# Good article on stress ( Chronic and fight or flight)for kids but good for adults too



## eric (Jul 8, 1999)

This is interesting. They have clues in IBS that there is habitual over arousal in the fight or flight response in IBS.On here the symptoms for chronic stress which IBS can certainly cause conicide with a lot of peoples symptoms with IBS.This is a good easy article on it. http://kidshealth.org/teen/mind_matters/fe.../stress_p3.html I think its good to learn the different types and kinds of stress there are and how they effect IBS long term and short term. http://kidshealth.org/teen/mind_matters/fe.../stress_p3.html Seems we get both altered fight or flight and chronic stress, at least I know I did and never recognized it and its role in my symptoms, which was way bigger then I ever imagined.This is on IBS and stress and the fight or flight response.Stress and GI symptoms http://www.med.ucla.edu/ndp/Newsletters/Fall99Stress.htm Why men and women are different in their fight or flight response. http://www.med.ucla.edu/ndp/Newsletters/Summer01Gender.htm This is really good on this from a Dr. Mary HackerStudent Health Service Physician"What is Irritable Bowel Syndrome and how do I know ifI have it?Irritable Bowel Disease or IBS is an exaggerated form of thenormal digestive processes. Our digestive system--thestomach, small and large bowel, liver, and gall bladder--helps us to utilize the food we eat. With the kidneys, itcontrols fluid balance. Digestion, like breathing, is atwenty-four-hour-a-day process and our system mustrespond to all the little ï¿½insultsï¿½ we give it. Most of us understand terms like butterflies in the stomachand gut wrenching. These familiar sensations occur becausethe digestive system has both a muscular and a hormonalcomponent for moving fluids through the system. Whenthere is stress like the classic fight or flight response, thewhole digestive process speeds up leading to cramping andnausea. Vomiting and diarrhea may also occur. The fasterprocess during stress can be helpful at these times becausethe body can divert its energy to more urgent needs.However, too strong a response will produce difficulties likefluid imbalance and subsequent weakness. Not only do people with IBS have an exaggerated responseto emotional stress; they also have an exaggerated responseto normal digestion and may feel bloated and crampy evenwhen not stressed. If the bowel muscles are workinginefficiently there can be bloating behind the crampedportion of bowel causing pain. Further, if the digestive juicesare slowed in their transit, constipation occurs. If thedigestive process is speeded up, mucous can be passedalong with a semisolid bowel movement. Anotherexaggerated response is a rush to the bathroom right aftereating, which occurs because eating stimulates the entire gut.Since transit time of digestive juices varies between peopleand can be up to 48 hours, it is often difficult to know if arecently consumed food is causing a problem. Digestion ofbeans and other complex carbohydrates requiresgas-producing bacteria, leading to increased gas. Caffeine,alcohol, and dairy products can cause problems, too.It is best to seek a medical evaluation if you are havingdigestive upset. You should not assume it is IBS. Colitis,diverticulitis, malabsorbtion, and other conditions can allmimic aspects of IBS. Medications can be used to smooththe process of IBS and you can do your part by eating aregular diet containing plenty of fruits, vegetables, and wholegrain cereals. You should avoid excess caffeine and alcoholand exercise regularly -- these affect transit time. Reductionof excessive stress is also very helpful. Only those whohave lactose intolerance need avoid dairy products. Yourhealth care provider is a good resource for more informationon IBS treatment. For more information, visit the web site ofthe National Institute of Diabetes and Digestive Diseases at: http://www.niddk.nih.gov/ (Click on Health Information andEducation)."


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## eric (Jul 8, 1999)

Stress also makes pain worse.The influence of stress on pain; interactions of the mind/body and this may turn out to play a very immportant part in IBS."Stress is also accompanied by an increase in the secretions of the adrenal cortex due to raised levels ofadreno-cortoci-trophic hormone(ACTH). ACTH is secreted in the anterior part of the pituitary glandunder the stimulation of Corticotropin -Releasing hormone (CRH). This hormone is secreted in thehypothalamus in response to stress and conveyed to the anterior pituitary gland through a portalsystem. The hypothalamus is part of the so called "limbic" system of the brain which was a name usedto include the hippocampus, amygdyla, septum and the cingulate gyrus. These areas of the brain allseem related to mood and emotion. Here motivation for behaviour originates in response to emotionssuch as fear, rage and aggression. When the feelings are resolved there are replaced by relief orsatisfaction. Feelings have a biochemical basis. They are partly generated by the levels of endorphinsand many other neuropeptides which that make us feel satisfied and content. " http://www.eclipse.co.uk/moordent/painstr.htm


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## eric (Jul 8, 1999)

Stress also makes pain worse.The influence of stress on pain; interactions of the mind/body and this may turn out to play a very immportant part in IBS."Stress is also accompanied by an increase in the secretions of the adrenal cortex due to raised levels ofadreno-cortoci-trophic hormone(ACTH). ACTH is secreted in the anterior part of the pituitary glandunder the stimulation of Corticotropin -Releasing hormone (CRH). This hormone is secreted in thehypothalamus in response to stress and conveyed to the anterior pituitary gland through a portalsystem. The hypothalamus is part of the so called "limbic" system of the brain which was a name usedto include the hippocampus, amygdyla, septum and the cingulate gyrus. These areas of the brain allseem related to mood and emotion. Here motivation for behaviour originates in response to emotionssuch as fear, rage and aggression. When the feelings are resolved there are replaced by relief orsatisfaction. Feelings have a biochemical basis. They are partly generated by the levels of endorphinsand many other neuropeptides which that make us feel satisfied and content. " http://www.eclipse.co.uk/moordent/painstr.htm


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## eric (Jul 8, 1999)

This should go here just for the info.Am J Med 1999 Nov 8;107(5A):12S-19S Emerging disease model for functional gastrointestinal disorders. Mayer EA. Division of Digestive Diseases, University of California Los Angeles School of Medicine, USA.This is interesting" Endogenous serotonin, peripherally released in response to stress, seems to be involved in stress- and central CRF-induced stimulation of colonic motility by acting on 5HT-3 receptors."Dig Dis 2001;19(3):201-11 Related Articles, Books, LinkOut Role of stress in functional gastrointestinal disorders. Evidence for stress-induced alterations in gastrointestinal motility and sensitivity. Monnikes H, Tebbe JJ, Hildebrandt M, Arck P, Osmanoglou E, Rose M, Klapp B, Wiedenmann B, Heymann-Monnikes I. Department of Medicine, Division of Hepatology and Gastroenterology, Universitatsklinikum Charite, Campus Virchow-Klinikum,  Humboldt-Universitat zu Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany. Psychological stress is widely believed to play a major role in functional gastrointestinal (GI) disorders, especially irritable bowel syndrome (IBS), by precipitating exacerbation of symptoms. The available data clearly demonstrate that inhibition of gastric emptying and stimulation of colonic transit is the most consistent pattern in the motility response of the GI tract to acute or short-term stress. Thus, one might propose that these alterations might play a pathophysiological role in dyspeptic symptoms and alterations in stool frequency and consistency in patients with stress-related functional GI disorders. Taken together, the above-mentioned studies suggest that the colonic motor response to stress is exaggerated in IBS. There is evidence that an increased emotional response is associated with this difference in colonic, and perhaps also gastric motor responses to certain stressors. However, almost no valid data are available so far from human studies addressing the question if differences in motility responses to stress between patients with functional GI disorders and healthy subjects are due to an altered stress response associated with an imbalance of the autonomic nervous system or increased stress susceptibility. We can summarize that in experimental animals the most consistent pattern of GI motor alterations induced by various psychological and physical stressors is that of delaying gastric emptying and accelerating colonic transit. Endogenous corticotropin-releasing factor (CRF) in the brain plays a significant role in the central nervous system mediation of stress-induced inhibition of upper GI and stimulation of lower GI motor function through activation of brain CRF receptors. The inhibition of gastric emptying by CRF may be mediated by interaction with the CRF-2 receptor, while CRF-1 receptors are involved in the colonic and anxiogenic responses to stress. Endogenous serotonin, peripherally released in response to stress, seems to be involved in stress- and central CRF-induced stimulation of colonic motility by acting on 5HT-3 receptors. Taken together, the limited data available from investigations in healthy subjects and patients with functional GI disorders provide some evidence that stress affects visceral sensitivity in humans. Acute psychological stress seems to facilitate increased sensitivity to experimental visceral stimuli, if the stressor induces a significant emotional change. In summary, studies in experimental animals suggest that stress-induced visceral hypersensitivity is centrally mediated by endogenous CRF and involvement of structures of the emotional motor system, e.g. the amygdala. Stress-induced activation or sensitization of mucosal mast cells in the GI tract seem to be involved in stress-associated alterations of visceral sensitivity. Copyright 2001 S. Karger AG, Basel Publication Types: Review Review, Tutorial PMID: 11752838 [PubMed - indexed for MEDLINE] In response to perceived or experienced change that is considered threatening to the individual, the central nervous system mounts a stereotypic response that decreases the sensitivity to pain, modulates the autonomic nervous system outflow, and activates the hypothalamic-pituitary-adrenal (HPA) axis. This response of the "emotional motor system" may or may not be associated with the conscious experience of feelings of fear or anxiety. Alterations in these response systems (either up- or downregulation) may produce symptoms, such as viscero-somatic hypersensitivity, altered bowel habits, or increased anxiety. Publication Types: Review Review, Tutorial PMID: 10588168 [PubMed - indexed for MEDLINE] 1: Eur J Surg Suppl 1998;(583):29-31 Related Articles, Books, LinkOut Intestinal and extraintestinal symptoms in functional gastrointestinal disorders. Mayer EA, Fass R, Fullerton S. UCLA/CURE Neuroenteric Disease Program, UCLA School of Medicine, Los Angeles, CA 90073, USA. emayer###ucla.edu Functional gastrointestinal disorders such as irritable bowel syndrome or functional dyspepsia have traditionally been regarded as syndromes limited to the digestive system. However, both clinical experience and published evidence show that patients with such disorders also report a series of other symptoms of physical distress, such as fibromyalgia and irritable bladder and alterations in vital functions, such as sleep, libido, appetite and energy level. Some of these extraintestinal symptoms can be explained in the context of an evolving comprehensive disease model which views functional gastrointestinal disorders as manifestations of alterations in the interactions between the nervous system, the viscera and the musculoskeletal system. Alterations in central circuits concerned with arousal, attention and fear, cognitions about bodily symptoms and possible alterations in the hypothalamic pituitary adrenal (HPA) axis may all contribute to the wide range of symptoms reported by affected patients. PMID: 10027669 [PubMed - indexed for MEDLINE]


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## eric (Jul 8, 1999)

This should go here just for the info.Am J Med 1999 Nov 8;107(5A):12S-19S Emerging disease model for functional gastrointestinal disorders. Mayer EA. Division of Digestive Diseases, University of California Los Angeles School of Medicine, USA.This is interesting" Endogenous serotonin, peripherally released in response to stress, seems to be involved in stress- and central CRF-induced stimulation of colonic motility by acting on 5HT-3 receptors."Dig Dis 2001;19(3):201-11 Related Articles, Books, LinkOut Role of stress in functional gastrointestinal disorders. Evidence for stress-induced alterations in gastrointestinal motility and sensitivity. Monnikes H, Tebbe JJ, Hildebrandt M, Arck P, Osmanoglou E, Rose M, Klapp B, Wiedenmann B, Heymann-Monnikes I. Department of Medicine, Division of Hepatology and Gastroenterology, Universitatsklinikum Charite, Campus Virchow-Klinikum, Humboldt-Universitat zu Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany. Psychological stress is widely believed to play a major role in functional gastrointestinal (GI) disorders, especially irritable bowel syndrome (IBS), by precipitating exacerbation of symptoms. The available data clearly demonstrate that inhibition of gastric emptying and stimulation of colonic transit is the most consistent pattern in the motility response of the GI tract to acute or short-term stress. Thus, one might propose that these alterations might play a pathophysiological role in dyspeptic symptoms and alterations in stool frequency and consistency in patients with stress-related functional GI disorders. Taken together, the above-mentioned studies suggest that the colonic motor response to stress is exaggerated in IBS. There is evidence that an increased emotional response is associated with this difference in colonic, and perhaps also gastric motor responses to certain stressors. However, almost no valid data are available so far from human studies addressing the question if differences in motility responses to stress between patients with functional GI disorders and healthy subjects are due to an altered stress response associated with an imbalance of the autonomic nervous system or increased stress susceptibility. We can summarize that in experimental animals the most consistent pattern of GI motor alterations induced by various psychological and physical stressors is that of delaying gastric emptying and accelerating colonic transit. Endogenous corticotropin-releasing factor (CRF) in the brain plays a significant role in the central nervous system mediation of stress-induced inhibition of upper GI and stimulation of lower GI motor function through activation of brain CRF receptors. The inhibition of gastric emptying by CRF may be mediated by interaction with the CRF-2 receptor, while CRF-1 receptors are involved in the colonic and anxiogenic responses to stress. Endogenous serotonin, peripherally released in response to stress, seems to be involved in stress- and central CRF-induced stimulation of colonic motility by acting on 5HT-3 receptors. Taken together, the limited data available from investigations in healthy subjects and patients with functional GI disorders provide some evidence that stress affects visceral sensitivity in humans. Acute psychological stress seems to facilitate increased sensitivity to experimental visceral stimuli, if the stressor induces a significant emotional change. In summary, studies in experimental animals suggest that stress-induced visceral hypersensitivity is centrally mediated by endogenous CRF and involvement of structures of the emotional motor system, e.g. the amygdala. Stress-induced activation or sensitization of mucosal mast cells in the GI tract seem to be involved in stress-associated alterations of visceral sensitivity. Copyright 2001 S. Karger AG, Basel Publication Types: Review Review, Tutorial PMID: 11752838 [PubMed - indexed for MEDLINE] In response to perceived or experienced change that is considered threatening to the individual, the central nervous system mounts a stereotypic response that decreases the sensitivity to pain, modulates the autonomic nervous system outflow, and activates the hypothalamic-pituitary-adrenal (HPA) axis. This response of the "emotional motor system" may or may not be associated with the conscious experience of feelings of fear or anxiety. Alterations in these response systems (either up- or downregulation) may produce symptoms, such as viscero-somatic hypersensitivity, altered bowel habits, or increased anxiety. Publication Types: Review Review, Tutorial PMID: 10588168 [PubMed - indexed for MEDLINE] 1: Eur J Surg Suppl 1998;(583):29-31 Related Articles, Books, LinkOut Intestinal and extraintestinal symptoms in functional gastrointestinal disorders. Mayer EA, Fass R, Fullerton S. UCLA/CURE Neuroenteric Disease Program, UCLA School of Medicine, Los Angeles, CA 90073, USA. emayer###ucla.edu Functional gastrointestinal disorders such as irritable bowel syndrome or functional dyspepsia have traditionally been regarded as syndromes limited to the digestive system. However, both clinical experience and published evidence show that patients with such disorders also report a series of other symptoms of physical distress, such as fibromyalgia and irritable bladder and alterations in vital functions, such as sleep, libido, appetite and energy level. Some of these extraintestinal symptoms can be explained in the context of an evolving comprehensive disease model which views functional gastrointestinal disorders as manifestations of alterations in the interactions between the nervous system, the viscera and the musculoskeletal system. Alterations in central circuits concerned with arousal, attention and fear, cognitions about bodily symptoms and possible alterations in the hypothalamic pituitary adrenal (HPA) axis may all contribute to the wide range of symptoms reported by affected patients. PMID: 10027669 [PubMed - indexed for MEDLINE]


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## eric (Jul 8, 1999)

Anyone read this post and understand what is going on here?


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## eric (Jul 8, 1999)

Anyone read this post and understand what is going on here?


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## eric (Jul 8, 1999)

They are also studying if this may also be in part why substances can effect the immune system also.


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## eric (Jul 8, 1999)

They are also studying if this may also be in part why substances can effect the immune system also.


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## eric (Jul 8, 1999)

This is some more on this.Gut Feelings: The Surprising Link Between Mood and Digestion "The stress alarm Whatever messages may be passing back and forth, they can easily become garbled in times of stress. When the brain senses a threat, real or imagined, it sounds the alarm by flooding the body with adrenaline and another hormone called CRF (short for corticotropin-releasing factor). These hormones trigger the "fight or flight" response -- helpful back in the days when humans had to run from lions, but a potential liability when we lose a job or go through a divorce. If you suffer from frequent emotional distress -- perhaps because of extreme stress, depression, or anxiety -- the unrelenting flood of adrenaline and CRF will take a toll on your digestive system. For one thing, the hormones can make the cells in the stomach and intestines extra-sensitive to pain. As a result, normal contractions and movements can become excruciating. The new signals can also disrupt the motion of the intestines, causing bouts of constipation or diarrhea." http://www.ahealthyme.com/article/primer/101186767 Emotions and the Immune System (slightly dated but pretty good.) http://www.attitudefactor.com/immune.htm


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## eric (Jul 8, 1999)

This is some more on this.Gut Feelings: The Surprising Link Between Mood and Digestion "The stress alarm Whatever messages may be passing back and forth, they can easily become garbled in times of stress. When the brain senses a threat, real or imagined, it sounds the alarm by flooding the body with adrenaline and another hormone called CRF (short for corticotropin-releasing factor). These hormones trigger the "fight or flight" response -- helpful back in the days when humans had to run from lions, but a potential liability when we lose a job or go through a divorce. If you suffer from frequent emotional distress -- perhaps because of extreme stress, depression, or anxiety -- the unrelenting flood of adrenaline and CRF will take a toll on your digestive system. For one thing, the hormones can make the cells in the stomach and intestines extra-sensitive to pain. As a result, normal contractions and movements can become excruciating. The new signals can also disrupt the motion of the intestines, causing bouts of constipation or diarrhea." http://www.ahealthyme.com/article/primer/101186767 Emotions and the Immune System (slightly dated but pretty good.) http://www.attitudefactor.com/immune.htm


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## LML (Jul 17, 2001)

<Anyone read this post and understand what is going on here? >Eric, this is VERY interesting stuff. While I'm not sure I understand all that's going on here, alot of this information (and it's a big read!) rings so true in my case since I believe my IBS is definately stress triggered. And some of these articles suggest that chemical changes in the nureological system can cause other real problems outside th GI tract. This is also happening to me. Not particularly good news, but at least understanding what's going on is some kind of comfort. Thanks for all the good info and links.Linda


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## LML (Jul 17, 2001)

<Anyone read this post and understand what is going on here? >Eric, this is VERY interesting stuff. While I'm not sure I understand all that's going on here, alot of this information (and it's a big read!) rings so true in my case since I believe my IBS is definately stress triggered. And some of these articles suggest that chemical changes in the nureological system can cause other real problems outside th GI tract. This is also happening to me. Not particularly good news, but at least understanding what's going on is some kind of comfort. Thanks for all the good info and links.Linda


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## eric (Jul 8, 1999)

LmL, pretty interesting stuff and the word stress here is in a way misleading as were talking right down to emotions and the core of us all. As you can see from the last thing I posted it says "EXCITEMENT" an important word in this.This also seems to be more in c and der's and der's then in c people from what I can tell so far.They are working on new drugs for this as well. Also, in my searches on this aspect it is being tied into fibro, cfs, and quite a few other conditions and diseases."The Nervous System and IBS In addition to altered gut and sleep perception, other investigators have suggested that IBS patients may have altered perception of all involuntary body functions. Investigators have been examining more closely the role of the central nervous system (which controls voluntary and involuntary activity) and the role of the autonomic nervous system (which controls involuntary body functions such as breathing and heart rate) in sensation perception in IBS patients. The central nervous system consists of the brain and the spinal cord, whereas the autonomic nervous system consists of a network of nerves that connects to the central nervous system. In the autonomic nervous system, "sympathetic" nerves tend to increase firing during times of EXCITEMENT (e.g., fight or flight response) whereas "parasympathetic" nerves tend to counter this effect." http://www.aboutibs.org/Publications/research.html Glad your finding it interesting I will keep looking for more on this.One thing also to remember here is serotonin is still being dysregulated right at the begining as the bowel expands and chemicals compete to enter the brain. Serotonin is still very important in all this also.


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## eric (Jul 8, 1999)

LmL, pretty interesting stuff and the word stress here is in a way misleading as were talking right down to emotions and the core of us all. As you can see from the last thing I posted it says "EXCITEMENT" an important word in this.This also seems to be more in c and der's and der's then in c people from what I can tell so far.They are working on new drugs for this as well. Also, in my searches on this aspect it is being tied into fibro, cfs, and quite a few other conditions and diseases."The Nervous System and IBS In addition to altered gut and sleep perception, other investigators have suggested that IBS patients may have altered perception of all involuntary body functions. Investigators have been examining more closely the role of the central nervous system (which controls voluntary and involuntary activity) and the role of the autonomic nervous system (which controls involuntary body functions such as breathing and heart rate) in sensation perception in IBS patients. The central nervous system consists of the brain and the spinal cord, whereas the autonomic nervous system consists of a network of nerves that connects to the central nervous system. In the autonomic nervous system, "sympathetic" nerves tend to increase firing during times of EXCITEMENT (e.g., fight or flight response) whereas "parasympathetic" nerves tend to counter this effect." http://www.aboutibs.org/Publications/research.html Glad your finding it interesting I will keep looking for more on this.One thing also to remember here is serotonin is still being dysregulated right at the begining as the bowel expands and chemicals compete to enter the brain. Serotonin is still very important in all this also.


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## eric (Jul 8, 1999)

This was written for the IFFGD on all this from a prominent top IBS doctor and researcher.I believe it will help to understand this some more and how it applies to IBS.From the Winter 2001 issue of ParticipateThe Neurobiology of Stress and EmotionsBy: Emeran A. Mayer, M.D., UCLA Mind Body Collaborative Research Center, UCLA School of Medicine, California http://www.aboutibs.org/Publications/stress.html


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## eric (Jul 8, 1999)

This was written for the IFFGD on all this from a prominent top IBS doctor and researcher.I believe it will help to understand this some more and how it applies to IBS.From the Winter 2001 issue of ParticipateThe Neurobiology of Stress and EmotionsBy: Emeran A. Mayer, M.D., UCLA Mind Body Collaborative Research Center, UCLA School of Medicine, California http://www.aboutibs.org/Publications/stress.html


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## bonniei (Jan 25, 2001)




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## bonniei (Jan 25, 2001)




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## bonniei (Jan 25, 2001)

In case the cartoon requires explanation, those are all symptoms of stress. Thought it was appropriate for a thread on stress. Check your e-mail, eric


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## bonniei (Jan 25, 2001)

In case the cartoon requires explanation, those are all symptoms of stress. Thought it was appropriate for a thread on stress. Check your e-mail, eric


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## eric (Jul 8, 1999)

The thing here is you may also not be conciously aware of how feelings effect your IBS like this.A lot of people with IBS carry around this chronic stress and get use to it and don't realize it exists or how they may be able to treat it.I believe this is very important for a lot of reasons.Thanks for the picture Bonnie, I think it is from a Portland artist.


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## eric (Jul 8, 1999)

The thing here is you may also not be conciously aware of how feelings effect your IBS like this.A lot of people with IBS carry around this chronic stress and get use to it and don't realize it exists or how they may be able to treat it.I believe this is very important for a lot of reasons.Thanks for the picture Bonnie, I think it is from a Portland artist.


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## partypooper (Mar 22, 2000)

Hi, Eric - I also thought thse articles were very interesting, particularly the one that discussed post-infectious IBS since this is what I have.I also fit the description perfectly of the individual who develops post-infectious IBS. I got married, quit my job, and moved cross country all within 3 months of the onset of my initial illness through food poisoning. Did they follow these post-infectious IBSers any further? I was curious to see if their symptoms eventually improved over time.


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## partypooper (Mar 22, 2000)

Hi, Eric - I also thought thse articles were very interesting, particularly the one that discussed post-infectious IBS since this is what I have.I also fit the description perfectly of the individual who develops post-infectious IBS. I got married, quit my job, and moved cross country all within 3 months of the onset of my initial illness through food poisoning. Did they follow these post-infectious IBSers any further? I was curious to see if their symptoms eventually improved over time.


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## LML (Jul 17, 2001)

This stress thing ... it's important to remember that stress is not just the bad stuff, as Ereic pointed out. If you look at all the events that transpire in a life, you might rate them on a scale of 1 to 10, with 10 being the highest. For example, a death of a loved one, a marriage proposal, a new job, a move across country, a promotion or beginning college can all be pretty high on the stress level. I think learning how to deal with the effects on the gut of stress can bea big help in dealing with IBS.Keep more of these articles coming as you come across them, Eric!Linda


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## LML (Jul 17, 2001)

This stress thing ... it's important to remember that stress is not just the bad stuff, as Ereic pointed out. If you look at all the events that transpire in a life, you might rate them on a scale of 1 to 10, with 10 being the highest. For example, a death of a loved one, a marriage proposal, a new job, a move across country, a promotion or beginning college can all be pretty high on the stress level. I think learning how to deal with the effects on the gut of stress can bea big help in dealing with IBS.Keep more of these articles coming as you come across them, Eric!Linda


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## eric (Jul 8, 1999)

partypooper, here is some more info on post infectious IBS. There are some researchers looking at being able to try and reverse people more prone to get IBS after and infection like gastritisis. From there studies right now they feel about 30 percent of people get it this way and they think it might be higher even. That's how I got it with an infection that went away and I was left with IBS.Lml, is right good stress can effect IBS, but and important thing here is that fight or flight responce and stress hormones.So this seems to be effecting a person when they say where's a bathroom or thinking about having to go to work say or having to go somewhere they don't feel safe.partypooper here is some info and you can also do a web search on the names of these doctors and IBS.Also, something to remember here is the serotonin and other imporrtant neurotransmitters are still dysregulating to parts of the brain and back also that effect this.Post Infectious Irritable Bowel Syndrome http://www.med.unc.edu/medicine/fgidc/post_infestious.htm


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## eric (Jul 8, 1999)

partypooper, here is some more info on post infectious IBS. There are some researchers looking at being able to try and reverse people more prone to get IBS after and infection like gastritisis. From there studies right now they feel about 30 percent of people get it this way and they think it might be higher even. That's how I got it with an infection that went away and I was left with IBS.Lml, is right good stress can effect IBS, but and important thing here is that fight or flight responce and stress hormones.So this seems to be effecting a person when they say where's a bathroom or thinking about having to go to work say or having to go somewhere they don't feel safe.partypooper here is some info and you can also do a web search on the names of these doctors and IBS.Also, something to remember here is the serotonin and other imporrtant neurotransmitters are still dysregulating to parts of the brain and back also that effect this.Post Infectious Irritable Bowel Syndrome http://www.med.unc.edu/medicine/fgidc/post_infestious.htm


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## eric (Jul 8, 1999)

