SUMMARY:   Bottom Line of this post: You want OFF the IBS diseasepan!  WHY? Because — putting aside pain, bowel issues, and bloat — IBS can alter the brain size and function in the emotion and sensory processing areas when having it a long time along with early life stressors [Labus et al., 2017], it is associated with A LOT of diseases, and there are A LOT of surgeries performed inappropriately because of misdiagnosis or poor manangement of IBS!  DISEASES that are associated with IBS — the listing is NOT comprehensive — includes:  Type 2 Diabetes, metabolic syndrome, fibromyalgia, chronic fatigue syndrome, IBD, CFS/ME, autism, anxiety, depression, MS, and Parkinson’s.  Inappropriate SURGERIES occurring due to IBS  misdiagnosis includes —  appendectomy, cholecystectomy, ovarian, and hysterectomy. See below for All of those links. There are lots of ways to get off the IBS diseasespan!  Learn in this post that it is YOUR choice:  IBS, Microbiome, Fodmaps, Probiotics, Mindfulness-based stress reduction, Cognitive behavioral therapy works… or targeted drugs!  Or not drugs — because of the poor efficacy of that current US standard of care:  “The physician should also emphasize the chronic nature of this syndrome [IBS] because nearly 75% of patients continue to have a diagnosis of IBS 5 years later.13 ”  [Occhipinti et al., 2012].  “Many different drugs have been suggested for IBS treatment, but their real benefits are very debatable.”  [Bellini et al., 2014].  Don’t be surprised.  In 2012, the FDA changed the endpoints of those drug studies to stop being only one endpoint because of how multi factorial IBS symptomolgy is, and the Bristol Stool Chart — defining what is a ‘normal BM’ (which you’ll learn in this post) — despite being around since 1997, is only now being validated, 2016!  Contrast all this to the UK British Dietetic Association guidelines for IBS — low FODMAP diet is the second-line intervention [Catassi et al., 2017]  [McKenzie et al, 2016]   [UK evidence-based practice guidelines for dietetic management of IBS in adults 2012 PDF]) as it helps about seventy-six percent of IBS patients [Magge et al., 2012]  [Bohn et al., 2015]   [Staudacher et al., 2011] and yet, it has come under attack with the current US standard of care still NOT recognizing the FODMAP diet (see this post).  A rebuttal to all the rift recently published in 2017, authored by Monash University ressearchers, the creators of the FODMAP diet.  See  [Hill et al., 2017] To piggyback the diet fix, studies continue to find that probiotics might be something to think about for some cases of IBS — see  [Whiteley, 2016].  Wondering about IBS and what early life stressors might mean?  That group had more history of early life trauma (general trauma (31 items), physical (9 items), emotional (7 items), and sexual abuse (15 items)) AND they had longer duration of IBS symptoms.  [Labus et al., 2017]  While we can’t change our early life stressors, there are lots of ways to tackle IBS using diet, probiotics, mindfulness-based stress reduction, cognitive behavioral therapy and targeted drugs — according to the Monash rebuttal [Labus et al., 2017].  Now you know!  Protect brain size and function, avoid potentially needless surgery and improve your disease status by fixing IBS; LISTEN to your gut!  Unbelievable… check out the global prevalence of IBS:
Category Archives: Blog: FODMAPS
Microbiome Awareness Conversation from Seminar
SUMMARY: Sharing more Microbiome Awareness conversation from the May 26 seminar, so that all can benefit, even those unable to attend!  Learn great microbiome support tips!  Amaze yourself with how much you actually learned and know!  Comment if I don’t touch on your thoughts; lets continue the conversation!Â
Background and more on our bio
Dana Grau and I spoke at the Microbiome Awareness Seminar.  We explained what the microbiome is and included discussion of diet and lifestyle impact to the microbiome which affects its health.  70+ percent our immunity resides in the health of the microbiome and that microbial community then plays a key role in determining your health:
What to do if taking ANTIBIOTICS, MICROBIOME
Summary:  Antibiotics carpet bomb the microbiome. Here’s important things to do if you must take an antibiotic as noted in this article by Dr. Robynne Chutkan, MD and gastroenterologist, see bio below. I’ve adapted the list to include the How-To-Do details.  Realize that the gist of the steps below you should ALWAYS be doing, not just during times you take antibiotics.  But be particularly diligent and persistent following these steps if you must take an antibiotic in order to try to counteract the antibiotics, microbiome, nuke!  For even more guidance on what to do before and after taking antibiotics, Dr. Mark Hyman’s recommendations from his article, Here’s the Downside of Antibiotics Your Doctor Might Not Tell You,  has been added.  Last,  the studies looking at antibiotics and Culturelle, VSL #3, and Saccharomyces boulardii or Florastor(®), as well as their precautions, are included.
