# How long does a trigger take



## mpacks (Apr 24, 2003)

OK. I'm new to this so be patient with me. A couple of weeks ago I decided to change my diet to do something about my D which was progressively getting worse. To try to make this as short as possible, a week ago I started using Citrucel which is doing a good job of firming things up. I also decided to try a gluten free diet (icky, pooey, yucky) for a few days to see what happens. I have a nice serving of citrucel every morning when I get up and again at night before dinner. Yummy!The last couple of days, as I said, the Citrucel seems to be doing its job but I still get crampy like I'm going to have D. So, yesterday I started popping an immodium as needed (is this a good idea?) Yesterday, in the morning I had a Clif Bar that had chocolate chips and oats in it and I decided to skip the gluten-free diet and had pasta around 8:00 for dinner. The pasta just had a little olive oil, garlic powder and italian seasoning.So, this morning I was awakened at 5:30 with the need to go. Relatively firm, but urgent. I'm almost never awakened with the need to go. So, the question is ... how long does it take a trigger food to trigger activity? How do I know what's triggering it until I know what the time frame is?I've thought for the past year that I was lactose intolerant and read yesterday that if somebody is lactose intolerant they will have diarrhea within 30 minutes to two hours after consuming dairy. This doesn't describe me -- if I have pizza for dinner, the diarrhea hits the next day. If I have pizza earlier in the day, it might hit later in the evening or the next day. So, am I really lactose intolerant?On a side note, I'm getting frustrated by the inconsistencies in the books I'm reading on this topic. One book says Fibercon is soluble fiber, another says it's insoluble fiber. One book says pepperment is good, another book says stay away from peppermint. Some books completely ignore the distinction between insoluble and soluble fiber. AAARRRGGGHHHH!!! Sorry, just venting.Thanks for any help.Mark


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## Engine23 (Nov 19, 2002)

Mpacks,You have described a problem many of us have. We simply have different trigger foods that have different trigger periods. I love chicken fried steak and eat it about every three months and then race home because it triggers a near immediate reaction. I have other trigger foods like a normal dinner salad that take one day to cause an attack. So your job is to find trigger foods and there corresponding travel times. Now wont that be fun. I would keep a diary of foods you eat and then look for at the previous day to two days each time you have an attack and find similar/same meals that may have caused the problem. Also keep in mind the fact that sometimes we just get sick with even the best diet and medication.Welcome to the board!Stay SafeAndy


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## Mercedes . (Apr 4, 2003)

Hi MarkI suffer with mainly abdominal pain and I have found that some trigger foods give me instant problems for example if i eat a pizza with in ten minutes of the first bite my abdomen has swollen up and I am in loads of pain, BUT (Sorry to be difficult) sometimes it can take a few hours before I feel anything, I ate a few strawberries the other day and a few hours later I had bad stomach pain. I guess it really depends on the person. I suggest keeping a food diary - write in it everything you eat and what happens to you it may help you figure out what you can and can't eat


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## mpacks (Apr 24, 2003)

The more I learn the more I realize there's no easy answer to any of this. The book I started reading yesterday and the van Vorous books make the point that dealing with IBS is really about a way of life. It's basically a constant vigilance of what's going in and the effects.Mercedes and Andy -- thanks for your quick replies!!mark


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## Jan LEAP RD (May 19, 2002)

Hi Mark,Having worked with many LEAP clients for over a year, I hate to tell you that it may be a lifelong thing. But, many clients find that taking the time to cook special foods, rotate their foods, limit their intake and keeping records is a price well worth paying in order to feel good again and live without diarrhea.IBS-D responds very well to the LEAP program. (You can read about it elsewhere on this board, or visit www.nowleap.com)And, because everybody is different, no one book or protocol works for everyone.Wishing you well,Jan -LEAP RD


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## loulou (Jan 18, 2001)

Your reaction to the pasta may be the carb's and not gluten. Have you been tested for parasites? Parasites love carb's. You may want to test out the Atkin's diet. If this is helpful to you then there could be a connection. I spent ten years wrongly diagnosed with IBS-D but now know I'm lymphocytic colitis instead. I always had my symptoms begin in the wee hours of the morning, but I believe that the chance that you've got this to be less likely since fiber seems to be a huge trigger for this disease.LouLou


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## mpacks (Apr 24, 2003)

Actually now that I've been using Citrucel regularly for a week (one scoop in the A.M. when I get up, one scoop before dinner), things have improved tremendously. I've even branched out a little from my rice, pasta, chicken, tortillas, bananas, peeled apples, applesauce, corn pops, and baked lays diet. Started having a little ground beef in a few things the last couple of days. Had green salads the last couple of days. Things are still OK. If it returns, I may look into the LEAP program. I'm trying to figure out what food to add in next ... beer or chocolate.


