What a surprise - gut bad = m.e bad

[Mick]

Also, take a look at this paper:
https://europepmc.org/article/pmc/pmc5545964

It says there that it significantly improves gastric emptying. If it is and if this is the mechanism by which it is helping you then it points again to problems with constipation/delayed emptying. And even though the real cause is not addressed by taking mirtazapine it is still helping because that's just the way things are: with faster passage the bacteria profile in gut is better, the absorption is better and many other things are better. And the causes may be practically endless. I've been trying to get tested for many years using X-ray and barium containing contrast in the gut (there is a name for this procedure that is used to find constrictions). It used to be quite a standard procedure because there was nothing else that could be done but not anymore. Now there are so many options (ie. many brands of stomach acid blockers ) that the doctors simply don't know about it anymore.

Anyway, how do we proceed when we see that it may improve gastric emptying? We use other supplements to achieve the same effect. There are so many of them. There was a time when I loved iberogast (before I got sensitive to menthol):
clicks.co.za/iberogast_oral-liquid-50ml/p/130607
You may use equivalent.
You also may use simethicone... (you would think that it can't help you in situations like these but it does)

You may also find useful elm bark powder...
And many other things but... maybe just try these things or rather zinc carnosine first and see if something gets better...

 

[Booble]

I think I'm unusual in that when I'm in the IBS-C-ish mode I feel pretty good. If I keep things inside I have good days. Then when I go, I get either extremely fatigued as soon as I finish going, or I get great discomfort in the lower abdominal intestinal area.
I think I have a lot of adhesions from previous severe endometriosis that the doctors tried to cut away as much as they can and that also may have left scar tissue...but my doc said there were adhesions all in the bowel area as well. So I don't know if that is part of my intestinal issues or not.
Either way, blah. I hate pooping as 8 times out of 10 I feel like crap after for between 4-24 hours.

 

[EddieB]

Whether mirtazapine works within the prostate - i

I don’t associate anything with mirtazapine and the prostate. I did find some studies linking prostate growth with low serotonin levels.
https://www.nature.com/articles/s41598-017-15832-5
Again, just more looking for clues. My prostate became enlarged in my 20’s, way sooner than it should. That’s also when my CFS and digestive issues began as well. The periodic anxiety attacks also. So to speculate, if a serotonin deficiency is the cause, it would have to began back then.

There is supposedly a gene defect that prevents/disrupts serotonin production, but I can’t find much about it, except for super technical stuff way over my level to understand.

Simply: serotonin is produced there (gut, brain, prostate) and consumed immediately on the spot.

Agreed, the brain and gut make their own serotonin. I do not believe that I have a brain serotonin deficiency, I don’t suffer with depression. But serotonin is transported about through platelets. I don’t know if this is to supply/replenish anything or simply means of communication. Maybe, just maybe, the psych will have some answers.
If not, I don’t know what type of doctor there is left to ask. I asked a neurologist and he practically threw me out of the office.

 

[EddieB]

It says there that it significantly improves gastric emptying.

Yes, I saw several studies like that when I first began researching it. There are a number of them claiming improvement with IBS, which is why I finally gave in and tried it at the gastrologist’s requests. The studies seemed to support his claims. I chatted with a guy from Texas that claimed a high daily dosage of it cured his gastroparisis and literally saved his life.

And once past the initial 6 weeks of start up, yes, things did improve. Semi regular bowel moves, decreased nausea, reflux, pain, fatigue, etc. But then started break through days, where symptoms came back for a day or two. Then those became weeks, and then there were no more good days. It felt as though digestion had stopped, I would burp food eaten 4or 5 hours earlier. The doctor had me Increase the dose, but it became even worse. That’s when I decided with my primary doctor to taper off.

These drugs are agonists or antagonists. They push or block chemicals. So again to speculate, for me it either,
1. Was blocking something, then lost its ability to continue to do so
2. Was promoting/pushing something, then ran out of it

 

[EddieB]

I've been trying to get tested for many years using X-ray and barium containing contrast in the gut (there is a name for this procedure that is used to find constrictions

Yes, it’s called a small bowel series, I had it done.

 

[Mick]

Maybe, just maybe, the psych will have some answers.
If not, I don’t know what type of doctor there is left to ask. I asked a neurologist and he practically threw me out of the office.

