# Developing a new treatment for IBS-D



## Carly Rosewarne (May 12, 2016)

Hi there!

My name is Carly Rosewarne and I'm a Research Scientist at CSIRO - an Australian Government science research organisation. I'm involved in development of a new product specifically for treatment of IBS-D. We know that each and every person who struggles with IBS has a different experience. I'm seeking information to understand what sufferers are looking for in terms of new management strategies by asking a few simple questions. If you're able to help, please respond to this post. You can answer the questions directly here, otherwise you can contact me through my LinkedIn profile. All information received via direct messaging will be kept confidential.


Which IBS symptoms are the most concerning for you?
Where do you turn to for advice about treatments for your IBS symptoms?
What strategies do you use to manage your IBS symptoms? Are they effective?
What do you like/dislike about your current strategies?
What features are important to you when considering a new product?

If you are located in Adelaide (Australia), have been diagnosed with a functional bowel disorder and are interested in participating in our clinical trial, more information is available on our website: http://www.csiro.au/en/Research/Health/Nutrition-and-health-research-clinic/Current-studies/IBS-starch-supplement-study

Thanks in advance!

Dr Carly Rosewarne, PhD


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## Leo41 (Dec 13, 2010)

See this is the problem. We do not seek management of this, we seek doctors who will dig to underlying cause and fix it.

The most concerning symptoms are going to be patient specific. For me the worst is the pain, which over time has caused a vomit reflex that I cannot control. But with this life becomes such a struggle. Most have to work, and some days it can be the D, others the C, others the gas, others the pain. When life itself becomes a struggle, I cannot express the difficulty and living nightmare it is to try to keep a job and get up every morning to go there all day, everyday, around normal people in extreme pain (and resulting anxiety from it). Again.. we seek this gone, the inflammation stopped, to be free of this, not manage or suppress symptoms. We want our lives back, we want real help.

Where to turn? There is nowhere to turn. Most docs in the US treat IBS as in your head, and change your diet. So you are forced to turn to groups like this, to others that have experience with this, it is all you can find.

Myself... I have turned to researching everything I can, talking to everyone with any experience, and trying to become an expert on this.. using my body as a lab. What has been somewhat effective ... Cannabis Oil (most effective), Levbid (very effective), peppermint tea and fennel tea (very effective), Align probiotic (effective, but relative to the current condition of things), L-glutamine (somewhat effective). Yet all this is to "manage" this, not fix it. The fixing is what we want. Seeing FMT fix some people and yet not be available anywhere is more of what we get. Heck even the AGA guidelines that all GIs go by the US is nothing more than a plan to medicate to suppress symptoms and never to heal the cause, or even LOOK for the cause. Then I could also add the new studies that Levbid and Bentyl both (the only drugs we even have over here in the US) not only cause glaucoma but dementia as well. So basically the best they can do for us... to "manage" it is also quite likely killing us, and no one at all even cares (as they greedily take our money to do it).

New product.. explain to me the science behind it. The fact that a company is willing to put science behind it is a big thing.

You want a picture of what this is like... here is my first tread here. I used it as a log of sorts as I stumbled through trying things. It has not been updated recently but does paint a good picture of what I am saying above if you care to read through.

http://www.ibsgroup.org/forums/topic/238785-hi-everyone-i-am-new-in-pain-and-hoping-for-some-answers/


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## acureisoutthere (Jun 28, 2014)

Dr. Carly Rosewarne,

Wishing you the best on your endeavor Ma'am.

Perhaps, you already know of Dr. Thomas Borody at the Centre for Digestive Diseases ? Alanna Collen in her book, "10% Human" reports that Dr. Borody is reversing IBS-D with an 80% success rate, and IBS-C with a 30% success rate. This is being done via an FMT, (a Fecal Microbiome Transplant). Glen Taylor at the Taymount Clinic in Hartforshire, UK is also reversing IBS, using an FMT. I reversed my own IBS-D with an FMT. Restoring the normal balance of flora/bacteria in our large intestine is quite often reversing IBS. It worked for me, of course I spent quite a bit of time researching the procedure. My IBS is gone. This is what people want, to be rid of this nasty disease and to lead a normal life again. I thank God that I have found a way to restore my health.