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## mpacks (Apr 24, 2003)

Oh, one more thing, back in September I was tested for just about everything possible and everything came back negative.


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## Julie McBride (May 7, 2003)

Mark,Don't worry you're going through the same stuff I went through when I first started dealing with this. A tigger will hit you in 2 hours or less (for me it's one hour). I could never figure out what my trigers were becuase I thought the reaction was comming much later. I have had a few early morning runs to the bathroom and could never figure out what that was for.For me most trigger are in 30 minutes, the longest that I know of was 5 hours and that was Lobster (all though I'm still in denial that I puked up at 45$ meal).Have you tried a food elimination diet? It really helped me to identify my triggers.


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## mpacks (Apr 24, 2003)

I'm working on a elimination diet now. A couple of weeks ago, I limited myself to rice, pasta, chicken, bananas, unsweetened applesauce, and other soluble fiber foods. As things stabilized I've started to add a few things back in. A week ago, I had some seasoned ground beef with tacos. Seemed to be OK. Last night I had spaghetti with a tomato based meat sauce. Within an hour, I was running to the toilet. I'm going to try it again to see if it happens again. I'm looking forward to the day I try beer again. I've eliminated it from my diet also and am missing my two beer a night habit. And with all of this, I've managed to lose 5 lbs. Not that I wanted to lose five lbs.Anyway, enough rambling, I am working on the food elimination diet. Thanks for the advice.Mark


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## eric (Jul 8, 1999)

The act of eating can set IBS off, even cold water, foods don't cause IBS, but can act as triggers. But a lot of times its not just foods, but hormones can play a part moods even the weather.You might find this enlightening.A nromal person 15 minutes after they eat







an IBSer 15 minutes after they eat.







This is in the lower colon. Its also important to understand normal transit time for digestion in regards to this, the food is still in the throat.


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## passionflower (Feb 1, 2003)

Mark, if the Cliff Bar set you off, I am soooo sorry for suggesting them. They work for me. If you are gluten intolerant,rather than wheat intolerant, the gluten in the oats could have set you off. Eric, thanks for that post. I remember seeing that in Heather's book. I lent that book to someone and never got it back. But, I remember it felt good to see something visual about IBS suffering. As for myself and triggers, sometimes they occur rather rapidly--within an hour to three.Other times, I can seem OK, and then have a horrible three days. I don't know why sometimes the response is delayed.


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## mpacks (Apr 24, 2003)

Cindy,I don't think the Clif bar was a problem. And you shouldn't apologize. I've now learned that we're all different, and suggestions should be taken with a grain of salt. Any suggestion that I follow I do so at my own risk.The good news is that things to be under control with Citrucel and as low fat a diet as I can stand. I had spaghetti last week with a red meat sauce. It went OK. And best of all, last night I had my first beer in almost three weeks. No problems whatsoever!!! Yippee! I also had chocolate chip pancakes this morning and the chocolate didn't set anything off.The next big step is dairy. I'm afraid of setting things off in a big way if I try dairy.Cindy, Thanks for all of your suggestions and helpful information.Mark


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## passionflower (Feb 1, 2003)

I'm so glad things are improving for you and that you're not too upset with the Cliff Bar thing. Yikes, I'll be a little more careful in the suggestion department in the future. Sounds like you're on an upward swing. Most excellent. And, beer to boot. How much more can one ask?


