# Dr Dahlman Program Users Updates



## daisysp (Jan 13, 2004)

All those who are using Dr Dahlman's products, let's use this post to say how we are doing, ask questions and such related to this. I just started mine on Saturday :feeling headachy,sick off and on with good also; getting hot flashes (not old enough to attribute it to anything else), feeling good, cleaned out 3 times already today which was nice yet also feel somewhat bloated. I know my symtoms may change daily while the products are doing things inside. I am staying away from dairy, breads, nuts and all beans. Those things I rarely eat anyhow. It's mostly vegetables, 1/2 tortilla here and there for a carb, saltines for feeling sick, and alittle fish and chicken every 2-3 days or so. I do have a problem with protiens, so this is staying away from them this much is NOT something I recommend.Anyone else ????????????????????????????????


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## Kacebece3 (Apr 17, 2002)

Hi all, I started using Dr. D's approach yesterday. I have to go with the economy plan that is using the Ultra Flora plus df and ultra clear sustain only. This is day two I am experiencing lots of gas and pressure, hope this is only temporary. Oh bye the way I'm IBS-c. Later Ken


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## daisysp (Jan 13, 2004)

I am IBS-c also. I didn't know there was an economy plan. I am not on the guarantee program as I cannot afford the phone consults. I do have certain products I am using for the first 30 days though as I have many many food allergies.I have heard of one other in particular who had lots of bloating and gas in the beginning.....they couldn't use the rice based products. How long have you had IBS and what was your typical diet before starting Dr D's 'stuff'?


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## SpAsMaN* (May 11, 2002)

Kacebece,i already try ultra-clear G.I. and i was unable to digest that.Dr.D told me that i had a bacteria and to take candibactin and another product(i think it was Ulcinex) to eradicate this bacteria first.I'm not in the program,i just evaluate it.


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## Kacebece3 (Apr 17, 2002)

A comment to Daisy, the economy plan doesn't give you a discount on products, you just don't use all the recommended ones. Note I am stopping the ultraclear sustain, had to use MOM last nite to try and clear things out. Will continue the probiotics and hope things settle down. Ken


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## calid (Aug 4, 2003)

Here's my protocol:Started with the probiotic Ultra Flora DF, Metagest, Azeo-Pangen, Intesol, and Ultra Clear Sustain. I had problems with gas so he had me stop the supplements as gas usually signifies a bacterial problem, and then did a stool test. The stool test showed some bacteria pathogens and minimal, if any, beneficial bacteria (despite taking the probiotics). Now I'm taking double the probiotics, Candibactin, Ulcinex and Tanalbit to try and wipe out the bad bacteria. That's where I'm at now. Note that my gastro's lab showed no bad bacteria, but they do not test for everything and are not as sensitive as Great Smokies Lab. The one issue that has been helped the most is the urgency issue. When I'm finished with this round I'll get a new stool test, then we'll go from there! I'm still having bad days, but am also having good days.


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## leahmonahan (Aug 22, 2003)

After reading Dr. D's protocol, I am fully supportive of what he is doing. Everything he describes is just like what I have been learning in my nutrition program for the past year.Calid, when you say you did a stool test, do you mean the CDSA 2.0? I am currently waiting on the results of that test for myself and then will decide how to proceed with treatment. I will likely work with my own nutritionist using similar tactics to Dr. D.Question for all doing Dahlman's program... What sources of protein does he recommend? I don't eat meat, other than fish. Would this pose a problem for me if I chose to do his program?


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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 that I posted on the other thread back on 2/12/2004. I will be talking to all this week to monitior their further progress.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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## kel1059 (Feb 28, 2003)

-----"The stool test showed some bacteria pathogens and minimal, if any, beneficial bacteria (despite taking the probiotics). "-----Calid's problem IMO shows just how deficient orthodox medicine really is. they would have happily waited till the autopsy to discover this bacteria that she is harboring.once again -- IMO it is amazing how incompetent they can be. it makes me wonder if they will ever get it.--and i am not saying that everyone's IBS is due to bad bacteria or dysbiotic gut but it would not surprise me in the least if this is true in the vast majority of cases.


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## BackFire44 (Nov 19, 2003)

Just a quick note not to the people who started this thread, but on others who are not familiar with Dr. Dahlman and may be first-timers to this board. There is another thread with Dr. Dahlman in the subject heading that is extremely long by now, but I think the first few pages are necessary reads for anyone seeking to try out Dr. Dahlman's treatment as both the up and downsides of his treatment are given. A lot of people feel he has helped them here, but I just want to make sure that people new to this discussion can see both sides and make up their own mind. There is plenty to read!


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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.at this point, i am optimistic about the future. i am even forseeing the day when i will be able to expand my diet.in my case, i think a lot of my problems were due to a dysbiotic gut and maybe even a dysbiotic system as in mycoplasma in the lungs, etc.as an experiment, i quit taking Ibsacol 10 or 11 days ago and i have not plunged into the depths of despair like i did the last time i quit taking ibsacol. however, it took a good 3 weeks before the effects of ibsacol were out of my system. therefore, i am eager to see what will happen over the next 3 or 4 weeks.if my asthma and brain disturbance come back then that is bad news. if it does not come back then that tells me one very important thing --- that a dysbiotic gut and possibly a body that is infected with any number of other organisms from spirochetes to viruses to mycoplasma to fungi is responsible for all of my problems.that would be amazing.as much as i believe in dr d's program and can clearly see the brilliance in it --- i still think that homeopathy has had some major impact on what has happened to me recently.after each of the 3 homeopathic remedies that i took i received some type of particularly nasty dieoff reaction. after the reaction was over i would feel much better.some of these reactions were..... gums that turned white and very sore, bad odors discharged from my underarms, noxious gas odors, noxious diarrhea, oily residues that kept forming, blood shot eyes, skin eruptions, ---- and then there were a host of other non-related symptoms.my conclusion at this point is that my immune system was weakened over the years and this made it easy for various organisms to find a happy home.i may never know the truth but so long as i am better i will have to settle for that.


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## Kacebece3 (Apr 17, 2002)

To Daisy, you asked what my typical diet was. First a little about me. I suffer with diverticular disease, had sigmiod colon removed. this helped some but unfortunatly the colon I have left is full of those evil pockets. Gastro doc says IBS now my problem yep I'm labeled. 10 mounths ago saw a homeopath her approach was along the same lines as Dr. D, during this time I have had more positive results than I ever got from medical doctors. My diet consists of just about all foods with these exceptions, corn, nuts seeds, skins, heavy spices. I dont seem to be able to tolerate fruit very well. I use fiber supplementation, groud flax, chew food well,drink60-80 oz water per day added mg supplements recently this has helped. I'm going to continue expermenting with the probiotics,I have been using them for 10 mounths now along with cats claw an intestinal builder per my homeopath also I'm going to try and save up enough cash to have the stool sample done. Does anyone have the costs for this? Ken


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## leahmonahan (Aug 22, 2003)

Ken,I paid $350 for the CDSA 2.0 plus parasites


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## daisysp (Jan 13, 2004)

Thanks Ken, it's good to know where some people are starting out from. I saw 4 regular MD's before a naturopath found that I had Ecoli and Blasitis........then got to go through the radical approach of antibiotics until it was all killed off. Meanwhile I got Leaky Gut syndrom so I have the oddest allergy to all forms of protiens. It's very frustrating and I have never met anyone with the same thing......neither have any of the 22 specialists and doctors I have seen in the last 7 yrs since this all began. My wishes are to be able to consume protiens again and get all the benefits of it without any of the negative side effects; feel good and go through the day without feeling like my gut is a frontpack I have to carry around all day (it feels thick and painful even when not bloated); I want to be able to benefit from all the cardio and weight training I do.......lose 20 lbs; be a shining example of someone who beat the odds with this craziness. I have eaten healthy foods all my life, and always workout......this isnt' fair at all. Poop !!I really hope I can get this cleared up with being very diligent and with a few phone calls to the amazing Doctor D, cause I cannot afford those lab tests. With this IBS I can only work a limited amount of hours a day.....being a single mom with no family around, I am making the best of what I can, thats for sure !! Always with a smile too, you gotta be thankful for what you DO have.


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## daisysp (Jan 13, 2004)

Oh, and I totally agree those who are any amount new to this subject, read some of all of the pages of the thread labeled Dr Dahlman's Patients; the information is invaluable, whether you try this program or not.


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## kel1059 (Feb 28, 2003)

"-------so I have the oddest allergy to all forms of protiens. It's very frustrating and I have never met anyone with the same thing......neither have any of the 22 specialists and doctors I have seen in the last 7 yrs since this all began--------"diasy,the same thing happened to me. i would get allergic to everything i ate. fortunately i never became allergic to mung, black and aduki beans, turnips, tapioca flour and a few other foods.for a while i would discover a new food but within 3 months my body was sensitized to it. it was a nightmare. i think it is finally slowly reversing itself. i can eat rice for the first time in 10 years. i tried rice last july and posted my response to it. i had a severe brain fog from eating it. however, the last 10 days or so i have ate rice 5 times without a single problem. there may have been some fatigue initially.something is changing for me. i feel different -- better. hope it lasts.


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## daisysp (Jan 13, 2004)

Wow, it'd be great to eat rice again !! I find that I must rotate my foods constantly as I cannot be consistant with anything yet a few types of vegetables. This week I have been eating a natural grainy toast for breakfast and normally that would upset my system. Rice has been out for about a year yet it was my major staple for awhile and helped with going to the bathroom. Now I get slow transit from it and brain fog. Protien is consistant though, I cannot eat it without both negative and posistive side effects. the negative outweigh the positive though. I know how badly my body needs it, you know what I do for a living.......so I eat it and suffer.I guess I better stop the bread today, and switch to something different. You are lucky you could eat beans, yet I am sure you didn't feel that way as there are so many things you cannot eat. Clients starting off with my program who want to lose fat and get into shape always ask me what I eat.......I lie and tell them it's what I am having them eat, ha ha. If they only knew I eat about 800 - 1000 calories a day and can gain weight from it.


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## eric (Jul 8, 1999)

Irritable Bowel Syndrome"DIAGNOSIS OF IBSThe diagnosis of IBS is based on identifying characteristicsymptoms and excluding organic disease. An earlyconfident diagnosis permits tests to be minimized andreassures the patient that there is no lethal disease. Thereare no physical findings or diagnostic tests that confirm thediagnosis of IBS. Therefore, diagnosis of IBS involvesidentifying certain symptoms consistent with the disorderand excluding other medical conditions which may have asimilar clinical presentation. The symptom-based Rome IIdiagnostic criteria for IBS (Table 1) emphasize a ï¿½positivediagnosisï¿½ rather than exhaustive tests to exclude otherdiseases. A validation study of the Rome criteria afterexcluding patients with symptoms suggestive of othermedical conditions other than IBS (ï¿½alarm signsï¿½ e.g.bloody stools, weight loss, family history of colon cancer,refractory and severe diarrhea) showed that 100% ofindividuals who met the diagnosis of IBS based on theRome criteria truly had IBS rather than an alternativediagnosis. At 2 years follow-up, none of the IBS patientsrequired a change in diagnosis.Other medical conditions which may present withsymptoms similar to those seen in IBS includeinflammatory bowel disease, GI infections, lactoseintolerance, thyroid disease, microscopic or collagenouscolitis and malabsorption syndromes such as celiac sprue(Table 2). A medical history and physical examination,laboratory and GI tests can help to exclude these otherdiagnoses. These tests include routine blood tests, stoolstudies for infection, and endoscopic procedures such asupper endoscopy, sigmoidoscopy and colonoscopy. Inpatients 50 years of age who meet diagnostic criteria forIBS and have no ï¿½alarm signsï¿½ suggestive of diseases otherthan IBS, initial screening tests such as a complete bloodcount to check for anemia and a chemistry panel can beobtained. Other screening tests to consider are a thyroidtest (TSH) and a blood test for celiac sprue. However,further tests and procedures such as a colonoscopy are notgenerally recommended. Patients 50 years of age with IBS symptoms should undergo a screening colonexamination with either a colonoscopy or flexiblesigmoidoscopy and barium enema if these tests have notbeen done previously, regardless if they have alarm signs(see Figure 1).In some centers, the presence of bacterial overgrowth isoften determined because this condition may causesymptoms similar to those of IBS. It is most commonlydiagnosed by a lactulose hydrogen breath test. Two studiesfrom the same research group found that 78% to 84% ofpatients with IBS had bacterial overgrowth. In patientswith evidence of bacterial overgrowth, those treated withan antibiotic such as neomycin had a greater reduction intheir GI symptoms compared with placebo. Although thesedata are intriguing, there are some methodologiclimitations in these studies and, therefore, the use ofwidespread hydrogen breath testing for bacterialovergrowth is still not generally advocated. PATHOPHYSIOLOGIC MECHANISMS OF IBS Although psychological and physiological abnormalitieshave been described, the overall pathophysiology of IBS isnot well understood. Similar to other chronic medicalconditions, a multi-component conceptual model of IBS,which involves genetic, physiologic, emotional, cognitive,and behavioral factors, has been formulated (Figure 2).Although all factors are closely interconnected, theimportance of individual factors in the generation of IBSsymptoms may vary greatly between individuals.Previously, IBS was considered primarily a disorder ofaltered gut motility. Currently, increased bowel sensitivity(visceral hypersensitivity) and altered brain-gutinteractions are felt to play a principal role in thepathophysiology of IBS. Recently, it has been found thatgenetic and environmental factors are important in IBS butfurther studies are needed to understand the importance ofthese factors in the prevalence, symptoms, physiologicresponses and response to treatment in IBS.Altered intestinal motor function.Altered intestinalmotility has been found in IBS, particularly exaggeratedcontractions (motor response) in the lower (sigmoid) colonto psychological stress and food intake. These alterationsmay explain why many IBS patients experience typicalIBS symptoms following meals and develop exacerbationsduring stressful life events. These changes in bowelmotility are likely due to alterations in the autonomicnervous system outflow to the intestine. Increased gut sensitivity.There has been compellingevidence that IBS patients have enhanced perception ofbowel (visceral) stimuli such as food or distensions of thegut wall. The initial clinical observations that led to thehypothesis that patients with IBS have visceralhypersensitivity included the presence of recurringabdominal pain as a principal symptom, the presence oftenderness during palpation of the sigmoid colon (leftlower abdominal area) during physical examination inmany patients, and excessive pain often reported bypatients during endoscopic examination of the sigmoidcolon. Published studies measuring visceral sensitivitysuggest that a variety of abnormal sensations orperceptions in relation to bowel stimuli may be morefrequent in IBS patients. At least two perceptualalterations can be distinguished, a hypervigilance(increased attention or vigilance) towards expectedaversive events arising from the bowel, and hyperalgesia(lowered threshold to pain) which is inducible by sustainedpainful visceral stimulation. These findings are paralleledby similar findings of target system hypersensitivity inother disorders such as fibromyalgia and myofascial paindisorder. In contrast to their enhanced perception ofvisceral pain, most IBS patients have normal or evendecreased pain sensitivity and tolerance for painful coldand mechanical stimulation of somatic (skin and muscle).However, there is a recent study that has demonstratedincreased somatic sensitivity to thermal heat in IBSpatients. Patients with IBS who also have co-existing fibromyalgia have increased somatic sensitivitycomparable to patients with fibromyalgia alone.Increased stress mediators in IBS.There is increasingevidence to support the prominent role of stress in thepathophysiology and in the clinical presentation of IBSsymptoms. There are few published reports on alterationsin stress mediators, such as catecholamines and cortisol tostress or visceral stimulation in IBS. Several studies havereported increased in catecholamines (norepinephrine andepinephrine) and cortisol levels in IBS patients. However,it remains to be determined whether these neuroendocrinealterations play a direct role in gut function and symptomgeneration. Altered brain-gut communication in IBS.A unifyinghypothesis to explain the functional bowel disorders is thatthey result from a dysregulation of the brain-gut axis. Anevolving theory is that normal gastrointestinal functionresults from an integration of intestinal motor, sensory,autonomic and CNS activity and GI symptoms may relateto dysregulation of these systems. Brain imaging studiessuch as functional magnetic resonance imaging (fMRI) andpositron emission tomography (PET) have been performedin IBS patients to measure brain activation patterns tovisceral stimuli. These studies suggest that brainactivation responses to visceral stimuli are distinctlydifferent in IBS patients compared to healthy individuals.IBS patients may have different emotional and cognitiveprocessing of sensory information from the gut comparedto healthy individuals. Post-infectious IBS.Symptoms suggestive of IBS occurin approximately 7-30% of patients following acute GIinfections, often persisting for years following completeresolution of the infection. A large cohort study identifieda self-reported history of acute gastroenteritis as a majorrisk factor for the development of IBS. Reported riskfactors for the development of post-infectious IBS includefemale sex, the duration of the acute diarrheal illness andthe presence of sustained psychosocial stressors around thetime of infection. Post-infectious IBS is not restricted to aparticular organism and has been documented with avariety of bacterial infections (Salmonella, Campylobacterand E. coli) as well as parasitic infection. However, therole of acute viral gastroenteritis in this condition isunknown.In post-infectious IBS, low grade GI inflammation orimmune activation may be a basis for altered motility,and/or nerve and mucosal (lining of bowel) function of thegut in IBS. Recent studies have also shown that in a subsetof unselected IBS patients (no documented history of apreceding gut infection), there is evidence of increasedinflammatory cells in the colon mucosa. It remains to bedetermined if altered gut immune function is a generalcharacteristic of IBS patients. The implication of stressfullife events in the development of post-infectious IBSsuggests a convergence of central (brain) and peripheral (gut) mechanisms in the clinical presentation of thissyndrome.Gender differences.In addition to IBS, many functionalGI disorders and other chronic visceral pain disorders (e.g.interstitial cystitis and chronic pelvic pain) and somaticpain disorders (e.g. fibromyalgia, myofascial paindisorder) are more common in women than in men.Increasing evidence suggests that gender differences existin the symptoms, pathophysiologic responses and responseto certain treatments in IBS. Female IBS patients are morelikely to be constipated, complain of abdominal distensionand certain extra-intestinal symptoms. Studies have alsosupported an influential role of ovarian hormones (e.g.estrogen and progesterone) on bowel function and painsensitivity which can in part explain the gender differencesin IBS. Several investigators have reported a variation inGI symptoms during different phases of the menstrualcycle, particularly increased abdominal pain and loosestools at the perimenstrual (just prior to and at time ofmenses) phase. TREATMENTTreatment of IBS includes both non-pharmacologic andpharmacologic therapies. An important component of non-pharmacologic treatment for IBS is a successful physician-patient relationship. The physician should strive toestablish effective bi-directional communication with thepatient, gain the patientï¿½s confidence with a concise,appropriate medical evaluation and offer reassurance andeducation that IBS is a real medical condition with apotential impact on health related quality of life butwithout significant long/term health risk. Some IBSpatients, especially those presenting with new onset ofsymptoms, express relief that their symptoms are notcaused by a serious condition such as malignancy. Othercomponents of non-pharmacologic treatment of IBSinclude diet recommendations, lifestyle modifications, andpsychosocial intervention if needed. Patients with mild IBS symptoms comprise the mostprevalent group, and are usually treated by primary carepractitioners, rather than specialists. These patients haveless significant functional impairment or psychologicaldisturbance. These patients do not see a clinician veryoften, and usually maintain normal daily activities.Treatment is directed toward education, reassurance, andachievement of a healthier lifestyle and occasionalmedication. Dietary advice may include avoidingoffending foods which can trigger symptoms (e.g. lactoseor fructose products, fatty foods, caffeine, gas-producingfoods). Fiber supplementation has been shown to beeffective for symptoms of constipation. ""CONCLUSIONSIBS is a common, chronic disorder characterized byexacerbations and remissions, which presents withsymptoms of abdominal pain and/or discomfort and alteredbowel habits. It has a chronic relapsing course and canoverlap with other functional GI (dyspepsia) and non-GI(fibromyalgia) disorders. The clinical diagnosis of IBS is based on identifyingsymptom criteria with a ï¿½positive diagnosisï¿½ and excludingorganic disease with minimal diagnostic evaluation.Clinicians should feel secure with the diagnosis of IBS, ifmade properly, because it is rarely associated with otherexplanations for symptoms. Although there are manyexpensive and sophisticated tests available for theevaluation of IBS symptoms, these are generally notneeded for patients with typical symptoms and no featuressuggestive of organic diseases. ""An integrated diagnostic and treatment approach firstrequires an effective physician-patient relationship. Acareful history will also identify the need for diagnosticstudies and treatments as determined by the nature andseverity of the predominant symptoms, and the degree andextent of influencing psychosocial and other factors. The fact that definite structural or biochemicalabnormalities for these disorders cannot be detected withconventional diagnostic techniques does not rule out thepossibility that neurobiological alterations will eventuallybe identified to explain fully the symptoms of mostfunctional disorders. Examples of such a shift inperspective from symptom-based disorders withoutdetectable abnormalities to medically treatable diseasesbased on specific neurobiological alterations includeaffective disorders (depression, anxiety) and migraineheadaches. Similar to other chronic illnesses, amulticomponent model that involves physiologic,affective, cognitive, and behavioral factors can beformulated for IBS. Although all factors are closelyinterconnected, the importance of individual factors in thegeneration of IBS symptoms may greatly vary betweenindividuals. Physiologic factors implicated in thegeneration of IBS symptoms include hypersensitivity ofthe GI tract to normal events, autonomic dysfunctionincluding altered intestinal motility response to stress andfood intake, alterations in fluid and electrolyte handling bythe bowel, and alterations in sleep. Many of the traditional therapies have been used to treatspecific IBS symptoms because they have not been shownto significantly relieve global symptoms, which wouldimprove an overall sense of well-being. However, thediscovery of novel serotonergic agents such as tegaserodand alosetron have been shown to be effective in treatingglobal symptoms in patients with IBS compared withplacebo. More recently published studies evaluating theefficacy of antidepressants, such as tricyclics and SSRIs,suggest that these medications may help improve generalwell-being in addition to treating psychological co-morbidity in affected individuals but further studies areneeded. Psychological and behavioral therapies have alsobeen showed to be effective for IBS however it potentiallycan be limited by the availability of experienced therapists.Instituting a multidisciplinary approach using non-pharmacologic and pharmacologic therapeutic modalitiesmay result in the most effective outcome. Future studieswill further enhance our understanding of this conditionand lead to newer, more effective treatments."http://216.109.117.135/search/cache?p=bloa...149D7A767&c=482 &yc=15315&icp=1[/URL]


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## calid (Aug 4, 2003)

Eric.........PLEASE PLEASE PLEASE STOP. This thread was created specifically for users of Dr. Dahlman's protocol to share their results with each other and others that may be curious about our trial. You are not one of his patients, nor are you truly intersted in hearing about any successes that some may have. You are just muddying the watersand making it harder for us to communicate with each other. My respect declines for you with each lengthy cut and paste post, in fact they've become so frequent I just scroll past each post you make in every thread. PLEASE STOP, I am asking you politely and explicitly to keep off this thread unless you have a specific question for one of the other posters who are truly trying to communicate.


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## eric (Jul 8, 1999)

What DR D is doing on the internet saying he can CURE, every gi problem and IBS I personally believe is wrong and I am not the only one. It is also confusing to new people on this bb. What's needed is accurate information from real doctors in all fields on IBS. Something he does even try to provide.I will say this again, I am glad for all who feel better, nobody who has had IBS for as long as I have would think any differently, but there is a much bigger issue here then each indivdual person in what he is doing on the bb and the interent. You can skip all the current state of the art research you want to, I believe DR D does also, and that's another part of the problem.


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## Arnie W (Oct 22, 2003)

I wish that the state of the art technology would trickle through to my doctors and gastros, who never suggested any breath tests, stool tests, food sensitivity tests.....Basically it's been a lone battle for me, having to do my own research and experimentations.Eric, please respect this thread. You have made your point on the other Dr D threads. This thread should be specifically about people sharing their results and answering questions from others who have a genuine interest in the programme.


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## kel1059 (Feb 28, 2003)

> quote: I will say this again, I am glad for all who feel better, nobody who has had IBS for as long as I have would think any differently, but there is a much bigger issue here then each indivdual person in what he is doing on the bb and the interent. You can skip all the current state of the art research you want to


eric, i did not think that i was going to improve either and i was a 20 year sufferer, but something has happened.i am still very skeptical that dr d's protocol is completely responsible but it is possible. maybe taking the 45 billion human strain bacteria every day for 6 weeks straight has done something powerful.personally i think that many of the things that dr d recommends does work. i have come to discover this on my own over the years.the enzymes, probiotics, fructose self-test, gluten, intestinal dysbiosis lab work, etcit is possible that the herbs over a long period of time may have helped me. personally i think that homeopathy is the thing that pulled the trigger for me. i have strong evidence for this.but anyway -- gret has responded and now i have responded. i honestly thought that i would not respond.i would also like to tell you that you may have been terribly misled by all of your doctors. the mental illness that you supposedly suffer from may not be the actual case. i have suspected for the longest time that your mental problems are the result of a severely dysbiotic gut. this would be due to a couple of reasons. the most important of which would be the massive use of antibiotics after you became infected with the amoeba when you were a teenager. i believe that it is possible for a person to carry bacteria that are mildly pathogenic yet fail to bring about severe consequences. instead, the person just suffers slowly over the long term. right at this very moment your brain might be under assault from various endo and exotoxins. this could be the reason why you are always talking about the HPA axis and brain brain dysregulation.your doctors at UNC and wherever else are seeing PET scans of screwed up brains. i suspect that the reason for this is due to some type of mild infection.you could be attacking the very doctor who actually holds the key for you to escape the incorrect mental illness label that has been handed to you.in the meantime your illness is being directed at us in the form of your fanatical belief system as to what IBS is and isn't.


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## Kacebece3 (Apr 17, 2002)

Eric, I had state of the art treatments from my gastro doc. The homeopath I saw gave me more results in 10 mounths than the 20 years I went to doctors. I didnt have every thing done but at some point in time you have to go with what works for you. I'm tired of your long posts, start a thread of your own PLEASE. Ken


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## kel1059 (Feb 28, 2003)

-------"The homeopath I saw gave me more results in 10 mounths"kacebece3,very interesting post. something very powerful happened to me after i received homeopathic lycopodium from a professional homeopath. there is a person who just posted that she had the same results from lycopodium as me. her name is Linda C. http://www.ibsgroup.org/ubb/ultimatebb.php...=1;t=036718;p=1 linda c. --- "It turned out that the "remedy picture" that I fit into was Lycopodium. I started taking it at different frequencies and different potencies based on the homeopath's recommendations. My symptoms improved almost immediately and within a week, I was basically symptom-free. I got to the point where I didn't have to take it all the time - only if/when I relapsed. I did that, and found that the relapses got further and further apart, so I had to take the remedy very rarely and, eventually, not at all." -----***************************************i don't know exactly what happened because i started oscillating all over the place on the daily 1LM lycopodium. this was followed up by a sulphur 200c remedy and that seemed to normalize me even more.i may not be out of the woods yet but i feel more normal than in years. for those people who don't believe in homeopathy then whatever has happened to me must be solely due to dr d's human strain probiotics. the next month or so will will be interesting. i'd have to say that i agree with dr d's belief that our bacterial balance can get out of whack and this can start the spiral downward.


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## BackFire44 (Nov 19, 2003)

Lek, you crack me up. I don't think you meant to, but your post came across as a bit funny to me. I've wasted enough posts asking people to stop yelling at others for posting -- censorship will not get anyone anywhere. If you want to do a Dr. D supporter only thread, I suggest that his website is a good place for that. Still, I understand everyone's annoyance. Eric, perhaps you could just post the links and your own words so that people can scroll past it if they want to. Maybe that is a happy compromise. But I am fairly confident that eric does not have any serious mental problems right now -- that's not what is meant by the brain-gut connection. You don't have to be certifiable for stress, depression, anger, etc, to affect your body. Every single person's body is affected adversely by stress. There are no exceptions. And eric never said that stress is the only thing that causes IBS. The reason he stresses it, I surmise, is because of its prevalence as a trigger and because it is the one thing we can really do something about usually without doctors. If many people didn't believe that dairy triggered IBS symptoms and eric was continuously posting that, would you feel different? I think we've come a long way from the time when any talk of stress or mental problems were hushed up; but its evident that there is still a stigma in society. Reducing stress and dealing with mental issues (which we all have) can only make your life better. The fact that it can also reduce IBS symptoms is just another plus. I think in general most IBS patients don't like being told that because dealing with stress and problems in your life is a lot harder than dealing with the physical symptoms of IBS. BackFire44


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## kel1059 (Feb 28, 2003)

i don't think that all mental problems are a direct result of either a slow simmering infection or the body's failure to deal with something that the overwhelming majority of us can handle with ease.however, there is a strong likelihood that he fits into this category. eric-- i know about your problems, but i am pulling for you. hint-- don't trust your doctors.you have been led down the wrong road.


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## BackFire44 (Nov 19, 2003)

kel -- I didn't think you said all mental problems were caused by infections, but thats not what I responded to. What I said is that everyone has mental problems to some degree, and reducing stress will help anyone with IBS.You still crack me up. I'm not sure if you are kidding or not. Your advice to eric seems like there is a big conspiracy working against him. You know the truth, but you will only give him clues and hints. I think you've watched the X-file a little too much!







I understand your mistrust of doctors -- there are a lot of wackos out there; but despite your bad experiences, most doctors really are helpful and do want to heal you. I hope you take my poking fun as good natured and well intended.







I know you have your own ideas about IBS and medicine -*-- I'm just noting that it sounds a bit dramatic in how you presented it.


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## kel1059 (Feb 28, 2003)

backfire, it is a little tongue in cheek but at the same time i believe that there is a great deal of truth to it.it is common knowledge that for our entire existance we must share our body with other organisms. i believe that many of us are harboring some organisms that are seriously screwing with us.i believe that it is more complicated than just this though. there is host susceptibility. there is stress that is above and beyond what is considered normal. there are many other factors, but to ignore the role of these organisms is not correct.he has stated many times something to the effect of " there is no bacteria (or whatever) implicated in ...blahblah"this is very short sighted.anyway, time will tell if my suspicions are correct. daisy, sorry about getting off the topic.


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## leahmonahan (Aug 22, 2003)

I keep checking in to see how you're all doing on Dr. D's program. Awesome that protein absorption is improving!Still haven't decided if I'll do the program. Can somebody tell me what forms of protein they are "allowed" on the program? Is it mostly meat-based?Thanks


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## eric (Jul 8, 1999)

IBS reaserch What's new?How is IBS DefinedBacteria and IBS"Many have wondered if IBS is caused by an infection. To date, no virus, bacteria, or parasite has been found to directly cause IBS. It has, however, been hypothesized that these microbes may indirectly cause IBS or at least exacerbate its symptoms. Some researchers question whether IBS begins with a common bacterial gastroenteritis. Gastroenteritis is an inflammation of the lining of the stomach and intestinal tract often caused by a bacterial infection. Symptoms may include vomiting, abdominal pain, and diarrhea. Other investigators question whether the number or type of bacteria that normally live in the colon affects symptoms.""Where is the Problem in IBS?The definition of IBS suggests that all routine investigations such as blood tests, endoscopy, and radiological imaging should be normal. The condition is diagnosed on the basis of symptoms, elicited through history and physical examination, in the absence of obvious gut abnormality. So what is the problem?Much work has been done to explain the underlying pathology (disease characteristics or cause) in IBS in the hope that treatment could be directly targeted to an abnormality. This approach could be hugely beneficial compared to available treatments that work symptomatically. *In IBS, we know the problem is not only in the gut but is also in the brain-gut axis and the autonomic nervous system.* Is the problem in the gut? Increased perception of sensations in the gut, or visceral hypersensitivity, has consistently been observed in IBS. Mertz and colleagues from California checked the discomfort threshold in IBS patients and in a control group. In response to balloon distention of the rectum, almost all (94%) of IBS patients showed lowered pain thresholds. The investigators proposed that increased rectal perception could be used as a reliable biological marker for IBS.Is the problem in the brain?Silverman and colleagues from UCLA used a special brain imaging technique, positron emission tomography (PET), to measure the changes in the pattern of blood flow in the brains IBS patients and a control group in response to balloon distention of the rectum. They found that different areas of the brain were activated in IBS patients when rectal stimuli were delivered. This suggests that the brains of people with IBS process signals from the gut differently.Is the problem in the general autonomic nervous system?Monga and colleagues from London checked bladder and esophageal perception and pain thresholds and found that women with IBS have both lower bladder and esophageal sensory thresholds. They suggested that IBS is part of a generalized disorder of smooth muscles. These women also had "irritable bladders." Francis and colleagues from Manchester, UK found that a higher proportion of patients who are seen in the urology clinic have IBS compared to patients seen in other clinics (dermatology; and ear, nose, and throat).There seems to be increasing evidence that the pathology in IBS is not limited to the gut, brain, or autonomic nervous system only. Rather there may be an involvement of all three systems. Therefore, any potential new therapy should be aiming at this widespread pathology." http://www.aboutibs.org/Publications/resea...ml#anchor143049 *In IBS, we know the problem is not only in the gut but is also in the brain-gut axis and the autonomic nervous system.* *In IBS, we know the problem is not only in the gut but is also in the brain-gut axis and the autonomic nervous system.* *In IBS, we know the problem is not only in the gut but is also in the brain-gut axis and the autonomic nervous system.*


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## kel1059 (Feb 28, 2003)

laylo,mine stated intestinal dysbiosis but i think that was based on having no bifidus in the colon. it concerns me that the cdsa can't identify a very large percent of the bacteria in us. and even if they could they don't know what effect it is having on us.2 months ago eric misinterpreted my statement above to suggest that i was saying that this fact means it should be ignored.i absolutely do not think these facts should be ignored. just because they can't identify various strains or tell us what they are doing to us does not mean we should ignore the issue.i think i may have stumbled onto a method of correcting this problem but i am not saying this is the only method and the only problem we face. unfortunately, most think it is either weak or placebo.it is possible that we can crowd out some of these bad bugs through long term implantation of human strain bacteria. bonniei's paper stated that this does not occur. maybe --maybe not. maybe it takes a very long time for some positive effect to occur, and her study was too short????in my case i am not so sure that this would have happened. probiotics were taken ever since the early 1990's and my response was variable. hard to say what each person will respond to.


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## leahmonahan (Aug 22, 2003)

I hope that you all do not think it inappropriate for me to be following your progress while I assess whether or not I want to do the program.For the record, I have read a good part of your previous thread on Dr. Dahlman's Patient.I am intrigued to find others who are pursuing a diet and supplement protocol that acknowledges imbalance in intestinal bacteria --and the possible presence of other pathogens. I have been researching (and implementing for myself) this line of health care for the past year ---and even decided to formally study nutrition as a result.kel, I have greatly enjoyed your contributions of critical thinking and your continued conviction that healing dysbiosis is an important factor in healing IBS. (Last time I said that, eric thought I was kidding. I am not.)I just want you all to know that it means a lot to me to be able to read your posts. Even though I'm not on Dr. D's program right now, your struggles are the most similar to my own than any I have read about. It is a huge source of encouragement.


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## calid (Aug 4, 2003)

Laylo, this is exactly what you should be doing to evaluate the program for yourself, that's why we are posting for everyone. Unlike Eric, I will be thrilled that some people will be helped by this program, I am hoping that I am one of them.BackFire44: Censorship is not what we are advocating at all, it's common courtesy and respect for what we are trying to achieve. What we are trying to achieve is a concise forum where we all that are trying the dr.'s protocol can talk about our progress. Those hideous cut and pastes do nothing but interfere with that process.If he had anything important to say, no one would request that he not post, but there's never any substance to it in relationship to what we're trying to do.


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## BackFire44 (Nov 19, 2003)

calid --I understand your point, however it can't be interfering too much. Hitting the page down key once is all it takes. I think it is much more harmful to try to tell people where they should and shouldn't post. Eric does have important things to say. I agree with you that he may not be getting across his message in the most helpful way with the cut and pastes, but his contribution to this forum as a whole is invaluable as he is one of the only people who actually reference current IBS studies. Anyway, we talk about this too much when we should be talking more about what's working and what's not working!







My advice is to ignore what you don't want to read and focus on your main message. We are all happy that Dr. D's program is seemingly working for so many!BackFire44


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## daisysp (Jan 13, 2004)

Is there some way we can have Eric eliminated from the IBS website ? I know that sounds so drastic yet he is only causing problems on threads he is asked to not contribute to. If folks want his information they can look to a thread with his name on it. I just scroll down past his information, don't even read a word of it and many times I will write separatly to people on here, including Dr D as I don't want Erics responses to what I say. That is sad we have to work around him. Eric, would you please remove yourself from this thread ? I intend to contact this website about your intrusions where not wanted.I have been on the products since Sat, and am feeling fine, nothing big to report. I feel evened out some, like I am not on a roller coaster anymore with my pain and foods. If I eat off though (foods I know I have a reaction to) I get a bad pain in my descending colon, so am being very careful. Gas is greatly reduced by being so careful with sugars.........yet still need to use fruit juice for my supplements; if I try to use water I will heave them back up right away. Even is great though, it's all I can ask for at this point. I am scared to give up my cleanser though that is not a Dr D product as I have never gotten more cleanout with anything else. I will be talking to him later on today about what to do. Bloated and constipated all afternoon and evening is not an option for me with what I do for a living.........and I don't want it anyhow !The brain, gut connection is so strong,it's amazing. I am in such a superb mood when my intestines are functioning well; I love everyone, ha ha. When it's upset though, I am cranky, tired and dont' even stand up straight. I am unmotivated and want to just sit or sleep when my body is not working well. When it's all cleaned out, I feel so inspired to work hard, do my cardio, get things accomplished, study and do things for work. Amazing the connection, folks without IBS (or Eric) don't really 'get' the way your gut decides how you feel. My boyfriends friend and I are always making jokes about how great it is to just go poop, ha ha. No one gets us yet we know what we are talking about. I am excited about maybe being able to process protiens again...........Kel, you had problems with protiens also ? I haven't been able to digest them for the last 7 yrs; yet I eat them every few days as I know my body needs it. You are noticing changes in that arena ?


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## eric (Jul 8, 1999)

"Amazing the connection, folks without IBS (or Eric) don't really 'get' the way your gut decides how you feel."LOL and I have had IBS for over thirty three years. I never noticed that the gut could upset the brain and the brain could upset the gut. You think, that is a lot of the information I am posting the connections from the enteric nervous system to the Brain and back to the enteric nervous system. OR when there dyregulating, IBS.If you only read the information, you might just see how much I do get it and how much is really IS known about it. From respected research IBS institutions around the world. What seems to be a problem is know one wants to know about their own condition Irritable Bowel Syndrome. Something Dr Dalman a chiropracter and nutritionist is not willing to provide on his threads, along with a disclosure he is not an MD.Maybe he can add a forum to his site where no IBS information or current IBS information is allowed, unless its things he believes in personally based on his own beliefs.


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## kel1059 (Feb 28, 2003)

daisy,i haven't tested myself fully yet. i can't quite explain it but it seems like everything is different. i could have reported this the last week of January but i held off because i did not trust it. it went back and forth for a while but now things really seem different.i'll have more to say in the future. that is when i will know for sure.


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## kel1059 (Feb 28, 2003)

.


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## kel1059 (Feb 28, 2003)

Yo, spam-boy – everyone who comes here can read your posts on the thousands of other threads that you have contributed to over the years. Please respect our intelligence in making informed decisions without your constant unsolicited protection.


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## calid (Aug 4, 2003)

*LMAO* Kel


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## Trinity (Sep 9, 2002)

I had my last phone conversation with Dr Dahlman yesterday. The supplements and diet restrictions did not change anything for me. I still have leaky gas and alot of sputtering and thumping on the right hand side. My stool analysis had shown no bifidus and I was also taking Ulta bifidus supplements. I felt OK, no cramping, bloating, pain or D or C, but the main symptoms I started with are still the same.


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## Kacebece3 (Apr 17, 2002)

Hello Eric, in your own words post what has worked for you in managing your IBS. Ken


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## daisysp (Jan 13, 2004)

Kacebece3, PLEASE do not encourage Eric to speak on this thread at all. Feel free to e-mail him personally yet we do not wish to have his input here. I have contacted the website for IBS here and told them what is going on. I am hoping to hear from them early tomorrow and a stop to this can be had.Trinity,How long did you use the program ? Did you adhere to all Dr D asked of you consistantly ?? What exactly were your symptoms before and now ??


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## AlphaMale (Jan 21, 2004)

> quote: Is there some way we can have Eric eliminated from the IBS website ?


It is not for you to decide.


> quote: I know that sounds so drastic yet he is only causing problems on threads he is asked to not contribute to.


If you know it is drastic, why you recommend it. Every one is entitled to state his views.


> quote: If folks want his information they can look to a thread with his name on it.


It is non of your business to tell folks what and where to read


> quote:I just scroll down past his information, don't even read a word of it


Then how do you know what he is writing and why you do not like what he is writing. And if you have a good solution why do you complain.I like kel, eric, and even flux.


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## BackFire44 (Nov 19, 2003)

I like you BeautyLover! I agree that its through all these different viewpoints that this forum is strong (save the turf wars now and then! -- be careful, or I'll break into my rendition of Maria). Sorry to hear Dr. D's program isn't working for you Trinity. Is he making good on his word to give you your money back?BackFire44


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## daisysp (Jan 13, 2004)

Beautylover,Everyone is entitled to their own opinions and free to speak where they want to, you are right. Yet have you not read how many folks wish he would not intrude here ? Have you read the many comments from the previous long Dr D thread ? Short responses that get to the point, that aren't a huge long scroll of copied/pasted information, would be fine. We welcome his information, it's the tone and format it's given in. I dont' deny he's got something to say, yet he's an antagonist and so very negative almost for the enjoyment of being so. I did before read many of his entries, and then stopped. Have YOU read them ?? I am not hating Eric, I only want him to respect what we are trying to accomplish here, with all sides of what we are experiencing, he does not do so.


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## drdahlman (Nov 6, 2000)

A quick note of explanation about Trinity. She is not a typical IBS patient, if she is an IBS patient at all. Let's remember back to when I made my offer of treating anyone on the board to show the effectiveness of my program. Seems so long ago by now. I said I would take on anyone who wanted to allow me to coach them, but she was obviously a different case from the beginning.Her only complaint is that gas leaks out of her and she is unaware of it. Her problem began after she felt her ileo-cecal valve "pop". The ileo-cecal valve is the junction between the small intestine and the beginning of the large intestine. The appendix is approximately at that junction. She and I discussed the prospect that my program will not fix a structural defect, change or injury. Neither of us entered into my program with any illusions that I might be able to fix this. I have never heard of anyone who felt a "pop" like this before, but taking her at her word, we decided to try my porogram for a short time to see if there might be any changes and report any progress back to the group. During our second discussion, she made the decision that she would like to submit a stool sample so she could find out if there were any abnormalities. We found low bifidus as our only irregularity. I have suggested to her that instead of spending any more money on products in a situation where she really doesn't have any IBS symptoms, she needs to concentrate on getting her ileo-cecal valve to work properly. How to do that? Who knows.I know that chiropractors can perform an ileo-cecal valve adjustment. I also know that you can perform a self massage on the area for a few months, if necessary, to see if over time you might be able to change the condition of the valve.The people who won't respond and who I have always excluded from any guarantee are those who have had parts of their small or large intestine removed, sustained an major injury of some sort or who have undergone any surgery that changes the God given structure of the gastrointestinal system. These surgeries would include stomach stapling and fundoplication, which is the wrapping of the upper part of the stomach around the base of the esophagus. It is used to treat reflux and it's side effects can include perpetual gas and bloating. It would not include gall bladder removal, we can overcome that loss with additional digestive enzymes.