For some people, probiotics offer a temporary help, but they don't solve the problem and make it go away completely. They continue to have to take a probiotic (if they are lucky enough to find one that helps them). The problem is that most probiotics lack the enzymes,or 'passwords' that let the body know that these are good, helpful bacteria, and that the stomach (the sieve) will let through, and they can implant on the intestinal wall. Thus for many, they need to continue to take them, instead of 'fixing' the problem.

We really need an independent body to test these probiotics to verify that they actually implant or colonize the large intestine with the new strains of bacteria. All we have now is claims, after claims, after claims, with no independent verification. It's very disappointing. Perhaps we should all be writing the FDA about this subject, as changes can be made.

The American Gut Project is teasing out the specific strains or imbalances that are related to different diseases. Perhaps when they have more data, and when we can make probiotics with the proper enzymes or 'passwords', then we can restore health and really solve problems. Managing symptoms is not the solution people are after, reversing the disease is what we want. Solving it. Getting rid of it. Restoring health. I've never been sorry I did my FMT.

One must understand : it is somewhat of a 'war zone' in our large intestine, with the established colonies of bacteria trying to out-compete newcomers and even producing antibodies to prevent their establishment. These existing bacteria like their place along the intestinal wall, they like their food source, and they want to keep them. I have my doubts as to whether the FMT pills that are in trials, right now, will ever be 100% effective, just for that reason. Sure, they will work for some, and this is great. But, for others a better approach will be needed, more likely an FMT.

It's May 12, 2016 perhaps we now have enough data for the FDA to relax it's directive on FMTs, and allow physicians to do an FMT for IBS also, [along with doing them for C. Diff. which they already do]. How much data do we need ? How many FMTs has Dr. Borody done ? How many FMTs has Glen Taylor done ? How about Dr. Grigleone, Dr Khoruts, Dr. Brandt, and countless others ? What are the outcomes ? Have there been any significant problems associated with an FMT ? From reading medical research, where they only use screened and tested donors, it seems there are very few problems associated with the procedure. Proper screening and proper testing of the donor are very important. We all carry 100 trillion bacteria in and on our body. We're mostly bacteria, as bacteria cells outnumber human cells by 10 to 1. But, having the proper species and proper balance of bacteria, is the goal to restore health.

Science magazine, has some interesting new articles about the human microbiome, with new understandings.

One more thing; it turns out that there are good, helpful bacteria found on fresh fruits and fresh vegetables. The ones we need.


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## Carly Rosewarne (May 12, 2016)

Hi Leo41 and acureisoutthere,

Please be assured that we hear you! Our research has become increasingly personal as we realise how many of our colleagues and friends are struggling on a daily basis. Involving sufferers in this process is a key step in making sure any new solutions are fit for purpose.

As you know, unfortunately there is no "one size fits all" treatment for IBS. Many people with chronic IBS-D end up with an imbalance in their gut microflora known as dysbiosis. Diarrhoea increases gut transit rate - the time taken for material to move through the digestive system. Many beneficial bacteria simply can't keep up - the system moves so fast that they are unable to replicate and survive! One of the benefits of a healthy and diverse microbiome is production of short-chain fatty acids. The SCFA butyrate in particular has the potential to improve bowel health by regulating gut muscle activity, reducing diarrhoea and reducing gut inflammation. The aim of our clinical trial is to assess the effectiveness of a starch supplement in reducing gastrointestinal symptoms in volunteers suffering from IBS-D. Our starch supplement is able to deliver high concentrations of butyrate directly to the large bowel. In this way we hypothesise that it will be possible to mimic the actions of the beneficial bacteria that are absent in IBS sufferers. Once the symptoms are under control as part of a management plan, we can then work towards implementing a cure - think of it as a way of trying to reset your system first. FMT may be an important component of this strategy, but we need more rigorous clinical trials to ensure it is safe and effective. I am currently involved in a project to test FMT as a treatment for ulcerative colitis. It is great to see that others are already looking at applications of FMT for IBS, it is something that we are actively discussing. I suspect that for FMT to be successful in anyone suffering from a gut disorder, the implanted microbiome will need to be tailored to each individual - a personalised medicine approach, if you like. With the available technologies this is not outside the realms of possibility and I'm excited at the very real potential to be able to assist people to live a normal life.

