# Dr. Dahlman's Patient



## Gret (Sep 23, 2003)

I began Dr. Dahlman's program on December 17 with a phone consultation. I started the products on Dec. 21 and since then have adhered to the no dairy rule, the no legume rule, and no drinking during a meal rule. Tough stuff to do over the holidays, but not impossible!Two days after starting the products, I gave up my Ibsacol for good. He told me to wean myself off of them, but for some reason I didn't feel the need for it anymore. I haven't had any D since.The only problem I'm having is a need to "go" quite a bit every morning. I can't seem to take care of it in one trip to the restroom, it takes about 3 times (Christmas morning it was 5 times) to get everything taken care of. Then I feel fine the rest of the day! I'm not kidding. The real test will be once my schedule is back to normal on Monday. I'm finishing up a two week vacation so we'll see how I handle the hustle and bustle of my ridiculous schedule!I don't feel "perfect" yet, but I feel more confident than ever that this thing can be licked.The thought of living with IBS for the rest of my life is what prompted me to call Dr. Dahlman. I can't tell you how glad I am that I made that call!Happy New Year, everyone!


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## overitnow (Nov 25, 2001)

Happy New Year, Gret. Welcome to the world of dietary supplementation. (One more down, how many still to go?) I know that your current problem will fade away in time, as your system starts to heal itself. I bet there will be a special feeling to your church playing this Sunday.Cheers,Mark


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## Gret (Sep 23, 2003)

Thanks, Mark.My goal is to not ever think about IBS! I want to wake up and not have to wonder if it'll be a good day or a bad day. The last few days have been pretty good, just a bit dicey in the mornings. Today I actually feel great, even after a bit of champagne last night! That stuff is a no-no for me!







I wish more people would try this so they could feel better too. I'll do an update in another week or so!


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## kel1059 (Feb 28, 2003)

as great as our suffering is, i think that a lot of people can't accept the fact that certain favorite foods may have to be eliminated.i read about wheat as a trigger back in 1987 but it took another 5 years before i was willing to believe that it might be affecting me.


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## Gret (Sep 23, 2003)

It very well could be that going dairy free is all I need to do. But I suspect it's more than that. Once I get my insides healthy again, I think I'll be able to tolerate dairy again. Wheat would be very difficult to eliminate. How do you manage that? I guess eating out would be completely out of the question. I just don't want this to run my life anymore!


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## overitnow (Nov 25, 2001)

Gret,Assuming you live in an urban area, there should be some bakeries that use spelt rather than wheat flour. The taste/texture is pretty much the same as normal bread but without the alergens. I was also able to tolerate soymilk so that was an easy substitute at the time.This is such a great time to enjoy the anticipation of your change; please just give yourself enough of it. It took me a year to be able to completely tolerate all of my triggers again, and I still had to control their intake for another couple of years. The fact that I didn't give them up during that first year probably lengthened the recovery time.As far as not thinking of this, good luck. Five years later I am still reminded of it on my daily trip to the john. I, too, wish more people would try this approach; but how long does it take for people to even try Caltrate, and that is just a mop-up. Once they see their doctor, who has neither studied nor believes in nutritional approaches, they are already halfway down the road to medical treatments and interventionist solutions. And then there are the cost issues. We all claim we would spend anything to get rid of this until the offer is made. Then the complaints come rolling in. I spend probably 1500 a year on supplements, a figure I would have found appalling. In the end, they have allowed me to earn considerably more than that from my vastly improved health. The fact that my bowels, digestion and cholesterol are once again normal just lowers the stress load and all of the damage that can do. I'm not running around looking for lower costs, just effective solutions.Enough of this. Enjoy the days and weeks ahead. There's a Rose Bowl to watch.Mark


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## Gret (Sep 23, 2003)

...not looking for lower costs, just effective solutions. YES!


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## kel1059 (Feb 28, 2003)

giving up wheat has been easier than i thought. the pain and suffering that wheat brought me is beyond description. i had severe low blood sugar attacks, violent cramping, severe bloat, and brain disturbances --- all from eating wheat. go figure. (actually it is not so much wheat at fault but a crippled immune system)the problem is that as i switched to other grains i developed reactions to these also. i ate lentils last week and they almost killed me. i have only had bad pain a couple of times in the last 16 months but the lentils did it. i can only guess that they contain some glycoprotein or lipoprotein that resembles a virus or bacteria that is on my "attack list". what else can it be????i admire your efforts to solve this curse. your purchase of ibsacol alone shows that you are willing to gamble on certain products. i don't want to sound like a wet blanket but i think that eric has a couple of valid points concerning dahlman's approach. i don't agree with eric's reasons because i have my own reasons --which differ-- why the dahlman approach is not the entire answer.it goes well beyond the fact that i have done all the things that dahlman has recommended (3x's over) yet i still have the disorder. of course, everyone is aware that i fully support his method and i have received a lot of symptom reduction from it.my main issue is that there seems to be some type of severe immune system dysfunction going on with me. there is some substantial research on the role of viruses and their impact on t-cells yet dahlman blows this off thinking that we have a bacterial (and maybe a fungal) issue. if it was just a bacterial and food issue then i would have been cured 10 years ago. granted -- i think that the bacteria issue is important but there is more going on for many of us.i just came across something that showed that a small part of the brain --some highly specific organ-- was completely destroyed by a virus, yet there was no evidence that the body even put up a fight. these things are complicated. everyone is different.by the way, it was about 3 weeks after quitting ibsacol last year that i started my swift decline into hopelessness as my symptoms of extremely poor stool formation returned. considering that the stuff has completely eliminated 35 years of asthma, got me off a powerful brain seizure medicine, and has gotten me to form normal stool for the first time in 20 years --- yet dahlman has criticized it (same as eric) tells me that both of them fail to understand the complexity of the issue. dahlman's approach never made even a dent in the asthma, the stool formation problem, or the brain disorder. but it did result in gas, bloat, pain, odor, and cramp elimination.the reason that ibsacol has worked so incredibly is because leukotrienes and prostaglandins really do run the WHOLE show. but i admit it is some type of huge bandaid approach to my problem.(they run the whole show ---- especially leukotrienes and smooth muscle of the lungs and gut) (sorry eric but if one was to place in order of importance serotonin would fall behind prostaglandins and leukotrienes in importance. you got fooled just as drossman and that vermont researcher has gotten fooled by the drug companies)


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## drdahlman (Nov 6, 2000)

Kel, Kel, Kel.....you have not tried my approach. I bet my shelf full of UltraClear Sustain you haven't. I know you are very aware of all the aspects of my program and I have no doubt that you have tried them all at separate times. Please admit to me that you haven't used the Metagenics products while beginning the dietary suggestions that I outline...at the same time! Please admit to me that you haven't done the lab testing through GSDL at exactly the stage I recommend in my protocol. Please admit to me that you haven't eliminated fructose and/or gluten AFTER doing what I have described above and done all this in the order that I have specified. If you have, you are psychic and that gives me additional ideas on how you can make alot of money predicting who gets IBS!







I do not blow off anything. I fully understand the immune issue as it relates to your gut. My goodness, 60% of the body's immune system operates within the gastrointestinal tract....for a reason. You and I are debating whether or not the immune problems occured first causing IBS or the IBS occured first and caused the immune system to go out of whack. Chicken or the egg. I have never asked anyone that I have worked with about their immune system. I have never tested the abilities of their immune system other than a reading that we get about SIgA from a Comprehensive Digestive Stool Analysis or the IgE and IgG reading we get from the food allergy test. So you see, I have never had to say to anyone that because of the state of their immune system, I'm sorry, but I can't help you. I don't qualify by that criteria that you're so sure would exclude you from being helped by my program....and everyone gets well.I have offered to you before to call me and let's talk about your exact experiences and let's see if I can pick up on anything that yet needs to be done. I know that I will, I have with everyone else. I also know that if I can help you, it negates all that you've been saying for quite a while here. But if I do help you, think of all the people that it could help.The only criticism that I have about Ibsacol is that you have to take it forever! My program is temporary with no need for any of the products forever. Anything that improves the health of the gut, imptoves immune function and reduces or eliminates inflamation will certainly reduce the or eliminate the symptoms you talk about. So does my program, I've seen many other symptoms go away, many times and you don't have to do it forever. I'm waiting to hear from you!


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## drdahlman (Nov 6, 2000)

Kel, And I just noticed, you take anti-fungal and anti-bacterial herbs every night!!!!!







NONE of my patients have to do that. Those products will have a perpetual negative influence on the beneficial bacterial levels. Whether antibiotics or anti-bacterial herbs, they will damage those levels. Yes, I know you feel better but look at all the products you're sentenced to a lifetime of taking. NONE of my patients do that.


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## brushie (Jul 17, 2002)

dr.d:how can the "bad bugs" get killed sufficiently without a high dosage of the herbs?Isn`t the dosage in your program with candibactin and ulcinex also high?I also think just out of my belly(which obviously might be wrong) that viruses are a big issue. i read that in a CFS book.i really want to take up your offer but i unfortunately can`t tolerate enzymes from animals. i tried them twice in low dosage and got very bad. not with my stomach as described in your article but i get severe distention, more than any food could cause. i also tried enzymes from yeasts which i tolerated, but they didn`t help much. is there a way in your program without the enzymes. my pankreas elastase is ok.to kel: what kind of herbs are you taking in?thanks







!


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## calid (Aug 4, 2003)

I am also one of the "boardies" that has taken the doctor up on his offer. Unfortunately I have been out of town so I haven't started his regimen yet. I am so glad you are having a positive experience, Gret, hopefully I'll also have a good experience to report to this group.


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## kel1059 (Feb 28, 2003)

> quote: Those products will have a perpetual negative influence on the beneficial bacterial levels.


not true at all. i was concerned about this but 2 things have me convinced it is a non-factor.1. my research has turned up abstracts from PubMed that clearly prove that very strong herbals like garlic and onion oil have no negative effect on bacteria. some people claim that grapefruit seed extract will kill beneficial bacteria but i take 50 drops per day yet i seem to be doing very good --(very large stool on my good days).i believe that my big issue is that my immune system is exerting some type of exagerated effect and possibly it is attacking all bacteria just like crohn's patients have been theorized to do. this is why i was not able to form stool for the last 20 years.however, due to ibsacol i can pass stool that is very high in bulk and volume unless i eat something that sets off an attack.therefore, my good bacteria is not being harmed. people have been using herbs for thousands of years. i trust mother nature. also, by using a wide array of herbs i am able to target multiple pathogenic bacteria and fungi.i think that brushie is correct. i highly suspect that there may be some type of viral activity going on. i am sure that many factors play a role. i think that vaccinations can cripple some people's immune systems. i think that the lack of breastfeeding babies is the stupidest idea that ever came about (i blame our doctors for failing to stop this ridiculous practice). i also think that heavy metals like mercury, lead, cadmium can severely alter normal immune function -- same for all the toxins that we are exposed to (DDT is still collecting in our bodies --this was just in the news).i have tried your program and it relieved me of many symptoms. to this very day i am still following it, but there is something else that is operating in the background that you and me are not aware of.i see a many problems with your claim that you cure 100% of the people. 1st you started out 3 years ago with a 90% claim and then it jumped to 95% and now it is 100%. irrelavant but it makes me wonder.also there is some overlap between IBS and IBD for some people. you don't claim a 100% cure rate with IBD (you claim a high success rate- but i am skeptical-- i think that you can improve IBD but not cure it). this begs the question.... are there not some patients who are in the murky, gray area of IBS-IBD??? if you can cure 100% of the IBSers then you must also be able to cure 100% of the IBDers since some of your patients must certainly have features of both disorders.how about all the people on this board who have multiple other syndromes such as CFIDS, fibromyalgia, asthma, IC, nervous disorders, inflammation of sinuses, and a hundred other conditions that must be viewed as very highly related to IBS. are you able to wipe out everyone's problems? i don't think so. what about people who have hormone problems that cause the body to have excessive inflammation. this may be related to a hypothalamus problem and have nothing to do with gut bacteria.not only do 4 of your products cause me to have bad reactions but the ELISA test is a poor indicator of what is happening (MNL has pointed this out). the stool analysis that you have us take does not reveal very good information (mine just said --good acidophilus, no bifidus, very low healthy e.coli ---- intestinal dysbiosis)i have done everything you recommend plus a whole lot more to the nth degree, yet my immune system is still highly screwed up. multiple allergies to both typical and atypical airborn allergens and foods. why do you think that my ELISA came back positive to 27 foods. --and it did not even list my worst foods...wheat, corn, lentils and dozens of others. probably because i had not eaten these foods in years prior to the test. it also did not list all the nuts i am allergic to.why would no bifidus show up on my stool test despite taking bottle after bottle after bottle of these organisms (multiple bifido strains from a large number of the best probiotics on the market) (i also consumed large batches of bifido goat milk fresh made--- yet nothing).there is more to this problem than simplistic answers. i am living proof of it.your failure to be intrigued with Ibsacol boggles my mind. the stuff has single-handedly cured my asthma, and has me forming stool for the first time in 20 years. your program has not even come close to accomplishing this.i have done your program and it fails miserably when it comes to shutting down an out-of-control immune response.your bifidus does not implant no matter what you claim. you claim that it does but you have no way of knowing what is really going on. how many people have mailed in their before and after CDSA's? sounds like your patients will need to take the bifidus for the rest of their lives since it is flushed out after 2 weeks.if i was taking your candibactin and ulcinex i would still need to be taking it. when i quit the herbs i got bad again after 7 days. i have taken supplements that are every bit as strong if not stronger than your products yet i need to stay on them. maybe Dr Sternberg is correct that once the system shifts to th2 then it is overwhelmed with microorganisms. how do you make the system become non-allergic? i am convinced that you can make a big difference in the overwhelming majority of your patients but as far as a 100% cure. i think it is more like 30% are completely cured. the other 70% still need to lead an incredibly restictive life and still suffer the same as me with a screwed up immune system.i had a chiropractor once tell me that he could cure my IBS by adjusting my back. i had a nutritionist tell me that he could cure me with a juice extract plus colostrum (despite the fact that i told him i am highly allergic to bovine colostrum).


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## SpAsMaN* (May 11, 2002)

candibactin and ulcinex as you recommand for those who have symptoms rigth after a meal,do you think i can feel improvement in few hours.I search for a long shot...I maybe want to be a guinea pig if your offer is still inexpensive.


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## kel1059 (Feb 28, 2003)

> quote: Kel.....you have not tried my approach.


You have no idea how much my program resembles yours. Your ultra clear sustain would cause horrific allergic reactions due to the high rice content. Plus I take a supplemnt from my M.D. that closely mimics the ultra clear sustain (it contains 33 ingredients, but no rice protein)Here is only a brief outline of what I have been doing: (almost all of it is simultaneous except for the things that i became allergic to such as chlorella) (nobody is as strict as me. i am determined to beat this thing, and i hardly ever screw up -- ex., alcohol only 3 or 4 times all of last year and only small quantities)Incredibly restrictive diet (due to 100% necessity) (my diet is legumes and exotic meat protein like emu and tapioca flour)Enzymes before every meal. Every day for 9 months straight. German Wobenzyme is my current enzyme.Zero sugar/honey/fructose, zero fruit, even became allergic to most veggies (I don't have an explanation).milk thistle extract 350 mglipoic acidheavy metal chelation till non-detectable levels were noted. (strange immune reactions like hives and bumps all over my head occurred during chelation)Ibsacol (my personal miracle)The herbs Carlsons Cod liver oilHealth from the sun fish body oil (epa and dha)Vitamin E (standardized for the correct gamma, beta, delta, alpha levels - comes from M.D.)GLA -borage oilBlue green algae (until I became allergic)Chlorella (till I became allergic)Individual supplemental minerals ordered by doctor - mag/pot aspartate, zinc picolinate, chrom, vanadium, etcNAG and glucosamine for intestinal tissue repair every day (500mg each)Seacure (dr d'adamo likes this and I just re-started it - something might be happening)Pure water, no tap waterTransfer factor (2 months, and it seemed to do something very positive. I will re-start soon)FOS (severe problems due to fructose)Arabinogalactans and other soluble fibers (severe problems!!! Especially apple pectin)Glutamine (but it caused a very bad brain problem every time I tried it)Probiotics (multiple brands ) (VSL#3 ---- 450 billion organisms per serving, Primal Defense, Kyodophilus, Jarrow, etc)Coconut oil (tropical traditions -virgin. Excellent product)MCT's and capryllic acid (everyday for 3 months --small amounts)CDSA 3 years ago and last May.Elisa test last januaryBioflavanoids&#8230;&#8230; grapeseed extract /high potency 200mg/day (Mark, it is not working)Quercetin & stinging nettle(M.D. recommended to lessen mast cell activation)Vit C 3 grams per day (MD recommended)Homeopathy (this has done some near-miraculous things for me. Amazing!!!)I have eliminated all gluten 11 years agoall dairy eliminated 5 years agoultra strict diet for 2 years running.I have eliminated all fructose and sucrose 16 months ago.


> quote: If you have, you are psychic and


Not psychic, but instead it is common sense and trial and error. I commend you for figuring it out despite the fact that your IBS was of such short duration. However, if you suffered from the same type of immune system devastation that I have experienced then your view would be different. Can you be certain that we don't have mycoplasma infections? How about MAP (mycobacterium a. paratuberculosis) this takes a very long time to get rid of. Active viruses --- HHV-6? Vaccination damage?I would contact you but I have allergic reactions to 4 of your products. I listed them on page 1 of the other thread. Plus, you will tell me to get another ELISA and I believe the MRT test is better. The elisa test has a lot of holes in it. The stool analysis was very non-specific.


> quote: and I have no doubt that you have tried them all at separate times


not true. see above for all the things that i do simultaneously. since you are a believer in homeopathy maybe you can use one of their fundamental beliefs to understand what might be happening and why some people don't heal until something is cleared away. this is one of the reasons why i am undergoing constitutional homeopathy. we shall see if it unravels my deep-seated bodily disturbance. (a very knowledgeable homeopath would like your approach but would also explain why it might fail to completely solve the problem.)


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## mtbike61384 (Dec 8, 2003)

I feel you Gret! I too am a patient of Dr.D and have starting feeling better again. Right now I am doing a stool test to see if I might have bacteria. I have not near as much gas and don't have c or d at all. Think I am on my way to a full recovery! To everyone who is sceptical. Why not try everything you can? You seem to try only things you want to try. But what if you could be healed by trying something not ordinary? It's your choice. But I can't speak for Gret, but I think we both feel much better.


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## Gret (Sep 23, 2003)

mtbike,Glad you are feeling better too! Why are you having a stool sample done though if you are not having gas, c, or d? Just curious. I'm hoping to avoid some of that. But, like you, will do anything to eliminate this from my life! Hopefully in this new year I'll get it all turned around! You too!


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## ohnometo (Sep 20, 2001)

After working with LEAP'S program and staying away from my trigger foods I havent had to take any medication or supplements for years...and my IBS is gone until I eat what I am not suspose to ....


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## drdahlman (Nov 6, 2000)

Kel, I so hate to disagree with someone who has been such a ally of mine and first and foremost, I do appreciate you for that. So, let's try to address some of the things you said.Many herbs are well known for their anti-microbial effects. Let's not take one study as gospel. In addition, every lab that does stool sampling will actually culture the bad organisms found and test their sensitivity to prescription antibiotcs and anti-fungals as well as herbals that they are sensitive to. I then get a report as to what to use to eliminate the organism if the patient wants to go the non-prescription route. Herbs and compounds like Uva-Ursi, plant tannins, oregano oil, berberine and garlic are the most common found to have activity against these organisms. If you're consistently taking herbs everyday that have anti-bacterial or fungal activity, you are damaging your normal bacterial levels. It goes without saying. You also admit this by describing your levels of bifudus as none. Not only might you be buying poor quality probiotics, you have no way of knowing, but you're taking the herbs. It doesn't surprise me at all that you have none.As part of my protocol, not only do we test to find the abnormalities but we retest to make sure that the protocol I designed was effective. Consistently we find the elimination of the bad bacteria. There are also times we find damage done to the good bacteria along with it. We then step up our efforts with the probiotics and again re-test till we get normal readings.You got bad again after 7 days because you haven't done a complete step-by-step program. The herbs keep your bad bacteria in check and you aren't using the right probiotic at the right time and the right dose. It's pretty simple.You also take digestive enzymes before the meal, I prescribe the before and after....another difference.Your ELISA test was a good one and the reason it didn't show positive for your "worst" foods is because there's a difference between an allergy and an intolerance. The ELISA test identified the foods that antibodies had been created for. Intolerances are simply foods that your digestive system can't tolerate, meaning they can't break down or digest and they can cause lots of problems. ELISA will never identify them because there are no antibodies created for them. MLN has only pointed out a controversy about the test. This lab, GSDL, has enabled me to help thousand of patients with their tests. I don't need to fix something that's not broken. There are other good labs out there also. Neither of you have any clinical experience with it, I'm telling you, the tests provide amazing answers.In looking at your regime of supplements, it's obvious that's not my program. In fact, I'm astounded that you put up with the taking of so many supplements. My program gets patients on their supplements for 3-6 months at the most, then we're done.Another thought, I don't screen anyone for viruses and I still maintain that in those patients that have completed my entire program, everyone got well. My original success rate that I quoted a couple years ago was based on my entire patient population. Now I only quote the success rate of those who complete my entire program. So Kel, please, you have 2 choices. Keep doing what you're doing......taking all that stuff, killing off your good bacteria while you continue to eternally take more, not believing the labs that I routinely use with awesome results or you can call me and let me rework your plan. The products you object to in my program can be substituted for. I do it everyday. Please quit trying to convince me here, let me spend time talking to those who aren't so sure about their program. One thing, please consider calling me and let's talk about it.To spasman, it's certainly worth a try, a few hours may be optimistic because if you have correctly identified your problem, it may take a few days to get the levels of anaerobic bacteria down so that they don't affect you and you're more comfortable.


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## brushie (Jul 17, 2002)

dr.d, please answer my queston above, or do you want to check this in our phonecall on monday? i have an 2 mounths old cdsa 2 test, and my bacteria was quite normal(firs time though in a stool flora test,but symptoms as ever, esp. bloating, feeling cold, weight loss when sport,tired...) no bacteria found.i didnt order the 4 diarrea bacteria listed extra on the ordering sheet,because i was tested for them several times negative before.the purged parasite test was also done. i had stool tests in other comprehensive labs before with high coli biovare, and have the symptoms you blame bacteria on. this german lab also tested for more bacteria than cdsa. do i need to retest the cdsa 2, for finding the correct herbs? thanks


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## drdahlman (Nov 6, 2000)

Brushie, Call me Monday and we can talk about it. Can you fax me the test results, I'll give you the number when we talk Monday.


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## brushie (Jul 17, 2002)

Iï¿½ve had my first phone call yesterday.Iï¿½m gonna start the diet from tomorrow and hope to get the products next week. i will also reduce fructose and wheat but not eliminate them in first step.if after one mounth i get no improvement im thinking about going low carb too, if dr.d agrees. what do you others think?dr.d said i should try also the enzymes, and if i get very bloated again(see post above) i can quit them.i dont have to do a stool sample right now because i had one in september, when i suspected to have parasites, what was negative, and did the bacteria test too.i`ll also begin with the herbformulas against anaerobic bacteria and the other stuff( i think ecept tï¿½the ultra clear sustain), as i have the symptoms that are an indication for it according to dr.d`s article(link to the article for people who don`t know what this thread is about: http://www.drdahlman.com/treatment.htm our next app. is in three weeks.how do you others being on his therapy feel till now?


> quote: spasman Member # 12277 posted 01-01-2004 07:13 PM-------------------------------------------------------------------------------- candibactin and ulcinex as you recommand for those who have symptoms rigth after a meal,do you think i can feel improvement in few hours.I search for a long shot...I maybe want to be a guinea pig if your offer is still inexpensive.


spasman, are you also on the program? if not, try to contact dr.d directly. i think we arent 5 yet?


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## BackFire44 (Nov 19, 2003)

In order to see if Dr. Dahlman's methods work, I would suggest doing everything he says to the T. Best of luck! and thanks for keeping us updated.


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## calid (Aug 4, 2003)

I'm in too. I spoke with the Dr. yesterday also. I'm now on a no gluten diet as I've been having problems with wheat and joint pain, and no potatoes as they're give me tremendous pain and gas. I'm already no-dairy as I've been following the Eating for IBS diet, but I will have to be much stricter about reading labels for hidden dairy sources such as milk protein. I'll be doing my diet to a T, no worries about me cheating. I'm anxiously awaiting my new "meds".........calid


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## Arnie W (Oct 22, 2003)

I've contacted Dr D, but am still awaiting a reply.In the meantime, I've finetuned my diet and for New Year I have completely eradicated gluten, lactose, etc. It wasn't as bad as I thought, though you sometimes feel you're being deprived. Even if I can't get accepted for the programme, I'll carry on with the diet, as a friend and I are considering entering a bodybuilding competition, and I would have to eliminate a lot of different types of food anyway. And I'm really determined to make headway with my digestive problems.


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## Trinity (Sep 9, 2002)

I contacted Dr Dahlman too to take him up on his offer. Nothing has worked for me so far but maybe a different approach will work. I chose it mostly because of his emphasis on gut bacteria. I haven't started his diet 100% but already have a rather limited diet and haven't received the supplements yet either. I posted this in the GAS section


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## Gret (Sep 23, 2003)

Third week into the program and I'm doing well! The past three days have been like a new me. One BM per day, no urges to get where I'm going in a hurry. It's almost strange! It's not perfect yet, I still feel pressure down low at times and wonder if I'll need to make a stop at the restroom, but then it passes. It's a good feeling to be on the road to recovery! I hope everyone else finds the same results!


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## Gret (Sep 23, 2003)

I got brave yesterday and decided I'd have breakfast before I left the house. I haven't had breakfast on an early morning out in a long time! Everything was fine so I actually had breakfast again this morning. We'll see if today goes as well. I don't see why it shouldn't, but IBS has no rules. It does whatever it wants, whenever! It's a very strange feeling to feel well like this. I can't describe it. It has been so long since I've felt like I could tackle a day w/o problems! Calid, how are you doing? Mtbike?Have a good day, everyone!


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## Blair (Dec 15, 1998)

dairy products can cause Bateria overgrowth of the small intestine, one of the technicians at Dr Pimentals office told me he tested positive for BO and eliminated dairy and then re-tested negitive. However he had no IBS symptoms before or after. I don't know if this information helps or not?


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## calid (Aug 4, 2003)

Gret: I just received the supplements last night. Took my first Metagest after dinner and one scoop of Sustain later.Thay gave me some gas, hopefully that will subside. Did you have that reaction also at first Gret? Am starting the full regimen today, I'm so happy that you're having good results, please rub off on me........lol.


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## skinny (Jul 27, 2002)

Gret,I thought you were doing well with the Ibsacol. Were your IBS symptoms eliminated while on it? Did you have any dietary restrictions while on Ibsacol?I'm curious if you went on Dahlman's program to free yourself from taking a supplement forever.skinny


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## kel1059 (Feb 28, 2003)

The ultra clear sustain is a lot of rice and rice protein (allergic-- bad) and a bunch of vitamins and aminos that I have been taking for about 3 years under the care of my M.D. who is non-AMA (instead ACAM). I am very allergic to rice. It seems to be restricted to a cerebral allergy as opposed to affecting my gut, but the again I have only eaten the stuff a few times in the last 3 or 4 years, so it could end up causing intestinal problems. I had to quit because the brain fog was so intense.The metagenics ultra flora DF is a product that interests me very much especially due to the fact it contains the immunoglobulins (don't know if they do anything but it is worth a try). I have taken countless probiotics that contain infantis, the NCFM strain (natren is just one of these products), the trenev trio ($2.00 per pill), VSL#3 (1/2 trillion bacteria per packet ($450.00 worth of this stuff), primal defense (at least 7 bottles), kyodophilus with human strains, jarrowdophilus, dds-1 strains, enteric coated strains of bifido, various exotic strains such as pure brevis, I have been doing this since 1990 or 91. I have also made fresh goat and sheep milk yogurt with the best strains possible (the sheep milk must be ordered overseas).Despite all of this, there has not been that much improvement due to probiotics (although it did stop diarrhea a couple of years ago and helped me gain weight).The fructose and gluten have been eliminated a very long time ago. The CDSA was done in sept 2000 and april/may 2003. My only question about the CDSA testing is that maybe if we pay extra money the lab will specifically try and culture some of these organisms. I need to check on this. However, in your paper you said that if there are sulfur reducing bacteria present the lab will (or may) not be able to detect them or identify them.The only thing they told me was that I had intestinal dysbiosis. I have no choice but to take them at their word and assume that this may be a key to my recovery. If it is true then you may be right on the mark.The question is ----"why can't I turn it around?" you say that it is something I am doing. I really don't think so. I had the test done twice. The herbs (which are very similar to yours - berberine, etc) were only started 6 weeks before the 2nd CDSA. Certainly all the probiotics and fresh yogurt that I consumed would have corrected the problem in year 2000 when I took no herbs. The same applies for year 2003 but I had consumed 6 weeks worth of the herbs leading up to the CDSA.I guess I am going to have to spend another chunk of money on more CDSA's (how frustrating).The only variable is the herbs but that can not be the problem based on the above info.The bacteria in my colon is probably stable and extremely difficult to replace. I am willing to go the antibiotic route but I hope it does not make me worse like it did in 1997.********************************************************************* quote is from your paper.... _ If after beginning the Ultra Clear Sustain you experience additional gas and/or bloating (you will know in 2-3 days), you will need to submit a stool sample because the additional gas and/or bloating means that you have something living inside you that needs to be eliminated. The test kit can be obtained from my office, a sample is collected, sent to the lab and if an abnormality is found, you must take either a prescription antibiotic/anti-fungal or all natural herbs that the lab recommends to eliminate these organisms. _ ***********************************************************************


> quote: Please admit to me that you haven't done the lab testing through GSDL at exactly the stage I recommend in my protocol.


(i could have taken the CDSA every single month from sept 2000 right up until may 2003 and it still most likely would have said the same thing, "intestinal dysbiosis". therefore, taking a CDSA right after taking ultraclear sustain is irrelavant. it is irrelavant because something nasty is going on inside of me (as of prior to June -- Ibsacol {and the same immune dysfunction/severe allergies, etc or bacterial dysbiosis still exists to this very day --i would think} ) therefore, it does not matter when i take the CDSA just so long as i take it when i have multiple gastro symptoms, and this is what i did twice.gas and bloating disappeared under 2 different scenarios. The first was through an extremely restricted carbohydrate diet and the 2nd method was through the use of herbs (the gas remained low even when I consumed high carbs -beans). Therefore the gas would be there (maybe 4 to 10 hours after eating), but not within an hour of eating. However, it is possible that after a few months of eliminating the herbs that the gas would start to develop within an hour. I don't know the answer to that one. It seems like there is no exact stage other than if a person takes ultra-clear sustain and they get gas then they are supposed to take the CDSA. I guess you are thinking that if a person gets gas it is due to the inulin and FOS. When I was taking FOS it did not seem to give me gas but within 1 week I started to get sicker and sicker with more and more stool disturbances. This tells me that I might have been feeding some pathogenic bacteria that was not necessarily a gas producing organism. Possibly this is the source of my troubles.I really need to get the full low-down on what the GSDL can do with the CDSA. -just how specific can they get in identifying these organisms. My understanding -so far - is that they can't so a very good job except for specific strains.Need help on what to do with this one. It is possible that my herbs are keeping the population in check but then the bad ones grow right back despite the fact that I have been gulping down probiotics for 12 years.The key for this whole thing is wiping out the bad bacteria (yeast should be low) and getting the probiotics to implant.To an extent this might be happening because I have made very steady improvements over the last 2 years. However, I think I am at the point where antibiotics may be necessary - this is going to be risky based on what happened last time. The part that may not be so easy is getting good bacteria to implant. I am thinking that wheat grass (fresh) may be a good method of getting natural probiotics into the system. The tricky part about antibiotics is that there is the possibility that they may not kill a very bad strain and then you end up with that bad strain taking over. That would be my worst nightmare. I can't take another round of severe, out-of-control brain dysfunction.


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## kel1059 (Feb 28, 2003)

i think i would be a fool if i were to automatically rule out the possibility that bacteria "could NOT possibly be the source of my brain dysfunction, asthma, sinus inflamation, and gut problems.put another way.....the hypothesis that .....Bad Bacteria in the gut can cause brain dysfunction, inflammatory conditions throughout the body (such as sinuses), asthma, and gut problems....... is something that i must NOT rule out.i can think of several scenarios whereby this situation (bad bacteria) could be 100% accurate, or even 75% accurate.for starters, i am convinced that bad bacteria (and fungi) emit toxic metabolites that may overwhelm the liver (or the liver may not be able to detoxify some of these --- cresol and ADHD is an example).if the hypothalamus is constantly bombarded by these chemicals then eventually it will start to malfunction ...the same with the pituitary gland and everything else in the brain.in fact everything starts to malfunction.i still believe that viruses and genetically induced leaky gut may play a role but i have no choice but to assume that bacteria MUST be dealt with (especially since my CDSA says.... 'intestinal dysbiosis')i think that since i have features of CFIDS then the prevailing theory is that there are 4 to 5 causes that need to be addressed. 1. bacteria 2. fungi (taken care of) 3. viruses 4. toxins such as heavy metals 5. ?????


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## Arnie W (Oct 22, 2003)

I have had a phone consultation with Dr Dahlman, for which I'm extremely grateful.Trinity, I'm so glad that you're doing it too, as your symptoms mirror mine, and I can identify with you so much.And sincerest wishes for good health to everyone else on this programme.I'm taking this so seriously that I've completely eliminated anything at all that might cause intolerance. The number of fingers on my hand is sufficient to count the items of food I'm eating - a bit harsh, maybe, but it won't be forever, and when I gradually begin to re-introduce other food, hopefully I'll get an idea of what triggers I have. I'm still allowed to drink coffee. I'm so glad as it means there is something I love that I don't have to eliminate, though I'm going to drink it in moderation.I would be interested to know what vegetables others are eating. By the time you'e eliminated the pulses, cruciferous vege's and fructose, there don't seem to be many left.


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## Lia AUS (Jan 6, 2004)

Arnie W, I am new to this website and I don't have a huge knowledge but wanted to reply to what vegetables other people are eating. I find that if I eat vegetables and foods that are low in Salicylates it generally has a good effect. I don't know if this is of any help, it works well for me.


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## Jhouston (Nov 9, 2003)

I also took dr d up on his offer. I had my first phone consult yesterday. waiting for the products. Glad to hear some are already feeling better! Is anyone IBS C on this program? Kel, I hear ya', I also have had CFS symptoms which for the most part have subsided about a year....around the same time IBS roared its ugly head. I am suppose to refrain from wheat. so tonight I had rice noodles, chicken, vegies. I had the worst brain fog/druggie feeling withing 10 minutes after eating. I don't know. I have had it where I could eat the same foods and not get a reaction. makes no sense. All I know is that I had slight IBS symptoms and brain fog after eating But after flagyl the gas and bloat was Scary. this year a UTI and bonafide IBS symptoms emerged. I tend to think antibiotics are the cause of my IBS and maybe even the CFS. or the antibiotics started the malfunction and CFS was able to take hold. Joann


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## Gret (Sep 23, 2003)

Calid! I'll be anxious to hear how you do with the supplements! Yes, I did have some gas. I didn't mention it to Dr. Dahlman because it was minor and went away. I'll mention it if it comes back. I feel sooooo much better. I hope you will too!Skinny: I did well with Ibsacol, but I would still get a sudden burst of D out of the blue occasionally and I could not figure out why! I still had panicky moments. It was not perfect! I also do not want to take supplements for the rest of my life! You hit that on the head!For the past three mornings I've actually had breakfast! I can't tell you how happy this makes me. My schedule is so wild that without eating in the morning I would get shakey by lunchtime. I know I'm performing my tasks much better because I'm not thinking about how many steps there are to the nearest restroom!Dr. Dahlman is a good man to take on all of us at no profit to himself. He benefits by making his point clear, but it is still a noble thing to do and I truly appreciate his efforts to get us well!


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## drdahlman (Nov 6, 2000)

To Kel, Still waiting for that phone call you promised because you address so many issues, sort of all over the place that I won't be able to sort through them all in an email, I need a back and forth conversation to make sure I have your case clear.You have many misconceptions. First, GSDL cultures (does a sensitivity report) automatically now on all samples. You have no need for a CDSA, I rarely use them, I simply test for good/bad bacteria and yeast most of the time. That test is called a Microbiolgy. In extreme cases, I also test for parasites.I still stand by my statement that you haven't done these tests at the exact time my program calls for because it isn't a matter of what would happen had you taken them every month, it's a process that you go through and if you start with a GSDL test and have abnormal findings, you treat them and then retest. In finding consistently that your good bacteria (bifidus) wasn't at optimal levels you could have changed products/protocol and saved many $ on the probiotics you eternally have been on. I have seen just a couple of people that were extremely difficult to get the proper bacterial levels implanted, but only a couple. Please re-read the "Step-by-Step Thought Process" in my article.I still maintain that you are using inferior probiotics, inferior for you, and damaging any progress you make with them by using the anti-microbials. You are correct that it's a good/bad bacterial problem for you and conquering that will be very helpful in getting you where you wanrt to be. You need someone who has seen 1000's and goes through a planned, step-by-step process, the same with each patient, a process of elimination to get the info you need. I'll give you the rest of next week to take me up on my offer of free help, I have 5-6 who already have, that's enough besides you. It can only help you.I have used the Sustain with people who are allergic to rice with mixed results. Luckily, most aren't allegic to it. There is another product that I use for them. Metagenics is very aware of allergies in their typical patient population and the processing of the rice they use removes most, if not all of the allergenic material.The lab cannot ID sulfur forming bacteria, but I can't remember the last time that I had to have someone treated for that bacteria. Thanks to all new patients who have posted, feel free to give any and all details about your experiences.


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## drdahlman (Nov 6, 2000)

To all, Please be careful in your discussion about what vegetables others are eating. What is OK for one is poison for another. You all have different chemistry and different intolerances and/or allergies. Think process of elimination. If you feel bad, think about what you ate and what might be the most likely culprit. Eat the same meal again without one of the foods. Eat only one of the foods for a meal. There's many ways to go about it. You must remove variables out of the equation. Good luck.


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## kel1059 (Feb 28, 2003)

i am going to call on monday. after re-reading my post i realize that it is not very clear. i sent an email i do plan on calling; however, it seems as though you have taken more cases than 5.if true that is very generous of you, and yes --- i have some very specific questions concerning the CDSA and what i should have them test forafter studying the bacteria issue last night i read that clostridium d. can overgrow when a person goes on the antibiotic amoxicillan.this was one of the antibiotics that i was on in fall of '96 or '97. i was on 2 antibiotics within 3 months of each other, and within 3 months my health took a noticable plunge.among many symptoms was a toxic/poisoned feeling that i had most of the day. this is gone as of 3 months ago.it seems that antibiotics are a double edge sword.it is still all very confusing. i guess that probiotics by themselves will not reverse everyones intestinal dysbiosis (i proved this). however, antibiotics or herbals (and you mention these in your paper) can help greatly to accomplish this.i sent you an email and i plan on calling you on monday. i want to re-read a few things. i need to try and memorize your program and the ingredients of your products.the ultra flora plus DF is the product that interests me the most. the immunoglobulins could be the key. if i had to take this stuff the rest of my life i would not mind. it is still cheaper than the VSL#3.the azeo-pangen is the other thing that i would take because it has lipase and amylase. the Wobenzyme have neither of these, but the lipase may not be necessary since i am mainly eating coconut oil and this does not need much help at all with its breakdown.the intesol has chamomile and i have big problems with this. the ultra clear sustain will definitely put my brain in a severe fog due to rice.


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## kel1059 (Feb 28, 2003)

> quote: I had the worst brain fog/druggie feeling withing 10 minutes after eating.


joann h,at the peak of my ill health i had the exact same thing. i would be fogged out of my mind within 10 minutes of eating. my breathing difficulties would assert itself. my sinuses would close up. i would get extremely tired and my brain would completely fog over.over the last year this has barely happened -- maybe on a much lower level.that is interesting about what happened to you after flagyl. do you have any idea why? do you think it could have had to do with the overgrowth of fungi that is a very likely result after antibiotic use? i am convinced that some of us have an extreme immune hypersensitivity to various strains of fungi. the Mayo clinic study is one of many sources to point this out.


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## overitnow (Nov 25, 2001)

Kel,We are all waiting for you to call the Doctor. There are so many of us standing at the edge of this pool, trying to find a reason not to jump in. (From my experience here I am convinced that many of us are more comfortable in our condition than we would be in giving a new therapy a shot.) Given his level of caring and concern, I am certain you will be in good hands. Think, as well, of the good that could be accomplished through your success. It would sure beat battling the fluxs and erics of the world. (And notice, as people begin to post about their success, that f & e do not show up so much.)This year I was able to return to hosting my annual New Year's salute to cholesterol with a huge variety of IBS unfriendly items on the table and no negative reactions. Not bad for a guy that used to c**p in his pants every day. I am convinced it is possible for all of us. Jump in and let us know how the water is.Call the Doctor!Mark


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## brushie (Jul 17, 2002)

> quote: dairy products can cause Bateria overgrowth of the small intestine, one of the technicians at Dr Pimentals office told me he tested positive for BO and eliminated dairy and then re-tested negitive


very interesting. when i began to get ill 5 years ago i started to eat muesli every morning. maybe that was to much for my gut.


> quote: My only question about the CDSA testing is that maybe if we pay extra money the lab will specifically try and culture some of these organisms. I need to check on this.


do you mean they should cultivate them to probiotics? sounds like a good idea, but i think it would be very expensive. i think there was a lab in germany who did that, but it unfortunately was shut down some years ago.


> quote: The bacteria in my colon is probably stable and extremely difficult to replace. I am willing to go the antibiotic route but I hope it does not make me worse like it did in 1997.


i`m optimistic the coli product coming in usa or the mutaflor here in europe could help much on that. read the infos on it: http://www.ardeypharm.de/mmm/en/index.php


> quote: The bacteria in my colon is probably stable and extremely difficult to replace. I am willing to go the antibiotic route but I hope it does not make me worse like it did in 1997.


what antibiotics did you get, and what happend?in dr.d`s article he writes he can not prescribe some antibiotics. why is this?


> quote:When I was taking FOS it did not seem to give me gas but within 1 week I started to get sicker and sicker with more and more stool disturbances. This tells me that I might have been feeding some pathogenic bacteria that was not necessarily a gas producing organism. Possibly this is the source of my troubles


think its similar im my case, because i dont get so much gas but get sick from fos and much fructose. i had the cdsa 2 done. there are some more interesting parameters there, including the purged parasite test. they didnt find some bad bugs. another lab found some half a year before: coli biovare. maybe my course of antibiotics,that didnt work for symptoms, i even got worse and the probiotics i took afterwards including. the mutaflor improved my flora. though symptoms(esp. bloat,low weight, cold limbs, toxic feeling,.......) are the same as before. so i wouldnt give to much on the stoolflora tests .


> quote: The tricky part about antibiotics is that there is the possibility that they may not kill a very bad strain and then you end up with that bad strain taking over. That would be my worst nightmare. I canï¿½t take another round of severe, out-of-control brain dysfunction


this is my biggest fear too. what antibiotics are you thinking about? do you know where to find accurate information on the spectrums of antibiotics? looking forward to getting the metagenics!!


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## brushie (Jul 17, 2002)

about the no drinks before and after eating rule: what about soups? are they allowed when not too liquid?kel,i understand that now that you feel better with the ibsacol ect. you dont want to jump off, esp. when your not allowed to take any other supplements than dr.d`s. for me its not such a problem because so far n othing i took was really helpfull.also your allergies to his products are a concern, but maybe he has some ideas how to cope wizh it. i too think you should call him. nothing too loose, and if you dont fell good with his suggestions you just let it bee. maybe in your case your allowed to continue the ibsacol?


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## eric (Jul 8, 1999)

You know Mark, I take offence to that remark really, its not some battle, we all supposedly suffer from IBS, but information to better understand IBS from many of the top IBS research doctors around the world who have the proper qualifications and study IBS in depth and gastro disorders. You can take the information and use it or not. People can constantly complain about western medicine and "the doctors don't have a clue" and take an alternitve view out of the sheer frustration they cannot cure IBS, but the bottom line is that science has not figured out totally IBS and they are honest about it, especially because they are peer reviewed. As far as people getting better, all treatments are reviewed after six months, not weeks or even a month, because of the high placebo rate in IBS regardless of the treatment. Even then the people would have to be reviewed years afterwards to see if they are "cured."Many people will get better, some people with mild IBS get better with fiber even and a small percentage in others it just goes away sometimes on its own. Many people can get better because of the brain gut relationship also, which is a fact!Dr Dalhman is treating people on a "BELIEF" his "Belief" from his persceptive as a Chiropracter in what he thinks is the cause, not on the science of IBS or that he actually knows what causes IBS.From everything I have read of his on IBS, he doesn't even study it in depth. He certainly does not follow continuing medical education on IBS, or if he does he does not subscribe to it. If he did, he would know there are physcial problems they have alreay found in IBS. He says chemistry can go wrong. Well it certainly can go wrong and it can go wrong in way more ways then he is pointing out. And as Kel, so rightfully points out a lot, they do not totally understand gut bacteria either. Nobody does yet. Another factor for sure is many many people have more then one problem, other then IBS.I also personally believe he is able to tell people he can "Cure" them and make the sales pitch, because of the general publics lack of information and understanding on IBS. His menthods are not all that new either.I also personally don't have a problem with him helping IBSers, but saying he can "Cure" something he does not actually know the cause of and by treating people over the internet and with phone calls without seeing people in person and even then his qualifications to diagnose and treat gastro disorders is extremely questionable to say the least.To me personally this is unethical.You can bash me all you want on this and I am sure people will take offence. I do hope however that people get better for their sake. I also personally wish Dr Dalhman, would change his approach to his "sales pitch" with the "cure" dangled like a carrot in front of people and put remission on his site to reflect a more accurate and ethical approach.---------------------------"Information that is provided about treatment, causes, or diagnosis may not be applicable to your particular circumstances. Always check with your physician before applying a diagnosis or treatment. It is medically unethical for a physician to diagnose or treat over the Internet. ""Self-help group or message board web sites.Certain precautions need to be kept in mind about the information from on-line self-help groups, bulletin boards, message boards, or newsgroups. Here are some general guidelines to keep in mind when seeking health related information:Because of the open nature of on-line group communication, you cannot make assumptions about the security or validity of the information, or of the "quality control" of the information provided. Web site policies and purpose should be clearly posted and followed.Is the information accurate? Is it factual, or does it represent opinions? Look for sources. It is important to determine whether the information provided arises from a reputable source (e.g., a scientific article or opinion from a professional expert), or whether it is the opinion of a non-professional. The questions, replies, and suggestions from participants on bulletin/message boards are often anonymous. Over time, it may be easy to attribute "authority" to familiar respondents based on their postings aloneï¿½without really knowing their level of training or experience as a health professional, if any. At all times, do not rely on anecdotal information. It helps to seek out more than one opinion, and you will then need to come to your own decision about the accuracy of the information. It helps to check it out with your physician. Information that is provided about treatment, causes, or diagnosis may not be applicable to your particular circumstances. Always check with your physician before applying a diagnosis or treatment. It is medically unethical for a physician to diagnose or treat over the Internet." http://www.iffgd.org/SelfHelp.html


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## Arnie W (Oct 22, 2003)

I have a similar question to brushie's. If I use rice protein powder, is it counted as a fluid or food?In regard to my question on the preceding page about vegetables containing fructose (and thanks for your reply, Lia AUS) I have done some research and have come to the decision that I will eliminate all vegetables whilst on the programme. Many of the vegetables I would be allowed to eat are gas-forming. Obviously this would not necessarily apply to others - it's just my personal choice.Kel, I sincerely hope that you will give this programme a chance. You have experimented and researched so much and you spend incredible amounts of time posting on this board. I echo what overitnow says - jump in the water and join us.


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## kel1059 (Feb 28, 2003)

we have some excellent discussion going on here.mark (overotnow), i here what you are saying but i know that in my case -- i would sacrifice my left leg to be able to go back in time and have none of this happen. there was a very specific reson why i did not jump in when the offer first came out. i emailed this reason to dr dahlman. ---and it had nothing to do with the ultra sustain rice allergy, or the intesol chamomile allergy, or even some of the meta-fiber (???) severe apple pectin allergy problems (but this product is not part of the main course)....it also had nothing to do with spending more money.... i have already spent a fortune. even though it hurts --spending the money -- in my case it is necessary. i have seen improvements with a few products.(also, i dreaded the thought of having to take the CDSA's again ---i believe that dahlman will have me take them TWICE more--- and paying out of my own pocket for it. this is why i hate modern medicine so much. if i want special testing done i have to lie to these clown doctors to keep them from blowing me off. ---and even lying does not result in success a lot of the time.) (note: i will take them but only if i am certain that they are going to specifically look for certain strains like C. difficile) (i am guessing that if i take it again i will get the same result ---- intestinal dysbiosis with no specific pathogen named.) the other reason for dragging this out is because i try to collect as much information as possible before i plunge in. it takes a long time to analyze the specifics of a program such as dr dahlman's, and figure out how to fit everything in with my current program. my current program is successful except for some lingering problems and a continuing serious immune dysfunction. as of right now i see 2 big differences between what he is doing and what i have done.1. i don't believe that i have exhausted all possible means at identifing pathogenic bacteria in my gut. (this is a very tricky area but i must pursue it).2. the Ultra Flora DF product ---- at first glance i thought to myself, "i have tried a million probiotics, what is so special about this one -- probably nothing". ---but after looking into it further, there may be something to it. especially if dr dahlman can help me get my hands on some of the e. coli strains that brushie is talking about. i would import them from europe but i need to make certain they are not nuking them at customs.anyway, i am ready to start taking Ultra Flora DF especially because of the immunoglobulins that it contains.


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## kel1059 (Feb 28, 2003)

arnie,i feel left out. it is driving me crazy. i was going to call him on thursday, but i did not know if he got my email then i was going to call on friday but i wanted to study all aspects of his program once again, but my concentration has been off lately. i am going to study the paper one more time. ---and i am going to read all the old posts including the posts where MNL seems to think that there may be some validity to all this (but i think he had some healthy skepticism same as me). --- and have one more look at how the ingestion of antibodies can help people out. construction of antibodies is something that requires your body to work very hard at -- i don't know all the details, but i was taking something similar a while ago and it may have been working. --but i want to join in with you guys. i don't want to end up choking on your dust.i don't want to have to claim some day that i am a "30 year sufferer and an ex-moderator..... who is hopelessly surrendered to this condition for life" ...when it just might be a simple case of not so friendly microorganisms in the gut.i mean think about it. we have all heard that typical flora is 85% good and 15% not so good. well it seems to ne that some of might have a situation whereby it is more like 50% good and 505 bad. ---and because our doctors are too ignorant to examine this issue in deep detail ----and to do whatever is necessary to reverse it--- we all continue to suffer.but somehow i think it is more complicated.(eric, in case you are reading this. i now know why you mispell so many words and make so many grammatical errors. *it is happening to me also!* my brain is slowly turning to mush from posting so much. this is not the only place where i post way too much. i need to stop!


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## missC (Oct 16, 2002)

kel, i'm curious. if you did do dr dahlman's procedure and experienced the dysbiosis problems you possibly anticipate, how long do you think it would take for you to regain the level of health you're at now through your current methods? if you're confident you could actually do that (worst-case scenario, if you weren't actually cured), then why not try it? what holds me back is lack of a)time and b)money. i'm just working too much and too broke.


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## Jhouston (Nov 9, 2003)

Kel, yes, for sure with flagyl the yeast/fungal overgrowth is a known. I had to use vaginal cream while using flagyl per doc orders. one time I used metrodiazanole cream which is flagyl and had the worst yeast infection in my life. ugh It is so weird that flagyl is used for antibiotic d and it gave me d, but only for a day and on the first day after last dose. but the bloat was out of this world and like some here have mentioned I could see it....belly moving as the gas moved around. Joann


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## brushie (Jul 17, 2002)

> quote: this is not the only place where i post way too much. i need to stop!


please dont stop posting, your posts are very interesting! maybe posting less would do you good. what other boards your on? sofar i only know this one and the google board where people help each other on ibs, and the often acompaining symptoms?


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## Jhouston (Nov 9, 2003)

To all, Any IBS C on Dr D's program? Joann


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## brushie (Jul 17, 2002)

sorry, i dont know about the classification. could you please list the different ibs types. thanks!!


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## Jhouston (Nov 9, 2003)

Brushie, IBS-D for predominant diarhea, IBS C for constipation and IBS d and c for alternating. Joann


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## calid (Aug 4, 2003)

I've also seen IBS-A for alternating between D and C.


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## overitnow (Nov 25, 2001)

Eric,I do not mean to insult you, because I think you bring a wealth of information to the Board, and I have no doubt that the HT techniques you espouse are a useful tool. I also believe we are all in the same boat here and that 99% of the voices here are "true" voices. I believe that those of us who have found successful treatments, be they within traditional medicine or not, need to be heard. What fascinates me most about Dr D is that he claims so many permanent cures, a long way from a lifetime of psychoactives, continual mopups, or endless lists of herbs, supplements, and meds that people bring here. (When I see the lists that some use it makes me want to cry. I use one supplement for this and I will presumably continue to use it for the rest of my life, because it helps my cardiovascular health and ought to keep me from the heart attack that my prior lifestyle so richly deserved. The fact that it has eliminated all of my IBS symptoms is just a welcome side effect.) What angers me most about the level of debate that this has brought on is that there seems to be no attempt to find out why his methods work, rather just a continual barrage on his credibility. If the Dr has developed a technique to deliver a cure, then all of medical science ought to be interested, rather than each continuing to grind their own ax.If he has successfully treated 1000s of us, then I think we ought to be pleased. And now we have an opportunity to watch and learn from others as they try out the therapy. I, for one, am hoping it is so. Maybe it will be tough on the Caltrate and Immodium sales, maybe it will cut into some of the other successful therapies presented, but maybe no one else will die from Lotronex or suffer from the side effects of the anti-depressants. And maybe a great number of us can just put this behind us and get on with our lives.Just a thought.Mark


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## Jhouston (Nov 9, 2003)

Mike, May I ask what exactly are you taking for heart/cholesterol? Joann


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## Jhouston (Nov 9, 2003)

I meant Mark not Mike (above) Joann


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## Guest (Jan 11, 2004)

overitnow,i'm interested too in what kind of supplement you are taking for you heart that helped your ibs. is it an omega 3 type supplement? i ask b/c since taking flax seed 3 days ago i feel really really good. and i can't imagine its the fiber. i wonder if its the rich source of omega 3 - which is similar to what is in Ibsacol (which also helps lots of people and did affect me but made me worse-STILL THATS AN INTERESTING EFFECT THOUGH!).


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## drdahlman (Nov 6, 2000)

Thanks to everyone for the continued discussion, the words of kindness, encouragement and open minds......well, not everyone!







I can't respond to every statement that has been made in the last day that I'd like to comment on. It takes too much time to go back and re-read and then answer. It's one of the reasons that treating any uncomfortable symptoms associated with the gastro-intestinal tract (my definition of this family of problems)is so difficult. Each patient has their own problems, sets of symptoms, awareness of their body and way of communicating. I am sorting through this with all my patients, everyday. I feel it's impossible for me to satisfactorily give any of you who are not under my care a complete picture of how I do what I do. It's the limitation of this method of communicating (bulletin board). I believe that the people who are under my care who are responding will do the best job for me. I sincerely regret this. But, I'll try my best.The soup question....it's mostly a liquid and should be eaten first or all by itself, but I can't be there with you, so you make the call if it's very thick. It's always safe to do it first or by itself.As to the cause of IBS that I don't know.....Okay, let's get off the word cause. What do practitioners like myself find consistently in people who complain about any symptoms associated with their gastro-intestinal systems? Hmmmmm...we can send out a stool sample and find low levels of acidophilus and bifidus, we might find abnormal bacteria, yeast or parasites and we can identify food intolerances or allergies. So, let's rebalance the abnormal findings of the stool samples and temporarily, maybe temporarily, eliminate the foods that we identify to be a problem. Please note that my ability to identify them through my step-by-step plan is usually better than the patient's attempts. And, dog gone it, all the sypmtoms associated with your gastro-intestinal system become a mere memory. So, maybe I don't know what causes it, but if you follow my plan, it goes away. Said another way, every scientist knows that there must be a proper population of beneficial bacteria living in the human gastro-intestinal system. Every scientist knows that there are organisms that if allowed to remain in your gut, will cause you problems. Every patient knows that certain foods cause them problems. This is the crux of my program. I will keep using the word cure because it's not a remission. If it were only a remission, I would have many patients getting back to me, some angrily, some just as a friendly heads up, that their symptoms have come back. I never have that happen. What does happen is a phone call from a patient who took an antibiotic and they did not follow my advice to take the probiotics for the time they take the antibiotic and for 1 month afterward. Some or all of their symptoms have returned. Upon using the probiotics, everything calms down again. Does that mean that antibiotics (and we've all taken them) caused enough of a change in the bacterial levels to start a basic chemistry change that resulted in sets of symptoms that are different in each of us because of our biochemical individuality? Over a lifetime, add to that the damage that prescription and over-the-counter meds, poor diet, alcohol cause.Whew! Complex issue. So for those of you who would like to continue beating me up for this simple, down home, common sense approach, please start your own thread. You have my permission to call it, "Dahlman, the Idiot". Thanks for all your interest and I'm looking forward to continued contact with those who have started my program in the last few days. Hang in there, you're going to be fine. I can't wait to talk to Kel!!!!


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## eric (Jul 8, 1999)

Has Dr Dalman, ask anyone he is treating over the phone and email without seeing them in person for their medical records from their practisng primary care doctors or gastroenterologists?


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## Arnie W (Oct 22, 2003)

ericI had an interview with Dr dahlman over the phone which lasted about the same time as with my doctor.I have never had an appointment re IBS with any doctor in which it would have had to be vital for me to be there in person.I do not need to take medical notes to any other form of alternative practitioner (hypnotherapist, naturopath, etc), so am comfortable about not having been asked to supply them to Dr Dahlman. I have been to several medical practitioners, and have always told them personally what investigations I had had in the past, rather than supplying written history.More of interest to Dr Dahlman were the results of my past tests at Great Smokies and further investigations which should be made. The trail he is on is the same as what was taken by a regular doctor of mine, the main problem being that at the time I was probably not given appropriate supplements and no follow-up to check whether there had been improvement in my gut.


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## Jhouston (Nov 9, 2003)

Anyone on Dr D's program IBS C?


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## calid (Aug 4, 2003)

I am IBS-D. Since starting his program on Thursday night, I have had no problems with D. I have bulked stools, no stomach cramping or urgency either. The only problem I'm having is the gas, which seems to be increasing.


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## Arnie W (Oct 22, 2003)

JhoustonI'm predominantly C, though certain food gives me D. I do, however, have frequent bms and incomplete evacuations, with the characteristic pebbles.


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## brushie (Jul 17, 2002)

If there is none yet ; ï¿½ introduce you to IBS B as Bloating.Its my main Symptom.Strangely mostly i dont have much gas movement, though my "ultrasound"(german name) shows much gas in the bowel. maybe im absorbing it and breathing it out a lot, as i have a quite big lungvolume?Usually i have bowel movements 5 times a week. Sometimes i have slight C(2 days no bowel movement), but had it stronger and permanently (2-3 days) at the beginning of my IBS 5 years ago, for 2 years.I mostly have low stool formation(means soft stool, right?) and seldom slight D(2-3 times dayly).Dr. D. didnt ask me about my "home doc" or gi.The metagenics should come tomorrow.


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## drdahlman (Nov 6, 2000)

Medical records usually aren't necessary, though I ask many questions about them. Almost every patient I've encountered has extraordinary recall concerning the tests they've been through as do all of you who post on this board. The usual patient has been tested up this way and down that way and never with anything to hang their hat on by the so-called real doctors. The 45-60 minutes I spend on the phone with each new patient is designed in part to take a complete history and gather a full understanding of the condition of the patient.You're reaching Eric, but good try.


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## brushie (Jul 17, 2002)

ps: but i told him that my gi wants me to take antibiotics and sent him several test results. so he knew about what my gi does.


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## Jhouston (Nov 9, 2003)

Dr D didn't ask me about medical tests or for records. My take on this is....it probably does not matter since the product would not harm and protocol would be the same for GI symptoms either way. excepting for NO Gallbladder than an extra product. Joann


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## Jhouston (Nov 9, 2003)

Brushie, Thanks for the info. I was concerned (a little) that all the good stuff was happening to IBS d. I also have mostly B for bloat but has changed this year to having an "attack" of some sort accompanying a bladder infection ot from eating something I cannot tolerate. Arnie, Thanks for info. I am like you. Mostly C but d or spasms like d with c if I eat the wrong foods or with a bladder infection. But the distended abdomen is a major symptom and the "attacks" Joann


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## Arnie W (Oct 22, 2003)

I've had a lot of UTIs, which is quite uncommon for males.....antibiotic therapy ensued each time. Hope I can put it all behind me.


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## Gret (Sep 23, 2003)

Calid, I'm glad your D has subsided. Dr. Dahlman will tell you what to do about the gas, I'm sure. Do you feel better other than the gas? I've had the best five or six days ever! Even Sunday morning was fine! I hope you will be the same way!


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## Trinity (Sep 9, 2002)

JHouston. I don't ever have D but am easily constipated. Actually, I think I'm pretty regular but some things tend to make me C, like digestive enzymes, some probiotics, and changes to my regular diet. The so called soluble fibers from Heather's diet, pasta, bread, white rice make me very constipated, but so did the specific carbohydrate diet where I gave up my regular cereal and whole grain breads. The problem is I don't usually know I'm starting to get C, then it's too late, I'm already blocked up. 1000g of magnesium works well but I only have to rely on that about once or twice a month


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## calid (Aug 4, 2003)

Well Gret, guess I spoke too soon. Had some problems today, I ate some open faced enchiladas yesterday (no cheese of course) but they contained lettuce, onions, tomatoes and lots of spicy enchilada sauce. Wasn't near as bad of an attack as usual though. Heck, it's been less than a week since I started the supplements and I wasn't expecting miracles within that short of a time anyway!


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## kel1059 (Feb 28, 2003)

well. i spoke with dr dahmlman today.i guess the plan is to work real hard to get bifidus implanted in my colon. i'm guessing that this is very important despite the uncertainty that exists in some scientific circles.It seems that dr dahlman is a fan of the products that I have mentioned -- the ones that contain transfer factor (smart immune complexes). I believe these are related in some ways to the immunoglobulins (antibodies) that are in the probiotic products that he uses. This could be a very important factor in a person's recovery. Ibsacol-Dianne tipped me off about these and i think she may be on to something. I was taking them back in October and it had a very calming effect on my brain. It was almost like a powerful natural valium. It was not a total cure-all because I would still react to various foods. http://www.restorehealthnow.com/page5.htm http://immunedisorders.homestead.com/AiE10.html http://www.immunesystemetc.com/AiE10.html _ Transfer Factor - At the end of a "battle" (let's say your body won), when antibodies no longer have a target and suppressor T cells call a truce to the immunological reaction, a new balance is set. Special cells of the immune system "remember" what happened so the body can respond much faster the next time when attacked by the same organism. These cells release special little molecules called transfer factor that prepare the stage for the next time that particular invader shows. When it does show up, your immune system is ready for it and can respond much more quickly. You may never be aware of it.Cytokines and Defensins - These are hormone-like messengers that facilitate communication between cells of the immune system. Without this communication your immune system can be unresponsive. An example of two of the better known cytokines are interferon (alpha, beta, gamma), and the interleukins (1,2,4,5,10,12).Lactoferrin - An iron binding protein that exerts an anti-microbial activity by withholding iron from ingested bacteria and fungi; a type of cytokine that also helps coordinate attacks on foreign invaders.Through a patented proprietary process the above factors can be "built" in one mammal (in this case the cow) and given to another (in this case, us), with accruing benefits, no known toxicity and no side effects. Ai/E10 *not only restores NK cell function, but also has a "spreading" effect over T cells, B cells and the immune system as a whole.* No other supplement of any kind causes this effect. A functional immune system prevents and fights disease and does so very effectively. _


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## Gret (Sep 23, 2003)

Kel, I hope you find relief with your new attack plan. Good luck and keep us posted!Calid, you're right. We can't expect miracles! But I'm glad it wasn't too bad! My day today was fine, but I had about 3 BMs which is more than the past few days. But my stomach has been upset and I have a headache so it could be the bug that has been flying around here. I think an evening in with something hot to drink will make it all go away. It's really cold here, and getting colder later this week!


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## Jhouston (Nov 9, 2003)

Calid, So some of us are not the d type on the program. I don't feel alone on this. Sometimes I have bm several days in a row but I still consider it C since the stolls are hard and not what I think stool should look like-long instead of ball shaped. Still waiting for products to arrive. Went to Whole Foods searching for gluten free food - slim pickin's. Found some cereals and some bread that is dairy free, gluten free and wheat free and even carrot muffins. Now to see if these don't bother me. Still do not understand Heather's diet with all that white bread and pasta which would make C worse and gas, bloating worse. or is this only me? Joann


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## calid (Aug 4, 2003)

Joann: I am IBS-D. I found some "Oreos" that are wheat free and dairy free yesterday. They're not too bad. The fat content is 31% which is a little high, but once in a while they shouldn't hurt if fat bothers you. They are by Mi-Del. Mi-Del also makes some great Ginger Snaps that are gluten free and fairly low in fat (23%), be sure to get the ones that state Gluten Free as some are made with wheat.


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## Jhouston (Nov 9, 2003)

Calid, Sorry, I meant Trinity. sometimes the board doesn't keep the posts available underneath the reply box and I forget screen name. Joann


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## kel1059 (Feb 28, 2003)

thanks gret. i hope you are successful also. keep posting all that happens to you.***********************************************i must have gone over the scenario of "bacteria and IBS" a million times.i am fairly certain that there was a worsening of my condition after 2 courses of antibiotics back in the fall of '96. it took a long while for me to circle the drain but it did happen. i think that many factors played a role in this.however, i also had some of my worst pain long before the antibiotics. wheat caused some of the worst pain.i hope that bacteria is responsible, but short of taking more antibiotics i have tried extremely hard to address bacterial issues. success has been the result, but some symptoms of IBS remain.i know that i am going to be one of the patients who is on the 6 month plan. by mid-july my results will be in. i am not optimistic, but i am very hopeful. there is a difference.


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## kel1059 (Feb 28, 2003)

i am over here thinking about something that dr dahlman has said to me that at first i did not agree with... he said that it is something i am doing. --referring to why bifidus is not implanting.i am thinking that possibly the 3 grams of daily vitamin C could be doing it. maybe the acidophilus is not affected by it but the bifidus is.. maybe since the acidophilus has some aerobic properties (i think) --- then that might protect it from the vitamin C.can't hurt to taper my way down to 100 mg per day and see what happens.vit C causes D in high doses so maybe 3 grams is enough to do it.


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## Jhouston (Nov 9, 2003)

Well, I had a carrot muffin -Gluten Free and immediately got bloated and felt too full. It is made with Brown rice flour, carrots, fruit juice concentrate (pineapple, peach and pear), whole eggs, canola oil, walnuts, baking powder, baking soda, spices, cinnamon. maybe its the fruit juice concentrate? Joann


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## ellisd5 (Jan 12, 2004)

Im new this forum, only just found it, I am thinking about following the Dr Dahlman's scheme.I havn't had IBS that long compared to most, only about 10 Months now.Let me give a quick rundown of my symptoms, The main one is Stomach pain/cramps, I usually dont feel them if im sitting down but after say a few minutes on my feet walking there back in full effect, this is what im gettin most the time, the other is at night, 7pm onwards i usually get gas.First went to my doctor about 3 Months in and she thought that i had probaly pulled a muscle in my stomach. After another 3 months I went to the Doctor again and she said it was IBS and she gave me some tablets, i forget there name. She advised I read up on IBS and what confuss's me is that nobody else's cass I have read seems to match mine in the movement respect, I know everyone's is differen't but that seems to be unheard of. The Doctor said that movement can irate the bowel?? Anyway the tablets I took made it worse and after not taken them for a while im back to square one. Started to doubt if I have IBS and not something else because of movement thing, but recently I think that there is a link between eating and my pains/cramps.So having reading that in people's experience, do you think that the Dr Dahlman's course work for me? Do you think I even have IBS?ThanksDale


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## BackFire44 (Nov 19, 2003)

Did the doctor do tests on you? (colonoscopy, stool sample, blood work, anything else?). You are right in that your symptoms don't sound to me like IBS, but I am not a doctor. I believe to be diagnosed IBS you have to either have constipation or diarrhea (or alternating both). You might want to get a second opinion.What was the medicine that she gave you? Did she recommend fiber? One thing that will not hurt is to try an IBS diet and see if you feel better. You can find a possible one on www....com.


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## calid (Aug 4, 2003)

JoAnn: I found eating relatively low fat foods helped me tremendously over the last year. At this point I would not eat whole eggs and oil in the same muffin as it would be too high in fat. Hopefully when I become more stable I can add those back in. I've heard a lot about Fructose intolerance, maybe you're right and you're one of those.


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## drdahlman (Nov 6, 2000)

JHouston....not just the fruit juice, but the carrots also. Both contain fructose. Have alot of carrots today and see if you get a similar reaction.IBS Definition for those who wonder if they "have it": Any uncomfortable symptoms associated with your gastro-intestinal system. My process addresses any and all. Could simply be mouth sores all they way through the "big ones", IBS, IBD, Colitis and Crohn's. In each case make sure the bacterial levels are proper with no pathogenic critters and identify food intolerances and allergies. Then see what you're left with. Usually nothing.


