Help for Low Magnesium absorption due to PPI

I can help a bit with some of this. First, I've read that it's very difficult to meaure magnesium in the body in a useful way. Blood magnesium levels don't tell us as much as you might expect. It's the best method in common use, but not worth much.

I was similarly stuck on a PPI (Nexium). The rebound acid was so severe it damaged my teeth. I was eating antacids constantly, but they weren't sufficient. I eventually got through it on the second try, but I had to do it ultra slowly, literally adding an hour between doses every day (yes, I had to get up at night a couple of times). Since then I have figured out a much, much easier way. I simply substituted a hefty dose of Zantac for the PPI. Zantac works fine at controlling stomach acid, but it's not a PPI and has no rebound when you stop it. Even without the rebound you'll have whatever reflux your body tends toward, but the transition from PPI therapy to your "baseline" reflux should be much smoother if you transition with an H2 blocker like Zantac. This method was effortless for me - just don't rush it.

Thank you Scott. Your story confirms what I have experienced, read and am scared of. But I know it is possible and that I will get through it. I'm just hoping to do it at a time when I have the magnesium issues under more control. I am feeling so overwhelmed right now with the consequences of long term PPI usage. I just want to be on in a more balanced place before I start the weaning process which will take a lot of exact attention and actions to succeed.

I probably should have led with this: the weaning was effortless once I figured out how to do it. If I were getting unacceptable side effect from the PPI (or thought I might be) I'd switch over to an H2 blocker without hesitation, and wean off of that after a week or three.

Oh, I'm glad you clarified that. Thanks.

Hi Scott - I just stumbled across this post while researching something else entirely but maybe you can answer a question for me.

I was on Nexium for years for severe reflux and recently switched to a less expensive and weaker dose product because of drug coverage. Anyway, I have 2 questions, 1) if I could get off the PPI's altogether does it stand to reason that the Imodium and Psyllium would be more effective?, and 2) would it also mean a higher acid content in the subsequent waste increasing the risk of butt burn?

I had major problems with my Magnesium levels when I had the interim ostomy between j-pouch surgery and takedown. I was hospitalized 4 times between February and June for IV replacement of Magnesium. I would get short of breath and severe muscles cramps when it got really low. However, I have not had a problem since then (at least no symptoms and no alarms when blood work monitored).

Kathy-
I wouldn't expect getting off PPIs to have any impact on Imodium or psyllium effectiveness. Neither one has much to do with stomach acid. For that matter, although some may consider it heresy, I've never been convinced of a strong connection between stomach acid and butt burn. The stomach contents are very acidic, but the contents of the ileum (the stuff in a J-pouch) are normally slightly alkaline. Perhaps butt burn is more of a chemical burn than an acid burn, or maybe when transit times are very quick there really is some stomach acid left at exit time. Others may have more real-life experience with butt burn, though. I was lucky enough to have nearly perfect results with barrier creams (used religiously) for about a year, and haven't needed them since.

Is there a reason for you to think your reflux may have gone away? I was able to get off PPIs for a while after I'd lost a lot of weight.

Congratulations on getting the magnesium under control.

Thanks Scott - I am just grasping at straws and very likely over thinking things. I was doing very well for about a week and then all of a sudden everything went to hell in a hand basket. I have had diarrhea now for over 48 hours and I have a severe case of butt burn. I use petroleum jelly religiously. The exterior skin in fine. All of the burn is on the inside. Between that associated pain and the frequency I have only had a couple of hours sleep for the past 2 nights. And tonight isn't looking very promising either.

I am taking 3-4 Imodium tabs 30-60 minutes before meals and at bedtime as well as the Psyllium fiber following meals. Should be enough to constipate an elephant shouldn't it?

I have concluded that it was just coincidence that it all started after I ate potato chips since there is no reason why the chips should be a problem. My diet has not changed so I can't relate it to something I ate. I am only 3 months post takedown. It it normal for this to happen periodically for no reason at all for a while? The frequency I can handle (although it is a nuisance and inconvenient) but the burning pain reduces me to tears. I want so bad to be a success story because I cannot [mentally] accept having an ileostomy.

I hate to be a complainer but it is a relief to be able to sound off to someone who can relate. I really appreciate the support that people offer on this site. Especially you and Jan. You are both knowledgeable and empathetic. Thanks.

quote:

Should be enough to constipate an elephant shouldn't it?

I would not even be able to open up my butt cheeks taking that quantity of imodium. I cringe at the amount of straining that would be needed to squeeze out even one tiny dollop of stool. I max out on 2 imodiums in a day and I am thick as a brick.

quote:

I would not even be able to open up my butt cheeks taking that quantity of imodium. I cringe at the amount of straining that would be needed to squeeze out even one tiny dollop of stool. I max out on 2 imodiums in a day and I am thick as a brick.

