Get Inspired: Woman With Crohn's Shares Bikini Photo With Colostomy Bags

Four years ago, Brittany Townsend would have never guessed that a photo of herself in a bikini would go viral on Facebook. The makeup artist from Worcester, England, has suffered from Crohn’s disease since age 3, and nearly died when her bowel ruptured in 2010. She woke up in a hospital bed with two colostomy bags, which remove waste from her body through an incision in her abdomen. “As soon as I had the colostomy bags, my confidence was totally knocked,” Townsend, 23, told BBC Midlands Today. “I lost so much weight going through all of that. I just wasn’t who I was, anymore.”

Then, last December, Townsend and her husband took a vacation to Mexico. “My husband always said to me, ‘If we go on holiday, I want you to wear a bikini.'” And on her first day there, she did. “I felt like I finally had the confidence after three and a half years of having them.” On June 21, she shared the photo above with the Crohn’s and Colitis UK Facebook page, which has generated more than 200,000 Likes and has been seen by millions.

Townsend hopes her photo will inspire confidence in others with colostomy bags who feel embarrassed or ashamed by their condition. And, bolstered by the positive response her photo has received, she’s decided to begin pursuing a part-time modeling career.What is Crohn’s disease?Crohn’s disease, a form of inflammatory bowel disease, causes inflammation and ulcers in the digestive tract, resulting in diarrhea, gut pain, and even skin, joint, and eye problems. It’s tough to diagnose and is often mistaken for other illnesses. Crohn’s is most commonly diagnosed in adolescents and young adults, but it can strike at any age.

More about Crohn’s:Myths and Facts About Crohn’s Disease10 Things Not to Say to Someone With Crohn’s Disease or Ulcerative Colitis11 Celebrities With Crohn’s Disease

No Increased Infection Risk Seen with Psoriasis, RA Drugs

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By Amanda Gardner

MONDAY, November 7, 2011 (Health.com) — A class of injectable drugs used to treat autoimmune disorders such as rheumatoid arthritis doesn’t raise the risk of serious infection when compared with more conventional treatments, according to a new analysis in the Journal of the American Medical Association.

The research, which was funded by the Food and Drug Administration and other federal health agencies, contradicts numerous earlier studies that did find an increased risk of infection associated with the drugs, known as tumor necrosis factor (TNF) inhibitors.

The possibility that TNF inhibitors—which include popular drugs such as Humira and Enbrel—pose no additional infection risk is a “very new and heretical idea,” says David T. Felson, MD, a professor of medicine and epidemiology at the Boston University School of Medicine, who cowrote an editorial accompanying the study. “Up until now there has been considerable evidence that anti-TNFs heightened the risk of serious infection compared to other treatments.”

Related links:

8 Signs and Symptoms of Rheumatoid Arthritis

10 Risk Factors for Inflammatory Bowel Disease

Got Psoriasis? 7 Signs You Have Arthritis Too

The lead author of the study, Carlos G. Grijalva, MD, a professor of preventive medicine at Vanderbilt University, in Nashville, Tenn., says the findings “should be reassuring for patients and providers.”

Dr. Felson, however, says the new findings aren’t sufficient to quell the concerns raised by previous studies. “We still need to be concerned about serious infection risk among patients starting these medicines,” he says.

Autoimmune conditions, including rheumatoid arthritis, psoriasis, and inflammatory bowel disease, arise when the body’s immune system goes awry and begins attacking healthy cells and tissue. TNF inhibitors—known as biologic drugs, because they’re derived from substances that occur naturally in humans and animals—work by blocking the action of TNF, an important immune-system molecule.

This class of drugs drastically improved the treatment of these conditions when first introduced in the late 1990s, but because they suppress the immune system they are believed to open the door to opportunistic infections. Some patients taking the drugs have died from these infections, and the FDA has been closely watching the drugs’ safety profile as more and more people use them.

Next page: Most previous studies have been small

Previous studies have found that TNF inhibitors as much as double the risk of serious infection compared with other treatment options. Those trials tended to be relatively small, however. The new study, which was presented this weekend at an annual meeting of the American College of Rheumatology, sought to address that weakness.

Dr. Grijalva and his colleagues combined data on more than 32,000 mostly low-income people from four large health-care databases, including those for Medicaid and Medicare. About half of the people took TNF-inhibitors for their conditions, and the other half took older, non-biologic drugs—such as leflunomide, hydroxychloroquine, and sulfasalazine.