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## eric (Jul 8, 1999)

This should sayDr Dalhmans *idea* of what he thinks and believes IBS might be from a non expert in gastroenterology and neurogastroenterology."IBS Definition for those who wonder if they "have it": Any uncomfortable symptoms associated with your gastro-intestinal system."It is wrong!!!!!!!!!!!!!!!!IBS is not a food allergy or intolerence either."Since I have suffered for thirty years of IBS I wonder what role foods play in IBS. So I asked Dr Douglas Drossman at the UNC Center for Functional GI and Motility disorders and here was his response. This is not a substitute for seeking medical advise from your doctor on any specific conditions you may have, but for educational purposes only. Dr. Drossman is Co-director of the Center and Professor of Medicine and Psychiatry at UNC-CH. Dr. Drossman has had a long-standing interest in the research and evaluation of difficult to diagnose and treat gastrointestinal disorders. He established a program of research in functional gastrointestinal disorders at UNC more than 25 years ago and has published more than 350 books, articles, and abstracts relating to epidemiology, psychosocial and quality of life assessment,design of treatment trials, and outcomes of research in gastrointestinal disorders. Dr. Drossman received his MD degree from Albert Einstein College of Medicine in 1970 and completed his medical residency at the University of North Carolina School of Medicine and NYU-Bellevue Medical Center. After his residency, he subspecialized in psychosocial (psychosomatic) medicine at the University of Rochester School of Medicine and in Gastroenterology at the University of North Carolina in 1976-1978. He is currently Professor of Medicine in Psychiatry at UNC.As the medical director of the Center, Dr. Drossman sees patients in the functional GI and motility clinic and precepts GI fellows and visiting gastroenterologists to help develop their clinical skills in treating patients. He also facilitates the learning of medical faculty, psychiatry residents, and medical students, on how to provide biopsychosocial care to patients with functional GI disorders.Dr. Drossman has an active research program, which relates to the clinical, epidemiological, psychosocial, and treatment aspects of irritable bowel syndrome (IBS). He has developed and validated several assessment measures, which are used worldwide for clinical research. Recently he began looking at brain imaging (fMRI) in functional bowel to determine if the reported changes in the brain are responsive to treatment. He also consults with several pharmaceutical and governmental agencies regarding treatment trials. He was responsible for organizing the Functional Brain Gut Research Group as a special interest section within the American Gastroenterological Association, chairs the ROME committee, and is a past president of the American Psychosomatic Society. Dr. Drossman sits on the Board of Directors and is Chair of the Scientific Advisory Board and the Awards Committee of the International Foundation for Functional Gastrointestinal Disorders. He also sits on the board for the medical website Medscape Gastroenterology. Dr. Drossman chaired the 1999 Digestive Health Initiative on Functional GI Disorders ï¿½ sponsored by the American Digestive Health Foundation. He was the recipient of the 1999 Janssen Award for Clinical Research in Digestive Disease.In 2001, Dr. Drossman was appointed Associate Editor of Gastroenterology, the official journal of the American Gastroenterological Association and in 2003 became chair of the Nerve-Gut Council of the American Gastroenterological Association. He received the prestigious Research Scientist Award for Clinical Research presented by the Functional Brain-Gut Research Group at Digestive Disease Week in Atlanta. Dr. Drossman is also involved in teaching the evaluation and management of patients with complex GI problems or difficult-to-diagnose conditions. He completed the AGA Clinical Teaching Project on IBS (unit 13), and the AGA GI Teaching Project on IBS-II. He is editor of the Manual of GI Procedures (now in its third edition), and Rome II: The Functional Gastrointestinal Disorders, 2nd Edition and has been appointed Senior Editor of the book, Rome III Committees with the book, Rome III, to be published in 2006.Dr. Drossman's educational and clinical interests in the psychosocial/behavioral aspects of patient care was a natural path to his developing a series of videotapes to teach physicians and other health professionals how to administer an effective interview, carry out a psychosocial assessment, and enhance the patient-doctor relationship (available through the Center). He has taught numerous US and European workshops on this topic, was the chair of the Physician-Patient Relations Committee of the American College of Gastroenterology from 1994 - 1996, and is a charter fellow of the American Academy on Physicians and Patients, a consortium of physicians which teaches these skills to medical school faculty. Dr. Drossman is considered a world authority in the field of (IBS), functional disorders, and on physician-patient communications. He presents at numerous national and international meetings throughout the year. http://www.med.unc.edu/medicine/fgidc/drossman.htm "Dr Drossman's comments on foods for IBS Health.Shawn,To say that people with IBS may get symptoms from food intolerances is an acceptable possibility, since the gut will over react to stressors of all types including food (high fat or large volumes of food in particular). Futhermore, there can be specific intolerances. So if you have a lactose intolerance for example, it can exacerbate, or even mimic IBS. Other examples of food substances causing diarrhea would be high consumers of caffeine or alcohol which can stimulate intestinal secretion or with the latter, pull water into the bowel (osmotic diarrhea). The same would be true for overdoing certain poorly absorbed sugars that can cause an osmotic type of diarrhea Sorbitol, found in sugarless gum and sugar substituted foods can also produce such an osmotic diarrhea. Even more naturally, people who consume a large amount of fruits, juices or other processed foods enriched with fructose, can get diarrhea because it is not as easily absorbed by the bowel and goes to the colon where it pulls in water. So if you have IBS, all of these food items would make it worse. However, it is important to separate factors that worsen IBS (e.g., foods as above, stress, hormonal changes, etc.) from the cause or pathophysiology of IBS. Just like stress doesn't cause IBS, (though it can make it worse), foods must be understood as aggravating rather than etiological in nature. The cause of IBS is yet to be determined. However, modern research understands IBS as a disorder of increased reactivity of the bowel, visceral hypersensitivity and dysfunction of the brain-but axis. There are subgroups being defined as well, including post-infectious IBS which can lead to IBS symptoms. Other work using brain imaging shows that the pain regulation center of the brain (cingulate cortex) can be impaired, as well as good evidence for there being abnormalities in motility which can at least in part explain the diarrhea and constipation. So finding a specific "cause" of IBS has grown out of general interest in place of understanding physiological subgroups that may become amenable to more specific treatments. Hope that helps."Doug ROME II SYMPTOM CRITERIA FOR IBS At least 12 weeks or more, which need not be consecutive, in the preceding 12 months of abdominal discomfort or pain that has two out of three features: 1) Relieved with defecation; and/or 2) Onset associated with a change in frequency of stool; and/or 3) Onset associated with a change in form (appearance) of stool. Other symptoms that are not essential but support the diagnosis of IBS: Abnormal stool frequency (greater than 3 bowel movements/day or less than 3 bowel movements/week); Abnormal stool form (lumpy/hard or loose/watery stool); Abnormal stool passage (straining, urgency, or feeling of incomplete evacuation); Passage of mucus; Bloating or feeling of abdominal distension. Irritable Bowel Syndrome:How Far Do You Go in the Workup? Douglas A. Drossman, MD, FACGUNC Center for Functional GI & Motility DisordersChapel Hill, NCPrintable formatThe diagnostic evaluation of patients with irritable bowel syndrome (IBS) can be challenging for several reasons. First, there is no biological marker for the disorder. The diagnosis is based primarily on the presence of a clustered set of symptoms relating to abdominal pain or discomfort and altered bowel habit. Second, it follows that a diagnosis based solely on symptoms can be unsettling; clinicians will struggle with the possibility of missing another diagnosis. This level of uncertainty may increase the risk of overdoing diagnostic studies, though many clinicians believe an extensive diagnostic effort justified: it seeks to satisfy the patient's request to and a specific diagnosis, as well as the physician's personal interest to "leave no stone unturned." Unfortunately, this approach contributes to the disproportionately high health care costs for IBS relative to other gastrointestinal disorders as reported in one Health Maintenance Organization study.1 Finally, developing a diagnostic algorithm for IBS can be challenging given the effect of daily and life stress, and other psychosocial factors on IBS.2Currently, the diagnostic evaluation of patients presenting with IBS symptoms has no simple standard; it is based on the art and science of medicine. Several factors can influence the decision making: (1) symptom pattern and severity will influence, for example, whether biopsies are taken for diarrhea-predominant symptoms, or ultrasound or computerized tomography (CT Scans) are done for pain and weight loss,3 (2) features such as older age on initial presentation or a family history of inflammatory bowel disease or colon cancer may lead to a more extensive (e.g., colonoscopic) evaluation, (3) a patient's pain communication style must be appraised in the light of objective screening data; this, for example, will reduce the tendency for physicians merely to order tests based on urgent requests to "do something" (furor medicus"),4 and finally (4), the clinical setting will influence the probability of other medical disorders; so primary care physicians more than gastroenterologists will minimize diagnostic studies, treat the symptoms of IBS and follow the patient expectantly,5 simply because the likelihood of another serious medical disease in a primary care setting is far less than in a referral practice.Efforts to consolidate these many influences on diagnostic decision making have occurred by creating specific published guidelines obtained by consensus.3,6,7 Most authors agree that an initial diagnosis of IBS should be fulfilled by: (a) meeting symptom-based diagnostic criteria, such as Rome II6,8 criteria, (







obtaining a negative physical examination, and © performing a cost-effective, conservative set of screening studies. These usually include a sigmoidoscopy (or colonoscopy for patients older than 50 years), a few laboratory tests (e.g., complete blood count, stool for occult blood or ova and parasites), and additional studies if certain "alarm" features are found: fever, an abnormal physical examination, blood in the stool, an abnormal complete blood count or elevated sedimentation rate, significant weight loss, nocturnal symptoms that awaken the patient, or a family history of cancer or inflammatory bowel disease.12,13 Several prospective studies now offer evidence that the proper application of such recommendations rarely leads to a revision in diagnosis, even for patients observed over many years.6,14,15 In one study, the positive predictive value for the diagnosis of IBS using Rome I criteria and excluding "red flags" over 1-year follow-up was 98%.12Of course, the gastroenterologist in referral practice may not be content to accept these probabilities without first excluding those rare conditions overlooked by routine evaluations. So how far should the gastroenterologist go in the workup of patients referred to them who typically present with IBS and have negative screening studies? One gastroenterologist recently commented to me: 'I order breath hydrogen studies and blood tests for celiac sprue on all my patients referred with IBS. No doubt this comment reflects the concern that referral gastroenterologists have an obligation to contribute additional expertise to the diagnostic effort. Recently, the breath H2 test is being requested more actively by physicians and the public alike, possibly because of media attention to a study claiming a 73% rare of bacterial overgrowth in patients with IBS referred for breath H2 testing, and a 50% improvement with antibiotic treatment.16 However, the design limitations of this study, including a high referral bias, use of an uncontrolled and unblinded treatment protocol, and only a 30% follow-up rate evaluated over a relatively short period of time, make it unlikely that clinicians in practice will also obtain such dramatic results. So although this study increases awareness of bacterial overgrowth as an entity that can mimic or exacerbate IBS, clinical experience suggests that the diagnostic yield in general gastrointestinal practice is probably much lower than reported, perhaps 10% or less.What about celiac disease? This disorder should always be considered in evaluating IBS because the diarrhea and abdominal discomfort caused by this intestinal disease will specifically respond to a gluten-free diet. There fore, making a diagnosis early may be cost-effective. The prevalence of celiac disease in the United States is reported to range from 1:250 to 1:1500.17 However, this is influenced by the method of assessment as well as the probability of the disorder being present in the population under study. With regard to the method of assessment, in a study set in Olmstead County,18 the reported prevalence was 1:4600, and the cases were identified by clinical and pathologic criteria. In contrast, when blood tests are used for diarrhea, the prevalence is at 1:250 or even higher,19 and in one recent study, the prevalence for women was 1:125 compared with males at 1:250.20 So, when clinically suspected, primary care physicians and specialists may now obtain anti-gliadin and anti-endomysial IgA antibody serologies. These are reasonably effective screening tests, given that the sensitivities and positive predictive values range from 90%-l00%.17 However, in populations in which the prevalence of this disorder is low, many positive serologic tests will be false positives. Therefore, because the gold standard of diagnosis requires upper endoscopy with duodenal biopsy, endoscopy is almost always needed for confirmation of the diagnosis. Recently there is considerable research being done to reduce the cost of unneeded diagnostic studies. The use of simple "Red Flags" or "Alarm Signs" based on the medical history or simple screenings and blood tests are examples. There are also more sensitive tests of intestinal inflammation (Calprotectin) that can be recommended from the stool and can exclude inflammatory bowel disease (ref - Tribble).Is it possible that some simple and inexpensive tests will emerge to accurately diagnose IBS? I do not think that IBS can by diagnosed by ordering tests, either to make a unitary diagnosis, or by default by excluding other disorders. There is evidence that IBS is a heterogeneous disorder in which different physiologic sub groups contribute to the clinical expression of the syndrome. For example, there is a subgroup of patients, called "post-infectious IBS' who appear to respond to an enteric infection such as cawpylobactor jejuni with an increased inflammatory cell response.22 This is associated with activating enterochromaffin cells to produce 5HT, and CD3 cells to produce cytokines, which in turn leads to enhanced motility and lowered visceral sensation thresholds.22,23 But microscopic inflammation cannot be a diagnostic marker for IBS because it does nor typically produce pain in those who have it. All patients with active celiac disease have microscopic inflammation, but a large proportion do not have abdominal pain, and patients with ulcerative colitis who also have microscopic inflammation when compared with patients with IBS seem to have higher pain thresholds.24 In individuals with these disorders, there may be central nervous system counter-regulatory measures responding to the peripheral pain/inflammatory processes that increase pain thresholds.With regard to IBS, the gut-related effects of microscopic inflammation may be only one component of a dysfunctional brain-gut system. In addition, and often in response to stress, there may be a failure to activate pain inhibition systems that lead to the perception of pain and produce other symptoms that typify this disorder.25 In one prospective study of postinfectious IBS, it was found that those who retained their symptoms 3 months after an enteric infection had not only increased inflammation in the intestinal lining, but also had increased psychosocial distress at the time of the infection. Furthermore, lowered visceral pain thresholds and increased motility were present after the infection regardless of whether or not the patients retained their symptoms.26 Therefore, the microscopic inflammation and its physiologic effects on motility and sensation contribute to, but are not always sufficient for, the clinical expression of IBS pain. At least for postinfectious IBS, this provides some evidence that psychologic distress alters brain pain regulatory pathways to amplify incoming visceral signals leading to the full clinical expression of this syndrome.27,28 Recent studies using brain imaging29,30 may help us to understand the physiologic mechanisms that modulate these central nervous system responses to pain, and in the process, identify the subgroup with IBS that are more amenable to psychologic and psychopharmacological treatments.As we continue to develop the means to assess the pathophysiological determinants of IBS symptoms, we will identify subgroups that will change our diagnostic assessment. This may even lead us to redefine what we mean by IBS. Postinfectious IBS and patients having concurrent psychosocial disturbances (among others to be determined) characterize subgroups that will be more responsive to more specific treatments. For the present, we must still make a diagnosis of IBS based on established guidelines, including symptom-based (e.g., Rome) criteria. We must also remain vigilant to identifying other relevant disorders like celiac disease that may mimic or exacerbate IBS, and will use clinical judgment (e.g., ordering anti-endomysial antibodies for patients with predominant diarrhea), rather than routinely ordering tests in all IBS patients just to exclude other disease. With careful appraisal of the historical and laboratory data and good clinical judgment, a positive diagnosis of IBS can be made in a cost-effective manner and with confidence.References1. Levy R Von Korff M, Whitehead WE, Stang P, Saunders K, Jhingran P, Barghout V, Feld AD. Costs of care for irritable bowel syndrome patients in a health maintenance organization. Am J Gastoenterol 2001;96:3122-3129.2. Drossman DA, Creed Fit Olden KW, Svedlund J, Toner BB, Whitehead WE. Psychosocial aspects of the functional gastrointestinal disorders. In: Drossman DA, Corazziari E, Talley NJ, Thompson WG, Whitehead WE, eds. Rome II. The functional gastrointestinal disorders: diagnosis, pathophysiology and treatment; A multinational consensus. 2nd ad. McLean, VA: Degnon and Associates. 2000:157-245. http://www.med.unc.edu/medicine/fgidc/how_..._the_workup.htm


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## eric (Jul 8, 1999)

American College of PhysiciansDoes diet affect IBS?Copyright ï¿½ 2003 by the American College of Physicians.Ask experts if diet affects irritable bowel syndrome (IBS) and you'll get a definite "maybe."Many IBS patients are afraid to eat certain foods for fear of triggering symptoms. But as Brian Lacy, MD, director of the Marvin M. Schuster Center for Digestive and Motility Disorders at Johns Hopkins Bayview Medical Center in Baltimore, Md., noted, "It's generally not what you eat but the act of eating that cause the symptoms." Besides, he continued, there are no good studies showing that dietary changes do anything to improve IBS. Gastroenterologist Douglas A. Drossman, FACP, co-director of the University of North Carolina Center for Functional Gastrointestinal and Motility Disorders at Chapel Hill, however, said there is good evidence that eating too much of certain foodsï¿½those that contain caffeine or a lot of fat, for instance, or those that trigger gas productionï¿½can activate the bowel and worsen IBS symptoms. Patients with IBS are prone to excessive gut reactions to stressors, he pointed out, which can include dietary substances."Frequent small feedings, a low-fat diet and avoiding excess caffeine are rational and research-based recommendations," Dr. Drossman added.He also recommended that patients keep a dietary record to see if any particular foods are linked to IBS symptoms. If so, patients can try to avoid those foods. The problem is that many diet restrictions are impractical, noted George F. Longstreth, MD, chief of gastroenterology at Kaiser Permanente Medical Care Program in San Diego, Calif. And Dr. Lacy cautioned against creating "dietary cripples" by imposing excessive food taboosï¿½and perhaps boosting stress that can worsen IBS symptoms.Finally, while experts used to think a high-fiber diet could improve patients' diarrhea, pain and constipation, recent studies found that the strategy relieved only constipation. Researchers have also found that even that relief may come at a price: One study found that high-fiber diets increased symptoms of bloating in more than one-third of patients. http://www.acponline.org/journals/news/sep03/diet_ibs.htm American Gastroenterological Association medical position statement: Irritable bowel syndrome" Pathophysiology of IBS symptoms TOP The symptoms of IBS have a physiological basis. Although no specific physiological mechanism is unique to, or characterizes IBS, there are at least 3 interrelated factors that affect symptoms to varying degrees in individuals with IBS: (1) altered gut reactivity (motility, secretion) in response to luminal (e.g., meals, gut distention, inflammation, bacterial factors) or provocative environmental (psychosocial stress) stimuli, resulting in symptoms of diarrhea and/or constipation; (2) a hypersensitive gut with enhanced visceral perception and pain; and (3) dysregulation of the brain-gut axis, possibly associated with greater stress-reactivity and altered perception and/or modulation of visceral afferent signals. Brain-gut axis dysregulation may also play a role in the subgroups of patients who have gut inflammatory and immune factors persisting following infection or inflammation of the bowel. Further studies are needed to characterize the precise role of these factors in IBS and to identify physiological subgroups more amenable to specific treatments." http://www2.gastrojournal.org/scripts/om.d...id=agast1232105


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## kel1059 (Feb 28, 2003)

in a nutshell, the only substantive information that drossman delivered was the declaration that, "...IBS is undetermined."in other words, "we don't have a clue."i have been leary of drossman ever since i discovered that he was past editor of a journal that holds to the psychosomatic dogma. i.e., our mind controls our bodily ills.it seems that he has backed away from this dogma over the years but i have to wonder how much this might be ingrained into his entire approach.all i can say is that 7 years of CBT and even hypno was worthless, but when i started to focus on the nuts and bolts of the digestive system -- i got progress. therefore, i am extremely leary of drossman, and i wonder if he --at times-- does more harm than good.*********************************************************************well, i started taking the transfer factor yesterday, and i got an incredible night of sleep.this is the same thing that happened last october. the stuff is powerful, but there is a possibility that the effect tapers.today there is a deep amount of relaxation -- almost sleepiness.i have been reading up on interferons and how they can have an incredible healing effect on the nervous system. of course, it could be any number of informational peptides or chemicals that is responsible.but it is interesting how they are finding elevated levels of various interleukins such as IL-6 in certain mental/nervous disorders. i really think that many of the people who have psychiatric problems really have immune disorders as opposed to serotonin disorders. i think that playing with serotonin is just a way of manipulating certain features of an illness.


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## eric (Jul 8, 1999)

The serotonin system is connected to the HPA axis system and the immune system!!!Maybe after a billion times you might just get it, but somehow I doubt it, because you have to try to learn about it all and your to busy worrying and thinking every thing on the planet is the cause of your severely comprimised immune system. Maybe its because you worry so much, no that couldn't be it. Do you get colds all the time?psyï¿½choï¿½soï¿½matï¿½ic ( P ) Pronunciation Key (sk-s-mtk)adj. Of or relating to a disorder having physical symptoms but originating from mental or emotional causes. *Relating to or concerned with the influence of the mind on the body, and the body on the mind, especially with respect to disease: psychosomatic medicine. * --------------------------------------------------------------------------------psychoï¿½soï¿½matiï¿½calï¿½ly adv. Source: The American Heritageï¿½ Dictionary of the English Language, Fourth Editioncopyright ï¿½ 2000 by Houghton Mifflin Company.Published by Houghton Mifflin Company. All rights reserved. "The American Psychosomatic Society, founded in 1942, is a worldwide community of scholars and clinicians dedicated to the scientific understanding of the interaction of mind, brain, body and social context in promoting health and contributing to the pathogenesis, course and treatment of disease. " http://www.psychosomatic.org/2003site/index.htm Biopsychosocial AssessmentImportant in Diagnosis and Managementfor Functional GI Patients Adapted from Gastroenterology & Endoscopy News, May 2003The biopsychosocial model of chronic gastrointestinal disease may be a better approach to diagnosing and managing patients than the traditional biomedical model, say experts, at the International Symposium on Functional Gastrointestinal Disorders, which was held in Milwaukee, Wisconsin, March 31st through April 4th (2003)." *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,"* professor of Medicine and Psychiatry in the Division of Digestive Diseases and Co-director of the University of North Carolina Center for Functional GI & Motility Disorders in Chapel Hill. Physicians can integrate the biopsychosocial model into their practices by evaluating dietary and lifestyle factors, the role of stress, social support, life trauma (e.g., abuse history) and the patient's coping mechanisms. "For treatment one should look at the severity of the condition, the biological and psychosocial factors that may be influencing the nature and severity of the symptoms, and let one's treatments be guided by that," said Drossman. Chronic gastrointestinal illnesses, illness being defined as the patient's perception of ill health are not fully explained by observable disease, defined as conditions externally verified with x-rays, endoscopy, histology or other analysis, according to Drossman. In contrast, biomedical researchers are looking to explain illness based on the presence of an organic cause of a disorder. "From their perspective, functional GI disorders are defined as the absence of organic disease, and id disease is not found, as a psychiatric disorder," Drossman explained. However, according to William B. Salt II, MD., clinical associate professor in the Department of Medicine's Division of Gastroenterology at the Ohio State University in Columbus mounting evidence shows that functional GI disorders have biological and psychological influences; and the interrelationship of environmental, physical and social factors is relevant. "When practicing, I use a mind/body/spirit language to communicate with patients," said Salt. Using the word biopsychosocial can be confusing for some patients, he noted. However, using the term mind/body/spirit helps to create a common language for patients and doctors. "Patients respond well to the idea," he said. "It helps them become open and receptive to therapy."Nicholas Diamant, MD, professor of medicine and physiology at the University of Toronto in Ontario, believes the biomedical model tends to restrict the view of the patient's condition to specific abnormalities, signs and symptoms, while the biopsychosocial model is a more holistic approach.Diamant encourages doctors to think beyond the physical, neurological, pathological and biochemical aspects of treatment and to consider cultural and spiritual aspects of the patient. Some doctors are more comfortable with the aspects of disease they can define and measure. However, Diamant believes that patients appear to be seeking a harmonization of the mind, body and spirit, which is illustrated by the fact that 40 percent of Americans are using alternative medicine.Definitions of illness and disease among health practitioners are important, said Diamant. "We need to be talking the same language when we're discussing disease models and the issues around our patients, but many times we are not," he said. " Illness and disease are often used as if they are the same thing; sometimes they may be, but other times they're not." Doctors' definitions of mind, psyche, conscious or self differ based on where they are coming from philosophically and biomedically, he added. Disease and illness do not always correlate when addressed by the biomedical model because it assumes that all conditions can be linearly reduced to a single etiology and that illness and disease are either organic, having a defined etiology, or functional with no specific etiology. "However, the blurring of organic and functional is beginning to occur," said Drossman.In the clinical setting, finding a specific disease that correlates with illness (i.e., the patient's perception of ill health) is rare, said Drossman. Often, when disorders such as chronic abdominal pain and irritable bowel syndrome appear to have no biological cause, they are considered to be psychosomatic, which is defined as pain based solely on psychological factors and the use of this term questions the creditability of the symptoms, which are real to the patient.Specifically, the biopsychosocial model for functional GI illness includes early life factors, either biologic or behavioral, and their later effect on psychosocial experiences, physiologic function or susceptibility to a pathological condition. "Early life factors might affect psychological factors and the physiology of the gut and interact with each other to produce symptoms," he said."Psychosocial factors also play a role in terms of the patient's appraisal, perception, and behaviors in response to the illness," said Drossman. "Psychosocial distress may lower pain threshold and may affect pain behavior and influence health care seeking." In fact, people with IBS who don't go to the doctor often have a psychological profile similar to control populations." http://www.med.unc.edu/wrkunits/2depts/med...sychosocial.htm


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## brushie (Jul 17, 2002)

eric, thanks for posting infos about dossmans research, but this isn`t the thread for that!we just want to get better, and the dossmans an co. totally failed to do so. i really get angry when i think of all the docs who seem to have thrown away their curiosity for medicine and just execute the "orders" from researchers as dr.dossman without seeking individually anymore.claiming that the brain has soooo much to do with it surely doesnt help to get docs searching again. it rather gives them a couchy feeling that they cant do anything about it anyway, and to send us to a psychotherapist who even might be a friend of them. most docs out there diagnose many gastro probs immediately with ibs.their prof. from the university would have given them a 5, but if you take it by the words its correct, our(the ones who get to such a board) bowels are irritated.if only rome II was ibs, many of us would be healthy people in that narrow cluster. BUT WE DONT FEEL AS!!!!!!


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## Jhouston (Nov 9, 2003)

Sometimes I feel soooo stressed reading the board. If it is a placebo effect I"LL TAKE IT! So the medical proffession says...We don't know why or what causes IBS but we know what doesn't. fine. How about we don't have IBS but they didn't make up another syndrome for us non-IBSers. and we are stuck in IBS limbo and want out into some sort of normalcy. Food has played a major role in my non-IBS. Joann


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## Jhouston (Nov 9, 2003)

This thread is for dr d's program I thought. Remember the mind is powerful so it is not nice to put a damper on the program before it has a chance for placebo effect or we will get reverse placebo effect.  Joann


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## kel1059 (Feb 28, 2003)

eric i am very familiar with the issue of serotonin. in fact, i was the one who had to correct you on how the body synthesizes it. you kept incorrectly claiming that it was metabolized from carbohydrates.by the way, prostaglandins and leukotrienes run the whole show -- look it up. serotonin activity is part independant and part dependant on orders from prostaglandins.************************************************************************i believe that Drossman was the editor of some journal called --" The Psychosomatic.....????" --- something with the word psychosomatic in it.kind of scary that this guy has so much power!!!!okay--- back to the subject, and yes eric i agree with brushie --- quit distracting us -- we have work to do.


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## brushie (Jul 17, 2002)

im still waiting for the metagenics. i`ve been 4 days now on the diet, first step plan for me. yesterday i was out with a friend. late we went to a restaurant where they only had some soups left. one that i dont like, and a "garlic soup". as i felt quite a bit better in symptoms, i thought that because i dont have the products jet,i could try one last time what difference diary makes( muchh cream in the garlic soups here, as in many foods). guess what, my bloat got very bad, as the cream has many cow proteins i think. since today on the diet again, without experiments now. postman hurry, hurry!!!


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## eric (Jul 8, 1999)

I posted whatI did because of what Dr Dalman used to define IBS!!!!!!!!!!!! IBS is not every complaints or symptom of the gastro system. Wrong, there are many conditions and some quite serious and they should not be diagnosed over the phone and the internet.Was Dr Drossman anyones doctor here?


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## Gret (Sep 23, 2003)

I don't believe in placebo effect when it comes to my IBS. Something helps or it doesn't. I've tried everything on good faith and it didn't work or it sort of worked..... Whatever this stuff is I'm using now is working, without a doubt. Now I hope it lasts forever! I'm definitely not making this up in my mind, I feel better!


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## kel1059 (Feb 28, 2003)

gret that is good news. what do you think is doing it. the probiotics with immunoglobulins? the enzymes? or the dietary restrictions.


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## drdahlman (Nov 6, 2000)

Eric, What you refuse to get is that no one here cares what it's called. A case can be made that there is no such thing as IBS and another case can be made that I actually am not treating IBS. Hence, the purpose of my definition. People consistently come to me after going to numerous other doctors with concerns about specific symptoms associated with their gastro-intestinal system. It doesn't need to be named. These folks are uncomfortable and the great Dr. Drossman can't help them. And I don't care if they come to me with a diagnosis of IBS, IBD, Colitis or Crohn's. I treat successfully, any symptoms associated with the gastro-intestinal system. And I'm only a Quackapractor....sorry, I mean Chiropractor.







I diagnose no one, they come to me with a diagnosis.The message you should be getting here is that no one on this thread cares about your opinion anymore. Pleae start your own thread, call it "Eric's Idol's Failed Ideas". You also still have my permission to start another thread called, "Dr Dahlman, the Idiot". You remind me of the youngsters that came to chiropractic school, inexperienced in life, no true belief systems, they were minds full of mush needing to take form. When the chiropractic gurus told them day after day after day, that chiropractic was all they need for health, they believed them. They were told that nutrition didn't matter, you never need drugs, only the spine needed to be in alignment. Keep the signals flowing from the brain and the body will take care of itself. It is actually an evangelical-like indoctrination in some chiro schools. As an older student and one who had no desire to practice chiropractic, I just kept my mouth shut and shook my head at these kids who were so impressionable. You are as impressionable as they are. You are easily impressed with degrees, studies, research, books, published articles. Now if we were talking about the cure for polio, I'd be impressed with the doctors credentials also.Please let us get on with what we're doing, start your own thread...obviously no one's paying any attention to your opinion.


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## Gret (Sep 23, 2003)

Kel, I wish I were as in tune with my system as you seem to be with yours! I don't really know what is going on! I think it's the combination of supplements being used that helps. For some reason I doubt that the digestive enzymes are the biggest help. It's more likely the Ultra Clear Sustain and the probiotics. BUT, like I said, I really don't know what's going on. All I know is that I have not had to leave a lesson or a rehearsal to use the restroom since I started using this stuff. The plan is to get free of all supplements, but honestly, if I had to take these for the rest of my life to feel like this, I'd do it! And it makes me wish I'd called Dr. Dahlman back in June when I first read about him. It was a comment by loulou back then that scared me off of the idea. I hope everyone else is doing well!


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## ohnometo (Sep 20, 2001)

Dr Dahlman,Can you tell me if you have ever treated anyone with Cyclic Vomiting Syndrome and your thought on that illness....Just curious because after taking some different things out of my system this illness improved...







Your quote below......People consistently come to me after going to numerous other doctors with concerns about specific symptoms associated with their gastro-intestinal system. It doesn't need to be named.


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## Arnie W (Oct 22, 2003)

eric, those who have phone/internet consultations with Dr Dahlman would, I imagine, invariably have had a diagnosis from practitioners who, thus far, have not been able to offer any improvement in symptoms.


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## eric (Jul 8, 1999)

What does this mean Dr Dalhman?On-line Self-help Groups and Message Boards What are self-help groups?Self-help groups offer mutual assistance among individuals with shared concerns. These groups do not depend upon (though may at times include) professional assistance. They can be a source of information on a wide range of topics, and may provide participants with a sense of shared experience and support. "Members of self-help groups share a common condition or life circumstance. Group members work together to overcome the difficulties they experience. Those directly affected are the ones who control the activities and priorities of the group. Self help is not self care or therapy. Self-help groups assist members to manage their personal situation or condition, but they are not set up and run by professionals..." ï¿½ Collective of Self Help Groups, Melbourne, Australia. What are message boards? Message boards (also called bulletin boards) are a way to communicate with other people on the Internet. The users, or members, are able to post messages on various topics that appear on the board. This results in a written discussion of topics that may include questions, opinions, and other information that is of interest to the users. The postings are visible for anyone to read.Self-help group or message board web sites.Certain precautions need to be kept in mind about the information from on-line self-help groups, bulletin boards, message boards, or newsgroups. Here are some general guidelines to keep in mind when seeking health related information:Because of the open nature of on-line group communication, you cannot make assumptions about the security or validity of the information, or of the "quality control" of the information provided. Web site policies and purpose should be clearly posted and followed. *Is the information accurate? Is it factual, or does it represent opinions?* Look for sources. It is important to determine whether the information provided arises from a *reputable source (e.g., a scientific article or opinion from a professional expert), or whether it is the opinion of a non-professional.* The questions, replies, and suggestions from participants on bulletin/message boards are often anonymous. Over time, it may be easy to attribute "authority" to familiar respondents based on their postings aloneï¿½without really knowing their level of training or experience as a health professional, if any. *At all times, do not rely on anecdotal information. * It helps to seek out more than one opinion, and you will then need to come to your own decision about the accuracy of the information. It helps to check it out with your physician. *Information that is provided about treatment, causes, or diagnosis may not be applicable to your particular circumstances.* Always check with your physician before applying a diagnosis or treatment. *(It is medically unethical for a physician to diagnose or treat over the Internet.) * A variety of self-help sites and commercial sites with message boards are available on the Internet. Examples that provide health related bulletin/message boards and other resources include the IBS Self Help Group (www.ibsgroup.org), WebMD (www.webmd.com), and HealthBoards.com (www.healthboards.com). *It is appropriate to question the value and reliability of any health related web site, book, or publication. * Some guidelines to help you evaluate the standards applied to particular sites can be found at the Health on the Net Foundation web site. The U.S. National Library of Medicine and the National Institutes of Health offers a Guide to Healthy Web Surfing: Evaluating the Quality of Health Information on Web Sites.For more information about IFFGD web site standards, please refer to our Privacy and General Policies page. http://www.iffgd.org/SelfHelp.html "You are easily impressed with degrees, studies, research, books, published articles."You mean facts and real science and research?" no true belief systems"I have a true belief that IBSers need more accurate information as opposed to all the disinformation that is already out there, supllied by people who are not experts in the field for one or who do serious IBS research.nice try with the analogy. lol"the great Dr. Drossman can't help them"How do you know how many people Dr Drossman has helped? This is also not about you helping people, but your information and the methods your using to do so.Your on a public forum here!!! And I believe supplying inaccurate information about digestive disorders. I am also not the only one who believes this, but I seem to be the only one saying anything, why because I care about IBSers and people and am not afraid to say something.


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## eric (Jul 8, 1999)

MEDLINEplus Guide to Healthy Web SurfingWhat should you look for when evaluating the quality of health information on web sites? Here are some suggestions based on our experience. Consider the source--Use recognized authorities Know who is responsible for the content. Look for an "about us" page. Check to see who runs the site: is it a branch of the federal government, a non-profit institution, a professional organization, a health system, a commercial organization or an individual. There is a big difference between a site that says, "I developed this site after my heart attack" and one that says, "This page on heart attack was developed by health professionals at the American Heart Association." Web sites should have a way to contact the organization or webmaster. If the site provides no contact information, or if you can?t easily find out who runs the site, use caution. Focus on quality--All web sites are not created equal Does the site have an editorial board? Is the information reviewed before it is posted? This information is often on the "about us" page, or it may be under the organization's mission statement, or part of the annual report. See if the board members are experts in the subject of the site. For example, a site on osteoporosis whose medical advisory board is composed of attorneys and accountants is not medically authoritative. Look for a description of the process of selecting or approving information on the site. It is usually in the "about us" section and may be called "editorial policy" or "selection policy" or "review policy." Sometimes the site will have information "about our writers" or "about our authors" instead of an editorial policy. Review this section to find out who has written the information. Be a cyberskeptic--Quackery abounds on the Web Does the site make health claims that seem too good to be true? Does the information use deliberately obscure, "scientific" sounding language? Does it promise quick, dramatic, miraculous results? Is this the only site making these claims? Beware of claims that one remedy will cure a variety of illnesses, that it is a "breakthrough," or that it relies on a "secret ingredient." Use caution if the site uses a sensational writing style (lots of exclamation points, for example.) A health web site for consumers should use simple language, not technical jargon. Get a second opinion! Check more than one site. Look for the evidence--Rely on medical research, not opinion Does the site identify the author? Does it rely on testimonials? Look for the author of the information, either an individual or an organization. Good examples are "Written by Jane Smith, R.N.," or "Copyright 2003, American Cancer Society." If there are case histories or testimonials on the website, look for contact information such as an email address or telephone number. If the testimonials are anonymous or hard to track down ("Jane from California"), use caution. Check for currency--Look for the latest information Is the information current? Look for dates on documents. A document on coping with the loss of a loved one doesn't need to be current, but a document on the latest treatment of AIDS needs to be current. Click on a few links on the site. If there are a lot of broken links, the site may not be kept up-to-date. Beware of bias--What is the purpose? Who is providing the funding? Who pays for the site? Check to see if the site is supported by public funds, donations or by commercial advertising. Advertisements should be labeled. They should say "Advertisement" or "From our Sponsor." Look at a page on the site, and see if it is clear when content is coming from a non-commercial source and when an advertiser provides it. For example, if a page about treatment of depression recommends one drug by name, see if you can tell if the company that manufactures the drug provides that information. If it does, you should consult other sources to see what they say about the same drug. Protect your privacy--Health information should be confidential Does the site have a privacy policy and tell you what information they collect? There should be a link saying "Privacy" or "Privacy Policy." Read the privacy policy to see if your privacy is really being protected. For example, if the site says "We share information with companies that can provide you with useful products," then your information isn't private. If there is a registration form, notice what types of questions you must answer before you can view content. If you must provide personal information (such as name, address, date of birth, gender, mother's maiden name, credit card number) you should refer to their privacy policy to see what they can do with your information. Consult with your health professional--Patient/provider partnerships lead to the best medical decisions. http://www.nlm.nih.gov/medlineplus/healthywebsurfing.html 10 Things To Know About Evaluating Medical Resources on the Web The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading. This short guide contains important questions you should consider as you look for health information online. Answering these questions when you visit a new site will help you evaluate the information you find. On this pageWho runs this site? Who pays for the site? What is the purpose of the site? Where does the information come from? What is the basis of the information? How is the information selected? How current is the information? How does the site choose links to other sites? What information about you does the site collect, and why? How does the site manage interactions with visitors? 1. Who runs this site?Any good health-related Web site should make it easy for you to learn who is responsible for the site and its information. On this site, for example, the National Center for Complementary and Alternative Medicine (NCCAM) is clearly marked on every major page of the site, along with a link to the NCCAM homepage.Top2. Who pays for the site? It costs money to run a Web site. The source of a Web site's funding should be clearly stated or readily apparent. For example, Web addresses ending in ".gov" denote a Federal Government-sponsored site. You should know how the site pays for its existence. Does it sell advertising? Is it sponsored by a drug company? The source of funding can affect what content is presented, how the content is presented, and what the site owners want to accomplish on the site.Top3. What is the purpose of the site? This question is related to who runs and pays for the site. An "About This Site" link appears on many sites; if it's there, use it. The purpose of the site should be clearly stated and should help you evaluate the trustworthiness of the information.Top4. Where does the information come from? Many health/medical sites post information collected from other Web sites or sources. If the person or organization in charge of the site did not create the information, the original source should be clearly labeled.Top5. What is the basis of the information? In addition to identifying who wrote the material you are reading, the site should describe the evidence that the material is based on. *Medical facts and figures should have references * (such as to articles in medical journals). Also, *opinions or advice should be clearly set apart from information that is "evidence-based" (that is, based on research results).* Top6. *How is the information selected? * Is there an editorial board? Do people with excellent professional and scientific qualifications review the material before it is posted?Top7. *How current is the information? * The most recent update or review date should be clearly posted. Even if the information has not changed, you want to know whether the site owners have reviewed it recently to ensure that it is still valid.Top8. How does the site choose links to other sites? Web sites usually have a policy about how they establish links to other sites. Some medical sites take a conservative approach and don't link to any other sites. Some link to any site that asks, or pays, for a link. Others only link to sites that have met certain criteria.Top9. What information about you does the site collect, and why? Web sites routinely track the paths visitors take through their sites to determine what pages are being used. However, many health Web sites ask for you to "subscribe" or "become a member." In some cases, this may be so that they can collect a user fee or select information for you that is relevant to your concerns. In all cases, this will give the site personal information about you.Any credible health site asking for this kind of information should tell you exactly what they will and will not do with it. Many commercial sites sell "aggregate" (collected) data about their users to other companies--information such as what percentage of their users are women with breast cancer, for example. In some cases they may collect and reuse information that is "personally identifiable," such as your ZIP code, gender, and birth date. Be certain that you read and understand any privacy policy or similar language on the site, and don't sign up for anything that you are not sure you fully understand.Top10. How does the site manage interactions with visitors? There should always be a way for you to contact the site owner if you run across problems or have questions or feedback. If the site hosts chat rooms or other online discussion areas, it should tell visitors what the terms of using this service are. Is it moderated? If so, by whom, and why? It is always a good idea to spend time reading the discussion without joining in, so that you feel comfortable with the environment before becoming a participant.TopNCCAM ClearinghouseToll-free: 1-888-644-6226International: 301-519-3153TTY (for deaf or hard-of-hearing callers): 1-866-464-3615 E-mail: info###nccam.nih.gov Web site: nccam.nih.govAddress: NCCAM Clearinghouse, P.O. Box 7923, Gaithersburg, MD 20898-7923 Fax: 1-866-464-3616 Fax-on-Demand Service: 1-888-644-6226 Evaluating Health Information http://www.nlm.nih.gov/medlineplus/evaluat...nformation.html


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## BackFire44 (Nov 19, 2003)

I think we need a big time out. Dr. Dahlman, it only hurts your cause and name to call other people names. And for eric -- I know you are just trying to help people. I think that most people realize that Dr. Dahlman is not a GI and that his methods have not been proven scientifically (although parts of his program have been tested in varying degrees). He obviously knows this as well. And yes, he is a bit of a salesman with his pitch. I think he knows the stuff you post, but in order to help his patience he puts the information in a less technical (and yes, less accurate) way. However, the fact remains that he has been helping people. And even if it is a placebo effect, if it helps, it helps. I do think its wise to tell everyone that they should clear things through their own GI or primary doctor as well, though. I also think its great to debate these issues and telling someone to get off this discussion is not very helpful. Let's keep the name calling out of it, though.


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## roger (Mar 26, 2003)

"Dr." Dahlman:According to you:


> quote: The message you should be getting here is that no one on this thread cares about your opinion anymore. Pleae start your own thread, call it "Eric's Idol's Failed Ideas". You also still have my permission to start another thread called, "Dr Dahlman, the Idiot".


Many of us that frequent this board "lurk" in the background looking for the occasional tidbit that offers some relief. I, for one, value Eric's opinion and find him to be careful and responsible when responding to any post on this board. I think his viewpoint and opinions provide a more balanced approach to understanding this awful affliction.I'm afraid that you, on the other hand, have shown less than professional behavior with your most recent posts on this thread. You jokingly referred to yourself as a Quackapractor! You are certainly free to do so but it does not instill the confidence in me that you are peddling anything other than "snake oil".Furthermore, you have already given some very bad advice to JHouston earlier in this thread:


> quote: JHouston....not just the fruit juice, but the carrots also. Both contain fructose. Have alot of carrots today and see if you get a similar reaction.


Advising someone to do something that has the potential to do more harm, in my opinion, is just plain irresponsible. You should be more careful. I spend every waking hour trying to avoid anything that is going to hurt me more than I already do. I think you should have advised JHouston to check the fructose contents of carrots and eliminate them if JHouston is certain that fructose is part of the problem. Instead, you told her to eat more carrots and see if you get sick!!!! Good job, "Dr.".Finally, I must rely on the old adage, "If it sounds to good to be true, then it probably is!". For you to summarily discount the work of Dr. Drossman, a real doctor, and all others involved in scientific research and treatment of IBS is just patently absurd. Just as absurd as your claim to cure everyone.Just my 2 cents.


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## brushie (Jul 17, 2002)

hahaha,, incredible. guess where the metagenics whent to: australia, though they where labeled with austria. as dr.d joked it seems that neil armstrong is the only person in the us postal office.dr.d sends away a new pack now and i should get it within 5 days.thanks!i totally agree with dr.d, but think eric should give his opinion. it mostly just should be in a more moderate way.


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## Gret (Sep 23, 2003)

I think we are suppose to keep each other updated on our progress on Dr. Dahlman's program. The other "stuff" is getting in the way of our communication of these updates. Another thread may be a good idea.


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## ohnometo (Sep 20, 2001)

You know it really dont matter who comes here with a new idea or approach to IBS...They seem to all get shot down and told they dont know what they are doing...So if it helps others that is following this program *THAT'GREAT !!!*


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## calid (Aug 4, 2003)

Gret: Another thread is definitely in order. I'm having a hard time wading through all the long cut and paste posts that have nothing to do with what we're supposed to be communicating in this thread. Go ahead and start a new one, hopefully there will be some respect for it.


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## kel1059 (Feb 28, 2003)

eric is still on this thread?!?! SOMEONE CALL SECURITY!


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## eric (Jul 8, 1999)

Thanks for the support Jrkatz and backfire.Something else here, is that Dr Dalhman should clearly be stating in his profile when he posts he is not an expert, nor does he do research on IBS and that he is a chiropractic doctor and that his methods are his own beliefs based on his own personal opinions.Dr Dalhman do you also tell patients to do their own back adjustments over the phone without personally and physically seeing them?


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## kel1059 (Feb 28, 2003)

Jrkatz you are wrong. Since when is eating carrots harmful especially if the person has eaten them before and needs to test for a sensitivity.All the major books that teach us how to identify food intolerances goes about this exact method of re-introduction.Eric argues with anyone who does not agree with his narrow view of IBS. He is at the center of almost all debates, and I for one do NOT consider him an authority on anything; he ‘steps and fetches’ some decent abstracts on occasion. His post high school education consists of cooking school. He has never had a post high school course in physiology, chemistry, biology or anything. What we have is a cook playing the role of an expert. There is a raging ego bordering on megalomania and it gets tiring.I for one have received extreme reduction in symptoms by following a program that is very similar to dr dahlman’s. lifelong gas and odor problem all but wiped out. Severe cramps gone. Pain gone. Bloat gone. The only thing that remains is some type of severe lost oral tolerance activity going on. Non-IgE food allergy which results in very poor stool formation if I get off a super strict oligoantigenic diet.Dr D. ignore these clowns. It will not be easy but always know that you have your supporters. (I am still skeptical that my severe immune dysfunction will be reversed but I will not know until I try) (even if you don’t solve it, I still have absolute knowledge that your program works to drastically reduce many of my symptoms.)arnie, you are the voice of reason (as are a few others here) i enjoy reading your posts.


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## roger (Mar 26, 2003)

Kel:You said:


> quote: Jrkatz you are wrong. Since when is eating carrots harmful especially if the person has eaten them before and needs to test for a sensitivity.


Please go back and read the original Dahlman post to Jhouston. I have nothing against carrots but evrything against bad advice.


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## kel1059 (Feb 28, 2003)

jrkatz,just what do you propose that jhouston do...... hire a gypsy fortune teller to read her palm in order to come up with the provoking foods?


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## calid (Aug 4, 2003)

LMAO Kel.........


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## roger (Mar 26, 2003)

Kel:I am not proposing that JHouston do anything. I will leave that to you.I was proposing that people that pass themselves off as doctors should be more responsible with the advice they offer. If, for example, someone believes they are fructose intolerant, then maybe they should eliminate or minimize fructose in their diet and see if they "feel better". I fail to see the wisdom of telling someone to "eat a lot of" something and then see if you get sick as a dog.


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## eric (Jul 8, 1999)

Kel, once again you don't have it right, but I am more then use to that now, since you have been wrong so many times."Eric argues with anyone who does not agree with his narrow view of IBS"What narrow view is that:""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 the view I subscibe to in regards to IBS as it incorporates the most." him an authority on anything"never claimed I was an authority on anything"His post high school education consists of cooking school."I did not go to cooking school."He has never had a post high school course in physiology, chemistry, biology or anything"I went to college and my major was English and my minor Phycology and I took every course available and passed them all with b's and above.I also studied astronomy and biology and vulcanism, as well as other sciences.Your occupation on your profile is yourself. You also seem to be pretty preoccupied with yourself. What sysmptoms do you really have, what are the symptoms of a SEVERLY COMPRIMIZED IMMUNE SYSTEM?I do know since you have been on this bb, you have diagnosed yourself with more problems then a person can have at one time and then call them all IBS.That has been all you have said for months now about your symptoms is your stools are not formed. Not to mention, not long ago you were positive you were "cured" with IBSacol. What happened there?I also know something else and its quite clear from your posts over the years. You have an anger problem."Welganet al. reported anger increased frequency of myoelectrical activity and motility of the colon in the IBS patients" http://cp.yahoo.net/search/cache?p=anger+a...ng/07806192.pdf Maybe its because of your anger that contributes to why you don't have perfect stools.


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## Arnie W (Oct 22, 2003)

We DEFINITELY need a new thread, especially once everyone has received the supplements and started the programme.There is no need to put "dr" in inverted commas or to say:"passes himself off as a doctor". Dr Dahlman is a doctor, ok. Not a medical doctor, obviously, but I'm sure we all know that and he has not told misled us about this. He does NOT diagnose over the phone. You have already heard the answer to that, eric, from the doctor, but you still continue on that track. I did a quick journey down memory lane while I was walking back from the gym this morning, and tried to bring to mind all the practitioners I have visited, specifically to get relief from IBS, over the years. I came up with 5 doctors, 2 gastro's, 2 hypnotherapists, 4 naturopaths, 1 homeopath, 2 acupuncturists, 1 chinese herbalist, 2 psychologists and a LEAP consultant. (I've probably missed a few too). So do I really need Dr D to give me a diagnosis over the phone? I've given him enough information and I'm prepared to go ahead with whatever he tells me.And the analogy with back manipulations over the phone does not bring you any credit, eric. Come on, you can do better than that.Jrkatz, what's the problem with Dr Dahlman's advice about carrots? At the very worst, Joann's going to get extra gas or bloating. So what? She'll know that she should avoid carrots. And if there's no problem, she could try one of the other ingredients.I'm doing the very same thing myself (not on Dr Dahlman's addvice by the way, just in case that becomes used as another weapon against him). I have been extremely stringent with my diet, and have greatly decreased the number of BMs. I reintroduced egg whites and a couple of sweet potatoes a few days back, and got very bad gas. A couple of days ago I ate some flavoured rice crackers. Again they set me off by giving me a much increased number of bms, but not D. So back to the drawing board forIf you guys can't do better than that, it would be best to leave this thread to those who want to share what results they are getting from Dr Dahlman.


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## Jhouston (Nov 9, 2003)

Kel, that is the first laugh I've had all day. (gypsy fortune teller) ha,ha Joann


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## Gret (Sep 23, 2003)

I had to giggle over "someone call security"!


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## overitnow (Nov 25, 2001)

I have to say this is the most optimistic thread I've seen in a long while here. (I had to chuckle when I read Gret allowing as how she might be able to keep taking the supplements if she could keep feeling this good. You are just opening the door to a world of possibilities. You will find that research has come a long way since One a Day's were introduced.)soon you will all be overitnow ;o)


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## drdahlman (Nov 6, 2000)

To jrkatz2003, My advice to try carrots was hardly irresponsible. The purpose of that advice was to try to identify if there was a difference in the reaction between the fructose in fruits/fruit juices and carrots. Pretty simple. So much of the advice I give is simple process of elimination. We know that fruits contain alot of fuctose, especially fruit juice. Carrots contain less, depending on how much is eaten. If the patient gets the same reaction, fructose is out, if the carrots don't give the patient the same reaction, what does that tell you? It tells me quite a bit.......I could go on and on about the process, but unitl you are truly involved in it, I understand how you might be confused. It's a one time experiment to gather information.Irresponsible? Hardly.I apologize if I insinuated anything about Eric, you're right and the rest of you are doing such a wonderful job with your comments about him so I'll just leave it up to you guys. His attacks change nothing that I'm doing. We have 5 people who have taken me up on my offer to help them from this board and there are also 2 others who have been posting that are also patients and I know that many of you are waiting for the results of their treatment. I can easily predict that all will completely eliminate their symptoms. Even if only 6 of the 7 report good results....I'll take those odds any day. Once these patients report their progress, Eric's info will be taken less seriously as it should. I just received an email from Bill Taylor today from http://pub104.ezboard.com/bdigestioninformation requesting me to post at his bulletin board (who has time?) and also telling me that Eric is banned from there. I agree that his cut and pastes would probably be better somewhere else.


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## eric (Jul 8, 1999)

The same Bill Talyor who was banned from this bb for causing trouble.The same Bill Talyor who lives in oregon right down the street from me and refused to go to any of the gi lectures on IBS with experts. The same Bill talyor who does not have IBS, his wife did and she never posted here or on Bill's bb.The same Bill Talyor who said HT was dangerous.A treatment taht the experts recommend and one Dr Dralhman says can help people because they can't help people.They know it can boost the immune system and lower anxiety also, but that is more a side effect from doing it, but it is also physically working on the condition phycophysiologically.The Effects of Hypnosison Gastrointestinal Problems Olafur S. Palsson, Psy. D.Research Associate, UNC-CHAPEL HillDepartment of MedicinesHypnosis is a treatment method, which still carries an aura of mystery,that unfortunately continues to be promoted by misrepresentations in movies and stage shows for entertainment. In reality, there is little mysterious about hypnosis anymore. It is a well-researched clinical technique which was formally accepted as a treatment method by the American Medical Association and the American psychological Association over thirty years ago. Clinical hypnosis is currently used by thousands of clinicians in the U.S. to treat both psychological and medical problems. Until recently, the possibilities of using hypnosis to treat gastrointestinal problems had received little attention. In the last 15 years, however, research has shown that hypnosis can influence gastrointestinal functioning in powerful ways, and that in particular, it is effective in helping patients with irritable bowel syndrome and to control nausea and vomiting. How Hypnosis Works:Hypnosis is a special mental state in which a person's focus of attention becomes narrow and intense like the beam of a bright flashlight in a dark room. This state is usually created with the aid of a hypnotist,who guides the person systematically to relax, focus only on one thing, and to allow things to happen by themselves.Whatever the mind focuses on while in this special mental state of hypnosis holds the entire attention. Therefore, people tend to experience things they think of, imagine or remember, more vividly and clearly than under usual circumstances. This is why people can sometimes recall things from their distant past under hypnosis even though unable to do so in the normal waking state (research has shown, however, that such hypnotically enhanced recall can be highly contaminated by the person's imagination). The narrow hyperfocus of this mental state is also why therapists using hypnosis are frequently able to help people make strong positive changes in their emotions and physical functioning. Hypnosis can work like a magnifying glass on the mind's effects on the body and emotion. Clinical hypnosis relies on suggestions, imagery, and relaxation to produce its therapeutic effects. Hypnotic suggestions are things that the hypnotist verbally suggests may happen while the person is under hypnosis. Due to the focused and receptive state of the hypnotized person, these suggestions happen almost automatically and without conscious decision or effort. If you, for example, receive the suggestion under hypnosis that your arm may be getting heavy, you will very likely feel it becoming heavy, without trying to do anything to make it happen. This "automaticity", the feeling of things happening by themselves, is by some considered the hallmark of hypnosis, and is often surprising to people experiencing hypnosis for the first time.Hypnotic imagery consists of picturing mentally events or situation or place in a way that has a desired positive physical or mental effect. For example, patients undergoing surgical or dental procedures are sometimes taught to enter a hypnotic state and go to a pleasant place in their mind. When successfully applied, the person gets completely engrossed in the vivid enjoyable imagery and is therefore happily unaware of the unpleasantness of the procedure. The hypnotic state is naturally accompanied by relaxation, and the physical relaxing effects are often deliberately strengthened further by clinicians through suggestions and relaxing imagery. Some of the benefits that come from hypnosis treatment are likely to result partly or entirely from the fact that hypnosis is a powerful relaxation method. Over decades of research and clinical experience, hypnosis has proven to have many valuable therapeutic uses. In psychotherapy, hypnotic techniques can speed the therapy process in various ways - for example by facilitating patients' self-understanding, extinguishing unfortunate habits, uncovering repressed or forgotten memories, reducing anxiety and phobias, and helping people to adopt a new and more adaptive outlook. In medicine and health psychology, hypnosis is used to reduce pain and discomfort associated with medical procedures such as childbirth, treatment of burns, and surgery where chemical anesthesia cannot be used effectively. It is also used to treat chronic pain and psychosomatic problems and counter unhealthy habits that contribute to illness. In dentistry, hypnotic analgesia is an effective needle-less alternative to topical anesthetic drugs, reduces bleeding and discomfort in oral surgery, and is used to treat teeth grinding and temporomandibular disorder. In recent years, the effects of gastrointestinal functioning and GI symptoms have been studied extensively. The Effects of Hypnosis on Gastrointestinal Functioning:The hypnotic state itself, without any particular suggestions, seems to slow down the gut, and clear-cut and specific changes in GI functioning can be induced in individuals by directing thinking or inducing specific emotional states under hypnosis. For example, one study(1) found that when healthy volunteers were hypnotized and simply instructed to relax, the orocaecal transit time (the time it takes material to pass through the GI tract from the mouth to the first part of the colon) was lengthened from 93 to 133 minutes. Another study(2) found that being in a hypnotic state decreases muscle movements in the stomach. The same study demonstrated that the emotional state of happiness, created under hypnosis, suppresses gastric muscle activity but anger and excitement increase muscle movement in the stomach . A pair of other studies(3) showed that when volunteers were guided to use imagery of eating a delicious meal while they were under hypnosis, gastric acid secretion was increased by 89%, and that acid production of the stomach could also be deliberately decreased during hypnosis using hypnotic instructions.Close to fifty published studies have reported on the therapeutic effects of hypnosis on nausea and vomiting problems related to chemotherapy, after surgery, and during pregnancy. Overall, this substantial body of literature indicates that hypnosis can be a powerful aid in controlling nausea and vomiting. Hypnosis may also be helpful in preventing gastrointestinal problems from recurring after they have been treated with medication: One study(4) of thirty patients with relapsing duodenal ulcers who had been successfully treated with a course of medication, found that only 53% of the patients who received preventive hypnosis treatment had a relapse within one year. In contrast everybody (100%) in a comparison group receiving no hypnosis relapsed in the same period of time. In 1984, researchers in Manchester in England published a study(5 )report in the journal Lancet, showing that hypnosis treatment dramatically improved the symptoms of IBS patients who had failed to benefit from other treatment. The researchers had randomly divided patients with severe IBS problems into two groups. Fifteen patients were treated with seven hypnosis sessions. Fifteen comparison patients were treated with seven sessions of psychotherapy, and those patients also received placebo pills (pills with no medically active ingredients) which they were told were a new research medication for IBS symptoms. Every patient in the hypnosis group improved, and that group showed substantial improvement in all central symptoms of IBS. The control group showed only very modest improvement in symptoms.Partly due to these dramatic results with treatment-refractory patients, a dozen other studies have followed, including three U.S. studies. The general conclusions from most of these studies are that hypnosis seems to improve the symptoms of 80% or more of all treated patients who have well-defined "classic" IBS problems, especially if they do not have complicating factors such as psychiatric disorders. The improvement is in many cases maintained at least for a year after the end of treatment. What is particularly remarkable is that this high rate of positive treatment response is seen even in studies where the participating patients all have failed to improve from regular medical care.The dramatic response of IBS patients to hypnosis treatment raises the question of exactly how this kind of treatment influences the symptoms in such a beneficial way. Four studies to date, two in England and two in the U.S., have tried to discover how hypnosis treatment affects the body of IBS patients. Since it is well known that many people with IBS have unusual pain sensitivity in their intestines, which is thought to be related to the clinical pain they experience, much of the focus of these studies has been on assessing the impact of this kind of treatment on intestinal pain thresholds. The two English studies both measured intestinal pain sensitivity with balloon inflation tests. The second study also measured muscle tone, to see if hypnosis relaxes the smooth muscles of the GI tract. No overall changes in pain sensitivity were detected, and gut muscle tension was also unchanged after treatment (except a subgroup of unusually pain-sensitive patients had lessened pain sensitivity in the second study(7). . In 1995-1996, during my post-doctoral fellowship in the Division of Digestive Diseases and Nutrition at UNC-Chapel Hill, we conducted the first U.S. study(8) on hypnosis for IBS under the direction of Dr. Whitehead. We evaluated the effects of a highly standardized treatment protocol, delivered verbatim following written scripts, on rectal pain thresholds and muscle tone. Seventeen out of the 18 patients we treated with hypnosis showed significant improvement in their clinical symptoms. However, we found, like the English researchers, that gut pain thresholds and muscle tension were unchanged after treatment. In a second study(9,) which I conducted with co-investigators at the Eastern Virginia Medical School, we used the same treatment protocol but this time measured autonomic nervous system functioning and blood levels of a gut hormone called vasoactive intestinal peptide. These are regulators of GI functioning in the human body, and the aim was to see if they would change due to treatment. Again, we found no changes in our physical measures after treatment (with the exception of reduction in sweat gland reactivity) even though 21 out of 24 treated patients were clinically improved. It should be noted, though, that in both our studies, we found clear improvement in the psychological well-being of our patients after treatment.In summary, it is clear from our work and other research that hypnosis treatment substantially improves all the central symptoms of IBS in the majority of patients who receive such treatment (see the effects of our two studies on clinical symptoms in the Figure). What happens in the body of these patients to cause such improvement, however, remains a mystery.Future prospects:In light of the many studies which have shown hypnosis treatment to be effective for such problems as IBS and nausea and vomiting, the question may be raised why this kind of treatment is not more widely available or generally offered to patients with such GI problems.One limitation is the fact that not everybody is equally hypnotizable. Research has consistently shown that at least 15% of people are practically non-hypnotizable, and even those who are able to enter a hypnotic state vary greatly in how well they respond. Interestingly, the ability to be hypnotized is a stable mental trait. In other word, if you are highly hypnotizable now, you will most likely be so also in thirty years. Fortunately, the majority of people are sufficiently hypnotizable to have a potential for enjoying at least some of the medical and psychological benefits of clinical hypnosis.Furthermore, the idea of being hypnotized does not agree with all people. Even individuals who are sufficiently hypnotizable, may not like the idea of "letting go", may have difficulty trusting a therapist to guide them in hypnosis, or may have other concerns about the hypnosis experience. Fortunately, other forms of psychological treatment for gastrointestinal problems - in the case of IBS especially cognitive-behavioral therapy -- have also been found to be effective and are good alternatives.Finally, an obstacle which has barred many patients from receiving help for gastrointestinal disorders with hypnosis is the fact that in the U.S. the technique is more commonly used by psychologists and other mental health professionals than by physicians. Many mental health professionals who use hypnosis are not accustomed to treating gastrointestinal disorders, and therefore reluctant to take on treatment of such problems. As the reliably beneficial effects of hypnosis on gastrointestinal functioning become better known both to health professionals and the general public, this benign and comfortable form of treatment will hopefully become a more popular treatment option for GI patients - especially for those who have not received much relief from standard medical management. As far as IBS is concerned, we have been making an effort in the last two years to encourage clinicians across the country who have adequate training in hypnosis to provide such treatment for IBS. We have done this by providing them, free of charge, with the complete standardized treatment protocol which has proven effective in our research. To date, more than eighty licensed health professionals, practicing in almost all states, are started using our protocol, making it a little bit easier for patients in many geographical locations to receive help with hypnosis. ReferencesBeaugerie, L., Burger A.J, Cadranel J.F, Lamy, P., Gendre J.P., & Le Quintrec, F. (1991). Modulation of orocaecal transit time by hypnosis. Gut, 32, 393-394.Whorwell PJ; Houghton LA; Taylor EE; Maxton DG. Physiological effects of emotion: assessment via hypnosis. (1992). Lancet, 340, 69-72Klein K.B., & Spiegel, D. (1989). Modulation of gastric acid secretion by hypnosis. Gastroenterology, 96, 1383-1387.Colgan, S. M. , Faragher, E. B. , & Whorwell, P. J. (1988). Controlled Trial of Hypnotherapy in Relapse Prevention of Duodenal Ulceration. The Lancet, 1(8598), 1299-300. Whorwell, P.J., Prior, A., & Faragher, E.B. (1984). Controlled trial of hypnotherapy in the treatment of severe refractory irritable bowel syndrome. Lancet, 2, 1232-1234.Prior A., Colgan, S.M., Whorwell P.J. (1990). Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome. Gut, 31, 896-898.Houghton, L.A., Larder, S., Lee, R., Gonsalkorale, W.M., Whelan, V, Randles, J., Cooper, P., Cruikshanks, P., Miller, V., & Whorwell, P.J. (1999) Gut focused hypnotherapy normalizes rectal hypersensitivity in patients with irritable bowel syndrome (IBS). Gastroenterology,116: A1009.Palsson, O.S., Burnett, C.K., Meyer, K., and Whitehead, W.E. (1997). Hypnosis treatment for irritable bowel syndrome. Effects on symptoms, pain threshold and muscle tone. Gastroenterology, 112, A803.Palsson, O.S., Turner, M.J., & Johnson, D.A. (2000). Hypnotherapy for irritable bowel syndrome: Symptom improvement and autonomic nervous system effects. Gastroenterology, 118,(4) A174 http://www.med.unc.edu/wrkunits/2depts/med...dc/hypnosis.htm The growing case for hypnosis as adjunctive therapy for functional gastrointestinal disorders"In 1984, Whorwell et al.1 in Manchester, England, published a small but well-designed placebo-controlled trial of hypnosis as a treatment of irritable bowel syndrome (IBS). They randomized 30 patients with severe, refractory IBS to either 7 sessions of hypnotherapy or the same amount of psychotherapy plus placebo pills. The results indicated that hypnosis treatment had specific (nonplacebo) effects that substantially improved the central IBS symptoms of all the patients in that group (who showed far greater improvement than the control group). In a follow-up article,2 the investigators reported that clinical improvement was maintained in all the hypnotherapy patients during a 2-year posttreatment period. A dozen other hypnosis studies on IBS, by the same group3ï¿½6 and by other investigators in several countries,7ï¿½14 have followed this initial trial. The additional studies have largely confirmed the high efficacy of hypnosis in IBS treatment, although the 100% response rate in the first study has generally not been equaled. This body of research has made hypnosis the most investigated psychologic treatment of IBS. In that regard, it is rivaled only by cognitive-behavioral therapy, which also shows a high success rate and substantial impact on IBS symptoms in some trials.15,16 Although some of these studies have been small and inadequate in design, hypnotherapy has emerged from the cumulative experience of this work not only as effective in improving the gastrointestinal (GI) symptoms that define IBS but also as a potent way to counter the quality of life impairment, disability, and excess health care costs associated with the disorder.3,4 This is most recently shown by the largest systematic assessment to date (250 consecutive patients) of the therapeutic impact of this treatment, reported in 2002 by the Manchester group.3 Based on the more than 50% average reduction in IBS severity, substantial reduction in anxiety and depression, significantly reduced health care costs and improved quality of life noted in this report, and good maintenance of symptom improvement beyond 2 years after treatment, it might be argued that hypnotherapy is more effective than any other single treatment modality for severe IBS. In the present issue of GASTROENTEROLOGY, the Manchester group again presents a controlled trial of hypnotherapy,17 this time targeting functional dyspepsia (FD). The design closely parallels the group's 1984 controlled trial1 for IBS. As in that study, patients were randomized to either hypnotherapy or to an equal amount of supportive psychotherapy combined with placebo medication. However, the present study added a second side-by-side control group of patients randomized to standard medical treatment. ""In conclusion, although some of the studies to date on hypnotherapy for functional GI disorders have been small and lacking in methodological rigor, and many research questions remain unanswered, the cumulative and consistent evidence for efficacy of hypnotherapy for these disorders seems to warrant serious consideration of its use as a regular adjunct in primary care and gastroenterology treatment of patients with FD and IBS." http://www2.us.elsevierhealth.com/scripts/...16508502004821& Hypnosis Treatment of Irritable Bowel Syndrome http://www.aboutibs.org/Publications/HypnosisPalsson.html Hypnotherapy for Functional Gastrointestinal Disorders By: Peter J. Whorwell, M.D., University Hospital of South Manchester, England http://www.aboutibs.org/Publications/hypnosis.html Overview of Published Research To Date on Hypnosis for IBSBy Olafur S. Palsson, Psy.D.Last updated September 24, 2003bWhorwell PJ; Prior A; Faragher EB. Controlled trial of hypnotherapy in the treatment of severe refractory irritable-bowel syndrome.The Lancet 1984, 2: 1232-4. This study is the earliest and perhaps the best study in this research area to date, as it was thoroughly placebo-controlled and showed dramatic contrast in response to hypnosis treatment above the placebo group. Thirty patients with severe symptoms unresponsive to other treatment were randomly chosen to receive 7 sessions of hypnotherapy (15 patients) or 7 sessions of psychotherapy plus placebo pills (15 patients). The psychotherapy group showed a small but significant improvement in abdominal pain and distension, and in general well-being but not bowel activity pattern. The hypnotherapy patients showed a dramatic improvement in all central symptom. The hypnotherapy group showed no relapses during the 3-month follow-up period. Graph adapted from the above paper, showing group differences in two of the main IBS symptoms:Whorwell PJ; Prior A; Colgan SM. Hypnotherapy in severe irritable bowel syndrome: further experience. Gut, 1987 Apr, 28:4, 423-5. This report summed up further experience with 35 patients added to the 15 treated with hypnotherapy in the 1984 Lancet study. For the whole 50 patient group, success rate was 95% for classic IBS cases, but substantially less for IBS patients with atypical symptom picture or significant psychological problems. The report also observed that patients over age 50 seemed to have lower success rate from this treatment.Harvey RF; Hinton RA; Gunary RM; Barry RE. Individual and group hypnotherapy in treatment of refractory irritable bowel syndrome. Lancet, 1989 Feb, 1:8635, 424-5. This study employed a shorter hypnosis treatment course than other studies for IBS, and the success rate was lower, most likely demonstrating that a larger number of sessions is necessary for optimal benefit. Twenty out of 33 patients with refractory irritable bowel syndrome treated with four sessions of hypnotherapy in this study improved. Improvement was maintained at a 3-month treatment. These researchers further found that hypnosis treatment for IBS in groups of up to 8 patients seems as effective as individual therapPrior A, Colgan SM, Whorwell PJ. Changes in rectal sensitivity after hypnotherapy in patients with irritable bowel syndrome. Gut 1990;31:896. This study found IBS patients to be less sensitive to pain and other sensations induced via balloon inflation in their gut while they were under hypnosis. Sensitivity to some balloon-induced gut sensations (although not pain sensitivity) was reduced following a course of hypnosis treatment.Houghton LA; Heyman DJ; Whorwell PJ. Symptomatology, quality of life and economic features of irritable bowel syndrome--the effect ofhypnotherapy. Aliment Pharmacol Ther, 1996 Feb, 10:1, 91-5. This study compared 25 severe IBS patients treated with hypnosis to 25 patients with similar symptom severity treated with other methods, and demonstrated that in addition to significant improvement in all central IBS symptoms, hypnotherapy recipients had fewer visits to doctors, lost less time from work than the control group and rated their quality of life more improved. Those patients who had been unable to work prior to treatment resumed employment in the hypnotherapy group but not in the control group. The study quantifies the substantial economic benefits and improvement in health-related quality of life which result from hypnotherapy for IBS on top of clinical symptom improvement.Koutsomanis D. Hypnoanalgesia in the irritable bowel syndrome. Gastroenterology 1997, 112, A764. This French study showed less analgesic medication use required and less abdominal pain experienced by a group of 12 IBS patients after a course of 6-8 analgesia-oriented hypnosis sessions followed by 4 sessions of autogenic training. Patients were evaluated at 6-month and 12-month follow-up.Houghton LA, Larder S, Lee R, Gonsalcorale WM, Whelan V, Randles J, Cooper P, Cruikshanks P, Miller V, Whorwell PJ. Gut focused hypnotherapy normalises rectal hypersensitivity in patients with irritable bowel syndrome (IBS). Gastroenterology 1999; 116: A1009. Twenty-three patients each received 12 sessions of hypnotherapy. Significant improvement was seen in the severity and frequency of abdominal pain, bloating and satisfaction with bowel habit. A subset of the treated patients who were found to be unusually pain-sensitive in their intestines prior to treatment (as evidenced by balloon inflation tests) showed normalization of pain sensitivity, and this change correlated with their pain improvement following treatment. Such pain threshold change was not seen for the treated group as a whole.Palsson, OS, Burnett CK, Meyer K, and Whitehead WE. Hypnosis treatment for irritable bowel syndrome. Effects on symptoms, pain threshold and muscle tone. Gastroenterology 1997;112:A803. Seventeen out of 18 patients with severe and treatment-refractory IBS who completed a 7-session standardized course of hypnosis treatment improved substantially. All central symptoms of IBS responded to treatment, including abdominal pain, diarrhea/constipation, and bloating. Psychological well-being also increased after treatment, with overall psychological symptoms, anxiety and somatization markedly decreased. Gut pain thresholds and smooth muscle tone, measured with a barostat and balloon inflation tests, were unchanged following treatment. Vidakovic Vukic M. Hypnotherapy in the treatment of irritable bowel syndrome: methods and results in Amsterdam. Scand J Gastroenterol Suppl, 1999, 230:49-51.Reports results of treatment of 27patients of gut-directed hypnotherapy tailored to each individual patient. All of the 24 who completed treatment were found to be improve. Galovski TE; Blanchard EB. Appl Psychophysiol Biofeedback, 1998 Dec, 23:4, 219-32. Eleven patients completed hypnotherapy, with improvement reported for all central IBS symptoms, as well as improvement in anxiety. Six of the patients were a waiting-control group for comparison, and did not show such improvement while waiting for treatment.Gonsalkorale WM, Houghton LA, Whorwell PJ. Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness. Am J Gastroenterol 2002 Apr;97(4):954-61.This study is notable as the largest case series of IBS patients treated with hypnosis and reported on to date. 250 unselected IBS patients were treated in a clinic in Manchester, England, using 12 sessions of hypnotherapy over a 3-month period plus home practice between sessions. Marked improvement was seen in all IBS symptoms (overall IBS severity was reduced by more than half on the average after treatment), quality of life, and anxiety and depression. All subgroups of patients appeared to do equally well except males with diarrhea, who improved far less than other patients for unknown reason. Palsson OS, Turner MJ, Johnson DA, Burnett CK, Whitehead WE. Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms. Dig Dis Sci 2002 Nov;47(11):2605-14. Possible physiological and psychological mechanisms of hypnosis treatment for IBS were investigated in two studies. Patients with severe IBS received seven biweekly hypnosis sessions and used hypnosis audiotapes at home. Rectal pain thresholds and smooth muscle tone were measured with a barostat before and after treatment in 18 patients (study I), and treatment changes in heart rate, blood pressure, skin conductance, finger temperature, and forehead electromyographic activity were assessed in 24 patients (study II). Somatization, anxiety, and depression were also measured. All central IBS symptoms improved substantially from treatment in both studies. Rectal pain thresholds, rectal smooth muscle tone, and autonomic functioning (except sweat gland reactivity) were unaffected by hypnosis treatment. However, somatization and psychological distress showed large decreases. In conclusion, hypnosis improves IBS symptoms through reductions in psychological distress and somatization. Improvements were unrelated to changes in the physiological parameters measured. 17 of 18 patients in study 1 and 21 of 24 patients in study 2 were judged substantially improved Improvement was well-maintained at 10-12 month follow up in study 2. Lea R, Houghton LA, Calvert EL, Larder S, Gonsalkorale WM, Whelan V, Randles J,Cooper P, Cruickshanks P, Miller V, Whorwell PJ.Gut-focused hypnotherapy normalizes disordered rectal sensitivity in patients with irritable bowel syndrome.Aliment Pharmacol Ther. 2003 Mar 1;17(5):635-42.This study evaluated the rectal sensitivity changes in IBS patients who received hypnotherapy, like a previous study by the same group (see Houghton et al's study above, but using a slightly different methodology. Twenty-three IBS patients were tested before and after 12 weeks ofhypnotherapy. Following the course of hypnotherapy, the mean pain sensory threshold increased in the hypersensitive subgroup and tended to decrease in the hyposensitive group,although the l. Reduction in gut pain sensitivity was associated with a reduction in abdominal pain. These results suggest that hypnotherapy may work at least partly by normalizing bowel perception in those patients who have abnormal gut sensitivity, while leaving normal sensation unchanged. http://www.ibshypnosis.com/IBSresearch.html A whole lot of people getting better, whatever the cause of IBS.