Okay, the more I look into this the more relevant it gets. However, its certainly not all clear yet for sure, especially to me. LOL"What is the Brain-Gut Axis? There are connections between the brain, the nervous system and the gastrointestinal tract. These connections take two forms. There are direct nerve fibers, essentially the way our body is electrically wired, that connect the brain with most of our body including the gastrointestinal tract. The second mechanism involves hormones which are chemical substances that are released in one part of the body, then travel through the blood stream to cause an effect elsewhere in the body. Specific to IBS, there have been several hormones isolated that fulfill this role(CCK, bombesin and others). After traveling through the blood, specific receptor sites within the GI tract are found where the hormones bind and cause stimulation of gut function. Many factors (stress, emotions, diet and others) may stimulate the brain to discharge nerve fibers or release hormones. The brain-gut access is one mechanism that helps us explain the way IBS symptoms are produced." http://www.cincygastro.com/ibs.html This system is important the HPA Axis."The body possesses an elaborate feedback system for controlling cortisol secretion and regulating the amount of cortisol in the bloodstream. The pituitary gland, a small gland at the base of the brain, makes and secretes a hormone known as adrenocorticotrophin, or ACTH. Secretion of ACTH signals the adrenal glands to increase cortisol production and secretion. The pituitary, in turn, receives signals from the hypothalamus of the brain in the form of the hormone CRH, or corticotropin-releasing hormone, which signals the pituitary to release ACTH. Almost immediately after a stressful event, the levels of the regulatory hormones ACTH and CRH increase, causing an immediate rise in cortisol levels. When cortisol is present in adequate (or excess) amounts, a negative feedback system operates on the pituitary gland and hypothalamus which alerts these areas to reduce the output of ACTH and CRH, respectively, in order to reduce cortisol secretion when adequate levels are present. " http://stress.about.com/library/weekly/aa012901a.htm CCK is associated with anticipatory anxiety and the fight or flight response.CCK"Cholecystokinin (CCK) - a chemical messenger related to some forms of panic disorder and associated gastrointestinal disorders. CCK-4 is a potent challenge agent that can induce anxiety or panic attacks even in people with no history of anxiety disorder."This is just something I found on"A comparison of serum cholecystokinin levels and gallbladdervolume between normal individuals, gallstone patients andindividuals with irritable bowel syndrome" http://physiology.cup.cam.ac.uk/Proceeding...pool/Files/S115 This is a cck gene prehaps linked to IBS http://webmd.lycos.com/content/article/1728.52273 They are also working on a new drug for IBS going this route.It also seems to play a role in appetite like serotonin.I am just posting this because I thought it was worth posting here for the info."STRESS: GOOD OR BAD? By Dr. Sharon Dollase D.C., R.N. WHAT IS STRESS? Stress is a condition that presents itself through a number of changes in the organs of the body. It's the wear and tear our bodies experience as we adapt to our ever-changing environment. Its effects are both physical and emotional, and can result in both positive and negative outcomes. Stress is not always bad; it is a very necessary part of our everyday lives, as everyday life and emotion produce stress on some level. However, your body systems must be prepared to take on this challenge, as the same level of stress that can excite and invigorate one individual, can cause an adverse effect on another and actually make them quite sick. There are two different "types" of stress: 1. Short-term Stress: This type of stress produces a "fight or flight" response that occurs during difficult or threatening situations, such as a job interview, a first date, being threatened, or taking a test at school, to name a few. The body can adapt to these types of situations by releasing a hormone called "adrenaline." An "adrenaline surge" is what you feel when you almost get in that accident on the freeway. The body does this to help it react to the potential threat, to help it respond at its best in a "fight or flight" situation. So what are some of the functions of this substance called adrenaline? Well, it helps to mobilize the sugars in your body. This gives your body easier access to more strength and stamina to help you run faster and/or fight harder. It also helps to decrease the blood that flows to your skin and other "non-essential" organs. This helps to keep bleeding to a minimum, and helps to ensure that energy is not wasted on processes that cannot be utilized immediately. Adrenaline can help you survive or perform at your best. However, excessive and prolonged exposure can cause you to become ill. 2. Long Term Stress: The symptoms related to sustained stress are more associated with fatigue, decreased morale and health than with short-term adrenaline management. Initially you will face challenges with plenty of energy, and your reaction will probably be of a positive and effective nature. However, if excessive levels of stress are sustained, the body starts to send out alarm signals. This is called "The General Adaptation Syndrome" and occurs in three stages. The Alarm Stage: In the face of threat or stress, adrenaline is produced and the body decides, "Am I going to fight or flight?" There is an immediate alarm reaction, and many signals are sent from the brain to the hormonal system to fight or run. If the stress stops we return to normal and all is well. The Resistance Stage: If the stress continues, our bodies go into a stage of resistance as they desperately try to adapt. We fight the threat, our muscles tighten up, and we struggle to maintain a balance in our systems. These 2 stages are an everyday part of our lives, and each one of us is exposed to them frequently. Our nervous and hormonal systems play a big part in maintaining resistance and balance in our bodies during stressful times. The Exhaustion Stage: If the stress continues unchecked, we may find ourselves in a state of exhaustion, as our bodies are not designed to be indefinitely "primed for action." With chronic stress the body and mind never have a chance to completely relax and unwind. The muscles remain tense and our precious energy is drained. The body becomes fatigued, and more susceptible to high blood pressure, colds, digestive problems, ulcers, heart disease, infection, and premature aging. This permanent, unchecked cycle of alarm/resistance/exhaustion can slowly rob a person of his/her health, vitality, and ultimately of life itself. WHAT CAUSES STRESS AND ANXIETY? Here are 5 unrealistic desires and beliefs that cause anxiety: 1.The desire to have the love and admiration of all people important to you 2.The desire to be thoroughly competent at all times 3.The belief that external factors cause all misfortune 4.The desire that events should always turn out the way you want them to 5.The belief that previous bad experiences will inevitably control what will happen in the future STRESS SYMPTOMS Stress symptoms depend greatly on whether the experience is short-term or long-term. Short-term stress Increased sweating Increased heart rate Rapid breathing Tight muscles Cool skin Dry mouth Cold hands and feet Nausea or "butterflies" Digestive disturbances Long-term stress Back pain Headaches Increased frequency of illness Loss of appetite Acne Aches and pains Constant fatigue Sexual disorders Asthma Inability to concentrate/make decisions, confusion Feeling overwhelmed Mood changes: depression, frustration, hostility, helplessness, impatience, irritability, and restlessness  Difficulty sleeping Increased drinking and/or smoking Increased reliance on medication Neglect of personal appearance Increased absenteeism MANAGING STRESS Can I eliminate stress from my life? The goal is not to eliminate stress from our lives but to turn it into something useful and positive. There is no one level of stress that is ideal for all people; each person is a unique individual with his/her own needs. It has been shown that most illness is related to unrelieved stress. If you are experiencing stress symptoms then you have gone beyond your optimum stress level and your body is losing its ability to adapt. You need to reduce the stress in your life and/or improve your ability to manage it. How can I manage stress better? Recognize what you can and cannot change Build your physical strength and reserves. Do aerobic or endurance exercises 3-4 times/week plus some type of weight training. Eat well-balanced nutritious meals and avoid too much caffeine. Ensure adequate intake of fruits and vegetables, grains, complex carbohydrates, and protein. Avoid nicotine Get adequate sleep Set priorities Become aware of your physical stresses and your responses to them. Take good care of your physical health " Dr. Sharon Latter-Dollase D.C., R.N. has a private practice in Agoura Hills, where she specializes as a Chiropractic Sports Physician. Dr. Dollase also teaches classes on various contemporary health topics.


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## eric (Jul 8, 1999)

Okay, the more I look into this the more relevant it gets. However, its certainly not all clear yet for sure, especially to me. LOL"What is the Brain-Gut Axis? There are connections between the brain, the nervous system and the gastrointestinal tract. These connections take two forms. There are direct nerve fibers, essentially the way our body is electrically wired, that connect the brain with most of our body including the gastrointestinal tract. The second mechanism involves hormones which are chemical substances that are released in one part of the body, then travel through the blood stream to cause an effect elsewhere in the body. Specific to IBS, there have been several hormones isolated that fulfill this role(CCK, bombesin and others). After traveling through the blood, specific receptor sites within the GI tract are found where the hormones bind and cause stimulation of gut function. Many factors (stress, emotions, diet and others) may stimulate the brain to discharge nerve fibers or release hormones. The brain-gut access is one mechanism that helps us explain the way IBS symptoms are produced." http://www.cincygastro.com/ibs.html This system is important the HPA Axis."The body possesses an elaborate feedback system for controlling cortisol secretion and regulating the amount of cortisol in the bloodstream. The pituitary gland, a small gland at the base of the brain, makes and secretes a hormone known as adrenocorticotrophin, or ACTH. Secretion of ACTH signals the adrenal glands to increase cortisol production and secretion. The pituitary, in turn, receives signals from the hypothalamus of the brain in the form of the hormone CRH, or corticotropin-releasing hormone, which signals the pituitary to release ACTH. Almost immediately after a stressful event, the levels of the regulatory hormones ACTH and CRH increase, causing an immediate rise in cortisol levels. When cortisol is present in adequate (or excess) amounts, a negative feedback system operates on the pituitary gland and hypothalamus which alerts these areas to reduce the output of ACTH and CRH, respectively, in order to reduce cortisol secretion when adequate levels are present. " http://stress.about.com/library/weekly/aa012901a.htm CCK is associated with anticipatory anxiety and the fight or flight response.CCK"Cholecystokinin (CCK) - a chemical messenger related to some forms of panic disorder and associated gastrointestinal disorders. CCK-4 is a potent challenge agent that can induce anxiety or panic attacks even in people with no history of anxiety disorder."This is just something I found on"A comparison of serum cholecystokinin levels and gallbladdervolume between normal individuals, gallstone patients andindividuals with irritable bowel syndrome" http://physiology.cup.cam.ac.uk/Proceeding...pool/Files/S115 This is a cck gene prehaps linked to IBS http://webmd.lycos.com/content/article/1728.52273 They are also working on a new drug for IBS going this route.It also seems to play a role in appetite like serotonin.I am just posting this because I thought it was worth posting here for the info."STRESS: GOOD OR BAD? By Dr. Sharon Dollase D.C., R.N. WHAT IS STRESS? Stress is a condition that presents itself through a number of changes in the organs of the body. It's the wear and tear our bodies experience as we adapt to our ever-changing environment. Its effects are both physical and emotional, and can result in both positive and negative outcomes. Stress is not always bad; it is a very necessary part of our everyday lives, as everyday life and emotion produce stress on some level. However, your body systems must be prepared to take on this challenge, as the same level of stress that can excite and invigorate one individual, can cause an adverse effect on another and actually make them quite sick. There are two different "types" of stress: 1. Short-term Stress: This type of stress produces a "fight or flight" response that occurs during difficult or threatening situations, such as a job interview, a first date, being threatened, or taking a test at school, to name a few. The body can adapt to these types of situations by releasing a hormone called "adrenaline." An "adrenaline surge" is what you feel when you almost get in that accident on the freeway. The body does this to help it react to the potential threat, to help it respond at its best in a "fight or flight" situation. So what are some of the functions of this substance called adrenaline? Well, it helps to mobilize the sugars in your body. This gives your body easier access to more strength and stamina to help you run faster and/or fight harder. It also helps to decrease the blood that flows to your skin and other "non-essential" organs. This helps to keep bleeding to a minimum, and helps to ensure that energy is not wasted on processes that cannot be utilized immediately. Adrenaline can help you survive or perform at your best. However, excessive and prolonged exposure can cause you to become ill. 2. Long Term Stress: The symptoms related to sustained stress are more associated with fatigue, decreased morale and health than with short-term adrenaline management. Initially you will face challenges with plenty of energy, and your reaction will probably be of a positive and effective nature. However, if excessive levels of stress are sustained, the body starts to send out alarm signals. This is called "The General Adaptation Syndrome" and occurs in three stages. The Alarm Stage: In the face of threat or stress, adrenaline is produced and the body decides, "Am I going to fight or flight?" There is an immediate alarm reaction, and many signals are sent from the brain to the hormonal system to fight or run. If the stress stops we return to normal and all is well. The Resistance Stage: If the stress continues, our bodies go into a stage of resistance as they desperately try to adapt. We fight the threat, our muscles tighten up, and we struggle to maintain a balance in our systems. These 2 stages are an everyday part of our lives, and each one of us is exposed to them frequently. Our nervous and hormonal systems play a big part in maintaining resistance and balance in our bodies during stressful times. The Exhaustion Stage: If the stress continues unchecked, we may find ourselves in a state of exhaustion, as our bodies are not designed to be indefinitely "primed for action." With chronic stress the body and mind never have a chance to completely relax and unwind. The muscles remain tense and our precious energy is drained. The body becomes fatigued, and more susceptible to high blood pressure, colds, digestive problems, ulcers, heart disease, infection, and premature aging. This permanent, unchecked cycle of alarm/resistance/exhaustion can slowly rob a person of his/her health, vitality, and ultimately of life itself. WHAT CAUSES STRESS AND ANXIETY? Here are 5 unrealistic desires and beliefs that cause anxiety: 1.The desire to have the love and admiration of all people important to you 2.The desire to be thoroughly competent at all times 3.The belief that external factors cause all misfortune 4.The desire that events should always turn out the way you want them to 5.The belief that previous bad experiences will inevitably control what will happen in the future STRESS SYMPTOMS Stress symptoms depend greatly on whether the experience is short-term or long-term. Short-term stress Increased sweating Increased heart rate Rapid breathing Tight muscles Cool skin Dry mouth Cold hands and feet Nausea or "butterflies" Digestive disturbances Long-term stress Back pain Headaches Increased frequency of illness Loss of appetite Acne Aches and pains Constant fatigue Sexual disorders Asthma Inability to concentrate/make decisions, confusion Feeling overwhelmed Mood changes: depression, frustration, hostility, helplessness, impatience, irritability, and restlessness Difficulty sleeping Increased drinking and/or smoking Increased reliance on medication Neglect of personal appearance Increased absenteeism MANAGING STRESS Can I eliminate stress from my life? The goal is not to eliminate stress from our lives but to turn it into something useful and positive. There is no one level of stress that is ideal for all people; each person is a unique individual with his/her own needs. It has been shown that most illness is related to unrelieved stress. If you are experiencing stress symptoms then you have gone beyond your optimum stress level and your body is losing its ability to adapt. You need to reduce the stress in your life and/or improve your ability to manage it. How can I manage stress better? Recognize what you can and cannot change Build your physical strength and reserves. Do aerobic or endurance exercises 3-4 times/week plus some type of weight training. Eat well-balanced nutritious meals and avoid too much caffeine. Ensure adequate intake of fruits and vegetables, grains, complex carbohydrates, and protein. Avoid nicotine Get adequate sleep Set priorities Become aware of your physical stresses and your responses to them. Take good care of your physical health " Dr. Sharon Latter-Dollase D.C., R.N. has a private practice in Agoura Hills, where she specializes as a Chiropractic Sports Physician. Dr. Dollase also teaches classes on various contemporary health topics.


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## eric (Jul 8, 1999)

The higher levels of cortisol in the mournings is one reason why some people have more difficulty in the mournings and more d. J Endocrinol Invest 2001 Mar;24(3):173-7 Related Articles, Books, LinkOut Actual stress, psychopathology and salivary cortisol levels in the irritable bowel syndrome (IBS). Patacchioli FR, Angelucci L, Dellerba G, Monnazzi P, Leri O. Department of Physiology and Pharmacology V. Erspamer, Medical Faculty, University of Rome La Sapienza, Italy. Although irritable bowel syndrome (IBS) can be considered a biopsychological disorder in which an association between life stress and physiological changes leading to bowel irregularity is present, there is a lack of data concerning possible modifications of the adrenal function during the disease. The aim of the present study was to measure biological and psychological variables related to the activity of the hypothalamo-pituitary-adrenal axis in IBS patients compared to healthy subjects. Cortisol was measured in the saliva (obtained by a stress-free, non invasive collection procedure) of 55 IBS outpatients and 28 matched controls. Moreover, each subject completed the following self-administered questionnaires: the Rome Burnout Inventory (RBI) in its physical (RBI-PE) and emotional-mental exhaustion (RBI-EME) components, Beck Depression Inventory, State and Trait Anxiety Inventory (STAI), Perceived Social Support Scale (PSSS) and a Scale for the Assessment of Perceived Actual Work-Non Work Stress. Compared with controls, IBS subjects showed significantly higher levels of cortisol in the morning and lower in the evening, while they maintained the physiological circadian fluctuation (i.e. cortisol morning level higher than in the evening). Moreover, IBS patients presented a significant difference from controls in RBI-PE scores, which confirms the presence of fatigue, a symptom frequently reported by the patients. Compared with controls, no differences were found in IBS patients with respect to other psychological parameters. These findings suggest a dysregulation of the adrenal activity in IBS patients. The results may be relevant considering that changes in cortisol levels have been shown to be sensitive indicators of psychosocial stress and coping patterns in both laboratory and life situations. PMID: 11314746 [PubMed - indexed for MEDLINE]


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## eric (Jul 8, 1999)

The higher levels of cortisol in the mournings is one reason why some people have more difficulty in the mournings and more d. J Endocrinol Invest 2001 Mar;24(3):173-7 Related Articles, Books, LinkOut Actual stress, psychopathology and salivary cortisol levels in the irritable bowel syndrome (IBS). Patacchioli FR, Angelucci L, Dellerba G, Monnazzi P, Leri O. Department of Physiology and Pharmacology V. Erspamer, Medical Faculty, University of Rome La Sapienza, Italy. Although irritable bowel syndrome (IBS) can be considered a biopsychological disorder in which an association between life stress and physiological changes leading to bowel irregularity is present, there is a lack of data concerning possible modifications of the adrenal function during the disease. The aim of the present study was to measure biological and psychological variables related to the activity of the hypothalamo-pituitary-adrenal axis in IBS patients compared to healthy subjects. Cortisol was measured in the saliva (obtained by a stress-free, non invasive collection procedure) of 55 IBS outpatients and 28 matched controls. Moreover, each subject completed the following self-administered questionnaires: the Rome Burnout Inventory (RBI) in its physical (RBI-PE) and emotional-mental exhaustion (RBI-EME) components, Beck Depression Inventory, State and Trait Anxiety Inventory (STAI), Perceived Social Support Scale (PSSS) and a Scale for the Assessment of Perceived Actual Work-Non Work Stress. Compared with controls, IBS subjects showed significantly higher levels of cortisol in the morning and lower in the evening, while they maintained the physiological circadian fluctuation (i.e. cortisol morning level higher than in the evening). Moreover, IBS patients presented a significant difference from controls in RBI-PE scores, which confirms the presence of fatigue, a symptom frequently reported by the patients. Compared with controls, no differences were found in IBS patients with respect to other psychological parameters. These findings suggest a dysregulation of the adrenal activity in IBS patients. The results may be relevant considering that changes in cortisol levels have been shown to be sensitive indicators of psychosocial stress and coping patterns in both laboratory and life situations. PMID: 11314746 [PubMed - indexed for MEDLINE]


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## partypooper (Mar 22, 2000)

Eric, thanks so much for that article on post-infectious IBS. That seems very consistent with what various GIs have told me about my own condition.


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## partypooper (Mar 22, 2000)

Eric, thanks so much for that article on post-infectious IBS. That seems very consistent with what various GIs have told me about my own condition.


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## eric (Jul 8, 1999)

No problem partypooper it matches mine also from ameobic dysentary. I posted some more info for you on another thread.This all maybe long but these are all things effecting IBS and it helps I believe to understand this the best you can.It looks like the HPA Axis is out of whack and the serotonin is dysregulating as well.This is just general on serotonin. Some of the problem is serotonin in the gut receptors and serotonin in the brain and the regulation of it back and forth."Seratonin: The chemistry of Well-Being More than 100,000 chemical reactions go on in your brain every second! The brain is also a radio transmitter, which sends out measurable electrical wave signals. In fact the brain continues to send out these signals for as long as 37 hours after death! Among the brain's many jobs is to be your own chemist. The brain produces more than 50 identified active drugs. Some of these are associated with memory, others with intelligence, still others are sedatives. Endorphin is the brain's painkiller, and it is 3 times more potent than morphine. Scientific research over the last several decades has led to the revolutionary discovery of opiate-like chemicals in the body that associate with opiate specific receptors in the brain and spinal cord, including Serotonin, a hormone manufactured by your brain. Serotonin is a neurotransmitter, involved in the transmission of nerve impulses. It is manufactured in your body using the amino acid tryptophan. It is manufactured in your body using the amino acid tryptophan. Release of serotonin or other drugs (depending on the type of nerve) causes the other nerve to fire and continue the message along the "cable".. The neurotransmitters are dopamine, serotonin, and norepinephrine. At the neurochemical and physiological level, neurotransmitters are extremely important, since they carry impulses between nerve cells. The substance that processes the neurotransmitter called serotonin is the amino acid tryptophan. It increases the amount of serotonin made by the brain. Certain aminos cause you to have better feeling of well being. Serotonin is a chemical that helps maintain a "happy feeling," and seems to help keep our moods under control by helping with sleep, calming anxiety, and relieving depression. The brain also makes Dopamine, which makes people more talkative and excitable. It affects brain processes that control movement, emotional response, and ability to experience pleasure and pain. All of these chemicals are natural chemicals that affect our bodily processes. Besides being involved in the process of addiction, low Serotonin levels are believed to be the reason for many cases of mild to moderate depression which can lead to symptoms like anxiety, apathy, fear, feelings of worthlessness, insomnia and fatigue. We are learning that depression is related to and a number of other health issues. Depression is the nation's most prevalent mental health problem, affecting about 15 million Americans who spend about $3 billion a year on drugs to battle it. Almost all of these medicines target either serotonin or norepinephrine, brain chemicals which are neurotransmitters. "Research over the past two decades has shown...that depression is an important risk factor for heart disease along with high blood cholesterol and high blood pressure." - National Institute of Mental Health A whole new class of antidepressant medications has been developed that affects chemical messengers within the brain (the neurotransmitters). These medications are believed to work by regulating the release or action of Serotonin. Those drugs do help many patients, but they can cause serious side effects, and some 20 percent of patients get no help from today's medicines. People seeking these medications normally indicate a feeling of being more or less in a state of depression. They may feel emotionally numb, "nothing feels nice," and/or vague aches and pains or perhaps the sensation of "aching all over," and almost invariably have a sense of some isolation. Some people do not admit anger, sadness or guilt; instead they withdraw and hide from society. They lose all interest in things around them and become incapable of any pleasure. Things appear bleak and time passes slowly for them. They are typically angry and irritable. They often try sleeping off their depression or do nothing but sit or lay around. In most people depression is not severe. They can still function, but do so at a lower capacity and at a slower pace. Symptoms of depression include chronic fatigue syndrome, insomnia or sleeping frequently and for excessive periods of time, loss of appetite or a ravenous appetite, headaches, backaches, colon disorders, and feelings of worthlessness and inadequacy. Many think of death and consider suicide. Depression may be caused by tension, upset stomach, stress, headache, nutritional deficiencies, poor diet, sugar mononucleosis, thyroid disorders, endometriosis (linked to depression in women), any serious physical disorder, or allergies. Some people become more depressed in the winter months when days are shorter and darker. The sun and bright light seem to trigger a response to a brain hormone known as melatonin (produced by the pineal gland), which is, in part, responsible for preventing the "blues." Stay in brightly-lit rooms on dark days. Research reveals that two hours of morning sun is very effective in lifting depression. The evening light had comparatively little results. Depression begins with a disturbance in the part of the brain that governs moods. Most people can handle everyday stresses; their bodies readjust to these pressures. When stress is too great for a person and his adjustment mechanism is unresponsive, depression may be triggered. In recent years anti-depressants are among the most widely prescribed medications, in spite of their side-affects. The presumption is that a chemically induced sense of well bring is better than none. Withdrawal from these medications can be particularly hazardous and must be managed carefully. Scientists have long hunted another way to attack depression. It has been discovered that some foods influence the brain's behavior, and the brain's neurotransmitters, which regulate our behavior, can be affected by what we eat. Research is showing that some foods such as bananas and turkey have proteins that help to create the chemical seratonin. So, diet may contribute to depression, especially poor eating habits and constant snacking on junk foods. We really do not know the triggers for hunger or appetite. It seems that serotonin is involved, but where and how are currently unknown. Serotonin release is triggered by a carbohydrate load (sugar, etc.) and there are many who feel that eating Carbohydrates under stress is aimed at this serotonin release. When the brain produces serotonin, tension is eased. When it produces dopamine or norepinephrine, we tend to think and act more quickly and are generally more alert. Eating carbohydrates alone seems to have a calming effect, while proteins increase alertness. Complex carbohydrates, which raise the level of tryptophan in the brain, have a calming effect. Protein promotes the production of dopamine and norepinephrine, which promote alertness. Protein meals containing essential fatty acids and/or carbohydrates are recommended for increased alertness. Salmon and white fish are good choices. Avoid foods high in saturated fats; consumption of port or fried foods, such as hamburgers and French fries, leads to sluggishness, slow thinking, and fatigue. Fats inhibit the synthesis of neurotransmitters by the brain in that they cause the blood cells to become sticky and to clump together, resulting in poor circulation, especially to the brain. A balance is achieved when the diet contains a combination of these two nutrients. A turkey sandwich on whole wheat bread is a good combination: the turkey is high in protein and tryptophan, and the whole wheat bread supplies complex carbohydrates. Consume more carbohydrates than protein if you are nervous and wish to become more relaxed or eat more protein than carbohydrates if you are tired and wish to become more alert. A depressed person who needs his spirits lifted would benefit from eating foods like turkey and salmon, which are high in tryptophan and protein. Beware: The body will react more quickly to the presence of sugar than it does to the presence of complex carbohydrates. The increase in energy supplied by the simple carbohydrates is quickly accompanied by fatigue and depression. Tyrosine is also needed for brain function. This amino acid may be good for those who have prolonged and intense stress. Uncontrollable stress may thereby be prevented or reversed if this essential amino acid is obtained in the diet. Vitamin C is required for the conversion of the amino acids L-tyrosine and L-phenylalanine into noradrenaline. The conversion of tryptophan into seratonin, the neurohormone responsible for sleep, pain control and well being, also requires adequate supplies of vitamin C. An herbal remedy has become popular. St. John's Wort contains an ingredient called "Hypericin, which prevents too much of the MAO (Mono Amine Oxidase) activity from being released and destroying Serotonin. Heredity is a significant factor in depression. In up to 50 percent of people suffering from recurrent episodes of depression, one or both of the parents were depressives. But the ability to be healthy and happy appears to be related to several simple techniques that are all related to relaxation, exercise, and nutrition. The interesting thing about these techniques is that research is beginning to show us how they impact us at a very basic level--our chemical processes. Not just our diet, but out thoughts, our emotions, and our behavior all effect body chemistry. For instance, relaxation produces the chemical norepinephrine with which low levels are implicated in depression. Also, exercise has been shown to produce another chemical known as endorphins, which help with depression, anxiety, sleep, and sexual activity. So, besides eating certain foods, relaxation, exercise, and are things that we do that can also affect the level and activity of these chemicals. Thomas Jefferson wrote that most people feel about as happy as they make up their minds to be. And indeed, a positive attitude is invaluable. Most people never heard of serotonin management, or even considered it at all except for medications. Serotonin management amounts to paying attention to the little things that make you feel good and systematically including them in your daily routine. We know, instinctively, that pampering ourselves is a door to a sense of well being, but we may not take time to schedule pleasant surroundings, favorite music or food, or even quality time with loved ones into our daily agenda. Just getting out of bed and into a warm shower elevates serotonin levels, making it easier to get into a positive, constructive frame of mind. And generally speaking, depression if it is mild enough can sometimes be managed without prescribed medications. Aerobic exercise, watching your carbohydrate & alcohol consumption, getting up early and moving, even if you don't feel like it, forcing structure on your life, using meditation and imagery (if can concentrate, which depends on how depressed you are), and seeking a support group or psychotherapy, have all proved helpful. A group of psychologists did an on-going survey about happiness. When asked to rate their over all level of happiness, on a scale from 1 to 10, most people indicated about 6.7 or so. Interestingly it was discovered that a divorce, or serious injury, even the loss of a limb, caused this level to go down a point or two, for a year or two. But then it usually came back to about 6.7. Falling in love or winning the lottery caused the level of happiness to go up a point or two for a year or two, but then it went back to the previous level. What this implies is that a slight increase that could be sustained, was more significant than more dramatic life events. In other words if you find small things that make you feel good, and do them on a regular basis, your overall level of happiness is greater than if you fall in love, win the lottery. Seemingly little things that taste good, smell good, or delight the senses can be very significant when systematically included in your daily routine. Violets for the soul may be one of your best investments, especially if you consider the fact that people who feel good are significantly less likely to tardy, absent, ill, or involved in accidents of all kinds. If you are in the habit of worrying about things, then put some boundaries on it. Actually take 10 or 15 minuets and really worry, then let it go and do something constructive for an equal period of time. Recogize that there are two kinds of worrying: conceptual, which is goal-oriented, and reactive, which is mostly destructive. Productive worrying seeks a trial soultion to the problem, while non-productive worrying usually seeks to blame or condemn. Attitude counts for a lot here. Is your cup half empty or half full? Most fearfull worry is wasted obsession with unfounded or un-realistic outcomes. Dissappointment is usually the product of poorly managed expectations. Taking time to smell the flowers implies a willingness to be spontaneous. A talent like this one is something that some just have while others must learn. Make a detailed list of little things that you enjoy and include them in your activities. Actually schedule a time of day to go for a walk, create or listen to your favorite music, read a poem, meditate, spend qualty time with family and friends, paint, excercise, or just play. Make a pact to try it, just for a few weeks, then see if your over-all well being is not improved." http://www.angelfire.com/hi/TheSeer/seratonin.html


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## eric (Jul 8, 1999)

