# Dr. Dahlman



## BackFire44 (Nov 19, 2003)

First, I see I am now a senior member. Must not be a very selective club to let me in!More to the issue, though, has anyone heard about this guy: www.drdahlman.com? He claims within 3 months (or 4-5 for some people) to get rid of most of your symptoms. A lot of his advice is the usual advice, avoid dairy, etc; but he has some supplements and other things that are a bit different. I'm not one to sign up to internet doctors, but I wondered if anyone here had or had heard bad/good things about him.


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## mtbike61384 (Dec 8, 2003)

I am a patient of his as of about two months. So far I have not been curred but he says I will be. If not then I better get my money back! He has a 100% guarantee. But I think that you might want to give it a try. He does help for sure and has alot of advice.


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## kel1059 (Feb 28, 2003)

But --Dr Dahlman leaves out a few key points to the eradication of IBS.I really think that people should read his paper. His paper is now free. He used to charge about $30.00 to view it. I am doing everything he talks about plus many other things. It is his approach plus "other things" that I am doing that is allowing me to finally beat this beast.As DavidLa was saying, "he hits on several KEY points". I firmly agree.


> quote: STEP-BY-STEP PROCESS OF THOUGHTHere's a review of the thought process that I put into play in my office when dealing with patients with stubborn symptoms. I follow this plan with each patient and the answer is always found within these steps. Work through these ideas in order:1) If you can say that you have gas and/or bloating and/or burping and/or stomach discomfort (any or all of these symptoms) occurring within 30-45 minutes after beginning a meal and, in some people, before they leave the table, you have an anaerobic bacterial problem that must be resolved.2) If you do not have those complaints or you have resolved the anaerobic bacterial problem, you may begin with all the products and make dietary changes as directed in my article and sit back and see what happens.3) If after beginning the Ultra Clear Sustain you experience additional gas and/or bloating (you will know in 2-3 days), you will need to submit a stool sample because the additional gas and/or bloating means that you have something living inside you that needs to be eliminated. The test kit can be obtained from my office, a sample is collected, sent to the lab and if an abnormality is found, you must take either a prescription antibiotic/anti-fungal or all natural herbs that the lab recommends to eliminate these organisms. Take all products except the Ultra Clear Sustain while you take the prescription (as directed by your physician) or all natural herbs (for minimum of 1 month) and remember to retest to make sure the organisms are gone. Very important: You must take the Ultra Flora Plus DF Powder while you are attempting to eliminate these organisms.4) If you did not need a stool sample or you have resolved the findings of a stool sample and you still have symptoms such as gas and/or bloating and/or stomach discomfort, further dietary restrictions need to occur. First we make sure that you're following the primary dietary suggestions properly. They are Dairy Detective, No Gas Causing Foods and No Liquids During Your Meals or for 1 Hour After (descriptions found in my article). The no dairy rule cannot be broken and if you have only eliminated all dairy by 85%, you still might not see any improvement. Please read all labels for milk, cheese, lactose and whey. 5) If you are true to the No Dairy rule and still have symptoms, then fructose needs to be removed along with the dairy. Fructose is contained in fruit, anything sweet (table sugar, honey, molasses, maple syrup, etc.), corn, corn syrup, beets, carrots, peas, onions, tomatoes, sweet potatoes and winter squash. You should know if this is effective within 2-3 weeks, sometimes less.6) If fructose doesn't seem to be the culprit, the next food group to be eliminated is gluten containing foods such as wheat, oats, barley and rye. In ingredient listings, look for gluten, wheat, oats, barley, rye and modified food starch. Don't eat dried fruits (they are coated with flour to prevent sticking) and anything associated with the word malt, because it is derived from barley. 7) If none of these suggestions eliminate all your symptoms, you are in need of a food allergy test done through blood work. Eighty-eight foods are tested and you will know exactly what you shouldn't eat. These tests are also available from my office, sent to you in the mail and you can go to your doctor, a hospital or local lab to have the blood drawn. It is then sent overnight by Airborne Express to the lab. Call me for more details about this test and the stool test.ADDITIONAL THOUGHT: If you use NutraSweet, aspartame or Equal, did you know that the FDA publishes a list of the most common side effects associated with the use of this product: stomach cramps is #5 and Diarrhea is #7! Eliminate this product!


He does NOT like dairy and I agree with him.He strongly suspects bacterial problems in the colon and small intestines. I AGREE WITH HIM! (Dr Pimental only suspects a bacteria problem in the small intestines for some sufferers -- Dr. P's approach is far too narrow to yield lasting effects). Dahlman even mentions a possible fungal or yeast overgrowth. When things get out of whack and we are making VERY poor food choices and our immune system is weak or tied up with other things ---then --this CAN happen. When there are "bad" bacteria problems --there can be the possibility of a fungal overgrowth. They go hand in hand. There was even a study on this in Britain. Meckle provided the link that listed the abstract (Dr Keith Eaton).He talks about FRUCTOSE being a problem for some of us. I think this is one of my bigger problems.He also wants people to investigate GLUTEN sensitivity (wheat, oats, rye, barley).He claims that Gastro doctors don't have a clue about IBS. He is correct on that one. GI doctors are much better for detecting crohn's disease and UC and MC and...diverticulitis...*************************************************The bacterial (and/or fungal) issue is critically important. Half of my problems disappeared when I went on a MEGA -herbal antibacterial & anti-fungal herb program and raw crushed garlic. The herbals need to be taken at the minimum once per day. In the beginning (the first month) maybe twice per day --- unless you want to go through the giant hassle of getting yourself tested. --and then who knows, you may get an antibiotic that allows yeast to gain a strong foothold in your system. I think the herbals are better if you have reason to suspect that bacteria has gotten out of hand (and I think dr Dahlman has got this one 100% correct.)I think that the herbals need to be taken for a VERY long time. this has been my experience (i am in my 9th month), and I continue to be free of bloat, gas, pain after suffering for 20 years with these problems. --But I had to also eliminate several foods and even ALL sugar (good luck on that one!).Dr Dahlman likes probiotics. Probiotics were worthless in relieving my symptoms. However, I am a BIG believer in them. They may take a very long time to help reverse a dysbiotic gut.He likes EFA's (ess fatty acids) like alpha-linolenic acid and linoleic acid, but he actually prefers FISH OIL --- EPA and DHA and even GLA.He even talks about PROSTAGLANDINS (my personal favorite topic!!!). He thinks that PROSTAGLANDINS MIGHT BE RESPONSIBLE FOR SOME OF THE PAIN. I agree that they might!!!! This is why I go on about Ibsacol. Ibsacol has singlehandedly turned my life around (but it can fail or be overridden if i eat the wrong foods). It was incredibly tricky to make it all work. I am COVINCED that I had to treat the bacterial (and maybe the fungal) overgrowth/issues that existed in me. I also had to strip my diet of sugar and almost every food imaginable (but my IBS was 20 years running --NO remission for even a day --- and it was SEVERE).Dr Dahlman says --NO --to legumes. i disagree. this is an excellent way to get carbs and they even have a lot of protein. If you kill the bacteria with very potent herbs, take ENZYMES, beano, a probiotic then beans will not cause gas. Pinto beans and several others cause a BAD food intolerance in me. All these food intolerances makes it difficult.He recommends a food allergy test (if you have trouble discovering your intolerances)He likes digestive ENZYMES (pancreatic enzymes).You can eat homemade yogurt at a MUCH later time in your recovery ---BUT no milk!He claims that people will experience a complete remission if they follow his advice. He would NOT have cured me. He would have suceeded in reducing several symptoms but he would NOT have got me to form large bulky stools with good peristalsis. The Ibsacol solved this problem (80 to 90%). The peristalsis problem MAY be responding to Fish Oil -- but I am not positive. Plus, if I eat a bad food (nuts, pinto beans, oats, etc, etc) then everything breaks down anyway.Anyway, I think that people should read his paper ---- it is NOW free to look at. http://www.drdahlman.netfirms.com/ib-thanks.htm#


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## kel1059 (Feb 28, 2003)

I think that dr Dahlman's approach can cut symptoms quite a bit. However, I do not think his approach is going to solve the medium to severe cases (just symptom reduction).I believe that one or two other strategies need to be employed also.I believe that when the gut is sick the mind is also sick. I believe that the Chinese have offered us an incredible insight into how the mind-gut works -- and when it does not work ---- how to fix it.it may be alternative which makes many people shy away but i think that the Chinese are correct about 'energy blockages' being a part of the problem. (accupuncture offers a very likely ability to reverse these blockages of the body's energy)i am also firmly convinced that homeopathy is an incredible healing tool. -- constitutional or classical homeopathy supposedly starts off by working on the mind. skeptics may immediately brush this off as nonsense and state that homeopathy is a sham. But it is not a sham. 1000's of M.D.'s (mostly in europe) would not committ themselves to this art if it was a sham.Hypnosis seems to have some success with various conditions. I suspect that the powerful effect it has on the mind can help the gut to function better.I don't think that any of these treatments --by themselves-- is powerful enough to solve the tough cases. But if hypnosis or accupuncture or homeopathy is combined with a decent approach like Dahlman then i think remission will be close by.


> quote: Dr. John Diamond, M.D., D.P.M., F.R.A.N.Z.C.P., M.R.C.Psych., F.I.A.P.M., D.I.B.A.K., is a pioneering figure in alternative and holistic medicine. His remarkable body of work embraces a wide range of disciplines, the result of over forty-five years of research and clinical practice. * He began his career in psychiatry but expanded into holistic medicine, concentrating on the totality of the sufferer, the interrelatedness and interdependence of the inseparable triune of body, mind, and spirit, how they relate, and how all three must be involved in every healing process. * He is a Fellow of the Royal Australian and New Zealand College of Psychiatry, a Foundation Member of the Royal College of Psychiatrists, a Member of the American Holistic Medical Association and is a Fellow and past President of the International Academy of Preventive Medicine.


Dr Diamond ---- "The Body Does Not Lie"


> quote: JOHN DIAMOND: THE THIRD SIDE OF THE TRIANGLEDr. John Diamond is a pioneering figure in alternative and holistic medicine. His development of Life-Energy Analysis in the 1970's (originally called behavioral kinesiology) and his discovery of the link between the meridians and the emotions, are just two examples of a remarkable body of work embracing a wide range of disciplines, the result of over 40 years of research and clinical practice. He began his career in psychiatry but expanded from there into holistic medicine with an emphasis on looking at the totality of the sufferer. This led him to develop an individual method of healing with a unique spiritual and eclectic approach. Today he practices as a holistic consultant and blends his experience in medicine, psychiatry, complementary medicine, the humanities, holism, applied kinesiology, acupuncture theory, and the arts (especially music) to help people overcome problems relating to body, mind, and spirit. Dr. Diamond was the first medical doctor trained in applied kinesiology to become a Diplomate of the International Board of Applied Kinesiology (1976) and he is the only doctor trained in applied kinesiology to have studied personally with Dr. Florence Kendall, publisher of Muscles-testing and Function that first inspired Dr. George Goodheart.Over the course of his long career in the healing and creative arts, Dr. Diamond has undertaken a significant amount of research into many healing modalities, which form the basis of his understanding of, and unique approach to, the nature of disease. At the basis of his method is the recognition that there is within each of us a great healing force, life energy. * Under different names, life energy has been recognized by various cultures including the Egyptians, Hindus, Chinese, Japanese, and Hawaiians as well as by scholars including Hippocrates and Paracelsus. For example, acupuncture is based upon the same premise that life energy flows along pathways or meridians in the human body and that blockages along these pathways, which can come from a physical, emotional or spiritual problem, result in illness. * --------------------------------------------------------------------------------The Third Side of the TriangleThe following is partially transcribed from The Work of John Diamond, M.D. and Applied Kinesiology, audio cassettes, with permission ï¿½ John Diamond, M.D., 2001I first became aware of Dr. Goodheart's work, applied kinesiology, back in 1973 after I had already been practicing as a psychiatrist for many years. My very first involvement in it showed me what a valuable tool it could be psychiatrically. I had heard something about "muscle testing" and eventually tracked down a chiropractor in the Bronx by the name of Josï¿½ Rodriquez, who was one of the first to take up the new technique. I walked in and introduced myself. He told me to put out my arm and say "I like hispanics" (he was Hispanic, of course), and my arm went weak. (In this particular instance my prejudice was precipitated by my previous work in drug-addiction. A week before this a Puerto Rican drug addict had tried to kill me. He lashed out at my belly with a knife and missed me by a fraction of an inch.) Instantly I recognized that this test had brought my unconscious belief to consciousness and if I was honest with myself, it was a truthful statement of how I really felt. I was so elated I embraced him!


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## BackFire44 (Nov 19, 2003)

Wow -- now that is a full reply! You should consider writing a paper yourself.As I've mentioned before, I'm heading down the cure list and trying things one at a time, but all of this is on my list eventually! Hopefully, though, I'll find something soon.Actually I've been feeling a lot better lately. I've been super strict with my diet (no dairy, fried stuff, carbonation, low on the sugar intake), taking citrucel at night before bed which has made a huge difference, the levsin, and meditation. That is one thing you forgot in your list -- meditation. I think it really has made a little difference. I've only been doing it a little over a week, but I find myself getting more deeply relaxed each time I try. Here's to hoping I continue to improve!


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## kel1059 (Feb 28, 2003)

you are correct about meditation. i have tried it many times but i am lousy at it. this may be why i failed at self-hypnosis. if i ever try it again, i will get a good pro and stick with it.--it seems like you are doing the same thing i am doing as far as putting together a few different strategies to solve your problem.i really think that most of us need to approach the problem from at least a few angles (single approaches have never done anything for me.)


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## Blair (Dec 15, 1998)

If what KEL posted is what Dr Dahlman is about its old stuff. I tried all that years ago. Gave the ultra clear sustain away. It may work for many but not me. IBS is too broad a label given to too many people for all things to work for all people. Avoiding fat helped me the most, and eating alot of spinch salads, no dressing. I used to think I had bacteria in my intestines causing havoc. And maybe I do? who knows, the SIBO test is positive for many who don't have IBS.


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## drdahlman (Nov 6, 2000)

I have been told by a couple of patients that there is some discussion here regarding my protocol for IBS. I have read the posts and the calls for me to join in and respond. I am happy to do that. I would first like to give you an overview of why my protocol works in all cases and then respond to some of the comments I have read I did not design the basics of my program, I learned from other physicians that have been in practice a lot longer than I. I have, over the years, refined it and I believe I have the ability to communicate it differently than many of my colleagues. It truly is a very simple fix. My protocol re-establishes bacterial balances, paying attention to the beneficial flora, SIBO and other potentially pathogenic bowel bacteria, yeasts and parasites. It also rebalances the chemistry of the intestinal tract by feeding nutrients that are specific to the intestines, used for fuel and repair. Digestive enzymes, in addition to making sure we are breaking down the food we eat completely, which could be a reason for some case of gas and bloating, also change the pH of the gut. The dietary eliminations also accomplish a major chemistry change.The dietary changes require the elimination of ALL dairy products, legumes (Yes, they are a great source of protein and fiber, but this is a temporary elimination just to rid ourselves of the potential for gas without taking an additional digestive enzyme) not drinking liquids during your meals or for an hour afterward (so we donï¿½t dilute our digestive enzymes) and only eating fruit before meals or as snacks. Each patient potentially might have to eliminate fructose, gluten or have a food allergy test run to identify other culprits.Within this information, explained in more detail in my 37 page article will be the answer to everyoneï¿½s set of symptoms. I have treated IBS patients for 13 years (six years working for another chiropractor and seven licensed in the state of Ohio) and have seen thousands of you. I began my money back guarantee two years ago in order to give the patients who called my office to ask questions, more confidence about me. I looked back into many of my files and saw that I had such a success rate in treating IBS that I felt comfortable in doing so. It tripled my practice. Confidence in me and my protocol is something that I fight all the time. As a chiropractor, many have a built in prejudice against us and as a holistic/alternative practitionerï¿½.many donï¿½t have any idea what that is either, I needed to do something that would give people the confidence to come and see me. I have seen almost 1,000 patients in just the last two years that have taken part in my money back program, well over 3,000 in seven years. My track record is actually 100% because the one person who received a refund was given it as a courtesy because they werenï¿½t quite where they should have been when family problems required they discontinue my care. The proof is in the pudding, as they say. I take all patients, no matter how severe their set of symptoms and I still guarantee everyone. In each case, we eliminate all symptoms and itï¿½s permanent, I donï¿½t get any calls in six months or 3 years that say that it has come back. With one exception. I get calls from patients that tell me that they had to go on an antibiotic and their symptoms have come back. They didnï¿½t follow my advice that if you take an antibiotic, please also take your probiotics while taking the antibiotic and for one month after. A short course of probiotics with these patients restored their system back to normal. This isnï¿½t rocket science. Please donï¿½t question me about studies or citing references to prove myself. You can do your own research. Any of us can go to any search engine or better yet, a medical search engine like Medline and put in keywords like acidophilus, bifidobacterium, hydrochloric acid, pancreatic enzymes, glutamine, fructo-oligosaccharides, klebsiella, citrobacter, bacillus, pseudomonas, candida, fructose intolerance, gluten intolerance, celiac disease, food allergy and see the voluminous amounts of information available. (Just to name a few things to be searched)For those more medical minded, yes there are also searches to be performed concerning serotonin, gut motility, visceral hypersensitivity, CNS modulation and immune/inflammatory mediators. The one thing missing when you quote these areas as something to be considered or else all I say becomes invalid is that possibly, with the re-establishment of bacterial levels and proper chemistry, will the now balanced gastro-intestinal system see a normalization of these factors? Everyone in my practice gets well, my answer would be yes. Considering the amount of serotonin produced in the gut and the high level of immune function there, doesnï¿½t it make sense that an imbalanced, unhealthy gastro-intestinal system would have problems in these areas? This is the reason that traditional doctors/scientists place great importance on serotonin, motility, hypersensitivity, etc. because they are ignoring the basics: bacteria and chemistry. They found these problems in people who by definition have abnormally low levels of good bacteria, possible presence of potentially pathogenic organisms and an imbalanced chemistry with possible inflammation. Bottom line: In my practice, everyone gets well. My website receives 20,000 hits per month, with some going it alone and some calling me for my help through phone consultations, and through a temporary protocol, all symptoms are eliminated. No HSOï¿½s, Digestrin, Ibsacol, Molo-cure or medication that you have to take forever or the symptoms return. Now, some specific responses:To Kel, who has said some very nice things: Thank you and though you believe that I might have helped you, but would not have cured you, I say that I certainly would have completely eliminated all your symptoms. I have in every other case. And I would do it without regard to the severity of the case. I also am seeing almost the same success with Colitis and Crohns. The difference for these patients is that I suggest a food allergy test at the beginning of the protocol because they are always there for them. Once identified and then following the rest of my protocol, most have a complete elimination of their ï¿½diseaseï¿½. Because of my success rate, I donï¿½t believe that I hit on several issues, but miss on others, as I said, everyone gets well. You asked if I have ever had IBS. I certainly have. I managed to go 23 years without an antibiotic and after taking one, all hell broke loose. I can still remember leaving a hotel to run the Chicago Marathon and having to turn around in the parking lot to return to my room one last time. It was this experience that forced me to refine my protocol so I could get relief.A word about the breath test for SIBO. I used to test for that and have decided that asking one question was as effective as the test: Do you get an increase in ANY uncomfortable symptoms associated with your gastro-intestinal system within one hour of beginning EVERY meal? Some of these people are uncomfortable before they finish their meals. If they answer yes, we treat for SIBO. The reason the question is effective is these organisms live on sugar (from any carb). Once the stomach releases the content, usually a carb full meal, the organisms get to eat. They repay us for the food with increased activity and increased symptoms. To Eric: No hype, just down home, good old common sense. Iï¿½ve addressed your concerns about serotonin, visceral hypersensitivity, etc. in an above paragraph.To loulou: There has never been a study anywhere that showed that 100% of the participants received benefit because of a placebo effect. Placebo never works that well. My program works in 100% of the cases and almost as good with Colitis and Crohnï¿½s. Your suggestion of the placebo effect diminishes not only me and my program, but also the intelligence of the 1000ï¿½s that have worked with me. Please see the testimonials at my website, where I have posted only a few of the nice notes I have received. You wondered why I think that I know something that no one else knows. I donï¿½t think I do. Everyone knows that we all need a beneficial bacterial balance and we donï¿½t need any potentially pathogenic bacteria, yeasts or parasites. Everyone knows that we must secrete sufficient amounts of digestive enzymes and that the chemistry of the gastro-intestinal system must be balanced. Everyone knows that some people have problems with dairy, some with fructose or gluten and some have allergies to other foods. Everyone knows that antibiotics are designed to kill bacteria. I have just put this information together in a way that makes sense to most and can be followed through a step-by-step process. Believe me, Iï¿½m no smarter than anyone else. As far as your comments about aspartame (NutraSweet), as you know, itï¿½s made up of three ingredients, methanol, and the amino acids phenylalanine and aspartic acid. If you read the manufacturers website or other websites that are medically driven, they remind us that all can be found in the food you eat. Very true. But Mother Nature is very smart. Methanol is found in apples as is ethanol. They negate each other, no side effects. Phenylalanine and aspartic acid are found in about every piece of protein you or I have ever eaten, but they are along side other amino acids causing a competition at receptor sites, therefore no overload of one or the other. Search Medline and put in any of these three ingredients with the word ï¿½dangersï¿½. You will find that it has been well known for decades that methanol is so dangerous that itï¿½s regulated by the FDA in food and OSHA in the workplace. It is the cause of the tremors that alcoholics experience. Phenylalanine and aspartic acid have also been known for decades to be dangerous as ï¿½isolated amino acidsï¿½ because the competition that the other aminos found in nature provide, isnï¿½t present. I have removed this product from numerous patients with curious and unusual symptoms and they have gone away. No placebo there either. Please see www.dorway.com, a poorly designed and ugly website but with the FDAï¿½s own list of 90 some side effects, the original studies done by Monsantoï¿½s own scientists who recommended the product not be approved and many letters from people whose lives have changed after eliminating aspartame. To Blair: Many of my patients say exactly the same thing, they tried all that. That simply means that at some time you tried UltraClear Sustain or at some time you gave up dairy or fat or at some time you tried digestive enzymes or at some time you used probiotics or at some time you had a stool sample that wasnï¿½t complete enough to be useful. I see it all the time. What you didnï¿½t try was my entire protocol, designed by me and followed in a step-by-step manner. Remember, everyone gets well.Thanks very much for your interest and this intellectual pursuit. The main goal here is to get people well. I will respond to anyone whoï¿½s nice to me and wonï¿½t respond to anyone out to prove how much smarter you are than me. Actually, you probably are, you just donï¿½t have a track record of treating IBS successfully. And actually, none of you have any proof that I do either. There is a certain amount of trust between myself and those that seek my help. This protocol Iï¿½ve designed will make sense to some and no sense to others. With me hanging my neck out on the line with a money back guarantee, I have never been sued over it, nor have I had any complaints filed with the Ohio State Chiropractic Board. You can all check that one out. Hereï¿½s an offer I will make to the first 5 who call me. I will guide you through this protocol without charging you for my time. I will charge you my costs for the products and any lab work we need. One condition, you must post to IBSGroup .org every two weeks at a minimum to explain to everyone the ups and downs you are experiencing as we work toward the complete elimination of ALL your symptoms. To your health, letï¿½s get started.P.S. To Flux: Donï¿½t bother.


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## BackFire44 (Nov 19, 2003)

Wow. Quite a claim. I'd volunteer in a second if I weren't in the process of going through my own doctor's instructions first. My doctor's advice to me is definitely making things better, so I want to see it through before trying anything else. For anyone who has had continuous problems, though, and has not been helped by the usual stuff -- I'd love to see how it goes with Dr. Dahlman's program. Anyone want to be a guinea pig? If six months down the line I am still no better than I am now, I would sign on in a second. However, for anyone thinking about this, I would discuss the treatment with my own doctor first just to make sure he didn't oppose it (he might think it won't work, but as long as he says it won't hurt me in the long run, I would try it). In any event, though, thanks, Dr. Dahlman, for such a responsive post. I hope you get some people to sign up from this site.


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## mtbike61384 (Dec 8, 2003)

Well if you want you can use me as a test. Right now I am in Dr. Dahlman's program. I will be totally honest about the results and will post how it turns out. You can't beat a money back guarantee! What kind of doctor does that?


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## kel1059 (Feb 28, 2003)

dr dahlman,good to hear from you. there are certain people who are impossible to deal with because they think they know everything. You need to ignore them.I know for a fact that your approach works to get rid of gas and bloat. I have used an approach that is almost identical to yours and I have completely rid myself of odor, gas, cramps, bloat, and pain. You are correct about the question of getting symptoms very shortly after eating. This described me perfectly. (But --i would also get symptoms 4 to 8 hours later.)Therefore, i did have some type of overgrowth issue. Wheat was my worst food followed by dairy. Fructose causes bad problems also. Literally dozens and dozens of foods cause a meltdown in me.However, i think that there is more going on than you are letting on to. Can you say for 100% certainty that a virus is not at fault? Dr William Shaw of the www.greatplainslab.com has shown that some patients have immune system defects that might be responsible for the chaos that is going on within us. he thinks that some patients have a very poor defense against various yeasts and fungi. He has some interesting data on nystatin and yeast metabolites and what happens when nystatin is withdrawn. He also thinks that the body might possibly be conditioned [from infancy -- via cd +3 (or +5 ??) (B cells) ]to not fight off bacteria.Some Mayo Clinic researchers think that some people are reacting to normal amounts of fungi in a highly exagerated and abnormal manner (immune related). then there is the issue of mycobacterium a. paratuberculosis (not enough is known about these things).the point is that any number of things are possible given that IBS is so many things for so many people. However, your approach would still help out most people even if they had one of these anomalies.My biggest issue is the fact that I have done everything under the sun (almost) to relieve my symptoms but the only thing that absolutely --positively -- without a question must be included for me is the fatty acid esters of Ibsacol. When I withdraw these esters then I go into a tailspin.If you want to know how these things might work then i suggest you read the book by Douglas Hunt M.D. (he is one of the "good" doctors -- he takes a natural approach.)even though the antibiotic herbs, garlic and nystatin reduced several symptoms. there was still something horrible going on with respect to my immune system. Manipulation of my prostaglandins and leukotrienes via Ibsacol has made a dramatic difference. Fish oil was tried multiple times and it did not help. By the way, the Ibsacol has completely eliminated my asthma problem that i had my entire life.I believe that it is possible that some of us might have some type of permanent or semi-permanent damage to our immune system due to a virus or maybe even a mycobacterium (anything is possible).they are finding mycobacterium paratuberculosis in over 90% of crohn's disease sufferers. this does not guarantee that this is the cause but i am suspicious.There is much more going on here than bacteria, fungi, lost oral tolerance (atypical food allergies), food intolerance, and pancreatic insufficiency (lowered digestive enzymes).for all we know there could be some type of low level auto-immune disorder going on (in some people). there seems to be some research that says some people are susceptible after several years of eating wheat -- even after giving it up.All i know is that there is still something strange going on within me, and i have done it all. For all we know there could be dozens of hormones in the hypothalamus that are seriously out of whack such as CRF (which reduces the immune response).You can eliminate a lot of suffering but many of us have a much more complicated problem going on.concerning the money back guarantee thing. i believe that most people will improve but many won't and that is because they fail to carry through with the strict guidelines. they know that they did not follow the advice to the letter therefore they quietly slink away.I am sure that there are a number of people who are outright cured by you, but i would not be one of them.As a chiroprator I would be interested in hearing your opinion of Goodhearts (???) kineseology (sp??). I believe that i am on to something concerning chinese medicine and the manipulation of bodily energy...


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## floridian (Sep 18, 2003)

> quote: IBS is too broad a label given to too many people for all things to work for all people.


I agree. You said fat is a problem for you. For many others, it is also. But not for me. If I cut the fructose (and maybe lactose), I am fine. I can now eat a hamburger and fries with no problems. Yes, too much fat will have somewhat of a laxative effect. But I can eat the average American diet (which I won't pretend is healthy) in terms of fat. But a can of soda, or too much fruit, and I am miserable. For some people, other categories of offensive foods may be the problem.Also, it may be rare that one thing is enough for anyone. Although the big change for me was with dietary restriction, I had also previously added calcium (with good improvement) and flax and fish oils (with possible improvement - can't be sure).


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## kel1059 (Feb 28, 2003)

> quote: For those more medical minded, yes there are also searches to be performed concerning serotonin, gut motility, visceral hypersensitivity, CNS modulation and immune/inflammatory mediators. The one thing missing when you quote these areas as something to be considered or else all I say becomes invalid is that possibly, with the re-establishment of bacterial levels and proper chemistry, will the now balanced gastro-intestinal system see a normalization of these factors? Everyone in my practice gets well, my answer would be yes. Considering the amount of serotonin produced in the gut and the high level of immune function there, doesn't it make sense that an imbalanced, unhealthy gastro-intestinal system would have problems in these areas? This is the reason that traditional doctors/scientists place great importance on serotonin, motility, hypersensitivity, etc. because they are ignoring the basics: bacteria and chemistry. They found these problems in people who by definition have abnormally low levels of good bacteria, possible presence of potentially pathogenic organisms and an imbalanced chemistry with possible inflammation. Bottom line: In my practice, everyone gets well. My website receives 20,000 hits per month, with some going it alone and some calling me for my help through phone consultations, and through a temporary protocol, all symptoms are eliminated. No HSO's, Digestrin, Ibsacol, Molo-cure or medication that you have to take forever or the symptoms return.


If someone mentions immune/ inflammatory mediators, prostaglandins, histamine, serotonin - it does not invalidate everything that you are saying. Eric will try to invalidate it but I won't. however, these are just a few things that need to be considered.A couple of other things. I had a CDSA in sept 2000. It showed zippo bifidobacteria. I had the same test done from the GSDL's in may of 2003, and the same result showed up. (plenty of acidophilus but nada on the bifidus) There is some reason why I don't have bifidus. I was taking probiotics for over 10 years. I was making my own yogurt - which helped in the beginning. Yet, they tell me that I have intestinal dysbiosis. Something strange is going on.What if the doctors who claim that mercury - if present will be certain to keep a dysbiotic gut in place??? What if these doctors are correct? Can you claim 100% certainty that these doctors are wrong? What if even a single patient worked in a mercury processing plant and accidentally breathed too many vapors? I believe that there are too many situations that could really muck things up.If you tell me that you successfully treated 3000 patients --- are you really going to tell me that each and every one of them was correctly diagnosed? A lot of the IBS cases turn out to be something else. However, I do believe that your program can help ease the symptoms of these pseudo-IBS cases.I think that if I was in your shoes and I really believed in my program then I would chalk up all failures as patient disobedience.You suggest that patients get a food allergy test. This is good advice but I had to pay for it myself because the conventional idiot doctors of mine don't believe in it. Many patients are going to run into the same roadblocks as me. If they don't pay for it themselves due to expense then they are automatically a consideration for the "patient disobedience" bin. Many of the doctors have never heard of SIBO and if a patient told them of you and the need for an antibiotic then the patient would be laughed out of the office. (despite your accurate advice)i.e., I can not believe that with so many roadblocks in the way that you can claim 100% success.Trust me on this one. You would be able to cure me (but you would be able to solve the gas, bloat, pain, cramps, and odor). I have been to some of the best doctors (non-mainstream) and I have spent 1000's upon 1000's on everything imaginable. (probably close to $2000 alone on dozens of different types of probiotics ) (are you aware that most probiotics don't even implant? - they are transient - I pay $75.00 a month for VSL#3 - 450 billion bacteria per serving - but they don't implant - and I don't think they help much at all)There is a guy here who is extremely intelligent. He provided some evidence that the immune system can even provoke an attack on beneficail bacteria.There are a lot of wacky things going on here with some of us. Are you aware that Dr shaw even thinks that some of us have swapped DNA with various fungi (resulting in intestinal cells with fungi DNA)? Some people would say hogwash, but how can anyone know for certain? Supposing this is true - then imagine the consequences.Can you be certain that there is not some type of genetic damage done to our mothers DNA (passed down to us) because of the overuse of antibiotics or other dangerous drugs. A million things could be happening here.Now you think that I am against you but I am not. I think that the people who have bad bloat need to pay attention to you. I still think that everyone should familiarize themselves with your work. ---but I know myself very well, and when I tell you that the only thing in 20 years that has reversed my problem is Ibsacol then I am speaking the truth (my immune system is completely whacked out -- even as a baby...).Read the double blind studies on what this stuff (CMO cetyl myristoleate ) has done for arthritis sufferers and fibromyalgia victims. Sure - I would like to get off of it, but there is no way (at least yet).What if a person has a fatty acid metabolic disorder. Fish oil is not going to do a whole lot for this condition. So many things can go wrong for so many of us. do you remember Lorenzo's oil (the little boy)?Human beings are not something that can be fed into a formula in order to achieve specific results. To an extent this will work but due to the complexity of matters a sizable percentage will fall through the cracks.Some bacteria is resistant to all antibiotics. Maybe some people have a small amount of this bacteria and their body is being drained battling it. what if some peoples immune system is "confused" by a virus or a mycobacterium or mycoplasma. As dr shaw has said - "it all depends on the amount and the type of toxins that are being produced." The same thing with the hormone CRF --- why do some people show such low levels? It is not due to the overly simplistic answer of low levels of EPA -- something else is going on.--but keep up the good work. p.s. digestrin is a joke, molocure has caused severe problems for a number of crohn's patients, but ibsacol is the real deal for many of us -- that is the way it is.


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## mtbike61384 (Dec 8, 2003)

kel, What do you think of Zelnorm and the idea that the main problem with ibs sufferers is that the gi mobility is not in rhythm? The parastalic effect is not moving the chyme through the intestines at the rate and timing as it should. In the commercial the little picture shows the intestine spasm out of order and not in a smooth pattern. I think that this may be part of the problem but just wanted to see what you thought. If the intestines are not contracting when they should, how do you fix that and what causes that? Possibly neuro transmitters malfunctioning or hormones? Our intestines are smooth muscle and therefore contract from signals from our brain. If these signals were messed up or altered, I think that this could have a great effect!


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## Gret (Sep 23, 2003)

I printed out and read Dr. Dahlman's paper this past summer. I've since read it many times! I've toyed with the idea of trying it. I would except that right now I'm feeling so much better with what I'm doing. Ibsacol and fiber and meditation have helped a lot. Of course, I've eliminated dairy too which was a biggie! The one thing that stopped me was how much he charges for his products! On another website you can get the EXACT same stuff - brand name and all - for a lot less. I wondered then if it was a scam. Most likely not, but it still soured me on the idea of calling him.Kel is right I think when she says when the gut is sick the mind is sick. The connection is unbelievable as anyone in the anxiety forum would tell you! I don't suffer from anxiety, but when times are stressful, the gut is very upset!Whoever decides to try Dr. Dahlman, please let us know how you are doing. I've thought about his paper so many times. It almost sounds too good to be true!


