# "No More IBS" diet-problems.Help please?



## Tracey Heynes (Nov 5, 2001)

I've been trying the diet recommended for IBS C in the book "No More IBS".I started about 5 days ago and over the last three days have noticed I am very bloated and sometimes feel very heavy and uncomfortable digestion after meals -ironic as I am now eating more healthily than before.Last night was especially bad.After a meal of steamed veg,tiny bit of rice,olive oil dressing and a small chicken leg,I felt very bloated and,after a while my stomach felt very acidy and I started to feel dizzy(I was out at the time)I also experienced something that I guess was heartburn,but I'm not sure as I've never had that.(I should add that I had taken a digestive enzyme with my meal.I am also on Zelmac).This morning,after a breakfast of banana,a few cherries,pecan nuts and black coffee,I feel that heavy feeling again and feel quite unwell.Is this normal?Anyone else on the diet experienced this?I'm sorely tempted to go back to my old eating habits but desperately want to solve the bloating problem and this diet was like my last hope !Help?


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## WashoeLisa (Sep 12, 2000)

Hi ibsed,What a bummer- starting a new diet in hopes of starting to feel better and you feel worse, with no real explanation.I haven't tried that particular diet, but as one who has controlled my IBS with diet- I can at least give you some ideas.First, if the diet is doing you some good, there is always the beginning period where you actually feel worse as your body is adjusting to its new regimen. Cleaning itself out, so to speak.Second, there is the strong possibility that you are reacting to something in your new diet. Foods that are healthy don't always mean they will agree with your body, unfortunately. For me, spinach is the worst in terms of reactions, even though it is a healthy food.A good book on the subject is "Food Allergies and Food Intolerance" by Dr. Brostoff. YOu can get it at amazon.com.Best of luck and I hope you feel better,Lisa from Nevada


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## Tracey Heynes (Nov 5, 2001)

WashoeLisaMany thanks for that.Strangely,NONE of the foods I've been having are ones I don't normally eat.That's the crazy thing.I do have a good book on Food Allergies and Intolerance,a very comprehensive guide,but it's no help in this case.Are you IBS C or D ?It seems to me that the latter type seem to get more benefit from diet changes to us C types.I got very depressed yesterday feeling so unwell.Not sure I can go on with diet but don't know where to turn next.


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## Mike NoLomotil (Jun 6, 2000)

IBSED: _______________________________________"...-ironic as I am now eating more healthily than before." ________________________________________Another victim of "one mans' meat is anothers poison". What is healthy for one is a disaster for another. One must find out first, though, if the problem really is at all managamebale with dietary manipulation.Could we have some history and symptoms info? It could help me help you better if I know a bit more about the problem and how it started.Will Check back tomorrow.MNL


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## WashoeLisa (Sep 12, 2000)

Hi Ibsed,Yes, I am IBS-D but a bit of cyclic C & D thrown in on occasion.Mike is a great one to help you sort some this out for yourself too. I hope you'll take advantage of him and learn all you can- and hopefully get you better!I was sorry to see you were feeling rotten yesterday...Take good care and I look forward to hearing more from you,Lisa from Nevada


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## Tracey Heynes (Nov 5, 2001)

Symptoms and history?Well,I have had the bloating for YEARS now as well as constipation,though oddly the latter used to be a problem I tended to have more at weekends(this was about 10 years ago)The bloating used to be occasional,then frequent and now it is all the time.I have a ling history of eating disorders(binge eating disorder until about 6years ago when I actually became Bulimic)For many years I usec laxatives often - but not in excessive doses-to cope with the constipation that usually followed overeating.I also used them later on when constipation had established itself as a real problem.So,I guess I have ultimately damaged the normal functioning of my system over many years.However,now my eating is much more normal.I rarely have Bulimic episodes.Even when eating "healthily" I can have very slow stomach digestion and bloating of the lower abdomen(at the moment,however,with my diet,the bloating starts from my stomach downwards)I'm on Zelmac just now but it isn't working as well as usual.I THINK I'm having a lot of trapped gas these days,which is not normally the case.My diet is :no grains except rice;no sugar,yeast,dairy products,potatoes,onions- that's basically it.A typical day for me would be:Breakfast:fruit(fresh or tinned),almonds,maybe a piece of banana,black coffeeLunch:rice,cold steamed veg.,olive oil,walnuts or tinned sardinessnack:rice cakes or piece of bananaDinner







iece of chicken with steamed veg. and olive oil.And lots of water !Well there it is .Hope that's complete enough.(Thanks again WashoeLisa for comments.My current situation is really getting me down)


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## WashoeLisa (Sep 12, 2000)

Hey Ibsed,I can't help with the clinical stuff- but I can offer my support.It really stinks to be so sick all the time. I can fully empathize... You know you aren't alone here, right?My body has betrayed me so often, I pretty much try to ignore it when tis acting up- but that can be really hard some days. I thank God that I was able to find out that the food was the crux of my problem. I really hope that we can find something for you. And I'm going to go with that thought!Rest easy and have a good weekend,Lisa from Nevada in California