As a team we have spoken about the potential to incorporate our starch into functional foods, like cookies and health food bars. We are researching FODMAPs and chemical intolerances to make sure we don't include anything that may cause symptoms to flare up. Is this something that would appeal to you? I'm also wondering if you would like to comment about your experiences with probiotics. Have you used them before, and did they work? My take on it is similar to yours, acureisoutthere - we don't know enough about them to know if they are effective. A recently published paper concluded that "This systematic review of the pertinent literature demonstrates a lack of evidence for an impact of probiotics on fecal microbiota composition in healthy adults". You can find it using the following link: https://genomemedicine.biomedcentral.com/articles/10.1186/s13073-016-0300-5

Thank you both for responding, I have found your comments to be informative and helpful.

Kind regards,

Carly


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## acureisoutthere (Jun 28, 2014)

Dr. Rosewarne,

I can't thank you enough for your interest in finding an effective strategy to reverse IBS. Your efforts are highly appreciated Ma'am.

I also appreciate your efforts for ulcerative colitus, an even more miserable condition.

Perhaps the data from the American Gut project will assist you in understanding the species that correspond with the different symptoms of IBS, and move us closer to tailoring an approach that will work to reverse IBS. I believe it would be very, very, helpful if more IBS patients would submit a sample to this project. The larger the pool of data they have, the better we can associate particular symptoms with particular strains missing, or imbalances present.

Please, join me in encouraging patients on this forum to submit samples to this very important initiative.

Your trial is important, and I hope you find many volunteers for your study. Every effort made, brings us closer to the solution. Without the kind efforts of researchers like yourself, we make no progress. The IBS community is certainly blessed to have your interest.

Some thoughts ; sugars promote the growth of our bad bacteria. Sadly, sugar is being added to so many, many products. Avoiding sugar would seem logical in any effort to reset the bacteria of our large intestine. Eating the foods that support and help our good bacteria to thrive and multiply will be helpful. Fresh fruits and fresh vegetables, along with cooked vegetables provide this. We should be avoiding processed foods with their added sugars and other ingredients, at the same time.

Perhaps, your starch supplement for a 2 to 4 week interval will calm the conditions of the large intestine, and allow a helpful diet (above) to reset the flora, at least to some degree ?

To clarify my earlier post : the doctors [Grigleone, Khoruts ] mentioned are performing FMTs, but not necessarily on IBS patients. As you know, interest in this procedure is exploding. I have written letters to the AGA in the past, encouraging this. I can only hope that the details of the best approach to this are being circulated. What's the point of a study, if the procedure misses important steps, possibly skewing the results ?

For me, probiotics didn't really help with any noticeable improvement. Kombucha seemed to help, only slightly, and only some of the time. The FODMAP diet helped me. For some, the FODMAP diet helps, and for others it doesn't. For some people, probiotics do seem to help them (although I'm not sure if they achieve an actual reversal of disease, but at least their symptoms are helped). As you probably know, each of us has a different microbiome. Couple that with the understanding that we each have had different influences that have disrupted our microbiomes, and the result is a wide variety of symptoms, and corresponding imbalances and/or loss of species.

Thank you for the link about the effectiveness of probiotics. I seem to remember reading something very close to this also. I read so much it seems.

I suspect that for ulcerative colitus it would take multiple FMTs, perhaps weeks apart, to gradually heal and restore the balance. As I have suggested to Dr. Borody many months ago, the appendix is most likely playing a role in the success of an FMT, and just recently I have read that it is now thought to be a reservoir for bacteria, playing an important role after a case of diarrhea. It is a mistake that this organ is still being removed Ma'am. Instead, we should be asking, what are the conditions that lead to it's inflammation, and to solve those problems.

One other thought ; you might consider contacting The Fecal Transplant Foundation, as they might list your comments/endeavor.

Kind regards Ma'am.


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## Carly Rosewarne (May 12, 2016)

Hi again acureisoutthere,

You are clearly a scholar of microbiome research! I applaud your efforts to understand your condition and to share your findings with others via this forum. For anyone else out there who is looking for introductory information about gut microbes, you might like to read an article I edited recently on behalf of the Australian Academy of Science: http://www.nova.org.au/people-medicine/gut-bacteria

I am aware of the American Gut Project and you are correct in saying that it is a worthwhile endeavour. I do encourage people to participate. Check this website for more information: http://ucsdnews.ucsd.edu/feature/american_gut_project_crowdfunds_1_million_to_study_the_human_microbiome. Rob Knight is a guru in this field - the Mark Zuckerberg of microbiology! He is part of our FMT for UC study team.