Learn from the athletes why reduce, eliminate gluten
Summary:  This post  details why you may want to reduce, eliminate gluten.  In summary, learn that 20% of your calories now comes from wheat (that contains gluten), learn FIVE reasons why you may want to reduce it’s intake, and why so many athletes (41% in a 910 cohort survey) eat gluten-free 50 to 100% of the time (reduced fatigue and GI distress, improved performance and nutrients — OFTEN FRUITS AND VEGETABLES ARE INCREASED WHEN GLUTEN IS DECREASED, lower toxin loads,…).  Where is gluten?  In wheat, barley, rye, bulgur, couscous, farina, graham flour, kamut matzo, semolina, spelt, triticale & oats (not certified gluten-free) not to mention that gluten is  renamed  and hidden often in processed foods.
How & Why Properly prepare SOAK Quinoa
SUMMARY: Quinoa is a whole grain substitute that is gluten-free though it actually is a seed, commonly termed pseudograin. Most simply rinse, drain, then toss quinoa into a pot and simmer for 12 minutes calling that cooked. Though cooked, it may not be very digestible, and this method may be downright harmful to your gut. So how do you properly prepare soak quinoa? Learn here that quinoa is super easy to properly prepare although it does require, as a minimum to reduce anti-nutrients, a 12 to 24 hour acid soak prior to cooking. I’d do the quinoa soak purely for the culinary taste improvement truth be known as it removes bitterness from quinoa’s anti-nutrients in addition to making it easier on your gut! For more science, see below the recipe for quinoa’s: Impact to the microbiome, nutrient (including protein) punch, anti-nutrients and impact on those due to quinoa processing, and label de-coding for a Kind bar containing quinoa!
IBS: FODMAPS, Stomach Microbiome, Rifaximin Antibiotic Treatment, seriously?!?
SUMMARY: Â Learn impact of FODMAPS, Stomach Microbiome, Rifaximin… Â FODMAPS Diet helps over 70% of IBS likely because long term diet changes the microbiome in the stomach & gut. Â FODMAPS isn’t a life long diet; you reintroduce & learn your individual dosing limits. Â
Many now realize the need, if not necessity, to transition to a whole foods diet. Â
Foods from restaurants or cafeterias, prepared foods (even at sites considered healthy such as Whole Foods), and the obvious boxed foods make it tough for consumers to avoid caloric dense non nutritive foods with industrial seed oils and added chemicals, pesticides, and GMOs.  The diet — health connection is becoming apparent; many suffering chronic disease(s) are trying to change diet and lifestyle to improve health and wellness.  Eating whole foods can be daunting but the safest bet is making it yourself and to do so in quantity so as to make this lifestyle change sustainable:
I am going to walk you through and example using a typical low fat diet, to show how easy it is to need to turn to the whole foods table to remedy digestive health issues.  Low fat dieters inadvertently increase carbohydrate loading in order to eat low fat; in doing so, they do not increase carbohydrate loads by eating more vegetables and low fructose fruits, rather grains and fructose dominant fruits dominate most low-fat diets.  Top that off with the quality issue inherent in low fat prepared or processed foods as they generally contain many questionable ingredients, chemicals, GMOs and pesticides.  The below slide drives home the macronutrient skew so you can see what 30 grams of carbs really looks like, two ways:
Many are now literally feeling the effects of such macronutrient skew either due to gluten sensitivity (or it could be due to another grain protein; we now realize that immunologic reactivity in celiac disease may not be limited to wheat gluten, but can involve certain nongluten proteins, too, see Nongluten wheat proteins triggered immune response in celiac patients), fructose malabsorption, or some other food intolerance/sensitivity).  The end result is that many suffer with Irritable Bowel Syndrome (IBS) which is second to missed work days only to the common cold.