The authors identified 1,172 infections requiring hospitalization during the study period. (The most common infections were pneumonia and skin and soft-tissue infections.) After one year of treatment, people taking TNF inhibitors had no higher risk of serious infections than those taking other types of drugs.

The researchers did find, however, that among patients with rheumatoid arthritis, the TNF inhibitor Remicade carried an approximately 25% higher risk of infection than Enbrel or Humira.

It’s not clear why Remicade might be riskier than other TNF inhibitors, but it’s possible that the higher initial doses the drug requires might be partly responsible, Dr. Grijalva says. The mechanism of action may also be slightly different than that of other TNF inhibitors, he adds.

The study does have an important limitation that detracts from the findings, Felson says. As he notes in his editorial, some 40% of participants taking TNF inhibitors dropped out within the first month, compared with only 15% in the comparison group.

In previous trials and in clinical practice, people who stop taking TNF blockers “tend to be older and at a higher risk of serious infections,” Dr. Felson says. That pattern, he adds, may have skewed the study results and made TNF inhibitors look safer than they perhaps really are.

How to Ease IBS Symptoms

WEDNESDAY, Jan. 6, 2016 (HealthDay News) — Doctors have long known that psychological therapies such as relaxation and hypnosis can temporarily ease the symptoms of irritable bowel syndrome (IBS). But, new research suggests they could also offer long-term benefits.

IBS is a gastrointestinal disorder that affects up to 16 percent of the U.S. population. It causes chronic abdominal pain, discomfort, bloating, diarrhea, or constipation. There’s currently no cure, but dietary changes, medication and psychological interventions can provide symptom relief, the study authors noted.

“Our study is the first one that has looked at long-term effects,” said the study’s senior author, Lynn Walker, a professor of pediatrics at Vanderbilt University Medical Center, in Nashville.

“We found that the moderate benefit that psychological therapies confer in the short term continue over the long term. This is significant because IBS is a chronic, intermittent condition for which there is no good medical treatment,” she said in a hospital news release.

The researchers analyzed results of 41 clinical trials involving more than 2,200 IBS patients.

The analysis found several different psychological therapies—including relaxation, hypnosis and cognitive behavioral therapy—equally beneficial in helping people change the way they think. Regardless of the length of treatment, the researchers found the effects may last at least six to 12 months after treatment ends.

Online treatments were just as effective as those conducted in person, the study, published recently in Clinical Gastroenterology and Hepatology, found.

The study’s first author, Kelsey Laird, a doctoral student in Vanderbilt’s clinical psychology program, said, “Western medicine often conceptualizes the mind as separate from the body, but IBS is a perfect example of how the two are connected.

“Gastrointestinal symptoms can increase stress and anxiety, which can increase the severity of the symptoms. This is a vicious cycle that psychological treatment can help break,” she said in the news release.

The researchers next plan to examine the effects of psychological therapies on patients’ ability to function at work, school and during other routine activities.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases provides more information on IBS.


Could That Bloody Scene on 'Downton Abbey' Really Happen?

Spoiler alert: If you’re a Downton Abbey addict and you missed Sunday’s episode—or if you’re just a little bit squeamish—this is your final warning to click away.

Last night on the British period drama, Lord Grantham’s health mystery came to graphic fruition when he vomited blood across the dinner table, a potentially life-threatening consequence of his stomach ulcer. (You can catch a clip from the scene here. A heads up: it isn’t pretty.)

The scene caused Health editors-slash-Downton fans to wonder: What the heck just happened—and can it happen to us?! We tapped our contributing medical editor, gastroenterologist Roshini Rajapaksa, MD, for the need-to-know facts on stomach ulcers.

The crater-like sores form when acid in the digestive tract eats away at the lining of the stomach or the duodenum (the first section of the small intestine), says Dr. Rajapaksa. “They’re potentially very dangerous if left untreated.”

The show’s blood-spewing scene wasn’t an unrealistic depiction of what can happen in an extreme case. “If the ulcer erodes deep enough into the lining of your stomach, two things can happen,” Dr. Rajapaksa explains. “It can erode into a blood vessel, which then can start bleeding very profusely, and that’s likely what happened in [Lord Grantham’s] case, because he began vomiting blood. Or, it can actually erode a hole all the way through your stomach, and stomach contents can then leak into the abdominal cavity,” a rare but potentially deadly scenario.