The approach in our clinical trial will be to use similar techniques to the American Gut Project and monitor how the microbiome changes over time within each individual. This should lead to information about how to personalise a management plan. Everyone should eat less sugar and processed foods, but it is especially important for people with IBS to be conscious of their diet. Increasing consumption of a specific type of fibre called resistant starch might be a good place to start. We have made a cool video (http://www.csiro.au/hungrymicrobiome/) to explain why resistant starch is important for gut health - it feeds your hungry microbiome. We've listed some foods that are high in resistant starch, but it's important to note that not all are compatible with a low FODMAP diet. If you want to start trying something different, do some research first (http://www.ibsdiets.org/fodmap-diet/fodmap-food-list/). Go slowly and increase gradually - you always need to give your gut microbes the best chance to adapt to new things. And remember that no two people are alike, so what works for you may not be the best thing for someone else. It is one of the difficulties we face when developing effective treatments.

Carly


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## Leo41 (Dec 13, 2010)

Carly,

Yes I agree, thank you for the assistance, and research. People like you are exactly what we need. I do wish I could be part of the study. Also thank you for sharing the science behind this. As you will likely find out many of us are fairly knowledgeable as we have to be to help ourselves.

I will be interested to try some of the starch foods. My body is a bit different, I find I can now eat things I should not be able to, but at times safe foods still trigger a problem.

Probiotics... I have tried quite a few, all OTC in the USA. None did very well. The Bifido family seemed to be most tolerable. All would make me feel uncomfortable in the gut, or constipate me, AND cause gas.. which would be become trapped due to the constipation. Most I could not tolerate more than a few days.

Only after the Cannabis oil have I been able to benefit from them. Honestly I really feel you should also research the effect of cannabis oil on this. Honestly the biggest, drastic improvement I have had was using hemp derived cannabis oil. Calmed the pain, actually numbed the mind to gut link, gave me a new (beautiful) numb feeling in my pain spot, and incrediblely made my stool solid for the most part. If you search the forum you will also see that Cannabis oil has improved symptoms for just about every single one who has tried it.

After a couple months I tried "Align" probiotic. I have seen a near total drop in pain since. I take them in the morning with morning meal and found this does MUCH better than dinner. I get a little gas in the late morning, and notice nothing but feeling better and even more normal stool for the most part.

I have been through a lot with this. I have come to believe a great deal of IBS pain is gas in sore intestines (colon) that is over active and sensitive. I believe as things worsen chronic inflammation sets in, and it takes a lot to calm this. I believe a drastic positive change in diet, and being consistent with it will starve a lot of bad bac, and increase the good. Though the network/connection that gets way over stimulated through that will never fully subside to what it was.


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## acureisoutthere (Jun 28, 2014)

Dr. Rosewarne,

I especially enjoyed your link to the Nova article, and following link, after link. Great reading, much of it I have read before, but still quite a bit I hadn't read before. I can't say enough how I appreciate your research, and efforts in this direction.

The research of others, and yours, confirms the importance of your trial, and it's potential to help IBS patients.

I've recently read that the placenta is now understood to carry some microbes, instead of being sterile. Bacteria are in our blood, so it makes sense.

We need to find out what role pesticide residues are playing on the human microbiome. We also have plastics in our bloodstream, what role are they playing ? When we take antibiotics we affect the microbiomes of not just the large intestine (where there is great interest) but other areas of the digestive tract as well. I suspect that in order to completely restore digestive health we will need to restore the ecosystems of bacteria from the mouth to the colon, as they are interconnected, and influence each other in ways we have yet to decipher. Which leads us to examine not only the foods we eat, but our toothpaste and mouthwashes too. What affect do these have ? It seems logical (without diving into research) that our mouthwash products are likely to be producing a negative affect on the esophageal microbiome, and may be related to esophageal cancer. It's time we examined this, and encourage the FDA to re-evaluate whether these products are truly benign for the human body, and the microbiome. Yet, we also need to encourage research into how to restore the other ecosystems of the digestive tract, not just the large intestine. We need a combined approach; changing our diets, eliminating unnecessary antibiotic exposure along with pesticides exposure and other products, and microbiome restorative therapies for many areas of the body.

Please join me in encouraging the FDA to rule against antimicrobial products in hand soap, this coming September. We also need to support the effort to stop using antibiotics as a growth additive for livestock. They may have a use for disease treatment in livestock, but use as a growth additive is one more mistake we are making.

