Most people only think about the bathroom when they have to go. But for Pamela G., a 69 year old Portland native, bathrooms were all she could think about.
Four years ago, at age 65, she started having bouts of unexpected diarrhea. “My whole life I had never had any problems, but now I was having accidents unexpectedly and frequently,” Pamela said.
“I started planning my days around places I knew had bathrooms and began turning down social events with friends because I was so embarrassed that I would have an accident in front of them.” She coped with her unexplained symptoms by carrying Poise pads and gloves everywhere she went in case an accident happened.
But enough was enough. Pamela decided to see a gastroenterologist and find out what was wrong. She made an appointment with Dr. Doug Shumaker, who scheduled her for a colonoscopy based off her symptoms.
One exam, biopsy, and round of tests later, she had her answer: Collagenous Colitis, an inflammatory bowel disease that typically affects women ages 50 and over.
“Getting that diagnosis was terrifying. My mother suffered from many different GI issues, had lots of surgeries, and eventually passed away at an early age from Collagen’s Disease…I didn’t know if my condition was related or not,” Pamela said.
What is collagenous colitis?
Collagenous colitis is less common than other forms of inflammatory bowel disease, such as Ulcerative colitis or Crohn’s Disease. Symptoms of this disease include frequent bowel movements of diarrhea and abdominal cramping.
“After we had Pamela’s diagnosis, I prescribed her a medication that usually reduces symptoms,” Dr. Shumaker said. But after a few months on it, it wasn’t helping. So another drug was prescribed, and Pamela started seeing improvements, but not a lot. “I was still extremely concerned about going anywhere that I knew didn’t have bathrooms. Being active just wasn’t a possibility for me anymore,” Pamela expressed.
Out of drug treatment options, but committed to helping Pamela feel better, Dr. Shumaker referred her to Tina Patnode, a registered dietitian nutritionist (RDN) who specializes in digestive health. After reviewing Pamela’s symptoms, Tina suggested she try a low FODMAP diet. “Most people know what it means to be gluten free or lactose free, but not many people know about a low FODMAP diet,” said Tina.
The low FODMAP diet
FODMAP stands for Fermentable Oligo-Di-Monosaccharides and Polyols. These are certain carbohydrates that are osmotic, meaning they pull water into the intestinal tract. They may not be well absorbed when eaten in excess, causing diarrhea. The low FODMAP diet was developed in Australia in 1999, and is backed by research from Stanford University Medical Center. Originally, the diet was intended to help treat irritable bowel syndrome (IBS), but has now grown to help alleviate the symptoms of other digestive diseases. “A recent trial found that 7 out of 10 people with severe IBS had symptom improvement while on the low FODMAP diet,” Tina said.
Armed with flyers, pamphlets, and books about the diet, Pamela started with the first stage of the diet, the Elimination Phase, where she eliminated all high FODMAP foods from her diet. “I knew implementing this diet wasn’t going to be easy, but it had gotten to a point where I was going to try anything to get better,” Pamela said.
Pamela’s return to normalcy
“In less than a week, I was symptom free. I absolutely could not believe it,” Pamela shared. But the journey didn’t end there. After 2-6 weeks of eliminating all high FODMAP foods, the Challenge Phase begins, which involves reintroducing each food group slowly into the diet over the course of a few weeks. “Most people don’t need to eliminate all foods with FODMAPs in them, just the ones that are triggers for their gastrointestinal issues,” Tina said. “That’s why we start incorporating foods back in, so that we can see which ones are causing the problems.”
“In less than a week, I was TOTALLY symptom free. I absolutely could not believe it.”
“It was a lot of trial and error. I still keep a list on my fridge of foods that I can and cannot eat,” Pamela explained. Cooking for herself and her husband has been fairly simple, but potluck dinner parties and eating out still present some challenges. “You just never know what a chef might use. Even a tiny amount of certain foods will give me issues.”
For the most part, life is back to usual for Pamela. “For a while it was hard to remember what normal was. I am so grateful to Tina and Dr. Shumaker for not giving up on me as a patient and to the low FODMAP diet for helping me get my life back.”
Now that bathrooms don’t dictate her social life, she is busier than ever. “Right now I’ve been rushing around trying to get things organized for a large dinner party I’m hosting. I’m so glad I don’t have to worry about what might happen anymore—life is hectic enough!”
Tina Patnode is a Registered Dietitian Nutritionist and Licensed Dietitian at The Oregon Clinic. Tina treats individuals with chronic digestive diseases.