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## overitnow (Nov 25, 2001)

Eric,It seems to me that the people who are trying out the Doctor's protocol have indicated that these responses would better be discussed on a seperate thread, so that they can report back on their results in a useful manner. I am sure that if there is no value to his snake oil, they will let us know. Thanks, Mark


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## eric (Jul 8, 1999)

Dr Dalhman took a stab at me with the Bill Talyor comment.My name was brought up here numerous times.I believe there is still the issue of what he's doing being unethical.So there are two issues here, what he is saying on a public forum and people doing his treatment wanting to relate their experiences. He has still not put a disclamer in his signature!


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## california123 (Jun 8, 2003)

Hi Eric,I just wanted to say I support your postings on this thread and find Dahlman's attempt to tell you or anybody else what they should post or where absolutely rude. (He is selling products/services, and frankly, that's where I think he should be posting, but that is his decision--or the moderator's--to make not mine.) Stick to your guns, Eric, you've certainly been helpful with your research postings and I look forward to more of them. Take care.


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## eric (Jul 8, 1999)

Thank you California.I realize, he is treating people and they want to talk about it, but at the same time, some extremely questionable information is being provided on a public forum, where I believe people can be mislead by someone who is not a regonized expert in the field of IBS.People should questioned his credentials or where he gets his information from. Not just his opinions and what he believes with out backing any of it up with research or science or facts.He should also clearly post who he is and what his title and qualifications are in regards to treating gastro disorders in his signature.People can be easily confused with the DR title and not know what kind of DR they are corresponding with in regards to gastroentestinal issues from medical experts such as gastroenterologist and neurogastroenterologist as opposed to a Chiropractic degree.


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## eric (Jul 8, 1999)

Perhaps, Dr Dahlman can explain the huge discrepancies between what he is saying and how he bases his information and what the experts from all over the world in the fields of neurogastroenterology, immunelogy and gastroenterology are saying about IBS?


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## Jhouston (Nov 9, 2003)

Ahem, to get back to me and my carrots.. I had fish, potato, and fresh cooked carrots last night .....no problem. I noticed in Whole Foods market the gluten free bread and those carrot muffins have fruit juice for sweetener and the bread that is Wheat free, actually Ancient Grains brand bread has no sweeteners but does not state Gluten free. I ate some of that....no problem. I also see that rice milk has some gluten from barley protein. so, no soy, milk, wheat and rice milk? Joann


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## Jhouston (Nov 9, 2003)

Eric, What do you think the med proffession should do about Dr D? Think they would take a look and do a double blind study on the protocol Dr D is using with the exact same products? As Dr D has mentioned in a previous post he did not invent this protocol. It is similar to a book I read about Candida by Dr Luc De Schepper MD, Lic, Ac, D.I. Hom., C.Hom. Joann


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## calid (Aug 4, 2003)

Joann: Perhaps the bread was made with Spelt, usually when they mention Ancient Grains, that's the grain they use. It does contain gluten. I am also off gluten, but usually drink rice milk w/o any problems. My rice milk states gluten from barley at .002%. I am not Celiac so I believe I should be able to tolerate minute amounts of it.Since I started the supplements I have had 4 good days and 3 not so good days. My good days are better and my bad days are better than before, but am still having problems. The gas from the supplements has subsided though, which is great!


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## drdahlman (Nov 6, 2000)

Yes, back to your carrots......very funny! Now, I would like you to ...irresponsibly.....drink that fruit juice, I can't remember, I believe it was fruit juice, again and see if you can duplicate the problem. If no problem, we have determined that it wasn't the fruit or carrots and we will look elsewhere when we talk. As far as cyclic vomiting syndrome,...this is gonna kill Eric,....yes, I have treated that also. And no, I have no degrees that should support my beliefs, but let's just put some good old down home common sense to it. Something has to propel the food upward. Could it be a muscular contraction? How about the creation of gas propels it at times? How about those weapons of mass destruction that used to be in Iraq? Anyway, we still approach it as we do with ANY symptoms associated with your gastro-intestinal system. We make sure we have a balanced bacterial population, restore chemistry and look for foods that might be the villians here. I've had 2 patients with this complaint, one a child and the other in their 40's. They no longer vomit. Everybody but Austria has their products, seems to be lost in the Australian Outback. I have shipped him a new package.


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## Trinity (Sep 9, 2002)

I took up Dr. Dahlman's offer because traditional medicine has not helped me either. And I've seen about 20 gastroenterologists, 10 internists, 5 surgeons, 2 neurologists, 2 psychiatrists, 1 psychopharmacologist, one traditional Chinese medical doctor, 3 accupuncturists, one hynotherapist, one biofeedback therapist, one psychologist and probalby even more but I can't remember them all. I've been on the supplements for almost a week. No change except that I have slight indigestion from the antispasmodic and can taste the mint, and also I have a mild to moderate stomach ache, but not every day


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## calid (Aug 4, 2003)

Trinity: it took me a while to get used to the peppermint also. It does get better, I don't seem to notice it now. I never had the indigestion, but had gas from something which has now subsided.


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## Jhouston (Nov 9, 2003)

Dr Dahlman, It was a Carrot Muffin (gluten free) not fruit juice. one of the ingredients is fruit juice concentrate. Brown rice flour, carrots, fruit juice concentrate(pineapple, peach, and pear), whole eggs, canola oil, walnuts, baking powder, baking soda, spices and cinnamon. had bloating, a foggy. then you said eat some carrots to see if reaction. I had fish, potato and carrots. no reaction. Joann


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## eric (Jul 8, 1999)

Jhouston "Eric,What do you think the med proffession should do about Dr D?" Do you really want me to answer that question?"Think they would take a look and do a double blind study on the protocol Dr D is using with the exact same products?"That would be the ethical and evidence based approach before claims of 'curing" all gastroentestinal problems.Candida is not IBS!Dr Dahlman,"And no, I have no degrees that should support my beliefs, but let's just put some good old down home common sense to it."That wasn't my question or are you going to just ignore it?The question was"Perhaps, Dr Dahlman can explain the huge discrepancies between what he is saying and how he bases his information and what the experts from all over the world in the fields of neurogastroenterology, immunelogy and gastroenterology are saying about IBS?"But I will ask some more?How do you restore chemistry? What if its a genetic defect!!! How many chemistry problems can go wrong? And in how many ways?Since the majority of IBSers demonstrate effective serotonin dyregulation, how does bacteria regulate serotonin?Also just an aside to your website "Its the Antibiotics" Antibiotics were discovered in 1929.Yet,History of Functional Disorders Douglas A. Drossman, MDCenter-Co-DirectorMelissa Swantkowski New York UniversityPrintable formatTHE PASTHISTORICAL PRECEDENTS *Historians and physicians have documented the presence of Functional GI disorders throughout recorded human history.* However, until recently, limited attention has been granted to these disorders due to the lack of identifiable pathology and the absence of a conceptual framework to understand and categorize them. Systematic investigation of functional GI disorders did not begin until the middle of the 20th century, and prior to this time, only occasional reports of functional GI symptoms were published, the first appearing only 200 years ago. Over the past 25 years, scientific attention to understanding and properly caring for patients with functional GI disorders has grown progressively. With the understanding comes the rationale for use of medications directed at intestinal receptors as well as psychopharmacological, behavioral, and psychological forms of treatment. Additionally, there has been an increase in the rate of scientific publications and greater media exposure to the public through television, radio, and Internet. To understand the historical classification of these disorders, two differing theories relating to the interaction between the mind and body should be considered.Holism: a theory built upon the foundation that the mind and body are integrated and utterly inseparable.Dualism: a theory that proposes a separation between the mind and the body.Greek philosophers Plato, Aristotle, and Hippocrates first proposed the principle of holism about 3,000 years ago, and later in the 12th century; Jewish physician and philosopher Maimonides reexamined this philosophy. Based on holism, the study of medical disease must take into account the whole person rather than merely the diseased part. However, societal concepts of illness and disease drastically shifted when European philosopher Rene Descartes offered the divergent theory of dualism in the 17th century. Prior to the notion of dualism, the church discouraged human dissection on the premise that the spirit resided in the body. The acceptance of dualism paved the way for the emergence of scientific investigation and new medical discoveries by lifting the prohibition of human dissection. This shift in medical thought was congruent with the societal changes of the 17th century: the shift towards a separation in church and state. IMPLICATIONS FOR FUNCTIONAL GI DISORDERSBased on the concept of dualism, disease was now understood in terms of structural abnormalities. Therefore, the validity of a disease rested with the observation of morphological abnormalities. Medical conditions occurring in the absence of such morphological abnormalities and symptoms were not considered legitimate, and were often viewed as psychiatric, consistent with the concept of dualism. The concept of dualism had other effects with regard to treatment. For example, this would include all the functional GI disorders and other somatic syndromes, such as fibromyalgia. Until the latter part of the 20th century, a medical illness was considered amenable to scientific inquiry and treatment. However, patients with psychiatric disorders were interred in insane asylums and considered to no longer be treatable by medical physicians. Unfortunately this concept leads to a clinical dilemma. Specific diseases explain only about 10% of medical illnesses seen by physicians. Furthermore, people with structural (i.e. organic) diagnosis such as inflammatory bowel disease or cancer show considerable variation in their symptom presentation and clinical behavior. Gastroenterologists (as well as other health care practitioners) are all too familiar with the poor correlation between structural findings on endoscopy and their patient's symptoms. Although efforts to find morphological or even motility etiologies for functional GI disorders in the latter part of the 20th century were unsuccessful, the assumption that functional GI disorders must be psychiatric has developed and has permeated current thinking. However, in the face of current scientific research, this is being seriously challenged. Studies have shown that persons with irritable bowel syndrome who do not seek health care are psychologically much like healthy subjects. THE PRESENT CONCEPTUAL BASES FOR THE STUDY OF FUNCTIONAL GI DISORDERSThe recent acceptance of functional GI disorders as legitimate medical entities is based on the following three developments: The concept of the Biopsychosocial model of illness and diseaseThe development of new investigative methods for studying diseaseThe development of the Rome CriteriaBiopsychosocial ModelIn 1977, the publication of the concept of the Biopsychosocial model by George Engel, and its later demonstration specifically for gastrointestinal disorders, marked an important change in thinking. A biopsychosocial model of illness and disease provides the needed framework to understand, categorize, and treat common GI symptoms. These symptoms are the integrated product of altered motility, enhanced visceral sensitivity, and brain-gut dysregulation and often are influenced by psychosocial factors. Figure 1 illustrates the proposed relationship between psychosocial and physiological factors with functional GI symptoms and the clinical outcome. Early in life, genetics and environmental influences (family attitudes toward bowel training or illness in general, major loss or abuse history or exposure to infection) may affect one's psychosocial development (susceptibility to life stress, psychological state, coping skills, social support) or the development of gut dysfunction (abnormal motility or visceral hypersensitivity). Additionally, the presence and nature of a functional GI disorder is determined by the interaction of psychosocial factors and altered physiology via the brain-gut axis. In other words, one individual afflicted with a bowel disorder but with no psychosocial disturbances, good coping skills and adequate social support may have less severe symptoms and not seek medical care. Another having similar symptoms but with coexistent psychosocial disturbance, high life stress, or poor coping skills may frequent his physician's office and have generally poor outcome. Development of New Investigative Methods The second concurrent process has been the expansion and refinement of investigative methods that allow the study of functional GI disorders in terms of biological, cultural, and psychosocial (i.e. brain) influences. These developments include:the improvement of motility assessment,the standardization of the barostat to measure visceral sensitivity, the enhancement of psychometric instruments to determine psychosocial influences,the introduction of brain imaging (PET, fMRI) to determine CNS contribution to symptoms, andthe molecular investigation of brain-gut peptides, which provide insight into how these symptoms become manifest. In less than ten years, these methods have produced new knowledge of the underlying pathophysiological features that characterize the age-old symptoms we now define as functional GI disorders. Rome CriteriaThe Rome Criteria is an international effort to characterize and classify the functional GI disorders using a symptom-based classification system. This approach that has its precedents with classification systems in psychiatry and rheumatology. The rationale for such a system is based on the premise that patients with functional GI complaints consistently report symptoms that breed true in their clinical features, yet cannot be classified by any existing structural, physiological or biochemical substrate. The Rome Criteria was built upon the Manning Criteria, which was developed from discriminate function analysis of GI patients. The decision to develop diagnostic criteria by international consensus was introduced as part of a larger effort to address issues within gastroenterology that are not easily resolved by usual scientific inquiry or literary review. By 1992, several committees had met to discuss the criteria, which ultimately resulted in the publishing of many articles in Gastroenterology International and a book detailing the criteria titled "The Functional Gastrointestinal Disorders (Rome I)". Elaboration of the Rome I criteria led to a second edition of the Rome criteria (titled Rome II) in 2000 as well as the publication of a supplement to the journal Gut in 1999. Recently the Rome Coordinating Committee has met to begin Rome III, expected to be published in 2006. To learn more about the Rome Committees and to see a summary of the Rome II book: go to www.romecriteria.com.PRESENT PATHOPHYSIOLOGICAL OBSERVATIONS Despite differences among the functional gastrointestinal disorders, in location and symptom features, common characteristics are shared with regard to:motor and sensory physiology, central nervous system relationships, approach to patient care. What follows are the general observations and guidelines. MotilityIn healthy subjects, stress can increase motility in the esophagus, stomach, small and large intestine and colon. Abnormal motility can generate a variety of GI symptoms including vomiting, diarrhea, constipation, acute abdominal pain, and fecal incontinence. Functional GI patients have even greater increased motility in response to stressors in comparison to normal subjects. While abnormal motility plays a vital role in understanding many of the functional GI disorders and their symptoms, it is not sufficient to explain reports of chronic or recurrent abdominal pain.Visceral HypersensitivityVisceral hypersensitivity helps to account for disorders associated with chronic or recurrent pain, which are not well correlated with changes in gastrointestinal motility, and in some cases, where motility disturbances do not exist. Patients suffering from visceral hypersensitivity have a lower pain threshold with balloon distension of the bowel or have increased sensitivity to even normal intestinal function. Additionally, there may be an increased or unusual area of somatic referral of visceral pain. Recently it has been concluded that visceral hypersensitivity may be induced in response to rectal or colonic distension in normal subjects, and to a greater degree, in persons with IBS. Therefore, it is possible that the pain of functional GI disorders may relate to sensitization resulting from chronic abnormal motor hyperactivity, GI infection, or trauma/injury to the viscera. Brain-Gut AxisThe concept of brain-gut interactions brings together observations relating to motility and visceral hypersensitivity and their modulation by psychosocial factors. By integrating intestinal and CNS central nervous system activity, the brain-gut axis explains the symptoms relating to functional GI disorders. In other words, senses such as vision and smell, as well as enteroceptive information (i.e. emotion and thought) have the capability to affect gastrointestinal sensation, motility, secretion, and inflammation. Conversely, viscerotopic effects reciprocally affect central pain perception, mood, and behavior. For example, spontaneously induced contractions of the colon in rats leads to activation of the locus coeruleus in the pons, an area closely connected to pain and emotional centers in the brain. Jointly, the increased arousal or anxiety is associated with a decrease in the frequency of MMC activity of the small bowel possibly mediated by stress hormones in the brain. Based on these observations, it is no longer rational to try to discriminate whether physiological or psychological factors produce pain or other bowel symptoms. Instead, the Functional GI disorders are understood in terms of dysregulation of brain-gut function, and the task is to determine to what degree each is remediable. Therefore, a treatment approach consistent with the concept of brain-gut dysfunction may focus on the neuropeptides and receptors that are present in both enteric and central nervous systems. The Role for Psychological FactorsAlthough psychological factors do not define these disorders and are not required for diagnosis, they are important modulators of the patient's experience and ultimately, the clinical outcome. Research on the psychosocial aspects of patients with functional GI disorders yields three general observations: Psychological stress exacerbates gastrointestinal symptoms in patients with functional GI disorders and can even produce symptoms in healthy patients (but to a lesser degree).Psychological disturbances modify the experience of illness and illness behaviors such as health care seeking. For example, a history of major psychological trauma (e.g. sexual or physical abuse) is more common among patients seen in referral centers than in primary care and is associated with a more severe disorder and a poorer clinical outcome. Additionally, psychological trauma may increase pain-reporting tendency.Having a functional GI disorder has psychological consequences in terms of one's general well-being, daily functional status, concerns relating to control over symptoms, and future implications of the illness (e.g. functioning at work and home). APPROACH TO TREATMENTThe approach to treatment for all functional GI disorders is founded on a therapeutic physician-patient relationship. The basis for implementing a strong physician-patient relationship is supported by evidence that patients with functional GI disorders have anywhere from a 30 to 80% placebo response rate regardless of treatment. Because functional GI disorders are chronic, it is important to determine the immediate reasons behind each visit, after which treatment can be based on severity and nature of symptoms, physiological and psychosocial determinants of the patients illness behavior, and the degree of functional impairment.These factors can separate patients into mild, moderate, and severe categories.Patients with mild symptoms: usually seen in primary care,do not have major impairment in function or psychological disturbance and can maintain normal activity. These patients have concerns about their condition but do not need to make many visits to their physician. Regarding treatment, these patients require education about their disorder and its symptoms as well as information regarding a proper diet and the kinds of medication that can have adverse effects. Patients with moderate symptoms:seen in both primary and secondary care facilities and experience intermittent disruptions in activity on account of their symptoms. may identify a close relationship between symptoms and inciting events such as stress, travel, or dietary indiscretion. For these patients, symptom monitoring to record time, severity, and presence of associated factors can help to identify inciting factors and give the patient a sense of control over the disorder. Additionally, pharmacotherapy directed at specific symptoms, particularly those that impair daily function, can be helpful, as can psychological treatments (relaxation, hypnosis, cognitive-behavioral therapy, and combination treatments) in reducing anxiety and encouraging health promoting behaviors. Patients with severe symptoms: have trouble functioning daily,find their disorder to be disabling and debilitating in nearly every facet of life,have a high frequency of associated psychological difficulties,make frequent visits to their physicians , andmay hope for a magical cure. In these cases a long-term physician-patient relationship, which sets realistic treatment goals (such as improved quality of life rather than elimination of all pain) is necessary. The focus for these patients needs to shift from treating a disease to coping with a chronic disorder, where much of the responsibility is place on the patient, himself. Furthermore, antidepressants have proven useful to control pain and alleviate associated depressive symptoms. THE FUTUREFuture studies will identify pathophysiological subgroups, each having its own set of determinants and treatment. Examples are as follows::Some patients will develop their disorders or exacerbate symptoms via sensitization of afferent transmission from infection, enhanced motility, or trauma to the gut. They may respond to the newly developing neurotransmitter blocking agents. Patients with more painful and severe symptoms may prove to have "abnormal perception of normal gut function" rather than abnormal function. This dysfunction in the central regulation of incoming visceral signs may be remedied with a psychopharmacological treatment approach. The symptoms of some patients could be attributed to genetic factors, which result in abnormalities in central reactivity to stress, in which case genetic manipulation strategies would prove beneficial. Early learning within the familial structure and socio-cultural influences has been demonstrated to affect symptom perception and illness behavior. Future studies are also likely to identify psychological and behavioral interventions that are targeted for this subgroup.While it is likely that there are potent new treatments that will follow our growing pathphysiologic knowledge of these disorders, it is unlikely that they will replace some of the fundamental clinical principles: active listening, careful decision making, an effective patient-physician relationship, andpatient centered biopsychosocial plan of care. http://www.med.unc.edu/wrkunits/2depts/med...aldisorders.htm Trinity, I am sorry to hear you have seen so many Drs.. I am almost at that number, but maybe not so many specialest. I have no idea if this applies to you or not, but its also known in IBS some people see tons of Drs looking for the 'cause' and a 'cure" in what is considered a chronic condition because their expectations can be to high. While others maybe in the percentage where treatment does not work so well, because this can happen too. Also others who have accepted it have gotten better just from accepting it.also FYI on peppermint. If you have IBS and dyspepsia or gerd and the peppermint is not enteric coated and even then it maybe problematic."Although peppermintï¿½s effects are mild and positive for most individuals, gastroesophageal reflux (GERD) or a hiatal hernia may be worsened by taking it. GERD happens when the lower esophageal sphincter -- the muscular ï¿½gateï¿½ that separates the esophagus and the stomach -- is already weak, allowing acidic stomach contents to splash back into the esophagus. If peppermint relaxes the lower esophageal sphincter even more, the symptoms of GERD may increase. A hiatal hernia occurs when part of the stomach pushes through the opening in the diaphragm where the esophagus enters. If the ï¿½gateï¿½ between the esophagus and stomach relaxes, more of the stomach may extend and the possibility of complications may increase. Individuals with GERD or a hiatal hernia should avoid taking peppermint.Taking large amounts of peppermint may encourage the start of menstrual periods. Therefore, its use during pregnancy is not recommended. Precautions Although peppermint is sometimes suggested to relieve gallstones, it should not be taken by individuals who have gallstones unless supervised by a doctor. Because peppermint may stimulate the production of bile, it may worsen some types of gallstones. " http://www.drugdigest.org/DD/DVH/HerbsCare...permint,00.html Also Gerd and dyspepsia and chocolate http://www.sciencedaily.com/releases/2001/...10523072217.htm


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## Jhouston (Nov 9, 2003)

Eric, You evaded my comments? Why? I was truly asking questions. And yes IBS is not Candida....I was merely pointing out the fact that the PROTOCOL is SIMILAR. and that the author of the book I mentioned BELIEVES Candida is the cause of IBS symptoms. Joann


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## eric (Jul 8, 1999)

I Guess you do want me to answer that. LOLI personally think they should review his methods and his license. Holistic and alternative medicine can be good things, but not bad medical information which I believe is more sales based then trying to be evidence based. The second one I answered."Think they would take a look and do a double blind study on the protocol Dr D is using with the exact same products?"That would be the ethical and evidence based approach before claims of 'curing" all gastroentestinal problems on the internet.


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## kel1059 (Feb 28, 2003)

> quote: but not bad medical information which I believe is more sales based then trying to be evidence based.


eric, just zip it. (as in --- shut up)i am convinced based on my own situation that he has extremely valuable information to offer. whether or not perfect cures are out there for everyone remains to be seen.but why go on and on about one particular point and then try to use that particular point to discredit all the good information that he has to offer.his paper has loads of good information --- everything from the info on how aspartame can cause serious problems for some people (joanof arc, etc) to fructose problems to gluten problems to dysbiosis ---- on and on.so once again ---shut it.this is clearly an ego thing that you are involved with ---- you think that you are the king of all information as it pertains to IBS, and you do not care about anything other than trying to show everyone that your mind-gut theory (which is incredibly vague and offers very little help to the majority of sufferers --- me especially) is the only theory that is valid.i have offered criticism of his idea that dysbiosis is the major or total factor in all of this, but at least i have an open mind and am able to recognize value in the approach. you --on the other hand -- are all negative, and i think many of us are sick of it.at this point i am still uncertain about intestinal dysbiosis. i know that it exists, and i have some personal evidence that working on this area can offer quite a bit of relief, but i also have some serious questions about it.at this point my mind is open to all possibilities --- even the possibility that all the hundreds of probiotics that i have consumed may have been overridden by some very nasty and resistant critters in my colon that are the driving force behind my problems. possibly the identification of this critter and eradication of it is the key to the whole thing.eric, i have only one thing to say to you and your negativity------H. PYLORI.


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## kel1059 (Feb 28, 2003)

my major source of skepticism and questions come from the fact that twice so far ....the taking of ibsacol had the effect of throwing a switch on my entire system.it was that clear. it was like flipping a light switch on the wall.granted -- ibsacol will fail if i eat provoking foods. it also seems to need a big boost from the antibacterial/fungal herbs, but without it there is nothing that has helped me to form stool in 20 years.---and then, last year after i quit taking it everything went straight downhill for me. when i restarted it i was completely normal within 48 hours.this is why i am skeptical of the whole thing. skeptical ---not negative. i have questions.


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## ohnometo (Sep 20, 2001)

EricPlease let people have their own opinion !!!! I am so sick of hearing about Science and the proof is in the pudding !!! If I had depended on the method of treatment that you keep posting I WOULD BE DEAD !!!!!!!!!!!!!!!!!You post ALOT of good information but it is not for everyone...I dont care what UNC says about IBS and all their studies...Why isnt people WELL by following what they suggest....You do the same thing to anyone who comes here new and that has different opinion then you..You think he is making a sales pitch...What are you doing here with the hypnotherapy tapes that you push off on people... I am sure you will have Jeff close this thread or try to get the Dr banned from here...If he has information to share people can take it or leave it


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## drdahlman (Nov 6, 2000)

Eric, I have no reason to answer any questions posed by you anymore. Please enjoy your comtempt for me and I'l let others speak for me as they have so eloquently.JHouston, We can still experiment by drinking some fruit juice to see if that ingredient was the culprit in the muffin. Other than that, we'll talk about it during our next consult.


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## california123 (Jun 8, 2003)

This is a message board. If you don't like what someone posts, just scroll right by it. If you guys want to have a "private" discussion with Dahlman, why not do it on his website? I'm sure all those who are interested will be happy to make the journey. If you choose not to, long time posters on this board certainly have a right to state their opinions. And the use of "shut up"? What are you, a five year old?


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## Arnie W (Oct 22, 2003)

This is a message board. If you don't like the topic, don't open the thread.


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## eric (Jul 8, 1999)

Donna and Kel, the two people who totally disregard stress in IBS for years now and have fought it tooth and nail in it having anything to do with IBS.Donna, this is the second time you posted this."If I had depended on the method of treatment that you keep posting I WOULD BE DEAD !!!!!!!!!!!!!!!!!"What method is that Donna, because I promote many methods, but the most important message is to work with a doctor with experince and knowledge in IBS? Also ,nobody suggested to you to rely on any one method Donna, nor have I ever 'Pushed any method on you', but MNL treatment for you included hypnotherapy. "I dont care what UNC says about IBS and all their studies...Why isnt people WELL by following what they suggest"Because like you and Kel, the both of you have totally ignore the role of stress in IBS and refuse to accept it has any role. Besides thousands of people are better and this is not about just you and Kel personally and your symptoms and situations. Please tell me how you know they have not helped anyone and their statistics of how many they have helped? All your thinking about are yourselves. Neither of you understand this aspect of it all, that there is more to this then oneselve.Besides, maybe its more benefical for you and Kel to read and learn more about IBS from trusted and respected sources and trying to understand it all better then dismissing the information you both do, then tell people to 'shut up' and work youresevles up with anger. Its quite clear your both angry and angry at me and the medical establisment. You can be as angry at me as you want, but it won't help you, it also doesn't change what they know about IBS or the information from the experts on IBS around the world, not just the UNC. What its more about are your own personal frustrations."Eric, I have no reason to answer any questions posed by you anymore."You haven't answered any of them from the begining, so what do you mean anymore. Wahts the problem with answering the questions?Besides that is a real problem then here if you can't answer the huge discrepencies, between what your saying and what the experts who actually study IBS are saying if you come to a public forum and promote a 'Cure' to all gastro problems.


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## ohnometo (Sep 20, 2001)

Alright EricI KNOW how important stress can be in playing a role in IBS....but what I am saying is that it really gets to me when you think that NOBODY can provide accurate information here but YOU... That is not true !!!! You know what ...You have helped alot of people understand IBS and me included...but it really pisses me off when you try to belittle me that I dont know a thing about IBS...I am saying that something other then STRESSSSSSSSSSSS was playing a huge factor in my IBS and yes I have IBS-D...Your right maybe I am angry but I am here telling you how I feel and I am not running to the potty over it...I am very thankful of all the information that you have posted and it has helped me to understand IBS...But one needs to keep an open mind about others opinion...I am not sick anymore and havent been for a while put I am just hanging around to keep you on your toes


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## Jhouston (Nov 9, 2003)

Eric, I meant "Do you think they (medical experts) would do a double blind study using the same exactingredients and protocol (Dr Dahlman's)? Joann


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## eric (Jul 8, 1999)

Donna, I have never had anything against you what so ever, regardless of all the yelling at me alot. Whats up with that? I tried also to answer the emails you sent me as best I could and to help you out in regards to stress and IBS. I don't want to yell or get angry or upset, I would much rather discuss things. But they are not being addressed?Instead I am being told I am negative and told to 'Shut Up".I also know you have comorbids issues other then IBS. Learning all you can about digestive disorders and IBS OPENS UP different treatment options. Don't you think the best place to be educated on IBS is from the research and experts from around the world in all the fields studing it, or is it better to believe in individual opinions from non experts?How many times have people said one thing doesn't work for everyone? There are still, eveidence based treatment options. Maybe some people have abandoned the medical profession, but is that the message everyone here should get? Should all people abandon doctors and gastroenterologists with gastroentistianl problems and IBS and be diagnosed and treated by people who have questionable qualifications to diagnose and treat these problems based on their 'Beliefs'? "I am saying is that it really gets to me when you think that NOBODY can provide accurate information here but YOU"other people here also provide accurate information, not just me. More people should be however. People are behind on the brain gut axis as well, in dismissing it. Its not a competition between the brain and the gut either, both are involved in symptoms in IBS!!! For one all pain is processed in the brain, so treating the brain is another option for people to considered, which should not be dismissed for a large population of IBSers.How did you come up with that? Its just something you may believe. I am not posting things I make up, the things I am posting come from trusted and respected sources. Argue with the IFFGD and the UNC and Mayo and UCLA and the researchers around the world who compare notes and are peer reviewed. Support the establisments so they can find a biological marker for IBS or the different etiologies that contribute to people suffering from GI disorders of Function.Ask people including any Drs and DR Dalhman where they get their information what its based on and about their qualifications. Its your health involved. "I am saying that something other then STRESSSSSSSSSSSS was playing a huge factor in my IBS and yes I have IBS-D."I know that and never said it didn't. However, I never see you talk about it, only argue and you yourself said to me, "I am probably the hardest nut to crack." I was not trying to crack you just explain to you, that it plays a very important role in IBS. There are other things that play important roles as well, because there are things they do know about IBS, thats the whole point! You can take the information or not, doesn't change the fact it plays a major role in IBS, not just you, again this is not about one person in the slightest or them feeling better, if you don't already know I care about IBSers, then you have not been reading all my posts the last four years or understand that I want to see people get better. Again one more time, this is not about anyone person, but the bigger picture of IBS and what is being presented here."But one needs to keep an open mind about others opinion."Your the one saying this, and it applies right back to you and others not just me. I can say people are not keeping an open mind to the experts information just as well. I am also not incline to keep my mind so open my brain falls out. Are you on Dr Dahlams program? What are you actually fighting with me about here? If you see something I am posting that is inaccurate, I would be happy to discuss it with you in a peaceful manner. This isn't about the people doing the program, its about how its being done! I don't think you recognize what the diference is in reagrds to this and the information?I am glad your doing and feeling better Donna and wish that for every IBSers on the planet.I am questioning Dr Dahlmans opinions and beliefs on a public forum and so far no satisfactory answers have been provided to my questions. What does anyone thing is the reason for that?


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## eric (Jul 8, 1999)

Jhouston Anybody can pay a research institute and have a study done. Studies and evidence are extremely important.


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## Jhouston (Nov 9, 2003)

This is not a discussion with Dr D. I thought this is for the exchange of info regarding the effects of Dr D's protocol. That Dr D is on the site posting is a bonus. Too bad it turned out like this! I am too stressed for this type of exchange of communication while starting something new. Joann


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## ohnometo (Sep 20, 2001)

Eric you are a good person and I shouldn't have yelled at you ...







I didn't tell you to shut up !!! I just dont always agree with you and that's ok...You know what opinions are like







and we all have one...I am going to try to not raise my voice again 







ps...I will have some good info about IBS after I visit John Edward


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## bonniei (Jan 25, 2001)

I think eric is raising some very good questions about Dr Dahlman/. It is very disappointing that Dr dahlman has not responded. If Dr dahlman wants to advertise his product as a purely commercial product he should pay Jeff for it. Dr Dahlman have you thought of advertising here?


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## kel1059 (Feb 28, 2003)

every time i hear you talk about your "experts" i want to hurl. leave us alone over here.if you want to debate someone so much i will do that on another thread with you.you start the thread and i will jump on.i was the one who told him to shut it. after reading eric's latest round of attacks it became a little too much. (i was searching the archives and i saw him ripping on ibsacol along with flux 2 1/2 years ago. i got sick of his negativity towards everything except the mind-gut axis theory of IBS)


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## Gret (Sep 23, 2003)

Dr. Dahlman did not come here to advertise his product. The products aren't even "his". He came here to answer some questions about his program, got caught in a whirlwind of comments and questions, then offered us the chance to try his protocol at no profit to himself. He's here to help out, that's all.


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## BackFire44 (Nov 19, 2003)

BTW, Gret, how are you feeling?


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## kel1059 (Feb 28, 2003)

correct.he is giving us the products at his cost, and not charging a penny for his time. he has some excellent advice and that is definitely worth something.--so when i hear eric going over the same things over and over with everyone who disagrees it gets annoying. the arguing with MNL on every point is another example of what happens with everyone who has a different perspective.MNL presents some really nice information and all we get from eric is a comment like, "why don't you talk about serotonin". sorry but it makes me sick.


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## eric (Jul 8, 1999)

Thanks Donna.  Kel, regarless if you believe it or not the FACT is the brain and the gut are connected and operate together. This is called the brain gut axis. In keeping with an open mind, this also needs to be addressed.


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## Gret (Sep 23, 2003)

Backfire, Thanks for asking! I'm doing very well! I really am amazed. I even went out for lunch today, had a grilled chicken sandwich (no cheese) and a few fries. (Not fast food though!) I feel wonderful.







I may even be gaining a few pounds, which would be good for me. I don't have a bathroom scale anymore, I'm thinking I should get one! I feel like eating again and I have a lot more energy. YAY!Kel, Ditto.


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## bonniei (Jan 25, 2001)

kel did you know that serotonin affects gut motility specifically transit time and could well be the cure for SIBO? Worth a thought ain't it, even if it is just my theory which I put forward as a non expert.I think Dr Dahlman is getting a lot of visibility on this site and hence needs to be questioned in detail about what he knows and doesn't so readers can make up their own minds depending on his answers. As long as he doesn't provide answers his presence is not a bonus. You all would be better served by going to his site where he no doubt gets unadulterated admiration. Just MHO.


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## kel1059 (Feb 28, 2003)

> quote: Kel, regarless if you believe it or not the FACT is the brain and the gut are connected and operate together.


i have never denied this. it is a given that the gut brain and the head brain share numerous features and neurotransmitters.it is also a given that 9x's more messages are sent to the brain than the brain sends to the gut.i am fairly certain that most of us here experience some degree of brain disturbance (even if extremely minor) when our gut brain is being triggered.I suspect that the overwhelming majority of us have a problem specifically with the gut or originating in the gut and the brain ends up sharing the burden via immune system messenger chemicals -- cytokines. but i am going to stop right there because this is distractive to the others who want to discuss the specifics of dahlman's program ---WHICH I KNOW WORKS TO ALLEVIATE MANY SYMPTOMS. the only thing that remains to be seen is whether or not it can unscrew my very messed up food-immune interface gizmo and whatever other weird things are going on with respect to lost oral tolerance.plus, my goal in all of this is to see if i can get bifidus to implant in my colon.stress does play a role -- strong for some, weaker for others. we don't need to talk about it here. B.,i think you bring up a valid point. the sm intestine does run a program to "sweep" itself. if this is not working it will probably do as you say.however, prostaglandins run the show, serotonin is involved as is acetylcholine. they are all important.


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## bonniei (Jan 25, 2001)

The only prostaglandin I have heard of in medical research is the prostaglandin E1 analog misoprostol. It increased stool frequency and accelerated colonic transit in a 3-week, double-blind, randomized placebo-crossover study, during which patients were treated for 1 week.Misoprostol is expensive, it may exacerbate abdominal bloating, and its beneficial effects appear to decline over time.I am afraid I don't know much about Ibsacol and Dianne did not share any good research with me. It seems to me that research has already been done on serotonin so why go after something else, regardless of whether it runs the show or not. Lotronex, Zelnorm are both covered by insurance. It seems to be something that people should become aware of and eric is merely trying to educate. I believe even my food intolerances are helped by meds which work on serotonin receptors. Ibsacol on the other hand has not been very well researched and you pay out of your own pocket for it.


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## kel1059 (Feb 28, 2003)

> quote: The only prostaglandin I have heard of in medical research is the prostaglandin E1 analog misoprostol. It increased stool frequency and accelerated colonic transit in a 3-week, double-blind, randomized placebo-crossover study, during which patients were treated for 1 week.Misoprostol is expensive, it may exacerbate abdominal bloating,


PGE1 is the bad guy in all of this. even if the drug you mention is an analog (similar molecule) i would be leary of this.very interesting that BLOAT is a side effect!!!!people can use whatever they want. i am not a fan of synthetic drugs. it seems that lotronex and zelnorm don't do the greatest job for forming stool. very artificial process going on here, but if it helps it helps.they are finally starting to come up with some scary side effects from long-term use of Prozac -- none of it sounds good.


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## drdahlman (Nov 6, 2000)

Bonniei, I don't get a lot of visibility from this site, in fact, it's a huge outlay of time for me that could be better spent elsewhere. Always up for a good challenge, that's why I offered to treat 5 people at no profit to me and potentially great embarrassment. I have spent money out of my own pocket to prove to you all that I can do what I say because I now have 2 shipments on their way to Austria and I have only been paid for one. I also have paid for the shipping for the second package while I wait to see if the US Postal Service will reimburse me for their sending the package to Australia.What really astounds me is how mean some of you can be. As far as a double blind study is concerned, it has been discussed with GSDL providing all the labwork we need and Metagenics the products. The study will be done in a local gastroenterologists office. I have an old friend from high school who is one of the city's best gastroenterologists, has taught me much and completely understands my protocol after years of discussion with him. There are 2 obstacles standing in our way at the moment. Time....both of us are as busy as we care to be and, most interestingly, how do we design the study? It probably can be done, but do any of you have any idea how complex the design will be when there are so many variables. Since IBS doesn't have one cause, how do you design a study that accounts for the fact that some will have IBS because of low levels of good bacteria, some because of low levels of good bacteria and the presence of yeast or other bacteria or parasites. Some will be lactose intolerant, others will be fructose intolerant or gluten intolerant. Some will be intolerant of all three. Some will be lactose intolerant, but have normal good bacterial levels. Some will have Klebsiella, Citrobacter, Bacillus or Psuedomonas or others in abnormally high levels. The design is key and we have little time for it and no need since our practices are full. So Eric, please understand that I have these conversations everyday with credentialed doctors. There are many MD's who refer patients to me quite frequently. They know they can't fix the condition and they have seen my results. I have no need to answer your questions because the failed medical approach is just that....it's failed and that's why all of you are still suffering. Your fascination with their approach and your regard for them is fine, it just doesn't work. I'm about getting people well, not proving anything to you. I was warned to ignore you when I first started this communication and I should have listened. Responding to you would be like debating with a 16 year old about how to rebuild a 4 barrel carburetor. The 16 year old has all the mechanics books, diagrams and info from the manufacturer, has never rebuilt a carbuetor, but wants to debate with me about whether or not the way that I rebuild the carburetor is correct or not, even though I've done it a hundred times. I won't answer your loaded questions.


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## kel1059 (Feb 28, 2003)

correction PGE1 may not be so bad. i am thinking of PGE2.dr dahlman i will perfectly understand if you take long breaks from posting here. it can be draining being attacked all the time. i don't think it is going to stop.a lot of the cruelty here is because people have mental problem.jhouston,i have extremely bad reactions to cinnamon among dozens and dozens of foods. is it possible that this caused the reaction? if it was me i would have had a reaction to everything in the muffin -- carrots are borderline. --but the eggs would have shut my colon down for 3 days.


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## eric (Jul 8, 1999)

You know Dr Dahlam, you keep making analogies and calling me things, this time a 16 year old. Very professional.But you can't answer the questions? You want people to act on blind faith with no explanations to support what your saying.There is way more to IBS then bacteria and food intolerences, there is genetics for one and more to numerous to post.Perhaps you can explain why there are"CONCLUSIONS: Individuals with PI-IBS are a clinically distinct subgroup characterized by diarrheal symptoms, less psychiatric illness, and increased serotonin-containing EC cells compared to those with non-PI-IBS."Am J Gastroenterol. 2003 Jul; 98(7): 1578-83. Related Articles, Links Distinctive clinical, psychological, and histological features of postinfective irritable bowel syndrome.Dunlop SP, Jenkins D, Spiller RC.Division of Divisions of Gastroenterology, University Hospital, Nottingham, United Kingdom.OBJECTIVE: Irritable bowel syndrome after gastroenteritis is well recognized. Our aim was to determine whether postinfective IBS (PI-IBS) has histological or clinical features that are distinct from those of IBS patients with no history of preceding infection. METHODS: A total of 75 consecutive IBS outpatients and 36 healthy control subjects completed a questionnaire detailing symptoms, mode of onset, and previous psychiatric history. All underwent a full diagnostic workup including rectal biopsy, which included immunostaining and quantification for lamina propria or intraepithelial T lymphocytes, serotonin-containing enterochromaffin (EC), and mast cells. Patients were divided according to onset of symptoms into PI-IBS (n = 23) or non-PI-IBS (n = 52) patients. RESULTS: Diarrhea predominance occurred more frequently in PI-IBS (70%) than in non-PI-IBS (42%) patients (p = 0.03). A history of previous treatment for anxiety or depression was present in 26% of PI-IBS patients compared to 54% of non-PI-IBS (p = 0.02). Biopsy results for all patients were normal using conventional criteria; however, quantification revealed that PI-IBS showed increased EC cells compared to those of non-PI-IBS patients (p = 0.017) and controls (p = 0.02). Lamina propria T lymphocytes were increased in PI-IBS (p = 0.026) and non-PI-IBS (p = 0.011) patients compared to controls. Mast cells were increased in non-PI-IBS patients (p = 0.054) compared to controls. CONCLUSIONS: Individuals with PI-IBS are a clinically distinct subgroup characterized by diarrheal symptoms, less psychiatric illness, and increased serotonin-containing EC cells compared to those with non-PI-IBS.PMID: 12873581Gastroenterology. 2003 Dec; 125(6): 1651-9. Related Articles, Links Relative importance of enterochromaffin cell hyperplasia, anxiety, and depression in postinfectious IBS.Dunlop SP, Jenkins D, Neal KR, Spiller RC.Background & Aims: Both psychological and mucosal changes (increased enterochromaffin EC cells and T lymphocytes) have been associated with postinfectious irritable bowel syndrome (PI-IBS). However, previous studies have been underpowered to determine the relative importance of these changes in predicting the development of PI-IBS. Our aim was to prospectively determine the relative importance of both psychological and histologic factors in the development of PI-IBS after Campylobacter infection. Methods: Questionnaires detailing psychological and bowel symptoms were sent to 1977 patients 3 months after infection. Twenty-eight patients with new-onset PI-IBS, 28 age- and sex-matched patient controls who were asymptomatic after infection, and 34 healthy volunteers underwent rectal biopsy, which was assessed for serotonin-containing EC cells, mast cells, and lamina propria T lymphocytes. Results: PI-IBS, predominantly of the diarrhea-predominant subtype, occurred in 103 of 747 (13.8%) of those infected. EC cell counts per high-power field (hpf) were higher in patients with PI-IBS (35.8 +/- 1.2) compared with patient controls (30.6 +/- 1.9; P = 0.022) and volunteers (29.1 +/- 1.8; P = 0.006). Lamina propria T lymphocytes per hpf were higher in patients with PI-IBS (127.1 +/- 8.7) and patient controls (113.4 +/- 6.2) in contrast to healthy volunteers (97.1 +/- 5.7) (P = 0.006 and P = 0.058, respectively). Anxiety, depression, and fatigue were significantly increased in patients with PI-IBS compared with patient controls. Multivariate analysis indicated that increased EC cell counts and depression were equally important predictors of developing PI-IBS (relative risk, 3.8 and 3.2 for each standard deviation increase in respective values). Conclusions: Both increased EC cells and depression are important independent predictors of developing PI-IBS.PMID: 14724817 Perhaps you can't expalin how the act of implanting probiotics works on increase serotonin containing cells and mast cells?Or please point out how you plan to change the chemistry of cell functioning in the gut?But more importantly perhaps you can explain why DR Drossman is saying this and your saying what your saying? Considering each of your qualifications. Not to mention your site is a commercial site and theirs is a major research institution."The cause of IBS is yet to be determined. However, modern research understands IBS as a disorder of increased reactivity of the bowel, visceral hypersensitivity and dysfunction of the brain-but axis. There are subgroups being defined as well, including post-infectious IBS which can lead to IBS symptoms. Other work using brain imaging shows that the pain regulation center of the brain (cingulate cortex) can be impaired, as well as good evidence for there being abnormalities in motility which can at least in part explain the diarrhea and constipation. So finding a specific "cause" of IBS has grown out of general interest in place of understanding physiological subgroups that may become amenable to more specific treatments. Hope that helps.Doug " http://www.ibshealth.com/ibs_foods_2.htm Dr. Drossman is Co-director of the Center and Professor of Medicine and Psychiatry at UNC-CH. Dr. Drossman has had a long-standing interest in the research and evaluation of difficult to diagnose and treat gastrointestinal disorders. He established a program of research in functional gastrointestinal disorders at UNC more than 25 years ago and has published more than 350 books, articles, and abstracts relating to epidemiology, psychosocial and quality of life assessment,design of treatment trials, and outcomes of research in gastrointestinal disorders. Dr. Drossman received his MD degree from Albert Einstein College of Medicine in 1970 and completed his medical residency at the University of North Carolina School of Medicine and NYU-Bellevue Medical Center. After his residency, he subspecialized in psychosocial (psychosomatic) medicine at the University of Rochester School of Medicine and in Gastroenterology at the University of North Carolina in 1976-1978. He is currently Professor of Medicine in Psychiatry at UNC.As the medical director of the Center, Dr. Drossman sees patients in the functional GI and motility clinic and precepts GI fellows and visiting gastroenterologists to help develop their clinical skills in treating patients. He also facilitates the learning of medical faculty, psychiatry residents, and medical students, on how to provide biopsychosocial care to patients with functional GI disorders.Dr. Drossman has an active research program, which relates to the clinical, epidemiological, psychosocial, and treatment aspects of irritable bowel syndrome (IBS). He has developed and validated several assessment measures, which are used worldwide for clinical research. Recently he began looking at brain imaging (fMRI) in functional bowel to determine if the reported changes in the brain are responsive to treatment. He also consults with several pharmaceutical and governmental agencies regarding treatment trials. He was responsible for organizing the Functional Brain Gut Research Group as a special interest section within the American Gastroenterological Association, chairs the ROME committee, and is a past president of the American Psychosomatic Society. Dr. Drossman sits on the Board of Directors and is Chair of the Scientific Advisory Board and the Awards Committee of the International Foundation for Functional Gastrointestinal Disorders. He also sits on the board for the medical website Medscape Gastroenterology. Dr. Drossman chaired the 1999 Digestive Health Initiative on Functional GI Disorders ï¿½ sponsored by the American Digestive Health Foundation. He was the recipient of the 1999 Janssen Award for Clinical Research in Digestive Disease.In 2001, Dr. Drossman was appointed Associate Editor of Gastroenterology, the official journal of the American Gastroenterological Association and in 2003 became chair of the Nerve-Gut Council of the American Gastroenterological Association. He received the prestigious Research Scientist Award for Clinical Research presented by the Functional Brain-Gut Research Group at Digestive Disease Week in Atlanta. Dr. Drossman is also involved in teaching the evaluation and management of patients with complex GI problems or difficult-to-diagnose conditions. He completed the AGA Clinical Teaching Project on IBS (unit 13), and the AGA GI Teaching Project on IBS-II. He is editor of the Manual of GI Procedures (now in its third edition), and Rome II: The Functional Gastrointestinal Disorders, 2nd Edition and has been appointed Senior Editor of the book, Rome III Committees with the book, Rome III, to be published in 2006.Dr. Drossman's educational and clinical interests in the psychosocial/behavioral aspects of patient care was a natural path to his developing a series of videotapes to teach physicians and other health professionals how to administer an effective interview, carry out a psychosocial assessment, and enhance the patient-doctor relationship (available through the Center). He has taught numerous US and European workshops on this topic, was the chair of the Physician-Patient Relations Committee of the American College of Gastroenterology from 1994 - 1996, and is a charter fellow of the American Academy on Physicians and Patients, a consortium of physicians which teaches these skills to medical school faculty. Dr. Drossman is considered a world authority in the field of (IBS), functional disorders, and on physician-patient communications. He presents at numerous national and international meetings throughout the year.To see a current list of these publications, click here. http://www.med.unc.edu/wrkunits/2depts/med...dc/drossman.htm Dr Dahlam"Doctor David Dahlman, a Chiropractic Physician with a degree in Nutrition, is Director of The Hyde Park Holistic Center in Cincinnati, Ohio and specializes in treatment of chronic health problems using nutritional, herbal and homeopathic therapies.Doctor Dahlman attended the University of Cincinnati and Life University in Atlanta, Georgia where he received Doctor of Chiropractic and Bachelor of Nutrition degrees.In addition, Doctor Dahlman is the publisher of the Natural Resource Guides available in Cincinnati, Dayton and Columbus, Ohio and Indianapolis, Indiana. He also has hosted a weekly hour-long radio talk show on Alternative Medicine and has been published in local magazines and quoted in many articles on his nutritional perspectives in the Cincinnati Enquirer.On a personal level, Dr. Dahlman has enjoyed and professed a healthful diet for 25 years. He has participated in over 100 triathlons, duathlons and marathons in the U.S. and Europe over the past 17 years.He is completely committed to educating the public that they have alternatives to traditional treatments that only suppress symptoms and never address the cause of illness." http://www.drdahlman.com/biography.htm Gut ThoughtsThough few know about it, humans have a second brain that handles most of the body's digestive functions. Study of the enteric nervous system is a rapidly growing specialty, offering insight into malfunctions of the "gut brain" as well as the more complex cranial brain. Digestion is such a prosaic function that most people prefer not to think about it. Fortunately, they don't have to ï¿½ at least not with the brain in their heads. Though few know about it, humans (and other animals) have a second brain that handles most digestive functions. Deep in your gut lies a complex self-contained nervous system containing more nerve cells than the spinal cord, and indeed more neurons than all the rest of the peripheral nervous system. There are over 100 million nerve cells in the human small intestine alone. Malfunctions of this "gut brain" may be involved in irritable bowel syndrome (IBS), a condition that affects an estimated 20 percent of the U.S. population and is believed to be responsible for $8 billion in health care costs alone in the United States each year, according to the International Foundation for Functional Gastrointestinal Disorders. Patients with IBS suffer bouts of chronic diarrhea, constipation, or sometimes both alternately. IBS is the most common diagnosis made by gastroenterologists. The study of the enteric nervous system is a rapidly growing specialty known as neurogastroenterology. "What the gut has to do is extremely complicated," says Michael Gershon, chair of the department of anatomy and cell biology at the Columbia University College of Physicians and Surgeons and author of The Second Brain (Harper Perennial, 1999). "If the brain had to control that, it would have to run huge cables and have a huge number of cells devoted solely to that purpose. It makes great evolutionary sense to [separate these functions] and essentially use a microcomputer that is independent rather than a central processing unit." In fact, researchers believe that the gut brain evolved first ï¿½ because digestion came before locomotion in multicellular creatures. In mammals, the two systems originate near each other in the outer layer of the early embryo. Like many poorly understood organs, the gut brain was discovered by classical anatomists in the 19th century and then ignored. "No one knew what it did," says David Wingate, emeritus professor of gastrointestinal science at Queen Mary, University of London. "When you'd ask what it was for in medical school, they'd say, 'Let's move on.' " In 1899, physiologists studying dogs found that unlike any other reflex, the continuous push of material through the digestive system (now called the peristaltic reflex) continued when nerves linking the brain to the intestines were cut. By the 1970s, a society for the study of gastrointestinal motility had been set up ï¿½ but how this motility was controlled remained unclear. The vagus nerve, for example, sends some fibers from the brain to the gut; however, it connects directly with only a tiny minority of cells there. In 1965, Gershon published a paper in Science suggesting that serotonin might act as a neurotransmitter in the gut. At the time, acetylcholine and norepinephrine were accepted as transmitters in the peripheral nervous system, but serotonin was seen as a centrally acting transmitter used by some nerves to modulate the action of others. The peripheral nervous system wasn't supposed to use such controls ï¿½ only the brain and spinal cord were believed to process information through "interneurons" such as those containing serotonin. At a meeting of the Society for Neuroscience in 1981, however, Gershon and others marshaled enough data to finally convince skeptics that serotonin was indeed a key transmitter in the gut. In fact, it is now known that 95% of the body's serotonin is used by the gut ï¿½ and the enteric nervous system contains every neurotransmitter and neuromodulator found so far in the brain. "We now know quite a lot about the library of programs run by the [gut brain]," says Jackie Wood, professor of physiology and cell biology and of internal medicine at Ohio State University. "For example, when the bowel is empty, one particular program runs." Called the migrating motor complex (MMC), this involves a series of movements running from the stomach to the end of the small intestine, which is believed to function in keeping the potentially dangerous bacteria stored in the colon from moving upwards rather than out. At least 500 different species of deadly bacteria have been found to inhabit a person's colon at any given time; "traveler's diarrhea" often results when this mix is changed through exposure to new pathogens. If this happens, the gut runs a program designed to expel as much of its contents as quickly as possible ï¿½ unpleasant for the vacationer, but much better than a fatal infection. "Another program involves a flood of serotonin throughout the entire circuit, which produces the digestive pattern that mixes and stirs the contents," says Wood. Because the gut brain is smaller and more accessible than the brain itself, understanding it could offer insights about how to parse the more complex organ. "[That idea] was what lead me to begin my research when I was a fledgling neuroscientist," says Gershon. "I looked at the brain and found it daunting, and I still do, so I looked for a simpler nervous system to study." He adds, " 'Simple nervous system,' of course, turned out to be an oxymoron." Unlike the cranial brain, however, the gut brain doesn't seem to be conscious ï¿½ or at least, in health, it doesn't impinge much on consciousness. "The gut is not an organ from which you like to receive frequent progress reports," says Gershon. For most digestive processes, no news is good news. The problem in IBS, in fact, may be that the enteric nervous system becomes overly sensitive to normal functioning and reports to the brain when it shouldn't. Or, the brain may overreact to normal bowel signals. Normally, the brain may avoid conscious awareness of most gut activity. But in IBS, says Wingate, one theory is that "the barrier to information being projected into consciousness is lowered." As in many heterogeneous conditions defined by symptoms rather than specific pathology, different subgroups of patients may have different causes or varying levels of contributions by different factors. In some cases, IBS may be an autoimmune problem ï¿½ something like multiple sclerosis of the gut, where immune cells attack nervous tissue. "If you catch it early enough," says Wood, "You can use steroids to treat it [in such cases]." High doses of steroids shut down immune activity and prevent immune cells from causing harm, but they don't help once damage has been done. The gut is, in fact, a major immune organ, containing more immune cells than the rest of the body combined. The enteric nervous system interacts intimately with the immune system, and can affect mood and behavior by signaling the central nervous system. Further, the gut brain may in fact be the only system that can refuse central signals. Says Gershon, "The gut brain can say no to the big brain, absolutely. In fact, there are nerve fibers that project towards the CNS, and if the [bowel] doesn't like the message, it can turn it off or cancel it." Indeed, the vagus nerve mostly carries information from the enteric nervous system to the brain ï¿½ for every one message sent by the brain to the gut, about nine are sent in the other direction. And recent research has found that stimulating this nerve can have antidepressant and even learning-enhancing effects ï¿½ so "gut feelings" could genuinely be more than just a metaphor. The similarities between the two nervous systems may also mean that they are vulnerable to similar toxins and disease processes. For example, in both Parkinson's disease and Alzheimer's, the degenerative processes seen in brain nerve cells are also seen in the neurons of the enteric system. by Maia Szalavitz Din meningPiskesmï¿½ld har fysiske og kemiske ï¿½rsagerSchleudertrauma hat physische und chemische Ursachen (deutsch)ï¿½velser til genoptrï¿½ning efter whiplash This link could also help explain the connection between psychological problems and gut problems ï¿½ and could put to rest the myth that problems such as IBS are simply "neuroses" because they so often occur in people with other psychological disorders. It may be that the real reason that bowel disorders often accompany psychological problems is that both brain and gut neurons are suffering simultaneously ï¿½ in addition to the fact that having to spend a significant portion of one's life attending to bathroom functions is in itself depressing. Simultaneous effects of drugs on both systems also account for the gastrointestinal "side effects" of Prozac and other drugs that act on serotonin metabolism ï¿½ which actually may have more effect on the bowel than on the brain, because serotonin predominates in the bowel and the drug moves through the digestive system before reaching the brain. Fortunately, in most people, the bowel quickly develops tolerance to these drugs, and gastrointestinal side effects usually subside within a few days or weeks of the start of treatment. In fact, low doses of SSRI (selective serotonin reuptake inhibitor) drugs may actually help patients with IBS. And since different serotonin receptors predominate in the brain and in the gut, new drugs may be developed to affect certain subtypes but not others. "What's exciting," says Wingate, "is getting away from essentially anecdotal ways of categorizing patients by symptoms and being able to study their Problems in a very systematic biological way." http://www.kiwiterapi.dk/whiplash/frames/gutthoughts.htm


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## bonniei (Jan 25, 2001)

Believe me you are getting a LOT of visbility, Dr Dahlman.Ah kel you are not a fan of synthetic drugs. Herbs are not necessarily safe either unless they have been studied for centuries by say the Ayurvedists. Chamomile gave me palpitations of the heart. I wonder what sort of herbal research Dr Dahlman relies on.


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## kel1059 (Feb 28, 2003)

eric,quit trying to bait him. all you are doing is hurting the rest of us. --and it is true, trying to explain something to you is hopeless. you don't listen. start your own dr d thread and see if he joins you. if he does not and i hope he does not --- i will join you.i think you have some valid points, but most of us here are all about taking action. maybe there will never be a perfect cure for the severe cases but why do you want to stop us from getting better.i have proof that we can get better. you don't listen to any of it though. i have no more pain after suffering for 20 years, same with bloat, gas, odor, cramps. PROOF that we can eliminate some of our worst symptoms.if people can get this good information at the beginning of their IBS maybe they can avoid the type of progression that i have experienced.i think that no matter what anyone says to you you will argue it or ignore it.you mention psychiatric illness in your last post. you also mentioned that you used to take anti-depressants but are no longer taking them. maybe you should reconsider. they might mellow you out a little.bonniei,ayurvedic www.quackwatch.org/04ConsumerEducation/chopra.html i believe that a certain person has criticized this healing method. i won't mention who. do you have clearance to talk about ayurvedici have a friend who has been trying to get me involved. i am eager to do so, but i am interested in chinese medicine presently.you posted something on fructose intolerance and depression --- i think this is something that happens to me. so i avoid fructose but it makes me think that if fructose can cause a mental disturbance (and i wish i knew how it did it) then so can many other things we eat, drink and do. one of these days i would like to discuss the immune systems role in certain mental disturbances. i believe it is an immune system problem...