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## Kacebece3 (Apr 17, 2002)

Daisy,I'll try to answer your questions.How long did you use the program ? Did you adhere to all Dr D asked of you consistantly ?? What exactly were your symptoms before and now ?? I followed the program strictly for two days using ultraflora plus and sustain. On the second day I encountered to much discomfort to continue with the sustain. I'm continuingusing the ultra flora. currenly my bowels are not normal, painful burning sensation with watery BM. I've experienced this before but not lately. My symptoms before were gas, pain, and constipation.I feel any program one follows requires a least 60 days to give it a chance and your body to ajust. I have been on the ultra flora plus DF for one week now. I suspect something might be living inside me that doest belong there. As a note whenever I took antibiotics for whatever reason, my bowel always worked alot better in the short term. I wonder why this is????? Ken


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## eric (Jul 8, 1999)

Ken , some antibiotics have Prokinetic effets: "Drugs that enhance propulsion of contents through the gut."Education on IBS was my best treatment, so you know and I wouldn't do anything here I would not do for my family or love ones, some of whom also have IBS.Qoute from the other thread and we know two people have not been and we don't know of any that have been "cure." Its only been three months of the trial period. That is not enough time in IBS."and everyone gets well.""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." This is only counting successes?????"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. ""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. "Who say's thats the problem or the entire problem in IBS, because they know of a whole lot more of them and about them from "every scientist" who is actually studying it!!!"I will keep using the word cure because it's not a remission"I believe this can be phycolgically damaging to the patients if he cannot cure them regardless of their money back. IT may even make symptoms worse for a person."IBS Definition for those who wonder if they "have it": Any uncomfortable symptoms associated with your gastro-intestinal system"It is??????????????????? NotThis should sayDr Dalhmans idea of what he thinks and believes IBS might be from a non expert in gastroenterology and neurogastroenterology who does not reaserch IBS or I belive adhere to it!The defintion of IBS is a " GI Disorder of function.""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/ibsfoodsinfo.htm IBS is not a food allergy or intolerence either."" Pathophysiology of IBS symptoms 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 "I treat successfully, any symptoms associated with the gastro-intestinal system."You do all these? And more? http://www.iffgd.org/GIDisorders/GIAdults.html "Eric's info will be taken less seriously as it should. "You mean the real researchers in all fields around the world and what they know about IBS and other functional disorders and other GI Diseases and what you have avoided talking about in any of this???"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."NOT ONE OF THESE ARE IBS!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! And the inflammation seen in subgroups of IBS patients is microscopic and embeeded in the digestive tract muscle wall and they have a very good idea of what does it. There is no evidence yeast causes IBS! There is no standard for ALL bacteria in the gut, they don't even understand it thouroughly yet, no one does! 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 or there overlapping or serious ones or any phycological aspects of them that effect the outcomes of patients and can trigger them of which a lot is also known.Dr Dalhman should clearly be stating in his profile when he posts, that 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.


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## daisysp (Jan 13, 2004)

ahhh again, we must scroll.......and scroll and scroll. Down we go, on to a posting with something to offer.....anyone ?


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## daisysp (Jan 13, 2004)

Update, 6 days. I know it's not been long yet my system is sensitive so usually get some results (good or bad) right off. I am not experiencing that this time though. I feel somewhat more balanced out........I may have said that before. I dont' seem to be having the highs and lows with pain and good, fatigue and energy, like I had before. I cut out sugars and certain other foods today so hope to feel even better tomorrow. Dont' know why I have never been able to eat soup though without getting a gut ache.....whats the deal with that ? Soup, it's all natural, so why ? I choose no gluten, no noodles and such.Going off my Primal Defense slowly and am so nervous !! I need the cleanout to continue, I cannot go through my day constipated, so this will be a test for sure.


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## Kellie2003 (Nov 4, 2003)

I'm not sure if it's already been mentioned...but i was wondering what the prices r like for this program? Also, can people who dont live in america do it?


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## drdahlman (Nov 6, 2000)

Kacebece3, You have 2 distinct signs that you have abnormal bacteria living inside you. The Sustain caused discomfort and when you took antibiotics, they made you feel better.The reasons are: The Sustain contains FOS, used to feed the beneficial bacteria. If you have abnormal bacteria, they will eat it also and they become more active and that activity can cause you discomfort. Your report is my clinical indicator that a stool test needs to be done.When you have occasion to take an antibiotic, what is it designed to do? Kill bacteria, right? The abnormal population of bacteria are affected by the antibiotic, decreasing their population and you will feel better for a short time until their population regrows. The addition of probiotics will inhibit their growth. I send out 4-500 stool samples each year after a patient reports what you do and only once or twice each year does the report come back without bacterial imbalances. Dealing with this issue is an integral part of your treatment and opportunity to get well.To KP2003, Please go to my website, www.drdahlman.com and on the left and right of the page, you will see a button that says, "The Costs and How to Become a Patient". I have patients in England, Saudi Arabia, Hong Kong, New Zealand, Austria, Canada and other countries. Makes it more difficult, but it can be done.


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## daisysp (Jan 13, 2004)

Dr Dahlman,What you wrote above reminded me of last year when I kept getting bladder infections. I loved the antibiotics as they made me feel so much better. A few times I felt I had an infection yet they said I didn't; was just feeling awful and knew the antibiotics would take care of that. Was glad I didnt' have an infection though on the times they found I didn't. I take Cranactin daily now and haven't had one since yet I had also gotten regular on my acidophilus.Should I worry about that ??


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## kel1059 (Feb 28, 2003)

http://www.sciencenews.org/articles/20030531/bob9.asp dr d,the link above does a nice job supporting your beliefs on our problems.something is definitely different in me. even on the days when stool formation is poor there is a noticeable difference in the way i feel. it is like i am not aware that there is trouble down there.


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## eric (Jul 8, 1999)

Kel, you are a nut, it doesn't in the slightest, it actually raises some concerns. About maniplulating them. I also think personally you have a bacteria and pathogen phobia!! That is very clear on your posts over the years.Also what happened to the cure IBSacol gave you?You swore up and down it cured you. Its just YOU think that way and cannot get over that there are all kinds of problems in IBS that are not directly connected to bacteria, also unless DR D new everything there is to know about the 500 to 1000 bacteria, and NOBODY DOES, not even the experts. Scand J Gastroenterol Suppl. 2003;(239):15-23. Related Articles, Links Probiotics in gastroenterology: indications and future perspectives.Goossens D, Jonkers D, Stobberingh E, van den Bogaard A, Russel M, Stockbrugger R.Dept. of Gastroenterology, University Hospital Maastricht. The Netherlands. Dominique.Goossens###intmed.unimaas.nlNowadays. there is a growing interest in probiotics as a safe way of changing the intestinal bacterial flora. Probiotics may have potential in several gastroenterological conditions, especially when the intestinal flora has been disturbed. Most scientific evidence is available for diarrhoea patients treated with Lactobacillus GG, Lactobacillus reuteri or Saccharomyces boulardii. Meta-analyses have shown an overall reduction in the risk of antibiotic-associated diarrhoea during treatment with probiotics, and benefits have also been demonstrated for patients with rota-virus-associated diarrhoea. Patients with inflammatory bowel disease, an inflammatory disorder characterized by a change in the intestinal flora, are another important target group for which probiotics may be beneficial. It has been claimed that in ulcerative colitis and Crohn disease patients, lactobacilli, S. boulardii and Escherichia coli reduce relapses. but most studies were not placebo-controlled. A reduction in relapses has also been demonstrated in pouchitis patients treated with a multispecies probiotic. Irritable bowel syndrome might be another clinical indication for probiotic therapy, but results of clinical trials performed in these patients are inconsistent. Additionally, probiotics may improve lactose absorption. Helicobacter pylori eradication and constipation. Finally, in animal models of colorectal cancer, treatment with probiotics reduces the prevalence of this disease, and in humans the amount of genotoxic substances in faeces has been reduced. In conclusion, the results of studies on the effects of probiotics in gastrointestinal conditions are encouraging. but well-designed placebo-controlled studies are warranted before recommendations for therapeutic or preventive use can be given. Many issues still have to be resolved, including optimal dose and duration of treatment, selection of and differences between the several available probiotic strains, and, importantly, their mechanisms of actions have to be elucidated.PMID: 14743878Br J Nutr. 2002 Sep;88 Suppl 1:S67-72. Related Articles, Links A review of the role of the gut microflora in irritable bowel syndrome and the effects of probiotics.Madden JA, Hunter JO.Gastroenterology Research Unit, Unit E7, Box 201 A, Addenbrookes NHS Trust, Hill's Road, CB2 2QQ, Cambridge, UK.Irritable bowel syndrome (IBS) is a multi-factorial gastrointestinal condition affecting 8-22 % of the population with a higher prevalence in women and accounting for 20-50 % of referrals to gastroenterology clinics. It is characterised by abdominal pain, excessive flatus, variable bowel habit and abdominal bloating for which there is no evidence of detectable organic disease. Suggested aetiologies include gut motility and psychological disorders, psychophysiological phenomena and colonic malfermentation. The faecal microflora in IBS has been shown to be abnormal with higher numbers of facultative organisms and low numbers of lactobacilli and bifidobacteria. Although there is no evidence of food allergy in IBS, food intolerance has been identified and exclusion diets are beneficial to many IBS patients. Food intolerance may be due to abnormal fermentation of food residues in the colon, as a result of disruption of the normal flora. The role of probiotics in IBS has not been clearly defined. Some studies have shown improvements in pain and flatulence in response to probiotic administration, whilst others have shown no symptomatic improvement. It is possible that the future role of probiotics in IBS will lie in prevention, rather than cure.Publication Types: Review Review, Tutorial PMID: 12215182 IBS FACT SHEET"The exact cause of IBS is not known. Symptoms appear to result from a disturbance in the interaction between the gut, brain, and nervous system that alters regulation of bowel motor or sensory function. IBS is not caused by stress. However, because of the connection between the brain and the gut, symptoms can be exacerbated or triggered by stress."Even though the exact cause is not known, there are molecular changes in the enteric nervous system in IBS as well as a lot of evidence on problems in the Anteiror Cingulate Cortex in IBS.


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## kel1059 (Feb 28, 2003)

> quote:kel you are a nut .... Also what happened to the cure IBSacol gave you?You swore up and down it cured you.


i *never* once said that it cured me. i was very specific in what i said it did for me. i said that it allowed me to form normal stool for the first time in 20 years. i also said that it seemed to help me control things but that i was still being forced to walk a tightrope.back in october, i became more convinced that there was likely to be some type of infection of some sort. it appears that i am correct.ibsacol had a tremendous effect on me, but it did not cure me. there is always the chance i will need to go back on it, but right now things are very settled.


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## skinny (Jul 27, 2002)

Eric I'm surprised you are resorting to building straw men and knocking them down. Kel never said the Isbacol cured her. You weren't paying attention.skinny


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## SpAsMaN* (May 11, 2002)

lek,i like you the way you are.xxx


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## eric (Jul 8, 1999)

Kel, you yelled it at the UNC doctors in their chat that IBSacol had cured you. You said it so much they had to set up a way to ban certain people from the chats for being disruptive. You also told them they knew nothing about inflammation in IBS or about the immune system in IBS. Which is something you have never seen or bothered to go look up, but they have seen it and have known about it for quite some time know and alot of the mechanisms likely causing it. "of some type of infection some sort. it appears that i am correct."You are? No you just don't know what your talking about, Infection causes inflammation and inflammation does not totally explain IBS.Irritable Bowel Syndrome: How far do you go in the Workup?"But microscopic inflammation cannot be a diagnostic marker for IBS because it does not 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 to patients with IBS appear 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 descending pain inhibitory systems that enable the clinical experience of pain and other symptoms that typify this disorder (25). In one prospective study of post-infectious IBS, it was found that those who retained their symptoms 3-months after an enteric infection had not only increased mucosal cellularity, but also had increased psychosocial distress at the time of the infection. Furthermore, lowered visceral sensation 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 physiological effects on motility and sensation contribute to, but are not always sufficient for the clinical expression of IBS pain. At least for post-infectious IBS this provides some evidence that psychological distress alters brain pain regulatory pathways to amplify incoming visceral signals leading to the full clinical expression of this syndrome" http://www.romecriteria.org/reading1.html Inflammatory Mediators in Irritable Bowel Syndrome " Importantly, overt colonic inflammation precludes a diagnosis of IBS. ""An increase in inflammatory mediators alone is insufficient to explain the pathogenesis of IBS. From post-infective IBS, we know that the most people who have gastroenteritis and accompanying inflammation do not develop IBS. As discussed earlier, several factors may be important in interacting with the gut insult and in predicting those who develop symptoms - one interesting factor here is the role of stress. Psychological stress is known to affect gut function in normal healthy humans, and in people with IBS stress may trigger or exacerbate symptoms. More recently there is evidence of a link between stress and inflammatory responses. Exposure to stress in both animals and humans has been shown to result in the release of mast cell mediators in the colon (18,19) and in a recent study stress was capable reactivating previous inflammation in rats (15). An important challenge for future work will be to clarify the interaction between inflammation, stress and IBS symptoms." http://www.med.unc.edu/wrkunits/2depts/med...rymediators.htm Not one person in the bacteria camp on this page has been able to explain IBS and show research about it casuing IBS and how it generates all the symptoms. I do however see a ton of Beliefs it does, but that is not basic sceince on IBS. There is a ton of research however that a bacterial enteritis can start IBS. And now some preliminary eveidence showing a virus maybe also able to start it.What the thread lacks is any proof or discussion from the bacterial camp posting here and the true relationships to IBS.The infallmation seen in IBS are specific cells embedded in the digestive system walls which can only be seen by powerful miscroscopes. It is NOT over Inflammation, like IBD conditions.Inflammtion is also studied in other gi conditions as well and the information applied to IBS.


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## missC (Oct 16, 2002)

dr d, i wasn't aware of exclusions to your money back offer (i am not saying they were not around to read, presumably i wasn't thoroughly reading the right threads/sites). i think it would be good for such a disclaimer to be added whenever you discuss your guarantee, however, otherwise some people might feel misled.


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## drdahlman (Nov 6, 2000)

Great point, MissC. Usually, when a person calls my office, I speak to them and answer as many questions as they might have. It is during this time that the prospective patient will tell me their story and if it includes surgery of any kind or what I have mentioned in my above post, I then tell them that I won't be able to offer a money back guarantee. This has probably happened in less that one percent of the people who have come to me. Trinity was certainly an unusual case. For someone to mention that they believe that they have "felt" something happen that has forever changed their health is very rare. It's as if she felt something give way. When she mentioned that, I again discussed the probability off success with my treatment. It just makes sense that if someone has a "structural" change to their gastrointestinal system, it will be more difficult to help them. Eric's concerns about manipulating bacterial levels in the gastrointestinal system are, as someone else has said, a straw man. If that were the case, his next email should be to the FDA to have all the probiotics removed from the shelves. There are no studies that claim that the use of probiotics have dangers associated with them. Once again, on his part, a nice try.


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## daisysp (Jan 13, 2004)

Ha ha ha. I read a couple of sentences of what Eric said, calling Kel a nut, ha ha. He is so from another planet. Kel, you are right on and I enjoy hearing about your progress. You were so skeptical in the beginning which validates more of what you are saying now.Eric's belief in the nedical industry amazes me. I have read so much here since being on this site, and alot with the survey that so many of us took part in. It was unnanamous (sp?) that we got no relief from our MD's despite their enthusiasm to try anything or run tests. They really dont' treat the body as a whole unit, they want to treat the symptoms. I have had this IBS for 7 yrs and have not once stopped trying to find a cure or even some major relief. I have done tons of spiritual work, tried tons of 'medicines' and alternatives. The natural products and techniques always gave me relief, the 'medicines' offered nothing to me but a change in side effects, which were usually more unbearable. So much of this is antagonized from nutrition..........not one MD ever suggested anything about diet, although said to try anything I thought may help.Thanks again for your comments Dr D. I have made my own juice for taking my pills. A combo of 1/2 gallon purified water, 3/4 cup grapefruit juice, 1 cup pure lemon juice and lots of liquid Stevia so it's bearable to drink. The lemon helps me to get rid of excess water, thats for sure. Grapefruit juice itself makes me burp and doesn't set well in my tummy.


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## eric (Jul 8, 1999)

I have no major problem with taking probiotics for IBS, my concern is what does it have to do with the problems they already know about IBS and how can you say its a cure for IBS, then post nothing to show it at all!!!Your are not even trying to explain anything and are totally ignoring the FACTS. Please explain how bacteria flora is causing IBS and the mechanisms behind the symptoms???? Please explain how that fits into all the research they alreay have on IBS and why its a fact its a brain gut disorder!!!!Daisy, what you don't understand in the slightest is basic sceince already done on IBS and the problem/ problems they have ALREADTY FOUND!!!"Eric's belief in the nedical industry amazes me."You mean the basic research on IBS going on for a long time now, of which they know of specific problems in IBS.Your confusion on IBS amazes me! Your belief that Dr Dahlman is the expert and all the other real experts on IBS shouldn't be listen too, amazes me quite frankly.The reasearch which you said in your own words I don't understand "The brain, gut connection is so strong,it's amazing. I am in such a superb mood when my intestines are functioning well; I love everyone, ha ha. When it's upset though, I am cranky, tired and dont' even stand up straight. I am unmotivated and want to just sit or sleep when my body is not working well. When it's all cleaned out, I feel so inspired to work hard, do my cardio, get things accomplished, study and do things for work. Amazing the connection, folks without IBS (or Eric) don't really 'get' the way your gut decides how you feel."Well here is a news flash for you from the father of neurogastroenterology and another expert on food allergies and IBS and the guy who coined the term brain in the gut and a top IBS expert. Did you know daisy there is what is called the brain in the gut, the enteric nervous system, with a hundred million nerve fibers, that communicate from the gut to the brain and back? Did you know the brain runs a lot of the show in digestion? Did you know there are specific gut abnormalities alreay and specific brain abnormalities already found in IBS?"The Enteric Nervous System: The Brain in the GutThe gut has a mind of its own, the "enteric nervous system". Just like the larger brain in the head, researchers say, this system sends and receives impulses, records experiences and respond to emotions. Its nerve cells are bathed and influenced by the same neurotransmitters. The gut can upset the brain just as the brain can upset the gut.The gut's brain or the "enteric nervous system" is located in the sheaths of tissue lining the esophagus, stomach, small intestine and colon. Considered a single entity, it is a network of neurons, neurotransmitters and proteins that zap messages between neurons, support cells like those found in the brain proper and a complex circuitry that enables it to act independently, learn, remember and, as the saying goes, produce gut feelings.The gut's brain is reported to play a major role in human happiness and misery. Many gastrointestinal disorders like colitis and irritable bowel syndrome originate from problems within the gut's brain. Also, it is now known that most ulcers are caused by a bacterium not by hidden anger at one's mother.Details of how the enteric nervous system mirrors the central nervous system have been emerging in recent years, according to Dr. Michael Gershon, professor of anatomy and cell biology at Columbia-Presbyterian Medical Center in New York. He is one of the founders of a new field of medicine called "neurogastroenterology."The gut contains 100 million neurons - more than the spinal cord. Major neurotransmitters like serotonin, dopamine, glutamate, norephinephrine and nitric oxide are in the gut. Also two dozen small brain proteins, called neuropeptides are there along with the major cells of the immune system. Enkephalins (a member of the endorphins family) are also in the gut. The gut also is a rich source of benzodiazepines - the family of psychoactive chemicals that includes such ever popular drugs as valium and xanax.In evolutionary terms, it makes sense that the body has two brains, said Dr. David Wingate, a professor of gastrointestinal science at the University of London and a consultant at Royal London Hospital. "The first nervous systems were in tubular animals that stuck to rocks and waited for food to pass by," according to Dr. Wingate. The limbic system is often referred to as the "reptile brain." "As life evolved, animals needed a more complex brain for finding food and sex and so developed a central nervous system. But the gut's nervous system was too important to put inside the newborn head with long connections going down to the body," says Wingate. Offspring need to eat and digest food at birth. Therefore, nature seems to have preserved the enteric nervous system as an independent circuit inside higher animals. It is only loosely connected to the central nervous system and can mostly function alone, without instructions from topside.This is indeed the picture seen by developmental biologists. A clump of tissue called the neural crest forms early in embryo genesis. One section turns into the central nervous system. Another piece migrates to become the enteric nervous system. According to Dr. Gershon, it is only later that the two systems are connected via a cable called the vagus nerve.The brain sends signals to the gut by talking to a small number of "command neurons," which in turn send signals to gut interneurons that carry messages up and down the pike. Both command neurons and interneurons are spread throughout two layers of gut tissue called the "myenteric plexus and the submuscosal plexus." Command neurons control the pattern of activity in the gut. The vagus nerve only alters the volume by changing its rates of firing.The plexuses also contain glial cells that nourish neurons, mast cells involved in immune responses, and a "blood brain barrier" that keeps harmful substances away from important neurons. They have sensors for sugar, protein, acidity and other chemical factors that might monitor the progress of digestions, determining how the gut mixes and propels its contents.As light is shed on the circuitry between the two brains, researchers are beginning to understand why people act and feel the way they do. When the central brain encounters a frightening situation, it releases stress hormones that prepare the body to fight or flee. The stomach contains many sensory nerves that are stimulated by this chemical surge - hence the "butterflies." On the battlefield, the higher brain tells the gut brain to shut down. A frightened running animal does not stop to defecate, according to Dr. Gershon.Fear also causes the vagus nerve to "turn up the volume" on serotonin circuits in the gut. Thus over stimulated, the gut goes into higher gear and diarrhea results. Similarly, people sometimes "choke" with emotion. When nerves in the esophagus are highly stimulated, people have trouble swallowing.Even the so-called "Maalox moment" of advertising can be explained by the interaction of the two brains, according to Dr. Jackie D. Wood, chairman of the department of physiology at Ohio State University in Columbus, Ohio. Stress signals from the head's brain can alter nerve function between the stomach and esophagus, resulting in heartburn.In cases of extreme stress, Dr. Wood say that the higher brain seems to protect the gut by sending signals to immunological mast cells in the plexus. The mast cells secrete histamine, prostaglandin and other agents that help produce inflammation. This is protective. By inflaming the gut, the brain is priming the gut for surveillance. If the barrier breaks then the gut is ready to do repairs. Unfortunately, the chemicals that get released also cause diarrhea and cramping.There also is an interaction between the gut brain and drugs. According to Dr. Gershon, "when you make a drug to have psychic effects on the brain, it's very likely to have an effect on the gut that you didn't think about." He also believes that some drugs developed for the brain could have uses in the gut. For example, the gut is loaded with the neurotransmitter serotonin. According to Gershon, when pressure receptors in the gut's lining are stimulated, serotonin is released and starts the reflexive motion of peristalsis. A quarter of the people taking Prozac or similar antidepressants have gastrointestinal problems like nausea, diarrhea and constipation. These drugs act on serotonin, preventing its uptake by target cells so that it remains more abundant in the central nervous system.Gershon also is conducting a study of the side effects of Prozac on the gut. Prozac in small doses can treat chronic constipation. Prozac in larger doses can cause constipation - where the colon actually freezes up. Moreover, because Prozac stimulates sensory nerves, it also can cause nausea.Some antibiotics like erythromycin act on gut receptors to produce ascillations. People experience cramps and nausea. Drugs like morphine and heroin attach to the gut's opiate receptors, producing constipation. Both brains can be addicted to opiates.Victims of Alzheimer's and Parkinson's diseases suffer from constipation. The nerves in their gut are as sick as the nerve cells in their brains. Just as the central brain affects the gut, the gut's brain can talk back to the head. Most of the gut sensations that enter conscious awareness are negative things like pain and bloatedness.The question has been raised: Why does the human gut contain receptors for benzodiazepine, a drug that relieves anxiety? This suggests that the body produces its own internal source of the drug. According to Dr. Anthony Basile, a neurochemist in the Neuroscience Laboratory at the National Institutes of Health in Bethesda, MD, an Italian scientist made a startling discovery. Patients with liver failure fall into a deep coma. The coma can be reversed, in minutes, by giving the patient a drug that blocks benzodiazepine. When the liver fails, substances usually broken down by the liver get to the brain. Some are bad, like ammonia and mercaptan, which are "smelly compounds that skunks spray on you," says Dr. Basile. But a series of compounds are also identical to benzodiazepine. "We don't know if they come from the gut itself, from bacteria in the gut or from food, but when the liver fails, the gut's benzodiazepine goes straight to the brain, knocking the patient unconscious, says Dr. Basile.The payoff for exploring gut and head brain interactions is enormous, according to Dr. Wood. Many people are allergic to certain foods like shellfish. This is because mast cells in the gut mysteriously become sensitized to antigens in the food. The next time the antigen shows up in the gut, the mast cells call up a program, releasing chemical modulators that try to eliminate the threat. The allergic person gets diarrhea and cramps.Many autoimmune diseases like Krohn's disease and ulcerative colitis may involve the gut's brain, according to Dr. Wood. The consequences can be horrible, as in "Chagas disease," which is caused by a parasite found in South America. Those infected develop an autoimmune response to neurons in their gut. Their immune systems slowly destroy their own gut neurons. When enough neurons die, the intestines literally explode.A big question remains. Can the gut's brain learn? Does it "think" for itself? Dr. Gershon tells a story about an old Army sergeant, a male nurse in charge of a group of paraplegics. With their lower spinal cords destroyed, the patients would get impacted. "At 10am every morning, the patients got enemas. Then the sergeant was rotated off the ward. His replacement decided to give enemas only after compactions occurred. But at 10 the next morning everyone on the ward had a bowel movement at the same time, without enemas." Had the sergeant trained those colons?The human gut has long been seen as a repository of good and bad feelings. Perhaps emotional states from the head's brain are mirrored in the gut's brain, where they are felt by those who pay attention to them.Reference: Taken from "A contemporary view of selected subjects from the pages of The New York Times, January 23, 1996.""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) 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."


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## kel1059 (Feb 28, 2003)

thanks daisy. but i have to repeat that i am positive that homeopathy is what has pulled the trigger for me. i wish this was not the case but it is. i wish it wasn't because very few people in the westerb world believes or inderstands this type of healing art. next to TCM it is the 2nd most practiced medicine in the world.a "linda c" on this forum has also responded in the exact manner as i with respect to the homeopathic remedy lycopodium. --but a sulphur remedy was equally important to my change, i think.on my own i discovered many of the things that dr d includes in his program -- they all help. it is possible that consuming 45 billion human strain bacteria every day -- day after day -- has made a big difference. unfortunately, i can not state this for certain.i will say that i was extremely skeptical that "we all get better" but i did try to keep an open mind. a closed mind gets us no where. --but maybe he has hit on something that others are overlooking. bonniei has posted some very interesting information lately on bacteria and IBSers. even eric posts information that implicates bacteria (dr esther sternberg among others).anyway, i am better. i still have trouble with foods like tomatoes, but recently i have really expanded my diet and i am hanging in there just fine. i even ate at a chinese buffet a few days ago. NO MAJOR TROUBLE! that is amazing.i will predict that i get bad again, but only so that my hopes are not crushed in case it happens. i do not feel lucky but we will see.


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## BackFire44 (Nov 19, 2003)

I hate to side with anyone here because I don't want to fuel this war going on, but just to offer a bit of sanity . . .Daisy, you must have been going to awful doctors. I know, there are a lot of awful doctors out there and it is hard to find a good one. My GI has always mentioned diet being a factor in IBS. And, when I finally get my stuff together, I am still going to publish the results of the survey that everyone so helpfully helped me out with recently. Right after that, work got insane, and I have been trying to catch up so I can get back to the survey, which takes a lot of time to compile. But, the survey clearly shows that most people are in fact happy with their doctors and their doctor's advice. Now, many people went through multiple doctors until they were happy -- but western science has helped a lot of people with IBS.In fact, Dr. Dahlman's methods certainly come from western science. He has not scientifically validated his method, but the idea of good bacteria in the stomach, of a certain diet that will not irritate your system, of certain supplements -- all of this is borrowed from western science.I agree that there are many things western science still doesn't know; and there are herbs and other remedies that other cultures have experience with that western science has not validated. However, you have to be very careful. A lot of the alternative medicines and remedies can actually be very harmful to you. Just like there are a lot of bad doctors, there are a lot of homeopathy salesmen out there trying to make a quick buck by taking an "ancient remedy" that is used in other cultures and selling it for themselves. Don't think just because it is an alternative medicine or an eastern herb that it a) will help you; or







is safe to take on a regular basis. Not that none of it can help, but a lot of it is just commercialization trying to capitalize on nature and eastern cultures. Generally, most of the things on this board have been tested and tried by western medicine. If it weren't for western medicine, I wouldn't be doing as well as I currently am; Dr. D wouldn't have a clue about bacterial levels; and we wouldn't even be calling this IBS (the syndrome's name and symptoms was created by science, don't forget).Before taking any alternative medicine I would speak to your doctor, or at the very least do some research on the internet about the negative studies done with each medicine. Every once in a while I have a friend or family member who starts taking X herb for whatever symptoms. I've been amazed at what I found out about X herbs. BackFire44


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## daisysp (Jan 13, 2004)

Thanks Kel for letting me know again that the homeopathy was a big factor in your recovery. I will keep that in mind. I do not have D so don't know if that same product will apply to me and offer the same type of relief you are experiencing.Eric, I don't read more than a very few sentences of your postings, so if you wish to make a point with me, you will need to keep it short and only to the point.BackfireWhat I read in the surveys that had been posted was that folks were happy with their doctors and yet admitted their doctors didn't know what to do in order to correct the problem. So many people said their doctors were more than happy to try anything they suggested and run various tests, yet did not get much relief from the results of those tests and or experiments.I do not buy into all alternative style therapies, and do not believe western medicine has no place at all. Quite the contrary, yet in my 16 yrs of experience with my own clients, to see what the medical practices have put them through, to see symptoms treated and not the whole person at all, to maybe only 1 out of 30 have relief from what they used of the doctors advice. I have seen a different side of it all than many of you have and have come away feeling very let down. I myself have been let down in as much as all the MD's I have seen, all the tests I have had run, all the specialists I have been to, no one had a clue and all just felt it was best to experiment. I like some semblence of confidence in the professional I intend to entrust my health to. I get that from Dr Dahlman, and that means alot to me. The outcome will be soon to be seen. I must remain optimistic or I will drown in depression over how the IBS has taken over my life.


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## eric (Jul 8, 1999)

The current state of the art approach to treating IBS is treating the mind and body. A holistic approach! With meds last!With accurate information and education on the disorder.There also seems to be malcontent to doctors, which is understandable and I have had my share of good and bad ones, which on the bb is spilled over onto the science of it all.I dislike doctors, so all science is bad.But they are not the same!Also it needs to be taken into consideration some people don't listen to their doctors or understand them or ask questions, or even know why certain treatments work for people. ect.Its easy for a patient to think altered gut flora and enzymes causes IBS, but is that true?A lot of people get better without treating those problems?Some people also just won't accept IBS. In part because its very hard to understand and very complex and the cause is not yet understood. That actually is a problem in and of itself. people feel hopeless they cannot find a cure. They continue to suffer, but abandoning the medical community and the science has the potential to lead to suffering even more for some.But you can't cure something they don't yet fully know the cause of, but the majority can manage it with what they do know about it. The basic science and understanding of the disorder.Its not just MD to MD its the same with alternative as well. Just as many people can feel better from both or worse. You can get bad advise and treatment from anywhere, especially from people who don't know what they are treating. What I have found personally are the people that learn the most from accurate sources do the best. Because they understand it the best and how to treat it and why.At the same time, doctors don't always take the time to help they should or take the time to learn the most current state of the art treatments and understanding of IBS. Something the patients can help with also however.both are major problems in IBSBoth even more reasons to learn as much as you can about IBS from accurate sources. There is a lot of real and accurate information on it.Knowledge is power in health! This explains some specific abnormalities in IBS http://www2.gastrojournal.org/scripts/om.d...id=agast1232108 But so far Dr Dahlman has not supplied any science, just some opionins and his own beliefs? No sources, no research, nada nothing, on how many pages???? What has been implied is simplistic and does not account for all they see in IBS, including molecular changes.


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## kel1059 (Feb 28, 2003)

you used a lot of words to say basically nothing.


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## AlphaMale (Jan 21, 2004)

> quote: The gut has a mind of its own, the "enteric nervous system". Just like the larger brain in the head, researchers say, this system sends and receives impulses, records experiences and respond to emotions. Its nerve cells are bathed and influenced by the same neurotransmitters. The gut can upset the brain just as the brain can upset the gut.


Big DealYour show down of knowledge means nothing, untill it cure the IBS. Does this complexity means we should not try anything?I do not see where all that knowledge says that Dr.D or homopathy methods should not work.Ok your state of the art approach is to address the brain and the guts, so what should we do in plain English?Let them research, and let the people continue to have hope in something that worked for some.You have very long boring posts for saying very little.


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## daisysp (Jan 13, 2004)

Huge Kudo's for Kel and Beauty Lover.......yet, Kudo's will upset your IBS, and (I am guilty of this also) any response to Eric only egg's him on. Shall we choose to ignore ?So, Kel,It's been so tough not being able to eat like normal folks. Any time I go out or am out and get hungry (usually I bring vege's) it becomes such a stressor to decide what I will eat and how much it's worth the pain later. So few places have vege's I can eat besides salads (can't do lettuce without constipation). When my boyfriend is off work and we hang out, I don't like to be so limited to eating only at home cause we are always out and about. It gets so old and irritating to always go to a restaurant and say "can you just stir fry me, or roast me, some vege's, yet no corn, cauliflower, onions....".I know you also have many many limitations with your foods, how do you cope ? I have eaten so limited for so many years yet find I am really at the end of my rope with it. 7 yrs of 3-4 foods and the occasional new food in and old food out (digestive system changes food allergies except protien..........always allergic to protein for the last 7 yrs.). We went to the movies today, I hadn't eaten much all morning since that feels best. On my own it's alright, and since he works 2pm-10pm, we miss many meals together so I can eat my limited diet in private. He ordered popcorn and man it smelled so good. I made the choice to eat it, wanted to have some I haven't had for about a year..........so bloated and irritated tonight for it. I also want to say thankful again for finding this website as for the last 71/2 yrs I really honestly believed I was the only person with this kind of gastrointestinal issue. My doctors would not give it a name, and never seemed to know what was really up. I have found a family here of sorts. And hey, isn't there always a family member we wish was not related to us? ha ha


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## eric (Jul 8, 1999)

ever wonder why they have called it nervous stomach in the past??????With permission from Jackson gastroenterologyIrritable Bowel Syndrome What is an Irritable Bowel?Medically, irritable bowel syndrome (IBS) is known by a variety of other terms: spastic colon, spastic colitis, mucous colitis and nervous or functional bowel. Usually, it is a disorder of the large intestine (colon), although other parts of the intestinal tract -- even up to the stomach -- can be affected. The colon, the last five feet of the intestine, serves two functions in the body. First, it dehydrates and stores the stool so that, normally, a well-formed soft stool occurs. Second, it quietly propels the stool from the right side over to the rectum, storing it there until it can be evacuated. This movement occurs by rhythmic contractions of the colon. *When IBS occurs, the colon does not contract normally. instead, it seems to contract in a disorganized, at times violent, manner. The contractions may be terribly exaggerated and sustained, lasting for prolonged periods of time. One area of the colon may contract with no regard to another. At other times, there may be little bowel activity at all. These abnormal contractions result in changing bowel patterns with constipation being most common. * A second major feature of IBS is abdominal discomfort or pain. This may move around the abdomen rather than remain localized in one area. These disorganized, exaggerated and painful contractions lead to certain problems. The pattern of bowel movements is often altered. Diarrhea may occur, especially after meals, as the entire colon contracts and moves liquid stool quickly into the rectum. Or, localized areas of the colon may remain contracted for a prolonged time. When this occurs, which often happens in the section of colon just above the rectum, the stool may be retained for a prolonged period and be squeezed into small pellets. Excessive water is removed from the stool and it becomes hard. Also, air may accumulate behind these localized contractions, causing the bowel to swell. So bloating and abdominal distress may occur. Some patients see gobs of mucous in the stool and become concerned. Mucous is a normal secretion of the bowel, although most of the time it cannot be seen. IBS patients sometimes produce large amounts of mucous, but this is not a serious problem. *The cause of most IBS symptoms -- diarrhea, constipation, bloating, and abdominal pain -- are due to this abnormal physiology. * IBS is not a diseaseAlthough the symptoms of IBS may be severe, the disorder itself is not a serious one. There is no actual disease present in the colon. In fact, an operation performed on the abdomen would reveal a perfectly normal appearing bowel. Rather, it is a problem of abnormal function. The condition usually begins in young people, usually below 40 and often in the teens. The symptoms may wax and wane, being particularly severe at some times and absent at others. Over the years, the symptoms tend to become less intense. IBS is extremely common and is present in perhaps half the patients that see a specialist in gastroenterology. It tends to run in families. The disorder does not lead to cancer. Prolonged contractions of the colon, however, may lead to diverticulosis, a disorder in which balloon-like pockets push out from the bowel wall because of excessive, prolonged contractions. CausesWhile our knowledge is still incomplete about the function and malfunction of the large bowel, some facts are well-known. Certain foods, such as coffee, alcohol, spices, raw fruits, vegetables, and even milk, can cause the colon to malfunction. In these instances avoidance of these substances is the simplest treatment. Infections, illnesses and even changes in the weather somehow can be associated with a flare-up in symptoms. So can the premenstrual cycle in the female. By far, the most common factor associated with the symptoms of IBS are the interactions between the brain and the gut. The bowel has a rich supply of nerves that are in communication with the brain. Virtually everyone has had, at one time or another, some alteration in bowel function when under intense stress, such as before an important athletic event, school examination, or a family conflict. People with IBS seem to have an overly sensitive bowel, and perhaps a super abundance of nerve impulses flowing to the gut, so that the ordinary stresses and strains of living somehow result in colon malfunction. These exaggerated contractions can be demonstrated experimentally by placing pressure- sensing devices in the colon. Even at rest, with no obvious stress, the pressures tend to be higher than normal. With the routine interactions of daily living, these pressures tend to rise dramatically. When an emotionally charged situation is discussed, they can reach extreme levels not attained in people without IBS. These symptoms are due to real physiologic changes in the gut -- a gut that tends to be inherently overly sensitive, and one that overreacts to the stresses and strains of ordinary living. DiagnosisThe diagnosis of IBS often can be suspected just by a review of the patient's medical history. In the end it is a diagnosis of exclusion; that is, other conditions of the bowel need to be ruled out before a firm diagnosis of IBS can be made. A number of diseases of the gut, such as inflammation, cancer, and infection, can mimic some or all of the IBS symptoms. Certain medical tests are helpful in making this diagnosis, including blood, urine and stool exams, x-rays of the intestinal tract and a lighted tube exam of the lower intestine. This exam is called endoscopy, sigmoidoscopy or colonoscopy. Additional tests often are required depending on the specific circumstances in each case. If the proper medical history is obtained and if other diseases are ruled out, a firm diagnosis of IBS then can usually be made. TreatmentThe treatment of IBS is directed to both the gut and the psyche. The diet requires review, with those foods that aggravate symptoms being avoided. Current medical thinking about diet has changed a great deal in recent years. There is good evidence to suggest that, where tolerated, a high roughage and bran diet is helpful. This diet can result in larger, softer stools which seem to reduce the pressures generated in the colon. Large amounts of beneficial fiber can be obtained by taking over-the-counter bulking agents such as psyllium mucilloid (Metamucil, Konsyl) or methylcellulose (Citrucel). As many people have already discovered, the simple act of eating may, at times, activate the colon. This action is a normal reflex, although in IBS patients it tends to be exaggerated. It is sometimes helpful to eat smaller, more frequent meals to block this reflex. There are certain medications that help the colon by relaxing the muscles in the wall of the colon, thereby reducing the bowel pressure. These drugs are called antispasmodics. Since stress and anxiety may play a role in these symptoms, it can at times be helpful to use a mild sedative, often in combination with an antispasmodic. Physical exercise, too, is helpful. During exercise, the bowel typically quiets down. If exercise is used regularly and if physical fitness or conditioning develops, the bowel may tend to relax even during non-exercise periods. The invigorating effects of conditioning, of course, extend far beyond the intestine and can be recommended for general health maintenance. As important as anything else in controlling IBS is learning stress reduction, or at least how to control the body's response to stress. It certainly is well-known that the brain can exert controlling effects over many organs in the body, including the intestine. SummaryPatients with IBS can be assured that nothing serious is wrong with the bowel. Prevention and treatment may involve a simple change in certain daily habits, reduction of stressful situations, eating better and exercising regularly. Perhaps the most important aspect of treatment is reassurance. For most patients, just knowing that there is nothing seriously wrong is the best treatment of all, especially if they can learn to deal with their symptoms on their own. http://www.gicare.com/pated/ecdgs03.htm


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## eric (Jul 8, 1999)

beautylover, why would someone who is diagnosed with a conditon want to know all they could about it???? What reasons would there be for that? Let me think.You can be angry but in fact I am trying to help all people with IBS.To learn what foods trigger symptoms?to learn if foods really are the problem at all?To learn if hormones trigger symptoms?To learn if the weather triggers symptoms?to learn if stress and what kind triggers symptoms?To learn why you feel the way you do?To learn why is my gut screwed up or just wonder?To learn so your not constantly in pain or suffering or on the toilet?You tell me what the big deal is that the brain and the gut are connected and both can trigger IBS symptoms?What does the brain have to do with pain?What do these mean? When they stick a ballon up the butt and apply pressure? When the emotional and pain areas are effected."Neuroimaging has provided evidence of physiological differences between normal individualsand those suffering from IBS in the way a visceral stimulus (ie, rectal distention) is processed inthe brain. 14,15 Initial data from positron emission tomography (PET) scans demonstratedincreased activation of the anterior cingulate cortex (ACC) among normal individuals, comparedto IBS patients. The ACC is a cerebral cortical area that is rich in opiate receptors and is thoughtto be a major component of cognitive circuits relating to perception as well as descending spinalpathways involving pain. More recently, fMRI was used to demonstrate increased activity in theACC, prefrontal (PF), and insular cortex areas, and in the thalamus of IBS patients compared tonormal individuals."














a newer one







Irritable Bowel SyndromeClinical Issues "What would be an example of new understanding?Well one example is that we're starting to understand how the brain is responding to the pain in IBS. There have been some studies done where they've artificially created a kind of an irritable bowel by placing a balloon to stretch the bowel, and that produces pain. Then they've compared people with IBS to non-IBS, or "normal" individuals. And what they've found is that when you stretch the bowel-and use PET scans to monitor the response-in normal individuals, certain areas of the brain that register pain respond and release chemicals called neurotransmitters that suppress and lower the pain. But it seems that doesn't happen as well in people with IBS. In fact, in people with IBS another area of the brain responds that is associated with anxiety. So what we find is that people with IBS, aside from having a bowel problem, may have some difficulty in terms of the way their brain is regulating the pain." http://www.aboutibs.org/Publications/clinicalIssues.html Why are there these abnormal lower colon contractions? bacterial or muscle?Normal sigmoid colon 15 minutes after a meal







IBS sigmoid colon 15 minutes after a meal.