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## drdahlman (Nov 6, 2000)

Kel, Thanks for the encouragement. I will have a difficult time responding to the many comments you make, a lack of time. Let me say a couple things. You are very thorough in your investigation of this problem and your knowledge of its many facets. You're right, it's a complex issue. My record still stands, everyone gets well. I have had a few bail out, disobedience, as you call it. But for everyone who has completed my entire program, no one has requested a refund. I remain in touch with many of them because they still return to my office to purchase multi vitamins, E, C, Calcium, etc. or e-mail me periodically with other health questions. I ask them how they're doing all the time. It's a permanent re-establishment of balance to the gut that can only be altered primarily by antibiotics. And even that can be mediated by the taking of probiotics during and after the antibiotics. Considering my track record, I have never considered the work of Dr. Shaw to be pertinent to my patients. I don't screen them for viruses or DNA changes. Everyone gets well. It remains that all things gastro-intestinal, from your mouth all the way to the other end are regulated by bacteria and chemistry. Once they are balanced, it's amazing to watch the symptoms disappear.Your success with Ibsacol makes sense. But let's agree on one thing first: As a headache isn't caused by a lack of Tylenol floating around your bloodstream, you do not have IBS symptoms because of a lack of Ibsacol (Meracol). Something else has caused them. You know my premise on that one. We can also agree that if you stopped taking Ibsacol, your symptoms will return. It also might not be for people without their gall bladder, with IBD, Colitis or Crohn's. My protocol is permanent after you've completed the program and can be used by those without a gall bladder and has almost the same success rate for those with IBD, Colitis or Crohn's.The reason you haven't been able to implant your bifidus population can be many. I have that problem in one or two patients a year. Not all probiotics are created equal, some are worthless. Or you are doing something on a routine basis that prevents them from implanting. Yes, there is a theory that an immune reaction can occur with the intake of probiotics. Again, this is the purpose of my program, to help people walk through, step-by-step, the ups and downs of getting this regulated. Again, everybody gets well.


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## mtbike61384 (Dec 8, 2003)

How do you know if the probiotics are getting planted or not?


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## Jhouston (Nov 9, 2003)

effective as the test: Do you get an increase in ANY uncomfortable symptoms associated with your gastro-intestinal system within one hour of beginning EVERY meal? Some of these people are uncomfortable before they finish their meals. If they answer yes, we treat for SIBO. The reason the question is effective is these organisms live on sugar (from any carb). Once the stomach releases the content, usually a carb full meal, the organisms get to eat. They repay us for the food with increased activity and increased symptoms. Dr Dahlman, Would 'uncomfortable' include Feeling Drugged after eating Anything? Joann


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## drdahlman (Nov 6, 2000)

jhouston, No, that would probably be a blood sugar problem because you just ate too many carbs. Try an all protein and fat meal and see if you feel the same.mtbike, through lab tests or a disappearance of symptoms.


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## loulou (Jan 18, 2001)

When it comes to IBS placebo does work extremely well. It usually works about 30% of the time with patients diagnosed with IBS. Your program may even attrack a higher percentage since I would perceive certain individuals to favor your method of treatment. I, however, know that when anyone states claims such as curing 100% of their patients they are lying. There's a sucker born every minute but I'm not your sucker. This claim not only sounds too good to be true ... it actually is too good to be true.As for the aspartame my mom is a dietition and I get all the latest info about food. It is perfectly safe. However, if you want to continue this fib to your patients I cannot stop it, but "curing" patients by eliminating it from their diet is the result of a placebo effect. These "cures" may even have happened by doing nothing.I do agree with you on one thing: What you are doing isn't rocket science, but rather the biggest snow job ever.


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## Jhouston (Nov 9, 2003)

posted 12-10-2003 05:47 PM-------------------------------------------------------------------------------- jhouston, No, that would probably be a blood sugar problem because you just ate too many carbs. Try an all protein and fat meal and see if you feel the same. Even though blood tests are normal? This symptom happens with 1 slice of flourless bread toast or soup,etc. has happened with a bagel and NOT happened with chocolate cake. it doesn't make any sense to me. now I have developed IBS. Joann


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## kel1059 (Feb 28, 2003)

> quote: As for the aspartame my mom is a dietition and I get all the latest info about food. It is perfectly safe. However, if you want to continue this fib to your patients I cannot stop it, but "curing" patients by eliminating it from their diet is the result of a placebo effect. These "cures" may even have happened by doing nothing.


dr dahlman,lou lou is one of these people that you absolutely must not answer. aspartame is EVERYTHING that dr dahlman has stated.this product is very dangerous -- especially for anyone who has glial cells that are not up to snuff.Just talk to joanofarc (susan) if you want confirmation on the damge that it can cause.


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## loulou (Jan 18, 2001)

Kel is one of these people that only believes in that which science cannot prove. Anything scientifically proven is rejected by Kel like the aspartame. Of course, Kel does listen to "experts" such as joanofarc (susan)!


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## kel1059 (Feb 28, 2003)

loulou, why do you have to be so nasty to this nice doctor. i also think that there is a slight exageration going on but who knows --- maybe he is dead on with everything he says. i certainly seem to be responding very nicely in many areas using his approach...... the future will reveal the truth for me.


> quote: What do you think of Zelnorm and the idea that the main problem with ibs sufferers is that the gi mobility is not in rhythm? The parastalic effect is not moving the chyme through the intestines at the rate and timing as it should. In the commercial the little picture shows the intestine spasm out of order and not in a smooth pattern. I think that this may be part of the problem but just wanted to see what you thought. If the intestines are not contracting when they should, how do you fix that and what causes that? Possibly neuro transmitters malfunctioning or hormones? Our intestines are smooth muscle and therefore contract from signals from our brain. If these signals were messed up or altered, I think that this could have a great effect!


Mtbike,I think the gi motility is not in rhythm due to some of the reasons that are stated by dr dahlman. Even dr pimental has stated this and he has some clinical research to back it up. ( bacteria in the small intestines -beyond what is considered normal-is a very likely factor) (but I think that other factors are also involved&#8230; I don't know what these are --- yet - ---- I am still fighting it ) http://www.docguide.com/news/content.nsf/n...5256C9B0001E1B7 (Ending Bacterial Overgrowth Results in Better Motility in Some Irritable Bowel Patients)Zelnorm may be okay to control symptoms but my overall belief is that we absolutely must get to the root cause and lack of zelnorm is not anyone's root cause. (dr dahlman has made that point clear to me about ibsacol - I understand his position, and that is why my signature states - "&#8230;still looking for the root cause of my IBS&#8221









> quote: It remains that all things gastro-intestinal, from your mouth all the way to the other end are regulated by bacteria and chemistry. Once they are balanced, it's amazing to watch the symptoms disappear.


The only thing that I can do at this point is assume that my colon is still dysbiotic. It is said that a normal person has ~85% beneficial bacteria and 15% not so friendly bacteria. It is very possible that mine is very slowly improving but the reason I still have symptoms is due to the presence of too many bad bacteria. But it still makes me wonder how a person can consume dozens and dozens of quarts of pure bifidus goat and sheep yogurt and still not have the bifidus register on a CDSA.I think I am going to start making yogurt with the human strains of bacteria from the kyodophilus probiotics. Although I have done this multiple times already and still no bifidus.I think that dr dahlman is correct that antibiotics can seriously upset the balance of colonic bacteria. Maybe this is a big reason why a lot of us suffer.


> quote: Yes, there is a theory that an immune reaction can occur with the intake of probiotics.


The beauty of ibsacol is that it seems to normalize immune function to a large degree. Maybe our bodies need this load lifted for a year or so until things get under control. The esters of ibsacol are naturally occurring molecules -therefore, I believe they are safer than drugs. They also work on all kinds of autoimmune disorders. The problem with ibsacol is that it may be far too strong for crohn's disease patients (simple remedy for this though). CMO may be far more gentle. I could go into detail on this subject but I won't because I promised dianne that I would not. (curiosity got the best of me so I scoured the Pacific Rim for information and did I ever come up with it) (ibsacol and CMO are capable of doing some amazing things.) ********************************************************************************can your program reverse celiac disease? No, that is why you have people eliminate gluten. But, there is some evidence that various fungi could be inciting an autoimmune response. Fungi can be reduced but not eliminated - it is in all our food. There are so many examples of things that are affecting us beyond bacteria and fungi. -all the things I listed plus many more. plus, some people are just born more sensitive than others.However, since my program (which is near identical to your program) has successfully wiped out bloat, pain, gas, cramps, odor, and visceral hypersensitivity (but NOT food intolerances, stool bulk (i.e., very slow diarrhea), low peristalsis,&#8230







then I can definitely say that you and me are on the right track.All I can do is to continue to focus on a few things including my supposed dysbiotic colon and see what happens.


> quote: As for the aspartame my *mommy* is a dietition


loulou, what school district lunch program does she work for?


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## loulou (Jan 18, 2001)

My mommy works at a hospital as a registered dietition. She is registered by the American Dietetic Association. In order to maintain active membership she must attend approved updated nutritional meetings to fulfill a minimum of 15 credits per year.


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## drdahlman (Nov 6, 2000)

loulou, I will follow Kel's advice and ignore you after this, but let me repeat one more time. Don't believe me, go to a MEDICAL search engine like Medline and search methanol, phenylalanine and aspartic acid along with the word/s "dangers" or "side effects". It's quite clear.As far as Registered Dieticians are concerned, she is not licensed to diagnose any disease and the majority of them are so far behind with regard to the latest innovations, supplements etc. it's a shame. I know, don't tell me, she also believes that you get all your nutrition from a balanced diet, no one needs supplements and low carb diets are dangerous.Please forward in a post the study that says that 30% of IBS patients respond to placebo. It's such a shame that you try to convince people that there's nothing out there for them because it's just a placebo. How hopeless.My claims even astound me, 100% or close to it is unbelieveable. I have one person who has taken me up on my offer to treat them for nothing except costs of products and lab work, soon we will have a few more and I will let them speak for me. A prediction: ALL five will have ALL their symptoms eliminated.


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## kel1059 (Feb 28, 2003)

here is some accurate information from dr D.


> quote: http://www.ibsgroup.org/cgi-local/ubbcgi/u...t=000256#000025 Kudos to Mike NoLomotil for the ability to express my position better than I have. Pity for &#8230;&#8230; for announcing his agreement that the discussion should be over, but needing to post just one more time. For clarity sake: I have experience that a bacterial/parasite/yeast imbalance is present in ALMOST all patients with IBS. It IS NOT the only reason for IBS. I do believe it to be A primary reason that starts a cascade of events that result in tissue, chemical and neurological changes that preceed IBS. Secondary causes of IBS are prescription medications, over-the-counter medications and poor dietary habits.You need no studies at all if you possess common sense. (kel says ----- "Correcto!&#8221


the more familiar i become with dr Dahlman -- the more i am convinced that he is on the right track.i have eliminated several symptoms using his approach. however, i am still battling this thing and therefore i suspect that the entire answer may not be found in his protocol.However, i am leaving my mind open to the possibility that my colon is still dysbiotic.--and i think that dr dahlman's belief about antibiotics may be very accurate. there are other ways to get IBS but the antibiotic theory makes a lot of sense.So far using the dahlman approach i have...eliminated:1. all pain2. gas is minimal despite a high legume diet (amazing)3. bloat -- food removal is the main reason this has completely disappeared.4. cramps/spasms5. odor (just kill the bad bacteria and that solves it)6. visceral hypersensitivity **********************************************************************************the symptoms that remain are.... 1. food intolerances which results in very low stool volume. (which results in fatigue and a few other symptoms)2. poor peristalsis (although even peristalsis has responded from time to time, but i think that is due to a combination of eliminating food intolerances, Ibsacol, and the dahlman approach)***************************************************************************ibsacol has solved the low stool volume problem, but even this will fail for various reasons (mainly foods).dahlman's approach needs to solve this issue before i will state that his protocol is 100% effective (for me).


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## kel1059 (Feb 28, 2003)

Dr D,what is nice is that you are backing up all the things that i have been doing and gaining relief from.this is why i need to take the antibiotic herbals, the antifungal herbals, (even black walnut and cloves which are anti-parasitic) (i actually viewed a parasite in my blood from a phase contrast microscope) the parasite was about 6 to 8 um in length, it was sectional and it was vibrating back and forth. animals have parasites -- humans are animals -- humans have parasites (most are harmless -- "MOST" not all)this is also why i gained relief from antifungal drugs.for some reason many of us have issues with bacteria (and some may have some fungal issues) being where it is not supposed to be.(p.s. i noticed that the moderator -back in yr 2000- erased flux's sarcastic comments to dr d. ---- good!!!)(flux must have been attacking dr d. unfairly. ---and yet dr d's protocol has reduced my suffering considerably. do you people see how dangerous mr. f can be?)


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## eric (Jul 8, 1999)

FYI"The importance of the therapeutic relationship is underscored by findings that IBS patients show a remarkable placebo response rate-30% to 80%-regardless of the treatment approach." http://abbc3.hsc.usc.edu/cme/ibs/contents/implications.html


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## kel1059 (Feb 28, 2003)

eric,thanks for not destroying this thread with terrorist tactics like posting papers that are a mile long. my "Page Down" button on my computer is worn down to nothing due to ..... (but i do take the time to read the stuff)******************************************************************************* http://naturalpathcenter.com/tek9.asp?pg=p...ecific=jnorjrf8 http://egeneralmedical.com/metulbifdfda.html http://www.thewayup.com/products/0128.htm http://www.metagenics.com/products/catalog...ail.asp?pid=104 UltraClear Sustain, (big trouble every time I take FOS, severely allergic to rice --- horrible brain fog every time I consume it)Ultra Flora Plus DF (50 gm.), (it does not say that these are human strains, they are probably transient)Azeo-Pangen (90 Tablets) (just started taking german wobenzyme )Intesol (chamomile - bad for me - very allergenic)Ultra Bifidus DF (75 gm.), Ultra Dophilus DF (75 gm.), (human strains???)Metagest (90 Tablets)


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## eric (Jul 8, 1999)

"thanks for not destroying this thread with terrorist tactics like posting papers that are a mile long."You mean posting accurate information from experts in the Field of IBS research?Because that's what this thread needs.


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## mtbike61384 (Dec 8, 2003)

Seriosly, some of these people in here are outright rude to people and doctors that they don't even know and who are just trying to help. Dr. Dahlman doesn't have to come in here and share his advice with anyone. He could charge everyone for his great advice! Its not right to bash his program without even trying it. Right now I am about 10 weeks or so into it and am doing better. He knows his stuff and will work with you to help find the problem for everyone. He adapts his program to fit every one of his patients needs. He really wants to help. So all of you stupid people who just like to bash people without doing your research just keep on ignoring what he says and see how far you get. I also bet if you try ALL of the things he says you will see an improvement. I used to try some of the things he offered. One at a time. Some enzymes here probiotics there. But it is the whole program that does the trick! It makes so much sense!


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## Gret (Sep 23, 2003)

Eric, I found that article interesting, and I know that stress exasperates IBS symptoms, but we know stress is not the CAUSE of IBS. This is where I get hung up. Dr. Dahlman believes that antibiotics are to blame. Even a small amount of them. This may be true. But I wonder, if someone could become IBS free on his program, would the stress thing counter-act all of that. ??? Does this make sense or is it too simplistic? I mean, if our bodies are free of IBS symptoms, could the stress bring the IBS back? I think dealing with the stress is important, but sometimes I wonder if I'm putting a band-aid on the symptoms and not tackling the real problem! Any thoughts?


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## drdahlman (Nov 6, 2000)

To Eric, Thanks for the study about placebo, but remember, it's placebo compared to drugs that don't work anyway, not placebo compared a complex protocol with many variables depending on the needs of the patient.....that actually works, all the time. There are also studies that claim that there isn't a placebo effect...ever. You all need to get off this placebo thing. If my protocol was placebo, I'd have an awful lot of people very unhappy with me when the placebo effect wears off.You say that you are putting info on here from experts in the field of IBS. If there were experts in the field, all of you would be cured and there would be no career for me. To Gret, Stress only exacerbates an unhealthy gastro-intestinal system. Once balanced, stress will no longer cause the symptoms that the patient is used to. It's not the cause.To Kel, I have tested people a year or more down the road and the levels of acidophilus and bifidus are still where they should be. HSO's are transient, not the NCFM strain.Please call me and let's see if I can come up with some reasons for you still struggling a bit.


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## BackFire44 (Nov 19, 2003)

I must concur that it is uncalled for to bash Dr. Dahlman. While I am certainly following my own doctor's regimen first, one that is more scientific -- meaning tested on a large scale for reliability and accuracy -- I think the main point I've learned from this board is that mainstream medical science is not up to par on how to best treat IBS yet. Dr. Dahlman's methods, while perhaps not scientific in that it hasn't been tested by mainstream medical science in a large enough group, seem to have helped many people. In addition, by offering a 100% money back guarantee, that seems to show that he wants to help people. I know, loulou, that you care about the people on this board, and have certainly given lots of great advice and support to me. Also, I was, and am still, skeptical about Dr. Dahlman's method. However, I haven't seen one post by anyone that was disatisfied by his method. I think that does say that we are dealing with something more than just a snow job.And, if it is placebo effect, and we do know that IBS has a strong mind-gut connection, then horrahs for the placebo effect. If I'm 100% better, I wouldn't care if it was actually drugs that did it, or just my own mind convincing my body that I am better. If anyone did have a negative experience with Dr. Dahlman, I suggest posting it here and contacting the medical board, or whoever handles such things, in Dr. Dahlman's state. Calling him names without any proof or evidence, though, is being not scientific yourself. Let's wait for the results before we pass judgment on his method.


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## kel1059 (Feb 28, 2003)

> quote: some of these people in here are outright rude to people and doctors &#8230; Dr. Dahlman doesn't have to come in here and share his advice with anyone. &#8230;all of you &#8230; people who just like to bash people without doing your research just keep on ignoring what he says and see how far you get.


Mtbike,I could not have said it better myself. The bashers can just keep going around in their circles.


> quote: but sometimes I wonder if I'm putting a band-aid on the symptoms and not tackling the real problem!


Gret, always good to hear from you. In a way I know exactly what you are talking about. The ibsacol is controlling my problem to a large extent (it is far from perfect but it is more powerful than anything I could have imagined). I am convinced that the Chinese have provided a portion of the answer and solution to us (maybe not "the" answer but a portion).I have had 3 kinesiologists demonstrate that there is some type of blockage of energy between my brain and the rest of my body. I have finally decided to act on this information and I am almost positive that benefit will come from it.


> quote: terrorist tactics


eric the terrorist. No one is safe from this ever looming threat. Nowhere to run, nowhere to hide. (just having some fun)


> quote: Your success with Ibsacol makes sense. But let's agree on one thing first: As a headache isn't caused by a lack of Tylenol floating around your bloodstream, you do not have IBS symptoms because of a lack of Ibsacol (Meracol). Something else has caused them


Dr dahlman,Although this may be true, your program is also chock-full of the same approaches. The enzymes are one such example.You may say that the enzymes are a natural part of every working body and therefore &#8230;&#8230;. However, I will counter with ----- the esters of Ibsacol (and I know precisely which 2 esters are being used) are being directly metabolized by the body in the manufacture of very specific and very important synthesis of prostaglandins, leukotrienes, possibly other hormones, and they become incorporated within the cell wall which some researchers have speculated enhances their effect. --- therefore, this is not the same as a synthetic drug that has no known "natural" metabolic actions within a human body. The restrictions within your program are extremely necessary but they are also incredibly severe. Since I am a severe case of IBS I have had to incorporate ALL of your severe restrictions plus many that you don't list such as the elimination of all beef, chicken, turkey, pork, EGGS, most vegetables (I ate baby greens 2 days ago and I ended up with ulcers all over my mouth and tongue - that shows how severe I am), and I could go on and on and on about food restrictions.I am convinced that you are on the right track, but I have several issues with some of your claims. First, it sounds like your IBS was child's play compared to mine. You barely even suffered from it. The length of duration was incredibly short. I believe that your situation is not at all reflective of what some of us endure. Therefore you are overly optimistic because of that fact (I have to agree with eric on one or two of his points but also several of my issues have not been addressed).I am 99.99% convinced that you are exaggerating a 100% cure rate. I don't even think that your bifidus is the type that implants ). Elaine gottschall has a big problem with the canola oil that you recommend (I know --- I am nitpicking here - I should not nitpick) . You claim that olive oil is the best oil - to an extent I agree with you - however even this oil (MUFA) is said to lead to excess inflammatory chemicals in susceptible people. Flax oil has some severe disadvantages for certain people (but not the reasons that you gave). The food allergy test that you recommend is probably the ELISA test. This test does not paint the true picture. The MRT test is most likely far superior.The GSDL stool analysis does a poor job of detecting most bad bugs.Eliminating these bad bugs is a lot harder than you are making it sound. Very soon it will be a year of me having to constantly take the antibiotic herbals - if I stop I get symptoms again. Your program is overly simplistic when dealing with the tough cases like me.3 of your products cause severe problems in me. (see my post above - ex., chamomile, rice, fructose intolerance (FOS) ---problems)I have several more points to hit on.However, TO ALL SUFFERING IBSers ---- dr dahlman's paper needs to be read. There is loads of information here that is VITAL to symptom reduction - and if you are a mild case you might see total remission.


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## Jenny Snell (Sep 14, 2003)

HiI have had IBS-D for almost a year now. I started taking probiotics in July and this did make some difference to me so I do believe that chemical imbalance may be the cause. I have just started taking Digestive Enzymes to see if they help.The strange thing with me is that I seem to have a problem with healthy foods. I cannot eat vegetables (except for peas), salads, fruit (except for banana & apple) and brown bread or anything that has high fibre in it as I have duch bad 'D' if I do. I am okay with a plate of chips, white bread, chocolate, etc, but I would rather be able to eat healthy foods!!Is there anyone else that has the same dietry problems as me??


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## kel1059 (Feb 28, 2003)

> quote: The basic premise is... IBS is simply a fundamental, functional deficit in 2 areas, BACTERIA and CHEMISTRY


And yet parasites, fungi are also admitted to be a factor. parasites are more common than most people are aware of -- see Dr leo galland. most microscopic parasites are not terribly harmful.1. can ALL "bad" bacteria be eliminated. Answer - no. bacterial spores can not be eliminated -- unless prolonged and aggressive action is taken. Certain bacteria are resistant to all antibiotics. Certain people are very poor responders to the intricate defense mechanisms of bacteria (namely staphylococcus aureus)in the entire history of the human race -- has there never been a case of genetically induced IBS. how about radon gas or radiation exposure? certainly there must be at least one case.


> quote: The primary reason, not the only reason, but the primary reason that we lose this population of beneficial bacteria is the use of antibiotics.


I agree with this, but if an infant is exposed to various bad bacteria then there is the likelihood that they could (according to Dr Shaw - ex-Center for disease control --MD) end up creating an immune system tolerance to these bacteria and fungi. Antibiotics and NOT breastfeeding your baby are 2 very important factors.


> quote: We can improve digestion with digestive enzymes which helps with gas, bloating, indigestion, heartburn and reflux.


I agree that this could be very important for many of us (I follow this rule religiously).


> quote: We will couple this all natural product protocol with temporary, at least we hope they're temporary, dietary suggestions.


Definitely NOT temporary for me. I may be eating my 3 bean diet for the remainder of my life. Oh yeah, I can eat turnips also.


> quote: Along the way we may need to send out lab tests to help us identify levels of beneficial bacteria, abnormal bacteria, yeast or parasites and also food allergies.


My CDSA's did not name a single organism. Instead it just claimed intestinal dysbiosis.


> quote: Bacteria or yeast can be a potential contributing cause of your Gastro-Intestinal problems. If found together, their consequences can be even worse.


I agree very much. But solving this problem may not be so easy. Some mycoplasma and mycobacterium infections require up to 2 years on a combination of antibiotics -- that is scary.In the entire history of civilization - no one has mycobacterium or viral induced IBS? Is everyone 100.00000000% convinced beyond a shadow of a doubt on this?Not a single sole - including the Mad Hatters -- have a very bad case of mercury poisoning that has destroyed immune and nervous function causing IBS? Very doubtful.


> quote: psoriasis, eczema, ...and asthma. Not all of these symptoms occur in everyone, but depending on your biochemical individuality, some or all may appear. How many of you with Irritable Bowel suffer from one or more of these symptoms? More proof of the Gastro-Intestinal connection.


There is a connection for certain, but breastfed infants even get psoriasis and eczema. One could claim that the baby picked up a bad bug from the mother, but I think it is more of a defect in the babies immune system. Interestingly enough - there is some good evidence that esters can dramatically alter T-cell function and have a strong effect on all of these "immune system" foulups. (including multiple sclerosis). research is ongoing, and it will prove to be a valuable assist instead of an outright cure.can one so brashly claim that all T-cell dysfunction is due to bacteria or fungi? nope. http://naturalpathcenter.com/tek9.asp?pg=p...ecific=jnpmnqg0 this looks like a decent product - ulcinex. I don't think I am allergic to anything in here. http://www.metagenics.com/products/catalog...ail.asp?pid=121 the metafiber spells horrible trouble for me.Many ulcerative colitis patients absolutely must avoid things like apple pectin. Apple pectin causes unbelievably severe problems in me - cramping, etc. the same with the Rice and the Oat.Ahhh, the complexity of it all.we have yet to discuss the CFIDS patients that have mycoplasma infections and active viruses simmering away.


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## kel1059 (Feb 28, 2003)

i have no choice but to pound away on the Ibsacol issue. But i am not doing it because i think that Ibsacol is "THE" answer, but instead to prove a point about ---oh, maybe ---- T-cell function.first, i don't think that Ibsacol is THE answer.however, i find it very interesting that my asthma disappeared after taking ibsacol (the CMO people have backed this up) , also i no longer need a certain drug to control a very bad brain dysfunction (characterized by an abnormal EEG), also gret's mennierre's syndrome went into remission, sciencegirl (who responded incredibly well to this treatment) all of a sudden got pregnant after taking it......the point that i am trying to make is that maybe Dr douglass hunt is DEAD -ON correct when he speaks of fatty acid esters as being some type of "UNIVERSAL" solution to all the problems that researchers have stated and proven will respond to EFA's. however, we all know that efa's are not terribly effective against the tough cases.however, if speculation is correct that *esters can re-program T-cells* -- then we have something very unique here. this is something that transcends the 'bacteria' issue as it concerns IBS.But --- i am not saying that the intestinal dysbiosis issue is irrelevant. it is extremely relevant.but my point illustrates why a person like me has improved greatly on your program but still suffered greatly until the addition of Ibsacol --- which has made the most dramatic difference of all. (actually if i ignore any of my factors i suffer greatly --- therefore everything is important) (namely the oligoantigenic diet, the antibiotic herbs, and the Ibsacol)(the enzymes and the probiotics -- i am not sure of --- but i will not stop taking them)


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## eric (Jul 8, 1999)