No problem partypooper it matches mine also from ameobic dysentary. I posted some more info for you on another thread.This all maybe long but these are all things effecting IBS and it helps I believe to understand this the best you can.It looks like the HPA Axis is out of whack and the serotonin is dysregulating as well.This is just general on serotonin. Some of the problem is serotonin in the gut receptors and serotonin in the brain and the regulation of it back and forth."Seratonin: The chemistry of Well-Being More than 100,000 chemical reactions go on in your brain every second! The brain is also a radio transmitter, which sends out measurable electrical wave signals. In fact the brain continues to send out these signals for as long as 37 hours after death! Among the brain's many jobs is to be your own chemist. The brain produces more than 50 identified active drugs. Some of these are associated with memory, others with intelligence, still others are sedatives. Endorphin is the brain's painkiller, and it is 3 times more potent than morphine. Scientific research over the last several decades has led to the revolutionary discovery of opiate-like chemicals in the body that associate with opiate specific receptors in the brain and spinal cord, including Serotonin, a hormone manufactured by your brain. Serotonin is a neurotransmitter, involved in the transmission of nerve impulses. It is manufactured in your body using the amino acid tryptophan. It is manufactured in your body using the amino acid tryptophan. Release of serotonin or other drugs (depending on the type of nerve) causes the other nerve to fire and continue the message along the "cable".. The neurotransmitters are dopamine, serotonin, and norepinephrine. At the neurochemical and physiological level, neurotransmitters are extremely important, since they carry impulses between nerve cells. The substance that processes the neurotransmitter called serotonin is the amino acid tryptophan. It increases the amount of serotonin made by the brain. Certain aminos cause you to have better feeling of well being. Serotonin is a chemical that helps maintain a "happy feeling," and seems to help keep our moods under control by helping with sleep, calming anxiety, and relieving depression. The brain also makes Dopamine, which makes people more talkative and excitable. It affects brain processes that control movement, emotional response, and ability to experience pleasure and pain. All of these chemicals are natural chemicals that affect our bodily processes. Besides being involved in the process of addiction, low Serotonin levels are believed to be the reason for many cases of mild to moderate depression which can lead to symptoms like anxiety, apathy, fear, feelings of worthlessness, insomnia and fatigue. We are learning that depression is related to and a number of other health issues. Depression is the nation's most prevalent mental health problem, affecting about 15 million Americans who spend about $3 billion a year on drugs to battle it. Almost all of these medicines target either serotonin or norepinephrine, brain chemicals which are neurotransmitters. "Research over the past two decades has shown...that depression is an important risk factor for heart disease along with high blood cholesterol and high blood pressure." - National Institute of Mental Health A whole new class of antidepressant medications has been developed that affects chemical messengers within the brain (the neurotransmitters). These medications are believed to work by regulating the release or action of Serotonin. Those drugs do help many patients, but they can cause serious side effects, and some 20 percent of patients get no help from today's medicines. People seeking these medications normally indicate a feeling of being more or less in a state of depression. They may feel emotionally numb, "nothing feels nice," and/or vague aches and pains or perhaps the sensation of "aching all over," and almost invariably have a sense of some isolation. Some people do not admit anger, sadness or guilt; instead they withdraw and hide from society. They lose all interest in things around them and become incapable of any pleasure. Things appear bleak and time passes slowly for them. They are typically angry and irritable. They often try sleeping off their depression or do nothing but sit or lay around. In most people depression is not severe. They can still function, but do so at a lower capacity and at a slower pace. Symptoms of depression include chronic fatigue syndrome, insomnia or sleeping frequently and for excessive periods of time, loss of appetite or a ravenous appetite, headaches, backaches, colon disorders, and feelings of worthlessness and inadequacy. Many think of death and consider suicide. Depression may be caused by tension, upset stomach, stress, headache, nutritional deficiencies, poor diet, sugar mononucleosis, thyroid disorders, endometriosis (linked to depression in women), any serious physical disorder, or allergies. Some people become more depressed in the winter months when days are shorter and darker. The sun and bright light seem to trigger a response to a brain hormone known as melatonin (produced by the pineal gland), which is, in part, responsible for preventing the "blues." Stay in brightly-lit rooms on dark days. Research reveals that two hours of morning sun is very effective in lifting depression. The evening light had comparatively little results. Depression begins with a disturbance in the part of the brain that governs moods. Most people can handle everyday stresses; their bodies readjust to these pressures. When stress is too great for a person and his adjustment mechanism is unresponsive, depression may be triggered. In recent years anti-depressants are among the most widely prescribed medications, in spite of their side-affects. The presumption is that a chemically induced sense of well bring is better than none. Withdrawal from these medications can be particularly hazardous and must be managed carefully. Scientists have long hunted another way to attack depression. It has been discovered that some foods influence the brain's behavior, and the brain's neurotransmitters, which regulate our behavior, can be affected by what we eat. Research is showing that some foods such as bananas and turkey have proteins that help to create the chemical seratonin. So, diet may contribute to depression, especially poor eating habits and constant snacking on junk foods. We really do not know the triggers for hunger or appetite. It seems that serotonin is involved, but where and how are currently unknown. Serotonin release is triggered by a carbohydrate load (sugar, etc.) and there are many who feel that eating Carbohydrates under stress is aimed at this serotonin release. When the brain produces serotonin, tension is eased. When it produces dopamine or norepinephrine, we tend to think and act more quickly and are generally more alert. Eating carbohydrates alone seems to have a calming effect, while proteins increase alertness. Complex carbohydrates, which raise the level of tryptophan in the brain, have a calming effect. Protein promotes the production of dopamine and norepinephrine, which promote alertness. Protein meals containing essential fatty acids and/or carbohydrates are recommended for increased alertness. Salmon and white fish are good choices. Avoid foods high in saturated fats; consumption of port or fried foods, such as hamburgers and French fries, leads to sluggishness, slow thinking, and fatigue. Fats inhibit the synthesis of neurotransmitters by the brain in that they cause the blood cells to become sticky and to clump together, resulting in poor circulation, especially to the brain. A balance is achieved when the diet contains a combination of these two nutrients. A turkey sandwich on whole wheat bread is a good combination: the turkey is high in protein and tryptophan, and the whole wheat bread supplies complex carbohydrates. Consume more carbohydrates than protein if you are nervous and wish to become more relaxed or eat more protein than carbohydrates if you are tired and wish to become more alert. A depressed person who needs his spirits lifted would benefit from eating foods like turkey and salmon, which are high in tryptophan and protein. Beware: The body will react more quickly to the presence of sugar than it does to the presence of complex carbohydrates. The increase in energy supplied by the simple carbohydrates is quickly accompanied by fatigue and depression. Tyrosine is also needed for brain function. This amino acid may be good for those who have prolonged and intense stress. Uncontrollable stress may thereby be prevented or reversed if this essential amino acid is obtained in the diet. Vitamin C is required for the conversion of the amino acids L-tyrosine and L-phenylalanine into noradrenaline. The conversion of tryptophan into seratonin, the neurohormone responsible for sleep, pain control and well being, also requires adequate supplies of vitamin C. An herbal remedy has become popular. St. John's Wort contains an ingredient called "Hypericin, which prevents too much of the MAO (Mono Amine Oxidase) activity from being released and destroying Serotonin. Heredity is a significant factor in depression. In up to 50 percent of people suffering from recurrent episodes of depression, one or both of the parents were depressives. But the ability to be healthy and happy appears to be related to several simple techniques that are all related to relaxation, exercise, and nutrition. The interesting thing about these techniques is that research is beginning to show us how they impact us at a very basic level--our chemical processes. Not just our diet, but out thoughts, our emotions, and our behavior all effect body chemistry. For instance, relaxation produces the chemical norepinephrine with which low levels are implicated in depression. Also, exercise has been shown to produce another chemical known as endorphins, which help with depression, anxiety, sleep, and sexual activity. So, besides eating certain foods, relaxation, exercise, and are things that we do that can also affect the level and activity of these chemicals. Thomas Jefferson wrote that most people feel about as happy as they make up their minds to be. And indeed, a positive attitude is invaluable. Most people never heard of serotonin management, or even considered it at all except for medications. Serotonin management amounts to paying attention to the little things that make you feel good and systematically including them in your daily routine. We know, instinctively, that pampering ourselves is a door to a sense of well being, but we may not take time to schedule pleasant surroundings, favorite music or food, or even quality time with loved ones into our daily agenda. Just getting out of bed and into a warm shower elevates serotonin levels, making it easier to get into a positive, constructive frame of mind. And generally speaking, depression if it is mild enough can sometimes be managed without prescribed medications. Aerobic exercise, watching your carbohydrate & alcohol consumption, getting up early and moving, even if you don't feel like it, forcing structure on your life, using meditation and imagery (if can concentrate, which depends on how depressed you are), and seeking a support group or psychotherapy, have all proved helpful. A group of psychologists did an on-going survey about happiness. When asked to rate their over all level of happiness, on a scale from 1 to 10, most people indicated about 6.7 or so. Interestingly it was discovered that a divorce, or serious injury, even the loss of a limb, caused this level to go down a point or two, for a year or two. But then it usually came back to about 6.7. Falling in love or winning the lottery caused the level of happiness to go up a point or two for a year or two, but then it went back to the previous level. What this implies is that a slight increase that could be sustained, was more significant than more dramatic life events. In other words if you find small things that make you feel good, and do them on a regular basis, your overall level of happiness is greater than if you fall in love, win the lottery. Seemingly little things that taste good, smell good, or delight the senses can be very significant when systematically included in your daily routine. Violets for the soul may be one of your best investments, especially if you consider the fact that people who feel good are significantly less likely to tardy, absent, ill, or involved in accidents of all kinds. If you are in the habit of worrying about things, then put some boundaries on it. Actually take 10 or 15 minuets and really worry, then let it go and do something constructive for an equal period of time. Recogize that there are two kinds of worrying: conceptual, which is goal-oriented, and reactive, which is mostly destructive. Productive worrying seeks a trial soultion to the problem, while non-productive worrying usually seeks to blame or condemn. Attitude counts for a lot here. Is your cup half empty or half full? Most fearfull worry is wasted obsession with unfounded or un-realistic outcomes. Dissappointment is usually the product of poorly managed expectations. Taking time to smell the flowers implies a willingness to be spontaneous. A talent like this one is something that some just have while others must learn. Make a detailed list of little things that you enjoy and include them in your activities. Actually schedule a time of day to go for a walk, create or listen to your favorite music, read a poem, meditate, spend qualty time with family and friends, paint, excercise, or just play. Make a pact to try it, just for a few weeks, then see if your over-all well being is not improved." http://www.angelfire.com/hi/TheSeer/seratonin.html


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## Dave-G (Feb 2, 2002)

<Anyone read this post and understand what is going on here? >Eric,Thankyou very much for these posts, It will take me a few days to fully digest(!) But most important of all you have given me something to help my 19 year old lad who does not have IBS but has not been able to attend college for the last 3 weeks, because he has not had ONE nights sleep in that time and is thinking of giving it all up. I will pass this info on to him and hope it helps him to cope with the stress.Thanks again for all your untired devotion to this site, what would we do without you and others like you?


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## Dave-G (Feb 2, 2002)

<Anyone read this post and understand what is going on here? >Eric,Thankyou very much for these posts, It will take me a few days to fully digest(!) But most important of all you have given me something to help my 19 year old lad who does not have IBS but has not been able to attend college for the last 3 weeks, because he has not had ONE nights sleep in that time and is thinking of giving it all up. I will pass this info on to him and hope it helps him to cope with the stress.Thanks again for all your untired devotion to this site, what would we do without you and others like you?


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## eric (Jul 8, 1999)

Dave, so you know I owe you an email and will email you as soon.It is really worth reading and understanding some of the info here and how it all applies to IBS, chemical dysregulation and the immune system being triggered via the HPA axis.Sorry to hear about son, maybe this info will help him also. I hope he can get a handle on it and not give up his studies.Your very welcome for the info, I am learning somethings on all this as well as I look into all this and how it applies to IBS and even other conditions.Sorry it long and may take sometime, but with everything IBS the info is always complicated and takes time to learn about and digest it. But it can help a lot I believe.


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## eric (Jul 8, 1999)

Dave, so you know I owe you an email and will email you as soon.It is really worth reading and understanding some of the info here and how it all applies to IBS, chemical dysregulation and the immune system being triggered via the HPA axis.Sorry to hear about son, maybe this info will help him also. I hope he can get a handle on it and not give up his studies.Your very welcome for the info, I am learning somethings on all this as well as I look into all this and how it applies to IBS and even other conditions.Sorry it long and may take sometime, but with everything IBS the info is always complicated and takes time to learn about and digest it. But it can help a lot I believe.


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## eric (Jul 8, 1999)

The Fight or Flight in Irritable Bowel Syndrome Overactivation Linked To Predominance of Diarrhea Symptoms An intense, powerful "fight-or-flight" response comes in handy when you're running away from a hungry tiger, but it could be the source of misery for people with certain digestive disorders. The chronic gastrointestinal distress of Irritable Bowel Syndrome (IBS) has been linked to "miscommunication" between the gut and the brain. Although it's still unclear just exactly how a glitch in gut-brain interaction sparks specific symptoms, a recent study has uncovered one important potential mechanism in a subgroup of patients. In patients with IBS who regularly experience diarrhea, pain, and other symptoms soon after eating, an "overdominant" sympathetic nervous system - signaled in part by the heightened release of the stress hormone cortisol after eating - may play a key role in triggering their symptoms. Researchers evaluated a group of 24 patients with IBS and a group of healthy controls, measuring their salivary cortisol levels, their heart rates, and their heart rate variabilities at different times of the day. Compared to the controls and to IBS patients with constipation, IBS patients with chronic food-induced diarrhea "demonstrated a significant increase in cortisol" soon after eating - with levels nearly doubling. This subset of patients also showed a more dominant sympathetic nervous system response, as evidenced by their heart rate variability ratios. The sympathetic nervous system tends to mobilize the body's stimulatory "fight-or-flight" response. Normally it's kept in check by the dampening effects of the parasympathetic nervous system. In patients with IBS with diarrhea, however, this muting response (mediated by the vagus nerve) appears weaker - a condition called "vagal withdrawal." "Notably, this vagal withdrawal was significantly associated with patients' reports of gastrointestinal symptoms," the researchers pointed out. These included bloating, abdominal pain, indigestion, and heartburn. A heightened, stimulatory stress response, characterized by overactivation of both the HPA-axis and sympathetic nervous system, may be triggered by "abnormal ascending feedback from the gut," the researchers speculated. NOTE: Two functional assessments help evaluate important dynamics of the gut-brain connection in stress-related gastrointestinal disorders. The Adrenocortex Stress Profile helps to pinpoint HPA-axis abnormalities affectin the body's response to stress, measuring salivary cortisol levels at four times during the day. A single DHEA assay and a DHEA/cortiso ratio is included to evaluate adrenal balance. The Comprehensive Digestive Stool Analysis evaluates microbial balance of the colonic environment, including yeast growth and bacterial balance, and markers for absorptive and digestive function. All of these can be significantly affected by stress. Source: Elsenbruch S, Orr WC. Diarrhea- and constipation-predominant IBS patients differ in postprandial autonomic and cortisol responses Am J Gastroenterol 2001;96(2):460-466.


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## eric (Jul 8, 1999)

The Fight or Flight in Irritable Bowel Syndrome Overactivation Linked To Predominance of Diarrhea Symptoms An intense, powerful "fight-or-flight" response comes in handy when you're running away from a hungry tiger, but it could be the source of misery for people with certain digestive disorders. The chronic gastrointestinal distress of Irritable Bowel Syndrome (IBS) has been linked to "miscommunication" between the gut and the brain. Although it's still unclear just exactly how a glitch in gut-brain interaction sparks specific symptoms, a recent study has uncovered one important potential mechanism in a subgroup of patients. In patients with IBS who regularly experience diarrhea, pain, and other symptoms soon after eating, an "overdominant" sympathetic nervous system - signaled in part by the heightened release of the stress hormone cortisol after eating - may play a key role in triggering their symptoms. Researchers evaluated a group of 24 patients with IBS and a group of healthy controls, measuring their salivary cortisol levels, their heart rates, and their heart rate variabilities at different times of the day. Compared to the controls and to IBS patients with constipation, IBS patients with chronic food-induced diarrhea "demonstrated a significant increase in cortisol" soon after eating - with levels nearly doubling. This subset of patients also showed a more dominant sympathetic nervous system response, as evidenced by their heart rate variability ratios. The sympathetic nervous system tends to mobilize the body's stimulatory "fight-or-flight" response. Normally it's kept in check by the dampening effects of the parasympathetic nervous system. In patients with IBS with diarrhea, however, this muting response (mediated by the vagus nerve) appears weaker - a condition called "vagal withdrawal." "Notably, this vagal withdrawal was significantly associated with patients' reports of gastrointestinal symptoms," the researchers pointed out. These included bloating, abdominal pain, indigestion, and heartburn. A heightened, stimulatory stress response, characterized by overactivation of both the HPA-axis and sympathetic nervous system, may be triggered by "abnormal ascending feedback from the gut," the researchers speculated. NOTE: Two functional assessments help evaluate important dynamics of the gut-brain connection in stress-related gastrointestinal disorders. The Adrenocortex Stress Profile helps to pinpoint HPA-axis abnormalities affectin the body's response to stress, measuring salivary cortisol levels at four times during the day. A single DHEA assay and a DHEA/cortiso ratio is included to evaluate adrenal balance. The Comprehensive Digestive Stool Analysis evaluates microbial balance of the colonic environment, including yeast growth and bacterial balance, and markers for absorptive and digestive function. All of these can be significantly affected by stress. Source: Elsenbruch S, Orr WC. Diarrhea- and constipation-predominant IBS patients differ in postprandial autonomic and cortisol responses Am J Gastroenterol 2001;96(2):460-466.


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## Mike NoLomotil (Jun 6, 2000)

COMMENT on several of many interesting elements in this thread which characterize the discussions in a vacuum which occur when talking about the possible mechanisms involved in symptom provocation in the various IBS populations: _____________________________________________"Although it's stillunclear just exactly how a glitch in gut-brain interaction sparks specific symptoms,a recent study has uncovered one important potential mechanism in a subgroup ofpatients."And"Compared to the controls and to IBS patients with constipation, IBS patients withchronic food-induced diarrhea "demonstrated a significant increase in cortisol" soonafter eating - with levels nearly doubling. This subset of patients also showed amore dominant sympathetic nervous system response, as evidenced by their heartrate variability ratios."And"..may be triggered by "abnormalascending feedback from the gut," the researchers speculated." _________________________________________________This is much clearer than many authors suggest at times by their speculations, as the speculations are at times made in a vaccum from other information that has been revealed elsewhere.There are "already discovered" obvious and quntifiable "glitches" in "brain-gut interractions". The easiest ones to see and qauntify are when an immunoglobulin mediated or chemotoxic or cell-mediated aberrant reaction begins in the small bowel in response to something ingested that the body should NOT respond to with activation of the inflammatory response. This has been duplicated over and over again over the years, and quantified both by chemical analysis and even tissue analysis. In particular with the work that has been done which isolates both immunologic and non-immunologically mediated activation of the inflammatory response system in the small bowel which clearly occurs in a very large % of the population of people diagnosed as having IBS (diarrheic and cyclic populations). What is helpful here is, like quantification of cortisol prodution, we have a known mechanism which can can be observed to produce specific action absent mystery. Each time, though, individual investigatiosn come up short as they look at one or two parameters instead of the rest of the equation as well. In the case of the cortisol investigations, for example, done in a vacuum from other markers, we need to go a step further, of course, and then investigate those physiologic events which regulate the release of cortisol, so as to identify the underlying mechanism which differentiate the two populations. Same with the several CRF studies or observations that are published.In patients where the inflammatory response system of the small bowel and microvasculature is activated (think mast cells as the fixed cells and various "white cell" classes such as lymphocytes, granulocytes, plus macrophages and platelets as the circulating mast cells) the dozens of mediators released include but are not limited to specific chemical mediators which act directly upon the nerves of the enteric nervous system as well as the smooth muscle of the gut wall, the endocrine and exocrine glands of the bowel, and the central nervous system structures as well. Their combined actions provide a tangible explanation via well known physiology for the upregulation of each of the elements of the gastroneuro system that have been quantified in IBS patients. It also can account for aberrations in response to normal endocrine functions as well as upregulation of endocrine function that are at times observed.Each element of the system can serve as a locus for activation of the IRS, and in different people does so at different times. It is not an exclusive domain of stress-response as the locus of IBS, anymore than IgE would be considered a sole locus of immune responses. Though in both cases there renmain people who behave as if it were so.We have to remember, if we want to talk about etiology as opposed to practical clinical treatment, that each of these observations must be made in the context of ALL other observations or we can lead people to form erroneous conclusions about the syndrome. It is certain that the argument in investigatory circles over the chicken-or-the-egg will go on endlessly until the investigatory population as whole is seen to have exposed the fact that there are subpopulations wherein each element of the integrated cns-ens-immune-and -endocrine system can serve as a locus of provocation thus symptoms at varying times.The key is to identifiy which forms of provocation and activation can be easily intervened with to reduce or eliminate symptoms with methods that are as well tolerated and simple as possible, and that those methods need to be integrated to get the best results possible.In addition to the links posted above each IBS victime who suffers from dirahheic predominant or cyclic diarrhea and constipation should also obtain a copy of and read this tutorial...note the link may no longer provide a free copy one may have to order it I did not take time to check. The freebie copy of the tutorial I believe is o longer available and one must pay to get a copy of Zar & Kumars tutorial 'food Hypersemsitivity and irritable Bowel Syndrome. http://www.blackwell-synergy.com/servlet/u...36.2001.00951.x his is because this tutorial is much more complete in its approach to how the central nervous system, enteric nervous system and immune system are fully interactive, and includes a wide array of references which are helpful at understanding some aspects of the ciondition which are often looked at in a vacuum by some authors from the findings of others. This leads to speculation about mechanisms when the mechnism may already have been isolated elsewhere. And some theories then become somehow morphed into pseudofacts. Pay particular attention to "Figure 1 . Pathogenesis of food hypersensitivity induced irritable bowel syndrome."This figure gives a pretty good graphic representation of the inextricable relationships between the ENS, the CNS, and the Immune System and how they interract to modulate gut function (sensorial and motility inclusive).The only thing missing from the diagram is the confirmed involvement of the non-mast cell immunocytes (circulating immunocytes) in precipitating the symptoms of IBS-d and cyclic IBS via activation of the inflammatory response system. The model onyl goes as far as the mast cell system, but that has been quantiifed as incomplete. Proinflammatory mediators are also rleased from localizee circulating immunocytes (lymphocytes, granulocytes, even platelets depending upon which mechanisms are provoked).Take the diagram and draw a line from the NON Ige Mechanisms box down to the Mediators box, then conect the (2) non IgE bioxes together and BINGO you have the WHOLE picture which reflects ALL perspectives of "current hinking", not just one channel of "current thinking". Integration of all the observations to date paints a clearer picture.What remains to be seen is the chicken-or-egg scenarios. By conducting the neurologic activity and immunologic activity studies simultaneously, and using direct jejunal isolation to monitor the sequencing of mediator release in the gut and tracking the systemic proinflammatory mediator release, as well as checking cerebrospinal fluid for which mediators cross over and which are released "endogenously" and under what conditions (as these are the chemicals which can alter the activity level of the varous componenets of each nervous subsystem either directly or as mediators of activation), one day it is hoped the subpopulations can be segregated.Each different mechanism (the chicken-or-egg phenomena) can be segregated, and the populations defined (that is in which patients dose the IRS activation originate via specific immune mechanisms and non-immune mechanisms, and then is amplified by the ENS and CNS, and vice versa, in which patients does it originate in the CNS or ENS and then the IRS is subsequently activated).Since both do occur and have been quantified, it will be of great interest if people working from both directions could collaborate and combine their protocols someday. In such way, for example, as the observations of altered sympathetic and parasympathetic function and/or reaction and/or modulation have mechanisms which are well known and easily observable when there is involvement of elements of the inflammatory response system involved, as there now obviously are in many IBS patients.Heck, just look at the lymphocytic mediators and the mast cell mediator arrays released in IBS patients in response to various forms of provocation&#8230;.right there is a host of chemical origins for the various neurologic and neuromuscular and endocrine changes observable. Nobody has put them all together yet at the same time, however.Eat well. Think well. Be well.MNL


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## Mike NoLomotil (Jun 6, 2000)

COMMENT on several of many interesting elements in this thread which characterize the discussions in a vacuum which occur when talking about the possible mechanisms involved in symptom provocation in the various IBS populations: _____________________________________________"Although it's stillunclear just exactly how a glitch in gut-brain interaction sparks specific symptoms,a recent study has uncovered one important potential mechanism in a subgroup ofpatients."And"Compared to the controls and to IBS patients with constipation, IBS patients withchronic food-induced diarrhea "demonstrated a significant increase in cortisol" soonafter eating - with levels nearly doubling. This subset of patients also showed amore dominant sympathetic nervous system response, as evidenced by their heartrate variability ratios."And"..may be triggered by "abnormalascending feedback from the gut," the researchers speculated." _________________________________________________This is much clearer than many authors suggest at times by their speculations, as the speculations are at times made in a vaccum from other information that has been revealed elsewhere.There are "already discovered" obvious and quntifiable "glitches" in "brain-gut interractions". The easiest ones to see and qauntify are when an immunoglobulin mediated or chemotoxic or cell-mediated aberrant reaction begins in the small bowel in response to something ingested that the body should NOT respond to with activation of the inflammatory response. This has been duplicated over and over again over the years, and quantified both by chemical analysis and even tissue analysis. In particular with the work that has been done which isolates both immunologic and non-immunologically mediated activation of the inflammatory response system in the small bowel which clearly occurs in a very large % of the population of people diagnosed as having IBS (diarrheic and cyclic populations). What is helpful here is, like quantification of cortisol prodution, we have a known mechanism which can can be observed to produce specific action absent mystery. Each time, though, individual investigatiosn come up short as they look at one or two parameters instead of the rest of the equation as well. In the case of the cortisol investigations, for example, done in a vacuum from other markers, we need to go a step further, of course, and then investigate those physiologic events which regulate the release of cortisol, so as to identify the underlying mechanism which differentiate the two populations. Same with the several CRF studies or observations that are published.In patients where the inflammatory response system of the small bowel and microvasculature is activated (think mast cells as the fixed cells and various "white cell" classes such as lymphocytes, granulocytes, plus macrophages and platelets as the circulating mast cells) the dozens of mediators released include but are not limited to specific chemical mediators which act directly upon the nerves of the enteric nervous system as well as the smooth muscle of the gut wall, the endocrine and exocrine glands of the bowel, and the central nervous system structures as well. Their combined actions provide a tangible explanation via well known physiology for the upregulation of each of the elements of the gastroneuro system that have been quantified in IBS patients. It also can account for aberrations in response to normal endocrine functions as well as upregulation of endocrine function that are at times observed.Each element of the system can serve as a locus for activation of the IRS, and in different people does so at different times. It is not an exclusive domain of stress-response as the locus of IBS, anymore than IgE would be considered a sole locus of immune responses. Though in both cases there renmain people who behave as if it were so.We have to remember, if we want to talk about etiology as opposed to practical clinical treatment, that each of these observations must be made in the context of ALL other observations or we can lead people to form erroneous conclusions about the syndrome. It is certain that the argument in investigatory circles over the chicken-or-the-egg will go on endlessly until the investigatory population as whole is seen to have exposed the fact that there are subpopulations wherein each element of the integrated cns-ens-immune-and -endocrine system can serve as a locus of provocation thus symptoms at varying times.The key is to identifiy which forms of provocation and activation can be easily intervened with to reduce or eliminate symptoms with methods that are as well tolerated and simple as possible, and that those methods need to be integrated to get the best results possible.In addition to the links posted above each IBS victime who suffers from dirahheic predominant or cyclic diarrhea and constipation should also obtain a copy of and read this tutorial...note the link may no longer provide a free copy one may have to order it I did not take time to check. The freebie copy of the tutorial I believe is o longer available and one must pay to get a copy of Zar & Kumars tutorial 'food Hypersemsitivity and irritable Bowel Syndrome. http://www.blackwell-synergy.com/servlet/u...36.2001.00951.x his is because this tutorial is much more complete in its approach to how the central nervous system, enteric nervous system and immune system are fully interactive, and includes a wide array of references which are helpful at understanding some aspects of the ciondition which are often looked at in a vacuum by some authors from the findings of others. This leads to speculation about mechanisms when the mechnism may already have been isolated elsewhere. And some theories then become somehow morphed into pseudofacts. Pay particular attention to "Figure 1 . Pathogenesis of food hypersensitivity induced irritable bowel syndrome."This figure gives a pretty good graphic representation of the inextricable relationships between the ENS, the CNS, and the Immune System and how they interract to modulate gut function (sensorial and motility inclusive).The only thing missing from the diagram is the confirmed involvement of the non-mast cell immunocytes (circulating immunocytes) in precipitating the symptoms of IBS-d and cyclic IBS via activation of the inflammatory response system. The model onyl goes as far as the mast cell system, but that has been quantiifed as incomplete. Proinflammatory mediators are also rleased from localizee circulating immunocytes (lymphocytes, granulocytes, even platelets depending upon which mechanisms are provoked).Take the diagram and draw a line from the NON Ige Mechanisms box down to the Mediators box, then conect the (2) non IgE bioxes together and BINGO you have the WHOLE picture which reflects ALL perspectives of "current hinking", not just one channel of "current thinking". Integration of all the observations to date paints a clearer picture.What remains to be seen is the chicken-or-egg scenarios. By conducting the neurologic activity and immunologic activity studies simultaneously, and using direct jejunal isolation to monitor the sequencing of mediator release in the gut and tracking the systemic proinflammatory mediator release, as well as checking cerebrospinal fluid for which mediators cross over and which are released "endogenously" and under what conditions (as these are the chemicals which can alter the activity level of the varous componenets of each nervous subsystem either directly or as mediators of activation), one day it is hoped the subpopulations can be segregated.Each different mechanism (the chicken-or-egg phenomena) can be segregated, and the populations defined (that is in which patients dose the IRS activation originate via specific immune mechanisms and non-immune mechanisms, and then is amplified by the ENS and CNS, and vice versa, in which patients does it originate in the CNS or ENS and then the IRS is subsequently activated).Since both do occur and have been quantified, it will be of great interest if people working from both directions could collaborate and combine their protocols someday. In such way, for example, as the observations of altered sympathetic and parasympathetic function and/or reaction and/or modulation have mechanisms which are well known and easily observable when there is involvement of elements of the inflammatory response system involved, as there now obviously are in many IBS patients.Heck, just look at the lymphocytic mediators and the mast cell mediator arrays released in IBS patients in response to various forms of provocation&#8230;.right there is a host of chemical origins for the various neurologic and neuromuscular and endocrine changes observable. Nobody has put them all together yet at the same time, however.Eat well. Think well. Be well.MNL


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## eric (Jul 8, 1999)

Whats important to recgognize here is there are two mechanisms, serotonin dysregulation first (this is a majorally important factor) and also the HPA malfuntion that sets your gut off regardless of what you eat and before a food may even cause a reaction.It may also be that foods cause a reaction because of the malfuntions preceeding them as one problem.