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## Tracey Heynes (Nov 5, 2001)

Dear Lisa,You know,I don't know what I'd do without this site .The messages from you and others really help me to feel less alone and frustrated when things are going badly.The helpful tips and advice I get(and hopefully give) have been very valuable.Let's hope something turns up just now because currently I'm going nuts - and the current heatwave makes it worse.Thanks again.Mike Nolomotil - any ideas?(apart from replacing my whole digestive system.Sometimes I wish I were a car.Life would be so much easier when something wasn't working properly)


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## Mike NoLomotil (Jun 6, 2000)

Hi IBSED.Sorry so slow I am travelling and so can only check in the morning before I hit the road again. I am also burdened by this horrific laptop....gotta get one where the keyborad can be reached without reaching OVER this also horrific pointing device....Satans idea of a joke (Oh, Ethan emailed me that its DELL's idea of a joke not Satan..sorry).Yes I do have couple ideas...and want to compact what I say down as typing is SO laborious with this thing.A gross generality is that when one suffers from the symptom set you suffer from the bloating sensation seems almost inevitable...picture putting things into a hose at a higher rate than they move through the hose. That hose is going to start to feel like it is bulging...this is a simplified explanation of that sensation.So the therapeutic trick as you know from your experiments is toa. find ways of making the movement of things through the tube more normal and getting the hose to empty out more easily...what medication is needed, and what works, varies with where the mobility problem is...upper gi. mid gi, lower gi, all of the above...there are ways that GI docs can evaluate this (motility in different parts of the gut)b. while that is going on you also experiment as you have with finding things that do not make much gas, and also important that when the chyme gets to the colon it ends up as a soft and easy to move waste productI have seen doctors and dieticians have way more success with slowing DOWN motility, as food and chemical sensitivities of various kinds which casue this can be more easily managed than can the polar opposite...slow bloated guts. This is a whole nother ballgame that medicine in general so far is not to good with.You are correct that you probably did not help yourself with the laxative abuse, but it is also understandable. Also I understand your situation a bit as my ex was a bulemic as well (among other problems).I do suggest, first off, that there are two books you should have as they contain info which will help you understand your diet and how to assess it more thoroughly...."FOOD ALLERGIES AND FOOD INTOLERANCE: THE COMPLETE GUIDE TO THEIR IDENTIFICTION AND TREATMENT", Professor Jonathan Brostoff , M.D.. Allergy, Immunology and Environmental Medicine, Kings' College, London http://www.amazon.com/exec/obidos/ASIN/089...6487508-3420903 IBS: A DOCTORS PLAN FOR CHRONIC DIGESTIVE TROUBLESBy Gerard Guillory, M.D.; Vanessa Ameen, M.D.; Paul Donovan, M.D.; Jack Martin, Ph.D. http://www.amazon.com/exec/obidos/search-h...9085785-1742301 people often think that Brostoffs book is not helpful except in a limited symptom spectrum...but the opposite is true...he covers a wide range of things that different foods can do in the body, and has many tips which can help your symptoms as well. And Guillory has some good tools to help you track, in an organized way, self-directed dietary experiments to minimize your suffering.Now, I have some more questions1. you say you eat fresh fruit. Which ones do you eat? Which ones do you never eat?2. you say you eat tinned fruit? Please look at the cans of tinned fruit and tell me which fruits and what the ingredients are on the label in addition to the fruits3 steamed veggies....what veggies do you eat...this is a cornicopia of possibilities...4. which specific laxatives did you find to be most effective at getting your colon to empty when you were using them...in other words a little accomplished a lot vs. laxative where a lot did littleThis can tell us a little about your gut too5. do you follow a rotation plan for your foods or do you tend to eat the same thing(s) pretty much every day? What form do you eat your flesh food (chicken) in...Gotta runbe back in the am for awhileEat well Think well Be well Don't swellMNL


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## Tracey Heynes (Nov 5, 2001)

Dear MNLAm knocked out by the length of your reply and the interest you have taken in trying to help.You said you'll look on tomorrow morning but I have had a very busy day,just got in now and am soon to bed coz very early start tomorrow(it's _like_ that over here !)No time to answer you properly but will do so later tomorrow probably.Many thanks again, Ibsed


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## sarah1234 (May 24, 2001)

Ibsed, I am having the same problems as you (constipation and bloating) as of two weeks ago I basically have the same diet as you... no yeast or anything causing it, sugar, wheat, dairy, etc.) Basically I eat eggs, chicken, and vegetables now. I have never felt worse. I am so bloated every day and my whole body feels completely thrown off- maybe a reaction to the sudden changes. I am curious to see what input you get since we seem to be in a similar boat.