Its a big deal when the gut or the brain is triggering off the symptoms.There are a lot of treatments for IBSHere people got a 50 percent reduction in two weeks? http://www.ibsgroup.org/cgi-local/ubbcgi/u...c&f=10&t=000854 How about five years"We recently published an audit of the first 250 patients treated and found that hypnosis not only helps the symptoms of IBS but also significantly improves quality of life.(1) Interestingly, it also relieves the additional symptoms from which so many patients with IBS suffer such as nausea, lethargy, backache, and urinary problems. This is in sharp contrast to the medications currently available for IBS, which often help one or two symptoms if at all. We have also undertaken some research in an attempt to ascertain how hypnosis might lead to benefit. There is no doubt that it can improve anxiety and coping capacities as might be expected. However, of far more interest, was the observation that motility and visceral sensitivity could also be modified in the desired direction. Thus, this approach to treatment appears to offer symptomatic, psychological, and physiological benefit and this presumably explains why it appears to be so effective. However, hypnosis should not be regarded as a panacea as up to 25% of patients fail to respond. Even when patients do improve, conventional approaches to treatment should not necessarily be ignored. Therefore it is still important that lifestyle factors such as diet are also taken into account. In addition, some patients may find that an occasional loperamide or laxative, depending on the bowel habit abnormality, maybe required. One concern over the use of hypnotherapy is the possibility that patients might relapse once a course of treatment has been completed. We have recently addressed this question with a study on the long-term follow up of patients attending the unit. This has shown that after a period of between one and five years, 83% of responders remained well with 59% requiring no further medication at all. Patients also took much less time off work and consulted the medical profession less often. Following the success in patients with IBS, we have recently looked at the use of hypnotherapy in functional dyspepsia, which is a closely related condition resulting in primarily upper gastrointestinal symptoms. Again, compared with controls, the hypnotherapy patients showed substantial improvements in both symptoms and quality of life. One of the most striking outcomes of this particular study was that, after a follow up of one year, not one patient in the hypnotherapy group required any further medication compared with 82% and 90% of subjects in the 2 control groups. Similar trends to those observed in the IBS studies were seen for a reduction in medical consultations and time off work. " http://www.aboutibs.org/Publications/hypnosis.html They are many treatments once you learn about it and what to treat and many take more then one method or treatment. Some diet, some stress reductions and some meds and some all three perhaps, but definetly the first two! That is extremely well known in IBS reaserch.!If homeopathy comes up with the answer first great.I don't know too many if any homeopathic doctors studying IBS however, with microspoces and pets scan and fmri tecnologies and from every field immunology, gastroenterology, neurogastroenterology and more. If you know some let me know I would like to see there work.So far Dr Dahlman has not even mentioned one problem, while treating perople unseen over the internet?also many people can have phycological issues along with IBS that effect their symptoms. Whats thier best approach being seen by a real doctor or not at all?Is it better to learn coping skills in IBS? How could they be applied to IBS and what effect would they have? Would any natural treatments that relaxed the body have an effected on anxiety or muscle tensions? Would that help IBS, or associated other symptoms like back pain? Acid reflux Perhaps?IS it good to learn about all these other GI disorders in adults that can overlap with IBS and quite often do? http://www.iffgd.org/GIDisorders/GIAdults.html Definition of Health: The World Health Organization.Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.


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## calid (Aug 4, 2003)

*SIGH*


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## kel1059 (Feb 28, 2003)

ah, our friend calid is back.


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## BackFire44 (Nov 19, 2003)

I feel like the middle child at times on this thread, and no more peace making for me!Know how you feel Daisy -- going to restaurants is such a pain. Originally my diet was much more restrictive and it was more difficult. I've slowly been introducing certain foods back into my diet as I can handle them, and now I can find something usually at most restaurants. Its tough because on top of all my IBS problems, I also eat a relatively kosher diet (i.e. I'll go to a non-kosher restaurant, but don't eat non-kosher meat), so I can't even order a plain piece of chicken at restaurants. My newest favorite is eggwhite omelettes (no cheese, though), which I surprisingly tolerate well. At the fancier restaurants I can usually get a piece of grilled fish, and at the diner-like restaurants the omelette does the trick. And I'm glad you have confidence in Dr. Dahlman. I posted a ways back that I think Dr. Dahlman's success on this board comes more from being an attentive doctor than specifically his treatments. Nothing beats a doctor who will talk with you and not at you.BackFire44


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## kel1059 (Feb 28, 2003)

eggs. that reminds me, i have been craving eggs for a long time. i think i will test them. they have been one of my worst foods after wheat, dairy, and beef.


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## daisysp (Jan 13, 2004)

Backfire, to be honest, you cannot be Kosher if you eat at any restaurants that are not strickly kosher themselves. I spent too many years as a very religious jew. Kosher to you may mean no dairy and meat in the same meal ? I guess that is still a valid way of doing things.......... Out for meals you really need to concentrate on proteins and vegetables, soups and salads. That way you stay away from the carbs. What I was writing about is that my own diet is so very limited (can't eat proteins but twice a week or so cause of my IBS being caused from a poisoning from beef). If you can eat Protiens and vege's you are good to go most anywhere, yet when you are limited to vegetables, and I dont' mean even lettuce (constipates me ), I end up so stuck at home in order to eat right.CALID, nice to see you back, how you feeling and doing ?? What are the symptoms you found relief from and what are you able to do now ?Was that a reply from Eric, I really didn't even notice.......hmmmm


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## BackFire44 (Nov 19, 2003)

Thanks Daisy, but that's why I said "relatively kosher" -- take a look back at my post. You don't have to go all or nothing for everything! I've made a compromise that I won't eat non-kosher meat, shellfish, etc; won't mix meat and milk -- but I will order other things in a non-kosher restaurant. Surprising that you aren't aware how many people keep kosher this way if you are/were religious -- but perhaps you live/lived in a small community. Or perhaps, you just don't approve. Can't do anything about that. Strange, though, that you are so religious and a personal trainer. I assume you don't train in a gym that men are in? You couldn't be strictly religious and do so unless I've misread my Talmud. Don't mean to offend, but just noting that we all make compromises in different ways. BTW, I don't subscribe either to many of the laws regarding women, which is a whole other discussion probably not topical for this board. I hope Dr. D has been able to help you and that you will be able to eat more normally eventually. My post was not meant to highlight my own problem, but just to say that I know how hard it is for me and it must be even harder for you! Seems like a good time for updates for Dr. D's patients. Haven't heard from many in a while. I know Gert was getting so much relief that she only comes back occassionally, but how is everyone else doing? BackFire44


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## daisysp (Jan 13, 2004)

ha ha, check my posting as I re-read yours. I was very religious, WAS, and am thankful to not be so anymore. I don't even subscribe to any religion now, I am deeply spiritual and tend more towards Buddism than anything else. You should highlight your problem as that is what this website is all about...........I enjoy hearing how others are doing, whether it be to complain or to compliment, or speak joy !!I too would love to get updates from folks on their progress on the DrD program. I am much more evened out than I was before it. I don't have the highs and lows I did, with pain and.....well, not as much pain (never a time without some pain). I really struggle with the constipation though as he's asked me to stop taking the one product (not his) that helped me out with that. I am frustrated daily with that issue. I enjoy Kel's postings, and thrilled Gret is feeling so much better. I would like to know just how many people from this website are using his products. BackFire; How are you doing with his stuff and what are you taking ? What differences have you experienced ?


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## daisysp (Jan 13, 2004)

BACKFIRE,Didn't mean to offend you at all with the talk abotu eating Kosher..........I forget sometimes there are those who choose a less drastic road to following what is comfortable with them. There are so many restrictions to that lifestyle, and it left a bad taste in my mouth. My older sister is still very religious, lives in upstate New York and has 11 or so (can't remember is there are 12) kids !!! Man, I dont' miss that yet I realize there are all walks of degree's of religiousness.Sorry !


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## kel1059 (Feb 28, 2003)

backfire,i honestly feel as though i am cured. people who know me or have read my posts know that i am somewhat of a complainer. i typically see the glass as half empty instead of half full. i am trying to find something to complain about right now. i guess about the only thing i can come up with is that i am still a little tired, and my sleep could be a little better.my sinuses are finally unblocked, i have normal peristalsis, normal stool formation despite being off of ibsacol for approx 21 days. i actually ate wheat for the 2nd time in a week yesterday. wheat was my worst food.i wish i could give dr d all the credit but i can't. i think his probiotics have made a positive change on me in that i am finally able to gain weight. possibly the probiotics have helped me in ways that i am not aware of. --but i am convinced beyond a shadow of a doubt that classical homeopathy is the main reason why my problems have completely turned around. for me it was just a matter of getting the correct remedy. i will say that i was using a hong kong doctor of TCM for about a month earlier this year. however, i don't think that his treatment made a big difference. it is possible though.(incidentally -- dr d -- you had me off the NCFM strain acidophilus for about 3 weeks. i started taking it again last week and there has been more much needed weight gain. it's only 3 or 4 pounds but it is something that i definitely notice. i believe that the acidophilus might be more responsible for the weight gain than the bifidus but i am not sure on that. once again i am glad for all of your money saving advice that you have given me. the VSL#3 was very expensive and i don't think it was helping me. )anyway, i expect people to be skeptical. in fact when gret reported that she ...(quote) "...it feels like i don't have IBS any longer" --- i was skeptical. i was thinking that it might be a temporary remission due to placebo. therefore i expect people to think that i am experiencing a placebo effect. in fact i actually do not trust the way i am feeling at all. i am very paranoid that it will all come back. if it does -- you people better believe that i will be back here complaining about my problems as usual.Quote from Linda C on the following thread ..... http://www.ibsgroup.org/ubb/ultimatebb.php...=1;t=036718;p=1 ------"In any case, I do have about 12 years' experience with homeopathy I could comment on. It, in fact, DOES work. It certainly did in my case. I had severe IBS from about age 15, to the point where I could not live a normal life. I had every test, tried every conventional treatment, etc., but had no success. I went to see a homeopath as a "last resort," having absolutely no faith in it. Within 5-7 days I was almost completely symptom-free. Through the years, I have continued to visit my homeopath and she has successfully treated me for a number of acute and chronic conditions, where the "regular" doctors have failed. I don't know a lot about how it works, and to be honest, I don't really care. Unlike....."linda c. elaborates on what happened to her further down on the thread.my recovery was not as dramatic as hers but nonetheless it did occur.since this is off the topic of this thread i will try to not mention it, but it is a part of my story. dr d and i have discussed it and he knows that it can work.


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## BackFire44 (Nov 19, 2003)

No problem, Daisy. Religion is a tough issue. No matter how much I might not understand other's choices, I try to respect them. I think there are good things to be learned from most religions, and it is interesting to note the similarities and differences. I know a lot of people who have a bad taste in their mouth from a strictly Orthodox childhood. I also know a lot of people who wouldn't trade it for the world. Interesting to see the differences. I'm actually not on Dr. D's program. So far, I have had great luck with my own GI. I take Levsin, Questran, and Fiber; and on top of that watch my diet carefully (not just what I eat, but the way in which I eat). After about five months now of tinkering with dosages and different eating regimes, I'm finally starting to feel semi-normal. Not that I don't struggle with symptoms still at all, but things are much much better, and I have high hopes they will continue to improve. My recent accomplishment is no D for three weeks! BackFire44


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## overitnow (Nov 25, 2001)

To Krazy Kel,I am so pleased to hear you are better. The good news is that you have probably turned the corner on this. The bad news is the fear will take some time to disappear. It has only been this year that I have finally realized that it ain't coming back again.Now what are you going to do with your life?Mark


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## Gret (Sep 23, 2003)

Hi again! Kel, it sounds like you are feeling better! I am so glad for you. I know how you feel about being paranoid it will come back. A while back, Mark (overitnow) told me that I would probably think about it every day for a very long time. I do. It still enters my mind each day, but I have no symptoms. Something that nearly ruined my life will not just go away from me emotionally! It's still here - in my thoughts. But I feel great. I doubt it's placebo, I really do. I believe I am well.Daisy, you sound better too! I really think that having one path to follow instead of trying this, that, and the other thing, is what really helps. I could focus on getting well instead of wondering if yet another approach was going to work.I had lasagna for lunch today! I eat anything I want and still feel fine. I wish that for all of you. IBS stinks. Anyone who suffers from this has my deepest sympathy. Yet I don't think it's something you have to tolerate anymore! Dr. Dahlman's program worked for me. I can't shout it loudly enough!Cya!


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## daisysp (Jan 13, 2004)

Wow, it's great to hear all that good stuff as I need to hear it tonight. I am in such pain, and have been feeling ****ty all week. Was doing well until this week...........been off my cleanser and it sucks ! I want to cut out my intestines with a knife. I will keep going with this program yet it's hard to maintain faith when I am in so much pain. Glad to hear Kel gained so much needed weight, yet if I gain weight off this I will be very very upset. With all the C I have from IBS, I am already over my person limit by 20 lbs. OVERITNOW: what did you have (d or C) and other symptoms, and what exactly did you do to get over it ?GRET: YOu had D right ? And you followed Dr D's program back to health ?KEL : I know I think what you've done, we've talked about it. Homeopathy and Dr D's products to a point. Tons of food alleriges and now are able to introduce some foods back in, right ?


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## SpAsMaN* (May 11, 2002)

Kel my lover,what is the homeo product who cure you?I just can't beleive it.I want to cry.


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## SpAsMaN* (May 11, 2002)

Kel,i know you snick around,tell me, Nux vomica is'nt?


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## overitnow (Nov 25, 2001)

Hi Daisy,Sorry to hear you are in such pain. Hopefully the Doc will have some suggestions for you.I was all d all the time (10 years) with GERD thrown in for special effect. I really had no hope of anything and was working from home. In 1998 I started taking a flavonoid supplement for my cholestorol. The rest is digestive history. I have been overitnow since the end of 1999. In the last year and a half I have been back to one a days. I no longer have any digestive or dietary issues. (It also corrected a long-running case of male smoker's impotence.) Of course I still take the supplement; but given the multiple benefits that hardly seems an issue.Mark


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## AlphaMale (Jan 21, 2004)

kelglad to hear you'r doing good.I am expecting a conclusion of what you felt was your cure.


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## Gret (Sep 23, 2003)

Hang in there, Daisy. I'm so sorry you feel yucky right now. Yes, I had severe D for years. Ibsacol gave me relief, but I'd still have episodes once a week or so. Now after following Dr. Dahlman's plan, I have no symptoms at all. Not at all. I think just getting the healthy stuff in me and nourishing the intestines with the Ultra Clear Sustain really did it for me. I followed the diet very carefully, but I don't abide by that now. I eat whatever I want. And I've got to stop, I'm eating constantly! I just feel so much better that's it's hard not to! You will get well, just keep doing what you are suppose to and don't cheat! I'm pulling for you!Calid, Arnie, how are you guys doing?


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## Kacebece3 (Apr 17, 2002)

Hi all, was wondering how all you are doing that are following Dr. D's approach. Gald to read about KEL's improvement. I wish I could afford to go all the way with the program. Right now I'm guessing about which anti microbial to try, think the Candibactin maked the most sense. Lets hear from you people on the full program. Ken


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## eric (Jul 8, 1999)

Ken here is the information for you.However, it should be noted this article is pretty bias and there are important statements made in it in regards to IBS.However, its basically the same approach to an alternative opinion based theory in regards to IBS, as opposed to a researched based one.But its free for one. It also seems to contradict itself. Use the bar at left to scroll the whole article.also it is not currently believed that IBS results from leaky gut. In the last five years they have learned very important aspects of IBS and problems, directly related to the condition.It is currently believed IBS results from.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: 11160782There are a lot of reasons and a lot of eveidence to the above.Nor does it mention the most effective current research based Nondietary Interventions for IBS. http://www.lef.org/protocols/prtcl-157a.shtml Again, its not people feeling better on this thread AT ALL, but the contradiction in information and the approach taken to sell people the program, that is extremely probematic, contradictory to modern IBS research and based on DR Dahlmans personal opinion as a chripracter and nutritionist. Use the bar at left to scroll the whole article. This however in the article is right on.While significant discoveries have been made about the etiology and pathophysiology of IBS in the past decade, researchers have a long way to go before clearly understanding the complex integrative pathways that link the immune, nervous, and endocrine systems with the GI tract."Then compare it to this one, which is more accurate and reflecks a more current understanding of the disorder.http://216.109.117.135/search/cache?p=lin+...table+bowel+syn drome&d=C2CC3AEBAC&c=482&yc=15315&icp=1[/URL]


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## georgie (Feb 19, 2004)

OK, I am fairly new at this. Please tell me if Dr. Dalhman has a website. I want to find out on my own if he can help me.Thanks, I read all the posts hoping to find a miracle.


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## SpAsMaN* (May 11, 2002)

I don't think the god is posting here.Sorry.Keep searching,we will find a way out.


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## Kacebece3 (Apr 17, 2002)

Eric one of the web sites you posted was very interesting. It spoke of using probiotics to curb bowel inflamation. My gastro Doc found I have an inflamed colon, the question is whats causing the inflamation. My Doc said he see's this in people that have just completed a recent course of antibiotics, but in my case that was not true. At this point I believe the inflamation is being caused by bacteria or possibly protazoa. If its foods I have not figured it out yet. The anti inflamatory prescription drugs work but the side effects are not tolerable. This is were the homeopath I visited came into play, her approach was to build the digestive system by natural means using herbs and probiotics. I got better results from her than from convetional medicine but desire even more results. It sounds like Dr. Dahlman is on the same track and I'll persue it until it helps or derails. So Eric what other info do you have along these lines? Just post the web site and I will check it out. Thanks Ken


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## drdahlman (Nov 6, 2000)

Kacebece3, You're right, I am on the same track and actually take the idea a bit further. If tissue is inflamed, let's not quibble about the exact cause of it, let's address all the issues that may play a role. Probiotics, certainly. But inflamed tissue needs to be fed the nutrients that will allow it to be healthier, in other words, less inflamed. L-glutamine and other nutrients work for that. If inflamation continues to play a larger role than we might first suspect, a sister product to the one that I use for IBS (Ultra Clear Sustain) is called UltraInflamX. It is about the same as the Sustain, but contains all natural anti-iinflamatory herbs and nutrients that don't have the side effects that you mentioned about the prescription drugs. This product is especially great for those who can point to one spot in the digestive tract that seems to hurt or burns the most. That one spot is usually the area of the gastrointestianl system that is the unhealthiest and has the most inflamation. Patients point this out frequently. Improving digestion and identifying food intolerances or allergies rounds out the plan. Your symptoms will end, your absorption of nutrients from your diet will increase and your health will change. All by re-establishing the bacterial balances and restoring proper chemistry, which reduces the inflamatory process.


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## eric (Jul 8, 1999)

This is extremely complex Ken, and Dr Dahlamn is not giving you all the roles for inflammation in the colon. Especially the reason behind it in IBS, and there is a ton of research on it and they know some of the problems.Also, if your doc found inflammation in your colon and from a colonoscopy without a microscope, then it might be microscopic colitus or Inflammatory bowel disease or maybe celiac sprue, or diverticulis which is NOT IBS. Or its possible to have more then one thing going on at once."If tissue is inflamed, let's not quibble about the exact cause of it, let's address all the issues that may play a role."from the artilce I first posted, with the leaky gut info."Biopsies often show no inflammation of the intestinal mucosa in patients with IBS."Visible inflammtion when the bowel is eximined in IBS is not seen. Until the layers are peeled away and then in some IBS patients, certain cells can be seen inflammed under a powerful microscope. This has to do also with PI IBS, where people already had an inflammed digestive system from a previous infection. This is why Dr Dahlamn needs to be talking the same IBS as the experts who actually do study and research it and what is known. Not guess based on his opinio, with no research to back it up.Of course he is not saying anything in regards to what is inflammed or showing any information or research AT ALL or any research or papers saying IBS is leaky gut? Where is the proof of that? There is evidence that stress can break down the barrier however. There is also a ton of eveidence how chrnoic stressors inflame those mast cells and can even reactivate inflammation after they have resumed to normal.Dr Dahlamns is not adressing some extremely important information and roles of some inflammation seen in some IBS patients, which are certain cells embedded in the digestive tract wall called mast cells. A major amount of research has been done on them and more being done. There are very important to IBS.The fact that I posted the other paper, along with a much much more accurate paper should tell you something and also tell you something about what I have been trying to tell people on these threads.I will also say more about it later, butInflammatory Mediators in Irritable Bowel Syndrome http://www.med.unc.edu/medicine/fgidc/infl...rymediators.htm after reading that you will notice it says'"An increase in inflammatory mediators alone is insufficient to explain the pathogenesis of IBS. From post-infective IBS, we know that the most people who have gastroenteritis and accompanying inflammation do not develop IBS. As discussed earlier, several factors may be important in interacting with the gut insult and in predicting those who develop symptoms - one interesting factor here is the role of stress. Psychological stress is known to affect gut function in normal healthy humans, and in people with IBS stress may trigger or exacerbate symptoms. More recently there is evidence of a link between stress and inflammatory responses. Exposure to stress in both animals and humans has been shown to result in the release of mast cell mediators in the colon (18,19) and in a recent study stress was capable reactivating previous inflammation in rats (15). An important challenge for future work will be to clarify the interaction between inflammation, stress and IBS symptoms."AlsoIrritable Bowel Syndrome: How far do you go in the Workup? http://www.romecriteria.org/reading1.html "So while 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 GI practice is probably much lower than reported, perhaps 10% or less." "There is evidence that IBS is a heterogeneous disorder where different physiological subgroups 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 campylobactor 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 not 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 to patients with IBS appear 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 descending pain inhibitory systems that enable the clinical experience of pain and other symptoms that typify this disorder (25). In one prospective study of post-infectious IBS, it was found that those who retained their symptoms 3-months after an enteric infection had not only increased mucosal cellularity, but also had increased psychosocial distress at the time of the infection. Furthermore, lowered visceral sensation 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 physiological effects on motility and sensation contribute to, but are not always sufficient for the clinical expression of IBS pain. At least for post-infectious IBS this provides some evidence that psychological distress alters brain pain regulatory pathways to amplify incoming visceral signals leading to the full clinical expression of this syndrome (27;28). "This article is 5 pages long and in medscape which is free, but you have to register.Here is some of it.Inflammatory Bowel Disease and Irritable Bowel Syndrome: Separate or Unified?Posted 07/15/2003 Sylvie Bradesi, PhD, James A. McRoberts, Ph.D, Peter A. Anton, MD, Emeran A. Mayer, MDInflammatory Bowel Disease and Irritable Bowel Syndrome: Separate or Unified?Posted 07/15/2003 Sylvie Bradesi, PhD, James A. McRoberts, Ph.D, Peter A. Anton, MD, Emeran A. Mayer, MD Abstract 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.IntroductionInflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) represent two conditions characterized by chronically recurring symptoms of abdominal pain, discomfort (urgency and bloating) and alterations in bowel habits. However, whereas IBD is characterized by inflammation or ulcerations in the small and/or large intestine, such "organic" changes have traditionally not been associated with IBS. IBD is usually classified as ulcerative colitis or Crohn disease, but it also includes forms of microscopic colitis, eg, histologic evidence of mucosal inflammation without macroscopic abnormalities. IBD is characterized by a constellation of patient-reported history and endoscopic, histopathologic, and radiologic findings, often with serologic correlates. Classic signs that reflect the inflammatory process within the gastrointestinal tract are rectal bleeding, diarrhea, fever, and weight loss, occasionally associated with extraintestinal manifestations. Interestingly, in the absence of complications, abdominal pain is not necessarily the most prominent symptom in IBD, despite extensive mucosal inflammation and presumably sensitization of peripheral visceral pain pathways. Genetic predisposition, environmental factors, infectious agents, altered gut epithelial permeability, and impaired immune responses have been incriminated in the still unclear cause of IBD.By contrast, IBS, classified as functional (as opposed to organic) bowel disorder, is currently diagnosed on the basis of a characteristic cluster of symptoms in the absence of detectable structural abnormalities. As a matter of fact, according to the currently used symptom criteria (Rome criteria), once organic changes are detected, a diagnosis of a functional syndrome can no longer be made.1 Because of the nonspecificity of the cardinal symptoms of abdominal pain or abdominal discomfort (the latter including bloating-type symptoms, a sensation of rectal urgency, or incomplete evacuation), the current diagnosis of IBS applies to a heterogeneous group of patients, even after attempts to define subgroups based on predominant bowel habit. Current theories to explain the pathophysiology of IBS include alteration in visceral perception, gastrointestinal motility and gut epithelial and immune function. Considerable evidence supports a role of psychosocial and physical (ie, gastroenteric infections) stressors as central and peripheral triggers, respectively, of first symptom onset or exacerbation.2* As reflected by an increasing number of publications on the subject, considerable interest in the putative role of low-grade chronic inflammation in the pathogenesis of IBS has recently emerged.3 Enhanced responsiveness to psychosocial and physical stressors has been suggested as a plausible mechanism that could explain most clinical and experimental findings in IBS, and that is consistent with the majority of the reported physiologic alterations.4"Several recent independent studies have demonstrated alterations in the gut-associated immune system. Quantitative assessment in unselected patients with IBS have shown increased mast cell numbers in the ileum 5 and colonic mucosa. 6 Preliminary evidence suggests an increase of overall cellularity in the colonic mucosa 7 and a higher number of mast cells containing tryptase (known to have proinflammatory effects) in the colonic lamina propria of patients with IBS.8 Additional preliminary results indicate a significant increase of inducible nitric oxide synthase (iNOS) expression in the colonic mucosa from unselected patients with IBS compared with control patients.9 " http://www.medscape.com/viewarticle/457728_2 also mast cells are not the only cells seen increased in IBS, there are an increase in other cells and EC cells, which release substances that control the gi tract, very importantly serotonin in IBS!!!If I were you Ken, I would work with a doctor on the inflammation first which lead to very serious problems in a person.Yes probiotics have shown some benefit in IBS and especially in IBD conditions, but they are not likely a cure in IBS, but another management approach to symptoms, not likely the cause, becasse they already know a lot about the causes.Dr Dahlamn also keeps saying, "restoring proper chemistry" this is way more complex, especially with the cell infiltrations of important cells and chemicals then taking a probiotic or enzymes. Yet, shows no information or eveidence on how that happens and how complex it all is and how much they already know, from people who actually study it around the world.be extremely wary of the no information and the guessing and non expert opinion based approach !!!So DR D. what inflamatory processes or altered chemistry are you talking about?"All by re-establishing the bacterial balances and restoring proper chemistry, which reduces the inflamatory process. "and please show research and how that happens in IBS?These not IBS!!! Just commorbid conditions a person may have along with IBS, but they have nothing to do with IBS other then triggers to the underlying condition."identifying food intolerances or allergies"also"This product is especially great for those who can point to one spot in the digestive tract that seems to hurt or burns the most. That one spot is usually the area of the gastrointestianl system that is the unhealthiest and has the most inflamation."This is straight up wrong information in IBS and just a major sales pitch!!!!!!!!!!!!!!The nerve cells lining the digestive tract are pressure sensitve and hypersensitve to all stimuli and a spot that hurts like the left side for example, is because that is where the bowel wall muscle is the thickiest and pain can radiate all over the abdomen and even into the back and does not always correlate to where it started or actually felt its coming from, the pain maybe felt on the left side and still be coming from another area.


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## eric (Jul 8, 1999)

alsojust fyiWhat You Need to Know About Enzymes "Bottom line: You rarely, if ever, need to worry about enzymes. In the great majority of cases, enzyme pills are just a costly, unnecessary, and insignificant protein supplement. " http://wellnessletter.com/html/ds/dsEnzymeSupps.php


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## drdahlman (Nov 6, 2000)

Anyway....back to reality. The reality is that if you allow me to guide you through my program, I guarantee the complete elimination of your symptoms. If not, you get your money back. My program is for those folks for whom it makes sense. If it doesn't make sense that assuring proper levels of probiotics, feeding tissue the nutrients they seek and identifying food intolerances or allergies are the right things to do, then my program isn't for you. Anyone can find information that refutes all of my suggestions as well as information that substantiates them. How foolish to quote an article about digestive enzymes as if that one article, one opinion, is gospel. And from the Berkeley Medical Center at that. Wow, that was hard to guess what their opinion would be. I believe they call that a closed mind. The same can be said for hypnosis. There are plenty of papers and studies that suggest it's a waste of time. Just put "hypnosis and fraud" into any search engine and....Oh My!.....16,400 hits on Google. Probably most of it stupid, baseless opinion. But if it makes sense for you, do it. That's the main difference between Eric and I. Eric blasts everything because he wants us all to think that he has looked at all options, read all studies and knows who the experts in the field are. No one can claim that. If I suggest eating crabgrass on all fours at midnight during the full moon and it completely eliminates your condition, who cares? Get a grip Eric, there is no reason to think that you have some sort of ability that others don't to be able to sort through all of this and decide what is state of the art or not. You opinions and questions are a joke.Bottom line. I have said this before and each time you you attack me it gives me another chance: If the patient allows me to guide them through my entire program, their symptoms will be completely eliminated and I guarantee it. No matter what you think. We have created the 2 biggest threads about my protocol and you don't like it. From a guy that's posted about 16,000 times (according to Jeff Roberts' statistics)....that's 3 times each day since the inception of the website, and you haven't been here since day one. This "condition" defines you, without it you have an empty life. No one has the time to post that much if they have a full life.Stop your foolish questions and respect the wishes of so many here. Go away and blast me on a thread you can call, "Dr Dahlman's an Idiot". That way we can choose to look at your self indulgent ego. Where are the patients who have found so much relief from your tapes that they are defending you here? Do you offer a money back guarantee that your tapes will completely eliminate ALL their symptoms?Two things, go back to cooking and please, please, please,....use a spell checker! What the heck does "advise of a quilified" mean?You are a simplistic thinker. According to you, we suddenly have many people who have problems with gut motility and visceral hypersensitivity etc. Of course there's a mind gut connection and it has an embryological origin. So what are you saying, that God suddenly decided to get rid of all the faulty wiring in the warehouse and that's why we suddenly have so many people with IBS? Tell me why a patient has these neuro-endocrine-immune abnormalities. And don't give me links or 80" of cut and paste. Tell me in your own words, from what you have learned from the people you respect, why these patients have this. Give me the cause! Maybe we can agree on one thing. I don't know the cause and neither do you. The difference between us are my degrees which included the taking of nutrition, biochemistry, pathology, radiology, endocrinology and dissection, just to name a few. Also, I have a clinic which you do not. I diagnose and treat patients each day and have for years, which you do not. And more importantly, I get almost everyone (99%+) well. And surprisingly, only people for whom this makes absolute sense come to see me. I wouldn't have it any other way. Have a great day Eric, hope you don't burn dinner.


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## daisysp (Jan 13, 2004)

ha ha ha. I need only read a few sentences of Eric's postings to give myself a good laugh. If I had realized this would be so humorous, I would spend more time reading his stuff..........yet NO. His faith in western medicine is amazing to me. Not that MD's don't have a place, yet it's a select few who earn their titles.GEORGIE go to DrDahlman.com and check out his site, his background and then read some of the threads that talk about his work.Crabgrass ??? I need to look that one up ! Some days I am willing to go outside the norm to cure this thing.ha ha ha, Dr Dahlman you crack me up, love your ability to put someone in their place and make them want to thank you for it. Thats great.Am feeling still 'off' from last week. Taking all my pills and really working at eating good. Summer is so close to being here, early this year, yet we've had some real warm days. The thought of not having this somewhat under control, and being able to lose this IBS weight, is so depressing !!


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## missC (Oct 16, 2002)

i don't have absolute blind faith in anyone: not allopathic doctors (including my own), not any naturopathic practitioner i've seen, not you either Dr Dahlman (especially since I haven't personally seen/talked to you). i state this to make it clear i'm not taking sides when i say that: has anyone noticed that some of those people who've used Eric's tapes and vigorously applaud him, go on to make such comments as 'while the tapes haven't eradicated my symptoms, they have vastly helped my ability to cope with and adjust to the symptoms'.....hmm. i've had plenty of time to adjust to GI symptoms. i've done all the adjusting i want to do. what i want now is eradication.p.s. tried HT, the real thing w/real practitioners. where did my money go?


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## missdiane (Mar 4, 2004)

Dr.D is it true that you are not an M.D, that you are a chiropractor? I have seen a couple of posts were you were asked about the cost of your program and you didn't reply, this kind of makes me curious. I would like to know how long does it take for your program to "cure" a patient? You also state a money back guarantee if you are not happy with the results, with exceptions. you said in cases where a patient undergoes surgery there is no refund. Do you mean surgery before your treatment, or during your treatment? To make myself clear, say I decide become one of your patients and while I am under your care I have to have emergency surgery on any part of my digestive system and I decide your program is not all that I hoped it to be and I wanted a refund, does that mean I'm S.O.L because I had surgery and my money is non refundable? Please don't send me to another website, just answer my inquiries. Thank You


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## missdiane (Mar 4, 2004)

Eric, your posts do seem quite lengthly and your articles are repetative, they have been very helpful in my quest for treatment of my condition ( I have ibs-a), which is a bear to treat, as I never know when I am going to go from one extreme to another. I was diagnosed with ibs three years ago and I know what caused it, mostly stress. I agree the brain does have effect on the GI tract. I took medication for the pain as that is what my only symptom was, that is until recently. Since Jan. I have been down with ibs-d, then this past week I've been sick with ibs-c. This is why I decided to join this forum to get imput from other people who suffer from this same condition. I am an opened minded person, but Dr. D sounds like a late night infomercial to me. Keep it up Eric, people that are new to this condition needs to know facts, just try to put it a little more in laymans terms you do tend to get technical. I understand quite a bit as I did study biology and psychiatry while I was earning my associates degree.


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## missdiane (Mar 4, 2004)

By the way I am not illiterate, I have a bad habit of not wearing my glasses when I'm typing, so excuse me for my typos.


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## daisysp (Jan 13, 2004)

Not to speak for Dr Dahlman, yet all those questions you have..........are answered on his website. Have you been there, have you read it ? Have you tried anything like his program before ? I am not cured of my IBS, yet, although I must say, with having this for almost 8 yrs now, and having seen over 22 doctors for it with no long term results (and tons of medicines and supplements I paid for), Dr D is at least competent, confident and experienced with what he is helping folks to deal with. If he's got all the schooling necessary to know what is wrong with you, and has a proven track record of curing what ails.......what do you care what kind of degree he's got ? Reason this is an issue for me, is I spend my days getting folks off high blood pressure medication, cholesterol medication, anti-depressants and diabetes shots with amazing success (love to see it happen), and yet I am a Personal Trainer and Nutritional Consultant. My record of 16 successful years speaks for itself; yet when I get someone who won't work with me because I am not a registered dietician (not capitalized for a reason), that is their own loss. I can help them, they choose to be ignorant. To me, that is someone who wishes to not be off their medication, who wishes to remain as they are so they can talk about it, complain about it and allow it to define who they are. Sounds like anyone we know here ??? Eric breeds this type of attitude, I pity anyone who agrees with that.......whether they agree with DrD or not.


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## eric (Jul 8, 1999)

Just keep making things up Dr Dahlamn as you go, for the sales pitch.The accuracy of his website is seriously in question, and completely contradicts, the current state of the art basic science on IBS, that's one of the points!!!! He refuses to clairify that problem! And its a huge problem!!!"Dr Dahlman, I have been showing inflammation research from the experts for years on here now, what your talking about isn't it, so explain it or just keep the sales pitch going, because that is all is is, no evidence just a big ole sales pitch, to people who don't understand IBS.Also if you type in IBS and hypnotherapy you will see just how effective it is for the majority of patients. I could put it all here so you can see it, becuase obviously if you don't know, then you have not been keeping up with IBS research. But I can see this is another attempt to change the fact you are not answering any questions or science."The same can be said for hypnosis. There are plenty of papers and studies that suggest it's a waste of time. Just put "hypnosis and fraud" into any search engine and....Oh My!.....16,400 hits on Google. Probably most of it stupid, baseless opinion. But if it makes sense for you, do it. "Try typing HT and IBS, lol.I personally believe, you should add your site into the mix, in no creditablity!!!!!!!!!!!!! You are too much Dr dahlman, just another jab at something he knows nothing about and to move the subject away from the fact he is not showing anyone anything new or any fatual information. None, nada, zip, None, nada, zip, None nada, zip!!!!!!!!In fact he has made a lot of it totally up in regards to IBS?Where's the inflammation in IBS Dr Dahlman, why don't you show people the real research???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 "We recently published an audit of the first 250 patients treated and found that hypnosis not only helps the symptoms of IBS but also significantly improves quality of life.(1) Interestingly, it also relieves the additional symptoms from which so many patients with IBS suffer such as nausea, lethargy, backache, and urinary problems. This is in sharp contrast to the medications currently available for IBS, which often help one or two symptoms if at all. We have also undertaken some research in an attempt to ascertain how hypnosis might lead to benefit. There is no doubt that it can improve anxiety and coping capacities as might be expected. However, of far more interest, was the observation that motility and visceral sensitivity could also be modified in the desired direction. Thus, this approach to treatment appears to offer symptomatic, psychological, and physiological benefit and this presumably explains why it appears to be so effective. ""One concern over the use of hypnotherapy is the possibility that patients might relapse once a course of treatment has been completed. We have recently addressed this question with a study on the long-term follow up of patients attending the unit. This has shown that after a period of between one and five years, 83% of responders remained well with 59% requiring no further medication at all. Patients also took much less time off work and consulted the medical profession less often. Following the success in patients with IBS, we have recently looked at the use of hypnotherapy in functional dyspepsia, which is a closely related condition resulting in primarily upper gastrointestinal symptoms. Again, compared with controls, the hypnotherapy patients showed substantial improvements in both symptoms and quality of life. One of the most striking outcomes of this particular study was that, after a follow up of one year, not one patient in the hypnotherapy group required any further medication compared with 82% and 90% of subjects in the 2 control groups. Similar trends to those observed in the IBS studies were seen for a reduction in medical consultations and time off work. " http://www.aboutibs.org/Publications/hypnosis.html Missc, hopefully you had a qualified doc for this otherwise it is not as effective, it has to be gut directed, not just HT.Have have shown both sides. You have shown absolutely nothing in IBS research, regarless what you have studied.I have been showing real research and of course you don't read it, you don't seem to believe it, but you don't research IBS nor are you an expert but they are experts.My posts are repetitive for new people for one and cut and copy because its to complex as to not be mistaken in me trying to explain it in my own words., so for accuracy sake they are ver batim!!! Its better then absolutely no information and opinions from a non expert in IBS and somebody who says IBS is gi symptoms of the digestive tract. What a complete line of crappolla!!!I know you know this and probaly like it sales wise."No matter what you think. We have created the 2 biggest threads about my protocol and you don't like it."You haven't once address your protocol in two huge threads, you have said nothing, but some absurd personally based statements on a lot of things , but almost nothing on IBS! "they choose to be ignorant""Sound like anyone we know" sure does, but its not me.another attempt to change the subject so as not to focus on the fact Dr Dahlamn has supplied no research or any science to back up his calims, which are much more then questionable and highly inaccurate. And I am not trying to sell a $1,500 dollar program.Hypnotherapy for Functional Gastrointestinal Disorders "We have also undertaken some research in an attempt to ascertain how hypnosis might lead to benefit. There is no doubt that it can improve anxiety and coping capacities as might be expected. However, of far more interest, was the observation that motility and visceral sensitivity could also be modified in the desired direction. Thus, this approach to treatment appears to offer symptomatic, psychological, and physiological benefit and this presumably explains why it appears to be so effective. However, hypnosis should not be regarded as a panacea as up to 25% of patients fail to respond. Even when patients do improve, conventional approaches to treatment should not necessarily be ignored. Therefore it is still important that lifestyle factors such as diet are also taken into account. In addition, some patients may find that an occasional loperamide or laxative, depending on the bowel habit abnormality, maybe required. One concern over the use of hypnotherapy is the possibility that patients might relapse once a course of treatment has been completed. We have recently addressed this question with a study on the long-term follow up of patients attending the unit. This has shown that after a period of between one and five years, 83% of responders remained well with 59% requiring no further medication at all. Patients also took much less time off work and consulted the medical profession less often. Following the success in patients with IBS, we have recently looked at the use of hypnotherapy in functional dyspepsia, which is a closely related condition resulting in primarily upper gastrointestinal symptoms. Again, compared with controls, the hypnotherapy patients showed substantial improvements in both symptoms and quality of life. One of the most striking outcomes of this particular study was that, after a follow up of one year, not one patient in the hypnotherapy group required any further medication compared with 82% and 90% of subjects in the 2 control groups. Similar trends to those observed in the IBS studies were seen for a reduction in medical consultations and time off work. ""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 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 Daisy I don't take medications and have not for years. You have no idea who I am or what I am about in the slightest.And I have had this 4 times longer then you so you know! And am in remission!"Eric breeds this type of attitude" if you actually read what I post, you might see that is the exact opposite of what I am trying to explain to you. You just don't read them!"Dr D is at least competent, confident and experienced with what he is helping folks to deal with"He is? He's an expert in IBS and gastro disorders.he lumped all these together as IBS?"GI Disorders in Adults GERD | Functional GI Disorders | Motility Disorders Gastroesophageal Reflux Disease (GERD)The most frequent symptoms of GERD are so common that they may not be associated with a disease. Self-diagnosis can lead to mistreatment. Consultation with a physician is essential to proper diagnosis and treatment of GERD. For additional information about GERD, be sure to go to another IFFGD website, www.aboutgerd.org. Heartburn, the primary symptom of GERD, is a fairly consistent problem for about 15% of the global population.(1) An occasional bout of heartburn is generally nothing to worry about, but if heartburn occurs two or more times per week, a more serious medical condition, gastroesophageal reflux disease (GERD), may be the problem. Data on the impact of this debilitating disease indicates that it often is not treated optimally. The result is that many patients, from adolescents to senior citizens, continue to suffer pain and other symptoms so severe that the quality of their lives is significantly impaired and they run the risk of even more serious medical complications. This is unfortunate because GERD is generally a treatable disease. GERD is a chronic disease. Treatment usually must be maintained on a long-term basis, even after symptoms have been brought under control. Issues of daily living, and compliance with long-term use of medication need to be addressed as well. This can be accomplished through follow-up, support, and education. Various methods to effectively treat GERD range from lifestyle measures to the use of medication or surgical procedures. It is essential for individuals who suffer persistent heartburn or other chronic and recurrent symptoms of GERD to seek an accurate diagnosis, to work with their physician, and to receive the most effective treatment available. 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 Functional bowel disorders and abdominal pain (symptoms generally attributable to the mid or lower gastrointestinal tract)IFFGD offers another website which focuses on IBS and the issues related to it, www.aboutibs.org. Irritable bowel syndrome (IBS) - a group of bowel disorders characterized by abdominal discomfort or pain associated with defecation or a change in bowel habitFunctional abdominal bloating - a group of functional bowel disorders dominated by a feeling of abdominal fullness or bloatingFunctional constipation - a group of functional disorders characterized by persistent difficult, infrequent, or seemingly incomplete defecationFunctional diarrhea - continuous or recurrent passage of loose or watery stools without abdominal pain Functional abdominal pain - continuous or frequently recurrent abdominal pain, either not or infrequently related to gut function, and associated with some loss of daily activitiesFunctional 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 durationBack to topExamples 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 That's an awful lot of postive research on HT and IBS Dr D, and I could show you a whole lot more?Care to commment on how effective it really is? And how absurd your comments were on it??????? And you call yourself a medical professional, and a holistic doctor? Seems pretty unprofessional to me personally?Care to show some research, any research on what your saying? Any, come on, any? Other then making it up as you go in regards to IBS? Are you scaring people into the inflammtion problems seen in IBS?Or can you actually show it and explain it? "Maybe we can agree on one thing. I don't know the cause and neither do you."I am not saying I can cure something like you are without knowing the cause? Another major problem!!!I am pointing out through years and years of IBS research what they know now about IBS and present abnormalities from specialists around the world, and your not!