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## bonniei (Jan 25, 2001)

Dr Chopra is a total quack. He is a product of an Easterner tryig to ride the tidal wave of natural healing fad in the West.All I can say is that some Ayurvedic products are sold in regular pharmacies. Those are the ones with some credibility because they wouldn't be able to market these without them having success with the products. To date I have tried Ayurvedic massage which I felt was a total waste of my money.I have tried Pudin Hara G for acidity and gas with great success. You can read this about the market for Pudin Hara G http://www.financialexpress.com/fe/daily/2...6/fst06026.html Other than that I don't really have any comments about Ayurvedic medicine


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## eric (Jul 8, 1999)

"some will have IBS because of low levels of good bacteria, some because of low levels of good bacteria and the presence of yeast or other bacteria or parasites. Some will be lactose intolerant, others will be fructose intolerant or gluten intolerant. Some will be intolerant of all three. Some will be lactose intolerant, but have normal good bacterial levels. Some will have Klebsiella, Citrobacter, Bacillus or Psuedomonas or others in abnormally high levels. The design is key and we have little time for it and no need since our practices are full. Lactose intolerence is not IBS. Fructose intolerence is not IBS. Gluten intolerent is not IBS! There is no evidence for parasites and IBS. There is no evidence for any one bactria or pathogen as the cause of IBS except post infectious IBS and IBS is not considered a bacterial infection. Inflammation cannot explain IBS! There is no evidence yeast causes IBS! There is no standard for bacteria in the gut, they don't even understand it thouroughly yet! There is no one pathogen or biological marker in IBS.However, they do know more on it now then ever and there are problems they see in IBS and other functional disorders, of which there are some 30 of them and Dr Dahalman has not mentioned any of them.IBS is a GI Disorder of Function, how the gut functions. Anyone who calls Lactose intolerence IBS is way behind in the current thinking and research on on IBS.Perhaps you can expalin all this?The Brain Gut Disconnect http://www.ibsgroup.org/ubb/ultimatebb.php...ic;f=1;t=036307 Dr. Mayer has a longstanding interest in clinical and neurobiology aspects of brain-gut interactions in health and disease. He has published more than 110 original articles, numerous review articles and chapters, co-edited two books and organized several interdisciplinary symposia in this area. Dr. Mayer has made seminal contributions to the characterization of physiologic alterations in patients with functional disorders, in particular in the area of visceral pain, stress-induced visceral hyperalgesia and altered brain responses. He has two active R01 grants, one on basic mechanisms of NMDA receptors in visceral nociception, the other on brain and perceptual responses to visceral stimulation. He is P.I. on a subcontract of another RO1 grant on the role of proteinase-activated receptors in neuronal activation, and co-investigator on a RO1 grant (P.I. Lin Chang) dealing with neuroendocrine alteration in IBS and fibromyalgia. Dr. Mayer has served on the editorial boards of the leading journals in digestive diseases, including Gastroenterology, Gut, Digestion and the American Journal of Physiology. He has served as reviewer for a wide range of medical and neuroscience journals and as ad hoc reviewer for national and international funding agencies. He has also served on ad hoc NIH study sections.Dr. Mayer has been involved in an administrative and leadership function in several large interdisciplinary programs at UCLA. He is the Director of the UCLA Center for Neurovisceral Sciences & Women's Health (CNS), a translational research program recently funded by the NIH that is currently viewed as the leading integrated research program in the world in the area of functional digestive disorders. Senior investigators within the CNS perform a wide range of basic and clinical research activities in the area of neurovisceral interactions in health and disease. Research efforts of this program include the study of cellular and molecular mechanisms of chemo- and mechanotransduction of primary afferent nerves; animal studies on stress modulation of visceral pain and associated autonomic responses; human physiology studies on cerebral, autonomic, neuroendocrine, and perceptual responses to visceral stimulation; and health outcomes, quality of life, and epidemiological studies in populations suffering from chronic gastrointestinal disorders. The Center includes more than 15 M.D. and Ph.D. researchers who are supported by individual RO1 grants. Dr. Mayer is the Chair of the recently established UCLA Collaborative Centers for Integrative Medicine, a multidisciplinary and interdepartmental clinical and research program related to different aspects of integrative medicine. Dr. Mayer has trained close to 20 postdoctoral fellows and has played an active role in promoting an integrative model of mind/brain/body interactions in his clinical practice, lectures and publications. Along these lines, he has organized two seminal interdisciplinary symposia on different aspects of mind/brain/body interactions and has published a volume of Progress in Brain Research on this topic." http://ibs.med.ucla.edu/Bios/MayerE.htm He also wroteInflammatory Bowel Disease and Irritable Bowel Syndrome: Separate or Unified?from Current Opinion in GastroenterologyPosted 07/15/2003Sylvie Bradesi, PhD, James A. McRoberts, Ph.D, Peter A. Anton, MD, Emeran A. Mayer, MDAbstract and IntroductionAbstractBoth irritable bowel syndrome and inflammatory bowel diseases share symptoms of altered bowel habits associated with abdominal pain or discomfort. Irritable bowel syndrome has been referred to as a functional bowel disorder, which is diagnosed by a characteristic cluster of symptoms in the absence of detectable structural abnormalities. Inflammatory bowel disease is a heterogeneous group of disorders characterized by various forms of chronic mucosal and/or transmural inflammation of the intestine. In this review, the authors discuss recent evidence suggesting several potential mechanisms that might play a pathophysiologic role in both syndromes. Possible shared pathophysiologic mechanisms include altered mucosal permeability, an altered interaction of luminal flora with the mucosal immune system, persistent mucosal immune activation, alterations in gut motility, and a role of severe, sustained life stressors in symptom modulation. It is proposed that similarities and differences between the two syndromes can best be addressed within the framework of interactions between the central nervous system and the gut immune system. Based on recent reports of low-grade mucosal inflammation in subpopulations of patients meeting current diagnostic criteria for irritable bowel syndrome, therapeutic approaches shown to be effective in inflammatory bowel disease, such as probiotics, antibiotics, and antiinflammatory agents, have been suggested as possible therapies for certain patients with irritable bowel syndrome.Complete article here: http://www.medscape.com/viewarticle/457728_1 Curr Opin Gastroenterol 9(4):336-342, 2003. ï¿½ 2003 Lippincott Williams & Wilkins"Readers' ExchangeDefining Stress in IBSFall 2003From Arizona -- Thank you so much for your efforts and support for those of us with GI disorders. Your first issue (Spring 2003) of Digestive Health Matters is both professional and informative. I would like to comment on one of the articles - "The CNS: Center for Neurovisceral Sciences and Women's Health at UCLA." I am encouraged to know that steps are being taken for funding research of IBS and interstitial cystitis. However, it is discouraging that researchers are still expending time and money to research "neurobiological mechanisms by which stress modulates brain-visceral interaction." I realize that stress is a popular theory in the discussion of IBS triggers, however, I believe this is completely backward and it is the chronic pain and totally unreliable bowel function of an IBS sufferer which causes the greatest stress. If research would focus on "fixing" the bowel, no doubt the panic and fear of IBS would be greatly alleviated. Comment from Emeran Mayer, M.D. -- In contrast to the common interpretation of the term "stress" as a psychological phenomenon, it should be understood as any real or perceived perturbation of an organism's homeostasis, or state of harmony or balance. For example, in this viewpoint a severe hemorrhage, starvation, extreme temperature, or worry about the unpredictable onset of abdominal pain all qualify as stressors -- some as "physical" stressors, others as "psychological" stressors. The fear to leave the house in the morning without knowing if one can make it to work without having to stop on the freeway because of an uncontrollable bowel movement, or the fear of experiencing uncontrollable abdominal discomfort during an important business meeting are sufficient stressors to activate the central stress system. The central stress system involves the release of chemical stress mediators in the brain (such as corticotropin releasing factor), which in turn orchestrate an integrated autonomic, behavioral, neuroendocrine, and pain modulatory response. This biological response in turn will alter the way the brain and the viscera interact, and this altered brain-gut interaction can result in worsening of IBS symptoms. Thus, pain and discomfort, fear of these symptoms, activation of the stress response, and modulation of the brain-gut interactions by stress mediators are part of a vicious cycle which need to be interrupted to produce symptom relief. The neurobiology of stress is not a theory, but a topic that can be studied in animal models, and one of the hottest topics in drug development for treatment of IBS e.g., substance P antagonists, corticotropin releasing factor antagonists. "From - Report on the 5th International Symposium onFunctional Gastrointestinal Disorders"Preliminary work also suggests that there may be family interventions that help reduce the impact of functional GI disorders on children.3 Shin Fukudo, Tohoku University School of Medicine, Japan discussed Possible Genetic Markers in Functional GI Disorders and Treatment Response, an emerging area of research. For some time it has been believed that brain-gut interactions -- autonomous activity in the GI tract and central nervous activity that influences bowel function in response to stressors -- play a major role in the origin and development (pathogenesis) of irritable bowel syndrome (IBS). Studies suggest that IBS patients have hyper-reactive bowels and unusually stress-sensitive brains. Studies by Dr. Fukudo's group include recent use of models to study serotonin (5-HT) reuptake transporter (SERT) genes, cross-cultural studies of 5-HT agents, and the effects of variations in the regions of the DNA strand that are the beginning of a gene (gene promoter regions) on one's responses to stress. Sensitization of the nerves (neurons) in the brain and the gut (intestines) may be due to a genetic effect as well as an acquired effect (resulting from a stimulus). More investigation on exploring genetic markers and therapeutic responses is warranted.4 http://www.iffgd.org/symposium2003factors.html Jack Wood, PhDProfessor of Physiology and Internal MedicineChairman Emeritus, Department of PhysiologyThe Ohio State University College of Medicine Dr. Wood was the first to use microelectrodes to record the electrical and synaptic behavior of neurons in the enteric nervous system. He coined the term "brain-in-the-gut" in view of emerging evidence that the enteric nervous system had neurophysiological properties like the brain and spinal cord. In recent years he has focused on signaling interactions between the enteric immune system and the brain-in-the-gut during infectious enteritis and food allergy. In this lecture he shows how the central nervous system, enteric nervous system and intestinal immune system are integrated during physical and emotional stress to produce irritable bowel symptoms of diarrhea and abdominal pain and discomfort. http://www.conference-cast.com/ibs/Lecture...cfm?LectureID=7 Nigel Bunnett, PhDUniversity of California School of MedicineDepartment of Surgery and PhysiologyAccumulating evidence indicates that sensory nerves play a major role in inflammation of multiple tissues, and that communication between the nervous system and mast cells is of particular importance. Dr. Bunnettï¿½s lecture will highlight recent experimental evidence that mast cell proteases signal to sensory nerves through novel receptors that couple to the release of proinflammatory peptides, and that defects in this mechanism result in uncontrolled inflammation and disease. Dr. Bunnett will present evidence that therapies designed to block signaling by neuropeptides and proteases are attractive treatments for inflammation. Inflammation: Role of Sensory Nerves and Mast Cell Mediators http://www.conference-cast.com/ibs/Lecture...dRegLecture.cfm J Neuroimmunol. 2004 Jan;146(1-2):1-12. Related Articles, Links Critical role of mast cells in inflammatory diseases and the effect of acute stress.Theoharides TC, Cochrane DE.Department of Pharmacology and Experimental Therapeutics, Tufts-New England Medical Center, Boston, MA, USAMast cells are not only necessary for allergic reactions, but recent findings indicate that they are also involved in a variety of neuroinflammatory diseases, especially those worsened by stress. In these cases, mast cells appear to be activated through their Fc receptors by immunoglobulins other than IgE, as well as by anaphylatoxins, neuropeptides and cytokines to secrete mediators selectively without overt degranulation. These facts can help us better understand a variety of sterile inflammatory conditions, such as multiple sclerosis (MS), migraines, inflammatory arthritis, atopic dermatitis, coronary inflammation, interstitial cystitis and irritable bowel syndrome, in which mast cells are activated without allergic degranulation.PMID: 14698841 Brain Imaging: CNS Abnormalities in Patients with IBSThe lack of a clearcut pathophysiology and an often noted association between physical and psychological symptoms has led some clinicians to dismiss irritable bowel syndrome (IBS) as a condition that is "all in their head." However recent findings showing CNS abnormalities in patients with IBS may offer a new perspective on the etiology of this debilitating condition, characterized by abdominal discomfort and pain and altered bowel habits. Until recently, the presence and severity of IBS were measured only by gut function and the subjective perceptions of the patient. "Now, the use of functional brain imaging techniques is contributing to an increased under- standing of the pathophysiology of this disease and new target areas for treatment," said Emeran A. Mayer, MD, Professor of Medicine, Physiology, and Biobehavioral Sciences, and Director of the CURE Neuroenteric Disease Program at the University of California, Los Angeles.Pathophysiology of IBSIBS is a disease that develops as the result of an abnormally altered brain-gut interaction (Table 1). One manifestation of this alteration consists of aberrant output patterns of the emotional motor system, a part of the limbic system in the brain, in response to external (psychosocial) or internal (immune, nutrient) stressors. Outputs from the limbic system in the form of autonomic, pain modulatory, and neuroendocrine responses can be modu- lated by cognitive factors, such as the beliefs, thoughts, and emotions of the patient. Aberrant output of the emotional motor system in large part accounts for the constellation of symptoms that makes up IBS. "A hyperresponsiveness of circuits in the brain may be one common link to both the abnormal responses to internal inflammatory stressors and external psychosocial stressors," Dr. Mayer explained. Treatment is chosen with consideration of altered motility, visceral hypersensitivity, and the brain's role in modulating these factors. The autonomic regulatory systems affect not only muscle cells in the gut, but also other cell types, such as mast cells, enterochromaffin cells, and nerve cells of the enteric nervous system. Responses of some of these cells to autonomic modulation, for example in the form of tryptase secretion by mast cells or serotonin secretion by enterochromaffin cells, may play a role in the modulation of visceral afferent sensitivity. According to Dr. Mayer, such mechanisms may play a role in the development of stress-induced visceral hyperalgesia. Another form of visceral hypersensitivity may be related to altered arousal or hypervigilance toward visceral sensations. Such hypervigilance can result in decreased tolerance to balloon distension and lower discomfort thresholds. A cognitive factor involved in the development of hypervigilance is an increased threat appraisal of visceral sensations.Functional Brain Imaging TechniquesRecently, functional brain imaging techniques have been used to assess directly the activation of certain regions of the brain in response to visceral stimulation. Today, these techniques, particularly functional magnetic resonance imaging, are being used to assess activation of brain circuits that process visceral afferent information from the gut. Dr. Mayer noted that there are distinct but overlapping brain circuits that relate to subjective perception of gut sensations, autonomic responses, and pain modulatory responses. Even in terms of subjective gut sensations, different overlapping circuits are present for intensity coding of the stimulus; threat appraisal of the stimulus; and attribution of primary affect, or "unpleasantness". Both serial and parallel pathways are involved in the processing of visceral sensory information and the control of descending modulatory systems. Input from the gut is derived from multiple channels, such as spinothalamic, vagal, and dorsal column pathways; different regions of the brain then code for intensity, appraise the threat of the stimulus, and determine the level of attention the brain attributes to the stimulus and the unpleasantness the patient experiences. These processes are modulated both by the stress- or arousal- activated system and by recollection of past experiences.Intensity Coding, Threat Appraisal, and UnpleasantnessIntensity coding. As visceral sensory information is delivered via the spinal cord, it is encoded for intensity in the anterior aspects of the insula, or visceral sensory cortex. PET scan studies of somatic and visceral experimental pain have shown that the insula most objectively and reliably encodes information. Interestingly, studies have also demonstrated a greater activation of the insula in male IBS patients, compared with female patients, when exposed to the same stimulus intensity. Threat appraisal and unpleasantness. The information that reaches the insula is "appraised" in the dorsal aspects of the anterior cingulate cortex. Blood flow changes in this part of the brain may also correlate with attentional processes and the subjective unpleasantness ratings in response to a somatic stimulus. The ventral (perigenual) cingulate cortex, which is rich in muopioid receptors, functions to encode the affective quality of the stimulus. In a study by Mayer and colleagues, rectal and sigmoid distension resulted in a lower activation of the ventral anterior cingulate cortex in patients with IBS compared with healthy controls, but an increased activation of the dorsal aspects of the anterior cingulate. Increased activation of an unspecified region of the anterior cingulate was also reported by Mertz and colleagues, in a functional MRI study. Modulatory factors. Finally, the CNS processing of sensory experience may be simultaneously modulated by two parallel pathways: memory-based modulation and stress- or arousal-induced modulation. The posterior parietal cortex, or sensory association cortex, forms a network with the hippocampus and the amygdala (the brain's memory centers) as well as with the lateral prefrontal cortex. Somatic pain studies have shown that, in response to a stimulus, the recall of a similar past event, along with subsequent interpretation of this memory in the lateral prefrontal cortex, plays a major role in the threat appraisal of a sensory experience. The second modulatory effect is the stress- or arousal-induced response. The pontine locus ceruleus is activated in response to potentially threatening experiences. This region then projects to nearly all other regions of the brain that receive visceral input, causing secretions of norepinephrine and arousal of these sections of the brain. When the secretion of norepinephrine is excessive, these target regions are inhibited. It is of interest that descending projections from the locus coeruleus complex to the sacral spinal cord appear to play a major role in the modulation of distal colonic motor and secretory function.ConclusionBrain imaging and other studies of IBS pathophysiology indicate that the perception of gut stimuli and altered autonomic responses to these stimuli are affected by activation of various parts of the brain, resulting in increased attention to these stimuli, greater unpleasantness of the subjective experience, greater threat appraisal, and greater arousal in response to visceral sensations. Further study may lead to new developments in treatment for persons with IBS. --------------------------------------------------------------------------------Table 1. Clinical Relevance of Altered Brain-Gut InteractionAltered attentional mechanismso Greater awareness of normally subliminal visceral afferent stimuliAltered affective stimulus processingo Greater unpleasantness of visceral sensations, including heartburn, bloating, fullness, abdominal pain, incomplete rectal evacuationAltered threat appraisalo Leads to fears such as not being close enough to a bathroom anything eaten may trigger abdominal painEnhanced arousalo Shared by clinical conditions frequently overlapping IBS, such as anxiety, panic disorder and PTSDo Arousal reduced by sedatives, anxiolytics, low-dose tricyclicso May respond to relaxation exercises" http://cp.yahoo.net/search/cache?p=ibs+sym.../pcp2000_01.htm Altered Visceral Perception Modulation Confirmed In Irritable Bowel PatientsA DGReview of :"Irritable bowel syndrome patients show enhanced modulation of visceral perception by auditory stress."American Journal of Gastroenterology01/29/2003By Elda HauschildtPatients with irritable bowel syndrome (IBS) have altered stress-induced modulation of visceral perception, confirms research from the United States.Investigators, from the University of California at Los Angeles, found that IBS patients rate visceral stimulus during stress significantly higher in terms of intensity and unpleasantness than do healthy controls."IBS patients also reported higher ratings of stress, anger and anxiety during the stress compared with the relaxing condition, whereas controls had smaller and non-significant subjective responses," they explain.Symptoms from IBS are known to be sensitive to psychological stressors. This could occur because of enhanced responsiveness of the emotional motor system, a network of brain circuits modulating arousal, viscerosomatic perception and autonomic responses associated with emotional response, the researchers point out.Rectal balloon distension during experimentally induced psychological stress was used to test psychological reactions in 15 IBS patients and 14 healthy controls to assess whether IBS patients demonstrate altered perceptual response. The mild stress condition involved dichotomous listening to two conflicting types of music. The control condition also involved listening but to relaxing nature sounds. Stress and relation stimuli were delivered over a 10-minute listening period preceding and during rectal distensions. Intensity and unpleasantness ratings measured included visceral sensation, subjective emotional response and heart rate. Neuro-endocrine measures were also taken.The investigators found that unlike healthy controls, IBS patients gave significantly higher ratings of the visceral stimulus in terms of intensity and unpleasantness. American Journal of Gastroenterology, 2003; 98: 135-143. "Irritable bowel syndrome patients show enhanced modulation of visceral perception by auditory stress." http://www.docguide.com/news/content.nsf/n...52568880078C249 Stress and the GutDr. Howard MertzAssociate Professor of Medicine and RadiologyVanderbilt UniversityStress is a ubiquitous condition that affects all people. Stress can be mental or physical, although in the context of this article the focus will be mental stress. Mental stress involves challenge, threat or worry about future adverse events. Such stress activates the brainï¿½s stress response systems, which in turn effect the body. Many of the bodyï¿½s major systems are altered by stress (cardiovascular, muscular, urinary, gastrointestinal, sweat glands, etc) often with adverse consequences. Gastrointestinal function is particularly influenced by stress. Common gastrointestinal symptoms due to stress are heartburn, indigestion, nausea and vomiting, diarrhea, constipation and associated lower abdominal pain. These symptoms and the alterations in intestinal function that cause them are becoming understood.Gastrointestinal Stress Reactions in Animals and CRFIn animals such as rats, stress can be induced in experimental situations. When rats are wrap restrained, or placed on a small platform surrounded by water they become stressed. During these situations, alterations in motility of the gut occur. The upper gut, including the stomach and small intestine, exhibits markedly reduced transit. This may be a defense mechanism to promote vomiting and reduce oral intake. Conversely the large bowel motility increases with increased stool output and transit speed. This may be a defense mechanism to eliminate toxins. We have learned that a hormone called corticotropin releasing factor (CRF) influences these changes. CRF is released from nerve cells in the hypothalamus of the brain. These nerve cells release the hormone via long processes into other parts of the brain such as the locus ceruleus, where arousal and autonomic nervous system changes are mediated. In rats, injection of CRF blockers into the brain fluid diminishes the stress induced motility changes in the gut. CRF directly injected into the brain fluid mimics the stress response closely (Figure 1). CRF also stimulates the gut directly via CRF-1 and CRF-2 receptors. CRF-1 receptors stimulate colonic contractions, while CRF-2 receptors reduce upper gut activity. Antagonists to CRF-1 receptors are currently being tested for treatment of depression, and may become available for testing in functional bowel disorders as well.Brain Areas Involved in Stress ReactionTwo of the primary brain regions involved in stress reactivity are the hypothalamus and the locus ceruleus. Activation of the hypothalamus by stress is likely to be mediated in part by the limbic brain (particularly the amygdala and hippocampus) and partly by the locus ceruleus in the brainstem. The locus ceruleus and the hypothalamus actually stimulate each other, creating the potential for a vicious cycle, where a stress reaction in one region stimulates the other, which in turn stimulates the first to react even more. The limbic system is a group of connected and related brain regions that mediate emotions and flight or fight attitudes. The limbic or ï¿½emotional brainï¿½ is more primitive by evolutionary standards, and is not necessarily under control by the higher intellectual cortex. This system receives sensory and higher cortical inputs, calls upon memories and determines the threat level imposed by a stimulus. The amygdala for instance is a limbic structure in the base of the brain that is important in anger and rage. In cats, electrical stimulation of the amygdala causes hissing, back arching and the hair to stand on end, typical of anger and defense postures in cats. In animals that have damage to the amygdala a placid state results in which anger cannot be induced. Inputs to the amygdala are thought to originate from the hippocampus, the cingulate cortex and other parts of the limbic sytem. The locus ceruleus is located in the pontine portion of the brainstem. The locus ceruleus is the source of most of the stimulant neurotransmitter norepinephrine in the nervous system. Cells here project to other brain areas, releasing norepinephrine to activate other systems and increase arousal and alertness. Release of norepinephrine increases heart rate, blood pressure and primes the muscles and nervous system for fight or flight. This reaction is not helpful in routine stress of daily activities. If the stress reaction is excessive or the perceived threat too frequent, tachycardia (racing heart), hypertension, muscle tension, bowel spasms and dyspepsia can result.Hypothalamic-Pituitary-Adrenal AxisCRF release is the first step in activation of the hypothalamic-pituitary-adrenal axis (HPA axis) involved in stress response. This is the major endocrine (hormonal) response system to stress. Release of CRF by the hypothalamus stimulates the pituitary gland immediately underneath it. The pituitary gland responds to CRF by release of adreno-corticotropic hormone (ACTH) to stimulate adrenal gland secretion of the stress hormone cortisol. Cortisol promotes fluid and salt retention and impairs inflammation, functions helpful in the short term during flight or fight situations or injury. Again, if the HPA system is activated too frequently adverse health outcomes such as hypertension (from salt retention) and impaired immune function (from excess cortisol) may result. The CRF system and the norepinephrine systems work together to respond to stress with resultant changes in bodily functions that prepare for flight or fight. (Figure 2)Gastrointestinal Stress Response in HumansHumans respond to stress in similar ways to animals. A variety of human studies indicate stress promotes decreased gastric emptying and accelerated colonic transit in normal volunteers. A pioneering study by Almy measured colonic contractions during flexible sigmoidoscopy. The volunteers were told that a cancer was found, leading to abrupt increases in colonic contractions, which resolved after the hoax was explained. Other stressors such as ball-sorting, driving in city traffic and mentally challenging listening tasks similarly increase colonic contractions and reduce gastric motility. Recent data also indicates that intestinal sensitivity increases with stress compared to relaxation. This effect may lower the threshold for sensing intestinal events. In gastroesophageal reflux for example, psychological stressors can increase heartburn symptoms. Analysis of the esophageal pH (measurement of acid) indicates that the amount of reflux doesnï¿½t increase during stress, but the probability of feeling a reflux as heartburn does increase. In one small study of normal controls, intravenous infusion of CRF induced greater rectal sensitivity to balloon distension. It may be that the sensitizing effects of stress on the gut are partly mediated by the stress hormone CRF. Irritable Bowel Syndrome and Functional DyspepsiaTwo of the major causes of uncomfortable or painful intestinal symptoms are irritable bowel syndrome (IBS) and functional dyspepsia. IBS occurs in approximately 12% of people world-wide. Dyspepsia (indigestion/upper abdominal discomfort) is also very common. The majority of dyspepsia is functional, that is not associated with ulcers, gallstones, reflux esophagitis or cancer. In both of these common disorders, motility and sensory changes are present which mimic the stress state. Both disorders demonstrate hypersensitivity of the gut (either stomach or intestine). Both disorders demonstrate alterations in motor function of the gut typical of stress and CRF-induced changes. In functional dyspepsia the stomach generally has mildly reduced emptying and reduced accommodation of meals. In IBS, colonic contractions are generally increased. Furthermore, IBS subjects appear to have increased stress responsiveness in the gut. In one study, IBS patients and healthy controls both underwent ambulatory motility recordings in the colon. Both groups were confronted on return to the lab (ï¿½youï¿½re lateï¿½, ï¿½you came to the wrong windowï¿½, ï¿½now the study may need to be repeatedï¿½). Colonic motility jumped up in the IBS patients during confrontation, but not in healthy volunteers.(Figure 3) IBS patients may also have greater sensitivity to the stress hormone CRF. Infusion of CRF intravenously to IBS patients and controls in one study caused significantly greater colonic motor responses in IBS patients. Another study indicates that listening stress increases rectal sensitivity to balloon distension in IBS patients but not controls. It appears both intestinal motility and sensory responses to stress are heightened in IBS patients. These alterations are likely to cause symptoms such as diarrhea and intestinal cramps due to increased contractions of the gut and increased sensitivity of the gut during stress. The chemical mediators of these changes are not yet established, although alterations in CRF release or CRF receptors may be implicated to some extent in functional bowel diseases.IBS (and other functional bowel symptoms) are generally worsened by stress. In fact recent research has indicated that IBS symptoms tend to resolve in those without major psychosocial stressors. Conversely, symptoms are persistent in subjects with ongoing ï¿½threateningï¿½ psychosocial stressors. The onset of IBS and functional dyspepsia often begin with bereavement, abuse or other major negative life events. Emotional distress is very common in IBS patients, particularly those who seek medical treatment for the condition. Anxiety and depression are significantly increased in IBS patient populations, present in nearly 40%. Psychosocial distress appears much less common in IBS sufferers who do not seek medical care. Population based surveys, however, do still suggest tendencies toward emotional reactivity in people with IBS. Accordingly, stress modification, psychotherapy and hypnosis appear helpful for IBS and functional dyspeptic symptoms. Tricyclic antidepressants also appear effective for IBS and other functional bowel symptoms, even in low doses. Recent evidence indicates the drugs may work by reducing the brainï¿½s response to intestinal pain during stress. Sedatives such as the benzodiazepine Librium can reduce the effect of stress on the gut. During ball sorting challenge, Librium blunts the colonic motor response to mental stress in IBS patients. This effect may explain the benefits of combined sedative-anti-spasmodic drugs for IBS.SummaryThere is much yet to learn about the effects of stress on the gastrointestinal tract. The exact neural and hormonal pathways that mediate excess gut sensitivity and altered contractility during stress are not defined. Where these pathways are excessive or dysfunctional in IBS, functional dyspepsia and other GI disorders is unclear. Specific neurotransmitters are likely to underlie the gastrointestinal stress reaction, and may be amenable to pharmacologic blockade. Psychological therapies are likely to blunt the stress response as well. New tools such as brain imaging to study brain responses to stressors and drugs, and molecular biology to study function of neurotransmitters and their receptors are likely to lead to better understanding of the stress response and its role in disease states. Based on this knowledge, advances in pharmacology may lead to better drug therapies to address these important health problems.www.med.unc.edu/wrkunits/...elcome.htmFYIFrom Medscape GastroenterologyMEDLINE Abstracts: Serotonin Signaling and Visceral Hypersensitivity in IBSPosted 10/23/2003 What's new concerning the role of serotonin signaling and mechanisms of visceral hypersensitivity in the pathophysiology of irritable bowel syndrome (IBS)? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Gastroenterology.--------------------------------------------------------------------------------Serotonin and Its Implication for the Management of Irritable Bowel SyndromeGershon MDRev Gastroenterol Disord. 2003;3(suppl 2):S25-S34Our understanding of the enteric nervous system (ENS) has evolved from the "classical" view, in which the brain controls all enteric behavior, to the current view, which holds that enteric innervation is one of local control within the bowel, modified by a bidirectional "dialogue" with the brain. The ENS independently controls enteric reflexes through intrinsic primary afferent neurons, which monitor intraluminal conditions. This monitoring is accomplished through the use of enteroendocrine cells in the mucosa, the best known of which are the serotonin-containing enterochromaffin cells. This article describes the roles that serotonin, specific serotonin-receptor subtypes, and the serotonin reuptake transporter play in the ENS and in the communication between the ENS and central nervous system. The way in which these findings have implicated serotonin in irritable bowel syndrome is discussed.Systematic Review: Serotonergic Modulators in the Treatment of Irritable Bowel Syndrome--Influence on Psychiatric and Gastrointestinal SymptomsKilkens TO, Honig A, Rozendaal N, Van Nieuwenhoven MA, Brummer RJAliment Pharmacol Ther. 2003 ;17:43-51Background: Both central and peripheral serotonergic modulators are used in the treatment of irritable bowel syndrome. The majority of patients with irritable bowel syndrome presenting to a gastroenterologist demonstrate affective dysregulation. Serotonin may play a regulatory role in both gastrointestinal motility and sensitivity, as well as in affective dysregulation, in irritable bowel syndrome.Aim: To analyse, systematically, randomized controlled trials studying the influence of serotonergic modulators on both gastrointestinal and psychiatric symptoms in irritable bowel syndrome, in order to elucidate baseline irritable bowel syndrome symptomatology and possible differential effects of serotonergic modulation on this symptomatology.Methods: A standardized qualitative analysis was performed of studies investigating the influence of serotonergic modulators on both gastrointestinal and psychiatric symptoms in irritable bowel syndrome using a blind review approach. The studies were ranked according to their total quality score (maximum 100 points).Results: Eleven studies fulfilled the entry criteria, six of which scored above 55 points. An association between gastroenterological and psychiatric changes was present in five of the six studies.Conclusions: The results strengthen the serotonergic association between gastroenterological and psychiatric symptoms. Adjusted guidelines for combined gastrointestinal and psychiatric assessments are recommended in order to further elucidate the serotonergic interaction between gastrointestinal and psychiatric symptoms.Tegaserod and Other Serotonergic Agents: What Is the Evidence?Chey WDRev Gastroenterol Disord. 2003;3(suppl 2):S35-S40Through effects on gastrointestinal motor and secretory function as well as visceral sensation, serotonin (5-HT) plays a key role in the pathogenesis of irritable bowel syndrome (IBS). In particular, 5-HT3 and 5-HT4 receptors appear to be very important in IBS. This article critically appraises the evidence supporting the use of the 5-HT3 receptor antagonist alosetron in the treatment of women with diarrhea-predominant IBS. The safety profile and restricted-use program for alosetron is also reviewed. This discussion is followed by a comprehensive review of the efficacy and safety data in support of tegaserod for women with constipation-predominant IBS.Sex Differences of Brain Serotonin Synthesis in Patients With Irritable Bowel Syndrome Using Alpha-11C Methyl-L-Tryptophan, Positron Emission Tomography and Statistical Parametric MappingNakai A, Kumakura Y, Boivin M, et alCan J Gastroenterol. 2003;17:191-196Background: Irritable bowel syndrome (IBS) is the most common functional bowel disorder and has a strong predominance in women. Recent data suggest that the brain may play an important role in the pathophysiology of IBS in the brain-gut axis. It is strongly suspected that serotonin (5-HT), a neurotransmitter found in the brain and gut, may be related to the pathophysiology of IBS. It is reported that a 5-HT3 antagonist is effective only in female patients with diarrhea-predominant IBS.Objective: In the present study, 5-HT synthesis was measured using positron emission tomography, with alpha-11 Cmethyl-L-tryptophan as the tracer, in patients with IBS. The aim of the present study was to compare 5-HT synthesis in the IBS patients with that in the controls, and to compare 5-HT synthesis between male and female IBS patients.Methods: Six male and six female nonconstipated IBS patients were scanned. Age-matched healthy volunteers were scanned as controls. Eighty minute dynamic scans were performed. Functional 5-HT synthesis images were analyzed using statistical parametric mapping.Results: 5-HT synthesis was greater only in the female IBS patients in the right medial temporal gyrus (multimodal sensory association cortex) compared with the female controls (P 0.001).Conclusions: The greater brain 5-HT synthesis in the female IBS patients than in the controls may be related to the pathological visceral pain processing of the IBS patients, a larger female predominance of the disorder, and the sex difference of the efficacy of the 5-HT3 antagonist in treatment.Sex-Related Differences in IBS Patients: Central Processing of Visceral StimuliNaliboff BD, Berman S, Chang L, et alGastroenterology. 2003;124:1738-1747Background & Aims: Women have a higher prevalence of irritable bowel syndrome (IBS) and possible differences in response to treatment, suggesting sex-related differences in underlying pathophysiology. The aim of this study was to determine possible sex-related differences in brain responses to a visceral and a psychological stressor in IBS.Methods: Regional cerebral blood flow measurements using H(2)(15)O positron emission tomography were compared across 23 female and 19 male nonconstipated patients with IBS during a visceral stimulus (moderate rectal inflation) and a psychological stimulus (anticipation of a visceral stimulus).Results: In response to the visceral stimulus, women showed greater activation in the ventromedial prefrontal cortex, right anterior cingulate cortex, and left amygdala, whereas men showed greater activation of the right dorsolateral prefrontal cortex, insula, and dorsal pons/periaqueductal gray. Similar differences were observed during the anticipation condition. Men also reported higher arousal and lower fatigue.Conclusions: Male and female patients with IBS differ in activation of brain networks concerned with cognitive, autonomic, and antinociceptive responses to delivered and anticipated aversive visceral stimuli.Functional Brain Imaging in Irritable Bowel Syndrome With Rectal Balloon-Distention by Using fMRIYuan YZ, Tao RJ, Xu B, et alWorld J Gastroenterol. 2003;9:1356-1360Aim: Irritable bowel syndrome (IBS) is characterized by abdominal pain and changes in stool habits. Visceral hypersensitivity is a key factor in the pathophysiology of IBS. The aim of this study was to examine the effect of rectal balloon-distention stimulus by blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI) in visceral pain center and to compare the distribution, extent, and intensity of activated areas between IBS patients and normal controls.Methods: Twenty-six patients with IBS and eleven normal controls were tested for rectal sensation, and the subjective pain intensity at 90 ml and 120 ml rectal balloon-distention was reported by using Visual Analogue Scale. Then, BOLD-fMRI was performed at 30 ml, 60 ml, 90 ml, and 120 ml rectal balloon-distention in all subjects.Results: Rectal distention stimulation increased the activity of anterior cingulate cortex (35/37), insular cortex (37/37), prefrontal cortex (37/37), and thalamus (35/37) in most cases. At 120 ml of rectal balloon-distention, the activation area and percentage change in MR signal intensity of the regions of interest (ROI) at IC, PFC, and THAL were significantly greater in patients with IBS than that in controls. Score of pain sensation at 90 ml and 120 ml rectal balloon-distention was significantly higher in patients with IBS than that in controls.Conclusion: Using fMRI, some patients with IBS can be detected having visceral hypersensitivity in response to painful rectal balloon-distention. fMRI is an objective brain imaging technique to measure the change in regional cerebral activation more precisely. In this study, IC and PFC of the IBS patients were the major loci of the CNS processing of visceral perception.Role of Visceral Sensitivity in the Pathophysiology of Irritable Bowel SyndromeDelvaux MGut. 2002;51(suppl 1):i67-i71Visceral hypersensitivity has been recognised as a characteristic of patients with irritable bowel syndrome (IBS). It may be involved in the pathogenesis of abdominal pain/discomfort, and seems to result from the sensitisation of nerve afferent pathways originating from the gastrointestinal tract. From a clinical point of view, hypersensitivity, although frequent, is not a constant finding among patients with IBS and cannot therefore be considered as a diagnostic marker of the condition. The advances made in understanding visceral hypersensitivity in patients with IBS are reviewed: the factors that influence abdominal distension are defined and different therapeutic perspectives are examined.www.medscape.com/viewarti...02/7001/-1


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## bonniei (Jan 25, 2001)

eric, While the fact remains that fructose intolerance and celiac are not IBS they are underdiagnosed among IBS patients and so Dr Dahlman does try to bring it to the attention of patients in a systematic way. Heck I wish I had thought of starting a website just to bring this to their attention. Who has the time or inclination?! Obviously Dr Dahlman did and that is to his credit.


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## california123 (Jun 8, 2003)

Since "Dr." Dahlman says posting on this site is a big waste of his time, I'm still wondering why he keeps coming back to do more posting. Why not just stay on his own site and do his work? Guess that's another question he won't even bother answering--except maybe to post and say he won't bother answering.


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## eric (Jul 8, 1999)

bonniei, Those two conditions are not IBS and that is very important.Just like you don't call lactose intloerence IBS.I agree that information on them should be known.Its also important to work with a certified gastroenterologist to test for these conditions if needed. Whats hard for the diagnoses in this is different conditions can overlap with IBS or exassperate IBS or mimick IBS like symptoms.In IBS they look for specific clusters of symptoms together. The medical profession does know about frunctose and celiac however.Chronic Diarrhea: Could It Have an Everyday Cause? http://www.aboutibs.org/Publications/chronicdiarrhea.html You should read this.Irritable Bowel Syndrome:How Far Do You Go in the Workup? http://www.med.unc.edu/medicine/fgidc/how_..._the_workup.htm


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## Jhouston (Nov 9, 2003)

Kel, I am ok with eggs, don't know about cinnamon. I'll experiment and see how it goes. Thanks for noticing my post.....I cannot really wade through all this now....I am a bit stressed. Need to think about calming things Thanks again, Joann


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## kel1059 (Feb 28, 2003)

> quote: IBS is a GI Disorder of Function, how the gut functions.


mystery solved. i guess we can all go home now.


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## Gret (Sep 23, 2003)

Eric, I can't read all your posts, I just don't have time! But I did look into that article about diarrhea having an everyday cause. Interesting. When my IBS was at it's worst, I quit drinking coffee - cold turkey. It helped quite a bit. However, there were obviously other causes as well, but I found it interesting that coffee affected me that way! I haven't had a drop in more than three years.I didn't make it all the way through the other article about the IBS workup. My doctor did not order up any tests for IBS. Being otherwise healthy, he determined I have IBS based on what I told him. I saw no reason to look for another opinion, I hate visiting with doctors! And I had just gone through multiple tests to determine I have Meniere's Syndrome. I'm just tired of all the syndromes with no cure.Being on Dr. Dahlman's program has made me feel healthier than I have in a long time. I feel like eating and excercising again! It feels like I'm back in the world!How's calid doing?


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## calid (Aug 4, 2003)

Gret: I'm happy you're doing so well! I posted an update on Thursday, but it's buried in the fighting and 80" long cut and pastes (yes I measured them). I have had more bad days, I don't know what the problem is. I haven't eaten any trigger foods (that I know of), but I keep having D. I put myself back on my safe meal of roasted chicken, rice and cooked veggies, we'll see if I can get a good movement back. My bet is that I'll need some testing, we'll see what the Dr. says on Thursday. As for you, keep up the good work! I hope all the other subjects start posting soon too.


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## Arnie W (Oct 22, 2003)

eric, it's frustrating that none of the doctors or gastroenterologists I went to ever suggested any breath tests for intolerances, or suggested that I modified my diet. I always felt there was a connection, and it was an alternative practitioner who told me I should consider a gluten/yeast-free diet. Also there's probably ineresting info in your cut and paste articles, but they're too long and I don't normally get round to reading them. Maybe you could abbreviate them a bit.Last week I asked my doctor about the fructose test. She did not know about it. I was wondering what other tests I should ask for too.calid, I identify with your diet. Chicken and rice are my mainstay and are making a big difference for me. But I can't think of any vegetables I can eat, as I'm trying to avoid fructose as well as the ones Dr Dahlman recommends to eliminate. What vege's are you eating? Maybe I can try to introduce some gradually.


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## Gret (Sep 23, 2003)

Calid, I'm sorry to hear of your struggles with the D monster! Hang in there, it's not going to go on much longer, I'm sure. And I bet chicken rice gets old after a while!







I would like to hear from some others too. I hope they are doing well!


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## kel1059 (Feb 28, 2003)

a chicken and rice meal, that sounds nice. for me it is the same thing over and over--- aduki, black, mung bean, emu meat and turnips.today i am going to try cucumbers. last time i tried them i think i was okay.i am no different but it has only been 3 days on the new probiotic.since June i have consumed over 90 trillion lactobaccilus and bifido bacteria. that's about 180 packets of VSL#3 at close to a 1/2 trillion bacteria per packet (1 packet per day for over 6 months).that would be the equivalent of taking 90,000 probiotic capsules if each one had 1 billion organisms. that would be 500 capsules per day.based on this, i would think that there would have to be some bifidus in my colon by now. if not then my body does not like bifidus. maybe it is time to add some of the e coli.the plan is to keep consuming it, and maybe something will happen to normalize my immune system.since ibsacol is the only thing to date that has restored my immune system i must continue to take it. i need to keep the load off my immune system for the best chance of recovering. i believe that it may have been in dr d's paper that when the body is tied up with non-IgE food allergies or whatever they may be then this takes away from its ability to fight microbes. this i believe.


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## eric (Jul 8, 1999)

You know the reason I am better personally and don't take anything and eat almost everything and know what I know about IBS is because I have had IBS for over thirty years, and have spent over three years and a huge amount of time, is because I made an took the time to read up on everything I could on IBS. If I didn't understand things I looked them up. It was my health and for my health and because I was starting to get suicidal from the IBS. My IBS went from very severe to very mild. One of the most important things you can do for IBS is learn about it and educate oneselve in depth FROM ACCURATE SOURCES if you suffer from it. Nobody is going to do it for you either, its something a person has to do themselves. It is not easy and IBS is extremely complicated and complex. But with a better understanding comes and understanding and treatment options and a whole lot less worrying, which in itself is a huge trigger to IBS. Over the years I have seen a lot of people spend a huge amount of time reading food labels and figuring out foods, which is very important, but not to the extent of not reading about IBS and the roles foods play in IBS or in other diseases and conditions. Foods are not the only triggers to IBS. Its well known emotions are as well. By learning these things, it opens up a lot of treatment options. I have also seen a huge amount of time wasted barking up the wrong trees.When you start reading sources, you will see fructose mentioned and other conditions that can exassperate IBS or that can even be misdiagnosed, although that is not as common as one might think, IBS is the most common condition seen by gastroenterologists. And despite what some may think, quite a bit of work has been going into it the last five or more years.On the internet, there is unfortuneatly a vast amount of innaccurate information however, so one needs to be careful and check the sources that are presented by people who are not experts and based on their own opinions.Again its your health.Fructose intolerence has been talked about on here for a couple years now. Recently the doctors suggest if presented based on symptoms, a person be checked for Celiac. Ten questions to ask your doctor is available here which can help tremedously and a person should take in the ROme criteria to their doctor or ask if that is the method a doctor is using to diagnose a person. If possible its important to have an active role and a good patient-doctor relatioship. I know this can be extremely hard, but if possible that is best and the researchers are doing their best to educate primary care doctors on IBS. There are good doctors and bad ones just like all professions. After diagnoses then its important for a person to get busy and learn, read books on it or accurate information on the internet, or join support groups, whatever it takes. But clearly in IBS its important for the person who suffers to take more control of their sitituation. It is no joke that life stlye changes can be super important in IBS.It also helps to know all the things that can trigger IBS. There are a lot, not just foods.Its also important because of other conditions and problems a person can have that overlap or coexist with IBS, like dyspepsia for one, which is pretty common and shares similar features to IBS, altered motility, hypersensitivity and brain-gut issues.Regardless, of what some people say on the bb here, the brain is in charge of most of the show and treatment options that target this can be very effective and long term.So on one hand your working on luminal factors that trigger IBS in the gut and brain gut triggers that trigger the gut, it works both ways, one can trigger the other. So targeting both is usally the most effective. All pain is processed in the brain and their is clearly evidence of pain transmission issues from the gut signals to the brain and back. These signals can be modified for relief in numerous ways. For example the Central nervous System can calm the Autonomic nervous system and vise versa.There is also a high placebo rate in IBS and this issue is important also and in part has to do with the brain gut connection working together. Many times on this bb people got all worked up and excited over a possible 'Cure' only to find six months or a year down the line, they still had IBS. However, no matter how you feel better, the point is you feel better, that is what phycosomatic medicine is all about really. People hear that term and think oh no its all in my head, but its really about physiology of the mind body connections.One thing that can really help is to understand homeostasis and another the enteric nervous system.However, they cannot "cure' IBS, because they don't totally know the cause, although that is getting better and they are begining to understand it more with new technologies and better reaserch. They don't know how to cure cancer, but they do know a lot about it for example. Arnie, you should ask them why they didn't mention or test you for fructose or LI ect. People also need to be proactive in working with doctors and if you have a bad one find another. Yeast is not implicated in IBS.The more a person educates themselves the more valuable the information is when seeing a doctor.The you can ask, what about this?On foods the more you learn, the more you learn about spoecific food problems and how they effect or can trigger IBS, but just as importantly how the 'ACT OF EATING" triggers IBS and even your moods when you eat.As complex as it all is, there are simple commen sense approaches to IBS that can make a person feel better. Worrying about every possible cause is not one of them. It is also known serotonin plays an important role in motility, secreation and sensation in IBS and that D patients can have a overreaction in the gut cells that cause the bowl to over react to the intake of food content which thus causes D. Two very important cells in IBS are serotonin-containing EC cells and mast cells. Both can be triggered by foods and emotions.


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## ShellyMcG (Jul 29, 2002)

Eric,I don't believe I have ever spoken to you before.That said, I have few observations.I have read most of this thread, and I find it very upsetting.It saddens me that we can't all just get along.We are all in this together--- after all.You wrote:On the internet, there is unfortuneatly a vast amount of innaccurate information however, so one needs to be careful and check the sources that are presented by people who are not experts and based on their own opinionsHere is a question that I have for you. How does one know who-- or what-- to believe?What works for one does not work for all--so how can a doctor (expert) be right/wrong?I live in the Chicago 'burbs, go to doctors at the largest teaching hospital in Chicago, and have gotten different opinions from all of them. Then---have made the mistake of doing my own research on the Internet. Everything I read contradicts what I have just read. YIKES!!!!Shelly"A hundred years from now it will not matter what my bank account was, the sort of house I lived in or the kind of car I drove. But the world may be a different place because I was important in the life of a child."


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## eric (Jul 8, 1999)

Shelly, you may not understand my reasons but I have a very good reason.I also am wondering why you think I am the one who is not 'Getting along' on this thread, when in fact I am pointing some very questionable issues out. I may be being view as a trouble maker on this thread, but the questions I am asking every person should be asking!!!It is also interesting to note the amount of time and effort I am spending here to actually point things out and I am not trying to sell anything to anybody here or in anyway personally pull the wool over the eyes of my fellow IBS suffers."How does one know who-- or what-- to believe?"That is a very good question really.Here are four accurate sources for you.U.N.C Center for Functional GI and Motility Disorders http://www.med.unc.edu/medicine/fgidc/ International Foundation for Functional Gastrointestinal Disorders http://www.aboutibs.org Mayo Clinic http://www.mayoclinic.com/invoke.cfm?id=DS00106&si=1096 UCLA/CURE Neuroenteric Disease Program http://ibs.med.ucla.edu/ There is also the AGA website and Medscape and Webmd for examples.Another good thing is to check is the website commercial based or information driven, for example. Are the sources reputable. If you read the whole thread there was information about reading the internet post as well.


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## kel1059 (Feb 28, 2003)

shelley,i agree with what you said. all the doctors i have seen have been almost completely worthless. in fact they were even worse than worthless. they kept piling the drugs one after the other on top of me. my body is probably still trying to undo the damage.others may have been helped by doctors but not me.the experts with their vague explanations such as, "well, the reason the bowel does not function well is because it is malfunctioning" -- does not help me.eric, don't answer here. please answer on your own thread --thanks.


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## ShellyMcG (Jul 29, 2002)

Thank You Eric for you quick response.You said;I also am wondering why you think I am the one who is not 'Getting along' on this threadDid I say that?Please don't presume to know what I am thinking.Thanx for the info, and have a nice day!!!Shelly" In spite of everything , I still believe that people are really good at heart ..." - Anne Frank


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## eric (Jul 8, 1999)

I applogize for that I misinterpreted it since your directed the the comments to me with my name.


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## eric (Jul 8, 1999)

Kel, it doesn't surprize me you were not helped by the doctors.Right now the only symptoms you seem to be complaining about very loadly I might add is altered stool formation.I have to ask you what things in life to you really enjoy?If you didn't have altered stool formation and were cured, what would you be doing with your life?Its also one reason why the ten question to ask the doctor and diganoes information and information on what to ask them and better ways to work with them, that information is not promoted enough on this bb here. More people post and respond to such things as mercury for example then testing and diagnostics and tinformation to help serve you better when you do go to a doctor.Also, I am sure just as many alternative routes have failed to 'Cure' IBS as orthodox ones.


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## eric (Jul 8, 1999)

Yesterday my girlfrined who also has IBS, threw away about 300 dollars worth of over the counter supplements for IBS. Kept a few however.


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## Arnie W (Oct 22, 2003)

I do want to stress that the people from this board who have consulted with Dr Dahlman (and other alternative practitioners) have probably had umpteen medical consultations but are still no better off.I have gleaned more information and ideas for plans of attack from this site in a few short months than I did from years of visiting doctors and doing my own research.I don't respond to the placebo effect having not had any improvement from any therapy or supplement I've tried.Most people come to this forum because they have not had success elsewhere. I still can't understand, given my symptoms, why it wasn't suggested that I be tested for food intolerance or bacterial growth. I don't know how many times I felt embarrassed about, and apologised for, bothering my doctor again. All of them could not have been kinder to me, but they just seemed to have no idea in which direction to steer me.


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## Arnie W (Oct 22, 2003)

BTW, I do think that the ten questions idea is very helpful, and would make a good sticky for this forum.I believe that this thread as such should be continued for debate, but it has gone faraway from what was intended. A new thread is needed because there is too much to wade through and people's progress notes are getting swallowed up.Let's now give the experiment a fair go and let the guinea pigs discuss progress, with others being able to comment and ask quesions. Let's have a thread in which ethics and credentials are not mentioned, because we've already gone down that path.


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## missC (Oct 16, 2002)

what's 'diganoes'? eric, i do have to say, and i'm not being snotty, that after several readings i still couldn't understand that post. have you had a couple of drinks? hey, no judgements here, it's saturday evening and i've had half (actually make that 3/4) of a bottle of wine.you know you seem to be taking offence when people suggest that your comments would be more helpful on a different thread. but i think they have a point. if you want to be helpful, rather than right, you might think about it.also we seem to be making heavy weather of semantics here. if people with gastrointestinal symptoms, who have been diagnosed with IBS, were originally misdiagnosed, how much does that matter? is it more important for you to be right, than for them to be helped? what if it turns out that all, or a huge proportion, of 'IBS' sufferers actually have dysbiosis/fructose intolerance/lactose intolerance/candida etc etc etc? would it be better for them to hear lectures about what IBS 'really' is and why Dahlman or anybody other than an allopathic practitioner is unfit to treat it? or to have their problems sorted out? would it be very terrible for anyone to be 'cured' by Dahlman? would they be better off sick, and sticking to approved treatment options?you know there are a lot of dumb doctors of medicine out there. and scientific researchers. i've known some, this isn't theorising. adequate intellect doesn't translate to applicable brilliance.


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## brushie (Jul 17, 2002)

eric


> quote: Its also important because of other conditions and problems a person can have that overlap or coexist with IBS, like dyspepsia for one, which is pretty common and shares similar features to IBS, altered motility, hypersensitivity and brain-gut issues.


that may be right, but what helps it when the gi`s out there seem to know nothing about syndromes mimic ibs.i read 2 of the interesting articles you posted right now(im really thankfull for them, but please post only some abstracts when available+ the links, so if interested one can click in). for example in the ibs and ibd similarity article there are so many diagnostic thing mentioned i would never get tested from a doc, even if i went to 20 more. maybe 100 but who has the time ,patience and money?! i even met the chief of functional gi disorders in the viennese main hospital, and asked him for si bacteriology. he refused and said they dont do it. so what helps all the science.... if barely any doc reads it or in consequence tests for the marker mentioned?? just prescribing chemicals that tie the system down after years cant be the approach.you might be right that its the best way to read all the info by ourselves and go teaching the docs and pay them for it. but i dont have the time ,will and patience for it, at least not so far.for now i feel much better to have a doc who tries to support my gut with natural products and helping me to find foods i dont tolerate. maybe it works lets see! the metas should FINALLY arrive tomorrow,if the postal office wants to. or maybe well have two abborigginees join us with the program soon?as before my diary experiment( i ate a soup with much cream that gave me bad bloat days ago) i feel a slight improvement with my bloating sofar only with the diet. I find it very hard not to drink to or after meals. how do you others cope with this rule?calcid,i hope you get better soon!!! if not maybe you should contact dr.d?


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## bonniei (Jan 25, 2001)

eric you said that we have been talking about fructose intolerance for the last two years. You must admit though that for the lat two years you have been posting studies that fructose restricted diets don't help and flux has been saying FI doesn't even cause symptoms like diarrhea and gas. So this site as been really misled by the two of you and the two of you have rendered me speechless. Atleast Dr dahlman's protocol is away from all the noise on this board.


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## Arnie W (Oct 22, 2003)

Hi, missC, not a bad post for having consumed 3/4 bottle of wine. You must be brilliant when you're sober. Much of what you said is what I can relate to - you just expressed it much more eloquently than I could have. I agree that Dr Dahlman offers a ray of hope where others have not been able to help. The strange thing is that, after countless visits to practitioners, noone has ever given me a dagnosis. I don't care what it is I have. I just want it to be "what I used to have", even if I don't know what it was called.Brushie, yes, I find the hour after a meal to be very difficult. At first I was virtually counting down until the hour was up then grabbing a dring right on the hour. I'm so used to drinking with meals. I'm finding it easier now. I think that the changes to diet can be related to giving up smoking. It does get easier in time. I'm beginning to accept the drinking regulation now and dealing with it. Sometimes, however, I find myself making a drink, then suddenly realising that I'm not allowed to have it. Ingrained habits take a while to change.


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## brushie (Jul 17, 2002)

> quote:i read 2 of the interesting articles you posted right now(im really thankfull for them, but please post only some abstracts when available+ the links, so if interested one can click in).





> quote: you know you seem to be taking offence when people suggest that your comments would be more helpful on a different thread. but i think they have a point. if you want to be helpful, rather than right, you might think about it.


though they are interesting, i agree that this isnt the thread for the articles. i understand that eric wonders why dr.d doesnt answer his questions, but also undersand dr.d, because the way of questioning hasn`t been very inviting.


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## bonniei (Jan 25, 2001)

Re: what I was saying and Miss c was saying about the proportin of IBS patients with Celiac and fructose Intolerance"However, the pretest probability of celiac disease in patients meeting symptom-based criteria for IBS was 10 times higher than the prevalence of celiac disease in the general population."from http://www4.infotrieve.com/newmedline/deta...ability&count=1 A total of 183 patients with unexplained abdominal symptoms had breath tests, of whom 134 (73%) were positive for fructose intolerancefrom http://www4.infotrieve.com/newmedline/deta...ance+&count=405


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## calid (Aug 4, 2003)

Eric: Like your girlfriend, I also have a cabinet full of supplements that I have tried/not tried and threw out, that is exactly one of the reasons to actually go with Dr. Dahlman. I've listened to all the people on the boards, ran out and bought Glutamine, Calcium, different vitamins, etc....than I go the local health food store and they've got their own recommendations. Why not turn it over to someone who's researched and tried it on others? Seems pretty smart to me. All of the items that we're taking (enzymes, probiotics, peppermint, etc.) have been tried and recommended by different posters on this board, it's foolish not to have a plan while taking them, this is our plan. I don't believe in HT, but I'm not going to beat you over the head about it, I know you sell it. It may help someone, but it won't help everyone and that includes me. You don't find anyone saying you shouldn't be hyping a hypnosis tape without having a doctoral degree, do you? Step back and let us try this program, after all it's no different than what we've all been reading on these boards, it just has someone with proven successes to guide us through the process.


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## Gret (Sep 23, 2003)

Calid, I agree. I have a box full of supplements in the basement. I've thought of tossing them, but they represent a huge sum of money so I just haven't - YET! When you've spent so much time, emotion, and money on things that don't work, it just seems time to let someone else help with the task. Today hasn't been as good as some others, but it still doesn't compare to what it was! I don't have any D, but a bit more frequency in BM. I think Sunday has something to do with it. I get pretty worked up about the service. Once it's going, I'm fine. It's just preparing. I'm better now that I'm home. Just had a huge lunch, so we'll see how it all sits.Dr. Dahlman, I hope I don't whine to you on Thursday. I really could use a piece of chocolate and some cheese! My comfort foods! Maybe dairy-free chocolate and goat's cheese??? Maybe?


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## overitnow (Nov 25, 2001)

Gret,Sorry to hear about the frequency issue. Since we take a different approach, the comparison may not hold, but my system took a long time to completely heal from both frequency and urgency issues; however as it healed those problems both dissappeared. Hopefully the same will occur for you. The question I wonder about is once you get the flora (or are bacteria really fauna?) rebalanced, does the cure include limiting your diet, or does everything return to anteIBS conditions? Will there be chocolate cake in your future?Cheers,Mark


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## Gret (Sep 23, 2003)

Mark,I appreciate your encouragement!From what Dr. Dahlman has told me, I believe I will have an unlimited diet. But knowing that certain foods may upset my system, I may choose to avoid some. He said the upsets would be less severe though. Along the lines of say someone who knows something gives them heartburn, but they enjoy it anyway! I have always, my whole life, had a reaction to pork sausage. I love it on pizza so I eat it. But the next day, I may have rumblings in my colon. But sometimes it's worth it. I'm very confident that I'll enjoy my chocolate again, although the amount of dairy I used to consume was not healthy, so I'll limit that. I think most people who don't suffer from IBS have foods they should avoid.


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## Gret (Sep 23, 2003)

I felt fine the rest of the afternoon yesterday. And so far today, although it's still early! I don't have any heavy thoughts going on today so I trust all will be well.


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## drdahlman (Nov 6, 2000)

Wow! What a lovely group of people we can be. Thanks so much for the support, I ignored you all for the weekend, I was busy, but honestly, you can only take so much. Lot's of great comments about what you're experiencing, exactly the right use for this thread. I can't wait to talk to the 5 of you this week so we can sort out our experiences. I'll mention this to each of you this week that it's probably not a good idea to give daily or almost daily updates on how you're doing. The fluctuations on a daily basis will prove to be irrelevant when compared to the longer term. Some people may be put off because of something you experience one day that they will relate to the products or a failure of the plan. Our bi-weekly talks are, in part, meant to clear up any misconceptions that the patient has about what is happening to them. I have seen 1000's of you and usually can add some perspective to what you might find confusing.MissC, what's the name of that wine? I greatly appreciate your analysis and if you can think like that after 3/4 of a bottle, I want some.With so many posts over the weekend, forgive me if I don't respond to questions that my patients have posed. We'll talk soon and everyone hang in there, you will get better.Gotta go anyway, I'm being told I have a call from the Outback!


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## Gret (Sep 23, 2003)

"You will get better." I like the way he says that!


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## Guest (Jan 20, 2004)

Dr. Dahlman, I'm interested in calling you and following your plan, but that won't be until April when I return to the US. Until then, what basic things should I do to minimize bowel discomfort? After reading your article yesterday, I cut out milk products, gas-causing foods, and drink water at the right times.


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## drdahlman (Nov 6, 2000)

Lou67, Thanks for the comments and you are doing the right thing by starting with my dietary suggestions. See what happens with "The Big Three" as you described. Since I don't know your symptoms, if some remain after a week or two, depending on what country you're in, go to a pharmacy....I know what you can find in Europe and S. America, Mexico and Canada...and ask for some probiotics....acidophilus or bifidus or sacchromyces boulardi...and take that for a few weeks and see what symptoms you are left with. If you still have symptoms, proceed through the "Step-by-Step Thought Process" section of my article and eliminate fructose....and see what happens, if you still have symptoms, also eliminate gluten at the same time for another week or two. That should take you close to April and then call me either way and let me know how you did.I'll be on my way to Australia to try to help some crocodiles, seems they got ahold of my products and the reports are startling. Scientists claim that their guts are more mobile than they used to be and their viscerals are hypersensitive! Hypnotherapy has failed because crocs are unable to follow the little thingy that you swing in front of them. Stand by for further reports from the Outback.


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## eric (Jul 8, 1999)

Dr Dahlamn, another stab with the HT comments?Again very professional.







You don't answer the very important questions on IBS being asked of you, yet you decide to make comments like that on an already established treatment for IBS.Its again pretty unprofessional to knock an already established and 20 year researched based safe treatment, for IBS that doesn't involve taking anything, unlike your apporach treatment. It really shows where your coming from and I believe the disregard you really have for IBS suffers. Real Doctors that care show more professionalism and don't try to knock effective IBS treatments. Considering the information you have posted so far it doesn't surprize me however. If you can't answer the questions, take a jab at HT. Interesting that HT does work regarless of what causes IBS.However, the truth is. "Why Consider Hypnosis Treatment for IBS?by Olafur S. Palsson, Psy.D.Hypnosis is only one of several approaches to treating irritable bowel syndrome and may not be the most suitable option for all patients (click here for discussion of treatment options for IBS). However, hypnosis treatment has some advantages which makes it an attractive option for many IBS sufferers with chronic and severe symptoms:- It is one of the most successful treatment approaches for chronic IBS. The response rate to treatment is 80% and better in most published studies to date. - The treatment often helps individuals who have failed to get improvements with other methods (see for example: Whorwell et al., 1984, 1987; Palsson et al., 1997, 2000).- It is a uniquely comfortable form of treatment; relaxing, easy and generally enjoyable.- It utilizes the healing power of the person's own mind, and is generally completely without negative side effects. - The treatment sometimes results in improvement in other symptoms or problems such as migraine or tension headaches, along with the improvement in IBS symptoms.- The beneficial effects of the treatment last long after the end of the course of treatment. According to research, individuals who improve from hypnosis treatment for IBS can generally look forward to years of reduced bowel symptoms." http://www.ibshypnosis.com/whyhypnosis.html "What can be done to improve Irritable Bowel Syndrome (IBS)?By Olafur S. Palsson, Psy.D.Last updated: August 2002Traditionally, physicians have had a great deal of difficulty coming up with adequate medical treatments for IBS. Medications used to treat the disorder have generally been aimed at treating single symptoms (such as pain or diarrhea) of this complex syndrome, and have often proven limited in effectiveness even on those symptoms. Among medications with most consistent effectiveness on IBS symptoms (Camilleri, 1999) are Loperamide and antidepressants (the latter help not only symptoms of depression in depressed IBS patients, but also improve pain and diarrhea in some individuals). Overall, the response of the syndrome to medication interventions has been inconsistent and disappointing, leaving a substantial proportion of patients with little or no lasting relief. Dr. Grant Thompson, one of the world's authorities on IBS, concluded in his review of pharmacologic management of IBS: ï¿½The sheer number and variety of drugs sold ï¿½for IBS treatment are testimony to their collective uselessness" (Thompson, 1994). This pessimistic picture might finally be changing to some degree as new classes of medications have emerged that seem to be able to address this disorder. The first among the drugs, Lotronex, was introduced with much fanfare in the Fall of 1999, but was was pulled voluntarily off the market less than a year later by Glaxo-Wellcome, due to concerns about several deaths which may have been attributable to the effects of this medication (see link to CNN story below). Many regretted the loss of this first medication specifically designed for IBS treatment. In a remarkable and unusual reversal (see link below), Lotronex has now been reapproved for use by the FDA, and reintroduced on the market with extra precautions to address the risks previously identified.The next medication to arrive on the market for IBS is Tegaserod, produced by Novartis, which has just been released in the U.S. This medication is marketed under the name Zelnorm,and is specifically intended to relieve constipation-type IBS problems. Zelnorm has been demonstrated to have effectiveness above placebo in tests (see link to story below). It will also be prescribed only for women. The availability of Lotronex and Zelnorm heralds a whole new era in IBS treatment: For the first time ever, IBS-specific medications are available to physicians. However, although promising, these drugs are likely to prove to be far from being the final answer in IBS treatment. Both are only effective in women, have relatively small impact on symptoms in many patients, and only about half of patients respond in a beneficial way to these treatments.Apart from medications, common methods used to attempt to control IBS include changes in diet, various alternative medicine methods, and psychological approaches. The most common symptom-inducing foods for IBS patients are spicy foods and food with high fat content. Often patients can get at least temporary relief by reducing the amount of such foods in their diet. However, such adjustments in diet rarely lead to lasting improvement in the condition. Increasing fiber in the diet, with fiber supplements of at least 12 g per day (Camilleri, 1999) helps many patients with constipation- predominent IBS. Many IBS sufferers who have not had good luck with regular medical management of their symptoms try various home remedies and alternative medicine medicine regimens. Unfortunately, they often fall prey to unwarranted claims for symptom relief from anything from herbal and homeopathic medications to colon cleansing, spending a great deal of money and may possibly suffer harm from the effects of such therapies. Among alternatives to medication, only psychological treatments and peppermint oil have the research base to back up their use in IBS.Among psychological treatments tested for the disorder, hypnosis treatment has shown the highest success rate in replicated studies, with studies commonly showing an astounding 80-95% of patients improving and improvement lasting for at least a couple of years. The other effective psychological treatment for IBS is cognitive therapy. Brief psychodynamic psychotherapy has also shown some success, but less research has been done on that form of IBS treatment to date than on hypnosis." http://www.ibshypnosis.com/IBStreatments.html Gastroenterology 2002EditorialsThe growing case for hypnosis as adjunctive therapy for functional gastrointestinal disordersOlafur S. Palsson William E. Whitehead Sections See article on page 1778. In 1984, Whorwell et al.1 in Manchester, England, published a small but well-designed placebo-controlled trial of hypnosis as a treatment of irritable bowel syndrome (IBS). They randomized 30 patients with severe, refractory IBS to either 7 sessions of hypnotherapy or the same amount of psychotherapy plus placebo pills. The results indicated that hypnosis treatment had specific (nonplacebo) effects that substantially improved the central IBS symptoms of all the patients in that group (who showed far greater improvement than the control group). In a follow-up article,2 the investigators reported that clinical improvement was maintained in all the hypnotherapy patients during a 2-year posttreatment period. A dozen other hypnosis studies on IBS, by the same group3ï¿½6 and by other investigators in several countries,7ï¿½14 have followed this initial trial. The additional studies have largely confirmed the high efficacy of hypnosis in IBS treatment, although the 100% response rate in the first study has generally not been equaled. This body of research has made hypnosis the most investigated psychologic treatment of IBS. In that regard, it is rivaled only by cognitive-behavioral therapy, which also shows a high success rate and substantial impact on IBS symptoms in some trials.15,16 Although some of these studies have been small and inadequate in design, hypnotherapy has emerged from the cumulative experience of this work not only as effective in improving the gastrointestinal (GI) symptoms that define IBS but also as a potent way to counter the quality of life impairment, disability, and excess health care costs associated with the disorder.3,4 This is most recently shown by the largest systematic assessment to date (250 consecutive patients) of the therapeutic impact of this treatment, reported in 2002 by the Manchester group.3 Based on the more than 50% average reduction in IBS severity, substantial reduction in anxiety and depression, significantly reduced health care costs and improved quality of life noted in this report, and good maintenance of symptom improvement beyond 2 years after treatment, it might be argued that hypnotherapy is more effective than any other single treatment modality for severe IBS. In the present issue of GASTROENTEROLOGY, the Manchester group again presents a controlled trial of hypnotherapy,17 this time targeting functional dyspepsia (FD). The design closely parallels the group's 1984 controlled trial1 for IBS. As in that study, patients were randomized to either hypnotherapy or to an equal amount of supportive psychotherapy combined with placebo medication. However, the present study added a second side-by-side control group of patients randomized to standard medical treatment. The hypnosis intervention used in this study is also largely identical in form and in content to what the Manchester group has used for many years for IBS, with some relatively small modifications to address FD symptoms. The impact on FD from the hypnotherapy reported in their article closely mirrors the benefits of hypnosis seen for IBS. The mean reductions in symptoms were about the same as for IBS3 (59%) and continued to improve after treatment, reaching a remarkable average of 73% reduction in severity at 1-year follow-up (in contrast with the comparison groups). Greater decreases in medication use and improvement of quality of life after hypnotherapy were noted in this trial. As in the treatment of IBS, the therapeutic effects are generally well preserved at long-term follow-up. Although replication of this first therapeutic trial for FD is needed, it expands considerably our knowledge of the potential for hypnotherapy as a treatment of functional GI problems. FD and IBS jointly account for more than half of the workload of gastroenterologists.18 Up to half of these patients are dissatisfied with standard treatment,19 which highlights a considerable unmet need for adjunctive or complementary treatments that can improve efficacy and patient satisfaction. With the present FD hypnotherapy study indicating that this treatment method may be as effective for FD as it is for IBS, it is becoming increasingly hard to ignore the notion that the skills of the hypnotherapist should be made routinely available to patients with functional GI disorders. The evidence consistently argues that wide availability of hypnotherapy would make management of these disorders more effective and would add broad benefits in improved emotional well-being and functional status of these patient groups. It might also produce large savings in cost of care for health care systems because of reduction in medication use and health care visits. These potential advantages of hypnotherapy as adjunct in the management of IBS and FD raise the question whether it would be possible to implement routine adjunctive hypnosis management in mainstream care for GI disorders. The short answer is that, although feasible, it would, at least in the United States, require overcoming substantial practical and systemic obstacles. Psychologic treatment is currently used only rarely as a therapeutic modality for functional GI patients, offered to less than 10% of all patients in primary care and gastroenterology clinics. Furthermore, this option is probably exercised mostly with patients who either present with significant psychologic symptoms or have not responded to conventional treatment. Many health maintenance organizations dissuade primary care physicians from routinely making outside referrals for psychologic treatment of functional GI disorders because of the higher up-front cost of such care. Reimbursement for psychologic treatment of functional GI disorders is furthermore limited or nonexistent in many insurance plans. All of these aspects of the health care system would have to be addressed and corrected to make hypnosis for FD and IBS widely available. Perhaps an even more serious hindrance to widespread application of hypnotherapy for functional GI disorders is the limited availability of suitably trained and experienced clinicians. Only a very small proportion of physicians and nursing staff have the training or experience to administer hypnotherapy. Because of time pressures on physicians, such work may be impractical, especially in primary care settings, in which a series of 30-minute sessions with any one patient is likely to seem an unattainable luxury. Close collaborative ties with hypnotherapists do not exist in most medical settings. In the United States, mental health professionals, many of whom have little knowledge of functional GI disorders and therefore are often reluctant to undertake treatment of these disorders, practice much of clinical hypnosis. Finally, popular perception of hypnosis, which even today carries an unfortunate and erroneous legacy of mystery and coercive influence over people from popular media and stage shows, may make some patients and physicians less receptive to considering this treatment option. In light of the growing evidence of the value of hypnotherapy in enhancing care for functional GI disorders, it would seem timely to make a concerted effort to examine ways to remove these barriers and facilitate the availability of such treatment; for example, by providing systematic training to health professionals specifically in hypnotherapy for functional GI disorders, integrating hypnotherapy services, and enhancing reimbursement and referral patterns for such treatment. The Manchester group, the pioneers in the domain of GI hypnosis, represents 1 model of how hypnotherapy can be effectively integrated with clinical gastroenterology. They have established a unit dedicated to medical hypnotherapy, working hand-in-hand with the gastroenterology service, and using 6 hypnotherapists who treat a large numbers of functional GI patients with hypnotherapy. Apart from practical hindrances that continue to keep hypnotherapy from broad use for GI disorders, a number of important research questions remain unanswered about such treatment: The mechanism of the impact of hypnosis on functional GI disorders remains obscure. Unlike pharmaceutic agents for IBS and FD, which have a clearly delineated mechanism of action, it is largely unknown how hypnotherapy produces its effects on GI symptoms. It is well documented that hypnosis can modulate GI functioning. The hypnotic state seems by its own virtue to increase oro-cecal transit time20 and quiet colonic motility.21 Experimental application of specific hypnotic suggestions and imagery can also have demonstrable effects on gastric secretion22 and transit time.20 Tests performed during hypnosis show decreased perception of discomfort in patients with IBS6 and FD.23 However, the research to date on posttreatment changes associated with hypnotherapy have provided very little evidence5,6,10,11 that overall changes in physiologic parameters such as pain thresholds, muscle tone, or autonomic functioning are central to the therapeutic effect, with the possible exception of increased pain thresholds for the most pain-sensitive subgroup of patients.5 Further work is needed to elucidate the main mechanism of action that produces improvement in GI symptoms. Side-by-side comparisons with other psychologic treatments are still lacking. Various other psychologic treatments have also been reported to have a positive impact on IBS symptoms, including cognitive-behavioral therapy,15,16 interpersonal therapy,24 stress-management training,25,26 and psychodynamic therapy.27 It remains uncertain at this time whether hypnotherapy is superior to these alternative psychologic treatments because no side-by-side comparative studies have been conducted. Combined effects with medications are unknown. To date, the research on hypnotherapy for FD has exclusively tested it as a monotherapy. The combination of this psychologic treatment with medications such as antidepressants and the 5-hydroxytryptamine modulating agents for IBS seems in order, if this type of treatment is to be considered as an adjunctive therapy in medical care. Such combination trials are also important because experience from non-GI trials of combined psychologic therapy and pharmacotherapy for headache28 and depression,29 for example, suggests that such a combined pharmacologicï¿½psychologic approach is superior to either intervention alone. It is unknown whether hypnotherapy for FD and IBS can be administered in an automated home-treatment format. Hypnosis is unlike most other psychologic treatments because it is largely a one-way talk therapy with very limited interactivity. For this reason, it can be used without a live therapist, and this is commonly done in the form of audiotaped home practice sessions that patients use between clinic visits. The availability and affordability of this therapy would be vastly increased if the same kind of face-to-face hypnosis treatment found effective for FD and IBS would also help patients when administered exclusively in a home-treatment audio format. No data have been presented to date to make it possible to conclude whether this is feasible. In conclusion, although some of the studies to date on hypnotherapy for functional GI disorders have been small and lacking in methodological rigor, and many research questions remain unanswered, the cumulative and consistent evidence for efficacy of hypnotherapy for these disorders seems to warrant serious consideration of its use as a regular adjunct in primary care and gastroenterology treatment of patients with FD and IBS. " http://www2.us.elsevierhealth.com/scripts/...16508502004821& To bad you can't answer, no refuse to answer on the bb here, the very important questions, in the major discrepensies in your IBS information and the experts IBS information, repeatly asked of you to supply in regards to IBS, but yet, want to be treated with respect."PRESENT PATHOPHYSIOLOGICAL OBSERVATIONS Despite differences among the functional gastrointestinal disorders, in location and symptom features, common characteristics are shared with regard to:motor and sensory physiology, central nervous system relationships, approach to patient care. What follows are the general observations and guidelines. MotilityIn healthy subjects, stress can increase motility in the esophagus, stomach, small and large intestine and colon. Abnormal motility can generate a variety of GI symptoms including vomiting, diarrhea, constipation, acute abdominal pain, and fecal incontinence. Functional GI patients have even greater increased motility in response to stressors in comparison to normal subjects. While abnormal motility plays a vital role in understanding many of the functional GI disorders and their symptoms, it is not sufficient to explain reports of chronic or recurrent abdominal pain.Visceral HypersensitivityVisceral hypersensitivity helps to account for disorders associated with chronic or recurrent pain, which are not well correlated with changes in gastrointestinal motility, and in some cases, where motility disturbances do not exist. Patients suffering from visceral hypersensitivity have a lower pain threshold with balloon distension of the bowel or have increased sensitivity to even normal intestinal function. Additionally, there may be an increased or unusual area of somatic referral of visceral pain. Recently it has been concluded that visceral hypersensitivity may be induced in response to rectal or colonic distension in normal subjects, and to a greater degree, in persons with IBS. Therefore, it is possible that the pain of functional GI disorders may relate to sensitization resulting from chronic abnormal motor hyperactivity, GI infection, or trauma/injury to the viscera. Brain-Gut AxisThe concept of brain-gut interactions brings together observations relating to motility and visceral hypersensitivity and their modulation by psychosocial factors. By integrating intestinal and CNS central nervous system activity, the brain-gut axis explains the symptoms relating to functional GI disorders. In other words, senses such as vision and smell, as well as enteroceptive information (i.e. emotion and thought) have the capability to affect gastrointestinal sensation, motility, secretion, and inflammation. Conversely, viscerotopic effects reciprocally affect central pain perception, mood, and behavior. For example, spontaneously induced contractions of the colon in rats leads to activation of the locus coeruleus in the pons, an area closely connected to pain and emotional centers in the brain. Jointly, the increased arousal or anxiety is associated with a decrease in the frequency of MMC activity of the small bowel possibly mediated by stress hormones in the brain. Based on these observations, it is no longer rational to try to discriminate whether physiological or psychological factors produce pain or other bowel symptoms. Instead, the Functional GI disorders are understood in terms of dysregulation of brain-gut function, and the task is to determine to what degree each is remediable. Therefore, a treatment approach consistent with the concept of brain-gut dysfunction may focus on the neuropeptides and receptors that are present in both enteric and central nervous systems. The Role for Psychological FactorsAlthough psychological factors do not define these disorders and are not required for diagnosis, they are important modulators of the patient's experience and ultimately, the clinical outcome. Research on the psychosocial aspects of patients with functional GI disorders yields three general observations: Psychological stress exacerbates gastrointestinal symptoms in patients with functional GI disorders and can even produce symptoms in healthy patients (but to a lesser degree).Psychological disturbances modify the experience of illness and illness behaviors such as health care seeking. For example, a history of major psychological trauma (e.g. sexual or physical abuse) is more common among patients seen in referral centers than in primary care and is associated with a more severe disorder and a poorer clinical outcome. Additionally, psychological trauma may increase pain-reporting tendency.Having a functional GI disorder has psychological consequences in terms of one's general well-being, daily functional status, concerns relating to control over symptoms, and future implications of the illness (e.g. functioning at work and home). APPROACH TO TREATMENTThe approach to treatment for all functional GI disorders is founded on a therapeutic physician-patient relationship. The basis for implementing a strong physician-patient relationship is supported by evidence that patients with functional GI disorders have anywhere from a 30 to 80% placebo response rate regardless of treatment. Because functional GI disorders are chronic, it is important to determine the immediate reasons behind each visit, after which treatment can be based on severity and nature of symptoms, physiological and psychosocial determinants of the patients illness behavior, and the degree of functional impairment.These factors can separate patients into mild, moderate, and severe categories." http://www.med.unc.edu/medicine/fgidc/hist...aldisorders.htm


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## eric (Jul 8, 1999)

"From - Report on the 5th International Symposium onFunctional Gastrointestinal DisordersApril 4, 2003 to April 7, 2003 Milwaukee, Wisconsin By: Douglas A. Drossman, M.D., UNC Center for Functional GI and Motility Disorders at Chapel Hill, and William F. Norton, IFFGDBasic Principles -- Brain-Gut Moderators: Emeran Mayer MD; Robin Spiller MD. Panel: Robin Spiller MD; Jackie Wood PhD; George Chrousos MD; Yvette Tachï¿½ PhD; Lisa Goehler PhD; G.F. Gebhart PhD; Emeran Mayer MD. IntroductionOutcomes of Pediatric Functional GI Disorders Epidemiology/Genetic/Behavioral Factors Brain Imaging Emerging Techniques to Evaluate and Treat Functional GI and Motility Disorders Clinical Applications of Diagnosis and Treatment Functional GI DisordersGeneral Principles of TreatmentPharmacological Treatment Psychological Treatment IFFGD Research Awards "The brain-gut axis refers to the continuous back and forth interactions of information and feedback that take place between the gastrointestinal tract, and the brain and spinal cord (which together comprise the central nervous system). These interrelated feedback circuits can influence brain processes and bowel functions -- affecting pain perception, thoughts and one's appraisal of symptoms, gut sensitivity, secretions, inflammatory responses, and motility. The brain-gut circuits can be activated by an external or internal factor or stimulus that makes a demand on the system, such as a stressful event, an injury, an emotional thought or feeling, or even the ingestion of food. Symptoms of functional GI disorders may result from a maladaptive response to stimuli at some point within the complex interactions that take place along the brain-gut axis. Basic science is the fundamental approach to understanding how systems work. Basic research takes place in the laboratory and often involves the study of molecules and cells. From this body of knowledge is drawn the means to investigate practical applications and to formulate clinical practices. Translational science converts basic science discoveries into the practical applications that benefit people. One of the more exciting areas of recent research relates to the basic and translational aspects of the effects of stress on inflammation, cytokine and immune modulation, and pain. (Cytokines are a type of protein released by cells of the immune system, which act through specific cell receptors to regulate immune responses.) This series of presentations address three important research areas in the field of functional GI disorders, which have recently attracted considerable attention: the role of immune activation in the gut and the interactions of the gut immune and nervous systems; the role of the central nervous system in the regulation (modulation) of pain perception (nociception); and the emerging field of animal models with relevance for functional GI disorder research. This section demonstrates the rapid progress seen in the last few years in better understanding of basic mechanisms, in particular the neuroimmune interactions underlying symptom generation in patients with "functional" GI disorders. There are immune responses to infections. To defend itself from a foreign substance or invader, such as a bacterium or virus, the body mounts an immune response controlled by the brain. There needs to be a balance between infection and the body's immune response; the immune system needs to turn on and turn off at the right times to destroy the invader but not to the degree that it may harm healthy tissue. Robin Spiller, University Hospital, Nottingham, England began the session by noting the difficulty in separating disorders of structure ("organic") from disorders of function. He noted, "The difference is based on how high the power of your microscope is." This was elaborated upon in his presentation on Post-infectious Functional GI Disorders. It has been observed that IBS-like symptoms, that persist for 6 months to a year or longer, may appear after a bout with an acute infection in the gastrointestinal tract (e.g., food-poisoning). This is termed, "post-infectious IBS." A study by Gwee et al showed that the presence of unusual or amplified life stress at the time of onset of infection increased the chances of developing IBS symptoms. Inflammation persisted in patients with IBS-like symptoms but did not in patients whose symptoms resolved. This suggests that the brain's management of certain stressful stimuli (i.e., psychologic distress) affects the brain-gut system's ability to inhibit inflammation. It has frequently been observed that some individuals with more severe symptoms of IBS have coexisting psychologic distress. Stress has been thought to influence health-care seeking behavior, either by increasing motility, visceral hypersensitivity or inflammation, or by enhancing one's perception of gut symptoms, all of which lead to a greater need to seek care for them. The concept of post-infectious IBS suggests that in some circumstances stress (the biological process by which the body adapts in response to a stimuli) may influence symptoms. An initial response to an infection in the gastrointestinal tract can involve the neurotransmitter, serotonin, which acts as a messenger (mediator) to cells involved with the immune response. Immune cells -- mostly in the blood, but also in the lymphatic system -- enter the infected area and remove the invader. Additionally, the body adaptively removes the infection (e.g., via vomiting or diarrhea -- normal beneficial responses that help the body expel an infecting organism). Persistence of the underlying inflammatory response may lead to post-infectious disorders of function. A variety of neuroimmune responses can lead to intestinal over-responsiveness (sensitization) and other clinical effects. These responses include direct toxicity to nerves that influence intestinal contractions, alteration in gut immune activation, abnormalities of serotonin metabolism, and persisting low-grade inflammation. IBS developing after infective gastroenteritis is associated with subtle increases in enteroendocrine and chronic inflammatory cells in the gut mucosa. The net effect may be to increase serotonin availability in the gut and enhance secretion and propulsive motility patterns. Serotonin antagonists may be beneficial in such patients Notably, the concept of "post-infectious IBS" has grown to include studies of their application in post-infectious gastroparesis and dyspepsia. 1Major inflammatory responses have not been observed in most IBS patients. However, in some studies subtle changes associated with inflammation have been noticed, such as increased presence of mast cells (a type of immune system cell present in blood and tissue). Jackie Wood, Ohio State University College of Medicine discussed the Effects of Inflammation on the Gut Enteric Nervous System, specifically noting the importance of mast cell degranulation (the release from within the cell of granules, or small sacs, containing chemicals that can digest microorganisms and fight infection). In tissue mast cells accumulate around nerve endings of nerves that contain the neurotransmitter serotonin. The release of substances that can induce activity in excitable tissue (i.e., histamine, Interleukin-1 (IL-1), and bradykinin) by mast cells can affect receptor and neurotransmitter function in the enteric nervous system - the part of the autonomic nervous system that controls function of the gastrointestinal tract. In other words, when mast cells in the intestinal lining empty their contents in response to an infection, they activate nearby nerve endings. In a subgroup of patients, this can have significance in terms of resulting clinical consequences of diarrhea and abdominal discomfort.2Yvette Tachï¿½, University of California Los Angeles discussed Stress and Inflammation. The experience of stress is an adaptive behavior common to all living organisms. The activation of corticotropin releasing factor (CRF) signaling pathway, is the major mediating mechanism involved with the body's stress response system in which gastric emptying is inhibited (with possible loss of appetite) while colonic motor activity is stimulated (producing a loose stool or a sensation of bowel urgency). There is growing evidence that activation of this CRF pathways impacts on inflammation, autonomic nervous system function, immunity, and clinical behavior or illness, all of which may be linked to the pathophysiology of the functional gastrointestinal disorders. While we often talk about how the brain -- influenced for example by arousal and/or psychosocial factors -- can affect immune function, the reverse is also true. Immune activation, following infection for example, can influence brain function. Lisa Goehler, University of Virginia discussed Cytokines and Vagal Afferents: Immune Signaling to the Brain. Cytokines are substances that are produced by white blood cells to regulate certain functions during inflammatory and immune responses. The vagus is a nerve made of both sensory and motor fibers that innervates nearly every internal organ. The gastrointestinal (GI) tract, along with the lungs and liver, is an area of tissue that most commonly comes in contact with microorganisms (pathogens), such as bacteria or viruses, capable of activating an immune response. Cytokine mediators activate neurons that convey messages from tissue to the brain (afferent neurons) through the vagus nerve. The GI tract is richly supplied with vagal afferents that can signal immune activation in the tissue. This process may underlie the mechanism that causes individuals to feel sick. The concept of "sickness symptoms" is not always recognized. The cytokine inflammatory and immune mediators distributed throughout the body (peripheral), which appear to interact through vagal pathways, have systemic effects that manifest as symptoms in the body. (Mediators are substances released from cells to regulate immune responses.) Such symptoms include fever, increased sensitivity to pain, loss of appetite, and decreased desire for social interaction. The process may provide the basis for a role of the vagus as an interface between the site of the immune response and the brain that results in symptoms of altered mood, including anxiety or depression, that are sometimes associated with gastrointestinal disease.4 Jerry Gebhart, The University of Iowa discussed the CNS Modulation of Visceral Nociceptive Responses. The central nervous system (CNS) is composed of the brain and spinal cord. The brain interprets and influences our perceptions of the pain sensation signals transmitted from the gut (visceral nociceptive responses) to the spinal cord and then to higher centers. Several structures in the brain (periaqueductal gray, dorsolateral pons, and rostroventral medulla) can facilitate or inhibit signals sent to the CNS and influence the perceived discomfort, or even whether the signals are experienced as pain. Inflammation of the bowel can produce increased sensitivity to pain or enhanced intensity of pain sensation (hyperalgesia) via increased activity of certain cells (for example, those that contain nNOS) in these higher brain modulatory centers.[5] To close the Brain-Gut sessions, Emeran Mayer, University of California Los Angeles discussed Evolving Animal Models of Visceral Hypersensitivity. In contrast to most other disorders of the digestive system, functional disorders of the gut continue to be defined by symptom criteria rather than by biological markers. Realistic animal models of functional gastrointestinal (GI) disorders in which to test hypotheses have not been available until recently. While it is unlikely that there will ever be an animal model to replicate all complexities of the human functional GI disorders, animal research is likely to help us understand some of the key underlying mechanisms responsible for symptom generation. This includes over-responsiveness of central stress circuits to visceral and psychological stimuli, resulting in altered autonomic responses (motility, secretion), increased pain sensitivity (visceral hypersensitivity) and possibly altered immune function of the gut. Future studies with genetically altered (i.e., transgenic) mice that become models for studying specific human diseases and their treatments may further increase our understanding of these mechanisms.6" http://www.iffgd.org/symposium2003brain-gut.html


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## Gret (Sep 23, 2003)

Did anybody read those last posts? I like to read them, but I haven't had time and wondered if someone could put it in a nutshell (if you found them interesting).Hope everyone is feeling well. We're past hump day now. I look forward to Thursdays.