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## Jan LEAP RD (May 19, 2002)

Time for triggers:It's all individual, but food allergy can be an immediate reaction (seconds). But, food sensitivity can also be delayed for 72 hours.Each person is different.Personally, I am reactive to alfalfa and clover sprouts. (I break out in little bumps in my face.) However, I decided to try them after a 10 year abstinence from them. I was able to eat them 3 times the first week. Had them 3 times the next week. On week three, I ate them again. . . and broke out in bumps that evening. . So, delayed response, but also dose related since they didn't bother me the first 2 weeks.


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## mpacks (Apr 24, 2003)

Jan,Thanks for the info. The good news is that I had an appointment with a clinical dietician today. She confirmed a lot of what I read in the Van Vorous books and others about things to eat, how to eat, etc. She also recommended Culturelle. So, I'm going to give it a try. Today I decided to have my first chips and salsa in the last month. So, I had a burrito with rice, carne asada, beans and chips and salsa on the side. Diarrhea occurred within 45 minutes. So, now I need to figure out if it was the beans, the spicy salsa or something else.Mark


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## Jan LEAP RD (May 19, 2002)

Mark,I'm assuming you've been tested for celiac disease and ruled that out? (First step, since 30% of IBS is really celiac disease.)And, you have to be properly tested, by a doc AND a lab and a pathologist that know what they are doing.AND, you have to be eating wheat about 4 times a day (minimum) for 4 weeks PRIOR to testing, or you can get false negatives.(And, I hope the clinical RD ruled this out as well? otherwise. . . careful.)


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## mpacks (Apr 24, 2003)

Well, let me ask you this. If it was celiac disease, would the addition of citrucel and elimination of a lot of high fat foods make a difference? Because that's what I've done in the past few weeks and things are soooo much better than they were. I started having beer again with dinner and haven't experienced problems with beer.I do know that celiac disease was one of the things I was tested for back in September. I don't know how knowledgeable all involved were in it. Nor was I told to eat gluten at least four times a day for four days before the test.But, I do know that I eat a lot of gluten -- either breads, pastas, tortillas, etc.Mark


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## Alynnecassie (Jun 25, 2003)

Hi Mark,I'm new to this, this is my first post. I'm home two days with D. Yesterday was worst than today. And I will have to go back to work tomorrow. So I thought I do some research on IBS and found this site...yeah.I think the problem I had was Monday night was very emotional and the next day, my problems began. I decided not to eat in the car rushing to work. And that appears to not worked. Everything I eat yesterday caused problems, and I wasn't hungry the entire day or wanted to drink anything. I forced myself because it's in the nineties here. But I went for a good ten hours without any intake.Breakfast was better, and nothing happened at lunch today. I think dinner will be okay also. I haven't taken any Anti Diarhhea medicine because it will bring on the constipation part of this syndrome. I save it for when I go out and special occassions and long drives.Responding to your question, how long before you get a reaction for me it varies. Sometimes, especial on road trips, I know I'm going to be in the bathroom before I've finished the last bite.I take two Immodium as an appetizer most of the time. I don't know if the drug helps or if my mind is saying here's what I did to prevent this so no stress.Other times, it's about a half hour to an hour after eating.And sometimes it has to do with time of day. One week it will be only after breakfast I'll have problems. Other weeks it will be the second meal of the day, everyday. Or the dinner meal. I'm not much of a snacker. And I'm currently trying to lose weight. Loss 4pounds in the last two days. But know I have too much fuild in my body which may or maynot be contributing to my diarrhea problem.I also wanted to mention, that in my case it doesn't appear to be what I eat one day it was good for me the next it caused problems. I have stopped eating pizza for breakfast which before all this I could eat anything I wanted anytime I wanted. Now I pause before I eat anything.It may also be a side effect of medication, but the doctor never mentioned that or even told me my diagnosis I read it on the bill.I don't know if that helps you any.Audrey


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## androsine (Apr 12, 2003)

Maybe someone mentioned this already to you, try some Caltrate 600. I read somewhere that this helps with the urgency for some. It works with me. Too much can make you sick so take them half at a time.


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## Lynda J (Mar 4, 2003)

Mark. I can have red wine but a beer will set me off like crazy. My herbalist said it is the hops they use. Also tomato sause will put me in the bathroom for a couple of days.


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## Lynda J (Mar 4, 2003)

Mark I have totally elimated heavy fats out of my diet. I grill, broil or steam most everything. On the buritto dinner what you may very well have done was put to much in your system. Having the buritto may not have hurt but add the other stuff and it probably did.