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## eric (Jul 8, 1999)

"You opinions and questions are a joke."American Gastroenterological AssociationAmerican 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." " Role of psychosocial factors in IBS TOP Although IBS patients show enhanced stress responsiveness, and more severe and prolonged impairment of bowel function related to various inciting factors, specific psychosocial factors are not characteristic of the disorder; they are not considered in diagnosis. However, their identification may help in planning psychological or psychopharmacological treatment, particularly for those with more moderate or severe symptoms, where psychosocial factors contribute to the clinical presentation. Psychological stress and other psychosocial factors may exacerbate gastrointestinal (GI) symptoms via alterations in gut motility, epithelial function, or perception of visceral stimuli or may modify illness experience and behaviors including pain reporting, physician visits, medication use, or the seeking of alternative medical treatment. A history of major life stress (e.g., abuse, family death, or divorce), comorbid psychiatric disorders, or maladaptive coping style strongly influence the clinical outcome. Because psychosocial factors affect health care seeking, patients with IBS seen at referral centers usually have greater psychological disturbances than patients seen in primary care or nonpatients in the community. Finally, IBS adversely affects health-related quality of life, including impairment of physical, psychosocial, emotional, and role function to a degree exceeding that found in most patients with other medical disorders. An integrative biopsychosocial model3 is needed to understand the multiple factors contributing to symptom generation and experience. The challenge faced by clinicians and investigators is to determine for each individual the degree to which each of these interacting factors are identifiable and remediable using current therapeutic options. " http://www2.gastrojournal.org/scripts/om.d...id=agast1232105 Dr DrossmanDr. 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. "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 Dr Drossman's siteUNC Center for Functional GI & Motility Disorders UNC center for disease and nutrition http://www.med.unc.edu/medicine/fgidc/welcome.htm http://www.med.unc.edu/wrkunits/2depts/medicine/gi/ Dr DahlmanBIO OF DOCTOR DAVID DAHLMAN, "NUTRITIONAL MEDICINEDoctor 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."Doesn't seem like he is addressing the cause of IBS through understanding and research?And the UNC does not use testimoninals???Dr Drossman is the chair of Rome to diagnose IBS and is involved n real research all over the world!


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## georgie (Feb 19, 2004)

If Dr Dahlman's Program works, why haven't the hundreds of sufferers from this IBS site tried it?He indicates noticable results in a few days. I think I will give it a try, what do I have to loose. Except weight, and I don't want to do that. Until something better comes along it's all there is, we all know the medicines the M.D.'s prescribe do not work for 75% of us.Wish me luck!


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## eric (Jul 8, 1999)

By the way."How foolish to quote an article about digestive enzymes as if that one article, one opinion, is gospel. And from the Berkeley Medical Center at that. Wow, that was hard to guess what their opinion would be. I believe they call that a closed mind. "About the Wellness Letter What is "Wellness"? Wellness is much more than simply the absence of sickness. It is optimal physical, mental, and emotional well-being, a preventive way of living that reducesï¿½sometimes even eliminatesï¿½the need for remedies. Wellness emphasizes personal responsibility for making the life-style choices and self-care decisions that will improve the quality of your life. One crucial tenet is that preventing illness is even more important than treating it, especially since many chronic diseases are incurable. Wellness is a positive, day-to-day approach to a long, healthful, active life. It includes both highly scientific and practical medicineï¿½from the latest research and most advanced tests to reliable home remedies and common sense. About the Newsletter Founded in 1984, the WELLNESS LETTER has more than 350,000 subscribers in the U.S. and Canada (plus thousands of readers of its foreign-language editions). It has been rated No. 1 by U.S. News & World Report, the Baltimore Sun, Money Magazine, and the Washington Post, for its "brisk," "reasoned" coverage of health issues. The WELLNESS LETTER relies on the expertise of the School of Public Health and other researchers at UC Berkeley, as well as other top scientists from around the world. It translates this leading-edge research into practical advice for daily livingï¿½at home, at work, while exercising, and in the market or health-food store. Rather than simply reporting quick health stories of the day, the WELLNESS LETTER puts the news in perspective and evaluates it. It constantly reviews the latest research to give you the edge in your quest to live the best life you can. In particular, it clarifies the often conflicting and superficial health information presented by the popular media. It doesn't promote faddish diets or other anecdote-based regimens. Nor does it simply repeat conventional medical advice from mainstream health organizations or pharmaceutical companies. The WELLNESS LETTER has no ads, no padding. It doesn't try to sell you supplements or products. Instead in every fact-packed issue, you'll find at least a dozen articles, on a wide variety of subjects related to food and nutrition, exercise, self-care, preventive medicine, and emotional well-beingï¿½plus many, many Wellness Facts and Tips. For a sample of the wide range of subjects in WELLNESS LETTER, take a look at our Index. About UC Berkeley & the School of Public Health Behind the WELLNESS LETTER stands one of the most respected educational institutions in the world. For over a century, the University of California, Berkeley has built an extraordinary record of achievement. Its faculty has produced 18 Nobel laureates, 4 Pulitzer Prize winners, 93 appointees to the National Academy of Sciences, and 12 winners of the National Medal of Science. For nearly 60 years, the School of Public Health at UC Berkeley has helped promote and protect the health of Americans. It is one of the nation's leading research and teaching institutions in this field. Its internationally renowned faculty includes physicians, educators, psychologists, nutrition experts, epidemiologists, and public health professionals. Among its areas of research are: the control of cancer, the relationship between diet and disease prevention, occupational health, the link between social support and good health, and environmental health. You can visit the UC Berkeley School of Public Health website. "Meet Our Editorial Board The members of the Editorial Board of the WELLNESS LETTER come from the faculty of the School of Public Health at UC Berkeley. CHAIR: John Edward Swartzberg, M.D., F.A.C.P.Clinical Professor of Health and Medical Science An internist with 26 years of clinical experience and a specialist in infectious disease, Dr. Swartzberg is a Clinical Professor of Medicine at UC Berkeley and UC San Francisco and Associate Director of the UC Berkeley Health and Medical Sciences program. He collaborated with Dr. Margen on the highly successful Wellness Self-Care Handbook in 1998 and the Complete Home Wellness Handbook in 2001. He is the associate director of the UCB-UCSF Joint Medical Program in the Division of Health and Medical Sciences at Berkeley's School of Public Health, and serves as Hospital Epidemiologist and Director of Infection Control at a major hospital in the Bay Area. ASSOCIATE CHAIR: Sheldon Margen, M.D.Professor Emeritus of Public Health Nutrition Dr. Margen was the Chair of the Editorial Board for the first 17 years of the Wellness Letter, until September 2001. He is a well-loved teacher and humanitarian whose work has influenced nutritional programs throughout the world. His original work on nutrients was used by the National Research Council and the World Health Organization to help establish recommended daily allowances of various nutrients, and he was among the first nutritionists to identify the relationship between diet and chronic disease. He is also widely regarded for his role in the fight against hunger, disease, and malnutrition. ASSOCIATE CHAIR: Joyce C. Lashof, M.D.Professor Emerita of Public Health Prior to her retirement, Dr. Lashof served as Dean and Professor of Public Health at the School of Public Health. Her career has combined government service and academic medicine. She has served as the Director of the Department of Public Health for the State of Illinois, as Deputy Assistant Secretary for Health Programs and Population Affairs, U.S. Department of Health, Education and Welfare, and as Assistant Director of the Office of Technology Assessment, U.S. Congress. She has held faculty appointments at the University of Chicago, University of Illinois and Rush Medical College. Dr. Lashof is a member of the Institute of Medicine and past President of the American Public Health Association. From 1995 to 1997 she served as Chair of the Presidential Advisory Committee on Gulf War Veteran's Illnesses. Lily Chaput, M.D., M.P.H.UCSF Clinical Research Fellow Dr. Chaput entered the UC Berkeley/UC San Francisco Preventive Medicine Residency Program in 1997. Currently, she is a UC San Francisco Clinical Research Fellow. Her research projects include topics related to the prevention of cardiovascular disease in women. She received her medical degree from Northwestern University in 1991 and her residency training in Internal Medicine from the UC Davis Medical Center. She received a Masters in Public Health from UC Berkeley in 1998. Patricia Morgan, Ph.D.Associate Professor of Behavioral Science Dr. Morgan is an internationally recognized for her work on cultural comparisons of drug, alcohol, and mental health problems and policy. She has been awarded numerous scientific research grants and has held several important fellowships. From 1991 to 1994, she served as Principal Investigator on a National Institute on Drug Abuse study of methamphetamine use among community-based populations in Hawaii, San Francisco and San Diego, and also worked on the California State Drug and Alcohol Feasibility Study. Dr. Morgan has directed the program evaluation study on the Real Alternatives Project, a drug prevention program involving high-risk Asian, Latino, and African American youth in Berkeley, California, from 1990 to 1997. Ralph S. Paffenbarger, Jr., M.D., Dr.P.H.Professor of Epidemiology Dr. Paffenbarger has devoted his career to studying the effects of physical activity on the risk of cardiovascular and other chronic diseases. Besides being a Research Epidemiologist at UC Berkeley School of Public Health, Dr. Paffenbarger is Professor Emeritus of Epidemiology at Stanford University School of Medicine. In 1960 he founded the famous College Alumni Health Study, involving more than 70,000 alumni and alumnae from Harvard College and the University of Pennsylvania. This ongoing study has yielded vital findings about the benefits of exercise, as well as other important data. In 1996 he was awarded the first gold medal by the International Olympic Committee for his achievements in sports science. Edward E. Penhoet, Ph.D.Dean of the School of Public Health, and Professor of Public Health and of Molecular and Cell Biology Dr. Penhoet is also a director and co-founder of Chiron Corporation, one of the world's leading biotechnology companies. Before that, he was a faculty member of the Biochemistry Department at UC Berkeley. While at Chiron, he continued as an adjunct member of the faculty, teaching a variety of courses. Dr. Penhoet is immediate past Chairman of the California Health Care Institute, Chairman of the Chabot Space & Science Center, and of the Bay Area BioScience Center. He is a member of the American Society of Biological Chemists, and has published more than 50 scientific articles and papers. William A. Pereira, M.D., M.P.H.Lawrence Livermore National Laboratory Dr. Pereira completed a Preventive Medicine residency at the University of California, Berkeley. He holds a staff position in the Health Services Department at Lawrence Livermore National Laboratory, where he is also a research associate with the Interdisciplinary Ergonomics Research Program. He is board-certified in Occupational and Environmental Medicine and is a Certified Independent Medical Examiner. He has extensive clinical experience in occupational, preventive, physical, and emergency medicine, and a special interest in the prevention and rehabilitation of cumulative trauma disorders of musicians. James P. Seward, M.D., M.P.P.Associate Clinical Professor of Public Health Dr. Seward teaches occupational and environmental medicine and co-directs the UCB-UCSF Joint Residency in Preventive Medicine. He also serves as Medical Director at the Lawrence Livermore National Laboratory. A board-certified specialist in Internal Medicine and in Preventive (Occupational) Medicine, he is currently President-elect of the California Academy of Preventive Medicine and serves on the Board of the Western Occupational and Environmental Medical Association. Allan H Smith, M.D., Ph.D.Professor of Epidemiology Dr. Smith is a world-renowned epidemiologist whose work has contributed to understanding human health risks posed by environmental toxins such as dioxins, silica, and diesel exhaust. During the past decade he has focused on the health effects of arsenic contamination of drinking water. Kirk R. Smith, Ph.D.Professor of Environmental Health Sciences Dr. Smith is Associate Director for International Programs at the Center for Occupational and Environmental Health of UC Berkeley, Davis, and San Francisco. He is also Chair of UCB Division of Environmental Health Sciences and Director of the Program in Health, Environment, and Development, as well as Director of the WHO Collaborating Center on Studies of Environmental Risk and Development. Since 1985, he has served as Senior Fellow at the Program on Environment, East-West Center (EWC), Honolulu. Dr. Smith conducts research on the environmental and health effects of air pollution, both indoor and outdoor. S. Leonard Syme, Ph.D.Professor Emeritus, Epidemiology For most of his 30 years at UC Berkeley, Dr. Syme has done research on risk factors for heart disease, with a major focus on psychosocial risk factors such as job stress, social support, and poverty. In doing this research, he has studied San Francisco bus drivers; Japanese people living Hawaii, California, and Japan; British civil servants; and people living in Alameda County. Since his retirement in 1993, Dr. Syme has devoted most of his time to the development of interventions to prevent disease and promote health. He currently is the Director of the Wellness Guide Project, which attempts to provide useful information for the maintenance of health."


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## eric (Jul 8, 1999)

http://www.berkeleywellness.com/


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## eric (Jul 8, 1999)

One of the cell problems in IBS is the mast cell."one problem in IBS is the mast cell. There is a lot of evidence of its involvement in IBS.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. "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 ""Gastroenterology. 2004 Mar;126(3):693-702. Related Articles, Links Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome.Barbara G, Stanghellini V, De Giorgio R, Cremon C, Cottrell GS, Santini D, Pasquinelli G, Morselli-Labate AM, Grady EF, Bunnett NW, Collins SM, Corinaldesi R.Background & Aims: The mechanisms underlying abdominal pain perception in irritable bowel syndrome (IBS) are poorly understood. Intestinal mast cell infiltration may perturb nerve function leading to symptom perception. We assessed colonic mast cell infiltration, mediator release, and spatial interactions with mucosal innervation and their correlation with abdominal pain in IBS patients. Methods: IBS patients were diagnosed according to Rome II criteria and abdominal pain quantified according to a validated questionnaire. Colonic mucosal mast cells were identified immunohistochemically and quantified with a computer-assisted counting method. Mast cell tryptase and histamine release were analyzed immunoenzymatically. Intestinal nerve to mast cell distance was assessed with electron microscopy. Results: Thirty-four out of 44 IBS patients (77%) showed an increased area of mucosa occupied by mast cells as compared with controls (9.2% +/- 2.5% vs. 3.3 +/- 0.8%, respectively; P 0.001). There was a 150% increase in the number of degranulating mast cells (4.76 +/- 3.18/field vs. 2.42 +/- 2.26/field, respectively; P = 0.026). Mucosal content of tryptase was increased in IBS and mast cells spontaneously released more tryptase (3.22 +/- 3.48 pmol/min/mg vs. 0.87 +/- 0.65 pmol/min/mg, respectively; P = 0.015) and histamine (339.7 +/- 59.0 ng/g vs. 169.3 +/- 130.6 ng/g, respectively; P = 0.015). Mast cells located within 5 microm of nerve fibers were 7.14 +/- 3.87/field vs. 2.27 +/- 1.63/field in IBS vs. controls (P 0.001). Only mast cells in close proximity to nerves were significantly correlated with severity and frequency of abdominal pain/discomfort (P 0.001 and P = 0.003, respectively). Conclusions: Colonic mast cell infiltration and mediator release in proximity to mucosal innervation may contribute to abdominal pain perception in IBS patients.PMID: 14988823Critical 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, USA. theoharis.theoharides###tufts.eduMast 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.Publication Types: Review Review, Tutorial PMID: 14698841Neurogastroenterol Motil. 2000 Oct;12(5):449-57. Related Articles, Links Increased mast cells in the irritable bowel syndrome.O'Sullivan M, Clayton N, Breslin NP, Harman I, Bountra C, McLaren A, O'Morain CA.Adelaide & Meath Hospitals, Trinity College Dublin, Ireland.Mast cells (MC) release potent mediators which alter enteric nerve and smooth muscle function and may play a role in the pathogenesis of the irritable bowel syndrome (IBS). The aim of this study was to determine if MC were increased in the colon of IBS patients compared to controls. Biopsy specimens were obtained from the caecum, ascending colon, descending colon and rectum of 28 patients: 14 IBS (Rome criteria); seven normal; and seven inflammatory controls. Tissue was stained immunohistochemically using a monoclonal mouse antibody for human mast cell tryptase (AA1). Tissue area occupied by tryptase-positive MC (volume density of mast cells) was quantified by image analysis. The number of plasma cells, lymphocytes, eosinophils, neutrophils and macrophages were each graded semiquantitatively (0-4) in haematoxylin and eosin stained sections. Mast cell volume density was significantly (P 0.05) higher in IBS (0.91 +/- 0.18; CI 0.79; 1.0) than normal controls (0.55 +/- 0.14; CI 0.40; 0.69) in the caecum but not at other sites. Apart from MC, there was no evidence of increased cellular infiltrate in the IBS group. MC were significantly increased in the caecum of IBS patients compared to controls. The multiple effects of the intestinal mast cell alone, or as a participant of a persistent inflammatory response, may be fundamental to the pathogenesis of IBS.PMID: 11012945Chronic stressors can activate the mast cell without a pathogen. Such as worry, anxiety, fear, wondering where a bathroom is, anything that sets off the fight or flight.This is a very active avenue right now of IBS research with a lot of evidence on their contribution to the symptoms. There are other cells as well under intense scrutiny in IBS.enterochromaffin cells for oneThey store the majority of serotonin in the gut, and they have found the receptors that control digestion and they are not working right? The Cleveland clinic"Neurotransmitter ImbalanceNinety-five percent of serotonin is in the GI tract, within enterochromaffin cells, neurons, mast cells, and smooth muscle cells. When released by enterochromaffin cells, serotonin stimulates extrinsic vagal afferent nerve fibers and intrinsic enteric afferent nerve fibers, resulting in such physiologic responses as intestinal secretion and the peristaltic reflex and in such symptoms as nausea, vomiting, abdominal pain, and bloating.15 Preliminary evidence suggests that patients with IBS have increased serotonin levels in plasma and in the rectosigmoid colon.16,17 Other neurotransmitters that may play a role in IBS include calcitonin gene-related peptide, nitric oxide, and vasoactive intestinal peptide""PATHOPHYSIOLOGY So far, no physiologic mechanism unique to IBS has been identified. Rather, it is currently viewed as a biopsychosocial disorder resulting from an interaction between increased visceral hypersensitivity, altered gut motility, and psychological factors.9 Additionally, persistent neuroimmune interactions after infectious gastroenteritis may lead to sensory dysfunction.Visceral HypersensitivityMany studies have shown that in patients with IBS, both awareness and pain caused by balloon distention in the large and small bowel are experienced at significantly lower balloon volumes than those reported by healthy subjects.10-12 However, It is not known at what level of pain signal transmission (starting at the receptor in the gut wall, through the spinal cord to the brain) this increased sensitivity is expressed, but it is selective to visceral stimuli, as patients with IBS have normal or even decreased sensitivity to somatic stimuli.11,13,14 Abnormal Gut MotilityThe changes in gut motility observed in IBS are qualitative, with no distinct pattern that can distinguish patients from healthy subjects. Two major changes are observed: (1) enhanced gut transit in some patients with diarrhea-predominant IBS and decreased gut transit in some patients with constipation-predominant IBS; and (2) increased motility compared with healthy subjects in response to various stimuli, such as psychological stress, meals, and balloon inflation in the gut.9 Psychosocial Factors IBS has long been dismissed as a psychosomatic condition, since it has no clear etiology or pathophysiology. Psychological stress and emotional events, eg, physical or sexual abuse, can result in GI symptoms in healthy subjects, but they affect patients with IBS to a greater degree. The common psychological symptoms associated with IBS are depression, somatization, anxiety, hostility, phobia, and paranoia. Up to 50% of patients with IBS meet criteria for a psychiatric diagnosis as compared with an average of 20% with organic GI disorders and 15% of control subjects.6 Although there are no psychological or psychiatric disorders specific to IBS, identification of such disorders may help in planning psychological or psychopharmacologic treatment. Neurotransmitter ImbalanceNinety-five percent of serotonin is in the GI tract, within enterochromaffin cells, neurons, mast cells, and smooth muscle cells. When released by enterochromaffin cells, serotonin stimulates extrinsic vagal afferent nerve fibers and intrinsic enteric afferent nerve fibers, resulting in such physiologic responses as intestinal secretion and the peristaltic reflex and in such symptoms as nausea, vomiting, abdominal pain, and bloating.15 Preliminary evidence suggests that patients with IBS have increased serotonin levels in plasma and in the rectosigmoid colon.16,17 Other neurotransmitters that may play a role in IBS include calcitonin gene-related peptide, nitric oxide, and vasoactive intestinal peptideLatent or Potential Celiac DiseaseThe concept of latent/potential celiac disease has recently been introduced into the pathogenesis of IBS. Abdominal symptoms in the absence of mucosal abnormalities are features of both IBS and latent or potential celiac disease.18 In a study of genetic, serologic, and histologic markers of celiac disease in 102 patients with diarrhea-predominant IBS, 35% of the patients had positive findings for HLA-DQ2, 23% had increased intraepithelial lymphocyte counts, and 30% had increased celiac disease-associated antibodies in the duodenal aspirates, including antibodies against gliadin, tissue tranglutaminase, β-lactoglobulin, and ovalbumin.18 Stool frequency and intestinal IgA level decreased significantly under a gluten-free diet in a subgroup of IBS patients with positive HLA-DQ2 and positive intestinal celiac disease-associated antibodies when compared with IBS patients without these markers.18 Infection and InflammationClinical, epidemiologic, and physiologic studies have shown that acute, transient GI infection is associated with a syndrome that, in many instances, meets diagnostic criteria for the diagnosis of IBS. In a subgroup of patients with IBS, their condition appeared to be preceded by an enteric infection, such as Campylobacter jejuni, with increased inflammatory cell response.19,20 IBS and small-intestinal bacterial overgrowth may share similar symptoms. In a study of 202 patients with IBS, 157 (78%) had small-intestinal bacterial overgrowth. Eradication of bacterial overgrowth improved patients' abdominal symptoms.21 Intraepithelial lymphocytes, lamina propria CD3 cells and CD25 cells, neutrophils, and mast cells are increased in patients with IBS.20 Exact mechanisms by which the inflammatory changes cause the symptomatology are not clear. The inflammatory response may be associated with activating enterochromaffin cells to produce 5-hydroxytryptamine (5-HT) and CD3 cells to produce cytokines, which in turn leads to enhanced motility, increased intestinal permeability, and lowered visceral sensation thresholds.19,20,22 In one prospective study of postinfectious IBS, it was found that patients whose symptoms remained 3 months after an enteric infection had not only increased mucosal cellularity but also had had increased psychosocial distress at the time of the infection. Lowered visceral sensation thresholds and increased motility were present after the infection regardless of whether or not the symptoms remained.23 *Therefore, the microscopic inflammation and its physiologic effects on motility and sensation contribute to, but are not always sufficient for, the clinical explanation of IBS pain.24 "* http://www.clevelandclinicmeded.com/diseas...ro/ibs/ibs1.htm


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## overitnow (Nov 25, 2001)

I haven't looked at the UC Wellness Letter in years; but the last time I did they were debunking all sorts of nutritional supplements. I can relate others' experiences, but my own have made a believer out of me: stopped falling asleep while driving, lowered cholesterol and blood pressure to normal values after over 20 years of high readings, stopped cr*pping in my pants after 10 years of that, eliminated related digestive issues that extend back 25 years or more, reversed male smokers' impotence, and eliminated all pain from a hip joint that had me limping after any more than an hour of walking. All done with high quality, scientifically developed, tested--and in some cases scientifically patented--nutritional supplements. Not a prescription medicine in my body. And there is not a single expert involved in any of this but in evaluating the blood tests and giving the physicals. Since the medical community is not interested in evaluating these types of experiences, and I am a long way from being alone with these types of successes, then the medical community is an ass. We can cure ourselves. Mark


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## eric (Jul 8, 1999)

So Mark. Let me get this stright we should give up all doctors and abandon science and experts and all try and cure what we believe we have?How would you know if you had cancer for instance, before it was to late? For the most part, the fact is we would all likely be dead if it wasn't for the medical community and science.That's really not the answer!Then you say "scientifically developed" LOLI don't believe it is a problem with trying alternative safe options or complimentary ones or conventional ones, based on the right information however, after diagnoses is made. It shouldn't be an either or really and its not some type of competition. Conventional medicince is also applying them to IBS, based on research however.


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## missdiane (Mar 4, 2004)

Daisysp I don't know why you feel that you have to answer on behalf of Dr.D I asked him very valid questions, if he feels that his prgrm is all that then why can't answer my inquiries? Yes amount of education does make a difference, one that has attended more years in research and study should be a little more wiser than one that hasn't. A person that has a degree is more informed than one that doesn't. If you need legal advice or in trouble with the law you would have common sense to see a lawyer not a legal secretary. Nothing against a legal secretary, she would be knowledgable about the law but not as much as her employer, the one with the degree. Yes, I am skeptical, I have had my experiences with chiropactors. One I went to in Ca. claimed she could cure my three year old son of his asthma if I would let her realign him. Yeah right, it is very dangerous to manipulate a young childs spine much less a toddler. Yes, when needed I take medication especially after my car accident that left me with chronic pain. I also tried different medications for ibs, but if I can find safe natural alternatives to medication I would much rather go the natural way. I am an open minded person that is why I decided to join this forum, but why should take the word of Dr. D. when he can't even answer a few questions?


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## drdahlman (Nov 6, 2000)

MissC, Please call me and we can discuss how you might get started.MissDiane, All of the questions you ask have been answered through this lengthy process on many threads on this board. I know how hard it is for anybody to read everything that has been posted. I will do my best to answer just for you. It's true, all that I tell you here about cost is on my website if you would like to review it. My first consultation is $195, all the follow-ups are $60. There will be additional expenses for the all natural products, first time we talk the cost is about $200 if you are a typical IBS patient. Each time we talk you will need to refill some of the products. Total cost is very near $1200 for 3 months without lab work.I have never had anyone need surgery in the middle of my program. If someone were that close to surgery, they probaly wouldn't come to see me till it was over. If someone has had surgery, they are told during our first conversation, before they ever decide to become a patient, that I can't offer a guarantee if parts have been removed. It is the only exclusion other than the guidelines I publish on my website to be followed to be guaranteed. My program is designed for a 3 month period. Some patients are amazed in a few weeks and some are difficult, need repeated lab work and may take 6 months, and all in between.I am not an MD, but a chiropractor with a degree in nutrition. Besides similar course work in school as does the medical school, I share one very important commonality with all MD's. We all can read. It's just that I spend my time reading about the biochemistry and physiology of the body and attending continuing education seminars about all this and MD's typically don't keep up with the curve. Witness the 30 year lag time before they acknowledged the Deadly Quartet (that they now have renamed Metabolic Syndrome), the importance of homocysteine, C-Reactive Protein (and now high sensitivity C-Reactive Protein), Fibrinogen, lipoprotein(a), etc as better markers of cardiovascular risk than total cholesterol of HDL or LDL or triglycerides. How about the 30 years it took for them to acknowledge that most ulcers were caused by a bacteria called H. Pylori? My point here is that research is great, but if it's done in the wrong direction, what's the use?I'm not here to do the research for those who are unwilling to open their eyes, and I'm only talking about one person really. The research is clear to support my position on the reasons that the symptoms commonly associated with IBS exist. And for many, my explanation simply makes sense. If it doesn't for you, that's OK. Nothing that I am doing is only my opinion. There are 1000's of doctors who attend the seminars that I go to for continuing education and we all practice a form of this type of thinking. It's a critical thought process that can't be taught in school. You either want to get to the cause of a problem or you want to suppress the symptoms and move on to the next patient. Eight of the top 10 chronic health conditions are diet related, but with no nutritional training, MD's are relegated to symptom suppression. It's really just very simple biochemistry. The traditional MD's that Eric quotes are just that, traditional doctors. No matter what their degrees or research, they can't critically think their way through a chronic condition to get to the cause. Imagine if we were arguing about cardiovascular disease. It's a nutritional problem in most cases, but if you visit your doctor, all you get is lipitor, zocor, high blood pressure meds....all with side effects. If it's Type II Diabetes, it's not only the wrong dietary advice, but then also drugs with side effects. Both of these are managed in clinics like mine without drugs and their side effects.Eric, Thanks for being able to show that you can't explain the cause, in your own words, without 80" cut and pastes, the cause on gastrointestinal inflamation, visceral hypersensitivity, improper gut motility of neurotransmitter imbalances. Didn't think you could. You are a parrot who repeats the ideas of others who you have decided to respect. As I said before, you are extremely impressionable. Unfortunately, you have blinders on to the others that may also have something to offer.I received 3 calls already this morning from people from the board who read your silliness and who would rather not engage with you and have no desire to report to you so you can question them. Thanks for helping me help more and more people. The number of you "lurking" in the background who have contacted this office is very gratifying. Georgie, please call me and we can discuss whatever you like. To anyone: If you have questions for me, please don't hesitate to call my office at 513-871-3300. Please don't accuse me of not answering your questions on the board, when this offer is plastered all over my website. Everyone has access to me each day through the phone or through e-mail. With what I do, answering questions so my potential patients have a full understanding of what they are looking at in my program is a huge part of what I do everyday. If you haven't called me, you may have some misconceptions.The 2 websites I would refer you to that will provide citations on the research that has been done, not only on the products, but also from Great Smokies Lab, who explains so much of why their tests are needed and therefore, the causes of IBS and its symptoms are:www.metagenics.com and www.gsdl.com , check out both and then call me and we can talk about it.Advise of a quilified??????


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## BackFire44 (Nov 19, 2003)

georgie, good luck if you do try out Dr. Dahlman.I personally haven't tried his program because I am getting help from my own GI and have been getting better. Here's my suggestion to you and anyone else thinking of trying Dr. Dahlman's program: stick it out with a good GI first (many people don't have good GIs in their area, and so this won't work for everyone). Try all the conventional treatments: fiber, antispasmatics, diet change, stress reduction, other (including questran for D, psych stuff for anxiety, etc). These methods have been scientifically proven to work in some people -- not all people, but some. If you have given your own doctor a good amount of time and you aren't experiencing any relief, by all means try Dr. Dahlman's program. In fact, I would discuss his program with your doctor to see what your doctor thinks. On this board, Dr. Dahlman has a good track record -- the majority of people that have gone on his program have had a reduction in symptoms. There was one person who did not experience relief, and we were told that was because of other complications. The fact is, though, that despite the sales pitch, Dr. Dahlman cannot cure 100% of people with IBS. He has helped a lot of people, though, and if you have tried the conventional methods, go for it -- all you have to lose is money.BackFire44


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## overitnow (Nov 25, 2001)

No Eric, it is not a case of not seeing doctors, it is the point that all of those conditions have been curable without invasive meds, and several with just one, which suggests that some condition in the body is manifesting itself in many ways. And yes, in respect to your smarmy LOL, the flavonoid supplement I use was developed by a Dr John Folts, who was one of the original discoverers of aspirin therapy for heart disease and a major researcher into the effects of wine/grape juice/grape seed. (You could punch his name into Pubmed if you want to get a listing.) The product has undergone frequent clinical tests and has published results in real medical journals. AND IT HAS STOPPED MY D FOR OVER 4 YEARS! (I just came back from a hockey weekend in Vancouver that included all of the eating and drinking excess associated with that type of event. NO GUT PROBLEMS AT ALL. Four years ago I couldn't have even contemplated that.) I'm not sure there is a medicine anywhere on the market that would give these same results, let alone improve brain and sex functions, lower oxidation and retard cholesterol. And the best part is that all of your wonderful experts will do anything possible not to investigate it. If you were truely interested in fighting this condition, you should ask one of them to get in touch with me. It just might prove beneficial to thousands of others just like us.Have a real nice day.Mark


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## eric (Jul 8, 1999)

He sure has a super high opiion of himself. He knows more about IBS, then UCLA and UNC and Mayo and every other research institution around the world studying IBS? That is quite an ego. Its also quite the accomplishment, since he doesn't formally study it???He doesn't know the cause but he can simply cure it? "Typical IBS patient" ?There is such a thing?He takes CME courses in IBS and calls it leaky gut, give me a break. You would have to be asleep at the wheel.as far as getting people, there is the saying "there is a sucker born every minute"And that is a pretty damn good percentage.These kinds of qoutes are a joke."The traditional MD's that Eric quotes are just that, traditional doctors. No matter what their degrees or research, they can't critically think their way through a chronic condition to get to the cause."I guess only Chripropracters are capable of critical thinking? Its that the take home message there?Its just the real researchers need confimation, double blind studies and real research and science and they aren't trying to sell people a 1200 program on the internet to people sight unseen and holding a "cure" like a carrot in front of people? When they don't know the total cause, and the things they do know, he is not talking about or taking into consideration. *Here is saying he knows the cause and earlier he says he doesn't, which is it?* More condradictions? There are a whole lot of contradictions however?He is no expert despite what he wants you to believe, he does not have the training or do physcial research on IBS.He also, in all those CME's must have missed how effective HT is for IBS? Or CBT? hmmmmmmmmm. And a whole lot more IBS information. The fact is he has not shown one research article that IBS is leaky gut, he is palying on peoples lack of knowledge on IBS, plain and simple.I personally believe they would leave him in the dust in real IBS research. Yet, his own posts shows he does not know what he talking about in regards to inflammation in IBS? His method is for you to believe with no research or information, except his based on his opinions?????? lets review the accuracy of this again since his ego is so big.Dr Dahlman, Dr DahlmanBIO OF DOCTOR DAVID DAHLMAN, "NUTRITIONAL MEDICINEDoctor 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."The cause of IBS is yet to be determined!!!He knows more then the father of neurogastroenterology?"Michael Gershon, MDChair, Department of Anatomy and Cell BiologyColumbia University College of Physicians And Surgeons Dr. Gershon's earliest work involved investigations of the function of serotonin in the bowel, but it soon also came to involve studies of the cellular and molecular basis of intrinsic reflex control and ontogeny of the ENS. Dr. Gershon's work has been vital in the rediscovery of the unique ability of the enteric nervous system (ENS) to function independently of CNS input, and he has become the acknowledged world leader in research in enteric neuronal development. In this lecture he shows how and why blocking signals from the brain to the gut with alosetron, a potent, long-lasting and specific 5-HT3 antagonist, relieves many of the symptoms of IBS. This lecture also includes a discussion of the 5-HT1P, 5-HT4 and 5-HT3 receptors. "who is an expert on the digestive system and its physiology?More then "Esther Sternberg, MDChief, Section on Neuroendocrine Immunology and BehaviorDirector, Molecular, Cellular and Behavioral Integrative Neuroscience ProgramNational Institute of Mental Health, National Institute of HealthA pioneer in the field of neural-immune interactions, Dr. Sternberg will present the scientific evidence proving molecular, neuroanatomical and hormonal links between the brain and immune system and will discuss the role that disruptions of such links play in inflammatory/autoimmune disease. "More then"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. "These are the people who are world experts in the fileds, not chiropracters.Some are also experts in food allergies and all are experts in the immune system, the enteric nervous sytem and brain gut interactions."William Orr, PhDPresident/Chief Executive OfficerLynn Health Science InstituteDr. Orr, one of the pioneers in the field of sleep medicine, will focus on a description of sleep physiology and how sleep alters gastrointestinal functioning in normal volunteers as well as in patients with irritable bowel syndrome. In addition, the presentation will cover disruptions in autonomic functioning in patients with IBS, and how this may be involved in the pathogenesis of irritable bowel syndrome. ""Bruce Naliboff, PhDCURE Digestive Disease Research CenterDepartment of Medicine, Physiology and PsychiatryIt is increasingly recognized that Irritable Bowel Syndrome is a common and diagnosable disorder that has a significant impact on Quality of Life. Dr. Naliboff is a leading authority on the interplay between psychological, behavioral, and biological factors in IBS. His research includes perceptual, autonomic, and brain imaging studies of visceral sensitivity, as well as studies of psychosocial variables that impact Quality of Life and symptoms in IBS. His lecture will review the most recent data on the broad range of intestinal and extra-intestinal symptoms in IBS, the overlap of IBS with psychiatric disorders, and the role of both symptoms and psychosocial factors in determining Quality of Life for IBS sufferers. ""Howard Mertz, MDAssociate Professor of MedicineDivision of GastroenterologyVanderbilt UniversityDr. Mertz has done extensive research on the role of intestinal hypersensitivity in a variety of functional bowel disorders including IBS, constipation, and functional dyspepsia. Currently his work has identified cerebral centers which are activated by visceral pain and how they are different in IBS. Dr. Mertz has reported the largest series of constipated patients studied, and classified their physiology and symptoms into a coherent picture. These findings and implications will be discussed in the presentation that follows. ""Michael Camilleri, MDHead, Motility Interest GroupDivision of Gastroenterology and HepatologyMayo Clinic The last decade has seen a dramatic increase in our understanding of the mechanisms and management (diagnosis and therapy) of irritable bowel syndrome. Dr. Camilleri is a physician investigator with specialist expertise in motility, sensory and functional disorders of the gastrointestinal tract. He summarizes the clinical and scientific advances and provides the evidence basis for future therapies in irritable bowel syndrome. Dr. Camilleri's presentation reviews the mechanisms of motor and sensory functions of the colon, and outlines the diagnosis, current approaches to therapy and potential future therapies for this common disorder.""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.""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.""Dr. Whitehead is Co-director of the Center and Professor of Medicine and Adjunct Professor of Psychology at UNC-CH. Although the UNC Center was begun in 1994, Dr. Whitehead has been involved in the field for over 30 years and is considered one of the top professionals in the field of functional disorders. Dr. Whitehead is associate editor of the Journal of Gastroenterology and has published more than 350 books, articles, and abstracts on functional gastrointestinal disorders. Prior to coming to UNC-CH in 1993, Dr. Whitehead was at the Johns Hopkins School of Medicine for 15 years where he was chief of the Gastrointestinal Physiology Laboratory at the Bayview Medical Center and head of a research program on vomiting disorders, IBS, and incontinence. Currently, as Director of the Gastrointestinal Motility Laboratory, Dr. Whitehead oversees diagnostic assessment and, when appropriate, biofeedback treatment to patients with motility disorders. He conducts research on visceral pain mechanisms in irritable bowel syndrome; behavioral treatments for constipation, incontinence, and IBS; and early learning experiences that contribute to the development of IBS. Dr. Whitehead has taught workshops on gastrointestinal motility assessment, biofeedback, and behavior modification to groups of physicians, psychologists, and nurses. He wrote the text, Gastrointestinal Disorders: Behavioral and Physiological Basis for Treatment (Academic Press, 1985) with Dr. Marvin Schuster. Dr. Whitehead provides clinical training in the conduct and interpretation of diagnostic gastrointestinal motility studies to Gastroenterology fellows and Urogynecology/Reconstructive Pelvic Surgery fellows. In addition, he trains and precepts postdoctoral and pre-doctoral psychologists in gastrointestinal psychophysiology. Former postdoctoral fellow now head their own research programs in departments or divisions of Gastroenterology, pediatrics, family medicine, gerontology, and psychology.In 1990, Dr. Whitehead was invited to join the steering committee of the Multinational Working Team Project to develop diagnostic criteria for functional gastrointestinal disorders (the Rome Criteria) and to chair the committee working on anorectal disorders. The steering committee later invited him too organize and chair the International Resource Committee composed of representatives of the Food and Drug Administration (FDA), the National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK), and the International Foundation for Functional Gastrointestinal Disorders (IFFGD). Dr. Whitehead was a major player in both the World Symposium in Vienna which was organized to develop a consensus on the definition of responder in clinical trials for functional GI disorders., In 2003, he was appointed Associate Editor of Gastroenterology, the official journal of the American Gastroenterological Association, was appointed to the General Clinical Research Committee (GCRC) Advisory Board at UNC, Chapel Hill, organized and chair the first conference on Advancing the Treatment of Fecal and Urinary Incontinence Through Research, and has been appointed Chair of the Anorectal Disorders for the Rome III Committees with the book, Rome III, to be published in 2006""Emeran A. Mayer, MDProfessor, Departments of Medicine, Physiology, Psychiatry & Biobehavioral Sciences, at the David Geffen School of Medicine, UCLA; Director, UCLA Center for Neurovisceral Sciences & Women's Health (CNS), UCLA Division of Digestive Diseases; Chair, UCLA Collaborative Centers for Integrative Medicine 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." *No critical thinkers on IBS there? Again more totally inacurrate information!!!* If he goes to CME on IBS is should know who these people are and how much expertise they really have!!!!Coming from a person with a huge ego!I have only shared for free the current state of knowledge on IBS from all fields and from the actual experts studying it. The problems they see already and how it works.I can tell you for a fact, that is not what he is doing!!!!!He does not dissect and study the digestive tract of IBS patients!!!!!He has not mentioned what formal training in IBS he has either? Which from his posts, I personally believe indicate very little if any. But it is easy to make things up as you go and convince people of it? he attacks me, because he can't argue the real science from real reserchers, so he has to resort to calling me a parrot. LOLI am a messenger on real IBS research, and you know what they say, don't shoot the messenger. Although I am sure he would like to see me out of the picture. Dr Dahlman, give it up, show one research study that confirms that the cause of all IBS and all gi conditions are leaky gut?"The research is clear to support my position " It is??????The proof please for everyone? Back up what your saying!!!!!!For those who has IBS? I bet he will not do this and that should tell you something in and of itself. He will refer you to his inaccurate website!


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## Gret (Sep 23, 2003)

eric, I don't know why you get so worked up over Dr. Dahlman! If you choose not to take part in his program, then don't. I think we as adults can decide for ourselves what is best for us. I chose to get well. I don't understand why this debate needs to continue. We all certainly know your position on the issue. It's all been said, we've all heard it many times....Meanwhile, I hope all of you are doing well!


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## BackFire44 (Nov 19, 2003)

Nice to hear from you Gret! Glad you continue to feel great! I have to admit the debate is getting a little old. I'm all for hearing both sides, but we've heard both sides about 50 times now







BackFire44


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## drdahlman (Nov 6, 2000)

Yawn. Your questions are pointless, Eric. You're irrelevant, except to yourself. Still waiting to hear the cause of gut motility, visceral hypersensitivity, etc. In your own words.