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## brushie (Jul 17, 2002)

finally i got the supplements today







i cant remember the last threads to well, and my english..... you`d be confused. i think it wasnt much more than arguing, except some posts inbetween.not so much differences for me till now, but i can say im a slight little better with bloating just from the dietary rules.hope the enzymes wont bloat me up as others did before. i begin taking them tomorrow. i got used to the water rule now, and(i`m sure this is valid for the others also) we are allowed to drink a sip of water after meals







. i asked dr.d for that because i missed just to wash the througt a bit after meals.brushie


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## ellisd5 (Jan 12, 2004)

Dr D's BIG 3.Do people on this course really stick to this rule 100%I know in the explanations it tells you what to look for in foods, So does that mean chocolate bars are a no no ?I am still unsure if to give this treatment a go as theres a mix bag of views on this. I have reduced nearly all Diary and have been doing the 1hour before drinking thing and I have to say my symptoms at times have all gone. There has certainly been a improvement. I only have two symptoms though which are stomach pains and gas at night, and thats real egg smelling gas. Something on Dr D article said that it could be sulphur (that smell like egg doesn't it?) producing bacteria living in my bowel. So I was thinking rather than try Dr D programme, id go see my Doctor (for free) and see what she has to say. Last time I saw her see gave me some tablets that made things realy bad!So im thinking do I really need to fork out for these supplements as things seem to be gettin better just avoiding diary. I feel sorry for you Dr D with the amount of people laying into you, all your trying to do is help people. For me just reading your article gave me some hope of curing this.What supplements would recomend for me after reading my symptoms i have described and whyThanksDale


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## Gret (Sep 23, 2003)

Yes, Dale, chocolate is a no-no. I've been addicted to it for years so this is tough. There is dairy free chocolate for truly desperate times, but it's not nearly as good! What tastes great isn't usually so good for you. I've been following the three rules 100% so far. Not sure if I'll end up cheating or not. I want so badly to get well that I don't want to jeopardize it! If you are feeling better by doing what you're doing, keep doing it!


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## calid (Aug 4, 2003)

I won't be cheating either, this is a one shot deal for me. I worry more that I'll accidently cheat with some undisclosed or missed ingredient.


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## drdahlman (Nov 6, 2000)

Dale, Thanks for the questions. Gret gave you a good answer about the chocolate. As far as 100% rule on dairy, let me answer it this way.I remember a patient who came to me and in talking and getting acquainted with him before we began our consultation, informed me he worked as a food scientist for Proctor and Gamble, which is based in Cincinnati. He also let me know he knew quite a lot about food. He was a very detail oriented person, who came equipped with studies to discuss and during the time I worked with him, mailed and e-mailed studies to me for later discussion. He began the plan and we certainly had gone over the details of my initial dietary suggestions in our first meeting. Four to six weeks had gone by and we werenï¿½t getting as much progress as I thought we should have seen by then. When that happens, I ask a lot of questions about a personï¿½s diet. What did you eat yesterday? What did you have for snacks? What was in that? Can you bring me the box or package so I can look at it and see if you missed something? We were getting nowhere. Finally, he admitted to me he ate lunch in the P&G cafeteria everyday and they served the best mashed potatoes he had ever had. He believed, being the food scientist he is, if he gave up about 85% of his dairy consumption, he would see an 85% improvement in his symptoms. He had seen none. This is an elimination to be taken seriously. Based on your symptoms, pleae re-read the section in my article called "The Step-by-Step Thought Process" and try the other dietary restrictions...fructose, then gluten. If you don't get as far as you would like to, we need to talk about your next step which might include stool tests. Keep me informed.


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## Arnie W (Oct 22, 2003)

The safest way to be 100% is to prepare your own food. If you buy at the staff cafeteria, you'll quite likely be eating lactose without being aware of it, esp if you're eating mashed potato, muffins, etc. And if anything is packaged or processed, again you have to know what you're eating. You can buy carob confectionery, but make sure it's lactose free.If bucks are going to be shelled out for any programme, I can't see the point in not following it to the letter, because it probably won't work otherwise.For those who are not eatinggluten/fructose/lactoseplease tell me what your diet consists of. I'm worried about not getting enough nutrients and variety.


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## kel1059 (Feb 28, 2003)

it took me forever to finally give up all foods that were on my suspect list. all i can say is that giving up on these foods keeps me out of severe trouble.i have not touched dairy in over a year. wheat is one of my worst foods as is corn.it takes a lot of discipline to be strict but the dividends are worth it.


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## eric (Jul 8, 1999)

"So I was thinking rather than try Dr D programme, id go see my Doctor (for free) and see what she has to say."Excellent idea and even if you go this route you should discuss it with your doctor first.Take these ten questions with you. http://www.medicinenet.com/script/main/art...rticlekey=13683


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## overitnow (Nov 25, 2001)

I thought that was an interesting response, as well, Eric. Especially since the last time she saw her doctor she gave her something that didn't work at all. It is always important to look at all sides of a subject. Sometimes you do get what you pay for. (Your agenda is showing.)


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## Gret (Sep 23, 2003)

Big step for me. I took the emergency Immodium out of my purse, out of my flute case, out of my desk drawer. Of course, it's still in my medicine cabinet at home, but I'm not fearful of a problem anymore. I always hated falling back on that. It made me feel better, then miserable for days. I hope everyone is feeling well today. It's Friday, have a good one!


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## Guest (Jan 24, 2004)

Dr. Dahlman's second rule of The Big Three is no legumes, and he mentions soy. Does that include soy milk or soy yogurt?


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## Gret (Sep 23, 2003)

I have been assuming no soy at all. No milk, yogurt, sour cream, etc. You could try rice milk. I use it in mashed potatoes and cooking, etc. I don't drink milk ever so I don't miss that.


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## calid (Aug 4, 2003)

Soy milk is a huge gas creator for me. I switched to rice milk shortly after trying soy and it's great. My brand of choice is Rice Dream, there are many out there, if you don't like one, try another.


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## ibsjohn (Jan 25, 2004)

HOw do I get the doctor's assistance?What is the costs involved?Thanks,John


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## Gret (Sep 23, 2003)

John,I originally found Dr. Dahlman by doing a Google search under IBS. His website is www.drdahlman.com. There he outlines his program thoroughly and supplies all the information you need to get started. Or his phone #513-871-3300.


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## LDonegan (Jul 4, 2003)

I have to say that maybe the reason some of you have such bad cases of IBS is because of all the arguing and worrying you do over which program is right and proving each other wrong. I have had IBs since 7/03 and have been watching what I eat and taking bentyol when needed. I realize my case is not as bad as some but i do know that stress is a huge part of it. So stop fighting with each other and realize that something that works for you may not work for others. I have to tell you reading your nasty responses to each other makes me have to go to the bathroom. Just because you sound smart and knowledgable doesn't mean we can't read the rudeness. Leslie


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## kel1059 (Feb 28, 2003)

> quote: and realize that something that works for you may not work for others


yep


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## kel1059 (Feb 28, 2003)

well, dr dahlman picked up on a potential problem with my thyroid. i have often wondered about this; i have a lot of the symptoms. i was even tested 7 years ago, but allopathic medicine has a flaw in their thyroid test (i believe that k9mom #1213 has mentioned this).i mentioned before that he is able to pickup on a lot of things that are being missed by the allopaths.thank you.


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## drdahlman (Nov 6, 2000)

Meckle wrote on another thread:question for you yeast sufferers out thereI have got rid of my abdominal symptoms following and antifungal approach but I still get other symptoms. Specifically:I was out at a function the other night and was drinking beer. I can get away with this in terms of abdominal symtoms. But - a friend of mine upset me a bit - but I totally over-reacted. I got depressed, angry, couldn't think straight etc. Luckily I didn't express these emotions as I knew I wasn't thinking straight and sometihng was up.Now I tinhk I've noticed a pattern that this type of thing only happens when I drink beer (my only dietary source of yeast currently) - and it wasn't the alcohol as I could drink all the spirits I like and I'm fine.Has anyone else experienced mood swings like this that seems to be triggered by yeast - or other foodstuff ? Or am I just trying to justify me being irrational and now regretting it ? Would appreciate your experience !!Would also appreciate this NOT turning into a re-run of the candida argument - pretty please ?Dr Dahlman - have your patients reported this type of thing ?----------------------------------I am not a doctor. One should always consult a medical professional regarding advice received.


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## drdahlman (Nov 6, 2000)

I responded:Hard to say...you sure you weren't drunk? The real answer to your question is that, yes patients have reported many unusual symptoms associated with having a yeast or candida overgrowth. The problem with your story is that you have been treated for it, so is it really the culprit?Granted, you may not have gotten rid of the overgrowth. Did your physician retest you to see if the protocol to get rid of it has worked?I have found yeast overgrowths to be common when we send stool samples to the lab. The key to getting rid of it is to identify it first and then use an anti fungal for a short period of time coupled with no sugar, fruit, gluten, alcohol or fermented products like soy sauce or vinegar. Did you do all that?If you did, we might assume that you do not have a yeast problem anymore.If you took a prescription that was not only anti fungal but also anti- bacterial, you probably did damage to your beneficial bacterial balance and that's possibly one of the reasons that you still have GI complaints.Do me a favor and let's take any further discussion over to "Dr Dahlmans Patient" because I just happened on your post as I don't usually go through the other threads much. Also, if we don't respond to the naysayers about candida/yeast, we can keep the discussion more civil.A warning to anyone who thinks that they may have a candida problem. Be very careful in reading info about this problem. If you have taken one of those "tests", checking off all the symptoms that you have and have come away from the test with a certainty that you MUST have a candida/yeast problem, consider this. When you go back and look at the symptom list in the test you took,......can you name any other symptoms that a human might have that's not listed in that test? In other words, the author of the test thinks that everything is caused by a candida/yeast overgrowth. That's not the case.I will post your question and my response on the other thread if you want to continue.


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## Gret (Sep 23, 2003)

It was a highly stressful day. Not one run to the bathroom! I've turned another corner......


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## Jhouston (Nov 9, 2003)

Dr Dahlman, Sent an e-mail to you directly. How long does the lab take for the stool test? Joann


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## Jhouston (Nov 9, 2003)

Disregard prior post I have spoken to Dr Dahlman. Joann


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## Gret (Sep 23, 2003)

It is so hard to find a healthy (or not!) snack! There is dairy or soy in nearly everything that I used to enjoy! I haven't tried a lot of fruit lately. Not sure how that would go. Of course, I like cheese with fruit! Oh well. Any suggestions?


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## calid (Aug 4, 2003)

Gret, are you eating wheat/gluten?


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## Gret (Sep 23, 2003)

Calid, I don't need to restrict wheat or gluten. Just dairy and legume family items!


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## Gret (Sep 23, 2003)

No problems with wheat or gluten.


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## calid (Aug 4, 2003)

Ah, you lucky duck. There are lots of things you can snack on. Try some low fat brownies, low fat wheat thins, vanilla wafers, Lay's baked potato chips, baked Doritos.........mmmmmmmm, I'd better go whip up some gluten free cookies!


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## mtbike61384 (Dec 8, 2003)

Hello everyone. I haven't posted hear in a few weeks for the simple fact that I have been feeling much better and have not fealt like hearing about ibs. I am also one of Dr. D's patients and have been now for over three monthns. We worked with diet and the products just like everyone else. But I had results but not quit what I should have had. Finally we decided to do a bacteria test. After I got the results from the test I found out that what casued most of my gas was an overgrowth of a certain bacteria. Also I didn't have any acidophalis in my system. So I have now started taking pills that kill bacteria and acidophalis powder. Already I have started to feel so much better. It is amazing what a little stool test can tell you about your health. The weird thing is that I had had lots of them before but no results. The main thing was that Dr. D knows what to look for in the tests and if it is there he will find it. Thank you so much Dr! I have not fealt this good in 4 years! I can't even imagine how I will feel when I am done with the pills since i just started them a few days ago.


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## kel1059 (Feb 28, 2003)

> quote:Also I didn't have any acidophalis in my system


excellent news. maybe this is why i am still having trouble --- lack of bifidus. i sure hope that this is the answer. if it is then i will proclaim dr d to be a genius and all opposers to be ....(i won't say it).


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## mtbike61384 (Dec 8, 2003)

Oh and one more thing. Does Eric really bug anyone else beside me? His comments are so negative and really damper the whole positive comments in here.


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## Gret (Sep 23, 2003)

mtbike! Yay! I'm glad you're so much better! I see the light at the end, it's getting better each day.Thanks, Calid for the suggestions. I realize I'm luckier than some when it comes to diet. I guess I was just feeling grumpy. I need to learn to shop differently. By the way, the baked Lay's are good, my whole family has switched to them. But I've noticed the last couple of times I've had them, I've had some rumblings. ???


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## drdahlman (Nov 6, 2000)

Low fat snacks??!! Shame on you! Everybody, repeat after me.....Fat is my friend!If there is anybody on this thread who knows how to do some research and then post lots and lots and lots of of the results that are found, would you please do me a favor and look for any study that suggests that a high fat diet (any type of fat)coupled with low carbohydrate intake causes any health problems at all. Must be a high fat and low carb diet. I can't find that anywhere.Thanks to MtBike, you're well on your way.


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## Gret (Sep 23, 2003)

I remember when I read Dr. Dahlman's article for the first time, I was so excited that he said to enjoy butter! I love it! It's not so much low fat snacks I'm looking for as it is anything w/o dairy or soy! Rice cakes are so BORING! Are brownies ok? My brownies use cocoa powder. The ingredient of which is "cocoa".


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## calid (Aug 4, 2003)

Ok Dr., beat me over the head about the low fat comments.......lol. I am going to have to take a long time to break that new habit as low fat has been my friend for a year now. I also like low carbs, I just feel better when I don't eat a lot of them. I made a major error last night and ate some green beans. I didn't realize that they would cause so much pain and gas. A new food for my don't eat list. Yes I know, NO BEANS was clearly stated in your protocol, I guess I had a momentary relapse but it won't happen again.


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## Gret (Sep 23, 2003)

Calid, wow! I can't believe green beans would do that to you! I have to confess some stupidity on my part. The other night I had no time to throw together dinner so I took some meatballs out of the freezer and made a quick dish. They were awesome! (From Schwan's!) The next day something nagged me to check the ingredients. 2nd on the list was soy protien, 3rd was romano cheese! Good grief! (No wonder they tasted so good!) Anyway, no more for me. I feel fine, no reaction yet so I think it won't bother me. I just wanted to be 100% dairy free for the three months. (Besides, if I'm going to sneak in dairy, it wouldn't be in meatballs!)


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## eric (Jul 8, 1999)

"CONCLUSIONSCarbohydrate meals induce colonic motor response, but the effects are short lived when compared with fat meals. The prolonged, segmental, and retrograde phasic activity induced by the fat meal may delay colon transit. Thus meal composition influences colonic motor response." http://gut.bmjjournals.com/cgi/content/abstract/46/2/205 UNC and Hormones and IBS" A substantial proportion of patients with IBS experience bowel symptoms soon after eating a meal. There is now some evidence indicate that these so-called postprandial symptoms may be brought on by abnormal reactivity in the hormones cholecystokinin (CCK) and motilin, which are thought to initiate the activity of different parts of the intestinal tract in response to eating. Sjolund and colleagues in Sweden 13 observed that patients with IBS had an exaggerated CCK response to a fat-rich meal, and a decreased motilin response to both a meal and water. Another Swedish group has found motilin to be elevated in IBS patients 14. Japanese research by Fukudo and Suzuki 15 furthermore reported 15 years ago that IBS patients show an increase in motilin in response to mental stress in a laboratory test, and that hormone rise is associated with abnormally increased gut activity. All of this may point to abnormal reactivity in the hormones that control the gut's reaction to internal stimuli being at fault to some degree in eliciting bowel symptoms in IBS patients after eating, and possibly (if the Japanese findings turn out to be replicable) in response to psychological stress." http://www.med.unc.edu/wrkunits/2depts/med...sand%20ibs.html " Dietary FatFat is the major dietary stimulant of the gastrocolonic response. 1 Patients have an exaggerated and prolonged release of cholecystokinin following ingestion of a fatty meal which appears to cause the onset of their symptoms.2 Those with diarrhea tend to be more sensitive to a fatty meal than those with constipation." http://www.findarticles.com/cf_dls/m0ISW/2...1/article.jhtml Although there is no credible evidence linking IBS to diet, consider specific dietary alterations according to the predominant symptom type of IBS, and to any apparent temporal relationship of symptoms to specific food intake.IBS can be confused with lactose intolerance 26 27. Remember, in lactose-deficient individuals an adequate lactose load (e.g., a glass of milk) is required to induce symptoms. Thus, consider a simple challenge test (drinking 1 quart/liter of milk at a single sitting) to exclude lactose intolerance. If the milk challenge test reproduces the patients IBS symptoms, consider a 2-week trial with a lactose-free diet, because it is reasonable and more cost-effective than a formal lactose tolerance test.	Sorbitol and fructose usually do not cause symptoms in patients with IBS when ingested in small amounts, but they may induce bloating and diarrhea with higher loads that improve when these sugars are avoided 28. Thus, based on the history, a 2-4 week sorbitol- and/or fructose-free trial may be used to screen for sorbitol and/or fructose malabsorption.	Fatty foods frequently cause an exacerbation of symptoms in patients with IBS, probably by inducing an increase in colonic activity, the so-called gastrocolonic response; consultation with a dietitian may be useful to design a low-fat diet that will still be palatable to such patients.	In patients with bloating, carbonated beverages and swallowing of air by eating too fast may be contributing and can be avoided. A diet low in lactose, starches, and legumes may also help reduce rectal flatus. Lactobacillus may reduce pain and flatus but not bloating 29, and alpha-galactosidase (Beano) on vegetables helps decrease excess flatus. http://merck.praxis.md/index.asp?page=bpm_...ion=report&ss=3 "IRRITABLE BOWEL SYNDROMEIrritable bowel syndrome (IBS) affects at least a quarter of the population. Although only one in three sufferers is male, this still represents a sizable proportion of the adult male population ï¿½ around one in 12. Symptoms usually begin between the ages of 15 and 40 but it can affect anyone at any age. It is also known as irritable colon, spastic colon or mucous colitis.The cause of IBS is not understood. The basic problem is a disturbance of muscle contraction in the intestinal tract, but no physical abnormality has yet been found as its cause.The intestines are a long muscular tube which contracts in ordered waves. This propels food along while nutrients and water are absorbed. In irritable bowel syndrome, these contractions are uncoordinated and cramps occur. Nobody yet knows why.The main symptoms of IBS are pain, wind, bloating, distension, sensations of incompletely evacuating the bowels, increased mucus from the back passage, and constipation or diarrhoea (or bouts of each).As these symptoms also occur in more serious bowel conditions it is important to have them checked by your doctor ï¿½ you should never make a diagnosis of IBS yourself. Most importantly, if you notice any change in your usual bowel habit, any blood or blackness in your stools, or weight loss, seek urgent medical advice.The pain of IBS is cramp-like or colicky and comes and goes in waves. It is felt anywhere in the abdomen but is often worse on the lower left-hand side. The pain may worsen after eating as this stimulates contraction of the colon (gastrocolic reflex). Sufferers usually find that opening the bowels or passing wind brings relief.Wind is a common problem. Because the bowels are not contracting properly, air that is naturally swallowed when eating and drinking builds up. It burbles around causing pain, distension and noises (borborygmi) until escaping suddenly and sometimes explosively.Constipation is another common feature of IBS, as spasm of the muscular bowel walls squashes its contents rather than pushing them through. As a result the bowels may not open for days at a time. When they do, straining is necessary to push out hard, rabbity pellets or thin ribbons of faeces.The bowels also frequently work overtime, with increased mucus secretion and intestinal hurry (diarrhoea). Constipation and diarrhoea often alternate and sufferers may notice an unpleasant sensation of not completely evacuating the bowels.At present, IBS is a diagnosis of exclusion, there is no definitive test that can pick it up. Initial examination of the abdomen is performed to elicit areas of tenderness and check for obvious lumps. A digital rectal examination is mandatory for any bowel problem. This is only slightly uncomfortable and gives important information regarding the texture of the bowel lining and whether the rectum is full or empty of stool, and can enable the detection of rectal tumours.Blood tests may be taken to look for anaemia, thyroid problems and signs of infection or inflammation. Further investigation of the lower bowel involves a barium enema, or endoscopy in which a scope is passed into the rectum and lower (sigmoid) colon. If a higher part of the bowel is examined via colonoscopy, light sedation is given. (A colonoscopy is a procedure in which a viewing device is inserted into the back passage so that the large colon can be examined and biopsied.) * The pain may worsen after eating as this stimulates contraction of the colon (gastrocolic reflex).* *Fatty foods frequently cause an exacerbation of symptoms in patients with IBS, probably by inducing an increase in colonic activity, the so-called gastrocolonic response*Fat, Fructose May Contribute to IBS SymptomsCharlene LainoOct. 14, 2003 (Baltimore) ï¿½ Two new studies exploring the role of diet in irritable bowel syndrome (IBS) suggest that fat and fructose may contribute to symptoms of the gastrointestinal disorder that affects more than 1 in 10 Americans.One study showed that patients with IBS and fructose intolerance who eliminated fruit and other fructose-rich foods from their diet experienced an improvement in symptoms.Another study showed that people with functional gastrointestinal disorders, about half of whom had IBS, consumed a diet with a higher proportion of high-fat, low-carbohydrate foods than their healthy counterparts.Neither study proves cause-and-effect, researchers stressed. But both studies, presented here this week at the 68th annual scientific meeting of the American College of Gastroenterology, point to the need to work with patients to identify possible dietary triggers of gastrointestinal symptoms, they said.In the first study, Young K. Choi, MD, from the University of Iowa in Iowa City, and colleagues tested 80 patients with suspected IBS; 30 had positive fructose breath tests. The patients were taught to identify foods high in fructose and urged to avoid them.While not as well known as lactose intolerance, fructose intolerance is common, with previous research by the same investigators showing it affects up to 58% of patients with symptoms of IBS.After one year, 26 patients were available for a follow-up evaluation that included a structured interview to assess their dietary compliance and symptom patterns. Only 54% of participants reported that they remained on the fructose-restricted diet for a significant amount of time, Dr. Choi reported.But those who remain on the fructose-restricted program reported significantly less abdominal pain, bloating, and diarrhea than before changing their diets P .05, he said. Noncompliant patients showed no improvement in symptoms.On the ROME I scale, only 43% of patients who complied with the fructose-restricted diet continued to have symptoms of IBS compared with 75% of those who continued to eat fructose-rich foods.Eleven (79%) of 14 patients who avoided fructose reported a strong correlation between occasional noncompliance and symptoms, the study showed, compared with 1 (8%) of 12 noncompliant patients.Richard G. Locke, III, MD, associate professor of medicine at the Mayo Clinic in Rochester, Minnesota, questioned whether patients in the study really had IBS. "We used to think people who were intolerant to milk had IBS but now we know they have lactose intolerance," Dr. Locke said. "The same thing could be happening here. It's a matter of labeling."The important message is to "educate patients that fructose can cause these symptoms," said Yuri A. Saito, MD, MPH, also of the Mayo Clinic. "The general public is not aware of this."The second study, performed by Dr. Saito and colleagues, from the Division of Gastroenterology and Hepatology at Mayo, enrolled 221 patients, aged 20 to 50 years, about half of whom reported symptoms of functional gastrointestinal disorders on a well-validated self-report bowel disease questionnaire. All of the participants completed the Harvard Food Frequency Questionnaire, and a subset of 53 cases and 58 controls also kept diet diaries for one week.Of the cases, 46% had IBS, 27% had functional dyspepsia, 20% had both, and the rest had other functional gastrointestinal disorders, Dr. Saito reported.The Wilcoxon rank sum test showed that patients with functional gastrointestinal disorders reported consuming more fat in their diets: 33.0% of total calories vs. 30.7% for control patients P .05. The findings held true for both saturated fat and monounsaturated fat, she said.Also, carbohydrates accounted for 49.1% of total calories in cases patients compared with 51.9% in control patients P .05, the study showed.No significant differences between the two groups were found for protein, fiber, iron, calcium, niacin, or vitamins B, C, D, or E intake.Subjects with functional gastrointestinal disease were also significantly more likely to suffer from food allergies than healthy subjects, Dr. Saito reported.Further studies are needed to determine whether a high-fat, low-carbohydrate diet causes gastrointestinal symptoms or reflects changes that are adaptive, she said.In the meantime, Dr. Saito said she does not recommend any blanket change in dietary recommendations. Instead, she works with her patients to uncover any foods that make their symptoms worse so they can be eliminated from the diet. "It is important to review my patients' food histories and look for obvious triggers such as excess fructose or sorbitol," she said.Kevin W. Olden, MD, associate professor of medicine in the Division of Gastroenterology at the Mayo Clinic in Scottsdale, Arizona, agreed. "I advise my patients to eat what they enjoy. If they identify a food that makes them feel sicker, they should not eat that food. But you can't tell everyone not to eat cornflakes." Dr. Olden was not involved with the study.ACG 68th Annual Scientific Meeting: Abstract 21, presented Oct. 13, 2003; Abstract 547, presented Oct. 14, 2003.Reviewed by Gary D. Vogin, MD *Fat is the major dietary stimulant of the gastrocolonic response.*


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## kel1059 (Feb 28, 2003)

he's baaaack!


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## eric (Jul 8, 1999)

This is one reason why a lot of IBS sufferers sometimes think that a particular food is the culprit to symptoms. When its actually the ACT OF EATING!"gastrocolic reflexThis is the reflex system that tells the colon to empty when food hits the stomach, or even in anticipation of a meal. This is why baby poops every time he nurses. It is also why kids with constipation complain of their belly aches right around mealtime. ""Medical DictionaryDefinition: increase of muscle movement in the gastrointestinal tract when food enters an empty stomach; may cause the urge to have a bowel movement right after eating. "In IBS this reflex is exaggerated."Why Symptoms OccurDuring normal digestion, foods are broken down in the stomach and small intestine so that their nutrients can be absorbed into the body. Undigested or partially digested portions -- mostly in liquid form -- then enter the large intestine colon where most of the water is reabsorbed. Movement through the intestines results from peristalsis, a wavelike contraction of muscles in the intestinal walls that propel their contents forward. When all is well, the end result is stool that is solid but soft enough to be excreted easily.Diet, eating habits, stress, and various environmental factors can disrupt the normal function of the intestines. If the intestines squeeze too hard or not enough, the partially digested food can travel too rapidly or too slowly through the digestive system. Movement that is too fast will result in diarrhea, because not enough water is reabsorbed. Movement that is too slow can result in constipation, because too much water is absorbed. Overly hard squeezing (spasm) can result in cramps. However, the diarrhea of IBS can also occur without pain.IBS symptoms occur after eating because of the gastrocolic reflex -- increased movement of the intestinal contents in response to food entering the stomach. The strength of this reflex can be influenced by the volume and temperature of the food and the number of calories. Large meals particularly high-fat meals and large amounts of cold beverages can trigger IBS attacks."More ../diet/trigger1.asp more"Physiological Differences in IBS Patient SubgroupsThe gastrocolic reflex, a partly neurogenic process, refers to an increase in colonic motility induced by feeding. Postprandial deviations from the normal motility patterns lead to altered bowel habits. For example, a spastic colon eg, diarrhea-predominant IBS D-IBS is characterized by an exaggerated motility response to food intake. This exaggerated postprandial response also occurs in response to intraluminal distention or to an injection of cholecystokinin CCK -- a hormone released in the duodenum in patients with IBS." http://www.medscape.com/viewarticle/418586_2 This is the result, eating signals the stomach that food is one the way, which then signals the, sigmoid colon and it overeacts to the signal.The responce is calorie dependent.A normal persons sigmoid colon 15 minutes after a meal







an IBSer 15 minutes after a meal.


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## eric (Jul 8, 1999)

What happened to Trinity?I see two people posting out of the five I think, Calid and Gret? Who are the other three?Also I thought after three months a person was suppose to be "CURED" of all IBS sympotms?Why is mtbike61384 waiting for more "pills" after three months?I am certainly happy for everyone that feels better, no doubt what so ever about that, and some people probably don't really understand why I am posting what I am posting here.


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## brushie (Jul 17, 2002)

i`m also on the program and posted here before, didnt you read it. maybe you were to focused on critzising dr.d?dr.d doesnt write in his article not to avoid fat. if someone experiences problems, he can still avoid it.i think he just wants to say avoiding fat by eating more carbohydrates can also likely work in the wrong direction.back to our experiencesi`m the sixth day now on the suppl.(metagest,azeo pangen,ultra flora +,ulcinex and candibactrin) and am







happy not to have increased bloating, as i got from other enzymes i tied some time ago.for the rest no markable changes so far. i also got used to the water rule which was hard for me in the beginning.calcid, why were you set glutenfree from the beginning. did you allready know you dont tolerate it?mtbike, glad you feeling better. your mtbiking much? i used to , but am limited in my energy since ibs, but 2 small rides a week (not in winter







) are still a must


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## brushie (Jul 17, 2002)

> quote: Also I thought after three months a person was suppose to be "CURED" of all IBS sympotms?


wrong, didnt you read the article?!


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## BackFire44 (Nov 19, 2003)

Kel, your "he's baack" was hillarious. I know there is a lot of fighting that is still going on, but I, for one, am benefiting from it. Through seeing both sides argue their issues, it is easy to see where common aggreement and disagreement is. I think the main argument is really over getting new tires or using a patch. Dr. Dahlman has experimented with different methods of helping someone with IBS have less symptoms, and the ones that generally have worked in most people he has kept. He's patching people up.Science is trying to figure out what caused the leak and how to prevent future leaks. Its a slow process and although progress is being made, it takes a while. Dr. Dahlman's patch may be better in some cases than what science has found out, but I think science will come through in the end, and it will be shown why Dr. Dahlman's methods helped some people. I'm still sticking with science, but I'm so glad many of you have gotten patched up! Also, nothing nothing nothing (did I say nothing?) beats a Doctor who is positive and caring. That alone has a big placebo effect.So, keep the debate raging; but, more importantly, keep feeling better! Its great for everyone when someone has a success story.BackFire


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## Arnie W (Oct 22, 2003)

I believe that there are actually more than five people participating in the programme.I, too, have been posting, but my posts were probably overlooked with all the debating going on.I have not yet been using the supps for 2 weeks because I live overseas and had trouble with getting my order.I started a strict diet in the New Year (gluten/yeast/lactose/fructose-free), nearly a month ago:chicken, fish, white rice, linseed oil, rice bread/flakes, rice protein powderI know you would not approve of it, eric, but I chose it for 2 reasons.1 I am thinking of competing in a bodybuilding competition and that is actually the diet I would need to follow2 I wanted to be able to establish some regular bowel habits and test what foods are triggers. The sad thing is that at this stage every new food I have introduced has brought on symptoms in one way or another.A month ago I was having several bms a day, right throughout the day. Normally 3 within the first hour of the day. Incomplete evacuations every time. Usually no real urgency, but often a strong urge.Well, I've gradually got down to a couple of bms a day, in the morning, and no need to go for the rest of the day. At first, I still was not completely evacuated, but a few days ago, I was completely evacuated throughout the day (I kept on checking!). That night I had a potato for tea, and the next day was sluggish throughout the day.Another time I had egg whites and had some pretty bad gas at night, but not as bad as it usually gets.The rumbling I get in the gut and around the anal area has greatly decreased, and is now mainly triggered when I eat introduced food.Today I'm going to try some zucchini, because I need some vege's.There are two concerns for me at the moment. I am often not aware when I am passing smelly gas, so would need someone to tell me if there's been an improvement. The fact I'm getting less rumbling gives me some optimism.I'm not passing as much in my bms as I think I should be. However, I don't think I'm constipated. If I can tolerate some vege's, that should help, and have started taking laxative teabags today.


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## Gret (Sep 23, 2003)

Arnie, It sounds like you are doing better! I hope so. What's up with the teabags? Have you tried them before? If so, what do they do for you?


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## Arnie W (Oct 22, 2003)

Thanks, Gret.As for the herbal teabags, I thought that because I don't have much fibre at the moment, it probably wouldn't harm to have a natural, mild laxative. I'll probably be able to determine very fast if the teabags have an adverse effect on my digestive system.I'm surprised at how I've been able to stick with the diet - the hard part is not drinking with meals.


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## calid (Aug 4, 2003)

Brushie: I was wheat free before I started the protocol. Wheat gives me some arthritis-like symptoms which I linked when I tried the SCD diet (for IBS). While on no grains my hands and shoulders stopped hurting, I didn't even realize it until I started eating grains again.As for my progress with Dr. Dahlman's program....I am awaiting to do the stool test. So I am on hold until I get the results back.


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## mtbike61384 (Dec 8, 2003)

In reply to Eric's post about three months. That is what normal people take. Dr. D says that it might take longer for people with additional issues such as what I had. I have no acidophalis and am over run with bacteria. So I am trying to kill those suckers. I will then have to take another stool test to see if they are gone. That will be in another 3 weeks or so. So who really cares if it takes longer than 3 months if you feel much better? And also I don't mt bike as much as I used to and would like. I have started to do weight lifting instead. Good luck all!


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## Jhouston (Nov 9, 2003)

Backfire, Science is looking for a cause? It seems like they are looking for something to treat with pharmaceuticals. My experience with GI dr is I tell him I had problems with bowels after taking Flagyl. He saysFlagyl doesn't do that. If the dr's are not listening and or taking the patient's experience I don't see how they will find a cause. Ibs happens randomly...not in a controlled lab. most likely for different for different people. for instance one has C the other has D ...they both have IBS....so they are saying. IMO most people do not have true IBS many have something overlooked and are clumped together as one illness. I think true IBS would be helped by Hypno therapy but as I said most probably do not have true IBS. Joann


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## Jhouston (Nov 9, 2003)

I am another on the program. I am easing into it....I have a cold right now and am taking other things for it. The diet does make a world of difference. I was off dairy before starting Dr D's protocol but now I see soy milk is a major bloater for me. I don't have many foods that I can eat. it is a problem. seems fruits are not agreeable much more than vegetables and certain flour products. not sure why about the flour. I received my stool report today. shows no acidolphilus, no E coli, and 1+ for Bifido. I have taken Acidophilus for over 5 yrs. go figure. Joann


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## drdahlman (Nov 6, 2000)

Great answers! Thanks to you all for your patience and trust. You guys "get it".


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## BackFire44 (Nov 19, 2003)

You may feel like science hasn't a clue, but if you were to actually read all the stuff eric posts (I know, its a lot to read), science is making great strides. Its a really hot issue right now, and I have no doubt that doctors will be able to treat and diagnose IBS a lot more effectively in the coming five years or so. That said -- there are tons of doctors who don't read the latest studies and keep current on the developments in IBS. This is why, I think, a lot of people feel that doctors can't do anything -- some doctors can't do anything because they aren't as knowledgeable as they should be. Also, there are too many doctors who want to give you a pill and won't talk to you about what you have.


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## overitnow (Nov 25, 2001)

I figure if I have been able to so successfully treat my symptoms with one supplement, and no one in the medical community shows the least interest in that, then the failure lies in their lack of curiosity, rather than in my lack of respect. I would rather feel healthy--even if patched--than be stuffing myself with constipators and waiting for science to find an answer.Mark


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## kel1059 (Feb 28, 2003)

> quote: I received my stool report today. shows no acidolphilus, no E coli, and 1+ for Bifido. I have taken Acidophilus for over 5 yrs. go figure.


jhouston, interesting post. seems like you are discovering some important pieces of information about your system/tolerances.flour is a big problem for me except for tapioca flour.i had plenty of acidophilus in my system but no bifidus or healthy e coli.i had taken so many bifidus supplements and i even made 100% bifidus goat milk yogurt yet nothing.the main focus of my program is going to be to get the bifidus implanted. i believe that taking human strains of bacteria is very important.i don't care if i have to take bifidus for the next 2 years. one way or another i am going to get this stuff inside of me.


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## drdahlman (Nov 6, 2000)

BackFire44, Thanks so much for the kind remarks a few posts earlier. I wanted to address one issue which is obviously only my opinion. I'm not being antagonistic towards you at all, I am just posting an intellectual question for us all to debate if we want to. You are willing to wait for science and feel as if there will be progress if not a cure in the next 5 years. Here's the question: Can you name any cures at all that the medical world has come up with other than antibiotics and, arguably, some cancers. We all know that headaches aren't caused by a lack of Tylenol floating around the bloodstream Tylenol only fools receptors into not accepting the pain messengers. So Tylenol isn't a cure. How about the top 10 chronic health conditions? Do the medications cure those conditions or only mask the symptoms?The point is, with such a poor track record, what makes anyone think that there will be a "cure" for any chronic condition?Every drug has followed the premise that one molecule (a prescription)can cure one symptom (heartburn, diarrhea, constipation, reflux, gas) that has one name (IBS). IBS doesn't exist. It's only an umbrella name for anyone who has any symptoms associated with their gastrointestinal system. And it's so complex, with so many contributing factors (causes) that traditional medicine will never come up with a cure.Thought I'd simply pose the question......don't want to see anyone waiting for something that may never come.


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## BackFire44 (Nov 19, 2003)

I think you are right in that what is now called IBS by many doctors is a misdiagnose of lactose intolerance, food allergies, bile salt diarrhea -- you name it. However, I think you are off track in that science has not cured anyone. And don't worry, I don't taken any discussion as critical of me. First, you start by excluding cancer and antibiotics! That's a huge category! That's like saying, "has an accountant every really helped you except by planning your finances or helping you on your taxes?" There are many other conditions too where doctors and science have found the correct treatments and are not just helping the symptoms. I really think that statement is way off base. Take a look in any medical book and you'll see what science has taught us about the human body and how to treat it. Before science, people thought we had the four elements (earth, fire, wind, water) in our body and would try to adjust those to fix sickeness. Have a fever? Must be because your fire is too overpowering. All you need is more water in your body. I'm not saying, though, that many people's mistrust of doctors and science is not based on anything. You are right in that many doctors try to control symptoms as a cure when they don't know what the problem is. That is what many people are doing with IBS. At this point and time, though, there is no cure to IBS.Yes, yes, I know your response. You have the cure. You have used it with over 1500 people and everyone is cured -- most of whom do not have to continue on any supplements or medicine. However, no one has validated your cure. My entire family would tell you that if you get the flu, you should have a spoonful of brandy twice a day. All of them say that it helps them get over the flu. We know from science, though, what the effects of brandy are, and we can run experiments to show that it really doesn't make a difference in most people. This is despite the fact that thousands of people think it has helped them.What you have is a hypothesis -- that IBS in many people is caused by chemical imbalences in bacteria levels etc. Science may validate that hypothesis. I think that science has already validated part of it. I would guess that eventually science will show that part of your regimen can combat IBS and part of it may not be necessary. Science is not something to be looked down on -- bad doctors are something to be looked down on. Science has allowed us to develop cures for tons of ailments. You wouldn't even know about chemicals in the intestines if it weren't for science telling you that they are there, what the levels should be, and how to change the levels. We will have to wait to see whether your methods are all scientifically valid, but just because science hasn't made a determination yet doesn't mean its something to be aschewed.


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## eric (Jul 8, 1999)

You advertise a cure, then say there is no cure. LOLIt probably would make more sense if you actually learned more about IBS. Since you cannot address any questions on IBS being asked of you that they alreay know about IBS and call things IBS that are not IBS. IBS is not a bacterial infection! *IBS has been around longer then antibiotics!!!* Not everyones IBS is from antibiotics. It is quite clear that changes in cells in the gut can happen after an enteric infection for one.Yet you advertise that is a cause, implying that is a cause for everyone! Without mentioning all the other causes?Because science has not been able to pinpoint exactly the problem in IBS, or even functional disorders, doesn't mean they have not learn a lot about them and have seen specific physiological problems in IBS and in functional disorders. I don't think you have the qualifications in gastroenterology or neurogastroenterology to make some of the blanket statements your making at all.So what do your treatments do to "cure" IBS? I know you are personally ignoring the questions, which only leads me to believe, you cannot answer them or don't have the experience to answer them?So far you have let people talk for you, why is that, how come you cannot talk for yourself? How come on a bb for IBS, where you are treating people and recruiting, you are refusing to talk at all about IBS and what they actually do know. Fructose intolerence is not IBS. Candida is not IBS. lactose intolerence is not IBS. There are specific conditions that are known about that you have lumped into IBS and that train of thinking is out of date and in no way reflexs the current state of the art issues in IBS and what the experts have learned recently about it.I believe understanding of IBS and your tactics are a joke! Clearly you are not addressing very important issues in IBS and IBS management.Also what happens if you tell people you can cure them and then cannot!!! What does that do to a person?How come you don't use the word remission? I guess "cure" sounds better when advertising to people who do not know much about IBS.


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## eric (Jul 8, 1999)

What does the LACK of what you have NOT said, have to do with all this?Why is it for example some people with an enteric infection get IBS and some do not?"Revisiting IBS: Perspectives for the New Millennium--------------------------------------------------------------------------------Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder that affects millions of Americans. Care for patients with IBS often falls to the primary care physician. The pathophysiology of the disorder is still not entirely clear, and current treatment options are ineffective in many patients. At the 2000 American College of Gastroenterology's Annual Meeting, attendees convened for the presentations of three experts in the field, who outlined the latest research on the pathogenesis and treatment of this clinically challenging condition.This program was sponsored by the University of Kentucky through an unrestricted educational grant from Novartis Pharmaceuticals Corporation and Bristol-Myers Squibb Company.--------------------------------------------------------------------------------Brain Imaging: CNS Abnormalities in Patients with IBSThe lack of a clearcut pathophysiology and an often noted association between physical and psychological symptoms has led some clinicians to dismiss irritable bowel syndrome (IBS) as a condition that is "all in their head." However recent findings showing CNS abnormalities in patients with IBS may offer a new perspective on the etiology of this debilitating condition, characterized by abdominal discomfort and pain and altered bowel habits. Until recently, the presence and severity of IBS were measured only by gut function and the subjective perceptions of the patient. "Now, the use of functional brain imaging techniques is contributing to an increased under- standing of the pathophysiology of this disease and new target areas for treatment," said Emeran A. Mayer, MD, Professor of Medicine, Physiology, and Biobehavioral Sciences, and Director of the CURE Neuroenteric Disease Program at the University of California, Los Angeles.Pathophysiology of IBSIBS is a disease that develops as the result of an abnormally altered brain-gut interaction (Table 1). One manifestation of this alteration consists of aberrant output patterns of the emotional motor system, a part of the limbic system in the brain, in response to external (psychosocial) or internal (immune, nutrient) stressors. Outputs from the limbic system in the form of autonomic, pain modulatory, and neuroendocrine responses can be modu- lated by cognitive factors, such as the beliefs, thoughts, and emotions of the patient. Aberrant output of the emotional motor system in large part accounts for the constellation of symptoms that makes up IBS. "A hyperresponsiveness of circuits in the brain may be one common link to both the abnormal responses to internal inflammatory stressors and external psychosocial stressors," Dr. Mayer explained. Treatment is chosen with consideration of altered motility, visceral hypersensitivity, and the brain's role in modulating these factors.The autonomic regulatory systems affect not only muscle cells in the gut, but also other cell types, such as mast cells, enterochromaffin cells, and nerve cells of the enteric nervous system. Responses of some of these cells to autonomic modulation, for example in the form of tryptase secretion by mast cells or serotonin secretion by enterochromaffin cells, may play a role in the modulation of visceral afferent sensitivity. According to Dr. Mayer, such mechanisms may play a role in the development of stress-induced visceral hyperalgesia. Another form of visceral hypersensitivity may be related to altered arousal or hypervigilance toward visceral sensations. Such hypervigilance can result in decreased tolerance to balloon distension and lower discomfort thresholds. A cognitive factor involved in the development of hypervigilance is an increased threat appraisal of visceral sensations.Functional Brain Imaging TechniquesRecently, functional brain imaging techniques have been used to assess directly the activation of certain regions of the brain in response tovisceral stimulation. Today, these techniques, particularly functional magnetic resonance imaging, are being used to assess activation of brain circuits that process visceral afferent information from the gut.Dr. Mayer noted that there are distinct but overlapping brain circuits that relate to subjective perception of gut sensations, autonomic responses, and pain modulatory responses. Even in terms of subjective gut sensations, different overlapping circuits are present for intensity coding of the stimulus; threat appraisal of the stimulus; and attribution of primary affect, or "unpleasantness".Both serial and parallel pathways are involved in the processing of visceral sensory information and the control of descending modulatory systems. Input from the gut is derived from multiple channels, such as spinothalamic, vagal, and dorsal column pathways; different regions of the brain then code for intensity, appraise the threat of the stimulus, and determine the level of attention the brain attributes to the stimulus and the unpleasantness the patient experiences. These processes are modulated both by the stress- or arousal- activated system and by recollection of past experiences.Intensity Coding, Threat Appraisal, and UnpleasantnessIntensity coding. As visceral sensory information is delivered via the spinal cord, it is encoded for intensity in the anterior aspects of the insula, or visceral sensory cortex. PET scan studies of somatic and visceral experimental pain have shown that the insula most objectively and reliably encodes information. Interestingly, studies have also demonstrated a greater activation of the insula in male IBS patients, compared with female patients, when exposed to the same stimulus intensity.Threat appraisal and unpleasantness. The information that reaches the insula is "appraised" in the dorsal aspects of the anterior cingulate cortex. Blood flow changes in this part of the brain may also correlate with attentional processes and the subjective unpleasantness ratings in response to a somatic stimulus. The ventral (perigenual) cingulate cortex, which is rich in muopioid receptors, functions to encode the affective quality of the stimulus.In a study by Mayer and colleagues, rectal and sigmoid distension resulted in a lower activation of the ventral anterior cingulate cortex in patients with IBS compared with healthy controls, but an increased activation of the dorsal aspects of the anterior cingulate. Increased activation of an unspecified region of the anterior cingulate was also reported by Mertz and colleagues, in a functional MRI study.Modulatory factors. Finally, the CNS processing of sensory experience may be simultaneously modulated by two parallel pathways: memory-based modulation and stress- or arousal-induced modulation. The posterior parietal cortex, or sensory association cortex, forms a network with the hippocampus and the amygdala (the brain's memory centers) as well as with the lateral prefrontal cortex. Somatic pain studies have shown that, in response to a stimulus, the recall of a similar past event, along with subsequent interpretation of this memory in the lateral prefrontal cortex, plays a major role in the threat appraisal of a sensory experience. The second modulatory effect is the stress- or arousal-induced response. The pontine locus ceruleus is activated in response to potentially threatening experiences. This region then projects to nearly all other regions of the brain that receive visceral input, causing secretions of norepinephrine and arousal of these sections of the brain. When the secretion of norepinephrine is excessive, these target regions are inhibited. It is of interest that descending projections from the locus coeruleus complex to the sacral spinal cord appear to play a major role in the modulation of distal colonic motor and secretory function.ConclusionBrain imaging and other studies of IBS pathophysiology indicate that the perception of gut stimuli and altered autonomic responses to these stimuli are affected by activation of various parts of the brain, resulting in increased attention to these stimuli, greater unpleasantness of the subjective experience, greater threat appraisal, and greater arousal in response to visceral sensations. Further study may lead to new developments in treatment for persons with IBS.--------------------------------------------------------------------------------Table 1. Clinical Relevance of Altered Brain-Gut InteractionAltered attentional mechanismso Greater awareness of normally subliminal visceral afferent stimuliAltered affective stimulus processingo Greater unpleasantness of visceral sensations, including heartburn, bloating, fullness, abdominal pain, incomplete rectal evacuationAltered threat appraisalo Leads to fears such as not being close enough to a bathroom anything eaten may trigger abdominal painEnhanced arousalo Shared by clinical conditions frequently overlapping IBS, such as anxiety, panic disorder and PTSDo Arousal reduced by sedatives, anxiolytics, low-dose tricyclicso May respond to relaxation exercises"posted 01-14-2004 12:32 AM "Revisiting IBS: Perspectives for the New Millennium--------------------------------------------------------------------------------Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder that affects millions of Americans. Care for patients with IBS often falls to the primary care physician. The pathophysiology of the disorder is still not entirely clear, and current treatment options are ineffective in many patients. At the 2000 American College of Gastroenterology's Annual Meeting, attendees convened for the presentations of three experts in the field, who outlined the latest research on the pathogenesis and treatment of this clinically challenging condition.This program was sponsored by the University of Kentucky through an unrestricted educational grant from Novartis Pharmaceuticals Corporation and Bristol-Myers Squibb Company.--------------------------------------------------------------------------------Brain Imaging: CNS Abnormalities in Patients with IBSThe lack of a clearcut pathophysiology and an often noted association between physical and psychological symptoms has led some clinicians to dismiss irritable bowel syndrome (IBS) as a condition that is "all in their head." However recent findings showing CNS abnormalities in patients with IBS may offer a new perspective on the etiology of this debilitating condition, characterized by abdominal discomfort and pain and altered bowel habits. Until recently, the presence and severity of IBS were measured only by gut function and the subjective perceptions of the patient. "Now, the use of functional brain imaging techniques is contributing to an increased under- standing of the pathophysiology of this disease and new target areas for treatment," said Emeran A. Mayer, MD, Professor of Medicine, Physiology, and Biobehavioral Sciences, and Director of the CURE Neuroenteric Disease Program at the University of California, Los Angeles.Pathophysiology of IBSIBS is a disease that develops as the result of an abnormally altered brain-gut interaction (Table 1). One manifestation of this alteration consists of aberrant output patterns of the emotional motor system, a part of the limbic system in the brain, in response to external (psychosocial) or internal (immune, nutrient) stressors. Outputs from the limbic system in the form of autonomic, pain modulatory, and neuroendocrine responses can be modu- lated by cognitive factors, such as the beliefs, thoughts, and emotions of the patient. Aberrant output of the emotional motor system in large part accounts for the constellation of symptoms that makes up IBS. "A hyperresponsiveness of circuits in the brain may be one common link to both the abnormal responses to internal inflammatory stressors and external psychosocial stressors," Dr. Mayer explained. Treatment is chosen with consideration of altered motility, visceral hypersensitivity, and the brain's role in modulating these factors.The autonomic regulatory systems affect not only muscle cells in the gut, but also other cell types, such as mast cells, enterochromaffin cells, and nerve cells of the enteric nervous system. Responses of some of these cells to autonomic modulation, for example in the form of tryptase secretion by mast cells or serotonin secretion by enterochromaffin cells, may play a role in the modulation of visceral afferent sensitivity. According to Dr. Mayer, such mechanisms may play a role in the development of stress-induced visceral hyperalgesia. Another form of visceral hypersensitivity may be related to altered arousal or hypervigilance toward visceral sensations. Such hypervigilance can result in decreased tolerance to balloon distension and lower discomfort thresholds. A cognitive factor involved in the development of hypervigilance is an increased threat appraisal of visceral sensations.Functional Brain Imaging TechniquesRecently, functional brain imaging techniques have been used to assess directly the activation of certain regions of the brain in response tovisceral stimulation. Today, these techniques, particularly functional magnetic resonance imaging, are being used to assess activation of brain circuits that process visceral afferent information from the gut.Dr. Mayer noted that there are distinct but overlapping brain circuits that relate to subjective perception of gut sensations, autonomic responses, and pain modulatory responses. Even in terms of subjective gut sensations, different overlapping circuits are present for intensity coding of the stimulus; threat appraisal of the stimulus; and attribution of primary affect, or "unpleasantness".Both serial and parallel pathways are involved in the processing of visceral sensory information and the control of descending modulatory systems. Input from the gut is derived from multiple channels, such as spinothalamic, vagal, and dorsal column pathways; different regions of the brain then code for intensity, appraise the threat of the stimulus, and determine the level of attention the brain attributes to the stimulus and the unpleasantness the patient experiences. These processes are modulated both by the stress- or arousal- activated system and by recollection of past experiences.Intensity Coding, Threat Appraisal, and UnpleasantnessIntensity coding. As visceral sensory information is delivered via the spinal cord, it is encoded for intensity in the anterior aspects of the insula, or visceral sensory cortex. PET scan studies of somatic and visceral experimental pain have shown that the insula most objectively and reliably encodes information. Interestingly, studies have also demonstrated a greater activation of the insula in male IBS patients, compared with female patients, when exposed to the same stimulus intensity.Threat appraisal and unpleasantness. The information that reaches the insula is "appraised" in the dorsal aspects of the anterior cingulate cortex. Blood flow changes in this part of the brain may also correlate with attentional processes and the subjective unpleasantness ratings in response to a somatic stimulus. The ventral (perigenual) cingulate cortex, which is rich in muopioid receptors, functions to encode the affective quality of the stimulus.In a study by Mayer and colleagues, rectal and sigmoid distension resulted in a lower activation of the ventral anterior cingulate cortex in patients with IBS compared with healthy controls, but an increased activation of the dorsal aspects of the anterior cingulate. Increased activation of an unspecified region of the anterior cingulate was also reported by Mertz and colleagues, in a functional MRI study.Modulatory factors. Finally, the CNS processing of sensory experience may be simultaneously modulated by two parallel pathways: memory-based modulation and stress- or arousal-induced modulation. The posterior parietal cortex, or sensory association cortex, forms a network with the hippocampus and the amygdala (the brain's memory centers) as well as with the lateral prefrontal cortex. Somatic pain studies have shown that, in response to a stimulus, the recall of a similar past event, along with subsequent interpretation of this memory in the lateral prefrontal cortex, plays a major role in the threat appraisal of a sensory experience. The second modulatory effect is the stress- or arousal-induced response. The pontine locus ceruleus is activated in response to potentially threatening experiences. This region then projects to nearly all other regions of the brain that receive visceral input, causing secretions of norepinephrine and arousal of these sections of the brain. When the secretion of norepinephrine is excessive, these target regions are inhibited. It is of interest that descending projections from the locus coeruleus complex to the sacral spinal cord appear to play a major role in the modulation of distal colonic motor and secretory function.ConclusionBrain imaging and other studies of IBS pathophysiology indicate that the perception of gut stimuli and altered autonomic responses to these stimuli are affected by activation of various parts of the brain, resulting in increased attention to these stimuli, greater unpleasantness of the subjective experience, greater threat appraisal, and greater arousal in response to visceral sensations. Further study may lead to new developments in treatment for persons with IBS.--------------------------------------------------------------------------------Table 1. Clinical Relevance of Altered Brain-Gut InteractionAltered attentional mechanismso Greater awareness of normally subliminal visceral afferent stimuliAltered affective stimulus processingo Greater unpleasantness of visceral sensations, including heartburn, bloating, fullness, abdominal pain, incomplete rectal evacuationAltered threat appraisalo Leads to fears such as not being close enough to a bathroom anything eaten may trigger abdominal painEnhanced arousalo Shared by clinical conditions frequently overlapping IBS, such as anxiety, panic disorder and PTSDo Arousal reduced by sedatives, anxiolytics, low-dose tricyclicso May respond to relaxation exercises" http://cp.yahoo.net/search/cache?p=ibs+sym.../pcp2000_01.htm Recent Advances in Pathophysiology of Irritable Bowel SyndromeDepartment of Behavioral Medicine, Tohoku University Graduate School of MedicineShin Fukudo, M.D., PhD.The gastrointestinal tract has autonomous activity and responds to the luminal stimuli moment-to-moment. Since theWalter B. Cannon's era, it also has been known that central nervous activity influences on the bowel function. Recentadvances in research clearly demonstrate mutual and reciprocal interactions between these two organs. These phenomena,the brain-gut interactions, are believed to play a major role in pathogenesis of functional gastrointestinal disorders.Irritable bowel syndrome (IBS) is a prototype of functional gastrointestinal disorders. The brain-to-gut effects and thegut-to-brain effects are supposed to form complex circuits.Psychosocial stress is known to exacerbate IBS symptoms. Drossman et al. reported that stress affected bowelfunction in 84 % of IBS subjects or induced abdominal pain in 69% of them. Whitehead et al. confirmed that IBSsubjects showed steeper slope of regression line relating stress to bowel symptoms, suggesting they have a greaterreactivity to stress. To see the effect of of mental stress on the bowel motility, we loaded mirror tracing stress to theIBS patients. The IBS patients showed higher colonic motility index during and after stress than the controls. Welganet al. reported anger increased frequency of myoelectrical activity and motility of the colon in the IBS patients. Thesetwo independent data express the stress-induced pathophysiology of colonic motility in the IBS patients.Simultaneous manometric measurements in the duodenum during and after the mental arithmetic stress expressed lessphase I, period of quiescence, and phase III, period of powerful rhythmic contractions with 11-12 cycle per min, ofmigrating motor complex in the IBS patients. Phase II, period of contractions with irregular intervals, prolonged moreprominently in the IBS patients. Twenty-four hrs prolonged recording in duodenal motility in the IBS patients disclosedexistence of dysmotility patterns during phase II. They were burst activity and clustered contractions. Arousal of thebrain has great impact on duodenal motility. In most individuals, either in the IBS patients or the controls, phase II isdominant during the awake, while it attenuates during the sleep.Dysmotility patterns more than 15 min of duration were limited in the IBS patients during the awake, suggestingprogrammed function of the enteric nervous system is disturbed by perturbations from the brain. Motility patterns of thesmall bowel during sleep were normal in the IBS patients.Power spectral analyses of electroencephalogram (EEG) demonstrated that stress decreased a-power and increasedb-power in the IBS patients and the controls. However, in the IBS patients, these changes were enhanced. Thesefindings implies that the IBS patients may have sensitive brain to stress. Moreover, abnormal sleep patterns of rapid eyemovement (REM) in the IBS patients are also reported by Kumar et al.- 113 ---------------------------------------------------------------------------------Page 2??????? ?????? 2002From these observations, the IBS patients are suggested to have stress-sensitive brain and hyper-reactive bowel. Manyneurotransmitters are supposed to be involved in these mechanisms. Corticotropin-releasing hormone (CRH) is one ofthe most plausible candidates to play a crucial role in pathogenesis of IBS. CRH is a 41-amino acids-peptide producedmainly in the hypothalamus and distributed in the colon. Stress releases hypothalamic CRH, resulting pituitary secretionof adrenocorticotropic hormone (ACTH). In rodents, CRH antagonists inhibits stress-induced alterations in the colonicmotility. Exogenous administration of CRH, intracerebroventricularly or intravenously, accelerates colonic transit. CRHmildly provokes colonic motility in humans. While in the IBS patients, CRH stimulates colonic motility moreprominently. ACTH secretion to CRH in the IBS patients is also exaggerated.Recently, studies on gut-to-brain direction are more focused on the research. That is because progressive knowledgedemonstrates that the brain plays a major role in the integration of the signal derived from the peripheral organs. Thesestudies are performed mainly using the barostat technique. Visceral hyperalgesia in the IBS patients are first reported byRichie and his group, replicated by Whitehead, and further investigated by Mayer et al. Repetitive mechanicalstimulation of the sigmoid colon provoked increase in colonic motility in the descending colon of the IBS patients,suggesting visceral hyperalgesia and simultaneous abnormal intramural reflex. Cerebral evoked potentials, as shown inthe first negative1-positive1-negative2-triphasic waves, were obtained using EEG recordings during the gut stimulation.IBS patients have abnormal patterns of viscerosensory evoked potentials. IBS patients were reported to have abnormalactivation patterns of the regional cerebral blood flow in response to the mechanical distention of the rectum.In this context, the IBS patients have stress-sensitive brain, hyper-reactive bowel motility, and visceral hyperalgesia toa larger or lesser extent. The initial involved point may be either. This notion is also supported by the report fromRead's group in the Lancet. When acute enterocolitis hits the bowel, patients with high scores for anxiety, depression,somatization, and neurotic trait become IBS. Once the vicious cycle is formed, visceral hyperalgesia will changeintramural reflex as well as brain neurotransmitter release, resulting exaggerated stress-sensitivity. Therapeutic approachfor IBS should be performed along these knowledge. Further investigations on reciprocal brain-gut interaction in IBS iswarranted.- 114 - http://cp.yahoo.net/search/cache?p=+hyper+...ng/07806192.pdf Altered Visceral Perception Modulation Confirmed In Irritable Bowel PatientsA DGReview of :"Irritable bowel syndrome patients show enhanced modulation of visceral perception by auditory stress."American Journal of Gastroenterology01/29/2003By Elda HauschildtPatients with irritable bowel syndrome (IBS) have altered stress-induced modulation of visceral perception, confirms research from the United States.Investigators, from the University of California at Los Angeles, found that IBS patients rate visceral stimulus during stress significantly higher in terms of intensity and unpleasantness than do healthy controls."IBS patients also reported higher ratings of stress, anger and anxiety during the stress compared with the relaxing condition, whereas controls had smaller and non-significant subjective responses," they explain.Symptoms from IBS are known to be sensitive to psychological stressors. This could occur because of enhanced responsiveness of the emotional motor system, a network of brain circuits modulating arousal, viscerosomatic perception and autonomic responses associated with emotional response, the researchers point out.Rectal balloon distension during experimentally induced psychological stress was used to test psychological reactions in 15 IBS patients and 14 healthy controls to assess whether IBS patients demonstrate altered perceptual response.The mild stress condition involved dichotomous listening to two conflicting types of music. The control condition also involved listening but to relaxing nature sounds. Stress and relation stimuli were delivered over a 10-minute listening period preceding and during rectal distensions.Intensity and unpleasantness ratings measured included visceral sensation, subjective emotional response and heart rate. Neuro-endocrine measures were also taken.The investigators found that unlike healthy controls, IBS patients gave significantly higher ratings of the visceral stimulus in terms of intensity and unpleasantness.American Journal of Gastroenterology, 2003; 98: 135-143. "Irritable bowel syndrome patients show enhanced modulation of visceral perception by auditory stress." http://www.docguide.com/news/content.nsf/n...52568880078C249 Stress and the GutDr. Howard MertzAssociate Professor of Medicine and RadiologyVanderbilt UniversityStress is a ubiquitous condition that affects all people. Stress can be mental or physical, although in the context of this article the focus will be mental stress. Mental stress involves challenge, threat or worry about future adverse events. Such stress activates the brainï¿½s stress response systems, which in turn effect the body. Many of the bodyï¿½s major systems are altered by stress (cardiovascular, muscular, urinary, gastrointestinal, sweat glands, etc) often with adverse consequences. Gastrointestinal function is particularly influenced by stress. Common gastrointestinal symptoms due to stress are heartburn, indigestion, nausea and vomiting, diarrhea, constipation and associated lower abdominal pain. These symptoms and the alterations in intestinal function that cause them are becoming understood.Gastrointestinal Stress Reactions in Animals and CRFIn animals such as rats, stress can be induced in experimental situations. When rats are wrap restrained, or placed on a small platform surrounded by water they become stressed. During these situations, alterations in motility of the gut occur. The upper gut, including the stomach and small intestine, exhibits markedly reduced transit. This may be a defense mechanism to promote vomiting and reduce oral intake. Conversely the large bowel motility increases with increased stool output and transit speed. This may be a defense mechanism to eliminate toxins. We have learned that a hormone called corticotropin releasing factor (CRF) influences these changes. CRF is released from nerve cells in the hypothalamus of the brain. These nerve cells release the hormone via long processes into other parts of the brain such as the locus ceruleus, where arousal and autonomic nervous system changes are mediated. In rats, injection of CRF blockers into the brain fluid diminishes the stress induced motility changes in the gut. CRF directly injected into the brain fluid mimics the stress response closely (Figure 1). CRF also stimulates the gut directly via CRF-1 and CRF-2 receptors. CRF-1 receptors stimulate colonic contractions, while CRF-2 receptors reduce upper gut activity. Antagonists to CRF-1 receptors are currently being tested for treatment of depression, and may become available for testing in functional bowel disorders as well.Brain Areas Involved in Stress ReactionTwo of the primary brain regions involved in stress reactivity are the hypothalamus and the locus ceruleus. Activation of the hypothalamus by stress is likely to be mediated in part by the limbic brain (particularly the amygdala and hippocampus) and partly by the locus ceruleus in the brainstem. The locus ceruleus and the hypothalamus actually stimulate each other, creating the potential for a vicious cycle, where a stress reaction in one region stimulates the other, which in turn stimulates the first to react even more. The limbic system is a group of connected and related brain regions that mediate emotions and flight or fight attitudes. The limbic or ï¿½emotional brainï¿½ is more primitive by evolutionary standards, and is not necessarily under control by the higher intellectual cortex. This system receives sensory and higher cortical inputs, calls upon memories and determines the threat level imposed by a stimulus. The amygdala for instance is a limbic structure in the base of the brain that is important in anger and rage. In cats, electrical stimulation of the amygdala causes hissing, back arching and the hair to stand on end, typical of anger and defense postures in cats. In animals that have damage to the amygdala a placid state results in which anger cannot be induced. Inputs to the amygdala are thought to originate from the hippocampus, the cingulate cortex and other parts of the limbic sytem. The locus ceruleus is located in the pontine portion of the brainstem. The locus ceruleus is the source of most of the stimulant neurotransmitter norepinephrine in the nervous system. Cells here project to other brain areas, releasing norepinephrine to activate other systems and increase arousal and alertness. Release of norepinephrine increases heart rate, blood pressure and primes the muscles and nervous system for fight or flight. This reaction is not helpful in routine stress of daily activities. If the stress reaction is excessive or the perceived threat too frequent, tachycardia (racing heart), hypertension, muscle tension, bowel spasms and dyspepsia can result.Hypothalamic-Pituitary-Adrenal AxisCRF release is the first step in activation of the hypothalamic-pituitary-adrenal axis (HPA axis) involved in stress response. This is the major endocrine (hormonal) response system to stress. Release of CRF by the hypothalamus stimulates the pituitary gland immediately underneath it. The pituitary gland responds to CRF by release of adreno-corticotropic hormone (ACTH) to stimulate adrenal gland secretion of the stress hormone cortisol. Cortisol promotes fluid and salt retention and impairs inflammation, functions helpful in the short term during flight or fight situations or injury. Again, if the HPA system is activated too frequently adverse health outcomes such as hypertension (from salt retention) and impaired immune function (from excess cortisol) may result. The CRF system and the norepinephrine systems work together to respond to stress with resultant changes in bodily functions that prepare for flight or fight. (Figure 2)Gastrointestinal Stress Response in HumansHumans respond to stress in similar ways to animals. A variety of human studies indicate stress promotes decreased gastric emptying and accelerated colonic transit in normal volunteers. A pioneering study by Almy measured colonic contractions during flexible sigmoidoscopy. The volunteers were told that a cancer was found, leading to abrupt increases in colonic contractions, which resolved after the hoax was explained. Other stressors such as ball-sorting, driving in city traffic and mentally challenging listening tasks similarly increase colonic contractions and reduce gastric motility. Recent data also indicates that intestinal sensitivity increases with stress compared to relaxation. This effect may lower the threshold for sensing intestinal events. In gastroesophageal reflux for example, psychological stressors can increase heartburn symptoms. Analysis of the esophageal pH (measurement of acid) indicates that the amount of reflux doesnï¿½t increase during stress, but the probability of feeling a reflux as heartburn does increase. In one small study of normal controls, intravenous infusion of CRF induced greater rectal sensitivity to balloon distension. It may be that the sensitizing effects of stress on the gut are partly mediated by the stress hormone CRF.Irritable Bowel Syndrome and Functional DyspepsiaTwo of the major causes of uncomfortable or painful intestinal symptoms are irritable bowel syndrome (IBS) and functional dyspepsia. IBS occurs in approximately 12% of people world-wide. Dyspepsia (indigestion/upper abdominal discomfort) is also very common. The majority of dyspepsia is functional, that is not associated with ulcers, gallstones, reflux esophagitis or cancer. In both of these common disorders, motility and sensory changes are present which mimic the stress state. Both disorders demonstrate hypersensitivity of the gut (either stomach or intestine). Both disorders demonstrate alterations in motor function of the gut typical of stress and CRF-induced changes. In functional dyspepsia the stomach generally has mildly reduced emptying and reduced accommodation of meals. In IBS, colonic contractions are generally increased. Furthermore, IBS subjects appear to have increased stress responsiveness in the gut. In one study, IBS patients and healthy controls both underwent ambulatory motility recordings in the colon. Both groups were confronted on return to the lab (ï¿½youï¿½re lateï¿½, ï¿½you came to the wrong windowï¿½, ï¿½now the study may need to be repeatedï¿½). Colonic motility jumped up in the IBS patients during confrontation, but not in healthy volunteers.(Figure 3) IBS patients may also have greater sensitivity to the stress hormone CRF. Infusion of CRF intravenously to IBS patients and controls in one study caused significantly greater colonic motor responses in IBS patients. Another study indicates that listening stress increases rectal sensitivity to balloon distension in IBS patients but not controls. It appears both intestinal motility and sensory responses to stress are heightened in IBS patients. These alterations are likely to cause symptoms such as diarrhea and intestinal cramps due to increased contractions of the gut and increased sensitivity of the gut during stress. The chemical mediators of these changes are not yet established, although alterations in CRF release or CRF receptors may be implicated to some extent in functional bowel diseases.IBS (and other functional bowel symptoms) are generally worsened by stress. In fact recent research has indicated that IBS symptoms tend to resolve in those without major psychosocial stressors. Conversely, symptoms are persistent in subjects with ongoing ï¿½threateningï¿½ psychosocial stressors. The onset of IBS and functional dyspepsia often begin with bereavement, abuse or other major negative life events. Emotional distress is very common in IBS patients, particularly those who seek medical treatment for the condition. Anxiety and depression are significantly increased in IBS patient populations, present in nearly 40%. Psychosocial distress appears much less common in IBS sufferers who do not seek medical care. Population based surveys, however, do still suggest tendencies toward emotional reactivity in people with IBS. Accordingly, stress modification, psychotherapy and hypnosis appear helpful for IBS and functional dyspeptic symptoms. Tricyclic antidepressants also appear effective for IBS and other functional bowel symptoms, even in low doses. Recent evidence indicates the drugs may work by reducing the brainï¿½s response to intestinal pain during stress. Sedatives such as the benzodiazepine Librium can reduce the effect of stress on the gut. During ball sorting challenge, Librium blunts the colonic motor response to mental stress in IBS patients. This effect may explain the benefits of combined sedative-anti-spasmodic drugs for IBS.SummaryThere is much yet to learn about the effects of stress on the gastrointestinal tract. The exact neural and hormonal pathways that mediate excess gut sensitivity and altered contractility during stress are not defined. Where these pathways are excessive or dysfunctional in IBS, functional dyspepsia and other GI disorders is unclear. Specific neurotransmitters are likely to underlie the gastrointestinal stress reaction, and may be amenable to pharmacologic blockade. Psychological therapies are likely to blunt the stress response as well. New tools such as brain imaging to study brain responses to stressors and drugs, and molecular biology to study function of neurotransmitters and their receptors are likely to lead to better understanding of the stress response and its role in disease states. Based on this knowledge, advances in pharmacology may lead to better drug therapies to address these important health problems.www.med.unc.edu/wrkunits/...elcome.htmFYIFrom Medscape GastroenterologyMEDLINE Abstracts: Serotonin Signaling and Visceral Hypersensitivity in IBSPosted 10/23/2003What's new concerning the role of serotonin signaling and mechanisms of visceral hypersensitivity in the pathophysiology of irritable bowel syndrome (IBS)? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Gastroenterology.--------------------------------------------------------------------------------Serotonin and Its Implication for the Management of Irritable Bowel SyndromeGershon MDRev Gastroenterol Disord. 2003;3(suppl 2):S25-S34Our understanding of the enteric nervous system (ENS) has evolved from the "classical" view, in which the brain controls all enteric behavior, to the current view, which holds that enteric innervation is one of local control within the bowel, modified by a bidirectional "dialogue" with the brain. The ENS independently controls enteric reflexes through intrinsic primary afferent neurons, which monitor intraluminal conditions. This monitoring is accomplished through the use of enteroendocrine cells in the mucosa, the best known of which are the serotonin-containing enterochromaffin cells. This article describes the roles that serotonin, specific serotonin-receptor subtypes, and the serotonin reuptake transporter play in the ENS and in the communication between the ENS and central nervous system. The way in which these findings have implicated serotonin in irritable bowel syndrome is discussed.Systematic Review: Serotonergic Modulators in the Treatment of Irritable Bowel Syndrome--Influence on Psychiatric and Gastrointestinal SymptomsKilkens TO, Honig A, Rozendaal N, Van Nieuwenhoven MA, Brummer RJAliment Pharmacol Ther. 2003 ;17:43-51Background: Both central and peripheral serotonergic modulators are used in the treatment of irritable bowel syndrome. The majority of patients with irritable bowel syndrome presenting to a gastroenterologist demonstrate affective dysregulation. Serotonin may play a regulatory role in both gastrointestinal motility and sensitivity, as well as in affective dysregulation, in irritable bowel syndrome.Aim: To analyse, systematically, randomized controlled trials studying the influence of serotonergic modulators on both gastrointestinal and psychiatric symptoms in irritable bowel syndrome, in order to elucidate baseline irritable bowel syndrome symptomatology and possible differential effects of serotonergic modulation on this symptomatology.Methods: A standardized qualitative analysis was performed of studies investigating the influence of serotonergic modulators on both gastrointestinal and psychiatric symptoms in irritable bowel syndrome using a blind review approach. The studies were ranked according to their total quality score (maximum 100 points).Results: Eleven studies fulfilled the entry criteria, six of which scored above 55 points. An association between gastroenterological and psychiatric changes was present in five of the six studies.Conclusions: The results strengthen the serotonergic association between gastroenterological and psychiatric symptoms. Adjusted guidelines for combined gastrointestinal and psychiatric assessments are recommended in order to further elucidate the serotonergic interaction between gastrointestinal and psychiatric symptoms.Tegaserod and Other Serotonergic Agents: What Is the Evidence?Chey WDRev Gastroenterol Disord. 2003;3(suppl 2):S35-S40Through effects on gastrointestinal motor and secretory function as well as visceral sensation, serotonin (5-HT) plays a key role in the pathogenesis of irritable bowel syndrome (IBS). In particular, 5-HT3 and 5-HT4 receptors appear to be very important in IBS. This article critically appraises the evidence supporting the use of the 5-HT3 receptor antagonist alosetron in the treatment of women with diarrhea-predominant IBS. The safety profile and restricted-use program for alosetron is also reviewed. This discussion is followed by a comprehensive review of the efficacy and safety data in support of tegaserod for women with constipation-predominant IBS.Sex Differences of Brain Serotonin Synthesis in Patients With Irritable Bowel Syndrome Using Alpha-11C Methyl-L-Tryptophan, Positron Emission Tomography and Statistical Parametric MappingNakai A, Kumakura Y, Boivin M, et alCan J Gastroenterol. 2003;17:191-196Background: Irritable bowel syndrome (IBS) is the most common functional bowel disorder and has a strong predominance in women. Recent data suggest that the brain may play an important role in the pathophysiology of IBS in the brain-gut axis. It is strongly suspected that serotonin (5-HT), a neurotransmitter found in the brain and gut, may be related to the pathophysiology of IBS. It is reported that a 5-HT3 antagonist is effective only in female patients with diarrhea-predominant IBS.Objective: In the present study, 5-HT synthesis was measured using positron emission tomography, with alpha-11 Cmethyl-L-tryptophan as the tracer, in patients with IBS. The aim of the present study was to compare 5-HT synthesis in the IBS patients with that in the controls, and to compare 5-HT synthesis between male and female IBS patients.Methods: Six male and six female nonconstipated IBS patients were scanned. Age-matched healthy volunteers were scanned as controls. Eighty minute dynamic scans were performed. Functional 5-HT synthesis images were analyzed using statistical parametric mapping.Results: 5-HT synthesis was greater only in the female IBS patients in the right medial temporal gyrus (multimodal sensory association cortex) compared with the female controls (P 0.001).Conclusions: The greater brain 5-HT synthesis in the female IBS patients than in the controls may be related to the pathological visceral pain processing of the IBS patients, a larger female predominance of the disorder, and the sex difference of the efficacy of the 5-HT3 antagonist in treatment.Sex-Related Differences in IBS Patients: Central Processing of Visceral StimuliNaliboff BD, Berman S, Chang L, et alGastroenterology. 2003;124:1738-1747Background & Aims: Women have a higher prevalence of irritable bowel syndrome (IBS) and possible differences in response to treatment, suggesting sex-related differences in underlying pathophysiology. The aim of this study was to determine possible sex-related differences in brain responses to a visceral and a psychological stressor in IBS.Methods: Regional cerebral blood flow measurements using H(2)(15)O positron emission tomography were compared across 23 female and 19 male nonconstipated patients with IBS during a visceral stimulus (moderate rectal inflation) and a psychological stimulus (anticipation of a visceral stimulus).Results: In response to the visceral stimulus, women showed greater activation in the ventromedial prefrontal cortex, right anterior cingulate cortex, and left amygdala, whereas men showed greater activation of the right dorsolateral prefrontal cortex, insula, and dorsal pons/periaqueductal gray. Similar differences were observed during the anticipation condition. Men also reported higher arousal and lower fatigue.Conclusions: Male and female patients with IBS differ in activation of brain networks concerned with cognitive, autonomic, and antinociceptive responses to delivered and anticipated aversive visceral stimuli.Functional Brain Imaging in Irritable Bowel Syndrome With Rectal Balloon-Distention by Using fMRIYuan YZ, Tao RJ, Xu B, et alWorld J Gastroenterol. 2003;9:1356-1360Aim: Irritable bowel syndrome (IBS) is characterized by abdominal pain and changes in stool habits. Visceral hypersensitivity is a key factor in the pathophysiology of IBS. The aim of this study was to examine the effect of rectal balloon-distention stimulus by blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI) in visceral pain center and to compare the distribution, extent, and intensity of activated areas between IBS patients and normal controls.Methods: Twenty-six patients with IBS and eleven normal controls were tested for rectal sensation, and the subjective pain intensity at 90 ml and 120 ml rectal balloon-distention was reported by using Visual Analogue Scale. Then, BOLD-fMRI was performed at 30 ml, 60 ml, 90 ml, and 120 ml rectal balloon-distention in all subjects.Results: Rectal distention stimulation increased the activity of anterior cingulate cortex (35/37), insular cortex (37/37), prefrontal cortex (37/37), and thalamus (35/37) in most cases. At 120 ml of rectal balloon-distention, the activation area and percentage change in MR signal intensity of the regions of interest (ROI) at IC, PFC, and THAL were significantly greater in patients with IBS than that in controls. Score of pain sensation at 90 ml and 120 ml rectal balloon-distention was significantly higher in patients with IBS than that in controls.Conclusion: Using fMRI, some patients with IBS can be detected having visceral hypersensitivity in response to painful rectal balloon-distention. fMRI is an objective brain imaging technique to measure the change in regional cerebral activation more precisely. In this study, IC and PFC of the IBS patients were the major loci of the CNS processing of visceral perception.Role of Visceral Sensitivity in the Pathophysiology of Irritable Bowel SyndromeDelvaux MGut. 2002;51(suppl 1):i67-i71Visceral hyper