How do you get a stomach ulcer in the first place?

The primary cause is a bacteria known as Helicobacter pylori, which was just discovered in 1982. “Many people have the bacteria in their bodies, but may not realize it until later in life, if and when they develop gastritis, which is inflammation of the stomach, or an actual stomach ulcer,” says Dr. Rajapaksa. (An estimated two-thirds of the world’s population carries H. pylori.) Another possible cause of stomach ulcers is the long-term use of nonsteroidal anti-inflammatories, or NSAIDs, like ibuprofen and aspirin, she adds.

RELATED18 Reasons Why Your Stomach Hurts

How do you know if an ulcer is developing?

You may not if the sore is just opening and you’re symptom-free, says Dr. Rajapaksa. But when an ulcer forms and deepens into the stomach lining, you’ll feel it, she says. Common symptoms include burning pain and nausea, even vomiting in some cases. “You may also feel a gnawing feeling of hunger,” Dr. Rajapaksa adds. “People with ulcers tend to feel a little bit better after they eat because food almost helps coat the stomach.”

If you notice these signs, Dr. Rajapaksa recommends seeing your doctor a.s.a.p. “Certainly if you’re vomiting blood, I would hope that everyone knows to immediately go to the hospital,” she says. “But even if you’re having other symptoms at home and you suspect you have an ulcer, I would suggest you get it diagnosed instead of trying to wait it out, or seeing if the pain goes away.”

Ulcers can be diagnosed through with X-ray tests, an endoscopy (a nonsurgical procedure that involves inserting a flexible tube with a light and mini-camera through your mouth to look inside your digestive tract), or a simple breath test that detects whether you have the H. pylori bacteria.

RELATED13 Ways Inflammation Can Affect Your Health

Can you prevent stomach ulcers?

Unfortunately, if you have H. pylori in your body, there are few precautions you can take to avoid getting a stomach ulcer. Some people believe that avoiding spicy foods can help, or that stress triggers stomach ulcers—but those are myths, says Dr. Rajapaksa. She advises limiting your intake of NSAIDs (and not popping more than the recommended dose per day).

The key is to get checked out early, she says. “As soon as the ulcer is diagnosed, you can take an acid-blocking medication that will treat the erosion and prevent it from getting any worse in most cases. In more extreme cases, surgery may be required to repair the damage.”

7 Natural Remedies for IBS

Treating irritable bowel syndrome (IBS) can be tough. It’s characterized by abdominal pain and either constipation, diarrhea, or a combination of both, but its symptoms are different for every person who suffers from it. So, then, is what works to provide relief.

Medications are available to ease the symptoms of , but some patients feel better trying natural remedies instead of (or in addition to) conventional drugs. The problem is, says Yuri Saito-Loftus, MD, a gastroenterologist at the Mayo Clinic, there’s not nearly as much scientific research on these “treatments” to show how well they really work.

“There’s usually not a big pharmaceutical company with billions of dollars to sponsor a randomized clinical trial for these alternative remedies,” says Dr. Saito-Loftus. “A lot of what we rely on to make recommendations to our patients are the rare cases when either the government or a large supplement company has enough interest to fund a study.” 

A new review does provide some hope for people who get no benefit, or have bad side effects, from traditional IBS medicines: Writing in the British Journal of Pharmacology, researchers noted that several alternative therapies do seem to be effective at relieving symptoms.

We asked Dr. Saito-Loftus (whose research is referenced in the review) for her thoughts on these and other natural remedies. Here’s her advice—including some words of caution—about what’s worked for her patients.

Probiotics

These live bacteria—found in supplements or in fermented foods like yogurt and kefir—fared well in the newly published review: The authors noted several randomized clinical trials that suggested probiotic consumption can relieve abdominal pain and other IBS symptoms better than placebo.

But the news isn’t all great. “I’ve met patients who swear that they make all the difference in the world, and others that don’t feel they make much of an impact at all in their symptoms,” says Dr. Saito-Loftus. “One problem is that there are so many brands and formulations, chances are what you pick up in the store is not the same product that performed well in clinical trials.”