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## LNAPE (Feb 9, 1999)

There is an awful lot of posting here with not too many success stories and the ones there are seem to be many threads by the same few people.Linda


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## eric (Jul 8, 1999)

You know how I know this is sales, because of comments like the above, a real doctor would be interested in research on IBS and read it and make real comments on it. A real doctor would.They would take the time to explain there treatment to people and how it fits into the current understanding of IBS from real researchers and experts. Its funny all the real research on IBS is not critical thinking, and their all wrong, yet, HIS Science he learned is Real. What an oximoron.Not ignore it or change the subject. There is a very real reason why Dr Dahlamn is doing this on here.We already no two people that were not helped, do you see that on his site? Were also missing quite a few. Kel was also not cured and could not attribute her feeling better just to Dr D.Wealso no others are taking things and doing things not in his program!We already know he gives no information on here and what has been said is inaccurate.Dr Dahlman,"Still waiting to hear the cause of gut motility, visceral hypersensitivity, etc. In your own words. "I don't have to do that nor would I, beause I am not an expert and admit it and I have already posted from REAL RESEARCHERS that are certainly way, way more qualifed then you.I am an IBS sufferer, or did you forget that Dr D, that has just learned way more then your average IBS sufferer.But you are selling people the "leaky gut theory" You ignore this and ignore this and ignore this, and you should if you were honest certainly post it for people here, since this is where your recruiting for your program. IF you were not able to recruit here, I bet you would be gone in a second. Yes your a big help to IBS, post bad information and then not explain yourself, how many times now?By the way, you missed one, its Motility, Visceral Hypersensitivity, and Brain Gut Axis."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. " http://www.med.unc.edu/wrkunits/2depts/med...aldisorders.htm Mark, sorry I did not answer I will on another thread soon.Gret, have you asked your doctor about "leaky gut" and the treatment your doing?Just curious, have you told him the guy treats people sight unseen over the internet? One of the most important aspects of treatment is actually seeing the person in real life."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 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. http://www.iffgd.org/SelfHelp.html No references, no nothing, nada, Zip except and opinion from a non Expert in IBS!!! Who doesn't even have inflammation in IBS accurate. Who says he can cure every person and doesn't know the cause of IBS! No one does at this time. Who does not provide any factual information!


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## drdahlman (Nov 6, 2000)

Completely agree with LNAPE. Very few people taking part in the discussion and one obstructing it. Succes stories? My program takes time and I'm not finished with my free treatment to these people. Look who I got when I offered to treat them at my cost: one who has a structural abnormality that isn't IBS like the rest of you perceive IBS, two others out of the country that I can't easily get product to or lab tests to and that leaves me with 4 others.....one who responded very quickly, Kel and 2 that I'm still working with.Last point: I don't do research. The research on the ingredients that I use has been done by many reseachers already. Then Metagenics....and others....come along and create products based on that research. But Eric wants me to do the research. Sounds a bit like taking coals to Newcastle....Eric won't understand that one. The research on lactose, fructose and gluten intolerances has been done. The research on allergies and their contribution to gastrointestinal problems has been done. But Eric needs me to do it for my own credibility.Here's what I need to do. I have an almost full practice. I took on the "free" patients from this board with great additional strain on my resources and time. I am writing a book that has 19 of 21 chapters pretty much finished...and there won't be one bit of research included. It will be a "how to" book called "Why Doesn't My Doctor Know This?" subtitled "Conquering Irritable Bowel Syndrome."I have very little time and to even try to read the short posts is near impossible. The only effect that this exercise with you all has had is to increase the people who have eliminated their symptoms, and I will try to convince those who are not willing to engage with a person who can't spell or put thoughts into his own words, I will try to get them to report back.When I look at the majority of people who post here, the misinformation that there is about gastrointestinal problems it's a shame that there can't be a dialogue that isn't impeded by a moron with too much time on his hands. Many of you seem to not really even want an answer, you now have a club to belong to that has a name. That's where Eric fits in. This is his identity. Can you imagine 16,000 post since the inception of the board? That's 3 each day and he hasn't been here since the beginning, so it's more like 4. He obviously views himself with great regard as evidenced by the Einstein picture he used until I pointed that out. Ego blinds.So, there's too much time involved for me, I have so many who come to me or contact me through my website to keep scrolling past nonsense to get to those of you who want to talk.The offer is still open. Anyone who wants to contact me can through e-mail or phone. I offer that on my website and have for years. My efforts each day have to move to another level and I won't be posting here anymore. Good luck to all of you, to those who still have app'ts with me, I look forward to taling to you then and to Eric: Hope you don't burn your twisted logic on the Jenn-Air.


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## missdiane (Mar 4, 2004)

Backfire, I don't know how you can endorse a program that you haven't even tried? To tell the truth I didn't think he would even reply to my post. I also think his program is a bit overpriced, for not even seeing the "good Dr."while using his program. I personally wouldn't pay for item or service sight unseen! Why is his program so expensive, he has no overhead, at least for his patients on the net.


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## missC (Oct 16, 2002)

Eric, you might want to check out the definition of 'oxymoron'. you seem pretty angry. people have heard your arguments and made their own decisions. you can't force other rational adults to agree with you.i question also whether it's necessary to fully understand disease causation before putting into practice an effective treatment. midwives a few centuries back weren't too big on germ theory to the best of my knowledge: they just knew from experience that a whole lot of handwashing between births cut risk of puerperal fever. many treatments favoured by allopathic doctors have been hallowed by long-time use and never been put through clinical trials: should their use be immediately ceased while such trials are put in place?you don't seem too happy about Gret's good health. which is pretty sobering as a response. not that it would do any harm for her to ok her current treatment with her conventional doctor (presumably the same doctor who has been unable to alleviate her condition).doctor D, you seem quite ratty too. are you regretting your offer? people such as Trinity can't help it if they don't fit a suitable disease template and respond to treatment.


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## BackFire44 (Nov 19, 2003)

missdiane, I have never "endorsed" Dr. Dahlman's program. All I said is that many people on this board have had success with his program, but that I advise everyone to try their own GI and more traditional methods first. Despite his sales pitch, which did rub me the wrong way at first, I just don't feel a need to attack him. And I have to accept what others are saying who are on his program: that it is helping them. Speak to Gret -- she has had a great recovery. Sorry to hear Dr. Dahlman is not posting here anymore. Always interested to hear a wide variety of views whether I agree with them or not. BackFire44


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## Jhouston (Nov 9, 2003)

Anyone interested .....about money: you do not need to Dr D any money! He wrote an article on his website that you may download for free. It contains exactly what his program entails. If you want someone to talk to on a regular basis he is available and this will cost some money. you may buy the products anywhere you see fit. If this isn't clear then I do not know what to tell you. Joann


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## daisysp (Jan 13, 2004)

I talked to Dr D this morning, and he's gotten so tired of the rift caused by certain individuals (you know who you are). He's got a practice to run, this website is not where he finds his clientelle. He's helped thousands in person and through his own website, so he's doing this bulletin to help out. I credit much of this to Eric and I don't care who gets mad I said that. He's not trying to help here at all. I was thrilled to find this site, happy I met so many folks who I could talk to about things no one I know understands or are dealing with. I have gotten so much help and hopefully made friends. There are others here (not only Eric) who just want to ###### and moan and complain. MissDiane, you obviously have not been to Dr D's website or done any research on who he is or what he's done to help so many people. His program is so not expensive if you check out how much it costs to see an alternative doctor and purchase some supplements. I have been so so many (over 20) and believe me, his program is a gift from heaven !! Not all of us have rich husbands or fancy insurance carriers to cover all our wims; for all my care in the last 8 yrs I have paid cash. If you mearly want to have someone to ###### at.......can't you keep it offline ? At least check the program out, and then, if you aren't interested, stick to another thread as this one was clearly for those who had information to give, or questions to ask, not negativity to throw out. Do we not get enough of that in our daily lives anyhow ? Jeez, some people here really need to get outside the house !!


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## daisysp (Jan 13, 2004)

BACKFIRE, I am feeling so much better, thanks for the letter in Weight Lifting, I just read it. I was eating too many calories so I needed to cut back. My system isn't ready for all that and I was feeling so much better the week before, I went over a bit. It caught up to me. I am back on track and checking in with Dr D every few days. He wants me to slowly increase my calories and slowly decrease my need for cleansers. I am scared of that, I told him so in many words ! My job does not allow me to be sick, to be bloated or to gain any more weight than I already have. He said he needs me to suffer some, I laughed !! What he meant was I need to allow my body to start working again on it's own, and it may take some days of real discomfort to get it going again. I am willing to do what I need to do, and I won't walk away just because I am uncomfortable. I have spent the past 8 yrs trying everything and not all of those were comfortable to say the least ! I wish I could take a couple of months off work, have time to recover and be sick, yet that isn't possible at all. AS it is my work hours are so reduced so I can be sick most afternoons. Any less and we are on welfare ! ha ha..........No way ! (single mom with no ex-hubby child support, or family near by). So, I put up a a fuss and then asked him what he needs me to do. I so appreciate the free help he gives me, never have I had so much help with a program......I will not turn away from this one.I hope you are doing well on your road to gaining muscle, do let me know how it's going. How is Lek ?????????


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## AlphaMale (Jan 21, 2004)

Daisysp glad to see that you are improving.


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## BackFire44 (Nov 19, 2003)

Things will work out in the end, Daisy. Being a single mom is tough -- I know firsthand as that was the situation my mom was in when I was little. With no family nearby, its gotta be worse. You present a strong example to your kids, though, when, despite your situation right now, you continue to work hard and fight to provide for them. I know my own mother gave me great confidence -- that I could do anything as long as I don't give up. I'll answer re muscle on the other thread so as to not bore the Dr D. affecianados!BackFire44


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## daisysp (Jan 13, 2004)

Am definitly feeling somewhat normal now after last week's bout, and then the recovery this weekend. I am going to start the Ultra Clear Sustain soon as he's already sent it. I am looking forward to the next step. It's so hard to avoid some foods though ! I thought it wasn't going to be a problem as I rarely eat wheat, sugar or dairy anyhow, yet to totally take them out, 100%, thats really hard. I do need my saltines for when I get nauseous though, so those have to stay. Yesterday my son really wanted to go to Baskin/Robbins after Judo, so I took him. I walked around there lamenting, which one should I have cause I really want one yet don't want to suffer to badly. At least they all indicte what they've got in them as far as the major allergy triggers, i.e. soy, dairy, wheat, nuts. I finally chose one, and then had to meditate (thanks Backfire for reminding me as that is SO important), on relaxing my intestines and being alright with eating this. My insides get into a knot if I am eating something I know will have a detrimental side effect later on me. So, I had gas all night from it, yet otherwise was alright. Tonight is Italian food at a rest. we were referred to. There are so many igredients I would need to stress about, yet plan to just have fish and roasted vege's, plus dessert. I can pass on the bread and wine easily, those aren't a big deal for me...........yet will want salad (seemingly so innocent, the salad), yet will pay for that one for sure !! Let's take a little survey: What two foods would you want to be able to eat again with no problems if you could choose ???For me, salads and fish.


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## BackFire44 (Nov 19, 2003)

No question for me -- both dairy: cheesecake and Ben & Jerry's Chubby Hubby Ice Cream. I haven't had real ice cream (except maybe a bite) in a long time. I can handle soy ice cream alright, but its not nearly the same.BackFire44


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## daisysp (Jan 13, 2004)

Ohhh, cheesecake, ya !!! That is a big one, I was thinking basic foods, yet I need to be more creative ! I can't even handle Rice Dream as far as ice creams go. Lately I have a heck of a time with soups, and that sucks as I love to have soup. The woman who runs the health food store I go to makes a great chicken rice soup, it's all natural and organic. She charges alot for a pint yet it's the only one that I can have without side effects. Shoot !Good choices Backfire !


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## Gret (Sep 23, 2003)

Daisy, Be tough with the diet! It's important! I thought I'd die w/o cheese, but now I don't even crave it! I do enjoy my Friday night pizza again though! Going out to eat was tough, but we tried to only go where I could have a nice piece of fish or steak and plain sides. I still won't eat a restaurant salad! I made one here at home last weekend and it was wonderful! But I'm scared of what they put into them in restaurants. I used to get sick on them even before IBS! But I'll try it one of these days. Probably at a better place it would be ok!Backfire, you are so diplomatic! I like your responses on this thread!


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## BackFire44 (Nov 19, 2003)

Thanks Gret. Just promise that when you are President, you'll make me an ambassador. Ooh, Pizza. Miss that too. BackFire44


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## AlphaMale (Jan 21, 2004)

I can live on Kamel milk and fine dates. You did not mension the drinks. Good (not sweet) wine and fine newly roasted coffee.


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## Arnie W (Oct 22, 2003)

I've beem waiting 3 1/2 weeks for the results of my GSDL stool test. Until then I'm in limbo, waiting to find out what needs to be addressed within the gut.The food I miss the most is fresh bread and home baking. I have a huge cache of muffins, cakes and cookies (actually we say biscuits) in the freezer which I fantasise about pigging out on in the future.


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## SpAsMaN* (May 11, 2002)




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## Kacebece3 (Apr 17, 2002)

Arnie W, I would be very interested in the results of your GSDL stool test. Hope ypu will post the results. Ken


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## BackFire44 (Nov 19, 2003)

Arnie, while you are posting the results of your GSDL stool test, I wondered if it might be best to actually send us a sample of your stool so we can see it firsthand. Also, if you could post your medical history, blood pressure, brain chemistry, and any STDs that you might have, it would really help us out.BackFire44 (Sorry, I couldn't resist)


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## calid (Aug 4, 2003)

Calid update. Still having issues, have finished the anti-fungal regimen and am awaiting another stool test to be sent to test for new results and hopefully lower bad bacteria levels. Am going to be on a very strict 2 week diet of absolutely NO gluten or fructose. Hard to do while traveling, but necessary. A big thank you to Dr. Dahlman for all the help, he's really a trooper in trying to figure this all out for me. Each person is so different, no one route is the same.


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## MariaM (Jan 19, 2003)

I started Dr. Dahlman's program. I have problematic bacteria in my gut so I am in for a long haul.







I was wondering if any of you who have been on the program for a while had to take herbs to fight the bad bacteria. Did they help you to feel better? How long did it take to get some relief? Did you have to go through really bad "die-off" symptoms?I am feeling worse right now.







Last night I woke up with overwhelming allergic, nauseous, panicky sensations. I sat in the bathroom a while but did not get sick, just belched huge puffs of air for about an hour. I still feel queasy and very gassy this morning. Is this a reaction to the powder which I take at bedtime?


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## BackFire44 (Nov 19, 2003)

A bacteria problem in your gut is very good Maria! That's something that is easily fixed as opposed to having to live with IBS symptoms for a long period. Taking antibiotics or probiotics to change those levels is relatively easy to do, and if that is your only problem (which is very possible), you'll find complete relief in a relatively short amount of time. Its possiblet that is only part of your problem, but I would take it as good news. What powder are you taking at bedtime? Its always a good idea to take your medicine, food, and drink more than an hour before bed. Try not to eat or drink something in the hour before you are going to go to sleep so that your stomach has time to digest your food.The panicky sensations could be a result of medicine, but most likely are similar to what we all get with this stupid syndrome. You've probably read through threads about stress & IBS before. You might benefit from stress reduction including exercise and perhaps meditation. Its helped a lot of people. Hypnotherapy might be good for you as well.Best of luck in feeling better! BackFire44


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## eric (Jul 8, 1999)

A comment on Dr Dahlamns comment on my ego with einstein as my old avatar. I am an einstein fan that is all there is to that, einstein was a great mind.But with his ego he believes he knows more then Dr Michael Gershon, the father of neurogastroenterology and the person who DICOVERED the brain in the gut. Now that is an ego for you, in believeing he knows more then every world expert on IBS. And he doesn't even do IBS research. I am also a bad speller with a slight case of dyslexsia and two of my fingers have no feelings. So what.Before DR Dahlamn convinces people of their probelms based soley on his opinion, it would help if the people knew all the problems in IBS.""IBS: An anatomy of what goes wrong in the bodyAlthough the precise trigger of irritable bowel syndrome (IBS) remains unknown, researchers in the last decade have made substantial progress in understanding what goes awry in patients who suffer from the condition. Studies have shown that many IBS sufferers are hypersensitive to stimuli in the gut. Their brains process those stimuli differently, and many also have heightened gut-immune responses.As a result, researchers are beginning to look at IBS as an explainable disease rather than as a mysterious disorder. "As more of these abnormalities are being found in IBS, the distinction between a functional disorder and an organic disorder is being blurred," noted George F. Longstreth, MD, chief of gastroenterology at Kaiser Permanente Medical Care Program in San Diego.Researchers at the University of California, Los Angeles, for example, found that when they used an inflatable balloon to distend the rectum and lower colon of IBS patients, PET scans of the brain showed greater activity in the brain's emotion and attention processing centers than in those of normal control subjects given the same stimulus. Those findings were confirmed by researchers at Vanderbilt University who used MRI studies instead of PET scans. "Patients with IBS are hypervigilant," explained Brian Lacy, MD, director of the Marvin M. Schuster Center for Digestive and Motility Disorders at Johns Hopkins Bayview Medical Center in Baltimore. "They listen to their guts too carefully and hear every little contraction, gurgle and peristaltic wave."Other studies have shown that IBS patients have lower visceral pain thresholds and greater gut reactions to psychological stress than control subjects. Those data have led some to hypothesize that a visceral hypersensitivity causes many IBS symptoms.Whether that hypersensitivity originates in the brain or in the nervous system of the gut is unclear. Regardless of its origin, treatments that target the region of the brain shown to be hyperactive in IBS patients can effectively relieve symptoms. That's why therapies like cognitive behavioral therapy, alosetron, low-dose tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) and cognitive therapy all work.Although abnormalities in brain processing are thought to play a role in IBS, researchers have also found how some symptoms stem from the actions of nerves in the gut. The role of the "gut-brain" connection has recently gained more prominence as researchers continue to uncover its extensive influence on bowel motility, secretion, immune responses and signaling to the central nervous system. Much of that influence gets carried out via the neurotransmitter serotonin. Remarkably, about 95% of the body's serotonin is found in the gut. Two serotonin receptor subtypes, 5-HT3 and 5-HT4, are thought to be responsible for the majority of the neurotransmitter's intestinal effects. " http://www.acponline.org/journals/news/sep03/ibs.htm?hp#body


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## calid (Aug 4, 2003)

Eric, don't you ever get tired of posting the same thing over and over and over and over and over and over again? I know I get tired of scrolling past them. Hopefully Dr. Dahlman, who by the way is going out of his way to help us, will not even respond to any more of your interfering posts. This is supposed to be a Dr Dahlman Program Users Updates, not an Eric wants to cut and paste thread. You are not a Dr. Dahlman patient and you have no updates. Please, for the fifth time, take your cut and pastes and put them somewhere else. We have a different agenda here and it's not the same as yours.


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## eric (Jul 8, 1999)

"We have a different agenda here and it's not the same as yours. "" you have no updates"I have an update for you, Dr Dahlamn is not an expert on IBS and has been supplying inaccurate information on IBS over the internet!


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## calid (Aug 4, 2003)

ATTENTION GRET: Dr. Dahlman has erroneously cured you, please resume your IBS symptoms immediately!!!


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## Gret (Sep 23, 2003)

Gotcha, Calid! Sure, I'll go back to feeling miserable. Right! She's right, Eric. You may have something to offer, but here isn't the place. Dr. Dahlman won't respond to it anymore so give it up.Maria, Dr. Dahlman probably told you that if you have severe gas and/or bloating initially, you will need to stop the Ultra Clear Sustain and have a stool sample done. Contact him directly for information on this. But, Backfire is right! This is good. You're going to get better!


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## overitnow (Nov 25, 2001)

To all of us who ever had GI disorders, if you no longer have them then you can't have had IBS-D because there is no known cause and therefore can be no effective treatment.I must have just had a ten year flu that miraculously just went away.If you define yourself by your illness and recover from that illness, then you no longer have a definition. This would be the Chronic Syndrome Syndrome. This website may well be held together by people who are actually not looking for a way out.Cheers,Mark


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## eric (Jul 8, 1999)

Do the three of you believe your experts on IBS? Do you think you know more about IBS then the father of neurogastroenterology who discovered the brain in the gut in the first place or the chairman of the rome committe? Do you think Dr Dahlamn does, since he does not have the qualifications as a chiropracter and nutritionist? Do you think he knows more about it then all of the worlds researchers actually studying IBS and functional disorders and inflamattory bowel diseases and other gi diseases?Do you know how all one hundred million nerve fibers in the gut are working and what they are doing?Do you fully understand how the gut and the brain communicate together and what that means in IBS?What about the abnormalities already detected in IBS??????????????Maybe the three of you can help explain the contradictory, erroneous and major inconsistencies in Dr Dahlmans theory based on his belief as a non expert on IBS and why he might not be explaining it all to you here? I would like to hear that?Foundation for Health and Nutrition.with permission"Irritable Bowel Syndrome at a Glance - Nosology, Epidemiology, and Pathophysiology (Monograph I)Inflammation Intestinal inflammation can cause neurological changes with effects on GI motility and visceral perception. Structural changes to the enteric nervous system are not restricted to areas of active inflammation. Functional abnormalities can persist long after resolution of the inflammation. Many patients with acute gastroenteritis develop chronic functional GI symptoms. Brain PhysiologyStress reproducibly alters gastrointestinal motility and sensation. The release of corticotropin releasing factor from the hypothalamus may mediate the stress response. Brain centers important in mediating visceral pain include the thalamus (general sensory), insular cortex (visceral sensory), anterior cingulate cortex (general pain awareness), and prefrontal cortex (general pain processing). Visceral pain in IBS is associated with increased prefrontal cortex activation. The normal correlation between subjective pain intensity and activation of the anterior cingulate and insula cortices is lost in IBS. The limbic system is involved in emotion, mood, and visceral autonomic control. Limbic abnormalities are seen in depression and IBS. Thus, this system is a possible site of convergence where emotional disturbance provokes intestinal dysfunction. Psychosocial Factors *It is no longer reasonable to discriminate between physiological and psychological factors; both are operative in IBS. * It is likely that dysregulation of the ï¿½brain-gutï¿½ neuroenteric systems, rather than the presence of structural disease, promotes the development and persistence of IBS. While psychosocial factors are not part of the diagnosis of IBS, they have a significant effect on gut motility, symptom experience, and health outcome. To legitimize the condition, it is essential to continue research-based efforts to challenge the myths associated with IBS. NosologyFunctional GI disorders are sub-classified according to the regions involved. There are no biologic or pathophysiologic markers by which to define IBS. IBS is characterized by a cluster of certain symptoms; diagnosis is augmented by prudent exclusion of structural disorders. EpidemiologyIBS is common, affecting 10%-20% of adults. IBS overlaps with other functional disorders and symptoms fluctuate over time. The prevalence of IBS is significantly greater in women than in men. A history of physical or sexual abuse is associated with increased severity of disease and greater healthcare utilization. The disorder is common in all ages and ethnic groups. IBS accounts for significant healthcare utilization and indirect costs. Motility and ElectrophysiologyIn IBS, diarrhea is characterized by decreased segmenting sigmoid contractions and an increased frequency in long spike bursts. Constipation and abdominal pain are characterized by increased segmenting sigmoid contractions and an increased frequency in short spike bursts. IBS patients may have diffuse motility abnormalities in the esophagus, stomach, and small intestine. Measured abnormalities in GI motor function do not define IBS. Visceral Sensitivity and PerceptionAltered visceral perception via changes in reflex responses and viscerosomatic referral areas is common in IBS. Both hyperalgesia (lower pain threshold) and allodynia (pain perceived in non-nociceptive pathways) are involved in the development of visceral hypersensitivity. Visceral perception can be modulated by the CNS (e.g., stress, anxiety, and distraction). It is believed that, as a result of central sensitization, a nociceptive memory response is created, which exaggerates and prolongs subsequent stimulation. The pathophysiology of visceral hyperalgesia is incompletely understood and appears to be multifactorial. " http://www.fdhn.org/html/education/gi/ibs_diagnosis.html from above"To legitimize the condition, it is essential to continue research-based efforts to challenge the myths associated with IBS."Myth number one all gi symptoms are from Leaky gut and a lack of enzymes!!!! Why do IBS D IBS patients have abnormal serotoinin levels in their gut after eating???Do you understand that people with Mild IBS can eat fiber and get better?Why do more women have it then men?Why are there so many triggers to IBS, even the weather or COLD WATER?How come the limbic system is invovled?IBS Fact sheetIrritable Bowel Syndrome (IBS)Fact SheetIrritable bowel syndrome (IBS) is a disorder characterized by abdominal pain or discomfort, and altered bowel habit (chronic or recurrent diarrhea, constipation, or both in alternation).IBS affects between 25 and 45 million people in the United States (10 to 15% of the population). Approximately 60 to 65% of IBS sufferers are female; 35 to 40% are male. IBS affects people of all ages, even children. The exact cause of IBS is not known. *Symptoms appear to result from a disturbance in the interaction between the gut, brain, and nervous system that alters regulation of bowel motor or sensory function.* IBS is not caused by stress. However, because of the connection between the brain and the gut, symptoms can be exacerbated or triggered by stress. The impact of IBS can range from mild inconvenience to severe debilitation, controlling many aspects of one's emotional, social and professional life. Those with moderate to severe cases, affecting an estimated 10 to 15 million people, must struggle to overcome symptoms that often impair their physical, emotional, economic, educational and social well-being.IBS is unpredictable. Symptoms vary and are sometimes contradictory, such as diarrhea alternating with constipation. Chronic and recurrent symptoms can disrupt personal and professional activities, upset emotional well-being and limit individual potential. Treatments are available for IBS to help manage symptoms. However, research is needed to provide greater relief and more treatment options.IBS Awareness MonthIrritable Bowel Syndrome: The Burden of IllnessA Call to Action for Sufferers of Irritable Bowel SyndromeTalking to Your Doctor About Irritable Bowel SyndromeIBS: It's About Lost PotentialPress Release: IFFGD Sponsors 7th Annual IBS Awareness Month to Provide Voice for Millions Although IBS is very common in the general population, few seek medical care for their symptoms. On average, patients report it takes more than three years from onset to diagnosis, and see nearly three healthcare professionals before their condition is diagnosed as IBS.Approximately 20 to 40% of all visits to gastroenterologists are due to IBS symptoms.For those with IBS an additional burden comes from living in a society where the word "bowel" may scarcely be spoken. Individuals are left to cope with multiple symptoms that affect every aspect of their lives while those around them may be unaware of the true impact, or even the existence, of the disorder. IBS can only be diagnosed by a medical professional. http://www.aboutibs.org/publications/IBSFactSheet.html


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## overitnow (Nov 25, 2001)

All I know for sure, Eric, is that I s**t my pants for 10 years and haven't for over 4 years, now. I think that is wonderful and I also think it OUGHT to be interesting to both your experts and yourself.I also think that whatever is happening to Gret and to the others that Dr D has helped ought to be interesting to both your experts and yourself. Further, I think these recoveries are to be CELEBRATED rather than complained about. Of course, that's just me.Have a real nice day.Mark


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## Gret (Sep 23, 2003)

This website may well be held together by people who are actually not looking for a way out.WOW! Something I've thought about too! IBS maybe defines some people and for them it would be difficult to overcome this problem because then who would they be? Mark, you hit a nerve there, I bet. But something that might be addressed by some lurking shrinks.I can understand the mind-gut connection. It's facinating. But if a person has D every day of their life, there is something wrong in the intestines! Get it fixed! Right now my mind and gut are seeing eye to eye! Have a great weekend everybody!


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## calid (Aug 4, 2003)

I think you can over-analyze IBS, as Eric does or you can choose to find out why you have problems as Gret did. I choose to find out what's causing my symptoms, with Dr. Dahlman's help. Sometimes it's as simple as cutting out lactose, or cutting out fructose, or gluten, and if that cures you, why in the heck would you not want to find it?I'm going to get well, if you're willing to keep floundering around in your cut and paste world still having symptoms, Eric, go ahead, no one's stopping you.


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## daisysp (Jan 13, 2004)

I am really steady on my diet, thanks for the words of encouragement though Gret. I go off so occasionally, yet I really pay for it. It's to where I plan so carefully what I am willing to get sick over. I guess most IBSer's do that.All those foods make me hungry, ha ha. Pizza is a big one, yeah ! And drinks, I had forgotten those. What is Kamel milk ?? Never heard of it.Arnie, what exactly is a GSDL test ? Who is doing the test for you ?Funny, Backfire, very hilarious about the stool test. I have done a few of those, uuck !HA HA HA, I am getting a kick out of the boldness of the postings here, so funny. Eric, why do you bother anymore here? Dr Dahlman has already said he's off this board so you are preaching to faces turned away from you. We are laughing at you, poking fun at you, have you had enough yet ? I am so ready to not have this IBS anymore. I am so ready to not have it be a part of my life. I would still come on this website to talk to others though as it has impacted my every moment for the last 8 yrs. I would love to help people here as well in person. I do not tell people I know about it, I don't talk about it, I don't allow it to limit me as much as I possibly can. I do not want to alter my lifestyle too much for it as I dont' intend to have this for much longer. I already have had to make some changes yet I keep in my mind, constantly, that this is temporary, I will go back to a normal everything. I won't give in to this, I will not allow it to define me !! Yet I do know that others do. It's important to not, I believe. To live your life as fully as you can, to find reasons to smile even when you are in pain and to continue to find a way to 'get it gone' (scared off from using the word Cure). Thank god for support, information and those who sacrifice for us. I have a few here that love me and who I love, it would be a lonely world if I shut myself down like I sometimes feel like doing. I cannot thank Dr Dahlman enough for what he's done already to help me. I am excited about the process, even if some days I am irritable, bloated, sick, nausous and wanting to cut my intestines out to escape the pain. Journaling helps, I recommend it, along with Backfire's suggestions to meditate.Has anyone heard from Lek/Kel lately ?????????


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## eric (Jul 8, 1999)

"All I know for sure, Eric, is that I s**t my pants for 10 years and haven't for over 4 years, now."Mark, you didn't do Dr Dahlmans treatment! Yet yopu got better? That says something in and of itself.For some IBSers, about 5% it goes away on its own. You are also not giving the brain as much credit as it deserves in IBS.Why do people get better for three months regarless of the treatment?Why is there a 30 to 80 percent placebo rate in IBS, think it has something to do with the brain and IBS?Gret, go to pubmed and type in IBS and leaky gut.Not one article in the national library of medicine comes up? Why is that?Then just to humor me, try looking at all these abstracts on IBS and abnormalities. Page after page http://www.docguide.com/news/content.nsf/A...52568880078C249 I am very happy people feel better, but that has nothing to do with what I am saying here and what Dr D is doing on the internet.There are also numerous reasons why people can feel better with IBS from someone helping them and reassuring them and using basic methods on the gut. It also make a big difference if you believe what your being told.


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## Arnie W (Oct 22, 2003)

Eric, weren't you listening? Dr Dahlman has left us. You don't need to bother sabotaging this thread any more because he won't be responding.I feel so disappointed with your deliberate attempts to disrupt our 'sharing' thread, which was intended to be a respite from the infighting of the other Dr D thread. You were asked ever so politely to refrain, or to at least make your postings brief and relevant. But, no, it was your duty to protect gullible, easily led victims from a charlatan. If you sabotaged this thread we would all be confused and might not end up being misled. And, horror of horrors, we might even be cured, and, as we all know, people with IBS don't get cured, or maybe they didn't have it in the first place. I feel very sad for you, eric.Daisy, gsdl is the great smokies laboratory which Dr D uses for his stool tests. Backfire, there will be a sample for you in the next post.And I, too, have been wondering and worrying about kel. Hope everything is OK.


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## missdiane (Mar 4, 2004)

Daisyp, sorry, I have'nt read your post sooner, it is was spring break here and I had a lot of children to look after this week. Sorry, I had to laugh when you said "insurance and rich husbands". I don't know what led you to believe I have either one. I am also one of the unfortunates that don't have insurance. All my Drs. visits meds, everything comes out of our pockets, cash or check. My husband is retired and on a teamsters pension and I own an operate a home childcare. All 7 of my







children are on dhs, so that means I am paid by the state of Okla. which is not very much. That is why I watch were my money goes. That is the reason why I joined this imformative group. To find what other people have dicovered to help themselves instead of paying out all this money to Drs. and other people that are out there to make a buck off my pain and discomfort. As far as the "bitchin" goes thats your opinion.


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## eric (Jul 8, 1999)

Mark, on thinking about what you said here.""All I know for sure, Eric, is that I s**t my pants for 10 years and haven't for over 4 years, now."So you are cured of all IBS symptoms? Did you only have D, did you have pain?But then I don't understand why your hanging out here and made this comment?"This website may well be held together by people who are actually not looking for a way out."No need to be sad for me Arnie. Someday maybe you will understand or maybe not.Your sharing thread carries over to the whole bb with inaccurate information he supplied or in the case of IBS hasn't supplied any real factual IBS information, if fact he called things IBS that ARE NOT IBS, but other medical disorders. You don't see a problem in that? for example, is the best treatment approach to a person who was abused and has IBS, inaccurate information and probiotics and enzymes? Does that get to the root causes they feel more pain and have more suffering? Will that cure them long term?Not to discount the placebo however.I can give you many more examples then that.I am not the only one who feels this way, but I seem to be the only one saying it, which is to bad. Experts don't call IBS any GI complaint. You don't see a problem in that?In three years if everyone is cured, well then we could talk about it and he could be published in the medical journals and a cure can be found for all IBSers. But it hasn't even been four months and already not everyone has been cured? Nor is it likely he can cure every gi complaint, considering he doesn't research them or call them what they really are, you don't see a problem in that?"easily led victims from a charlatan"Why would you use those words?Maybe more accurate to say easily lead non IBS experts, by a non IBS expert!If there is a cure found for IBS, this BB will know about it, the bb goes further then you know into the IBS community and research from actual experts. Not to mention, there will be more then one approaches to subgroups of IBSers to cure different physiological problems and some of those problems are molecular and not completely understood yet.also"Definition of Health: The World Health Organization.Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. "This also has to be considered."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"Dr Drossman is the chair of the rome committe to diagnose IBS and the head of sixty international experts around the world Actually studying IBS and connected to research around the world on IBS. We have been told by Dr Dahlman that none of those Doctors are capable of "Critical Thinking" LOLDr Gershon can't do critcal thinking? Well that is so far from the truth it is from a different planet. Its not earth that's for sure."The brain in the gut plays a major role in human happiness and misery. But few people know it exists, said Dr. Michael Gershon, a professor of anatomy and cell biology at Columbia Presbyterian Medical Center in New-York. "He is the father of neurogastroenterology. You don't see a problem in that information. Its stuff like this that is the tip of the whole picture.Read this.The Enteric Nervous System:A Second BrainMICHAEL D. GERSHONColumbia University Once dismissed as a simple collection of relay ganglia, the enteric nervous system is now recognized as a complex, integrative brain in its own right. Although we still are unable to relate complex behaviors such as gut motility and secretion to the activity of individual neurons, work in that area is proceeding briskly--and will lead to rapid advances in the management of functional bowel disease. http://www.hosppract.com/issues/1999/07/gershon.htm Its a little more complicated then probiotics and leaky gut and enyzmes and all IBS being caused by antibiotics. That is not accurate information and people are mislead by those statements. There are also other problems already known, that will not be cured by those approaches."There is a growing understanding of the multi-faceted nature of functional gastrointestinal disorders. Symptoms, behaviors, and treatment outcomes for individuals with these disorders relate to disturbances in gastrointestinal motility and sensation that is effected by interactions that take place via the brain-gut axis. To understand and study these conditions, physicians and researchers must become familiar with evolving knowledge that integrates basic science, physiology, clinical medicine, psychology, and psychiatry. Indicated below are some of the highlights of the presentations at the 4th International Symposium for Functional Gastrointestinal Disorders, which we believe truly reflect the developing areas of research in Irritable Bowel Syndrome (IBS) and the functional gastrointestinal (GI) disorders.""During the last decade the concept of unique bi-directional interactions between the gut and the brain as an important factor in coordinated gut function in health has become widely accepted. More recent speculations have considered the possible role of these brain-gut interactions in brain function and the regulation of emotions. A dysregulation of brain-gut interactions is thought to play an underlying role in the functional GI disorders and may account for accompanying disorders related to emotional states (e.g., anxiety). This session focused on basic physiological principles (i.e., the characteristics of vital processes or functions). " http://www.iffgd.org/symposium2001.html He is not even giving you some or even all of the real reasons they see intestinal permeablity in IBS, which can be do to STRESS and that's from experts who actually research and dissect and study IBS.What does this mean?The second guy is a world expert on Post infectious IBS, you think none of these people have considered bacteria. They study it in depth and look at the actual digestive system under a microscope! There is a lot of research that follows and goes along with these problems and a whole lot of complex research that has already been done and is being done.They also already KNOW specific abnormalites!I bet you don't know who these DRs really are? Yet, people dismiss them for a chiropracter and nutritionists word only? You don't see a problem with that?"Inflammation Moderator: Robin Spiller MD; Panel: Jackie Wood PhD, Mary Perdue MD, Robin Spiller MD The last few years have led to a greater understanding of the role of inflammation in influencing intestinal hypersensitivity in the functional GI disorders. For example, a well-defined subgroup (up to 25% of IBS patients) appear to develop their IBS after an infectious illness. Jackie Wood from Ohio State University, discussed how inflammation alters the neurophysiology of the enteric nervous system (ENS) by activating nerves within the ENS. There are a variety of ENS neurons that can direct responses within the body leading to altered motility, sensation and secretion, and ultimately, symptoms of diarrhea, constipation, and pain. Mary Perdue from McMaster University, Ontario discussed the importance of the epithelial intestinal barrier to maintain immune tolerance to potentially harmful matter, such as bacteria, ingested when we eat or drink. (Everything that enters the human body must pass through an epithelial layer. Various types of epithelial tissues line not only the body cavities, blood vessels, and most organs, but also our outer surface-our skin. Within the intestines, epithelial tissue forms an intestinal barrier involved with absorption, secretion, sensation, contractility, and protection.) Studies in animal models show that psychological stress can disrupt this barrier, leading to the penetration of bacteria into the gut, inflammation, an immune system response (inflammatory cytokines), and ultimately sensitization of neural signals from the gut to the brain that can heighten the perception of pain. Robin Spiller from the University of Notingham, UK brought this basic information to the human model of post-infectious IBS. The predictors of post-infectious IBS include increased life events and psychological distress, female sex, and longer duration of diarrhea episode. In response to bacterial infection, there is an increase in certain gut (enterochromaffin) secretory cells (5HT producing) and inflammatory cells (cytokine producing) leading to prolongation of pain and diarrheal symptoms, and this may be aggravated by the presence of psychological stressors. These findings suggest ways in which infection-induced inflammation might interact with chronic stress to produce long lasting bowel dysfunction. They also suggest possible treatments that need study. "What about all this info?"Introduction Irritable bowel syndrome (IBS) is a chronic condition characterized clinically by altered motility, pain, and diarrhea and/or constipation. Current thinking attributes the chronic symptoms of IBS to intestinal motor, sensory, autonomic, and central nervous system (CNS) activity.1 Our understanding of IBS has evolved over the years from a model based primarily on disordered motility to one that incorporates dysregulation of brain-gut function in terms of gut hyperreactivity and enhanced visceral sensitivity to stressors and altered CNS processing of visceral afferent information.2 top Physiologic and Psychological Stress Early experiments showed that stress had demonstrable effects on motility, revealing that the gut is an effector of emotion.3-5 An enhanced intestinal motor response has been observed in response to psychological stress, meals (the gastrocolic response), balloon inflation, and cholecystokinin.1 Balloon inflation studies of the sigmoid colon, ileum, and colorectum demonstrated that IBS patients had enhanced responses to distension and experienced pain at significantly lower pressures and volumes than control subjects did. IBS patients have also demonstrated enhanced sensitivity to physiologic functions (spontaneous migrating motor complexes). IBS symptoms often follow or coincide with a stressful event. Stress-induced gastrointestinal (GI) symptoms are common in the general population but appear to be amplified in patients with IBS. In a questionnaire survey, 73% of subjects in the IBS group (persons who had not sought medical care for IBS) and 54% of control subjects reported that stress altered their stool pattern; 84% of IBS subjects and 68% of control subjects reported that stress brought on abdominal pain.6 A recent prospective study by Bennett et al showed that over 90% of the variation in IBS symptoms was related to severe, prolonged stressors.7 top Psychosocial Factors Prevalence and impact. The connection between psychological disturbance and GI symptoms is well documented.1,3 Depression and anxiety are the most common psychological disorders in IBS patients.8 Research has shown that the frequency of psychological difficulties in patients with IBS seen in referral practices ranges from 42% to 61%,9-11 which is substantially higher than in IBS patients seen by primary care physicians or in persons with IBS who do not seek medical care (IBS nonpatients). When investigators analyzed the association between psychological features and health care utilization, they found that IBS patients had a higher frequency of personality disturbances and lower positive stressful life event scores and that they more commonly exhibited illness behaviors than both IBS nonpatients and normal control subjects (p 0.001).11 IBS nonpatients have psychological profiles similar to those of control subjects and have greater coping abilities. Conversely, patients who frequently seek medical care, regardless of their diagnoses, typically show a high frequency of psychosocial difficulties.1 These findings suggest that although psychosocial factors are not a part of IBS, they interact with other mechanisms of IBS, such as physiologic abnormalities in the bowel, CNS disturbances, and genetic factors, thus affecting the experience of the illness and the outcome (Figure 1).1 Sexual and physical abuse strongly linked to illness outcome and behavior. The link among psychosocial disturbance and illness outcome and health care utilization is supported by a study of the association between sexual and physical abuse and GI disorders.12,13 The frequency of a poor outcome was higher in persons with an abuse history, independently of demographic factors and diagnosis. A history of abuse was present in 44% of women seen at a GI referral practice; the prevalence was higher in patients with functional disorders (53%) than in patients with structural disorders (37%). The frequency of rape or incest was 31% for patients with functional GI disorders compared with 18% of patients with organic disorders. This relation has been confirmed in subsequent studies. A study by Talley et al found that functional bowel disorders were 2.8 times more likely in patients who reported a history of sexual abuse.14 A more recent study using a comprehensive interview showed that independent of GI diagnosis (ie, whether disease was functional or organic), abuse history is strongly predictive of adverse outcome (pain scores, functional status, psychological distress, physician visits, and surgical procedures) among women seen in a GI clinic.15 Symptom severity related to psychosocial disturbance. The frequency of an abuse history increases with increasing severity of IBS, with the highest frequency of abuse reported in patients from a GI referral practice.12,16 These findings indicate that a history of abuse translates to an increased risk for pain, greater disability, and a higher level of health care utilization. Regression analysis of data from our institution showed that behavioral factors were the strongest predictors of health care utilization and the number of days in bed among patients with moderate or severe IBS. 17 Although patients with severe IBS reported greater pain intensity, there was no significant difference in visceral sensitivity, as measured by the tracking volume or pressure at pain threshold between moderate and severe patients.17 Thus, behavioral and psychosocial constructs appear to be important determiners of the severity of symptoms. top Can Stress Predict IBS? A study by Gwee et al of patients who developed postinfectious IBS after acute gastroenteritis is the first study to suggest that psychosocial distress may predict the development of IBS symptoms.2,18 Gwee et al reported that 22 (23%) of 94 patients with acute gastroenteritis developed IBS, as diagnosed by the Rome criteria. IBS symptoms were significantly associated with psychosocial difficulties; pre-existent life stress and hypochondriasis were the strongest predictors of IBS. Patients with acute gastroenteritis had increased rectal mucosal inflammation, which persisted at 3 months only in those patients who developed IBS. At 3-month follow-up, patients with or without IBS who had had gastroenteritis showed physiologic evidence of gut dysfunction compared with healthy controls, but there were no significant physiologic differences between patients with or without IBS. These findings suggest that psychological factors may activate the perception of these physiologic changes as symptoms. The increase in inflammation may be a sensitizing event that is perpetuated through a brain-gut-cytokine connection in persons with stress.2,19,20 top Implications for Treatment The synergistic effects of physiologic and psychosocial factors on symptoms, the severity of illness, and illness behavior highlight the importance of taking both physiologic and psychosocial factors into consideration when planning a treatment strategy. Patients with mild symptoms, who are usually seen in the primary care setting, may respond to patient education and dietary and lifestyle changes. Patients with moderate symptoms usually have intermittent, sometimes disabling, symptoms that are correlated with gut physiology.1 These patients are candidates for pharmacologic agents that target gut physiology (anticholinergics, antidiarrheal agents). Patients with severe symptoms may show a response to a multicomponent strategy: pharmacologic agents directed at the gut, behavioral or psychological interventions, and, possibly, long-term therapy with antidepressants. top Efficacy of Psychological Treatments Psychological treatment has been shown to be of some benefit to patients who have moderate to severe IBS symptoms in conjunction with psychological disturbance.1 A number of modalities are used in IBS patients, including interpersonal (dynamic) and cognitive or cognitive-behavioral therapy, relaxation therapy, hypnosis, biofeedback, and relaxation and stress management techniques.1,9 Hypnosis, relaxation therapy, and cognitive behavioral therapy, alone and in combination, have been found to reduce anxiety and other psychological symptoms and to improve pain and diarrhea.9 Guthrie et al reported that psychodynamic therapy combined with medical therapy was superior to medical therapy alone for improving pain and diarrhea and psychosocial factors such as depression and anxiety21 and that patients who participated in a prolonged course of psychotherapy showed a sustained improvement in symptoms.22 top 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://216.109.117.135/search/cache?p=dros...=858DAE39E2&c=4 82&yc=9573&icp=1[/URL]Calids remarks"Sometimes it's as simple as cutting out lactose, or cutting out fructose, or gluten, "well that can help if those are your problems, but they are not IBS or the cause of IBS! This is an IBS BB. When will he address IBS for you? and daisys comments."HA HA HA, I am getting a kick out of the boldness of the postings here, so funny. Eric, why do you bother anymore here? Dr Dahlman has already said he's off this board so you are preaching to faces turned away from you. We are laughing at you, poking fun at you, have you had enough yet ? "I take IBS and IBS suffering to seriously to let those kinds of comments bother me from someone who does not understand IBS. Who knows daisy, you might be back reading the information I posted you have skipped over now in the future.


