# A right way to add food back?



## kac123 (Aug 2, 2002)

Hello! I've lurked around this section of the bb for a while now and could definitely use some advice. My IBS shuffles between C and D - with C being the norm (I go almost everyday but always strained) and D being very active if i get anxious or nervous. I am currently taking bentyl for the spasms and citrucel for fiber and using Mike's tapes for the anxiety. Since all of this started i started cutting out foods. I took the LEAP "quiz" but i wasn't a good canidate. The cutting out started with the foods that made sense (red meat, alcohol, greasy food, dairy, whole wheat, etc) and now has gotten completely out of control so i basically live on a diet of broiled chicken, rice, pasta, pretzels, and english muffins. Vitamins (i've tried the one-a-day kind) make me sick as a dog so i'm afraid to add them back - i know, not good for me but please don't yell! I went to a dietician and she said i'm a little low on a few vitamins and definitely low on the calcium but i'm otherwise ok. My question is, is there a "good" way to add foods back that wouldn't overwhelm my system (i'm especially worried about trying dairy again.) I WANT to eat more, add more variety but frankly i'm scared of the effect of putting more variables into the equation, so to speak. Any information that would help will be appreciated!Thankskac


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## Mike NoLomotil (Jun 6, 2000)

Hi KAC.The process of adding-back foods to check for tolerance (is it a food which results in pain or diarrhea or bloating) is the process that follows a patient having isolated a safe diet first.That is, a diet whereby their symptoms have gone into remission for some time.If the paient is on a diet whereby they remain symptomatic it is ery hard to have any oral challenge regimen which is effective at isolating the real culprits.On the vitamins, no yelling, you do have to supplement but you simply have to use vitamins which are 100% non-antigenic (no colorings no additives no food extracts...pure vitamin...the health food store usually has at least one or two lines which qualify. Tell the people at the store you have food ALLERGY...even though you don't...and need 100% non antigenic vitamins...then check the label to see if they know what they are doing. OR you can contact the LEAP Dietician through the email, Jan Patanaude, for recommendations on what lines to use).[as a sidebar if you do suffer C frequently the idea of eliminating hard to digest fiberous foods, like red meats and the so-called "other white meat" like pork, is a good idea...keep it up...eating steak is like ingesting a colonic plug for people with c-type symptoms).The appearence, however, of diarrheic episodes from time to time does suggest (assuming that the GO doc has ruled out other organic disease alrady) that you may have one or more offending foods in the diet to which eithera. you have a dose dependent intolerance orb. you only eat episodicallyIf the cycle of c and d is frequent and regular, some people simply get the c as a consequence of what we do behaviorally when we get diarrhea...restrict food intake and fluid intake when we are acutely ill while the bowel is being evacuated and then start back eating a low bulk low fiber first phase diet. How many people follow up diarrhea with such thinhs as a few crackers etc?Anyway, the whole concept of the Stoneage Diet approach to getting symptoms under control and then reintroducing foods comes from the idea of evolved lost oral tolerance....go back to eating only a few foods which preceed the development of chemical invasion of the food supply and processing of foods...so they start with something like rice, lamb and pears...each of which has a low probability of sensitivity if it is organic.very unhealthful nutritionally but it can lead within a week or so to symptom relief...a good non-antigenic multivitamin regimen needs to e used in split doses too by the way.Anyway once a person is feeling asymptomatic (oh if you have c don't eat the lamb for example in the form of fileted meat...grind it up well and make lamb patties..e.asier to digest).Then the person reintroduces one food at a time and waits 2 days at least after introduction to make sure no symptoms appear. Some start with alist of "foods I want to eat soon" some start witha list of "foods with low probability of reaction" or the opposite, "high probability of reaction"...depends on the protocol du jour and the doctor who set up the protocol.Anyway is symptoms appear...elimiante the food and allow a 2-3 day washout before the next open oral challenge.Now the weakness of open oral chalenge is sometimes it can create self-fulfiling prophcies...the person thinks they are reactiove to food A so they eat it and do perceive symptoms. his is why blind oral challenge is the theoretical way to go...but it only works for allergies which are NOT dose dependent. You usually cannot get a blind oral challenge dose for food intolerance into the person at the high provoking dose that may be required...







