago and I feel great. No rabbits, no bloating, no side affects. Why didn't my Dr. suggest this to me?
since i stopped the zelnorm my ibs w/constipation has been worse than before the drug. i recently ended up in the hospital e.r. with a totalblockage, not fun. i eat tons of fiber take stool softners and nothing happens. give back my zelnorm it's worth the risk for me. there's too much pain and suffering with out it. i think i will have a heart problem faster with the severe constipation and blockage i am having. miserable in south carolina
I am amazed at how many other people are suffering like myself. I have tried everything I was only on Zelnorm for a year before I became pregnant & stopped taking it. After having the baby I went to refill my prescription only to find that Zelnorm had been suspended! I immediately contacted my GI! She advised me to dbl up on Miralax (only worked some), and prescribed me Amitiza! This medicine should be removed from the mkt. It is a complete waste of our money!!! After reading this info I know understand why my stomach is always qweezy feeling, the bloating & embarrassing gas! I think we should all come together & write to Novartis & plea why should we sufer, we didn't have any negative symptoms, only relief!
This post has been removed by the author.
stopping wheat has been an enormous help for me.
i had been on zelnorm for almost 2 years and it was losing its effectiveness for me....however i was still terrified of what would happen when i stopped. i had decreased it to once a day when i started noticing that my symptoms kicked in later on the days when i had oatmeal for breakfast than the days when i had toast.
avoiding wheat is really hard, but it might be the key for a lot of us diagnosed with IBS (even testing negatively for celiac sprue, as i did).
good luck to everyone.
Amitiza is a great substitute for zelnorm. It acually has worked better for me than the zelnorm. It made me throw up when I took it with food b/c that is what my doc suggested but taking it without food just like with the zelnorm the headaches and nausea were gone.
Has anyone tried charcoal pills? Saw something on the web. but cant find any info except from the manufactor?
Has anyone received Zelnorm yet going through their doctor, the FDA and Novartis? My wife is supposed to be getting her Zelnorm back but we've been waiting months now. She finally got her IND number from the FDA but still no Zelnorm.
Anybody?
Desparately seeking Zelnorm. What a miracle drug. I took Amitza for 30 days - N/V, headache, acid reflux, bloating and on and on. Yes, I am on Miralax as well, very little help. I have IBS and Gastroperesis so forget fiber. I took Reglan 15 years ago, can't remember the side effects or if it worked. Must not have I quit taking it. Is there a natural alternative until Zelnorm returns?
Ocala, Florida
Although I understand the need to have a great drug to help with IBS, I would encourage those pushing for Zelnorm to seriously reconsider. I used it for several years before developing severe chest pain. It was so intense I believed I was having a heart attack. I couldnt sleep at night the pain in my heart was so intense. I had began being tested for a heart condition when I received a letter with the recall notice and realized all that pain (and fear!) was a result of Zelnorm.
amitiza does not work at all dont waste your time the only thing did not give me any side effect of headache and nausea constipation got worse gas and cramps
do you think the use of zelnorm made your IBS worse
Please bring Zelnorm back! OK, some people may have double risk for cardiac problems, but how about the vast majority who don't?
i took zelnorm ever since it came out and it was the only thing that helped me i have severe ibs, my colon hurts so bad every day of my life extreme spasms and Amitiza does NOTHING for the symptoms, it causes diarrrea which makes the pain and agony worse, bring back ZELNORM in some form quick !!
PLEASE bring Zelnorm back. Amitiza is a joke, and so is Miralax. Bloating, cramps, nausea, constipation....who needs it?? Zelnorm worked for me for 2 years. I want it back!!
Ok, all of you on here are bashing Amitiza, however, did you all try it more than a few days to a week for your body to adjust to it? I find it works very well and I have gone EVERY route for CHRONIC constipation. I have Crohns Disease and IBS with Chronic Constipation. I also already have had one surgery. (Bowel Resection-- so, I do know what I am talking about!) Also, do any of you try other sorts of "helping yourselves" such as being pro-active in your lives instead of just relying on medication to fix your problem? ( exercice, eating the right foods, drinking enough fluids, psych. help?) I also watch what I eat. I could be better. I am far from perfect, however, I still need help with medication. I have been using Amitiza now for just about 3 months and have been VERY HAPPY with the results. NO PAIN, NO BLOATING, NO NAUSEA, NO VOMITTING (never ever did any of that stuff!) NEVER A HEADACH ! I just must be one of the lucky ones or one that just didn't copy down all of the side effects on the leaflet that comes in the package. Sorry for being a bit nasty but not fair for this GREAT drug to be torn apart like this for no reason and for "Zelnorm" with worse side effects PROVEN to be this wonderful "miracle drug". I WOULDN'T TAKE IT IF YOU PAID ME AND TOOK MY CROHNS DISEASE AWAY FOR LIFE...!