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## eric (Jul 8, 1999)

Whats important to recgognize here is there are two mechanisms, serotonin dysregulation first (this is a majorally important factor) and also the HPA malfuntion that sets your gut off regardless of what you eat and before a food may even cause a reaction.It may also be that foods cause a reaction because of the malfuntions preceeding them as one problem.


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## Mike NoLomotil (Jun 6, 2000)

"It may also be that foods cause a reaction because of the malfuntions preceeding them as one problem."Of course. And clinically, so what which came first...is the immunologic event primary or an ENS or CNS primary? Clinically does it matter or restirct one from successfully reducing or eliminatign symptoms at this time? No.At times in fact, the primary arming of the IRS it may be quite the opposite and the ENS/CNS consequences the same. For example the so called observed "dysregulating serotonin" may not be "dysregulating" at all but is being dumped by mast cells in the gut wall via IgE mediated local reactions to antigen, t-lymphocyte reactions, macrophage repsonse to immune complexes, and even PAF release in these reactions (inlcuding mast cell response) causes mass amounts of serotonin to be offloaded by platelets in the microvasculature of the gut....any and all events can and do occur primary depending upon the specific population and even the specific momentary event or insult.These events occur independent of ENS and CNS influence, rather will upregulate the ENS and CNS if primary this is the whole point...the inverse also occurs hence the "model" I referred to clearly shoing the cross-talk between the systems.One does not need to know whether the chicken or the egg came first to alleviate the provoking event and eliminate the symptoms, anymore than one needs to know the mechanism of creation a carcinoma to remove it. Perhaps someday we will all be in a Nirvana where everyone looks at everyone elses info objectively and teaches accordingly. But not yet...What IS important is that whether the immunocytes in the samll bowel, where all the action is, are ARMED by specific immunoglobulin, or the cellular reactions are precipitated by complement activation or a cytiotoxic reaction occurs or any one or more of several other mechanisms is MOOT clinically to symptom management/disease managment clincally.Example, IF a food or chemical in a food PROVOKES activation of the IRS when ingested and presented to the immune system via the digestive tract, thus RESULTING in mediator release and upregulation of the smooth muscles, nerves, altered gut permability, the whole chain of events which results in SYMPTOMS and if you have the ability to IDENTIFY WHICH ONES DO IT TO THAT PERSON, then you can teach that person to AVOID the provoking event and thus all that follows as a consequence: symptoms. This is what matters to the patient, not which mechanism was primary.The chicken-egg debate will go on and is just rhetoric until each of the mechanisms has been isolated understood and the populations defined by each event are defined. Since the work is not coordinated, this could take awhile to occur since the objectives are at times at odds (preventive medicien vs. pharmacomedicine vs behavioral medicine). What is of clinical import at this very moment is that since the COMMON END POINT IS THE SAME (mediator release) irrespective of the mechanism, avoid mediator release and avoid symptoms is the therapeutic objective of dietary manipulation in IBS (and other conditions involbving IRS activation). This goes for dietary provocation as well as stress induced provocation.This is why an integrated approach using the best available techniques for both dietary modification and stress reduction produces the best outcomes.So any dietary protocol is only as effective as the tools which support it. If you are not able to isolate all the patient-specific ingestants regardless of mechanism which provoke the IRS activation, your protocol is that much less effective, and thus more dependent on the crutch of pharmacotherapy, just as if ones CBT program, for example, is poorly implemented then the outcomes are compromised.MNL


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## Mike NoLomotil (Jun 6, 2000)

"It may also be that foods cause a reaction because of the malfuntions preceeding them as one problem."Of course. And clinically, so what which came first...is the immunologic event primary or an ENS or CNS primary? Clinically does it matter or restirct one from successfully reducing or eliminatign symptoms at this time? No.At times in fact, the primary arming of the IRS it may be quite the opposite and the ENS/CNS consequences the same. For example the so called observed "dysregulating serotonin" may not be "dysregulating" at all but is being dumped by mast cells in the gut wall via IgE mediated local reactions to antigen, t-lymphocyte reactions, macrophage repsonse to immune complexes, and even PAF release in these reactions (inlcuding mast cell response) causes mass amounts of serotonin to be offloaded by platelets in the microvasculature of the gut....any and all events can and do occur primary depending upon the specific population and even the specific momentary event or insult.These events occur independent of ENS and CNS influence, rather will upregulate the ENS and CNS if primary this is the whole point...the inverse also occurs hence the "model" I referred to clearly shoing the cross-talk between the systems.One does not need to know whether the chicken or the egg came first to alleviate the provoking event and eliminate the symptoms, anymore than one needs to know the mechanism of creation a carcinoma to remove it. Perhaps someday we will all be in a Nirvana where everyone looks at everyone elses info objectively and teaches accordingly. But not yet...What IS important is that whether the immunocytes in the samll bowel, where all the action is, are ARMED by specific immunoglobulin, or the cellular reactions are precipitated by complement activation or a cytiotoxic reaction occurs or any one or more of several other mechanisms is MOOT clinically to symptom management/disease managment clincally.Example, IF a food or chemical in a food PROVOKES activation of the IRS when ingested and presented to the immune system via the digestive tract, thus RESULTING in mediator release and upregulation of the smooth muscles, nerves, altered gut permability, the whole chain of events which results in SYMPTOMS and if you have the ability to IDENTIFY WHICH ONES DO IT TO THAT PERSON, then you can teach that person to AVOID the provoking event and thus all that follows as a consequence: symptoms. This is what matters to the patient, not which mechanism was primary.The chicken-egg debate will go on and is just rhetoric until each of the mechanisms has been isolated understood and the populations defined by each event are defined. Since the work is not coordinated, this could take awhile to occur since the objectives are at times at odds (preventive medicien vs. pharmacomedicine vs behavioral medicine). What is of clinical import at this very moment is that since the COMMON END POINT IS THE SAME (mediator release) irrespective of the mechanism, avoid mediator release and avoid symptoms is the therapeutic objective of dietary manipulation in IBS (and other conditions involbving IRS activation). This goes for dietary provocation as well as stress induced provocation.This is why an integrated approach using the best available techniques for both dietary modification and stress reduction produces the best outcomes.So any dietary protocol is only as effective as the tools which support it. If you are not able to isolate all the patient-specific ingestants regardless of mechanism which provoke the IRS activation, your protocol is that much less effective, and thus more dependent on the crutch of pharmacotherapy, just as if ones CBT program, for example, is poorly implemented then the outcomes are compromised.MNL


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## eric (Jul 8, 1999)

"It may also be that foods cause a reaction because of the malfuntions preceeding them as one problem." Of course. And clinically, so what which came first...is the immunologic event primary or an ENS or CNS primary? Clinically does it matter or restirct one from successfully reducing or eliminatign symptoms at this time? No.To me it matters alot. First the first event maynot be immunologic AT ALL!!!!!!We have already been over the mast cells releasing excess serotonin. Then there is importantly other cells releasing serotonin directly in the gut wall as soon as the gut expands. Serotonin they know is dysregulating from enterochromaffin cells in the gut to the brain and back.An important aspect of this alter fight or flight responce is:"Altered threat appraisal o Leads to fears such as not being close enough to a bathroom ANYTHING EATEN MAY CAUSE ABDOMINAL PAIN." http://www.macmcm.com/pcp/pcp2000_01.htm So yes to me the order of IBS mechanisms MATTER GREATLY. This helps explain alot but it also helps explain why some people who thought food was there problem and then went on lotronex or HT or CBT or other meds ect.. and then found foods weren't so much the problem afterall.The serotonin dysregulation is VERY IMPORTANT and the HPA dysregulation also seems to be very important in this subset of patients which is the majority of IBS patients.


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## eric (Jul 8, 1999)

"It may also be that foods cause a reaction because of the malfuntions preceeding them as one problem." Of course. And clinically, so what which came first...is the immunologic event primary or an ENS or CNS primary? Clinically does it matter or restirct one from successfully reducing or eliminatign symptoms at this time? No.To me it matters alot. First the first event maynot be immunologic AT ALL!!!!!!We have already been over the mast cells releasing excess serotonin. Then there is importantly other cells releasing serotonin directly in the gut wall as soon as the gut expands. Serotonin they know is dysregulating from enterochromaffin cells in the gut to the brain and back.An important aspect of this alter fight or flight responce is:"Altered threat appraisal o Leads to fears such as not being close enough to a bathroom ANYTHING EATEN MAY CAUSE ABDOMINAL PAIN." http://www.macmcm.com/pcp/pcp2000_01.htm So yes to me the order of IBS mechanisms MATTER GREATLY. This helps explain alot but it also helps explain why some people who thought food was there problem and then went on lotronex or HT or CBT or other meds ect.. and then found foods weren't so much the problem afterall.The serotonin dysregulation is VERY IMPORTANT and the HPA dysregulation also seems to be very important in this subset of patients which is the majority of IBS patients.


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## Mike NoLomotil (Jun 6, 2000)

There is too much selective thinking and reading to even begin to expound further as it is futile. You do not understand the clincial context nor the content of what I wrote. And one cannot understand that which one does not wish to.But in passing, I see you still persist with these protestations-from-the-tunnel of "We have already been over the mast cells releasing excess serotonin" dogma, as if this is the only immunologic effector and/or mechanism potentially and actually involved in the IRS activation suffered by IBS victims, and which has been documented and described. You are forgetting all about the REST of the other immunologic and inflammatory mechansims, other specific involved immunocytes and dozens of mediators mediators which have been seen to be involved and provocable.The 'THIS IS VERY IMPORTANT' is rhetorical as no one ever said that the referenced mechanism is NOT improtant. In fact everyone of note all know that each of the involved mechanisms and the mediators of those mechasnisms is important. This is ONE of them. (1). UNO. EINS. Important but ONE. In the context of being singular. Alone. Solitary as in unaccompanied by others. And since this is NOT the case in this Syndrome when one examines all that is known and in all the subpopulations, the exclusionary overemphasis can be misleading to people.What is also very improtant is to understand ALL the mechanisms and ALL the mediators and hormones which regulate gut function and motility and nociception etc etc to understand The Syndrome. AND to be able to understand that "belived to be" or "suggested" or "may prove to be" or "postulated" are qualifiers that must be taken into account when reading and interpreting investigative reports.Also of note is you state with great conviction:"This helps explain alot but it also helps explain why some people who thought food was there problem and then went on lotronex or HT or CBT or other meds ect.. and then found foods weren't so much the problem afterall."This does not explain that. It provides one of many explanations. It only explains it to you satisfactorily because you do not understand nor consider all the origins of mediator release nor the phsyiologic effects upon the integrated CNS-ENS-IRS-Endocrine response. Further it suggests that whatever dietary protocol you may be suggesting to people is not altogether effective. This of course is not unusual since many are not as the premise and tools are inadequate for full effect. So the user and provider are led to false conclusions by an abscence of insight.You cannot block the effector mechanism of a mediator and then state that this proves the provoking mechanism did not exist. In fact the two are wholly independent.Your logic here is akin to stating that Diarrhea Dan, who was experienced severe episodic diarrheic IBS which was proven by blind oral challenge via jejunal isolation to be provoked by ingestion of soy, takes Immodium and the diarrhea stops. So he eats soy and has no diarrhea as long as he keeps pounding Immodium and therefore this proves that the soy was not the provocation in the first place.Nor can you conclude that a patient who has regained a measure of oral tolerance following behavioral therpay and who is now on antidepressant therapy is indicative that they never suffered from or still experience clinical or subclinical oral provocation.Sufficient bandwidth and time does not exist to reteach over and over the interractive mechanisms in such detail that one is accsued of wasting people valuable eyeball time. That is why it takes hundreds of pages for an immunolgist/allergist to do it, and the new medical textbook on the subject which is pending publication is over 1,000 pages long. It is not a throwaway subject.One either reads the studies, the cases, the books on the subject and sees how the phenomenon fits into the picture or chooses not to. Choosing not to does not alter what is factual. If you understood the mechanisms in toto you would understand why this is an effort to create a controversy where non exists, and you would also understand more than one or two mechansism by which the symptom sets seen in IBS patients are generated and explainable and manageable. You would also understand more than one mechanism by which oral tolerance is regained, including buit not limited to attenuative therapies and immunomodulation, rather than persistently interpreting clinical data narrowly and even wrongly and presenting that interpretation or conclusion as "proof" of a specific contention, when in fact in many cases it may be quite the opposite of the conclusion set forth.


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## Mike NoLomotil (Jun 6, 2000)

There is too much selective thinking and reading to even begin to expound further as it is futile. You do not understand the clincial context nor the content of what I wrote. And one cannot understand that which one does not wish to.But in passing, I see you still persist with these protestations-from-the-tunnel of "We have already been over the mast cells releasing excess serotonin" dogma, as if this is the only immunologic effector and/or mechanism potentially and actually involved in the IRS activation suffered by IBS victims, and which has been documented and described. You are forgetting all about the REST of the other immunologic and inflammatory mechansims, other specific involved immunocytes and dozens of mediators mediators which have been seen to be involved and provocable.The 'THIS IS VERY IMPORTANT' is rhetorical as no one ever said that the referenced mechanism is NOT improtant. In fact everyone of note all know that each of the involved mechanisms and the mediators of those mechasnisms is important. This is ONE of them. (1). UNO. EINS. Important but ONE. In the context of being singular. Alone. Solitary as in unaccompanied by others. And since this is NOT the case in this Syndrome when one examines all that is known and in all the subpopulations, the exclusionary overemphasis can be misleading to people.What is also very improtant is to understand ALL the mechanisms and ALL the mediators and hormones which regulate gut function and motility and nociception etc etc to understand The Syndrome. AND to be able to understand that "belived to be" or "suggested" or "may prove to be" or "postulated" are qualifiers that must be taken into account when reading and interpreting investigative reports.Also of note is you state with great conviction:"This helps explain alot but it also helps explain why some people who thought food was there problem and then went on lotronex or HT or CBT or other meds ect.. and then found foods weren't so much the problem afterall."This does not explain that. It provides one of many explanations. It only explains it to you satisfactorily because you do not understand nor consider all the origins of mediator release nor the phsyiologic effects upon the integrated CNS-ENS-IRS-Endocrine response. Further it suggests that whatever dietary protocol you may be suggesting to people is not altogether effective. This of course is not unusual since many are not as the premise and tools are inadequate for full effect. So the user and provider are led to false conclusions by an abscence of insight.You cannot block the effector mechanism of a mediator and then state that this proves the provoking mechanism did not exist. In fact the two are wholly independent.Your logic here is akin to stating that Diarrhea Dan, who was experienced severe episodic diarrheic IBS which was proven by blind oral challenge via jejunal isolation to be provoked by ingestion of soy, takes Immodium and the diarrhea stops. So he eats soy and has no diarrhea as long as he keeps pounding Immodium and therefore this proves that the soy was not the provocation in the first place.Nor can you conclude that a patient who has regained a measure of oral tolerance following behavioral therpay and who is now on antidepressant therapy is indicative that they never suffered from or still experience clinical or subclinical oral provocation.Sufficient bandwidth and time does not exist to reteach over and over the interractive mechanisms in such detail that one is accsued of wasting people valuable eyeball time. That is why it takes hundreds of pages for an immunolgist/allergist to do it, and the new medical textbook on the subject which is pending publication is over 1,000 pages long. It is not a throwaway subject.One either reads the studies, the cases, the books on the subject and sees how the phenomenon fits into the picture or chooses not to. Choosing not to does not alter what is factual. If you understood the mechanisms in toto you would understand why this is an effort to create a controversy where non exists, and you would also understand more than one or two mechansism by which the symptom sets seen in IBS patients are generated and explainable and manageable. You would also understand more than one mechanism by which oral tolerance is regained, including buit not limited to attenuative therapies and immunomodulation, rather than persistently interpreting clinical data narrowly and even wrongly and presenting that interpretation or conclusion as "proof" of a specific contention, when in fact in many cases it may be quite the opposite of the conclusion set forth.


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## eric (Jul 8, 1999)

FYI"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.aboutibs.org/Publications/pastParticipate.html For anyone following this thread that has fibro or cfs should do a search on the fight or flight and cfs or fibro and see what you come up with.


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## eric (Jul 8, 1999)

FYI"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.aboutibs.org/Publications/pastParticipate.html For anyone following this thread that has fibro or cfs should do a search on the fight or flight and cfs or fibro and see what you come up with.


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## eric (Jul 8, 1999)

FYI"Mother Brain and Baby BrainWhat's the deal withS T R E S S?A plague of butterflyies swarms the stomache beforean exam, when a deadline approaches, after arelationship ends. "Why the butterflies?" a nervousboss wondered recently gripping his abdomen. Thequest for an answer to this seemingly simple question required a queasyjourney into the world of stress and the digestive system. The body really hastwo brains - the mind's brain, and the digestive system's own nervous system Ultimately, the brain in your head rules all the organs. But when it comes to self-knowledge, perhaps the gut - which refers to the entire digestive system, from mouth to anus - may know best. Of course, not everyone gets butterflies. Some vomit.Some have diarrhea. Some suffer constipation. Why people react in differentways isn't known."Who's controlling things? asks University of Ottawa scientist AnthonyKrantis in his broad Australian accent. A neuroscientist, Krantis originallywanted to investigate the brain for his PhD thesis years ago. But in the end,he settled on researching nerves of the gut.The nervous system of the gut now fascinates Krantis. Also known as theenteric nervous system, the little brain is a collection of nerves lining the wallsof the digestive system. Huge, in fact, the little brain contains as many nerve cells as the spinal cord.Many of its chemicals are also found in the actual brain. To study nerves,the gut is so much more accessible than the brain, Krantis says. Sever the gut from the rest of the body, stick it in a special bath and,remarkably, it still works, sweeping particles along rhythmically. The bossisn't the only one with queries about the digestive system. For researchers,there are still many unanswered questions.Krantis, part of a University of Ottawa digestive diseases group, isdiscouraged that the scientific world doesn't pay enough attention to thedigestive system. Digestive diseases aren't usually fatal, but they're severelydebilitating. He says they aren't considered "sexy", a word medical scientistsoften use to describe research into heart disease, cancer or AIDS.Krantis wants to know how the nerves of the digestive tract work normally,and how they become disrupted in digestive diseases. He's studying disorderssuch as inflammatory bowel disease and Hirschsprung's disease, a congenitalnerve problem of the gut.The digestive system, even with its own brain, is intimately connected to themain brain through paths along nerves. This is where stress comes in. When being chased by a tiger, for example, digestion isn't a priority. Bloodand oxygen are better sent to the heart, the muscles, the lungs. So the braindecides to shut down the gut. It seems to do that by wreaking havoc onnormal gut functions. It's this kind of disruption that produces the digestive symptoms associatedwith stress, says Krantis, who occasionally get knots in his stomach whenstressed and in his spare time wonders why Pepto-Bismol is pink.Butterflies are small muscle contractions in the digestive tract, directed bynerve signals from the brain, summarizes Mary Perdue, head of an intestinaldiseases group at McMaster University in Hamilton.Perdue, who studies stress and digestive disorders such as the painfulirritable bowel syndrome likens the butterfly response to an asthma attack inthe lungs. Asthma attacks can also be provoked by stress.In short, butterflies arise when a higher power doesn't consider the digestivesystem vital at the moment. Thus disrupted, the gut's normallywell-orchestrated muscles contract in an odd way that the mind canperceive. In essence, the gut is robbed of grace.And that's really the best answer to the butterfly question. The truth is,butterflies aren't well-understood. Nor are the other digestive symptoms ofnervousness. "We don't understand vomiting yet. We're still trying to cometo grips with it," Krantis says. The subject is important, he adds, becausevomiting is a major side effect of chemotherapy. Under normal circumstances, the body vomits to rid itself of an infectiousorganism or harmful substance. Such a radical response during emotionalstress doesn't seem to make sense. Krantis believes the gut itself triggersvomiting ï¿½ even though a centre exists in the stem of the brain. Again,which "brain" is in control? Although the gut seems overly sensitive, Krantis is astonished it can take theabuse it gets, exposed as it is to infectious organisms that come in throughthe mouth. Think of the gut as an open window to the elements, moreoutside the body than inside it. That's why the digestive system is also animportant immune organ. Interestingly, immune cells in the gut are partlyunder the control of nerves. "Through her research, Perdue has discovered that the digestive liningbecomes leakier under stress, allowing harmful chemicals and even infectiousorganisms to creep inside the body.""We should listen to signals from the digestive system," says Perdue. Inother words, when the gut senses trouble, try to take it easy. It may knowyou better than you know yourself!"


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## eric (Jul 8, 1999)

FYI"Mother Brain and Baby BrainWhat's the deal withS T R E S S?A plague of butterflyies swarms the stomache beforean exam, when a deadline approaches, after arelationship ends. "Why the butterflies?" a nervousboss wondered recently gripping his abdomen. Thequest for an answer to this seemingly simple question required a queasyjourney into the world of stress and the digestive system. The body really hastwo brains - the mind's brain, and the digestive system's own nervous system Ultimately, the brain in your head rules all the organs. But when it comes to self-knowledge, perhaps the gut - which refers to the entire digestive system, from mouth to anus - may know best. Of course, not everyone gets butterflies. Some vomit.Some have diarrhea. Some suffer constipation. Why people react in differentways isn't known."Who's controlling things? asks University of Ottawa scientist AnthonyKrantis in his broad Australian accent. A neuroscientist, Krantis originallywanted to investigate the brain for his PhD thesis years ago. But in the end,he settled on researching nerves of the gut.The nervous system of the gut now fascinates Krantis. Also known as theenteric nervous system, the little brain is a collection of nerves lining the wallsof the digestive system. Huge, in fact, the little brain contains as many nerve cells as the spinal cord.Many of its chemicals are also found in the actual brain. To study nerves,the gut is so much more accessible than the brain, Krantis says. Sever the gut from the rest of the body, stick it in a special bath and,remarkably, it still works, sweeping particles along rhythmically. The bossisn't the only one with queries about the digestive system. For researchers,there are still many unanswered questions.Krantis, part of a University of Ottawa digestive diseases group, isdiscouraged that the scientific world doesn't pay enough attention to thedigestive system. Digestive diseases aren't usually fatal, but they're severelydebilitating. He says they aren't considered "sexy", a word medical scientistsoften use to describe research into heart disease, cancer or AIDS.Krantis wants to know how the nerves of the digestive tract work normally,and how they become disrupted in digestive diseases. He's studying disorderssuch as inflammatory bowel disease and Hirschsprung's disease, a congenitalnerve problem of the gut.The digestive system, even with its own brain, is intimately connected to themain brain through paths along nerves. This is where stress comes in. When being chased by a tiger, for example, digestion isn't a priority. Bloodand oxygen are better sent to the heart, the muscles, the lungs. So the braindecides to shut down the gut. It seems to do that by wreaking havoc onnormal gut functions. It's this kind of disruption that produces the digestive symptoms associatedwith stress, says Krantis, who occasionally get knots in his stomach whenstressed and in his spare time wonders why Pepto-Bismol is pink.Butterflies are small muscle contractions in the digestive tract, directed bynerve signals from the brain, summarizes Mary Perdue, head of an intestinaldiseases group at McMaster University in Hamilton.Perdue, who studies stress and digestive disorders such as the painfulirritable bowel syndrome likens the butterfly response to an asthma attack inthe lungs. Asthma attacks can also be provoked by stress.In short, butterflies arise when a higher power doesn't consider the digestivesystem vital at the moment. Thus disrupted, the gut's normallywell-orchestrated muscles contract in an odd way that the mind canperceive. In essence, the gut is robbed of grace.And that's really the best answer to the butterfly question. The truth is,butterflies aren't well-understood. Nor are the other digestive symptoms ofnervousness. "We don't understand vomiting yet. We're still trying to cometo grips with it," Krantis says. The subject is important, he adds, becausevomiting is a major side effect of chemotherapy. Under normal circumstances, the body vomits to rid itself of an infectiousorganism or harmful substance. Such a radical response during emotionalstress doesn't seem to make sense. Krantis believes the gut itself triggersvomiting ï¿½ even though a centre exists in the stem of the brain. Again,which "brain" is in control? Although the gut seems overly sensitive, Krantis is astonished it can take theabuse it gets, exposed as it is to infectious organisms that come in throughthe mouth. Think of the gut as an open window to the elements, moreoutside the body than inside it. That's why the digestive system is also animportant immune organ. Interestingly, immune cells in the gut are partlyunder the control of nerves. "Through her research, Perdue has discovered that the digestive liningbecomes leakier under stress, allowing harmful chemicals and even infectiousorganisms to creep inside the body.""We should listen to signals from the digestive system," says Perdue. Inother words, when the gut senses trouble, try to take it easy. It may knowyou better than you know yourself!"


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## JeanG (Oct 20, 1999)

Thanks for posting these articles, Eric.







Stress can really cause problems with the digestive system, that's for sure. I find that the more I practice the relaxation and other techniques learned in the hypno tapes, the less stress I have, and the better my health is overall, not only the digestive system. I really think learning how to destress is key for me.JeanG


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## JeanG (Oct 20, 1999)

Thanks for posting these articles, Eric.







Stress can really cause problems with the digestive system, that's for sure. I find that the more I practice the relaxation and other techniques learned in the hypno tapes, the less stress I have, and the better my health is overall, not only the digestive system. I really think learning how to destress is key for me.JeanG


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## ohnometo (Sep 20, 2001)

I have been on Lotronex, celexa, paxil, prozac, zolof, bentyl, levisin, levibid, phenegran, zofran, ativan, every pain medicine, and hundreds of other pills and nothing stopped my symptomsthe anti-spasmodics would help sometimes when it wasnt real bad but forget the rest...For meFood has played a huge part in my IBS-D ( I am off of all medicine now and have been for a while) and I understand food dont play a part in everyone's. but so far it is working for me when no other methods ever worked.....If foods is that rare in playing a part with IBS-D and Cyclic Vomiting Syndrome.. I must consider myself the luckiest person in the world or all my praying over atLourdes worked.....What ever is working in my life today I just need to keep doing tomorrowwhat I did today and stay away from what is making me sick ......My illness caused so much anxietyin my life for many years but when I started to feel so much better physically ...mentally I got much better....and the only anxiety I get now is being able to go to the stores and spend money !!!!! Wherei hadnt been able to go shopping for along time and really enjoy it...now I dont have to shop on E-Bay I can get in the car and go....... I believe stress can play a huge part in IBS !!! I am only putting here what is working for me and the difference it makes is amazing ...Fight or Flight SyndromeI was always fighting ...instead of going with the flow....Getting rid of the food and chemicalswas a blessing for me....Donna QUOTE*******************************************************************************************************"This helps explain alot but it also helps explain why some people who thought food was there problem and then went on lotronex or HT or CBT or other meds ect.. and then found foods weren't so much the problem afterall."


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## ohnometo (Sep 20, 2001)

I have been on Lotronex, celexa, paxil, prozac, zolof, bentyl, levisin, levibid, phenegran, zofran, ativan, every pain medicine, and hundreds of other pills and nothing stopped my symptomsthe anti-spasmodics would help sometimes when it wasnt real bad but forget the rest...For meFood has played a huge part in my IBS-D ( I am off of all medicine now and have been for a while) and I understand food dont play a part in everyone's. but so far it is working for me when no other methods ever worked.....If foods is that rare in playing a part with IBS-D and Cyclic Vomiting Syndrome.. I must consider myself the luckiest person in the world or all my praying over atLourdes worked.....What ever is working in my life today I just need to keep doing tomorrowwhat I did today and stay away from what is making me sick ......My illness caused so much anxietyin my life for many years but when I started to feel so much better physically ...mentally I got much better....and the only anxiety I get now is being able to go to the stores and spend money !!!!! Wherei hadnt been able to go shopping for along time and really enjoy it...now I dont have to shop on E-Bay I can get in the car and go....... I believe stress can play a huge part in IBS !!! I am only putting here what is working for me and the difference it makes is amazing ...Fight or Flight SyndromeI was always fighting ...instead of going with the flow....Getting rid of the food and chemicalswas a blessing for me....Donna QUOTE*******************************************************************************************************"This helps explain alot but it also helps explain why some people who thought food was there problem and then went on lotronex or HT or CBT or other meds ect.. and then found foods weren't so much the problem afterall."