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## mtbike61384 (Dec 8, 2003)

I think that most people would agree with me when I say that they would not care if they were "cured" as long as they didn't feel the pain and discomfort associated with ibs. Like Dr. D said earlier, when you have a headacke you are not lacking Tylenol in the system. But millions of people pop a pill so they won't feel the pressure. Since we don't even know exactly what causes ibs, why not try to mask the symptoms and feel better?


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## Jhouston (Nov 9, 2003)

This is ridiculous. Science is GOOD. Ibs is a SYNDROME. like CFSD. I read IBS is FUNCTIONAL. IBS is not a disease. Therefore, it cannot be cured. Have I got that correctly? Dr D is helping people with GI symptoms. The only reason I can see for using the term IBS is because that is the "dx" given. a functional GI disorder. Like I said before True IBS is most likely a very small percentage of "IBS". Joann


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## Jhouston (Nov 9, 2003)

Kel, What do you think about low Acidophilus and Bifidus after taking it for years? It doesn't implant? Stomache acids destroy it so it does not get to lower GI? Joann


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## drdahlman (Nov 6, 2000)

BackFire44, Can't disagree with much of what you've said and you suggest an interesting concept. That science may validate that IBS isn't caused by any one thing, that it's caused by a variety of issues.Possibly, science may abandon the term IBS and relaize that a bacterial infection doesn't cause IBS, it causes GI symptoms in some people. That a fructose intolerance is not IBS, it just causes GI symptoms in some people.That candida is not IBS, an overgrowth just causes symptoms in some people. That lactose intolerance is not IBS, it just causes GI symptoms in some people.It is possible that science will validate these ideas, but then we have the problem of what they would tell the pharmacuetical companies. How do you produce a pill that addresses all of these issues or just some of them.I understand your thoughts, and even though I mentioned cancer and antibiotics, that still leaves heart disease, high blood pressure, high cholesterol, stroke, Type II Diabetes, arthritis, headaches, depression or auto-immume disease just to name a few. Where are the cures for these?Eric, My how peaceful it has been without you. I don't answer, not because I cannot or don't have the experience to....I don't answer because you're irrelevant to what we are trying to accomplish here. In the meantime, everyone who allows me to guide them through my entire program completely eliminates their symptoms.


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## loulou (Jan 18, 2001)

The only thing "Dr. " D is helping people with is depleting their bank accounts. He's a crook.


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## drdahlman (Nov 6, 2000)

Well said JHouston. Again, as I said, this is a person who "gets it".The good bacteria may not implant for a number of reasons. It might be "non-implantable" like Primal Defense. It might be poor quality and not even survive shelf life of 6 months. It has to be taken on an empty stomach. It should be refigerated even though some brands say that you don't need too. (This is a controversy, though possibly some strains don't need to be, but do they implant?) Your body might develope an immune reaction to what you're taking. Purchases at the health food store are a shot in the dark.Also, there may be lifestyle issues that kill it off and you never have a permanent population. Occasional prescription antibiotics or herbal anti-microbials would keep it at low levels. An alcoholic might be considered to have lower levels. Someone on many prescriptions could damage their population, who knows? Conceiveably, the anti bacterial chemicals in tap water could also kill it off, after all, that's what the chemicals are put in there for.Once in a great while, I find a patient in who I can't get the population to implant. I then switch to another brand and take shopts in the dark to see if we can get the job done. Very rare, though.


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## kel1059 (Feb 28, 2003)

hey flux is back.


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## Jhouston (Nov 9, 2003)

Dr D, I was taking Solgar brand Advanced Acidophilus. I took it at night on an empty stomach. regrigerated it even though it satates it does not need. no alcohol etc. it seems worthless. I wonder if any gets through to lower GI. Joann


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## kel1059 (Feb 28, 2003)

jhouston,i am not certain what is happening. i used to buy brand after brand of probiotics just to be certain i was getting a good one. many times i would take 3 brands at the same time.i do know that for every bifidus product i probably took 10 acidophilus products (probiotic).most of the yogurt that i made was either acidophilus or an acidophilus/ bifidus blend.maybe the acidophilus outcompeted the bifidus in the culture.not sure of what happens, but i am going to be INCREDIBLY diligent with bifidus. i will never miss a dose. this is our plan (dr d and mine)**********************************************************************by the way, loulou who i think is flux, called dr d a crook.dr d has already saved me money by critiquing a very expensive product that a nutritionist has been selling me.i politely argued with the nutritionists claims about Juice Plus+ and dr d backed it up when i merely mentioned the product.he confirmed that the product was extreme hype, and i will no longer purchase it ----noe will i purchase some other garbage product that i fiercely debated the nutritionist over. some garbage product with .....forget it (it is from Infinity).dr d seems to have an extreme knack for the practical.


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## Gret (Sep 23, 2003)

How are we defining "science"? To me science is:the ability to produce solutions in some problem domain. With other variables, of course. Dr. Dahlman's approach is scientific! He's working with chemical balances and imbalances. Probably sounds too imbecile to many of you. I don't have the time nor the desire to worry about what's being implanted where. I just want to get well. I have too many other things to think about. If someone can tell me how to get well, I'm going to just do that - get well. However, I admire the extent to which many of you are willing to go to understand all that is going on inside of you. It's just more than my mind can wrap around right now.


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## eric (Jul 8, 1999)

How many Chriopracters mapped the human Genome? Which they thought would take years?Basic science did that and already huge strides have been made in biology. This is the biological revolution going on right now and it is happening so fast they cannot even keep up with it!Science has ALREADY ABANDONED candida as the cause of IBS and fructose intolerence as IBS and and lactose intolerence as IBS? Where have you been?This is part of the problem with your information, because it doesn't seem you are up to date at all on IBS.For a fact you don't actually do research on IBS, with a microscope and physically look in to the digestive system yourself!!! So where do you get your information from if not from science, or is your science only and what you want to believe and your opinion and want others to believe it also? Cause that is all I am seeing.How do you know what bacteria each person needs in the gut? Nobody knows that and it changes all the time anyway due to a persons environment and even where they live location wise, someone in NY does have the same as someone in Cal.?Using that logic, stomach cancer and IBD would be IBS. I do agree there maybe subgroups with different reasons for IBS.But DR Dahlamn what cause viceral hypersensitivity?What cause altered motility?Interesting also to bash the drug companies and then use a MLM OTC sales business? Where and how were those items TESTED?Whats the difference between people like you selling OTCs and people selling drugs. They are both businesses?


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## brushie (Jul 17, 2002)

reminded on the company by kel the post before,want to share this result from an test magazine from germany, called "ï¿½ko-test"they found a quite big quantity of gene soya in an juice plus diet drink back in 98. i put the text in the abacho.de translator: (hope its understandable) the source is from www.oekotest.de


> quote: Four of the most well-known Diaetdrinks contain genetically changed Soja. The Freiburger laboratory gene CAN and of Bremen Hanse analytics found to the bio standard Diaetdrink hereditary property of genetically altered soy beans with an investigation on behalf of OEKO TEST in Herbalife Formula 1, Juice Plus+Lite, in Slim nearly and. Gene CAN proved partly unusually high quantities of changed hereditary substance in these products. The result shows that it concerns no longer only traces from gene Soja, which were dragged for instance in the case of transport or with the processing inadvertently into the product. Who strives nowadays Soja finished and not particularly for such from genetic engineering-free production, it must count on the fact that its Soja contains several per cent of genetically altered beans. Because the Gensoja from the USA and increasingly also from South America is transported and supplied mixed with conventional Soja. From conventional Soja the Roundup ready Soja of the company Monsanto, who was found in the Diaetdrinks, differs by an additional gene. With its assistance the manipulated plant poison showers with the weed killer Roundup projects. Possible side effects of such genetically manipulated food are not so far clarified. Critics fear however that Allergiker do not know any longer, whether in the food for it dangerous materials are contained. Also from ecological view there are doubts: By the resistance against weed killers gigantic monokulturen will receive. In addition the danger exists that changed hereditary property will transfer unplanned to other kinds. Diaetdrinks are not disputed however only because of gene Soja, as our test shows in the OEKO TEST special edition health. Who wants to decrease healthy, finds there also alternatives without such finished drinks. You get the special edition at the kiosk or with the map apart from S. 90 for 12,80 Marks plus 2,50 Marks postage.


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## eric (Jul 8, 1999)

Answer me this Dr D, if you can't cure someone after telling them you can, what phycologically is that going to do to a person and what will that do to their IBS symptoms? Does it have the possiblity to make them worse?And please don't tell me you tell me you can cure every gi symptom and condition on the planet.


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## Trinity (Sep 9, 2002)

eric wanted to know where I was. I already posted this but I will again. I got a stomach ache and some indigestion from the supplements so I am also waiting for results of a stool test from Great Smokies


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## eric (Jul 8, 1999)

Thank you Trinity for the update because that is important.have you ever read this on there site? The Fight or Flight Response in Irritable Bowel SyndromeOveractivation Linked to Predominance of Diarrhea SymptomsAn 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" sympatheti 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 affecting the body's response to stress, measuring salivary cortisol levels at four times during the day. A single DHEA assay and a DHEA/cortisol ratio is included to evaluate adrenal balance. http://www.gsdl.com/news/connections/vol12...30.html#anchor2 Something I have been pointing out here on the bb for years now. It is also a big reason why people have troubles especially in the mornings when cortisol leves are at there highest.


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## kel1059 (Feb 28, 2003)

> quote: Thank you Trinity for the update because that is important.


eric you are misinterpreting this information. it means that trinity probably has a problem with microbes.trinity were you taking enzymes -- i think that he has us hold off on that for a while correct???eric,i don't think trinity has a stress problem. if anything she is stressed due to the headache of this problem.


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## kel1059 (Feb 28, 2003)

eric,don't you ever worry about the fact you are breaking the law by posting those 88 inch abstracts that clog up the bandwidth and frustrate the living heck out of us?(copyright laws--- unauthorized use of information)


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## eric (Jul 8, 1999)

Everything I have posted are abstracts or parts of the articles in quotes with links to the sites.In a lot of cases I have permission from the sources as well if I post the whole paper.as a webmaster I am aware of the internet.


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## m_m_forth (Oct 21, 2003)

Eric. That article is excellent. That is EXACTLY where I am at. Now that I am working on my stress and anxiety, I am really experiencing some relief! Thanks for all the great info that you supply us with. Know that many of us appreciate it!


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## drdahlman (Nov 6, 2000)

I use no MLM (Multi Level Marketing) products. Haven't found any that get EVERY patient well who allows me to guide them through my whole program.


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## BackFire44 (Nov 19, 2003)

Gret, you are right in a sense. Technically, of course what Dr. Dahlman is doing is science. However, there are ways to validate certain treatments. Evidence of how many people have been helped is one way to validate a treatment, but it is not the best way because it can't show cause and effect.Consider my brandy example again. Is the fact that ten people in my family think they have gotten better by taking brandy when they have the flu proof that it works? It is some evidence, but its not the best evidence; and the fact remains that it really didn't help them in the way they think that it did. Science would require a group of people, half of which took brandy and half of which took something that tasted like brandy, but wasn't. Then, both groups would not know what they were taking. If the group that took the real brandy improved, then we have better evidence that they are linked.Of course, though, I agree with you -- like you, I don't care if I get better through a placebo effect or through something that is actually physically fixing the problem. All I care about is getting better. That's why I'm not so quick to criticize Dr. Dahlman. I think a doctor who is attentive to you can do more for your IBS than most drugs can right now. As I said, I would guess that some of his methods will be shown to be scientifically based and some will be shown to be unnecessary, but the fact that he is so attentive is probably why his patients have so much success.


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## Trinity (Sep 9, 2002)

eric, I don't have alot of time to read long abstracts but I don't have a problem with stress. I have a structural problem that allows contents from the cecum to reflux back into the ileum, causing leaky gas. I don't have D ever or even cramping and bloating. I don't even believe I have true IBS if you go by the definition. But if you go by diagnosis, I'd say about 15 of the GI doctors I went to diagnosed IBS.of course they all just fell in line once one doctor diagnosed it and came up with the same thing.It wasn't until I emphasized to one GI doctor, SIX YEARS LATER that i was tired of the same old diagnosis and treatments that didn't work and insisted thatsomething popped while straining and I've had GI symptoms ever since that I finally got a different diagnosis. But I bet if I started seeing other GI doctors again and didn't mention the Mass General Doctor's diagnosis and just told them my symptoms, showed them the normal test results I' d continue to be diagnosed with IBS. At the time I KNEW something had happened to the intestine which was causing my problems, I just didn't know what until the doctor said I'd blown out the ileocecal valve. I had been fine for over 35 years and as soon as I felt that pop in the lower right hand side, I've never been right since. So because I'm busy and overworked, I don't have time to read anything except that which i believe pertains to my problem, that is leaky gas, bacterial overgrowth, or incompetent ileocecal valve


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## BackFire44 (Nov 19, 2003)

I don't want to speak for eric, but I did want to note that everyone has a problem with stress to one degree or another. You don't have to "feel stressed out" to have a problem. Stress is an insipid creature, and unless you are the Dalai Lama, everyone can benefit from stress reduction techniques. They can only help, and I think if you gave some of them a good try, you'd realize their benefit. Stress doesn't cause IBS and a lack of stress won't cure IBS, but lowering stress will help your symptoms.


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## Gret (Sep 23, 2003)

I'd have to agree with Backfire. Stress doesn't cause IBS, but it makes it worse. I've been trying different relaxation techniques since high school. Some work, most don't. My mind is pretty shut to the relaxation thing. If I could, I know I'd feel better about a lot of things! I'm not a highly stressful person though. Most things are manageable in my world!


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## Gret (Sep 23, 2003)

Dr. Dahlman told me I could experiment with gas-producing foods such as beans. I tried some green chile stew with pinto beans last night and haven't had adverse effects from it. I would love to not worry about diet restrictions! Can't try dairy for another 6 to 8 weeks, I think.


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## eric (Jul 8, 1999)

Trinity, do you have antisipatory anxiety you will have another attack? Is your condition stressful and worrisome in and of itself?


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## Trinity (Sep 9, 2002)

I don't know what you mean by anticipating another attack. I never have any attacks, I have leaky gas 24/7, no matter whether I'm at work, home, or just out taking a walk. Or whether I limit my diet or eat whatever. I don't have D, bloating, cramping, distention, so no I'm not worried about getting any attacks since I don't get them anyway. The condition is stressful as any condition is which is chronic and no cure but is not the cause or the reason why I still have problems. If they had a solution for the structural problem, I wouldn't have any problems. lgloscontimico9non He tyince soininconstioaoSo no I don't anticipate any attackstaat


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## mtbike61384 (Dec 8, 2003)

One weird thing about the whole ibs deal is that now I feel much better but have some gas that will hang around and make some funky noises in my stomach and intestines. Does anyone else have some weird noises like very loud gurgling and what sounds like internal farts? Kind of weird I think. All I know is that it is gas moving around or something.


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## Arnie W (Oct 22, 2003)

mtbike, I know EXACTLY what you're talking about, except that my internal rumbling is often inaudible, except for when it's stomach gurgling. The worst sensation for me is in the anal area.If you've had so many improvements in other areas, and I guess that's by getting the bacterial levels sorted out, maybe your residual problems are from swallowing air, eating too fast, etc. And let's face it, this can happen to 'normal' people as well. Just food for thought.One thing I have learned while following Dr Dahlman's protocol is to be particularly aware of how I eat my food. It is typical for me to eat on the run, gobble my food and not chew it properly. I guess it is as important to watch not just what we eat, but how we eat.


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## Gret (Sep 23, 2003)

Arnie's probably right about how we eat! My mom used to (and probably still does!) get hiccups every time she sat down to dinner. She probably gulped the first bite or two and took in air.I get the same noises as you do, mtbike. My students think I never eat, they think it's my stomach, but it's a different feeling than that.


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## BackFire44 (Nov 19, 2003)

I must agree -- Dr. Dahlman definitely has that going for him. I actually time myself to make sure that I don't eat so quickly. Gulping things down and barraging my stomach and colon with food is a sure fire way to get discomfort and perhaps symptoms.


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## BackFire44 (Nov 19, 2003)

Gret, how are you doing? Do you continue to improve with Dr. Dahlman's methods? Also, there were many others who were trying out Dr. Dahlman. For all of you, are you improving? Is it slow going? Is anything not working?


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## brushie (Jul 17, 2002)

Hi all together.I had my second appointment with dr.dahlman today.I startet 2 weeks ago with the products i listed above in the thread.







as i am i took only the half herb dosage in the first week. Sofar i have one quite remarkable change: as mt.biker i feel better overall. its the first improvement of energy and toxicfeeling since my symptoms startet 5 years ago. dont know where it comes from.maybe its from the herbs as mtbiker is also on the herbs and experiences similar improvements in overall feeling? you still feel like going more downhill mtbiker







?my bloating and distention wich i get esp. after meals didnt really change, but i have an emptyer belly feeling. I also experienced bit of gurgling and stuck gas.i hope this is the bacteria dieoff.no changes with my coldness syptoms,or low weight sofar.Another thing is that my stool swims less in my toilet,so may have less undigestet fat in it? I have to clean less after defecation but stool is still as mushy.This could be from the products( ithink esp ulcinec) coating the intetines as discribed on the metgenics homepage?Also i have a bit more bowel movements wich for me is a good thing.everyday at least one max. 2 so far. before i had some days without and days upto 4 times. also remarkable is the mornig stool reflex after awakingi had on some days.I never ever had that as i remember,i think its a good sign.I am to go glutenfree now. I cant start it this weekend, would be to problematic but on monday. if i dont get improvement ill go fructosefree too a week after. man, this two together will be hard stuff in the beginning as I never did that 100%lygot some tips what to eat then someone? i cant figure out in first thought. Im gonna search for a good cooking book for that.how are you others? "pressing thumbs"







!brushie


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## bonniei (Jan 25, 2001)

Brushie, There are recipes on the U of Iowa website for fructose restricted diets.I haven't checked if they are gluten free http://www.uihc.uiowa.edu/FRUCTOSE/Recipes.htm


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## Gret (Sep 23, 2003)

Yes, I think I've continued to improved. I told Dr. Dahlman I keep waiting for it to come back. He assures me I'll be fine! I haven't had any attacks of D or even suspected D since before Christmas. I've had a couple days where I feel I can't completely evacuate. It's just a feeling that is "there", not really troublesome. And it's not all the time, only on days after I've had a huge meal. The other day I was on my way to teach and noticed that I hadn't stalled around the house to use the bathroom again! I just got my stuff together and left like a normal person! I felt that was a big sign that I'm getting used to feeling fine! Hope all of you are feeling well today! Have a good one.


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## Gret (Sep 23, 2003)

Maybe I've been an easy patient! Or my symptoms just responded so well to this treatment. I had a "perfect" weekend! No problems at all. When I was at my worst, I was in the bathroom no less than 8 times per day (mostly morning and afternoon) with severe D. It was horrible driving anywhere. I was in a constant state of terror thinking about the next bout of D. I really hope those of you who are on this program get to feeling as wonderful as I do! Good luck, everyone!


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## Arnie W (Oct 22, 2003)

Dr Dahlman asked me if I had access to Metagenics products locally, (I am not in the States) and I decided to find out, as it would save me a lot on postage. By chance there was a distributor/practitioner at my gym, about a mile away from where I live.When I received my first order, the Alpha Flora Plus had not been refrigerated and I didn't pick up that it needed to be until Gret mentioned it in a pm. I mentioned it to the distributor and he said that it could be left unrefrigerated for several weeks. I'm not comfortable with that reply. Did anyone else receive their alpha flora plus/bifidus/dophilus unrefrigerated? I'm just enquiring because if it has lost its potency, it's not worth taking.I do feel that I am making progress, but at this stage it's still important that I am very strict with what I eat. When I re-introduce a certain food, I'll get symptoms, but not as serious as previously. I've now been on the programme for 3 weeks.


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## drdahlman (Nov 6, 2000)

ArnieW, If the AlphaFlora is the same product as the UltraFlora Plus, it most certainly needs to be refrigerated. Find someone who can sell it to you and has it refrigerated!


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## Jhouston (Nov 9, 2003)

Ultra flora NEEDS to be refrigerated BUT when I received in the mail it was not refrigerated. What are you talking about? How could it be kept cold? Joann


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## Arnie W (Oct 22, 2003)

Sorry, I meant Ultra Flora Plus.Joann, apparently there is a way that it can be sent. I made an enquiry and it was going to cost $US50 to have something posted internationally that way, which is a bit over the top.There must be a time limit in which these products can be unrefrigerated before damage occurring, and I'm wondering whether transit in the post would be too long. It's possible that mine could have been in higher temperatures for over 2 weeks. Not wanting to be a scare-mongerer, but I want to do everything to the letter.


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## kel1059 (Feb 28, 2003)

high heat ( 118F is the upper limit where yogurt will not culture correctly) will definitely kill the bacteria, but i think that room temperature is not that much of a problem for a short period of time. i think that refrigeration just prolongs the life of the product.the expiration date on the bottle is the best gauge of its worth. i have had the most trouble culturing bacteria when the probiotic goes beyond the exp date.


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## SpAsMaN* (May 11, 2002)

I'm asking me about the people on the program who said they are better, is it just a manifestation of overpositivities due to the scareness of an incurable digestive problem or, real improvement?


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## Jhouston (Nov 9, 2003)

I have been doing ok But I have a cold so not feeling as good as I could be. Today I put some Cumin seed powder in eggs. I have pain.....not sure if that did it but I am sorry I tried....read somewhere it would help with a cold. Joann


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## mtbike61384 (Dec 8, 2003)

I can honestly say that I really do feel much better. I am still not yet to where I think I should be but well on my way. I have suffered for 5 years now. I know that compared to some that is not long. But it was hell. I had horrible gas pain and cramping. I thought I would pop. But now I only have occasional cramping and some gas. I get the most probably in the morning. It makes total sense because I had so much bacteria inside of me and no acidophallis that my digestive tract could not do its job. I still get gas and bloating in my stomach though. I am not sure what that is from. Maybe because the pills I am taking to kill the bad bacteria are also killing the good. But thats why I take probiotics. But I really do feel better and it is not in my head. I have tried everything and can tell the difference.


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## Arnie W (Oct 22, 2003)

spasman,I have never ever had improvement with countless therapies, supplements, etc, and the placebo effect does not work at all with me. If it did, I would not have the need to visit this site religiously every day.At the moment, I'm having improvement in many ways. A lot of this must be put down to sticking to a tough, boring diet and following the protocols laid down by Dr Dahlman for eating. However, I feel that the supplements are helping too, and I do still have several weeks treatment to go and have to give them time to work.


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## drdahlman (Nov 6, 2000)

OK everybody, let's understand that the statement that the product needs to be refrigerated is the simplest thing to say to avoid giving everybody a long dissertation about the product. Usually these products are given out to patients in an office and the material handed out or statements made say to keep it refrigerated. The patient leaves and goes home and puts it in the refrigerator. Done deal, no need for further discussion.To those of you who have the product shipped...it needs to be refrigerated WHEN you get it. The product is viable for a time without refrigeration or cold packs in the box. Normal shipping throughout the country requires no concern about the temperature. I have shipped to patients throughout the country in the summer and still gotten the patients well without a cold pack in the box. There is certainly a time limit to the no refigeration...about 1 week.If your product hasn't been refrigerated for longer than that, I would say it's dead. Don't use it. It won't hurt you if you do use it, it just wouldn't help what we are trying to do.


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## Gret (Sep 23, 2003)

spasman, I think I've said that I'm definitely better! I go on about my day as if I never had a problem. I don't think twice about getting in the car to leave. I don't case out a new place for the restroom ahead of time. I don't do the stuff I had to do before. I feel well again! Placebo effects mean nothing to me. Something works or it doesn't. I'm very certain of that.Going from 8 to 10 trips to the bathroom in any 12 hour period to 2 BMs per day is quite an improvement, I'd say! (Sometimes it's just one, but usually two.)


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## BackFire44 (Nov 19, 2003)

I think there is a misunderstanding about what the placebo effect is. Maybe if I recount how a study would run it would help.Let's assume a study of 200 people. Half of them would get a sugar pill, but would be told that it is a cure for IBS. The other half would just have their symptoms evaluated for the same time. Studies have shown that the placebo effect in IBS is really high -- I've seen 85%! What does that mean? Out of the 100 people that got sugar pills, 85 of them got better over this time period (more technically they would be compared to how many of the other hundred got better with some fancy math). What does this mean? That if someone gave you a pill to treat IBS and told you it was a cure -- and you really believed them; that 3/4 people would feel better even if the pill did nothing. And they don't just think they are better. If you measured the amount of D or Pain before, you would see a lot less of it after the study.What does this tell us? The mind has a huge role to play in IBS. If we are convinced something will help us -- it probably will, whether or not it physically does. So, saying you don't believe in the placebo effect or that the placebo effect doesn't work for you is just saying that you don't believe your mind can lessen your symptoms on its own. And, you are actually wrong. It may be that you don't have control over that part of your mind, but you can learn to control that part of your mind. What does this say about Dr. D's methods? Just that part of the success could be due to the placebo effect. As I've said before, I suspect that part of his program physically addresses the issues an IBS sufferer has; and part of the success is really due to the placebo effect, but who cares? If you're better, you're better!


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## kel1059 (Feb 28, 2003)

i have to agree with Gret. the placebo effect is vastly overrated. there was an interesting paper on this subject i am going to try and find it.the placebo effect --when it occurs-- lasts only a short time before symptoms return. i think that most long-term sufferers are relatively immune to the placebo effect.with respect to my IBS, i never benefited from the placebo effect. almost everything i ever tried for IBS has been a complete failure right from day 1.i am immune to the placebo effect. possibly, the unscientific people who have only suffered a short while may be the most likely people to respond to a placebo. also if someone has the type of IBS that fluctuates a great deal then this would help the placebo effect.my IBS was extremely steady --365 days a year -- year after year after year. i am immune to placebo..


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## kel1059 (Feb 28, 2003)

> quote: So, saying you don't believe in the placebo effect or that the placebo effect doesn't work for you is just saying that you don't believe your mind can lessen your symptoms on its own. And, you are actually wrong.


would a celiac all of a sudden be able to tolerate gluten if they believed that a pill would reverse it? i guarantee that in a VERY, VERY short time (if at all) they will be suffering greatly. same with a diabetic.even in the beginning of my quest to solve IBS nothing worked -- medications did not help, herbal remedies did not help, probiotics did not help. the only thing that helped was when i started removing specific foods like wheat and dairy.


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## bonniei (Jan 25, 2001)

There is a high probabilty that Dr Dahlman's product would work without the placebo effect justt because diet is one of the main things that help. i have got well without Dr Dahlman. just with diet. Do not underestimate the power of diet, reggardless of what eric says!


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## BackFire44 (Nov 19, 2003)

That's a good point you brought up. Many times you see an initial placebo effect, but then with long term studies the placebo effect disappates over time. I don't know of any studies that studied the placebo effect for a long time. Eric? I'd be interested to see what you post. Again, though, the fact that you are immune to the placebo effect just means that you can't fool yourself into thinking there is a cure. If, however, you were able to convince yourself that something was a cure -- you would probably see the placebo effect again (well, unless it really was a cure!). Easier said than done, I know. On the flip side, though, consider this. Your mind can make your condition worse just like it can make it better. Feeling that there is no cure could actually cancel out a real cure! I feel that the best thing you can do to help yourself is think positive thoughts, don't dwell on negative thoughts, and learn how to not think at times (meditation). Then, you can make your mind a positive contributor to the problem (or, at the very least, not a negative contributor). Obviously, I don't know what you've tried in this vein, and perhaps you have mastered relaxation to no positive end (although it is impossible really to master it -- many people spend their entire lives trying to gain more control over their mind and body).


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## BackFire44 (Nov 19, 2003)

And again not to speak for eric, but I don't think he ever said changing your diet can't help. In fact, current medical research advocates stopping caffeine, alcohol, carbonated beverages, and high fatty foods. In addition, doctors have shown the link between IBS and food allergies and intolerances (especially lactose intolerance).


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## bonniei (Jan 25, 2001)

Ah but eric has ignored fructose intolerance for a long time. Remember i have been here for three years. of course i don't know what he has been saying of late. i have stopped reading his long posts so perhaps hidden some where there he talks about fructose intoolerance. Fructose intolerance more than lactose intolerance affects iBS patients.i do know eric has been talking about fat. But perhaps if his goal is to educate people he should start talking about FI. I apologize If he already has been.


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## bonniei (Jan 25, 2001)

Also


> quote:doctors have shown the link between IBS and food allergies


which study is that?


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## kel1059 (Feb 28, 2003)

> quote: just means that you can't fool yourself into thinking there is a cure


I guess I can't fool myself (very high hopes may be something entirely different - what do you think?). it is 16.5 years later and I still think that there is some combination of treatments that is going to unravel the mystery. In the beginning I was all eager about everything that I tried. The more logical it sounded the more convinced I was that it would work. I think that by the early 1990's I became disillusioned about everything. I went into each new trial hoping for the best but expecting the worst.I had the same attitude with Ibsacol - and I was shocked that it worked but it took me a long time to figure out that Ibsacol was the magic and not Primal Defense or the herbs. (the herbs were a nice catalyst and the primal defense may have helped but both of them -without ibsacol-were a total washout.)--so looking back over the previous 20 years I can honestly say that things either worked or they did not work.


> quote: On the flip side, though, consider this. Your mind can make your condition worse just like it can make it better.


Very true. But even during my happiest times symptoms would rear their ugly head. It was like a clock it did not matter if I was happy, sad, ecstatic, worried, peaceful&#8230;. The only exception was 12 years ago when the stress was unbearable due to life events and I had diarrhea round the clock for 2 to 3 weeks.By the way, I do believe that HT can have a profound impact on the way the body operates, but for me it will not work unless I do all the "physicals" (diet, etc) correctly. i have tried it and it did not work, but i am all for similar techniques such as EFT, polarity therapy, accupuncture, accupressure...


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## kel1059 (Feb 28, 2003)

PLACEBO EFFECT OVERRATED(however, this needs to be taken with a grain of salt due to vast differences among all of us...) http://www.usatoday.com/news/health/2001-05-23-placebo.htm In most of the studies, the placebo group fared about the same as the group getting no treatment. The exceptions were studies of pain treatments and some others with subjective results, meaning patients reported how much symptoms bothered them, rather than having an objective measure such as blood pressure.Placebo recipients in the pain studies averaged a 15% reduction in pain, and patients in the other subjective studies had even smaller improvements.Many past studies and textbooks suggest that about one-third of patients given placebos in medical experiments get better, presumably because they believe they are getting an effective treatment. But the new research casts doubt on this long-held belief.(con't...)


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## kel1059 (Feb 28, 2003)

Placebo effect..._The Danish researchers combined the findings of 114 such studies from around the world, involving dozens of conditions ranging from colds and seasickness to Alzheimer's disease and schizophrenia, to see how the sham treatment stacked up to no treatment.In most of the studies, the placebo group fared about the same as the group getting no treatment. _ http://www.detnews.com/2001/health/0105/25/a10-227948.htm _But in the most comprehensive effort yet to evaluate whether placebos work, Danish researchers conclude that they have little effect after all and should not be used outside research settings. ._ --but it seems as though people are fooled into thinking they are better ----roughly 1/3rd of them. i think i definitely fit into the 2/3rds who do not respond to the placebo effect. i have never been much of a conformist. anyone who has seen me take on our resident sociopath knows that i don't care much about what people think about me. i certainly would not want to make an M.D. feel important -- i tell it like it is.


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## kel1059 (Feb 28, 2003)

> quote: So, saying you don't believe in the placebo effect or that the placebo effect doesn't work for you is just saying that you don't believe your mind can lessen your symptoms on its own. And, you are actually wrong.


in order to get the mind to really work in this manner -- short AND long term-- there needs to be some substance behind the treatment far beyond a sugar pill.HT is one such treatment that can work for some people as a means of altering 'something' in the brain.as to why up to 1/3 of the people report 'subjective' improvement is interesting. maybe there problems originate from loneliness and being in a study makes them feel important and it may help them to socialize. maybe some people are just very eager to please. maybe some people have a mind that is wired for a quick response to anything.***********************************************************************re-reading your sentence -- i would have to say that i believe that some therapies that are directed at the mind can definitely alter our perception of the condition or even the condition itself. --but concerning the placebo effect and its effect on me --- i would have to say a definite ---no ---since i have not experienced its benefit in 16.5 years.


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## Trinity (Sep 9, 2002)

Re: stool test from Great Smokies. Got the results. Lactobacillus is fine, I have no bifidus, and 1+ klebsiella pneumoniae. Now taking bifidus supplement


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## kel1059 (Feb 28, 2003)

I remember seeing this "not-so-bright" GI doc a long time ago. For $95.00 cash I got a long explanation as to why psylium would ease the pain –as he mimicked the actions of the colon with his hands. He sat there all proud and happy because he was the expert and he knew about these things….. Turns out that the average GI doc knows a fraction of what we board members know about our particular condition.--so I go home rather excited thinking that psylium is going to be the answer –“all right, I am going to be cured” – the result --------- far worse than ever before. The stuff made everything much worse.I want my money back!


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## Gret (Sep 23, 2003)

I agree, Backfire, that negative thoughts can alter your IBS. I think now that I'm feeling so much better, the negative thoughts are fewer as well. I don't worry because I know I'm going to be fine. But I had to start feeling better before I could feel confident that I'd make it through a Sunday service without having urgent thoughts and feelings! Now I will sometimes try to conjure up feelings to see if I'll have problems. It doesn't work, there's nothing there to worry about anymore! I try to test myself to see if I'm really, truly better! I sure feel better! I've always tried each method of eliminating IBS symptoms with a great deal of optimism - positive that this time it would work! They didn't. Ibsacol came close, but not perfect enough for me. NOW I know what it means to really feel better.


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## kel1059 (Feb 28, 2003)

Gret,i am really happy for you. i am still the same but it is early in the program. i am fully committed to doing whatever it takes to get the bifidus implanted. if i have to take 4 stool samples over the next 12 months then that is what i will do.the good news is that i seem to be holding steady with the gas problem. by this i mean that i no longer am dependant on the herbs to keep gas low. i think that maybe being on the herbs for 9 months may have done the trick. however, the gas does seem to fluctuate depending on how i am feeling. i.e, if i wake up feeling sick then throughout the day the gas is usually double or triple on days when i don't feel sick.feeling sick ='s gasfeeling well ='s low gasTRINITY,my GSDL stool sample is the same as yours except they did not pick up klebsiella and they did not identify any other bad bugs.stick around, if you ever retake the stool test and if i retake it it will be interesting to see if the bifidus is implanted.


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## SpAsMaN* (May 11, 2002)

kel as i understand,you're on the program now.It is relatively easy to get better with a specialist of ibs,but to get cure,i'm sceptical.I have ibs for 10 years,it is a big problem.How long it take for Dr.Dalhman to cure ibs?I'm still questionning me.The member who makes survey should make one here.


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## kel1059 (Feb 28, 2003)

> quote: It is relatively easy to get better with a specialist of ibs,but to get cure,i'm sceptical


frank,i believe that he can definitely get almost all of us functioning much better. a lot of it is common sense, but none of it is very easy. it takes a lot of resolve to follow it.at this point i am uncertain that a cure will come about for me. but one never knows about these things. i have quite a bit of faith in homeopathy based on what it has done for me so far. i am thinking that homeoapthy might offer a reasonable chance for correcting my system.


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## medietrich (Sep 27, 2000)

..


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## Jhouston (Nov 9, 2003)

Kel, Do you know about these bacteria in GSL tests? Acid (*NG) Bifido (1+) Escherichia (*NG) Additional Bacteria alpha haemolytic streptococcus NP 4+ gamma haemolytic streptococcus NP 4+ Haemolytic Escherichia coli NP 4+ Coag negative Staphylococcus NP 1+ Mycology *NG Also, would this test pick up fungi? Joann


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## Gret (Sep 23, 2003)

It sounds like you are improving, kel! I really hope so!Frank, we're all skeptical, I'm sure. But for the first time ever I'm hopeful! No, I'm actually quite sure I'm going to be completely well! I haven't used the word "cure" yet, but I think I might some day. Remember I was as bad off and a lot of people here. If I were still in that situation, I think I'd make myself housebound and quit doing all the things I love to do. I am so grateful to Dr. Dahlman's program!


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## kel1059 (Feb 28, 2003)

Jhouston,Mine says..Lactobacillus species------4+Escherichia coli-------NG (NG = No Growth)Bifidobacterium-------NGGamma haemolytic streptococcus------- 4+ (NP) [NP = Non Pathogen]Alpha haemolytic strep----------4+ (NP)Esch coli A-D ---------------4+ (NP)Haem e. coli ----------------4+ (NP)Mycology ------------------ (NG)It did not list any PP or P ------- potential pathogen or pathogen.The commentary section is interesting. One of the claims is that bifidobacteria should be recovered to 4+ levels. This I believe to be true.


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## bonniei (Jan 25, 2001)

Jhouston'The genera bacteroides, bifidobacterium, eubacterium, clostridium, peptococcus, peptostreptococcus, and ruminococcus are predominant in human beings, [1 and 6] whereas aerobes (facultative anaerobes) such as escherichia, enterobacter, enterococcus, klebsiella, lactobacillus, proteus, etc are among the subdominant genera. Every individual has several hundreds of species belonging to these genera, with a particular combination of predominant species that is distinct from that found in other individuals. [1 and 16] The species vary greatly between individuals. [16] The composition of the individual's flora can fluctuate under some circumstances, for instance acute diarrhoeal illnesses, antibiotic treatment, or to lesser extent induced by dietary interventions, but individuals' flora composition pattern usually remain constant. [1 and 16] Several bacteria that can be seen by direct microscopic examination of diluted faecal specimens cannot be grown in culture media. Unicellular organisms need biodiversity for growth. Thus, 40ï¿½80% of the total microscopic counts are not recoverable by culture,[17 and 18] although estimates vary between individuals and between studies. Molecular biological procedures can now also be used to investigate the microbial ecology in the colon without use of cultures. [19] Results of an analysis [18] of bacterial genes in human faeces showed that many DNA sequences correspond to previously undescribed microorganisms, and some data [20] suggest that every individual has unique strains of bacteria. Quantitative analysis [21] of faecal bacteria shows important differences between individuals and over time within the same individual that are not always detectable by conventional culture techniques. [22] Molecular procedures have shown that aerobes, including Escherichia coli, enterococci, and lactobacilli, achieve very high densities and metabolic activity in the human caecum, since 50% of total bacteria ribosomal RNA in caecal contents correspond to these species.[23] By contrast, these species account for only 7% of bacteria ribosomal RNA in faecal samples. [23] Such species could have an important role in caecal fermentations. "It is from a per by F Guarner and J-R Malagelada . Can't locate the title right away._Edit_ oh i found it. The title is 'Gut fllora in health and disease'


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## drdahlman (Nov 6, 2000)

Whew! That's a lot of discussion. Let me comment on placebo. Don't have any disagreement with the high level of placebo effect with IBS. I trust your statistics. Here's the difference. Traditional controlled, double blind, peer review studies usually test one item (drug) on a number of people with others getting the sugar pill. The possibility of some on the sugar pill feeling better is well documented, though there always is discussion about the validity of placebo at all. Let's take it for granted that there is a thing called the palcebo effect. The difference in my protocol is that we never test one item (in my case a natural supplement or dietary suggestion) and then sit back and watch the results. Never do I give probiotics and see if that and only that works. Never do I provide a nutritional supplement like L-Glutamine (which is in one of my products) and sit back to see the results. Never do I just use digestive enzymes by themselves. Never do I do a stool or food allergy test by themselves with no product usage. Never do I simply tell a patient to go off only dairy or only fructose or only gluten.If studies were done using the above, I believe that a small percentage of the people in each test would see positive results. In the no dairy test, those that needed probiotics would see no benefit. In the probiotic group, those that needed to eliminate dairy or fructose, would see no benefit...and so on.The reason I don't buy the placebo effect due to my program is for many reasons: First, this negates the intuition of someone like Gret who has seen remarkable changes and has been told by others who have recommended other "cures" that they could help her and they didn't, until she began my program. Why didn't the others work according to placebo? Second, no study can account for the struggles and change in protocol in midstream that I go through with many of my patients. I tell my patients this will work and we begin with a set dosage of products and dietary guidelines. Nothing's working. So I change the dosage and fine tune the diet some more. Why didn't the placebo effect take place with my first set of rules and products? Why did it take the second set of rules ....or third set of rules and changes. Make no mistake, my program is not set in stone, I massage it for each individual. What do I do with a vegetarian who eats lots of legumes, a no-no in my initial program? I make changes. Sometimes we are struggling 3-4-5 months with limited progress and then we hit upon the final key to the puzzle. Why are some patients such a struggle if placebo is so powerful. Third, I rarely get calls from patients 3 months down the road or 3 years down the road saying that their symptoms have come back and we all know that placebo effect only lasts so long. I only get that call a couple times a year and numerous times each year a patient calls to say they went on an antibiotic and some symptoms have returned. Fourth, this doesn't account for the patients who call me for help and can remember that their symptoms began after taking a course of antibiotics. The use of my program and the probiotics clears them right up.The stool test you all are discussing....yes, you were tested for fungus, which is the Candida/yeast organism.I will summarize later today about the progress that each of my "test" patients from the group are making after I talk with one more of you at 2:00.


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## eric (Jul 8, 1999)

Bonniei, you have been confused about my posts for years now. Then usally when I try to clarify them, you get angry, so I quite talking about it with you. Without beiing sure of what I have been saying for years now, why comment on what I have been saying, because its wrong. You also stated recently your were never officially diagnosed with IBS, but now you have found out your FI. So either you have just FI or FI and IBS. If you have Just fI then you might not totally understand the IBS person and symptoms.Fructose intolerence is not IBS, can you have both, sure! The mechanisms however are not the same for symptoms generation.I have posted about it for a long time now. Maybe if you did read the "long" articles I post it would make more sense.I have also been stating for years now foods can trigger symptoms, but they are not the cause of IBS by themselves, other then if they caused at one time bacterial enteritis or something, there is an underlying disorder or disorders.So yes people are helped with diets. Hence why I have all the food information on my site and hence why I asked one of the worlds leading experts on IBS about it.But what's very important is foods are not the only triggers and to focus just on foods might be a big mistake for a lot of IBSers, unless that's all it takes to get better and for some, just adding fiber can make them better.also, on Kels remark about HT and IBS, it can make changes in the gut as well as the brain. Why, because they are MAJORALLY CONNECTED. Nor has she ever gotten this or even know much about HT and IBS, otherwise her posts would not contain the constant inaccurate information on it all the time.for example"Lea R, Houghton LA, Calvert EL, Larder S, Gonsalkorale WM, Whelan V, Randles J,Cooper P, Cruickshanks P, Miller V, Whorwell PJ.Gut-focused hypnotherapy normalizes disordered rectal sensitivity in patients with irritable bowel syndrome.Aliment Pharmacol Ther. 2003 Mar 1;17(5):635-42.This study evaluated the rectal sensitivity changes in IBS patients who received hypnotherapy, like a previous study by the same group (see Houghton et al's study above, but using a slightly different methodology. Twenty-three IBS patients were tested before and after 12 weeks ofhypnotherapy. Following the course of hypnotherapy, the mean pain sensory threshold increased in the hypersensitive subgroup and tended to decrease in the hyposensitive group,although the l. Reduction in gut pain sensitivity was associated with a reduction in abdominal pain. These results suggest that hypnotherapy may work at least partly by normalizing bowel perception in those patients who have abnormal gut sensitivity, while leaving normal sensation unchanged." http://www.ibshypnosis.com/IBSresearch.html On Placebo and IBS and I am not going to get into it with kel or the belief the placebo doesn't work or anyone for that matter. Pain. 2003 Sep;105(1-2):17-25. Related Articles, Links The contributions of suggestion, desire, and expectation to placebo effects in irritable bowel syndrome patients. An empirical investigation. Vase L, Robinson ME, Verne GN, Price DD. Department of Psychology, University of Aarhus, Asylvej 4, 8240 Risskov, Denmark. In order to investigate external factors that may influence the magnitude of placebo analgesia as well as psychological factors that mediate placebo analgesia, 13 irritable bowl syndrome (IBS) patients rated evoked rectal distension and cutaneous heat pain under the conditions of natural history (NH), rectal placebo (RP), rectal nocebo (RN), rectal lidocaine (RL) and oral lidocaine (OL). Patients were given verbal suggestions for pain relief and rated expected pain levels and desire for pain relief for both evoked visceral and cutaneous pain, respectively. Large reductions in pain intensity and pain unpleasantness ratings were found in the RP, RL and OL condition as compared to the natural history condition, whereas no significant difference in pain reduction between the three treatment conditions was found. Ratings during RN and NH were not statistically different. Compared to a previous study, which shows that rectal lidocaine reverses visceral and cutaneous hyperalgesia, these results suggest that adding a verbal suggestion for pain relief can increase the magnitude of placebo analgesia to that of an active agent. Since IBS patients rate these stimuli as much higher than do normal control subjects and since placebo effects were very large, they probably reflect anti-hyperalgesic mechanisms to a major extent. Expected pain levels and desire for pain relief accounted for large amounts of the variance in visceral pain intensity in the RP, RL, and OL condition (up to 81%), and for lower amounts of the variance in cutaneous pain intensity. Hence, the combination of expected pain levels and desire for pain relief may offer an alternative means of assessing the contribution of placebo factors during analgesia. Publication Types: * Clinical Trial * Randomized Controlled Trial PMID: 14499416 Br J Clin Pharmacol. 2003 Oct;56(4):362-9. Related Articles, Links Erratum in: * Br J Clin Pharmacol. 2003 Nov;56(5):584. Evaluation of drug treatment in irritable bowel syndrome. Talley NJ. Mayo Clinic, Charlton 8-138, 200 First Street S.W., Rochester, MN 55905, USA. talley.nicholas###mayo.edu The irritable bowel syndrome (IBS) remains a therapeutic challenge in part because of the limited understanding of the pathophysiology. *The placebo response rate varies in randomized controlled trials from 20 to 70%, and can persist for up to at least 1 year. * It is contentious whether dietary fibre and bulking agents relieve the symptoms of IBS; constipation probably improves. Anticholinergic and antispasmodic agents are of questionable benefit in IBS despite positive meta-analyses of poor quality trials. A meta-analysis concluded that the tricyclic antidepressants were superior to placebo in IBS, although the individual trial results were variable. Selective serotonin reuptake inhibitors are of uncertain benefit. Laxatives are used for constipation but probably poorly control the IBS symptom complex. Loperamide is superior to placebo in improvement of diarrhoea but not abdominal pain in IBS. Tegaserod is a well- tolerated aminoguanidine indole derivative of serotonin that is a partial 5HT4-receptor agonist with prokinetic properties; a therapeutic gain over placebo of 5% to 15% has been observed in constipation-predominant IBS in females. Alosetron is a 5HT3-receptor antagonist that is efficacious in females with diarrhoea-predominant IBS, with a 12% to 17% therapeutic gain; the risk of ischaemic colitis is 1 in 350, with very severe constipation occurring in about 1 in 1000. Optimizing study design remains a challenge in IBS. New visceral analgesic and motility modifying agents, as well as anti-inflammatory agents are in trials, and hopefully additional efficacious therapeutic options for patients with IBS will soon emerge. Publication Types: * Review * Review, Tutorial PMID: 12968980Curr Treat Options Gastroenterol. 2003 Aug;6(4):329-337. Related Articles, Links Treatment of Irritable Bowel Syndrome. Spiller RC. Department of Gastroenterology, University Hospital, Derby Road, Nottingham NG7 2UH, UK. robin.spiller###nottingham.ac.uk Irritable bowel syndrome (IBS) is an extremely common cause of consultation, and at present is diagnosed on the basis of symptoms and a few simple exclusion tests. Exclusion diets can be successful, but many patients have already attempted and failed such treatments before consulting. Anxiety and somatization may be an important driver of consultation. Patients' concerns should be understood and addressed. Those with prominent psychiatric disease may benefit from psychotherapy. Hypnotherapy benefits symptoms in those without psychologic disturbance, but its availability is limited. Antidepressants are effective in improving both mood and IBS symptoms globally, and the evidence is particularly good for tricyclic antidepressants. * Although antispasmodics are currently the most commonly prescribed drugs, most responses (75%) are due to the placebo effect and not specific to the drug.* Bulk laxatives such as ispaghula can increase stool frequency and help pain, but bloating may be aggravated. Loperamide is effective treatment for urgency and loose stools, but less effective for bloating and pain. 5-HT(3) antagonists such as alosetron improve urgency, stool consistency, and pain in diarrhea-predominant-IBS. The 5-HT(4) agonist tegaserod shows modest benefit in constipation-predominant IBS, improving stool frequency, consistency, and bloating as well as global improvement. There are many new drugs, such as cholecystokinin, neurokinin, and corticotropin receptor antagonists, in development. PMID: 12846942There is a ton of information on Placebo and IBS out there to read.All it takes for this mainly is believeing something will work. It also should be more of a clue in the *currently widely accepted the brain gut and brain connections.* "From - Report on the 5th International Symposium onFunctional Gastrointestinal DisordersApril 4, 2003 to April 7, 2003 Milwaukee, WisconsinBy: Douglas A. Drossman, M.D., UNC Center for Functional GI and Motility Disorders at Chapel Hill, and William F. Norton, IFFGDBasic Principles -- Brain-GutModerators: Emeran Mayer MD; Robin Spiller MD. Panel: Robin Spiller MD; Jackie Wood PhD; George Chrousos MD; Yvette Tachï¿½ PhD; Lisa Goehler PhD; G.F. Gebhart PhD; Emeran Mayer MD.Click on Titles to View Other TopicsIntroductionOutcomes of Pediatric Functional GI DisordersEpidemiology/Genetic/Behavioral FactorsBrain ImagingEmerging Techniques to Evaluate and Treat Functional GI and Motility DisordersClinical Applications of Diagnosis and TreatmentFunctional GI DisordersGeneral Principles of TreatmentPharmacological TreatmentPsychological TreatmentIFFGD Research AwardsThe brain-gut axis refers to the continuous back and forth interactions of information and feedback that take place between the gastrointestinal tract, and the brain and spinal cord (which together comprise the central nervous system). These interrelated feedback circuits can influence brain processes and bowel functions -- affecting pain perception, thoughts and one's appraisal of symptoms, gut sensitivity, secretions, inflammatory responses, and motility. The brain-gut circuits can be activated by an external or internal factor or stimulus that makes a demand on the system, such as a stressful event, an injury, an emotional thought or feeling, or even the ingestion of food. Symptoms of functional GI disorders may result from a maladaptive response to stimuli at some point within the complex interactions that take place along the brain-gut axis.Basic science is the fundamental approach to understanding how systems work. Basic research takes place in the laboratory and often involves the study of molecules and cells. From this body of knowledge is drawn the means to investigate practical applications and to formulate clinical practices. Translational science converts basic science discoveries into the practical applications that benefit people.One of the more exciting areas of recent research relates to the basic and translational aspects of the effects of stress on inflammation, cytokine and immune modulation, and pain. (Cytokines are a type of protein released by cells of the immune system, which act through specific cell receptors to regulate immune responses.) This series of presentations address three important research areas in the field of functional GI disorders, which have recently attracted considerable attention: the role of immune activation in the gut and the interactions of the gut immune and nervous systems; the role of the central nervous system in the regulation (modulation) of pain perception (nociception); and the emerging field of animal models with relevance for functional GI disorder research. This section demonstrates the rapid progress seen in the last few years in better understanding of basic mechanisms, in particular the neuroimmune interactions underlying symptom generation in patients with "functional" GI disorders.There are immune responses to infections. To defend itself from a foreign substance or invader, such as a bacterium or virus, the body mounts an immune response controlled by the brain. There needs to be a balance between infection and the body's immune response; the immune system needs to turn on and turn off at the right times to destroy the invader but not to the degree that it may harm healthy tissue.Robin Spiller, University Hospital, Nottingham, England began the session by noting the difficulty in separating disorders of structure ("organic") from disorders of function. He noted, "The difference is based on how high the power of your microscope is." This was elaborated upon in his presentation on Post-infectious Functional GI Disorders. It has been observed that IBS-like symptoms, that persist for 6 months to a year or longer, may appear after a bout with an acute infection in the gastrointestinal tract (e.g., food-poisoning). This is termed, "post-infectious IBS." A study by Gwee et al showed that the presence of unusual or amplified life stress at the time of onset of infection increased the chances of developing IBS symptoms. Inflammation persisted in patients with IBS-like symptoms but did not in patients whose symptoms resolved. This suggests that the brain's management of certain stressful stimuli (i.e., psychologic distress) affects the brain-gut system's ability to inhibit inflammation.It has frequently been observed that some individuals with more severe symptoms of IBS have coexisting psychologic distress. Stress has been thought to influence health-care seeking behavior, either by increasing motility, visceral hypersensitivity or inflammation, or by enhancing one's perception of gut symptoms, all of which lead to a greater need to seek care for them. The concept of post-infectious IBS suggests that in some circumstances stress (the biological process by which the body adapts in response to a stimuli) may influence symptoms.An initial response to an infection in the gastrointestinal tract can involve the neurotransmitter, serotonin, which acts as a messenger (mediator) to cells involved with the immune response. Immune cells -- mostly in the blood, but also in the lymphatic system -- enter the infected area and remove the invader. Additionally, the body adaptively removes the infection (e.g., via vomiting or diarrhea -- normal beneficial responses that help the body expel an infecting organism). Persistence of the underlying inflammatory response may lead to post-infectious disorders of function. A variety of neuroimmune responses can lead to intestinal over-responsiveness (sensitization) and other clinical effects.These responses include direct toxicity to nerves that influence intestinal contractions, alteration in gut immune activation, abnormalities of serotonin metabolism, and persisting low-grade inflammation. IBS developing after infective gastroenteritis is associated with subtle increases in enteroendocrine and chronic inflammatory cells in the gut mucosa. The net effect may be to increase serotonin availability in the gut and enhance secretion and propulsive motility patterns. Serotonin antagonists may be beneficial in such patientsNotably, the concept of "post-infectious IBS" has grown to include studies of their application in post-infectious gastroparesis and dyspepsia. 1Major inflammatory responses have not been observed in most IBS patients. However, in some studies subtle changes associated with inflammation have been noticed, such as increased presence of mast cells (a type of immune system cell present in blood and tissue). Jackie Wood, Ohio State University College of Medicine discussed the Effects of Inflammation on the Gut Enteric Nervous System, specifically noting the importance of mast cell degranulation (the release from within the cell of granules, or small sacs, containing chemicals that can digest microorganisms and fight infection).In tissue mast cells accumulate around nerve endings of nerves that contain the neurotransmitter serotonin. The release of substances that can induce activity in excitable tissue (i.e., histamine, Interleukin-1 (IL-1), and bradykinin) by mast cells can affect receptor and neurotransmitter function in the enteric nervous system - the part of the autonomic nervous system that controls function of the gastrointestinal tract. In other words, when mast cells in the intestinal lining empty their contents in response to an infection, they activate nearby nerve endings. In a subgroup of patients, this can have significance in terms of resulting clinical consequences of diarrhea and abdominal discomfort.2Yvette Tachï¿½, University of California Los Angeles discussed Stress and Inflammation. The experience of stress is an adaptive behavior common to all living organisms. The activation of corticotropin releasing factor (CRF) signaling pathway, is the major mediating mechanism involved with the body's stress response system in which gastric emptying is inhibited (with possible loss of appetite) while colonic motor activity is stimulated (producing a loose stool or a sensation of bowel urgency). There is growing evidence that activation of this CRF pathways impacts on inflammation, autonomic nervous system function, immunity, and clinical behavior or illness, all of which may be linked to the pathophysiology of the functional gastrointestinal disorders.While we often talk about how the brain -- influenced for example by arousal and/or psychosocial factors -- can affect immune function, the reverse is also true. Immune activation, following infection for example, can influence brain function. Lisa Goehler, University of Virginia discussed Cytokines and Vagal Afferents: Immune Signaling to the Brain. Cytokines are substances that are produced by white blood cells to regulate certain functions during inflammatory and immune responses. The vagus is a nerve made of both sensory and motor fibers that innervates nearly every internal organ. The gastrointestinal (GI) tract, along with the lungs and liver, is an area of tissue that most commonly comes in contact with microorganisms (pathogens), such as bacteria or viruses, capable of activating an immune response. Cytokine mediators activate neurons that convey messages from tissue to the brain (afferent neurons) through the vagus nerve. The GI tract is richly supplied with vagal afferents that can signal immune activation in the tissue.This process may underlie the mechanism that causes individuals to feel sick. The concept of "sickness symptoms" is not always recognized. The cytokine inflammatory and immune mediators distributed throughout the body (peripheral), which appear to interact through vagal pathways, have systemic effects that manifest as symptoms in the body. (Mediators are substances released from cells to regulate immune responses.) Such symptoms include fever, increased sensitivity to pain, loss of appetite, and decreased desire for social interaction. The process may provide the basis for a role of the vagus as an interface between the site of the immune response and the brain that results in symptoms of altered mood, including anxiety or depression, that are sometimes associated with gastrointestinal disease. 4Jerry Gebhart, The University of Iowa discussed the CNS Modulation of Visceral Nociceptive Responses. The central nervous system (CNS) is composed of the brain and spinal cord. The brain interprets and influences our perceptions of the pain sensation signals transmitted from the gut (visceral nociceptive responses) to the spinal cord and then to higher centers. Several structures in the brain (periaqueductal gray, dorsolateral pons, and rostroventral medulla) can facilitate or inhibit signals sent to the CNS and influence the perceived discomfort, or even whether the signals are experienced as pain. Inflammation of the bowel can produce increased sensitivity to pain or enhanced intensity of pain sensation (hyperalgesia) via increased activity of certain cells (for example, those that contain nNOS) in these higher brain modulatory centers. 5To close the Brain-Gut sessions, Emeran Mayer, University of California Los Angeles discussed Evolving Animal Models of Visceral Hypersensitivity. In contrast to most other disorders of the digestive system, functional disorders of the gut continue to be defined by symptom criteria rather than by biological markers. Realistic animal models of functional gastrointestinal (GI) disorders in which to test hypotheses have not been available until recently. While it is unlikely that there will ever be an animal model to replicate all complexities of the human functional GI disorders, animal research is likely to help us understand some of the key underlying mechanisms responsible for symptom generation. This includes over-responsiveness of central stress circuits to visceral and psychological stimuli, resulting in altered autonomic responses (motility, secretion), increased pain sensitivity (visceral hypersensitivity) and possibly altered immune function of the gut. Future studies with genetically altered (i.e., transgenic) mice that become models for studying specific human diseases and their treatments may further increase our understanding of these mechanisms.6 http://www.iffgd.org/symposium2003brain-gut.html I believe its really a shame the way Dr Dahlman has approached the bb and how he has coducted himself here and the lack of information he feels he should suppy here on IBS, other then his own views on bacteria and IBS and leaky gut and IBS and people need to remember they are just his views and his own beliefs.Again I would like to poit out "what if he says he can cure everyone and then can't, what does it do to a person to think and be told they are going to be "cured" if they cannot be "cured"?Will it make it all worse?I also understand Gret and a fews others feels better and that is great and will see if she is "cured", but so far I have not seen anyone say they were totally "cured", which is what DR D is saying he can do. Which I find odd since he is not addressing all the issues both phycologically and physiologically that are known in IBS already by actual IBS researchers, unlike DR D who I believe is not really even qualified and who certainly is not backing up any of his claims with any evidence or researched information. His views on IBS are extremely simplistic on IBS and I believe this is a reflextion on the fact he is a chiropracter and not a real GI doctor or researcher." What is a Functional Gastrointestinal Disorder? Functional gastrointestinal (GI) disorders can affect any part of the GI tract, including the esophagus, stomach, and intestines. They are disorders of function (how the GI tract works), not structural or biochemical abnormalities. As a result, x-rays, blood tests, and endoscopies can have essentially normal results. Importantly, they are not psychiatric disorders, although stress and psychological difficulties can make the functional GI symptoms worse. The most common disorders are Irritable Bowel Syndrome (altered bowel consistency combined with abdominal pain that is usually relieved with a bowel movement) and Functional Dyspepsia (ulcer-like symptoms - upper abdominal pain, feeling of indigestion). Approximately 25 million Americans have functional GI disorders. 50 - 80% of them do not consult physicians, although they may take over-the-counter medications and report significantly more job absenteeism and disability. There are three primary features to functional GI disorders: Motility, Sensation, and Brain-Gut Dysfunction. Motility is the muscular activity of the GI tract. Normal motility (e.g., peristalsis) is an orderly sequence of muscular contractions from top to bottom. In functional GI disorders, the motility is abnormal. There can be muscular spasms that can cause pain, and the contractions can be very rapid or very slow. Sensation is how the nerves of the GI tract respond to stimuli (for example, digesting a meal). In functional GI disorders, the nerves are sometimes so sensitive that even normal contractions can bring on pain or discomfort. Brain-Gut Dysfunction relates to the disharmony in the way that the brain and gastrointestinal system communicate. With functional GI disorders, the regulatory conduit between brain and gut function may be impaired. An Area of Growing Interest Fortunately, attention to functional GI disorders is increasing, as reflected in support of research in this area. The Center, whose Co-directors are two of only several investigators ever funded by NIH for research involving these disorders, has received funding for several NIH-funded projects, as well as many pharmaceutical-funded projects. Research is focused on understanding mechanisms that may cause this group of disorders, treatment options to improve the symptoms, and understanding the complexity of symptoms. Publication of these research findings in peer reviewed scientific journals helps to educate other physicians about this rapidly expanding field. Recent efforts by the Center and the International Foundation for Functional Gastrointestinal Disorders (IFFGD) and by the Digestive Health Initiative at the American Digestive Health Foundation have led to greater public awareness. Drs. Drossman and Whitehead, and Nancy Norton, IFFGD President, have been quoted in many mainstream magazines for their work, including Cosmopolitan, Self, Ladies Home Journal, New Woman, Prevention, American Health, Redbook, and Better Homes and Gardens. Support groups and patient-focused symposia are becoming easier to find, and patients are beginning to have more access to accurate information about their disorders. While it is true that research funding agencies, institutes of medical education, and the general public are beginning to recognize functional GI disorders as a legitimate area of focus, the field has plenty of room for further growth. Functional GI Disorders: Current State of Knowledge It is safe to assume from the writings of physicians and historians that functional GI disorders have existed throughout history, but the lack of identifiable cause prevented their categorization as diseases, and may have made their diagnosis and treatment "second class" in medical school, residency teaching, and research. There were only occasional reports of these disorders until the middle of this century, when systematic investigation began. Scientific attention to understanding and caring for patients with functional GI disorders developed only in the last 20 years, and has grown progressively. Some reasons for increased interest relates to the symptoms viewed as a syndrome that has treatment options, as well as the use of newer investigative techniques in gastrointestinal physiology. There is a need for additional research on these disorders given their health care impact. In order to train physicians and psychologists to care for these patients, investigation into the pathophysiology, classification, and treatment of functional GI disorders must continue. Research on the psychosocial aspects of these disorders has yielded three general observations: 1. Psychological stress exacerbates gastrointestinal symptoms. 2. Psychosocial disturbances amplify illness experience and adversely affect health status. 3. Having a functional GI disorder impairs the quality of oneï¿½s life. Psychological Stress Exacerbates Gastrointestinal Symptoms The evolving theory suggests that chronic GI symptoms are generated by a combination of intestinal motor, sensory and CNS activity. The mechanism for these associations relates to the existence of bi-directional pathways between the central and enteric nervous systems, the so-called "brain-gut" axis. These bi-directional pathways provide the linkage between sensation in the gut and intestinal motor function. External stressors and cognitive information (emotion, thought) have, by nature of their neural connections in the brain, the capability to affect gastrointestinal sensation, motility, and secretion. Conversely, not only does the brain affect the gut, but activity in the gut affects central pain perception, mood, and behavior. Psychosocial Disturbances Amplify Illness Experience and Adversely Affect Health Status Patients with functional gastrointestinal disorders show greater psychological difficulties than healthy subjects or other medical patients. However, these data are drawn from selected patients at referral centers which overestimate the true association. For example, persons with irritable bowel syndrome who do not consult a physician are psychologically similar to normal subjects. This shows that IBS is not a psychiatric disorder. Rather, psychosocial factors modulate the illness experience and health outcomes, including physician visits. Having a Functional GI Disorder Impairs the Quality of Oneï¿½s Life Any chronic illness, including IBS, will affect one's health-related quality of life (i.e., oneï¿½s general well-being, ability to carry out everyday activities, concerns about the illness, and satisfaction with health care). The investigation of clinical and psychosocial outcomes, including quality of life, is new to Gastroenterology." http://www.med.unc.edu/medicine/fgidc/over...i-disorders.htm