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## Mike NoLomotil (Jun 6, 2000)

IBSEDbeleive me I know what you mean...I am in Atlanta on biz and have a full day too...get up early to stop by and see if any q's to reply to so I can get busy.I stop in every morning even when I am on the road so feel free to post at your leisure...or lack thereof?







SarahAm I reading you right that these symptoms just stared when you switched to your present diet? Besides the stuff you listed is there nything else you are eating? Also are you rotating foods like evry 2-3 days or are you eating basically the same things every day?Be backMNLHot 'Lanta Mobile Unit


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## Tracey Heynes (Nov 5, 2001)

Sarah,Sorry to learn you're in the same boat.No fun,is it?It is also EXTREMELY hot here at the moment which makes the discomfort that much more difficult to cope with.MNL,At last time to type a proper answer.Firstly,I should say that I have broken my diet having got to the stage of being SO uncomfortable for so long and in unbearably hot weather.I'm afraid I have turned to my comfort foods.HOWEVER,I would like to try again when things cool down(we're in a heatwave and I cope badly in hot weather at the best of times).So I'm still interested in what you have to say - and maybe it can help Sarah too.Getting my Gastro. to investigate where the motility problem is would be difficult - he's basically lost interest.I however feel the whole system is out of order :at the moment ,the stomach empties very slowly,and the intestines are also sluggish as I'm getting lots of trapped gas and less frequent and smaller stools(even with Zelmac).Thanks for your understanding approach to my Bulimia -I do appreciate that.Thank you for the book recommendations.I do have a very good book that sounds similar to the Brostoff one - ha!Now wouldn't you just know it?I've just gone to look....it *IS* the book you mentioned !!!!Indeed it has been my "Bible" over the last couple of years and I know it almost inside out.The other book I don't know,but to be honest I'm really reluctant to invest in more books.I have wasted so much money over the years on this type of stuff.The last time was in September:It turned out to be a waste of time and money and I'd had to get it from the UK and spent ages reading it and making notes as it was very complicated.The second book I came across I didn't buy but got a friend to photocopy relevant bits for me(I'd read it first quickly)I'm glad I didn't buy it because this one was also a wasted effort.You see my dilemma?Now to your questions:1.I eat:bananas(very ripe),strawberries and cherries in season,raspberries(frozen),mangoes,papaya,pears,apples(cooked only),kiwi fruitI never eat:citrus fruit,fresh pineapple(too expensive and never good here!),plums,2.Tinned fruit







ears,peaches,or pineapple in fruit juice.My current tin of pears contains only pears,pineapple juice and pear juice.No sugar added.3.Veg:mostly carrots,frozen green beans,fennel,courgettes,Swiss chard(a dark green thing a bit similar to spinach-it's not of the cabbage family),roquette(rocket salad in English?),aubergines,red peppers(occasionally).I usually steam a whole batch then keep the leftovers in the fridge to eat cold over two days(no longer than that)4.Most efficient laxative







ulcolax tablets,Agiolax with senna(a kind of bulking laxative you take with lots of water),Transipeg (iso-osmotic).However,these seem to be effective at different times egTransipeg didn't help me at all last time I tried taking it.There seem to be periods when certain things just don't work but others do and vice-versa.5.Chicken is roasted without fat in an oven bag,slowly so it's nice and soft.I usually freeze some to defrost and eat cold.I tend to eat much the same thing every day on a diet as it's easier to organise that way (especially if I'm busy like this week)Will be interested to see what comments you have.Incidentally,do you have any medical knowledge or are you like me - I mean over the years I've read so much I'm basically more knowledgeable than my doctors and am probably a qualified nutritionist without realizing it !!Many thanks for your time.


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## WashoeLisa (Sep 12, 2000)

Hi Ibsed,Been outta commission here with the flu. (It always strikes me as cruel that not only do we have IBS, BUT WE STILL get the flu!!)I had to laugh when I read your last line- yes, I know more than alot of my own doctors about some of this stuff. And that still freaks me out a bit! LOL!Hang in there!Yes, I do like this board for the support it offers, and you are a good part of it too!Lisa from NevadaP.S. Your English is terrific! Did you learn to speak it as a child?


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## Tracey Heynes (Nov 5, 2001)

WashoeLisa,Ho,ho.Lisa,I laughed too - I *am* English,hence my superior linguistic skills! Your message is doubly amusing as I have just spent several days assessing Swiss students taking English oral exams !!I must say,sitting down all day did NOT help me feel less bloated and yukky !


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## Tracey Heynes (Nov 5, 2001)

WashoeLisa,Just wanted to add,I'm so glad I looked in tonight as I have had a MISERABLE day and your posting made me smile and has cheered me up before I go to bed - can't be bad,eh?