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## eric (Jul 8, 1999)

FYI Dig Dis 2001;19(3):212-8 Related Articles, Books, LinkOut Basic pathophysiologic mechanisms in irritable bowel syndrome. Mayer EA, Naliboff BD, Chang L. UCLA/CURE Neuroenteric Disease Program, Department of Medicine, Physiology and Biobehavioral Sciences, UCLA School of Medicine, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA. emayer###ucla.edu Converging evidence supports the concept that the irritable bowel syndrome (IBS) symptom complex results from altered regulation of gastrointestinal motility and epithelial function, as well as an altered perception of visceral events. Despite similar symptoms, there is likely heterogeneity of underlying dysfunction and pathogenesis in different subgroups of IBS patients: the syndrome may be produced by primary alterations in the central nervous system (CNS; top down model), or by primary alterations in the periphery (bottom up model), or by a combination of both. One plausible mechanism by which alterations in the CNS result in symptoms, is the enhanced responsiveness of central stress/emotion circuits. The physiological effects of psychological and physical stressors on gut function and brain-gut interactions are mediated by outputs of the emotional motor system in terms of autonomic, neuroendocrine, attentional and pain modulatory responses. IBS patients show an enhanced responsiveness of this system manifesting in altered modulation of gastrointestinal motility, secretion, immune function and in alterations in the perceptual and emotional response to visceral events. Copyright 2001 S. Karger AG, Basel Publication Types: Review Review, Tutorial PMID: 11752839Am J Physiol Gastrointest Liver Physiol 2001 Mar;280(3):G315-8 Related Articles, Books, LinkOut Stress and the Gastrointestinal Tract IV. Modulation of intestinal inflammation by stress: basic mechanisms and clinical relevance. Collins SM. McMaster University Medical Centre, Hamilton, Ontario L8N 3Z5, Canada. scollins###fhs.mcmaster.ca The stress response in a healthy organism is generally viewed as a warning and thus a protective reaction to a threat. However, the response may be deleterious if it is linked to an inflammatory stimulus or if it proceeds an inflammatory event. Prior stress enhances the response to an inflammatory stimulus by a mechanism that is independent of the release of hypothalamic corticotropin-releasing factor (CRF) or arginine vasopressin. Putative mechanisms include an increase in intestinal permeability as well as the release of the proinflammatory neuropeptide substance P. Stress may also reactivate previous inflammation when applied in conjunction with a small luminal stimulus. This reactivation involves increased permeability and requires the presence of T lymphocytes. Inflammatory mediators activate hypothalamic pathways, and a negative feedback loop, mediated by CRF release, has been proposed because animals with impaired hypothalamic CRF responses are more susceptible to inflammatory stimuli. Together, these experimental observations provide insights into the expression of inflammatory disorders in humans, including inflammatory bowel disease and postinfective irritable bowel syndrome. Publication Types: Review Review, Tutorial PMID: 11171612 Dig Dis 2001;19(3):201-11 Related Articles, Books, LinkOut Role of stress in functional gastrointestinal disorders. Evidence for stress-induced alterations in gastrointestinal motility and sensitivity. Monnikes H, Tebbe JJ, Hildebrandt M, Arck P, Osmanoglou E, Rose M, Klapp B, Wiedenmann B, Heymann-Monnikes I. Department of Medicine, Division of Hepatology and Gastroenterology, Universitatsklinikum Charite, Campus Virchow-Klinikum, Humboldt-Universitat zu Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany. Psychological stress is widely believed to play a major role in functional gastrointestinal (GI) disorders, especially irritable bowel syndrome (IBS), by precipitating exacerbation of symptoms. The available data clearly demonstrate that inhibition of gastric emptying and stimulation of colonic transit is the most consistent pattern in the motility response of the GI tract to acute or short-term stress. Thus, one might propose that these alterations might play a pathophysiological role in dyspeptic symptoms and alterations in stool frequency and consistency in patients with stress-related functional GI disorders. Taken together, the above-mentioned studies suggest that the colonic motor response to stress is exaggerated in IBS. There is evidence that an increased emotional response is associated with this difference in colonic, and perhaps also gastric motor responses to certain stressors. However, almost no valid data are available so far from human studies addressing the question if differences in motility responses to stress between patients with functional GI disorders and healthy subjects are due to an altered stress response associated with an imbalance of the autonomic nervous system or increased stress susceptibility. We can summarize that in experimental animals the most consistent pattern of GI motor alterations induced by various psychological and physical stressors is that of delaying gastric emptying and accelerating colonic transit. Endogenous corticotropin-releasing factor (CRF) in the brain plays a significant role in the central nervous system mediation of stress-induced inhibition of upper GI and stimulation of lower GI motor function through activation of brain CRF receptors. The inhibition of gastric emptying by CRF may be mediated by interaction with the CRF-2 receptor, while CRF-1 receptors are involved in the colonic and anxiogenic responses to stress. Endogenous serotonin, peripherally released in response to stress, seems to be involved in stress- and central CRF-induced stimulation of colonic motility by acting on 5HT-3 receptors. Taken together, the limited data available from investigations in healthy subjects and patients with functional GI disorders provide some evidence that stress affects visceral sensitivity in humans. Acute psychological stress seems to facilitate increased sensitivity to experimental visceral stimuli, if the stressor induces a significant emotional change. In summary, studies in experimental animals suggest that stress-induced visceral hypersensitivity is centrally mediated by endogenous CRF and involvement of structures of the emotional motor system, e.g. the amygdala. Stress-induced activation or sensitization of mucosal mast cells in the GI tract seem to be involved in stress-associated alterations of visceral sensitivity. Copyright 2001 S. Karger AG, Basel Publication Types: Review Review, Tutorial PMID: 11752838


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## eric (Jul 8, 1999)

FYI Dig Dis 2001;19(3):212-8 Related Articles, Books, LinkOut Basic pathophysiologic mechanisms in irritable bowel syndrome. Mayer EA, Naliboff BD, Chang L. UCLA/CURE Neuroenteric Disease Program, Department of Medicine, Physiology and Biobehavioral Sciences, UCLA School of Medicine, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA. emayer###ucla.edu Converging evidence supports the concept that the irritable bowel syndrome (IBS) symptom complex results from altered regulation of gastrointestinal motility and epithelial function, as well as an altered perception of visceral events. Despite similar symptoms, there is likely heterogeneity of underlying dysfunction and pathogenesis in different subgroups of IBS patients: the syndrome may be produced by primary alterations in the central nervous system (CNS; top down model), or by primary alterations in the periphery (bottom up model), or by a combination of both. One plausible mechanism by which alterations in the CNS result in symptoms, is the enhanced responsiveness of central stress/emotion circuits. The physiological effects of psychological and physical stressors on gut function and brain-gut interactions are mediated by outputs of the emotional motor system in terms of autonomic, neuroendocrine, attentional and pain modulatory responses. IBS patients show an enhanced responsiveness of this system manifesting in altered modulation of gastrointestinal motility, secretion, immune function and in alterations in the perceptual and emotional response to visceral events. Copyright 2001 S. Karger AG, Basel Publication Types: Review Review, Tutorial PMID: 11752839Am J Physiol Gastrointest Liver Physiol 2001 Mar;280(3):G315-8 Related Articles, Books, LinkOut Stress and the Gastrointestinal Tract IV. Modulation of intestinal inflammation by stress: basic mechanisms and clinical relevance. Collins SM. McMaster University Medical Centre, Hamilton, Ontario L8N 3Z5, Canada. scollins###fhs.mcmaster.ca The stress response in a healthy organism is generally viewed as a warning and thus a protective reaction to a threat. However, the response may be deleterious if it is linked to an inflammatory stimulus or if it proceeds an inflammatory event. Prior stress enhances the response to an inflammatory stimulus by a mechanism that is independent of the release of hypothalamic corticotropin-releasing factor (CRF) or arginine vasopressin. Putative mechanisms include an increase in intestinal permeability as well as the release of the proinflammatory neuropeptide substance P. Stress may also reactivate previous inflammation when applied in conjunction with a small luminal stimulus. This reactivation involves increased permeability and requires the presence of T lymphocytes. Inflammatory mediators activate hypothalamic pathways, and a negative feedback loop, mediated by CRF release, has been proposed because animals with impaired hypothalamic CRF responses are more susceptible to inflammatory stimuli. Together, these experimental observations provide insights into the expression of inflammatory disorders in humans, including inflammatory bowel disease and postinfective irritable bowel syndrome. Publication Types: Review Review, Tutorial PMID: 11171612 Dig Dis 2001;19(3):201-11 Related Articles, Books, LinkOut Role of stress in functional gastrointestinal disorders. Evidence for stress-induced alterations in gastrointestinal motility and sensitivity. Monnikes H, Tebbe JJ, Hildebrandt M, Arck P, Osmanoglou E, Rose M, Klapp B, Wiedenmann B, Heymann-Monnikes I. Department of Medicine, Division of Hepatology and Gastroenterology, Universitatsklinikum Charite, Campus Virchow-Klinikum, Humboldt-Universitat zu Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany. Psychological stress is widely believed to play a major role in functional gastrointestinal (GI) disorders, especially irritable bowel syndrome (IBS), by precipitating exacerbation of symptoms. The available data clearly demonstrate that inhibition of gastric emptying and stimulation of colonic transit is the most consistent pattern in the motility response of the GI tract to acute or short-term stress. Thus, one might propose that these alterations might play a pathophysiological role in dyspeptic symptoms and alterations in stool frequency and consistency in patients with stress-related functional GI disorders. Taken together, the above-mentioned studies suggest that the colonic motor response to stress is exaggerated in IBS. There is evidence that an increased emotional response is associated with this difference in colonic, and perhaps also gastric motor responses to certain stressors. However, almost no valid data are available so far from human studies addressing the question if differences in motility responses to stress between patients with functional GI disorders and healthy subjects are due to an altered stress response associated with an imbalance of the autonomic nervous system or increased stress susceptibility. We can summarize that in experimental animals the most consistent pattern of GI motor alterations induced by various psychological and physical stressors is that of delaying gastric emptying and accelerating colonic transit. Endogenous corticotropin-releasing factor (CRF) in the brain plays a significant role in the central nervous system mediation of stress-induced inhibition of upper GI and stimulation of lower GI motor function through activation of brain CRF receptors. The inhibition of gastric emptying by CRF may be mediated by interaction with the CRF-2 receptor, while CRF-1 receptors are involved in the colonic and anxiogenic responses to stress. Endogenous serotonin, peripherally released in response to stress, seems to be involved in stress- and central CRF-induced stimulation of colonic motility by acting on 5HT-3 receptors. Taken together, the limited data available from investigations in healthy subjects and patients with functional GI disorders provide some evidence that stress affects visceral sensitivity in humans. Acute psychological stress seems to facilitate increased sensitivity to experimental visceral stimuli, if the stressor induces a significant emotional change. In summary, studies in experimental animals suggest that stress-induced visceral hypersensitivity is centrally mediated by endogenous CRF and involvement of structures of the emotional motor system, e.g. the amygdala. Stress-induced activation or sensitization of mucosal mast cells in the GI tract seem to be involved in stress-associated alterations of visceral sensitivity. Copyright 2001 S. Karger AG, Basel Publication Types: Review Review, Tutorial PMID: 11752838


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## JeanG (Oct 20, 1999)

Thanks again, Eric. I'm so glad I discovered that food has absolutely nothing at all to do with IBS shortly after mine started. That way I didn't have to go down the route of denying myself food, thinking that it was the culprit, when it wasn't at all. Learning how to relax and destress, which is so pleasant and calming, is a much better route to go.JeanG


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## JeanG (Oct 20, 1999)

Thanks again, Eric. I'm so glad I discovered that food has absolutely nothing at all to do with IBS shortly after mine started. That way I didn't have to go down the route of denying myself food, thinking that it was the culprit, when it wasn't at all. Learning how to relax and destress, which is so pleasant and calming, is a much better route to go.JeanG


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## Mike NoLomotil (Jun 6, 2000)

"...food has nothing at all to do with IBS"Now That's funny.







Remind me to tell you all the story of idiopathic rhinitis sometime when I have time to blow on non-issues. The whole approach to IBS presented by many folks is the same kind of selectivity and extension of possiblity into fact, and unobserved-data as nonexistent as was once true of that and many other so-called idopathic or functional diseases. It parrallels perfectly what is going on in IBS research fir years. Another laugher.In addition to the info posted above one should also read this tutorial...note the link may no longer provide a free copy one may have to order it I did not take time to check. http://www.blackwell-synergy.com/servlet/userag ent?func=synergy&synergyAction=showFullText&doi=10.1046/j.1365-2036.2001.00951.x[/URL]Pay particular attention to "Figure 1 . Pathogenesis of food hypersensitivity induced irritable bowel syndrome."This figure gives a pretty good graphic representation of the inextricable relationships between the ENS, the CNS, and the Immune System and how they interract to modulate gut function (sensorial and motility inclusive).The only thing missing from the diagram is the confirmed involvement of the non-mast cell immunocytes (circulating immunocytes) in precipitating the symptoms of IBS-d and cyclic IBS via activation of the inflammatory response system. The model only goes as far as the mast cell system, but that has been quantified as incomplete. Proinflammatory mediators are also released from localized circulating immunocytes (lymphocytes, granulocytes, even platelets depending upon which mechanisms are provoked).Take the diagram and draw a line from the NON IgE Mechanisms box down to the Mediators box, then conect the (2) non IgE boxes together and BINGO you have the WHOLE picture which reflects ALL perspectives of "current thinking", not just one channel of "current thinking". Integration of all the observations to date paints a clearer picture.In Donnas case she suffered from both a primary humoral reactions to antigen which could not be detected by allergy testing as it is localized, as well as cellular antigenic reactions which when isolated with MRT testding and removed elicited remission. To assist her in improving her stress and anxiety coping skills and to reduce the learned behaviors associated with her severe symptoms her program also included this stress reduction program from these doctors www.ibstherapy.com.







Hey, Donna, how did you REALLY do it? Faith healing?







Eat well think well be well.MNL


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## Mike NoLomotil (Jun 6, 2000)

"...food has nothing at all to do with IBS"Now That's funny.







Remind me to tell you all the story of idiopathic rhinitis sometime when I have time to blow on non-issues. The whole approach to IBS presented by many folks is the same kind of selectivity and extension of possiblity into fact, and unobserved-data as nonexistent as was once true of that and many other so-called idopathic or functional diseases. It parrallels perfectly what is going on in IBS research fir years. Another laugher.In addition to the info posted above one should also read this tutorial...note the link may no longer provide a free copy one may have to order it I did not take time to check. http://www.blackwell-synergy.com/servlet/userag ent?func=synergy&synergyAction=showFullText&doi=10.1046/j.1365-2036.2001.00951.x[/URL]Pay particular attention to "Figure 1 . Pathogenesis of food hypersensitivity induced irritable bowel syndrome."This figure gives a pretty good graphic representation of the inextricable relationships between the ENS, the CNS, and the Immune System and how they interract to modulate gut function (sensorial and motility inclusive).The only thing missing from the diagram is the confirmed involvement of the non-mast cell immunocytes (circulating immunocytes) in precipitating the symptoms of IBS-d and cyclic IBS via activation of the inflammatory response system. The model only goes as far as the mast cell system, but that has been quantified as incomplete. Proinflammatory mediators are also released from localized circulating immunocytes (lymphocytes, granulocytes, even platelets depending upon which mechanisms are provoked).Take the diagram and draw a line from the NON IgE Mechanisms box down to the Mediators box, then conect the (2) non IgE boxes together and BINGO you have the WHOLE picture which reflects ALL perspectives of "current thinking", not just one channel of "current thinking". Integration of all the observations to date paints a clearer picture.In Donnas case she suffered from both a primary humoral reactions to antigen which could not be detected by allergy testing as it is localized, as well as cellular antigenic reactions which when isolated with MRT testding and removed elicited remission. To assist her in improving her stress and anxiety coping skills and to reduce the learned behaviors associated with her severe symptoms her program also included this stress reduction program from these doctors www.ibstherapy.com.







Hey, Donna, how did you REALLY do it? Faith healing?







Eat well think well be well.MNL


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## JeanG (Oct 20, 1999)

Mike:You obviously have problems with people who don't believe the way you do, and have found that food has nothing to do with it. Many of us here feel the same way. Get over it. You can't force people to think way you do.JeanG


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## JeanG (Oct 20, 1999)

Mike:You obviously have problems with people who don't believe the way you do, and have found that food has nothing to do with it. Many of us here feel the same way. Get over it. You can't force people to think way you do.JeanG


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## Mike NoLomotil (Jun 6, 2000)

__________________________________"You obviously have problems with people who don't believe the way you do, and have found that food has nothing to do with it. Many of us here feel the same way. Get over it. You can't force people to think way you do." ___________________________________Not at all. I have a problem with people who make flat statements to sick people which are patently incorrect as the one you made is.If they accept it as correct, a populaton of "many" of them (who also dwell here and elsewhere) will suffer needlessly as they will not pursue potentially benefical therapeutics. After 30 years in healthcare this is not something I am going to "get over", nor should I.Now, if you qualify your statement that, in YOUR CASE, you found "food" had nothing to do with your symptoms, that is appropriate as it may very well be correct, and correct for a population of patients with the same history and physical findings as you.But you did not say that. If it offends you when someone points out a patently erroneous statement when it is made, then perhaps you need to reexamine your own motives, not those of the person who points out the error, and takes the time to try to explain to the sick why it is an error.MNL


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## Mike NoLomotil (Jun 6, 2000)

__________________________________"You obviously have problems with people who don't believe the way you do, and have found that food has nothing to do with it. Many of us here feel the same way. Get over it. You can't force people to think way you do." ___________________________________Not at all. I have a problem with people who make flat statements to sick people which are patently incorrect as the one you made is.If they accept it as correct, a populaton of "many" of them (who also dwell here and elsewhere) will suffer needlessly as they will not pursue potentially benefical therapeutics. After 30 years in healthcare this is not something I am going to "get over", nor should I.Now, if you qualify your statement that, in YOUR CASE, you found "food" had nothing to do with your symptoms, that is appropriate as it may very well be correct, and correct for a population of patients with the same history and physical findings as you.But you did not say that. If it offends you when someone points out a patently erroneous statement when it is made, then perhaps you need to reexamine your own motives, not those of the person who points out the error, and takes the time to try to explain to the sick why it is an error.MNL


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## JeanG (Oct 20, 1999)

Deal with it, Mike. I find you an extremely insulting person. To make statements like, "This is funny" and "more laughter", just shows where you are coming from. If you cannot get your point across without insulting a person, keep your mouth shut.I don't believe in what you do, period. Don't waste your breath trying to convince me. We've been through this before. Take it to someone who wants to hear.JeanG


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## JeanG (Oct 20, 1999)

Deal with it, Mike. I find you an extremely insulting person. To make statements like, "This is funny" and "more laughter", just shows where you are coming from. If you cannot get your point across without insulting a person, keep your mouth shut.I don't believe in what you do, period. Don't waste your breath trying to convince me. We've been through this before. Take it to someone who wants to hear.JeanG


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## Jeffrey Roberts (Apr 15, 1987)

Mike/Jean - Let's try and stay on topic and keep the insults to your own mailboxes.J*


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## Jeffrey Roberts (Apr 15, 1987)

Mike/Jean - Let's try and stay on topic and keep the insults to your own mailboxes.J*


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## ohnometo (Sep 20, 2001)

Eric ,First let me say that I love all the information they you share with us about IBS.and Stress does play a huge part in IBS ..I have no doubt about it...I had to add hypnotherapy tapes with my IBS because the anxiety was so bad in the morningsbefore I even got out of bed I would look down and see my covers on me shaking...I dont want to see this post get out of hand because you have provided wonderfulinformation it that helps so many people....When I talk about food I only sharewhat is working for me...I am not here trying to push LEAP down anyone's throat.I am so excited to have relief after 40 years.....Staying away from what makes me sosick is working for me.....I think Mike gets so excited after suffering for many yearsand finding out what works for him that he just wants to give the people a chancethat maybe it will work for them.....by me sharing my story If I could only help one personout of thousands ....That would be such a huge gift......So I hope people wouldjust keep an open mind when they read what is working in others life .....I talk aboutit alot because it has turned my life around in so many ways....If no ones wants to readwhat Mike has wrote..Just pass on by and keep your nasty comments to yourself...







I believe in LEAP.... and Mike if there is not one other person that you have helpedyou will never know how grateful I am to you for helping me get my life alotmore manageable...


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## ohnometo (Sep 20, 2001)

Eric ,First let me say that I love all the information they you share with us about IBS.and Stress does play a huge part in IBS ..I have no doubt about it...I had to add hypnotherapy tapes with my IBS because the anxiety was so bad in the morningsbefore I even got out of bed I would look down and see my covers on me shaking...I dont want to see this post get out of hand because you have provided wonderfulinformation it that helps so many people....When I talk about food I only sharewhat is working for me...I am not here trying to push LEAP down anyone's throat.I am so excited to have relief after 40 years.....Staying away from what makes me sosick is working for me.....I think Mike gets so excited after suffering for many yearsand finding out what works for him that he just wants to give the people a chancethat maybe it will work for them.....by me sharing my story If I could only help one personout of thousands ....That would be such a huge gift......So I hope people wouldjust keep an open mind when they read what is working in others life .....I talk aboutit alot because it has turned my life around in so many ways....If no ones wants to readwhat Mike has wrote..Just pass on by and keep your nasty comments to yourself...







I believe in LEAP.... and Mike if there is not one other person that you have helpedyou will never know how grateful I am to you for helping me get my life alotmore manageable...


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## eric (Jul 8, 1999)

Donna, I have no problem with the fact leap helped you what so ever and am glad to hear your life has been turned around that is very good to hear and I hope it contines for you. I know foods can be triggers and for some more then others. Obviously this HPA plays into foods being a trigger before you even eat them in just thinking about eating them and that they will cause pain. This starts certain chemicals to start doing their thing. The HPA from what I am looking at now is also invovled in Fibro and CFS among other things.I am trying to look at and figure out all the information and mechanisms (off which I know food is one, but not the first) going haywire and see what things are happening in what order and the consequences of them. This is really important here however as far as serotonin is concerned in IBS and one of the first mecanisms out of whack in IBS and has to do with just the act of eating and not foods themselves.""Enterochromaffin cells play a critical role in peristaltic activity within the GI tract because they release serotonin when stimulated, as occurs with luminal distension during a meal." Soon as the colon distends it releases serotonin when we prepare ourselfs to eat and the mouth starts creating saliva and the digestive tract gets ready for foods, which is being disregulated right from the start and also foods aren't the only trigger for this mechanism. This is a question someone asked a Harvard Doctor on 5ht supplements. http://www.intelihealth.com/IH/ihtIH/WSIHW...438/325205.html "Irritable bowel syndrome is now recognized as a disorder of serotonin activity. Serotonin is a neurotransmitter in the brain that regulates sleep, mood (depression, anxiety), aggression, appetite, temperature, sexual behavior and pain sensation. Serotonin also acts as a neurotransmitter in the gastrointestinal tract. " "Excessive serotonin activity in the gastrointestinal system (enteric nervous system) is thought to cause the diarrhea of irritable-bowel syndrome. The enteric nervous system detects bowel distension (expansion) on the basis of pressure-sensitive cells in the bowel lumen (opening). Once activated, these pressure-sensitive cells  promote the release of serotonin, which in turn promotes both secretory function and peristaltic function (the contractions of the intestines that force the contents outward). At least four serotonergic receptors have been identified to be participants in the secretory and peristaltic response. Patients with diarrhea-predominant IBS may have higher levels of serotonin after eating than do people without the disorder. This recognition led to the development of the first drug used specifically to treat diarrheal symptoms of IBS, alosetron (also known as Lotronex). Alosetron blocked the specific serotonin receptors responsible for recognizing bowel distention. In doing so, it blocked the effects of serotonin and reduced both bowel secretions and peristalsis. Constipation was the most common side effect seen. (Note: Alosetron was removed from the market by the manufacturer after repeated reports of a dangerous condition known as ischemic colitis became known.) Tegaserod (Zelmac) is another drug under development and under review by the U.S. Food and Drug Administration for approval. Tegaserod is indicated for the treatment of constipation-predominant IBS and works to increase enteric nervous system serotonin activity. So, increasing serotonin activity in the enteric nervous system produces increased bowel secretions and peristalsis (and potentially diarrhea), whereas depressing serotonin activity produces reduced secretions and reduce peristalsis (and potentially constipation). Increasing serotonin activity in the brain would increase awareness and, in higher doses, produce anxiety, insomnia and restlessness." If the serotonin is depleted in the ens you suffer from constipation and depletion in the brain depression.I also seems like the HPA axis has a big role in all this also and right now I am looking at how serotonin communicates with the HPA axis and it seems like it is a messenger/player for that as well.Its fine if Mike wants to focus on nothing but immunology and foods and IBS, but you would think he would be interested as well as in how the brain produces stress hormones that constantly effect IBS and the symptoms. And even if he doesn't want to acknowledge any of this, I believe he should still present the information, but I really hope others will benefit and be able to use the information in the big picture of IBS.Anyone can take a minute go into yahoo and type in IBS and the HPA axis, or fight or flight and the HPA axis, or fibro and the HPA axis or CFS and the HPA axis and read some of the things they are talking about.


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## eric (Jul 8, 1999)

Donna, I have no problem with the fact leap helped you what so ever and am glad to hear your life has been turned around that is very good to hear and I hope it contines for you. I know foods can be triggers and for some more then others. Obviously this HPA plays into foods being a trigger before you even eat them in just thinking about eating them and that they will cause pain. This starts certain chemicals to start doing their thing. The HPA from what I am looking at now is also invovled in Fibro and CFS among other things.I am trying to look at and figure out all the information and mechanisms (off which I know food is one, but not the first) going haywire and see what things are happening in what order and the consequences of them. This is really important here however as far as serotonin is concerned in IBS and one of the first mecanisms out of whack in IBS and has to do with just the act of eating and not foods themselves.""Enterochromaffin cells play a critical role in peristaltic activity within the GI tract because they release serotonin when stimulated, as occurs with luminal distension during a meal." Soon as the colon distends it releases serotonin when we prepare ourselfs to eat and the mouth starts creating saliva and the digestive tract gets ready for foods, which is being disregulated right from the start and also foods aren't the only trigger for this mechanism. This is a question someone asked a Harvard Doctor on 5ht supplements. http://www.intelihealth.com/IH/ihtIH/WSIHW...438/325205.html "Irritable bowel syndrome is now recognized as a disorder of serotonin activity. Serotonin is a neurotransmitter in the brain that regulates sleep, mood (depression, anxiety), aggression, appetite, temperature, sexual behavior and pain sensation. Serotonin also acts as a neurotransmitter in the gastrointestinal tract. " "Excessive serotonin activity in the gastrointestinal system (enteric nervous system) is thought to cause the diarrhea of irritable-bowel syndrome. The enteric nervous system detects bowel distension (expansion) on the basis of pressure-sensitive cells in the bowel lumen (opening). Once activated, these pressure-sensitive cells promote the release of serotonin, which in turn promotes both secretory function and peristaltic function (the contractions of the intestines that force the contents outward). At least four serotonergic receptors have been identified to be participants in the secretory and peristaltic response. Patients with diarrhea-predominant IBS may have higher levels of serotonin after eating than do people without the disorder. This recognition led to the development of the first drug used specifically to treat diarrheal symptoms of IBS, alosetron (also known as Lotronex). Alosetron blocked the specific serotonin receptors responsible for recognizing bowel distention. In doing so, it blocked the effects of serotonin and reduced both bowel secretions and peristalsis. Constipation was the most common side effect seen. (Note: Alosetron was removed from the market by the manufacturer after repeated reports of a dangerous condition known as ischemic colitis became known.) Tegaserod (Zelmac) is another drug under development and under review by the U.S. Food and Drug Administration for approval. Tegaserod is indicated for the treatment of constipation-predominant IBS and works to increase enteric nervous system serotonin activity. So, increasing serotonin activity in the enteric nervous system produces increased bowel secretions and peristalsis (and potentially diarrhea), whereas depressing serotonin activity produces reduced secretions and reduce peristalsis (and potentially constipation). Increasing serotonin activity in the brain would increase awareness and, in higher doses, produce anxiety, insomnia and restlessness." If the serotonin is depleted in the ens you suffer from constipation and depletion in the brain depression.I also seems like the HPA axis has a big role in all this also and right now I am looking at how serotonin communicates with the HPA axis and it seems like it is a messenger/player for that as well.Its fine if Mike wants to focus on nothing but immunology and foods and IBS, but you would think he would be interested as well as in how the brain produces stress hormones that constantly effect IBS and the symptoms. And even if he doesn't want to acknowledge any of this, I believe he should still present the information, but I really hope others will benefit and be able to use the information in the big picture of IBS.Anyone can take a minute go into yahoo and type in IBS and the HPA axis, or fight or flight and the HPA axis, or fibro and the HPA axis or CFS and the HPA axis and read some of the things they are talking about.