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## bonniei (Jan 25, 2001)

eric when i say i don't read your long posts i mean i don't read every one of your long posts on every thread. But as late as 7 months ago when i was trying to spread the word about FI you posted a study on this thread http://www.ibsgroup.org/ubb/ultimatebb.php...t=033847#000000 which said


> quote: but the benefits even among patients with coexistent fructose intolerance are as yet not established."


it was an article written in 2002 even though there was an article written http://www4.infotrieve.com/newmedline/deta...rance&count=405 which said otherwise before you posted on that thread. And another one which said fructose restricted diets help F.C. Johlin, M. Panther and N. Kraft, A fructose restricted diet and dietary counseling in patients with dietary fructose intolerance demonstrates significant reduction in symptoms and an improvement in quality of life proportionate to the amount of fructose eliminated. Gastroenterology 120 I have found that very irritating.if i have got angry with you it is because everytime i posted about FI and how fructose restricted diets help you were trying to contradict me and say the opposite. i can give you many examples of it. It was only when jeff posted the article in november http://www.ibsgroup.org/ubb/ultimatebb.php...c;f=10;t=000856 did you see the importance of fuctose.As for IBS and FI being different, not only is it a red herring but regardless of whether i have iBS or not, i know FI leads to gas and diarrhea and these are symptoms of iBS too and being able to control those symptoms goes a long way towards managing IBS. I think you were completely confusing the issue by talking about it not helping iBS patients. maybe it won't help the pain but if one can get rid of D and gas then people have a lot to be thankful for.


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## bonniei (Jan 25, 2001)

And the university you are affilated with does not even do fructose intolerance tets http://www.med.unc.edu/medicine/fgidc/breath.htm


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## calid (Aug 4, 2003)

Well, my stool samples are also back. Showed no Acidopholis, minimal 1+ Bifidus and 3 bacterias. I don't have the specific names of the bacterias yet, when I get the hard copy I'll post them. I'd been taking the Acidopholis/Bifidus combo, and showed only minimal residual probably due to the bad stuff growing in there also. No Candida or yeast. So now, I bump up the probiotics and start taking something to kill the bad guys.


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## drdahlman (Nov 6, 2000)

Here is a list and progress report of the people from this board who are under my care: MtBike: Began treatment with a history of constipation, but was experiencing mostly gas, bloating, cramps and pain. Followed program, treated for anaerobic bacteria, did better with only occasional gas, bloating and cramps. Not where we wanted him to be, so we did a stool test based on his symptoms. Test revealed non- existent acidophilus and good levels of bifidus. Currently using probiotics to bring up levels and reporting continued progress as you have all read in his posts.Trinity, Began program and main complaint is leaking gas. At her request we did a stool sample immediately. Low levels of bifidus found. Slightly lessening of symptoms so far. Will bring up levels of bifidus and eliminate fructose and gluten to see what effect that has.Gret, What can we say about Gret? She's one of the lucky ones who progressed quickly and has had an amazing elimination of all her symptoms. Read her posts.Brushie, Began program complaining of soft stools, gas, bloating and overall fatigue. Decided to treat him for anaerobic bacterial problem. Within the first month he reported a better mood, increased energy, less gas and bloating. He is having more BM's but needing to "clean" less, that means a more solid BM. He says this is first time in 5 years he has seen a positive change. Kel/Lek, Major complaints were a lack of consistent stool formation and peristalsis. Her lab work showed no bifidus. Has a multitude of very unusual problems and has a limited diet. During our third conversation she reported that she has gained 16 pounds and that was something she had been trying to do for a long time. She has stopped all other vitamins, minerals and herbs (a list as long as your arm and very expensive) she was using to magage her symptoms except for Ibsacol and Wobenzyme. Unfortunately, during our last conversation, I learned for the first time that she uses an enema every 2 days. My belief is that it would be impossible to have consistent stool formation and peristalsis if you don't allow your gut to do the work on its own. Helping it with an enema will sentence a person to the symptoms that she is reporting. We will see what she reports next time having not used the enemas. Calid, Began program with complaints of IBS-D, frequent BM's and cramping. She experienced additional gas and bloating with the use of my products and stopped the powders and we awaited the results of a stool sample. We found non existent acidophilus and low levels of bifidus. We also found 3 bacteria that needed to be eliminated: Bacillus species, Proteus mirabilus and Citrobacter freundi complex. Now on protocol to eliminate them and bring up the levels of the good bacteria.JHouston, Began the program listing the symptoms that she used to have if not adhering strictly to a specific diet. I mis-interpreted that and thought these were current complaints. Apparently, she has no gastrointestinal related complaints as long as she follows her diet.What she would really like is to be able to expand her foods choices and be free of other non-gastrointestinal symptoms that have befuddled all her traditional doctors. She has extreme sensitivity to an already identified list of foods and I suspect that there is another list of chemicals, excipients, binders, fillers, spices, colorings, preservatives, etc. that needs to be identified for her to eliminate her non gastrointestinal related symptoms. Will continue my program to see if there might be a residual effect on the additional complaints and possibly to be able to expand her foods choices. For many people, once you have identified the foods that cause problems, you may never be able to eat them again without a bad reaction. Arnie W, My New Zealander with whom I have had only one consult. No info yet. To him, please call me at 2:00 Friday, my time, to catch up and see where we're at. You keep calling me at times I can't answer the phone and I don't have your info because you are filed by last name and you never leave your last name in your message and I don't know what it is without your file. I got your message that you will be able to ship out a stool test from NZ. Hopefully we'll talk soon. So the summary is that all patients a really progressing through the program as expected, one quickly successful and others more slowly, gathering info about what is out of balance and addressing each issue as we find it. Bottom line is that all of them....OK, maybe one won't, but probably all of them will completely eliminate their symptoms. We will keep you all posted.To all of you who have taken me up on this offer:If I have mis-spoken about any of your cases, please feel free to correct me.


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## Arnie W (Oct 22, 2003)

Unfortunately, being on the other side of the world, there are sometimes difficulties in communicating and also in having to wait for supps and tests to arrive.I wanted to do the GS stool test at the outset, but I'm glad I didn't wait, because it's taken about 3 weeks for the kit to arrive. I'll have that posted off soon.I've gone the full hog with the diet. I didn't want to leave anything to chance and I virtually eliminated all the main triggers, until I get the results of the stool test and can discuss with Dr Dahlman what I should do next.So far I've made more progress by far than I have with any other intervention. I'm feeling more comfortable and confident. I'll leave it at that for now and Dr Dahlman or I can do a more comprehensive report in the future.


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## bonniei (Jan 25, 2001)

> quote: For many people, once you have identified the foods that cause problems, you may never be able to eat them again without a bad reaction.


My translation- forget Dr D's herbs and probiotics and other supplements. Stick with the diet. Find your triggers on your own by starting with a basic(safe) diet for three days and then introduce a new food group9lactose, fructose, gluten) leaving them out if they cause problems.


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## calid (Aug 4, 2003)

Bonnie: I have far too many trigger foods to live this way the rest of my life. I only weigh 112 pounds and my family is beginning to get worried.I need to eat.


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## bonniei (Jan 25, 2001)

calid, have you identified your food triggers accurately. like lactose, fructose and gluten. usually people are not intolerant of lactose and fructose at the same time. So if you can't get your calories from veggies and fruits and grains, you can make up for it with going heavy on lactose. And chicken, fish, meat will be your staples (most people can tolerate chicken and fish atleeast). If you haven't identified as a food group like Lactose, fructose or gluten, you might need Dr Dahlman's help if you can't be systematic on your own.


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## SpAsMaN* (May 11, 2002)

i thank that kel was a man,enema is very irritating ,poor her.It seems intesresting treatment but i wait more and try others things,i'm going by myself.I go in circle for years,Dr.Dahlman,how long it takes to be really better usually.


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## overitnow (Nov 25, 2001)

Frankly, Bonnie, I wandered around in that jungle of trying to isolate triggers for about 10 years. If I had stuck with that approach, I would be eating the same 5 or 6 things over and over and worrying constantly. I know that supplementation offends "purists" and Dr. D's approach would certainly not have been affordible; but I much prefer being done with it than to be trying to live without all those foods I love. Cheers,Mark


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## calid (Aug 4, 2003)

Bonnie: Let me give you a little history on my eating fiascos. When I first had this problem, I tried the SCD diet, which cuts out your carbs and grains. That didn't work, so I found Heather's Eating for IBS diet. When I went to her diet, I felt much better, but couldn't bring the carbs back in w/o bloating and gas pains. Then I realized when I was on the SCD diet, my arthritis and headaches disappeared. So now I'm on a no dairy (recommended by both Heather and Dr. Dahlman), low carb, low fat, and no wheat diet which leaves basically chicken, fish, and veggies. That's about the only things I can eat safely. I'd like to bring back in a grouping, but right now I can't. Even just removing the wheat still leaves me with some arthritis pain, I'm beginning to think it's more than just wheat, which will further limit my diet if I go off all grains again. So you see it's not easy with me, there are other things roaming around in my body other than IBS. I need to get over the IBS so I can concentrate on the arthritis pain diet. I've been trying to figure out the correlations for over a year now and need help. I appreciate all the posts you and Kel have made in the past, you both seem to use logic a lot, which most doctors don't have the time or desire to do (except Dr. Dahlman).


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## bonniei (Jan 25, 2001)

overit i hear you. Glad you found your way out. i have fructose intolerance and _maybe_ probiotics of the right kind might help me. i am still researching this.calid i wish i could help you on the arthritis thing but i am very narrow in my reading . i just read mainstream iBs related stuff. it seems if you have found your safe diet that is a step in the right direction.


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## calid (Aug 4, 2003)

Bonnie: Even though the dr. states that I have "arthritis", I believe it is more of an allergy/intolerance to something. If histamine is released, you can have joint pain that mimics arthritis. Histamine can also (from what I've read on these boards) affect IBS. Somehow I think both of my problems may be connected, this is why I need to try and get the IBS out of my system. Both problems came about approximately at the same time. Take a look at these websites, the second one is interesting because of what I discovered accidently when I went on/off the SCD diet. Who know, maybe these are all intertwined somehow. http://www.healthpromoting.com/Articles/articles/art.htm http://www.emagazine.com/september-october...9gl_health.html


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## kel1059 (Feb 28, 2003)

> quote: During our third conversation she reported that she has gained 16 pounds and that was something she had been trying to do for a long time.


it is actually closer to 11 pounds but it might be 9 pounds since i usually gain a couple of pounds in the winter. --but it is a badly needed 11 pounds. i need to keep weight on in order to feel good. i thank dr d for some valuable information concerning a product that i was wasting $ on. i told the nutritionist that i thought the 2 products were useless but the nutritionist thought he knew more than me. one product was Juice Plus and the other was some worthless 100mg (Infinity) colostrum product that i told him i was allergic to i would have to say that i greatly appreciate having someone like dr d help me to reverse the intestinal dysbiosis problem. 3 years ago it was severe and i could barely function. i think that intestinal dysbiosis is a difficult problem to overcome (for some of us at least).even though my good doctor (not the HMO doctor but the Holistic doctor) knew about the dysbiosis he did not push the issue the way it should be pushed.


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## bonniei (Jan 25, 2001)

interesting. i did a search in the databases i usually search and they said a veg diet excluding gluten helped. Come to think of it the last 3 months i have been virtually wheat free and i was judst thinking the other day that my joint pain was not present. Very curious article that you posted calid. Thanks


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## kel1059 (Feb 28, 2003)

> quote: Somehow I think both of my problems may be connected, this is why I need to try and get the IBS out of my system.


Calid,i strongly suspect that the conditions are related.i know for a fact that my conditions are related.i had/have gut problems, breathing (asthma-like condition), sinus inflammation, and a brain disorder.Ibsacol was originally developed for asthma and since it targets leukotrienes it worked the best for this symptom of mine. Singulair is a drug that blocks inflammatory leukotrienes with respect to the lungs.the fact that ibsacol got me off a specific drug tells me that there was some type of inflammatory response being set off in my brain (non-overt inflammatory response).i know all these conditions are related since ibsacol had a dramatic impact on 3 of the 4 conditions. they are related by the common features that are shared by the immune system --prostaglandins and leukotrienes among dozens of others.this is one of the reasons that i am very skeptical of being cured. any IBS cure is going to have to also quiet the rest of my body down not just my gut. if i do end up with a cure then that means that all inflammatory conditions are tied strongly to gut dysbiosis and food hypersensitivities. as a skeptic i must remain open minded on this, but i think it is a stretch. maybe reversing dysbiosis and striving for an optimal gut flora could go a long, long way to reducing symptoms throughout the body. i hope.i think it begs the question --"why are mast cells --located all over the body including the brain-- so trigger happy? is it genetic? microbial? viral? vaccination damage? western diet? all of the above?Calid have you ever read Dr Brown's theory of RA (do you have RA or osteo) --- his theory is that microbes are a big part of the problem. --and not microbes just in the gut but throughout the entire organism -- mycoplasma, L-form bacteria, streptococcus forms...


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## calid (Aug 4, 2003)

Bonnie: You're welcome, please let me know if you continue this venue of thought.Kel: No I haven't read that, can you point me in the right direction? My first doctor said I had RA, but the inflammation level was low so my Rheumatoid dr said I didn't have it. I was getting so confused I decided to stop the anti-inflammatories and start investigating myself.


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## kel1059 (Feb 28, 2003)

i think that you can still have a similar problem to mine and tests will not pick it up. you may very well respond to ibsacol just like me.there is another fatty acid ester called CMO --cetyl myristoleate and it also targets inflammatory leukotrienes and prostaglandins associated with arthritis. there is a lot of information on it on the net. there is also a real nice double blind PC study that shows it works.calid,your condition resembles mine to a large degree. i only get the joint pain when i am at my absolute worst. i.e., it is the last symptom to kick in.


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## drdahlman (Nov 6, 2000)

Someone asked how long it takes to feel better and my answer is that everyone is different. Gret began to get better almost immediately, others take longer to see progress and others I struggle with. Bottom line is everyone gets well.Bonniei, Anyone can just start out with the dietary suggestions and see what happens. It's the least expensive way to go. As Heather proves everyday, some people even get well with her dietary suggestions that even includes gluten and fructose. But others do not. My suggestions occur in a step-by-step manner, sort of a process of elimination to find out what foods are the culprit.Consider, and I have only anecdotal evidence, that by restoring proper bacterial balance and feeding the tissue the nutrients necessary to be healthy and repair the cells, a person might, in time, be able to re-introduce some of the foods that have historically caused problems. This will only be accomplished by using supplements to fully restore health to the system. It is not a common occurence though.


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## kel1059 (Feb 28, 2003)

Calid,i strongly suspect that the conditions are related.i know for a fact that my conditions are related.i had/have gut problems, breathing (asthma-like condition), sinus inflammation, and a brain disorder.Ibsacol was originally developed for asthma and since it targets leukotrienes it worked the best for this symptom of mine. Singulair is a drug that blocks inflammatory leukotrienes with respect to the lungs.the fact that ibsacol got me off a specific drug tells me that there was some type of inflammatory response being set off in my brain (non-overt inflammatory response).i know all these conditions are related since ibsacol had a dramatic impact on 3 of the 4 conditions. they are related by the common features that are shared by the immune system --prostaglandins and leukotrienes among dozens of others.this is one of the reasons that i am very skeptical of being cured. any IBS cure is going to have to also quiet the rest of my body down not just my gut. if i do end up with a cure then that means that all inflammatory conditions are tied strongly to gut dysbiosis and food hypersensitivities. as a skeptic i must remain open minded on this, but i think it is a stretch. maybe reversing dysbiosis and striving for an optimal gut flora could go a long, long way to reducing symptoms throughout the body. i hope.i think it begs the question --"why are mast cells --located all over the body including the brain-- so trigger happy? is it genetic? microbial? viral? vaccination damage? western diet? all of the above?Calid have you ever read Dr Brown's theory of RA (do you have RA or osteo) --- his theory is that microbes are a big part of the problem. --and not microbes just in the gut but throughout the entire organism -- mycoplasma, L-form bacteria, streptococcus forms...


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## kel1059 (Feb 28, 2003)

*.Actions of microorganisms that cause RA-mycoplasmas, mycobacteria, molds, spirochetes (e.g., Lyme), viruses, bacteria and their L-forms;* http://www.roadback.org/books/review.shtml Conventional Rheumatoid Arthritis (RA) treatments include toxic drugs that reduce painful symptoms but do not treat the root causeï¿½ bacterial infection. An immune system weakened by addictive drugs (such as antidepressants or anti-histamines), improper diet, stress, and multiple infections is unable to produce the quantity and quality of natural antibodies to stave off new attacks.Infection by pathogenic microbes like mycoplasma has been proven to be the cause of many chronic illnesses, including RA. This book describes the steps necessary to:ï¿½ Identify, attack, and remove the cause(s) of the infection(s); ï¿½ Neutralize toxins and other harmful enzymes generated by pathogens;ï¿½ Flush toxins and wastes from the body; and ï¿½ Restore the body's systems to normal, healthy function.Until recently, testing methods to identify these microorganisms precisely and to prescribe effective treatments have not been available. Traditional treatments with immunosuppressing drugs often breed stronger, more resistant bacterial organisms, which mutate and grow, overwhelming the immune system's resources. Undiagnosed food and chemical allergies can also amplify the severity of arthritis symptoms. In this book, both the lay reader and physician will find an effective course of treatment possibly leading to a cure for RA and other chronic illnesses with arthritis-like symptoms such as lupus, fibromyalgia, MS, scleroderma and many others.In this book you will discover:ï¿½ Actions of microorganisms that cause RA-mycoplasmas, mycobacteria, molds, spirochetes (e.g., Lyme), viruses, bacteria and their L-forms;ï¿½ Their role in other chronic illnesses with arthritis-like symptoms;ï¿½ Online authoritative medical information and support organizations;ï¿½ Some of the best Internet sites to research health, drugs, nutrition supplements, tests, treatments, and disease-causing organisms; ï¿½ What diagnostic tests are available and where to get them;ï¿½ Low-dose, long-term antibiotic protocols for treatment of chronic infections; ï¿½ Some useless and possibly dangerous treatments that should be avoided; ï¿½ What new research has started to reveal about the field of molecular medicine.


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## kel1059 (Feb 28, 2003)

Rheumatoid Arthritis: The Infection Connection Targeting and Treating the Cause of Chronic Illness ï¿½2002 by Dr. Katherine M. Poehlmann “Dr. Poehlmann has compiled an outstanding resource that finally offers the lay and professional audience a long-needed, contemporary, natural medicine update of Dr. Brown’s pioneering low-dose antibiotic protocol for Rheumatoid Arthritis… This therapy works!” A research scientist and former arthritis sufferer outlines a proven treatment that could banish your arthritis pain forever.This well-documented study asserts that rheumatoid arthritis (RA) and other chronic illnesses are caused by a microbial infection. When the infection triggers allergic reactions, it appears that the body's immune system has turned on itself. Once the cause of the infection and allergies are identified and removed, arthritis symptoms will decrease and likely disappear as long as the body's collective systems remain in balance.


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## kel1059 (Feb 28, 2003)

> quote:some people even get well with her dietary suggestions that even includes gluten and fructose. But others do not


i would be in serious trouble with her diet. even the chicken -- a high lectin food-- causes severe trouble in me. everyone is different.dr d -- it seems that if dr brown is correct then it lends strong support for your protocol.i suspect that microbes throughout all the tissues, blood -- anywhere that mycoplasma, L-form bacteria can thrive needs to be addressed.i find it disturbing that doctors find mycobacterium and mycoplasma in people but they shrug their shoulders for the most part. they don't have a clue about these things.i have to agree with people who think that food hypersensitivities can dramatically weaken the system allowing these pathogens a wider birth.chicken or the egg --- which came first the allergy or the mycoplasma, l-form...


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## SpAsMaN* (May 11, 2002)

I was thinking about Dr D. and i must tell at this second that it is better to go on with this treatment rather than doing nothing. I'm still questionning me about getting into it.


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## eric (Jul 8, 1999)

Bonniei, the UNC does test for fructose, are you serious?FI can mimmick or make IBS worse, but ITS NOT IBS. It is a pretty common problem though and people can have both!That's why FI has its own name and IBS has its own name. That's why FI is and Intolerence to fructose and IBS is a functional disorder."An Effective Physician-Patient Relationship *The importance of the therapeutic relationship is underscored by findings that IBS patients show a remarkable placebo response rate-30% to 80%-regardless of the treatment approach* .4 This relationship requires a nonjudgmental, attentive, and flexible attitude on the part of the physician.23 In large part, the outcome of the physician-patient encounter is determined not so much by what the physician does as by how he or she does it. A number of key factors come into play in the evaluation of patients: identifying their concerns, explaining the basis of their symptoms, providing reassurance, performing a cost-effective evaluation, involving the patients in their own care, and providing continuity of care. Rather than asking patients outright if they're experiencing stress, physicians may find it more effective to discuss the established connection between IBS symptoms and psychological stress, giving the patient an opening to introduce his or her own concerns and the physician an opportunity to learn something about the patient's coping skills. A feeling of helplessness and lack of control over the illness - a phenomenon known as catastrophizing - is a strong predictor of a poor outcome.24 The ability to elicit this information from the patient will allow the physician to explore a comprehensive treatment approach that will be most effective for the patient. " http://abbc3.hsc.usc.edu/cme/ibs/contents/implications.html


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## calid (Aug 4, 2003)

Bonnie and Kel: I think we've just hijacked a thread.......lol. I'm going to post a new thread for us as I think this is an interesting concept that needs more talk.


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## bonniei (Jan 25, 2001)

eric the link you posted on the BreathHydrogen tests did not show a test for FI. http://www.med.unc.edu/medicine/fgidc/breath.htm So am i to conclude from your statement that UNC does do FI tests that you have as usual not paid attention to FI. Why not put a link to the FI test too.*Secondly I do know that FI and IBS are different.* Different because IBS'ers have pain and discomfort too due to the inefficient movement of gas and visceral hypersensitiuity. But many of them have D and gas in addition and that is where doing the breath test helps iBS patients. You can shout till you are blue in the face that the two are different but that is not goinfg to make Fi go away. it is not going to make the D and gas go away. That is where i think Dr Dahlman is doing a great service, he is helping people rule out fructose. IMO All the people you haave confused by saying Fi is not iBS will now be paying noney to Dr Dahlman to get their confused heads straightened out. DO YOU UNDERSTAND? I hope I don't have to explain it again. i don't see you hanging out on the D board or the gas board advocating that people do the Fi test. Ask the people here how many people have done the FI test? THen think again whether you should go on saying FI is not IBS. *FI is an underrecognized problem in iBS patients.*. So if you are planning to help people do no harm first. Shout out to the board that the FI test must be done. And everytime you say that FI is different from IBS mention why so you don't confuse people


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## kel1059 (Feb 28, 2003)

> quote: *FI is an underrecognized problem in iBS patients.. *


very accurate statement.besides, IBS is basically a garbage can diagnosis that millions of us get labeled with.since there is so much overlapping with respect to general underlying causes, triggers, dispositions etc... it can be a little difficult sorting it all out. -- can a person make such confidant statements that they KNOW what IBS is and isn't.not too long ago they KNEW that ulcers were not due to a bacteria. wrongo.


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## drdahlman (Nov 6, 2000)

My unscientific study suggests that about 25% of my patients find that eliminating fructose is helpful. Might be a bit high.The one thing Eric and I agree on is that FI is not IBS. Where we disagree is that I contend that nothing is IBS. There are only uncomfortable symptoms associated with the gastrointestinal system that people want to get rid of. Names mean nothing, solutions mean everything. We are all different, some need probiotics, some need to eliminate critters that they have picked up that shouldn't be living inside them, some need to cut out dairy, others fructose and/or gluten. Some people must do a combination of or all of that to feel better.The names come from the medical/pharmacuetical establishment because you can't design a drug for something that's not named.


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## eric (Jul 8, 1999)

The Merck manual IBSIrritable Bowel Syndrome(Spastic Colon)A motility disorder involving the entire GI tract, causing recurring upper and lower GI symptoms, including variable degrees of abdominal pain, constipation and/or diarrhea, and abdominal bloating.Etiology The cause of irritable bowel syndrome (IBS) is unknown. No anatomic cause can be found. Emotional factors, diet, drugs, or hormones may precipitate or aggravate heightened GI motility. Some patients have anxiety disorders, particularly panic disorder; major depressive disorder; and somatization disorder. However, stress and emotional conflict do not always coincide with symptom onset and recurrence. Some patients with IBS appear to have a learned aberrant illness behavior; ie, they tend to express emotional conflict as a GI complaint, usually abdominal pain. The physician evaluating patients with IBS, particularly those with refractory symptoms, should investigate for unresolved psychologic issues, including the possibility of sexual or physical abuse (see also Approach to the Patient in Ch. 21).Pathophysiology In IBS, the circular and longitudinal muscles of the small bowel and sigmoid are particularly susceptible to motor abnormalities. The proximal small bowel appears to be hyperreactive to food or parasympathomimetic drugs. Small- bowel transit is variable in patients with IBS, and changes in bowel transit time often do not correlate with symptoms. Intraluminal pressure studies of the sigmoid show that functional constipation can occur when haustral segmentation becomes hyperreactive (ie, increased frequency and amplitude of contractions); in contrast, diarrhea is associated with diminished motor function.Excess mucus production, which often occurs in IBS, is not related to mucosal injury. Its cause is unclear, but it may be related to cholinergic hyperactivity.Hypersensitivity to normal amounts of intraluminal distention exists, as does a heightened perception of pain in the presence of normal quantity and quality of intestinal gas. The pain of IBS seems to be caused by abnormally strong contraction of the intestinal smooth muscle or by increased sensitivity of the intestine to distention. Hypersensitivity to the hormones gastrin and cholecystokinin may also be present. However, hormonal fluctuations do not correlate with clinical symptoms. The caloric density of food intake may increase the magnitude and frequency of myoelectrical activity and gastric motility. Fat ingestion may cause a delayed peak of motor activity, which can be exaggerated in IBS. The first few days of menstruation can lead to transiently elevated prostaglandin E2, resulting in increased pain and diarrhea. This is not caused by estrogen or progesterone but by the release of prostaglandins.Symptoms and Signs IBS tends to begin in the second and third decades of life, causing bouts of symptoms that recur at irregular periods. Onset in late adult life is rare. Symptoms usually occur in the awake patient and rarely rouse the sleeping patient. Symptoms can be triggered by stress or the ingestion of food.Features of IBS are pain relieved by defecation, an alternating pattern of bowel habits, abdominal distention, mucus in the stool, and sensation of incomplete evacuation after defecation. The more symptoms that are present, the likelier that the patient has IBS. In general, the character and location of pain, precipitating factors, and defecatory pattern are distinct for each patient. Variations or deviations from the usual symptoms may suggest intercurrent organic disease and should be thoroughly investigated. Patients with IBS may also have extraintestinal symptoms (eg, fibromyalgia, headaches, dyspareunia, temporomandibular joint syndrome).Two major clinical types of IBS have been described. In constipation-predominant IBS, constipation is common, but bowel habits vary. Most patients have pain over at least one area of the colon, associated with periodic constipation alternating with a more normal stool frequency. Stool often contains clear or white mucus. The pain is either colicky, coming in bouts, or a continuous dull ache; it may be relieved by a bowel movement. Eating commonly triggers symptoms. Bloating, flatulence, nausea, dyspepsia, and pyrosis can also occur.Diarrhea-predominant IBS is characterized by precipitous diarrhea that occurs immediately on rising or during or immediately after eating. Nocturnal diarrhea is unusual. Pain, bloating, and rectal urgency are common, and incontinence may occur. Painless diarrhea is not typical and should lead the physician to consider other diagnostic possibilities (eg, malabsorption, osmotic diarrhea).Diagnosis Diagnosis of IBS is based on characteristic bowel patterns, time and character of pain, and exclusion of other disease processes through physical examination and routine diagnostic tests. Standardized criteria have been developed for IBS. The Rome criteria for IBS includes abdominal pain relieved with defecation and a varying pattern of altered stool frequency or form, bloating, or mucus. The key to diagnosis is effective history taking, which requires attention to directed, but not controlled, elaboration of the presenting symptoms, history of present illness, past medical history, family history, familial interrelationships, and drug and dietary histories. Equally important are the patient's interpretation of personal problems and overall emotional state. The quality of patient-physician interaction is key to diagnostic and therapeutic efficacy.On physical examination, patients with IBS generally appear to be healthy. Palpation of the abdomen may reveal tenderness, particularly in the left lower quadrant, at times associated with a palpable, tender sigmoid. A routine digital rectal examination should be performed on all patients, and a pelvic examination on women.Stool examination for occult blood (preferably a 3-day series) should be performed. Routine testing for ova and parasites or a stool culture is rarely indicated without a supporting travel history or supporting symptoms (eg, fever, bloody diarrhea, acute onset of severe diarrhea).Proctosigmoidoscopy with a flexible fiberoptic instrument should be performed. Introduction of the sigmoidoscope and air insufflation frequently trigger bowel spasm and pain. The mucosal and vascular pattern in IBS usually appears normal. In patients with chronic diarrhea, particularly older women, mucosal biopsy can rule out possible microscopic colitis, which has two variants: collagenous colitis, seen on trichrome stain as increased submucosal collagen deposition, and lymphocytic colitis, characterized by increased numbers of mucosal lymphocytes. The mean age of presentation for these disorders is 60 to 65 yr, with a female predominance. Similar to IBS, presentation involves nonbloody, watery diarrhea. Diagnosis can be made via rectal mucosal biopsy.Laboratory examination should include a CBC; ESR; 6- and 12-channel biochemical profile (sequential multiple analyses 6 and 12), including serum amylase; urinalysis; and thyroid-stimulating hormone. An abdominal sonogram, barium enema x-ray, and upper GI esophagogastroduodenoscopy or colonoscopy may be selectively used, based on the history, physical examination, patient age, and follow-up evaluations. However, these studies should be undertaken only when less invasive and less expensive studies reveal objective abnormalities.Diagnosis of IBS should never preclude suspicion of intercurrent disease. Changes in symptoms may signal another disease process. For example, a change in the location, type, or intensity of pain; a change in bowel habits; constipation and diarrhea or vice versa; and new symptoms or complaints (eg, nocturnal diarrhea) may be clinically significant. Other symptoms that require investigation include fresh blood in the stool, weight loss, very severe abdominal pain or unusual abdominal distention, steatorrhea or noticeably foul-smelling stools, fever or chills, persistent vomiting, hematemesis, symptoms that wake the patient from sleep (eg, pain, the urge to defecate), or a steady progressive worsening of symptoms. Patients > 40 yr are more likely than younger patients to have an intercurrent organic illness.Differential Diagnosis Common illnesses that may be confused with IBS include lactose intolerance, diverticular disease, drug-induced diarrhea, biliary tract disease, laxative abuse, parasitic diseases, bacterial enteritis, eosinophilic gastritis or enteritis, microscopic (collagenous) colitis, and early inflammatory bowel disease. The bimodal age distribution of patients with inflammatory bowel disease makes it imperative to evaluate both younger and older patients for these conditions. In patients > 40 yr with a change in bowel habits, particularly those with no previous IBS symptoms, colonic polyps and tumors must be excluded by colonoscopy. In patients > 60 yr, ischemic colitis should be considered.Pelvic examination in women helps rule out ovarian tumors and cysts or endometriosis, which may mimic IBS. Hyperthyroidism, carcinoid syndrome, medullary cancer of the thyroid, vipoma, and the Zollinger-Ellison syndrome are possibilities in patients with diarrhea. Patients with constipation and no anatomic lesion should be evaluated for hypothyroidism or hyperparathyroidism. If the patient's history and laboratory studies suggest malabsorption, absorption tests should rule out tropical sprue, celiac disease, and Whipple's disease. Finally, elimination disorders (eg, pelvic floor dyssynergia) should be considered as a cause of constipation in patients who report excessive straining on defecation.Treatment Therapy is supportive and palliative. A physician's sympathetic understanding and guidance are of overriding importance. The physician must explain the nature of the underlying condition and convincingly demonstrate to the patient that no organic disease is present. This requires time for listening and explaining normal bowel physiology and the bowel's hypersensitivity to stress, food, or drugs. These explanations form the foundation for attempting to reestablish regular bowel routine and individualizing therapy. The prevalence, chronicity, and need for continuing care of IBS should be emphasized. Psychologic stress and anxiety or mood disorders should be sought, evaluated, and treated (see Chs. 187 and 189). Regular physical activity helps relieve stress and assists in bowel function, particularly in patients who present with constipation.In general, a normal diet should be followed. Patients with abdominal distention and increased flatulence may benefit from dietary reduction or elimination of beans, cabbage, and other foods containing fermentable carbohydrates. Reduced intake of apple and grape juice, bananas, nuts, and raisins may also lessen the incidence of flatulence. Patients with evidence of lactose intolerance should reduce their intake of milk and dairy products. Bowel function may also be disturbed by the ingestion of sorbitol, mannitol, fructose, or combinations of sorbitol and fructose. Sorbitol and mannitol are artificial sweeteners used in dietetic foods and as drug vehicles, whereas fructose is a common constituent of fruits, berries, and plants. Patients with postprandial abdominal pain may try a low-fat diet supplemented with increased protein.Increasing dietary fiber can help many patients with IBS, particularly those with constipation. A bland bulk-producing agent may be used (eg, raw bran, starting with 15 mL [1 tbs] with each meal, supplemented with increased fluid intake). Alternatively, psyllium hydrophilic mucilloid with two glasses of water tends to stabilize the water content of the bowel and provide bulk. These agents help retain water in the bowel and prevent constipation. They also can reduce colonic transit time and act as a shock absorber to prevent spasm of the bowel walls against each other. Fiber added in small amounts may also help reduce IBS-induced diarrhea by absorbing water and solidifying stool. However, excessive use of fiber can lead to bloating and diarrhea. Fiber doses must therefore be adjusted to individual patient needs.Anticholinergic (antispasmodic) drugs (eg, hyoscyamine 0.125 mg 30 to 60 min before meals) may be used in combination with fiber agents. The use of narcotics, sedative hypnotics, and other drugs that produce dependency is discouraged. In patients with diarrhea, diphenoxylate 2.5 to 5 mg (one to two tablets) or loperamide 2 to 4 mg (one to two capsules) may be given before meals. Chronic use of antidiarrheals is discouraged because tolerance to the antidiarrheal effect may occur. Antidepressants (eg, desipramine, imipramine, and amitriptyline 50 to 150 mg daily) help many patients with either type of IBS. In addition to constipation and diarrhea, abdominal pain and bloating are relieved by antidepressants. These drugs can also reduce pain by down-regulating the activity of spinal cord and cortical afferent pathways arriving from the intestine. Finally, certain aromatic oils (carminatives) can relax smooth muscle and relieve pain caused by cramps in some patients. Peppermint oil is the most commonly used agent in this class.


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## eric (Jul 8, 1999)

"A Misunderstood DiseaseConsidering how many people are affected by IBS, there is a lot of misunderstanding and confusion surrounding this disorder. It is sometimes confused with inflammatory bowel disease (IBD), a more serious and unrelated condition whose symptoms may include weight loss and blood in stools. And the fact that emotions can intensify symptoms in people with IBS ï¿½ and that stress reduction may reduce those symptoms ï¿½ sometimes leads to the mistaken notion that IBS is a psychological rather than a physical disorder.The cause of IBS is not yet fully understood. Experts believe that interaction between the brain and bowel is abnormal in people who have IBS; research into that relationship may provide insight into why some people develop IBS, how brain and bowel dysfunction may trigger the disorder and what can be done to alleviate symptoms.The Mind-Body ConnectionThe word "irritable" doesnï¿½t refer to people with IBS, but rather to the unusually sensitive nerve endings in the lining of their bowels and the unusually active nerve that controls the muscles of their guts. Certain foods, stress, gas and other stimuli that would not pose major problems for most people can cause contractions in the bowels of people with IBS, resulting in pain and discomfort." http://www.dhn-online.org/free_month_issues/ibs.html


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## Gret (Sep 23, 2003)

I think most of us have read every available definition of IBS. But like Dr. Dahlman said,"Names mean nothing. Solutions mean everything!"I don't care what you call it, I want to be rid of it!


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## missC (Oct 16, 2002)

i don't know how to do proper quotes people (still less stupid show-off graphics that fail to answer points in an opponent's argument), so you're going to have to bear with me.DR DAHLMAN:"The one thing Eric and I agree on is that FI is not IBS. Where we disagree is that I contend that nothing is IBS."ERIC"Etiology The cause of irritable bowel syndrome (IBS) is unknown. No anatomic cause can be found."Now that's kind of interesting. A description isn't a diagnosis, and it seems that allopathic medicine, by its own admission, is foisting a mere description of symptoms off on us. bearing this in mind, the collection of symptoms we've been told to call IBS could in fact be a hodge-podge of FI, lactose intolerance, BO, neurological problems... and if these are all added up, stay with me here people, MAYBE there is in fact NO 'functional disorder' you can call IBS which is separate from all the things Eric tells us don't qualify as IBS.Now guys... that would be funny. come on Eric, make me laugh. easy tiger.


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## eric (Jul 8, 1999)

From above"The cause of IBS is not yet fully understood"That does not been its not understood at all.In fact they have learn quite a bit about it recently.Other conditions, I.E. lactose intolerence and fructose intolernce can mimmick SOME of the symptoms, but they don't match all the symptoms of IBS. It is outdated to call these conditions IBS.If you want a more up to date understanding of IBS and even this is from 2001, here you go.Annu Rev Med. 2001;52:319-38. Related Articles, Links Irritable bowel syndrome.Ringel Y, Sperber AD, Drossman DA.UNC Center for Functional GI and Motility Disorders, Division of Digestive Diseases and Nutrition, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7080, USA. ringel###med.unc.eduThe irritable bowel syndrome (IBS) is a functional gastrointestinal disorder whose hallmark is abdominal pain or discomfort associated with a change in the consistency or frequency of stools. In the western world, 8% to 23% of adults have IBS and its socioeconomic cost is substantial. Research-generated insights have led to the understanding of IBS as a disorder of brain-gut regulation. The experience of symptoms derives from dysregulation of the bidirectional communication system between the gastrointestinal tract and the brain, mediated by neuroendocrine and immunological factors and modulated by psychosocial factors. The biopsychosocial model integrates the various physical and psychosocial factors that contribute to the patient's illness. This model and the recently revised symptom-based criteria (i.e. the "Rome II criteria") form the basis for establishing a comprehensive and effective approach for the diagnosis and management of the disorder.Publication Types: Review Review, Academic PMID: 11160782"Features of IBS are pain relieved by defecation, an alternating pattern of bowel habits, abdominal distention, mucus in the stool, and sensation of incomplete evacuation after defecation. The more symptoms that are present, the likelier that the patient has IBS. "Again DR Dahlman what really is the difference in you selling over the counter products and the drug companies, both are businesses. Where were your products tested, are they FDA approved?Are those products specifically and clinically tested for treating IBS?Still these things are not IBS."We are all different, some need probiotics, some need to eliminate critters that they have picked up that shouldn't be living inside them, some need to cut out dairy, others fructose and/or gluten."One is celiac, one is LI one is FI one is an organic disease.Probiotics are a treatment option in IBS, but no studies show they cure IBS or there total relationship to IBS. A lot of this has nothing to do with them what so ever. It also is looking more like a prevention measure then a cure.Then there is IBS, of which the cause is not fully understood yet, but progress is being made.And yes people may have different pathophysiologies for various reasons and some not understood yet, when they learn more about the brain and brain gut connections they hopefully will become clearer.and heance why the chairman of the Rome committee and one of the worlds leading reserchers wrote this for me."Since I have suffered for thirty years of IBS I wonder what role foods play in IBS. So I asked Dr Douglas Drossman at the UNC Center for Functional GI and Motility disorders and here was his response. This is not a substitute for seeking medical advise from your doctor on any specific conditions you may have, but for educational purposes only. Dr. Drossman is a Co-director of the Center and Professor of Medicine and Psychiatry at UNC-CH. He established a program of research in functional gastrointestinal disorders at UNC more than 15 years ago and has published more than 250 books, articles, and abstracts relating to epidemiology, psychosocial and quality of life assessment, design of treatment trials, and outcomes research in gastrointestinal disorders. Dr Drossman's comments on foods for IBS Health.Shawn,To say that people with IBS may get symptoms from food intolerances is an acceptable possibility, since the gut will over react to stressors of all types including food (high fat or large volumes of food in particular). Futhermore, there can be specific intolerances. So if you have a lactose intolerance for example, it can exacerbate, or even mimic IBS. Other examples of food substances causing diarrhea would be high consumers of caffeine or alcohol which can stimulate intestinal secretion or with the latter, pull water into the bowel (osmotic diarrhea). The same would be true for overdoing certain poorly absorbed sugars that can cause an osmotic type of diarrhea Sorbitol, found in sugarless gum and sugar substituted foods can also produce such an osmotic diarrhea. Even more naturally, people who consume a large amount of fruits, juices or other processed foods enriched with fructose, can get diarrhea because it is not as easily absorbed by the bowel and goes to the colon where it pulls in water. So if you have IBS, all of these food items would make it worse. However, it is important to separate factors that worsen IBS (e.g., foods as above, stress, hormonal changes, etc.) from the cause or pathophysiology of IBS. Just like stress doesn't cause IBS, (though it can make it worse), foods must be understood as aggravating rather than etiological in nature. The cause of IBS is yet to be determined. However, modern research understands IBS as a disorder of increased reactivity of the bowel, visceral hypersensitivity and dysfunction of the brain-gut axis. There are subgroups being defined as well, including post-infectious IBS which can lead to IBS symptoms. Other work using brain imaging shows that the pain regulation center of the brain (cingulate cortex) can be impaired, as well as good evidence for there being abnormalities in motility which can at least in part explain the diarrhea and constipation. So finding a specific "cause" of IBS has grown out of general interest in place of understanding physiological subgroups that may become amenable to more specific treatments. Hope that helps.Doug " http://www.ibshealth.com/ibs_foods_2.htm There is the issues of people here and them getting better for whatever reasons, and the issue of DR D inadequacy and franky bias, based on his own beliefs information in presenting information on the internet about IBS. Its really to bad to see people do this when more accurate IBS information is crucial to IBS suffers in the big picture and not just thinking about oneself.I don't hear any talk about the irregularities seen in the enteric nervous sytem, the autonomic nervous sytem, the Central nervous system, the neurotranmsitters, mast cells and EC cells, etc. ect.. All of which open new treatments for the different subgroups of IBSers.Without talking about it or even knowing about it all, I think its absurd that DR D says he can "cure" them all. Which I believe is being played out, because of the lack of knowledge and more accurate information already known about IBS within the IBS patient community.


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## Jhouston (Nov 9, 2003)

Eric, In all your readings and talks with GI specialist ..Have any other symptoms come up? like feeling Foggy or Druggie after eating? Joann


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## Jhouston (Nov 9, 2003)

Calid, I eat like you only chicken, fish, veg, rice. Do you eat alfalfa sprouts? I recall reading they can mimic Lupis symptoms. Bonnie, besides GI symptoms for FI, what other if any symptoms are associated with FI? Joann


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## kel1059 (Feb 28, 2003)

jhouston,rice gave me a very bad case of the drugged/foggy feeling.any chance at all that this could be the case. i hate to bring this up because i may be taking away the only starch that you think you can tolerate.however, i have found that i can tolerate starches from a few sources and none of them are from a grain or a potato.beans and tapioca flour.*********************************************************MISSC,once again very good points you make.


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## Jhouston (Nov 9, 2003)

Kel, It is really hard to say whats what with me. I have bizzare symptoms. When I first came down with "the virus" in 1998 Anything I ate gave me the "fog". I lost so much weight. Anyway, what I did to survive was eat one egg every day. small amounts of food. usually soup. then ezekial bread. then I found if I drank coffee before, during or after meal I it would counteract the fog. I know it is not a healthy way to fix but I was left with no alternative. docs look at me like I am nuts. they check thyroid, fasting sugar and say it is weird. I notice that this fog symptom has subsided and then returned say after a bout with a cold or if I need to take antibiotics then after it returns. hopefully it will subside again. I have had this fog after eating any food. less with some food. I even checked my blood pressure to see if anything. looks to me like a drop in bp. low like 95/65. adrenal exhaustion? Joann


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## calid (Aug 4, 2003)

Bonnie, that quote was one from Lek's posts. I thought it rang true and would like to know more.Check out her 9:39 pm post above.Joann: No I don't eat sprouts at this time.


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## Arnie W (Oct 22, 2003)

It doesn't really matter whether I have candida albicans, FI, LI (and I might possibly have all of these) or IBS. Perhaps one day I'll find out. Abdominal discomfort, gas, C and frequent bms have been bed companions for me for a long time.If I have LI, I've still got the symptoms which are consistent with IBS. I agree with those who suggest to look at anything which will help to bring about relief no matter what the diagnosis is.I haven't got a diagnosis.


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## drdahlman (Nov 6, 2000)

Thanks MissC, for a voice of reason from someone new.And here's a news flash for everyone: This past week, I refunded the costs of my first patient since I began my money back guarantee. That's 1 out of 917 patients who have allowed me to guide them through my entire program since November of 2001. I'll take that record anyday.I have a very simple life. Patients come to me with complaints. Most have been diagnosed with a garbage can diagnosis because their condition is NOT understood by traditional medicine. They simply want relief. I put them through a program that in ALL cases (except one), eliminates ALL their symptoms. Nobody cares what it's called, they just want their symptoms to go away and their quality of life returned. Bottom line: It works.Relying on info from the Merck manual simply keeps the patient in the revolving door to nowhere. Quoting from people who can't help is a ridiculous way of trying to prove credibility. Why post failures? And the difference between me selling products and the pharmacuetical companies? Thanks for the softball.....the difference is my products coupled with dietary eliminations, in a nutshell, works. Complete elimination of symptoms versus symptom management. Next question?


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## eric (Jul 8, 1999)

So your treating Arnie, over the internet and he has not even gotten a diagnoses? How wrong is that?"their condition is NOT understood by traditional medicine"No their condition is not Totally understood! There is however quite a bit that is understood about IBS. You have however, not talked about any of it."Relying on info from the Merck manual simply keeps the patient in the revolving door to nowhere."You mean accuate information, that is just what people should rely on. accurate sources such as mearck and the 100 of others that have been posted from creditable sources."Quoting from people who can't help is a ridiculous way of trying to prove credibility."You keep saying this by I know 1000's of people who have been helped.So where do you get these statistics from? How do you know how many people have actually been helped? Besides its you that has no credibility, the UNC and Mayo and UCLA are already crediable IBS research centers, so what are you talking about? You have listed one reference or creditable source. yes, both you and the drug companies run businesses and have products. I thought it was three thousand people, now its 917 and all that is your anecdotal evidence. *"Regular medicine has antidotes: alternative medicine has anecdotes." - Frank Coffman * --------------------------------------------------------------------------------One of the scientific rules is that anecdotal evidence doesn't cut it. Suppose I tell you that I thought of a long-lost friend. Just then the phone rang, and it was my old friend. That's a nice anecdote. So why doesn't it prove anything about precognition? If this story proved anything, it would be proving that the unlikely had happened. But there's no way to tell if the event was in fact unlikely. Perhaps I think about the friend a lot. Perhaps I've thought of people a zillion times, and only one of them phoned. And there's the lottery-ticket thing. The person with the winning ticket sees that as very unlikely. But someone had to win. So, how many other people thought of a long-lost friend, and got no call? I don't know the answer. And until I know the answer, the anecdote doesn't prove anything. A large collection of anecdotes isn't necessarily any better than a small collection. There are several famous cases where large groups of people all swore that some new remedy was a wonder cure. (For example, Mesmer's "animal magnetism".) The main value of the collection is that their number might inspire someone to look into the matter properly. Anecdotes about health are often useless. This is because some number of patients will get well anyway, no matter what treatment they receive. If a cancer goes into remission, it is very human to think that some recent change caused a cure. Anecdotes are also entirely too susceptible to being unverifiable. If someone tells a story, and you press him for details, it is entirely likely that he doesn't have them. He can't remember, it was long ago. Or, no doctor ever actually verified the disease, much less its cure. Or, it turns out it didn't actually happen to him: it happened to his sister. If you force him to contact his sister, she remembers it differently. Or, worse, it turns out it happened to a friend of the sister. We are now chasing down a FOAF (Friend Of A Friend) story. FOAF stories are usually rumors or "urban legends". In short: anecdotes, bleah. http://www.cs.colorado.edu/~lindsay/skeptic/anecdotal.html


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## eric (Jul 8, 1999)

Irritable Bowel Syndrome mm/dd/yyyy 11/04/2003 UEGW: Tegaserod Rapidly Effective in Patients With Constipation-Predominant Irritable Bowel Syndrome - (DGDispatch) 11/04/2003 UEGW: Renzapride Improves Symptoms in Constipation-Predominant Irritable Bowel Syndrome - (DGDispatch) 10/22/2003 IDSA: Travelers' Diarrhoea Can Trigger Irritable Bowel - (DGDispatch) 10/17/2003 ACG: Many Patients with Irritable Bowel Also Suffer from Dyspepsia - (DGDispatch) 10/15/2003 ACG: After Menopause, Women Have Same Severity of Irritable Bowel Syndrome As Men - (DGDispatch) 06/09/2003 ASHP: Patients with Irritable Bowel Syndrome and Constipation Unhappy with Conventional Treatments Because of Side Effects and Lack of Efficacy - (DGDispatch) 05/19/2003 DDW: Excess Body Weight and Speed of Colon Transit Linked to Idiopathic Bile Acid Malabsorption - (DGDispatch) 04/01/2003 Probiotic VSL#3 Could Relieve Some Irritable Bowel Abdominal Bloating - (DGReview: Aliment Pharmacol Ther) 03/31/2003 No Large Association Between Traveller's Diarrhoea, Risk Of Irritable Bowel Disease - (DGReview: Am J Gastroenterol) 03/21/2003 Peripheral Inflammatory Response Enhanced In Post-Gastroenteritis Irritable Bowel Syndrome - (DGReview: Gut) 03/10/2003 Irritable Bowel Syndrome More Frequent In Bacterial Gastroenteritis Patients - (DGReview: Am J Gastroenterol) 03/04/2003 Alosetron Has Positive Impact On Irritable Bowel Symptoms, Pain And Discomfort - (DGReview: Neurogastroenterol Motil) 02/26/2003 Normalising Abnormal Lactulose Breath Tests With Neomycin Reduces Irritable Bowel Symptoms - (DGReview: Am J Gastroenterol) 02/07/2003 One-Quarter Of Irritable Bowel Syndrome Patients Fit Alternating Bowel Habits Subtype - (DGReview: Eur J Gastroenterol Hepatol) 02/05/2003 Irritable Bowel Symptomatology Scoring Measures Scored - (DGReview: Am J Gastroenterol) 01/30/2003 Peptide, Neuropeptide Levels Differ among Patients with Irritable Bowel Syndrome - (DGReview: Eur J Gastroenterol Hepatol) 01/29/2003 Altered Visceral Perception Modulation Confirmed In Irritable Bowel Patients - (DGReview: Am J Gastroenterol) 01/20/2003 Rome I May Not Be Sensitive Enough To Detect All Irritable Bowel Patients - (DGReview: Gastroenterol Clin Biol) 01/17/2003 Ending Bacterial Overgrowth Results in Better Motility in Some Irritable Bowel Patients - (DGReview: Dig Dis Sci) 01/17/2003 Irritable Bowel Patients Most Often Self-Classify Symptoms As Discomfort, Not Pain - (DGReview: Am J Gastroenterol) 01/13/2003 Some Irritable Bowel Patients Genetically Predisposed To Produce Less Interleukin-10 - (DGReview: Gut) 01/07/2003 Women With Diarrhoea-Predominant Irritable Bowel Satisfied With Alosetron Therapy - (DGReview: Am J Gastroenterol) 12/23/2002 Otilonium Bromide Confirmed As More Effective Than Placebo For Irritable Bowel Pain - (DGReview: Eur J Gastroenterol Hepatol) 12/17/2002 Colonic Fermentation in Irritable Bowel Not Affected By Lactobacillus Plantarum - (DGReview: Dig Dis Sci) 12/11/2002 Gender Differences Reported In Vitality, Mental Health Among Irritable Bowel Patients - (DGReview: Dig Dis Sci) 12/10/2002 Irritable Bowel Pathogenesis Involves Myenteric Plexus Neuronal Degeneration - (DGReview: Gastroenterology) 12/04/2002 Irritable Bowel Syndrome Benign Despite Patient Concerns - (DGReview: Am Fam Physician) 12/03/2002 Lactose Intolerance Unlikely in Aetiology of Post-Infectious Irritable Bowel - (DGReview: Eur J Gastroenterol Hepatol) 11/29/2002 Enhanced Central Nervous System Reactivity Reported in Irritable Bowel - (DGReview: Am J Gastroenterol) 11/26/2002 No Evidence for Standardised Testing in Patients Meeting Symptom-Based Irritable Bowel Criteria - (DGReview: Am J Gastroenterol) mm/dd/yyyy 11/25/2002 Rome I Could Be More Sensitive Than Rome II in Irritable Bowel Diagnosis - (DGReview: Am J Gastroenterol) 11/21/2002 Delayed Gastric Emptying Associated with Post-Prandial Irritable Bowel Fullness - (DGReview: Am J Gastroenterol) 11/20/2002 Lotronex (Alosetron Hydrochloride) Tablets Now Available For Women With Severe Diarrhea-Predominant Irritable Bowel Syndrome - (DGNews) 10/24/2002 ACG: ACG Report Finds Drugs Effective in Irritable Bowel Syndrome - (DGDispatch) 10/22/2002 New Study Shows Zelmac (Tegaserod) Effective and Safe for People with Non-Diarrhea Irritable Bowel Syndrome - (DGNews) 09/02/2002 Naloxone Improves Pain Management, Symptom Control In Irritable Bowel Syndrome - (DGReview: Aliment Pharmacol Ther) 07/24/2002 FDA Approves Zelnorm (Tegaserod Maleate), A Novel Treatment For Irritable Bowel Syndrome In Women With Constipation - (DGNews) 07/24/2002 Hope For Four Million Canadian Women: First Specific Treatment for Irritable Bowel Syndrome Now Available - (DGNews) 06/25/2002 Rectal Characteristics Differ In Irritable Bowel Subtypes - (DGReview: Neurogastroenterol Motil) 06/07/2002 Lotronex (Alosetron) Tablets To Be Re-Introduced For Women With Severe Diarrhea-Predominant Irritable Bowel Syndrome - (DGNews) 05/23/2002 DDW: Meta-Analysis Shows Tegaserod Effective, Safe in Treatment of IBS - (DGDispatch) 04/11/2002 Higher Prevalence Of Irritable Bowel Syndrome In Patients With Gastroesophogeal Reflux Disease - (DGReview: J Clin Gastroenterol) 03/13/2002 Menses Heighten Symptoms Among Women With Irritable Bowel Syndrome - (DGReview: Gut) 01/22/2002 Australia Approves Zelmac (Tegaserod) for Irritable Bowel Syndrome - (DGNews) 12/27/2001 Tegaserod Benefits Some Women with Irritable Bowel - (DGReview: J Clin Gastroenterol) 12/19/2001 Central Nervous System Response Altered in Irritable Bowel Patients - (DGReview: Scand J Gastroenterol) 12/18/2001 Somatostatin, Octreotide Confirmed Effective for Refractory Diarrhoea - (DGReview: Aliment Pharmacol Ther) 12/13/2001 Re-Evaluate Irritable Bowel Patients Only When Symptoms Change - (DGReview: MMW Fortschr Med) 12/10/2001 Phobic Anxiety-Related Brain Activity May Influence Severity Of Irritable Bowel Syndrome - (DGReview: Psychosom Med) 12/07/2001 Clonidine Relaxes Fasting Colonic Tone, Reduces Pain - (DGReview: Am J Physiol: Gastrointest Liver Phsyiol) 12/06/2001 Markers Found For Irritable Bowel Subgroup With Celiac Disease - (DGReview: Gastroenterology) 12/06/2001 Irritable Bowel Patients Use More Health-Care Dollars - (DGReview: Am J Gastroenterol) 11/30/2001 Cortical Activation in Rectal Distension Greater in Women - (DGReview: Am J Physiol: Gastrointest Liver Phsyiol) 11/30/2001 Irritable Bowel Treatment Management Remains Problematic - (DGReview: International Journal of Clinical Practice) 11/29/2001 Personality Traits Linked to Irritable Bowel - (DGReview: Zhurnal Nevropatologii i Psikhiatrii Imeni S. S. Korsakova) 11/22/2001 Probiotic VSL-3 Improves Clinical Picture for Irritable Bowel Patients - (DGReview: Research in Microbiology) 11/20/2001 Canadian Irritable Bowel Prevalence Is 6 Percent - (DGReview: Can J Gastroenterol) 11/20/2001 Irritable Bowel Patients Exhibit Intolerance to Gut Manoeuvres - (DGReview: Can J Gastroenterol) 11/14/2001 SNA: Some Pain Relief Drugs Could Alleviate Irritable Bowel Syndrome - (DGDispatch) 11/14/2001 Prevalence of Irritable Bowel Symptoms Increases Over Long-Term - (DGReview: Am J Gastroenterol) mm/dd/yyyy 11/14/2001 Irritable Bowel Syndrome Impacts Patients' Personal Relationships - (DGReview: Eur J Gastroenterol Hepatol) 11/13/2001 Family Doctors Evaluate Irritable Bowel Differently Than Do Specialists - (DGReview: BMC Gastroenterol) 11/08/2001 Post-Prandial Mental Stress Greater for Women with Irritable Bowel - (DGReview: Psychosom Med) 11/08/2001 Hypothalamic Digoxin Could Play Irritable Bowel Role - (DGReview: Indian J Gastroenterol) 11/06/2001 Irritable Bowel Syndrome Patients Shoud Be Checked For Celiac Disease - (DGReview: Lancet) 11/01/2001 Irritable Bowel, Other Syndromes Need Reconsideration As Separate Entities - (DGReview: Journal of Psychosomatic Research) 11/01/2001 Zelnorm (Tegaserod) Safe, Effective for Multiple Symptoms of Irritable Bowel Syndrome - (DGNews) 10/31/2001 Probiotic LP299V Could Help Patients With Irritable Bowel - (DGReview: Eur J Gastroenterol Hepatol) 10/31/2001 Probiotics Require Further Research Before Use in Irritable Bowel - (DGReview: Eur J Gastroenterol Hepatol) 10/25/2001 Vegetarian Diet Does Not Affect Intestinal Motility - (DGReview: Scand J Gastroenterol) 10/25/2001 Central Sensitisation Contributed to Visceral Hypersensitivity - (DGReview: Am J Physiol: Gastrointest Liver Phsyiol) 10/25/2001 Antral Contractions Not Predictive of Gastric Emptying - (DGReview: Am J Physiol: Gastrointest Liver Phsyiol) 10/19/2001 New Non-Steroidal Anti-Inflammatories Significantly Reduce Gastric Mucosal Permeability - (DGReview: Gut) 10/19/2001 Diagnostic Criteria Determine Prevalence of Irritable Bowel - (DGReview: Scand J Gastroenterol) 10/18/2001 ACG: Dexloxiglumide Shows Results in Constipation-Predominant Irritable Bowel Syndrome - (DGDispatch) 10/18/2001 Social Learning Influences Development of Irritable Bowel - (DGReview: Gastroenterology) 10/12/2001 Diarrhoea-Predominant Irritable Bowel Women More Responsive to Alosetron - (DGReview: Am J Gastroenterol) 10/10/2001 Irritable Bowel Diagnosis Excludes Usual Methods - (DGReview: Ugeskrift for Laeger) 10/10/2001 Alosetron Controls Urgency in Irritable Bowel Women - (DGReview: Am J Gastroenterol) 10/05/2001 Inflammatory Changes Seen in Irritable Bowel Chronic Pelvic Pain - (DGReview: World J Urol) 10/04/2001 Electrogastrography Helps Distinguish Irritable Bowel From Dyspepsia - (DGReview: European Journal of Internal Medicine) 10/04/2001 Irritable Bowel Pain, Constipation Relief Sustained with Tegaserod - (DGReview: Aliment Pharmacol Ther) 09/27/2001 New Algorithm Helps Diagnose Irritable Bowel - (DGReview: Arch Intern Med) 09/25/2001 Irritable Bowel Prevalence Lower In Older People - (DGReview: J Am Geriatr Soc) 09/21/2001 Computer Auscultation Distinguishes Irritable Bowel, Crohn's Disease - (DGReview: Dig Dis Sci) 09/19/2001 Irritable Bowel Patients Often Dissatisfied With Medical Care - (DGReview: Psychotherapie, Psychosomatik, Medizinische Psychologie) 09/14/2001 Quality of Life Poor For Irritable Bowel Patients - (DGReview: PharmacoEconomics) 09/04/2001 Spinal Hyperalgesia Seen In Irritable Bowel Patient - (DGReview: Am J Gastroenterol) 09/03/2001 Diverse Approach Needed In Management of Irritable Bowel Patients - (DGReview: Eur J Gastroenterol Hepatol) 08/29/2001 Role of Lactose Malabsorption Seen In Irritable Bowel - (DGReview: Eur J Gastroenterol Hepatol) mm/dd/yyyy 08/29/2001 Intestinal Ultrasound Helps Differentiate Between Irritable and Inflammatory Bowel - (DGReview: Eur J Gastroenterol Hepatol) 08/29/2001 More Evidence of Defective Visceral Afferent Transmission In Irritable Bowel - (DGReview: Am J Gastroenterol) 08/23/2001 Potential Underlying Mechanism Identified for Irritable Bowel Syndrome - (DGReview: Am J Gastroenterol) 08/23/2001 No Diagnostic Markers For Irritable Bowel Syndrome - (DGReview: Primary Care) 08/21/2001 Post-Infectious Irritable Bowel A Possibility - (DGReview: Current Treatment Options in Gastroenterology) 08/16/2001 Irritable Bowel Reason for 12 Percent of Visits to US Doctors - (DGReview: Am J Manag Care) 08/13/2001 Psychological Therapies Help Patients with Irritable Bowel Syndrome - (DGReview: Current Treatment Options in Gastroenterology) 08/13/2001 Patients With Campylobacter Enteritis At Risk For Irritable Bowel - (DGReview: J Infect Dis) 08/09/2001 Costs High In Management Of Irritable Bowel Syndrome - (DGReview: American Journal of Managed Care) 08/09/2001 Gender Differences In Irritable Bowel Unrelated To Menstrual Cycle - (DGReview: Am J Gastroenterol) 08/09/2001 Comorbid Irritable Bowel, Dyspepsia Leads to Referral To Secondary-Care - (DGReview: Postgrad Med J) 08/03/2001 Drugs Acting on Nociceptive Pathways Best For Irritable Bowel - (DGReview: Scand J Gastroenterol) 08/01/2001 Patients With Irritable Bowel Need To Be Warned Of Extended Care - (DGReview: Rev Med Chile) 08/01/2001 Rectal Hypersensitivity Relates To Irritable Bowel Subgroup - (DGReview: Scand J Gastroenterol) 07/26/2001 Presence of Fibromyalgia Associated Only With Severity of Irritable Bowel Syndrome - (DGReview: Int J Colorectal Dis) 07/23/2001 Twelve-Week Alosetron Treatment Relieves Irritable Bowel Pain - (DGReview: Arch Intern Med) 07/19/2001 Comorbid Irritable Bowel, Fibromyalgia Require Pharmacologic Treatment - (DGReview: Current Pain and Headache Reports) 07/19/2001 Pediatric Recurrent Abdominal Pain Not Necessarily Irritable Bowel Forerunner - (DGReview: Pediatr Elec Pages) 07/13/2001 Prevalence Of Irritable Bowel, Dyspepsia In The Netherlands Lower Than In Other Countries - (DGReview: Netherlands Journal of Medicine) 07/12/2001 Limited Follow-Up After Irritable Bowel Diagnosis - (DGReview: American Journal of Managed Care) 07/09/2001 Fibromyalgia, Irritable Bowel Symptoms Overlap - (DGReview: Turk J Gastroenterol) 07/04/2001 Exclusion Diets Have Limited Use in Irritable Bowel Treatment - (DGReview: J Hum Nutr Dietetics) 07/04/2001 No Adjustment for Age, Gender Needed for Tegaserod for Irritable Bowel - (DGReview: Aliment Pharmacol Ther) 07/02/2001 Relaxation Mediation Program Works in Irritable Bowel Syndrome - (DGReview: Behavioural Research and Therapy) 06/29/2001 Cutaneous Hyperalgesia Seen In Irritable Bowel Patients - (DGReview: Pain) 06/29/2001 Autonomic Function Differs According To Irritable Bowel Symptoms - (DGReview: Dig Dis Sci) 06/27/2001 No Magic Bullet To Relieve Varied Irritable Bowel Symptoms - (DGReview: Aust Prescriber) 06/20/2001 Irritable Bowel Patients Report Frustration, Isolation - (DGReview: J Fam Pract) 06/19/2001 Ill-Defined Pathologic Mechanisms Tied To Anxiety, Depression - (DGReview: Ann Intern Med) 06/18/2001 Recruitment Methodology Affects Irritable Bowel Study Results - (DGReview: Aliment Pharmacol Ther) mm/dd/yyyy 06/12/2001 Powerful Contractions One Cause Of Irritable Bowel Pain - (DGReview: Am J Gastroenterol) 06/12/2001 Irritable Bowel Patients' Response To Rectal Stimuli Altered - (DGReview: Psychosom Med) 06/12/2001 Understanding Of Gut Microflora Holds Promise - (DGReview: Inflammatory Bowel Diseases) 06/06/2001 Possible Pathophysiological Link Between Irritable Bowel, Asthma - (DGReview: Am J Gastroenterol) 06/06/2001 Irritable Bowel Syndrome Found In Rural Bangladesh - (DGReview: Am J Gastroenterol) 06/04/2001 Colonic Serotonin Levels Elevated In Patients With Constipation-Predominant Irritable Bowel Syndrome - (DGReview: Digestion) 05/28/2001 Physical/Psychological Symptoms In Severe Irritable Bowel Limit Quality Of Life - (DGReview: Ann Intern Med) 05/25/2001 Fructose Malabsorption, Irritable Bowel Symptoms Similar - (DGReview: Scand J Gastroenterol) 05/24/2001 Unexplained Clinical Conditions Such as Irritable Bowel Often Overlap With Others - (DGReview: Ann Intern Med) 05/23/2001 Irritable Bowel Symptoms Overlap Chronic Pelvic Pain - (DGReview: Am J Obstet Gynecol) 05/23/2001 Quality Of Life Reduced For Women With Irritable Bowel Syndrome - (DGReview: Scand J Gastroenterol) 05/22/2001 DDW: Tegaserod Safe, Well-Tolerated in Treating Constipation-Predominant Irritable Bowel Syndrome - (DGDispatch) 05/14/2001 Unfermented Carbohydrates Could Play Role In Irritable Bowel - (DGReview: British Journal of Nutrition) 05/10/2001 Adrenal Dysregulation Seen In Irritable Bowel Patients - (DGReview: Journal of Endocrinological Investigation) 05/09/2001 Irritable Bowel Unrelated To Anxiety Or Depressive Disorders In Young Adults - (DGReview: Am J Gastroenterol) 05/09/2001 Word Recall Suggests Cognitive-Behavioural Theory For Irritable Bowel - (DGReview: Am J Gastroenterol) 05/09/2001 Increased Standing Abdominal-Muscle Activity Affects Irritable Bowel Patients - (DGReview: Am J Gastroenterol) 04/25/2001 Irritable Bowel Syndrome Becoming Common In Elderly - (DGReview: Drugs and Aging) 04/25/2001 Gap Exists Between Basic, Clinical Research Into Drugs For Irritable Bowel Syndrome - (DGReview: Drugs) 04/25/2001 Few Benefits From Low-Lactose Diet For Irritable Bowel Patients - (DGReview: European Journal of Gastroenterology and Hepatology) 04/18/2001 Women With Fibromyalgia More Likely To Have Irritable Bowel Than Men - (DGReview: Current Rheumatology Reports) 04/18/2001 Irritable Bowel Syndrome Outcomes Evaluated Using SF36 Survey - (DGReview: Australian and New Zealand Journal of Public Health) 04/11/2001 Intestinal Tract Endometriosis Can Mimic Irritable Bowel Syndrome - (DGReview: American Journal of Surgical Pathology) 04/11/2001 Long-Term Alosetron Therapy Well Tolerated by Irritable Bowel Patients - (DGReview: American Journal of Gastroenterology) 04/11/2001 Sigmoid Adhesions Could Cause Irritable Bowel Symptoms - (DGReview: Obstetrics and Gynaecology Communications) 03/23/2001 Women With Anxiety Often Have Food-Related Irritable Bowel Symptoms - (DGReview: Digestion) 03/23/2001 Interstitial Cystitis Seen In Irritable Bowel Syndrome Patients - (DGReview: Expert Opinion on Investigational Drugs) 03/22/2001 Artichoke Leaf Extract May Provide Irritable Bowel Syndrome Relief - (DGReview: Phytotherapy Research) 03/20/2001 Therapeutic Audiotape Can Effectively Counter Resistant Irritable Bowel Syndrome - (DGReview: Int J Colorectal Dis) 03/12/2001 Lactobacillus Plantarum 299v Reduces Irritable Bowel Bloating - (DGReview: American Journal of Clinical Nutrition) Seems like quite a bit of information to me. http://www.docguide.com/news/content.nsf/A...52568880078C249


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## Arnie W (Oct 22, 2003)

Eric, You say that I'm being treated over the internet and I haven't gotten a diagnosis.I have been in person to so many specialists that I have lost count, and have not been given a diagnosis. You have missed the point. I meant that no one has given me a diagnosis.NO remedy has alleviated my symptoms one iota.I am not expecting a diagnosis over the internet. All I want is treatment given in response to the symptoms I described in the hope I will get satisfaction after everything else has failed.As has already been suggested, there is a mishmash of possible causes for the condition, which might not even be IBS. I'm heading now to the feeling that whilst food intolerances might not have brought on the condition, it is very possible that longterm relief might come from eradicating certain things from my diet.But it is also posible that getting bacteria, etc, sorted out could make life a lot easier.I appreciate where you are coming from, but you chose to pick out only one part of my posting. What about the possibility that there are so many things going on that it would be very difficult and expensive to get a completely accurate diagnosis?Even if someone had given me a diagnosis, it would not have been much use if I couldn't get any successful treatment for it.