I have also been taken off of zelnorm and given amitzia...it is horrible, I only took it one time and had an instant headache and was vomiting! I would rather be constipated! I do have to mention that while regular dairy makes my symptoms worse, the new LiveActive cheeses have made a noticable difference in my daily activity. I eat one stick a day with dinner and continue my normal fiber therapy and I have been better (not as good as the Zelnorm though)
TWO SUGGESTIONS:
#1 Hyoscyamine tablets (They are awesome...my stomach and back begin to hurt-I just pop a few and I'm good!)
#2 Buy a book called "What to eat if I have Irritable Bowel Syndrome" and it will help! I've learned to avoid those nasty foods that hurt my tummy.
LAST BIT OF ADVICE: If your DOC hasn't suggested any of these-you need to find a new doc!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Wow--what can I say. I have had CHRONIC constipation with IBS for years. I know--that's backwards.
Usually it's the other way around.
And I do mean CHRONIC. I've had it for about 20 years. I'm 55. I've taken many over the counter med's, but when Zelnorm came on the market and I started it--it was a "miracle drug." I was devastated when they took it off the market. I then tried Amitiza for about a month and a half. That made me nauseated ALL the time. I stopped that on my own. Tried Miralax. That made me so severly sick I thought I would heave my guts up. Stopped that.
I am VERY careful about what I eat and drink lots of water and exercise. Am a very active person, when I'm not sick with my stomach and constipation!!
I have lost 35 pounds on Weight Watchers. My goal is 20 more. Anyway. I'm desperate for help!?! I just recently saw my GI doctor. He couldn't help me. He said I maybe would have to have my colon removed in the future if the problems persist. WOW.... what was I supposed to say to that!?!
God knows... and I'm NOT going to give up on a drug that can help me live a normal LIFE!!!!!!!! Even if I am 55!!!
I have been prescribed hyoscyamine to replace zelnorm. has anyone tried this yet?
I was prescribed symax duotab tablets. I have ibs symptoms with diaherra. I just got them today. I will let you know if these work for my problems too.
Sounds like alot of the Amitiza bashing is coming from disgrunted Novartis reps. Seriosly, Amitiza WILL BE approved April 2008 for IBS-C with PLACEBO like side effects due to 1/3 dose currently available. Headaches & vomiting, sounds like rep talk to me...
i have been taking amitiza for a month now,and i have been eating right and exercising but, can't get rid of my bloating and my back and feet hurt constantly, does anyone have any suggestion on what i can do . thanks, mansfield,ohio
I was raking zelnorm dor years and loved it. the GI put me on amitiza and I have all the side effects including severe joint pain. Has anyone else had these problems. I want my zelnorm back!
I tried Zelnorm and just made my severe IBS worse.
Zelnorm was a gift,I'm miserable,I hope if they can put Celebrex back on the market after the problems it caused Zelnorm will return. After 2 years I doubt it.
Zelnorm did work for me but was a bit too strong and much too expensive. And I didn't like the thought of being on a maintenance drug. Citracel is helpful for me as is regular aerobic exercise.
Thanks for this article! I'll try some of your tips.
My doctor prescribed Reglan for my chronic IBS, which had become so severe it affected my walking, balance, etc. For the first time in years I am pain-free again and feel like being a part of humanity! I know this medication is not for everyone, but it's certainly worth talking to your doctor about. So far I have not had any side effects.
Miralax works wonders for me. My doctor prescribed Amitizah and it did absolutely nothing. Fiber only makes me MORE constipated, bloated, and gassy. Increasing Magnesium intake did nothing. Exlax worked, but the effects were harsh and unpredictably delayed (think 2-4 hours sometimes, and 24 hours others) which caused problems with work. Miralax started working on the third day of a daily one-cap-full dosage. I've even learned to adjust up to a cap and a half during holidays like Thanksgiving because I eat like a pig, and down to 3/4 of a cap on days I don't eat much. One thing to look out for: DON'T take Miralax if you know you are going to consume alcohol that day/night. I had 3 pretty violent diarrhea episodes before I figured it out. I mean, sudden, stop the car on the side of the road or else. Other than that, I can't stop singing it's praises!
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