Ach du LIEBER MNL all I wanted was a simple answer and you are driving me crazy.Yes this is because there are few simple answers for the food intolerant patient....only folks who hope to make it simple as they do not grasp the big picture.have you read any of the books on the subject? It can make it much more understandable and easy to resign oneself to a regimen which will have a high likelihood of actually working well.This is also a good book as it can help you get organized with a simple dietry intake management plan which can help people with less-complex situations regarding their food sensitivities:IBS: A DOCTORS PLAN FOR CHRONIC DIGESTIVE TROUBLESBy Gerard Guillory, M.D.; Vanessa Ameen, M.D.; Paul Donovan, M.D.; Jack Martin, Ph.D. http://www.amazon.com/exec/obidos/ASIN/088...3369143-6824157 ï¿½FOOD ALLERGIES AND FOOD INTOLERANCE: THE COMPLETE GUIDE TO THEIR IDENTIFICTION AND TREATMENTï¿½, Professor Jonathan Brostoff , M.D.. Allergy, Immunology and Environmental Medicine, Kingsï¿½ College, London http://www.amazon.com/exec/obidos/ASIN/089...6487508-3420903 FOOD ALLERGY AND INTOLERANCE, Professor Jonathan Brostoff, MD, Stephen Challacombe, MD (NEW 2002) http://www.amazon.com/exec/obidos/ASIN/070...product-details MNL


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## kac123 (Aug 2, 2002)

Hi Mike - thank you very much for taking the time to write all that out! I actually posted this hoping that it would be you that would respond just from other replies that i've seen you give. I definitely fall into the class of people that try a food "knowing" that it will cause a reaction and then -surprise- it does. I do have the Food allergies and food intolerance book by Brostoff and have read through some of it but he basically comes straight out and says if you have C then food is not a trigger. I understand that intolerance is not a cut and dry situation - but i feel sort of like i've backed myself into a corner by eliminating so many foods that i was lost as to how to put them back. i will read through the book again. and i will try the "eat a food and then wait 2 days for symptoms" approach. thank you again for your response.-Kac


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## Jan LEAP RD (May 19, 2002)

Hi Kac,Here's a few links that may help you work on the things like increasing fiber and such.Also, do you ever eat bananas, or drink tea? For some people, these are VERY constipating. Constipation http://www.niddk.nih.gov/health/digest/pubs/const/const.htm http://www.medformation.com/mf/CAM.nsf/con...tipationcc.html http://www.medformation.com/mf/CAM.nsf/con...tipationcc.html The Bowel Movement http://www.consciouschoice.com/healthconsc...scious1401.html Gas in the Digestive Tract http://www.niddk.nih.gov/health/digest/pubs/gas/gas.htm


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## kac123 (Aug 2, 2002)

Hi Jan, Thanks for all the links! Nope - no bananas. I've never been a very good fruit or veggie eater - never ate a lot of them prior to the IBS which is probably why I have this nightmare to deal with now! (Don't tell my mom i said that - i'd never hear the end of it!)







And no tea. i think it upsets my stomach more than it helps. As for increasing the fiber - thats what i'm afraid of even though it makes the most sense. I'm trying to build myself up to more foods because literally i ONLY eat what i posted before -- my dietician thinks i'm crazy. She's probably right.







Oh - and MNL said to ask you about a brand of antigen-free vitamins to look for. Any suggestions? Thanks for replying!kac


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## Mike NoLomotil (Jun 6, 2000)

