# Jeffrey Roberts chosen as guest expert in November for Women's Health Matters site



## Jeffrey Roberts (Apr 15, 1987)

Jeffrey Roberts, the President and Founder of the IBS Self Help and Support Group and Irritable Bowel Syndrome Association, was chosen as the guest expert in Women's Health Matters Le Club website for the month of November.Le Club stated, "Typically, people just don't like to talk about their bowels. That's one thing that makes irritable bowel syndrome (IBS) particularly difficult - people often suffer in silence, alone. That's why in November, our topic is Irritable Bowel Syndrome (IBS) in Le Club - with added resources, links and articles. It's a place where you can ask questions, read up on the latest research, talk to other women and maybe even offer some advice of your own."Women's Health Matters Le Club is a virtual meeting place for women of all ages and backgrounds. Visitors can read personal stories, participate in conversations and submit health questions. Your experiences could turn out to be an important source of knowledge and inspiration for others.Women's Health Matters: http://www.womenshealthmatters.caLe Club: http://www.womenshealthmatters.ca/le_clubThe IBS Self Help and Support Group formed its charter in 1987 in support of those who suffer from IBS, those who are looking for support for someone who has IBS, medical professionals who want to learn more about IBS and to be responsible patient advocates on local, regional and federal levels. The IBS Self Help and Support Group works to educate those who are living with IBS and to increase awareness about this and other functional gastrointestinal disorders. The IBS Self Help and Support Group website was launched in May 1995, as the first website about Irritable Bowel Syndrome, and currently has the largest collection of postings about IBS - in excess of 550,000, making it the largest community created specifically for IBS sufferers.IBS Self Help and Support Group: http://www.ibsgroup.orgIrritable Bowel Syndrome Association: http://www.ibsassociation.orgJeffrey Roberts is a patient advocate for Irritable Bowel Syndrome sufferers. He has testified to the United States Food and Drug Administration (FDA) several times on behalf of IBS patients. His testimony to the FDA Advisory Committee about Lotronex was instrumental in returning the drug to the market in 2002 for diarrhea predominant IBS sufferers. Jeffrey also provided testimony to the FDA in support of Zelnorm for the treatment of chronic idiopathic constipation and constipation predominant IBS. Jeffrey has appeared on the Discovery Channel, National Public Radio and in Canadian Living Magazine, Today's Dietitian, the FDA Consumer Magazine and has been quoted by CBS Evening News, Washington Post, USA Today, United Press International (UPI), Reuters, Associated Press, New York Times, Globe and Mail, and CBC Online.Jeffreyâ€™s answers to your questions about Irritable Bowel Syndrome (IBS). Q: Can IBS be caused by hypoglycemia?A: Despite the advancement in the many theories as to the cause of IBS, research does not indicate that it is caused by or associated with hypoglycemia. Current research suggests, although there is no direct connection to diet, modifications in ones diet for mild or moderate IBS may benefit from the elimination of some trouble foods. These troubled foods could perhaps also be seen as being associated with hypoglycemia, but there is no direct connection with IBS. --------------------------------------------------------------------------------Q: Why do I sometimes have issues with constipation for weeks, then am suddenly struck with explosive, runny bowel movements? How can I prevent this?A: It is not altogether unusual for an individual with constipation predominant IBS to have this pattern. The diagnostic criteria of IBS using the Rome II criteria indicates a pattern of fewer than three hard or lumpy bowel movements a week and the possibility of one of loose, watery stools or more than three bowel movements per day. This cyclical pattern is classic IBS. Additionally, for women, it is not usual for diarrhea to proceed around menstruation.For sufferers of this pattern, new medication that modulates the passage of stool in the gut is available to be prescribed by your doctor.--------------------------------------------------------------------------------Q: Are there any surgeries being done in Ontario to correct IBS? If so, what?A: IBS is classified as a Functional Bowel Disorder, which is characterized by abdominal pain and changes in bowel habits which are not associated with any abnormalities seen on clinical testing. Since no abnormality is present no surgical procedure is warranted.--------------------------------------------------------------------------------Q: Are there any medications that make a difference?A. Medication therapy is best used in IBS patients with moderate to severe symptoms which do not respond to education and dietary modifications. However, there is no medication which provides effective treatment of the multiple symptoms of IBS sufferers. Therefore, first line treatment has traditionally been aimed at treating the most bothersome symptom. That being said, a new recent physician prescribed therapy for constipation predominant IBS, Zelnorm (tegaserod), has recently been introduced and it has been shown to effectively treat the multiple symptoms of IBS-C (constipation predominant). Clinical studies with tegaserod indicate it improves symptoms and function in patients over a 12-week treatment course.Available only in the US, Lotronex (alosetron) has the opposite effect of Zelnorm. It is for IBS-D (diarrhea predominant) sufferers and it regulates the motility in the gut thereby slowing down the movement of stool along with reducing diarrhea and abdominal pain.Additionally, using the anticholinergic (pain relief) and diarrhea or constipation side effects of antidepressants have effectively treated many IBS sufferers. A complete medication listing for IBS is located at http://www.ibsgroup.org/main/medications.shtml.