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## Mike NoLomotil (Jun 6, 2000)

IBSED:Ok here we go with a little chat....------------------Firstly,I should say that I have broken my diet having got to the stage of being SO uncomfortable for so long and in unbearably hot weather.I'm afraid I have turned to my comfort foods.Well, its not ideal but you are also not alone…that’s why they call them comfort foods…for when one cannot cope!-----------------I'm getting lots of trapped gas and less frequent and smaller stools(even with Zelmac).I have heard that a lot from Zelmac users…the sensation of trapped gas etc. I think ibne needs to bulk up with soluble fiber, too, esp. pectin. It makes a gel which is easier to move.-------------------Thanks for your understanding approach to my Bulimia -I do appreciate that.------------------Hey people do not understand it is not like you woke up one day and made a conscious decision “Okay I am going to be bulemic now and everyone else be damned.” Thoush people act like folks do that…”Stop it. Just get over it” etc. Yeah right. Get a clue.Some ideas random in nature….1.	Skip the bananas…eat more of the fruit with a lot of “pectin”…apple pear etc. Also mango…and papaya as tolerated (enzyme). Add plums if at all possible and if you can stand the taste, a couple prunes each day. With the symptoms you describe you could use as much fruit fiber, and the added “aid” from the plum and prune, as possible. At least(4) per day. Now what happens can only be assessed if you add one new fruit at a time, for say 2 days, to make sure it does not give you some pain or gas. If you add a new fruit, and eat it a coup,e times a day for 2-3 days and nothing “bad” happens then keep it in the rotation.2.	skip all the pineapple for now…just in case. Some people have trouble with the enzymes in it. MAKE SURE that the canned fruit is just that…fruit and fruit juice only…no corn syrup sweeteners etc. Go for fresh apple and pear and peach and the like as much as possible. Grape plum raisin prune….see a pattern?3.	Do cruciferous veggies give you gas and pain? If not one can increase their ratio of these in the diet to increase the fiber they can bring…some people just get too much gas however.4.	“tolerance”….what about plain old neutral not chemically active mineral oil…ever try that instead of “active” laxatives? Start with a smaller dose than they say on the bottle and work up. HINT: Put it in the fridge so it is REAL COLD and it goes down easy. OR mis it in with ice cream if you eat that, or in the blender with some frozen fruit (whip it into the smoothie and drink promptly before they separate…never know it is there….). Might be worth a try as a reliable neutral way of prophyklaxis or handling the occasional bout.5.	all I suggest is that you rorate your proteins for sure. The chicken should be rotated with, say, ground lamb patty, ground pork patty, fish as you like….grinding the fibery meat up into a losse burger or loaf will make it easier to digest…ground chicken patty can help too. The idea is the smash everything up as much as possible and chew at least 15 times before you swallow so you really take every opportunity to break down your food. As far as knowledge? I am a retired Registered Respiratory Therapist (in the States these are paramedical people trained in cardiopulmonary diagnostics and therapeutics who work as physicians assistants with those types of patients and use all this expensive equipment for diagnostics up to and including the life support equipment you see Intensive care units). So the only natural knowledge I have is/was in that area.What I may know or seem to know on this subject is nothing more than spending the last 8 years working with the immunologists/allergists who have worked for years on food sensitivities and who were the first to ever tell me this was my IBS problem…and help me to remission with certain technology-based dietary therapy. So I began working with them formally in business as I felt this would be a fantastic boon to people all over the country with the same kinds of symptoms that nobody else was helping with what they did.So I just pick up things from them and from reading a lot of literature (books and scientific articles) on related subjects…and keeping them around since it is way too much to remember!Eat well. Think well. Be well.MNL


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## Tracey Heynes (Nov 5, 2001)

Dear Mike,SO glad to get your posting.I've been looking in every day,sometimes 3 times a day,so desperate have I been just lately.Being on a diet,then off it is very destabilising for someone with an eating disorderThings have not been good.Thank you for all your comments/ideas.1.The trapped gas thing is very recent - coinciding with the diet;but I started Zelmac a few weeks ago.I don't connect it to Zelmac -had no problems with trapped gas when I first took Zelmac for a while in the spring.2.You mention apples,but I have often been advised that these are not good for constipation or bloating .Indeed a friend of mine eats them when she has IBS D attacks. She calls it the BRAT diet :bananas,rice,apples and toast.I have also been told that apples are not good if you're bloated.What do you say to all that?3.OK goodbye to bananas-I only ate them to keep me filled up as the only other starch allowed on the diet was brown rice(and you can't snack on that on the bus!)Also,I had been told that when they're very ripe,they're full of fibre.4.I had been eating rice cakes but wonder if they contribute to bloating as they are "puffed".What on earth can I snack on easily between meals,especially when travelling?Fruit isn't always filling enough for long enough.Any suggestions?I can only take so many nuts and seeds!5.You advocate prunes-but what about the yeast?So many diets for IBS C with bloating cut out yeast,and dried fruit has loads of it-fruit skins too apparently.There's also a question about when to eat fruit as I have been advised a few times that fruit taken at the wrong time(eg,after a meal) can cause fermentation.I've even been wondering lately if fruit agrees with me at all!On Saturday I had some fresh strawberries and rasperries for breakfast and my stomach felt so acidy afterwards.Good pears and apples are not available here right now but the lovely summer ones seem to be too acidic for me(apricots,raspberries,peaches etc)6.Cruciferous veg.don't give me noticeable problems but I've always avoided them as they are "usual suspects".Cabbage does bother me though.7.Mineral oil-would that be paraffin?I thought that can be harmful to the gut?8.What about coffee?I've been advised in the past that it's bad if you're bloated.However,I know it can help as a mild laxative.It's allowed on my diet - one of the few pleasures.Do you think it contributes to the bloating?Once again,thank you SO MUCH for your help.I'm feeling so down these days and this website is becoming like a lifeline.In the abscence of any real help from medics., I feel like I'm stumbling around in the dark trying to help myself - and frequently I find myself falling over.I shall take on board your ideas.Thanks again,Ibsed