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## missC (Oct 16, 2002)

is that the same Merck Manual which was partially responsible for the 'thud' scandal of the 70's? in which a group of trained psychiatrists and psychologists presented themselves for diagnosis and treatment at a variety of emergency rooms and mental hospitals? they said a voice in their head was saying 'thud'. that's it. no distress, no alteration in affect, nothing. no incitement to unusual behaviour. without exception they found themselves incarcerated and medicated with a diagnosis of psychosis or schizophrenia.the relevant categories in the manual had to be completely re-written.post-script: the medical professionals involved were so humiliated and angry, they threw down the gauntlet: 'go on, send as many fakers as you like to our hospitals over the next three months. we'll catch every damn one.' they threw out maybe a hundred people claiming mental distress during the period.turned out the experimental group hadn't sent one damn 'agent' in.i don't have anything against scientific method or allopathic medicine (no i REALLY DON'T. i mean i REALLY don't). i do have a problem with untrained credulity when people aren't prepared to treat 'scientific' data, papers, findings and results with the same scepticism and subject it to the same rigorous criticism they apply to anything coming from left-field and outside the Masonic-handshaking white-maling mentoring and often close-minded scientific community.some guys here like REALLY need to read Kuhn and find out just how illogical and unscientific 'science' can be. it's a CLUB, boys. and because you're not a member it has a seductive mystique for you. but it's not unflawed, and it doesn't always operate by its own precepts. and just because somebody doesn't belong to the club, doesn't mean their ideas are unworthy of investigation. very often it means their ideas just aren't in vogue with the power-brokers in the club.


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## Gret (Sep 23, 2003)

Hey, missC, I always enjoy your posts! How's everyone feeling? I'm quite sure I got slipped some dairy last night - out to dinner for Valentine's Day! I think the lobster cakes might have had cream in them and the butternut squash ravioli too. But, oh well. Guess it's time for an experiment and see if maybe I do have a dairy problem. Not so far, but I'll keep on alert for a few days and see.


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## drdahlman (Nov 6, 2000)

Oh Boy! We've got a good one here with MissC. An articulate voice of reason. I look forward to more of your posts.Dearest Eric, I have treated thousands of people for IBS since I started practice 8 years ago. The 917 are those who have taken part in my money back guarantee program SINCE I began it in November 2001. You need to pay more attention if you're going to attack me. Nice try, keep tossing the softballs.You ask the difference between me selling products and the pharmacuetical companies? Another easy one. My products work because they're coupled with a process of elimination to determine what foods might be contributing to the set of symptoms. And there's a huge difference between symptom suppression and getting to the cause of the problem.So, why don't you stop attacking me? Take your beef with me and start your own thread. It's foolish for you to think that simply because you post the most (almost 16,000 times, that's 3 each day since the board started) and the longest (one post measured 80 inches) that you therefore have the most credibility. That's called beating people over the head. The reality is, you don't matter. You are very impressionable and your experts are not another's. We could all post lengthy citations on the consequences of antibiotics, the need for probiotics, the consequences of certain critters living inside you that shouldn't be there, the benefits of nutritional products like L-glutamine on the gut, the effects of intolerances to dairy, fructose or gluten or whatever we would like to prove. But we don't. This is a discussion board not Eric's reading room. Very few people on this board read your posts. To those to whom you do matter, please take it somewhere you're appreciated. Endless attacks on me make you look childish and foolish. Read my summary (a day or two ago)about the patients from this board, and how they are progressing. One very quickly, some more slowly and some I will struggle with. Just like in my office where everyone, except one, who has allowed me to guide them through my entire program has had a complete elimination of their symptoms. Quote whatever experts you wish, but no one has the success record I have. It's just that simple.Here's another offer to the members of the board. If anyone is near enough to Cincinnati to come to my office, let's conduct a study. And you will be in complete control of that study and the results. We will go to my files, you can point to the file you want and we will look at it. I will protect the anonymity and privacy of each patient, but we will go through my notes in each file and you can keep statistics on how they progressed through treatment and what the end result was. I don't know a better way to prove to anyone what goes on in my office. Who's up for this? How about you, Eric?


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## kel1059 (Feb 28, 2003)

eric start your own thread; you are a distraction to those of us who are being helped by his common sense approach to this problem.jhouston,i have been free of the fog for 2 months now. i think it will come back during allergy season but i hope not. foods --especially carbs-- were the worst cause of the fog. i don't understand what goes on or why it has eased up.i am thinking that the fog might have something to do with a certain immune messenger chemical. i really think that my immune system is messed up for some reason or another. i like dr esther sternberg's description of what might be happening -- a shift from a th1 to th2 immune function. a confused immune system, one that has trouble distinguishing harmless substances from harmful ones.on the bright side it sounds like you are improving. i know that i have improved over the last few years.MissC,i agree with your opinion of these matters; it's nice to see support.


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## Jhouston (Nov 9, 2003)

Kel, It is interesting about th1 and th2 disregulation of immune function. What is weird this last year is that I felt better, even thought cfs was finally over. and IBS became an issue. it wasn't perfect before (some bloating) but now I am intolerant of lots of foods that I could eat before. I typed in "feeling drugged after eating" search. there are others that use the same description. most talk about "syndrome X" and Carbohydrate Intolerance.....too much insulin etc. We'll see if getting the flora balanced helps. hopefully the ultra flora will implant. the one I have been taking for 5 or 6 yrs hasn't. Joann


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## kel1059 (Feb 28, 2003)

quote--------"but now I am intolerant of lots of foods that I could eat before. "i can't for the life of me figure it out. i have a lot of clues. my high T4 cell count indicates that my body is fighting something. a CFIDS MD claims that it could be mycoplasma.a chinese herbalist told me that my immune system is weak from a chinese pulse reading technique.i have a contact who thinks i need to be on olive leaf extract. she is a person who i trust very much. i have been reading about it and it sounds impressive. i used to take it but i thought i had a problem with it -- allergy-wise.my research says that it stimulates the immune system. it is possible that immune stimulation is something that i need to be careful of.i suspect that my problem may lie in the murky area of autoimmune disease. these people need immune stimulation but it must be done in a very specific manner otherwise big trouble is possible.


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## mtbike61384 (Dec 8, 2003)

Dr. D,I am just curious why you had to give this person their money back? Obviously they didn't get well. But why do you think that was? Did you walk them through every possible avenue and still no luck?


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## drdahlman (Nov 6, 2000)

Mtbike61384, This patient worked with me very patiently for about 10 months. The remaining problem was looseness to her bowels. Lab tests consistently showed an inability to implant the beneficial bacteria, therefore the reason for her symptoms. We used multiple varieties of probiotics in order to get it implanted. We discussed other lifestyle issues that might contribute to her being unable to implant the bacteria.She was very patient and we just got to a stage where she wasn't willing to continue trying. This is fortunately, the only patient in whom I have been unable to get bacteria implanted.I missed something or she was doing something that we didn't think was important and we both missed it.


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## kel1059 (Feb 28, 2003)

dr d, i certainly appreciate your generosity in treating us. i realize that soon i will be on my own.when that happens i will continue to use your human strains of probiotics over VSL#3 and any others that i have tried. (although i am looking forward to hearing any recommendations about additional probiotics) (plus, i always have the hope of Probactrix--e.coli when it comes out)if i am a person who can not get the bifidus to implant then i will just have to keep trying until i do. --even if that means taking a low dose of steroids to calm things down (or any number of other things that i may have to try)hopefully i will not have to resort to that.at this point i can tell you that since our last talk 9 days ago i am doing pretty good in terms of the gas production remaining very low despite being off the herbs.this has to be my biggest surprise so far.i would thank you for that but at this point i am uncertain as to why i have control over the gas issue. i know that many people are skeptical of homeopathy, and they should be skeptical -- it does not mesh very well with our present understandings of physics and energy systems.--but i have a nagging suspicion that my 2nd remedy, lycopodium, may have settled things down. just as the nux vomica created some type of dieoff the lycopodium had the same effect. they warned me that it was a slow process; i have to agree.there is always the possibility that your probiotics could have made the difference. i must not rule anthing out. it is possible that both are having an effect. i think that Gret could be responding nicely to the probiotic. i really hope for her sake it holds up. it makes me wonder if other D people would benefit greatly from a high quality probiotic. i know that probiotics and yogurt was valuable when i was really bad a few years ago, but it had a tapering effect.i really should not single out one aspect of your program because i think the beauty of it is that i brings together various combinations. i believe that using combinations is our best chance of gaining control.


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## kel1059 (Feb 28, 2003)

large bowl of black beans today and no gas or problems to speak of. in fact today was better than last summer when i started to take the herbs on a daily basis.based on the fact that i am not taking any antibacterial/antifungal herbs and i am doing better than ever in terms of gas then i have to say that something good is finally happening.--but for some odd reason stool formation has been a bit of a struggle lately. usually ibsacol does a decent job on this symptom. i wonder what is up.


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## bonniei (Jan 25, 2001)

But you are still taking homeopathy, kel? You cannot attribute any success to just Dr Dahlman's program then?


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## SpAsMaN* (May 11, 2002)

Kel,do you thing black beans are the easiest one to digest in the beans family?Is there others names for black beans?I heard about Garbanzo bean,what the heck is that?


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## kel1059 (Feb 28, 2003)

frank,i have bad reactions to most beans. lima beans, pinto beans, chick peas, navy beans and several others cause problems.the beans that i can tolerate are black, aduki and mung. i have to soak them overnight.based on my symptoms i would say that it does not have to do with digestion but instead some type of immune system response. intense brain fog would be just one of many symptoms. breathing problems and of course a complete breakdown in bowel function.we hit 400 replies. that is pretty good.


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## BackFire44 (Nov 19, 2003)

Wow. I stop reading for a few days and we're up to 11 pages on this thread! I wanted to respond to some of my posts way back on pages 7 and 8 regarding the placebo effect.While the USA Today article is interesting -- when I speak about the placebo effect, I'm speaking specifically about it being so much more effective in IBS patients than in other patients. Study after study has shown that "sugar pills" work much much better for IBS patients than with other patients. This is because the occurrence of IBS symptoms have a very strong connection to the mind. I'm not saying that it is "all in your head." Nothing makes me more mad than when someone who has read an article about IBS tells me that. I'm just saying that the mind has a lot of control over the "gut" and can reduce or increase symptoms very easily. Getting in touch with how your mind is affecting your gut is very beneficial with IBS.Regarding Dr. Dahlman, I never said that your methods don't physically change anything or work. What I suspect is that many of your methods physically help people, but that being an attentive and hope inspiring doctor actually helps people even more.I'm glad so many people on this board are being helped by you, and I hope all of them continue to improve. I do wish you and Eric would stop the attacks, however. Discussion is one thing, but anyone can see that your posts to each other are a bit more than just a friendly discussion. Regardless of who "started it" perhaps both of you can tone down the posts a bit. I think it detracts from the goal of this board when you suggest eric get off the board or that no one reads his posts. I understand that he has attacked you, but anyone has to admit that eric provides helpful information to this board -- as do you. This thread has been a help to people, and I think perhaps everyone needs to remember why we post. BackFire44


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## SpAsMaN* (May 11, 2002)

400 but only few who claims to be better,i find the treatment slow to strart.Lek(sound like a boy name),tell us what you've done sice the beginning with Dr. Dalh...


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## SpAsMaN* (May 11, 2002)

...since the beginning with...


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## calid (Aug 4, 2003)

spasman: there are only a few of us who are actually trying the complete program, that's why there are only a few posting about it. Yes it is a slow start for some of us. We have to rule out some things and have testing done which takes time. This is not a quick process, it will take a lot of time, studying clues, and the most important, dedication. We have had to give up a lot of things and be very diligent about it. This is not an easy course, it takes a lot of determination and willpower, but it will be worth it in the end if this is all resolved.


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## daisysp (Jan 13, 2004)

I ordered my products from Dr D to be sent on Friday, so will get to start my program next week. I already dont' eat the items he says to eliminate. I got rid of them years ago, helped yet not totally.I am so excited to get some normalicy back to my life, I guess I am holding out maybe too much hope it'll work......even if slowly. I cannot deal with this anymore in my life. I remember too well how it felt to be fine, energetic, free of pain and being able to lose weight easily. I guess I want more information about Dr D, as does my boyfriend who is very skeptical about it. I will go read his biography on his website, yet that is subjective as I assume he wrote it. I just don't want to follow another dog and pony show as I dont' have the extra money to waste at all !My questions are:how did he come about this knowledge and work with IBS if he's a chiropractor ? How does he conduct his research ? When does he fit in Chirporactic work if he's answering phones and e-mails all day ?Why does he not have a staff ?How long has he been successful with this ?What lab produces his products and what outside testing company does he use ?Anyone has anyinsight..........Dr D, are you online today ? I have enjoyed talking to you on the phone and hope we will end up with a great professional relationship. If you are able to help me, I have many clients who will purchase your products to heal themselves.......


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## daisysp (Jan 13, 2004)

Lek, I forgot to respond that I am doing the Dr D program on my own terms to save money. I am a single mother of two with no child support coming in, so money is tight !! I would be able to work more normal hours though if I did not have all this pain to deal with.Thrilled to have read back a page or two and see you are getting relief from gas and bloating. I can't imagine eating beans of any kind though, yet it'd be so great to do so !!!! How long have you been trying the products before trying the beans ?


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## daisysp (Jan 13, 2004)

Talk about brain fog !! I can't remember stuff from one minute to the next..........I keep forgetting to comment on that, haha. The only time I dont' feel it is if I barely eat, or take some caffiene. The caffeine has it's own negative side effects though, so it's not worth it after a couple of days. Some days I feel so clear and it's amazing, I want to run around and do everything ! How wonderful to have felt that way all the time, I remember that at least.


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## eric (Jul 8, 1999)

"My questions are:how did he come about this knowledge and work with IBS if he's a chiropractor ? How does he conduct his research ? 1 He does not follow the current state of the art information and research on IBS nor its history and his treatment is only based on his own alternative beliefs. He is a chiropractor, not a MD doctor or gastroenterologist, or neurogastroenterologist. He really has no qualifications in IBS. 2 He does not conduct any IBS research!


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## eric (Jul 8, 1999)

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


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## Jhouston (Nov 9, 2003)

Daisy, Wow! You are the first person IBS or otherwise to state ....fog connected to eating and the caffeine fix. Do you have cfs? I am also on Dr D's program. I get the feeling druggie after eating. but it has subsided in the past and returned. not sure why. If I have lots to do I would usually not eat until finished with errands. when going out to eat I would drink coffee to counteract the fog/drugged thing. Doctors have not made an attempt to figure it out. GI doc said it was "weird". How long has this been going on for you? almost 6 yrs intermitantly. Joann


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## SpAsMaN* (May 11, 2002)

I cannot blame someone to help ibs people through his own experience after many years.If eventually the people get well,it's a proof that you can beata thing without seeing it.Some people have ibs for years without any help from the medical system,any holistic trial is a helping hand.I just hope that this program have some benefits at least.


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## calid (Aug 4, 2003)

Well said Spasman!


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## SpAsMaN* (May 11, 2002)

I like Eric a lot but his last post is so long.Eric can you tell me what is deep ibs infos in ten lines?


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## Arnie W (Oct 22, 2003)

Well said again, spasman!


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## Arnie W (Oct 22, 2003)

I sympathise very much with those who have the IBS-related pain. However, if pain is the criteria for IBS, I think that many of us on this forum, myself included, would have to query whether we're corresponding at the appropriate message board.If I read Eric's post correctly, I assume that we need another name to cover the condition that many of us have that encompasses C, D, gas, bloating, abdominal discomfort, etc, but without significant pain. Apparently we don't have IBS.I have far too many of the non-GI symptoms mentioned in Table 1.


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## ibsjohn (Jan 25, 2004)

I would like to make a suggestion that we close this tread and we open two new treads, one for Dr. Dahlman and one for Eric. I think that would make things easier for most people here?John


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## eric (Jul 8, 1999)

Here you go spasman.Annu Rev Med. 2001;52:319-38. Related Articles, Links Irritable bowel syndrome.Ringel Y, Sperber AD, Drossman DA.UNC Center for Functional GI and Motility Disorders, Division of Digestive Diseases and Nutrition, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7080, USA. ringel###med.unc.eduThe irritable bowel syndrome (IBS) is a functional gastrointestinal disorder whose hallmark is abdominal pain or discomfort associated with a change in the consistency or frequency of stools. In the western world, 8% to 23% of adults have IBS and its socioeconomic cost is substantial. Research-generated insights have led to the understanding of IBS as a disorder of brain-gut regulation. The experience of symptoms derives from dysregulation of the bidirectional communication system between the gastrointestinal tract and the brain, mediated by neuroendocrine and immunological factors and modulated by psychosocial factors. The biopsychosocial model integrates the various physical and psychosocial factors that contribute to the patient's illness. This model and the recently revised symptom-based criteria (i.e. the "Rome II criteria") form the basis for establishing a comprehensive and effective approach for the diagnosis and management of the disorder.Publication Types: Review Review, Academic PMID: 11160782


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## BackFire44 (Nov 19, 2003)

Boiled down -- you don't have to have pain to have IBS. The diganostic criteria currently in use says you have to have abdominal discomfort. Just having diarrhea, though, would not qualify you alone. And who says what IBS is? The people who invented it. Don't forget that IBS is a name invented by doctors. They define it. If they say IBS means X, it means X. Doesn't mean, though, that if you only have diarrhea or some other symptoms that IBS type treatments can't help you. Many of the diet suggestions will help anyone's gastrointestinal track. And let's please stop suggesting separate threads for everyone. That's just silly. Eric posts research reports because they are authoritative and he doesn't wants to offer direct evidence. If you don't have time to read it, you can just scroll down.


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## eric (Jul 8, 1999)

GI Disorders in Adults Gastroesophageal Reflux Disease (GERD)"Functional GI DisordersThe term "functional" is generally applied to disorders described by symptoms when no organic explanation is detected using common diagnostic procedures. The Rome Diagnostic Criteria categorize the functional gastrointestinal disorders and define symptom based diagnostic criteria for each category.(2)Functional esophageal disordersGlobus - a sensation of a lump, something stuck, or a tightness in the throatRumination syndrome - effortless regurgitation of recently swallowed food Functional chest pain - the feeling of chest pain, presumably of esophageal origin (can be confused with cardiac pain which must be examined) Functional heartburn - persistent burning sensation in the absence of gastroesophageal reflux disease (GERD), a motility disorder, or a structural explanationFunctional dysphagia - the sensation of difficulty swallowingFunctional gastroduodenal disorders (symptoms generally attributable to the mid or upper gastrointestinal tract)Functional dyspepsia - pain or discomfort located in the upper abdomenAerophagia - repetitive air swallowing or ingesting air and belchingFunctional vomiting - recurrent vomiting in the absence of all known medical and psychiatric causes "Irritable bowel syndrome (IBS)Functional abdominal bloatingFunctional constipation Functional diarrhea Functional abdominal pain "Functional disorders of the biliary tract and pancreas (symptoms generally attributable to the upper or upper right abdomen)Gall bladder dysfunction - characterized by episodes of severe steady pain accompanied by decreased gall bladder emptyingSphincter of Oddi dysfunction - a motility disorder characterized by severe steady pain with no structural abnormalities that explain the symptoms. It sometimes occurs following gall bladder removal, but also may occur with an intact gall bladder. Functional disorders of the anus and rectum Functional fecal incontinence - recurrent uncontrolled passage of fecal material where no structural or neurological cause is evident Functional anorectal pain - Levator ani syndrome is a dull ache in the rectum that lasts for hours to days. Proctalgia fugax is an infrequent sudden, severe pain in the anal area of short duration"Examples of GI Motility Disorders""Motility" is a term used to describe the contraction of the muscles that mix and propel contents in the gastrointestinal tract. The gastrointestinal tract is divided into four distinct parts that are separated by sphincter muscles; these four regions have distinctly different functions to perform and different patterns of motility (contractions). They are the esophagus (carries food to the stomach), stomach (mixes food with digestive enzymes and grinds it down into a more-or-less liquid form), small intestine (absorbs nutrients), and colon (reabsorbs water and eliminates indigestible food residues). Abnormal motility or abnormal sensitivity in any part of the gastrointestinal tract can cause characteristic symptoms.(3)""Intestinal dysmotility, intestinal pseudo-obstructionAbnormal motility patterns in the small intestine can lead to symptoms of intestinal obstruction. Symptoms of bloating, pain, nausea, and vomiting can result either from weak contractions or from disorganized (unsynchronized) contractions. Small bowel bacterial overgrowthToo many bacteria in the upper part of the small intestine may lead to symptoms of bloating, pain, and diarrhea. Symptoms occur immediately after eating because the bacteria in the intestine begin to consume the food in the small intestine before it can be absorbed. Small bowel bacterial overgrowth is a result of abnormal motility in the small intestine. ConstipationThe symptoms of constipation are infrequent bowel movements [usually less than 3 per week], passage of hard stools, and sometimes difficulty in passing stools. One motility problem that can lead to constipation is a decrease in the number of high amplitude propagating contractions [slow transit] in the large intestine. The test used to detect this is a transit time (Sitzmark) study. Outlet obstruction type constipation (pelvic floor dyssynergia)The external anal sphincter, which is part of the pelvic floor normally stays tightly closed to prevent leakage. When you try to have a bowel movement, however, this sphincter has to open to allow the fecal material to come out. Some people have trouble relaxing the sphincter muscle when they are straining to have a bowel movement, or they may actually squeeze the sphincter more tightly shut when straining. This produces symptoms of constipation. DiarrheaThe symptoms of diarrhea are frequent, loose or watery stools, and a subjective sense of urgency. An excessive number of high amplitude propagating contractions [rapid transit] can be a cause of diarrhea; it reduces the amount of time food residues remain in the large intestine for water to be reabsorbed. Changes in the motility of the small intestine may also occur, but there is little information available on this. For more information about incontinence, please see another IFFGD website, www.aboutincontinence.org. Fecal incontinenceFecal incontinence means involuntary passage of fecal material in someone over the age of 4 years. The most common causes are (a) weakness of the anal sphincter muscles; (







loss of sensation for rectal fullness; © constipation, in which the rectum fills up and overflows; and (d) stiff rectum, in which the fecal material is forced through the rectum so quickly that there is no time to prevent incontinence by squeezing the sphincter muscles. Diarrhea can also lead to fecal incontinence.Hirschsprung's disease There are actually two anal sphincter muscles: an internal anal sphincter that is part of the intestines, and an external anal sphincter that is part of the pelvic floor muscles. The internal anal sphincter normally stays closed to prevent the leakage of gas or liquid from the rectum, but when the rectum fills up with gas or fecal material, a reflex causes it to open to allow the bowel movement to pass through. The nerves that this reflex depends on are sometimes missing at birth, with the result that the internal anal sphincter stays tightly closed and bowel movements cannot occur. This congenital (birth) defect is called Hirschsprung's disease. GastroparesisGastroparesis is a disorder in which the stomach takes too long to empty its contents. Gastroparesis is most often a complication of type 1 diabetes. At least 20 percent of people with type 1 diabetes develop gastroparesis. It also occurs in people with type 2 diabetes, although less often. Symptoms of gastroparesis are nausea, vomiting, an early feeling of fullness when eating, weight loss, abdominal bloating, abdominal discomfort. These symptoms may be mild or severe, depending on the person. In most cases treatment does not cure gastroparesis -- it is usually a chronic condition. However, treatment does help manage the condition.AchalasiaAchalasia is an esophageal motility disorder. It is diagnosed when there is a complete lack of peristalsis within the body of the esophagus. The lower esophageal sphincter does not relax to allow food to enter the stomach. Symptoms are difficulty swallowing both liquids and solids. Many people also have associated regurgitation, vomiting, weight loss, and atypical chest discomfort. " http://www.iffgd.org/GIDisorders/GIAdults.html


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## Jhouston (Nov 9, 2003)

Eric, I take that as a NO....regarding my question? Joann


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## eric (Jul 8, 1999)

I answered this the best I could on another thread for you.


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## SpAsMaN* (May 11, 2002)

Eric,i have read you're REASONABLE post and my own research have conclude that the majorshighways from the brain to the bowel ARE NOT MODULATED BY PSYCHOSOCIAL FACTORS,BUT PSYCOSOCIAL FACTORS CAUSES IBS,NOT NECESSARLY FEED IT AS YOU TRYING TO SAY.Simple as when a house is burn,what left still to burn.Spasman research:1995-2004Eric said;The experience of symptoms derives from dysregulation of the bidirectional communication system between the gastrointestinal tract and the brain, mediated by neuroendocrine and immunological factors and modulated by psychosocial factors


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## daisysp (Jan 13, 2004)

JHouston,Sorry I didn't respond sooner, my computer is making me so mad !! I consult folks all the time about caffiene, and it's various side effects. I get that clear head when I take it, love how it feels to be energetic and feel like I can think and do research and feel motivated. This condition of mine, had for 7 yrs now, has really turned life upside down as I have such a slow metabolism now in every way. The caffiene is a temp fix though, and then to counteract all the negative side effects I get from it, I take lots of vit B complex, lots of Chromium and some Stevia liquid to being my blood sugar back to level. It's a circle I end up staying in, yet it can wreck havoc on your adrenals !!What is CFS ? I feel like I should know, yet brain fog today. It seems to be getting slowly worse, so I am hopeful for Dr D's program to lift that for me somewhat. So many folks, and doctors I have talked to for reasons of my own situation or that of a client, they dont' know about the caffiene 'thing', the dairy problems folks deal with, the problems with wheat, the problems with HRT's.........western medicine is so far behind it blows my mind. My boyfriend says "how can alternative doctors of any kind know more than regular MD's about IBS and how to cure it ?" To me there is no question that alternative and conventional each are necessary in their own ways, yet conventional will always be a huge step behind in connection the whole body to every sypmtom we suffer from. I got my IBS from Ecoli and then loads of antibiotics to fix it. From then I got Leaky Gut and with that tons of food allergies. IT's a daily struggle and yet I have to act confident and full of energy for what I do for a living. Most days I fake it, then go home and sleep for a couple of hours to reboot.Can I say I agree that Eric needs his own thread. Can we please just have Dr D's postings on one juncture of their own ??? Would like to see what he's got to say and read about others who are trying, or questioning his program. All if favor, say "I" !!


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## daisysp (Jan 13, 2004)

Alright, CFS, yes I am familiar with that, needed a minute to think straight. I have found consitantly with my own clients, that when we change their foods around, add exercise regularly, they report how much energy they have and how great they feel. Sleeping patterns even out and they don't feel sluggish. Those that have IBS though are a different flock; they need to change much more, be incredibly consistant with their foods and can't cheat often at all with the side effect of fatigue. When the digestive system is not funcitioning optimally, you end up feeling tired, sluggish, irritable and just generally slow. IF I eat 1/2 the amount I am acually hungry for at any given meal, I have much more energy..........yet remain hungry. Maybe that is just a state of mind to adjust to??


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## Jhouston (Nov 9, 2003)

CFS or CFIDS Chronic fatigue syndrome or Chronic fatigue immune dysfunction. It is a stupid name I think for what actually happens. Last year I felt like cfs was finally over and then IBS attacks...exacerbated to a situation to seek medical advise and testing. I used to be on cfs boards looking for info. even those boards did not mention eating and fog at the same time. so I don't know. is it a brain issue or pancreas issue, GI issue? (fog/drugged) Joann


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## bonniei (Jan 25, 2001)

" *Imbalances of beneficial flora and dysbiotic flora were identified in 100% of subjects by CDSA*. Nineteen subjects completed the trial. There was a trend to improvement of beneficial flora after probiotic treatment but no change in dysbiotic flora. *Bowel flora did not correlate with symptom severity*, QOL, or treatment outcome."The American Journal of Gastroenterology Volume 98, Issue 9, Supplement 1 , September 2003, Page S276 doi:10.1016/S0002-9270(03)01601-0 Cite or link using doi Treating irritable bowel syndrome with a food elimination diet followed by food challenge and probiotics So it seems that there is no change in the dysbiotic flora after probiotics. Any commemnts Dr D?


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## overitnow (Nov 25, 2001)

Joann,According to some correspondance I had with the ME Soc in UK they reported consistant lower perfusion (blood circ) in brain stem of CFS; just as Australian study I have cited in the past found lower perfusion in digestive centre of the brain for IBS. Try some ginko or omega 3 for a period. If you see an improvement, the brain is your answer.Mark


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## missC (Oct 16, 2002)

spasman, i can usually understand you: you usually get your point across admirably. but i confess your last post has left me fuddled. what fire? where are the fire men? where the village people? i like the construction worker myself.


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## SpAsMaN* (May 11, 2002)

i was trying to explain to eric that when someone have post-stress ibs,after that your in troubles anyway.Maybe that psychsocials factors influences ibs but it does not feed ibs itself.I mean,i can stay a month alone,i will again have ibs.


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## eric (Jul 8, 1999)

Emotions can phycophysiologically feed IBS itself and can and does generate symptoms.







Mark is talking about abnormalities in blood flow to the ACC part of the brain in IBS.


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## drdahlman (Nov 6, 2000)

I would never expect that the taking of probiotics would eliminate any abnormal (dysbiotic) bacteria. That is why when we get the results back from a lab and find their presence, we treat the patient with anti-microbial herbs to kill them and continue with the probiotics till we get normal readings on subsequent tests. Daisysp, all the questions that you ask have been answered in previous posts, but we're now over 430 posts and I sure you didn't have the time to read them all. Please call me and I would be happy to answer all of them.Please be careful about the can of worms that opens up when you ask those questions. It gives Eric a chance to answer them for me and he isn't interested in a discussion, he wants simply to attack me and my methods. For a story about my success, there was a post by me a week or so ago that described the progress that 6 or 7 patients who frequent this board are having with my protocol. One has responded quickly, several more slowly because of tests that we are doing and I'm sure I'll struggle with someone. Just like in my office, where everyone who allows me to guide them through my protocol achieves a complete elimination of ALL their symptoms. Please note that Eric sells hypnotherapy tapes to treat IBS, so he has a vested interest in attacking me. I am a practicing doctor with a chiropractic degree and I don't see patients for chiropractic. I have a chiropractor working in my office. I have no need to do research, because I am simply using concepts and products that have been researched already. It's the way I put together the program using this info that makes a difference for people. My entire practice is nutritional/alternative/holistic. I have no need for a staff because of computerization and all products are shipped from a warehouse in Illinois. Makes it so much simpler.Thanks for your trust in me and I assure you that you will see a complete elimination of ALL your symptoms. I'm committed to it.


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## eric (Jul 8, 1999)

"Please note that Eric sells hypnotherapy tapes to treat IBS, so he has a vested interest in attacking me. "Nothing could be further from the truth once again.Hypnotherapy already has a proven tract record for IBS and that is not why I am posting the things I am posting at all, hypnotherapy has nothing what so ever to do with this at all. Its just his method of distracting the issues he refuses to address.Really he is here for your business.Nutritionists and chiropractic are NOT experts in the fields of gastroenterology and neurogastroenterology and immunology or any of the other fields of real researchers studying IBS.What DR Dalhman is doing I personally believe is praying on those who are not all that knowledgable in IBS research and what they already know about it. I believe in real IBS circles if he could even get in one, he would have his license revoked for the stunts he is trying to pull off here.You don't have to take it off the bb, why can't he answer the questions posed to him right here?And being nice has nothing to do with accuracy of information."Self-help group or message board web sites.Certain precautions need to be kept in mind about the information from on-line self-help groups, bulletin boards, message boards, or newsgroups. Here are some general guidelines to keep in mind when seeking health related information:Because of the open nature of on-line group communication, you cannot make assumptions about the security or validity of the information, or of the "quality control" of the information provided. Web site policies and purpose should be clearly posted and followed.Is the information accurate? Is it factual, or does it represent opinions? Look for sources. It is important to determine whether the information provided arises from a reputable source (e.g., a scientific article or opinion from a professional expert), or whether it is the *opinion of a non-professional.* The questions, replies, and suggestions from participants on bulletin/message boards are often anonymous. Over time, it may be easy to attribute "authority" to familiar respondents based on their postings aloneï¿½without really knowing their level of training or experience as a health professional, if any. *At all times, do not rely on anecdotal information. * It helps to seek out more than one opinion, and you will then need to come to your own decision about the accuracy of the information. It helps to check it out with your physician. Information that is provided about treatment, causes, or diagnosis may not be applicable to your particular circumstances. Always check with your physician before applying a diagnosis or treatment. ( *It is medically unethical for a physician to diagnose or treat over the Internet.* ) A variety of self-help sites and commercial sites with message boards are available on the Internet. Examples that provide health related bulletin/message boards and other resources include the IBS Health Online Bulletin Board (www.ibshealth.com), IBS Self Help Group (www.ibsgroup.org), and WebMD Message Boards (www.webmd.com).It is appropriate to question the value and reliability of any health related web site, book, or publication. Some guidelines to help you evaluate the standards applied to particular sites can be found at the Health on the Net Foundation web site. The U.S. National Library of Medicine and the National Institutes of Health offers a Guide to Healthy Web Surfing: Evaluating the Quality of Health Information on Web Sites." http://www.iffgd.org/SelfHelp.html If you notice above, my site is listed along with this one on the international foundation for functional gastro disorders and I subscribe to the Health on the Net Foundation." HON's mission is to guide lay persons or non-medical users and medical practitioners to useful and reliable online medical and health information. HON provides leadership in setting ethical standards for Web site developers."www.ibshealth.com http://www.hon.ch/ His site has no standards or "Web site policies and purpose should be clearly posted and followed" and relies solely on anecdotal information and DR Dalhmans personal opinion. His site has no "scientific articles or opinions from a professional experts" or rely on reputable sources.I am going to say this again.( *It is medically unethical for a physician to diagnose or treat over the Internet.* ) As much as he says I am not diagnosing over the internet, he really is, he is calling things that are not IBS, IBS for one. So he is diagnosing people over the internet and treating WHAT HE BELIEVES IS IBS.Real doctors know the real importance of seeing their patients in person, it is a very important part of patient doctor relationships.We here have seen absolutely no research what so ever from him to back up any of his claims on IBS. Why is that?It is also " appropriate to question the value and reliability of any health related web site,"I have seen him try to get onto other bb's and either they did not pay much attension to him or it was made clear he was not welcomed.Your boyfriend was right you should be very skeptical and research IBS and any information supplied to you by Dr dalhman you should share with your doctor if you proceed with his methods.


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## drdahlman (Nov 6, 2000)

I don't diagnose anyone. As has been said by many, no one who comes to me needs a diagnosis. I am a doctor of last resort after they have already been diagnosed. And I am licensed to treat using nutritional or natural methods.It obviously makes no difference to Eric whether or not anyone gets well or is satisfied with the results of my program. While he continues to attack me, everyone gets ALL their symptoms completely eliminated. Thanks for helping create the largest thread on the board! Those that are posting their experiences with me and the additional people that have come to my practice that aren't posting here are not paying any attention to your narrow minded views. You don't matter.


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## Gret (Sep 23, 2003)

Whatever! I feel better than I have in years. Doesn't that count for something?????


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## SpAsMaN* (May 11, 2002)

I don't think Eric sincerity can be altered by any ways.Eric is so involved here tobring his financials activities influences his comments.He is an aware surfer!


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## SpAsMaN* (May 11, 2002)

It's up to you to buy his tapes or not.The thing is that's not hurt if the tape don't work.Dr.D. If you're confident about your treatment,why do you need to be upset anyway?


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## SpAsMaN* (May 11, 2002)

If this works,this treatment should be evaluate by someone and use worldwide even if Dr.D. is not an M.D.


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## kel1059 (Feb 28, 2003)

quote ----- "and I'm sure I'll struggle with someone."dr d, in case you are referring to me -- i have to tell you that something positive is happening, but it is a little complicated and we will talk about it in 2 days.thanks eric your comments belong on a separate thread. the fact that Gret is doing much better is something that needs to be seen for what it is ----PROGRESS.bonniei has some interesting information about dysbiosis. dr dahlman speaks about dysbiosis quite a bit. i believe strongly in the dysbiosis theory of the gut following antibiotic treatment. many of us might have this problem due to antibiotics or some other reason. regular MD's are NOT addressing this issue. dr d is.my only concern is that the CDSA is not able to name the majority of these species of bacteria.i took herbal antibiotics for a very long time and it helped but problems remained.probiotics helped me in the past but the effect is limited. fortunately DR D. is a firm believer in getting bifidus implanted in the colon. this is an excellent strategy.my biggest question mark is that a homeopathic remedy last october seems to have got my body to throw some particularly nasty bacteria out of me. afterwards i felt much better. same thing happened with lycopodium last month, and now my gas is extremely low without even using the herbs.i question how effective the herbs really are. i think that there are bacteria that exist in people that are not known as being harmful for most people but may be very troublesome for IBSers. i know the herbs worked for me but i had to take them for a long time, and they must not have been 100% effective.


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## daisysp (Jan 13, 2004)

Lek, would love to know how you are doing, am interested in your progress. I have not received my 'supplies' yet, should next week. I am anxious to get started and get well !!The brain fog seems so related to the foods and blood sugar levels......and obviously the emotional base you are working from. I can't believe how many doctors wont' relate food to symptoms and side effects we are dealing with. I hate this brain fog, I feel so stupid. I used to be so quick with information and answers to my clients, friends and associates. Now I fear being asked a question that is any amount technical and have to look it up, when I know I could have pulled that out of my head easily even only a year ago. So, over time, it's getting worse with this IBS. My hope remains though with the Dr D program.........scary to put any hope in any program after all I have tried !!Sorry to have fueled Eric, I don't read his stuff anymore, I scroll down........maybe we all should do so. If we don't respond or react to what he says, he will stop posting in time ?


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## kel1059 (Feb 28, 2003)

it IS the food --- but --- it also is NOT the food. i believe some foods are going to be trouble no matter what....ex would be dairy and maybe wheat.the problem is that there appears to be something going on in the body that is "confusing" the thing that helps determine what is safe and what is not safe. MNL talks about it but he left due to a busy schedule.the best example would be that of an allergy sufferer. it is claimed that if an allergy sufferer were to pack up and move elsewhere then it is only a matter of time before the new pollens that she is exposed to start creating a reaction.therefore -- it is not the food (accept in certain cases--celiac, etc) but the hypersensitivity of the patient.why the hypersensitivity? beats me. viruses? mycoplasma? stress which beats up on the immune system so much that viruses can reactivate? overconsumption of certain foods that tie up the immune system which allows for viruses which then further confuse the immune system ad infinitum?


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## kel1059 (Feb 28, 2003)

daisy i know what you are talking about with the brain fog. i live in fear of it coming back. i hope it is gone. i think mine is partly from mold spores and even foods with a high mold/fungi concentration.


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## kel1059 (Feb 28, 2003)

daisy wrote -------"Thrilled to have read back a page or two and see you are getting relief from gas and bloating. I can't imagine eating beans of any kind though, yet it'd be so great to do so !!!! How long have you been trying the products before trying the beans ?" i received substantial relief from bloating by getting rid of all provoking foods.the gas was trickier. i had to go very low carb for a while and then i started taking a lot of antibacterial and antifungal herbs -- and i mean a lot over a very long time 10 months or so.over the summer i quit taking them and the gas came right back after about 6 or 7 days.dr d got me off the herbs and i thought that gas would come back but it did not. actually it was fluctuating quite a bit while i was taking lycopodium but then it just stopped and i have been feeling much better ever since.i may have messed up dr d's experiment by taking lycopodium but --- hey what the heck no one believes that homeopathy even works in the first place.by the way i had IBS symptoms for 20 years without any relief at all. i have been eating the beans for over a year without major problems, and this tells me that gas is more a function of "how we TOLERATE our food" than the actual food itself. my theory is that a fractured immune system is what allows bacteria/gas to run rampant. of course this is not entirely complete but i can't get into it deeper.


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## daisysp (Jan 13, 2004)

I agree it's not the food itself, with everyone. Most my clients are off wheat and dairy right away as doing so gets rid of water weight, bloating, gases and mucus. Wheat can also raise your estrogen levels and no one wants that !! ha ha.So many folks can tolerate those foods really well, my boyfriend for instance. He does not eat dairy but once in a great while, yet does like grainy breads and always partiakes in breads when we go out, with no reactions. Metabolism doesn't seem to count all the way, just some. I work with folks who have a high metabolism and they feel so great when off wheat and dairy, slow also do. The slow metabolism folks lose water and body fat quicker without those two items. So, there are different reactions from everyone.For me, I used to be able to consume large amounts of foods, about 2500 calories a day, before getting sick. Now everything bothers me ! I can say which foods are the most yet really, they all upset my intestines to a degree.


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## Gret (Sep 23, 2003)

I think all of my life I've had problems with certain foods. Many people are like that. For me it was cabbage and maybe strong onions. As I've gotten older, I don't tolerate beans as well as I used to. This is a big bummer. I'm trying small amounts now and it's fine. Don't know about a huge bowl of spicey chili though. And the reaction wasn't always D, it could be just cramps. Sauerkraut was a big one for cramps.


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## calid (Aug 4, 2003)

Just a quick update on my progress. I'm currently taking all the supplements to kill the bacteria. I've actually had great movements, NO URGENCY at all, I'd actually forgotten what it was like to not HAVE to go immediately. I've been going, though, 3 times a day, but the stools have been firm and well formed (I don't understand where all this poop is coming from, I'm a tiny little thing and I don't eat that much...lol).


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## brushie (Jul 17, 2002)

HiHave been a bit board lazy the last 2 weeks:In my last update i had some slight improovement. http://www.ibsgroup.org/cgi-local/ubbcgi/u...=1;t=036204;p=8 then after that i first quitted gluten. nothing changed for some days, then i bought some glutenfree corn products: pasta and bread not realizing that corn is so fructoserich. so i got really bad bloating and stuck gas. unfortunately i realized it could be the corn only after 4 days. so i quitted the fructose too. so i`m fructose and glutenfree for 7 days now.unfortunately the increased gas and bloating which startetd with the corn only lessened slightly. so now my bloating is worse than before the program.i think its esp. brecause of my sins with the corn, so eric, dont blame the program rightaway for this!!usually the bloated belly reduces quite strong overnight and comes back after eating. now it doesnt really go back which makes me think its more gas + the usuall distention after eating (maybe blood flowing in the belly)?i dont know why is this. maybe the better mood and emptier belly feeling( it wasnt really less bloating, but i felt less preassure) was a placebo in the beginning? or maybe its the rice and potatoes i exchanged with pasta and bread? makes me think if should go low carbs too?i could also be a reaction to the enzymes because i had increased bloating before from other enzymes. i will ask dr.d if i should supend the enzymes for a while.unfortunately with the increased gas the mood improvement has also gone as fast as it came.:-( but theres enough to try left.the stool is still better formed but i`m a bit constipated, i think from the stuck gas. talking to dr.d again on tuesday next week.what about making a thread only for our updates. i think if someone wants to know how we progress he wont find it easily in this discussion dominated 500 post thread?brushie


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## kel1059 (Feb 28, 2003)

good to hear from you brushie. i am doing better also but i had a big setback after eating hommus (garbanzo beans, sesame seeds, garlic, lemon juice). it caused a major reaction all throughout my body. for a day and a half i was miserable.i want to know more about these immunoglobulins that are in the metagenics probiotics.i am wondering if this could be a key part of the whole program.could these immunoglobulins cause our immune systems to rebuild.are these immunoglobulins found in any other probiotics or just metagenics.are these immunoglobulins the reason that dr d claims that we all get better? (although i am firmly aware that the dairy, fructose and all the other rules are very critical also)i am very curious about this issue.calid, sounds like good news for you!


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## Gret (Sep 23, 2003)

Calid, YOu are on your way to much better health! I am very happy for you!


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## kel1059 (Feb 28, 2003)

i am going to challenge myself with rice again and see what happens. usually i get the brain symtoms.


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## BackFire44 (Nov 19, 2003)

brushie, if you really want to test Dr. D's methods and give them a chance, I suggest going over any diet changes with him. From prior posts, I'm sure he'll be happy to help you find the culprit. And I think this thread is fine. Rather than search through multiple threads on Dr. Dahlman, anyone who wants to know all sides of his treatment can come here and see updates, criticisms, and accolades. I think its important for anyone coming to read this to get an entire picture so that they can make an informed decision about their treatment.


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## drdahlman (Nov 6, 2000)

Brushie, I'm going to let us talk about this during our next app't. I have a feeling that there's more going on than just the dietary changes you mentioned. We'll figure that out next week. As an experiment, please go off the enzymes and report back to me next week to see if you had a silmilar reaction to the last time.Kel, do you mean the FOS in the probiotics?


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## overitnow (Nov 25, 2001)

I wouldn't worry too much about the frequency, calid. That was also a part of my recovery. I'm betting that will clear up over time. Mine has.ISN'T IT GREAT?Mark


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## kel1059 (Feb 28, 2003)

Dr D,this is what i am referring to. --but i am starting to think that this website may have made a mistake. maybe the immunoglobulins are in a different product?????? http://thewellnessstore.com/skinp/aprod13/aprod13.html Ultra Flora Plus is a patented probiotic formula that provides highly viable, pure strains of Lactobacillus acidophilus (NCFMï¿½ strain) and Bifidobacterium lactis along with supportive factors.  Helps maintain a healthy balance of intestinal flora and has broad intestinal, digestive, and immune system support functions.  Provides the valuable *Probio-Proteinï¿½ factor, a concentrate of immunoglobulin proteins (antibodies)* from whey to help maintain a healthy intestinal environment.


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## Jhouston (Nov 9, 2003)

What if we take a brisk walk after eating? thinking instead of caffeine. or at least NOT relax...counteract the fog? just a thought Joann


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## Jhouston (Nov 9, 2003)

Well, I did a no,no. last week my grandson was baptized...they had lasagna (spinach and cheese), and a cake that had whipped cream. I ate both. thought well, I'll pay for this tomorrow. Nothing happened! I mean nothing...didn't loosen stools which is weird for me. I have not had dairy again ...don't want to push it. Joann


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## drdahlman (Nov 6, 2000)

Kel, You are not using that product and I don't normally with any patients. My Ultra Flora Plus DF is dairy free, that's what the DF stands for. The product you are looking at contains whey and I try to keep that away from everyone. Having said that, I'm not against you trying it. You may have no reaction.As far as stimulating the immune system, look at Transfer Factor Plus, from memory it contains colostrum, transfer factor, IP6, thymus and assorted mushrooms. Search Google for it and we can talk about it during our app't. Metagenics makes a similar product called Thymic Synergy.


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## kel1059 (Feb 28, 2003)

okay -- i see the difference. we take the product that is "DF". the product that i posted from the website is different.we discussed the Transfer Factor product; i am glad that you were aware of it (and reported a positive case). the ai/e10 and the transfer factor both seem to be the real mccoy -- they do something.i have 2 friends that can confirm this. i have anecdotal reports for the most part.i need to stay away from both of these for a while. they seem to put me flat on my back when i take them.i am going to continue to keep all variables to the minimum while i work with you --- thanks.once again -- i appreciate your commitment to this problem. i think you have done a nice job with gret so far. all the cynics must step back and reflect upon this fact for a minute.the fact that must be reflected on is that it is very possible that you may have dramatically altered at least one person's life. in my opinion that is amazing.


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## daisysp (Jan 13, 2004)

Great to read about the folks trying the Dr D products, I am still awaiting the arrival of mine. I see a huge difference in being able to eat Rice now compared to years past.Brown rice was a staple of mine once flour products were cut out and now I get major brain fog from it and I want to take a nap if I eat it. I also get intestinal upset. I have been able to eat about 1/2 a tortilla instead and saltines, yet thats about it for the carbs. Used to be brown rice cleaned me out..........can't live on the used to be's though or I will be in therapy all day !! Wondering though how I will be able to go to work from 8am - 11am daily if I am running to the bathroom ?? I work pretty much steady for those 3 hours, then am off for a few before going back. I cannot work the afternoons if I work the mornings as it is cause of the GI upset, how will I fit in earning a living with the healing process ??


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## daisysp (Jan 13, 2004)

Oh, gluten free products seem to really upset my system also........whats up with that ? I make my pancakes on Sundays with gluten free flour, rice milk and one egg white........or have a piece of gluten free toast in the am; and upset GI all afternoon for it.


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## Gret (Sep 23, 2003)

Joann,Hope the dairy won't bother you! You've had trouble with dairy before? I'm afraid to try and I don't know why. I've been doing so well! I'm wondering if I should try some Digestive Advantage and then give it a go. But then I won't know for sure if I am intolerant. I could really use a piece of pizza right now!Dr. Dahlman, I'm out of Ultra Flora. Will that be a problem before I talk to you next week?


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## eric (Jul 8, 1999)

IBShttp://216.109.117.135/search/cache?p=bloa...149D7A767&c=482 &yc=15315&icp=1[/URL]


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## Gret (Sep 23, 2003)

eric, Was there a particular part of that article you thought was relevant to us right now? I scanned it, but it's long and I wasn't sure which part you were highlighting.


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## Jhouston (Nov 9, 2003)

Gret, I have not been able to have ANY straight milk for years.....but used to be able to eat cheese until almost a year ago. Thhen all dairy was a trip to toilet. I was surprised by a "no reaction". but I am not going to start eating dairy yet. If you do try dairy, I would try a very small amount. What does Dr D think? Joann


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## Jhouston (Nov 9, 2003)

Daisy, Pancakes! I have not been able to eat pancakes for many years, causing cramps and gas.tortilla do the same. That is when I could eat bread. don't know why. Whats up with that? is right! I tried gluten free bread and carrot muffins and brain fog was horrible. Actually, I posted about some pages ago. I listed the ingredients. thought it could be the Fruit juice concentrate I notice is in all the gluten free products at health food store. but I am not sure. Ezekiel bread and Pacific Bakery products have been easier to tolerate which is yeast free, wheat free, but not gluten free and have no fruit juice. I think it is the "flour" of wheat (Ezekiel is flourless). the other is wheat free but has spelt, amaranth, quinoa, kamut. is delicious. and fat free. not sure what is at work here. Joann


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## eric (Jul 8, 1999)

Gret, the entire article is relevent to anyone who has IBS.


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## Gret (Sep 23, 2003)

Joann, Dr. D thinks exactly what you said. Try a very small amount and wait for three to five days. If nothing happens, try a bit more, etc. I'll give it a go. I do know after three hits now that beans are bit no-no. Pinto or kidney beans are the worst, I think.Eric, thanks. I'll give the article a look. There is just so much reading on IBS. A lot is repetitive. That's why I asked, I wondered if there was a specific point in there that would stand out.


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## daisysp (Jan 13, 2004)

I am feeling like it's any flour products at all. Gluten free, wheat free, all of them bother my intestines except some in small doses. I had brought home a small packet of two saltines tonight from work. My son found them and snagged them.......I wanted to bite his arm off yet I held back, ha ha. I can only eat those without a reaction, so was saving them for morning. I actually want to put my son on this Dr D program if it works for me. He used to be so thin and lively, now has so many intestinal problems and is so sluggish with too much fog. He's been drinking lemon juice lately and that helps. He's so picky about food so getting him to eat right is tough. I only keep healthy foods in the house yet he eats at school and at his dads house with abandon. Will wait for summer break, so he can be on the toilet all day.


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## eric (Jul 8, 1999)

Kids Take Sickness Cue From Parents IBS http://preventdisease.com/news/articles/ki...s_parents.shtml


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## Jhouston (Nov 9, 2003)

Daisy, I hear ya'. I have the same thought "flour products". thought it meant a "yeast problem" but stool test did not show any. still think it might have something to do with it. my logic is...if there is NO good flora then what is opposing the yeast etc? guess it is a moot point. Another thought I have about the fog.... Adrenal exhaustion. know adrenals have a play in carb digestion. some of my thoughts Joann


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## eric (Jul 8, 1999)

Adrenals play an important role in IBS.


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## Jhouston (Nov 9, 2003)

Daisy, What is your temperature? just curious. My temp is usually 97.2. my thyroid test have been normal. Joann


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## daisysp (Jan 13, 2004)

my regular temp runs low, about 97 also. I take a natural thyroid supplement daily and cannot stop or I gain weight within about 3 days......and get tired, and slowed digestion. I have had many natural doctors try to get my temp up with other T supplements, yet none of them worked. I feel better at this temp.I have been taking the Rhodiola for a week now and am loving it. I feel so much more balanced out, less emotional, mor energetic and able to retain information from my studies. I had really given up on studying for my next exam as I wasn't retaining anything, feeling stupid !! My boyfriend is so analytical, intelligent and studious, I need to keep up, ha ha.Today I had 1/2 piece bread for am, and just had the other 1/2. I feel alright. With the gluten free stuff I feel a gut ache right away. Rice products are pretty much out of my plan now, rice milk, rice cereal and brown rice. Dang !!!


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## daisysp (Jan 13, 2004)

oh, about the adrenals........I was taking liquid adrenal for a long time, now I replaced it with the Rhodiola and I like it plenty. The adrenals are VERY important and can run low from stress' of pretty much any kind if consistant.


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## SpAsMaN* (May 11, 2002)

Hi,for those who comments their own Dr.D treatments,can you you tell for how many daysweeksmonths you've strart the treatment.I try to evaluate if there is a real improvement.


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## SpAsMaN* (May 11, 2002)

I don't know why the screen is so large,that begin to irritate me.


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## Gret (Sep 23, 2003)

Hi Spas, The big screen is irritating me too! I started with Dr. Dahlman on Dec. 17, 2003. I'm pretty much normal now except for an occasional day of feeling like I need to go more! And I think it correlates to beans each time! I experimented three times with legumes and each time had the same reaction. So.......... This weekend I'll try some dairy. Improvement for me came right away. I'm wondering if part of it was that I was on a two week vacation when I started the program. It was right at Christmas though, and that in itself was a challenge! I had 24 people over for dinner! YIKES. They ate stuff I certainly could not have. It was hard, but not impossible.


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## brushie (Jul 17, 2002)

are sheep dairy products, like feta allowded in the program?i dont think so, but theres nothing written about it in the article?thanks!


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## meckle (Mar 5, 2003)

Completely off the point but:I thought folks might find this interesting: http://news.bbc.co.uk/2/hi/health/3492902.stm


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## daisysp (Jan 13, 2004)

I am still awaiting my starter supply from Dr D. How long does it take once it's sent ?? Also, I need to work mornings, from about 8am - 11am, how can I do this when I will be running to the bathroom.........usually I go mornings anyhow, and then have C all day, yet from what Gret said, she was in the bathroom alot in the beginning. I dont' have the luxury until after noon, yikes !!P.S., can we get more Dr D patients on here with comments, complaints and compliments.....and results ??????


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## calid (Aug 4, 2003)

Daisy, I'm being treated right now for some bacteria problems by Dr. D. So, it's hard for me to really judge how the program is working. I have several great days, then two bad ones, then some more good ones. I can't distinguish if the anti-fungals bother me or it's still IBS, and I probably won't know until I stop the extra supplements. The first few days on the regular program I had no problems with the original supplements. We are all different though, so they may affect you better or worse.


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## drdahlman (Nov 6, 2000)

Feta cheese, technically, since it's a fermented product that creates a different molecule, should not be a problem for IBS people if they don't have a history of eating it. But, you have to be very careful when you look to purchase it. Many times the manufacturer, especially Kraft Foods, will use cow's milk with enzymes and still call it feta. Look carefully at the ingredients. Goat's milk shoul also, technically, be able to be tolerated. I don't recommend it, go slowly with it if you want to try it.


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## Jhouston (Nov 9, 2003)

Meckle It makes me so mad! I didn't listen to them I read enough to know better. Joann


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## daisysp (Jan 13, 2004)

Dr D, I got my products today and am so excited !! Would you be able to answer the question I posed though:How can I go to work mornings from 8am - 11am if I am gonna be in the bathroom all day ? I don't have that luxury of running when I want to as I am with clients.....although I can try to schedule more time between them to give myself that option to go about every 30-45 min. Is it the norm for the body to do alot of involuntary movements the first few days or weeks ? I wish I could take a month vacation to get through the first part of this. As it is I can only work a limited number of hours per day because of the IBS, and that accounts for my limited income right now. Will be great to work a normal day sometime soon !!!!!!!!!(more than anything I want to get my food moving along and digested so I can lose this weight I am trying so hard to get rid of)


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## Jhouston (Nov 9, 2003)

Daisy, Why do you think you will be in the toilet all morning? Joann


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## daisysp (Jan 13, 2004)

I was reading what Gret said about when she started it. I wish folks would report what they experienced when starting, during and how they are doing all along. This thread isn't what I had hoped for as far as it focusing on the patients of Dr D, and others who are wanting his information or having questions. I'd like to know what to expect, what is typical and what I may look forward to as I go along..........I now everyone is different, so was hoping to hear if there is any consistancy to this process.


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## Jhouston (Nov 9, 2003)

Well, Daisy....Gret was IBS D so I don't think that applies to you. unless I have it wrong. I hope you have an easy time of it....I'll keep you in my thoughts. good luck, Joann


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## Gret (Sep 23, 2003)

Hi Daisy, I'm happy you will be getting started! It's true, I had some frequency issues in the beginning. But there was not urgency. I just had to make a minute to excuse myself - more often than I wanted, but it wasn't a big rush to the pot or anything! You'll probably be fine. One thing I've noticed is a huge lack of urgency! I can feel the need to go when I'm out and put it off till I have the time! I feel like a regular person again, making plans to do normal, everyday things! I wish the same for you and everyone else!


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## daisysp (Jan 13, 2004)

I started a new post on the main page for Dr D users to post their results and maybe say what they are eating, trying and experiencing. I started yesterday and am feeling both good and bad. Funny how it can be both at the same time, yet it is. I have the most horacious hunger for sugar though right now.........I need to either surrender to it or hold out, yet it's strong right now. M&M's sound so good right now !! I don't have D though, so I guess I won't be doing the cleanout as Gret did. I did go already 3 times today and it's only 5pm now, so I am very very happy about that. I don't only eat 3 meals aday though, cause I need to eat small little meals throughout the day........so I guess I need to take the enzymes at the bigger meals 3x a day, and not at all of them.


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## kel1059 (Feb 28, 2003)

in the past 2 or 3 weeks something has changed in me for the better. i don't know what it is that has changed but everything seems more settled.i am able to eat rice for the first time in almost 10 years without experiencing brain symptoms. Hommus still causes problems. i am sticking with a very strict diet.i am convinced that homeopathy has played a substantial role in my improvement. i spoke with dr d about this and he supports the use of this healing treatment. i am going to continue to concentrate on bifidus bacteria implantation in my colon. this can only improve my situation.


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## Gret (Sep 23, 2003)

lek, I think getting onto one path of treatment may have helped you! Instead of frantically trying everything, you can concentrate on one or two things and maybe that's made a difference. Actually, who cares, just so you feel better!


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## BackFire44 (Nov 19, 2003)

Glad to hear you are feeling better lek. I think with IBS -- especially people that have suffered with it for such a long time -- it is often just a change that their body needs to get back on the right track: a change in diet, a change in outlook, a change in hope. I'm glad whatever you have changed is working for you. It gives a lot of other long time sufferers hope as well. There are tons of methods out there to help with IBS, and I am convinced that something out there will work for everyone.Gret -- it makes me so happy to hear about your urgency decrease. That's the worst problem for me. I can handle anything else -- but I am worried, like many others, that it will prevent me from what I want to do professionally. Glad to know you are finding relief. I continue to improve myself through my own doctor, and I hope I get to a point where I don't have to worry about it!


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## Gret (Sep 23, 2003)

Worrying about IBS episodes is the worst! Backfire, hang in there and keep the faith that you'll find relief too. I am so happy to be in charge of my life again!


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## kel1059 (Feb 28, 2003)

thanks backfire and gret.


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## BackFire44 (Nov 19, 2003)

How is everyone doing still? Gret -- every day still getting better?


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## daisysp (Jan 13, 2004)

I think folks are hanging out on the other thread, we were trying to avoid Eric....


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## Gret (Sep 23, 2003)

Thanks for asking, Backfire. Honestly, I think I'm out of here! I don't even think I have IBS anymore! I'll check back occasionally to see how you are all doing. Thank you all for your encouragement and support, it's all appreciated. If there is anything I can say or do to help anyone, please let me know! Good luck and keep the faith!


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## kel1059 (Feb 28, 2003)

wait don't go.


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## BackFire44 (Nov 19, 2003)

That's so great Gret! Be sure to check back periodically to let us know how you are doing and share your wisdom with others. Couldn't be happier for you, though. A lot of us have been following your ups and downs, and its great to see a happy ending.




























Daisyp, I have a sneaking suspicion your plan to change the names of the thread to "lose" eric wouldn't quite work. You know how I feel about the matter, but what thread we are on doesn't matter to me really! BackFire44


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## daisysp (Jan 13, 2004)

Thanks Backfire, you are right and I should just scroll down and let it go. I wish he would stick to responses that really target the subject and try to have a point other than making trouble and giving the pessemistic side of anything folks say. I am letting him get under my skin and that is my problem.......so no more, thanks for reminding me to breath.Gret, wow, you are so lucky........good luck !!


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## calid (Aug 4, 2003)

I think the problem we have with Eric is that he posts items totally unrelated to the subject of the thread. He believes he is the only one who has the right answers and won't allow us to easily follow the thread of others' experiences with the Dahlman protocol, which is why this thread was created. I don't care if he posts his cut and pastes on other threads, but if they don't have anything to do with Dr. Dahlman and the patients involved in the study, he should stay quiet. He can ask us all the questions he wants that relate to this particular subject. I don't paste Dahlman progress on the food thread, or the hypnosis thread as there is no relevance.Common courtesy and respect should be followed by all on the board.


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## daisysp (Jan 13, 2004)

well said, thank you ! I know one other person named Calid, is that your regular name ? Are you from Washington state ?


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## calid (Aug 4, 2003)

Nope to Daisy, California.


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