As would most people me thinks. But oh no, not me. I pray for the day when I will only need a teaspoon of Metamucil now and again.

When I was at your stage Kathy I was probably still taking 4 to 7 imodium daily, as well as Metamucil capsules. I didn't drink Metamucil as I hated it so usually took 3 capsules 2-3 times a day, which worked out to be 1-2 doses. Sorry I don't remember this exactly but I was on a moving schedule. The further out from my surgeries the less I needed of Imodium and Metamucil. I still take Loperamide, prescription Imodium, which I like better, as I have IPS which is like IBS. The prescription form works faster for me as it is in capsule form, therefore I don't end up over doing the dosage.

I still take my PPI.

About the Magnesium. I have fibromyalgia and take a supplement twice a day which consists of 3 capsules each of a product called "Fibro Malic". My surgeon was aware of this and told me that magnesium does produce a laxative effect, like Phillips of Magnesium - ha ha. He didn't see any problem with me continuing it or any of my medications or other supplements. Since I was on the supplement before my surgeries and still am I don't know the difference regarding diarrhea. I do know that my magnesium levels are always normal on my blood tests.

"Fibro Malic" gel caps are clear a full of powder which has to get into my system quickly. It has several other vitamins and 2 capsules yields 86 mg of elemental Magnesium, which is 50% of the daily value. Since I take 3 capsules 2 times daily I get 150% the daily value. I order it from Amazon or other places on-line and it's probably in health food stores as well. I wonder if there are other products that are similar you might want to consider for your low level. This one also contains some Vit C, B Malic Acid (what we get from apples), Olive - dried powdered extract from leaves, and MSM. I'm guessing that these all work together to help with absorption. That is a big guess. I found out about this supplement years ago so don't remember everything about it - sorry. I don't know if this is something that might help you or not.

We are all different in how fast our new plumbing learns to do it's new job as a holding tank. It seems that those on here that have had their pouches for a long time don't need Loperamide (Imodium) or Metamucil much anymore. They tend to also tolerate a larger variety of foods. I keep trying a bite here and there of something that I can't eat to see if I can eat it yet.

Instead of vasoline I suggest you used Calmoseptine for your butt burn. I you still have internal burn that will not go away you should go see your doctor as it could be cuffitis. Cuffitis is UC in the few cm of the rectal cuff that is left to staple your j-pouch too. Usually a doctor can do an examination in her/his office to confirm this and it's treated with suppositories. (This assumes you had UC and the double stapled procedure operation)

A couple of additional considerations:
1) Lomotil works better than Imodium for some folks (like me).
2) Make sure the Metamucil dose is adequate. I think it's closer to a tablespoon than a teaspoon. I used one of the Metamucil packets (which I have for travelling), and poured it into *my* usual kitchen spoon to see what "a dose" looked like. I was surprised by how much it is.
3) Marie's point about the laxative effect of magnesium supplements is important, if you're taking any of those. Heck, read up on everything you're taking to look for offenders.
4) If Calmoseptine is too strong for you, simple zinc oxide ointment might do as well. Neither of them really should be applied internally.
5) What does your doctor think? Do you have a J-pouch-knowledgable GI? Have you been scoped?

Thanks. I have not tried the Lomotil because the Imodium works for me (most of the time) but I may give it a try.
I also measured the amount of Metamucil or Psyllium that I take and you are right, it is more like a good size tablespoon.
I am not having problems with my Magnesium now and am not taking any supplements and my burn is all on the inside. The outside skin is fine.
I have 100% faith in both my GI surgeon and specialist. Have not been scoped (post takedown) yet but there is a plan to do it in January (6 month mark).

Today, I feel great. Had a decent sleep last night and am planning an outing on my motorcycle today for the first time this season.

The diarrhea and subsequent butt burn usually lasts 3 days when I get it which seems to be about every 3-4 weeks. In between I do fine. I just wish I knew what causes it if I can't relate it to food. All part of the healing process I guess but it is not pleasant. But I'm on the road again - until next time.

Good News! As Scott pointed out I was talking about external use of calmoseptine. If you'd rather use the capsules than drink Metamucil then I think 5 or 6 of them equal one dose. They come in generic form too I know Walgreens and Walgreens make them.

I doubt it is cuffitis if it comes and goes and suspect it is related to a food or maybe your monthly cycle Carol. You might want to look in the Women's Heath & Pregnancy forum.

Have an awesome weekend, zoom, zoom, zoom......