--------------------------------------------------------------------------------Q: I was recently UNDIAGNOSED after 20 yrs with IBS & would like to know why. I had a scope, due to having some new symptoms. I am back and forth to the bathroom with diarrhea up to 10 times some days before I even eat. Other times I am constipated for days on end with no relief. When the internist did my scope he said I had an unremarkable bowel but he diagnosed me with ulcerative rectal proctitis. I have researched this and there are THREE ways to have this condition. 1. Crohn's 2. Colitis 3. STD (I KNOW I do not have that!!) He did no biopsy to rule out any of the three, and I have found out that he should have. But to undiagnose me with IBS when I have suffered for 20 years seems strange. I also have severe chronic fibromyalgia and some chemical sensitivity. Please help!A: There are no physical findings or diagnostic tests that confirm the diagnosis of IBS. Therefore, diagnosis involves identifying certain symptoms consistent with the disorder and excluding other medical conditions that may have similar symptoms. Sometimes this can take years. There are also individuals with the co-morbidity of IBS along with Crohnâ€™s disease or ulcerative colitis or fibromyalgia or others. I am not aware of any research studies which indicate that having IBS undiagnosed leads to worse or prolonged IBS although I believe it would be helpful to have a clear diagnosis as soon as the IBS symptoms affect your quality of life.--------------------------------------------------------------------------------Q: I have IBS and I seem to be getting more and more constipated. Sometimes I can go for up to three days without a bowel movement â€" is this normal? I know what foods will irritate my symptoms, but sometimes even eating fibre or taking laxatives doesn't help. Can IBS symptoms lead to other serious intestinal problems?A: There is no definition for what is normal for the number of bowel movements an individual may have per day or per week. In terms of IBS, the consistency of the stool and the presence of abdominal pain are the most notable features that a physician will look for when making the diagnosis of IBS. With constipation predominant IBS, hard lumpy stools with straining, a feeling of incomplete passage and a bloated feeling are common. A diagnosis of IBS, though greatly impacting on oneâ€™s quality of life, does not lead to further more serious intestinal problems or a predisposition for any types of digestive malignancies.Some individuals find that adding additional fibre or taking laxatives can relieve their constipation predominant IBS. For moderate to severe IBS, these measures may not be enough and actually too much fibre could contribute to an increase in discomfort due to impaction and severe constipation.--------------------------------------------------------------------------------Q: My father has recently been diagnosed with IBS and also has Ankylosing Spondylitis. I have Ankylosing Spondylitis and have recently been having lower GI troubles. My symptoms included times where I'm constipated and bloated, followed by cramping and loose stools. I have noticed a trend that I get GI flare ups at the same times as I get inflammation flare ups with my Ankylosing Spondylitis. Is there a connection between IBS and Ankylosing Spondylitis?A: Ankylosing Spondylitis is usually a complication of Inflammatory Bowel Disease (IBD), one of Crohnâ€™s disease or ulcerative Colitis. IBD is characterized by visible inflammation of the digestive system and is a different illness than IBS; however, it is possible to have the co-morbidity of IBS along with IBD even when there is no active disease. There is no research which shows any relationship between IBS and Ankylosing Spondylitis. That being said, in order to confirm that you are not suffering from IBD versus IBS, a clinical work-up would be required to be carried out. --------------------------------------------------------------------------------Q: I am a 59-year-old female with IBS.I have a long colon according to my doctor. Is there a link between IBS and having a long colon? Also is there any medication to relieve the cramps and spasms? Thank you.A: Having a long colon is not a characteristic in the diagnostic criteria for IBS.The diagnosis of Irritable Bowel Syndrome has relied on a diagnosis of exclusion. Because the symptoms of IBS share the symptoms of so many other intestinal illnesses, it sometimes takes years before a correct diagnosis is made to exclude the obvious, and not so obvious, conditions which present symptoms similar to IBS.Physicians rely on a variety of procedures and laboratory tests to confirm a diagnosis. The