Browsed by
Tag: IBS

Dear Dr. K;

Dear Dr. K;

I recently underwent food allergy testing at the behest of my gastroenterologist to see if food allergies are causing or contributing to my irritable bowel syndrome.  It turns out I’m allergic to five foods.  My question is how do I determine if all five are causing my symptoms or just one or two?

That is a great question.  The guidelines I’m going to share with you were worked out in clinical research units.  In these settings patients are kept in a controlled environment (typically a hotel appended to the university hospital) and avoid the implicated (food allergy test positive) foods for two weeks.  It seems to take this long to fully “clean the system”.  Then, one food at a time is re-introduced.  In the research setting this is done double blinded and placebo controlled by putting the food to be tested inside gel-caps.  On a given day the patient may receive a placebo or an actual food.  Now, obviously this is a very tedious and protracted protocol.  But it has led to some basic rules to be used at home.

So, first of all, you need to avoid all five foods at the same time for two weeks.  If food allergy is causing your IBS, you will feel better at the end of two weeks. 

Then start adding a single food. You should have this food in “a usual portion size” and have it at least three days in a row.  If you have “tummy troubles” the very first day it could be due to the food or serendipity.  So, you need to repeat the experiment to verify. 

Now here is the hard part.  If you have symptoms you need to go back to the elimination diet until you feel well again before you try the next food.  Unfortunately, this could take up to two weeks again.  But you need a symptom reduced baseline to have clarity. 

Once you’ve tested all the foods there is another step you might need to take.  But this is necessary only if all the individual tests were negative.  This step involves testing food combos.  By way of example let’s say you tested positive to cheese, tomato and wheat.  Tested individually: no issue.  But tested together might reveal synergism.  So, pizza would be a mechanism to test all three.  Good luck, be patient. 

Hypnotherapy for IBS

Hypnotherapy for IBS

Scientists at Monash University in Melbourne, Australia have developed a hypnotherapy-based computer app to help people with IBS (irritable bowel syndrome). 

The program called Nerva guides users through a ten-minute hypnotherapy session every day for six weeks.  The neural therapy is designed to correct the disordered signaling from brain to gut.  Patients who complete the six-week program report a reduction in symptom severity from 67 (on a scale of 100) to 39.  Adding a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet has additional benefit. 

Q – Tips: IBS

Q – Tips: IBS

Recent research on IBS (Irritable Bowel Syndrome) has uncovered the fact that many persons with this condition have a bacterial toxin called cytolethal toxin B (Cdt B) in their stool. This toxin is produced by unhealthy gut microbes. A potential treatment is the use of probiotics.

Q – Tips: FODMAPS

Q – Tips: FODMAPS

Avoiding carbs known as FODMAPS (trust me, you don’t have to know the acronym’s long name), may help prevent irritable bowel syndrome. Vocabulary words to remember for these short-chain carbohydrates include fructose, lactose, fructans (found in wheat), galactans and polyol sweeteners. Remembering this list is important in fending off this painful syndrome because the body has a hard time absorbing these items. They remain in the GI tract and become a source of “GI tumult” when the gut bacteria ferment them. Galactans are found in dried beans and peas, and while polyol sweeteners are in lots of healthy fruits with pits or stones (e.g., peaches), they are also are used in many artificial sweeteners

Don’t despair at urgent, post-meal, ‘uh-oh’ moments

Don’t despair at urgent, post-meal, ‘uh-oh’ moments

Postprandial Diarrhea Syndrome (PPDS) – the unexpected and urgent bowel movement shortly after eating a meal – was the topic of a recently review article in The American Journal of Medicine. The authors of this review (from the Mayo Clinic) commented that this condition is often given the all-embarrassing moniker of irritable bowel syndrome (IBS).

But they go on to say that unlike IBS, where no cause is known, PPDS can have a treatable cause. The most common of these are food allergy, celiac disease, maldigestion due to bile acid malabsorption, pancreatic deficiency or an a-glucosidase deficiency.

Food allergy is best diagnosed by allergy skin testing. The treatment is avoidance of the allergenic foods. Celiac disease is an immune (non-allergic) reaction to gluten and can be diagnosed by blood test or intestinal biopsy. Again, the treatment is avoidance of wheat and other grains.

Bile acid malabsorption is best diagnosed by an empirical trial of a taking a bile acid-binding resin. There are sophisticated GI tests that can be done, but these are usually only available in a research medical setting. If the bile-acid binding resin controls the symptoms, then it is continued as a maintenance therapy.

Pancreatic insufficiency (lack of the digestive enzymes produced by the pancreas) can be diagnosed by a fecal fat analysis. Treatment consists of taking replacement pancreatic enzymes orally.

A-glucosidase deficiency is the lack of one or more enzymes that break down certain sugars. The most common ones are deficiency of sucrase, glucoamylase, maltase and isomaltase. Treatment involves avoidance of foods that contain the specific sugars.

Before embarking on a diagnostic trip for PPDS it is important to have proper gastro-intestinal evaluation to rule out more serious underlying conditions, such as cancer, Crohn’s disease or other inflammatory bowel diseases.