KAC...You point out something interesting toe xpand on a little: __________________________________"...he basically comes straight out and says if you have C then food is not a trigger." __________________________________One thing to consider is that the book you have is a several years old edition, and also it is written for patients not doctors. This results in some oversimplification at times, some older information, or the context of a statment has to be considered.With looking at GI symptoms in IBS victims most doctors tend to either beleive the old dogma that there is no direct relationship between food and symptom generation in any IBS patients, so their interest and study never goes there nor do their therapeutics. Often the whooe concept of what the "oral tolerance mechanism" is remains a bit of a mystery.Sometimes if they do understand that there is a population (identifiable and large) within the "IBS population" where non-allergic food intolerance is an important mechanism of generating symptoms, they will tend to look at the GI symptoms in vaccum at the bedside as no one has provided them a very clear tool to evaluate systemic symptoms as well GI symptoms to determine if the patient has non-allergic food intolerances.Since the GI pain and diarhhea are the classic primary symptoms of the gastroneuroimmune system trying to rid itself of something (thus most food intolerance translates into thsoe symptoms) there RE patients who suffer from food or chemical sensitivity reactions which are of a type that the bowel is not the site of primary insult. The reaction occurs via a amechanism which has gone awary and which occurs as a late reaction within the blood stream, for example, involving cells and mechanisms which are not part of the "guardians of the gut portal".So there is a subpopulation of people who have been diagnosed with constipation-predominant IBS who do suffer from food or chemical intolerance as a COMORBIDITY...they can be spotted by the OTHER symptoms they may show routinely which are "extraintestinal".There are respected clinicians who have attempted to convey this to the rest of the medical community tor aise their awareness of it when confronted with a patient with systemic symptoms. It is based upon studies showing that this indeed does occur....and a c-typ for example migh suffer ADDED symtoms atop whatever the base disorder is, since if a systemic reaction occurs it will just further amplify the primary symptoms (more gut pain for example) plus add other systemic symptoms ranging from chills, dizziness, nausea, disorientation, even joint and muscle pain (arthralgia), fatigue, chills....just feeling sick beyond the primary bowel dysfunction.So if the book, and the newer one, are taken as whole it is clearer that what these fellas are trying to say is true, and you are correct in that you may indeed be a c-type and still have symptoms of food intolerance. All FI is not diarrhea...just MOST...think of migraine! The head is blowing off but there is no bowel evacuation. A differet thing is occurring elsewhere in the body. ____________________________________: Lancet 2000 Jul 29;356(9227):400-1	Related Articles, Books, LinkOut Relation between food provocation and systemic immune activation in patients with food intolerance.Jacobsen MB, Aukrust P, Kittang E, Muller F, Ueland T, Bratlie J, Bjerkeli V, Vatn MH.We found that food provocation in food intolerant patients was characterised by a general and systemic immune activation accompanied by an increase in systemic symptoms. Our findings might be important for the understanding of the mechanisms involved in the pathogenesis of food intolerance. __________________________________MNL


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## kac123 (Aug 2, 2002)

Hi MNL, I just read your response and i understand that food intolerance can exist in addition to IBS and aggravate the IBS symptoms while adding on a few of its own -- the question i have now is how does a patient that is C predominately and suspects comorbid FI determine exactly what is going on??? If i'm reading what you wrote correctly you're saying that if a person is C than even if they have an intolerance to food that food is not really aggrevating my IBS attacks. That though i may perceive that what i'm eating is upsetting my stomach, in actuality its a secondary pain caused by mechanisms independent from the IBS.?? How do i prove what is happening with my body then --- how do i find the intolerances without mistaking them for IBS symptoms? I apologize if i am misreading or misinterpreting -- just trying to figure it all out -- plus I'm tired of eating the same foods over and over again - its depressing.Thanks-kac


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## Mike NoLomotil (Jun 6, 2000)

No, its OK, it is a confusing subject that's all. It's sort of like having a leaky boat. You have a hole in the hull and water is coming in regardless. BUT if you put a lot of people and cargo in the boat, adding weight, the weight will just make the water come in faster...but it did not cause the primary problem (leak from hole in hull)it is just compounding it.So a patient with chronic constipation in spite of eating a healthy diet with adequate fiber, and also has pain, perhaps incomplete evacuation, bloating sensations, and other discomforts and is thus diagnosed with IBS when the tests all come back inconclusive MAY also suffer one or more forms of food hypersensitivity other than allergic OR there are some who have real food allergy too.Instead of getting diarrhea, they get feverish hot flashes and hives...or maybe (like the daughter of one severe D-type IBS patient we had) the person suffers from intractable eczema. And when the offneding food was indentified the eczema disappeared.If you have some fundamental dysfuntion that alters the bowels normal evacuatory functions, but lay atop that a loss of oral tolerance reaction, you could have a patient who gets abdominal pain and bloating and systemic symptoms from some form of non-allegric food intolerance, but the underlying "motility problem" is not "overcome" by a biochemical stimulus to evacuate when a food is misidientified as if it were a pathogen. The person could have a patern of mediator relase which primarily further alters sensory function...and get worsened pain or worsened sensations of distention...or worsened systemic symptoms.There are really only (2) ways to figure out if the person has some non-IgE fod sensitivity which accounts for some of theie symptoms.A strict elimination diet followed by open oral challenges, done in accordance with the rules of 'Stoneage Dieting'...and this can be very difficult for the constipated person as the stoneage diet does not promote adeuate fiber intake...or to have a workup for food allegry and intolerance with in vitro tests, knowing it is being done to "rule out" abnormal reactions to foods or chemicals, and that the results may come back negative, or equivocal. That is there is a much lower probability of being test positive unless you have a bunch of the classic symptoms. BUT it isnot impossible. You just have to be willing to accept more modest expectations from both testing and, if test positive, the outcomes of any diet based on positive tests since this is not the primary problem. The degree of symptom change (unless yo have some dramatic non-GI symptoms like urticaria or eczema or asthma or ....whatever)may be modest.You may wish to get Guillory's book and try the elimination diet regimen he suggests...it may be a helpful first step for you without committing to anything more than the $15 or so for the book, and some perosnal effort. It could be enough.But this "type" of patient has the hrdest time of all isolating accurately ofending foods, as the symptomology and effects are so much more subtle...additive instead of "causative" of primary symptoms.Make sense?