Rome II Criteria, however now defines markers which allows professionals to diagnose IBS after a careful examination of a sufferers medical history and physical abdominal examination which looks for any 'red flag' symptoms.Red Flag symptoms which are NOT typical of IBSain that awakens/interferes with sleep Diarrhea that awakens/interferes with sleep Blood in your stool (visible or occult) Weight loss Fever Abnormal physical examination The Rome II Criteria states:The diagnostic criteria of Irritable Bowel Syndrome always presumes the absence of a structural or biochemical explanation for the symptoms and is made only by your health care professional. Irritable Bowel Syndrome can be diagnosed based on at least 12 weeks, which need not be consecutive, in the preceding 12 months of abdominal discomfort or pain that has two out of three features: Relieved with defecation; and/or Onset associated with a change in frequency of stool; and/or Onset associated with a change in form (appearance) of stool. Relief from the symptoms of cramps and spasms can sometimes be found by dietary modification for mild symptoms. Common foods which may contribute to causing the symptoms are caffeine, alcohol, fat and fructose and other sweeteners. The introduction of antispasmodics or antidepressants for more severe symptoms has shown some anecdotal evidence. The anticholinergic (pain relief) and diarrhea or constipation side effects of antispasmodics and antidepressants have effectively treated many IBS sufferers with these symptoms.--------------------------------------------------------------------------------Q: In my situation, diet is a big factor. I was diagnosed with Crohnâ€™s disease which is a little more severe than IBS, however from the same family. Could you make some suggestion as to a proper diet to follow? I also have high cholesterol and am taking lipitor to keep that under control. Is there a specific diet to follow for these problems?A: Although Crohnâ€™s Disease, a form of IBD, is different than IBS, it is not unusual for IBD and IBS to share dietary concerns. However, there is no evidence that digestion of food is different in those with IBS compared to those without IBS. Although the exact cause of IBS is not known, there are factors that appear to aggravate symptoms or make a person feel worse.While dietary factors do not cause IBS, they may aggravate symptoms in some persons. Increased intestinal muscle reactivity and/or heightened sensitivity in IBS can cause the bowel to over-respond to stimuli. Even a normal event such as the act of eating itself, and not a particular food, may aggravate symptoms at times.Common foods which may contribute to causing the symptoms are caffeine, alcohol, fat and fructose and other sugary sweeteners. Some foods are gas producing (e.g., beans, cabbage, legumes, cauliflower, broccoli, lentils, Brussels sprouts) and eating too much may cause increased gas, which can be associated with symptoms of bloating. In general the low-fat diet for cholesterol should be okay for Crohnâ€™s Disease or IBS since high fat meals can increase the gastro colic reflex that can bother some people.--------------------------------------------------------------------------------Q: Does IBS ever resolve on its own, or is it a lifelong condition? What lifestyle changes are most effective in treating/managing the condition?A: IBS is an illness that waxes and wanes overtime. Its unpredictable nature is very troublesome for sufferers and leads to the impact of ones quality of life. Some do find that IBS symptoms appear to resolve on its own with modification of lifestyle and diet.Stress contributes to the anxiety associated with the unpredictable nature of IBS. Cognitive behavioural therapy and hypnosis have shown, through clinical studies, that they can be effective for helping to modify ones lifestyle and outlook on coping with IBS. Many clinical therapists, psychologists and hypnotherapists are aware of how effective this can be.--------------------------------------------------------------------------------Q: Hello Mr. Roberts. I am in need of assistance as I have been suffering for years with acute constipation with mild intermittent diarrhea. This is excruciatingly painful, uncomfortable and embarrassing. Presently, I take 1 tsp Metamucil daily and once in awhile Zelnorm, and also need to use enemas, which provide instant relief. My family doctor says I have a lazy bowel. Firstly, does the use of enemas have any long term effect and secondly, what can I do to ease the daily discomfort? I am a very healthy, fit female with no pertinent medical problems. I lead a very healthy lifestyle and have a healthy diet. Any comments or suggestions you can provide are greatly appreciated.A: Constipation is one of the most frequent GI tract complaints in Western countries. There are at least 2.5 million visits to the physician for constipation annually in the US with hundreds of millions of dollars spent on laxatives and other treatments.Many find the use of enemas helpful for intermittent relief of the symptoms of constipation yet many worry that they will become dependent on them or that over the long run they will harm themselves or require them more often. A recent global study which was prepared by a manufacture of enemas reported â€œConstipation sufferers should be reassured that they will not become dependent on laxatives. Clinical studies and extensive experience show that laxatives, such as bisacodyl and sodium picosulphate, are not addictive and can be trusted as safe and effective treatments.