Dr. Saito-Loftus is also cautious about recommending probiotics to IBS patients because they do alter the amount and ratio of natural gut bacteria—which, in some cases, could do more harm than good. Her advice? Talk to your doctor about the potential risks and benefits, and decide together whether to give probiotics a try.

RELATED: 9 Probiotic Foods That Aren’t Yogurt

Prebiotics

Only a few studies have been done on prebiotics—nondigestable carbohydrates that feed the good bacteria in your gut—with conflicting results, the new review notes. (The same goes for synbiotics, which are combination products that contain both pre- and probiotics.)

There’s not enough evidence to say how well they really relieve IBS symptoms, says Dr. Saito-Loftus. But there’s little harm—besides the price tag of the supplement—if patients want to try them, she adds. Prebiotics are also in healthy foods like garlic, onions, bananas, and raw asparagus, as well, and eating them can be a win-win. 

“With prebiotics, patients aren’t consuming live bacteria, so I like that it’s more of an indirect way of trying to manipulate your microflora,” she says. “They’re certainly reasonable to try, but there’s not a lot of background to form conclusions either way.”

Fiber

Getting more fiber, either through food or supplements, does seem to improve some cases of IBS, says Dr. Saito-Loftus. The new review cites several studies on different types of fiber—including psyllium, wheat bran, and calcium polycarbophil—that had promising results in earlier studies.

“I definitely am a big advocate of at least trying fiber as a remedy, particularly for my patients with constipation-predominant IBS,” says Dr. Saito-Loftus. She’s a bit more cautious for those who have a lot of bloating, gassiness, or diarrhea, since fiber can make these symptoms worse.

Foods high in fiber—such as beans, fruits, vegetables, and whole grains—are typically low-calorie and full of vitamins and other nutrients, so Dr. Saito-Loftus recommends incorporating them into your diet if you can. But if getting all your fiber from food is too difficult, taking a regular supplement can help make up for what’s missing.

“I do caution my patients that fiber doesn’t work for everybody,” she says. “But if you find that after transitioning to a high-fiber diet that you aren’t feeling better, at least you can say you tried.”

RELATED: 3 Ways to Get More Fiber

Peppermint oil

Of all the herbal remedies studied in the new review, peppermint oil seemed to have the most promising results, with clinical trials dating back to 1972.

“It’s something I recommend to patients particularly with a lot of IBS-related pain,” says Dr. Saito-Loftus. “Peppermint oil is thought to be a natural anti-spasmodic, and it seems to be beneficial—maybe not for constipation or diarrhea, but specifically for those who do have a lot of pain.”

Iberogast

Dr. Saito-Loftus also recommends Iberogast (also known as STW-5), a trademarked liquid formula made of nine different plant extracts—including peppermint—to patients with IBS-related pain. It seems to work particularly well for people who have pain around mealtime, she adds.

In the new review, the authors note that Iberogast also seems to have anti-spasmodic qualities, although it’s unknown which ingredient (or ingredients) are most responsible.

Digestive enzymes

These supplements weren’t included in the review, but Dr. Saito-Loftus says that they may be helpful, particularly for people with diarrhea-predominant IBS. “It may simply be that there’s no data on them, but I can tell you that a lot of my patients come to me already taking them,” she says.

Dr. Saito-Loftus says the risk of trying these is low, and the potential benefits—anecdotally, at least—are high. “I’ve had patients who swear by them, and others who have not,” she says. “It comes down to reading the bottle and considering the price and making the decision whether it’s worth it to give them a try.”

RELATED: 18 Reasons Why Your Stomach Hurts

Stress-reduction strategies

While relief may not come in a bottle (and was not discussed in the new review), Dr. Saito-Loftus says it’s one of the most important natural remedies to consider when dealing with IBS.

“I think sometimes stress worsens symptoms and sometimes symptoms worsen stress, but the combination of the two is very important,” she says. “You can’t always modify your stressors, but you can modify your response to that stress—and I think working on that is so important.”

She encourages patients to explore different options for stress reduction and find what works best for them. “For some people it’s yoga, exercise, or meditation,” she says. “And sometimes it’s simply a matter of mindfulness and reflection, and making a conscious effort to try not to worsen the stress that’s already there.”