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## eric (Jul 8, 1999)

By the way, after thirty plus years of severe IBS pain predominate alternating c and d, diagnosed by numerous GI doctors, I can now eat candy, pizza, popcorn and fast food as well as most other foods, only a few foods bother me now and when I get any symptoms and most have disappeared, they are very mild gi upsets.


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## Gret (Sep 23, 2003)

There are times when Eric is helpful. Thanks for the information regarding Pubmed. These articles support Dr. Dahlman's protocol. Way too much to read, however.Everyone interested in Dr. Dahlman's patients: Maybe we should all seek help from Jeffrey Roberts and ask that Eric be banned from just this thread. Then perhaps Dr. D will come back and help those that would like some assistance. I think everyone benefits from the experiences of others. Something Dr. Dahlman may say to someone may be of help to another. Then you would not have to contact the doctor privately and we could all see your results here. If you agree, send a private message to Jeffrey Roberts and ask that Eric be banned from here only.


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## eric (Jul 8, 1999)

"These articles support Dr. Dahlman's protocol. Way too much to read, however."Gret, post some that do, because that was what I was asking him to do? I am all for research and studies and any scientific based knowledge from actual researchers.By the way I have read almost every article in pubmed on IBS. Along with almost every IBS article on the web in the last four years and the Gastroenterologists IBS intiative for doctors and much much more? I believe also that Jeff, tries to promote accurate information on IBS. I am not sure if he saw the comments from Dr D, IBS is "any GI symptoms" or that Dr D can make everyones symptoms disappear, but I would imgine he would have a problem with that also.You might also want to read the recent article in Canadian Health Magazine Jeff contributed too. http://www.ibsgroup.org/other/CdnLivingpMagFeb2004.pdf


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## eric (Jul 8, 1999)

I might as well put this here too.FYI 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. http://www.med.unc.edu/wrkunits/2depts/med...idc/sitemap.htm


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## missdiane (Mar 4, 2004)

Gret I don't think it would be right to have Eric banned. He has just as much right to be on this thread as anyone else. I came on this thread to get info about the Dr. and he did answer my questions. Don't you ever ask question of your physicians or practioner, or do you just blindly follow? I have a good relation with my Dr. and he doesn't mind answering my questions. Many other people like me are in a quest to find relief from our suffering. I did get some hostile reaction because "I had the nerve" to question the Dr.. According to the Dr. even if I wanted to try his program I wouldn't be a likely candidate because my digestive system has surgically altered. Eric posts are helpful, as people can see both sides of the coin and make their own decisions. If you don't like what Eric has to say why not just scroll past his posts?


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## Gret (Sep 23, 2003)

I do scroll on past. The only reason I brought it up is that Dr. Dahlman cannot come on here w/o being attacked and it is helpful to all concerned to read what he has to say to someone else. A lot of people have been helped. Just trying to keep that clear and not befuddled with all the lengthy posts. Which we've all seen numerous times. I have found information that Eric has provided helpful at times. But there is obviously antagonism between he and Dr. Dahlman and many here have suffered because of THAT!


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## AlphaMale (Jan 21, 2004)

this is not a happy ending of the thread, I was hoping to conclude something mor meaningfull.Sorry I could not add value, I will not read this thread again.


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## daisysp (Jan 13, 2004)

I am so very disappointed we no longer have Dr D on here as that was the whole idea of this particular thread. I love to be able to post my results and hear others, yet Eric takes up so much space with non-sense most of us (most) dont' want to read. If his postings weren't here, we would only be on page 2 of good information. I don't blame Dr D for deciding to not deal with it, I get so frustrated myself having to scroll down so far to get to someone reasonable.He can be on other threads, we've asked him to not be here......so MISSDIANE you can find him somewhere else easily, we DO have the right to ban him from this as we've asked him politely for so long, to no avail. I just wrote to Jeffery Roberts and I hope all the others will also so we can get back to the basics of information that will help, and feedback that pertains.I myself and not sure how I am doing right now. I have gotten so extreme with my diet and am fine with it. It's a mindset to be so very exact with every ingredient you put into your mouth. I still dont' feel like I get full evacuation with myBM's though and that is the most frustrating !!! I am getting alot of reading done in the bathroom though, just being patient and waiting. Maybe I should use that time to meditate, haha. Want some relief soon, it's hard to smile some days yet I do because others in my life dont' need to ride the roller coaster with me.


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## daisysp (Jan 13, 2004)

Does anyone have Kel's personal e-mail ?? Maybe Dr D can contact her for us, I will write to him and ask.aj


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## overitnow (Nov 25, 2001)

I sent a PM asking her how whe was doing. So far have heard nothing. Hopefully that is good.Mark


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## missC (Oct 16, 2002)

i don't know. i've heard that somebody who shall remain nameless (but i'm sure we all know who i mean) does his best to get anyone he regards as an 'enemy' (gawd, what a mindset) deep in it with their ISP, even banned and service withdrawn if he can. might explain the silence. thanks a lot buddy. how come it's never the people who wouldn't be missed? hem hem.


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## calid (Aug 4, 2003)

Daisy: We as Dr. D's patients can and should still post our results, how else will we really find out if his techniques work? If Gret hadn't posted, we wouldn't know that she had gotten better. Keep the thread going, all updates are important.


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## Arnie W (Oct 22, 2003)

I have pmed Kel too. I made contact with her in the past this way once, so I hope it gets through to her.Yes, I'm sure that Dr D would be able to contact her and let her know that we are concerned.


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## daisysp (Jan 13, 2004)

I wrote a long letter to Jeffery so I hope something gets done. I wrote to Kel also, and will write to DrD about her tonight, just to see if there is any info.I am so tired of this IBS !! Some days I feel like not even leaving my bed. I don't even want to get up and walk to the kitchen or bathroom. I hate this so much today. Every time I eat something my intestines get into a bunch, like my body reacts when I eat now. Was nice to stay home today though cause I was able to be in the bathroom all day.Arnie, how you been ??


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## missdiane (Mar 4, 2004)

I know Eric does go on, to tell the truth I read the 1st paragraph, then I scroll down and try to catch bits and pieces of what he posts. His posts do become overwhelming at times. But, he does have his points and he feels he is doing a service to the "newbies" who come to this thread. Dr.D has the choice to come back. He can ignore Eric and scroll past his posts. But isn't everyone entitled to freedom of speach whether you agree or disagree with what a person has to say?







Jay, has been a thorn in my side since he came on here but he has the right to make a fool of himself and show his ignorance, that his right as long as he keeps his obscenities, and his idiotic cures to himself.


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## Arnie W (Oct 22, 2003)

Daisy, Dr D has received the results of my stool test, but I haven't seen them yet. I'm continuing with food experimentation, and beginning to discover more about what my food triggers are.I, too, feel disappointed, (no, gutted would be a better word), about what happened on this thread. Granted, eric is most generous with his time, especially to newbies, and I give him credit for that.But there are two bones I have to pick with eric.1


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## Arnie W (Oct 22, 2003)

Daisy, Dr D has received the results of my stool test, but I haven't seen them yet. I'm continuing with food experimentation, and beginning to discover more about what my food triggers are.I, too, feel disappointed, (no, gutted would be a better word), about what happened on this thread. Granted, eric is most generous with his time, especially to newbies, and I give him credit for that.But there are two bones I have to pick with eric.1 He deliberately destroyed the flow of the thread to make it less coherent2 He seems to think that we are infantile creatures who will be cheated by a charlatan (you have virtually accused Dr D of this, eric) if he is not there to protect us.What do you take us for, eric? Why bring in the reference to having possibly been abused in the past? Don't you think that if we had been affected by this (or any other number of things) that we would have had the foresight or intelligence to have already pursued professional treatment or help? I've said it before, I've tried almost every treatment available, including several hundred dollars on hypnotherapy. Nothing helped. Now I'm trying Dr D. It would have been so much easier for my progress if this thread had been just for those who could share how they were going, what changes they were making to their diet, etc.But, no, you were determined that this shouldl not happen. It frustrates me, but I'm not going to let it get to me, because I'll end up giving myself a good dose of D.


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## eric (Jul 8, 1999)

MissC. I hope your not implying I get people in trouble with their ISP, because I have never ever done that in my life. Nor have I ever personally banned a member from this site.Kel's silence has nothing to do with me."i don't know. i've heard that somebody who shall remain nameless (but i'm sure we all know who i mean) does his best to get anyone he regards as an 'enemy' (gawd, what a mindset) deep in it with their ISP, even banned and service withdrawn if he can. might explain the silence. thanks a lot buddy. how come it's never the people who wouldn't be missed? hem hem. "So this, if you are reffering to me is a total lie and totally fabricated.


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## missC (Oct 16, 2002)

eric dear, no, it wasn't you i was thinking of, nor you i'd heard that story about. but why, i wonder, would you assume it was?and why such a paranoid and aggressive response? i don't remember you reacting with such vehemence to your good buddy flux's positively libellous signatures...


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## BackFire44 (Nov 19, 2003)

In all fairness to eric, missC, it seemed to me as well that you were specifically talking about him. Let's stop the ad hominem attacks, alright? We can all disagree on something and not have to start calling each other names. Although, considering that this is the internet, perhaps we aren't all adults.







Maybe Kel/lek is just feeling better? We can all hope. Nice to know people get missed, though!BackFire44


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## SpAsMaN* (May 11, 2002)

I found outrageous to not get an update on a cure.


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## brushie (Jul 17, 2002)

hiits time for an update on my progress. wrote another 2 weeks ago but it didnt appear. i must have forgotten to click the post button. stupid me!!heres my last one on the board: http://www.ibsgroup.org/ubb/ultimatebb.php...204;p=12#000446 after the call i talked about in the last update we agreed to suspend the enzymes for some days. i recodnized less energy and more dizzyness. so i restarted the enzymes and it got better again. so te enzymes work on my overall feeling then i suspended the probiotics for 5 days too: no difference. i also reduced the carb intake for 1/4.but the bloating is still worse. it could come from the herbs, i will know when i stop them.another possibility is that it comes from the absence of an probiotic i was taking for appr. 1 year and wich i had to suspend. i sent dr.d some info about it and am allowed to take it again now.in a few days i will finish the antibac. herbs and then start with the ultra clear sustain. unfortunately the herbs after 2 mounths didnt work on bloating, so the bacs might not be the main problem or the herbs werent strong enough? dr.d suggestts now to make an allergy test, and i`m awaiting his reply if they gsdl ships it to austria too.the slight constipation has gone again. i still have to clean less but the stool is still mushy. i re4lly hope my probiotic will decrease the bloat again. its an enteroccocus strain. anyone else experience with that ?no weight gain so far but i have a bit more power when doing sport.i didnt read all the posts here jet, but it seems that the thraed isnt about the Topic: Dr Dahlman Program Users Updates. sad that this isnt possible!hope all others are improoving!!!brushie


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## daisysp (Jan 13, 2004)

Brushie, you are right,this thread isn't being what we want it to be......and I will name names, Eric is making a mess of it all. I wish folks would stop responding to him. MissDiane, you can find Eric on many other threads, he is so not welcome here. Yes he's got the right to be here, yet we've specifically asked him to depart !I am thrilled to see folks give updates,that makes it easier to keep up with my own process. I wish it would be more cut and dry though with, feel yuck to clean junk out and then slowly start feeling better and better. Yet it's a puzzle the whole way through. Today I feel better than I have in a few weeks. I went off my Ultra Flora DF for a few days as I forgot it at home and wasn't here for 3 days. (did have comuter access yet not home-fridge access). I feel less bloated now, so wonder if it was doing that to me. Always in the past I have gotten bloated from acidophilus and any other intestinal repair products. I dont' know if the enzmyes are making me feel sick,so will try not taking them for 2 days to see. I get nauseas in the mornings and need to figure out why cause it's really not fitting into my work schedule.I hate the gut ache after I eat !! It's so much easier to not eat !


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## Gret (Sep 23, 2003)

Daisysp, I felt when I first started that the Metagest made my stomach hurt. I cut them in half and that helped that a lot. Then when I had a particularly hard to digest meal, I took a whole tablet. Does that help at all? Hang in there, your system has been out of whack for quite a while, it'll take some time to adjust everything!


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## missC (Oct 16, 2002)

la la la WHATEVER. eric, re-reading this thread i can see how you might have thought i meant you. perhaps that's not a very flattering thing to say - just because you've disagreed with people (and boy, have you ever!)doesn't mean those with whom you've disagreed would assume you capable of such behaviour. but the context was unfortunate, and for that I'M SORRY. not shouting there, just emphasis. i don't say that very often - make the most of it!however, backfire, a description of an alleged behaviour (on the part of anyone) doesn't constitute an ad hominem attack. i wasn't disparaging anybody's arguments by means of an attack on their character. if you mean it would be a pity to let negativity and rumour play a part in the intercourse of the forum, then fair point. but you may be a little late there already... it's also cozy for some individuals to cloak scummy behaviour in silence, thinking nobody knows. i'm sure we can all think of examples in public and private life. is that preferable? certainly i'll concede neither option is especially palatable.


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## daisysp (Jan 13, 2004)

Thanks for the encouragment, I am keeping on. I think I need to take more enzymes per meal, to speed up my transit time. I asked DrD about it. I got my Ultra Clear Sustain today, yet read it's mostly Rice based, and I have a real bloating problem with Rice, so don't know what to do there yet. Again, I wrote to Dr D and asked him. I know I should go back on my Ultra Flora DF yet like not feeling so bloated. Maybe I need less. I definitly need to not take it on an empty tummy in the morning cause that is what was causing my nuaseasness. I usually do well until about 2-3 pm, then I go downhill and feel ucky all evening. That sucks ! If I dont' get my workout done early on, I may as well kiss it goodbye. It's hard to be calm sometimes, I want to just scream and lose it at times. I am working on Meditating little bits constantly to calm my insides and relax. Thanks again Backfire for reminding me to do so.


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## Gret (Sep 23, 2003)

Anybody heard from kel/lek???


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## calid (Aug 4, 2003)

Gret, I'm starting to get concerned about her.


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## Gret (Sep 23, 2003)

Calid, me too. She hasn't shown interest in any of these threads. I've searched around a bit for her. What do you think?Anybody?


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## kel1059 (Feb 28, 2003)

Hello everyone,Greetings to all my online friends – gret, calid, arnie, jhouston, daisy, brushie, backfire, missC and any I missed.For a while I was doing perfect but it slipped a little. Presently I am eating foods that I have not been able to eat in years. Overall this is the best that I have been in 20 years. I will add that in 20 years I have never had a single remission; my symptoms were every day. The suffering was great. (Ibsacol made a huge difference in terms of stool formation etc, but the food hypersensitivities were still fully in place)I wish that I could give all the credit to dr dahlman but I can’t. I definitely think that his human strain probiotics have made a noticeable difference in me but I am convinced that classical homeopathy is the main difference maker for me. There is a reason why it is the 2nd most practiced healing art in the world today and that is because it works. It is dismissed as a sham by many of the scientific types of the Western world but that is only because they do not understand how energy medicine works. I suspect that there is something operating at the quantum level but I really have no idea what it might be.Anyway, I still believe in the intestinal dysbiosis model. I think that this is an area that absolutely needs to be addressed. My concern is that correcting this problem might be a difficult thing to do – not sure though. Supposing that a person has been assaulted for years by endotoxins from bacteria then it could take a long time for the immune system, body, and brain to recover.In my case, I know that my immune system is messed up. It seems to be correcting itself though. I still question the role of viruses, mycoplasma, and other pathogens –but as long as I continue to improve I won’t have to worry about the actual cause of my troubles.I am fairly certain that if people download dr d’s paper and follow it to the best of their ability then they will experience a good deal of improvement. If some stubborn symptoms persist then they could address the problem from an additional approach. I happen to believe that acupuncture, HT, meditation can make a difference. In fact I just finished reading an interesting article in Discover on how meditation can actually change the brain. I believe that a multimodal approach is going to give the best results.


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## calid (Aug 4, 2003)

Even if she'd been booted, she could go to another computer and re-enroll under a different name and at least let us know she's ok. I fear something's wrong, or maybe she just went on vacation. Strange, though, that she wouldn't tell anyone.


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## Arnie W (Oct 22, 2003)

WELCOME BACK....like a breath of fresh air!!I'm so glad that you are making progress.


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## Gret (Sep 23, 2003)

kel - wait! What kind of classical homeopathy are you talking about??? You saw a specialist? Was is supplements or what? I am SO glad you are doing well!


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## Gret (Sep 23, 2003)

I've been thinking about what kel said regarding Dr. Dahlman and homeopathy. I still think that once she stopped taking all the stuff she was taking and limited herself to one plan of attack, she started to get better. Dr. Dahlman got her to stop the madness with the mile-long list of supplements she was using! Perhaps a combo of the two approaches helped, I don't know. How could your body know what to do with all the stuff she was putting in? Kel, if I'm wrong, let me know. I just think the turning point was Dr. D's program. If nothing else, you got your body clear of all the stuff you were putting in!


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## eric (Jul 8, 1999)

FYIIrritable bowel syndrome: a model of the brain-gut interactions.Mulak A, Bonaz B.Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland.Brain-gut interactions are increasingly recognized as underlying pathomechanisms of functional gastrointestinal disorders. Bi-directional communication between the central nervous system (CNS) and the enteric nervous system (ENS) occurs both in health and disease. Various CNS- and gut-directed stressors stimulate the brain-gut axis. Processes modulating responsiveness to stressors along the brain-gut axis involve neural pathways, the immunological, and endocrinological mechanisms. Disturbances at every level of neural control of the gastrointestinal tract can affect modulation of gastrointestinal motility, secretion, immune functions as well as perception and emotional response to visceral events. ENS function, central processing, and autonomic regulation play an important role in the brain-gut dialogue. Stress and emotions may trigger neuroimmune and neuroendocrine reactions via the brain-gut axis. Various non-site specific neurotransmitters influence gastrointestinal, endocrine and immune function, as well as human behavior and emotional state, depending on their location. The physiology of the digestive tract, the subjective experience of symptom, health behavior, and treatment outcome are strongly affected by psychosocial factors. Recently, a biopsychosocial model of IBS containing physiological, emotional, cognitive and behavioral components has been proposed. Rapid progress in neurogastroenterology, using new brain imaging techniques, should bring better understanding of the brain-gut axis and open new therapeutic perspectives.PMID: 15039657


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## SpAsMaN* (May 11, 2002)

Kel,why you don't give the name of the homeopathicproduct you take?


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## daisysp (Jan 13, 2004)

Thank goodness Kel is alright and doing well !! That is so great to hear. I have been feeling awful myself, such an upset intestinal track. It feels like I am getting worse, yet not sure if that is just because I need to be more patient, or if I am clearing stuff out, or if I really am getting worse. I didnt' think it could get worse and I feel that is so unacceptable. I am still taking all the Dr D products yet he's stopped talking to me for the most part. I may have bothered him as I have many questions and want to know the details about what I am doing and why, yet I hate the silence. I will assume he's just been real busy, it makes me feel better. I jsut started the Ultra Sustain today. I hope it works for me as Rice is a major trigger food, and it's rice based. I do feel less nauseas since stopping the last of the Ulta Flora DF, less bloated and such also.Anyone else have a report.


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## Arnie W (Oct 22, 2003)

I heard from Dr D about 3 days ago and it appears that I will need to use anti-bacterials. I have not heard back since, but I am itching to get on with it.I don't think that my self-imposed, severely- restricted diet can be very good for me long-term and I look forward to the day when I might be able to have a much greater variety in my diet.Hoping that Ultra Sustain works for you. It certainly seems that there can be a die off period before improvement occurs.


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## Kacebece3 (Apr 17, 2002)

I have been using Dr. D's protocal with the ultra flora plus and a antimicrobial. Had to stop using the Sustain after two days to much disscomfort. I'm having some progress,need a lot more but its to early to make an accurate evaluation. Dr.D has responded to my emails Ken


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## BackFire44 (Nov 19, 2003)

Sorry to hear you are still having trouble, Daisy. Dr. Dahlman won't talk to you? Do you mean he is just slow in returning your phone calls? That is very troubling. I hope my enthusiasm for Dr. Dahlman being so attentive wasn't misplaced. BackFire44


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## daisysp (Jan 13, 2004)

I have heard from Dr D, guess he's just really busy and when I am in a bad way, I hope for a quicker response. I do remember he is offering me free advice, and I don't want him to not think I do not appreciate it immensly.......yet if I am feeling so awful and not knowing what steps to take, well I guess I should write a letter, be patient and then journal in my personal IBS journal.....and Breathe ! The Ultra Clear and the Ultra Flora both caused me bloating. I am still using the Ultra Clear as he said I should keep going for a bit with it.........yet it's tough to carry on when I feel so bloated and thick. IT impacts my daily life so much to be in that state. My diet is so very limited due to numerous food allergies, so when I feel bloated I cannot eat. This further limits my calories I take in. He wants me to eat more, yet cannot when I am full of air and gas.Feeling stuck and very very frustrated. I do not blame his program at all ! If I feel upset in my intestinal tract, I get so irritated, anxiety big time and hopeless.How's that for an update ?!


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## Gret (Sep 23, 2003)

I'd say it's an up-to-the-moment update, Daisy. I hope the bloating goes away soon. It's funny, I'm usually sensitive to supplements like these, but I had no problems other than the tummy aches after the meta-gest. That went away pretty quickly too. Anxiety and irritability all goes with the territory. There were days I didn't feel like even trying to get things done. Right now I'm planning my summer continuing education trip. Last year when I got home, I swore I wouldn't go again. My entire trip was ruined by IBS. Now I can't wait to settle on a course and go! Amazing how much better I feel 9 months later! I haven't had a bout of D since before Christmas. I'm still amazed and relieved! Hang in there, anyone who is still having troubles. You will get well.


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## daisysp (Jan 13, 2004)

Thanks for the encouragement. Has anyone tried a juice fast to clean 'things' out ? Probably no one with D, yet manybe those who have C like I do ? I was thinking a fast of sorts, with broth, non-sugar vege juice and the Ultra Clear plus supplements, for about 10 days to clean my system out and allow the intestines to rest while healing. I have fasted before and it feels great after about 2 days.


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## daisysp (Jan 13, 2004)

Am wanting to read my article, yet cannot download it. I have tried so many times, and the one sent to me via e-mail came with only the title, no article........and brought a pop up with it that wipes out my whole screen. I really want to read it !! Man, these computers.I dont' think I can fast though, I get so friggin hungry cause I workout so much. I am staying off the Ultra's until I get Dr D a stool sample to see what is up down there. I get such a gut ache when I eat anything, and so much bloating from the Ultra products. Arnie, did you get your results back yet ??? Do we know what is going on with you ??


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## Arnie W (Oct 22, 2003)

I assumed that the local distributor who arranged my test would have received my results, but I talked with him today and he has nothing to report to me yet, even though Dr Dahlman received the information several days ago. That is the frustration with being so faraway, as supplements, etc, seem to take so long to arrive. Anyway I know that Dr D has recommended some herbs which are used for urinary problems, so that's interesting. Actually I urinate heaps, so there could very well be a link-up with my digestive problems. Daisy, I mentioned on another thread that I'm gradually re-introducing vegetables and fruit. I'm not sure where I'm heading. It will be very much trial and error. Maybe you have some suggestions, but I think that salad veggies might be the safest option at this stage. I've been eating lettuce and tomatoes - so far, so good.Overall, I'm feeling much more at ease, especially when with other people, and I am going for long periods without having to have a bm. My main problem is leaky gas, which is very difficult to evaluate, but everything else is plodding along quite nicely.Good luck to everyone.


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## BackFire44 (Nov 19, 2003)

For the Dr. D afficianados out there -- wasn't there something in his paper about IBS and a histamine reaction? I ask because we were discussing it on another thread as it seems a number of people can get rashes or itchy skin with IBS. Or, Eric, maybe you know?BackFire44


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## Gret (Sep 23, 2003)

Yes, page 11 and 12 of his article speaks of Histamine. I will re-read it and try to put it out there for you later when I get a chance.


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## eric (Jul 8, 1999)

There is a lot of evindence right now in IBS research around the world that chronic stressors in IBS patients, either conciously or unconciously perceived activates the HPA axis -hypothalamic-pituitary-adrenal - and this activates mast cells in the gut to release histimine. The release of toxins from the mast cells effect the smooth muscle and its believed this is in part what causes pain in IBS. Chronic stressor can activate this system without a pathogen!!!Years of research have already gone into this and it is a very hot topic in IBS research right now.


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## SpAsMaN* (May 11, 2002)

Eric,bladder overflow irritate the bowel surfaces and the bowel is unable to heal himself because of the waste around.That's the cause of ibs.


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## Gret (Sep 23, 2003)

Hey, Calid. Any changes? Hope Daisysp is feeling better. Arnie, did you ever figure out what your "diagnosis" was on your little protrusion problem?Hope everyone has a great weekend!


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## BackFire44 (Nov 19, 2003)

Hi Gret -- good to hear from you. I take it from your post that you are still doing great







BackFire44


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## calid (Aug 4, 2003)

Hi Gret, glad to hear from you. My second stool test has showed even more bad bacteria. The next step is to try an antibiotic regimen to clear everything out and try to rebuild the good bacterias. I could tell things weren't going well, but the Dr. is working diligently with me to try and find out what the problem is, which is FAR more than any gastro has ever attempted to do. I firmly believe we can figure this out, it's just frustrating. So in 2 weeks, after the antibiotic therapy, we do a new stool test to see if things are dead.


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## Arnie W (Oct 22, 2003)

My protrusion went down before I had my doctor's appointment, gret, but at least I was told that it wasn't a hernia. All I can think was that I was impacted because I've allowed myself so little fibre recently, so I'm gradually increasing my vegetable intake now.Interesting point, calid, and I agree so much that what Dr D is doing far surpasses what most practitioners have ever done for me. For those who slam him because he is not a medical doctor and because he is working with us (note, that I did not write 'diagnosing') over the internet, if your practitioners have been as diligent, then all well and good, but mine, generally speaking have not been. The processes he uses seem to make a lot of sense.


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## Gret (Sep 23, 2003)

I'm glad you guys are still positive about getting well! A good perspective helps a lot. I'm continuing to feel great! Some days I think about how I was just months ago and I can't believe it!


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## daisysp (Jan 13, 2004)

I haven't been online for quite awhile to this site, glad to hear so many people are doing well or in the process of getting on track. I am awaiting my stool test from Dr D as the Ultra Clear Sustain and the Ultra Flora both gave me so much bloating and gas. With the other little pills I take 20 min before eating, I have to definitly eat in that 20 min or I get really nauseas. I also found that I need to really relax myself inside before I take a bite of something. My system is so used feeling aweful after I eat, that I find I tense up before eating, my heartrate goes way up and I get anxious. Also, after I eat, I need to just sit and relax things inside down; laying down is a good option if I am at home. I am down to 4 very tiny meals a day so I can have at least one good BM in the mornings (I am C so having a BM is a godsend !). If I eat more than that, I feel bloated and need my nightly assistance to be able to go.I am so looking forward to the stool test (alright, looking forward to seeing whats in there, not taking the sample). As soon as I eat anything, I get a gut ache and we all know it takes hours to get down that far. I feel like I am upsetting the colonies living inside me, ha ha.Arnie, I would not start your vege trip with salads as they tend to be really hard on IBSer's. Since you wrote that awhile ago you probably have already gotten going on it, yet that is my advice. Start with easier vege's like zuchinni, summer squash, mushrooms and green beans. I envy Gret feeling so great and having to remember she's somewhat over things. Am thrilled for her, and will look forward to asking myself when was the last time I had pain when I ate ? When was the last time I got all bloated ? Will be so cool !!Hope to hear from you all soon,aj


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## BackFire44 (Nov 19, 2003)

Let us know what the stool sample says, Daisy. Be careful that you don't fall into the IBS trap of just not eating to feel better. In the long run, that will hurt your body a lot more. BackFire44


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## daisysp (Jan 13, 2004)

So, you read what I wrote to DRO. Well it's so easy to not eat as it feels so much better. About 2pm every day is when I start to feel so awful and it goes downhill from there. The two days a week I work evenings, I stay clear of most foods so I won't be too hurting to work. I guess I didn't realize it was so common to not eat with IBSers, I am learning so much about how many of us suffer the same. I didn't have much to eat today, yet am so crampy feeling........and I have to work tonight. Will lay down for a bit. That though is a big deal. I am such a high energy person when I feel good (and used to be) that I feel so guilty to not be out doing something unless it's pouring rain or snowing. It's a nice day, and was yesterday also. I was stuck in yesterday from a breakfast that made me sick. Sucks !! We went out to a country diner for breakfast as we were around friends, I could not just forgo eating. I did the best I could yet there really aren't many choices if you can't eat salads or protein.Sorry, to be dumping today, I am aching and I hate to talk much to my boyfriend about it cause I hate to come across as sickly. I am supposed to represent health, so it's hard to accept feeling bad. Will send off my pooper scooper tomorrow, and Dr D said to all him 10 days after I send it to set up an appt to discuss the findings.Arnie, have you found out yet ?????????


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## Arnie W (Oct 22, 2003)

Daisy, I do feel for you. Keep your head high. We've got to exterminate this beast. I managed to find out that, because I had asked the local agency to send a copy of the stool test results to Dr D, they assumed, in their wisdom, not to send a copy to my distributor. So I should get it any day, and will let you know.My body's taken a bit of a battering because I went overboard with re-introducing the vegetables, but it does feel good to be eating them again and I'm not feeling so blocked up now.


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## daisysp (Jan 13, 2004)

Great to hear you are eating vege's again !!!! If I had to eliminate all vege's I would starve to death as thats about all I can eat. I do miss being able to eat Brown Rice though, it was a staple I liked at least.I sent off my sample today, so will call DrD in 10 days. You would think I would not have an issue with collection, being as I am so 'personal' with my BM's anyhow, yet I gagged and had to breath through my mouth the whole time. Funny ! Amazing how many poop jokes we've come up with here at my house, and rating farts on a number scale (1-10) so as to keep things light hearted. My boyfreind works with two guys (cops) who have IBS and yet won't deal with it, so they are out sick all the time, or get sick so easily after they eat dinner out. I guess some folks wish to stay in denial for a time. Like I said before, I thought I was the only one on the planet like me, now I feel like I have this big family out there who I didnt' know existed.


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## ibsjohn (Jan 25, 2004)

I am 2 months into Dr D's program, going it alone and am feeling much better. I had gas, bloating and discomfort. I havn't followed everything to the T, but have been pretty good about it. I am working on cutting back on some of the meds and was wondering what experience everyone had. I found meds at another store cheaper so it took some of the financial discomfort out of it. Really, I feel much better than I have in many years. I had one doctor taking my gall bladder out, but cancelled my app. at the last moment. Good for me based on what I hear. Good Luck


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## Kacebece3 (Apr 17, 2002)

Hi there ibsjohn, I also am going it alone, but not totally, DrD has responded via email. For me a stool sample was called for but cant afford it so we are guessing at witch antimicroboals to use. I fit class 2 in the stuborn problems outline in the protacal. My progress is not as good as yours but I'm not giving up yet. Been following the protical about 4 weeks now.Ken


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## Gret (Sep 23, 2003)

John and Ken, I'm glad the program seems to be working for you. John, the meds I found the least helpful were the Intesol and the Azeo Pangen. What probably got me through the best was initially the Ultra Flora and the Ultra Clear Sustain. I am almost done with my last tub of Ultra Clear Sustain and I'm feeling really well. Some days I forget to take it because I'm not thinking about IBS. You may or may not be having trouble with digesting your food. If you are, you'll need the enzymes. I don't know that I needed them that much, although I plan to use enzymes when I eat a heavy meal. So far I haven't needed anything. I'm back on dairy (though probably not as much as I used to eat!), and nothing seems to upset my system anymore. Try to be diligent with the diet too. I think that really helped me a lot. Good luck!


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## BackFire44 (Nov 19, 2003)

ibsjohn, I hope your doctor wasn't going to take out your gallbladder just to see if that helped your IBS! If you have gallstones or some problem with your gallbladder and your doctor wanted to take it out, you might reconsider. However, I'm glad you know that it very well could have a lifelong effect and could make your symptoms worse. It doesn't happen with everyone, but I think its a lot more than the 10% the doctors quote.Arnie, I know how you feel. When I started to feel better on Levsin months ago, I tried to reintroduce too much and paid the price. Then, when I started to feel better on the Questran, went out and ate pizza. In general I think the GI system just takes a long time to adjust to things. Hope you are doing better now.Daisy, my heart goes out to you every time I read your posts. I really think that you'll look back over these posts sometime in the near future and barely remember how bad you felt. Its a long frustrating process to find a remedy that works for you, but it is out there. I hope Dr. D will be able to shed some light on your situation. BackFire44


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## ibsjohn (Jan 25, 2004)

Ken, I believe that someone said it was about 300 US$ to get a stool sample done. I haven't got one done yet, but plan on getting my dr recommend one and the insurance co will pay. That's the plan anyway. I think persistance is the key and finding the right niche for each indivual to fix the abnomally.Gret, I have just ordered some more meds and after this I will look at dr d's list again and try to decide. I think you may be right on the enyzmes and perhaps I'll experement in a while but don't want to rush into it since I'm doing pretty good and feeling much better. Sounds like you are doing good, that's great.Backfire, yes, they wanted my gallbladder out because of the bloating etc. I was 2 days away from losing it, but got gun shy. Yes, I've heard that once one has their gallbladder removed, their diet is much more restrictive etc....Have a great day.JOhn


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## eric (Jul 8, 1999)

from what it looks like, out of the orginal five people that tried this program, which is questionable for sure, one got better, when its advertised everyone does and they will have no symptoms and DR D has said he can cure every IBSer?Gret, so far is the only one I have seen better with what she says are no symptoms.Two dropped out that I know of and some others have not said anything and some are still in rough shape.I also think its very questionable to guess what "witch antimicroboals to use."especially since DR D's theories do not add up to the problems in IBS and current state of the art IBS research?


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## BackFire44 (Nov 19, 2003)

True, eric, but I believe that others have posted that they are feeling better generally. Let's give it some more time before we make a conclusion. BackFire44


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## eric (Jul 8, 1999)

Backfire, doesn't it concern you any that people are getting inaccurate information on IBS from Dr D over the internet?


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## calid (Aug 4, 2003)

Innacurate? Dr. Dahlman has been working with me for the past few months, trying to figure this thing out. My stool tests showed a heightened amount of bad bacteria, we tried clearing it up with supplements, but found that the bacteria had thrived instead. So now I'm on Cipro, an antibiotic and I've been symptom free for 3 days now. As far as I'm concerned, YOU Eric are the one giving out innacurate information. If I'd have listened to you, I'd still be having horrible IBS attacks.IBSJohn: the lab that the dr. uses is different somehow in they way they test. The regular lab that my gastro used, twice, showed no bad bacteria. Be sure and get a recommendation to a more sensitive lab.


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## Jhouston (Nov 9, 2003)

Calid, How are you with Cipro? I mean what are you taking it for? I have just had Floxin which in the same category of drugs for a urinary tract infection and feel back to square one with gi symptoms. I am thinking the drug wipes out "bad bacteria"? my stool test did not show bad bacteria but didn't show good bacteria/flora much either. I had a different GI symptom the other day....nausea. Joann


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## TheSerialKiller (Apr 8, 2004)

some wories about cipro http://www.ibsgroup.org/ubb/ultimatebb.php...t=037361#000000


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## calid (Aug 4, 2003)

J: I've been doing quite well on Cipro. I read all the directions which call for lots of water.I can't believe the difference in how I feel, I actually had a trigger food yesterday and no reaction at all. I'm also taking the probiotics to help counter all the killing that's going on.Serial: Yes it's a worry, but so is Tylenol and Aspirin. I'm not usually a medication person, in fact I don't ever take Tylenol/Asprin but when this is a possible cure for me, I'm taking it. I'm just being careful with the instructions to minimize any problems that may occur. Thanks for the link!


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## Kacebece3 (Apr 17, 2002)

Thanks for the post Ibsjohn and about the antimicrobials,( for Eric) I am the one doing the guessing because of lack of funds. These are herbal preparations that have been shown to have antimicrobial activity.


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## eric (Jul 8, 1999)

Who says altered flora or bacteria causes IBS calid? Other then it being DR D's THEORY?Its is only a part of a bigger problem. Who is prescibing the antibiotics to you calid, your doctor? Are you working closely with your doctor while you work with DR D?Why do the majority of real doctors treating IBS not prescribing antibiotics to all their patients?What information would you have listened to that I promote, that would give you or would be promoting you to have attacks?The problem in part is you don't understand what they already know about IBS.Accurate IBS information does not cause IBS attacks.You all have been convinced your troubles and all IBS is bacterial in origin. That is not the case in IBS research.You can yell at me all you want, it won't change the research on IBS. Maybe if it was understood better it would make more sense however.


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## Kacebece3 (Apr 17, 2002)

Eric you do not understand what this thread is about. This is as simple as I can make it for you.If one can give the human body the best chance to heal itself, the body will stive to do just that. We can only hope the bodies we live in still have that ability, so why not give it a chance? Sounds like good old horse sense doesn't it? Ken


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## eric (Jul 8, 1999)

Okay a new study. Which should be taken with quite a bit of caution as to its meaning."2004-03-31 'Leaky gut' leads to irritable bowels Tainted water tragedy yields new explanation for common intestinal condition A "leaky gut" could help explain why some people develop irritable bowel syndrome (IBS) after an intestinal infection, says a researcher who studied victims of the tainted water tragedy in Walkerton, Ont.Seven people died and more than 2,000 were sickened when the town's water supply was contaminated by E. coli bacteria in May 2000.Some residents continue to suffer from IBS, a condition characterized by abdominal pain, diarrhea, constipation and bloating."One of the frustrating things with IBS is people can describe the symptoms, but clinicians struggle to find the source and explanation for these symptoms ... so patients feel they're dismissed," says Dr. John Marshall, an assistant professor of medicine at McMaster University in Hamilton. "It can be a nuisance or quite disabling, and many people in Walkerton remain unwell."Marshall is the lead author of a new study that may help explain how those symptoms start.The study involved 132 Walkerton residents with IBS and 86 residents without the condition. Average age was 46 years and about 60 per cent were female.Nearly 36 per cent of IBS cases had abnormal intestinal permeability, or "leaky gut syndrome," a condition in which the lining of the intestines allows more bacteria, toxins and food to leak in and potentially irritate the deeper tissue layers. In comparison, less than 19 per cent of non-IBS participants had a leaky gut.Marshall says his findings represent only a small piece of the entire IBS puzzle, but he hopes they will provide the basis for future research in the Walkerton population. "This at face value may sound like all IBS is leaky gut. However, 19 percent of the people here without IBS had "leaky gut" And only 36 percent with IBS had "leaky gut" and may have other molecular changes in the digestive tract not mentioned in this article, but mentioned in a lot of previous work in post infectious IBS.Also why more women then Men?Even this doctor studying it is saying it is only a "small piece of the entire IBS puzzle."They know from previous work in Post infectious IBS that there are cellular changes in the digestive tract and an increase in Mast cells and EC cells, and the ec cells release serotonin and that intiates contractions and they know there is a problem with that casuing motility issues, in IBS. They also know that the HPA axis is involved in IBS and is directly related to those cells in the gut but also to stress and infection, which the HPA axis is involved in both fighting infection and also the fight or flight or a "threat to the organism.""Inflammation Moderator: Robin Spiller MD; Panel: Jackie Wood PhD, Mary Perdue MD, Robin Spiller MD The last few years have led to a greater understanding of the role of inflammation in influencing intestinal hypersensitivity in the functional GI disorders. For example, a well-defined subgroup (up to 25% of IBS patients) appear to develop their IBS after an infectious illness. Jackie Wood from Ohio State University, discussed how inflammation alters the neurophysiology of the enteric nervous system (ENS) by activating nerves within the ENS. There are a variety of ENS neurons that can direct responses within the body leading to altered motility, sensation and secretion, and ultimately, symptoms of diarrhea, constipation, and pain. Mary Perdue from McMaster University, Ontario discussed the importance of the epithelial intestinal barrier to maintain immune tolerance to potentially harmful matter, such as bacteria, ingested when we eat or drink. (Everything that enters the human body must pass through an epithelial layer. Various types of epithelial tissues line not only the body cavities, blood vessels, and most organs, but also our outer surface-our skin. Within the intestines, epithelial tissue forms an intestinal barrier involved with absorption, secretion, sensation, contractility, and protection.) Studies in animal models show that psychological stress can disrupt this barrier, leading to the penetration of bacteria into the gut, inflammation, an immune system response (inflammatory cytokines), and ultimately sensitization of neural signals from the gut to the brain that can heighten the perception of pain. Robin Spiller from the University of Notingham, UK brought this basic information to the human model of post-infectious IBS. The predictors of post-infectious IBS include increased life events and psychological distress, female sex, and longer duration of diarrhea episode. In response to bacterial infection, there is an increase in certain gut (enterochromaffin) secretory cells (5HT producing) and inflammatory cells (cytokine producing) leading to prolongation of pain and diarrheal symptoms, and this may be aggravated by the presence of psychological stressors. These findings suggest ways in which infection-induced inflammation might interact with chronic stress to produce long lasting bowel dysfunction. They also suggest possible treatments that need study."However, inflammation does not totally explain IBS. The cells they see inflammed in IBS which is very different then inflammatory bowel disease in the digestive tract on the microscopic level are mast cells which can be inflammed by chronic stressors without a pathogen. When degranulated they releases toxins onto the smooth muscle and this is believed to contribute to the pain in IBS. A lot of research has been done on all this, when a person gets an infection, it infllames the gut and alters the cells in the gut, but then the inflammation resolves and they are left with cellular changes still and chronic stress can reactivate the inflammation of the cells in the gut. The two important systems in all this are the serotonin system and the HPA axis system, both of which are connected and are connected to stress, not the kind of stress people think about though and previous infection.However, the bigger picture isMed Sci Monit. 2004 Mar 23;10(4):RA52-RA62. Epub ahead of print Related Articles, Links Irritable bowel syndrome: a model of the brain-gut interactions.Mulak A, Bonaz B.Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland.Brain-gut interactions are increasingly recognized as underlying pathomechanisms of functional gastrointestinal disorders. Bi-directional communication between the central nervous system (CNS) and the enteric nervous system (ENS) occurs both in health and disease. Various CNS- and gut-directed stressors stimulate the brain-gut axis. Processes modulating responsiveness to stressors along the brain-gut axis involve neural pathways, the immunological, and endocrinological mechanisms. Disturbances at every level of neural control of the gastrointestinal tract can affect modulation of gastrointestinal motility, secretion, immune functions as well as perception and emotional response to visceral events. ENS function, central processing, and autonomic regulation play an important role in the brain-gut dialogue. Stress and emotions may trigger neuroimmune and neuroendocrine reactions via the brain-gut axis. Various non-site specific neurotransmitters influence gastrointestinal, endocrine and immune function, as well as human behavior and emotional state, depending on their location. The physiology of the digestive tract, the subjective experience of symptom, health behavior, and treatment outcome are strongly affected by psychosocial factors. Recently, a biopsychosocial model of IBS containing physiological, emotional, cognitive and behavioral components has been proposed. Rapid progress in neurogastroenterology, using new brain imaging techniques, should bring better understanding of the brain-gut axis and open new therapeutic perspectives.PMID: 15039657"Scientists believe IBS symptoms are due to hypersensitive nerves that misfire pain signals to brain regions that register pain sensations. Research has shown that these pain signalsï¿½triggered by intestinal contractions, stress, hormonal changes, food and bloatingï¿½activate a different pattern of brain activity in people with IBS than in individuals without IBS.These findings suggest that IBS involves "faulty wiring" of nerves connecting the gastrointestinal tract and the brain. "and back to one of the worlds leading authorities on IBS and the chairman of the Rome committe to diagnose IBS and an expert on digestive conditions."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 It is quite possible that the chronic stress of having IBS, allows for gut permeability for one. It is also quite possible that altered motility of the intestines can predisposes a person to altered gut flora.