Dr Dalman, there are many experts in IBS and IBS is a very complex condition of which they do not know the cause. The fact they cannot cure people reflexs on the fact they don't totally know what the problem is exactly. To say it is only unbalanced gut flora is majorally an over simplification of IBS.I know your a Chiropractic Physician and I don't personally believe that qualifies you as an expert on IBS like a gastroenterologist or neurogastroenterologist or even the expert immunologists studying IBS.Also not everyone gets IBS from antibiotics.Also there are many problems going on in IBS that have nothing to do with gut flora.Also I find it odd personally that you have "Cured" 3000 people and not one has ever been on here in the last four years saying they were "cured."Even with SIBO there is a motlity problem. Also these condition mimick some IBS symptoms, but not all and a good doctor can diagnose the difference."Small bowel bacterial overgrowthToo many bacteria in the upper part of the small intestine may lead to symptoms of bloating, pain, and diarrhea. Symptoms occur immediately after eating because the bacteria in the intestine begin to consume the food in the small intestine before it can be absorbed. Small bowel bacterial overgrowth is a result of abnormal motility in the small intestine. " http://www.iffgd.org/GIDisorders/GIAdults.html Gret, it is not the total cause but can for sure be a contributing factor to the cause and this is well known. Also even though IBS is a gut physiological problem, the systems it effects are majorally connected to stress systems. "Readers' ExchangeDefining Stress in IBSFall 2003From Arizona -- Thank you so much for your efforts and support for those of us with GI disorders. Your first issue Spring 2003 of Digestive Health Matters is both professional and informative. I would like to comment on one of the articles - "The CNS: Center for Neurovisceral Sciences and Women's Health at UCLA." I am encouraged to know that steps are being taken for funding research of IBS and interstitial cystitis. However, it is discouraging that researchers are still expending time and money to research "neurobiological mechanisms by which stress modulates brain-visceral interaction." I realize that stress is a popular theory in the discussion of IBS triggers, however, I believe this is completely backward and it is the chronic pain and totally unreliable bowel function of an IBS sufferer which causes the greatest stress. If research would focus on "fixing" the bowel, no doubt the panic and fear of IBS would be greatly alleviated. Comment from Emeran Mayer, M.D. -- In contrast to the common interpretation of the term "stress" as a psychological phenomenon, it should be understood as any real or perceived perturbation of an organism's homeostasis, or state of harmony or balance. For example, in this viewpoint a severe hemorrhage, starvation, extreme temperature, or worry about the unpredictable onset of abdominal pain all qualify as stressors -- some as "physical" stressors, others as "psychological" stressors. The fear to leave the house in the morning without knowing if one can make it to work without having to stop on the freeway because of an uncontrollable bowel movement, or the fear of experiencing uncontrollable abdominal discomfort during an important business meeting are sufficient stressors to activate the central stress system. The central stress system involves the release of chemical stress mediators in the brain (such as corticotropin releasing factor), which in turn orchestrate an integrated autonomic, behavioral, neuroendocrine, and pain modulatory response. This biological response in turn will alter the way the brain and the viscera interact, and this altered brain-gut interaction can result in worsening of IBS symptoms. Thus, pain and discomfort, fear of these symptoms, activation of the stress response, and modulation of the brain-gut interactions by stress mediators are part of a vicious cycle which need to be interrupted to produce symptom relief. The neurobiology of stress is not a theory, but a topic that can be studied in animal models, and one of the hottest topics in drug development for treatment of IBS e.g., substance P antagonists, corticotropin releasing factor antagonists. " http://www.aboutibs.org/Publications/StressDefined.html The Neurobiology of Stress and EmotionsBy: Emeran A. Mayer, M.D., UCLA Mind Body Collaborative Research Center, UCLA School of Medicine, California "What does this have to do with IBS Converging evidence from different laboratories and research groups are consistent with the concept of an "enhanced stress responsiveness" as a major vulnerability factor in many IBS patients. As outlined above, such an enhanced stress responsiveness may not be obvious to the affected individual, until he or she is exposed to a period of sustained threatening stressors (financial or employment problems, divorce, aftermath of a major disaster with consequences on daily life), repeated mild to moderate stressors, or a one time severe (life threatening) type stressor (robbery or physical assault). Under these circumstances the mechanisms that normally turn off the stress response are overwhelmed, and attempts of the nervous system at adaptation or habituation fail. Many of the vulnerability factors for such enhanced stress responsiveness have been identified and many of them occur in a particular vulnerable period of the developing brain (before age 10). Some of the best-studied factors include loss of the primary care giver, distant mother-child relationship, emotional neglect, and physical and verbal or sexual abuse. In order to understand how a chronically enhanced stress response can produce the cardinal symptoms of IBS (abdominal pain and discomfort associated with altered bowel habits) we have to go back to the earlier section on the emotional motor system: activation of the stress system will stimulate contractions and secretion in the sigmoid colon and rectum. Depending on the specific emotional context (fear vs. anger), the upper GI tract will be either inhibited (fear) or stimulated (anger). In addition, recent research in animals has demonstrated a phenomenon referred to as stress-induced visceral hyperalgesia. What this means is that in vulnerable animals, exposure to an acute moderate stressor will make the colon more sensitive to distension (and the perception of discomfort or pain). "Perceptions of pain, muscle tensions, and other somatic symptoms can cause stress levels to spiral upward. Self-regulation strategies that reduce unpleasant symptoms offer both physical and psychological relief." ï¿½R. Sovik Why do the symptoms go away after one stressful situation has resolved and persist in another? Amongst many factors, anxiety and fear generated by IBSsymptoms themselves are sufficient in many patients to maintain the stress responsiveness in a chronically enhanced state. Some of the more common symptom related anxieties include: Am I close enough to a bathroom when my symptoms come on? Will I be OK for the rest of the day, unless I completely empty my colon in the morning before leaving the house? " http://www.aboutibs.org/Publications/stress.html Most people still do not understand stress and IBS and its impact on the condition. But it has to do with Homeostasis and also the fight or flight among other things. Which in their own right are very complex systems.Report on the 5th International Symposium on Functional Gastrointestinal DisordersApril 4, 2003 to April 7, 2003 Milwaukee, Wisconsin"Shin Fukudo, Tohoku University School of Medicine, Japan discussed Possible Genetic Markers in Functional GI Disorders and Treatment Response, an emerging area of research. For some time it has been believed that brain-gut interactions -- autonomous activity in the GI tract and central nervous activity that influences bowel function in response to stressors -- play a major role in the origin and development pathogenesis of irritable bowel syndrome IBS. Studies suggest that IBS patients have hyper-reactive bowels and unusually stress-sensitive brains. Studies by Dr. Fukudo's group include recent use of models to study serotonin 5-HT reuptake transporter SERT genes, cross-cultural studies of 5-HT agents, and the effects of variations in the regions of the DNA strand that are the beginning of a gene gene promoter regions on one's responses to stress. Sensitization of the nerves neurons in the brain and the gut intestines may be due to a genetic effect as well as an acquired effect resulting from a stimulus. More investigation on exploring genetic markers and therapeutic responses is warranted." They know the majority of IBSers presenting to gastroenterologists, effectively demonstrate dysregulation of the serotonin system.They also know there is a problem with the HPA axis, which fights infection and is also involved in the fight or flight and stress.They also know that parts of the brain are effected by nerve fibers traveling from the gut to the brain that are involved in emotions and anxiety and pain.because they cannot cure it at this time does not mean they don't have solid research on it, its that they have not figured out every neurotransmitter and hormone and the digestive system and how they all work and how they communicate to the brain and back.They have pretty solid research on why there is d and c and d/c at this point on the motility end of things however and why those symptom are happening, but not the gobal condition."Basic Principles -- Brain-Gut Moderators: Emeran Mayer MD; Robin Spiller MD. Panel: Robin Spiller MD; Jackie Wood PhD; George Chrousos MD; Yvette Tachï¿½ PhD; Lisa Goehler PhD; G.F. Gebhart PhD; Emeran Mayer MD. Click on Titles to View Other TopicsIntroductionOutcomes of Pediatric Functional GI Disorders Epidemiology/Genetic/Behavioral Factors Brain Imaging Emerging Techniques to Evaluate and Treat Functional GI and Motility Disorders Clinical Applications of Diagnosis and Treatment Functional GI DisordersGeneral Principles of TreatmentPharmacological Treatment Psychological Treatment IFFGD Research Awards The brain-gut axis refers to the continuous back and forth interactions of information and feedback that take place between the gastrointestinal tract, and the brain and spinal cord which together comprise the central nervous system. These interrelated feedback circuits can influence brain processes and bowel functions -- affecting pain perception, thoughts and one's appraisal of symptoms, gut sensitivity, secretions, inflammatory responses, and motility. The brain-gut circuits can be activated by an external or internal factor or stimulus that makes a demand on the system, such as a stressful event, an injury, an emotional thought or feeling, or even the ingestion of food. Symptoms of functional GI disorders may result from a maladaptive response to stimuli at some point within the complex interactions that take place along the brain-gut axis. Basic science is the fundamental approach to understanding how systems work. Basic research takes place in the laboratory and often involves the study of molecules and cells. From this body of knowledge is drawn the means to investigate practical applications and to formulate clinical practices. Translational science converts basic science discoveries into the practical applications that benefit people. One of the more exciting areas of recent research relates to the basic and translational aspects of the effects of stress on inflammation, cytokine and immune modulation, and pain. Cytokines are a type of protein released by cells of the immune system, which act through specific cell receptors to regulate immune responses. This series of presentations address three important research areas in the field of functional GI disorders, which have recently attracted considerable attention: the role of immune activation in the gut and the interactions of the gut immune and nervous systems; the role of the central nervous system in the regulation modulation of pain perception nociception; and the emerging field of animal models with relevance for functional GI disorder research. This section demonstrates the rapid progress seen in the last few years in better understanding of basic mechanisms, in particular the neuroimmune interactions underlying symptom generation in patients with "functional" GI disorders. There are immune responses to infections. To defend itself from a foreign substance or invader, such as a bacterium or virus, the body mounts an immune response controlled by the brain. There needs to be a balance between infection and the body's immune response; the immune system needs to turn on and turn off at the right times to destroy the invader but not to the degree that it may harm healthy tissue. Robin Spiller, University Hospital, Nottingham, England began the session by noting the difficulty in separating disorders of structure "organic" from disorders of function. He noted, "The difference is based on how high the power of your microscope is." This was elaborated upon in his presentation on Post-infectious Functional GI Disorders. It has been observed that IBS-like symptoms, that persist for 6 months to a year or longer, may appear after a bout with an acute infection in the gastrointestinal tract e.g., food-poisoning. This is termed, "post-infectious IBS." A study by Gwee et al showed that the presence of unusual or amplified life stress at the time of onset of infection increased the chances of developing IBS symptoms. Inflammation persisted in patients with IBS-like symptoms but did not in patients whose symptoms resolved. This suggests that the brain's management of certain stressful stimuli i.e., psychologic distress affects the brain-gut system's ability to inhibit inflammation. It has frequently been observed that some individuals with more severe symptoms of IBS have coexisting psychologic distress. Stress has been thought to influence health-care seeking behavior, either by increasing motility, visceral hypersensitivity or inflammation, or by enhancing one's perception of gut symptoms, all of which lead to a greater need to seek care for them. The concept of post-infectious IBS suggests that in some circumstances stress the biological process by which the body adapts in response to a stimuli may influence symptoms. An initial response to an infection in the gastrointestinal tract can involve the neurotransmitter, serotonin, which acts as a messenger mediator to cells involved with the immune response. Immune cells -- mostly in the blood, but also in the lymphatic system -- enter the infected area and remove the invader. Additionally, the body adaptively removes the infection e.g., via vomiting or diarrhea -- normal beneficial responses that help the body expel an infecting organism. Persistence of the underlying inflammatory response may lead to post-infectious disorders of function. A variety of neuroimmune responses can lead to intestinal over-responsiveness sensitization and other clinical effects. These responses include direct toxicity to nerves that influence intestinal contractions, alteration in gut immune activation, abnormalities of serotonin metabolism, and persisting low-grade inflammation. IBS developing after infective gastroenteritis is associated with subtle increases in enteroendocrine and chronic inflammatory cells in the gut mucosa. The net effect may be to increase serotonin availability in the gut and enhance secretion and propulsive motility patterns. Serotonin antagonists may be beneficial in such patients Notably, the concept of "post-infectious IBS" has grown to include studies of their application in post-infectious gastroparesis and dyspepsia. 1Major inflammatory responses have not been observed in most IBS patients. However, in some studies subtle changes associated with inflammation have been noticed, such as increased presence of mast cells a type of immune system cell present in blood and tissue. Jackie Wood, Ohio State University College of Medicine discussed the Effects of Inflammation on the Gut Enteric Nervous System, specifically noting the importance of mast cell degranulation the release from within the cell of granules, or small sacs, containing chemicals that can digest microorganisms and fight infection. In tissue mast cells accumulate around nerve endings of nerves that contain the neurotransmitter serotonin. The release of substances that can induce activity in excitable tissue i.e., histamine, Interleukin-1 IL-1, and bradykinin by mast cells can affect receptor and neurotransmitter function in the enteric nervous system - the part of the autonomic nervous system that controls function of the gastrointestinal tract. In other words, when mast cells in the intestinal lining empty their contents in response to an infection, they activate nearby nerve endings. In a subgroup of patients, this can have significance in terms of resulting clinical consequences of diarrhea and abdominal discomfort.2Yvette Tachï¿½, University of California Los Angeles discussed Stress and Inflammation. The experience of stress is an adaptive behavior common to all living organisms. The activation of corticotropin releasing factor CRF signaling pathway, is the major mediating mechanism involved with the body's stress response system in which gastric emptying is inhibited with possible loss of appetite while colonic motor activity is stimulated producing a loose stool or a sensation of bowel urgency. There is growing evidence that activation of this CRF pathways impacts on inflammation, autonomic nervous system function, immunity, and clinical behavior or illness, all of which may be linked to the pathophysiology of the functional gastrointestinal disorders. While we often talk about how the brain -- influenced for example by arousal and/or psychosocial factors -- can affect immune function, the reverse is also true. Immune activation, following infection for example, can influence brain function. Lisa Goehler, University of Virginia discussed Cytokines and Vagal Afferents: Immune Signaling to the Brain. Cytokines are substances that are produced by white blood cells to regulate certain functions during inflammatory and immune responses. The vagus is a nerve made of both sensory and motor fibers that innervates nearly every internal organ. The gastrointestinal GI tract, along with the lungs and liver, is an area of tissue that most commonly comes in contact with microorganisms pathogens, such as bacteria or viruses, capable of activating an immune response. Cytokine mediators activate neurons that convey messages from tissue to the brain afferent neurons through the vagus nerve. The GI tract is richly supplied with vagal afferents that can signal immune activation in the tissue. This process may underlie the mechanism that causes individuals to feel sick. The concept of "sickness symptoms" is not always recognized. The cytokine inflammatory and immune mediators distributed throughout the body peripheral, which appear to interact through vagal pathways, have systemic effects that manifest as symptoms in the body. Mediators are substances released from cells to regulate immune responses. Such symptoms include fever, increased sensitivity to pain, loss of appetite, and decreased desire for social interaction. The process may provide the basis for a role of the vagus as an interface between the site of the immune response and the brain that results in symptoms of altered mood, including anxiety or depression, that are sometimes associated with gastrointestinal disease.4 Jerry Gebhart, The University of Iowa discussed the CNS Modulation of Visceral Nociceptive Responses. The central nervous system CNS is composed of the brain and spinal cord. The brain interprets and influences our perceptions of the pain sensation signals transmitted from the gut visceral nociceptive responses to the spinal cord and then to higher centers. Several structures in the brain periaqueductal gray, dorsolateral pons, and rostroventral medulla can facilitate or inhibit signals sent to the CNS and influence the perceived discomfort, or even whether the signals are experienced as pain. Inflammation of the bowel can produce increased sensitivity to pain or enhanced intensity of pain sensation hyperalgesia via increased activity of certain cells for example, those that contain nNOS in these higher brain modulatory centers.5 To close the Brain-Gut sessions, Emeran Mayer, University of California Los Angeles discussed Evolving Animal Models of Visceral Hypersensitivity. In contrast to most other disorders of the digestive system, functional disorders of the gut continue to be defined by symptom criteria rather than by biological markers. Realistic animal models of functional gastrointestinal GI disorders in which to test hypotheses have not been available until recently. While it is unlikely that there will ever be an animal model to replicate all complexities of the human functional GI disorders, animal research is likely to help us understand some of the key underlying mechanisms responsible for symptom generation. This includes over-responsiveness of central stress circuits to visceral and psychological stimuli, resulting in altered autonomic responses motility, secretion, increased pain sensitivity visceral hypersensitivity and possibly altered immune function of the gut. Future studies with genetically altered i.e., transgenic mice that become models for studying specific human diseases and their treatments may further increase our understanding of these mechanisms.6 http://www.iffgd.org/symposium2003brain-gut.html Brain Imaging Moderator: Reza Shaker MD. Panel: Reza Shaker MD; Bruce Naliboff PhD; David Thompson MD. http://www.iffgd.org/symposium2003imaging.html Also, the gut flora maybe unbalanced due to stress."Mary Perdue from McMaster University, Ontario discussed the importance of the epithelial intestinal barrier to maintain immune tolerance to potentially harmful matter, such as bacteria, ingested when we eat or drink. Everything that enters the human body must pass through an epithelial layer. Various types of epithelial tissues line not only the body cavities, blood vessels, and most organs, but also our outer surface-our skin. Within the intestines, epithelial tissue forms an intestinal barrier involved with absorption, secretion, sensation, contractility, and protection. Studies in animal models show that psychological stress can disrupt this barrier, leading to the penetration of bacteria into the gut, inflammation, an immune system response inflammatory cytokines, and ultimately sensitization of neural signals from the gut to the brain that can heighten the perception of pain. Robin Spiller from the University of Notingham, UK brought this basic information to the human model of post-infectious IBS. The predictors of post-infectious IBS include increased life events and psychological distress, female sex, and longer duration of diarrhea episode. In response to bacterial infection, there is an increase in certain gut enterochromaffin secretory cells 5HT producing and inflammatory cells cytokine producing leading to prolongation of pain and diarrheal symptoms, and this may be aggravated by the presence of psychological stressors. These findings suggest ways in which infection-induced inflammation might interact with chronic stress to produce long lasting bowel dysfunction. They also suggest possible treatments that need study. " http://www.iffgd.org/symposium2001.html and last but not least, bevcause they is a huge body of research pointing to serotonin problems as at least part of the problem in IBS.From Medscape GastroenterologyMEDLINE Abstracts: Serotonin Signaling and Visceral Hypersensitivity in IBS Posted 10/23/2003 What's new concerning the role of serotonin signaling and mechanisms of visceral hypersensitivity in the pathophysiology of irritable bowel syndrome IBS? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Gastroenterology.Serotonin and Its Implication for the Management of Irritable Bowel SyndromeGershon MDRev Gastroenterol Disord. 2003;3 suppl 2:S25-S34Our understanding of the enteric nervous system ENS has evolved from the "classical" view, in which the brain controls all enteric behavior, to the current view, which holds that enteric innervation is one of local control within the bowel, modified by a bidirectional "dialogue" with the brain. The ENS independently controls enteric reflexes through intrinsic primary afferent neurons, which monitor intraluminal conditions. This monitoring is accomplished through the use of enteroendocrine cells in the mucosa, the best known of which are the serotonin-containing enterochromaffin cells. This article describes the roles that serotonin, specific serotonin-receptor subtypes, and the serotonin reuptake transporter play in the ENS and in the communication between the ENS and central nervous system. The way in which these findings have implicated serotonin in irritable bowel syndrome is discussed.Systematic Review: Serotonergic Modulators in the Treatment of Irritable Bowel Syndrome--Influence on Psychiatric and Gastrointestinal SymptomsKilkens TO, Honig A, Rozendaal N, Van Nieuwenhoven MA, Brummer RJAliment Pharmacol Ther. 2003 ;17:43-51Background: Both central and peripheral serotonergic modulators are used in the treatment of irritable bowel syndrome. The majority of patients with irritable bowel syndrome presenting to a gastroenterologist demonstrate affective dysregulation. Serotonin may play a regulatory role in both gastrointestinal motility and sensitivity, as well as in affective dysregulation, in irritable bowel syndrome.Aim: To analyse, systematically, randomized controlled trials studying the influence of serotonergic modulators on both gastrointestinal and psychiatric symptoms in irritable bowel syndrome, in order to elucidate baseline irritable bowel syndrome symptomatology and possible differential effects of serotonergic modulation on this symptomatology.Methods: A standardized qualitative analysis was performed of studies investigating the influence of serotonergic modulators on both gastrointestinal and psychiatric symptoms in irritable bowel syndrome using a blind review approach. The studies were ranked according to their total quality score maximum 100 points.Results: Eleven studies fulfilled the entry criteria, six of which scored above 55 points. An association between gastroenterological and psychiatric changes was present in five of the six studies.Conclusions: The results strengthen the serotonergic association between gastroenterological and psychiatric symptoms. Adjusted guidelines for combined gastrointestinal and psychiatric assessments are recommended in order to further elucidate the serotonergic interaction between gastrointestinal and psychiatric symptoms.Tegaserod and Other Serotonergic Agents: What Is the Evidence?Chey WDRev Gastroenterol Disord. 2003;3 suppl 2 :S35-S40Through effects on gastrointestinal motor and secretory function as well as visceral sensation, serotonin 5-HT plays a key role in the pathogenesis of irritable bowel syndrome IBS. In particular, 5-HT3 and 5-HT4 receptors appear to be very important in IBS. This article critically appraises the evidence supporting the use of the 5-HT3 receptor antagonist alosetron in the treatment of women with diarrhea-predominant IBS. The safety profile and restricted-use program for alosetron is also reviewed. This discussion is followed by a comprehensive review of the efficacy and safety data in support of tegaserod for women with constipation-predominant IBS.Sex Differences of Brain Serotonin Synthesis in Patients With Irritable Bowel Syndrome Using Alpha-11C Methyl-L-Tryptophan, Positron Emission Tomography and Statistical Parametric MappingNakai A, Kumakura Y, Boivin M, et alCan J Gastroenterol. 2003;17:191-196Background: Irritable bowel syndrome IBS is the most common functional bowel disorder and has a strong predominance in women. Recent data suggest that the brain may play an important role in the pathophysiology of IBS in the brain-gut axis. It is strongly suspected that serotonin 5-HT, a neurotransmitter found in the brain and gut, may be related to the pathophysiology of IBS. It is reported that a 5-HT3 antagonist is effective only in female patients with diarrhea-predominant IBS.Objective: In the present study, 5-HT synthesis was measured using positron emission tomography, with alpha-11Cmethyl-L-tryptophan as the tracer, in patients with IBS. The aim of the present study was to compare 5-HT synthesis in the IBS patients with that in the controls, and to compare 5-HT synthesis between male and female IBS patients.Methods: Six male and six female nonconstipated IBS patients were scanned. Age-matched healthy volunteers were scanned as controls. Eighty minute dynamic scans were performed. Functional 5-HT synthesis images were analyzed using statistical parametric mapping.Results: 5-HT synthesis was greater only in the female IBS patients in the right medial temporal gyrus multimodal sensory association cortex compared with the female controls P<0.001.Conclusions: The greater brain 5-HT synthesis in the female IBS patients than in the controls may be related to the pathological visceral pain processing of the IBS patients, a larger female predominance of the disorder, and the sex difference of the efficacy of the 5-HT3 antagonist in treatment.Sex-Related Differences in IBS Patients: Central Processing of Visceral StimuliNaliboff BD, Berman S, Chang L, et alGastroenterology. 2003;124:1738-1747Background & Aims: Women have a higher prevalence of irritable bowel syndrome IBS and possible differences in response to treatment, suggesting sex-related differences in underlying pathophysiology. The aim of this study was to determine possible sex-related differences in brain responses to a visceral and a psychological stressor in IBS.Methods: Regional cerebral blood flow measurements using H 2 15 O positron emission tomography were compared across 23 female and 19 male nonconstipated patients with IBS during a visceral stimulus moderate rectal inflation and a psychological stimulus anticipation of a visceral stimulus.Results: In response to the visceral stimulus, women showed greater activation in the ventromedial prefrontal cortex, right anterior cingulate cortex, and left amygdala, whereas men showed greater activation of the right dorsolateral prefrontal cortex, insula, and dorsal pons/periaqueductal gray. Similar differences were observed during the anticipation condition. Men also reported higher arousal and lower fatigue.Conclusions: Male and female patients with IBS differ in activation of brain networks concerned with cognitive, autonomic, and antinociceptive responses to delivered and anticipated aversive visceral stimuli.Functional Brain Imaging in Irritable Bowel Syndrome With Rectal Balloon-Distention by Using fMRIYuan YZ, Tao RJ, Xu B, et alWorld J Gastroenterol. 2003;9:1356-1360Aim: Irritable bowel syndrome IBS is characterized by abdominal pain and changes in stool habits. Visceral hypersensitivity is a key factor in the pathophysiology of IBS. The aim of this study was to examine the effect of rectal balloon-distention stimulus by blood oxygenation level-dependent functional magnetic resonance imaging BOLD-fMRI in visceral pain center and to compare the distribution, extent, and intensity of activated areas between IBS patients and normal controls.Methods: Twenty-six patients with IBS and eleven normal controls were tested for rectal sensation, and the subjective pain intensity at 90 ml and 120 ml rectal balloon-distention was reported by using Visual Analogue Scale. Then, BOLD-fMRI was performed at 30 ml, 60 ml, 90 ml, and 120 ml rectal balloon-distention in all subjects.Results: Rectal distention stimulation increased the activity of anterior cingulate cortex 35/37, insular cortex 37/37, prefrontal cortex 37/37, and thalamus 35/37 in most cases. At 120 ml of rectal balloon-distention, the activation area and percentage change in MR signal intensity of the regions of interest ROI at IC, PFC, and THAL were significantly greater in patients with IBS than that in controls. Score of pain sensation at 90 ml and 120 ml rectal balloon-distention was significantly higher in patients with IBS than that in controls.Conclusion: Using fMRI, some patients with IBS can be detected having visceral hypersensitivity in response to painful rectal balloon-distention. fMRI is an objective brain imaging technique to measure the change in regional cerebral activation more precisely. In this study, IC and PFC of the IBS patients were the major loci of the CNS processing of visceral perception.Role of Visceral Sensitivity in the Pathophysiology of Irritable Bowel SyndromeDelvaux MGut. 2002;51 suppl 1:i67-i71Visceral hypersensitivity has been recognised as a characteristic of patients with irritable bowel syndrome IBS. It may be involved in the pathogenesis of abdominal pain/discomfort, and seems to result from the sensitisation of nerve afferent pathways originating from the gastrointestinal tract. From a clinical point of view, hypersensitivity, although frequent, is not a constant finding among patients with IBS and cannot therefore be considered as a diagnostic marker of the condition. The advances made in understanding visceral hypersensitivity in patients with IBS are reviewed: the factors that influence abdominal distension are defined and different therapeutic perspectives are examined.www.medscape.com/viewarti...02/7001/-1 Also"Irritable Bowel Syndrome Return to irritable bowel main pageWhat is Irritable Bowel Syndrome?Common names for this condition include spastic colon, nervous colon, nervous stomach, mucous colitis and spastic colitis. Physicians often refer to this condition by the initials IBS. The typical symptoms of IBS include crampy abdominal pain, bloating, distention and abnormal bowel habits. There may be diarrhea, constipation or a combination of both. It is common for IBS to affect teenagers and young adults. Symptoms may even date back to early childhood. Occasionally the syndrome can start in middle age. The symptoms can wax and wane and return in periods of stress throughout a personï¿½s lifetime.What is the role of stress and what is visceral hypersensitivity?Stress is a major factor that plays a significant role in many patients who have IBS. Some people react to stress by getting tension headaches. People with IBS often get tension and pain in the abdomen in response to stress, anxiety and depression. People who are prone to IBS are affected by many stimuli to various levels of the nervous system. An overly sensitive neurological sensory system is a major component that contributes to IBS - this is often referred to as visceral hypersensitivity. This system is susceptible to the effect of stress. What is abnormal in people with IBS?Patients with IBS have an abnormal electrical system of their colon with a higher electrical cycling activity and are set up to be more contractile under various stimuli. Intense prolonged, spastic contractions of the colon occur in IBS. When two parts of the colon go into contraction, the colon in between becomes stretched out like a balloon. As a result the abdomen will feel bloated or distended. The sensory or pain nerve fibers get stimulated when there is a stretching of the colon wall. The brain perceives this as pain. The brain actually communicates with the gut through a complex series of nerves that is called the Brain-Gut connection. These connections are abnormal in IBS and the location can be in either the brain or the gut. Stress, depression and various chemical imbalances can affect the Brain-Gut connection. The nerves and muscles of the intestine that are abnormal in IBS may be affected directly by specific food that is eaten. Some researchers feel that a viral infection is responsible for a long-lasting disturbance of the Brain-Gut system. It is also possible that this disturbance is inherited or occurs as the fetus develops in the uterus. With abnormal nerves and heightened responses to digestive hormones, IBS patients have abnormally strong and prolonged contractions of their intestines compared to people without IBS. These strong contractions of the colon help explain why people with IBS often have an urge to have a bowel movement 15 to 30 minutes after eating. The bowel movement is often diarrhea because the muscular contractions are spastic and move the waste material quickly from the right side of the colon to the left side and does not allow for the time required to absorb the water and form the stool. When colon spasms relaxes in one area, the stool can rush into another segment and with a sudden contraction it will come out as diarrhea. If the colon remains in spasm for too long, the stool that is staying in one area can get dried out because the colon is a very effective sponge to wick out or absorb water. This can results in small hard stools, which can alternate with diarrhea. There may be different levels of the Brain-Gut connection that are affected and result in a similar set of symptoms in people labeled with IBS. A combination of the abnormal Brain-Gut system, visceral hypersensitivity and hyperactive intestines appear to be responsible for IBS.Why is IBS called a syndrome and not a disease?IBS is called a syndrome rather than a disease because it is comprised of a group of symptoms and there are no specific blood tests, endoscopic findings or biopsy results that are diagnostic for IBS. A syndrome may feel like a disease but you cannot die from IBS like you can from a disease. The symptoms of IBS can be so oppressive that it can severely impact oneï¿½s life. How is IBS diagnosed?Abdominal pain or discomfort is the hallmark symptom of IBS. In order to make a clinical diagnosis of the IBS there should be a change of bowel habits and all other medical conditions that could produce these gastrointestinal symptoms need to be excluded. Other symptoms that occur with irritable bowel syndrome many include relief of pain with defecation, bloating, passage of mucus and an incomplete sense of evacuation. In this case one may feel never completely empty and it may be necessary to return to the toilet multiple times. There may also be a sense of urgency and need to strain. Other symptoms unrelated to the digestive system occur frequently and include anxiety, depression, back pain, urinary frequency and discomfort with sexual intercourse. " http://www.specialistsingastro.com/irritablebowelQA.html Researchers Identify Molecular Aberration in IBS Patients http://cfids-cab.org/cfs-inform/Ibs/ibs.medscape.03.htm


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## kel1059 (Feb 28, 2003)

> quote: My *mommy* works ... as a registered dietition. She is registered by the American Dietetic Association.


loulou,are they still serving those pizzaburgers to those little kids, how about that yummy rainbow colored meat (it is meat -- isn't it???)eric,you make a few decent points. i would like to hear from a few of these total cures. actually i am sure that there are some total cures.i am stating right here and now that dr d's approach has done quite a bit for me with respect to some of my symptoms.however, that is not good enough for you. ***********************************************************************but dr D does miss on certain points. I emphatically state that he could not cure me with his program. he claims he can but i know different. i have stated the reasons above.for one thing --- 3 or 4 of his products are a big-time taboo for me.**************************************************************************i don't think any single person has the answer for the entire population. we are all different. different genes. different damage. different toxins. dozens and dozens of various reasons.But --- his advice is sound -- very sound! (just very incomplete for some of us).


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## drdahlman (Nov 6, 2000)

Kel, Don't think for a moment that my experience has anything to do with they way I view IBS. Yes, I agree, my experience with it sounds quite easy compared to yours, but.....I have seen thousands of people. What affect do you think it has on my view when I'm dealing with an 80 year old WWII veteran who comes into my office wearing a diaper? This is the toughest of the tough and he's angry with the world because he's wearing a diaper. To make matters worse after about 2 months of working with him, beating my head against the wall trying to figure out what's going on, he walks into my office and wants his money back and tells me that he's going to his Gastro-enterologist and request that they remove his intestines. He figured he only had a few years left and it would be better with a bag. I finally convinced him that we had one more test to look at, food allergy test, and he finally agreed. Two weeks later he had solid bowel movements. All symptoms were gone. My personal experience has nothing to do with anything. For any of you to suggest that without going through it a doctor can't be of any use is silly. I have hundreds of other dramatic cases of quality of life being reduced to where people don't want to live, have to know every bathroom between their home and destination or can't go to the bathroom but once every 10 days. These are the experiences that make a difference for me.To Eric, Stop wasting your time on me. There's no way I have time to read what you post from "experts" who can't do anything with the condition. You post info or studies done by people who are so scared to think outside the box that they continue to do studies on the end results of the imbalances that I talk about, not the cause. They're trying to put a piece of black tape across the engine warning light instead of checking the engine. As far as my being an expert, only you need me to be one, as long as it fits into your definition. I don't need to be one in your eyes, only the eyes of the people who come to me. As I said to Flux......Eric, don't bother.I'm off to Miami for a vacation till Monday, you guys fight it out, but I must be honest. I played on this site 2-3 years ago and some of you are still here arguing it out trying to convince each other how smart you are. I don't have the time to spar with some of you. I get the results I want, happy patients, no lawsuits and not too many complaints. None of you have even taken the time to call the chiropractic board and check me out. When I get back from vacation, I'll check in to see what's happened, but my goal is to help as many as possible and all I get are the same 5-6 people wanting to tell me how wrong I am. I may post in other areas of this board or I may not. Not many are asking for help and my energy is better placed somewhere else. I have a website with 20,000 hits a month and growing, an online store and a book due out next summer with a complete step-by-step guide to conquering IBS, IBD, Colitis and Crohn's, complete with instructions for every contingency. It's the same protocol that I use in my office that gets everybody well. My offer is still there for 5 people to allow me to coach them through the protocol and I'll only charge manufacturers costs for the products and lab work. I'll let them do the talking for me. If you guys don't open your minds, you'll be standing still forever.


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## BackFire44 (Nov 19, 2003)

Have a nice vacation, Dr. Dahlman. Despite some heavy criticism, I think your contributions to this board and to finding help for IBS are positive. Whether your methods can help 100% of people out there is still to be seen, but I hope some people who have not had success with their own doctor take you up on your offer. No, in the past years there have not been a huge group of people coming to this board saying they were cured by you; but at the same time not one person has come forward saying they weren't. Plus, it is more likely that anyone who had a bad experience with you would report it here since if you cured someone, they might not be sticking around here.In any event, thanks for the discussion. Hopefully I'll have control over my own case through my current regimen, but if my current doctor fails, I plan to take a hard look at your program.Enjoy the waves


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## kel1059 (Feb 28, 2003)

> quote: that they continue to do studies on the end results of the imbalances that I talk about, not the cause. They're trying to put a piece of black tape across the engine warning light instead of checking the engine.


This is what i firmly believe. i have stated many times that the brain is partly the target organ and not necessarily the organ of origination.However, i will not go so far to say that i am 100% convinced that gut dysbiosis or even lost oral tolerance is solely responsible for brain dysfunction.brain dysfunction can be due to a variety of factors. severe, unrelenting stress can even alter brain biochemistry... among many things.a fatty acid metabolic disorder can cause havoc all over the body.But i recognize dr D's reason for not wasting time theorizing over it.i consider dr d to be light years ahead of these doctors and researchers who are "putting the black tape over the engine warning light".you got to love it!!! this is such an apt description of what these guys are doing.i guess if the Zelnorm people came knocking on my door -- i would give them what they wanted. when zelnorm says, "hey there are billions of dollars for the next gut SSRI -- jump to it!" if you want the money then you say, "how high should i jump?"that little trick they perform with the balloon is an easy one to explain and it is not incredibly difficult to solve it. i solved it, but it meant major sweeping changes in my diet and a few other areas. i.e., work on the gut problems and the brain chemistry normalizes to some degree.the tricky part is that several issues of hypersensitivity still exists within me. exposure to mold sends me off the deep end. eating the wrong foods also cause a meltdown.i am not entirely convinced that inhaling mold spores which then sets me off is the fault of a dysbiotic gut. it could be but i am very uncertain at this point.


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## Arnie W (Oct 22, 2003)

Thankyou for your contributions to this most interesting and informative thread, Dr D. What a pile of reading. I'll go to your site when I have time.Might I add that I have tried virtually every medication, supplement and therapy in the book. As far as the placebo effect goes, I would be THE guinea pig, but I can tell you in all honesty that my symptoms have remained with me all the way.With the discomfort after meals, what about when you feel gassy and bloasted ALL day long, not specifically after meals? With certain food, though, I get far worse symptoms within an hour or so of eating.Have a wonderful holiday.


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## drdahlman (Nov 6, 2000)

Quick reply for an honest question before I call it quits and turn in for the night. You certainly can have both an anaerobic and arobic problem that causes the gas. You could also have food intolerances or allergies that cause it. The purpose of my step-by-step approach is to walk a person through what needs to be done to identify the culprits. So much of what I do is simple process of elimination. Download my article and follow the suggestions found there in the section on "Step-by-step Thought Process". Good Luck.


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## mtbike61384 (Dec 8, 2003)

You want to know the greatest thing though about being a patient of Dr. Dahlman? He does all the figuring out for you! I can't even remember how many nights I have lost sleep over trying to figure out what product I was going to try next and what food I shouldn't eat and what new and crazy pill I should take. But with Dr. D you can just tell him your symtoms and what is happening in your body and he will tell you exactly what to do! It takes alot of stress off of you trying to figure everything out! And since you know that if you are not well you will get your money back, you know he is trying his very hardest to make sure he prescribes and treats all the symtoms for you! I will admit though that it can be hard finding food to eat that is ok in his diet. It seems like everything has dairy or sugar or something I am not supposed to eat! No wonder our bodies are so out of wack. My uncle is one of those doctors who is working on finding a "cure" for ibs through the scientific world if you will. I have talked to him and he is stuck on pills and meds that mask the symtoms and don't get to the cause. If you don't eliminate the cause, can ibs possibly allow you to get worse things or become a new beast of its own? I don't know. SO mouch to think about and try to comprehend! Our bodies are so amazing and complex that when they get out of wack, it is a hell of a time trying to get them back in order!


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## Jhouston (Nov 9, 2003)

Mike, How long have you been on Dr D's program? Joann


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## Jhouston (Nov 9, 2003)

I meant Mtbike


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## bonniei (Jan 25, 2001)

I suggest eliminating dairy and fructose from your diets and add some good brand of probiotics before buying any of Dr Dahlman's products or program. This is what I have been saying for years on the board.


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## bonniei (Jan 25, 2001)

Oh and for your info fructose includes fruits, veggies and wheat. You might want to eliminate wheat, fructose and lactose in that order so that you don't unnecessarily eliminate more than necesssary.


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## eric (Jul 8, 1999)

I find it odd that someone who treats IBSers over the internet, hopefully and very importantly with a diagnoses from thier physcians or gastroenterologists, does not want to know and read everything about IBS and dismisses the last five years of basic science on it. Then says we are not thinking outside the box. Then says they can cure a well known chronic condition, without knowing what causes it? Do you have IBS?When in fact we subscribe to, the biopsychosocial model."The biopsychosocial model proposes that illness and disease result from interacting systems at the cellular, tissue, organismal, interpersonal and environmental levels."Which is thinking more outside the box!They are also looking at every aspect of the IBS engine uder very powerful microscopes. http://www.med.unc.edu/medicine/fgidc/biopsychosocial.htm


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## kel1059 (Feb 28, 2003)

but they 'isn't' doing much to fix people up -- now are they?dr d's advice is good, solid, and practical.for you to just outright bash it without any support tells me that there is something wrong with you.there are hundreds of people here who post results that back up what he is saying.he puts it into a systematic plan that seeks to rule things out.he may not have all the answers for everyone, but who does? certainly not your ivory tower "experts" ("experts" -- you must be joking)most of your 'experts' are on the indirect payroll of the big drug companies. --and their role is to obtain as many customers for life as possible to please the shareholders.your IBS may have come about due to post-infection but that may only account for 20% of the IBS cases. therefore you are in the minority and yet you seem to be trying to dictate the rules for the other 80% of us. why is that???


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## DavidLA (Nov 28, 2000)

I find Dr. Dahlman's posts very straight forward..How many conventional Drs. do we know that give guarantees/money back refunds if their patients aren't happy with the results? His goals are simple..to relieve people suffering with "IBS" and return them to good health. The bottom line to his approach is..his PATIENTS ARE GETTING WELL! Conventional Drs. have FAILED us miserable. They have NO ANSWERS, just a collection of hodge-podge theory's..that means absolutely NOTHING if their patients aren't getting BETTER! If you try Dr. Dahlman's approach, get better, and believe its strictly a placebo effect..I personally we choose that option..than suffering with this condition 7 Days a Weeks & believing all the "IBS EXPERTS" theory's!


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## eric (Jul 8, 1999)

"but they 'isn't' doing much to fix people up -- now are they?"This totally not true."most of your 'experts' are on the indirect payroll of the big drug companies."Kel, when was the last time , you sent a check to support IBS research? At least the doctors are honest when they say they don't know what causes it exactly, so they are also honest when they say they cannot cure it.


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## california123 (Jun 8, 2003)

But Eric, since Dr. Dahlam is not a medical doctor, he is not bound by any rules. If he wants to say he cures everybody, what the heck. If he wants to make money off of IBS--I assume he makes a profit on the advice and non-medicines he sells--then he is absolutely free to do "treatment" by internet that is "guaranteed" (though the number of ways his website says you can void the guarantee is truly a work of art.) With the outcry that people don't want to be on meds, but then will put all manner of things (known and unknown) into their bodies I find truly baffling. As to medical doctors not being interested in helping, I've been surprised at how many lab tests and procedures people pressue their doctors to put them through to make sure it is IBS. On the other hand, the mention of psychiatric treatment sends those same people through the roof--even though so many studies show the connection. I understand people's reluctance to take anti-anxiety drugs, but I certainly think many would benefit from taking the drug for a brief period to find out if their IBS symptoms improve. That doesn't mean they need to stay on the medication, but it could lead to treatment methods--like CBT, hypontherapy etc--that they hadn't considered before. I remain baffled but, for myself, much better. Take care.


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## DavidLA (Nov 28, 2000)

MTBIKE, Excellent post! So many people are "waiting" for conventional medicine to help them with their suffering or their looking at the latest "research"& "studies" that the Drug Company's are sponsoring being done.I also like the ones where they show you the brains of people that have "IBS" to illustrate the differences. Please!!!Dr. Dahlman is sincerely trying to help people. Not every alternative Dr. is a Quack..running some kind of a scam exploiting "IBS" patients. As he mentioned in his post, his treatments are based on the work of many other Drs, his own observations, and most importantly his own SUCCESS. So many people are brainwashed thinking that there is No Cure for their "IBS". Its no mystery where these Ideas & thoughts come from..everytime you visit your Dr.or possible reading some of these posts.


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## eric (Jul 8, 1999)

I agree Cal.David, please explain to me how you "cure" something that you don't know the "cause" of. That cannot happen.Also if there is no cure, maybe that is why some people are so frustrated? They can never obtain such high hopes? It may also depend on what they are doing to treat themselves in the first place, because I have seen things tried here that have nothing to do with IBS.Here is something to ponder for you."Everybody wants to change the world, but no one thinks of changing himself"- Tolstoy


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## bonniei (Jan 25, 2001)

I want to add it is possible to have symptoms of gas within an hour after meals due to the exaggerated gastrocolic reflex common to IBS'ers. It may not be a symtom of BO.And a bettwer way of going about the elimination diet is for 3-4 days have only rice and fish or chicken. Nost people don'yt have symptoms with this. If there are no symptoms add the lactose group for three days. If there are symptoms eliminate lactose. It means you have a problem with Lactose. Now add gluten for the next three days.If there are no symptoms with lactose leave that group in and add gluten.If there are symptoms with gluten eliminate that because you have a problem with gluten.Add fructose without wheat for thre daysIf there are no symptoms leave that in and add fructose See if you have or don't have symptoims and conclude accordingly.It is better to start with a no frills diet as the results are much more clear.Ok I am done with acting pseudo expert for my lifetime. Bye everyone ! Have fun.