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## Mike NoLomotil (Jun 6, 2000)

"The act of eating can set IBS off, even cold water, foods don't cause IBS, but can act as triggers. But a lot of times its not just foods, but hormones can play a part moods even the weather." ________________________________This is what I would characterize as confusing semi-facts. Lets try to add soem more factual info on a confusing subject and I will try to use plain english as much as possible...this compromises the content somewhat for the more advnced readers so those who might say 'Hey MNL isn't that supposed to b [fill in blank for left out material]...'. To those I apologize I am trying to ratchet it down a notch.Basically among the multiple symptoms that are typically diagnosed as "IBS" there is a subpopulation (people whose symptoms include a diarrheic component) whose "upregulation of the gut" is linked to what is sometimes called Food Intolerance...or Loss of Oral Tolerance...and the emergeing "Intestinal Allergy"...by immunologists and allergists who study this aspect of IBS symptomology and mechanisms.We have to remember that doctors diagnose IBS based on the symptoms...combined with the absence of obvious disease of the colon or obvious detectable infection.So there is no single "disease of IBS" defined at this time by pathology. There are Symptoms which are used to define and diagnose IBS...and research is finding multiple ways that these symptoms can be produced, so it lookd like there are going to end up being multiple abnormalities which may overlap with each other to varyiong degrees, like Chronic Obstructive Pulmonary Diseases dne very important mechanism which is often ignored as it is not well studied or understood by many people, even the experts who study it have not fully discovered every aspect of it, is the Oral Tolerance mechanism.Your gut and immune system work together to examine everything you swallow to identify what is safe and what is not safe (pathogens...disease causing organisms).If a dangerous thing like bacteria is detected the immune system reacts through a complex sequence of events to protect the body from the danger. In some cases this also involves releaseing mediators which are designed to help purge the GI tract...so you get pain, diarrhea, even nausea or vomiting if the danger is felt to be severe.On the other hand as the upper GI tract digests your food and the immune system examines it, the immune system can see that it is not YOU but it can also tell that it is safe. So there are mechanisms we develop from birth which are designed to turn OFF the protective response when it is food or a benign chemical like a food coloring for example.This process we all go through is induction of Oral Tolerance.Some people, especially prevalent among those who develop what is usually diagnosed based on symptoms as IBS ...with a diarrheic component and often other body symptoms as well...suffer a partial LOSS of oral tolerance to some foods or additives in our diet.Yeah I went through this for 30 years myself before it was learned how to isolate and mange it.This Oral Tolerance process, which begins in the upper small intestine as food enters and is being digested, and continues in the blood stream afterwards, for one of several reasons still under investigation, is compromised in some people and they begin to get abnormal inflammtory responses (abnormal activation of immune system protective functions) in response to benign things...an apple, a pork chop, a cherry, a tomato, a chicken....it can be anything (varies from person to person).This is not food allergy, where the body has accidentally formed antibodies against a food and then gets a violent reaction immediatley whenever even a tiny amount is ingested. It is also not "chemical irritation", which is a seprate kind of food sensitivity, nor is it a digestibe enzyme deficiency, another type...no it is a distinct non-allergic abnormal immune response to staple foods which cannot be detected with allergy tests since there are no circulating IgE antibodies to the offending foods.It is also very difficult to detect with food logs since these reactions are dose deopendent and delayed onset...hours to days after exposure before a reaction fulminates. So the ingestion of antigen and the onset of symptoms is often wayyyy out of synch.So people often misidentify the food, or see no pattern so conclude that there is none (it is just too out of phase and too dose dependent to see, or it is a combination of foods).Some people also keep confusing it with something that is a trigger.A trigger, any trigger, is an event...an irritant, an anxiety event, a big bolus of mixed food shoved into the gut all, at once like a big meal, a chemical irritant in a food...anything which produces a rapid symptom