I encourage you to submit an article to TIME magazine encouraging the 25 million, or more, people with IBS to participate in the American Gut project. We need data from a larger population to decipher IBS. Certainly, your important study should be explained, and encouraged. It certainly is a worthy approach. A follow-up article might also help to explain the valuable information found in the Nova article you provided a link to. Educating 7 billion people has to begin somewhere.

I agree, Dr. Rob Knight is pretty impressive ! Also, worth noting; Dr. Martin Blaser's book, "Missing Microbes" is worth reading, and should be on every single health care professional's desk. This needs to be encouraged.

Your presence here on this forum is greatly appreciated. I can't thank you enough.

I am very impressed by your efforts Ma'am.


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## mellosphere (Sep 22, 2015)

I wish I could participate in the study as well but I'm here in the US. I'll answer the questions and keep enjoying the comments. THANK YOU for posting here and showing that you are up to date on the current state of treatments - and that something is still missing.


Which IBS symptoms are the most concerning for you? - diarrhea and cramps, and the insomnia and cold chills that they cause
Where do you turn to for advice about treatments for your IBS symptoms? - ibsgroup.org!
What strategies do you use to manage your IBS symptoms? Are they effective? I use rifaximin, doxycycline, and probiotics, as well as lot of loperamide every single day. I also only eat a very limited diet which is almost no fruits and vegetables. 
What do you like/dislike about your current strategies? I like that my diarrhea and cramps have improved as well as my cold chills are much fewer. I don't like the extremely restricted diet I have to maintain just to keep some level of comfort. 
What features are important to you when considering a new product? Ideally, it treats the problem and doesn't just mask the symptom or cause my symptoms to get worse. 

Would love to try FMT and the starch supplement. I will be watching for any developments. Thanks again for your time.


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## Carly Rosewarne (May 12, 2016)

Hi again!

Thanks for keeping the responses coming, sorry I haven't had more time to respond. I've been busy over the last few days trying to secure funding for a new and exciting research project. Gastrointestinal organoids are three-dimensional organ "buds" that can be grown in the lab. Our collaborators are taking biopsy samples from colon cancer patients and growing organoids in the lab to test which chemotherapy will be most effective in killing their cancer cells. The ability to provide information to individualise treatments is part of the so-called "personalised medicine" revolution. This paper provides an outline of how it works: http://journal.frontiersin.org/article/10.3389/fgene.2014.00169/full. I want to know if organoids can be used to study gut disorders such as IBS and IBD. It should allow me to monitor how different microbes interact with the cells in our gut - I'd really like to identify new anti-inflammatory strains that can be used as probiotics in FMT cocktails. One of the great things about organoids is they will allow me to study microbes in a biological system without having to use animals for testing, which unfortunately is common in microbiome research. Fingers crossed that I can get support for my ideas!

This conversation thread has really helped me to think about how I would like to do my research in the future. I will keep you all updated as to how everything is progressing. One of the things about science is that it can be slow, so I have learnt to be patient. In the meantime if you ever have any questions, please get in touch!

Cheers,

Carly


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## acureisoutthere (Jun 28, 2014)

Carly,

Best wishes on your new approach.

One thought comes to mind; we shouldn't forget the 'elephant in the room' in relation to cancer research. Since bacteria cells outnumber human cells by 10 to 1, perhaps we should keep this in mind. I've thought for a long time that the imbalances of the bacteria in the gut may play a decisive role in allowing the gateways to the intestinal wall to stay open longer than normal, thus allowing bad actors into the bloodstream, and possibly leading to cancer in different areas of the body.

The elephant in the room are the bacteria cells in the large intestine, so it's seems logical that we should ask ; what in particular is happening to these bacteria cells, what are the differences in cancerous patients and in non cancerous patients ?

It's easy for us to only concentrate on human cells, it's been our history. But now we must also always consider our commensal bacteria and also be asking what role they are playing.

Chemical and pesticide residues on our food may be playing a role in changing these bacteria cells (we've probably overlooked this), and in turn changing our health. It's an important question; the chemical residues from Round-Up for instance, have they been studied in regards to what they do to the bacteria in our gut ? We've 'approved' a long list of products as safe to use, but when the studies were done, I am betting that they never took into account the microbiome, and what affect each product has on it. We look past the elephant and concentrate on the fly, which seems to be a mistake at this point. You and I, we're mostly bacteria. It's time we adjust our way of thinking.