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## DavidLA (Nov 28, 2000)

Quote







avid, please explain to me how you "cure" something that you don't know the "cause" of.Eric-Since "IBS" is just a catch-all term. The "cause" maybe 100 different things. I used to getsevere cramps after lunch..As an experiment I stopped eating iceberg lettuce & my cramps dis-appeared. My goal is a simple one..To no longer have digestive symtoms interfering with my life!. I DON'T Need or Care to know EXACTLY why these symtoms are gone. I'm not selling any drugs, products, services,or running for Mayor of "IBS CITY". Dr. Dahlman & other Alternative DRs. are able to help me achieve this goal..they have seen it first hand hundreds of times! They have a theory that if you follow some basic rules, these mysterious & vague symtoms will dis-appear, In addition,I have personally seen it with other "IBS" dianosed patients many times..who's symtoms were much more intense than my own!. They currently NO LONGER have any digestive problems. In fact: some of these people don't even remember what it was like to have it at all.These aren't 3-4 months re-missions either, but over 4-5 years! By going the alternative route..there is no need to keep taking anything to help you "manage your symtoms" None of the people I know that are now better..are currently taking ANYTHING! What they are doing is using lots of common sense..like having a proper diet, avoiding junk foods, exercising, not taking anti-biotics everytime they have a cold & trying not to get to stressed out. Eric you seem so wrapped up with what Conventional Medicine is doing regarding "IBS"--You're constantly quoting one paper/Dr. after another. Like its all in STONE or the LAW.You're constantly trying to put everyone who has been diagnosed with "IBS" into the same BOAT..Why not start putting more focus on relieving symtoms..some people are suffering terrible with this..having D 10x a day can't be much fun or constantly having C & praying each time you go that something will happen. Focusing on the symtoms first. And then, if you want to try to figure out WHY you're feeling so much better after trying/taking some supplements..the project will be much more enjoyable! I understand where you're coming from..I was EXACTLY like you regarding this for years..I read all the same JUNK, was on every mailing list, spoke live with many of the Drs/Authors writing it,was "up to date with all the advances" I learned everything I could about the mind-gut connection. Practiced it daily!! And yes..it HELPED me manage my symtoms better..BUT TWO things happened. Number one: it still NEVER gave me the freedom I wanted..I always had to be on a strict food program, could never really be that excited over ANYTHING! Good or Bad. The second thing that happened was, after a long round of an anti-biotic, (Cipro) my symtoms became much worst. This is when I completely jumped into being Pro-Acive with another theory. This is when I considered that maybe Conventional Drs. didn't have all the answers to "IBS". When I look back at this time is was horrible, more pain that I thought I could deal with..but after doing my own research, reading, and YES experimenting with supplements my symtoms are a thousand times better. I hope you don't have to get sicker before you'll ever consider a different path. I don't know what it would take for you to consider another path??But, if you're waiting for some long 50 page report, with 5000 "IBS" patients taking part,double blind/placebo study being done on Dr. Dahlman conclusions/Research or ANY alternative Dr, research,which will run in JAMA or some other Journal..IT WON'T HAPPEN! But..this doesn't mean it doesn't work!!!!


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## mtbike61384 (Dec 8, 2003)

Jhouston, I have been a patient for a little over two months and have now started to have better bowel movements. No c or d. The gas level has fallen. I still have a good bit of gas a cramps but we are working on that. The bloating though in my stomach and intestines is much reduced also. I actually had a couple good days in a row! Amazing. I think I might be on my way to freedom!And to DavidLA,very well said! It would be nice to know why or what causes ibs. But who really cares if you feel better? I know there is no one, well maybe eric, who would say that they didn't want to be healed unless they knew the cause of this disorder. When I am feeling good, I am not going to spend my time trying to figure out what caused it. I will just be careful what I eat and that I don't take anti-biotics. I have wasted enough time in my life with this ibs ####.


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## eric (Jul 8, 1999)

David, are you cured? Your symptoms are a 1000 times better and that is great, but are you cured?Your symptoms are probably a lot better because of all you have learned in treating them, both conventionally and alternatively.I use conventional and complimentary personally.There is mild moderate and severe IBSers, some people in the mild catergory take fiber or change a few things and they are symptoms free. This is well known."I used to getsevere cramps after lunch..As an experiment I stopped eating iceberg lettuce & my cramps dis-appeared."Yeah the fiber was causing your IBS to act up, iceberg lettuce is a pretty common trigger in IBSers, especially on an empty stomach.IBS is not the catch all term that you think it is anymore, that is outdated thinking."My goal is a simple one..To no longer have digestive symtoms interfering with my life!."That is everyones goal with IBS and totally understood.For one a lot of things you say here are true."common sense..like having a proper diet, avoiding junk foods, exercising, not taking anti-biotics everytime they have a cold & trying not to get to stressed out."This is good advise for sure and no one is arguing with that I am majorally promoting it even." Eric you seem so wrapped up with what Conventional Medicine is doing regarding "IBS"--You're constantly quoting one paper/Dr. after another."For many reasons, the basic science of IBS and state of the art treatments. And to know when someone is scamming me and to be able to tell what is accurate IBS information and what is not.You said your self there are many causes for IBS, but the fact is they do not know at this time what causes classic IBS. There are many causes for digestive problems and more then one functional disorder and many organic diseases and a lot of them can and do overlap. That's one reason for studying IBS research to seperate issues." Like its all in STONE or the LAW.You're constantly trying to put everyone who has been diagnosed with "IBS" into the same BOAT.."In the big picture most IBSers share common abnormalities. Rectal sensitivity is one and dyregulation of the serotonin system is another and abnormalities in the brain are another and abnormalities in the activation of the HPA aixs is another."Why not start putting more focus on relieving symtoms..some people are suffering terrible with this..having D 10x a day can't be much fun or constantly having C & praying each time you go that something will happen."Nobody needs to tell me persoanlly how bad IBS can get, I had majorally severe IBS to the point of suicide. I would go up to 14 times in a couple hours in the mornings or swing back and forth on most days and the pain was through the roof and I was getting two attacks a day four times a week.I understand the "Common Sense" aspect as well as the big picture IN IBS now and I don't take anything anymore and am bascially in remission. I do HT and take altoids sometimes. I would not say honestly I am cured or would tell anybody I could cure them or there was a cure. I would not say that to my fellow IBS sufferers. Experts know not to use the word cure but they do use the word remission as it is more accurate. Again you cannot cure something you don't know the cause of!!!!"I read all the same JUNK"That's just it *it is not Junk* , but real science on IBS by numerous research centers around the world and from many experts in many different fields of medicine. This information gives you better more effective ways to treat IBS.I don't think for example Dr Dalman got his degree in Chiropractic medicine from not going to school and studying the Muscle Skeletons systems.However, maybe I should personally just make stuff up which is not backed up by any major studies or basic science or even match what they know and say I can cure everyone and charge money for it. I see a lot of this on the web all the time.There are ways to give common sense information on IBS and still be accurate and still care about people suffering from IBS and still understand the different problems with different people and still focus on people getting better and making sure they were accurately diagnosed.Maybe I will go on the internet and tell everyone I can cure the common cold?"Why not start putting more focus on relieving symtoms"This is my focus.But how many people do we watch taking over the counter supplements that basically do squat for IBS. Maybe because they don't understand what they are up agaisnt. Maybe because what they are taking is not getting to some of the issues involved and to some of the real problems they have identified in IBS or understand will make the persons quality of life better and give them less symptoms.Maybe because they have fructose intolerence and not IBS, but they are trying to "Cure it" with probiotics???" Conventional Drs. didn't have all the answers to "IBS". "I know this and so do they and why they say they can't cure IBS, but it doesn't mean a total disregard for what they are saying or for paying attension to state of the art research on IBS and what they have learned so far.There are many doctors researching and studying probiotics in IBS and IBD right now. They especially show promice in IBD, and perhaps benefical in IBS. The different strains also need to be figured out and what does what. There is some hype right now about them in IBS however that does not toally reflect the real research.No one is saying either not to take them they can be benefical in some if not most IBSers. They are also not likely to harm anyone.To say they cure IBS would be a big strecth of the literture on it however to say the least.Lets take a paragraph from Dr Dalmans site here, which I personally believe it total hype and a sales pitch to the patient here and reflects the lack of accurate information that could be presented."Continued visits to your favorite physician to make the same complaint over and over again results in an unspoken, industry wide red flag that you need a prescription for an anti-depressant or a referral to counseling. This is a veiled medical insult. Your doctor is telling you that they have no idea how to help you, but it canï¿½t possibly be their fault. Do they think you are too emotional, a little too tense, so maybe you should just calm down, go home and feel better about feeling so bad? Who wouldnï¿½t be tense living with IBS?"Well this is not why they give antidepressants for IBS.This is. http://www.med.unc.edu/medicine/fgidc/anti...sentsandibs.htm Counselling and phsycotherapy are well known to be effective in IBS and moves towards a more holistic approach to treatment of IBS. Exactly what people want, but usally don't understand.Emotions directly effective the digestive system and majorally IBS!!!!! This is extremely well known to anyone paying even the slightest attension to IBS research. This is state of the art. This article has Kmottus in it.Gut reactions Treating the emotional componentof irritable bowel syndrome http://www.nydailynews.com/12-10-2002/city...64p-39684c.html This combined with conventional are the most effective treatments to date for IBS.The HT and CBT are totally safe and effective treatments also, why not promote them since they work and are effective?Yes, I do admit I follow the UNC and mayo, UCLA and Cleveland clinic information a lot, as I have found it extremely helpful and accurate as can be on IBS.I trust Dr Drossman caring attitude and expertise. He is also an expert in Gastroenterology for one, not just a Chiropractic doctor.I check my references." Douglas A. Drossman, MD Professor of Medicine and Psychiatry, UNC-CH 1. Funding Sourcesï¿½ Multicenter trial of functional bowel disordersNIH R01 DK49334ï¿½ Psychophysiology of IBSNIDDKD R01 DK31369 co-investigatorï¿½ An 8-Week Randomized, Double-blind, Placebo-Controlled Study to Evaluate the efficacy and safety of Alosetron 1 mg BID in the Treatment of Anxiety in Females with Irritable Bowel SyndromeGlaxo Wellcome, Inc. 2. Research Projects & PlansDr. Drossman established a program of research in functional gastrointestinal disorders at UNC more than 15 years ago and has published more than 200 articles and abstracts relating to epidemiology, psychosocial and quality of life assessment, design of treatment trials, and outcomes research in gastrointestinal disorders. He is recognized as one of the leading international authorities on functional GI disorders, and was responsible for organizing the Functional Brain Gut Research Group as a special interest section within the American Gastroenterological Association. This group now has an international membership of more than 500 and has been actively involved in abstract selection and organization of symposia at Digestive Diseases Week relating to the functional GI disorders. Dr. Drossmanï¿½s research has included the following: 1 With NIH support, Dr. Drossman compared IBS patients attending medical clinics to individuals with IBS who had not consulted physicians. He found that while psychological symptoms were not the cause of IBS, they influenced the decision to consult a physician. 2 In 1990, he found that approximately half of women with IBS seen in referral practices had a history of sexual or physical abuse and this was associated with poor health outcome. With NIH support, Dr. Drossman is expanding on this finding, investigating how abuse and other psychosocial factors contribute to the health status and outcome of patients with GI illness. 3 Dr. Drossman organized the Rome Criteria Committees, an international group of experts brought together to develop a nosology for functional GI disorders. He subsequently used the diagnostic criteria developed by these committees to carry out a national epidemiologic survey of the prevalence and health care impact of these disorders. Recently the committees have been re-activated for the development of Rome II, the revised Rome criteria, which is to be published by the year 2000. 4 Dr. Drossman has been the primary investigator studying health-related quality of life and health outcomes in gastroenterology. He has developed two disease-specific quality of life instruments for inflammatory bowel disease and has completed a quality of life instrument for IBS. 5 Dr. Drossman recently completed an NIH multicenter Phase III clinical trial evaluating cognitive/behavioral treatment versus the antidepressant Desipramine in patients with moderate to severe functional bowel disorders. This study also includes physiological evaluation under the direction of Dr. Whitehead and outcome assessment. The result of this study, now being reviewed for publication, indicate that both treatments are effective for treating patients with functional bowel disorders. 6 Dr. Drossman has continued to evaluate innovative diagnostic and treatment approaches. Recently, along with Dr. Yehuda Ringel, this has included studies of PET and Functional MRI in patients with IBS to determine conditions, psychosocial correlates, specific findings, and responsiveness of these findings to treatment. In addition, Dr. Drossmanï¿½s group has been studying a variety of new receptor active agents to reduce pain sensitivity and hypermotility in these disorders.3. Impact of CenterDr. Drossman interacts actively with Dr. William Whitehead, on projects relating to functional GI disorders. In addition, Dr. Drossman and his research group frequently consults with Dr. Shrikant Bangdiwala, director of the Biostatistics Core, for statistical and data management questions relating to ongoing and planned research." http://www.med.unc.edu/gibiolog/drossman.html You can also come listen to him on their chat with the experts, which they do for free for the benefit IBS sufferers. Regarless of Kel or others bashing them and conventional information. In Janurary. Hopefully Kel does not make the display she did the last time however, and decides if she comes to behave herself and try listening."The cause of IBS is yet to be determined. However, modern research understands IBS as a disorder of increased reactivity of the bowel, visceral hypersensitivity and dysfunction of the brain-but axis. There are subgroups being defined as well, including post-infectious IBS which can lead to IBS symptoms. Other work using brain imaging shows that the pain regulation center of the brain cingulate cortex can be impaired, as well as good evidence for there being abnormalities in motility which can at least in part explain the diarrhea and constipation. So finding a specific "cause" of IBS has grown out of general interest in place of understanding physiological subgroups that may become amenable to more specific treatments. Hope that helps.Doug " http://www.ibshealth.com/ibs_foods_2.htm "IBS is not caused by an overgrowth of bacteria, but an overgrowth of bacteria in the intestine can cause symptoms that mimic IBS." http://my.webmd.com/content/article/65/79522.htm If you listen carefully to what I have ever said about IBS treatment approach, its diagnoses first and diet and stress reduction as hugely important. And medication only if its needed, before other methods have been tried and depending on the person. But you seem to lump me in with conventional medicine like they are my personal theories and maybe somehow think I am a pill pusher for drug companies. That could not be any less accurate. The diet and stress redcutions do alleviate symptoms and do work for the majority of people with IBS and do work to stop suffering and improve quality of life for IBSers. If that doesn't then meds.Do people do better when they learn and know about homeostasis and its effect on IBS and how to work at trying to keep things balanced and keep the brain gut axis calm, and hence maintain a more healthy gut bacteria or do they do better everyday trying to figure out what food they ate for lunch that caused their gut to act up day in an day out? Or what OTC supplement might effect a serotonin dysregulation and possible nerve communication problems?


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## eric (Jul 8, 1999)

GI Disorders in adults http://www.iffgd.org/GIDisorders/GIAdults.html


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## Jhouston (Nov 9, 2003)

After reading posts on this board for the past month my think on ibs has changed quite a bit. First...I notice that there are sets and subsets of IBSers. Some I think truly have a mind gut scene going on. I can relate to this: after 911 all the talk about Anthrax I could not even look at the tv or listen to radio, everytime I heard the word Anthrax I literally ran to the toilet! obviously a mind-gut reaction. Maybe a subset of these IBSers suffer from PTSD type IBS if following an event. or this is their peronality/born with this inclination to cope with stress. Second set of IBSers know exactly the time and place of onset of IBS ....after a round of antibiotics, or an illness. a Physical triggering event. a subset of this might be an auto-immune illness that is subclinical. Probably some are mis-diagnosed and have an illness undetected and some have IBS and do not know it. I can relate to the latter. I never sought medical attention for gas, C, or even the several years of bloating until spastic flareups recently brought me to a diagnosis of IBS. In the past ibs might be called 'a nervous stomach'. As for Chiropractors....I know in California many of applicants have a degree in biology, microbiology and if not prerequisites biology, microbiology, anatomy, physiology, physics lots of chemistry etc. No pharmaceutical course. Since Rome criteria is basically A stomach ache with C or D chronic condition of unknown cause it is possible that all the different perspectives are correct for someone. I thought I would say my piece if anyone is interested Joann


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## eric (Jul 8, 1999)

Joann, the first two are intricately connected.This is in part how the vicous cycle is created."What would be an example of new understanding?Well one example is that we're starting to understand how the brain is responding to the pain in IBS. There have been some studies done where they've artificially created a kind of an irritable bowel by placing a balloon to stretch the bowel, and that produces pain. Then they've compared people with IBS to non-IBS, or "normal" individuals. And what they've found is that when you stretch the bowel-and use PET scans to monitor the response-in normal individuals, certain areas of the brain that register pain respond and release chemicals called neurotransmitters that suppress and lower the pain. But it seems that doesn't happen as well in people with IBS. *In fact, in people with IBS another area of the brain responds that is associated with anxiety. So what we find is that people with IBS, aside from having a bowel problem, may have some difficulty in terms of the way their brain is regulating the pain."* http://www.aboutibs.org/Publications/clinicalIssues.html There are people who genetically or for other reasons have issues going on like PTSD that impact there IBS."There is a growing understanding of the multi-faceted nature of functional gastrointestinal disorders. Symptoms, behaviors, and treatment outcomes for individuals with these disorders relate to disturbances in gastrointestinal motility and sensation that is effected by interactions that take place via the brain-gut axis. To understand and study these conditions, physicians and researchers must become familiar with new and evolving knowledge that integrates basic science, physiology, clinical medicine, and psychology. A summary of major topics is presented." http://www.aboutibs.org/Publications/currentParticipate.html The brain gut axis is widely accepted now in IBS. More so then the public accepts it."Basic Principles -- Brain-Gut Moderators: Emeran Mayer MD; Robin Spiller MD. Panel: Robin Spiller MD; Jackie Wood PhD; George Chrousos MD; Yvette Tachï¿½ PhD; Lisa Goehler PhD; G.F. Gebhart PhD; Emeran Mayer MD. IntroductionOutcomes of Pediatric Functional GI Disorders Epidemiology/Genetic/Behavioral Factors Brain Imaging Emerging Techniques to Evaluate and Treat Functional GI and Motility Disorders Clinical Applications of Diagnosis and Treatment Functional GI DisordersGeneral Principles of TreatmentPharmacological Treatment Psychological Treatment IFFGD Research Awards The brain-gut axis refers to the continuous back and forth interactions of information and feedback that take place between the gastrointestinal tract, and the brain and spinal cord which together comprise the central nervous system. These interrelated feedback circuits can influence brain processes and bowel functions -- affecting pain perception, thoughts and one's appraisal of symptoms, gut sensitivity, secretions, inflammatory responses, and motility. The brain-gut circuits can be activated by an external or internal factor or stimulus that makes a demand on the system, such as a stressful event, an injury, an emotional thought or feeling, or even the ingestion of food. Symptoms of functional GI disorders may result from a maladaptive response to stimuli at some point within the complex interactions that take place along the brain-gut axis." http://www.iffgd.org/symposium2003brain-gut.html


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## eric (Jul 8, 1999)

with permission from the UNCIBS ï¿½ Beyond the Bowel: The Meaning of Co-existing Medical ProblemsOlafur S. Palsson, Psy.D.William E. Whitehead, Ph.D.Irritable bowel syndrome (IBS) is a disorder that is defined by a specific pattern ofgastrointestinal symptoms in the absence of abnormal physical findings. The latestdiagnostic criteria for IBS, the Rome II criteria created by an international team ofexperts, require that the patient has abdominal pain for at least 12 weeks in the past 12months, and that the pain satisfies two of three criteria: It is relieved after bowelmovement, associated with change in change in stool frequency or associated with stoolform. It is becoming clear, however that these bowel symptoms do not tell the wholestory of symptoms experienced by IBS patients. People with this disorder often havemany uncomfortable non-gastrointestinal (non-GI) symptoms and health problems inaddition to their intestinal troubles.Symptoms all over the body in IBSSeveral research reports have established that IBS patients report non-bowel symptomsmore frequently than other GI patients and general medical patients. For example, fourstudies that have asked IBS patients about a wide variety of body symptoms1-4 all foundheadaches (reported by 23-45% of IBS patients), back pain (28-81%) and frequenturination (20-56%) to be unusually common in individuals with IBS compared to otherpeople. Fatigue (36-63%) and bad breath or unpleasant taste in the mouth (16-63%) werefound by three of these four studies to be more common among IBS patients.Additionally, a large number of other symptoms have been reported to occur withunusually high frequency in single studies. In our recent systematic review of the medicalliterature5, we found a total 26 different symptoms, listed in Table 1, that are reported tobe more common in IBS patients than comparison groups in at least one study.Table 1. Non-gastrointestinal symptoms more common in irritable bowel syndromepatients than in comparison groups5.1. Headache2. Dizziness3. Heart Palpitations or racing heart4. Back pain5. Shortness of breath6. Muscle ache7. Frequent urinating8. Difficulty urinating9. Sensitivity to heat or cold10. Constant tiredness11. Pain during intercourse (sex)12. Trembling hands13. Sleeping difficulties14. Bad breath/unpleasant taste inmouth15. Grinding your teeth16. Jaw pain17. Flushing of your face and neck18. Dry mouth19. Weak or wobbly legs20. Scratchy throat21. Tightness or pressure in chest22. Low sex drive23. Poor appetite24. Eye pain25. Stiff muscles26. Eye twitchingOverlap with other medical conditionsResults from numerous studies (reviewed by Whitehead, Palsson & Jones, 20025) also indicatethat IBS overlaps or co-exists more often than would be expected with other medical conditionsthat appear to have little logical connection with the gut. The most researched example of suchan overlap is the co-existence of IBS with fibromyalgia, a disorder characterized by widespreadmuscle pain. Fibromyalgia affects an estimated 2% of the general population, but in contrast, 28-65% of IBS patients have the disorder. Similar results are obtained when this overlap isexamined the opposite way, by studying fibromyalgia patients and looking for IBS: 32-77% offibromyalgia patients have IBS.Chronic fatigue syndrome (CFS) is another medical condition that has been found to have manytimes the expected co-occurrence with IBS. CFS is thought to affect only 0.4% of people ingeneral, but it has been reported to be present in 14% of IBS patients2, and conversely, 35-92%of chronic fatigue syndrome patients have IBS. Other conditions documented in multiple studiesto have excess overlap with IBS are temporomandibular joint disorder (TMJ), found in 16-25%of IBS patients2,6, and chronic pelvic pain (35% of IBS patients7). In addition to these wellestablishedrelationships, many other medical conditions appear (judging from single studyreports) to have an excess overlap with IBS, although the frequencies of most of them in IBS aremuch lower than for the disorders already discussed. In fact, we recently8 compared thefrequencies of a broad range of diagnoses in the medical records of 3153 IBS patients in a largeHealth Maintenance Organization in the U.S. Northwest to an equal number of non-GI patientsin the same HMO, and found that the IBS patients had a higher frequency of almost half of allnon-gastrointestinal diagnoses, or 64 of the 136 sampled diagnoses.In summary, non-GI symptoms and co-existing medical problems seen in many IBS patients farexceed what is typical for medical patients or GI patients in general. This raises importantquestions about what causes this phenomenon, and what the implications of it are for IBSpatients.What explains non-GI symptoms and co-existence of other disorders in IBS?There are several possible explanations for the preponderance of general symptoms and disordersin IBS. Our research group is currently conducting several research studies that may help shedsome light on this mystery, but it is far too early to come to definite conclusions. We will listhere some of the possible explanations, and discuss relevant data coming from work by our teamand other investigators.1. A common physical cause? One rather obvious explanation for the high rates of co-existingsymptoms and conditions in IBS patients would be that there is something biologically wrong inIBS that also causes the other symptoms or conditions. There are a number of distinctphysiological characteristics or ï¿½abnormalitiesï¿½ that are seen in many IBS patients, althoughnone of them are found in all patients. These include heightened pain sensitivity in the gut,increased intestinal contractions (motility) or hyper-reactivity to meals or stress (too muchmovement of the intestines ï¿½ this is the reason why IBS was called spastic colon in the past),patterns of dysfunction in the autonomic nervous system (the part of the nervous system thathelps regulate our inner body functions) and vague signs of immune activation seen in some IBSpatients. Although one can suggest ways in which these physiological abnormalities would playa role in some other disorders that co-exist with IBS, there is little evidence so far of a commonpattern of physical abnormality that could link IBS and its most common coexisting conditionsand symptoms. Patterns of autonomic dysfunction in IBS are not like the ones seen infibromyalgia and chronic fatigue syndrome, for example; and fibromyalgia patients do not showthe same gut pain sensitivity as IBS patients, and conversely, IBS patients do not show the painsensitivetender points that are characteristic of fibromyalgia9-10. Furthermore, as can be seenfrom reviewing the symptom list in Table 1, the non-GI symptoms that plague IBS patients areso varied, and cover so many different organ systems, that it would be hard to identify anybiological connection between them. On the contrary, it seems like the only overall commonalitybetween these symptoms may be that they are non-specific ï¿½ they are, in other words, not clearsymptoms of any identifiable disease processes or diagnosable disorders. Indeed, the symptomsthat are most common among IBS patients are generally those that are also common in thegeneral healthy population ï¿½ they just tend to occur at an even higher rate in people with IBS.2. Physical expression of emotional discomfort? Another possible explanation for the highnumber of non-GI symptoms and disorders in IBS is the tendency to translate strong emotionsinto physical ï¿½symptomsï¿½. This is sometimes called somatization (ï¿½somaï¿½ is the Greek word forï¿½bodyï¿½ and somatization therefore literally means ï¿½to express in the bodyï¿½). All peopleï¿½somatizeï¿½ to some degree: It is normal to feel butterflies in your stomach, to blush or go pale,get a lump in your throat, or feel the heart beating in your chest if you get very emotional. Shakyhands, stiff neck or excess sweating are likewise quite ordinary when people are under a greatdeal of stress. However, some people are more vulnerable than others to letting negativeemotions express themselves physically. This is often thought to be an alternative and lesshealthy way of exhibiting or feeling emotional discomfort. Some people may develop a strongtendency to do this because they have a basic personality style that shies away from interpersonalexpressiveness. For others, it could be the result of growing up in the care of strict, repressive orabusive parents or caretakers, where normal expression of negative emotions was not allowed orwould have been dangerous: Getting a headache or a stomach ache may be an alternative way toï¿½give voiceï¿½ to negative emotions under such circumstances. It seems that excessive habitualsuppression of ordinary verbal and emotional expression of negative emotions, regardless of thereason for it, may lead to the tendency to somatize. There is evidence that this tendency may beat work in IBS, at least among some women with the disorder. Dr. Brenda Toner has found intwo studies11-12 that women with IBS score higher than depressed women and healthy women onquestionnaires measuring of the tendency to avoid expression of negative emotions or views.3. Learned over-attention to body symptoms and excess disease attribution? All people ignoremost of the sensations from their bodies most of the time. This is necessary so that we are notoverwhelmed by the vast amount of information our senses supply to our brains every momentof our lives. For example, if you are reading this sitting down, you have probably not been at allaware of the sensations of the seat under your body until right now ï¿½ nor the feeling in yourscalp, etc. Our brains constantly sift through the mass of incoming body information and decidewhat is important for us to become consciously aware of, based on such things as our pastexperiences and how likely the information is to indicate threat to our health or well-being. Mostminor symptoms (those that might be uncomfortable and bothersome if they would get ourattention), are simply dismissed in our busy everyday lives, because other things win out in themoment-to-moment competition for our limited attention resources.More frequent attention to mild physical symptoms can be learned, however, and can become ahabit. As with most things, such habitual over-attention is probably most easily learned inchildhood. It would seem reasonable, for example that a child would get into the habit ofnoticing physical symptoms more if his or her parents are always talking about their ownsymptoms. We have recently found13 that the more medical problems the parents in thechildhood home had, the more general physical symptoms adult IBS patients report.A possible consequence of a childhood where the child grew up with parents or others who wereseriously ill, is a tendency to interpret common normal physical sensations as symptoms ofserious illness. Such serious view of symptoms can also be modeled after the parentsï¿½ approachto common illness. Dr. Whitehead and colleagues found in a telephone survey of 832 adults 20years ago14 that people whose parents paid more attention to cold or flu symptoms in childhoodwere more likely to view such symptoms as serious in adulthood and to visit doctors for them.They were also more likely to have IBS diagnosis.Evidence that IBS patients interpret physical sensations differently than others is emerging frombrain imaging studies. This type of research takes a ï¿½snapshotï¿½ of the amount of activity indifferent parts of the brain in response, using techniques such as PET scans (positron emissiontomography) and functional MRI (functional Magnetic Resonance Imaging). By examiningwhich parts of the brain react most to painful sensations, it is possible to deduce to some degreehow the brain processes the information. In one such study, by Silverman and colleagues15 , IBSpatients but not control subjects reacted to physical sensations from a painful balloon inflation inthe rectum with increased blood flow in the left prefrontal cortex, a part of the brain known toprocess personally threatening information. In contrast, that study and others16-17 found that IBSpatients do not show activity in the anterior cingulate cortex that is indicative of generaldiscomfort in healthy subjects. IBS patients are also more likely to respond to physical stimuli inthe GI tract by activating brain centers that handle emotional events. Collectively, this suggeststhat IBS patients may process body information associated with bowel sensations (and perhapsother physical sensations as well) differently than other people, interpreting them as personallythreatening and more emotionally relevant events rather than ordinary discomfort. Such differentinterpretations of physical sensations would also explain hyper-attention to such sensations.4. Faulty neurological filtering? After entering the spine (the information highway from thebody to the brain), information destined for the brain about body pain is sent along nervesthrough gates that control how much of this information passes through. Our brains continuallysend signals down to these spinal gates to cause them to block signals that are of too lowintensity to provide valuable information (you do not want to constantly know about all yourminor aches and discomforts from regular body activity). This is one of the ways that the brainuses to limit the vast amounts of information constantly streaming in from millions of nervesensors throughout our bodies. A current popular hypothesis in the field of IBS research is thatan inadequate amount of this ï¿½descending inhibitionï¿½ of incoming pain information is at leastpartly to blame for the hypersensitivity to intestinal discomfort and pain seen in IBS, and causessignals from pain sensors that would normally be blocked to pass on through to the brain. Someresearchers have further suggested that the same kind of slack traffic control could be morewidespread in IBS and may explain the observed proneness to headaches, back pain or muscleaches. People who have more open pain gates because of faulty inhibition would theoretically belike the princess in H.C. Andersenï¿½s classic story ï¿½The Princess and the Peaï¿½ who could feel apea through 20 mattresses. The problem with this as an explanation for symptom overabundancein IBS is, first, that it would explain only excess in pain-type symptoms, which are but one ofmany types of overabundant symptoms in IBS, and secondly, that there are no direct data on IBSpatients yet to show us how valid this view is.5. Result of greater psychological distress? As was explained above, it is normal for people whoare emotionally distressed to experience more physical symptoms. At least half of IBS patientswho have consulted doctors have been diagnosed with an affective (ï¿½emotionalï¿½) disorder ï¿½typically either depression or an anxiety disorder. Additionally, many people with IBS who haveno affective disorder diagnosis have significant symptoms of anxiety and depression. One mighttherefore ask whether the physical symptoms reported could simply be a side effect ofpsychological distress. We have addressed this question in two studies presented at this yearï¿½sAnnual Meeting of the American Gastroenterological Association18-19. In the HMO data18mentioned above, we found that having a psychological diagnosis was associated with increasednumbers of physical diagnoses these IBS patients had received (from an average of 7.1 to 9.7).However, we also found that even patients with no psychiatric diagnosis had more physicaldiagnoses per person than the other HMO patients (7.5 vs. 5.5), so the presence of psychologicalproblems is not the whole answer. In the other study19, we examined the relationship betweendepression and anxiety scores of 795 people with IBS and the number of physical symptoms theyhad experienced over the past month. Statistical methods that estimate how much of thevariability in one measured characteristic can be explained by other measured factors tell us thatthe psychological symptoms roughly accounted for 25-30% of physical symptoms of thesepeople. In short, psychological distress is almost certainly a part of the explanation for greaterbody symptoms in IBS, but not nearly the whole story.Future research will have to determine which of the above explanations are applicable in IBS,but it is likely that more than one of them, and maybe some other factors unrecognized so far,work together to account for the high frequency of symptoms and disorders that co-exist withIBS.The impact of extra physical symptoms and disorders on IBS patients.What do these extra (or ï¿½non-IBSï¿½) symptoms and co-existing medical conditions mean inpractical terms for patients with IBS? The first thing to note is that not all IBS patientsexperience additional health problems and symptoms, so it is not a concern for all people withIBS. For those who do, however, symptoms and disorders beyond the bowel can add measurablyto the overall burden of illness for the individual, and also lead to greater health care needs andhealth care costs for IBS patients.It is by now well established that IBS patients visit doctors more than is typical for other people.Only recently has it been recognized, though, that most of the extra health care visits people withIBS make are not for their bowel problems. Levy et al.20 reported that IBS patients had abouttwice as many doctor visits compared to other patients in the same HMO, but they found that78% of the additional visits were due to other problems than IBS. It seems quite likely that theseextra non-gastrointestinal doctor visits of IBS patients are due to the tendency to experiencemore general body symptoms over time, based on study results we presented at the AnnualMeeting of the American Gastroenterological Association last year21. Using a scale askingpatients about the 26 physical symptoms in Table 1, we found that those IBS patients who reportan unusually high number of these symptoms over the past month missed six times as many daysfrom school or work due to illness (see Figure 1) compared to those with low or moderate(normal) symptoms. The ï¿½high-symptomï¿½ IBS patients also had twice as many doctor visits andmore hospital days (Figure 2), and their quality of life was furthermore measurably poorer onthe average.A general tendency to have a large number of body symptoms is therefore very costly in terms ofthe IBS patientï¿½s overall well-being and ability to function normally in life, and also increasessubstantially the health care costs for these individuals. These findings clearly underline the needto find a way to help the many IBS patients who score unusually high on body symptomquestionnaires to reduce that tendency.Is it possible to reduce non-gastrointestinal symptoms in IBS?It is unknown to what degree standard medical treatment for IBS, when successful, also results inimprovement in non-GI symptoms. The problem is that most IBS treatment research has notexamined how non-IBS symptoms change. Non-IBS symptoms have also not been a focus ofstandard IBS treatment. An exception to this is psychological treatment trials for IBS, whichsometimes have included general physical symptom questionnaires among the measures oftreatment effects. We therefore know from our two studies of hypnosis treatment for IBS22 aswell as from research in England23 that hypnosis treatment for IBS regularly improves non-GIsymptoms substantially in addition to beneficial effects on bowel symptoms. Less is knownabout improvement in non-GI symptoms from cognitive-behavioral therapy, which is the otherwidely researched psychological treatment for IBS. However, there is every reason to believethat cognitive-behavioral treatment can reduce the tendency to experience a lot of generalphysical symptoms, based on a review of over 30 such treatment studies24. These benefits ofpsychological treatment for IBS point to extra value of such treatments for the subgroup of IBSpatients who have many non-GI symptoms.Research in coming years will hopefully identify other ways to improve the well-being and lifefunctioning of IBS patients by reducing non-GI symptoms, and this is likely to become anintegral part of managing IBS effectively in the subset of patients who suffer many symptomsand conditions beyond the bowel.References:1. Whorwell PJ, McCallum M, Creed FH, Roberts CT. Non-colonic features of irritable bowel syndrome. Gut 1986; 27:37ï¿½40.2. Jones KR, Palsson OS, Levy RL, Feld AJ, Longstreth GF, Bradshaw BH, Drossman DA, & Whitehead WE. Comorbid disorders andsymptoms in irritable bowel syndrome (IBS) Compared to other gastroenterology patients. Gastroenterology 2001:120:A66.3. Zaman MS, Chavez NF, Krueger R, Talley NJ, Lembo T. Extraintestinal symptoms in patients with irritable bowel syndrome (IBS).Gastroenterology 2001; 120(Suppl 1):A636.4. Maxton DG, Morris J, Whorwell PJ. More accurate diagnosis of irritable bowel syndrome by the use of ï¿½non-colonicï¿½ symptomatology. Gut1991; 32:784ï¿½786.5. Whitehead WE, Palsson O, Jones KR. Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are thecauses and implications? Gastroenterology 2002 Apr; 122(4):1140-56.6. Aaron LA, Burke MM, Buchwald D. Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, andtemporomandibular disorder. Arch Intern Med 2000; 160: 221ï¿½227.7. Walker EA, Gelfand AN, Gelfand MD, Green C, Katon WJ. Chronic pelvic pain and gynecological symptoms in women with irritable bowelsyndrome. J Psychosom Obstet Gynaecol 1996; 17:39ï¿½46.8. Whitehead WE, Palsson OS, Levy RL, Von Korff M, Feld AD, Turner MJ. Excess comorbidity for somatic disorders in irritable bowelsyndrome (IBS) is related to hypervigilance. Gastroenterology 2003 (abstract in press).9. Chang L. The association of functional gastrointestinal disorders and fibromyalgia. Eur J Surg Suppl 1998 ;( 583):32-6.10. Chang L, Mayer EA, Johnson T, FitzGerald LZ, Naliboff B. Differences in somatic perception in female patients with irritable bowelsyndrome with and without fibromyalgia. Pain 2000 Feb; 84(2-3):297-307.11. Toner BB, Garfinkel PE, Jeejeebhoy KN. Psychological factors in irritable bowel syndrome. Can J Psychiatry. 1990 Mar; 35(2):158-6112. Toner BB, Koyama E, Garfinkel PE, Jeejeebhoy KN, Di Gasbarro I. Social desirability and irritable bowel syndrome. Int J Psychiatry Med1992; 22(1):99-103.13. Whitehead WE, Palsson OS, Jones KR, Turner MJ, Drossman DA. Role of parental modeling in somatization of adults with irritable bowelsyndrome. Gastroenterology 2000; 122 (Suppl 1): A502.14. Whitehead WE, Winget C, Fedoravicius AS, Wooley S, Blackwell B. Learned illness behavior in patients with irritable bowel syndrome andpeptic ulcer. Dig Dis Sci 1982 Mar;27(3):202-8.15. Silverman DH, Munakata JA, Ennes H, Mandelkern MA, Hoh CK, Mayer EA. Regional cerebral activity in normal and pathologicalperception of visceral pain. Gastroenterology 1997 Jan; 112(1):64-72.16. Bonaz B, Baciu M, Papillon E, Bost R, Gueddah N, Le Bas JF, Fournet J, Segebarth C. Central processing of rectal pain in patients withirritable bowel syndrome: an fMRI study.Am J Gastroenterol 2002 Mar;97(3):654-61.17. Bernstein CN, Frankenstein UN, Rawsthorne P, Pitz M, Summers R, McIntyre MC. Cortical mapping of visceral pain in patients with GIdisorders using functional magnetic resonance imaging. Am J Gastroenterol 2002 Feb;97(2):319-27.18. Whitehead WE, Palsson OS, Levy RL, Von Korff M, Feld AD, Turner MJ. Comorbid psychiatric disorders in irritable bowel syndrome (IBS)and inflammatory bowel disease (IBD). Gastroenterology 2003 (abstract in press).19. Palsson OS, Levy R,Von Korff M, Feld A, Turner MJ, Whitehead WE. Comorbidity and psychological distress in irritable bowel syndrome(IBS). Gastroenterology 2003 (abstract in press).20. Levy RL, Whitehead WE, Von Korff MR, Feld AD. Intergenerational transmission of gastrointestinal illness behavior. Am J Gastroenterol2000; 95:451ï¿½456.21. Palsson, O.S., Jones K.R., Turner M.J., Drossman D.A., & Whitehead, W.E. (2002). Impact of somatization and comorbid medicalconditions on health care utilization, disability, and quality of life in irritable bowel syndrome (IBS). Gastroenterology, 122 (Suppl 1): A501-502.22. Palsson OS, Turner MJ, Johnson DA, Burnelt CK, Whitehead WE. Hypnosis treatment for severe irritable bowel syndrome: investigation ofmechanism and effects on symptoms. Dig Dis Sci 2002 Nov; 47(11):2605-14.23. Gonsalkorale WM, Houghton LA, Whorwell PJ. Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service withexamination of factors influencing responsiveness. Am J Gastroenterol 2002 Apr; 97(4):954-61.24. Kroenke K, Swindle R. Cognitive-behavioral therapy for somatization and symptom syndromes: a critical review of controlled clinical trials.Psychother Psychosom 2000 Jul-Aug; 69(4):205-15. http://www.med.unc.edu/medicine/fgidc/IBS%...the%20bowel.pdf


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## candywithaholeinthemiddle (Dec 9, 2003)

Thank you for posting this, Eric - it's a good read!