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## Mike NoLomotil (Jun 6, 2000)

OOPS....forget the link and cannot edit posts....IBS: A DOCTORS PLAN FOR CHRONIC DIGESTIVE TROUBLESBy Gerard Guillory, M.D.; Vanessa Ameen, M.D.; Paul Donovan, M.D.; Jack Martin, Ph.D. http://www.amazon.com/exec/obidos/ASIN/088...3369143-6824157 MNL


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## kac123 (Aug 2, 2002)

Yup - i understand. I do have one more question (well at least one more







) - Prior to the IBS kicking in 2 years ago i never had an allergic reaction to anything - could eat whatever i wanted, take whatever prescription drugs i needed to without being affected by side effects, didn't have asthma or any skin condition, etc. So, given that, is it possible that the IBS and its 'cellular inner-workings' could push a person into becoming intolerant of foods that never bothered said person before? Is there any evidence that shows a switch over in mediators of allergic reactions after IBS is present? Does/can IBS cause food intolerance -- or is it the other way around? I'm sorry if i'm asking questions that have already been answered previously, if they have been please redirect me!







Thanks again for the replies-kac


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## Jan LEAP RD (May 19, 2002)

Hi Kac,I HATE it when that happens. Had a whole letter typed out, and then lost it. . .


> quote:basically live on a diet of broiled chicken, rice, pasta, pretzels, and english muffins. Vitamins (i've tried the one-a-day kind) make me sick as a dog so i'm afraid to add them back - i know, not good for me but please don't yell! I went to a dietician and she said i'm a little low on a few vitamins and definitely low on the calcium but i'm otherwise ok.


Are you sure this was a REAL DIETITIAN??? To think this is okay is ridiculous! You're not getting enough Calcium, magnesium, potassium, vitamins A, D, E or K; Lack of vitamin C or phytochemicals! I could go on, but won't! AND I'M NOT YELLING!







hahahaAs to a supplement, without knowing a lot more, it's tough to say. But, Kirkman Labs (http://www.kirkmanlabs.com/products/multiv...mins_index.html) seems to have some pretty decent hypoallergenic formulas. And, you can order a small sample size first to try out. I like the idea of a powder too, then you can start with a VERY small amount, and/or take a tiny bit 2-3 times during the day. And, whatever you do, don't take on an empty stomach, but after you've eaten something.Another we recommend is Twin Labs Allergy Multi Cap. It's hypoallergenic and pretty well tolerated.As to foods to add back, I agree with Mike. It's tough to say without really knowing what you react to.That said, it's less likely that you will be reactive to foods you've never or rarely eating in the past. I'm thinking about things like artichokes, jicama, duck, lamb, asparagus (you should still eat your veggies!) papaya, etc. You get the idea. If it's a food you never recall eating, it's likelier to be safe.


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## kac123 (Aug 2, 2002)

Hi Jan, Thanks for not yelling - LOL!