Best wishes on your endeavors Ma'am.


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## IBS2 (Feb 7, 1999)

Dr. Rosewarne,


 Took a look at your website and had a question. For those of us who live in the US who will not be able to be part of your study and since your study involves Butyrate and since Butyrate is available as a supplement would it be worth while for those of us in the US with IBS D to give Butyrate a try? If so, is there a recommended dose of Butyrate that should be used and at what frequency?

Thanks,

Tom


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## celestin (May 20, 2004)

and a good treatment against Blastocystis Hominis would be a giant leap...


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## Carly Rosewarne (May 12, 2016)

Hi Tom (IBS2),

Our product has a unique property that differentiates it from pure butyrate. The butyrate is attached to a starch backbone by a chemical modification process. Once consumed, the butyrate remains attached to the backbone until it reaches the bowel. We say it is able to "survive digestion". Once it reaches the bowel, the action of gut microbes releases the butyrate from the backbone. In this way we are able to deliver high concentrations of butyrate to exactly where it is needed to provide symptom relief. If you consume pure butyrate, it will be absorbed in the upper gut before it has a chance to reach the bowel. Unfortunately pure butyrate cannot be used as a replacement for our novel product.

Have you ever tried increasing consumption of low FODMAP foods that are high in resistant starch? Good options are oats (provided you are not sensitive to wheat), chickpeas, brown rice and cold cooked potato. The process of cooking and cooling potato changes the structure of the starch (a process called retrogradation) which increases the health benefits. Another favourite of mine is green banana flour, it can be baked into all sorts of delicious goodies. But why is resistant starch important? It is naturally converted into butyrate by bacteria in the bowel, so by changing your diet slightly you might be able to get the same effect.

So why can't everyone just treat their IBS by eating resistant starch? Unfortunately the syndrome is complex and not well understood at the moment. My hypothesis is that some people who have been suffering with IBS-D for a significant period may not be able to convert resistant starch into butyrate. The constant bouts of diarrhoea are likely to reduce the diversity of microbes in the gut, meaning that some people will have lost the microbes that are able to perform this function. For these individuals, our starch supplement may be a better solution.

Clearly there is a lot more work that needs to be done. I think it is definitely worth trying to change your diet, because resistant starch has a number of other positive effects - such as weight loss! I don't have IBS, but I have lost more than 10 pounds over the last couple of months by changing what I've been eating. I provided some resources and advice earlier in the thread for those who want to give resistant starches a try - go slowly, monitor how your body responds and seek advice from a health care professional who can understand and support your needs and condition.

Carly


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## Carly Rosewarne (May 12, 2016)

Hi Celestin,

Thanks for the tip about Blastocystis. I'm relatively new to this area of research (less than 6 months) and am still working my way through the literature. Most standard methods for studying microbes in faecal samples (so called "next generation sequencing") can't detect protozoa - the focus is normally on bacteria. I will definitely add this to the list of microbes we need to be monitoring in the clinical trial.

Carly


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## IBS2 (Feb 7, 1999)

Dr. Rosewarne,

Thank you for your kind response. I will indeed take up your suggestions and as they say "give it the old college try". I hope you'll keep us up to date on your study and any other research you might have found interesting.

Regards,

Tom


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## Lorelei56 (Apr 7, 2014)

Which IBS symptoms are the most concerning for you? - Loose stools, pain, illness and fatigue.
Where do you turn to for advice about treatments for your IBS symptoms? - the internet - most GIs have no knowledge about this and just want to give me pills that make me stupid (methscopalamine or Bentyl). This last GI actually mentioned FODMAP food sensitivites, which started my research on other food sensitivities. 
What strategies do you use to manage your IBS symptoms? I am on a severely restricted diet (chicken, rice, green peas, cashews, some red meat) since I have become sensitive to almost everything else. I take Prevalite, methscopalamine (despite resulting stupidity), calcium, and mesalamine since I also have UC, alas. 
What do you like/dislike about your current strategies? My diet and medicine allow me to keep working and functioning most of the time, but I do so want to live a life with energy to do fun things and not have to worry about whether there's a bathroom close by.
What features are important to you when considering a new product? That it doesn't make the problem worse (as most remedies I've tried do), that I don't have an allergic reaction to it, that there are no unpleasant side effects, that it is affordable.

I wish you luck and speedy, definitive results in your research. I would love to hear any updates in your progress.


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