For today’s post, my colleague, Linda shares how she learned that her high blood pressure medication was contributing to her debilitating GI distress. We live in the world of big Pharma…new medications are ‘born’ every day. We have made amazing strides in healthcare and use of these many novel drug therapies are truly life-saving…but sometimes with the good comes some unwanted side effects. Working with your pharmacist and doctor is essential when adding a new medication therapy.
“Pharmacists can see the whole picture of all the meds and OTC (over the counter) products someone is taking and cross reference that with side effects the patient complains about. When someone sees more than one provider, the risk of having overlapping toxicity can increase tremendously.” –Jenna Pedone RPh. Some patients are afraid to share with their doctor the numerous supplements they are taking. But, this comes with potential risk and side effects.
A few years ago, I was accepted into University of Chicago’s Celiac Preceptorship Program. This program was so informative and helped expand my understanding of celiac disease. One of my favorite speakers was the pathologist. He spoke about reviewing the biopsies of patient’s with villous atrophy (flattening of the intestinal villi, finger like projections that line the intestine). Villous atrophy is a key component of the diagnosis of celiac disease. The pathologist reviewed other conditions that may result in villous atrophy including small intestinal bacterial overgrowth, tropical sprue and medication side effects. In particular, Olmesartan, a angiotensin II receptor antagonist (ARA) indicated for the treatment of hypertension, is implicated in villous atrophy. Other ARAs such as Losartan are associated with GI distress (but not villous atrophy).
Here is Linda’s story:
“My name is Linda. I’m a dietitian and I love to eat!
So, when I started having problems with my gut, I went into a bit of a depression mixed with anxiety. I have always been strong and independent, but this problem was not one I could figure out on my own. About five years ago, I started experiencing severe constipation. I saw multiple primary and GI doctors, just to be told they couldn’t find anything wrong. They told me to drink more water and eat more fiber, which I was already doing! When things got really bad, I would use my “nuclear laxative,” which was a liter of the solution typically used for colonoscopy prep. Even after receiving a positive breath test for SIBO (Small Intestinal Bacterial Overgrowth) and lab work that was “suspicious” for Crohn’s disease, my gastroenterologist still wouldn’t provide a diagnosis because he saw no signs of inflammation after a colonoscopy & endoscopy. He referred me to a pelvic floor dysfunction clinic. I called it the “poop clinic” because it’s where they teach you how to poop. While there, I worked with a wonderful physician and physical therapist. They showed me how to use a Squatty Potty and how to give myself an abdominal massage. However, they told me that I did not have a pelvic floor dysfunction but agreed I had severe constipation.
My condition got worse. I had no appetite; I had to force myself to eat. Feeling bloated, I looked five months pregnant. Friends drove me to doctor’s appointments because I was so weak. Also, I didn’t trust my ability to clearly communicate with a doctor due to the “brain fog” I was experiencing. During this time, I ate very little food, and I drank supplements intended for persons who need tube feedings. These canned drinks tasted like fish-flavored milk! I even brought a case on a camping trip with my family & friends. I would “eat” meals at the campsite & later chug one of my “tasty” drinks. 🙂 But I didn’t give up! Family and friends were there for me. They would bring meals to our house. I subscribed to a meal delivery service so I wouldn’t have to always cook. Church leaders and my Christian friends prayed. I believe their prayers lead me to the people who would eventually help.
But I got worse.
While hospitalized for an unrelated condition, I had a nurse who could relate to my IBS constipation! She suggested I see the doctor who helped her. I saw that doctor, and she said she thought she knew what was causing my problem. She said her husband had severe constipation, and it was caused by his blood pressure medication, Losartan. I was taking Losartan, I was taking Losartan and stopped taking it. The constipation went away, and I felt normal for a few days. However, when I started on another blood pressure medication, the constipation returned. I decided to consult another dietitian who specialized in GI disorders. She helped me understand the low FODMAP diet. The low FODMAP diet got me back in the kitchen again. I started trying new foods and spices. I was enjoying meals with my family. 🙂
Today, I’m exploring different ways to manage my blood pressure with little to no medication. I eat a modified FODMAP diet. I, once again, enjoy meals with friends and family. I am so grateful to God, family, friends, and especially to health providers God has given. I hope my story helps someone else. Remember: YOU ARE NOT ALONE. Your answer may be just around the corner!”