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## WashoeLisa (Sep 12, 2000)

Hi Ibsed,LOL!!!







Glad I could provide you with a laugh!







I am good for some comic relief on occasion. I come from a family of frustrated comics and so it had to rub off a bit on me!So...I guess it would be safe to say that you DID learn English as a child!







Big hugs,Lisa from Nevada


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## Tracey Heynes (Nov 5, 2001)

Mike,I know you're a busy person,but would you be able just to answer the questions I put following your last posting on this subject?I'd be really very grateful.Thanks


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## Mike NoLomotil (Jun 6, 2000)

IBSED:You are not gonna beleive this...I FINALLY got the time since it is a holiday morning and the phone is not rininging here to answer every single question for you. It took me over an hour and a half to write the answers, and I posted a couple references too. Very proud of myself for finally getting it done.So I go to post the reply click ze mouse and I get this error message something about "This symbol is not allowed in HTML tag" or some such gibberish unintelligable to a normal user, also not describing my error in terms I could use to FIND IT!!!...so when I went BACK to see what the problem was this boards software ERASED MY WHOLE FREAKIN POST!!! All I got is a white box!!!



































I am sorry, as I know you want the info. I promise to do it over again tomorrow but I promised the kids DaddyNL would not be at the office all day so I will have to come back and do it agin tomorrow. Next time I will write it in my wordprocessor and copy it over in case this bleeding program gives me another error message and erases my work again.







I know you are frustrated....imagine it from my side of this cyberspace....I almost tossed the monitor out the door...which seemed, once I had picked it up and wound up for the pitch, seemed a bit like "shooting the messenger".I will be back I promise. Sorry I really did try. Ask my monitor!MNL


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## mrygrl (Jun 26, 2002)

ibsed, MikeNL is a very knowledgeable, one bloating/gas problem (among others) is chicken, for me (and I never would have realized that on my own). I hope you feel a little better today?Carol


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## mich2002 (Jan 14, 2002)

Mike - whats the deal with bananas? at one stage I used to have 3-4 a day know Ive gotten it down to one small one a day - everytime I try find out why I need to cut down I get such mixed messages (yes are good or no are terrible etc...) I'm D predominant and have had no success with food diaries, elimination diets etc to figure out what foods affect me?? so dont know how bananas affect me?


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## Mike NoLomotil (Jun 6, 2000)