As to whether or not this woman is a real dietician - i've had my doubts to be honest. Basically she falls into the "you have IBS so you should be eating whole wheat EVERYTHING" mindset and she was really only worried about my calcium intake because of the osteoporosis issues. Eh. i know what i'm doing isn't healthy i just can't seem to get past my own illogical thought process. I will get in touch with kirkman labs and try out their powder - Thanks again for the information-Kac


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## kac123 (Aug 2, 2002)

Jan - I was just looking through the website for kirkman labs and i have a quick question. I know the effects that calcium and magnesium can have on the two IBS types (as i consider myself a C/D patient i'm hoping to catch just the right balance of the two of these) -- i noticed that the 'spectrum complete" kind has a whole lot of vitamin C which i think i read somewhere aggravated symptoms by causing D -- and there's an awfully high percentage of b vitamins. I know i'm probably just being paranoid







, but do you know what effect the B vitamins would have? Because of my lack of luck with vitamins in the past i'm a little scared of them - plus i know minerals have a huge effect on my body.Sorry again for the mess of questions!Thank you!-Kac


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## Jan LEAP RD (May 19, 2002)

I took a look again at Kirkman hypoallergenic powder. Although the B vitamins are 300% or so of the RDI, that's not really too bad. It's well below the "upper safe limit" level. As to why so much B-12, I don't know. But, as of now, I've never seen where B-12 is toxic at any level, so I'd be okay with it.As to Ca/mg, those levels are low enough to not be a problem, and usually Vit. C will produce diarrhea only above 1000 mg/day.The other thing, with the powder, start out with minimal amounts, WITH A MEAL.Also, start eating more veggies. . . they really should help with constipation.


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## kac123 (Aug 2, 2002)

Thanks Jan! I'll give it a try and hope for the best







-Kac


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## Mike NoLomotil (Jun 6, 2000)

Hi Snappy KACie...Sorry to take so long to amswer. I just don't have time to come out and play like I used to...let's review your questions: _______________________________________"So, given that, is it possible that the IBS and its 'cellular inner-workings' could push a person into becoming intolerant of foods that never bothered said person before?" ______________________________________Oh yes this is sort of the cradinal rule with that population of people whose IBS symptoms are from food or chemical intolerance. The person slowly (or in some cases quickly) loses tolerance to things that they previously tolerated...hecne the "change in bowel habits" and appearence of other symptoms, which tend to revolve around a diarrheic core symptom...either alone or a cycle of diarrheic and constipated episodes.The digestive system and immuen system work together to help the body diiferentiate "safe" from "not safe" so that "Not safe" does not gain entry into the body itself via the portal of the GI tract tubing and its interface with the blood stream and lymphatics.If, when a person is first exposed to a "Safe substance" to which they form the wrong antibody (an antibidy like IgE which will next time tell the immune system to react violently to that thing when exposed becuase it is NOT SAFE, then you have an allergy...food or inhalant or contact whatever).If a person is just hunky-dory and for some reason (there are several ways this can occur) begins to lose tolerance to a food or chemical this is why we use the term 'loss of oral tolerance'. Since before the immune system basically said TOLERATE that thing it is safe, don't react, but now it starts to react, you are LOSING oral tolerance...it is what they call the emchanism itself.There are a wide range of reactiosn that can occur, because ther are a wide range of diiferent mechanisms by which the immune system may show activation, and thus a very wide range of what mediators or combinations may be involved. remember there are at least about 100 knonw so far.So one of the main ways that loss of oral tolerance starts to show itself in public is a person who develops symptoms that the doctors who use symptom-based diagnosis (which is most in the USA) call Irritable Bowel Syndrome. On the other side of the pond there are many doctors who, when presented with symptoms this change in boel habits and see thast the patient has normal GI tests and is negatibve to food or chemical allergy, and do a careful history includding dietary-symptom analysis, they do not even diagnose the patient as having "IBS". the call it "food intolerance" or "loss of orla tolerance" or "food sensitivity"...term du jour. Especially when the patient responds to elimination diet and/or a trial of drugs which are immunomodulating...drugs known to block the release of inflammatory mediators.This is what has led to there being different perspectives on the whole subject of IBS...in the USA though these skills and approaches are not widely taught, understood, nor practiced, and our system is pharmaco-driven anyway. So the diagnosis of IBS is mcuh more often assigned to those symptoms when they appear.So it does not matter if a dog is called "dog" in English or "hund" in German...it dioes not make it a different animal by using a different name...it still is what it is. ______________________________________" Is there any evidence that shows a switch over in mediators of allergic reactions after IBS is present?" ______________________________________What happens is if a person has true food allergy (IgE allergy) the orimary mediators in the acite reaction are mast cell mediators....which may the recruit other types of cells as the reaction progresses. (Tyoe I Gel & Coombs recation).Loss of oral tolerance in this person will result in other types of reactions than Type I being primary so yes the early appearence of mediators from other cell types is characreristic...this has been seen many times both in the plasma and in the direct-food challenge of the small bowel (jejunum) an then analyzing the washings.the provoking food may also recruit mast cells as well so those can be in the mix too. Even in the patient who has NO CLINICAL ALLERGY and NO CIRCULATING ANTIBODIES to the offending food.In some of these cases Swedish allergists have isolated LOCAL IgE in the bowel washings to the provoking foods (sometimes) which suggests that there is more than one way IgE can be involved...you don't have to be able to see the antibody in the plasma.This is one of the many reasons that classic blood allergy tests (immunoglobulon assays) are of very limited help in IBS dietary therapy...the other reaosn is that Ig[x] may not be involved at all...T Cells may be primary for example. ______________________________________"Does/can IBS cause food intolerance -- or is it the other way around?" ______________________________________Loss of oral tolerance provokes symptoms that are used to define the syndrome. Whatever causes loss of oral tolerance in those patients thus causes IBS.IBS is a name for a symptom set....think about this recent explanation, in the newest (and only) book written by doctors for doctors on the subject of food intolerance: _______________________"ï¿½Considerable confusion is now arising over the relationship between food intolerance and the Irritable Bowel Syndrome (IBS). Although the name has been hallowed by long usage, IBS is not a distinct entity but merely a collection of disorders which are characterized by abdominal symptoms but no obvious organic pathology. G.W. Thompson forecast in 1985: ï¿½the IBS is organic; that is all sufferers will eventually be found to have measurable, unique pathologic defects.ï¿½ When that happy day arrives, the term ï¿½IBSï¿½ will no longer be used, and each patient will receive a more precise diagnosis. Until then it is sufficient to appreciate that food intolerance represents an important proportion of the conditions which together make up IBS.ï¿½John Hunter, MD, FCRPDirector or Gastroenterology and Consultant PhysicianAddenbrookeï¿½s HospitalCambridge, United KingdomFromï¿½Food Allergy and Food Intoleranceï¿½ Second Edition 2002J. Brostoff, MDS. Challacombe, MDSaunders ____________________________chicken-or-egg analysis is basically moot..since the underlting disease needs to be uncovered in which case there is jo IBS there is the disease. IBS is used to give a name to a seemingly faceless enemy or enemies, thats all.So the enemy may end up being one that results in loss of oral tolerance thus symptoms we associate with IBS appear.On the other hand, loss of oral tolerance my have a specific immunologic process in certain people which reflects cytotoxicity due to chemical overload...in which case LOT could be said to be the disease itself.It all remains to be elucidated.