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## eric (Jul 8, 1999)

On CFS"To investigate the basis for the differences in symptoms, studies focused on a corticotropin-releasing hormone (CRH), which is a neurohormone produced in the hypothalamus region of the brain and is a component of that portion of the bodyï¿½s stress system called the hypothalamic pituitary adrenal axis (HPA). Animal studies have shown CRH to recapitulate many of the physiological and behavioral aspects of the stress system. Studies of CRH levels have demonstrated that the hormone is down regulated in CFS, in atypical depression, and in seasonal affective disorder (SAD), but not in melancholic depression. When CFS patients are stimulated with a cortisol inducer, they have an exaggerated response to small doses and a reduced response to high doses. In both FMS and CFS, there are reduced levels of another stress mediator, norepinephrine. In addition, CRH response to exercise is blunted in CFS patients. Lower levels of CRH and HPA axis activity tend to result in hypoarousal, lethargy, decreased plasma volume, and inflammatory symptoms. " http://www.immunesupport.com/library/showarticle.cfm?ID=2948


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## eric (Jul 8, 1999)

On CFS"To investigate the basis for the differences in symptoms, studies focused on a corticotropin-releasing hormone (CRH), which is a neurohormone produced in the hypothalamus region of the brain and is a component of that portion of the bodyï¿½s stress system called the hypothalamic pituitary adrenal axis (HPA). Animal studies have shown CRH to recapitulate many of the physiological and behavioral aspects of the stress system. Studies of CRH levels have demonstrated that the hormone is down regulated in CFS, in atypical depression, and in seasonal affective disorder (SAD), but not in melancholic depression. When CFS patients are stimulated with a cortisol inducer, they have an exaggerated response to small doses and a reduced response to high doses. In both FMS and CFS, there are reduced levels of another stress mediator, norepinephrine. In addition, CRH response to exercise is blunted in CFS patients. Lower levels of CRH and HPA axis activity tend to result in hypoarousal, lethargy, decreased plasma volume, and inflammatory symptoms. " http://www.immunesupport.com/library/showarticle.cfm?ID=2948


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## ohnometo (Sep 20, 2001)

Thanks EricAgain, alot of good information...I wanted to share this with you...Many timesover the years when I would be so sick ...horrible pain and vomiting and D..I did try hypnosis many times for my illness during the attacks and on dayswhen I didnt have any symptoms.....I was so sick setting in this one psychaitristoffice that he tried hypnosis on me at that time I couldnt even sit up to listen to him,,And the reason I was at a psychiatrist's office because of ALL THE YEARS they wastelling me I was doing this to myself....Give me a break....So he looked at me andsaid you cant be hypnotized so lets just give you a thorazine and send you on your way.What Dr would ever give someone that pill for IBS ????? Maybe it didn't work becauseI was putting all things in my body that I couldn't tolerate...I just get so upset with theDr's that said I was making myself sick and you need to relax Donna....For me I have triedso many relaxing things over the year's but it never stopped the pain and running to thebathroom....I know now that I am 100 % better that if I wanted to use hypnosis for relaxingit would probably work for me.....But it never worked for my IBS-D and Cyclic Vomiting Syndrome.....Deep down I always had a feeling that something more was happening to methat wasn't stress related...and I had so much anxiety that I thought I was loosing my mind..I hope I never ever have to go down that road again because I dont know if I could liveanother 40 years like that.....I want to say that I am not here telling people not to try hypnosis because it may work for them..I am only sharing my story that when food plays a part on your immune system that I have never found anything to work "EXCEPT" taking away thefoods ect....that makes me so sick......and when I started feeling better the anxiety left ..I thank God everydaythat I dont have to take any medicines expecially those SSRI'S because they made me somuch worse....And they help so many people and thats great...Stress plays a part in IBS but so does Foods.....I am very grateful for my health today........and that I knowwhat makes me sick......So I have a choice do I want to put that in my body ordo I want to stay well ? Before I had no options....The last sentence that Dr Marvin Schusterat John Hopkins said to me was at this time I dont think stress is playing a part in Donna'sIBS but wasnt able to tell me anything because even they were puzzled...He did diagnose my Cyclic Vomiting Syndrome....To bad he is retired now from John Hopkins because I wouldlike to tell him what seems to be working now for me...I dont want to step on anyones toesI just get upset with everyone telling me all my life "It's Stress" thats making you sickDonna


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## ohnometo (Sep 20, 2001)

Thanks EricAgain, alot of good information...I wanted to share this with you...Many timesover the years when I would be so sick ...horrible pain and vomiting and D..I did try hypnosis many times for my illness during the attacks and on dayswhen I didnt have any symptoms.....I was so sick setting in this one psychaitristoffice that he tried hypnosis on me at that time I couldnt even sit up to listen to him,,And the reason I was at a psychiatrist's office because of ALL THE YEARS they wastelling me I was doing this to myself....Give me a break....So he looked at me andsaid you cant be hypnotized so lets just give you a thorazine and send you on your way.What Dr would ever give someone that pill for IBS ????? Maybe it didn't work becauseI was putting all things in my body that I couldn't tolerate...I just get so upset with theDr's that said I was making myself sick and you need to relax Donna....For me I have triedso many relaxing things over the year's but it never stopped the pain and running to thebathroom....I know now that I am 100 % better that if I wanted to use hypnosis for relaxingit would probably work for me.....But it never worked for my IBS-D and Cyclic Vomiting Syndrome.....Deep down I always had a feeling that something more was happening to methat wasn't stress related...and I had so much anxiety that I thought I was loosing my mind..I hope I never ever have to go down that road again because I dont know if I could liveanother 40 years like that.....I want to say that I am not here telling people not to try hypnosis because it may work for them..I am only sharing my story that when food plays a part on your immune system that I have never found anything to work "EXCEPT" taking away thefoods ect....that makes me so sick......and when I started feeling better the anxiety left ..I thank God everydaythat I dont have to take any medicines expecially those SSRI'S because they made me somuch worse....And they help so many people and thats great...Stress plays a part in IBS but so does Foods.....I am very grateful for my health today........and that I knowwhat makes me sick......So I have a choice do I want to put that in my body ordo I want to stay well ? Before I had no options....The last sentence that Dr Marvin Schusterat John Hopkins said to me was at this time I dont think stress is playing a part in Donna'sIBS but wasnt able to tell me anything because even they were puzzled...He did diagnose my Cyclic Vomiting Syndrome....To bad he is retired now from John Hopkins because I wouldlike to tell him what seems to be working now for me...I dont want to step on anyones toesI just get upset with everyone telling me all my life "It's Stress" thats making you sickDonna


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## Mike NoLomotil (Jun 6, 2000)

Comment on posted pontification: _________________________________________"Its fine if Mike wants to focus on nothing but immunology and foods and IBS, but you would think he would be interested as well as in how the brain produces stress hormones that constantly effect IBS and the symptoms. And even if he doesn't want to acknowledge any of this, "I" believe he should still present the information, but I really hope others will benefit and be able to use the information in the big picture of IBS.Anyone can take a minute go into yahoo and type in IBS and the HPA axis, or fight or flight and the HPA axis, or fibro and the HPA axis or CFS and the HPA axis and read some of the things they are talking about." __________________________________It is really quite amazing that every time I go to great lengths to set forth the fact that I am not only wholly aware of and have read all these same papers as well, and set forth posts and references which detail the integrated relationships between the ENS,CNS, IS and ES, such as this brief suggestion posted repeatedly.In your Righteous Indignation, perhaps these posts in plain simple english, not the obfusction of scientific jargon, are incomprehensible? _____________________________________"In addition to the link posted above that you may want to read, one should also read this tutorial...note the link may no longer provide a free copy one may have to order it I did not take time to check. http://www.blackwell-synergy.com/servlet/userag ent?func=synergy&synergyAction=showFullText&doi=10.1046/j.1365-2036.2001.00951.x[/URL]Pay particular attention to "Figure 1 . Pathogenesis of food hypersensitivity induced irritable bowel syndrome."This figure gives a pretty good graphic representation "of the inextricable relationships between the ENS, the CNS, and the Immune System and how they interract to modulate gut function (sensorial and motility inclusive)."The only thing missing from the diagram is the confirmed involvement of the non-mast cell immunocytes (circulating immunocytes) in precipitating the symptoms of IBS-d and cyclic IBS via activation of the inflammatory response system. The model only goes as far as the mast cell system, but that has been quantified as incomplete. Proinflammatory mediators are also released from localized circulating immunocytes (lymphocytes, granulocytes, even platelets depending upon which mechanisms are provoked).Take the diagram and draw a line from the NON IgE Mechanisms box down to the Mediators box, then conect the (2) non IgE boxes together and BINGO you have the "WHOLE picture which reflects ALL perspectives of "current thinking", not just one channel of "current thinking". Integration of all the observations to date paints a clearer picture.What remains to be seen is the chicken-or-egg scenarios. By conducting the neurologic activity and immunologic activity studies simultaneously, and using direct jejunal isolation to monitor the sequencing of mediator release in the gut and tracking the systemic proinflammatory mediator release, as well as checking cerebrospinal fluid for which mediators cross over and which are released "endogenously" and under what conditions (as these are the chemicals which can alter the activity level of the varous componenets of each nervous subsystem either directly or as mediators of activation), one day it is hoped the subpopulations can be segregated.Each different mechanism (the chicken-or-egg phenomena) can be segregated, and the populations defined (that is in which patients does the IRS activation originate via specific immune mechanisms and non-immune mechanisms, and then is amplified by the ENS and CNS, and vice versa, in which patients does it originate in the CNS or ENS and then the IRS is subsequently activated).Since both do occur and have been quantified, it will be of great interest if people working from both directions could collaborate and combine their protocols someday." ____________________________________How does one write what you write unless you simply cannot comprehend the words or the referenced diagram of the integrarted systems? I guess you just ignore it.You perpetually post that I am denying the existence of the research you post as if I have actually done so. This is odd behavior, clearly intended to provoke a debate where there is none.So on the flipside, to be direct, you must be uncomfortable with these facts as it adds other dimensions to consider to the CNS as primary etiologic basis postulates....since whenerver it comes up you do not wish to discuss that aspect of the etiology or mechansism, rather moce immediately to how the thought of eating can provoke a reaction to food, which is wholly different mechanism and the two are not mutually exclusive....example. you address a person with known humoral and cellular reactivity to dietary components, who is now in remission for the first time in, what, 30 years?, by avoidance of those reactions, with the following: ________________________________________"Donna, I have no problem with the fact leap helped you what so ever and am glad to hear your life has been turned around that is very good to hear and I hope it contines for you. I know foods can be triggers and for some more then others."Obviously" this HPA plays into foods being a trigger before you even eat them in just thinking about eating them and that they will cause pain.And"This is really important here however as far as serotonin is concerned in IBS and one of the first mecanisms out of whack in IBS and has to do with just the act of eating and not foods themselves." ____________________________________These things are known to be self evident:1. if you intubate the jejunum of patients with IBS -d and cyclic symptoms, isolating it2. and double blind challenge it with various potentially antigenic substances3. then study the washings and/or biopsy the small bowel wall or both4. you find you have collected the specific markers of a humoral immune response and/or a cell-mediated immune response to specific dietary components (mechanisms which are present as surely as the other mechnisms you have posted are present, but which operate independently as immunologic responses).5. When this occurs, as it does, this is not "believed" or "suggested" or "implies", as it is quantified, the specific mediators (up to as many as 100 including and beyong 5HT) that will upregulate the local and peripheral nervous sytem and endocrine syetm have thus been inappropriately released dirctly into the gut wall and local circulation and directly to the neural system locally, further you find that 6. removal of the substances which provoke the reactions results in the reactions disappearing along with the patients symptomsagain, if you choose consider this a mere sidebar to the etiologic basis of the variosu IBS populations, or as mechanisms which do not also exist and account for patient response to dietary therapy, do as you wish. Pretend that they are mere coincidental findings in these patients.for instance, from one of the posts you set forth, in the words of the author: ___________________________________"Excessive serotonin activity in the gastrointestinal system (entericnervous system) is thought to cause the diarrhea of irritable-bowelsyndrome." ____________________________"Is thought to" is a very weak even in the face of all the evidence that 5HT is one of the primary mediators of gut motility and sensorial function. he authoer equivocates even in this, as the mechanisms are known to be more complex than a single mediator.So we must put each of the references we use into the context of what the author claims, and they equivocate as they know there are interractive mechanisms which are not fully elucidated. when something is confirmed it "is", and when it is "thought to" it is, "thought to". What still remains is that "true and false are attributes of speech, not of things, and where there is no speech there is no truth nor falsehood...only fact". The fact is you misquote me, and your purpose in so doing can only be inferred.Anyway off to Atlanta to spread more misguided therapeutics and heresy!You have the floor...Enjoy.







Eat well. Think well. Be well.MNL


----------



## Mike NoLomotil (Jun 6, 2000)

Comment on posted pontification: _________________________________________"Its fine if Mike wants to focus on nothing but immunology and foods and IBS, but you would think he would be interested as well as in how the brain produces stress hormones that constantly effect IBS and the symptoms. And even if he doesn't want to acknowledge any of this, "I" believe he should still present the information, but I really hope others will benefit and be able to use the information in the big picture of IBS.Anyone can take a minute go into yahoo and type in IBS and the HPA axis, or fight or flight and the HPA axis, or fibro and the HPA axis or CFS and the HPA axis and read some of the things they are talking about." __________________________________It is really quite amazing that every time I go to great lengths to set forth the fact that I am not only wholly aware of and have read all these same papers as well, and set forth posts and references which detail the integrated relationships between the ENS,CNS, IS and ES, such as this brief suggestion posted repeatedly.In your Righteous Indignation, perhaps these posts in plain simple english, not the obfusction of scientific jargon, are incomprehensible? _____________________________________"In addition to the link posted above that you may want to read, one should also read this tutorial...note the link may no longer provide a free copy one may have to order it I did not take time to check. http://www.blackwell-synergy.com/servlet/userag ent?func=synergy&synergyAction=showFullText&doi=10.1046/j.1365-2036.2001.00951.x[/URL]Pay particular attention to "Figure 1 . Pathogenesis of food hypersensitivity induced irritable bowel syndrome."This figure gives a pretty good graphic representation "of the inextricable relationships between the ENS, the CNS, and the Immune System and how they interract to modulate gut function (sensorial and motility inclusive)."The only thing missing from the diagram is the confirmed involvement of the non-mast cell immunocytes (circulating immunocytes) in precipitating the symptoms of IBS-d and cyclic IBS via activation of the inflammatory response system. The model only goes as far as the mast cell system, but that has been quantified as incomplete. Proinflammatory mediators are also released from localized circulating immunocytes (lymphocytes, granulocytes, even platelets depending upon which mechanisms are provoked).Take the diagram and draw a line from the NON IgE Mechanisms box down to the Mediators box, then conect the (2) non IgE boxes together and BINGO you have the "WHOLE picture which reflects ALL perspectives of "current thinking", not just one channel of "current thinking". Integration of all the observations to date paints a clearer picture.What remains to be seen is the chicken-or-egg scenarios. By conducting the neurologic activity and immunologic activity studies simultaneously, and using direct jejunal isolation to monitor the sequencing of mediator release in the gut and tracking the systemic proinflammatory mediator release, as well as checking cerebrospinal fluid for which mediators cross over and which are released "endogenously" and under what conditions (as these are the chemicals which can alter the activity level of the varous componenets of each nervous subsystem either directly or as mediators of activation), one day it is hoped the subpopulations can be segregated.Each different mechanism (the chicken-or-egg phenomena) can be segregated, and the populations defined (that is in which patients does the IRS activation originate via specific immune mechanisms and non-immune mechanisms, and then is amplified by the ENS and CNS, and vice versa, in which patients does it originate in the CNS or ENS and then the IRS is subsequently activated).Since both do occur and have been quantified, it will be of great interest if people working from both directions could collaborate and combine their protocols someday." ____________________________________How does one write what you write unless you simply cannot comprehend the words or the referenced diagram of the integrarted systems? I guess you just ignore it.You perpetually post that I am denying the existence of the research you post as if I have actually done so. This is odd behavior, clearly intended to provoke a debate where there is none.So on the flipside, to be direct, you must be uncomfortable with these facts as it adds other dimensions to consider to the CNS as primary etiologic basis postulates....since whenerver it comes up you do not wish to discuss that aspect of the etiology or mechansism, rather moce immediately to how the thought of eating can provoke a reaction to food, which is wholly different mechanism and the two are not mutually exclusive....example. you address a person with known humoral and cellular reactivity to dietary components, who is now in remission for the first time in, what, 30 years?, by avoidance of those reactions, with the following: ________________________________________"Donna, I have no problem with the fact leap helped you what so ever and am glad to hear your life has been turned around that is very good to hear and I hope it contines for you. I know foods can be triggers and for some more then others."Obviously" this HPA plays into foods being a trigger before you even eat them in just thinking about eating them and that they will cause pain.And"This is really important here however as far as serotonin is concerned in IBS and one of the first mecanisms out of whack in IBS and has to do with just the act of eating and not foods themselves." ____________________________________These things are known to be self evident:1. if you intubate the jejunum of patients with IBS -d and cyclic symptoms, isolating it2. and double blind challenge it with various potentially antigenic substances3. then study the washings and/or biopsy the small bowel wall or both4. you find you have collected the specific markers of a humoral immune response and/or a cell-mediated immune response to specific dietary components (mechanisms which are present as surely as the other mechnisms you have posted are present, but which operate independently as immunologic responses).5. When this occurs, as it does, this is not "believed" or "suggested" or "implies", as it is quantified, the specific mediators (up to as many as 100 including and beyong 5HT) that will upregulate the local and peripheral nervous sytem and endocrine syetm have thus been inappropriately released dirctly into the gut wall and local circulation and directly to the neural system locally, further you find that 6. removal of the substances which provoke the reactions results in the reactions disappearing along with the patients symptomsagain, if you choose consider this a mere sidebar to the etiologic basis of the variosu IBS populations, or as mechanisms which do not also exist and account for patient response to dietary therapy, do as you wish. Pretend that they are mere coincidental findings in these patients.for instance, from one of the posts you set forth, in the words of the author: ___________________________________"Excessive serotonin activity in the gastrointestinal system (entericnervous system) is thought to cause the diarrhea of irritable-bowelsyndrome." ____________________________"Is thought to" is a very weak even in the face of all the evidence that 5HT is one of the primary mediators of gut motility and sensorial function. he authoer equivocates even in this, as the mechanisms are known to be more complex than a single mediator.So we must put each of the references we use into the context of what the author claims, and they equivocate as they know there are interractive mechanisms which are not fully elucidated. when something is confirmed it "is", and when it is "thought to" it is, "thought to". What still remains is that "true and false are attributes of speech, not of things, and where there is no speech there is no truth nor falsehood...only fact". The fact is you misquote me, and your purpose in so doing can only be inferred.Anyway off to Atlanta to spread more misguided therapeutics and heresy!You have the floor...Enjoy.







Eat well. Think well. Be well.MNL


----------



## eric (Jul 8, 1999)

FYI"The majority of patients with irritable bowel syndrome (IBS) associate stressful life events with the initiation or exacerbation of their symptoms. Emerging evidence suggests that this association may be due to an alteration in the way the brain communicates with the gut during periods of prolonged or severe life stresses. While stress and stress related symptoms have long been regarded as a domain of psychology, tremendous progress has been made in our understanding of the biological processes that mediate the body's response to stress. The brain network which plays a central role in the stress response is the hypothalamic-pituitary-adrenal cortex (HPA) axis which produces the hormone cortisol. The HPA axis interacts with other brain areas which are concerned with the responses to pain and in the autonomic (nervous system) function of the bowel during stress. There is a growing body of evidence that suggests that altered HPA responses in IBS and other chronic pain syndromes, such as fibromyalgia, play a role in the body's increased sensitivity to painful and non-painful stimuli resulting in chronic pain and other symptoms of discomfort and distress.

Activation of the HPA axis in response to stress leads normally to a coordinated series of adaptive physiologic and behavioral changes which attempt to maintain and restore our body's homeostasis (in a state of equilibrium). In the setting of stress, adaptive behaviors such as increased arousal, vigilance, focused attention, and alertness occur. Altered function of the HPA axis in response to stress may play a primary role in behavioral abnormalities such as fatigue, lack of motivation, abnormal sleep and appetite, which are commonly seen in patients with functional bowel disease, such as IBS. In our patient database of functional bowel disease, 71% reported frequent tiredness and fatigue and the two-thirds reported sleep disturbances. These symptoms in turn play an important role in the impact of IBS on quality of life. Stress responses involving the HPA axis are mediated by the release of corticotropin releasing hormone (CRH) from a brain region called the hypothalamus. Stressful events activate the HPA axis which result in the eventual release of CRH which then results in release of adrenocorticotropin hormone (ACTH) from the pituitary gland. ACTH then acts on the adrenal cortex causing it to release cortisol into the bloodstream. Cortisol and ACTH are secreted in a specific rhythm over the course of 24 hours each day, and both reach their highest levels in the early morning and their lowest in the late afternoon and evening. The cortisol peaks correlate with the state of greatest alertness and energy in the majority of healthy people. Cortisol can be measured in the blood and urine. Regulation of the HPA axis has not been studied well in IBS. We have preliminary evidence which suggests that IBS patients have blunted or decreased levels of cortisol in response to a stressor such as balloon distension of the lower colon and rectum. There is also evidence that IBS and fibromyalgia patients have lower baseline levels of 24-hour urine cortisol. In order to learn more about how stress may play a role in chronic pain disorders, the UCLA Neuroenteric Disease Program has several ongoing studies in IBS, fibromyalgia and gastroesophageal reflux disease (GERD). There is a study measuring ACTH and cortisol levels in the blood over a 24-hour period in patients with IBS and/or fibromyalgia, and healthy individuals. In addition, we are studying how stress may affect the perception of signals originating from the intestine. We are completing another study which has examined the relation of stressful life events and increase in heartburn symptoms in patients with GERD. In summary, alterations in the HPA axis in patients with chronic pain syndromes such as IBS or fibromyalgia may play a role both in the inadequate activation of the body's own pain inhibition systems (including the endorophin system), resulting in bowel and/or muscle hypersensitivity. A better understanding of the way the body responds to stress via the HPA axis will therefore help in the development of novel therapies for these common conditions" http://www.med.ucla.edu/ndp/Newsletters/Wi...teredStress.htm Fibro"Fibromyalgia and the serotonin pathway. Juhl JH Altern Med Rev 1998 Oct;3(5):367-75 Fibromyalgia syndrome is a musculoskeletal pain and fatigue disorder manifested by diffuse myalgia, localized areas of tenderness, fatigue, lowered pain thresholds, and nonrestorative sleep. Evidence from multiple sources support the concept of decreased flux through the serotonin pathway in fibromyalgia patients. Serotonin substrate supplementation, via L-tryptophan or 5-hydroxytryptophan (5-HTP), has been shown to improve symptoms of depression, anxiety, insomnia and somatic pains in a variety of patient cohorts. Identification of low serum tryptophan and serotonin levels may be a simple way to identify persons who will respond well to this approach. ""Neuroendocrine perturbations in fibromyalgia and chronic fatigue syndrome. Neeck G, Crofford LJ Department of Rheumatology, University of Giessen, Bad Nauheim, Germany. gunther.neeck###kerckhoff.med.uni-giessen.de Rheum Dis Clin North Am 2000 Nov;26(4):989-1002 A large body of data from a number of different laboratories worldwide has demonstrated a general tendency for reduced adrenocortical responsiveness in CFS. It is still not clear if this is secondary to CNS abnormalities leading to decreased activity of CRH- or AVP-producing hypothalamic neurons. Primary hypofunction of the CRH neurons has been described on the basis of genetic and environmental influences. Other pathways could secondarily influence HPA axis activity, however. For example, serotonergic and noradrenergic input acts to stimulate HPA axis activity. Deficient serotonergic activity in CFS has been suggested by some of the studies as reviewed here. In addition, hypofunction of sympathetic nervous system function has been described and could contribute to abnormalities of central components of the HPA axis. One could interpret the clinical trial of glucocorticoid replacement in patients with CFS as confirmation of adrenal insufficiency if one were convinced of a positive therapeutic effect. If patient symptoms were related to impaired activation of central components of the axis, replacing glucocorticoids would merely exacerbate symptoms caused by enhanced negative feedback. Further study of specific components of the HPA axis should ultimately clarify the reproducible abnormalities associated with a clinical picture of CFS. In contrast to CFS, the results of the different hormonal axes in FMS support the assumption that the distortion of the hormonal pattern observed can be attributed to hyperactivity of CRH neurons. This hyperactivity may be driven and sustained by stress exerted by chronic pain originating in the musculoskeletal system or by an alteration of the CNS mechanism of nociception. The elevated activity of CRH neurons also seems to cause alteration of the set point of other hormonal axes. In addition to its control of the adrenal hormones, CRH stimulates somatostatin secretion at the hypothalamic level, which, in turn, causes inhibition of growth hormone and thyroid-stimulating hormone at the pituitary level. The suppression of gonadal function may also be attributed to elevated CRH because of its ability to inhibit hypothalamic luteinizing hormone-releasing hormone release; however, a remote effect on the ovary by the inhibition of follicle-stimulating hormone-stimulated estrogen production must also be considered. Serotonin (5-HT) precursors such as tryptophan (5-HTP), drugs that release 5-HT, or drugs that act directly on 5-HT receptors stimulate the HPA axis, indicating a stimulatory effect of serotonergic input on HPA axis function. Hyperfunction of the HPA axis could also reflect an elevated serotonergic tonus in the CNS of FMS patients. The authors conclude that the observed pattern of hormonal deviations in patients with FMS is a CNS adjustment to chronic pain and stress, constitutes a specific entity of FMS, and is primarily evoked by activated CRH neurons. ""Serotonin (5-HT) precursors such as tryptophan (5-HTP), drugs that release 5-HT, or drugs that act directly on 5-HT receptors stimulate the HPA axis, indicating a stimulatory effect of serotonergic input on HPA axis function. Hyperfunction of the HPA axis could also reflect an elevated serotonergic tonus in the CNS of FMS patients. "


----------



## eric (Jul 8, 1999)

FYI"The majority of patients with irritable bowel syndrome (IBS) associate stressful life events with the initiation or exacerbation of their symptoms. Emerging evidence suggests that this association may be due to an alteration in the way the brain communicates with the gut during periods of prolonged or severe life stresses. While stress and stress related symptoms have long been regarded as a domain of psychology, tremendous progress has been made in our understanding of the biological processes that mediate the body's response to stress. The brain network which plays a central role in the stress response is the hypothalamic-pituitary-adrenal cortex (HPA) axis which produces the hormone cortisol. The HPA axis interacts with other brain areas which are concerned with the responses to pain and in the autonomic (nervous system) function of the bowel during stress. There is a growing body of evidence that suggests that altered HPA responses in IBS and other chronic pain syndromes, such as fibromyalgia, play a role in the body's increased sensitivity to painful and non-painful stimuli resulting in chronic pain and other symptoms of discomfort and distress.