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## Jhouston (Nov 9, 2003)

Eric, you want to know 'who says altered flora causes IBS'? Nobody! What you are calling IBS is a set of symptoms. There are books by drs about these same symptoms not calling it IBS. Go to any bookstore or healthfood store. It has been the theory for many years, at least 30+ as far as I recall. Joann


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## eric (Jul 8, 1999)

Joann, not quite sure what your actually trying to say?But"What you are calling IBS is a set of symptoms"They are a very specific set of symptoms to diagnose IBS or to diagnose something else. When those cluster of symptoms are seen together it is a more positive diagnoses of IBS. "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%.12""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: 1. Relieved with defecation; and/or2. Onset associated with a change in frequency of stool; and/or3. Onset associated with a change in form (appearance) of stool.Symptoms that Cumulatively Support the Diagnosis of IBS: Abnormal stool frequency (may be defined as greater than 3 bowel movements per day and less than 3 bowel movements per 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. Supportive Symptoms of IBS:1. Fewer than three bowel movements a week2. More than three bowel movements a day3. Hard or lumpy stools4. Loose (mushy) or watery stools5. Straining during a bowel movement6. Urgency (having to rush to have a bowel movement)7. Feeling of incomplete bowel movement8. Passing mucus (white material) during a bowel movement9. Abdominal fullness, bloating, or swellingDiarrhea-predominant: 1 or more of 2, 4, 6 and none of 1, 3, or 5; or: 2 or more of 2, 4, or 6 and one of 1 or 5. (3. Hard or lumpy stools do not qualify.)Constipation-predominant: 1 or more of 1, 3, 5 and none of 2, 4, or 6;or: 2 or more of 1, 3, or 5 and one of 2, 4 or 6." http://www.ibsgroup.org/main/diagnosis.html with permissionIrritable 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 Characteristicsof IBS The IFFGD""Irritable Bowel" refers to a disturbance in the regulation of bowel function that results in unusual sensitivity and muscle activity."Syndrome" refers to a number of symptoms and not one symptom exclusively.""The symptoms of IBS are produced by abnormal functioning of the nerves and muscles of the bowel. In IBS there is no evidence of an organic disease, yet, something -- a "dysregulation" between the brain, the gut, and the central nervous system -- causes the bowel to become "irritated," or overly sensitive to stimuli. Symptoms may occur even in response to normal events. " http://www.aboutibs.org/characteristics.html


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## eric (Jul 8, 1999)

"Gastroenterology Expert ColumnDiagnosing Irritable Bowel Syndrome: What's Too Much, What's Enough?Posted 03/12/2004 Susan Lucak, MD IntroductionIrritable bowel syndrome (IBS) is the most common gastrointestinal disorder diagnosed in clinical practice in the United States. Because there is no biological marker to confirm the diagnosis of IBS, it is a diagnosis that has challenged clinicians for decades. In the past, IBS was a "waste-basket" diagnosis given to patients with unexplained gastrointestinal symptoms. It was considered to be "the diagnosis of exclusion" when extensive work-up for organic disease yielded no diagnosis. *In recent decades, it was recognized that patients with IBS experienced a constellation of specific gastrointestinal symptoms.* Manning criteria were described in 1978,[1] followed by Rome I in 1989[2] and Rome II criteria in 1999.[3] Rome I and Rome II criteria were initially developed by multinational working groups to provide a framework for the selection of patients in diagnostic and therapeutic trials. These criteria are being continuously modified as we gain new knowledge about functional bowel disorders.Recently published diagnostic guidelines[4,5] recommend using symptom-based criteria in making the diagnosis of IBS in clinical practice. Using these criteria in conjunction with "alarm features" allows a physician to minimize the extent of diagnostic testing needed to make the diagnosis of IBS. Furthermore, recent systematic review of the literature indicates that performing a number of diagnostic tests did not result in a significant increase in the diagnosis of organic gastrointestinal disease.[6]This column discusses novel approaches to the diagnosis of IBS."


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## eric (Jul 8, 1999)

http://www.medscape.com/viewarticle/465760


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## daisysp (Jan 13, 2004)

I scroll, I scroll and I scroll...........then I get to read something. I wish we could have a button where we can click on Eric's info if we want it, otherwise it only shows as a blip on the page. I totally agree you need to let Dr D do your lab test as his results will be much more complete than your average doctor of western medicine. I paid less than 300.00 for my test, and awaiting the results.Funny, Cipro made me so very very sick when I took it two years ago for a bladder infection, yet I did feel better once it was all over. Then I got the bladder infection a few times more as my flora was gone..........so I took other antibiotics to get rid of it and things got so out of hand. I dont' remember what antibiotic I took 8 yrs ago to get rid of the Ecoli that started this IBS (and a very huge day of stress that kicked it all into place); I can find out though. I wonder what my stool sample will show as every supplement (besides Azeo-Pangen) causes me to be bloated. Getting off Intensol and Candibactin was a big relief yet I did them for the time I was supposed to. I am feeling so much better now, barely eating yet that works for me cause my transit is so friggin slow !!!! If I eat more than the 600-800 calories a day I am doing , I get bloated and constipated. I am off my cleanser I take at night also, so I really need to be so very careful.Thanks Backfire, the support and help you all give me keeps me going in the biggest way. I cannot thank you all enough even so far. I wish I could give out some hugs !!!!!!!!!!I have sent a few folks to Dr D, folks I know and a client of mine, and they are so happy already ! No one else has claimed to be able to confidently help us, I wont' slam him in any way. I dont' care if he's a veterinarian..........or a monkey doctor, he's smart and is helping people who gave up hope and who have found no other outlet. I wish he would come back online.........he can just scroll down past Eric's stuff like I do; we need to ask him to please come back and offer his comentaries.


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## overitnow (Nov 25, 2001)

Just for what it is worth--and you probably already know this--there are now cranberry extracts to treat bladder infections.


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## daisysp (Jan 13, 2004)

Thanks so much for your comment.........I take Cranactin daily now religiously, and haven't had any issues with it since. I also take a Kidney supplement daily so I stay healthy 'down there' in every way I can. Thanks again !!


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## daisysp (Jan 13, 2004)

One more posting for tonight..........what I meant was I wouldn't care if I found out Dr Dahlman was a Veterinarian or if he was a Monkey Doctor, cause he's got a program that helps and possibly cures this lifechanging illness. Obviously he's very educated and a doctor of respect on many levels, so that just makes it easier to respect his information. Some days I really don't want to do all the things I need to do with this, yet I have faith in his program, I have to have this faith or I will feel hopeless and depressed.I also wanted to re-iterate that any time I have taken antibiotics I feel so much better, so symptom free, that I was almost feeling like I was hooked on them. I think the doctors thought I was also after a while ! I kept going back after the bladder infections were gone, yet I was still hurting, and it was the IBS. I just felt so good on the drugs. Then, I got the nasty side effects from having used the drugs.........what a nasty circle !!Still wondering how Kel is doing, we haven't heard from her in so long.


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## Jhouston (Nov 9, 2003)

Eric, You are putting me on, right? go back and read what you wrote to Calid....then read my response. it seems clear. Joann


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## BackFire44 (Nov 19, 2003)

Eric,There are some things about Dr. Dahlman that concern me, but I don't take the view that you do. It concerns me that he is a bit of a salesman. Obviously everyone on here knew that when he said he could cure 100% of people that it just wasn't true. But it makes me glad that he is an attentive doctor who has been able to get to the bottom of some of the people's problems here whose own doctors have failed them. Yes, technically IBS is not a bacterial infection or a lack of good bacteria. IBS is not a histamine reaction. IBS probably is not caused by antibiotics. However, many people on this board don't have IBS. They have gastrointestinal problems. Lazy doctors of theirs have labeled their problem IBS, told them to take two Fibercon and never call them again. Dr. Dahlman at least works with the patient to try to identify the problem.I think his "solution" to IBS is partly helpful and partly unnecessary. But where you and I differ in our views of Dr. Dahlman is that I see that he has helped some people that haven't found help in years and say it can't be that bad. The fact is that he does help isolate certain problems that people have. His "solution" does get people on an IBS friendly diet and helps them to identify triggers. His attentiveness does make people feel confident and that they have hope. Do I care that he doesn't really understand IBS? Somewhat -- but as long as he is helping people I can overlook that. He's helped Gret completely. He's helped others somewhat. That's why I said let's wait to see what happens.The minute I hear that he has not given a refund to someone who deserves it or that he is not treating people nicely or fairly I will change my mind and join you. I haven't heard one complaint so far on this board, though. BackFire44


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## Jenny Snell (Sep 14, 2003)

Eric - I don't care that Dr Dahlman is not an MD. My own doctor said I had to live with it because there is apparently no cure. The hospital did loads of tests and could find nothing wrong with me. None of them bothered to check my bacteria levels or even thought about it! They were all qualified MDs!! I bought loads of books about IBS and read all about brain/gut axis and loads of technical jargon about it. Then I came across Dr Dahlmans programme, which to me made total sense! I followed it by taking the enzymes, acidoplilus & bifidus and altered my diet by excluding dairy, etc and, Hey Presto, for the last five weeks, life has been normal. I don't even think about a toilet now! Dr D talks common sense. You don't need to be an MD to work it out. I have since spoken to many therapists working with alternative medicine and they all say it's to do with chemical imbalance, etc. The only ones who don't seem to know this are the MDs!!Even the NHS in the UK are now saying that Antibiotics destroy the friendly bacteria in the gut. Antibiotics have been handed out so readily; food goes through so many processes with chemicals and additives being used; water has chlorine added to it.....and so on - Is it no wonder our digestive systems are having problems?


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## eric (Jul 8, 1999)

Why is calid about to start antibiotics? Who is prescribing them?It may make sense to you, but not the big picture in IBS.There are reasons simple things will make big differences.Killing all the bacteria will lessen the gas from bateria and that can make you feel better, but is that the cure to IBS. NO!"Even the NHS in the UK are now saying that Antibiotics destroy the friendly bacteria in the gut. "It destroys all bacteria! They have known this for a long time know.They know reasons why people get IBS now.If they did blood and stool samples they checked for bacteria and infection.The brain/gut axisIncorporates all these problems.some antibiotics have prokentic effects.There is no cure, because they have not yet nailed the eact cause causes down yet, but they know way more then most people thing they know about IBS. Dr Dahlman has left a TON and I mean a ton of information out of his sales pitches.The brain also still is in charge of infection.How much do you really know about post infectious IBS Jenny?as Dr dahlman said on a previous thread and I quote " IBS is all gi complaints" This is a total joke and not helpful and clearly innacurate.There are twenty functional conditions alone and things like IBD which is a gi complaint is not IBS. Gi disease are not IBS.Backfire, "he said he could cure 100% of people that it just wasn't true."That is all I needed to hear along with the total lack of expert information on IBS and his ego, as well as his sales pitches.Do you think he would put on his website now, he can't cure everyone with IBS, somehow I doubt it.If you only count success then you can have 100 percent. LOLMoney back, does not help the damage to someone who may try it for months and find out it didn't work, physcologically this is damaging to an IBSers. They may also not even mention it.IBS is still really misunderstood. It has been a brain gut problem now for over seven years.


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## Jhouston (Nov 9, 2003)

Eric, Don't take this the wrong way. but I have been biting my lip for awhile when reading your comments. I thought about hp tapes at first, but the way you go on and on it makes me wonder What else is in those tapes? It gives the impression you have been brainwashed. It is scary....or OCD? Please do not be offended by above. I am having heart palps saying this. It does a dis-service to the cause 'hp tapes' sincerely, Joann


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## Jhouston (Nov 9, 2003)

If I could delete the above message I would. Sorry


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## daisysp (Jan 13, 2004)

Backfire, do you honestly believe that Dr Dahlman doesn't understand IBS ? I have studied this for so many years, as have probably most of us here, and I feel he's got a good handle on GI issues in general. Much more than any of the 22 doctors I went to see, that is for sure !!Jenny Snell, I haven't seen you here before, welcome !!JHouston, why would you have wanted to delete your comments to Eric ? My hope is enough people will write to him, put him in his place, he'll decide he's not wanted on this thread.Like I wrote to Dr D, Eric is so defined by his IBS, he's got no life without it. He would be lost if he was 'cured' or without symptoms daily, hourly or monthly. I do not allow it to define me, I intend to find a way for it to no longer be a part of my life. That is why I believe those who are on this thread are so devoted to a process of healing; we do not define ourselves, describe ourselves, by our GI issues. It may impact our lives, yet it is not who we are. It IS WHO ERIC IS.Amazing how even such a little piece of wheat toast upset my tummy today. I had like 1/2 a very thin slice of wheat free bread.........yet it had other grains in it to be sure, so it was a no-no. For lunch I had two bites of my son's whole wheat pita bread with my vege's..........an hour later and upset tummy from the both of those. Jeez !! Gonna go have lobster feed tonight, all fish actually, and vege's, no breads. Glad I will be home all day tomorrow for my yard sale, so I can purge it all out, ha ha.


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## Jhouston (Nov 9, 2003)

Daisy, The reason I would want to delete above is I do not know what is going on in someone's life that is online.....I did not want to put Eric or anyone else in their place. I basically stated what is going on in my mind by what I am reading. Joann


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## eric (Jul 8, 1999)

Jhouston, I have spent the last four years after helping myself first, helping IBSers, starting and teaching the first in my state IBS suppport groups and at hospitals, but it is not my job, even though I have actually been payed to teach IBS. I have read more then you will ever know about IBS. I have attended expert lectures and have made friends with some of the worlds leading authorities on IBS. Why, because I have had it for over thirty years and I can and have helped thousands of people with IBS, but more importantly because I had to help myself. However, in no way does IBS define me, it use to, but it does not anymore. I do this to help people and that maybe hard for a lot of people to understand. People here think I am attacking them, I am not. I am in remission, because I now know enough about IBS to treat myself. I know why I got it, I know what I have and I know what is going on in regards to my IBS and how to treat it. I have three jobs a great and supportive family and a lot of fun in my life. I am not complaining about eating a small slice of wheat toast and then someone saying IBS defines me. I understand the big picture of IBS more then most people on this thread even could guess at. IT can take many years to learn IBS research. Perhaps if people actually took the time and understood all I have been saying it would be a lot more understood where I am coming from, and I am certainly not the only one believe me, I am just the one voicing it.I eat basically whatever I want and do anything I want and have turned totally severe IBS completely around.This has nothing to do with the tapes in the slightest. It would be your loss or anyones not to try them. They have already helped thousands of people and all you do is listen, no major diet changes, no drugs, nothing, just listening. No expensive supplements to buy ect. IS it a cure no, does it help everyone, almost, actually a very high percentage, some majorally, like myself and others and its been researched for over fifteen years now successfully for IBS. They also use it to study IBS.These were the last to people to post to the HT and cbt success thread. I have also done more for HT and IBS then almost anybody but the researchers. It is a validated treatment for IBS.These are the last to posts to the thread of successes and you can read the whole thread yourself if you want."I haven't posted to any of the message boards for the past few months and felt kind of bad! I posted a lot more when I was feeling bad, but when I started feeling better, I quit. I want to encourage people to use the hypo CD's. I finished using them about two months ago. I didn't see any difference for the first 2/3 at least of the program, but now I haven't had a stomach attack in about 3 months. I'm eating pretty normally - I follow some of the IBS diet as needed (mostly low fats, no salad, no chocolate, low insoluble fiber), but otherwise can eat quite a bit of normal stuff. I've had IBS for 35 years, since I was 10. I'm not saying my stomach always feels completely fine, but it's not enough to change my life much anymore. I honestly wonder if the hypnosis can really do this, but I didn't do anything else different!! Hope this encourages all of you who are doing the program to keep at it!Lori ""Just thought I'd tell everyone that it has now been 3 years since starting Mike's tapes and I am still totally symptom free and like a new person.I have been having some other health problems lately and it appears that I will have my Gallbladder removed. The HIDA Scan yesterday to check for Gallbladder function took two hours of laying still under a Gamma-ray camera, something I could never have done while still suffering IBS/D problems.I sure suggest that anyone suffering IBS symptoms give themselves what I consider my best gift. Get Mike's tapes and start on the path to a better life.Norb ""FYIZ Gastroenterol 2003 May;41 5:405-12Hauser W.Medizinische Klinik I, Klinikum Saarbrucken gGmbH, Saarbrucken. w.haeuser###klinikum-saarbruecken.deHypnosis is one of the oldest remedies against physical diseases and mental disorders of mankind. The term hypnosis is used for the description of a technique as well as for the description of an altered state of consciousness which is induced by this technique. Hypnosis is a scientific tool in psychophysiological studies of gastrointestinal functions secretion, motility, visceral sensitivity and their processing in the central nervous system. Hypnosis is an empirically validated treatment of the irritable bowel syndrome even refractory to medical treatment which is recommended by international expert groups Rome II and the British Society of Gastroenterology.""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 do you really know about gut directed HT for IBS, because I have studied it throughly in regards to IBS along with every other possible IBS treatment in the research and everything about IBS that's been published. This is not about the tapes at all, it is about accurate IBS information for all people with IBS!!!!Advances in Irritable Bowel SyndromeLecture series http://www.conference-cast.com/ibs/Lecture...dRegLecture.cfm With permissionIrritable Bowel Syndrome at a Glance - Nosology, Epidemiology, and Pathophysiology (Monograph I)Inflammation Intestinal inflammation can cause neurological changes with effects on GI motility and visceral perception. Structural changes to the enteric nervous system are not restricted to areas of active inflammation. Functional abnormalities can persist long after resolution of the inflammation. Many patients with acute gastroenteritis develop chronic functional GI symptoms. Brain PhysiologyStress reproducibly alters gastrointestinal motility and sensation. The release of corticotropin releasing factor from the hypothalamus may mediate the stress response. Brain centers important in mediating visceral pain include the thalamus (general sensory), insular cortex (visceral sensory), anterior cingulate cortex (general pain awareness), and prefrontal cortex (general pain processing). Visceral pain in IBS is associated with increased prefrontal cortex activation. The normal correlation between subjective pain intensity and activation of the anterior cingulate and insula cortices is lost in IBS. The limbic system is involved in emotion, mood, and visceral autonomic control. Limbic abnormalities are seen in depression and IBS. Thus, this system is a possible site of convergence where emotional disturbance provokes intestinal dysfunction. Psychosocial FactorsIt is no longer reasonable to discriminate between physiological and psychological factors; both are operative in IBS. It is likely that dysregulation of the ï¿½brain-gutï¿½ neuroenteric systems, rather than the presence of structural disease, promotes the development and persistence of IBS. While psychosocial factors are not part of the diagnosis of IBS, they have a significant effect on gut motility, symptom experience, and health outcome. To legitimize the condition, it is essential to continue research-based efforts to challenge the myths associated with IBS. NosologyFunctional GI disorders are sub-classified according to the regions involved. There are no biologic or pathophysiologic markers by which to define IBS. IBS is characterized by a cluster of certain symptoms; diagnosis is augmented by prudent exclusion of structural disorders. EpidemiologyIBS is common, affecting 10%-20% of adults. IBS overlaps with other functional disorders and symptoms fluctuate over time. The prevalence of IBS is significantly greater in women than in men. A history of physical or sexual abuse is associated with increased severity of disease and greater healthcare utilization. The disorder is common in all ages and ethnic groups. IBS accounts for significant healthcare utilization and indirect costs. Motility and ElectrophysiologyIn IBS, diarrhea is characterized by decreased segmenting sigmoid contractions and an increased frequency in long spike bursts. Constipation and abdominal pain are characterized by increased segmenting sigmoid contractions and an increased frequency in short spike bursts. IBS patients may have diffuse motility abnormalities in the esophagus, stomach, and small intestine. Measured abnormalities in GI motor function do not define IBS. Visceral Sensitivity and PerceptionAltered visceral perception via changes in reflex responses and viscerosomatic referral areas is common in IBS. Both hyperalgesia (lower pain threshold) and allodynia (pain perceived in non-nociceptive pathways) are involved in the development of visceral hypersensitivity. Visceral perception can be modulated by the CNS (e.g., stress, anxiety, and distraction). It is believed that, as a result of central sensitization, a nociceptive memory response is created, which exaggerates and prolongs subsequent stimulation. The pathophysiology of visceral hyperalgesia is incompletely understood and appears to be multifactorial. Irritable Bowel Syndrome at a Glance - Diagnosis and Treatment (Monograph II) DiagnosisThe biopsychosocial model of IBS proposes that symptoms arise from the interaction of a host of biological, cultural, social, interpersonal, and psychological factors. There are no structural or biochemical markers for IBS. IBS symptoms often are non-specific and the course of illness is inconsistent. The Rome II panel defines IBS as a clinical symptom complex comprising abdominal discomfort or pain linked to relief with defecation or associated with a change in the frequency or consistency of stool. A patientï¿½s psychosocial and medical history can provide important diagnostic clues in the planning of care. Once a symptom-based diagnosis is made and the dominant symptom pattern established further evaluation should be conservative and undertaken only as appropriate. Performing extensive laboratory, radiologic, or endoscopic procedures does not establish a diagnosis of IBS; it is unnecessary and may be harmful. Physicians and patients benefit from the formation of an open, interactive, empathetic therapeutic partnership. Positive physician-patient interactions yield improved outcomes. TreatmentTreatment strategies should be based on severity of symptoms: on average, 70% of patients will have mild symptoms, 25% will have moderate symptoms, and 5% will have severe, seriously disabling symptoms. Negotiate an individualized treatment plan with patients and set reasonable goals. Medications and fiber supplements can be targeted at predominant gut symptoms. Psychotropic medications influence functional GI symptoms through direct effects on pain perception and possibly motility, and by improving comorbid psychiatric conditions. At present, tricyclic antidepressants (TCAs) are considered the most useful psychotropic medications for IBS, and in low doses reduce symptoms independent of their psychiatric actions. Novel approaches include 5-HT3 receptor antagonists, 5-HT4 agonists, CCK-antagonists, alpha2 receptor antagonists, and dopamine2 antagonists. Psychotherapeutic approaches, including cognitive-behavioral therapy, interpersonal psychotherapy, hypnosis, and stress management are often effective in the treatment of IBS, either alone or in conjunction with other therapies. Irritable Bowel Syndrome: A Concise Guide for Medical Professionals What is it?Irritable bowel syndrome (IBS), a specific cluster of chronic abdominal symptoms, is the most common functional gastrointestinal disorder. About 15-20% of the general population suffer from IBS, including all racial/ethnic subsets and adult/adolescent age groups. Females predominate, especially among the most severely affected patients. IBS accounts for enormous direct medical costs as well as work absenteeism and other indirect costs. It is one of the most common diagnoses in primary care practice.PathogenesisIBS is not explainable on structural or biochemical grounds. Various pathogenic mechanisms support a biopsychosocial concept: Abnormal motor function Visceral hyperalgesia, the enhanced perception of visceral stimuli Abnormal cerebral processing of bowel stimuli Luminal factors, such as malabsorbed sugars or previous infection Psychological factorsThe multifactorial nature of IBS emphasizes the need for an individualized approach to diagnosis and treatment!DiagnosisIBS usually can be diagnosed confidently by a typical history and limited laboratory and structural evaluation. Careful attention to the description of pain and bowel habit is critical. The characteristic features form the basis for diagnostic criteria developed by multinational consensus.The characteristic symptoms alone do not always differentiate IBS from organic disease, and inquiry should be made about medication use and potential dietary factors, such as caffeine, fructose in fruit juice and sorbitol in artificially sweetened candy. Psychosocial factors, including recent stress, may influence the clinical presentation. Importantly, warning ("alarm") signs that are not attributable to IBS should be sought: weight loss, hematochezia, fever, frequent nocturnal symptoms. Physical examination reveals no explanation for the symptoms.Diagnostic testing should be individualized according to the patientï¿½s age, predominant symptom, severity and duration of symptoms, and presence of psychosocial factors. In primary care, the emphasis should be on minimizing tests in patients with typical symptoms and no warning signs. The evaluation can be limited to that required for the physician to confidently provide explanation, reassure, and initiate therapy.Prolonged, fruitless diagnostic evaluation tends to increase patient anxiety and needlessly raises costs. In young patients, no testing or only basic blood tests, such as a complete blood count and erythrocyte sedimentation rate, may be considered. Other tests, especially large bowel endoscopy or barium enema, may be needed in some young patients and should be used more routinely in older patients.ManagementEstablishing an effective clinical relationship is probably the most cost-effective and beneficial treatment for patients with IBS. The following steps are often helpful in establishing such a relationship: Acknowledge the pain Adopt an empathetic and non-judgmental point of view to maximize the therapeutic relationship Educate and reassure Set reasonable goals Help the patient take responsibility, as by using a symptom diary Know your limitations ï¿½ refer to specialists Most patients (70%) with IBS have mild symptoms and little or no psychological difficulties. A positive diagnosis coupled with education, reassurance, and dietary and lifestyle changes are often sufficient. Patients should be advised to eat well-balanced, regular meals, avoid food fads and excess fat, and reduce irritants such as caffeine, sorbitol, and alcohol. Regular exercise and efficient management of life stress should be encouraged.Patients with moderately severe symptoms (25%) often require pharmacotherapy directed at the gut. Some may be interested in psychological treatment to help manage associated emotional distress, when present.Patients with severe symptoms (5%) commonly have psychological co-morbidities and are more often seen in tertiary referral centers. For these patients, strong reassurance of the correct diagnosis is necessary to reduce concerns and health-care resource use. Antidepressants may be helpful to reduce pain and treat psychiatric disorders. Referral to a mental health professional to help manage symptoms and reduce stress can be useful.Medications for IBS are typically directed toward the predominant symptom, such as pain, diarrhea, or constipation.Pain-predominant symptomsThe most frequently prescribed drugs for pain and bloating are the anti-spasmodic agents. These agents affect motor activity and reduce colonic responsiveness to eating and to stress. In the US, anticholinergics (e.g., hyoscyamine, dicyclomine) are the most commonly prescribed anti-spasmodics. These drugs are best taken 30 minutes before eating. Sublingual and suppository preparations of hyoscyamine are available. Antidepressants are also commonly used to treat pain-predominant IBS symptoms. Of the tricyclic antidepressants, desipramine and nortriptyline tend to have fewer side effects and may be preferred over amitriptyline and imipramine. Dosing of the tricyclic antidepressants is typically in the range of 50-100 mg/day, with starting doses of 10-25 mg/day to avoid side effects. Newer antidepressants, including the SSRIs, may also be helpful in IBS although fewer studies currently are available. In general, dosing for the SSRIs is similar as for psychiatric illnesses (e.g., 10-50 mg/day for paroxetine, 50-200 mg/day for sertraline, 10-40 mg/day for fluoxetine). Recent data indicate that alosetron (1 mg po bid), a 5-HT3 antagonist, can reduce IBS symptoms including abdominal pain in women with bowel habit patterns other than constipation.Diarrhea-predominant symptomsLoperamide (2-4 mg up to qid) will enhance intestinal water absorption, strengthen anal sphincter tone, and decrease intestinal transit ï¿½ thereby increasing stool consistency and reducing frequency. Prophylactic use of loperamide prior to events which typically trigger symptoms may reduce anxiety and increase confidence. In general, loperamide is preferable to diphenoxylate, codeine or other narcotics as it does not cross the blood-brain barrier. Alosetron also can improve stool consistency and reduce urgency in women with diarrhea-predominant symptoms.Constipation-predominant symptomsIncreased dietary fiber can enhance colonic transit in patients with reduced fiber intake (20-25 grams/day). In these patients, supplemental dietary fiber (e.g., wheat bran) or commercially available fiber products (e.g., psyllium, methylcellulose, calcium polycarbophil) should be recommended. Patients who develop bloating and gas with the addition of fiber should be instructed to gradually increase intake from a low starting dose or switch to another form of fiber. Newer agents with prokinetic effects on the colon also are being developed for IBS symptoms. Psychological therapies for IBSPsychological therapies should be considered for patients with motivation to use these non-pharmacological approaches, with refractory IBS symptoms, or with co-morbid psychiatric disorders.The most common psychological therapies used in IBS are stress management/relaxation, cognitive-behavioral psychotherapy, and hypnosis. In general, a psychologist is employed to design and administer these treatments.Rome II Diagnostic CriteriaAbdominal discomfort or pain that has 2 of these features: Relief with defecation Onset associated with change in stool frequency Onset associated with change in form (appearance of stool) Symptoms for at least 12 weeks in the preceding 12 months (need not be consecutive weeks) The following symptoms, while not essential, increase the diagnostic confidence with their presence: Abnormal stool frequency (3/day or 3/week) Abnormal stool form (lumpy/hard or loose/watery) Abnormal stool passage (straining, urgency, feelings of incomplete evacuation) Passage of mucus Bloating or feeling of abdominal distention From: Gut 1999; volume 45 (Supplement II)So Jhouston, I will ask you, should there be more accurate information on IBS from real IBS research and experts on this BB and to all IBS suffers, or should we all guess and have people like DR D who is not an IBS expert and shows no IBS research or sources and prays on people who know very little about IBS and then be treated by his theories?For example, what is wrong with these kinds of statements."IBS is all gi symptoms.""I can cure all IBS patients"the implying that all IBS is from antibiotics?This is the top IBS center in the US, they will send you a free issues of "digest" with the current IBS research.I have read every article on this site and many more, along with tons of other information given to me by experts and by centers. I also suggest reading the news and research forum of this site. Jeff, myself and others stay on top as much as possible with every new IBS research out there and try to post it there.I suggest the same for everyone if they have IBS.


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## Arnie W (Oct 22, 2003)

Eric, I have responded several times to your opinions on the Dr D threads, but it doesn't seem to get through to you. So, to recap, most of us using Dr D's protocol have gone down the conventional (and unconventional, no doubt, as well) path. We are at the end of our tether, and are looking for hope to help overcome what can be a miserable existence. Like Joann I feel reticent about bleating about you, but the good doctor has done far more for me than any medical doctor. All I generally get is a prescrption for fibre or an offer of anti-depressants. No suggestions about modifying my diet, eliminating certain foods or checking out the bowel flora. I've tried almost every therapy available with no improvement, despite the thousands and thousands of dollars I've spent.For someone who exhorts us to follow all the new and exciting developments in IBS care and mocks us for trying something unconventional, what have you got to offer us besides the screeds of cut and paste articles? What do your experts offer us? Not much apparently because you can't seem to give us any hope at all. From experience on the Gas board, it seems that most experts can't even be bothered to reply to personal emails.


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## eric (Jul 8, 1999)

Arnie, its not that I don't care you get better or anyone else with IBS and it never was about that, its about all people getting better and understanding IBS, and treating effectively what the problems are and that is what opens up treatment options and approaches to the real problems seen in IBS.If your hope is a cure, no I can't offer that no one can thats part of the point, there is no cure at this time and to tell people there is is a major problem on the internet and in general.The experts are saying diets, stress reductions and meds IF NEEDED for very good reasons not well understood here.What do any of you know about the role of serotonin in IBS?Why do the majority of IBSers presenting to gastro clinics effectively demonstrate serotonin dysregulation?Read all the medscape articles on medscape.com, have you done that Arnie?Have you read this and really understand it?American Gastroenterological Association medical position statement: Irritable bowel syndrome http://www2.gastrojournal.org/scripts/om.d...id=agast1232105 Do you know what causes pain in IBS?


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## eric (Jul 8, 1999)

What does this mean Arnie?Researchers Identify Molecular Aberration in IBS PatientsCharlene LainoOct. 15, 2003 (Baltimore) ï¿½ Significant alterations in serotonin signaling exist in the gastrointestinal tracts of IBS patients that do not appear in patients without IBS, according to new research. The findings shed light on gut motility, secretion, and sensation, as well as on the clinical manifestations of IBS, said Peter Moses, MD, associate professor of medicine and director of Clinical Research in the Digestive Diseases at the University of Vermont in Burlington. He presented the findings here Monday at the 68th annual scientific meeting of the American College of Gastroenterology. "We're showing a change at the molecular level in the gut," said co-investigator Gary Mawe, PhD, professor of anatomy and neurobiology at the University of Vermont. "Our finding that key elements of serotonin signaling are changed in IBS lends credibility to the notion that IBS is not all in patients' heads, but due to altered gut biochemistry and interactions between the gut and the brain." Researchers already knew that 95% of the body's serotonin (5-HT) is located in the gut and is primarily synthesized by and stored in endocrine cells, Dr. Moses said. That led them to suspect that alterations in serotonin may contribute to abnormal conditions in the gastrointestinal tract, leading to the development of pharmacologic agents that target 5-HT receptors, he said.While the drugs have proven effective in relieving symptoms of IBS, "no one has ever shown cause-and-effect," Dr. Mawe said. "The drugs were developed with the knowledge that serotonin affects gut motility and secretion, but what we didn't know is exactly how they were working." In their current research, the investigators have shown "a significant decrease in the serotonin transporter in cells that form the inner lining of the bowel" in patients with IBS, Dr. Mawe told Medscape. "In the gut, this transporter acts as a sponge to remove serotonin once it is released, and therefore stops its actions. But if you take the sponge away, serotonin that is released stays around longer, and this can lead to changes in motility, secretion, and sensitivity." For the study, the researchers examined tissue from 43 healthy controls, 32 patients with IBS, and 22 patients with inflammatory bowel disease. Each sample was evaluated using immunohistochemical staining, ELISA radioimmunoassay for serotonin content and release, and quantitative reverse transcriptase polymerase chain reaction for measurement of mRNA encoding. The researchers also measured serotonin content, the endocrine cell number, serotonin release, and presence of serotonin transporters (SERT). The study showed that samples from patients with IBS had significantly lower serotonin content ï¿½ about 70 to 80 pM/mg of tissue compared with about 50 pM/mg in control patients (P .005). Patients with IBS also had significantly higher endocrine cell populations compared with control patients (P .005). Also, SERT mRNA and SERT immunoreactivity were markedly reduced, leading to a decrease in the capacity to remove serotonin from intracellular space once it was released, Dr. Moses reported.However, serotonin release from endocrine cells was not significantly different in cases and controls, he said.The bottom line, according to Dr. Moses, is that "patients with IBS have a deceased ability to remove serotonin once it is released. This tells us for the first time that there is a definitive change in the bowels of patients with IBS.""It's not a matter of too much or too little serotonin, but how the serotonin molecules interact with the receptor," said Kevin W. Olden, MD, associate professor of medicine in the Division of Gastroenterology at the Mayo Clinic in Scottsdale, Arizona."We'll see an explosion of drugs in this area," he said. "Interventions that target serotonin receptors in the brain have revolutionized the treatment of depression and this goes way beyond that."Lawrence Brandt, MD, a gastroenterologist at Montefiore Hospital in the Bronx, New York, agreed and noted two such drugs are already on the market. "The more serotonin you have, the more peristalsis," he said. That's why drugs that activate serotonin receptors, such as tegaserod, help relieve constipation, he said. "Patients with too much serotonin, on the other hand, have diarrhea," Dr. Brandt said. "If we could interrupt that pathway and block it with a serotonin analog, we could help." One such drug, alosetron, is currently available, he said.The selective serotonin reuptake inhibitors that are used to treat depression do not help patients with gastrointestinal disorders because they target a different subtype of serotonin receptors, Dr. Olden said. The study was funded by Novartis Pharmaceuticals, the manufacturer of tegaserod, and one author has received financial support from Novartis. ACG 68th Annual Scientific Meeting: Abstract 20. Presented Oct. 13, 2003.Reviewed by Gary D. Vogin, MDHow about this?Visceral Perception Thresholds After Rectal Thermal and Pressure Stimuli in Irritable Bowel Syndrome PatientsPosted 02/05/2004 Yanqing Li; Yanmei Wang; Xiuli Zuo; Yuting Guo; Haiyan Zhang; Xuefeng Lu; Junman Li; Paul V Desmond Abstract and IntroductionAbstractBackground and Aim: Visceral hypersensitivity has been shown to be present in irritable bowel syndrome (IBS). The current study sought to compare the characteristics of visceral perception thresholds after rectal thermal and pressure stimuli between IBS patients and healthy subjects.Methods: A total of 46 patients with IBS were diagnosed using Rome II criteria. Thirteen healthy individuals participated in the study. Rectal visceral perception thresholds were examined in patients with IBS and in normal controls after thermal and pressure stimuli. Subjects were asked to report the sensation type, location, and spread.Results: Compared with healthy subjects, IBS patients demonstrated significantly initially lower perception thresholds and defecation thresholds to rectal thermal and pressure stimuli, particularly in patients with diarrhea-predominant IBS. Ice stimuli on the abdominal wall had varied effects on symptoms in patients with IBS and did not affect perception thresholds.Conclusions: Visceral perception thresholds were decreased significantly after rectal thermal and pressure stimuli in patients with IBS. Visceral hypersensitivity may be one of the important pathogenic mechanisms in IBS.IntroductionThe irritable bowel syndrome (IBS) is one of the most common disorders seen by gastroenterologists. Patients classically present with chronic abdominal pain and altered bowel habit in the absence of structural or biochemical disorders to account for these symptoms. Though symptoms may be severe,1 the underlying pathophysiology is incompletely understood, and current therapies for the disease are suboptimal.2The pathophysiology of IBS has variously been attributed to deficiency of dietary fiber3,4 gut infections,5,6 gastrointestinal (GI) dysmotility,7-9 stressful life events,10-12 and psychopathology.13,14 However, none of these factors adequately explains the diverse symptomatology and physiological alterations seen in IBS.15 Abnormal visceral perception has recently been proposed to underly the observed heightened visceral sensitivity in IBS. It is manifested by increased intensity of sensations, lowered thresholds for visceral pain, and/or exaggerated viscerosomatic referral in comparison with control subjects.Several recent reports have indicated that lowered sensory threshold to rectal balloon distension is pre-sent with IBS.16,17 This was not part of generalized hypersensitivity or arousal, as cutaneous sensation was found to be normal and was unrelated to any psychoneuroticism.18Because many patients with IBS complain of worsening of symptoms following a chilled meal or ice on the abdomen, the effect of thermal stimulation on visceral perception has not been studied. The present specific aim was to record visceral perception thresholds after rectal thermal and pressure stimuli in patients with IBS and controls, and to compare them in order to provide more evidence of visceral hypersensitivity in IBS. http://www.medscape.com/viewarticle/466817


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## eric (Jul 8, 1999)