Fibromyalgia Drug May Help Treat IBS Symptoms

According to a small, preliminary study, a drug that’s typically prescribed for fibromyalgia might also relieve pain related to irritable bowel syndrome (IBS)—the common GI disorder estimated to affect as many as 15% of adults. There’s not enough evidence to recommend pregabalin (sold under the brand name Lyrica) to IBS patients yet, says the lead investigator, but she hopes her research will prompt further studies on the topic.

There is considerable overlap when it comes to and IBS, says Yuri Saito-Loftus, MD, a gastroenterologist at the Mayo Clinic. Many patients experience both conditions together, and both involve pain of some sort.

Previous studies, mostly in animals, have suggested that pregabalin—which is also used to treat seizure disorders and diabetic nerve pain—could decrease visceral hypersensitivity, a sensation of pain within the internal organs that’s common in bowel disorders. So Dr. Saito-Loftus asked Pfizer, the drug’s parent company, to fund a small study to determine whether it may help people with IBS.

“Treatment options for managing abdominal pain—particularly moderate to severe pain—are limited to antispasmodics and neuromodulators such as tricyclic antidepressants,” Dr. Saito-Loftus told Health. “But if patients don’t respond to those agents, there were few proven alternatives.”

RELATED: 18 Reasons Why Your Stomach Hurts

For the study, Dr. Saito-Loftus and her colleagues recruited 85 people with IBS, ages 18 to 70, all of whom reported high levels of abdominal pain. The participants took either pregabalin or a placebo for 12 weeks. Those who took the drug reported improvements in pain management, compared to those who didn’t take it.

Preliminary data also showed improvement in other IBS symptoms, including bloating and diarrhea. (Pfizer provided funds, medication, and placebo pills, but had no direct involvement in the study’s design or implementation.)

Dr. Saito-Loftus cautions that, because the study was so small, the results are not definitive. She also says that—as with any drug—there would be pros and cons to consider if pregabalin were shown to be an effective IBS treatment.

“Neurological side effects such as sleepiness and feeling funny or dizzy are known side effects of pregabalin,” she says. This isn’t surprising, she adds, since the drug is known to target nerve cells.

Cost could also be a factor for patients. Lyrica, which received a 9.4% price hike earlier this year, won’t be available as a generic drug in the United States until at least December 2018. 

RELATED: 15 Foods That Help You Poop

Dr. Saito-Loftus presented her research this week at the annual meeting of the American College of Gastroenterology in Las Vegas and it has not yet been published in a peer-reviewed medical journal, a key step for confirming new results. She says she doesn’t have set plans to do a larger study, but will be reaching out to Pfizer to gauge the company’s interest.

At another annual meeting of gastroenterologists held this week—UEG Week in Vienna, Austria—researchers presented other research that may also one day help IBS patients better manage their symptoms. Their study was on a dietary treatment.

A low-FODMAP diet—which involves restricting carbohydrates such as wheat, barley, onions, legumes, and many fruits—has been shown to relieve IBS symptoms in about half of patients who try it. But there is currently know way to know who will respond and who won’t.

RELATED: 7 Natural Remedies for IBS That May Work for You

Now, researchers from the University of Gothenburg in Sweden say that fecal samples of patients who are helped by a low-FODMAP diet have a different bacterial composition than samples of those who aren’t. Testing people, they say, could potentially predict who will benefit. 

“Being able to predict if a patient is unlikely to respond to a low-FODMAP diet means that other therapies could be discussed earlier,” said lead investigator and doctoral student Sean Bennet in a press release, “and these patients could be spared a demanding diet that might have no effect on, or even worsen, their symptoms.”

I Was Diagnosed With IBS After 3 Years of Constant Constipation

It started when I was 18 during my first year of college. Instead of a normal bowel movement, I began spending very long periods of time in the bathroom straining with extremely little output. This would happen every day, and what came out was probably no bigger than a pebble.

Even more alarming was that I was often only passing mucus. It was frustrating and also scary; I’d never heard of that being possible. I also started feeling really bloated and my belly became distended, which got worse over time. 

The next three and a half years of my life was a constant battle to find out what was causing these symptoms, and what I could do to alleviate them. I spent lots of time and money, and I pretty much tried everything.