onset.These things are things that the GI tract normally tolerates because it has normal sensory and motor repsonses to stimuli.However, the GI tract of the IBS patient for one or more reasosn is twitchy...like the airways of an asthmatic. Why? two of the most common reason are thatn there may be what is called a top-down problem (as is commonly described by the practice of psychogatroenterology) whereas one or more forms of intrinsic defect has occurred somewhere along what is called the 'BRAIN-GUT AXIS' which ahs cused the sensory and motor nerves the brain and gut communicate with to become too sensitive to stimuli or too responsive to stimuli. Same with the muscle tissue and mucosa of the gut. Oversensitive.So a nrmal stimulsus produces an exagerrated pain (or other sensory response) or motility (or other motor) response.On the flip side, the patient with lost oral tolerance are routinely eating foods or addivies in their diet that they have lost oral tolerance to. So in the bowel wall and in the blood stream their immune system is releasing an array of proinflammtory and proalgesic (leads to pain) mediators. many of these act directly on the gut muscle, nerves, exocrine glands, and blood vessels to produce this same state of twitchiness (called "upregulation" in tekkie terms).So as long as the person keeps eating these foods, the gut remains upregulated and the same thing can happen...apparent triggers are formed from normal events. Thi is then interpreted as a primary probelm when in fact if you isolated and removed the foods to which the oral tolerance has been lost which are producing mediator release and upregulating the gut, then many if not all of those so called triggers will stop being triggers.One caveat is that a small percentage of people, including IBS victims, do have comorbid food allergy as well....maybe 8% by one estimate...so a true food allergy will act like a so called trigger as the symprom onset will be rapid one exposure.Anyway this is a little more accurate description of the problem...oral tolerance and "intestinal allergy" as it is sometimes called, has only been first discovered in about 1994, and has only been studied by direct jejunal isolation and food challenge in Europe (it was first pioneered in Sweden)...and found to be a quantifiable probelm in many people who clincially would be and are diagnosed with mysterious IBS when in fact this is part of or much of or all of the basis for their symptoms.here is an online slide show about oral tolerance mechanisms you can look atSLIDE SHOWORAL TOLERANCEUNIVERSITY OF SUNDERLAND, U.K. http://www.sunderland.ac.uk/~hs0acu/lec01.ppt Note it is 41 pages and if you donï¿½t click on the single-line- down arrow on the right of the browser the thing will jump past a bunch of infoï¿½Oral Immunity and Oral Tolerance: Outline of lecture (PDF file)From Washington University St. Louis http://www.nslc.wustl.edu/courses/ucollege...2/21lecture.pdf people with these symptoms will find these books helpfulIBS: A DOCTORS PLAN FOR CHRONIC DIGESTIVE TROUBLESBy Gerard Guillory, M.D.; Vanessa Ameen, M.D.; Paul Donovan, M.D.; Jack Martin, Ph.D. http://www.amazon.com/exec/obidos/ASIN/088...3369143-6824157 ï¿½FOOD ALLERGIES AND FOOD INTOLERANCE: THE COMPLETE GUIDE TO THEIR IDENTIFICTION AND TREATMENTï¿½, Professor Jonathan Brostoff , M.D.. Allergy, Immunology and Environmental Medicine, Kingsï¿½ College, London http://www.amazon.com/exec/obidos/ASIN/089...6487508-3420903 and may find discussion threads at this post with others who have had these problems helpful as well http://www.ibsgroup.org/ubb/ultimatebb.php...ic;f=1;t=033220 Sorry if there are typos in a hurry and typed fast and no time to edit.







MNL


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## mpacks (Apr 24, 2003)

Thanks for all of the replies to my original question. Sorry, I haven't been able to respond sooner. On vacation, in the mountains of the Eastern Sierra Nevada with my family. This was a trip I told my wife a few months ago that I wouldn't take unless things improved. What has really improved things for me was the additional of Citrucel -- a scoop in the morning and a scoop just before dinner. I eat most things now that I used to eat before -- with a few exceptions. I don't eat refried beans or whole beans when I order Mexican. Sometimes, it seems that tomatoes might set me off. Basically, I'm in the process of trying to figure out what my triggers are. Fortunately, I haven't found too many. Fatty foods don't seem to be a problem. Beer is definitely not a problem. During the week I was on vacation, I even had pizza one night, and cheese for a couple of other meals and with the Lactaid pills, had no problem.So, it's all a gradual learning process.Thanks again.mark


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