Activation of the HPA axis in response to stress leads normally to a coordinated series of adaptive physiologic and behavioral changes which attempt to maintain and restore our body's homeostasis (in a state of equilibrium). In the setting of stress, adaptive behaviors such as increased arousal, vigilance, focused attention, and alertness occur. Altered function of the HPA axis in response to stress may play a primary role in behavioral abnormalities such as fatigue, lack of motivation, abnormal sleep and appetite, which are commonly seen in patients with functional bowel disease, such as IBS. In our patient database of functional bowel disease, 71% reported frequent tiredness and fatigue and the two-thirds reported sleep disturbances. These symptoms in turn play an important role in the impact of IBS on quality of life. Stress responses involving the HPA axis are mediated by the release of corticotropin releasing hormone (CRH) from a brain region called the hypothalamus. Stressful events activate the HPA axis which result in the eventual release of CRH which then results in release of adrenocorticotropin hormone (ACTH) from the pituitary gland. ACTH then acts on the adrenal cortex causing it to release cortisol into the bloodstream. Cortisol and ACTH are secreted in a specific rhythm over the course of 24 hours each day, and both reach their highest levels in the early morning and their lowest in the late afternoon and evening. The cortisol peaks correlate with the state of greatest alertness and energy in the majority of healthy people. Cortisol can be measured in the blood and urine. Regulation of the HPA axis has not been studied well in IBS. We have preliminary evidence which suggests that IBS patients have blunted or decreased levels of cortisol in response to a stressor such as balloon distension of the lower colon and rectum. There is also evidence that IBS and fibromyalgia patients have lower baseline levels of 24-hour urine cortisol. In order to learn more about how stress may play a role in chronic pain disorders, the UCLA Neuroenteric Disease Program has several ongoing studies in IBS, fibromyalgia and gastroesophageal reflux disease (GERD). There is a study measuring ACTH and cortisol levels in the blood over a 24-hour period in patients with IBS and/or fibromyalgia, and healthy individuals. In addition, we are studying how stress may affect the perception of signals originating from the intestine. We are completing another study which has examined the relation of stressful life events and increase in heartburn symptoms in patients with GERD. In summary, alterations in the HPA axis in patients with chronic pain syndromes such as IBS or fibromyalgia may play a role both in the inadequate activation of the body's own pain inhibition systems (including the endorophin system), resulting in bowel and/or muscle hypersensitivity. A better understanding of the way the body responds to stress via the HPA axis will therefore help in the development of novel therapies for these common conditions" http://www.med.ucla.edu/ndp/Newsletters/Wi...teredStress.htm Fibro"Fibromyalgia and the serotonin pathway. Juhl JH Altern Med Rev 1998 Oct;3(5):367-75 Fibromyalgia syndrome is a musculoskeletal pain and fatigue disorder manifested by diffuse myalgia, localized areas of tenderness, fatigue, lowered pain thresholds, and nonrestorative sleep. Evidence from multiple sources support the concept of decreased flux through the serotonin pathway in fibromyalgia patients. Serotonin substrate supplementation, via L-tryptophan or 5-hydroxytryptophan (5-HTP), has been shown to improve symptoms of depression, anxiety, insomnia and somatic pains in a variety of patient cohorts. Identification of low serum tryptophan and serotonin levels may be a simple way to identify persons who will respond well to this approach. ""Neuroendocrine perturbations in fibromyalgia and chronic fatigue syndrome. Neeck G, Crofford LJ Department of Rheumatology, University of Giessen, Bad Nauheim, Germany. gunther.neeck###kerckhoff.med.uni-giessen.de Rheum Dis Clin North Am 2000 Nov;26(4):989-1002 A large body of data from a number of different laboratories  worldwide has demonstrated a general tendency for reduced adrenocortical responsiveness in CFS. It is still not clear if this is secondary to CNS abnormalities leading to decreased activity of CRH- or AVP-producing hypothalamic neurons. Primary hypofunction of the CRH neurons has been described on the basis of genetic and environmental influences. Other pathways could secondarily influence HPA axis activity, however. For example, serotonergic and noradrenergic input acts to stimulate HPA axis activity. Deficient serotonergic activity in CFS has been suggested by some of the studies as reviewed here. In addition, hypofunction of sympathetic nervous system function has been described and could contribute to abnormalities of central components of the HPA axis. One could interpret the clinical trial of glucocorticoid replacement in patients with CFS as confirmation of adrenal insufficiency if one were convinced of a positive therapeutic effect. If patient symptoms were related to impaired activation of central components of the axis, replacing glucocorticoids would merely exacerbate symptoms caused by enhanced negative feedback. Further study of specific components of the HPA axis should ultimately clarify the reproducible abnormalities associated with a clinical picture of CFS. In contrast to CFS, the results of the different hormonal axes in FMS support the assumption that the distortion of the hormonal pattern observed can be attributed to hyperactivity of CRH neurons. This hyperactivity may be driven and sustained by stress exerted by chronic pain originating in the musculoskeletal system or by an alteration of the CNS mechanism of nociception. The elevated activity of CRH neurons also seems to cause alteration of the set point of other hormonal axes. In addition to its control of the adrenal hormones, CRH stimulates somatostatin secretion at the hypothalamic level, which, in turn, causes inhibition of growth hormone and thyroid-stimulating hormone at the pituitary level. The suppression of gonadal function may also be attributed to elevated CRH because of its ability to inhibit hypothalamic luteinizing hormone-releasing hormone release; however, a remote effect on the ovary by the inhibition of follicle-stimulating hormone-stimulated estrogen production must also be considered. Serotonin (5-HT) precursors such as tryptophan (5-HTP), drugs that release 5-HT, or drugs that act directly on 5-HT receptors stimulate the HPA axis, indicating a stimulatory effect of serotonergic input on HPA axis function. Hyperfunction of the HPA axis could also reflect an elevated serotonergic tonus in the CNS of FMS patients. The authors conclude that the observed pattern of hormonal deviations in patients with FMS is a CNS adjustment to chronic pain and stress, constitutes a specific entity of FMS, and is primarily evoked by activated CRH neurons. ""Serotonin (5-HT) precursors such as tryptophan (5-HTP), drugs that release 5-HT, or drugs that act directly on 5-HT receptors stimulate the HPA axis, indicating a stimulatory effect of serotonergic input on HPA axis function. Hyperfunction of the HPA axis could also reflect an elevated serotonergic tonus in the CNS of FMS patients. "


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## eric (Jul 8, 1999)

FYI"Einar Bjï¿½rnsson, Gï¿½teborg, Sweden The role of nutrients in the sensitisation of IBS Summarized by Anna Gunnarsdottir, Dept. of Medicine, Sahlgrenska University Hospital. Gï¿½teborg Postprandial exacerbation of symptoms is common in patients with IBS. Different studies have shown that 63-71% of pain periods in IBS patients are after eating (Ragnarsson 1998, Dainese 1999, Simrï¿½n 2000). The pathogenesis of postprandial symptoms in IBS is not fully understood but it has been speculated that one or more of the following might play a role: # motility disturbances # malabsorbtion # psycological distress # food allergy # GI hormons # perceptional disturbances MOTILITY Motility studies in the small intestine of patients with IBS have shown that the proportion of retrograde contractions is higher in these patients than in healthy volunteers and this is more striking in the postprandial period than in phase II of the migrating motor complex. Motility index is also higher postprandially in these patients compared with healthy controls. The gastrocolonic response has been studied by distending the stomach with a fluid filled balloon in the antrum (antral distention) and measured by a barometer in the descending colon. The colonic motor respons to different food has been studied. The colonic respons to duodenal lipids is very different in IBS patients vs. controls, that is more phasic events in the IBS patients but decreased colonic volume in the controls. MALABSORBTION It is very common that these patients ask if their symptoms are originating from some kind of food intolerance. It has been speculated about malabsorbtion of lactulose fructose bile acids or of food allergens. The clinical significance of lactose malabsorbtion in IBS has been a matter of debate but patients often report symptoms after milk intake and many avoid milk completely. Food allergy has been speculated to be a possible part of the symptoms in patients with diarrhea predominant IBS, but more prospective studies are needed. PSYCOLOGICAL DISTRESS Studies have shown that IBS patients can get sever GI reaction after normal salin infusion when the patients thought they were getting a solution they were allergic to, so if they thougth they were allergic they got sick. GI-HORMONS A study form Lund University showed that CCK peak after meal was more pronounced in these patients than in controls. Other studies have shown that 5-HT after meal are significantly higher in IBS patients than in controls. Motilin is a stimulatin hormon fore the upper small intestine. Higher basal levels have been reported in patients with IBS and even abberant patterns in response to food in IBS patienst compared with controls. PERCEPTION A study af the colonic perception in IBS patients has been performed (Simrï¿½n 1999) using a barometer a pressure in a colonic balloon was increased to a sensory treshold and then the patients and healthy controls were given lipids or salin and a new measurement performed. After the lipid infusion the IBS patients had lower sensory treshold and this was not seen after salin infusion this was significantly different comparing IBS patients vs. controls. The patients reported pain on a body map by marking the area were they felt the pain. IBS patients often report abdominal distention and increased gas after meals. It is difficult to measure gas but it has indirect measurements have been tried by measuring changes in girth length. CONCLUSION More studies are needed in IBS and relation to food. There are no studies based on the Rome II criteria and no randomized controled trials. Food intolerance could play a role in the IBS pathogenesis by generally increasing sensitivity but an important role is not supported by the available litterateur.


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## eric (Jul 8, 1999)

FYI"Einar Bjï¿½rnsson, Gï¿½teborg, Sweden The role of nutrients in the sensitisation of IBS Summarized by Anna Gunnarsdottir, Dept. of Medicine, Sahlgrenska University Hospital. Gï¿½teborg Postprandial exacerbation of symptoms is common in patients with IBS. Different studies have shown that 63-71% of pain periods in IBS patients are after eating (Ragnarsson 1998, Dainese 1999, Simrï¿½n 2000). The pathogenesis of postprandial symptoms in IBS is not fully understood but it has been speculated that one or more of the following might play a role: # motility disturbances # malabsorbtion # psycological distress # food allergy # GI hormons # perceptional disturbances MOTILITY Motility studies in the small intestine of patients with IBS have shown that the proportion of retrograde contractions is higher in these patients than in healthy volunteers and this is more striking in the postprandial period than in phase II of the migrating motor complex. Motility index is also higher postprandially in these patients compared with healthy controls. The gastrocolonic response has been studied by distending the stomach with a fluid filled balloon in the antrum (antral distention) and measured by a barometer in the descending colon. The colonic motor respons to different food has been studied. The colonic respons to duodenal lipids is very different in IBS patients vs. controls, that is more phasic events in the IBS patients but decreased colonic volume in the controls. MALABSORBTION It is very common that these patients ask if their symptoms are originating from some kind of food intolerance. It has been speculated about malabsorbtion of lactulose fructose bile acids or of food allergens. The clinical significance of lactose malabsorbtion in IBS has been a matter of debate but patients often report symptoms after milk intake and many avoid milk completely. Food allergy has been speculated to be a possible part of the symptoms in patients with diarrhea predominant IBS, but more prospective studies are needed. PSYCOLOGICAL DISTRESS Studies have shown that IBS patients can get sever GI reaction after normal salin infusion when the patients thought they were getting a solution they were allergic to, so if they thougth they were allergic they got sick. GI-HORMONS A study form Lund University showed that CCK peak after meal was more pronounced in these patients than in controls. Other studies have shown that 5-HT after meal are significantly higher in IBS patients than in controls. Motilin is a stimulatin hormon fore the upper small intestine. Higher basal levels have been reported in patients with IBS and even abberant patterns in response to food in IBS patienst compared with controls. PERCEPTION A study af the colonic perception in IBS patients has been performed (Simrï¿½n 1999) using a barometer a pressure in a colonic balloon was increased to a sensory treshold and then the patients and healthy controls were given lipids or salin and a new measurement performed. After the lipid infusion the IBS patients had lower sensory treshold and this was not seen after salin infusion this was significantly different comparing IBS patients vs. controls. The patients reported pain on a body map by marking the area were they felt the pain. IBS patients often report abdominal distention and increased gas after meals. It is difficult to measure gas but it has indirect measurements have been tried by measuring changes in girth length. CONCLUSION More studies are needed in IBS and relation to food. There are no studies based on the Rome II criteria and no randomized controled trials. Food intolerance could play a role in the IBS pathogenesis by generally increasing sensitivity but an important role is not supported by the available litterateur.


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## eric (Jul 8, 1999)

FYI http://www.healthcare.ucla.edu/pls/ibs.htm "Irritable Bowel Syndrome (IBS) What is it? Irritable Bowel Syndrome (IBS) is a chronic clinical problem which includes a combination of abdominal pain and altered bowel habits. Patients may also suffer from a range of associated problems such as the feeling of incomplete emptying of the bowel, peculiar shape of their stool, discharge of mucus, the sensation of bloating, excessive gas, and abdominal distension. IBS can manifest itself in different degrees of severity. In its most devastating form, symptoms are longstanding, incapacitating, nearly constant, and have little correlation with food intake or bowel movement. In its milder form, symptoms may have flared only within the last few years and are closely related to food intake or bowel movement. Regardless of its severity, IBS is a chronic, frequently lifelong disease. Who may be affected? IBS is an extremely common problem, affecting as many as 40 million Americans. Sufferers of IBS make up almost half the patients seen by gastroenterologists (bowel specialists). Interestingly, about 8 million more Americans experience similar, less severe symptoms that do not interfere with their lives or prompt them to see a doctor. What causes it? It has long been thought that spasms of the colon or psychiatric factors were the cause of this syndrome. Even though such factors may be associated with IBS in certain patients, they don't seem to play a major role in causing IBS in the first place. In the past few years, scientists have identified a specific abnormality in the sigmoid colon and rectum that can explain most of the symptoms of IBS (such as bloating, gas, fullness, or constipation). This abnormality is an increased sensitivity of sensors within the bowel wall. This internal hypersensitivity is comparable to what occurs when you have a sunburn; the slightest touch or even breeze can be painful while unburned skin will hardly feel the same stimulus. For someone with the hypersensitivity, normal contraction and expansion of the rectum or colon can result in intense sensations. It therefore appears that most of the symptoms of IBS are due to an excessive perception of internal sensations. Frequently, other symptoms of hyper-sensitivity are associated with IBS. A patient may experience headaches, lower back pain, or pain during intercourse. This may be related to the fact that whatever mechanisms cause the hypersensitivity in the colon can also have the same effect on other parts of the body. Why this hypersensitivity develops is not yet understood. There may be genetic factors that make an individual susceptible to this problem. However, once someone is susceptible, factors in that person's environment become the most important triggers and aggravating forces. What affects the problem? Even just drinking water can cause bloating in some patients. For others, specific food items may cause or be related to distension of the stomach. Spices, milk products, artificial sweeteners, acids, and fats all interact with the same nerve receptors in the gut that are affected by IBS. Unresolved emotional problems, interrupted sleep patterns, grieving, depression, and anxiety can also trigger symptoms. So can situations an individual may perceive (consciously or unconsciously) as stressful. Most often, symptoms are triggered by a combination of factors. What can be done? IBS cannot be cured, but it can be controlled in many cases. While scientists try to discover the causes of hypersensitivity and develop more effective medications, the goal of treatment is to reduce the severity of symptoms to a level where they do not interfere with the person's lifestyle. The first step is seeing a physician who can rule out other treatable conditions and establish a firm diagnosis of IBS. Some physical abnormalities can be corrected with surgery, while medications can relieve some diarrhea, constipation, and pain. For most IBS patients, the gastroenterologist will identify specific triggers (dietary, behavioral, or psychological) so that a "custom-tailored" treatment can be planned. Therapies may include medications, relaxation training, short- term psychotherapy, acupuncture, and dietary counseling. Usually a combination of therapies is most effective. In general, a good response to treatment is more likely when symptoms are related to specific dietary or behavioral triggers, when onset or worsening of the problem is relatively recent, and when the patient accepts the special nature of the disease. What can I do? Should problems develop, seek a thorough evaluation and counseling from a physician familiar with the variety of causes and treatments for bowel disorders, such as a gastroenterologist. Keeping a diary of foods eaten or circumstances that worsen the problem can help provide information to your physician. And, since the problem is largely one of hypersensitivity, cooperate with your physician to understand your problem and follow recommendations. "


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## eric (Jul 8, 1999)

FYI http://www.healthcare.ucla.edu/pls/ibs.htm "Irritable Bowel Syndrome (IBS) What is it? Irritable Bowel Syndrome (IBS) is a chronic clinical problem which includes a combination of abdominal pain and altered bowel habits. Patients may also suffer from a range of associated problems such as the feeling of incomplete emptying of the bowel, peculiar shape of their stool, discharge of mucus, the sensation of bloating, excessive gas, and abdominal distension. IBS can manifest itself in different degrees of severity. In its most devastating form, symptoms are longstanding, incapacitating, nearly constant, and have little correlation with food intake or bowel movement. In its milder form, symptoms may have flared only within the last few years and are closely related to food intake or bowel movement. Regardless of its severity, IBS is a chronic, frequently lifelong disease. Who may be affected? IBS is an extremely common problem, affecting as many as 40 million Americans. Sufferers of IBS make up almost half the patients seen by gastroenterologists (bowel specialists). Interestingly, about 8 million more Americans experience similar, less severe symptoms that do not interfere with their lives or prompt them to see a doctor. What causes it? It has long been thought that spasms of the colon or psychiatric factors were the cause of this syndrome. Even though such factors may be associated with IBS in certain patients, they don't seem to play a major role in causing IBS in the first place. In the past few years, scientists have identified a specific abnormality in the sigmoid colon and rectum that can explain most of the symptoms of IBS (such as bloating, gas, fullness, or constipation). This abnormality is an increased sensitivity of sensors within the bowel wall. This internal hypersensitivity is comparable to what occurs when you have a sunburn; the slightest touch or even breeze can be painful while unburned skin will hardly feel the same stimulus. For someone with the hypersensitivity, normal contraction and expansion of the rectum or colon can result in intense sensations. It therefore appears that most of the symptoms of IBS are due to an excessive perception of internal sensations. Frequently, other symptoms of hyper-sensitivity are associated with IBS. A patient may experience headaches, lower back pain, or pain during intercourse. This may be related to the fact that whatever mechanisms cause the hypersensitivity in the colon can also have the same effect on other parts of the body. Why this hypersensitivity develops is not yet understood. There may be genetic factors that make an individual susceptible to this problem. However, once someone is susceptible, factors in that person's environment become the most important triggers and aggravating forces. What affects the problem? Even just drinking water can cause bloating in some patients. For others, specific food items may cause or be related to distension of the stomach. Spices, milk products, artificial sweeteners, acids, and fats all interact with the same nerve receptors in the gut that are affected by IBS. Unresolved emotional problems, interrupted sleep patterns, grieving, depression, and anxiety can also trigger symptoms. So can situations an individual may perceive (consciously or unconsciously) as stressful. Most often, symptoms are triggered by a combination of factors. What can be done? IBS cannot be cured, but it can be controlled in many cases. While scientists try to discover the causes of hypersensitivity and develop more effective medications, the goal of treatment is to reduce the severity of symptoms to a level where they do not interfere with the person's lifestyle. The first step is seeing a physician who can rule out other treatable conditions and establish a firm diagnosis of IBS. Some physical abnormalities can be corrected with surgery, while medications can relieve some diarrhea, constipation, and pain. For most IBS patients, the gastroenterologist will identify specific triggers (dietary, behavioral, or psychological) so that a "custom-tailored" treatment can be planned. Therapies may include medications, relaxation training, short- term psychotherapy, acupuncture, and dietary counseling. Usually a combination of therapies is most effective. In general, a good response to treatment is more likely when symptoms are related to specific dietary or behavioral triggers, when onset or worsening of the problem is relatively recent, and when the patient accepts the special nature of the disease. What can I do? Should problems develop, seek a thorough evaluation and counseling from a physician familiar with the variety of causes and treatments for bowel disorders, such as a gastroenterologist. Keeping a diary of foods eaten or circumstances that worsen the problem can help provide information to your physician. And, since the problem is largely one of hypersensitivity, cooperate with your physician to understand your problem and follow recommendations. "


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## JeanG (Oct 20, 1999)

Hi Eric:Interestingly enough, regarding the hyper-sensitivity you mentioned in your last post, once I took care of my stress, not only was my ibs greatly alleviated, but lately I have had much less pain in my back and knees. The back problem, as I've mentioned to you before, was definitely from stress. The doc couldn't determine what was wrong with my knees except for a little arthritis. But those aches and pains, along with others, are very minimal now. Which means most of the symptoms I had were because of stress.JeanG


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## JeanG (Oct 20, 1999)

Hi Eric:Interestingly enough, regarding the hyper-sensitivity you mentioned in your last post, once I took care of my stress, not only was my ibs greatly alleviated, but lately I have had much less pain in my back and knees. The back problem, as I've mentioned to you before, was definitely from stress. The doc couldn't determine what was wrong with my knees except for a little arthritis. But those aches and pains, along with others, are very minimal now. Which means most of the symptoms I had were because of stress.JeanG


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## ohnometo (Sep 20, 2001)

Jean I can sure relate about the pain that you was having in your knees ...I was alwaysrunning to the Dr. and they was doing arthritis blood test and they kept coming backnothing was the matter....When I would get these attacks with IBS-D my joints wouldhurt so bad....where I had to always be rubbing them..I bet I used tons of Bengay..That's wonderful that when you got your stress under control that the symptoms got alot better...Mine started to improve when I started taking the things out of my diet that I shouldn'tbe eating...It's funny how IBS can affect different people in different ways.. I am so glad not to have that constant aching anymore....It feels wonderful...Donna







********************************************************************************I am glad that at least someone is willing to do more studies about food and IBS.I guess I consider myself one of the lucky ones that food did play a huge part in myIBS...QUOTE:CONCLUSION More studies are needed in IBS and relation to food. There are no studies based on the Rome II criteria and no randomized controled trials. Food intolerance could play a role in the IBS pathogenesis by generally increasing sensitivity but an important role is not supported by the available litterateur.


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## ohnometo (Sep 20, 2001)

Jean I can sure relate about the pain that you was having in your knees ...I was alwaysrunning to the Dr. and they was doing arthritis blood test and they kept coming backnothing was the matter....When I would get these attacks with IBS-D my joints wouldhurt so bad....where I had to always be rubbing them..I bet I used tons of Bengay..That's wonderful that when you got your stress under control that the symptoms got alot better...Mine started to improve when I started taking the things out of my diet that I shouldn'tbe eating...It's funny how IBS can affect different people in different ways.. I am so glad not to have that constant aching anymore....It feels wonderful...Donna







********************************************************************************I am glad that at least someone is willing to do more studies about food and IBS.I guess I consider myself one of the lucky ones that food did play a huge part in myIBS...QUOTE:CONCLUSION More studies are needed in IBS and relation to food. There are no studies  based on the Rome II criteria and no randomized controled trials. Food intolerance could play a role in the IBS pathogenesis by generally increasing sensitivity but an important role is not supported by the available litterateur.


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## eric (Jul 8, 1999)

Donna, I remember you saying that apples bugged you, were you eating a lot of fruit and did you ever have malabsorbtion studies done ever?Just curious what foods you eliminated and what foods you were reactive to from what the leaps tests told you. Can you list them if you don't mind.Jean, very good to hear and of course I am thrilled you have improved.


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## eric (Jul 8, 1999)

Donna, I remember you saying that apples bugged you, were you eating a lot of fruit and did you ever have malabsorbtion studies done ever?Just curious what foods you eliminated and what foods you were reactive to from what the leaps tests told you. Can you list them if you don't mind.Jean, very good to hear and of course I am thrilled you have improved.


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## ohnometo (Sep 20, 2001)

Eric,The number one highest food that come back was Apple showing very reactive....The others were Benzoic acid, Mustard, Cottage cheese, coconut, Oat was kinda high but not as bad as the others....I have lived on apple juice for ever.My mother even told me when I was little I would drink apple juice and just lay on the floor and cry ....Now, why she didnt figure that out is beyond me....All last yearwe I was getting really sick the only thing I was drinking was sodas, apple juiceHi-C..I lived on mounds bars and would always eat cottage cheese I loved it.. I havelived on Apple juice for 40 years...Now when I have been in the hospital and I wasgetting the IV they would bring me in a clear liquid diet and on my tray was alwayshad apple juice on it...I would drink it because I was so thirsty from throwing up..I would lay over there for days with my stomach , vomiting, nausea, D untill I was so bad they even took the tray away and I had nothing at all to drink..When that happenedmy Pain, Nausea, Vomiting, joint hurting stopped, One reason I never figured out itwas apple because I had allergy test done (skin prick) and everything was fine....So I didnt think it was the foods I was eating that was causing all of this expeciallwhen it turned up everything was ok...... Now if you have been reading my postand you know I have been here asking for help before I decided to go with LEAPYou take someone who has been in the HOSPITAL every month last year and onetime I was there and got out on a Wednesday and was back on Friday being admittedagain for the same thing....You take someone as sick as I have been for 40 andstart taking away the things thats making me sick (food) and the improvent is beyond belief.....Of how much better I got since I have not been eating or drinking the stuffIf food had not played a part in this you can bet my A*ss I would be in the ER or setting on my comode with my head in the trash can coming out both ends.....And there is no waybefore anyone says it that I am just excited about working with LEAP and thats why I amall better.....I dont think so...........My mind is powerful but not that powerful.....I have never in my life ever, ever, ever, had this much remission in a life time.And for the anxiety it is almost gone but I still need some work on it....I have notone time ever had D or vomiting, nausea, headache, joint aches, face turning red, sweatingfrom horrible pain, getting dependent on pills, belching, gas ect.....Since I have stopped putting the things in my system I shouldnt.....Why wouldnt I want to come here and share what is working for me....I lived for 40 years people telling me your are just nerveous, your sickbecause your Dad was an alcoholic, You worry to much, ect.....Yeah rightAfter you hear that for years and years I just felt like there was no hope for me..Becausethe more I tried to practice relaxation it never worked for me when I was sick.......I dont know why it is such a big deal why people cannot accept that I am better by noteating what I shouldnt......You know they took my Gallbladder out and said that was the problem ...NO it wasnt....Many years ago they did a Hysderectomy (didnt spell right)said I had endrometrosis.....NO it didnt work...and that is not all of the surgery's...yes I had alot more then one opinion....As far as the test you are asking me about I dont even know what they are ???? I have had so many test in all ends of my body...And all the testing I went throught down John Hopkins was enought to last me a life timeEric, I dont want to sound nasty or anything because i really do enjoy the stuff you postbecause I have learned alot from it......and you was here to help me when I first come aroundhere on the BB...You might have been the first one to stick your hand out to me...But all I know when I follow the directions that was suggested to me it works....I dont knowhow and I dont know why IT JUST WORKS.... when NOTHING else in the world did..I am not hear trying to argue with you just letting you know out of excitement that I am a different personDonna


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## ohnometo (Sep 20, 2001)

Eric,The number one highest food that come back was Apple showing very reactive....The others were Benzoic acid, Mustard, Cottage cheese, coconut, Oat was kinda high but not as bad as the others....I have lived on apple juice for ever.My mother even told me when I was little I would drink apple juice and just lay on the floor and cry ....Now, why she didnt figure that out is beyond me....All last yearwe I was getting really sick the only thing I was drinking was sodas, apple juiceHi-C..I lived on mounds bars and would always eat cottage cheese I loved it.. I havelived on Apple juice for 40 years...Now when I have been in the hospital and I wasgetting the IV they would bring me in a clear liquid diet and on my tray was alwayshad apple juice on it...I would drink it because I was so thirsty from throwing up..I would lay over there for days with my stomach , vomiting, nausea, D untill I was so bad they even took the tray away and I had nothing at all to drink..When that happenedmy Pain, Nausea, Vomiting, joint hurting stopped, One reason I never figured out itwas apple because I had allergy test done (skin prick) and everything was fine....So I didnt think it was the foods I was eating that was causing all of this expeciallwhen it turned up everything was ok...... Now if you have been reading my postand you know I have been here asking for help before I decided to go with LEAPYou take someone who has been in the HOSPITAL every month last year and onetime I was there and got out on a Wednesday and was back on Friday being admittedagain for the same thing....You take someone as sick as I have been for 40 andstart taking away the things thats making me sick (food) and the improvent is beyond belief.....Of how much better I got since I have not been eating or drinking the stuffIf food had not played a part in this you can bet my A*ss I would be in the ER or setting on my comode with my head in the trash can coming out both ends.....And there is no waybefore anyone says it that I am just excited about working with LEAP and thats why I amall better.....I dont think so...........My mind is powerful but not that powerful.....I have never in my life ever, ever, ever, had this much remission in a life time.And for the anxiety it is almost gone but I still need some work on it....I have notone time ever had D or vomiting, nausea, headache, joint aches, face turning red, sweatingfrom horrible pain, getting dependent on pills, belching, gas ect.....Since I have stopped putting the things in my system I shouldnt.....Why wouldnt I want to come here and share what is working for me....I lived for 40 years people telling me your are just nerveous, your sickbecause your Dad was an alcoholic, You worry to much, ect.....Yeah rightAfter you hear that for years and years I just felt like there was no hope for me..Becausethe more I tried to practice relaxation it never worked for me when I was sick.......I dont know why it is such a big deal why people cannot accept that I am better by noteating what I shouldnt......You know they took my Gallbladder out and said that was the problem ...NO it wasnt....Many years ago they did a Hysderectomy (didnt spell right)said I had endrometrosis.....NO it didnt work...and that is not all of the surgery's...yes I had alot more then one opinion....As far as the test you are asking me about I dont even know what they are ???? I have had so many test in all ends of my body...And all the testing I went throught down John Hopkins was enought to last me a life timeEric, I dont want to sound nasty or anything because i really do enjoy the stuff you postbecause I have learned alot from it......and you was here to help me when I first come aroundhere on the BB...You might have been the first one to stick your hand out to me...But all I know when I follow the directions that was suggested to me it works....I dont knowhow and I dont know why IT JUST WORKS.... when NOTHING else in the world did..I am not hear trying to argue with you just letting you know out of excitement that I am a different personDonna


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## ohnometo (Sep 20, 2001)

EricI just wanted to tell you that I do get upset when I feel someone dont believewhat I am saying...I have tried to tell someone what was going on with me sinceI was able to talk...and deep down in my heart I always felt that there had to besomething else going on with me beside stress......Like I said before I am nottrying to push leap down anyone throat...I thank God everyday that I am better.I have said many prayers over my life time about getting better and I think I havefound something that works...Maybe I am just one of the lucky ones where foodplayed the part in my IBS-D...If I get sick tomorrow I am so thankful for these lastfew months of being blessed to be symptom free.....


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## ohnometo (Sep 20, 2001)

EricI just wanted to tell you that I do get upset when I feel someone dont believewhat I am saying...I have tried to tell someone what was going on with me sinceI was able to talk...and deep down in my heart I always felt that there had to besomething else going on with me beside stress......Like I said before I am nottrying to push leap down anyone throat...I thank God everyday that I am better.I have said many prayers over my life time about getting better and I think I havefound something that works...Maybe I am just one of the lucky ones where foodplayed the part in my IBS-D...If I get sick tomorrow I am so thankful for these lastfew months of being blessed to be symptom free.....