I cut gluten and dairy from my diet, and I put them back in. I spent $16 at a time on charcoal drinks and kombucha, trying to overwhelm my stomach with probiotics. I reduced my coffee intake and pumped it back up. I ate lots of vegetables for more natural fiber. I drank apple cider vinegar with ginger, which is supposedly really good for you, but is also disgusting.

RELATED: 15 Ways to Ease Your IBS Symptoms

I also had a colonoscopy, which was ordered by my gastroenterologist to rule out anything physical wrong with the structure of my colon. I believe that doctors do this before they can move on to considering more systematic things that aren’t caused by a physical defect. But everything came back normal.

The nutritionist I then began seeing told me that consuming lots of protein would help “heal my gut.” So I upped my protein intake to 90 grams a day. (The RDA for someone my age is less than 50 grams.) I drank tons of water and digestive tea. No change.

As time went on, I became more desperate. I spent extra cash for one-day shipping to get psyllium husk delivered, which was supposed to work miracles but just left me $20 poorer. I bought colon health probiotics, I bought antacids, I bought laxatives, I bought suppositories, I bought anti-gas medications. I ordered digestive enzymes on Amazon, and I only realized they included a toxic ingredient when they arrived at my door. They are still unopened and I have not yet managed to return them to Amazon.

I started believing that my distended stomach was actually fat. I tried diet pills. I became despondent thinking that I’d never be in harmony with my body. No matter what I ate, how much money I dropped on pills and products and probiotics, my stomach bloated quickly after I ate and remained that way for days. I never felt good in my clothes. My constipation was ridiculous and relentless, sometimes even intolerable. I resented my body.

Finally, I decided to consult my gastroenterologist again. Of course I should have done it sooner, but I held off for two reasons. One, as the doctor who performed my colonoscopy years earlier, he had already told me there was nothing wrong with my colon.

RELATED: 13 Surprising Causes of Constipation

Second and most importantly, I was too proud to admit that I couldn’t deal with my stomach problems myself. I read tons of stories online about people who were able to heal their digestive issues through their own research. I tried so hard to do that, and I felt like a failure.

But after I graduated from college earlier this year, I decided to start acting like I was an adult. Fake it til you make it, right? Three and a half years of chronic constipation—nearly my entire college career—was enough. In this spirit of forced adulthood, I finally made an appointment with my gastroenterologist. 

I was prepared for battle when I went into the exam room. I was ready with a mental list of every symptom, everything I’d tried, all the doctors I’d seen, everything this undiagnosed issue had cost me for the last three years. When I saw him a few years ago, I wavered more about my complaints. Now I was pretty forceful about saying that something was wrong and I needed help. I was ready for paper gowns and lubricant. I was ready to do what needed to be done.

But all my preparation was unnecessary. Once I told the doctor my primary symptoms, he looked at me like I had three heads, and said, “Well, you have ,” as if I had overlooked a huge neon sign flashing those three initials.

I was taken aback. This doctor wasn’t puzzled? I didn’t have to undress and get in a weird position? He wasn’t going to give me some wishy-washy answer about a possible non-celiac gluten sensitivity, or a “twisted” colon, or maybe I should drink more water? No, he was resolute. 

Turns out constipation is a hallmark sign of IBS, or IBS-C, to be precise—a form of irritable bowel syndrome with constipation as a main symptom. When you think of IBS, most people probably imagine diarrhea or stomach cramps, but constipation is often a sign as well, it turns out. IBS is not actually a disease but a collection of symptoms. It tends to strike people before the age of 35, and women are more likely to have it than men, I later found out. 

RELATED: 5 Ways to Beat the Bloat

To treat what I had always experienced as an infuriating and totally mystifying problem, the doctor recommended a regimen of non-prescription medications available any drugstore. Twice a day, I take a fiber pill and a laxative with a full glass of water. Then before bed, I take a probiotic supplement and mix a different laxative into a glass of water. My evenings are very well-hydrated.

That’s it. It’s not invasive, it’s not risky, and it started working within a few days, I swear. Without being graphic, I can say that in the last few weeks, my time in the bathroom has become much more productive and much less time-consuming.

I still have to watch what I eat. I try to stay away from gluten (I was never diagnosed with a gluten allergy but I find that the less I consume, the better my digestive system works) and dairy unless there’s a special occasion, or there’s cake in the office. My belly bloat is mostly gone too. As dramatic as it sounds, thanks to this experience, feel more in control of my body and my life.