MNL


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## kac123 (Aug 2, 2002)

Hi MNL, oy. no wonder no one has figured this out yet.







Apparently i need to go back and dust off some of my old bio books and brush up on my immuno! This quote caught my attention:------------------------------------------------G.W. Thompson forecast in 1985: 'the IBS is organic; that is all sufferers will eventually be found to have measurable, unique pathologic defects.' When that happy day arrives, the term 'IBS' will no longer be used, and each patient will receive a more precise diagnosis. Until then it is sufficient to appreciate that food intolerance represents an important proportion of the conditions which together make up IBS."-------------------------------------------------Ok - so, why was i told that LEAP testing in my case would not be beneficial because it appeared from the questions asked that my issues were not intolerance based? Please don't read that in a belligerent way (i've seen what can happen on this board!)







I am just trying to understand it all. I apologize for all the questions and greatly appreciate the answers. I am most definitely from the USA "quick-fix" mindset and i guess all i really want from it all is to be told that my stomach issues are not caused by food so that i can start eating like a rational human being.ok - time for bed. Thanks again for all of your help.kac


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## Jan LEAP RD (May 19, 2002)

Hi Again Kac,


> quote: so that i can start eating like a rational human being.


It's not to say that you 'without a doubt' wouldn't find some reactive foods with testing. It's just that it's 'likely' you won't, and unless it's a pretty sure thing, why spend your money. (Okay, I know a LOT of people - or insurance companies - have spend thousands on colonoscopies, MRTs, endoscopies and meds and they were never a 'sure thing' either!!