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## m_m_forth (Oct 21, 2003)

Jhouston, I completely agree with you about the subsets of IBS. I think you can quote all the research you want but IBS is a disorder in which it is likely difficult to get a representative sample. As was mentioned, many people do not know that they have IBS, leading many to not seek medical attention. Many others will also not seek medical attention because because we are all so ashamed to talk about our bowels. How is research to be conducted on these people? We do not understand all the possible scenerios. To fully understand IBS, more research on ALL the types much be conducted. As for Dr.D, well, I don't know what to say. Firstly, I don't believe anyone when they say they can cure 100% of IBSers. That is far to brave. I don't by that anyone has a CURE yet. Symptom reduction, maybe, but cure? What about all the studies on 5HT receptors then? That must mean it's caused by food? I dont buy it. Call me a pessimist, but I am a Realist (hahaha). Well, I am.


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## Jhouston (Nov 9, 2003)

Eric, I understand where you are coming from. Let me say this: What you say is probably Right. The balloon experiment....not to make less of it but who or whom would not feel UNCOMFORTABLE with a balloon in the rectum? (not really a question). and of course IBSers would be more inclined to react to it brainwise. They are already in a tither about their rectum. Pain? What is pain? to some it is sharp excruciating, others it is pressure and or cramping. Not every DXed IBSer has pain all the time or what they perceive to be pain. Then there is the MYSTERY of the symptoms that may cause or exacerbate the problem....like 'why was I ok yesterday and not today' We live in a cause and effect world. What I was TRYING to say in the previous post is the different ways we experience IBS and the way Rome criteria is set up WE DO NOT ALL Have THE SAME ILLNESS. hence KEL and ERIC can both be right. This is the best debating board I ever read  Joann


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## Jhouston (Nov 9, 2003)

Realist, It sure does sound impossible about Dr D Maybe he NEVER gives up. if a person doesn't respond to treatment he keeps on going until he finds something that will make most of what is making them miserable TOLERABLE. simple explanation, I know, sometimes simple is what is right in front of you and missed because experts are not seeing it so why should simple be the answer, it must be complicated. just a thought Joann


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## Jhouston (Nov 9, 2003)

Eric, Excellent read Joann


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## eric (Jul 8, 1999)

Jhouston, just a couple comments here." The balloon experiment....not to make less of it but who or whom would not feel UNCOMFORTABLE with a balloon in the rectum? (not really a question). and of course IBSers would be more inclined to react to it brainwise. They are already in a tither about their rectum. "A very high percentage of IBSers have rectal sensitivity of the nerves.They have taken into account what your saying, is the brain just activated because of the ballon causing anxiety.They have confirmed brain abnormalities in more then one study although it is still a big part of IBS research at this time. They have also found IBSers have specific brain abnormalites then normals who they have done the ballon with also as controls and with other conditions. So IBSers have specific patterns seen in IBS."Neuroimaging has provided evidence of physiological differences between normal individualsand those suffering from IBS in the way a visceral stimulus ie, rectal distention is processed inthe brain.14,15 Initial data from positron emission tomography PET scans demonstratedincreased activation of the anterior cingulate cortex ACC among normal individuals, comparedto IBS patients. The ACC is a cerebral cortical area that is rich in opiate receptors and is thoughtto be a major component of cognitive circuits relating to perception as well as descending spinalpathways involving pain. More recently, fMRI was used to demonstrate increased activity in theACC, prefrontal PF, and insular cortex areas, and in the thalamus of IBS patients compared tonormal individuals."





















Also just for the info. 15 minutes after a meal in the lower colon.


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## mtbike61384 (Dec 8, 2003)

Thanks for the pics Eric! I think that that goes to show that there is a big part of our brains that have alot to do with our problems. But I still believe that it is not our brains that caused it. I think it started in our gut and our brain just reacts to the changes in our guts. I know stress has alot to do with it. Some people get headaches when stressed while others just feel tired or sick. We get digestive problems. But I now do belive that our brains have changed do to ibs.


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## kel1059 (Feb 28, 2003)

everyone is different.the balloon experiments are possibly leading everyone down the wrong path -- plus, where is the 'wonder drug' that fixes this balloon-brain problem? there is none. there never will be a synthetic wonder drug to fix these problems.a common link between the gut is Prostaglandins. I got lucky. Ibsacol has been a miracle discovery for me. so long as I do things right with respect to a very strict diet, taking enzymes, going after a dysbiotic gut -- I was able to reverse my condition substantially.if a person has a cascade of inflammatory prostaglandins being set off in one part of the body, then it is a good bet that they might also be set off in the brain.Our doctors/researchers are determined to try and solve/medicate this problem via serotonin pathways -- this approach is not working very well.serotonin may be unbalanced but it seems that the issue with prostaglandins and leukotrienes holds a much greater promise of getting things working normally.serotonin acting drugs =='s big $$$but esters and EFA's can't make the drug companies rich or keep a doctor's monopoly intact --- therefore, there is little interest in them.


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## jack_c81 (Aug 10, 2003)

im no doctor, nor do i pass myself off as being any sort of ibs/medical expert. I do, however, have common sense, and this all sounds like a load of #### to me."To Kel, who has said some very nice things: Thank you and though you believe that I might have helped you, but would not have cured you, I say that I certainly would have completely eliminated all your symptoms. I have in every other case."He has a 100% refund policy for patient whom do not experience imporvement, yet he fails to believe patients who tell him they have not experienced improvement.Furthermore, in his multiple postings, he has failed to, in any way, answer an questions posed to him, nor has he managed to justify his proceedures in any sort of way - other to brag about his "100% success rate".not convinced, sorry. common sense prevails.


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## drdahlman (Nov 6, 2000)

Apparently, I just can't stay away from the foolish on this board.To Jack: Not only are you not a doctor or an expert on IBS, you also lack humility because you believe you have common sense. You actually believe that a patient comes to me and I just sell them products and charge lots for my time and then at the end of 3 months they call me and say they are no better and I say I don't believe you and refuse to refund them. Is that what you think happens here? How many lawsuits or complaints to my Chiropractic Board do you think that would generate?During the scheduled 3 months of phone consultations, not to mention the additional calls or e-mails that are placed to me to answer questions, I get to know quite a bit about the patient. Both the patient and I are aware of whether or not they are progressing. We talk at every phone consult about whether or not they are getting better or worse. At the end of each consult we make a plan to try to eliminate whatever symptoms are still present. I don't need to "believe" anybody, I'm actively participating in the process and it's quite apparent to both of us as to whether or not the patient is getting better or not. There are no surprises to either of us.What you are correct about is that I can only brag, I can't prove to any of you that my process works. Short of you showing up here and going through my files (protecting the patient's identity, of course), I can't think of any way to do that. Anyone who would like to show up here is welcome, but since none of you are willing to take the time to check out the lack of complaints with my Chiropractic Board, I don't think any of you will show up. The offer is open. I have offered 5 of you virtual free care and now you can come to my office to look through my files. What else can I do?Common sense is very uncommon.


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## DavidLA (Nov 28, 2000)

Eric,-After reading your post..there's just to many things I don't agree with you & I'm not interested in having some kind of on-going debate with you. My feeling is..you've already made up your mind which path for NOW you want to go. Like I mentioned in my post..I also shared your views for years.(believing that Conventional Medicine was the only option).The only thing that motivated me to change was getting sicker!!-and then seeing & feeling so much better after following a different course. When you use terms like "classic IBS" it makes it very difficult for me not to be sarcastic or rude..But, since I believe that you've suffered first hand with this & you sincerely want to help people..its probably better that I just don't say anything..except good luck.


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## Arnie W (Oct 22, 2003)

Dr Dahlman,First of all, I have the highest respect and regard for chiropractors. I know for a fact that I would not be able to do weightlifting were it not for chiropractic care. No other form of physical therapy that I tried gave me any relief for my injuries.In fact I've made an appointment with my chiropractor for just before Christmas, and I'll refer your site to him.I'm certainly prepared to consider your offer. However, our exchange rate, although better than it has been for some years, still makes any conversion from US dollars very expensive. Offers that sound too good to be true often are, but you do not make your details private, so that is reassuring. I need to re-read your report. I thought there was a lot of good info there which could be applied even if the course is not purchased.I would like to know if you have success with eliminating gas. Getting my BMs back to normal would be nice, but oh to be able to be socially acceptable again.Does coffee have to be completely eliminated (I do need one comfort in my diet)?Also, what effect would the occasional use of sleeping pills, analgesics, etc, have on the outcome of the programme?Thanks.


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## drdahlman (Nov 6, 2000)

Gas and bloating are always eliminated. Through the porocess that I describe in my article, we will figure out what the villian/s are. I never take coffee away in the beginning of my program. Enjoy!


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## drdahlman (Nov 6, 2000)

Forgot to answer.......I never take away any medications that you're on. For one, I'm not licensed to put a patient on any nor to tell them to go off any. Therefore, we just proceed and usually they have no effect on our results, but in a minority of patients, they may contribute to what we are trying to overcome. It all depends on what you are taking. We do address it as a part of my process.....and some say I don't answer any questions....!?!


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## loulou (Jan 18, 2001)

Dr. Dahlman may be complaint free at the Chiropractic Board but he is not complaint free at the Better Business Bureau.


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## kel1059 (Feb 28, 2003)

> quote: HYDE PARK HOLISTIC CENTERCustomer Experience Based on BBB files, *this company has a satisfactory record* with the Bureau. To have a Satisfactory Record with the Bureau, a company must be in business for at least 12 months, properly and promptly address matters referred to it by the Bureau, and be free from an unusual volume or pattern of complaints and law enforcement action involving its marketplace conduct. In addition, the Bureau must have a clear understanding of the company's business and no concerns about its industry. When evaluating complaint information, please consider the company's size and volume of business. The number of complaints filed against the company may not be as important as the type of complaints and how the company handled them. Closed Complaints Number of complaints processed by the BBB in last 36 Months: 1 Number of complaints processed by the BBB in last 12 months: 0


I looked up his practice and it has received only one complaint in the last 3 years. a single complaint in 3 years is in my opinion an excellent track record.*****************************************************************************All i can say is that I have had definite symptom reduction and even outright elimination of symptoms using his approach. Therefore, i am convinced that it is very practical and it will help an overwhelming majority of people here.However, there is something else going on with me, and therefore at this time I don't think dr d's approach can solve the entire issue.I still suspect that the possibility of a viral issue could be behind many cases of IBS. Viral issues are not being considered here. Dr Dantini -in florida- has a program that addresses viral problems. http://www.doctordantini.com/FMnargen.htm he states that most of his CFIDS patients have a great number of food intolerances, and he thinks this is due to a viral presence.****************************************************************************the other main problem that i see is that many of my symptoms are starting to respond to various forms of energy medicine --- Accupuncture and Homeopathy. this fact has been very welcome but it seriously complicates the picture for me. energy blockages and correction of bodily energy has muddied up the picture for me. I find it very interesting that dr Dahlman endorses homeopathy. My respect for you deepens dr d.homeopathy breaks all the rules of modern medicine therefore people --especially our learned people -- automatically jump to the incorrect conclusion that homeopathy is a sham. Nothing could be further from the truth. i take perverse pleasure in knowing that these arrogant know-it-alls will never experience this remarkable healing method. ego and arrogance have a price.however, to the skeptical people who have a mind that is open. I hope that you get a chance to study this healing method at some point in your life. energy medicine is the real deal -- it works.


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## overitnow (Nov 25, 2001)

Dr D, I just want to extend my appreciation for what you have done for others. I think your offer of free treatment for five of us is very generous. I can only assume you had to beat them away with a stick after you made that. Try not to take to heart the negativity that surrounds this place. I am pretty sure it comes from people who are afraid they would lose their "expertise" if your claims of 100% success were shown to be correct. It was very interesting to see the last two posts re the Better Business Bureau. Clearly someone is lying. What agenda does that person hold?Once again, thank you for your efforts on behalf of all of us who are looking for effective treatments and explanations.Mark


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## eric (Jul 8, 1999)

Dr Dahlman, just a couple questions?What causes IBS and where did you learn the cause? And please present research and scientific proof, not refer me to your online article. You said on another article to someone else you base your information on science. What training have you had and for how long .i.e how many hours in gastroenterology and neurogastroenterology and Immunology and from where? Do you take current countinuing medical education CME courses in IBS to stay up on the current IBS research from around the world?You say "I did not design the basics of my program, I learned from other physicians that have been in practice a lot longer than I. "Were these physicians gastroenterologists or neurogastroenterologists or certified MDs in immunology? Or were they other Chiropractic Drs?


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## Arnie W (Oct 22, 2003)

I wonder how much gastroenterologists, despite their training and credentials, are able to contribute to recovery from IBS.My doctor referred me to one. After the initial investigation I had 3 follow-up appointments. I was given no advice about diet and no blood or stool tests were taken. I was prescribed amitryptaline, which I stopped after about 2 weeks, because I felt like a zombie.I'm at the stage where I've lost too many years, and I'm prepared to give anything new a go.


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## kel1059 (Feb 28, 2003)

eric,your questions are meaningless. GI doctors -for the most part- are completely useless when it comes to IBS. I had some guy tell me to take psylium -- worthless! another --after being asked about food intolerances responded, " all i do is look for abnormalities, that is it". he was worthless.the doctors who you quote, who love to shove balloons up rear ends are not helping to solve the problem.you obviously have some agenda you are working on. why else would you not acknowledge the fact that i have repeatedly stated that i was able to completely get rid of bloat, gas, pain, cramps, odor, and visceral hypersensitivity using my own approach which is nearly identical to dr d's?to not recognize the value of that means that you care more about proving your narrow viewpoint than having other people exposed to dr d's information which will result in a great deal of symptom reduction for most.******************************************************************************the point that i would like to make clear is that Dr d must not think that he has the entire answer. i do not believe that he is curing 100% of the people. if dr d thinks he has the entire answer then when patients like myself fail to get all symptoms relieved, then we end up being accused of doing something wrong when really it is a seriously screwed up immune system behind everything.the more that i read papers such as the one below --then the more i come to realize that IBS is highly tied to a dysfunctional immune system for many of us. --and correcting a dysbiotic gut, getting rid of all food intolerances, and taking acidophilus/bifidus is all well and good ----BUT it will not solve a damaged immune system. an immune system that has been turned upside down by viral and mycoplasma infections. _ http://members.austarmetro.com.au/~julian/...limas-paper.htm Immunotherapy of Chronic Fatigue Syndrome: Therapeutic Interventions Aimed at Modulating the Th1/Th2 Cytokine Expression BalanceABSTRACT. Based on the postulates of viral and autoimmune etiologies of CFS, several interventions have been designed and tested by different research groups around the world, including the United States, Sweden, United Kingdom, Italy, and Japan. This review addresses those interventions aimed at altering the balance of certain cytokines, the mediators of immune responses. Patients with CFS who show evidence of activation of the immune system have poor immune cell function and a predominance of what is called a T -helper (Th)2-type cytokine response when their lymphocytes are activated. A Th2-type response, which is characterized by production of cytokines such as interleukin (IL)-4, -5, and -10, favors the function of B lymphocytes, the cellular factories of immunoglobulins. A predominance of a Th2-type response is therefore consistent with pathologies, such as autoimmunity and atopy, _


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## drdahlman (Nov 6, 2000)

Luckily it's snowing here today and patients have cancelled, giving me time to toy with Eric.It's obvious by the photo that you have chosen to go along with your posts, what your opinion of yourself is. Very telling. You believe that by attacking me, your position will gain strength. The questions you pose to me are done simply to provide you with ammo for your next post. I know where you're going.Wouldn't it be better not to attack the messenger, but to debate the message? A far better strategy would be for you to speak about the strengths of your position rather than denounce me. Attack my protocol, not me. Promote the validity of your favorite treatment, don't go after me.But you can't. Attacks generally come from those with weak positions. If you had an answer or those you respect had an answer, you could simply tell me how wrong I am because of the success of those you respect. And you would prove it to me. But you can't. You are waiting for Godot. The message from that play by Samuel Beckett involves two bums, Vladimir and Estragon and is primarily about hope. They spend each and every day, all day, wondering why they are suffering and waiting for Godot to come and save them. The irony is that each minute spent waiting brings death one step closer to the characters and makes the arrival of Godot less likely. The similarities to you........Let's admit one thing here, Eric. You have no respect for me. You are not alone. It's okay.So here's my catch 22. If I answer your questions, you have the ammo to continue your attack. If I don't, you will attack me for not answering. Yawn.If you need answers to those questions in order to continue this debate or to take me seriously, then I need from you your qualifications to analyze ANY data that you might find on the subject. What is your training on how you make a determination about the validity of the study, are all variables accounted for, can it be reproduced? See how we can go round and round on this? And please don't provide that answer for me, it's not necessary. So let's not go round and round. Conservatives cannot convince liberals to see it their way, nor vice versa. Please continue with your wait for Godot. It seems to make you happy. You are proud of yourself for being able to find studies that make sense to you. I am pround of myself for being able to put together a train of thought that makes sense to the average person. When they read my article and then talk to me, it simply makes sense. As I said in a previous post, use a Medline search engine and put in any of the beneficial bacteria, potentially pathogenic bacteria, yeasts or parasites, glutamine, any of the digestive enzymes, dairy/fructose/gluten intolerance, food allergies and there will be more to read on the consequences of their deficiencies or the benefits of their use as a treatment or their elimination than you or I have time to read.The studies you quote are end results of an imbalanced gastro-intestinal system. I am aware of them and have been. The question you should be asking is why is it imbalanced? Instead you attack me. The problem in your reliance on any individual's formal training to determine their authority and having not gone through the training of an MD, DO or DC yourself, is that any formal training is limited. The best doctors continue to learn after the formal training because it's a passion, because it's needed. The most important similarity between myself and any MD is that we both know how to read. I just have a different logic than those you quote. Not a better logic, it's just different. So, let's not act like conservatives and liberals and let's not wait for Godot to only perpetuate a person's suffering. And please leave me alone, answer questions in this board from people who feel they need you and I will answer questions from those who feel they need me. Which poses an interesting question. Where are the people on this board? There seems to be very few who actually participate. My website recieves 20,000 hits a month, over 100 downloads of my article a day and about 30-40 e-mail or telephone questions each day. Seems to be the same people with a few of you trying to impress the other few. So, Eric, you can see, you're a waste of time for me. But, you're fun to toy with if I have the time. Thanks to Kel for doing the legwork about complaints at my Chiropractic Board and the BBB.


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## kel1059 (Feb 28, 2003)

no problem dr d. certain people are very twisted and that is why loulou (by the way, where is flux) will post nonsense from the BBB.i defend you because i know that you are hardcore practical, and that if people took your program seriously then they would receive improvement.your program is NOT easy. it requires a lot of work, and most people are either too beaten down to invest the time and money or they can not fathom giving up their comfort foods. plus, they are skeptical for a number of reasons.*************************************************************************concerning eric's qualifications, apparently after high school he either went to cooking school or he went to cooking school after working for a number of years.so basically what we have is a cook (i like cooks!)(i really do!)(cooks are good people) who has aligned himself with certain 'experts'. these experts speak in very vague terms about the "brain -- gut" connection. --and that appeals to eric. also, these experts are being funded by the drug companies to a very large extent.eric's IBS is post-infective which only accounts for 20% of the IBS cases. eric's IBS does not seem to obey the rules that my IBS obeys. for example, fat does not bother me, but fat bothers him. he does not have severe food intolerances or lost oral tolerance.in other words, eric has is IBS and many others have IBS that is similar to mine. But he is unwilling to accept the fact that IBS is different for all of us. therefore he continues to attack you which ends up hurting all the people that should be reading your message.actually -- he is really helping to get your message across. due to his negativity, he is generating responses from people like me who are offering up solid evidence for what you are saying (despite the fact that i still think you are leaving out viral induced immune dysfunction as a cause or contributing factor)by the way, i saw that you responded to the evil psychiatrist dr steven ('have you ever known a psychiatrist who did not need one?) barrett. that man is twisted. he is a whore for the drug companies, the medical/dental lobbys, the insurance industry, and all the other pimps out there. Once again, it would be easy for you to lose your cool at eric. afterall, he is attacking your work, and you put a lot of time into it. that would upset almost everyone. it is like having your family attacked. --but just remember that he is a cook and he really does not know any better. he is trying to make a living the same as you are. he makes money from the sale of tapes. i think that his choosing 'einstein' for his picture tells a lot about what he must be thinking. he is a nice guy but there is a raging ego in there. he constantly argues with MNL who is clearly one of the brighter people who has posted here.


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## eric (Jul 8, 1999)

I figured you would not answer.What concerns me is first you are making some huge claims and your treating people over the phone, without anyway to tell what digestive conditions they may have, or if they have more then one? Or how serious they are even?Of course you don't want to answer any real questions.I don't have to be an expert to ask for your qualifications? We are not debating IBS here, as I know from doing my homework you are saying you can cure something you don't know the cause of. Really what this is about is a sales pitch to the max.When someone says they can cure IBS and fibro and IBD, all chronic conditions that the cause or pathophysiology are not known, is a major red flag!Then say I can cure it, but if I can't here is your money back. I also believe the terms for your "money Back" you use are a joke. If you know what causes these conditions for sure and can cure it, you wouldl't have to make the money back offer? Most of the things you recommend for IBS are alreay in the IBS literture for the most part.Also the doctors being bashed here are the honest ones saying we don't know what causes it, it is very very complex and they don't have all the tools or understanding or answers yet of the human body to make those claims. They also don't diagnose and treat people over the phone and through email. As for the website traffic, big deal so does mine and I answer emails for free."As I said in a previous post, use a Medline search engine and put in any of the beneficial bacteria, potentially pathogenic bacteria, yeasts or parasites, glutamine, any of the digestive enzymes, dairy/fructose/gluten intolerance, food allergies and there will be more to read on the consequences of their deficiencies or the benefits of their use as a treatment or their elimination than you or I have time to read."I have read about these things, but more importantly what do they have to do with IBS?Food allergies are not IBS! They have not found one single pathogen that causes IBS! Foods don't cause IBS! There is another conditon lactose intolerence, which is not IBS and fructose intolerence which is not IBS! Food intolerences or food sensitivities are not IBS! Yeasts don't cause IBS and inflammation alone does not cause IBS! So what are you talking about? They may be triggers to some people with IBS however and you can have more then one, but you seem to be diagnosing all these conditions as IBS over the phone and treating people through the internet?


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## eric (Jul 8, 1999)