SAFFRON:---------------whats the deal with bananas?&#8230;. everytime I try find out why I need to cut down I get such mixed messages (yes are good or no are terrible etc...) I'm D predominant and have had no success with food diaries, elimination diets etc to figure out what foods affect me?? so dont know how bananas affect me? ---------------The age old conundrum&#8230;.one woman's banana another woman's poison&#8230;.People who talk about healthy eating are talking about health eating for normal people, and when you try to apply "healthy eating" rules to people with chronic diarrhea seen with IBS d-types you can only speak in terms of genera; probabilities. Like lost all the foods and chemicals with a known chemo-active agent or property which can stimulate the gut to evacuate faster and hope that you hit some of the persons problem foods. This leaves out a whole array of foods or chemicalss which normal people can process without incident because the bodies mechanisms for telling the difference between "food" and "pathogen" (oral tolerance) are intact. One of the cardinal signs of LOSS of oral tolerance to one or more things is the chronic episodic d-driven woes diagnosed as "IBS" when nothing else is apparent.A very famous person from the world of athletics, a paradigm of health and fitness and whose job it is to optimize the athletic performance of others, kept having d-episodes, and none of the doctors at the medical school at the university he works for (major medical university) could find the cause. We tested him. Test-positive for an abnormal reaction of the immune system to banana which was not allergy, but something else otherwise not detectable unless you had the technology our immunologists and engineers developed. "Banana GOOD for diarrhea! Eat banana, diarrhea better." So the medical dogma he was taught went. Plus "Banana healthy. Eat banana every day." He had d dose-related hypersensitivity reaction to bananas, and he had become so sensitivity over time that any banana ingestion would result in enough of a reaction, a day later, to produce symptoms.Hence the deal with banana, or ANY other food. You can remove it form the diet 100% for a week and watch your symptoms without it. Know thy body. The go ahead and eat some banana (1) then stop and wait 48 hours. No change, eat (2). Stop and wait 48-72 hours. Nothing? Eat every day for three days&#8230;stop and wait. No change? Banana good. Symptoms come? Banana probably bad.IBSED:OK let's try again&#8230;.1.	"The trapped gas thing is very recent"The perception of trapped gas is real. What it represents, on the other hand, is not always clear to the patient unless one does studies which allow you assess the amount of gas in the intestines and its configuration, and motility status of the gut. Since the sensation of distention is exaggerated in many IBS victims, for example, normal volumes of gas may feel like more, and real increases in gas volume may also feel like more, and segmentation of the bowel (circular smooth muscle band contraction ) which is prolonged. Increased in strength or both can produce actual "trapping" of contents in a bowel segment where the nerve signals themselves (or their perception by the brain, or both) are amplified. It is very hard externally to quantify what is actually going on.BUT the bottom line is that a change in symptoms, an increase in severity, episodic or not, is a signal that something has occurred which has provoked the symptom. So the job of the clinican is to help isolate what provokes that symptom and eliminate it. Hence the function of the disease management approach to symptom reduction: understand that there are multiple possible mechanisms at work and then have a plan which will isolate en evaluate these and what provokes them so as to reduce the symptoms.There are a number of reasons that this experience has occurred, and nobody can tell you from afar which is correct. Sometimes we see that even a subtle change in the diet of the reactive-gut patient can introduce a new seemingly inconsequential ingestant which exaggerates symptoms, a social issue arises which alters the patients base mental state and increases the stress-sourced stimuli to the gut via the nervous system&#8230;or both. That is why we deal with both whenever possible, since you can quantify what ingestants provoke symptoms, and the psychologic effects are more difficult to quantify&#8230;but you can observe behavior which suggests that one shoukd use a modality to "turn down the volume" ('attenuate&#8221







the stress component. Hence the use of CBT, HT, and even biofeedback.2.	"You mention apples,but&#8230;..What do you say to all that?"I say the exact same thing I said to SAFFRON above when she asked about bananas. I am a d-type but I tolerate apple quite well,,,it has no positive effect on my symptoms either. I know an immunologist who, if he eats apple, will have an anaphylactic reaction.BRAT diet is just another form of "stoneage bas diet" approach to establishing base diet which will provoke no symptoms. It should only be used as a base diet from which to proceed with serial oral challenge to isolate symptom provoking foods as it is nutritionally unsound at best. And the BRAT diet may be a good base diet for patient A and a disaster for patient B&#8230;.what if you are apple and wheat and banana intolerant? You will be on the can non-stop. One mans BRAT another&#8230;NOT!That is why I recommend these books. They contain the info one needs to understand food and chemical sensitivity assessment and avoidance among other things:IBS: A DOCTORS PLAN FOR CHRONIC DIGESTIVE TROUBLESBy Gerard Guillory, M.D.; Vanessa Ameen, M.D.; Paul Donovan, M.D.; Jack Martin, Ph.D. http://www.amazon.com/exec/obidos/search-h...9085785-1742301 "FOOD ALLERGIES AND FOOD INTOLERANCE: THE COMPLETE GUIDE TO THEIR IDENTIFICTION AND TREATMENT", Professor Jonathan Brostoff , M.D.. Allergy, Immunology and Environmental Medicine, Kings' College, London http://www.amazon.com/exec/obidos/ASIN/089...6487508-3420903 There are tools which can be found in them which are useful for finding a base diet that works for you&#8230;.this is the main reason the results of dietary therapy in IBS are considered spotty by so many people. The plans are not patient-specific OR they follow the rules of food allergy, which food intolerances refuse to abide by, so you cannot find them. So when your only tool is a hammer everything by necessity becomes a nail&#8230;.and you are going to ruin a lot of perfectly good screws, if only you had a screwdriver.








3.	"OK goodbye to bananas&#8230;." Which may or may not be correct. See my response to SAFFIE4.	"I had been eating rice cakes but wonder if they contribute to bloating as they are "puffed".What on earth can I snack on easily between meals,especially when travelling?Fruit isn't always filling enough for long enough.Any suggestions?I can only take so many nuts and seeds!"If you do not know a persons food and chemical sensitivities you cannot rpovide any suggestions as to what to eat. You can flip a coin on every food to decide (this is sometimes called Skin Pricke Testing)&#8230;That is why I suggest a book or two be read which can guide the patient on how to isolate their safe foods. And why a DM program was developed for that purpose for those who want a shortcut. That's all it is&#8230;a couple of shortcuts and a specific protocol to follow for tbhose who cannot or do not desire to go it alone. There are many roads to Cleveland but you must have a map&#8230;otherwise you could be stuck in the Wichita Kansas bypass road forever