I don't expect any psych to have this kind of an answer. She will be empathetic with you, she will listen to you, maybe prescribe another drug from this family, maybe a combo of two drugs (m. + something) but don't expect that she will tell you anything beyond what we found here in these papers. I'd rather expect a reaction like at neurologist's if you push too hard. It's simply impossible to know what you ask. And sometimes the body has a paradoxical reaction - that is a funny thing that you never account for and get caught by surprise. You could get the answer by trial and error of many supplements (and drugs) which will take years. But it's still kind of worth to go to find out everything about everything. Don't forget to make a list of your symptoms + a list of questions + a list of papers (titles + abstracts). This should speed things up.

If this doesn't work (and I give you less than 1% of chance, sorry to say that) then all you can do is to try to find the right supplements.

 

[Mick]

Yes, it’s called a small bowel series, I had it done.

So... your guy is much better than my guy... but it's rather a matter of the paid healthcare system. In the US everything can be paid for and in Poland...

It's not that important but: this small bowel series can't be paid for out of patient's pocket; and it's kind of expensive in terms of the state healthcare system; so it can only be ordered by the state healthcare doctors but they avoid it at all costs and thus they do not appreciate that it is necessary and should be performed quite often.

So, the problem is that you never know where and how an obstacle hits you.

 

[EddieB]

And many other things but... maybe just try these things or rather zinc carnosine first and see if something gets better...

It will take a week or two for me to get zinc carnosine. I have a zinc gluconate that my wife takes. Would it be a waste of time to try taking it for now?

 

[Mick]

A week? And what about local supplement shops or even pharmacies? They sometimes carry these (especially the Now brand which is also fine though more expensive and has elm bark in it). Swanson's... ?

Zinc gluconate doesn't work for your gut the same way as zinc carnosine does.
But if you're zinc deficient it will help you somewhat with your gut (and a lot with the rest of your body). But as you said you take a multivitamin that contains zinc. But they often contain zinc oxide and in such a case the absorption is zero (especially in people with gut problems) and additional zinc gluconate might help you.

 

[Mick]

PS. These days some supplements are not available at all. Take a look at quercetin at iherb. Not even one brand is available...

 

[EddieB]

And what about local supplement shops or even pharmacies?

Checked, they don’t carry it. Thanks.

 

[Frunobulax]

I didn't notice that at first. If you do eat protein then it may still be not absorbed.

Protein absorption is tricky. Often the problem lies with low stomach acid: We need to break down the protein to digest it, and we need a lot of acid for that. Some people are protein deficient even though they eat a lot of protein, because their stomach acid is low. Other micronutrients are also affected, vitamin B12 and iron come to mind. And stomach acid is a first line defense against many bacteria that you digest with your food.

Nowadays PPIs are subscribed a lot, other people take antacids, a lot of people have low stomach acid without knowing it. There is a test out there where you can check if you have enough stomach acid, using baking soda. Stuff like Betain HCL can help people with low stomach acid.

But figuring out stomach issues is tricky, so much can go wrong. This would be my checklist:
1. Make sure you have the right amount of stomach acid.
2. Try to feed your good gut bacteria with probiotics and prebiotics.
3. Avoid feeding your bad gut bacteria with sugar and carbohydrates.

I can't remember for sure (this means: check with dr Google just in case) but as far as I remember gut serotonin has nothing to do with brain serotonin and probably prostate serotonin. Simply: serotonin is produced there (gut, brain, prostate) and consumed immediately on the spot.

I would question that. IIRC, serotonin can't cross the blood-brain-barrier, but 5-HTP can (precursor of serotonin). And 5-HTP/Typtophane is also produced by gut bacteria (unless we killed them all with roundup, which is supposed to be harmless for humans bit kills the bacteria living in our gut).

Given that we usually have homeostasis with those hormones, I'd expect low gut serotonin to imply low 5-HTP, hence low brain serotonin.

Before we start considering some crazy theories (because this "gut requires more serotonin" theory is quite crazy but I will not dwell on that this time but basically we still don't know what serotonin is doing in the gut so it's hard to say if it's good or bad to have too much or just the opposite) let's just think about it how this drug may work.

Oh come on. Quite crazy? There has been little research to the function of a lot of neurotransmitters/hormones. Mainstream medicine is to throw drugs at symptoms, but not to ask for the cause of problems. We can't even agree on how to handle insulin, which has been extensively researched. The gut may not need serotonin, but the rest of our body does, and not only in the brain. At the very least because serotonin is required for dopamine regulation, and we do need dopamine pretty much everywhere.