More IBS facts:
-  IBS affects 10-20% of the general population, with women 20-40 years old accounting for the majority of patients. (2008 Clinical approach to irritable bowel syndrome, Astegiano et. al. 2008)
- Irritable bowel syndrome affects approximately 10-15% of the European population and up to 70% of individuals with IBS may not be formally diagnosed. (Quigley et. al. 2006)
- Patients with IBS cost a average $1300 more per year than non-IBS patients (Costs of care for irritable bowel syndrome patients in a health maintenance organization. Levy et. al. 2001)
- IBS results in more than $10 billion in direct costs (eg, office visits, medications) and $20Â billion in indirect costs (eg, through work absenteeism and reduced productivity) each year.
(IBS – Review and What’s New, Foxx-Orenstein A. 2006) - Approximately 12% of all primary care doctor visits are IBS related, making IBS one of the top 10 reasons people go to the doctor. (Total Costs of IBS: Employer and Managed Care Perspective, Cash 2005)
- Roughly 30% of all visits to a gastroenterologist are IBS related, making it the number one reason people see a gastroenterologist. (Total Costs of IBS: Employer and Managed Care Perspective, Cash 2005)
- IBS is the leading cause of missed work days in the US (second only to the common cold). (Total Costs of IBS: Employer and Managed Care Perspective, Cash 2005)
- IBS patients are more likely than others to have their gall bladder removed unnecessarily and with no positive effect on their IBS symptoms.  IBS have an increased risk of cholecystectomy that is not due to an increased risk of gallstones, but rather to abdominal pain, awareness of having gallstones, and inappropriate surgical indications.  (Gallstones, cholecystectomy and irritable bowel syndrome (IBS) MICOL population-based study, Corazziari et. al. 2008)
- The physician must realize that a strong physician–patient relationship will be the foundation for effective treatment and realistic expectations. Many patients with IBS have bounced around the medical field for many years with varying diagnoses because of the lack of interest or profound frustration by the physician in treating IBS, possible stigma of this disease as being a psychiatric entity, or lack of clinical, physical, or laboratory diagnostic criteria… The physician should also emphasize the chronic nature of this syndrome because nearly 75% of patients continue to have a diagnosis of IBS 5 years later.13  –Irritable Bowel Syndrome: A Review and Update, 2012
- A lot more citations to top IBS articles can be found at: Food Allergy and Intolerance Foundation (Selected Research Articles on IBS, Food Allergies, and Related Issues.Top Articles).
Rifaximin antibiotic treatment for IBS, seriously?!?
IBS is a serious issue; if it isn’t controlled the conventional treatment will use the antibiotic Rifaximin.  Gastroenterology and Endoscopy News January, 2015 issue just reported that a second dosing of Rifaximin can be used since 2/3 relapse using one course Rifaximin  (1,074 of 2,579): see Rifaximin Redo Benefits Some With Diarrhea-Predominant IBS (Abstract 45 presented at the 2014 annual meeting of the American College of Gastroenterology.) Also see American Gastroenterological Association Institute Guideline on the Pharmacological Management of Irritable Bowel Syndrome, Sept. 2014 for more IBS guidelines (generally recommends a lot of medicines, some are posted in Comment below).
The Role of Diet as provided in, Irritable Bowel Syndrome: A Review and Update, 2012, is a valid alternative for IBS:
Patients with IBS commonly complain that specific dietary misadventures contribute to their symptoms of abdominal discomfort, bloating, or exaggerated gastric-colic reflex (urgent bowel movement after eating a meal). The truth is that no specific food is likely the culprit because true food allergies are rare. It is merely the act of eating that most likely initiates these postprandial symptoms. Patients may begin to associate ingestion of certain foods such as fatty foods, caffeine, alcoholic beverages, carbonated foods, or gas-producing foods as the etiology of their complaints.2 The physician does not want to restrict the patients’ diet excessively because of the risk of encountering nutritional deficiencies. However, it may be a good idea to instruct the patient to limit suspected foods and slowly reintroduce these items individually to see if similar symptoms reoccur… [recommend] maintaining a daily food diary.