Flagyl is sometimes prescribed for excessive gas and diarrhea. It is an antibiotics that works well on certain bacteria that accumulates in the GI tract and contributes to the gas and the bloating.
These bad bacteria flourish when patients consume significant and excessive fiber and carbohydrates (sugars, salad, pasta etc.) The FIRST line of defense against flatulence, bloating, and diarrhea should be eleminating the culprits in the diet. This point can not be stressed enough. Adding a daily dose of yogurt may improve symptoms due to yogurts probiotic benefits. To be beneficial, Yogurt should contain live bacteria cultures, not contain artificial sweeteners or have a high sugar content.
Artificial sweetness also area source of the excessive gas and should be avoided.
Before Flagyl is prescribed, it is important that the diet is critically examined to make sure that the carbohydrates and the fiber as source of gas and bloating is minimized or eliminated. Excessive use of medications that may be needed for other infections should be avoided.
Chronic diarrhea should be evaluated to rule out GI infection with C. diff bacteria or other bacteria or parasite.
Additional Information on C. Diff (Clostridium Difficile) and probiotics.
The consumption of carbonated drinks is discouraged after weight loss surgery. In fact, there is a wealth of information that documents the detrimental health effects of carbonated drinks for each individual. These include osteoporosis, obesity, and premature dental decay, just to name a few. Indirectly, carbonated drinks have been found to increase risk of stroke and Cardiac events. There are studies that show a 48% increase in heart attack and stroke rates for individuals who drink diet sodas vs. those who drink it rarely or not at all.
There is also no health benefit to diet carbonated drinks. In fact, there are animal studies that show that rats who consume no-calorie sweeteners found in diet sodas experience an increased appetite (Susan Swithers, PhD- 2004).
There are also other factors to consider. The carbonation comes from a mixture of dissolved gasses that are released when the container is opened. The Carbon Dioxide gas dissolved in the drinks, amongst others, can distend the stomach. Potentially, stretching your stomach. There is also acidity that needs to be corrected by the body. This has been shown to result in changes in the bacterial population in the GI track, resulting in significant bloating and reduced absorption of nutrients.
Calcium loss is caused by the leaching of the calcium from the bones with carbonated drinks, which can cause osteoporosis.
The relationship between the consumption of food, bloating, and excessive gas is a subject that comes up frequently. In our practice, this is a complaint usually raised 3 or 4 years after receiving the duodenal switch operation. It appears that patients eventually disregard the recommendations made for a healthier diet of low carbohydrate, high protein, hydration, supplements, and then everything else.
In general, carbohydrates, carbonated drinks, artificial sweeteners (such as Splenda®, sugar alcohols, etc.), vegetables, excessive amounts of food, and an intake of fat will cause significant gas and bloating. This is not to be taken out of context and assumed that one cannot consume any of these products. However a diet that has fruits and vegetables will cause significant gas and bloating. These can not be controlled by probiotics, antibiotics, or other products such as Beano.
Simple carbohydrates/sugars (sugar, candy, cakes, cookies, pies, regular soda pop, jelly, jam, syrup, ice cream, sherbet, and sorbet, etc.) are easily absorbed. Simple carbohydrates/sugars can increase diarrhea due to the Duodenal Switch allowing more undigested sugars/fuel for intestinal bacteria to feed upon, multiply and form gas. The end result can be gas, bloating, and diarrhea.
Complex carbohydrates have more structure than simple carbohydrates/sugar which are harder for the intestinal bacteria to break down and may cause less bloating, gas and diarrhea. Also, complex carbohydrates usually contain higher fiber content. The fiber in the colon will help to absorb water from the stool and can reduce diarrhea. However, this is not the case for all Duodenal Switch patients.
When a patient reports these problems, I recommend that the consumption of all carbonated drinks should be stopped. No patient should consume carbonated drink of any sort. Artificial sweeteners should also be avoided all together. A good alternative would be honey, maple syrup or Stevia. Minimize or reduce the carbohydrate intake.
It has been our experience in the majority of cases that excessive gas and bloating is a result of dietary indiscretion. In some patients, once the dietary sources have been ruled out, it should be further evaluated by a barium enema to rule out the diagnoses of a redundant colon.
The best approach would be to first go back to a high protein and low carbohydrate. This should allow a patient to rule out any dietary sources for the bloating and excessive gas. It is recommended to next be seen by your physician for a further workup.
To summarize, when a patient has excessive amount of gas, diarrhea and bloating, the first line of treatment is elimination of all of the possible causes. These include carbohydrates, fruits, vegetables, artificial sweeteners, carbonated drinks and milk products. I can not overemphasize the importance of this step prior to anything else such as antibiotics or probiotics.
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