In many years where I eventually started to embrace functional medicine, I had one insight: Our body does nothing randomly. If healthy humans produce any substance A, then we need it for something. And we often get it wrong, just look at cholesterol (which was "evil" for many years, but pretty much all studies in the last 40 years are pretty clear that high cholesterol is innocent, and most likely beneficial - even though this is a complex issue that I won't discuss in detail here).

Given that our medicine has yet to find a treatment for ME/CFS, I checked out a lot of theories that some people might call crazy -- if (and only if) they made sense to me from some biochemical standpoint. And I did find a lot of things that helped me. (I did find many more things that didn't help me, too. Only one way to find out, you know.) Among them raising serotonin, using a serotonin drug and 5-HTP + taking care of my microbiome, which helps me sleep a lot better than I used to. And conversely, if I eliminate these drugs/supplements, my sleep suffers severely within 2-3 weeks. (Because I always try to get rid of drugs/supplements after a while, and in regular intervals.)

 

[Frunobulax]

I don’t associate anything with mirtazapine and the prostate.

I know that some seemingly unrelated drugs helped me with my RLS, drugs that were supposed to be neutral or even detrimental for it. Eventually it turned out that they were all metabolized using CYP3A4 (as is mirtazapine, btw). I wonder if sometimes drugs are beneficial or detrimental simply because they inhibit/enhance other drugs, or compensate for other (epi)genetic influences that we have. Possibly far, far away from the intended mechanism of the drug (e.g. a SSRI designed to enhance serotonin may trigger something via a CYP3A4 interaction).

 

[EddieB]

Thanks for your interest...

Among them raising serotonin, using a serotonin drug and 5-HTP + taking care of my microbiome, which helps me sleep a lot better than I used to. And conversely, if I eliminate these drugs/supplements, my sleep suffers severely within 2-3 weeks. (Because I always try to get rid of drugs/supplements after a while, and in regular intervals.)

Yes, a game of inches, trial and error...

All I can do is look at cause and effect. After an initial 6 weeks of worsening symptoms, the mirtazapine did seem to cause an improvement. Not completely, but better than I’d seen in quite a while, lasted about 8 weeks. Then came break thru symptoms, for a day or two, then subside. Then weeks, then no more. Finally the worse crash I’ve ever had.

My best guess, is that the mirtazapine utilized every bit of something (serotonin?) until it ran out.

I’ve been digging up information on the effects of low serotonin, and according to what I’m finding I may have been severely deficient for years. I don’t really have depression, but the low whole “low serotonin/depression” theory is controversial. Some things of note and questions I have...
1. I have had low blood platelets for years. Since serotonin is a major part of platelets, is there a correlation?
2. If there was a limited supply of “raw material” to produce serotonin, would the brain take priority in claiming it?
3. I’ve had low/low normal testosterone for many years, yet what I’d consider a much higher than normal libido (also indicative of low serotonin). Referring to that study on serotonin and BPH, I had an enlarged prostate at age 30. Is there a connection here? Does serotonin influence testosterone?
4. I have/do suffer from anxiety attacks at times, and am a bit OCD. Also linked to low serotonin.
5. Unexplained fatigue/low serotonin?
6. Excessive amounts of serotonin correlates with nausea, but does deficiency cause it as well?

And I don’t mean to hang all my troubles on serotonin, there are dozens of other chemicals/compounds involved.
It just seems to float to the top of the pile. As for cause and effect, I would suspect an inability to produce/process tryptophan, possibly by mitochondrial/neurological damage from past viral infection. My immunologist strongly supports this theory.

 

[Mick]

the mirtazapine did seem to cause an improvement

Or... something else might have cause an improvement.

And I don’t mean to hang all my troubles on serotonin

Good, I kind of started to worry that you concentrate only on one thing. While it is good to theoretically consider and get to the bottom of this in my experience this almost never helped in any way.
First I used to take a supplement to treat only a symptom and only then I could find a solution because I could see how this symptom reacted. So, what I'd do - I'd go over all of the available combinations. That's how I finally reached a conclusion - I started taking supplements one after another even though I wasn't exactly convinced that they might help me. But they did.