Revlimid Diarrhea and Gastritis: What has helped me
April 2025 update after one year off treatment and still MRD negative.
This is focused on my myeloma adventure but may be useful to other hematology patients. Always check with your healthcare team before making any changes.
. Colestipol can free you from being near the bathroom all the time. I am currently off it.
Dr. Paul Richardson, 2016: “Lenalidomide [Revlimid] related diarrhea is I think probably an under-appreciated problem. The good news is that it’s very manageable. It typically occurs when lenalidomide is used in maintenance without steroids, and it can definitely become a problem over time. The good news is it’s a sign that the lenalidomide or Revlimid is probably doing its job because it’s basically working on the immune system and stimulating not only immune system throughout the body to fight myeloma, but it seems it may be also stimulating the immune system in the gut.”
https://www.lls.org/sites/default/files/National/USA/Pdf/Slides_Transcipts/transcript_myeloma_1.6.17.pdf
. Does IBS develop during immunotherapies? Low FODMAP is important but many gastros don’t know about it even though the American College of Gastroenterology recommends it. Foods and quantities can be tricky, most info on the internet is wrong. Get the app from
https://www.monashfodmap.com/ibs-central/i-have-ibs/get-the-app/
. More fiber. Anthony’s organic whole psyllium husk:
https://a.co/d/5XWv5ep Note Metamucil has either high sugar or artificial sweetener banned in Europe. Suggested by a social worker in a support group. I think this alone helped me to taper off Colestipol.
. Probiotic each day. Quality is extremely variable, check reviews like this:
https://www.reviewscout.org/top-5-probiotics/ I am trying StoneHenge because it is US made, in glass bottles, etc.
. Amitriptyline for “functional dyspepsia”, suggested by PCP. Slows down the whole gut system a bit. “Titrated low-dose [10 mg to 30 mg once daily] amitriptyline was superior to placebo as a second-line treatment for IBS in primary care across multiple outcomes, and was safe and well tolerated.”
https://www.sciencedirect.com/science/article/pii/S0140673623015234
. I have been able to gradually taper off Gaviscon Double-Acting (Alginate antacid imported from England with high price), then licorice DGL. DGL is better than taking antacids:
https://a.co/d/7d43tD5
. When my stomach is uncomfortable I eat a tiny bit of pure, high quality Stevia powder which makes me salivate:
https://a.co/d/1PomcT6 This is surprisingly effective at least for me.
. One key has been taking a PPI for a few weeks to allow recovery when needed: Pantoprazole 40 mg (Protonix). My PCP suggests that this is worth the problems PPIs cause as long as I take B-12 sublingual (for absorption) and calcium citrate that absorbs without stomach acid. I am currently off Pantoprazole.
. I have started taking Glutamine powder under the guidance of a Naturopathic Doctor (ND) who specializes in oncology. It may be helping me to stay off both Colestipol and Pantoprazole.
. Exercise every day (as possible). Wear a sports watch and elevate your heart rate. Move to live.
. MIND diet or similar. The gut is most of the immune system. Reduce inflammation which drives many problems. If nothing else, reduce refined sugar to reduce inflammation. Anticancer book by David Servan-Schreiber is still essential reading:
https://a.co/d/7i8l8Ar
. Stress damages the immune system. Laugh a lot. Watch comedians on YouTube or whatever.
. Meditate even for a few minutes a day. I use the Muse EEG headband for neurofeedback meditation (and to measure my sleep quality occasionally). I have been doing mindfulness meditation since 2008 and neurofeedback drives me way deeper. The research is credible:
https://choosemuse.com/pages/muse-research
. Sleep is a large part of the immune system. I use the OmniPEMF system to stimulate my vagus nerve in the afternoon and then push me into deeper sleep at night. My Muse EEG shows big gains in deep sleep time since I started using Omni. And I have stayed in remission (MRD negative) during that time. Coincidence? Maybe. Deeper and longer deep sleep is essential for the immune system. The research is credible:
https://www.tandfonline.com/doi/full/10.1080/15368378.2025.2462649
. Hypnotherapy is misunderstood. It is simply helping you settle into a state of deep relaxation and then suggesting things to help with whatever is challenging you; “John, you are going to sleep well”, “You will be very relaxed”, “You will let that topic go”. “Sleep now” - I can’t say those two words now without yawning. I did not expect much and have been surprised how effective it is.
https://www.apa.org/monitor/2024/04/science-of-hypnosis
. Find a support group that you can share experiences, ideas, and techniques with. Teams help to overcome challenges.
. Share what works for you
In Part 2, I will report results from working with a Naturopathic Doctor (ND) who specializes in oncology.