)But, diet MAY WELL play a role. First suspect is all diary. And bananas, and tea. It's just that MRT testing may not pick these up. Sometimes it seems for 'functional' than 'sensitivity.'Keep us updated.


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## kac123 (Aug 2, 2002)

Hi Jan, Gotcha. I guess my biggest problem with it all is trying to find a rational explanation, an "x = y" solution, and there just doesn't seem to be one out there but i'm too stubborn to accept that!







-sigh- ok off to bed. thanks again for all of your help and suggestions - greatly appreciated.







kac


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## Mike NoLomotil (Jun 6, 2000)

KAC...What you desire (x=y) does indeed exist for a specific subpopulation of people with IBS...typically the ones who have had a complete proper differentil diagnosis which was negative, negative history of food allergy and who present with persistent diarrheic episodes or persistent cyclic diarrhea and constipation.This is the high-probability population, about 2/3 of IBS victims.The odds go higher with every extra-intestinal symptom they experience (hot flashes, sweats, dizziness, fog-brain, and all manner of other signs that the worng chemcials have come out of variosu immune cells and are in the bloodstream at the wrong time).for these people it is very straightforward and a very high rate of return on non-allergic food intolerance testing is achieved thus a high rate of response to specific dietray therapy.The lower the frequency and severity of the know signs and symptoms of food intoelrance the lower the probability of test-positive foods which will make a noticeable difference in the persons symptoms if removed.These books can mae it clearer, the role in IBS and the role in systemic dysfunction, but its a lot of reading (beleive me I done it







)There are patients who demonstarte modest symptoms of food or chemical intolerance, and these tend to come back with modest results on testing and therapy. Asymptomatic people come back with subclinical or no reactivity.So our Patient Care Committee for Homecare develoepd a set of guidelines for the RD's to use which are designed to seprate those with a high probability of benefit from thsoe with a low probability, and to then accept those into the program with the former.We do not want to have people's expectations to be high for what is NOt a cheap thing to do (this is not a cheap type of testing to do and RD time for counslleing is not cheap either)and then get modest results at best, or to simply set up the thing as a screening. Some people do that...and it is nothing more than a way to sell a lot of tests..."the test becomes the tool for determining ability to benefit".We do not agree with this approach UNLESS there was no other way to seprate the populations. BUT since there is, it is not only ethical but in the long run will produce better results and a population of satisfied clients. IF there was a way to do the testing really cheaply then this might be the way to go. But there is not. Maybe someday as automoation becomes more sophisticated one could simply save the time and do a lot of cheap screning with it...But the doctors we work with have a similar view of "allergy" testing for food allergy. it is overused when most food allergies can be identified clinically without testing, with a good history.But thats another branching-logic area of discussion and OOPS I gotta run!be lack another day to chat more...I understand where you are coming from and we can help you in ways other than just sticking needles in you perhaps.







MNL


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## kac123 (Aug 2, 2002)

Hi MNL, Thanks again for writing. I understand why the LEAP questions are there and in this day and age I actually respect the fact that they exist! I am open to any and all advice you can offer - and not getting stuck with a needle is yet another plus.







Now i just have to figure out how to get home through all this new snow fallin down.....yick.







Thanks again and i hope you are well-kac


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## Jan LEAP RD (May 19, 2002)

Hi Kac,Hope you made it home safely and in one piece. I lived in a Philadelphia suburb from 90-97 or so, including those 2 years the got 'dumped on' and the city was stranded for weeks.Having lived most of my life in northern Minnesota or Colorado, I laughed at the 'locals' who would stay home from work, get in my 4-wheel drive truck and drive anyway. The worst part was the people around me that I couldn't trust to drive with any skill.And then I'd be home and teach the local kids how to build snow-forts, since their parents whined it was "too cold" to spend time outside. . . bunch of weenies!





















Nothing personal!!


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## kac123 (Aug 2, 2002)

Hey Jan, Yup - made it home in one piece







Being a western pa girl for a good part of life i am used to the cold snowy weather - but there is nothing more disgusting than snow in a city! Dirty sloppy mess! No snowmen, no snowforts - just sludge that never goes away! The REAL problemm with getting home in snowy weather is having to rely on public transportation to get in and out of the city (thus to and from work). If i hear the expression "icy rails" one more time....







Oh well. Time for bed. I hope its warm where you are







-kac


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