Training with IBS-C and on 75mg Sertraline

[Macca1987]

I have a couple of chronic health conditions that impact my training and ability to make gains, and would like some advice about if there are ways around it, since I feel I’m just going around in circles atm.

Firstly I have IBS type C, which flares up for months at a time. It suppresses appetite, and the attendant lethargy, stomach pain and headaches make me feel particularly weak while training. Also, as I have a number of food allergies and intolerances, including eggs and protein shakes, and my IBS consistently flares up when I try to increase caloric intake, it makes it nigh impossible for me to achieve a daily caloric surplus and get sufficient macros to make size gains.

Secondly, I’m on 75mg of Sertraline for anxiety, whose side effects also produce increased lethargy, and I believe lower testosterone levels.

It seems as though both of these conditions have given me a number of handicaps when it comes to strength and conditioning, evidenced by the fact that my lifts and weight gains have completely stagnated for over two years, yet coming off Sertraline isn’t an option, and any dietary changes just produce IBS flare-ups.

Any recommendations for how I might still achieve some progress despite these restrictions? Or should I just accept the prospect that all I can now hope for is to maintain whatever gains I have already made.

Many thanks.

[Austin Baraki]

Do you work with a physician and dietician with expertise in IBS?

If you feel you are experiencing intolerable side effects from sertraline, there are many other options available with differing effect profiles. Many of these are outlined here: https://depressiondecisionaid.mayoclinic.org/index

Targeting these issues, as well as ensuring your sleep is as good as it can be, would be first steps in my opinion. From there, I think that these kinds of complex situations are honestly best handled with an experienced coach (much like the medical conditions discussed above). This is because some conversations likely need to be had about expectations, goals, and formulating training accordingly. There may be some beliefs that need to be fleshed out and challenged a bit, for example the concern over fluctuations in testosterone levels making a significant impact on your progress -- which is unlikely to be a major contributor to your issues. The programming that you've been following may itself have been inappropriate for your situation as well, and this requires a bit more detailed conversation and, often, trial and error over time.

[Macca1987]

The only medical advice I have been given with respect to my IBS is from my GP, who directed me to generic NHS guidance on low fod-map diets, and prescribed long term Mebeverine (Colofac) 3x per day to offset GI symptoms, without much effect.

I had wondered whether the frequent lactic acid produced, particularly in high intensity cardio workouts, could be irritating my gut over time? I asked my doctor this question but he wasn’t conversant enough with strength and HIIT conditioning to offer an opinion.

Could you provide an insight into this?

I am currently 8 weeks into Powerbuilding II, and have 5 years’ continuous experience lifting, having previously completed The Bridge, Alan Thrall’s 12-week programme, and Hypertrophy II, so am fairly conditioned to these programmes and training style. But I would say that even though they’re excellently periodised, can feel very taxing when I’m doing them back-to-back.

As regards medication, I have historically been on Citalopram and Fluoxetine, and found Sertraline to be the most sustainable, since the other two tend to increase agitation, whereas Sertraline has more of a tranquilising effect. Although the lethargy Sertraline causes makes workouts more challenging, within the first six months of the three years I have been taking it I did manage to put on 1 stone in size, and saw commensurate strength increases, but I assumed this was more attributable to increasing my days lifting from 3 to 4 days per week, and moving from 5/3/1 programming structure, to BBM programmes.

[Jordan Feigenbaum]

The only medical advice I have been given with respect to my IBS is from my GP, who directed me to generic NHS guidance on low fod-map diets, and prescribed long term Mebeverine (Colofac) 3x per day to offset GI symptoms, without much effect.

You may benefit from other medications after discussion with your physician, as there are many available if suitable treatment has not been found.

I had wondered whether the frequent lactic acid produced, particularly in high intensity cardio workouts, could be irritating my gut over time?

It is unlikely. Lactate (not lactic acid) is produced during anaerobic metabolism and this is fed almost directly to the liver for energy production.