Kel, your a waste of time now and I told you I won't debate you anymore, as you don't believe anything that has to do with facts and guess at things constantly, most of the time being wrong and ignoring to much to debate that doesn't suit you personally.Send some money to IBS research if you want to complain about drug companies, start a campaign to raise money! Do something else beside ###### all the time about how impertfect the world is.There are no IBS experts?Here are some from many fileds and they are experts and perhaps if someone actually viewed the lectures and read their work, they would actually understand better. http://www.conference-cast.com/ibs/Lecture...dRegLecture.cfm Would you say Dr Gershon is an expert on the enteric nervous system?The Enteric Nervous System:A Second BrainMICHAEL D. GERSHONColumbia University Once dismissed as a simple collection of relay ganglia, the enteric nervous system is now recognized as a complex, integrative brain in its own right. Although we still are unable to relate complex behaviors such as gut motility and secretion to the activity of individual neurons, work in that area is proceeding briskly--and will lead to rapid advances in the management of functional bowel disease. Dr. Gershon is Professor and Chair, Department of Anatomy and Cell Biology, Columbia University College of Physicians and Surgeons, New York. In addition to numerous scientific publications, he is the author of The Second Brain (Harper Collins, New York, 1998). Structurally and neurochemically, the enteric nervous system (ENS) is a brain unto itself. Within those yards of tubing lies a complex web of microcircuitry driven by more neurotransmitters and neuromodulators than can be found anywhere else in the peripheral nervous system. These allow the ENS to perform many of its tasks in the absence of central nervous system (CNS) control--a unique endowment that has permitted enteric neurobiologists to investigate nerve cell ontogeny and chemical mediation of reflex behavior in a laboratory setting. Recognition of the importance of this work as a basis for developing effective therapies for functional bowel disease, coupled with the recent, unexpected discovery of major enteric defects following the knockout of murine genes not previously known to affect the gut, has produced a groundswell of interest that has attracted some of the best investigators to the field. Add to this that the ENS provides the closest thing we have to a window on the brain, and one begins to understand why the bowel--the second brain--is finally receiving the attention it deserves. Discovery of the ENSThe field of neurogastroenterology dates back to the nineteenth-century English investigators William M. Bayliss and Ernest H. Starling, who demonstrated that application of pressure to the intestinal lumen of anesthetized dogs resulted in oral contraction and anal relaxation, followed by a propulsive wave (which they referred to as the "law of the intestine" and we now call the peristaltic reflex) of sufficient strength to propel food through the digestive tract. Because the reflex persisted even after all of the extrinsic nerves to the gut had been severed, Bayliss and Starling deduced--correctly--that the ENS was a self-contained hub of neuronal activity that operated largely independent of CNS input. Eighteen years later, the German scientist Paul Trendelenburg confirmed these findings by demonstrating that the peristaltic reflex could be elicited in vitro in the isolated gut of a guinea pig, without participation of the brain, spinal cord, dorsal root, or cranial ganglia. Trendelenburg knew this finding was unique; no other peripheral organ had such a highly developed intrinsic neural apparatus. Cut the connection linking the bladder or the skeletal muscles to the CNS, and all motor activity ceases. Cut the connection to the gut, however, and function persists. Trendelenburg's results were published in 1917. That they were accepted by at least some of his contemporaries is evident from the description of the ENS contained in John N. Langley's classic textbook, The Autonomic Nervous System, published in 1921. Like Trendelenburg, Langley knew that intestinal function must involve not only excitatory and inhibitory motor neurons to innervate the smooth muscle, glands, and blood vessels but also primary afferent neurons to detect increases in pressure, as well as interneurons to coordinate the wave of activity down the length of the bowel. The brain could not perform these complex functions alone, he reasoned, because the gut is innervated by only a few thousand motor fibers. Logic dictated that the nerve cells in the bowel--which Langley suspected, and we now know, number in the millions--had to have their own separate innervation. Thus, when he described the autonomic nervous system, it was as three distinct parts: the sympathetic, the parasympathetic, and the enteric. Unfortunately, Langley, who was owner and editor of the Journal of Physiology, alienated many of his colleagues. After his death, editorship of the Journal passed to the Physiological Society, whose members reclassified the enteric neurons as parasympathetic relay ganglia, part of the vagal supply that directs gut motility. To an extent, of course, they were right. The vagus nerve is normally responsible for commanding the vast microcircuits of the ENS to carry out their appointed tasks. What it cannot do, as Langley and his predecessors intuitively grasped, is tell them how to carry them out. That is strictly an inside job, and one that the gut is marvelously capable of performing. In addition to propulsion, the ENS bears primary responsibility for self-cleaning, regulating the luminal environment, working with the immune system to defend the bowel, and modifying the rate of proliferation and growth of mucosal cells. Neurons emanating from the gut also innervate ganglia in neighboring organs, such as the gallbladder and pancreas (Figure 1). After Langley's death, however, the concept of an independent ENS fell by the wayside, as investigators turned their attention to new developments in chemical neurotransmission. Epinephrine and acetylcholine had been identified as the sympathetic and parasympathetic transmitters, respectively (although the true sympathetic transmitter was later revealed to be norepinephrine), and neuroscientists were taken with the idea of a neatly matched set of chemical modulators, one for each pathway. The "two neurotransmitters, two pathways" theory remained essentially unchallenged until 1965-1967, when I proposed in a series of papers in Science and the Journal of Physiology that there existed a third neurotransmitter, namely serotonin (5-hydroxytryptamine, 5-HT), that was both produced in and targeted to the ENS. A Third NeurotransmitterSince serotonin was already known to possess neurotransmitterlike qualities, the storm of protest that greeted this suggestion came as quite a shock to me. At the time, of course, there was no scientific proof that enteric neurons contain endogenous serotonin or can synthesize it from its amino acid precursor, L-tryptophan. By the early 1980s, however, enough evidence had accumulated--not only about serotonin but also about dozens of other previously unknown neurotransmitters--that most investigators agreed that the old "two and two" hypothesis no longer seemed credible. It is now generally recognized that at least 30 chemicals of different classes transmit instructions in the brain, and that all of these classes are also represented in the ENS. Recent attempts to determine which peptides and small-molecule neurotransmitters are stored (often collectively) in various enteric neurons have begun to shed light on this remarkable confluence and have provided a more detailed picture of the functional anatomy of the bowel. By assigning a chemical code to each combination of neurotransmitters and then matching the code with the placement of lesions in animal models, investigators have been able to determine the location of specific, chemically defined subsets of enteric neurons. This work provides ample evidence that the ENS is no simple collection of relay ganglia but rather a complex integrative brain in its own right. However, a number of serious questions must be addressed before we can state with assurance that we understand how the neurons of the gut mediate behavior. Species differences have been found in the chemical coding of enteric nerve cells, so observations made in guinea pigs cannot be directly applied to rodents and certainly not to humans. This is somewhat baffling, because if there are patterns of enteric behavior that are common to all mammalian species, then the neurons responsible for those behavior patterns ought to be fairly uniform. Another issue concerns the degree to which the various neurotransmitters identified in the bowel are physiologically relevant. The criteria are stringent: in addition to being present in the appropriate cells and synapses, the substance being tested should 1) have demonstrable biosynthesis, 2) be released on nerve stimulation, 3) mimic the activities of the endogenously secreted transmitter, 4) have an adequate means of endogenous inactivation, and 5) be antagonized by the same drugs in the laboratory and in vivo. Acetylcholine, norepinephrine, nitric oxide, serotonin, and vasoactive intestinal peptide meet the criteria, but less is known about other candidate molecules. Anatomy of the ENSThe ENS is remarkably brainlike, both structurally and functionally. Its neuronal elements are not supported by collagen and Schwann cells, like those in the rest of the peripheral nervous system, but by glia that resemble the astrocytes of the CNS (Figure 2). These qlia do not wrap individual axons in single membranous invaginations; rather, entire bundles of axons are fitted into the invaginations of enteric glia. The axons thus abut one another in much the same manner as those of the olfactory nerve. The ENS is also vulnerable to what are generally thought of as brain lesions: Both the Lewy bodies associated with Parkinson's disease and the amyloid plaques and neurofibrillary tangles identified with Alzheimer's disease have been found in the bowels of patients with these conditions. It is conceivable that Alzheimer's disease, so difficult to diagnose in the absence of autopsy data, may some day be routinely identified by rectal biopsy. In addition to the neurons and glia of the ENS, the gut contains interstitial cells of Cajal (ICC), which do not display neural and glial markers such as neurofilaments or glial fibrillary acidic proteins and are therefore believed to be a distinct cell type. Because ICC tend to be located between nerve terminals and smooth muscle cells, Ramï¿½n y Cajal believed that they were intermediaries that transmitted signals from nerve fibers to smooth muscle. For a while, this concept was abandoned, because it was thought that no intermediaries were required. Now, however, Cajal's concept is being reconsidered. ICC are also thought to act as pacemakers, establishing the rhythm of bowel contractions through their influence on electrical slow-wave activity. This assumption is supported by 1) the location of ICC in regions of smooth muscle where electrical slow waves are generated, 2) the spontaneous pacemakerlike activity displayed by ICC when they are isolated from the colon, and 3) the disappearance or disruption of electrical slow-wave activity when ICC are removed or uncoupled from gut smooth muscle. The entire structure of the ENS is arranged into two ganglionated plexuses (Figure 3). The larger, myenteric (Auerbach's) plexus, situated between the muscle layers of the muscularis externa, contains the neurons responsible for motility and for mediating the enzyme output of adjacent organs. The smaller, submucosal (Meissner's) plexus contains sensory cells that "talk" to the neurons of the myenteric plexus, as well as motor fibers that stimulate secretion from epithelial crypt cells into the gut lumen. The submucosal plexus contains fewer neurons and thinner interganglionic connectives than does the myenteric plexus, and has fewer neurons per ganglion. Electrical coupling between smooth muscle cells enables signals to rapidly alter the membrane potential of even those cells that have no direct contact with neurons and ensures that large regions of bowel--rather than small groups of muscle cells--will respond to nerve stimulation. The Serotonin ModelSome sensory neurons are directly activated by the stimuli to which they respond, making them both sensory receptors and primary afferent neurons. Other sensory neurons, such as the auditory and vestibular ganglia, do not respond to sensory stimuli but are driven by other, nonneuronal cells that act as sensory receptors. It has not yet been conclusively shown to which of these categories the primary afferent neurons of the submucosal plexus belong. They could be mechanoreceptors that become excited when their processes in the intestinal mucosa are deformed. Or they could be stimulated secondarily to the activation of a mechanosensitive mucosal cell. Such cells do exist in the gut--they are the enterochromaffin cells of the gastrointestinal epithelium, and they contain over 95% of the serotonin found in the body. (A small amount of serotonin is also secreted by ENS interneurons.) The serotonin in enterochromaffin cells is stored in subcellular granules that spontaneously release the amine into the adjacent lamina propria, which is endowed with at least 15 distinct serotonin receptor subtypes (Figure 4). Additional serotonin is released when the cells are stimulated either by increased intraluminal pressure, vagal stimulation, anaphylaxis, acidification of the duodenal lumen, or exposure to norepinephrine, acetylcholine, cholera toxin, or a variety of other chemical substances. In a patient receiving radiation therapy for cancer, for example, excess serotonin leaking out of enterochromaffin cells activates receptor subtype 5-HT3, located on the extrinsic nerves, rapidly leading to nausea and vomiting. The symptoms can be blocked by giving an antagonist like ondansetron that is specific for 5-HT3 receptors. The antagonist does not interfere with other serotonin-mediated functions, such as peristalsis or self-cleaning activities, because they involve other 5-HT receptor subtypes. We now have extensive data (from studies of the serotonin antagonist 5-HTP-DP and anti-idiotypic antibodies that recognize 5-HT receptors) confirming that 1) serotonin stimulates the peristaltic reflex when it is applied to the mucosal surface of the bowel, 2) serotonin is released whenever the peristaltic reflex is initiated, and 3) the reflex is diminished when the mucosal source of serotonin is removed. Consequently, there is wide support for the hypothesis, first proposed by Edith Bï¿½lbring in 1958, that enterochromaffin cells act as pressure transducers and that the serotonin they secrete acts as a mediator to excite the mucosal afferent nerves, initiating the peristaltic reflex (Figure 5). The serotonergic neurons of the ENS probably inactivate the amine by a rapid reuptake process similar to that described for the CNS. A specific 5-HT plasma membrane transporter protein has recently been cloned; it is expressed in epithelial cells scattered throughout the gut as well as in the brain. Serotonin blockade can also be achieved by other means, such as removal of acetylcholine or calcitonin gene-related peptide. Uptake of serotonin can be blocked in both the ENS and CNS by antidepressant drugs such as chlorimipramine, fluoxetine, and zimelidine that have an affinity for the transporter. In the absence of rapid uptake, serotonin continues to flow outward in the direction of neighboring nerve cells, which become excited in turn. Eventually, however, desensitization takes place, and the process grinds to a halt. In the guinea pig model, insertion of an artificial fecal pellet into the distal colon was followed by rapid proximal-to-distal propulsion. The same effect was achieved even when the experiment was repeated for eight hours. Addition of a low dose of fluoxetine accelerated propulsion, while at higher doses the 5-HT receptors became desensitized and intestinal motility slowed and eventually stopped. Clinical Implications. Obviously, these data have important implications for physicians who regularly prescribe mood-altering drugs. Because the neurotransmitters and neuromodulators present in the brain are nearly always present in the bowel as well, drugs designed to act at central synapses are likely to have enteric effects. Early in the course of antidepressant therapy, about 25% of patients report some nausea or diarrhea. With higher dosages or longer duration of therapy, serotonin receptors become desensitized, and constipation may occur. (Presumably, the 75% of patients who do not complain of gastrointestinal disturbance either are not taking enough of the antidepressant or have compensatory mechanisms that reduce the impact of prolonged serotonin availability.) If these effects--which are not side effects per se but predictable consequences of transporter protein blockade--are not anticipated and carefully explained to the patient, they are likely to reduce adherence and limit the value of treatment. On the other hand, the same drugs that tend to cause difficulty for patients who take them for emotional illness may be a godsend to those with functional bowel disease. Moreover, because the ENS reacts promptly to changes in serotonin availability, patients with chronic bowel problems often find their symptoms relieved at pharmacologic concentrations far below those used in conventional antidepressant therapy. More About the Brain-Gut ConnectionProvided that the vagus nerve is intact, a steady stream of messages flows back and forth between the brain and the gut. We all experience situations in which our brains cause our bowels to go into overdrive. But in fact, messages departing the gut outnumber the opposing traffic on the order of about nine to one. Satiety, nausea, the urge to vomit, abdominal pain--all are the gut's way of warning the brain of danger from ingested food or infectious pathogens. And while the brain normally responds with appropriate signals, the ENS can take over when necessary, as for example when vagal input has been surgically severed. Naturally, the balance of power between the two nervous systems is a topic of considerable scientific interest. It has been proposed that vagal motor axons innervate specialized command neurons in the myenteric plexus, which are responsible for regulating the intrinsic microcircuits of the ENS. In favor of this concept is the observation that vagal motor fibers appear to synapse preferentially on certain types of enteric neuron (Figure 6). For example, vagal efferent axons preferentially innervate neurons in the myenteric plexus of the stomach that express serotonin or vasoactive intestinal peptide. Other recent studies have suggested that vagal input may be more widely dispersed than the command-neuron hypothesis would imply, especially in the stomach. The interplay between the two systems is thus still a bit unclear. Correlation or Causation? Whatever the exact connection, the relationship between the cerebral and enteric brains is so close that it is easy to become confused about which is doing the talking. Until peptic ulcer was found to be an infectious disease, for example, physicians regarded anxiety as the chief cause. Now that we recognize Helicobacter pylori as the cause, it seems clear that the physical sensation of burning epigastric pain is generally responsible for the emotional symptoms, rather than the other way around. But because most ulcer patients, if questioned, will admit to feeling anxious, the misunderstanding persisted for decades. Another illustration is ulcerative colitis, which was considered the prototypic psychosomatic disease when I was in medical school. There were even lectures on the "ulcerative colitis personality." The ulcerative colitis personality, if indeed there is one, is a consequence of living with a disabling autoimmune disease that prevents patients from feeling relaxed and comfortable in social situations. It is altogether possible that with passage of time, many of the ailments currently labeled as functional bowel diseases will prove to have similarly identifiable physiologic causes. Embryonic Development: New InsightsIn order to better appreciate ENS functioning, it is helpful to know something about its embryonic development. Which sites in the embryo give rise to the precursors of enteric neurons and glia? What impels these precursors to migrate to the bowel? And what features of the enteric microenvironment ultimately cause these incipient nerve cells to arrest their journey and undergo phenotypic differentiation? The neural and glial precursor cells of the ENS are the descendants of ï¿½migrï¿½s from the vagal, rostral-truncal, and sacral levels of the neural crest. Of these three, the vagal crest is the most influential, because its cells colonize the entire gut. The rostral-truncal crest colonizes only the esophagus and adjacent stomach, whereas the sacral crest colonizes the postumbilical bowel. It might be assumed that premigratory cells in each of these regions are already programmed to locate their appropriate portion of the gut and differentiate as enteric neurons or glia. However, that idea has been shown to be incorrect. The premigratory crest population is multipotent--so much so that whole regions of the crest can be interchanged in avian embryos without interfering with ENS formation. Furthermore, even the group of crest-derived cells that are destined to colonize the bowel contains pluripotent precursors with a number of "career" options. Terminal differentiation does not take place until the ï¿½migrï¿½s have reached the gut wall and interacted with the enteric microenvironment via a number of specific chemical growth factor-receptor combinations. If these molecules are unavailable, the migration of the crest-derived cells will be cut short, and aganglionosis of the remaining bowel will result. Nerve cell lineages are defined by their common dependence on particular growth factors or genes. For example, there is a very large lineage defined by dependence on stimulation of the Ret receptor by glial cell-derived neurotrophin factor (GDNF) and its binding molecule, GFR-alpha1. This so-called first precursor gives rise to essentially all of the neurons of the bowel, with the exception of those of the rostral foregut. Partial loss of GDNF-Ret may result in a precursor pool that is too small to colonize the entire gut, while complete loss of either GDNF or Ret eliminates the possibility of nerve cells below the level of the esophagus. A second lineage depends on Mash-1, a member of the basic helix-loop-helix family of transcriptional regulators. These neurons, which include those of the rostral foregut as well as a subset of cells in the remainder of the bowel, are transiently catechola-minergic, develop early (enteric neurons develop in successive waves), and generate the entire set of enteric serotonergic neurons. A third lineage is independent of Mash-1, develops later, and gives rise to peptidergic neurons such as those that contain calcitonin gene-related peptide. Sublineages of enteric neurons include those dependent on neurotrophin 3 (NT-3) and endothelin 3 (ET-3). The peptide-receptor combination ET-3-ETB is particularly interesting because it appears to act as a brake that prevents migrating cells from differentiating prematurely--before colonization of the gastrointestinal tract has been completed. Absence of ET-3 results in loss of nerve cells in the terminal portion of the bowel. In humans, this condition, known as Hirsch-sprung's disease (congenital megacolon), occurs in roughly one in 5,000 live births. Without innervation, intestinal traffic is blocked, and the colon becomes enormously dilated above the blockage. Surgery is extremely difficult because the aganglionic portion of the infant's intestine must be removed without damaging functioning ganglionic tissue. One experimental model for this disease, the lethal spotted mouse, lacks ET-3, while another laboratory strain, the piebald mouse, lacks the endothelin receptor ETB. In either case, the result is a mouse with the equivalent of Hirschsprung's disease. (The link between ET-3 deficiency and aganglionosis was discovered quite by accident, when Masashi Yanagisawa knocked out genes coding for ET-3 and ETB to study their effect on blood pressure regulation. The animals had such severe bowel abnormalities that they did not live long enough to manifest cardiovascular problems.) Our laboratory is currently attempting to define exactly where the endothelins are expressed, as well as to clarify the role of another putative factor in the pathogenesis of Hirschsprung's disease, laminin-1. This is an extracellular matrix protein excreted by smooth muscle precursors that both encourages adhesion of migrating cells and promotes their differentiation into neurons (Figure 7). We are trying to produce a transgenic mouse that overexpresses laminin in the gut, and anticipate that Hirschsprung's disease equivalent will result. We also are studying an interesting group of molecules called netrins, which are expressed in both gut epithelium and the CNS. Netrins are attraction molecules that appear to guide migrating axons in the developing CNS and neuronal precursors in the bowel and may be especially important in forming the submucosal plexus. The attraction they create is so powerful that if netrin-expressing cells are placed next to the gut, neuronal precursors will migrate out of the bowel in search of the netrin-expressing cells. Two potential receptors for the netrins have been identified, neogenin and DCC (deleted in colorectal cancer). Antibodies to DCC will counter the attraction of netrins and cause nerve cell precursors to suspend their migration. Other teams are studying avoidance molecules called sema-phorins that are the opposite of the attraction molecules (i.e., they repel the enteric precursors). Mention should also be made of the important role that technology has played in accelerating scientific progress in this area. In particular, the ability to isolate crest-derived cell populations by magnetic immunoselection and then to culture them in defined media has made it possible to test the direct effects of putative growth factors on the precursors of neurons and glia, as well as to analyze cell receptors, transcription factors, and other developmentally relevant molecules (Figure 8). The alternative--carrying out experiments with mixed populations of enteric precursor cells or cells cultured in serum-containing media--would have produced unreliable results because of the uncontrolled interaction of crest-derived and non-crest-derived cells in media of unknown content. Future DirectionsClearly, much has been accomplished since the days when the ENS was dismissed as an inconsequential collection of relay ganglia. Although we still are unable to relate such complex behaviors as gut motility and secretion to the activity of individual neurons, work in that area is proceeding briskly. Similarly, we are moving toward an overarching picture of how the CNS interacts with the microcircuits of the bowel to produce coordinated responses. Finally, it seems inevitable that advancement of basic knowledge about the ENS will be followed by related clinical applications, so that the next generation of medical practitioners and patients will find fewer ailments listed under the catch-all heading of functional bowel disease. http://www.hosppract.com/issues/1999/07/gershon.htm There are also other reasons left out. Structural or congential birth defect damage for example. But there are more.


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## eric (Jul 8, 1999)

Oh and by the way I highly respect Einstein and his work in science. Which is why I choose the avatar, which has nothing to do with me personally.""If we knew what it was we were doing, it would not be called research, would it?"- Albert Einstein


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## Arnie W (Oct 22, 2003)

In a nutshell, then, what are the main triggers for IBS?


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## kel1059 (Feb 28, 2003)

i think it varies from person to person. a good example would be the fat example. i am not bothered by fat but some people are bothered by it.some people get dramatic symptom reduction by going low carb. others will follow heather's advice and receive symptom reduction that way.I think that dr d's advice is at least a thousand times better than any doctor's advice that i ever received. doctor's were a complete waste of time for me.dr d's approach is a step by step process that identifies trouble spots. plus it is filled with excellent advice on a few related topics such as water...


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## calid (Aug 4, 2003)

My doctor's advice consisted of taking fiber, eating less fat and medication. I've learned more about this condition from using this board and the Eating for Ibs board by far.


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## Gret (Sep 23, 2003)

So Kel, it's obvious you respect Dr. Dahlman's approach to healing. Why don't you take him up on his offer? What have you got to lose? What do any of us have to lose??? I don't want to be around here a year from now. As much as I appreciate everyone's support and encouragement, I just want to live my life without IBS. So, again, what do any of us have to LOSE???? IBS?


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## jr71 (Oct 26, 2003)

this question is for dr dalman yuor program sound interesting.but my question is i have ibs and i had a endoscopy with biopsy.biopsy came back normal for bacteria.is it possible i could still have bad flora.


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## kel1059 (Feb 28, 2003)

i was getting ready to take him up on his offer, but when i started to look into the products i discovered that i was allergic/hypersensitive to 4 of them (i listed them on page 2 of this thread).i am using one of the best digestive enzymes on the market -- German Wobenzymethe other change i am going to make is to include the human strains of Bifidus everyday into my regimen.my future strategies are going to include the TRANSFER FACTOR immune system products such as the antigen infused bovine colostrum (all the colostrum is removed leaving the immune factors in place) http://members.austarmetro.com.au/~julian/cfs/tf.htm http://members.austarmetro.com.au/~julian/...limas-paper.htm http://www.quantum-research.com/immunemodulation.asp http://www.quantum-research.com/pdf/immune_modulation.pdf http://www.quantum-research.com/history.asp i need to gather more research first, but if the claims are true then i may be able to re-shift my immune function from th2 back to th1. hopefully that would solve my food intolerances and allergies.i know that the accupuncture and homeopathy will work but i am very impatient. i want to speed things along. plus the energy medicine may not solve the entire problem.since dr d writes about homeopathy in his website -- i would like to hear is opinion of it as it relates to IBS symptoms.have you ever thought about getting licensed in accupuncture?


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## kel1059 (Feb 28, 2003)

> quote: biopsy came back normal for bacteria.is it possible i could still have bad flora.


most definitely. our doctors don't really know what constitutes good/bad flora.there is a new e coli product that will be released next year Probactrix, and i am hoping that this can help displace some of the bad bacteria. However, i am sure that this is another bacteria that will NOT implant and therefore we will have to take it for the rest of our lives --- oh well, if it helps, it helps.acidophilus and bifidus are not the sole answer. i think that dr shaw needs to be taken more seriously by us.


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## flux (Dec 13, 1998)

> quote.S. To Flux: Donï¿½t bother


I hadn't noticed this thread, and I haven't read it but if I were guessing, wouldn't this be an accurate summary:


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## Gret (Sep 23, 2003)

Kel, too bad about the allergies/hypersensitivities. But it sounds like you have a game plan. Hope it all works out...


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## Arnie W (Oct 22, 2003)

I have read Dr D's report with an open mind, and, yes, I am tempted to at least follow his advice.To me, it is not an issue that I will not be able to consult with him in person. I have been to at least half a dozen doctors, and have had several sessions with many of them. In retrospect, I could have had the appointments over the phone. There was no need for me to be in the surgery. I was never physically examined. I had no signs which needed to be identified. I had symptoms which I described to them.The fact that I can only have phone or email consultations is not a concern for me.


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## eric (Jul 8, 1999)

Gret, his offer is still not free, so you know, you will still have to buy things and probably have food or other testing done which would not be refundable.To do the full program itself is $1200. Plus possible other costs and testing.Then"If at any time I feel as if you are not following the dietary guidelines, your guarantee will be voided."It would not surprize me if you have to continue to stay on his products for life to keep the flora balanced as well.Arnie, some well known triggers.Emotions, anxiety and stress. The very act of eating itself.Over eating.Some foods.Hot and cold and even the weather.Here is something for you to read.FYI from webmd"Dr. Burbige: We can talk a little about treatment. first of all,there is no cure for IBS, but there are treatments. Thetreatment of IBS for all cases requires education. Peopleneed to become educated about their disease, the causesand exacerbations of it. When diagnosis is made, theirquestions need to be answered. Then lifestyle modification.A large component of that would revolve around diet.Generally, we recommend a low-fat, high-fiber diet. Inaddition, we recommend to decrease the caffeinatedbeverages, alcohol, which increases intestinal secretions,chocolate, gassy foods, and certain carbohydrates. Interms of diet, there is no causal relationship between foodelements and IBS. However, certain substances canworsen symptoms. Included in there are particularly thecarbohydrate intolerance, such as lactose, and rarelysucrose or fructose intolerance. Again, I stress they don'tcause IBS, but can worsen symptoms. These carbos orsugars, if not absorbed in the small intestine, pass to thelarge intestine, where bacteria digests them. This producesgas and diarrhea. Lactose intolerance, or the inability todigest lactose sugars, is fairly common. Sucroseintolerance is rare, and so is fructose intolerance. However,if anyone ingests large amounts of these substances, theymay overwhelm the body's ability to digest them. Theseshould be taken in moderation. If lactose intolerance ispresent, either avoidance of dairy, or the taking ofover-the-counter supplements can help in the digestion ofthese products.Moderator: Can you please give us examples of thecarbohydrates that should be avoided? What gassy foodsshould be avoided?Dr. Burbige: Going into diet in a little more depth, weneed to consider an individual's intolerances. As I've said,there is no causal relationship between diet and IBS, butonly worsening of symptoms in people with IBS. Not allpeople with IBS need to avoid carbos. Generally, Irecommend to my patients, that if they can eat a particularfood without problem, then to go ahead and eat that food,except for caffeinated beverages, chocolate and alcohol. Ifcertain foods do cause symptoms, then for that patient, theavoidance of that product is recommended. In general,people who are lactose intolerant have to avoid dairy suchas milk, cheeses and ice cream. But if a person can eatthese with no symptoms, then they don't need to avoidthem. In terms of gassy foods, they're the ones we all knowabout such as beans, apples, broccoli, cabbage -- butagain, if you can eat these without any symptoms, there'sno reason to avoid them. They may contain good fiber,which may help in the underlying bowel problem. Onseveral occasions, I've mentioned high fiber, and the valueof fiber in products such as apples and other veggies.Physicians recommend fiber routinely for IBS, but to behonest, it's role is controversial. There is no doubt that fiberhelps patients with constipation predominant IBS, itdecreases transit time in the bowel, relieves abdominaldistention, and relieves abdominal pain. It may also helpsome patients with diarrhea by changing pressurecharacteristics of the bowel and relieving spasms.However, in some individuals, it may actually worsensymptoms because the fiber is fermented in the bowel andproduces more gas and distention. Therefore, the use offiber remains controversial, but should be given as a trial."Irritable Bowel Syndrome: Diagnostic andTreatment Issues Special ProgramBy Eugene Burbige, MD Event Date: 08/29/2000.This event is sponsored by Glaxo Wellcome. GlaxoWellcome has had no influence on the selection of theguest or the content presented in this event.Moderator: Welcome to WebMD Live Events. Our guesttoday is Eugene Burbige, MD, chairman of thegastroenterology division of Mount Diablo Medical Centerin Concord, CA. We will be discussing diagnostic andtreatment options for irritable bowel syndrome. Welcome Dr. Burbige. How are you today?Dr. Burbige: I'm fine. How is everybody out there?Moderator: Before we begin taking questions, can youplease tell everyone a little bit about your background andarea of expertise?Dr. Burbige: I can start at I went to University Statemedical school, did my residency and gastroenterologyfellowship at John Hopkins Hospital in Baltimore, then Imoved to California in 1975, where I was chief ofgastroenterology, at the hospital of University of Californiaat Davis, for 12 years. I've been in private practice inConcord, CA for 12 years, where I'm chief ofgastroenterology at Mount Diablo Medical Center. Andalso am chief of liver research and gastroenterology atEast Bay, Concord, CA. I've done research in peptic ulcer,IBS, and reflux disease.mommyme1_webmd: How can I tell if what I have is IBS(irritable bowel syndrome)? What are the symptoms? I getdiarrhea frequently and suddenly.Dr. Burbige: The definition of IBS is that it's a chroniccondition that affects people from years to decades, withsymptoms of abdominal pain, altered bowel habits, andbloating distension, which results in changes in quality oflife. The diagnostic criteria for IBS is 12 weeks within thepreceding 12 months of abdominal pain, associated withaltered bowel habits. In order to make diagnosis, somepreliminary diagnostic tests must be done by your doctor torule out other serious illnesses.morris71_lycos: What is the difference between IBS andIBD (inflammatory bowel disease)?Dr. Burbige: IBS is abdominal pain associated withaltered bowel habits in the absence of structural change inthe bowel. IBD is associated with inflammation of the bowelwall. In other words, if a biopsy of the bowel is taken from apatient with IBS it will look normal, whereas with IBD, therewill be inflammation of the lining of the bowel. This isimportant, because both abnormalities are treated bydifferent means.mommyme1_webmd: What kind of tests do I have tohave done? You said the doctor had to do somepreliminary diagnostic tests.Dr. Burbige: The full definition for IBS is as I mentioned,12 weeks in the preceding 12 months of abdominal pain,with pain relieved with bowel movement, or associatedchange with passage of stool, or appearance of stool. Thedoctor, depending upon the age of patient, will do bloodtests to make sure there's no anemia, no elevated sed rate(sedimentation rate) which is an indirect test forinflammation, and the stool will be tested for hidden blood.And a history will be done, depending upon age of thepatient, there may be necessity to do a sigmoidoscopy. Asigmoidoscopy is a test where the physician looks in thelower part of the colon with a flexible tube to make surethere is no premalignant, or malignant changes, orinflammation in the bowel wall. This is done after apreparation with a laxative, and an enema.morris71_lycos: Can IBS cause colon cancer if leftuntreated?Dr. Burbige: First of all, IBS does not lead to more seriousillnesses, such as colon cancer. There is no documentedcausation of colon cancer by IBS. However, IBS can lead tomarked changes in people's quality of life. Worrying aboutcolon cancer is important, and often makes people withIBS seek medical attention. One out of five Americanwomen suffer from IBS. But only about 15 to 20% of thosepeople seek medical care. There's lots of reasons whypeople do not seek medical care for IBS. One isembarrassment over talking about bodily functions. Anotherreason is fear over diagnosis such as cancer. Anotherreason is that women have seen physicians in the past forthese symptoms and have come away wanting foradequate diagnosis and treatment. The reason thatprompts people to seek medical care is diagnosis ofcancer in a friend, or death of a relative. People come tomyself and other physicians, worrying about cancer, pepticulcer disease, and other serious illness. I'll say again, thatIBS does not lead to colon cancer. Although IBS is not lifethreatening, patients frequently report restricted lifestylethat has been adapted to cope with their condition. Thesecoping mechanisms have cost the patients in terms of timelost from work, job opportunities, psychologicalconsequences, and social interactions with family andfriends. That's a long winded answer to "Does IBS causecolon cancer?" It doesn't, but can affect people's lives inserious ways.Moderator: Please describe what normal bowel habitsare?Dr. Burbige: As human beings, we feel that everyone isthe same as we are. So what is our bowel habits becomenormal to us. However, if we go by strict definitions ofnormal bowel habits, in order to qualify for diarrhea as adiagnosis, it has to be more than three bowel movementsper day. To qualify for constipation, it has to be less thanthree bowel movements a week. However, for an individual,what becomes abnormal is a change in bowel habits. If anindividual has two bowel movements a day, for the last tenyears, then suddenly begins having three or four a day, thatis abnormal. At this point they should seek medical help tomake sure there is no organic issues causing the problem.What are the most common food irritantsfor IBS sufferers? I've read that fructose is one of them andI am amazed at the number of food products containing it.Dr. Burbige: We can talk a little about treatment. first of all,there is no cure for IBS, but there are treatments. Thetreatment of IBS for all cases requires education. Peopleneed to become educated about their disease, the causesand exacerbations of it. When diagnosis is made, theirquestions need to be answered. Then lifestyle modification.A large component of that would revolve around diet.Generally, we recommend a low-fat, high-fiber diet. Inaddition, we recommend to decrease the caffeinatedbeverages, alcohol, which increases intestinal secretions,chocolate, gassy foods, and certain carbohydrates. Interms of diet, there is no causal relationship between foodelements and IBS. However, certain substances canworsen symptoms. Included in there are particularly thecarbohydrate intolerance, such as lactose, and rarelysucrose or fructose intolerance. Again, I stress they don'tcause IBS, but can worsen symptoms. These carbos orsugars, if not absorbed in the small intestine, pass to thelarge intestine, where bacteria digests them. This producesgas and diarrhea. Lactose intolerance, or the inability todigest lactose sugars, is fairly common. Sucroseintolerance is rare, and so is fructose intolerance. However,if anyone ingests large amounts of these substances, theymay overwhelm the body's ability to digest them. Theseshould be taken in moderation. If lactose intolerance ispresent, either avoidance of dairy, or the taking ofover-the-counter supplements can help in the digestion ofthese products.Moderator: Can you please give us examples of thecarbohydrates that should be avoided? What gassy foodsshould be avoided?Dr. Burbige: Going into diet in a little more depth, weneed to consider an individual's intolerances. As I've said,there is no causal relationship between diet and IBS, butonly worsening of symptoms in people with IBS. Not allpeople with IBS need to avoid carbos. Generally, Irecommend to my patients, that if they can eat a particularfood without problem, then to go ahead and eat that food,except for caffeinated beverages, chocolate and alcohol. Ifcertain foods do cause symptoms, then for that patient, theavoidance of that product is recommended. In general,people who are lactose intolerant have to avoid dairy suchas milk, cheeses and ice cream. But if a person can eatthese with no symptoms, then they don't need to avoidthem. In terms of gassy foods, they're the ones we all knowabout such as beans, apples, broccoli, cabbage -- butagain, if you can eat these without any symptoms, there'sno reason to avoid them. They may contain good fiber,which may help in the underlying bowel problem. Onseveral occasions, I've mentioned high fiber, and the valueof fiber in products such as apples and other veggies.Physicians recommend fiber routinely for IBS, but to behonest, it's role is controversial. There is no doubt that fiberhelps patients with constipation predominant IBS, itdecreases transit time in the bowel, relieves abdominaldistention, and relieves abdominal pain. It may also helpsome patients with diarrhea by changing pressurecharacteristics of the bowel and relieving spasms.However, in some individuals, it may actually worsensymptoms because the fiber is fermented in the bowel andproduces more gas and distention. Therefore, the use offiber remains controversial, but should be given as a trial.kelseygram_webmd: Isn't it associated with stress, theindividual's reaction to stress?Dr. Burbige: For years IBS has been thought of as apsychosomatic disorder. People have been told it's in thereheads. However, we now realize it is a real disorder, withpathophysiologic abnormalities. It's no longer rational for usto decide whether IBS is psychological or physiologic.We've come to realize it's a combination of the two, and it'simportant for doctors to realize this and determine thedegree to which each of these is fixable. We nowrecognize that IBS is associated with the hypersensitivity ofthe nerves within the bowel. This sensory input is influencedby psychological factors. The thinking now is almost a bigbrain/little brain type of situation, with the little brain beingthe nervous system in the bowel, which can actindependently than our brain in our cranium. Thisconnection between the big brain and little brain is referredto as the brain/gut axis. We have to remember that there'sa bi-directional communication between the brain and gut.Things we see, hear, and smell, are modified by memoryand affect, they are then taken with the input from the gut,and sensation is then felt. These influences then havephysiologic affects on bowel motility and secretions, andcan affect our conscious perception of symptoms. Thisagain is a complicated long answer to the question aboutstress. Stress is important in causing worsening ofsymptoms, but there is an underlying abnormality of thebowel itself. In the majority of people with IBS, they do nothave significant psychological abnormalities. In a smallernumber of people, 20 to 25% of people with IBS, they mayhave more severe psychological disturbances. They willbenefit from some type of psychological counseling. Thereare a number of psychological interventions which havebeen looked at in IBS, but there have not been a lot ofclinical studies. There are studies looking at various typesof psychological intervention including relaxation therapy,hypnosis, interpersonal psychotherapy, and cognitive orbehavioral psychotherapy. There are only about 11well-controlled studies done using a combination of thesetypes of therapies, and about 60 to 70% showed significantimprovement with psychological treatment overconventional treatment.kelseygram_webmd: So other than diet restrictions suchas corn, should there be medications prescribed?Dr. Burbige: As when we talked about treatment earlier,we talked about reassurance, education, and lifestylemodification. These should be instituted in every case. Butif we look at IBS overall, doctors tend to break them downto mild, moderate and severe cases. If we move on fromthe mild to moderate cases, they require the threeelements we talked about, but at this point it is usuallynecessary to move to medical treatments. Additionally,counseling can be helpful for those who can associatetrigger factors that set off symptoms, such as stress. If welook at medications for treatment, unfortunately for a longtime, most treatment has been aimed at individualsymptoms. In other words, one medication for diarrhea,one for bloating, one of pain, resulting in a number ofmedications to control all of the symptoms. Medicationsthat have been used for diarrhea include Lomotil(diphenoxylate/atropine), or Imodium (loperamide), ortincture of Opium. Medications for spasm and pain haveincluded anticholinergics, although there is no control studyto prove that anticholinergics work for pain associated withIBS. The use of some of these medications may also beassociated with adverse effects, such as constipation,more bloating, dry mouth, and blurry vision. Recently, onenew medication has been approved for treatment ofdiarrhea-predominant IBS. That product is alosetron(Lotronex), and is approved for female patients withdiarrhea-predominant. Another medication is soon to beapproved for constipation-predominant IBS, and is namedtegaserod (Zelmac). In patients with severe IBS, this groupcomprises five percent of the patient group. In theseindividuals, the pain is more constant, and is associatedwith marked psychological abnormalities. In these patients,besides medications for bowel symptoms, the use ofpsychotherapeutic medications, such as antidepressants,are often necessary.daisy_63_webmd: After four weeks of diarrhea with nomedications working, my gastroenterologist put me ontincture of opium. This past week I am having bloating andabdominal pain. Could it be the medication?Dr. Burbige: With tincture of opium, it affects the motility ofthe bowels, and tends to slow things down. This may easilylead to more distention of the bowel and a feeling ofbloating. In the case of any adverse reaction, or possibleadverse reaction to medication, it's wise to inform yourphysician of these changes. I would recommend that younotify him/her, but your symptoms may be due to that.He/she may want to consider the use of the newer agent Imentioned earlier, Alosetron (also known as Lotronex)which is recommended for people withdiarrhea-predominant. It's been shown to decreasefrequency of bowel movements, and improves theconsistency. If diarrhea is predominant, with noconstipation, this agent may be helpful for you. But youshould check with your physician. With the particular agent,you'd not have the adverse affects you've described.cnettles_webmd: Are the side effects we've heard aboutthese drugs temporary?Dr. Burbige: If we look at the side effects of drugs used totreat IBS, the ones that happen most commonly are theones with the anticholinergics. The newer agent, Alosetron,has a side effect profile similar to placebo or sugar pill inclinical trials. Except for constipation. In the clinical trials,constipation occurred in high percentages of patients. Thismay well be an expected side effect in a drug meant totreat diarrhea. The dosage of the drug needs to be titratedin individuals who develop constipation. This should bedone in conjunction with your physician. It's recommendedthat if constipation develops while taking this medication,that it be stopped and your physician be notified. In mostcases, after treatment of constipation, the drug can berestarted. There have been a small number of cases ofrectal bleeding in patients using this medication. And if thisdevelops, the physician again needs to be notified. Theseside effects have occurred in a very small number ofpatients, and overall, the drug has a good safety profile.enbee_lycos: Why is it that a person can live for manyyears with no problems, and then suddenly develop IBSsymptoms?Dr. Burbige: Generally, in most individuals withgastrointestinal symptoms, it may date back toadolescence. It may be they are low-grade symptoms, butthen a sudden life event may exacerbate the symptoms.This can be something like retirement, which can bring onchanges in bowel habits. It may not be that the person wasasymptomatic, but may have had low grade symptoms,which become exacerbated. It's important that if a patienthas a sudden change in bowel habits, it may be somethingmore serious than IBS, and you should see your physicianfor further investigation.rosie2000_webmd: Can exercise help?Dr. Burbige: There are many alternative strategies to usewith symptoms, and exercise is one. The bowel is thoughtof as a muscle, and will improve with exercise. Exercisedoes a number of things, such as increasing endorphinlevels, and can decrease psychological stress, which canworsen IBS. In a general healthy lifestyle, exercise is animportant component.topgun99_webmd: Is there a way to know which doctorsin my area are particularly knowledgeable about IBS?Dr. Burbige: It's difficult to give direct information on yourarea, I generally recommend that you first see your primarycare physician, discuss the problem, and it will benecessary to get a feel for how well the physician seems tolisten to you, and to be knowledgeable of IBS. This is awidespread problem. In a recent survey, women reportedseeing an average of three physicians before a diagnosiswas made, and that took on an average of three yearsbefore a diagnosis was made. In that same series, 3% ofthe patients had to see eight or more physicians beforediagnosis was made. Therefore, I recommend seeing yourpersonal care physician, and see how he reacts and howknowledgeable he seems. In most cases your physiciancan handle the problem. If there is uneasiness, or a lack ofknowledge, then you should see a gastroenterologist. Isuggest that patients check with friends or relatives forreferral information. This is not an easy problem, becausethe same survey I alluded to also showed a wide variancein their knowledge of IBS. Generally, questions to thephysician to determine his knowledge of pathophysiologyshould be helpful. If the physician understandshypersensitivity in association with the psychologicaleffects, that's a good sign. If the doctor feels it's totallypsychosomatic, then it may be wise to seek other help.Moderator: We are almost out of time, Dr. Burbige. Doyou have any final comments for our members today?Dr. Burbige: I want to thank everyone for their questions,all of which were very good. I hope I've enlightened peopleabout this condition, and hopefully people who have notsought help, will seek help. My aim is to increaseawareness of IBS, that it is a serious disorder in somepeople in that it can affect people's sleep, employment,sexual functioning, leisure and travel, and can vary fromtrivial complaints to incapacitating complaints, with thelatter having a major impact on social and functional areas.The disorder is real, it can be diagnosed, and there istreatment that is effective. I would end by encouragingindividuals who think they may have this disorder to seekhelp.Moderator: We are out of time. Our thanks to our guest,Dr. Eugene Burbige of the Mount Diablo Medical Center.daisy_63_webmd: Thank You." http://my.webmd.com/content/article/1700.50850


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## kel1059 (Feb 28, 2003)

_Dr. Burbige: Going into diet in a little more depth, we need to consider an individual's intolerances. As I've said, there is no causal relationship between diet and IBS_ By Eugene Burbige, MD This event is sponsored by *Glaxo Wellcome* . sure there is. dairy and wheat are my death. i guess Glaxo Wellcome told this doctor what to say, and he is saying it.