Here is one more review on olmesartan and villous atrophy. And another one here on causes of villous atrophy unrelated to celiac disease.
As a reminder from registered pharmacist, Jenna Pedone, “Don’t forget to involve your pharmacist in the conversation about GI distress you are feeling. They might just realize it is coming from one of your medications.”
Angela Guptill
Thank you for sharing this!!! Any info I can collect helps me understand my GI condition more and more everyday. 🙂
Kathy Stahl
I had experienced a situation where pills made me sick. I couldn’t figure out what I was doing differently in my diet and after thoroughly examining what I was eating, I remembered that I had lately changed my vitamin b12. When I read the label of the new pills I saw that sorbitol was one of the main ingredients. It was just a tiny pill but quitting them eliminated my discomfort .
katescarlata
It is amazing how small amounts of an ingredient can trigger distress. Thanks for commenting.
Carol Ginsberg
Thanks for your info on the blood pressure meds. when I challenged my doctor about the BP meds making my constipation worse, she told me to drink more water, if I drink anymore water, I will have to live in the bathroom.
Jean
Hello
My name is Jean and I have had IBS for 25 years – with the main issue being constipated for up to two weeks at a time. I spend days in the ER and hospital only to be told ‘just drink water – you will be fine’ or ‘you brought this on yourself – just make it go away’. I did see a mental health professional who said ‘your head and stomach are connected and therefore this is relationship – let’s talk about it. So we did andthere was some stress contributing to the constipation. It was only when I saw a nutritionist that I was introduced to the FODMAP diet -which made all the difference in the world. I then sent an email to the gas doctors I had seen who prescribed pills for each meal – I wanted to alert them to the FODMAP diet which was so helpful – unfortunately their response was ‘thanks but we are sticking with the pills – diet does not matter! I am here to say – ‘DIET DOES MATTER. Kate – please keep up your excellent work – you are an angel!
katescarlata
Hi Jean, so glad you were kept searching for your answer. And glad you find the low FODMAP diet works for you!!
Arlene Hoffman, RD
Thank you. I’m grateful that my GI doc led me to the FODMAP diet. With his guidance, I also take a maintenance of rifaxamin twice a day to treat SIBO, which has been diagnosed by hydrogen breath test three times. Unfortunately he didn’t see the omeprazole problem for years. Hopefully he’s now alert to this possibility for other sufferers.
Arlene Hoffman, RD
Due to losing parts of my intestines through surgeries for benign tumors, I had severe intractable non-IBS diarrhea since the early 2000’s. Lately it worsened to every night for hours at a time. Sometimes I actually had to sleep on the bathroom floor, and was actually considering having a colostomy to improve my quality of life.
I also have GER, for which I’ve taken Prilosec/omeprazole once or twice daily for more than ten years. About six months ago, on my own, I stopped the Prilosec due to its contributing to both severe iron deficiency anemia and osteoporosis.
Along with the anemia, guess what else has now improved by about 75% since stopping Prilosec?
That’s right, my diarrhea is so much, much better. I no longer spend every evening in the bathroom and can lead a relatively normal life, so long as I also follow FODMAP guidelines. That I’d done, btw, for a more than a year prior to stopping Prilosec, with little benefit until then. .
I’m no longer thinking about having a colostomy. Now spending time with family and friends. Going out in the evenings. Attending meetings and celebrations. Living my life again.
All from quitting a medication that, for me, was apparently toxic. I’m not saying it would be so for others, just sharing my experience. Perhaps others might benefit without spending so many years suffering needlessly.
katescarlata
Thank you Arlene, for sharing your story and experience. So glad you feel better.
Arlene Hoffman, RD
Thank you.
Carol Perecman
Hi Kate,
Do you know if Valsartan might also cause constipation? I have been struggling with it for a few years now and it looks like Valsartan, which I take for hypertension, might be a related medication. Also, can you suggest someone at U of Michigan whom I could go see about my gut issues? Dr Chey has a wait list of months. Should I wait for him, or do you know of someone else in the department who is also good?
Thanks, and thanks so much for your helpful posts,
Carol
katescarlata
How about Richard Saad–he has great expertise in constipation—http://www.uofmhealth.org/profile/9/richard-joseph-saad-md I am not sure about Valsartan—but surprisingly some of these anti-hypertensive meds can have GI effects. Talk to your doctor.