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## eric (Jul 8, 1999)

Donna, you won't get an arguement from me on your feeling better, as I think thats great and I am very happy to hear it. I mean that from the heart.I asked about the fructose malasorption tests, because it sounds like it maybe a problem for you for sure.Mike and I have major disareements yes, but on some mechanisms of IBS not on people getting better which I am sure were both happy to hear about no matter what method they used.It possible that the food senstitivity issues he talks about are comorbid with IBS and not really a part of IBS( as much as he likes to say it is) and is just another trigger.I believe there is an underlying disorder and he has stated before there isn't, that its the food sensitivity issue. I would be a much happier camper for the most part if he just stated this is a mechanism and a trigger and did not ignore for the most part all the other mecahnisms involved. Do I believe foods effect IBS certainly I do.I have talked to quite a few top gi doctors in depth on foods for my own reasons. There are some major reasons foods aren't the underlying culprit, but are triggers for sure. And as Mike has pointed out the mechanisms that show how they can be.The serotonin/chemical issues and the hpa axis issues are BIG issues in IBS however.So I want you to know this has nothinng to do with you or your success with food elimination. Most people struggle hard with that part of IBS and a dietian or whatever way you need to go is fine by me really. I also like you as a person and you have been very nice everytime we have ever conversed. I am sure you find this information I am posting interesting also. I also think its important to use both a food and a stress management approach for the best outcomes and both Mike and I agree on that for sure.Seriously if I were you I would think about having a fructose malasorption test done just to know.Flux, could probably give you the best info on the testing for it.


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## eric (Jul 8, 1999)

Donna, you won't get an arguement from me on your feeling better, as I think thats great and I am very happy to hear it. I mean that from the heart.I asked about the fructose malasorption tests, because it sounds like it maybe a problem for you for sure.Mike and I have major disareements yes, but on some mechanisms of IBS not on people getting better which I am sure were both happy to hear about no matter what method they used.It possible that the food senstitivity issues he talks about are comorbid with IBS and not really a part of IBS( as much as he likes to say it is) and is just another trigger.I believe there is an underlying disorder and he has stated before there isn't, that its the food sensitivity issue. I would be a much happier camper for the most part if he just stated this is a mechanism and a trigger and did not ignore for the most part all the other mecahnisms involved. Do I believe foods effect IBS certainly I do.I have talked to quite a few top gi doctors in depth on foods for my own reasons. There are some major reasons foods aren't the underlying culprit, but are triggers for sure. And as Mike has pointed out the mechanisms that show how they can be.The serotonin/chemical issues and the hpa axis issues are BIG issues in IBS however.So I want you to know this has nothinng to do with you or your success with food elimination. Most people struggle hard with that part of IBS and a dietian or whatever way you need to go is fine by me really. I also like you as a person and you have been very nice everytime we have ever conversed. I am sure you find this information I am posting interesting also. I also think its important to use both a food and a stress management approach for the best outcomes and both Mike and I agree on that for sure.Seriously if I were you I would think about having a fructose malasorption test done just to know.Flux, could probably give you the best info on the testing for it.


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## ohnometo (Sep 20, 2001)

EricIf this was the case Fructose malasorption How come I can eat other fruit andthe least active item after working with Leap was pineapple ? I eat pinapple and other fruit without a problem....What could that test tell me if apple is the problem andI am ok with other fruits ? Also, fructose come back as being really low to one ofthe things that I was tested for ******************************************************Seriously if I were you I would think about having a fructose malasorption test done just to know. :


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## ohnometo (Sep 20, 2001)

EricIf this was the case Fructose malasorption How come I can eat other fruit andthe least active item after working with Leap was pineapple ? I eat pinapple and other fruit without a problem....What could that test tell me if apple is the problem andI am ok with other fruits ? Also, fructose come back as being really low to one ofthe things that I was tested for ******************************************************Seriously if I were you I would think about having a fructose malasorption test done just to know. :


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## eric (Jul 8, 1999)

Some fruits are higher in fructose then others. Fructose however is in a lot of things.You know after thinking about it, really if you feel better and foods are not bothering you anymore I guess you could skip the test and just not eat foods that you feel and leap feels are triggers for you.


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## eric (Jul 8, 1999)

Some fruits are higher in fructose then others. Fructose however is in a lot of things.You know after thinking about it, really if you feel better and foods are not bothering you anymore I guess you could skip the test and just not eat foods that you feel and leap feels are triggers for you.


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## ohnometo (Sep 20, 2001)

Thanks Eric....I will continue to stay away from the foods that "trigger" my IBS-Dand see how that works.


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## ohnometo (Sep 20, 2001)

Thanks Eric....I will continue to stay away from the foods that "trigger" my IBS-Dand see how that works.


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## eric (Jul 8, 1999)

Donna, no prroblem and am very happy things are going well for you and I hope they continue for sure.







FYI on how they have begun or in a way been forced to look at the condition more holistically. http://www.med.unc.edu/medicine/fgidc/biopsychosocial.htm "The biopsychosocial model proposes that illness and disease result from interacting systems at the cellular, tissue, organismal, interpersonal and environmental levels, explained Douglas Drossman, MD,"This is really a good thing and I believe an advancement to all medicine as a whole.


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## eric (Jul 8, 1999)

Donna, no prroblem and am very happy things are going well for you and I hope they continue for sure.







FYI on how they have begun or in a way been forced to look at the condition more holistically. http://www.med.unc.edu/medicine/fgidc/biopsychosocial.htm "The biopsychosocial model proposes that illness and disease result from interacting systems at the cellular, tissue, organismal, interpersonal and environmental levels, explained Douglas Drossman, MD,"This is really a good thing and I believe an advancement to all medicine as a whole.


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## ohnometo (Sep 20, 2001)

Thanks Eric...I read it several times ...I am glad to see that theyat least mentioned diet as one of the triggers.. I know this is one of thetop hospital that works with GI symptoms and IBS....Now I have a questionI wanted to ask before but never did...I called them last year and also searchedtheir site for information on Cyclic Vomiting Syndrome...and sent them an email.I dont think they ever heard of it....When I called down there no one knew what I wastalking about...They did send me alot of good information on IBS but nothingabout vomiting and nausea...Maybe I wasnt searching the site in the correct place..Why wouldnt this hospital know anything about CVS ? Is theresomething on their site that I haven't found ? Dont you think that Dr. Drossmanwould have heard of it or treated others with this condition ( I know it is a rare disorder) expecially being such a good hospital....I know last year I wanted to go to UNCabout this CVS and with CVS being a GI problem I was just surprized.Like I say , there may be something on their site that I haven't found and it has been allittle while since I searched there....Just curious if you know what DrDrossman opinion would be on CVS....If he has posted any reports on thissyndrome...


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## ohnometo (Sep 20, 2001)

Thanks Eric...I read it several times ...I am glad to see that theyat least mentioned diet as one of the triggers.. I know this is one of thetop hospital that works with GI symptoms and IBS....Now I have a questionI wanted to ask before but never did...I called them last year and also searchedtheir site for information on Cyclic Vomiting Syndrome...and sent them an email.I dont think they ever heard of it....When I called down there no one knew what I wastalking about...They did send me alot of good information on IBS but nothingabout vomiting and nausea...Maybe I wasnt searching the site in the correct place..Why wouldnt this hospital know anything about CVS ? Is theresomething on their site that I haven't found ? Dont you think that Dr. Drossmanwould have heard of it or treated others with this condition ( I know it is a rare disorder) expecially being such a good hospital....I know last year I wanted to go to UNCabout this CVS and with CVS being a GI problem I was just surprized.Like I say , there may be something on their site that I haven't found and it has been allittle while since I searched there....Just curious if you know what DrDrossman opinion would be on CVS....If he has posted any reports on thissyndrome...


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## eric (Jul 8, 1999)

Donna, I know Dr Drossman has heard of it.There is some info in the merck manual and he is the consultant for it for gastroenterology.I just saw some info somewhere on it in one of the sites, but I think it was the IFFGD and it was a link to the CVS organization.I'll see if I can find some more on it.Also wanted to post this here.Irritable Bowel Syndrome in Adults with Lin Chang, M.D. and Lonnie Zeltzer, M.D. http://my.webmd.com/content/article/1707.50228


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## eric (Jul 8, 1999)

Donna, I know Dr Drossman has heard of it.There is some info in the merck manual and he is the consultant for it for gastroenterology.I just saw some info somewhere on it in one of the sites, but I think it was the IFFGD and it was a link to the CVS organization.I'll see if I can find some more on it.Also wanted to post this here.Irritable Bowel Syndrome in Adults with Lin Chang, M.D. and Lonnie Zeltzer, M.D. http://my.webmd.com/content/article/1707.50228


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## ohnometo (Sep 20, 2001)

Thanks EricI read the site you posted on another thread and I had come across it last month when I wassearching the internet.. I am a member of the CVS ...I think that may be the site that you was refering to. I though that Dr. Drossman would have heard of it but when I was at their site and typed inCyclic Vomiting Syndrome I couldnt get anything to come up....I tried it again yesterday...I might be wrongbut I thought I read somewhere that Dr Drossman once worked with Dr Marvin Schuster of JohnHopkins...It seems like they were connected in someway or another ....Maybe I was dreaming







Dr Lin Chang also did a article on CVS like the one he did with IBS ..I have read that one before....


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## ohnometo (Sep 20, 2001)

Thanks EricI read the site you posted on another thread and I had come across it last month when I wassearching the internet.. I am a member of the CVS ...I think that may be the site that you was refering to. I though that Dr. Drossman would have heard of it but when I was at their site and typed inCyclic Vomiting Syndrome I couldnt get anything to come up....I tried it again yesterday...I might be wrongbut I thought I read somewhere that Dr Drossman once worked with Dr Marvin Schuster of JohnHopkins...It seems like they were connected in someway or another ....Maybe I was dreaming







Dr Lin Chang also did a article on CVS like the one he did with IBS ..I have read that one before....


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## eric (Jul 8, 1999)

I think it was the CVS site I posted before.Dr Marvin Schuster is retired now, but did a huge body of work on serotonin and the gi tract. Dr Drossman educate's MDs and gastroenterologists all over the US on gi diorders and Dr Ling Chang was just at the UNC working and studying under Dr Drossman. They are all trying to figure out IBS and other disorders and they share research. So you weren't dreaming.







You might not find to much if anything on CVS on that site, because it may not be a functional disorder or some reason like that perhaps, I know its not well understood either.Have you seen this UK site on it? http://freespace.virgin.net/cvsa.uk/ And this was probably the site I posted before and the one you looked at. http://www.cvsaonline.org/ I think this article is brand new for you. http://www.emedicine.com/ped/topic2910.htm...on~introduction By the way it mentions the same thing I am talking about here effecting IBS with the HPA axis."Stress activation of the hypothalamic-pituitary-adrenal axis also can induce episodes ofCVS. "


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## eric (Jul 8, 1999)

I think it was the CVS site I posted before.Dr Marvin Schuster is retired now, but did a huge body of work on serotonin and the gi tract. Dr Drossman educate's MDs and gastroenterologists all over the US on gi diorders and Dr Ling Chang was just at the UNC working and studying under Dr Drossman. They are all trying to figure out IBS and other disorders and they share research. So you weren't dreaming.







You might not find to much if anything on CVS on that site, because it may not be a functional disorder or some reason like that perhaps, I know its not well understood either.Have you seen this UK site on it? http://freespace.virgin.net/cvsa.uk/ And this was probably the site I posted before and the one you looked at. http://www.cvsaonline.org/ I think this article is brand new for you. http://www.emedicine.com/ped/topic2910.htm...on~introduction By the way it mentions the same thing I am talking about here effecting IBS with the HPA axis."Stress activation of the hypothalamic-pituitary-adrenal axis also can induce episodes ofCVS. "


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## ohnometo (Sep 20, 2001)

ohyesmetoo....This is exactly what happens to me word from word..Thank God I havent foamedat the mouth ...When I get like this and laying in the ER I can hear those Dr's and nurses talkingto me but I am so sick I cant even answer them...The last time there I threw-up for 29 hoursand the time before that it was 31 hours non-stop ...Now I dont want to bring up stress but I amI just dont understand how you could practice Relaxation when you are this sick...How in theworld could hypnosis ever stop someone like this to get better....I am not trying to be nasty I justdont understand...Maybe that dont use Hypnosis for this I dont know.....I hope I wont go back for along along time.....This is why I talk about me being so much better that something might be helping me......I have my hammer ready for you Eric because some of the articles talks about stress !!!!! lolProlongedvomiting can lead to bleeding from irritation and damage to the oesophagus.During an episode the vomit may contain bile and/or blood.Many CVS patients describe a feeling of unreality during an episode, as if they arein some way in a dream like state. Some describe it as being taken over, or beingout of control. During an episode they may be unresponsive, unwilling to talk orbe touched.Some sufferers will drink excessively, perhaps in an attempt to reduce the burningsensation of acidity associated with vomiting or to induce vomiting, in order torelieve the nausea. Others will avoid swallowing as this may induce vomiting, thismay explain the excessive salivation, if a sufferer is scared to swallow. This canlead to dribbling, spitting or foaming around the mouth. Unusual behaviours can be related to the unresponsiveness, photo- or phono-phobias or to physical discomfort. The sufferer may not like to lie flat as this maymake them feel worse, when combined with an unresponsiveness this may appearto medical staff as signs of uncooperativeness or even mental imbalance. In fact itis neither, the sufferer is simply trying to reduce their suffering, talking, beingtouched, being made to lie in a bed etc. may all be unbearable. A sympathetic andcalm environment is the solution. Increased awareness of CVS is essential forparents, family and medical staff dealing with new sufferers. When faced with anindividual who doesn't respond to you, is dribbling or spitting and appears to beout of control it isn't too surprising that too many CVS sufferers have been treatedas psychiatric cases. As those who know a CVS sufferer can tell you thesebehavious stop when the vomiting, pain and nausea stop. Between episodes theperson has completely normal behavious, during an episode it is a simple andunderstandable response to the pain and nausea. In cases where anti-emetic drugsare given and can stop an episode the patient will also return to normal. Awarenessof CVS in the casualty dept./emergency room needs to be raised to prevent suchmis-diagnoses, until then many may suffer needlessly and be mis-judged by thosewho should be caring for them.


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## ohnometo (Sep 20, 2001)

ohyesmetoo....This is exactly what happens to me word from word..Thank God I havent foamedat the mouth ...When I get like this and laying in the ER I can hear those Dr's and nurses talkingto me but I am so sick I cant even answer them...The last time there I threw-up for 29 hoursand the time before that it was 31 hours non-stop ...Now I dont want to bring up stress but I amI just dont understand how you could practice Relaxation when you are this sick...How in theworld could hypnosis ever stop someone like this to get better....I am not trying to be nasty I justdont understand...Maybe that dont use Hypnosis for this I dont know.....I hope I wont go back for along along time.....This is why I talk about me being so much better that something might be helping me......I have my hammer ready for you Eric because some of the articles talks about stress !!!!! lolProlongedvomiting can lead to bleeding from irritation and damage to the oesophagus.During an episode the vomit may contain bile and/or blood.Many CVS patients describe a feeling of unreality during an episode, as if they arein some way in a dream like state. Some describe it as being taken over, or beingout of control. During an episode they may be unresponsive, unwilling to talk orbe touched.Some sufferers will drink excessively, perhaps in an attempt to reduce the burningsensation of acidity associated with vomiting or to induce vomiting, in order torelieve the nausea. Others will avoid swallowing as this may induce vomiting, thismay explain the excessive salivation, if a sufferer is scared to swallow. This canlead to dribbling, spitting or foaming around the mouth. Unusual behaviours can be related to the unresponsiveness, photo- or phono-phobias or to physical discomfort. The sufferer may not like to lie flat as this maymake them feel worse, when combined with an unresponsiveness this may appearto medical staff as signs of uncooperativeness or even mental imbalance. In fact itis neither, the sufferer is simply trying to reduce their suffering, talking, beingtouched, being made to lie in a bed etc. may all be unbearable. A sympathetic andcalm environment is the solution. Increased awareness of CVS is essential forparents, family and medical staff dealing with new sufferers. When faced with anindividual who doesn't respond to you, is dribbling or spitting and appears to beout of control it isn't too surprising that too many CVS sufferers have been treatedas psychiatric cases. As those who know a CVS sufferer can tell you thesebehavious stop when the vomiting, pain and nausea stop. Between episodes theperson has completely normal behavious, during an episode it is a simple andunderstandable response to the pain and nausea. In cases where anti-emetic drugsare given and can stop an episode the patient will also return to normal. Awarenessof CVS in the casualty dept./emergency room needs to be raised to prevent suchmis-diagnoses, until then many may suffer needlessly and be mis-judged by thosewho should be caring for them.


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## trbell (Nov 1, 2000)

it is kind of silly to fight over who is right when even the experts can't agree?I do think there is a difference between a disagreement and a fight. Actually I can make that staement professionally as I've spent twenty years explaining this to people.tom


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## trbell (Nov 1, 2000)

it is kind of silly to fight over who is right when even the experts can't agree?I do think there is a difference between a disagreement and a fight. Actually I can make that staement professionally as I've spent twenty years explaining this to people.tom


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## eric (Jul 8, 1999)

I fell nausous reading it about it. LOLDoesn't sound good and I am glad I don't have that and am sorry you do Donna.Donna, like IBS it would seem some chemical things are happening in CVS.I don't know much about hypnotherapy for CVS, but it would seem like it would help on a couple different levels. Its also some what possible to do it while sleeping really or right before bed.However, I am sure other techniques would be benefical it would seem also and you should look into them for their benefits.Stress sometimes seems to be the wrong word in all this such as IBS, its emotions and feelings and anxiety etc., some on the concious level and some on the subconcious level. However, stress of some sort or another effects everything. The majority of people do not understand it well and hence this thread for some info., which I am posting also as I learn more.I am surprized sometimes at the fight or flight responce when its dicussed. LOL"I have my hammer ready for you Eric because some of the articles talks about stress !!!!! lol"Its important to understand and really helps for treatments in how everything effects the body and health. If you ignore or don't want to learn about (and I know your not doing this, but some do) these mechanisms your not going to get the whole picture of some of the things they do know and how they effect your body and symptoms.For example and I am talking about IBS here, Hypnotherapy is one of the top most effective treatments long term for the majority of IBS sufferers. The top GI doc's know this. Its record surpasses almost every treatment statistically. It may not be for everyone, nor is a cure, but its worth a shot for sure as it can throw the switch on IBS.But until the patient understands really what is happening in IBS and how hypnotherapy really works for IBS and fines someone who knows how to use it for IBS, they don't make the connection easily sometimes. They have begun studying it on fucntional dyspesia with a high success rate already, because its already been established to work on IBS and some of these conditions share some of the same causes. Its not because "IBS is all in the head", its because HT causes physical changes to a physical condition.This is also something to understand and thats is even if your not "stressed" and if you have IBS I feel that is highly unlikely, the relaxation techniques and talk therapies HT, CBT, yoga, breathing excerices, tai chi etc.. benefit the body and conditions in there own way physically as well as mentally. That is also important to realize. Even if you don't feel stresssed breathing techniques still put your gut in relaxation mode. The better you learn and become at them the more help they are and the easier it gets and the better your likely to feel. They have no side effects for the most part (actually most are benefical in more ways then one), so that is a plus.Donna, on the CVS I am not an expert and don't know a lot about it, it looks complicated for sure. I am gald your feeling better however for sure. You may want to email the DR who wrote that CME article or just follow the things he writes about it as they learn about it and it may help.


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## eric (Jul 8, 1999)

I fell nausous reading it about it. LOLDoesn't sound good and I am glad I don't have that and am sorry you do Donna.Donna, like IBS it would seem some chemical things are happening in CVS.I don't know much about hypnotherapy for CVS, but it would seem like it would help on a couple different levels. Its also some what possible to do it while sleeping really or right before bed.However, I am sure other techniques would be benefical it would seem also and you should look into them for their benefits.Stress sometimes seems to be the wrong word in all this such as IBS, its emotions and feelings and anxiety etc., some on the concious level and some on the subconcious level. However, stress of some sort or another effects everything. The majority of people do not understand it well and hence this thread for some info., which I am posting also as I learn more.I am surprized sometimes at the fight or flight responce when its dicussed. LOL"I have my hammer ready for you Eric because some of the articles talks about stress !!!!! lol"Its important to understand and really helps for treatments in how everything effects the body and health. If you ignore or don't want to learn about (and I know your not doing this, but some do) these mechanisms your not going to get the whole picture of some of the things they do know and how they effect your body and symptoms.For example and I am talking about IBS here, Hypnotherapy is one of the top most effective treatments long term for the majority of IBS sufferers. The top GI doc's know this. Its record surpasses almost every treatment statistically. It may not be for everyone, nor is a cure, but its worth a shot for sure as it can throw the switch on IBS.But until the patient understands really what is happening in IBS and how hypnotherapy really works for IBS and fines someone who knows how to use it for IBS, they don't make the connection easily sometimes. They have begun studying it on fucntional dyspesia with a high success rate already, because its already been established to work on IBS and some of these conditions share some of the same causes. Its not because "IBS is all in the head", its because HT causes physical changes to a physical condition.This is also something to understand and thats is even if your not "stressed" and if you have IBS I feel that is highly unlikely, the relaxation techniques and talk therapies HT, CBT, yoga, breathing excerices, tai chi etc.. benefit the body and conditions in there own way physically as well as mentally. That is also important to realize. Even if you don't feel stresssed breathing techniques still put your gut in relaxation mode. The better you learn and become at them the more help they are and the easier it gets and the better your likely to feel. They have no side effects for the most part (actually most are benefical in more ways then one), so that is a plus.Donna, on the CVS I am not an expert and don't know a lot about it, it looks complicated for sure. I am gald your feeling better however for sure. You may want to email the DR who wrote that CME article or just follow the things he writes about it as they learn about it and it may help.


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## ohnometo (Sep 20, 2001)

I am not fighting over this....Different things work for different people and I am one ofe thosewhere changing my diet has really improved my health....and Eric shares how working throughhypnosis can really help people....That is all this is about ..I also used relaxation techniquesalong with my food intolerance....And something is really working....more then anything I have everdone, been to, tried, swallowed..ect...Could you shares what you have been trying to explain for the last 20 years to people..?I sure didnt get a whole lot of answers when I was working with Doctors, or Psycholigsts...Thats forsure...except let's take this out and oh by the way it might be this that needs to come out...GrrrrrrrI am not here arguing about food or hypnosis because both of them works.............************************ QUOTEt is kind of silly to fight over who is right when even the experts can't agree? I do think there is a difference between a disagreement and a fight. Actually I can make that staement professionally as I've spent twenty years explaining this to people


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## ohnometo (Sep 20, 2001)

I am not fighting over this....Different things work for different people and I am one ofe thosewhere changing my diet has really improved my health....and Eric shares how working throughhypnosis can really help people....That is all this is about ..I also used relaxation techniquesalong with my food intolerance....And something is really working....more then anything I have everdone, been to, tried, swallowed..ect...Could you shares what you have been trying to explain for the last 20 years to people..?I sure didnt get a whole lot of answers when I was working with Doctors, or Psycholigsts...Thats forsure...except let's take this out and oh by the way it might be this that needs to come out...GrrrrrrrI am not here arguing about food or hypnosis because both of them works.............************************ QUOTEt is kind of silly to fight over who is right when even the experts can't agree? I do think there is a difference between a disagreement and a fight. Actually I can make that staement professionally as I've spent twenty years explaining this to people


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## ohnometo (Sep 20, 2001)

Eric ,I hope that you are not saying that I dont have IBS and I am reading this incorrectly....? but if you aresaying I dont have IBS Please hold your ears because I am going to start hollaring.... I knew when I started talking about CVS with you and you started reading on it expecially the symptoms...you was going to say that I didnt have IBS...The symptons are a little like IBS but much much worse...I didnt throw up everytime my IBs-D would kick in ...There is years that have gone by where my CVS wasnt evenactive...Just good ole IBS-D, ..I questions Dr Schuster about this many of times ..I would ask himdo you think I just have CVS and not IBS and he told me no, no, no probably 10 times ..When myIBS is really bad that's when the CVS would kick in......So I have both...Along time ago I was wondering if I should even bring up my CVS here...because someone would say Oh your CVS symptoms is alittle like IBS....Trust me they are two totally different things...I am am just luckyenough to have them both.....Now if you wasn't saying that you thought I didnt have IBS I take back my hollaring at you ..and willsave it for another day....just kidding....But I hope I was reading it the wrong way....Anyway from nowon I am only going to talk about my IBS-D and what is working for me....because I dont have engeryto convince anyone that I have both and they are all together different...and Dr Schuster would havenever told me that if it wasnt true..That is one Dr I really trusted out of the other 100's..********************** QUOTEThis is also something to understand and thats is even if your not "stressed" and if you have IBS I feel that is highly unlikely, the relaxation techniques and talk therapies HT, CBT, yoga, breathing excerices, tai chi etc.. benefit the body and conditions in there own way physically as well as mentally. That is also important to realize.


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## ohnometo (Sep 20, 2001)

Eric ,I hope that you are not saying that I dont have IBS and I am reading this incorrectly....? but if you aresaying I dont have IBS Please hold your ears because I am going to start hollaring.... I knew when I started talking about CVS with you and you started reading on it expecially the symptoms...you was going to say that I didnt have IBS...The symptons are a little like IBS but much much worse...I didnt throw up everytime my IBs-D would kick in ...There is years that have gone by where my CVS wasnt evenactive...Just good ole IBS-D, ..I questions Dr Schuster about this many of times ..I would ask himdo you think I just have CVS and not IBS and he told me no, no, no probably 10 times ..When myIBS is really bad that's when the CVS would kick in......So I have both...Along time ago I was wondering if I should even bring up my CVS here...because someone would say Oh your CVS symptoms is alittle like IBS....Trust me they are two totally different things...I am am just luckyenough to have them both.....Now if you wasn't saying that you thought I didnt have IBS I take back my hollaring at you ..and willsave it for another day....just kidding....But I hope I was reading it the wrong way....Anyway from nowon I am only going to talk about my IBS-D and what is working for me....because I dont have engeryto convince anyone that I have both and they are all together different...and Dr Schuster would havenever told me that if it wasnt true..That is one Dr I really trusted out of the other 100's..********************** QUOTEThis is also something to understand and thats is even if your not "stressed" and if you have IBS I feel that is highly unlikely, the relaxation techniques and talk therapies HT, CBT, yoga, breathing excerices, tai chi etc.. benefit the body and conditions in there own way physically as well as mentally. That is also important to realize.


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## eric (Jul 8, 1999)

Donna, so you know I do beleive you have both. You need to say you have both also when you talk about it thats important also. And all the things you do that help also as thats important.There are a ton of people running around with more then one problem for sure. Some peoples problems are very connected like dyspepsia and IBS ect..They know more about IBS then this bb reflexs also. They just don't have all the answers, they do however have some of them and they also have solid research going.To me its like studying astronomy which I did for 20 some years. We know there is a sun and a moon and a solar system and even quite a bit about the big bang and the universe and how a lot of it does work, but do we understand the universe hell no. But we have to work with what we do understand. The gut brain and the brain are like this hugely complicated intereactions, we barely scratch the real surface on here, because we also have very limited real knowledge as patients. I for one am glad there are some top people out there trying to really help and I know some of them and they are really trying to figure this out and help.When people say they " just don't know", thats not totally accurate and a patient reads that here and goes into a doc with a preconcieve notion they know nothing, the doctors are a waste of time for the most part and that is not true. They actually no more on somethings then we try to guess at. I am not talking either about bad doctors either or a patients frustrations as I have had them also.I am certainly not arguing with you on anything Donna so you know, only Mike. LOL


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## eric (Jul 8, 1999)

Donna, so you know I do beleive you have both. You need to say you have both also when you talk about it thats important also. And all the things you do that help also as thats important.There are a ton of people running around with more then one problem for sure. Some peoples problems are very connected like dyspepsia and IBS ect..They know more about IBS then this bb reflexs also. They just don't have all the answers, they do however have some of them and they also have solid research going.To me its like studying astronomy which I did for 20 some years. We know there is a sun and a moon and a solar system and even quite a bit about the big bang and the universe and how a lot of it does work, but do we understand the universe hell no. But we have to work with what we do understand. The gut brain and the brain are like this hugely complicated intereactions, we barely scratch the real surface on here, because we also have very limited real knowledge as patients. I for one am glad there are some top people out there trying to really help and I know some of them and they are really trying to figure this out and help.When people say they " just don't know", thats not totally accurate and a patient reads that here and goes into a doc with a preconcieve notion they know nothing, the doctors are a waste of time for the most part and that is not true. They actually no more on somethings then we try to guess at. I am not talking either about bad doctors either or a patients frustrations as I have had them also.I am certainly not arguing with you on anything Donna so you know, only Mike. LOL


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## eric (Jul 8, 1999)

I meant to post this here also for the info. http://www.gastroendonews.com/specreps/gen...0106lesson.html


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## eric (Jul 8, 1999)

I meant to post this here also for the info. http://www.gastroendonews.com/specreps/gen...0106lesson.html


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## trbell (Nov 1, 2000)

interesting article, eric. know anything about McMahon? the question of who's selling what to whom seems to be getting more important on the web, almost like TV?tom


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## trbell (Nov 1, 2000)

interesting article, eric. know anything about McMahon? the question of who's selling what to whom seems to be getting more important on the web, almost like TV?tom


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