â€A review by the American Journal of Gastroenterology found that â€œAt recommended doses, stimulant laxatives are unlikely to be harmful to the colon. Although some patients with chronic constipation depend on laxatives for satisfactory bowel function, this is not the result of prior laxative intake. Tolerance to stimulant laxatives is uncommon; there is no evidence of "rebound constipation" after stopping laxative intake, and there is no potential for addiction even though laxatives may be misused.â€Relying on laxatives for satisfactory relief of constipation is likely not a long term solution. Diet and exercise seem to play a positive role in relieving symptoms of constipation. Zelnorm, a physician prescribed medication, has shown to have an excellent safety profile. Long term studies in its use longer than the initial 12-week course have been positive for constipation predominant IBS sufferers. Zelnorm also is now prescribed for chronic constipation sufferers. Further discussion with your physician about its continuous use may provide more reliable relief. --------------------------------------------------------------------------------Q: What are some drug-free options for relieving IBS attacks and are there any over the counter items that should be included in my diet as an IBS sufferer?A: Several drug-free options are available for IBS sufferers. Both cognitive behavioural therapy with or without medication have clinically shown to benefit sufferers. Hypnotherapy by someone trained in a specific IBS protocol has also clinically been beneficial. Peppermint oil capsules act as a smooth muscle relaxant for the bowel and may provide relief from abdominal pain and feeling of bloating feeling. Recent studies about the use of probiotics, in particular, Bifidobacterium infantis and Lactobacillus acidophilus, have shown that they may provide multiple symptom relief of IBS. With probiotics it is important to only rely on specific clinically studied concentrated formulas. Seek vendors using evidence based studies.--------------------------------------------------------------------------------Q: I have a few questions: Is there research about the link between emotions and IBS/colitis? What does research show about daily asacol and its success in preventing flare-ups of ulcerative colitis? What are your suggestions about diet and ulcerative colitis? Different things I read say different things and it is confusing. Thanks!!A: Stress is a factor in our lives and it contributes to the anxiety associated with the unpredictable nature of IBS. However, there are no research based studies which indicate that stress causes IBS; however it is understanding that IBS causes stress as a result of the reduced quality of life of a sufferer. It is not entirely clear how stress, anxiety, and IBS are related or which one comes first but studies show they tend to co-exist. The most common mental ailment suffered by people with IBS is generalized anxiety disorder. Although psychological problems such as anxiety do not cause IBS, people with IBS may be more sensitive to emotional troubles. Stress and anxiety may make the mind more aware of spasms in the colon. Stress management is an important tool for an IBS sufferer. Some people use relaxation techniques such a deep breathing or visualization, where they imagine a peaceful scene. Others reduce stress by doing something enjoyable.There is a lot of conflicting information about diet and IBS because very often people respond in different ways to diet. Much of the time diet recommendations are based on anecdotal evidence rather than systematic review which can lead to very conflicting advice depending on which people were used to come up with the list of safe vs. unsafe foods. Additionally some lists are made based on nutritional theories rather than data, and the theories may or may not be valid.Unfortunately since Asacol is a 5-ASA anti-inflammatory which is normally prescribed for sufferers of Inflammatory Bowel Disease (IBD) which includes ulcerative colitis, I do not have any experience in this area.--------------------------------------------------------------------------------Q: What is and what causes IBS? I believe that my 25-year-old daughter is suffering from IBS. If she is lucky she may have a bowel movement once a week. I believe she eats correctly (lots of fruit and veggies). However, she does eat a lot of cheese and pasta with cheese which I have told her to cut back on. She bought a bowel cleanser from the health food store. Is this healthy? What can she do or take to help alleviate this problem with constipation? Her family doctor doesn't seem to concerned, should she be? Any info on this would be greatly appreciated.A: Research continues to determine the cause of IBS; however the cause remains unknown. Recent studies have concentrated on the motility of the gut. Current medications to help relieve symptoms have been focused on these areas. Zelnorm for IBS-C, helps to regulate the motility of the gut by adding more serotonin to the gut. This seems to increase the rate that the gut moves stool along thereby reducing constipation and abdominal pain.Non-medication treatments for constipation are