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## overitnow (Nov 25, 2001)

I just want to say that I once had problems with lactose, fats, alcohol, caffine, spices (is there anything I have forgotten?) and I don't have problems with any of them any more. I had diarrhea multiple times through the day for 10 years. It hasn't been a problem for over 4 years,now. Isn't that what all of us are seeking?It has cost me 25$ Canadian a month to treat this.Have a nice day.Mark


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## california123 (Jun 8, 2003)

And I would just bet you sell this product, right. The research concludes, happily, that no supplement can beat fresh fruit, vegetables and moderate alcohol consumption for health benefits. http://www.aim-digest.com/gateway/pages/ge...es/pleasure.htm


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## Arnie W (Oct 22, 2003)

Eric,The problem with the triggers which you and kel have documented is that I always have the same symptoms, viz excessive gas and frequent BMs. I never have a day of relief, but fortunately never get discomfort which is so bad that I have to reach for pain relief. So the problem is that I can't pinpoint why I get IBS (or maybe it's leaky gut) or how to deal with it. The only thing I know for sure is that when I eat certain foods, I suffer even more so. Well, I'm going to eat whatever I like until Jan 2nd, then will eliminate all fructose, lactose, wheat and gluten, and if that doesn't help, will give up coffee too. Ideally I will last for at least 3 months. It is going to be difficult, but it does seem that being rigid with my diet, with no cheating at all, is vital.


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## SteveE (Jan 7, 1999)

All of the tiggers I've eliminated (mostly fructose, corn and caffeine) aren't doing me any good this morning. I think I've got stomach flu or something vs. the usual IBS. That's one of my biggest concerns about IBS...if you have a serious flare-up...how do you know it is an IBS flare-up or something that might need a doctor's attention?!Anyway, I'd considering trying to give-up coffee before wheat. Wheat is an important source of fiber--unless of course you are gluten intolerant, but there are tests for that. Caffeine is a known problem for true IBSers of both C and D types.I hope everyone feels better than I do this AM,Steve


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## Arnie W (Oct 22, 2003)

....no causal relation between diet and IBSSometimes I wonder if I l have IBS, and not just some food intolerance or allergy. I don't know for sure why my symptms came on, but I do know that in a life where every day has bowel problems, some days are far worse than others, and that's often because of the food I've consumed. I feel that getting the diet right for my condition will be the main way to get improvement.It's almost impossibe to fight a battle when you don't know what the condition is, how it originated and how to fight it


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## kel1059 (Feb 28, 2003)

> quote: Dr. Burbige: Going into diet in a little more depth, we need to consider an individual's intolerances. As I've said, there is no causal relationship between diet and IBS By Eugene Burbige, MD This event is *sponsored by Glaxo Wellcome * .


this is a very misleading statement. it can only be made if they have definite knowledge of what IBS is. But they don't have a clue. IBS is a collection of symptoms, and everyone has there own unique set of triggers and non-triggers.for all they know, some IBSers may have some type of 'off-the-radar' gluten intolerance that triggers any number of different symptoms. a million possibilities exist.But so long as Glaxo wellcome is calling the shots then the doctors must follow orders or the golf outings will be cancelled.Food elimination has given me and 1000's of others substantial symptom relief. Although in my case there appears to be something else going on. Viral?? part genetic?? mycobacterium?? compromised immune system due to shift to th2??heck --- severe food intolerances could have radically shifted my immune function to an allergic side which lessens its impact on microorganisms leading to a vicious cycle.


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## eric (Jul 8, 1999)

Kel, why don't you post the rest of what that sponsoring says perhaps for accuracy? Yes?Kel its because you do not try to understand the condition as a whole or take time to read the information, flat out the truth. You are also extremely negative to the science behind IBS and lack the knowledge on what they already know about IBS.Its also that you base IBS on your own personal symtoms and views and you don't even understand some basics of how the human body and digestion work to begin with right out of the gate.So far you have said you haveIBSMercury poisoning.An out of control immune systemfood intolerences, which you thought were about the immune system, but are not.food sensitivitesCFSFibroaltered gut bacteriacandidafungusleaky gutand I am sure there is many more I am missing.I do know you suffer from excessive worry and negativity which causes more anxiety, but yet you don't incorporate this into your own treatment or into the holistic medicine approach of the mind body and there interactions and reactions. with permission"Does diet affect IBS?Copyright ï¿½ 2003 by the *American College of Physicians.* Ask experts if diet affects irritable bowel syndrome (IBS) and you'll get a definite "maybe."Many IBS patients are afraid to eat certain foods for fear of triggering symptoms. But as Brian Lacy, MD, director of the Marvin M. Schuster Center for Digestive and Motility Disorders at Johns Hopkins Bayview Medical Center in Baltimore, Md., noted, "It's generally not what you eat *but the act of eating that cause the symptoms* ." Besides, he continued, there are no good studies showing that dietary changes do anything to improve IBS. Gastroenterologist Douglas A. Drossman, FACP, co-director of the University of North Carolina Center for Functional Gastrointestinal and Motility Disorders at Chapel Hill, however, said there is good evidence that eating too much of certain foodsï¿½those that contain caffeine or a lot of fat, for instance, or those that trigger gas productionï¿½can activate the bowel and worsen IBS symptoms. Patients with IBS are prone to excessive gut reactions to stressors, he pointed out, which can include dietary substances."Frequent small feedings, a low-fat diet and avoiding excess caffeine are rational and research-based recommendations," Dr. Drossman added.He also recommended that patients keep a dietary record to see if any particular foods are linked to IBS symptoms. If so, patients can try to avoid those foods. The problem is that many diet restrictions are impractical, noted George F. Longstreth, MD, chief of gastroenterology at Kaiser Permanente Medical Care Program in San Diego, Calif. And Dr. Lacy cautioned against creating "dietary cripples" by imposing excessive food taboosï¿½and perhaps boosting stress that can worsen IBS symptoms.Finally, while experts used to think a high-fiber diet could improve patients' diarrhea, pain and constipation, recent studies found that the strategy relieved only constipation. Researchers have also found that even that relief may come at a price: One study found that high-fiber diets increased symptoms of bloating in more than one-third of patients. http://www.acponline.org/journals/news/sep03/diet_ibs.htm Since I have suffered for thirty years of IBS I wonder what role foods play in IBS. So I asked Dr Douglas Drossman at the UNC Center for Functional GI and Motility disorders and here was his response. This is not a substitute for seeking medical advise from your doctor on any specific conditions you may have, but for educational purposes only. Dr. Drossman is a Co-director of the Center and Professor of Medicine and Psychiatry at UNC-CH. He established a program of research in functional gastrointestinal disorders at UNC more than 15 years ago and has published more than 250 books, articles, and abstracts relating to epidemiology, psychosocial and quality of life assessment, design of treatment trials, and outcomes research in gastrointestinal disorders. Dr Drossman's comments on foods for IBS Health.Shawn,To say that people with IBS may get symptoms from food intolerances is an acceptable possibility, since the gut will over react to stressors of all types including food (high fat or large volumes of food in particular). Futhermore, there can be specific intolerances. So if you have a lactose intolerance for example, it can exacerbate, or even mimic IBS. Other examples of food substances causing diarrhea would be high consumers of caffeine or alcohol which can stimulate intestinal secretion or with the latter, pull water into the bowel (osmotic diarrhea). The same would be true for overdoing certain poorly absorbed sugars that can cause an osmotic type of diarrhea Sorbitol, found in sugarless gum and sugar substituted foods can also produce such an osmotic diarrhea. Even more naturally, people who consume a large amount of fruits, juices or other processed foods enriched with fructose, can get diarrhea because it is not as easily absorbed by the bowel and goes to the colon where it pulls in water. So if you have IBS, all of these food items would make it worse. However, it is important to separate factors that worsen IBS (e.g., foods as above, stress, hormonal changes, etc.) from the cause or pathophysiology of IBS. Just like stress doesn't cause IBS, (though it can make it worse), foods must be understood as aggravating rather than etiological in nature. The cause of IBS is yet to be determined. However, modern research understands IBS as a disorder of increased reactivity of the bowel, visceral hypersensitivity and dysfunction of the brain-but axis. There are subgroups being defined as well, including post-infectious IBS which can lead to IBS symptoms. Other work using brain imaging shows that the pain regulation center of the brain (cingulate cortex) can be impaired, as well as good evidence for there being abnormalities in motility which can at least in part explain the diarrhea and constipation. So finding a specific "cause" of IBS has grown out of general interest in place of understanding physiological subgroups that may become amenable to more specific treatments. Hope that helps.Doug http://www.ibshealth.com/ibs_foods_2.htm People should be asking themselves why does the ACT of Eating cause symptoms?Also, not everyones Gut flora is the same even demographically. People in Florida don't have the same gut bacteria people in NY have or California have, because gut bacteria protect us from our own local environments and the pathogens we are around and exposed to locally.Nor are they all bad, many are support important to proper gut function and immune protection.Or that altered motility can cause imbalances in Gut flora, so what causes the altered motility?Or that killing indiscriminately the bacteria in your gut can cause some serious problems.Bacteria: More Than PathogensBy Trudy M. Wassenaar, Ph.D. Bacteria are usually associated with dirt, disease, and death. Misunderstood bacteria Bacteria suffer from negative public relations. You probably associate bacteria with the three D's: dirt, disease and death. And indeed, for centuries bacterial infections were the major cause of infant and child mortality worldwide. Child mortality began to decline after people were educated about better hygiene. The decline continued with the introduction of antibiotics for better treatment and vaccination for prevention of common deadly diseases.Bacteria are certainly involved in dirt, disease and death, to which we should add decay. Spoilage of leftover food, decomposition of garden cuttings, decay of dead bodies, or smelly water in a forgotten vase, are all the result of bacterial activity. As is body odor, caries, strep throat, or bubonic plague, to name a few diseases from both ends of the spectrum. No wonder that bacteria receive a bad press. Bacteria that caused large-scale disease in our history may be close to extinction. Commercials want us to believe that the only good bacterium is a dead bacterium. Antimicrobial agents are added to tooth paste, soaps, detergents, and plastics. There is no Society for the Protection of Bacteria, although there is a satirical initiative for the Ethical Treatment of Bacteria.1 Some bacteria may even hover on the edge of extinction, and it is no coincidence that these are pathogenic (disease-causing) bacteria such as Salmonella typhi (the cause of typhoid fever) or Yersinia pestis (the cause of plague). Fortunately for the little critters, populations survive in remote areas where they are not efficiently hunted with vaccines and antimicrobials, and people are still at risk for the diseases they cause in these places. The bacterial kingdom It is about time we take a closer look at the Bacterial Kingdom, with capitals. For a Kingdom it is, biologically speaking, and the ancient lineage, diversity, and evolutionary power of its inhabitants deserve royal treatment rather than disgust. A bacterium differs from a virus in its structure and in the way it inhabits a host. Before kindling fascination for the world of bacteria, a common misconception must be cleared: bacteria are not viruses. Whereas most bacteria live as independent cells with a membrane to separate them from the outside world, viruses can only multiply inside, and to the detriment of, the cells they infect. Interestingly, some viruses, called bacteriophages, have specialized to infect bacteria.2,3 Viruses consist only of genetic material (DNA or RNA) surrounded by a protein shell. They cannot metabolize and once inside a host cell, their genetic material hijacks the cell's machinery to produce replicas of the virus. Bacteria are much more similar to you and me. They exhibit the basic characteristics of all living things -- they breathe, metabolize, produce waste, and maintain a membrane potential. However, they do not have a nucleus in which their DNA is separated from the rest of the cell, as plants and animals do, and that is the major distinction between prokaryotes (a type of cell that most microorganisms are made of, including all bacteria) and eukaryotes (a different type of cell making up nucleated microorganisms, such as yeasts, or cells in an organism, e.g., human). Both viruses and bacteria can cause disease. However, not all types of viruses cause disease in humans, and not all bacteria cause disease. The majority of bacteria are harmless and some are beneficial. Another common misconception is that all bacteria are bad for you. Some bacteria you'd better not meet, but the majority of them are completely harmless, and some are highly beneficial to us. Confusingly, certain bacteria can be beneficial to some animals, and pathogenic to others. More commonly, pathogenic bacteria are harmful only to a limited number of hosts, or even only to one, whereas they live happily within other hosts without causing trouble. If the suffering host happens to be human, the culprit bacteria are called human pathogens; however, from the bacterial point of view, humans are just the wrong host to be in. So who is to blame for the disease? Harmless bacteria can become deadly in certain circumstances. Most bacteria are completely harmless Although a tree can kill a person when it falls, we usually don't regard trees as harmful. The same is true for most bacteria -- although they may cause problems under specific conditions, they usually live their lives without interfering with ours. An example is Pseudomonas aeruginosa, which commonly lives in soil without doing harm. However, if it is inhaled by a person with Cystic Fibrosis, it can colonize their lungs and cause lethal infections.4 The human body is not the natural environment for many bacteria. For many bacteria, the human body is not the right place to live in at all. They couldn't cope with the lack of oxygen (inside our cells the oxygen concentration is lower than that of air) or with the presence of oxygen (for bacteria that live in oxygen-deprived environments, oxygen is toxic). They couldn't withstand our defense mechanisms such as the salt present on our skin and in our tears, the lack of iron (a smart device keeps iron, a vital element to all living organisms, inaccessible to most microorganisms in our body), or with the toxic radicals that cells release when under attack of bacteria. It could be too warm for them, or too cold, as certain bacteria have specific temperature requirements to grow. Or they could be deprived of food, as the members of the Bacterial Kingdom have specialized to live on almost anything, but each species has specific nutrient needs. In conclusion, we have little to fear from most bacteria that we encounter. Our bodies can resist most bacterial attacks. It is no big surprise that we are relatively inert to bacteria. After all, mammals have evolved in the presence of bacteria, and have developed specialized strategies to keep bacteria under control. In contrast to what your mother taught you, soap is not essential to survive. Our body can resist the bombardment of bacteria it receives every day quite efficiently. Just as well that we can't see them (for the idea is unpleasant) but with every breath of air, every bite we take, little bugs are unknowingly entering our body. And this shouldn't worry you in the least. As long as you keep the troublemakers -- the real pathogens -- out. The human body is home to millions of beneficial bacteria. We couldn't live without bacteria We house millions of bacteria on our skin and in our nose, mouth, and gut:up to 500 species can be found as normal oral flora5 there can easily be 25 species living in a single mouth a milliliter of saliva can contain as many as 40 million (4 x 107) bacterial cells6 108 bacterial cells present in the cecum (the initial part of the colon) per milliliter of content is normal and many of these species are different from those found in the mouth7 Strictly speaking, the inside of our mouth, stomach and intestines are part of our outer surfaces. Although they are inside our body, their surfaces are in direct contact with the outside world, and as food particles pass the mucosal inner lining of our intestines, hitchhiking bacteria can stay there and multiply. We are born sterile (free of bacteria) but within hours we are colonized by our little friends, not to be left alone again. Antibiotics can wipe out our body's beneficial bacteria, causing unwanted health consequences. Without bacteria we would not survive. They help us digest our food, produce vitamins, and occupy niches that would otherwise be available for competing pathogens. This competitive effect becomes apparent when we wipe out a large proportion of our intestinal flora, for instance by an antibiotic that is prescribed to treat a bacterial infection. Diarrhea is frequently the unwanted result, as 'foreign' bacteria take their chance to occupy the 'empty' niches. Healthy bacteria take over in time, so that in most cases the side effects of antibiotics are soon gone. Bacterial populations grow into a state of equilibrium until some external factor disturbs it again. Certain foods and the way we process food depend on bacteria. We can buy supplements or foods with beneficial bacteria. Certain bacteria are good for you For centuries, people have eaten certain food deliberately for the bacteria it contains and have used bacteria in food preparation.The best-known example is the consumption of yogurt and other fermented milk products, which have the combined effect of reducing spoilage, and enhancing tolerance for partially lactose-intolerant individuals. A major industry has developed to produce bacterial preparations, in the form of powders, drinks, and dairy products; all sold as healthy and beneficial (and sometimes tasty) supplements. Although some of their promises are unrealistic (some products don't even contain viable bacteria), it is generally accepted that certain bacteria are beneficial, especially when intestinal flora is unbalanced (as with antibiotic-associated diarrhea). The most commonly used bacterial species as so-called probiotics are lactobacilli and bifidobacterium.8 A number of bacterial species are required for the preparation of food, and may or may not arrive on our plate alive.9 Notably, many cheese varieties are dependent on their characteristic bacterial starter culture. Fermenting bacteria are required to produce sausages and sauerkraut; they even help cacao and coffee beans to attain their desired flavor.10 Conclusion: Bacteria are essential to human health and the world's ecosystems. Earth: the planet of bacteria In a gram of soil, approximately 108 bacteria are present11 and these are estimated to represent over 10,000 species. Interestingly, there are more than 1030 bacteria on earth, compared with fewer than 1010 humans.12 Bacteria were the first living organisms found on Earth. They inhabit deserts, ice caps, oceans and hot springs. The number of bacterial species worldwide is estimated to be more than a thousand million.11 Their individual sizes may be insignificant, but their number and diversity is unimaginably large. Bacteria contribute substantially to the total biomass in marine environments.13 And, since oceans cover 70% of our planet's surface, bacteria make up a significant part of the total biomass on Earth. These facts are truly impressive for organisms so small that they are invisible to the eye. It is to our advantage to look at bacteria as more than just pathogens. ï¿½ 2002, BioScience Productions, Inc., an organization promoting bioscience literacy. Educators have permission to reprint articles for classroom use; other users, please contact editor for reprint permission. See reprint policy. About the author: Trudy Wassenaar, Ph.D., is a molecular biologist specializing in microbiology. She has done research at the University of Amsterdam and the University of Utrecht (The Netherlands), as well as at the University of Mainz (Germany), for over 15 years. In 2000, she founded a consulting company to assist research groups in academia and governmental agencies with the development of research strategies and dissemination of results. She is Curator of the Virtual Museum of Bacteria (supported by the Foundation for Bacteriology). http://www.bacteriamuseum.org/homepageTW.shtml


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## kel1059 (Feb 28, 2003)

eric,you just don't get it do you? my IBS never followed the rules of dr drossman. i can eat all the fat i want and not get symptoms. i can eat large quantities of beans and not get symptoms. i don't have the type of IBS that you have. now --what is so difficult about that?people are different. based on the extremely large number of typical and atypical allergies that i was tested for --- there is something wrong with my immune system. if i eat certain nuts i get very bad symptoms. the same with wheat, corn, dairy and dozens of other foods.MNL is correct in all his posts. you argue with him and you are wrong. I agree with susan thatif we listen to you --we not only waste a lot of money but we fail to get any improvement. (i have improved tremendously, but i still have a few nagging things to work out.)(by the way, your hypnosis may work for some people but it did not help me. however, i find the treatment to be rather fascinating and i think it could be a valuable assist to almost everyone here. ---but for people like me --it will not solve our problems.)


> quote: IBSMercury poisoning.An out of control immune systemfood intolerences, which you thought were about the immune system, but are not.food sensitivitesCFSFibroaltered gut bacteriacandidafungusleaky gut


i never said i had mercury poisoning. however, i fully realize the disaster that it is and i am extremely glad that i got rid of the lead and the mercury. why is lead so damaging to children's brains but not adults????tell me --oh great scientific thinker eric-- why is it not possible for the 3,000,000,000,000,000 mercury atoms that are released each day from fillings to not be taken up by our gut nerves thus causing dysfunction? *One amalgam filling releases 3,000,000,000,000,000 mercury atoms per day into the body. Mercury poses a serious threat to normal kidney function. Men and women chronically exposed to mercury are at risk for lowered immune function *


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## flux (Dec 13, 1998)

> quote:One amalgam filling releases 3,000,000,000,000,000 mercury atoms per day into the body. Mercury poses a serious threat to normal kidney function. Men and women chronically exposed to mercury are at risk for lowered immune function


Where did you read this?


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## drdahlman (Nov 6, 2000)

To jr71, Endoscopy has nothing to do with an attempt to find the bacterial levels of the large or small intestine. The bacteria the doctor said you were free of was probably Helicobacter Pylori, a common cause of stomach ulcers. You would need a stool sample to determine the bacterial levels, both good and bad, of the intestines or colon.


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## Jenny Snell (Sep 14, 2003)

I have suffered with IBS 'D' for a year now and have had stomach pains daily, awful indigestion and the constant urge to 'go'. I have had various hospital tests and was told I had IBS. I couldn't eat vegetables, fruit, brown bread or drink coffee. I started to take probiotic tablets in the summer and noticed the 'D' attacks were less severe.Having read Dr Dahlmans view on IBS, I went out and bought some Digestive Enzyme tablets and some Acidophilus tablets and within a few days the pain virtually disappeared and the indigestion stopped. The urgency to rush to the toilet has reduced considerably, so much so that I am now able to leave the house for longer periods! Because the urge to 'go' has reduced, I no longer feel so worried about having an 'accident' that I don't feel so anxious. The 'D' has reduced to almost normal bowel movements. I was also able to eat some vegetables recently without having 'D' afterwards. Long may this continue as I am beginning to feel human again!


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## drdahlman (Nov 6, 2000)

Jenny Snell, Thanks for your story, a few suggestions: Stay on your regime for 2-3 months. If you don't see a COMPLETE elimination of all your symptoms, try the additional food eliminations I suggest and if you don't see the reults you want from that, a stool sample test would be next. Make sure that you eliminate dairy also. That means no cream in your tea!


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## drdahlman (Nov 6, 2000)

Forgot to add that you might want to make sure your acidophilus also contains bifidus.


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## brushie (Jul 17, 2002)

from gret on page one:


> quote:The one thing that stopped me was how much he charges for his products! On another website you can get the EXACT same stuff - brand name and all - for a lot less. I wondered then if it was a scam. Most likely not, but it still soured me on the idea of calling him.


dr. dahlman, why didn`t you answer on this, and why is it? first cheaper shop i found: http://store.ediblenature.com/metagenics.html (there might be even cheaper ones?)


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## Jenny Snell (Sep 14, 2003)

Thank you Dr Dahlman for your advice. The tablets I am taking do contain bifidus. I do keep dairy to a very minimum, in particuar eggs which I try to avoid completely as they do seem to upset me.So far things are still going very well and I have had no 'D' attacks, no abdominal pain, no indigestion and no anxiety. I will post regularly with my progress with the hope that this will encourage others.


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## BackFire44 (Nov 19, 2003)

Where are the other posts? I know at least one person took Dr. Dahlman up on his offer. We were supposed to have weekly posts about how the person was doing on his regimen. Maybe just gone for the holidays?And to answer the question about cost -- the answer is that Dr. Dahlman is trying to make a living. I'm sure he wants to help people, but its also his profession. Do you go into your local grocery store and ask the manager why you can buy milk at a grocery store down the street for $0.50 less? Dr. Dahlman may actually be paying more for the products than the other places on the internet -- or, he may just feel that the market will pay more for the products. I don't think less of him for trying to make money - he never said he was not-for-profit. Same with all doctors, though.


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## eric (Jul 8, 1999)

FYI"Irritable Bowel Syndrome: Physiology and ManagementDisclosuresNicholas J. Talley, MD, PhD Introduction The field of irritable bowel syndrome (IBS) appears to be entering a new and exciting phase; evidence that at least some aspects of this disorder represent an organic or neurologic bowel disease has firmed, and novel management approaches are currently under investigation.At this year's Digestive Diseases Week meeting, data on current and emerging pharmacologic interventions and psychologic therapies were presented. This report reviews and discusses some of this novel and topical information.Postinfectious IBS One of the most exciting areas in terms of new research in IBS relates to the potential role of infection, inflammation, and its therapy within the setting of this syndrome. Composition of Colonic Inflammatory Infiltrate On routine histology, colonic biopsies appear normal in IBS. Studies by Gwee and colleagues,1 and Spiller and coworkers,2 among others, have shown that in at least a subset of IBS patients, there is a quantifiable, albeit modest, increase in colonic inflammatory cells. Hollerbach and associates3 prospectively evaluated 20 patients with IBS disease diagnosis based on Rome II criteria and 15 healthy controls. Following careful histologic evaluation with quantitative morphometry, the study authors observed that patients with IBS had significantly greater numbers of 1 plasma cells in the rectum and sigmoid colon; 2 goblet cells in the transverse, descending, and sigmoid colon as well as in the rectum; and 3 mast cells in the terminal ileum, cecum, and appendix. In contrast, the number of eosinophils was decreased in IBS patients compared with controls at all anatomic locations. Although these findings represented subtle differences, they appear to be real, and confirm that a residual inflammatory process is indeed present in some patients with classic IBS symptoms. Clinical Subtyping Dunlop and colleagues4 also evaluated 76 patients with IBS and 40 healthy controls, applying immunohistochemical staining for lamina propria and intraepithelial lymphocytes, enteroendocrine serotonin-containing cells, and mast cells. They subdivided their patients into 3 groups, those with: 1 postinfectious IBS; 2 constipation-predominant IBS; and, 3 nonconstipated, non-postinfectious IBS. These investigators found that cell counts in constipation-predominant IBS were not significantly different from that of controls. In contrast, patients with diarrhea, but without a postinfectious history, showed increased CD3 and lamina propria lymphocytes, in addition to mast cells, whereas patients with postinfectious IBS had increased enteroendocrine cells, CD3, and lamina propria lymphocytes. These findings suggest that subgrouping of IBS by bowel symptoms may identify distinct histomorphic phenotypes within IBS, which in turn suggests that treatment may need to be tailored to symptom subgroups.Mast Cells Park and colleagues5 applied electron microscopy and found that mast cell counts were significantly higher in the cecum among patients with IBS, and that the number of activated mast cells close to nerves was increased in IBS patients vs controls. Similarly, Barbara and coworkers6 employed immunofluorescence and found that tryptase-containing mast cells were increased 3-fold in IBS patients compared with controls. They also found evidence of mast cell degranulation. Therapeutic Intervention* In view of the increasing evidence of histologic abnormalities in IBS, and providing that this is indeed a true organic bowel disease, might intervention to reduce the inflammation have utility? If such intervention was able to prevent the development or progression of IBS, then this would be of major clinical importance. Prednisolone. Therefore, Dunlop and colleagues4 conducted the first randomized, double-blind, placebo-controlled trial of prednisolone in postinfectious IBS. Three or more months after their initial infection, 31 patients with postinfectious IBS received either oral prednisolone at a dose of 30 mg per day or placebo for a period of 3 weeks. They found that CD3 counts fell significantly and similarly, following both treatment with placebo and prednisolone. Enteroendocrine cells did not significantly change. Similarly, neither crypt nor surface intraepithelial lymphocytes nor mast cell counts decreased in either treatment group. There was no reduction in symptom scores with prednisolone therapy as was seen with placebo. Hence, prednisolone therapy, at least at the dose tested, was disappointingly ineffective. There may be a number of explanations for these results. First, it is possible that the mild inflammatory changes seen in IBS and the symptoms are not connected, just as Helicobacter pylori- induced gastritis is often entirely asymptomatic. Alternatively, in this study, the inflammatory cell changes were minimally influenced by prednisolone treatment, suggesting that more specific antiinflammatory therapy may need to be applied. Indeed, 3 months after infection may be too late for intervention; even earlier intervention trials may be needed. Cyclooxygenase (COX) inhibitors. An alternative, less toxic approach to intervention may involve the use of available COX inhibitors. Barbara and colleagues8 have previously shown that transient acute infection can result in intestinal muscle hypercontractility that is persistent, but which can be reversed, with COX-2 inhibitors. Akiho and coworkers9 showed in NIH Swiss mice infected with (or without) Trichinella spiralis that changes in muscle hypercontractility could be maintained by the presence of transforming growth factor-beta-1 in the muscularis externa, which induces COX-2 and promotes prostaglandin E2 production in the muscle cells. This finding suggests that COX-2 inhibition would warrant testing in postinfectious and postinflammatory IBS patients. Tryptase inhibitors and protease-activated receptor-2 antagonists may also have value in exploring postinfectious IBS because of the evidence for mast cell degranulation. This is clearly such a clinically important area of focus that much more research is required before an anti-inflammatory approach should be abandoned.Antibiotics and Probiotics in IBS*Antibiotic TherapyWhether antibiotics exacerbate or are protective in IBS is currently highly controversial, with conflicting evidence published in the literature.10,11 Pimentel and colleagues11 reviewed patients with symptoms of IBS presenting for breath testing because of the suspicion of small intestinal bacterial overgrowth. Broad-spectrum antibiotic therapy that reversed abnormal breath testing appeared to improve IBS symptoms in these patients. However, the study was not a randomized, placebo-controlled trial and could be difficult to interpret as it was potentially biased. Pimentel and colleagues12 have followed up their initial work with a new trial evaluating neomycin, a nonabsorbed antibiotic, in IBS. They randomized IBS patients to neomycin 500 mg (n = 49) or placebo (n = 52) twice daily for 10 days. At entry and 7 days after the completion of treatment, subjects returned for a lactulose breath test. Based on an intention-to-treat analysis and defining response as greater than 50% improvement in symptoms, the study authors found that neomycin led to a 39% improvement in IBS symptom scores compared with 12% on placebo. Bowel habit improved in 40% of patients treated with neomycin but in only 15% treated with placebo. Those patients who had an abnormal breath test were the ones who tended to improve. In a separate study, Pimentel and associates13 also showed that a 14-day elemental diet improved an abnormal lactulose breath test in 72% of patients, compared with just 21% of those treated with neomycin. Moayyedi and colleagues14 have provided some supporting evidence to indicate that antibiotics may be protective in IBS. They reanalyzed a trial of H pylori therapy conducted in symptomatic and asymptomatic patients from the community, aged 40-49 years. Defining IBS by Manning's criteria (ie, > 2 of 6 symptoms present), patients given antibiotic therapy (clarithromycin and tinidazole) for H pylori infection were significantly less likely to have a diagnosis of IBS at the end of 2-year follow up (6%) than those who received placebo (9%). However, the number of patients with IBS who initially entered the study and who still had IBS at 2 years was similar in both groups. Of course, this was a hypothesis-generating study, but the concept that antibiotics may protect some patients from IBS warrants more extensive scrutiny. Commentary Many questions remain regarding the role of antibiotics in IBS. Do antibiotics change the host intestinal flora and predispose to IBS in some cases, while protecting in others? If antibiotics do benefit patients with IBS, which groups will respond and why? Is therapy required long term, and in whom? Are there safety issues, particularly with broad-spectrum antibiotics, including concern regarding bacterial resistance? The concept and findings suggesting that antibiotics may be useful for treating patients with IBS will need to be replicated and further investigated before the approach can be recommended. Probiotic Strategies Probiotic bacteria compete with pathogenic bacteria and also have anti-inflammatory effects on gut mucosa. For this reason, there has been increasing interest regarding the potential role of probiotics in IBS. Lactobacillus plantarum has been shown to reduce flatulence and abdominal pain but not bloating in IBS.15 Quigley and colleagues16 studied 77 patients with IBS who were randomized to receive either Lactobacillus spp or Bifidobacterium spp, added to a milk drink, for 8 weeks; the control group received the milk drink alone. Subjects who received Bifidobacterium had a significant improvement in pain, bloating, and stools. However, any benefit of Lactobacillus was limited to improvement in pain at only the second and seventh weeks. Hence, probiotic strain specificity may be important in determining the outcome in IBS. Probiotics represent a promising, safe therapeutic class in this clinical setting. Motility-Modifying Drugs: Serotonin Agonists and Antagonists Tegaserod Tegaserod is a partial 5HT4 receptor agonist that is effective in constipation-predominant IBS, although the efficacy appears to be restricted to women, with an approximately 10% therapeutic gain over placebo.17 Schoenfeld and colleagues18 performed a meta-analysis of the published and unpublished randomized controlled trials involving tegaserod. They concluded that tegaserod is effective and safe at a dose of 6 mg twice daily. The number needed to treat NNT was 10, meaning that of 10 patients prescribed the medication, 1 will have a definite benefit, representing modest efficacy. But how is tegaserod working in this setting, as a prokinetic action alone would likely only explain an improvement in constipation? Wei and associates19 evaluated an isolated rat colorectal-inferior splanchnic nerve preparation to test the hypothesis that tegaserod modulates visceral pain signalling. They found that pretreatment with tegaserod inhibited high-threshold polymodal inferior splanchnic afferents induced by colonic distension. Studies to test the hypothesis that tegaserod is a visceral analgesic in humans are now awaited with interest. The 5HT3 Antagonists There is no longer any doubt that 5HT3 antagonists are useful in the treatment of diarrhea-predominant IBS.17 Alosetron (originally marketed at a dose of 1 mg twice daily) may have limited rerelease in the United States in 2002 for this indication, despite reports of the drug causing severe constipation and ischemic colitis.17 Cilansetron, another 5HT3 antagonist, also appears promising in diarrhea-predominant IBS. Caras and colleagues20 reanalyzed data from two 12-week double-blind, placebo-controlled randomized trials, in an attempt to demonstrate that cilansetron improved outcome in patients who, at baseline, appeared more likely to have resistant symptoms. Unfortunately, this subanalysis, although positive, remains very difficult to interpret because the randomization process is no longer operational, and thus bias may account for the results. Despite this issue, there is continued interest in 5HT3 antagonists, and especially in finding ways to improve their safety profile. One approach is based on pharmacogenetics, because receptor polymorphisms may theoretically affect therapeutic outcomes. Camilleri and colleagues21 investigated the potential relevance of polymorphisms of the serotonin transporter protein in patients with diarrhea-predominant IBS. They evaluated whether transit times were different in subgroups of patients with polymorphisms in the promoter region of the gene following a dose of alosetron administered at 1 mg twice daily for 6 weeks. The study authors found that there was a greater response to slowing of colonic transit after alosetron administration in patients with long allelic lengths (n = 8 patients) vs in those with long-short lengths (heterozygous, n = 11). Perhaps altering the dose of alosetron in patient subgroups based on transport protein status may help reduce side effects without any loss in efficacy. However, further work is required to confirm these results in larger and more representative IBS patient populations. Other Antidiarrheal Agents Loperamide improves diarrhea, but not pain, in patients with IBS.17 Clonidine* is a central alpha-2 adrenergic agonist that relaxes the left colon, reduces pain thresholds, and increases fluid absorption. The latter may therefore be useful for treatment of diarrhea, pain, and urgency in IBS.17 However, an overall problem with this drug class is postural hypotension associated with feelings of light-headedness and fatigue. Camilleri and colleagues22 conducted a phase 2 trial of 40 patients given clonidine at doses of 0.5 mg and 0.1 mg vs placebo over a 4-week treatment period. The primary goal was to determine the sample size needed to assess the efficacy of clonidine. Overall, 67% of patients responded to 0.1 mg of clonidine, as defined by adequate relief; stool frequency, consistency, and ease of passage also improved. This finding was not significant; 90 patients per treatment arm would have been required to show a 20% benefit over placebo. Unfortunately, side effects were frequent with clonidine. Hence, titrating the dose to ensure efficacy with minimal side effects remains the challenge with all of the alpha-2 adrenergic agonists. Anticonstipation Agents* RU-0211 The novel compound RU-0211 is a bicyclic fatty acid that acts as a chloride channel-opener, increasing intestinal water secretion. Cuppoletti and associates23 demonstrated that RU-0211 activated CIC-2 chloride channels in gastrointestinal epithelial cells in an in vitro model. Johanson and colleagues24 evaluated the efficacy of RU-0211 in patients with chronic functional constipation (n = 129) in a 3-week randomized, placebo-controlled study. They showed that there was a significant improvement in spontaneous bowel movements as well as an improvement in stool consistency and bloating. Although nausea increased among patients receiving the drug, it appeared to otherwise be well tolerated. It is unclear at this time whether this class of agents would be superior to standard laxatives; the latter would require head-to-head trials. Whether this drug relieves abdominal pain also remains unclear. Trials involving RU-0211 specifically in the setting of IBS are therefore required. Polyethylene glycol (PEG) PEG is an osmotic laxative that appears to be better tolerated than the standard osmotic laxatives. No trials have tested this agent in patients with IBS. Pashankar and associates25 reviewed the long-term use of PEG in children with constipation and/or encoparesis. They found that PEG was well tolerated and appeared to be effective in this patient population. A controlled trial in patients with IBS would therefore be of interest.CCK1 Central Receptor Antagonists Another potential drug class of value in constipation-predominant IBS are the CCK1 antagonists.17 Dexloxiglumide is being investigated in large clinical trials currently under way. Using a rat model, Bonnafous and coworkers26 showed that this drug reduced sensory thresholds in both the uninflamed and postinflammatory states, indicating that it may have visceral analgesic effects. The phase 3 trial results are awaited with interest. Opioid Antagonists Assuming opioid tone is increased in constipation-predominant IBS, opioid antagonists theoretically could reduce delays in intestinal transit and therefore relieve symptoms. Hawkes and colleagues27 evaluated the efficacy of naloxone, an opioid antagonist, in a randomized, double-blind, placebo-controlled 8-week pilot study of 28 (22 female) patients with constipation-predominant IBS. These investigators prescribed 10-mg enteric-release naloxone tablets twice daily or identical placebo. They found that 43% of patients in the naloxone group were responders compared with 25% in the placebo group, based on the end point of adequate relief. Quality of life also improved. Surprisingly, no change in stool form or frequency was observed, suggesting that any prokinetic effect was very modest. These promising results need replication in larger, controlled trials, but do suggest that this class of agents may represent a novel and safe approach for at least a subset of patients with IBS.Visceral Analgesics* Asimadoline Visceral analgesics are theoretically "attractive" agents for treatment of IBS because they should blunt abdominal pain regardless of the primary mechanisms underlying the syndrome. The kappa-opioid agonist fedotozine, however, was relatively disappointing in patients with IBS.17 Asimadoline is a new kappa-opioid receptor agonist that has shown efficacy in animal models. Delgado-Aros and colleagues28 evaluated healthy subjects who were randomly assigned to receive either asimadoline 0.15 or 0.5 mg twice daily or placebo. Asimadoline 0.5 mg decreased colonic tone in the fasting state, but did not alter colonic compliance or transit. This finding suggests that patients who have postprandial exacerbations of IBS may benefit from such an agent, but, of course, clinical trials will be required to test this hypothesis prospectively.Tachykinin Receptor Antagonists Another class of potential visceral analgesics are the tachykinin receptor antagonists.17 Gaultier and colleagues[29] showed that the NK2 and NK3 receptor antagonist SR 48968 and SR 142801, respectively, reduced rectal hyperalgesia induced by stress, as well as rectal allodynia induced by inflammation, in rat models. This class of agents can have a constipating effect, but at the dose used in these studies, the visceral analgesic change was induced without modifying colonic transit time. How this effect will translate into human studies is uncertain. Corticotrophin-Releasing Factor (CRF) AntagonistsYet another class of agents currently being explored for potential value in treating IBS are the CRF antagonists. In rats, a CRF1 antagonist was shown to prevent stress-induced visceral hyperalgesia and to reduce stress-induced increases in colonic transit.30 Chronic stress does appear to be relevant in IBS, but how effective CRF antagonists will be in this setting remains speculative. AntispasmodicsAlthough the efficacy of antispasmodics in IBS remains controversial, a recent meta-analysis by Poynard and colleagues31 that combined multiple small, often flawed controlled trials suggested that this class of agents is of benefit over placebo. Chalder and associates32 evaluated patients with IBS in primary care in the United Kingdom to determine whether it was possible to predict who would respond to an antispasmodic regimen. They evaluated mebeverine, a popular antispasmodic papaverine-like agent not available in the United States, and found that neither symptoms, duration of illness, nor demographic factors predicted response to treatment. Thus, the hypothesis that agents that induce smooth muscle relaxation will also help IBS pain is not particularly convincing based on the available evidence.Antidepressants and Psychologic Treatments for IBS* Antidepressants There is increasing interest in the value of antidepressants for IBS. The tricyclic antidepressants appear to be effective in this setting,33 but is this because they are central analgesics? Amitriptyline. Mertz and colleagues34 evaluated the effect of amitriptyline on brain activation during stress. They evaluated 10 women with IBS who were randomized to either a month of amitriptyline therapy at a dose of 25-50 mg or to matching placebo; after washout they were crossed over to the other treatment. Colorectal distension was performed during stress (babies crying) or no stress (relaxing music) condition. Amitriptyline significantly reduced activation of the limbic system that had been induced during stress. What we still lack are clinical predictors of who is most likely to respond to this drug class; large trials remain warranted.Selective serotonin reuptake inhibitors (SSRIs). The efficacy of the SSRIs in IBS remains uncertain despite positive anecdotal reports,33 as there are no published trials. Kuiken and colleagues35 reported on the results of an important randomized trial evaluating fluoxetine 20 mg daily or placebo for 6 weeks in 40 patients with IBS. Although abdominal pain scores decreased with fluoxetine, this effect was restricted to female sex. What's more disappointing, global symptom relief was similar on active treatment and placebo. Quality of life also did not improve with fluoxetine. The study authors also determined rectal sensitivity to distension with a barostat balloon at entry and after 6 weeks of treatment; rectal thresholds were not altered by placebo or active treatment. These findings are contrary to a small, albeit positive, crossover study reported by Broekaert and associates36 during last year's Digestive Disease Week meeting. It is notable that the number of patients included in the present trial by Kuiken and colleagues was relatively small, and it is conceivable, therefore, that the study "suffered" from a type 2 error (that is, it missed a real difference). Furthermore, it may be that only subgroups of patients with IBS respond to this treatment. For example, SSRIs tend to cause diarrhea, thus constipation-predominant IBS may be the optimal subgroup to target. Additional large studies are definitely well warranted with this class of agents. Psychologic Strategies The value of psychologic therapies for IBS is generally thought to be positive, although methodologic limitations have often inhibited interpretation of the clinical trials.37 Hypnotherapeutic options. Hypnotherapy has been shown in randomized studies to improve IBS symptoms.37 Simren and associates38 evaluated 26 patients with refractory IBS; 13 were randomized to receive gut-directed hypnotherapy and 13 to receive supportive therapy. Colonic sensory thresholds were evaluated before and after lipid infusion. The study authors found that there were higher colonic baseline tones present in the hypnotherapy group compared with the control group at 3 months. Phasic motor events were similar in both groups, but hypnotherapy appeared to reduce colonic hypersensitivity to lipid infusion. Presumably, hypnotherapy alters colonic function via central mechanisms, but this remains to be ascertained. Gonsalkorale and colleagues39 followed up with 239 patients who had undergone gut-directed hypnotherapy between 1 and 5 years previously. They found that 83% of patients reported that their symptoms had remained controlled since the end of hypnotherapy, and that only 17% had suffered some deterioration. Quality of life also remained improved, but these observations were uncontrolled. Therefore, gut-directed hypnotherapy should be considered an option for patients who have persistent symptoms despite standard therapy and who do not have significant psychologic comorbidity.Behavioral therapy. In another study, Darnley and colleagues40 compared the efficacy of cognitive behavioral therapy CBT with mebeverine in primary care patients with IBS. These investigators showed that CBT was superior at both 12 weeks posttreatment and at subsequent 3-month follow-up.Self-management. Heitkemper and associates41 evaluated women who were randomized to either (1) a self-management program (which comprised 8 standardized sessions with a masters-prepared nurse therapist covering the topics of stress management, relaxation, cognitive restructuring, and diet), (2) a 1-time brief self-management session, and (3) usual care. The full self-management program was superior to usual care, with reductions in pain, bloating, and constipation observed. It is interesting to note that women who received only the brief intervention program also significantly improved compared with usual care, implying that such a simple approach in physician practice may be applied effectively without the need for more costly intervention programs. The addition of standard CBT should be considered for IBS patients who fail to improve after usual treatment, although the cost benefit of this approach remains to be established. ConclusionsSeveral new and promising approaches for treatment of IBS are currently undergoing exploration. Additional work regarding anti-inflammatory strategies is warranted, despite disappointing results achieved with the prednisolone trial. Serotonin receptor agonists and antagonists appear to be efficacious in subgroups of IBS patients, but further work is needed to address how best to optimally target treatment in practice. Results of therapy with SSRIs appear disappointing, but it is too early to dismiss this class of agents. *It must be emphasized that a simple but comprehensive nonpharmacologic management program is most likely to succeed in practice in terms of achieving the best outcomes in IBS. * Drugs should generally remain second-line in IBS until agents with better efficacy and established safety profiles become available.*This section mentions off label uses for some medications. These may describe clinical uses for medications that have not been approved by the FDA. http://www.medscape.com/viewarticle/434526