5.	"You advocate prunes-but what about&#8230;..[everything else that follows]"Ditto what I said before. You have to test yourself for oral tolerance and this can be easy for some foods and very very difficult for others. And to be able to glean what is right for one person from afar is wayyyy over-assumptive when it is done. There are so many possible mechanisms by which a person can lose oral tolerance to something that you must have more information on the subject than can be set forth here (other than the tired "don' eat list du jour&#8221







which leaves many people baffled. I don't advocate prunes&#8230;.or "disadvocate" anything either. I advocate trying (it) and checking your response in accordance with rules that apply to food intolerances for that and food allergies for that&#8230;.and the two may be present singly or together or not at all.6.	"Mineral oil-would that be paraffin?I thought that can be harmful to the gut?"Mineral oil is a petroleum product, like many products, and appears non toxic when used as directed BUT obviously due to its action can block the absorption of vitamins http://www.healthwell.com/healthnotes/Drug/Mineral_Oil.cfm That page gives a brief on how to manage that if you want to try MO and see if it helps constipation.7.	"What about coffee?I've been advised in the past that it's bad if you're bloated.However,I know it can help as a mild laxative.It's allowed on my diet - one of the few pleasures.Do you think it contributes to the bloating?"Again, another one of those "probabilities advisements" which may or may NOT apply to you. You can do a coffee challenge like the banana challenge I described to SAFFIE and if it is reaction which is significant, as opposed to subtle (that is the problem that can make "sensitivity" so frustrating compared to allergy&#8230;what is the dose required over what period of time to provoke enough reaction that you can actually perceive the symptoms distinctly).It sounds incredibly crass to say "what works works and what doesn't doesn't" aside the advice given about one mans meat another poison, but I have seen that when patients understand this it produces more realistic expectations, less disappointment and disillusionment, less stress, more methoduical thus successful work on their diet, and overall better outcomes and happier patients. It's like being lied to by the government&#8230;what they think is for your own good often is just the opposite, and the rationale suits their interests not ours."I feel like I'm stumbling around in the dark trying to help myself -"hence the usefulness of those books as well&#8230;.the doctors wrote them so people would not have to feel this way. It is also why we do what we do.Eat well. Think well. Be well.MNL


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## Tracey Heynes (Nov 5, 2001)

Wow,MIKE NLM !What can I say?I'm so grateful for your long and thoughtful reply and for all the effort and time you have put into trying to help me.Thank you so much.It seems churlish to ask another question-it may be that I'm too thick ,but I feel a bit confused.I don't understand how you can find an intolerance to any food without starting off on an exclusion diet(like it says in the Brostoff book).I mean,excluding a food,like bananas,and doing the experiment you describe is fine if bananas are the ONLY problem food for you.However,if several foods are causing a reaction then surely you'll still be getting symptoms even if you exclude bananas?I promise this will be my *last* question to you.I don't want to overburden you! I will try to get hold of the other book you mention - but does it give significantly more info. than the other one?Many thanks again.I really appreciate your help. *Mrygrl* Thanks for your message - yes,I am better(since I came off the diet !!!)But still bloated and fed up.Ibsed


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## Mike NoLomotil (Jun 6, 2000)

it may be that I'm too thick ,but I feel a bit confusedThis is a common reaction to my dense verbosities&#8230;don't worry.Your questions are logical and can be answered together. Guillory et al are a contract to Brostoff in that Brostoff deals with the whole spectrum of food and chemical intolerances and provides certain protocols he has had success with, He also takes the pro-con approach, presenting the information from both points of view and remains objective. It's a big-work and info dense on all the aspects of the problemThe other book is a practical concise book for IBS sufferes which reduces the density of information to daily practicalities. He also provides some simpler and mpre direct instructions on elimination diets than JB does&#8230;.in JB's book you don't always have a chapter on dietary intake management which is SPECIFIC to the diarrheic and gassy IBS type. This is just one manifestation of possible hypersensitivity to foods in JB's book so you have tot take the entire book in context and then sort it out mentally.Guillory sort of does that for you, and gives you practical tips of daily living. Also including the other aspects of IBS management (stress reduction strategies etc). The two, to me, are complementary for todays IBS patient looking to gain some understanding and control and who is highly self directed. It is worth the few extra bucks for the way he might be able to make a light-bulb click on for you after you have read JB's book ("Ohhhh&#8230;.I see&#8230;.yes this makes sense&#8230;.now I see how to apply that information). Etc.yes you have to find a BASE DIET which can suatin the person and to which they are 100% non reactive. There are several ways to approach that...most AMericans have no reactivity or allergy to lamb or rice, for example, so these are a good starting point as part of a stoneage base diet usually. The you add in pears, for example, and that is a low probability food as well. BRAT diets are not in this day and age likely to work with Americans as a base since it contaisn wheat and we eat WAYYYYY to much wheat. Anyway you alos must have a non-allergenic 100% chemical free vitmain-mineral supplement selected as well since the base diet is nutrient deficient.Start to see the picture a little?If you have Guillorys book, you will understand how to approach elimination diets more clearly, and then the answer to how to do it will be more self evident. The book has a good chapter on it which simplifies it and makes it logical, so the thinks which puzzle you should not. I would have to write out the whole chapter...which I would love to do if it were not nearing noon already. Kids want dad home today sometime.