anecdotal in nature. They include modifications of diet, an increase in fibre and liquids, exercise and the occasional laxative.Bowel cleansers are not a usual remedy for relieving the symptoms of IBS. Since the mechanism of IBS seems to be related to a regulation of the gut, temporarily removing the stool may provide some immediate symptomatic relief. However, in the long run, symptoms will likely reappear when new stool is present.If you suspect your daughter has a problem with constipation, you can speak with your doctor about further evaluation initially using a non-invasive test such as a SitzMark test. It is a bowel transit study to objectively measure the severity of the constipation, and it helps to establish the primary cause of the constipation. In the SitzMark test radio-opaque markers are swallowed and it is observed where the markers are after 3-5 days. The presence of more than 25 percent of the markers in the colon at day 5 is indicative of a positive test. Markers evenly spread throughout the colon are consistent with slow transit constipation. A negative SitzMark test with fewer than 25 percent of the markers on day 5 is suggestive of normal transit constipation or a patient who is not compliant with the instructions regarding no laxative use during the testing.--------------------------------------------------------------------------------Q: I have been reading that probiotics can help with irritable bowel syndrome. Apparently there is a probiotic called "Align", which is only available in the US at the moment. Studies have shown that it does reduce the gas and bloating associated with IBS. Do you know if it might be available in Canada soon, or are there other probiotics that might be of help?A: I have partly answered this question about probiotics in question #12. To summarize, recent studies about the use of probiotics, in particular Bifidobacterium infantis and Lactobacillus acidophilus, have shown that they may provide multiple symptom relief of IBS. With probiotics it is important to only rely on specific clinically studied concentrated formulas. Seek vendors using evidence based studies.Align, which is manufactured by Proctor and Gamble, is only available at this time via the internet in the US. Several clinical studies specifically studying the active probiotic in Align, namely Bifidobacterium infantis, have shown very promising results at relieving multiple IBS symptoms. Another probiotic, VSL #3, available in the US and Canada, is a highly potent concentrated cocktail of beneficial bacteria. In the last year a clinically controlled study with VSL#3 and IBS has shown positive outcome for IBS sufferers. VSL#3, normally recommended by a physician, is available online in Canada from http://www.vsl3.ca/.--------------------------------------------------------------------------------Q: I eat a fairly healthy diet, and my bowel movements are very regular, occurring daily. However, most mornings I experience the following problem. About 15 - 30 minutes after awaking and moving around, I have an almost uncontrollable urge to go to the bathroom. The result can vary from a regular bowel movement to almost diarrhea. At times, this episode may recur within an hour. However, it does not occur at any other time of the day. Is this a symptom of IBS?A: When they measure colon activity in normal people they find that the most active time of the day for anyoneâ€™s colon is right around the time you wake up. There are additional increases in activity after meals which may also be a problematic time.Patients prone to diarrhea predominant IBS find that the first stool in the morning is usually normal in consistency. However, a great deal find subsequent urgent bowel movements which become more watery and mucoid, and are associated with intestinal cramps, rectal urgency and bloating. Symptoms are relieved with the passage of stool but often quickly return.Some patients get up early each day or do not leave their home in the morning until the diarrhea comes under control. The thought behind the urgency each morning is from the amplified hypersensitivity of the waking bowel. IBS sufferers have much more sensitivity to the normal muscle contractions in the bowel and this has a greater tendency to force an emptying of the bowel.The evaluation of IBS in patients is by the use of the Rome II criteria as long as no Red Flag symptoms are noted (see question #8 for Rome II and Red Flag symptoms); however, symptoms such as urgent diarrhea should be followed up by a physician to rule out other illnesses with similar symptoms.


----------



## overitnow (Nov 25, 2001)

Funny, before I found this site, the only one I could talk about it to, was my doctor. Because of what you have done, Jeffrey, and made to seem just a normal part of life,I can now talk about it to a complete stranger, at a bus stop.For helping us all feel normal,Thank you and congrats.Mark


----------



## eric (Jul 8, 1999)

Mark "I can now talk about it to a complete stranger, at a bus stop."Pretty funny







Jeff, great job!!!


----------



## Jeffrey Roberts (Apr 15, 1987)

I have updated my original posting (above) with the answers to the questions that were posed to me. Thanks to Kathleen M. for her assistance in reviewing and editing of the answers.They are also posted here:http://www.womenshealthmatters.ca/le_club/expert/q&a.cfmJeff


----------