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## eric (Jul 8, 1999)

FYI"Irritable Bowel Syndrome: From Epidemiology to TreatmentNicholas J. Talley, MD, PhD IntroductionThe management of irritable bowel syndrome (IBS) and other functional gastrointestinal disorders remains a significant challenge to the physician at the front lines of disease management. At this year's meeting of the American College of Gastroenterology, new information on the epidemiology, pathophysiology, and management of IBS and related conditions was presented.This report discusses some of the more key and interesting data presented during this meeting, and thus provides the relevant context for highlighting their implications on clinical practice.Epidemiology, Impact, and Practice VariationsSymptom ComplexesOne of the difficulties in managing patients with IBS remains the multitude of symptoms that many describe either spontaneously or on systems review. Sometimes this confounds management because such complaints may lead to extensive evaluations, even if the patient clearly has a positive clinical diagnosis of IBS and there are no alarm features present. However, the exact prevalence of the combinations of different functional gastrointestinal symptom complexes remains unclear.To examine the prevalence of gastrointestinal symptoms, Tutega and colleagues1 reviewed 1069 employees of an integrated healthcare system in Salt Lake City, Utah, 623 of whom responded to a validated questionnaire. They found a striking overlap between IBS and functional dyspepsia: 70% of individuals with IBS also had functional dyspepsia, whereas 43% of subjects with dyspepsia also had IBS. Moreover, more individuals with such overlap reported consulting a physician than those who had IBS or dyspepsia alone.In a community survey from Olmsted County, Minnesota, Locke and colleagues2 evaluated a similar number of subjects drawn from the general population. Six hundred fifty-seven of 935 eligible subjects responded to a validated questionnaire. These study authors found that symptom complex overlap was much more the rule than the exception in this community sample. This applied to IBS with constipation as well as IBS with diarrhea in terms of overlap with upper gastrointestinal tract symptoms. It is important to note that there was no predominant pattern of overlap identified consistent with a common underlying pathophysiology. Hence, artificial subdivision of these functional gastrointestinal complaints may not be particularly helpful in terms of management.These data arguably challenge the subdivision of the functional gastrointestinal disorders into finer and finer categories, which has been the tendency over the past decade.3Ethnic DifferencesAn area that has been understudied in IBS is the issue of ethnic differences in disease manifestation and presentation. Wigington and colleagues4 studied black and white patients with IBS and evaluated the symptomatic presentations. A similar prevalence of IBS was found among both blacks and whites. However, there were some unexplained sociodemographic differences between the groups. For example, blacks with IBS and diarrhea were significantly more likely to have lower incomes compared with white patients, who tended to have higher incomes. Age, sex, and education differences were not observed, however.Such differences may be explained by confounding. Alternatively, there may be different etiologic explanations for IBS in different races (eg, genetic) yet a common final pathway in terms of symptom expression. However, confirmation of racial differences in IBS in the United States, which to date has been largely ignored, is still required.Bowel PatternOne issue that remains controversial in IBS is subdivision into bowel pattern subgroups. In particular, what defines an alternating bowel pattern is unclear from the literature. Indeed, there is no definitive guidance from the Rome committees regarding this issue. Simply defining patients not fitting into an arbitrary diarrhea or constipation subgroup as an alternator may be overly simplistic and even misleading.In a study by Locke and coworkers,5 the investigators aimed to determine what individuals meant when they said that they had an alternating bowel pattern, as based on a large community survey. A valid questionnaire was mailed to 4029 randomly selected individuals in Olmsted County, of whom 3022 eligible subjects provided data. Overall, 7.6% of the population had a self-reported alternating bowel pattern, compared with 9.2% who stated that their usual bowel pattern was constipation and 2.5% who said that their usual bowel pattern was diarrhea. It was interesting to note that the feeling of incomplete rectal evacuation and passage of mucus were significant predictors of reporting an alternating bowel pattern in this general population. Of those individuals who reported an alternating bowel pattern, 59% met symptom criteria for constipation based on standard and accepted groupings of individual symptoms, whereas 35% met symptom criteria for diarrhea and 20% met criteria for both (25% met criteria for neither).These findings suggest that "alternators" may not comprise a distinct subgroup from constipation and diarrhea in this population. Further work is needed to define an appropriate, clinically relevant subclassification of IBS based on colonic symptoms. The latter could be very useful in terms of making management strategies more logical and evidence-based.Primary-Care vs Gastroenterology ClinicsThe approach to management of IBS in practice has been little evaluated. In particular, it is unclear how gastroenterologists and primary-care physicians treat IBS in the United States.Whitehead and colleagues6 studied 1665 patients diagnosed with a functional bowel disorder in both gastroenterology and primary-care clinics of a large health maintenance organization; some interesting differences in management were noted. Primary-care physicians more commonly prescribed laxatives than did gastroenterologists. About one quarter of patients in both settings were prescribed antidiarrheal agents and about one quarter were prescribed antispasmodics, but only 1 in 10 were given antidepressants and 1 in 10 prescribed anxiolytics or muscle relaxants. Approximately one third of patients had lifestyle changes suggested to them, or were advised to exercise -- and this approach was similar in both clinical practice settings. Gastroenterologists were more likely to tell their patients about the certainty of diagnosis than were primary-care physicians, although this presumably reflects standard practice in primary care. However, surprisingly, gastroenterologists were less likely to explain the cause of the symptoms than were primary-care physicians (40% vs 54%), which was significant.Other data suggest that explanation, reassurance, and education are all important in reducing subsequent visits to clinic for patients with IBS.7 Therefore, such differences in practice patterns may have real clinical relevance. Gastroenterologists and primary-care physicians achieved only modest patient satisfaction levels, which may be improved with the adoption of more appropriate management strategies.PathogenesisPostinfectious IBSThere continues to be major interest in postinfectious IBS. Marshall and colleagues8 investigated an outbreak of acute gastroenteritis (that was attributed to a viral pathogen) and the subsequent development of IBS. This study documented a large foodborne outbreak of severe acute gastroenteritis at a meeting of the Canadian Society of Gastroenterology Nurses and Associates. The attendees were subsequently surveyed and followed-up. The study authors obtained a 71% response rate; 107 respondents (77%) described an acute enteric illness during the outbreak. Among those subjects who had enteric illness, the incidence rate of IBS at 3 months was 24%, although by 6 months the rate had dropped to 14%, compared with 3% and 11% among controls, respectively.Hence, although there was an increased incidence of IBS among subjects at 3 months, by 6 months there was no difference in the rates. Vomiting appeared to be indicative of some protection from the development of postinfectious IBS, although this effect remains unexplained. These study results are consistent with other published data that suggest that postinfectious IBS is a distinct subgroup with more diarrhea and less psychiatric illness.9 It seems likely that infection can precipitate IBS in individuals who are otherwise predisposed. Whether subclinical infection could explain the increased incidence rates in the control patients as well is unclear. Unfortunately, at this time there is no way to prevent the development of IBS in individuals so exposed. A recent trial of high-dose prednisone failed to demonstrate any benefits in postinfectious IBS.10Relationship Between Menstrual Cycle and IBS SymptomsSome women with IBS report an exacerbation of symptoms across the menstrual cycle. Heitkamper and colleagues11 studied 195 women with IBS who reported that they often felt bloated and distended. The study authors used a daily diary as well as a standardized questionnaire to assess bloating and other gastrointestinal symptoms in menstruating women during perimenstrual and non-perimenstrual days. Bloating was associated with menses-type symptoms; they also noticed that bloating was worse on days with loose or hard stools. Could these findings reflect abnormal visceral pain perception in different phases of the menstrual cycle?Wrzos and associates12 evaluated 11 women, 5 of whom had IBS, and induced distention with a rectal barostat to experimentally cause visceral-type pain. They found that the thresholds for sensation were lower in patients with IBS than in healthy volunteers as would be expected, with no differences in somatic sensation. It was interesting to note that in the healthy volunteers -- but not in the patients with IBS -- there were lower pressure thresholds in the follicular vs luteal phase for each sensation level. The level of anxiety was not associated with the changes observed. Hormonal changes during the menstrual cycle may therefore affect "normal" individuals differently from those with IBS. Most likely, the threshold for pain sensation is set lower in IBS and is not modulated by hormonal changes during menses.Overall, these data suggest that menstrual cycle hormonal fluctuations in IBS are unlikely to be a major explanation for changes in symptoms. Although chemical castration of women with leuprolide has been proposed as a therapy for IBS, trials with this agent had methodologic limitations and thus, such an approach cannot be recommended.13Serotonin SignalingThere remains major interest in serotonin signaling in IBS. Moses and colleagues,14 in a follow-up of previous work, evaluated serotonin (5-hydroxytryptamine; 5-HT) content, serotonin release, and serotonin transporter levels in patients with IBS with either constipation or diarrhea, ulcerative colitis, and controls. They found that 5-HT content in colonic biopsies was reduced in patients with IBS as well as in patients with ulcerative colitis. There were actually increased enterochromaffin cells (which store serotonin) in individuals with IBS compared with controls. The presence of the 5-HT transporter was reduced in patients with IBS, but also was reduced in those with ulcerative colitis.These data suggest that in the setting of IBS, more 5-HT is released, but less can be removed because there is less transporter available. Unfortunately, these findings are not specific to IBS. Moreover, the results no longer seem to explain the differences between patients who present with IBS and constipation and those who present with IBS with diarrhea, contradicting earlier findings from the same group.15 It is possible, however, that in individuals with constipation there may be greater serotonin receptor desensitization than in those with diarrhea despite the greater availability of 5-HT, which could explain the clinical differences between IBS with constipation and IBS with diarrhea." http://www.medscape.com/viewarticle/463420


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## eric (Jul 8, 1999)

FYI"CausesResearchers remain unsure about the cause or causes of IBS. It is called a functional disorder because it is thought to result from changes in the activity of the major part of the large intestine (the colon). After food is digested by the stomach and small intestine, the undigested material passes in liquid form into the colon, which absorbs water and salts. This process may take several days. In a healthy person the colon is quiet during most of that period except after meals, when its muscles contract in a series of wavelike movements called peristalsis. Peristalsis helps absorption by bringing the undigested material into contact with the colon wall. It also pushes undigested material that has been converted into solid or semisolid feces toward the rectum, where it remains until defecation. In IBS, however, the normal rhythm and intensity of peristalsis is disrupted. Sometimes there is too little peristalsis, which can slow the passage of undigested material through the colon and cause constipation. Sometimes there is too much, which has the opposite effect and causes diarrhea. A Johns Hopkins University study found that healthy volunteers experienced 6-8 contractions of the colon each day, compared with up to 25 contractions a day for volunteers suffering from IBS with diarrhea, and an almost complete absence of contractions among constipated IBS volunteers. In addition to differences in the number of contractions, many of the IBS volunteers experienced powerful spasmodic contractions affecting a larger-than-normal area of the colon--"like having a Charlie horse in the gut," according to one of the investigators." http://www.healthatoz.com/healthatoz/Atoz/...l_syndrome.html


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## drdahlman (Nov 6, 2000)

In trying to run a clinic, obviously there are costs of doing business. I have choices as to how I charge for my services. I charge for consulting time and for products. I have purposely set the prices higher than many others for the products because of how much of my time I give away. It's important that patients who contact me get my full advice and if money is a problem, we can use fewer products or stretch them a little.I don't charge to answer e-mails and take all phone calls from any patient at any time in between their scheduled appointments without charging. You'd be surprised how much time it takes. I spend the whole day on the phone. Some doctors may charge less for products and more for their time. I know doctors who charge by the minute...they must think they're lawyers! Bottom line, everyone gets well and I must place a value on that.If someone wants to purchase the products somewhere else, I will still work with them, though I might be a bit stickier about the money back guarantee if we run into supply problems. If treatment is delayed because your other source is out of stock, that's a problem.I am for profit and the payments on the chateau in the south of France are astronomical!


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## drdahlman (Nov 6, 2000)

To BackFire44, It is the holiday season and I have begun with only 1 patient who has taken me up on my offer. I have had 2 or 3 inquires that I have responded to, but it will be after the holidays till I get started with them. The offer was made yet I'm surprised how few of you have responded. This brings me back to a previous post where I commented that there actually are very few of you guys that participate on this board. Same names time and time again. Once in a while a new one. So, I'll do my best to treat those that contact me, but please understand, my time is better spent contacting and helping those that contact my website than to try to change the minds of those that don't want to change their minds. I also won't police anyone to make sure they post their results with me. To everyone else: This is a really simple problem that all of you have, and I know how stupid that sounds to those who have suffered for a very long time. It's just a bacterial and chemistry imbalance, take care of that and couple it with the dietary suggestions I make in my article and all your symptoms go away. What more can I say? All of you have the opportunity to simply read my article and purchase the products I suggest from other sources. That takes me out of the profit loop, but my main goal of helping is still realized. Happy New Year everybody and it's the new year you can finally get back to normal if you'd just trust and quit relying on traditional medicine. They've already admitted they can't help this condition. Good luck.


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## ohnometo (Sep 20, 2001)

I dont have time to read through this long thread but I wanted to ask the Dr. if staying away from certain foods clears up the problem...(and that was the case for me) why take a supplement ? After working with LEAP and following their program to a T...I have got results beyond my wildest dreams with my IBS-D and my CVS...


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## drdahlman (Nov 6, 2000)

To Ohnometo, I agree to some degree, if dietary change clears it up...great! Here's the problem: In the early days of my practice dietary changes were the mainstay of the treatment. Some got well and some didin't. The protocol that is the entire program was developed in part because of that fact. Yes, some could get well with just the dietary issues, some only needed to spruce up their bacterial levels, some just needed digestive enzymes. Big problem occured: The amount of time taken to go through all the options one at a time caused many patients to lose their focus as more time went by and then to start missing appointments. That didn't help them at all.So, I put it all together in a planned, concise way that encompasses the entire spectrum of all that needs to be done for the patient.About 30% of my patients are found to have abnormal bacteria in them, simple dietary change wouldn't have helped them. Some never needed to do away with dairy, it was the fructose or gluten.Anyway, long story to say that whatever works is great, just be careful that if it comes back, you didn't do enough.LEAP is a great technique in the hands of the right person, but doesn't work for everyone.


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## ohnometo (Sep 20, 2001)

I agree you have to follow any program the way that is suggested or you are just wasting your time and money....Dr. are you a sufferer of IBS ? Why have you become so interested in IBS ? Just curious







I think it is great if your program works..


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## eric (Jul 8, 1999)

Donna, didn't you have part of your bowel removed? Why did the doctors do that?


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## ohnometo (Sep 20, 2001)

Hi EricThey did do surgery for a fast growing mass that showed up all of a sudden and they thought it was cancer but it wasn't...The symptoms was completly different then my IBS and CVS...The mass was picked up on a cat scan and I had a cat scan the previous year and it was not there at that time...My IBS and CVS was worse then the mass on my colon....Yep ! 18 inches of it gone







So see it is two totally differnt problems here







Eric You ALWAYS doubt what I have to say














and sit tight because there is so excellant news coming about about LEAP


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## eric (Jul 8, 1999)

Donna, it was just that you should mention this probably in the big picture, I was not doubting you that you had part of your colon removed or that you got better removing apple juice from your diet.I know all about Leap and what Mike no lo is trying to do.I also know Mike NO LO was the one who wrote the new leap and IBS information. LOLI really hope all IBSers work with their doctors and not over the phone without the doctor actually seeing the patient!!!For Patients Understanding IBS (Irritable bowel Syndrome): A Primer for Patients Chapter 4: How Can the Muscles and Nerves of the Gut Go Wrong in IBS?James Christensen, M.D. and Robert W. Summers, M.D.Peer Review Status: Internally Peer Reviewed--------------------------------------------------------------------------------The Things that Control Gut Contractions Hormones The Intrinsic Regulatory Properties of the Gut Muscle The Nerves The Consequences of Neuromuscular Disorders in the Gut --------------------------------------------------------------------------------Most people assume that IBS is a disorder of the muscular contractions of the gut. Since the operation of the muscle of the gut is strongly influenced by its nerves, most people also assume that the problem lies in the nerves. However, the nerves are not the whole story in gastrointestinal motility. Actually, three different sorts of control systems regulate the muscle of the gut: (1) hormones, (2) the regulatory processes that are built into the muscle itself and (3) nerves. The Things that Control Gut Contractions HormonesAt one time, scientists assumed that most of the regulation of gastrointestinal motility represents the action of hormones. This was true because certain hormones that the gut produces (secretin, cholecystokinin, and gastrin) were among the first hormones to be discovered. That observation led physiologists at first to neglect the study of the other two kinds of control systems, the nerves of the gut and the intrinsic properties of gut muscle itself. Certainly, hormones do affect the gut, even though they are not the whole story in explaining its complex operations. Several well-known endocrine conditions produce gastrointestinal symptoms. For example, hypothyroidism commonly causes constipation, and hyperthyroidism produces diarrhea. Also, the hormonal changes that take place in pregnancy affect the esophagus to cause heartburn and affect the large intestine to cause constipation. The whole gut is affected in such conditions although one part may produce more symptoms than other parts. Of course, when such endocrine causes of symptoms are suspected in a patient, the diagnosis is readily made by other tests, especially chemical tests to measure the presence of the hormones in the blood. The Intrinsic Regulatory Properties of the Gut Muscle Only recently, scientists have recognized that the muscle itself has a lot to do with the way it contracts. We now know that pacemakers in the gut wall, like the pacemakers in the heart, control the rhythm of its contractions. The pacemakers in the gut are collections of specialized muscle cells called the interstitial cells of Cajal. Pacemakers do not occur in all parts of the gut but only in those parts that beat or contract rhythmically. Thus there is no pacemaker in the esophagus, in the top part of the stomach, or in the gallbladder. There are pacemakers, though, in the bottom part of the stomach, in the small intestine, and in the large intestine. Everyone knows how easy it is to record the action of the pacemakers of the heart in patients. Scientists have a hard time to record the activity of the gut pacemakers in human beings. Still, we know a lot about them now from the study of these pacemakers in animals. We can say now that a major disturbance in the activity of the gut pacemakers can occur in patients because examples have been detected. However, the possibility that such disturbances might be common and that they might explain common symptoms is still not something that has been explored much. This is partly because the gut is so hard to get at and partly because so few medical centers have doctors who are trained in this area. Pacemaker problems in the gut may exist, but medical science is not looking for them very actively. The Nerves The properties and functions of the nerves of the gut were very poorly understood for a very long time, even though the existence of these nerves was discovered over a century ago. The situation was a little like that in the brain---the enteric nervous system seemed too complicated and too hard to get at so that theories were constructed about it that were based on incomplete information. For a long time, it was taught that the contractions of gut represent the balanced influence of one set of excitatory nerves and one set of inhibitory nerves. That idea probably still persists in many minds, but the situation is much more complicated than that. Many people tend to think that the nerves of the gut mainly control directly the muscles of the gut. However, nerves also influence directly the absorption and secretion by the epithelial layer. Both these kinds of nerves are called motor nerves. Other nerves carry impulses outward, away from the gut. These are called sensory nerves. Some sensory nerves influence the motor nerves in the wall of the gut as a part of the system of reflexes that makes the gut a self-regulated system. Others transmit painful sensation to the brain. In the past, when we had so few facts, it was possible to create ideas about disease that did not require factual evidence to support them. Thus, the idea of intestinal neurosis, nervous indigestion, the unhappy bowel, and so on seemed to offer an explanation for symptoms without actually saying anything about the way the enteric nervous system actually operates. Science still cannot explain how the enteric nervous system works, just as it cannot fully explain the operation of the brain. Because the different kinds of nerves in the wall of the gut are fundamentally alike throughout the tract, the different regions exhibit only quantitative differences from one another. This means that a defect in the way the enteric nervous system works is not likely to be confined to one part of the gut, although it may be more severe in one place than in another. Of course, where the muscle is entirely different, as in the upper pharynx and upper part of the esophagus, there are diseases that do not affect the other parts of the gut. This is because the kind of nerves that control the sort of muscle found there, striped or striated muscle, are completely different from the kind that control the smooth or plain muscle that makes up the rest of the gut. All nerves in the body are alike in certain fundamental properties. For that reason, the disturbance of a fundamental property of nerves is likely to be apparent in the gut as well as in the brain. In fact, some nervous disorders that are generally thought of as diseases of the central nervous system actually affect the gut as well, although many people are not aware of that. Thus, for example, Parkinson Disease often produces troubled swallowing and constipation. Diseases not thought of as nervous diseases at all, such as diabetes, also can produce serious trouble in the gut through changes that occur in the nerves throughout the whole body. Nerves differ from one another especially in the kind of chemicals they produce at the synapses where they control other cells. We can change the way a nervous system operates by changing the way nerves communicate with other cells. Nearly all drugs used to treat disorders of the nervous system are drugs designed to affect the chemical transmission that takes place at synapses. Since the same kinds of transmission take place in the brain as in the enteric nervous system, many drugs designed to alter the operation of the brain, such as sedatives and antidepressants, also change the way the nerves work in the enteric nervous system. Nerves also differ from one another in the way they are arranged. We usually assume that the patterns in these arrangements are stable, unchanging. There is a lot of evidence, however, to indicate that the connectivity can change, that patterns of connections mutate in response to new conditions. This property of nervous systems is called plasticity. We know that it occurs in the enteric nervous system, but we have no easy way to study it in human beings. A major part of the problem in gastroenterology is the difficulty of actually seeing the enteric nervous system. We can look with the microscope at pieces of tissue that have been removed at operations, of course, but we have rarely done so, and we almost never do so with the best available methods. We simply have not done enough with the microscope to say clearly what is normal and what is abnormal in diseases that are thought to represent disordered function of the enteric nervous system. Of course, we ought to be able to evaluate the nerves of the gut by looking at their functions, at how they are operating. This is not easy. We lack established or standard ways to do that in clinical practice, and many possibilities cannot even be tested for. For example, the importance of the reflex involved in stomach accommodation (or receptive relaxation) cannot be doubted. Its existence has been known for more than a century, and its importance in nutrition has been clear for that long. However, no standard method exists to test for it. The same can be said for virtually every reflex that is known to exist in the gut. A few scientific centers have worked on reliable and accurate tests for certain enteric nerve functions, but they remain largely undeveloped, certainly not well enough developed to be widely adopted. The Consequences of Neuromuscular Disorders in the Gut The gut is primarily a mechanical device designed by nature to move the liquids and solids consumed in eating. It must move the food materials in complicated ways so as to: promote the digestion that breaks down foods; provide the special flow patterns needed for the absorption of the substances released by digestion; remove the indigestible residue; adapt to the wide-ranging physical and chemical properties of the materials it receives; protect the gut from the damage that occurs when material in one part of the gut gets into another part where it does not belong. Since the motions of the gut reflect the operations of its nerves, any major nerve problem is likely to show up in the form of abnormal motions. Since the gut motions govern flow along the gut, disturbed motions must disturb flow. Motions may be too fast or too slow, or they may occur in abnormal patterns. Since the correct pattern of flow is necessary in each organ to accomplish normal digestion, absorption, and defecation, disturbed nerve function is almost certain to disturb digestion, absorption, and/or defecation. Motor nerves also affect directly the absorbing and secreting cells of the gastrointestinal epithelium, and sensory nerves act in reflexes to alter contraction, secretion and absorption and to transmit sensations to the brain. Thus, disorders of the nerves can disturb digestion, absorption and secretion in many ways. Disturbed digestion, absorption, and defecation usually cause signs, problems that are easily seen by everyone, like weight loss, or problems that are easily detected by doctors, such as changes in certain blood tests or an abnormal appearance of the gut when it is examined by x-ray. The symptoms produced from disturbed motility can include almost all the symptoms that can possibly come from the gut, including nausea and vomiting, trouble in swallowing, abdominal pain, constipation, diarrhea, and so on. But the disturbances can vary in degree, and so the symptoms and the physical consequences of neuromuscular disorders in the gut can also differ a great deal. Also, people differ a lot in how much they notice or worry about symptoms, especially such common ones as those that come from the gut. This makes it hard to know from symptoms alone exactly what is going on in the neuromuscular diseases of the gut, and to judge how bad the problem is. When so much can be proposed about neuromuscular disorders of the gut from basic laboratory investigations but so little can be proved by clinical observation, there is sure to be a lot of guessing and speculation about disorders of this biological system. This is certainly an important factor in contributing to the problem we have with IBS. The only answer possible to the question posed in the title of this chapter is the statement that many explanations could account for the syndrome. We don't have any yet that are proved to everyone's satisfaction. There are others waiting to be tested further. *All the ideas, however, must take into account the evidence from the science of neurogastroenterology. * http://www.vh.org/adult/patient/internalme...rome/chap4.html


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## ohnometo (Sep 20, 2001)

Eric







You are not being fair or honest for that matter. Believe you and me Mike isn't here wasting his time trying to argue with people that his way has helped MANY of sick people...You provide much useful information but your way isnt always the best way.....and there is no reason to explain the big mass on my colon in the whole picture here...that is totally different from my IBS...My IBS had been much better (2 years) before the mass showed up...If I was to have followed just your way I would have commited suicide by now because I couldnt have taken any more suffering...


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## drdahlman (Nov 6, 2000)

Donna, Certainly did have IBS after an antibiotic for the first time in 27 years. It was my struggle with fixing myself that fine tuned my program and gave me the confidence to offer a money back guarantee.I decided a couple of years before I graduated that I would open a clinic that focused on the gut no matter what the patient's complaint was. My belief was that if there 2 things you could do to affect a person's health the most, it was what goes in and how it's processed. We are not what we eat, we are what we absorb. IBS became such a major part of it because of the number of sufferers.


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## eric (Jul 8, 1999)

Donna, what exactly is just my way? Seeing and working with Doctors for an accurate diagnoses in regards to IBS or any other disease or comborbid health problem? Using many approaches towards IBS? Based on what they do already know about IBS? As far as your own health, wasn't it the doctors that found the mass in the first place through testing? What if you were treated over the phone without a physical and testing and an actual experienced doctor seeing you in person, who has the medical background in gastroenterology to test and treat you?


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## brushie (Jul 17, 2002)

> quote: Seeing and working with Doctors for an accurate diagnoses in regards to IBS or any other disease or comborbid health problem?


eric, i`ve been to appr. 6 Gi Docs till now. beside the usual tech. diagnoses(also capsule was done: slight inflammation alterimg towards the colon and strange movements according to my actual doc) they all made the same standard blood tests. nothing severe was found( now remember high ige,400, on high limit lymphozytes(viruses?),ige food allergies(leaky gut)?, and some more. reading for example the studie above makes me feel that here must be many more important bloodtests that could find known causes for our conditions, than practicising docs are using commonly.for example:


> quote:Of course, when such endocrine causes of symptoms are suspected in a patient, the diagnosis is readily made by other tests, especially chemical tests to measure the presence of the hormones in the blood.


gi hormones tests for example werent done for me. is it because they read the presence of them in other blood chemical`s levels? i have t4 and t3 levels on high limit, and my doc says its okay. i`m twentyfive and the limits are for all ages, are they? this for example makes me feel beeing ignored by most doc`s i`ve seen,mostly school medicines.all doc`s denied that there were more usefull blood tests, so i`m actually thinking about having some gsdl toxic and liver tests done, though my doc say`s they weren`t scientific. does someone know a list of blood,urine...tests that could discover any known reason for causing gut disorders? or where can such a list be found?please always excuse my spelling, i`m not very good in englishthanks!!


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