[Why?...oh yeah, as SteaphanieNL asked last night :"Daddy, can I have your wallet? You have monies right?". Ah like mama like daughter







)Do not hesitate to post me a question you think I might be able to help with. I set aside part of each day to visit here and help out&#8230;just sometimes I do not have as much time as others so I have to skip or redirect to another source.But no one ever asked too much, only if they ask the same question 10 times over. LOL.As the famed Dr. Osler taught "If you talk to the patient long enough [he] will tell you exactly what is wrong with [him]." Nowadays docs just don't have the time to talk that much&#8230;.Eat well. Think well. Be well.MNL


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## Tracey Heynes (Nov 5, 2001)

Mike NoLomotil,Thank you so very much for your help.I am quite bowled over that a stranger who doesn't know me at all has taken so much time to try and help me in some way.I am EXTREMELY grateful.I only hope someone else has been able to benefit from all the info. too.Thanks again!Ibsed


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## lasernr (Jun 20, 2000)

I have been away from the board for a while, am a D type IBS with occasional C. You ask what can you snack on that is healthy, has fiber, no sugar etc. I have struggled with that for years and might suggest, depending on how much fiber your system can tolerate, Triscuts and Shredded wheat. Both are available at most super markets and have no added ingredients and are high fiber. Also, is rice the only grain you eat? There are other wonderful grains such as Quinoa and Spelt, trying them will give you more variety in your diet. I make alot of casserols with Quinoa and freeze them in small containers for use later. Try the more "esoteric" rice types, Aborial, wild, brown etc. Most health food stores these day carry a variety. Are you soy tolerant? Find a soy milk you like and use it in cold cereals, hot cereal, shakes etc. Every day I find new foods that I can eat and so can you. I hope the initial discomfort and pain of your new eating habits has eased somewhat and assure you the result is well worth it.Lasernrp.s. How can you tolerate coffee? even one cup in the a.m. can affect you all day long. Better to try to eliminate it if you can. It is very abrasive and acidic.


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## Mike NoLomotil (Jun 6, 2000)

"It is very abrasive and acidic. "...not to menton the caffeine...this IS one good way for many D-types to ensure themselves of a good flushing (x2).







"Thanks again!Any time, IBSED, [when I have it LOL]







MNL


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## Tracey Heynes (Nov 5, 2001)

Laserner,Thanks for your imput.Unfortunately wheat is a "No"for my diet so shredded wheat(and maybe Triscuits?)are out.Don't know how I could snack on quinoa etc when out eg.on the bus,out for a walk etc!I do know of quinoa and can take soya.Coffee is not a problem for me (as far as I know!) as I am *C* not D !For the time being,I'm waiting before trying a diet again - I felt so unwell before and got very depressed


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## Tracey Heynes (Nov 5, 2001)

MNL,If you have time - and energy-could you maybe look at my BRIEF posting on the Ask the Specialist forum?I'd appreciate your opinion,as I'm not really sure whether these diet efforts are just a waste of time in my situation.The message is "Eating disorders and IBS"Many thanks


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## Mike NoLomotil (Jun 6, 2000)

I'll take a peek...I don't go there much as for some reason we are not "experts" at this...MNL


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## Mike NoLomotil (Jun 6, 2000)

Hey..I don't even see the link for ASK THE EXPERTS...where did they hide it? Hmmm...rather than burn daylight I need to hunt for it, give me the url for your post and I will hop to it later when I get a chance.Thanks...MNL


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## Tracey Heynes (Nov 5, 2001)

Dear MNL,So sorry,I thought you were more expert at all this than me.I'm afraid I don't know what the URL is(what it means)so don't know how to give it to you.The "Ask The Specialist" link is hidden away on the home page on the bottom left side(they moved it from the message board page for some reason).I had to ask someone, via the message board ,what had happened to that forum!I just assumed you would know as you're more familiar with all this stuff than I am -sorry.Otherwise I've put more or less the same post on the "Bloating" page,if that's easier.Blimey - I could have typed the whole thing out for you by now !Thanks for being there.Ibsed


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## Mike NoLomotil (Jun 6, 2000)

Hey I never claimed to be an expert on this computer stuff...far from it I just 2-finger type and push enter a alot.







I have to go as the free time is gone for the day gotta work...but I will be sure to go follow up on this tomorrow AMMNL


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## Tracey Heynes (Nov 5, 2001)

MNL,Thanks.Found your answer - by chance !-on the IBS page.Still find the whole thing very confusing though.Thanks even so.


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