Virtual Hospital Understanding IBS (Irritable bowel Syndrome): A Primer for Patients Chapter 10: What Could IBS Be? James Christensen, M.D. and Robert W. Summers, M.D.Peer Review Status: Internally Peer ReviewedThe Problem of Defining IBS What Could Have Gone Wrong in IBS? What Areas of Neurogastroenterology Especially Need Study? The "Brain-Gut Axis" Hypersensitivity of the Nerves in the Gut Pacemaker Disturbances in the Gut How Can We Make Progress in Treating IBS? --------------------------------------------------------------------------------The Problem of Defining IBS When we use a technical term like IBS, we assume that we all understand what it means. If it means different things to the different people who use it, then confusion and misunderstanding arise. That actually happened with IBS, and that is why several experts put forward the standard definition about a decade ago. The definition that the experts settled on includes: abdominal pain; disturbed defecation (altered stool form, altered stool frequency, straining, urgency, a feeling of incomplete evacuation, and the passage of mucus from the rectum); and bloating or a feeling of abdominal distension. The definition includes no objective evidence of disease and no abnormal results of tests and examinations. Furthermore, it states that the complaints must have been present for at least two years, and it requires that other causes for the symptoms must have been excluded before the diagnosis can be made. What Could Have Gone Wrong in IBS? After all possibilities have been excluded to explain the symptoms in a patient with the complaints that define IBS, what remains that might possibly explain them? The answer is that everything we do not know about ways the nerves work in the gut could explain IBS. Because the nerves do so much to regulate the gut, this includes almost everything we do not know about the ways the gut works. This truth accounts for the way doctors have always used the term. From the beginning, experts said that IBS could be diagnosed only when all other reasonable explanations for the syndrome had been excluded. That is, only after a doctor had thought of all the other possibilities that could account for a patient's complaints could the doctor resort to the diagnosis of IBS. It has always been a diagnosis of exclusion. Over the past few decades, our understanding of gut disease has increased a great deal. Many diseases can now be recognized that were not recognized or even suspected before. This is the result of the great advances that have occurred in our ability to examine the gastrointestinal tract and to test its operations. Before we knew as much as we do now about how the gut works, doctors must have told many patients with other diseases that they had IBS because doctors had no way to get at the truth. No one now can believe that experts have finally learned everything there is to know about the gut. A lot of ignorance remains about it, especially about the nerves that regulate its various operations. That leaves many possibilities for new diseases to be discovered. That is, many unsuspected diseases may exist that we do not know how to identify. If we have no way to identify them, we cannot describe them, but only deal with them as something that we know nothing about. That is what doctors do with IBS. That is the only thing they can do. What areas in Neurogastroenterology Need Study? The "Brain-Gut Axis" Everyone knows that the mind can affect the operations of the gut, for everyone has observed that extreme fear or anxiety can produce abdominal cramps and diarrhea. Everyone also knows that people become constipated under certain circumstances, when they are depressed or lethargic. This universal recognition that the mind can affect the gut led many doctors of the past to propose that IBS is simply the abnormal dominance of this normal mechanism. This theory implies that the gut itself is normal in IBS, that a governing system of normal nerves is being made to operate in an abnormal way, and that the real problem lies in the mind. This concept and these implications remain common in the minds of doctors and patients everywhere. If this concept is true, the problem in IBS is a problem for psychiatrists to deal with, not physicians who treat diseases of the gut. But the attempts by psychiatrists to identify the personality characteristics that define IBS or to treat it as a disorder of the emotions have not worked well. Psychiatric treatment can help to relieve the gastrointestinal symptoms that accompany such emotional conditions as depression, chronic anxiety, and panic disorder. Gastrointestinal symptoms can develop often as a manifestation of these psychiatric disorders. Since nerves control the gut, gastrointestinal symptoms can also arise from the use of various drugs used to treat emotional disorders. Still, emotional disorders cannot be ruled out as contributing factors in IBS, and, conversely, the persistence of chronic unexplained gastrointestinal symptoms can certainly lead to anxiety and depression. It is a major challenge to investigate the relationship of two such associated symptom complexes--emotional disturbances and chronic unexplained gastrointestinal symptoms--when hard science still cannot adequately explain either one. Hypersensitivity of the Nerves of the Gut Long ago, doctors proposed that the sensory nerves of the gut might be overreacting to normal stimulation. This was the origin of the term, "irritable bowel." They considered only the sensory nerves of the gut to be involved, and they implied that the sensory nerves that are abnormal include both those that carry painful sensations and those that excite the motor nerves of the gut in reflexes. Investigators have carried out many experiments recently to see if the nerves that carry the sensation of pain from the gut are overreactive. Some suggest that they are. Again, this observation might explain some cases but not all. If overactivity of the nerves that carry feelings of pain from the gut is a part of the problem in some patients with the diagnosis of IBS, it needs to be asked exactly where in this system the abnormality lies. Is it at the sensory endings of the pain-detecting nerves in the gut wall, at the synapses that lie along the pain pathway or in the higher centers in the brain? These three possibilities cannot now be investigated because we know too little about what goes on normally at these three points in the pain pathway. We know very little about how the pain fibers in the gut are activated. We know only a little more about the synapses at the prevertebral ganglia and in the spinal cord. The operation of higher centers such as the pain system in the brain remains one of the great challenges of modern biology. Pacemaker Disturbances in the Gut The presence of pacemakers in the gut was established three-quarters of a century ago, but we still know very little about them. Our ignorance stems in part from the fact that they are hard to get to for study, and in part because there aren't many experts who are prepared or trained to study them. Thus, although it seems likely that pacemaker disturbances can and do cause a lot of trouble in the gut, there is no easy way to prove that in a clinical setting, and there is no established way to treat this kind of problem How Can We Make Progress in Treating IBS? When we must deal with a disease that we do not understand, we can only treat the symptoms, not the disease. We have no other choice. But that produces no advances. The only way to make real progress in treatment is to learn more about the system that gives rise to the symptoms. The real hope for progress lies with the science of neurogastroenterology. This is nothing new. All advances in the history of medicine came through the advancement of science. We improved our ability to treat heart disease because we learned how the heart works. We are making progress in the treatment of mental illnesses because we are beginning to learn how the brain works. Learning comes not just from studying the patients with disease but from first studying the system that can become diseased. A disease can be defined only as a situation where something has gone wrong. We have to know what is normal before we can recognize what is abnormal. We have to know how the system looks when it is operating correctly. What we need in this field is better science, better understanding of the way the nerves and muscles of the gut work. http://www.vh.org/adult/patient/internalme...ome/chap10.html Revisiting IBS: Perspectives for the New MillenniumBrain 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 mechanisms o Greater awareness of normally subliminal visceral afferent stimuliAltered affective stimulus processing o Greater unpleasantness of visceral sensations, including heartburn, bloating, fullness, abdominal pain, incomplete rectal evacuationAltered threat appraisal o Leads to fears such as not being close enough to a bathroom anything eaten may trigger abdominal painEnhanced arousal o Shared by clinical conditions frequently overlapping IBS, such as anxiety, panic disorder and PTSD o Arousal reduced by sedatives, anxiolytics, low-dose tricyclics o May respond to relaxation exercises--------------------------------------------------------------------------------Post-Infective Irritable Bowel SyndromeAmong many postulated causes of irritable bowel syndrome (IBS), one of the most intriguing is that the syndrome represents sequelae of an acute enteric infection. In fact, such an association is not just an interesting theory. According to Stephen M. Collins, MBBS, FRCP, FRCPC, Professor of Medicine and Director of Gastroenterology at McMaster University in Hamilton, Ontario, Canada, "Acute enteric infection appears to be a significant contributing cause to the development of irritable bowel syndrome." The changes associated with such enteric infection appear to be reversible, introducing the opportunity for new treatment strategies for persons at high risk for irritable bowel syndrome (IBS).Clinical observations have suggested that transient infection in the gut can lead to persistent neuromotor dysfunction, and possible symptom generation in persons with IBS. In a large review, Chaudhary and Truelove found that 33% of persons with IBS reported an acute onset to their symptoms. Indeed, a recent controlled study showed that enteric infection was a strong risk factor for developing IBS.Animal Studies: Neuromuscular Dysfunction Post-InfectionIn one animal study by Tougas, Collins and colleagues infected mice with Trichinella spiralis. The results showed that the infection was accompanied by inflammation, reaching its peak in week 2. By week 3, the parasite had been expelled and inflammation had subsided. However, accompanying muscle hypercontractility persisted for up to 6 weeks' post-infection.In a second study by Tougas, the colons of the infected mice were distended using a small balloon and there was evidence of increased afferent nerve activity not only during the infection, but also 4 to 6 weeks' post-infection. Together, these results suggest that transient infection and subsequent inflammation in the gut can alter muscle contraction and increase sensory activity in the colon, suggesting a possible basis for dysmotility and hyperalgesia that occurs in post-infective IBS. But are these effects reversible?In a third study, animals were infected and allowed to recover. After 3 weeks, a short course of dexamethasone was administered. In the animals treated with steroids, muscle hypercontractility was prevented or reversed by day 28 post-infection. "Post-infective changes appear to be reversible and thus provide a basis for designing new experimental approaches in patients," said Dr. Collins.Clinical Association Between Infection and IBSFive recent studies showed that 7% to 31% of persons having food poisoning-associated bacterial gastroenteritis developed IBS, 3 to 12 months' post-infection. This phenomenon has also been observed with parasitic infection; however, the role of viral gastroenteritis is not yet known. The development of IBS appears to be due to a convergence of infection, inflammatory stimuli, central nervous system stimuli, and psychological factors. "The response to inflammatory stimuli is enhanced under stress, with the timing of the stress in relation tostimuli being important," Dr. Collins explained. Psychological factors, however, do not appear to be the sole determinants of whether someone develops IBS post-infection and other human studies suggest that local alterations in response to inflammatory stimuli may be important; this may be, in part, genetically determined.One study showed that 32% of persons with Salmonella-related gastroenteritis developed IBS symptoms within 2 years' post-infection. Biopsies showed no overt inflammatory presence; however, a semiquantitative approach showed an increase in inflammatory cells in those with IBS. Indeed, there was an increased number of lymphocytes and hyperplasia of the serotonin-containing enterochromaffin cells, a major source of 5-HT in the gut. "It is likely that 5-HT measurements would be increased in this subgroup, affording new therapeutic opportunities for these patients," Dr. Collins said. In addition, other studies have shown a potential role for lumenal factors and for cholestyramine-type factors, especially for diarrhea-dominant disease.ConclusionIn closing, Dr. Collins noted that post-infection effects associated with IBS appear to be reversible, warranting further clinical investigation of anti-inflammatory agents and other innovative therapies for persons at risk for IBS. Treatment Options in Irritable Bowel SyndromePrimary care physicians often refer patients with irritable bowel syndrome (IBS) to gastroenterologists because of difficulty finding an effective treatment. IBS is a condition characterized by abdominal pain, as well as diarrhea, constipation, or an alternating of the two. Treatment options for IBS are targeted to relieve either diarrhea, constipation, or pain, depending on the patient's predominant symptom (Table 1). For many patients, available therapies have not been successful in relieving their IBS, making further study and development of new products essential, said Anthony J. Lembo, MD, Instructor at Harvard Medical School and Director of the GI Motility Center at Beth Israel Deaconess Medical Center, in Boston. Focusing on pain-predominant IBS, Dr. Lembo profiled current and emerging new therapies. Recent studies suggest that the new smooth muscle relaxants can be effective against pain-predominant IBS and that antidepressants can be beneficial in treating functional gastrointestinal disorders. According to Dr. Lembo, these agents, together with newer 5-HT4 agonists, may offer promise for persons with pain-predominant IBS.Antispasmodic AgentsAntispasmodic agents are beneficial to some patients with IBS because they interfere with the exaggerated gastrocolic response that occurs with IBS, thereby reducing postprandial motor activity. The three main classes of antispasmodics include anticholinergics, peppermint oil, and the newer direct smooth muscle relaxants. Of four randomized double-blind studies of anticholinergics in IBS, only one showed a significant global symptom improvement over placebo. In this study, more than 50% of patients developed anticholinergic side effects. Of five randomized, double-blind studies of peppermint oil products, three showed significant global symptom improvement over placebo. However, significant side effects occurred with treatment, and the studies consisted of small sample sizes and short duration of followup. Constipation is one potentially significant side effect of antispasmodic agents. In a recent meta-analysis of all antispasmodic agents, Poynard and colleagues found that antispasmodics did benefit patients in terms of global symptom improvement in general, and pain, in particular. The antispasmodics that were most effective were the newer smooth muscle relaxants not currently available in the United States.Antidepressant AgentsAntidepressant agents, including tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors, are used in persons with IBS (particularly pain-predominant) because they are effective against chronic pain (especially TCAs); pain reduction is independent of effects on mood; and they are effective against conditions that often overlap with IBS. Side effects with these agents might include sedation, agitation, anticholinergic effects, and constipation.5-HT3 Antagonists and 5-HT4 AgonistsThere are four main types of 5-HT receptors, of which 5-HT3 and 5-HT4 are most relevant to the treatment of IBS. 5-HT3 receptors are associated with the provocation and perception of pain, the emesis reflex, and gut motility and secretion; while 5-HT4 receptors are associated with emesis reflex, visceral sensation, secretion, and activation of neurotransmitter release and gut motility. 5-HT3 antagonists have been shown to increase colonic compliance, reduce postprandial rectal sensitivity and motility, enhance jejunal water and sodium absorption, and prolong left colon transit time. Alosetron has been the only U.S. Food and Drug Administration (FDA)-approved 5-HT3 antagonist for the treatment of IBS (in women); however, Glaxo Wellcome has since voluntarily withdrawn this drug from the market after some reports of ischemic colitis and severe constipation. "Studies have shown 5-HT4 agonists to decrease small bowel transit time in persons with constipation-predominant IBS; to dose dependently inhibit afferent nerve activity to rectal distention in cats; and to inhibit visceral discomfort in rats," said Dr. Lembo. When serotonin is released from enterochromaffin cells in the gut, it stimulates 5-HT4 receptors on primary intrinsic afferent nerves, which in turn stimulate both ascending excitation and descending inhibition of motor neurons, resulting in peristaltic contraction in the gastrointestinal tract. 5-HT4 receptor agonists, such as tegaserod maleate, directly stimulate the peristaltic reflex and accelerate gastrointestinal transit. In a study of tegaserod, 881 persons having IBS-associated constipation and abdominal pain, were treated. Those taking tegaserod showed significant symptom improvement over placebo. In addition, tegaserod was associated with a significant increase in number of stools, improvement in stool consistency, and decrease in bloating. A significant response was achieved in women; small sample sizes of men studied thus far make these data difficult to interpret. Side effects included transient diarrhea (12% vs 5% in placebo), but there were no effects on QTc intervals. Tegaserod is currently under review by the FDA. In closing, Dr. Lembo emphasized that, "promising new agents-such as new muscle relaxants and 5-HT4 agonists-may soon mean more treatment options and greater relief for persons with IBS." Has everyone on this thread emailed on the April is IBS awareness month?That will help all IBSers.Dr Dahlamn is right about one thing, chemistry can go wrong and it is majorally complex in regards to IBS.


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## Jenny Snell (Sep 14, 2003)

Hi DaisyspI have posted here before but, to be honest, I have got so fed up in seeing Eric's posts and am totally bored of them now that I rarely come in here!I have read so much on the internet and have several books on IBS and I know I dodn't have IBS. I saw several doctors and hospital specialists who basically said they couldn't help me. I had no advice on changing my diet, no tests for bacteria levels and was just prescribed various drugs which did absolutely nothing for me except make me feel tired!Dr Dahlman is the only person who actually said things that made sense.I am sure Eric is an expert on IBS, but there are many people here that most probably don't even suffer from IBS, and bashing us with cut and pastes from various sites won't help them in the slightest!It seems that the medical profession just label you as an IBS suffer as they either don't have the time, the knowledge or funds to be bothered to help!


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## Jhouston (Nov 9, 2003)

Jenny, That is what I have been saying. but frankly, This is bizarre. We are talking apples and oranges. I am not feeling very well at the moment so I cannot respond anymore...don't have the energy. one more time, with feeling......not all and myself included believe they have "IBS" but have been Dxed IBS by GI docs. Joann


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## missC (Oct 16, 2002)

"I have read more then you will ever know about IBS"that's pretty snooty. how do you know? i certainly believe you have read a lot Eric: i do however doubt how much you have understood, since you seem to stumble when it comes to a coherent, layperson-friendly analysis of your readings in your own words. people can go read scientific papers themselves if they want to: it's the level of comprehension that counts. mostly it seems we don't want to: i'm not the only one who scrolls past your endless cut'n'paste attempts to prove your erudition.some of your assertions are in many cases not true: e.g. that most doctors response to an IBS dx is to advise on diet, stress and medication. medication is all the docs i have seen are interested in. one doc yawned and looked at her watch when i tried to bring up diet. some refuse any more technical discussion of ibs despite knowing i am a life sciences grad and capable of at least a basic comprehension of such a discussion. i don't know about the us but getting a referral to a consultant in the uk is just a joke oftentimes. and gps are - sorry to any med students - very often the scrapings of medical school, qualified only to hand out prescriptions.i tell you what, eric. if you post a link - a link, not a cut'n'paste! - to a paper which conclusively proves the existence of your famed brain-gut axis, then i'll actually read it. i said 'proves', not makes a grand assertion of a theory about on a par in terms of scientific method with Freud's joke attempts at being a scientist. if it proves all ibs cases are dependent on this link, so much the better.you know you've been hostile towards Dr D before on the basis that any successes he experiences are with people who NEVER had ibs in the first place. well, you know many of us here regard ibs as a wastebin diagnosis, resorted to when a doctor can't be bothered to probe further: what exactly is your brain-gut axis theory going to do for these people, better than anything Dr D can do?


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## Talissa (Apr 10, 2004)

Hi Everyone,This thread, and the previous Dr. D thread, have been so informative and interesting to read. Thanks to most all of you. My quick history: I've gotten back to fairly normal over 5 years, after once having painful chronic D. I've done it by trying to re-balance my gut flora(this took some time) & diet adjustments. I'm not 100% yet, only about 92%, & if the DA-IBS that I'm waiting for doesn't push me over to no longer needing the gobs of fiber I ingest daily, I'll try to buck up and give his program a whirl. I honestly don't think I've the self-discline. Gret's amazing.Just fyi, I once made 8-14 trips to the loo daily, with unbearable cramping. I now make 3-4 trips daily, formed by fiber. This only gets messed up if I mistakening eat something with High Fructose Corn Syrup, or intentionally eat raw cucumbers, etc...Anyways, I couldn't not add to the discussion any longer. I'm going to paste some links to a few mainstream medical sources which point to bacterial imbalance as a key to the IBS mystery. I also want to add that mind control, stress management, meditation & the like are very important to easing virtually all diseases. And isn't it possible that having imbalanced intestinal bacteria would by its very existence mess up the brain-gut connection? Just a thought.These are for Eric(I have more):"Ending Bacterial Overgrowth Results in Better Motility in Some Irritable Bowel Patients" http://www.docguide.com/news/content.nsf/n...5256C9B0001E1B7 "Irritable Bowel Linked to Bacteria" http://my.webmd.com/content/article/21/3052_837 "Irritable Bowel Syndrome More Frequent In Bacterial Gastroenteritis Patients" http://www.docguide.com/news/content.nsf/n...5256CD40031C81B I do have more, but don't worry, I won't post them. Eric seems so obsessed with being right here, it'd be pretty bad to get into that kind of a bb war here on a thread meant for something else. I just couldn't resist, pls forgive me. And Eric, Dr. D did mess up when he said he "cures" everyone who follows his program. He's exuberant, but he put them in remission-- which sounds pretty d**n good to me.Best wishes to all, T-


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## calid (Aug 4, 2003)

Talissa: Thank you for those posts, please feel free to post more for us that are very interested in this subject. Just ignore Eric, he is so focused on being right (which centers on an obsession to discredit Dr. Dahlman), he loses sight of the real problem we're all discussing.Most of us welcome ALL information, not just what one person THINKS is right. Welcome, and continue to post please!


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## TheSerialKiller (Apr 8, 2004)

> quote:The selective serotonin reuptake inhibitors that are used to treat depression do not help patients with gastrointestinal disorders because they target a different subtype of serotonin receptors, Dr. Olden said.


Eric I am not sure that this is accurate.


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## kel1059 (Feb 28, 2003)

> quote: I'm going to paste some links to a few mainstream medical sources which point to bacterial imbalance as a key to the IBS mystery. I also want to add that mind control, stress management, meditation & the like are very important to easing virtually all diseases. And isn't it possible that having imbalanced intestinal bacteria would by its very existence mess up the brain-gut connection? Just a thought.


talissa, brilliant post. i have been saying the same things for a while now. i think that a less than optimal bowel flora can show up as altered brain function. afterall the gut sends 9x's as many signals to the brain as vice versa.however, just to play the devil's advocate for a second, it is also my belief that some of us might be able to supplement our recovery by working on the brain aspect at the same time. it is possible that some of us have a brain that operates in some helter skelter manner (independent of bowel flora) and this could be partly responsible for some of our problems (i don't have proof of any of this).i started using a Holosync meditation tape recommended by Dr Mercola and the results are rather interesting so far. http://www.mercola.com/article/neuro_technologies.htm When i wake up in the morning i am in the twilight zone for 1/2 an hour. prior to the meditation tape i would be instantly awake with a scattering of negative thoughts.****************************************eric,this is a fascinating learning experience for everyone and if you are trying to ruin it because you make money from selling your hypnosis tapes then shame. to pick up where joann has left off --- i wonder if the dope smoking that you admit to is interfering with your cognition. i have to agree with joann that your reasoning is very BIZARRE. could this be due to the marijuana (just a thought for you to ponder-- how many ounces do you spark up per week?). also, my friend and i have both reported that we feel as though we have been "zombified" somewhat by the meditation CD. could she be correct in thinking that the hypnosis tape has "doped" up your mind? i only ask because of what might be happening to me. although i think i need my mind to be doped up a little. overall i may be better off this way.****************************calid,i hope that things turn out okay after the cipro. i think that dr d is light years ahead of other doctors who give out antibiotics without any thought of suggesting that a person also take probiotics to guard against the bad bacteria running amok once the antibiotic is stopped.


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## eric (Jul 8, 1999)

kel, I won't respond to any of your comments, they are just a personal attack, with no merit to them.Perhaps not everyone has IBS?Well I agree and some people have more then just IBS, and there are names for those conditions and they are not all leaky gut or bacterial floara imbalance. Also someone in NY does not have the same flora as someone in cal.However, IBS is no longer a "wastebasket diagnoses" there are specific symptoms and if people learned an go by the Rome 2 criteria and ask their doctors if that is what there using the diagnoses for IBS is specific to IBS.For Dr D to say names of these conditions don't matter, is untrue, they matter greatly to treatments.Also motlity problems lead to SIBO.GI Disorders in adults. http://www.iffgd.org/GIDisorders/GIAdults.html It is imporant to treat these conditions for what they are, not guess.Second, because peoples doctors didn't help them, is not a condition that all IBS research is the problem, the problem are those doctors and in some regards the patients.yes you will go to doctor after doctor if your looking to be cured.Even they know the drugs and most methods are suboptimal, and hence the combination of things.Serial killer, it is pretty accurate, Prozac was just found not to help IBS in a recent study.also on "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. "* There is a motility problem already.Some people have this problem and there are tests for it.Bacterial Overgrowth in IBS http://www.med.unc.edu/medicine/fgidc/bact...rowthandibs.htm IBS PublicationsAnother look at bacteria and IBSBy Douglas A. Drossman, M.D. http://www.aboutibs.org/Publications/bacteria.html A Role for Probiotics?A Role for Antibiotics? http://www.youngagain.com/marcella75/ibs1.html Miss c for youFrom - 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 "Patients with IBS show some differences in how their brains respond to a visceral event and these effects may relate directly to both the hypersensitivity and hypervigilance associated with this disorder." http://www.iffgd.org/symposium2003brain-gut.html Brain Imaging Moderator: Reza Shaker MD. Panel: Reza Shaker MD; Bruce Naliboff PhD; David Thompson MD. http://www.iffgd.org/symposium2003imaging.html Cerebral Activation in Patients With Irritable Bowel Syndrome and Control Subjects During Rectosigmoid Stimulation http://www.psychosomaticmedicine.org/cgi/c...t/full/63/3/365 Stress and the Gastrointestinal TractV. Stress and irritable bowel syndrome "In summary, an extensive literature is consistent with an enhanced stress responsiveness in IBS patients, manifested by predicted autonomic, pain modulatory, and attentional responses and a sensitized GC feedback. This response pattern is associated with changes in brain activity in limbic regions. The blunting of the HPA axis together with alterations in sympathetic modulation of immune function may predispose individuals to develop postinfectious IBS. The fact that up to 40% of IBS patients show evidence for increased anxiety and the fact that the changes are similar to those reported in a variety of other so-called "functional" disorders (e.g., fibromyalgia, chronic fatigue syndrome, and interstitial cystitis) suggest a model in which alterations in the central stress circuits in predisposed individuals are triggered by pathological stressors and play a primary role in pathophysiology. " http://ajpgi.physiology.org/cgi/content/full/280/4/G519 Irritable Bowel SyndromeClinical Issues "What would be an example of new understanding?Well one example is that we're starting to understand how the brain is responding to the pain in IBS. There have been some studies done where they've artificially created a kind of an irritable bowel by placing a balloon to stretch the bowel, and that produces pain. Then they've compared people with IBS to non-IBS, or "normal" individuals. And what they've found is that when you stretch the bowel-and use PET scans to monitor the response-in normal individuals, certain areas of the brain that register pain respond and release chemicals called neurotransmitters that suppress and lower the pain. But it seems that doesn't happen as well in people with IBS. *In fact, in people with IBS another area of the brain responds that is associated with anxiety. So what we find is that people with IBS, aside from having a bowel problem, may have some difficulty in terms of the way their brain is regulating the pain."* http://www.aboutibs.org/Publications/clinicalIssues.html "Where is the Problem in IBS?The definition of IBS suggests that all routine investigations such as blood tests, endoscopy, and radiological imaging should be normal. The condition is diagnosed on the basis of symptoms, elicited through history and physical examination, in the absence of obvious gut abnormality. So what is the problem?Much work has been done to explain the underlying pathology (disease characteristics or cause) in IBS in the hope that treatment could be directly targeted to an abnormality. This approach could be hugely beneficial compared to available treatments that work symptomatically.In IBS, we know the problem is not only in the gut but is also in the brain-gut axis and the autonomic nervous system.Is the problem in the gut? Increased perception of sensations in the gut, or visceral hypersensitivity, has consistently been observed in IBS. Mertz and colleagues from California checked the discomfort threshold in IBS patients and in a control group. In response to balloon distention of the rectum, almost all (94%) of IBS patients showed lowered pain thresholds. The investigators proposed that increased rectal perception could be used as a reliable biological marker for IBS.Is the problem in the brain?Silverman and colleagues from UCLA used a special brain imaging technique, positron emission tomography (PET), to measure the changes in the pattern of blood flow in the brains IBS patients and a control group in response to balloon distention of the rectum. They found that different areas of the brain were activated in IBS patients when rectal stimuli were delivered. This suggests that the brains of people with IBS process signals from the gut differently.Is the problem in the general autonomic nervous system?Monga and colleagues from London checked bladder and esophageal perception and pain thresholds and found that women with IBS have both lower bladder and esophageal sensory thresholds. They suggested that IBS is part of a generalized disorder of smooth muscles. These women also had "irritable bladders." Francis and colleagues from Manchester, UK found that a higher proportion of patients who are seen in the urology clinic have IBS compared to patients seen in other clinics (dermatology; and ear, nose, and throat).There seems to be increasing evidence that the pathology in IBS is not limited to the gut, brain, or autonomic nervous system only. Rather there may be an involvement of all three systems. Therefore, any potential new therapy should be aiming at this widespread pathology." http://www.aboutibs.org/Publications/resea...ml#anchor147531 "Neuroimaging has provided evidence of physiological differences between normal individualsand those suffering from IBS in the way a visceral stimulus (ie, rectal distention) is processed inthe brain.14,15 Initial data from positron emission tomography PET scans demonstratedincreased activation of the anterior cingulate cortex (ACC) among normal individuals, comparedto IBS patients. The ACC is a cerebral cortical area that is rich in opiate receptors and is thoughtto be a major component of cognitive circuits relating to perception as well as descending spinalpathways involving pain. More recently, fMRI was used to demonstrate increased activity in theACC, prefrontal (PF), and insular cortex areas, and in the thalamus of IBS patients compared tonormal individuals."





















fMRI Imaging: Rectal Distension in IBS Patients http://www.medinfo.ufl.edu/cme/grounds/verne/slide13.html Pain in the brain and IBS http://www.cns.med.ucla.edu/Articles/Patie...leFl97Brain.htm altered stress responce in IBS. http://www.cns.med.ucla.edu/Articles/Patie...teredStress.htm breakthroughs in IBS research http://www.cns.med.ucla.edu/Articles/Patie...eakthroughs.htm *"It is no longer reasonable to discriminate between physiological and psychological factors; both are operative in IBS. "* Sensations from the gut are processed in the brain, all pain is processed there.There are abnormalities in the Limbic system in IBS, the HPA axis and the serotonin system, which communicates back and forth from the gut to the brain.There are also subtle changes in molecular structures in the gut. With advanced technology, they will start understanding IBS better in the future.from above"When we must deal with a disease that we do not understand, we can only treat the symptoms, not the disease. We have no other choice. But that produces no advances. The only way to make real progress in treatment is to learn more about the system that gives rise to the symptoms. The real hope for progress lies with the science of neurogastroenterology. This is nothing new. All advances in the history of medicine came through the advancement of science. We improved our ability to treat heart disease because we learned how the heart works. We are making progress in the treatment of mental illnesses because we are beginning to learn how the brain works. Learning comes not just from studying the patients with disease but from first studying the system that can become diseased. A disease can be defined only as a situation where something has gone wrong. We have to know what is normal before we can recognize what is abnormal. We have to know how the system looks when it is operating correctly. What we need in this field is better science, better understanding of the way the nerves and muscles of the gut work. "


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## SpAsMaN* (May 11, 2002)

Hi Kel,do you experience a vengeance?If not,what was the homeopathic product who do the trick?Kel, i agree with you and i feel that my bowel is so disturbs that it control my whole body.Bowel flora is a MAJOR factor for an healthy body.Maybe some bacterias make the hell inside causing abnormal sensitivity.Even my mouth flora seems affected by these bacterials mutations.


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## eric (Jul 8, 1999)

IRRITABLE BOWEL SYNDROMELin Chang, M.D.CNS: Center of Neurovisceral Sciences & Womenï¿½s Health, CURE: Digestive Diseases Research Center,Division of Digestive Diseases, David Geffen School of Medicine at UCLACorresponding Author:Lin Chang, M.D.Center for Neurovisceral Sciences & Womenï¿½s HealthCURE: Digestive Diseases Research CenterVA Greater Los Angeles Healthcare System11301 Wilshire Blvd., Building. 115, Room. 223Los Angeles, CA. 90073 http://216.109.117.135/search/cache?p=chan...&yc=15315&icp=1 videosPatient Education Video - Irritable Bowel Syndrome: Transforming Your Life Through IBS Management. http://www.fdhn.org/html/education/gi/ibs_video.html Toc 13 and IBSIrritable Bowel SyndromeCTP 13 Table of ContentsTitle Slide Functional GI Disorders - Definition Functional GI Disorders - Definition Functional GI Disorders - Anatomic Regions Esophageal Functional GI Disorders Gastroduodenal Functional GI Disorders Bowel Functional GI Disorders Biliary Functional GI Disorders Anorectal Functional GI Disorders Definition of IBSIBS - Epidemiology U.S. Prevalence World Prevalences Health Care Seeking Doctor Visits by Gender Prevalence of Diagnosis in Clinical Practice Work and School Absences - U.S. Data Physician Visits per Year - U.S. Data Epidemiology SummaryGastrointestinal Physiology Effects of Stress on GI Symptoms Time Line of Physiologic Research in IBS Normal Colonic Response to Stress - Almy, 1951. Increased Meal-Stimulated Sigmoid Motility in IBS - Rogers, 1989 Effect of Anticholinergic on Meal-Stimulated Sigmoid Motility - Sullivan, 1978 Stress-induced Effects on Jejunal Activity - Kumar, 1985 Normal Migrating Motor Complex Discrete Clustered Contractions in IBS - Kellow, 1987 Prolonged Propagated Contractions in IBS - Kellow, 1987 Pain Produced from Rectosigmoid Distension - Whitehead, 1980 Lower Pain Tolerance in IBS Occurs Primarily in the Bowel - Whitehead, 1990 Brain-Gut Physiology Integration of CNS-Gastrointestinal Function Ascending Pain Pathway #1 Ascending Pain Pathway #2 (continued) Descending Pain Modulating System The Enteric Nervous System Enteric Nervous System Anatomy Effect of CNS on ENS Activity Visceral Hypersensitivity Spinal Hyperexcitability - General Concept Visceral Hypersensitivity - Normal Regulatory Activity Visceral Hypersensitivity - Painful Event Visceral Hypersensitivity - Sensitizing Event Visceral Hypersensitivity - Regulatory Activity After Sensitization Visceral Hypersensitivity - Summary slide Molecular Mechanism for Visceral Hypersensitivity - I. Magnesium Block Molecular Mechanism for Visceral Hypersensitivity - II. Ca2+ Entry and Binding Molecular Mechanism for Visceral Hypersensitivity - III. Nitric Oxide Diffusion Colonic Distension in Normals - Pain Reporting Rectal Pain Threshold Post Distension - IBS vs. Normals Change in Symptoms and Rectal Sensitivity Over Time Sigmoid Distension - Fedotozine Effect Effect of Octreotide on Pain Reporting in IBS Regional Cerebral Activation - PET Scan Correlation of Anterior Cingulate Activity with Rectal Pain Intensity Increased REM Sleep in IBS Pathophysiology SummaryPsychosocial Factors Dysmotility and Hyperalgesia, Symptoms and Health Care Seeking Self-selection into Clinical Practice Psychosocial Disturbances in Referral Practices Frequency of Psychiatric Disorders in IBS - Referral Centers Are Psychological Disturbances the Same? Comparison of Psychologic Disturbance Abnormal MMPI Scores Among IBS Patients and Non-patients and Normals Conceptual Model of IBS Psychosocial Factors Affecting Outcome in IBS IBS and Abuse - Abuse Reporting Based on IBS Severity and Treatment Site IBS and Abuse - Effects on Health Status Severe IBS and Abuse - Possible Mechanisms IBS and Abuse - Self-Selection Psychosocial SummaryDiagnosis Timeline of Diagnostic Approaches Diagnostic Approach - Overall Scheme Establish Symptom-Based Diagnosis Manning Criteria Rome Criteria Identify Dominant Symptom Other Clinical Factors Perform Diagnostic Tests Initial Evaluation -Rome Recommendations "Red Flags" Differential Diagnosis Initiate Treatment - Reassess in 3-6 Weeks Additional Specialized Studies Change in Diagnosis Unusual After Initial Evaluation Symptoms Retained at Follow-up Symptom Onset and DisappearanceTreatment Physician-Patient Relationship - Treatment Guidelines Treatment Guidelines and M.D. Visits Combined Slide - Listing of Treatment Guidelines and M.D. Visits The Patient's Agenda The Doctor's Agenda Factors Affecting Treatment Placebo Response Rate Spectrum of Severity in IBS Mild IBS - Routine Check-up with Primary Care Physician Education and Reassurance Dietary Modifications Moderate IBS - Referral to a Gastroenterologist Monitoring and Modification Symptom Diary Pharmacotherapy of Gut Symptoms Pharmaceutical Agents Psychological Treatments Psychological Treatments - Definitions Psychologic Interventions - Treatment Study Results Psychotherapy - Interpersonal Treatment Psychotherapy - Interpersonal Treatment (cont.) Severe IBS - Sent to Referral Center Set Realistic Goals Focus on Health, not Illness Antidepressants for Pain Control Brain - Gut Inhibitory Pain Pathway ("Gate" Control) Comparison of Tricyclic and SSRI Antidepressants Referral for Symptom Management Indications for Referral Treatment Summary Future Pharmacological Agents http://www.milner-fenwick.com/agaslides/ctpunits/ctoc13.htm


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## missC (Oct 16, 2002)

oh lordy lordy. i said one link, eric. one link, and no cut and paste. however over the next week or two (!) i will devote some of my valuable and minimal free time to your suggestions. i certainly hope it proves to be worth it."It is no longer reasonable to discriminate between physiological and psychological factors; both are operative in IBS" doesn't this work both ways? i think part of the problem, eric, is that some of us perceive you as overstating the role of the mind and understating the role of the body in ibs: as kel stated, it's more than interesting that nine times as many neural messages are sent from gut to brain as vice versa. i'm sure from your posts that you don't in fact believe that the mind and stress are the sole players in ibs: but you often seem to think that others think it plays no role whatsoever, and that it is your job to put them right. this is almost never the case! i would say 'never' but there may be a very few exceptions.if you are still fixated with Dr Dahlman, then i think you are wasting your time: presumably he is operating within the law, has a training which his clients deem adequate for their needs, and they are adults who are fully compos mentis and responsible for their own choices. it really isn't up to you to save them from themselves: in fact it's often a little insulting to them. both his methods and successes seem problematic to you: if his successes are due to his clients being other than ibs, what of it? are you still unwilling to rejoice with them in their renewed health?you are sceptical of his claims: i am myself. but you want to re-orientate them towards conventional medicine, which you admit yourself, and many of us have found, certainly has no statistically preferable treatments and outcomes. if it had, they wouldn't be resorting to dr d. i am sure some people on this board under his care are themselves doubtful of any 99% successful outcome: but they're willing to give it a try, and in the end that's their business. certainly if failure results in their getting their money back.eric, won't you show some fellow feeling, and continue to share your information with other posters here without berating them for making choices you personally disagree with?


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## Jenny Snell (Sep 14, 2003)

Oh no, not more copy and pastes by Eric!! I'm off. Maybe back again in a month or so to see how you all are!Joann - sorry you are feeling awful. I used to feel so bad with the 'D' until I found Dr Dahlman's programme (bless him for giving me back my life!!)And Talissa - I can sympathise with you because I used to go to the loo up to 20 times a day, had no energy and felt simply retched! I couldn't leave the house unless I had consumed a whole packet of Imodium, and the 'D' would still continue. If you really want to feel better, I encourage you to try his programme and stick to it. You will be really pleased you did, I can assure you.I think rather than calling it IBS, we should change it to 'Digestive Disorder'!


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## Jenny Snell (Sep 14, 2003)

....and well said missC in Manchester!


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## eric (Jul 8, 1999)

Its not them getting better, its the information Dr D provides. I wish them all the best and what I am saying here should not effect their outcomes if the treatments really work for them and they are all cured, qoute" with no symptoms."But what about the people who do have IBS and can't be cured by these methods, he doesn't count them. Money back is not helpful to the physcological damage it can do to someone with IBS. If he can cure all IBSers great, get some research going and prove it and help all IBSers in the world.It already hasn't for everyone although and it was stated it would. This is a major problem!when he calls food intolernces IBS or celiac sprue or other gi conditions for one, this is inaccurate. He is also not an expert on IBS, that is a fact!!!!That is not to say that some of his methods are not helpful in and of themselves, peppermint or fiber or probiotics and even some dietary changes and emotional support. They did a study once and told people IBS was caused by a virus and that made them feel better. This is the major reason"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 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." http://www.iffgd.org/SelfHelp.html Kel is the last person who understand the brain gut connections.Lets ask her though what parts of digestion the brain does control?While true more messages are sent from the gut to the brain, the brain is still in charge."The brain is in charge of the body more than any other organ.""The action of the smooth muscle surrounding the intestines is controlled by the specialised enteric nervous system. This, in turn, is connected to the central nervous system (brain) by the interconnecting autonomic nervous system." http://www.ibs-research-update.org.uk/ibs/brain1ie4.html There is a direct connection to stress and IBS through mast cells in the digestive tract.Activated mast cells in proximity to colonic nerves correlat-------------------------------------------------------------------------------- FYImore evidence of this going on and stress/threat to the organism/ can activate these cells without a pathogen.Activated mast cells in proximity to colonic nerves correlate.Gastroenterology. 2004 Mar;126(3):693-702. Links Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome.Barbara G, Stanghellini V, De Giorgio R, Cremon C, Cottrell GS, Santini D, Pasquinelli G, Morselli-Labate AM, Grady EF, Bunnett NW, Collins SM, Corinaldesi R.Background & Aims: The mechanisms underlying abdominal pain perception in irritable bowel syndrome (IBS) are poorly understood. Intestinal mast cell infiltration may perturb nerve function leading to symptom perception. We assessed colonic mast cell infiltration, mediator release, and spatial interactions with mucosal innervation and their correlation with abdominal pain in IBS patients. Methods: IBS patients were diagnosed according to Rome II criteria and abdominal pain quantified according to a validated questionnaire. Colonic mucosal mast cells were identified immunohistochemically and quantified with a computer-assisted counting method. Mast cell tryptase and histamine release were analyzed immunoenzymatically. Intestinal nerve to mast cell distance was assessed with electron microscopy. Results: Thirty-four out of 44 IBS patients (77%) showed an increased area of mucosa occupied by mast cells as compared with controls (9.2% +/- 2.5% vs. 3.3 +/- 0.8%, respectively; P 0.001). There was a 150% increase in the number of degranulating mast cells (4.76 +/- 3.18/field vs. 2.42 +/- 2.26/field, respectively; P = 0.026). Mucosal content of tryptase was increased in IBS and mast cells spontaneously released more tryptase (3.22 +/- 3.48 pmol/min/mg vs. 0.87 +/- 0.65 pmol/min/mg, respectively; P = 0.015) and histamine (339.7 +/- 59.0 ng/g vs. 169.3 +/- 130.6 ng/g, respectively; P = 0.015). Mast cells located within 5 microm of nerve fibers were 7.14 +/- 3.87/field vs. 2.27 +/- 1.63/field in IBS vs. controls (P 0.001). Only mast cells in close proximity to nerves were significantly correlated with severity and frequency of abdominal pain/discomfort (P < 0.001 and P = 0.003, respectively). Conclusions: Colonic mast cell infiltration and mediator release in proximity to mucosal innervation may contribute to abdominal pain perception in IBS patients.PMID: 14988823 FYIJack 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. www.conference-cast.com/i...ectureID=7Nigel 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 Mediatorswww.conference-cast.com/i...ecture.cfmJ 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 FYIHarvard healthThe Mind and the Immune Systemï¿½Part IOne of the standing mysteries of medicine is the relationship between the mind and physical healthï¿½how feelings, thoughts, attitudes, and behavior are related to physical illness, how psychological and social stress affect the likelihood of developing a disease or the ability to resist it, and how counseling for emotional problems can aid recovery from illness. One of the clues to this mystery lies in the immune system, the network that defends us against microbes and other invaders. Interest in the connections between the brain and the immune system has given birth to the discipline of psychoneuroimmunology. These systems communicate through the sympathetic nervous system and the endocrine glands, especially the hypothalamic-pituitary-adrenal (HPA) axis. Like the immune system, both are dedicated to the defense of the body against stress and danger, and both are directed from the same part of the brain, the hypothalamus. All threeï¿½the immune system, sympathetic nervous system, and HPA axisï¿½respond to some of the same transmitter chemicals. The sympathetic nervous system is part of the autonomic nervous system, which controls involuntary functions like heart rate, digestion, and breathing. The sympathetic nerves serve as an emergency response network, heightening the bodyï¿½s readiness to accept a challenge or escape in the face of danger. The sympathetic nerves are connected to various organs of the immune system, such as the thymus gland, the bone marrow, the spleen, and lymph nodes. Immune cells, including T cells, monocytes, and B cells, have receptors for the neurotransmitters released by sympathetic nerves. Damage to the hypothalamus and loss of sympathetic transmitters impairs the functioning of the immune system. An injection of antigens (foreign substances that activate the immune system) affects the concentration of sympathetic neurotransmitters in the brain. Immune LearningAnimal experiments show that the immune system can ï¿½learnï¿½ by association. In one experiment, rats drank sweetened water containing a drug that causes nausea and depresses the immune system. They became so sick that they avoided sweetened water for some time after the drug was removed. That behavioral conditioning eventually was extinguished (wore off), and they returned to drinking the waterï¿½only to start developing infections at an abnormally high rate. Apparently, by association with the immunosuppressant drug, sugared water was provoking a conditioned response that continued to suppress the ratsï¿½ immune systems even when it no longer affected their behavior. Another experiment involved mice bred to be genetically vulnerable to an autoimmune disease (one in which an overactive immune system attacks the bodyï¿½s own tissues). They were given a flavored solution containing a drug that suppresses the immune system, delaying the onset of the disease. Then most of the drug was removed, but as long as the flavor remained, the rats continued to drink the liquid and resist the disease. The immune system had learned by association to suppress itself when the animals recognized that taste. Conditioned learning can also enhance immune function, as another experiment showed. Mice were repeatedly forced to smell camphor while they were injected with a substance that stimulated the activity of natural killer (NK) cells, a type of white blood cell. When they were exposed to the smell of camphor without the injection, the activity of their NK cells still increased. Hormonal EffectsThe HPA axis regulates the bodyï¿½s activity through the circulation of the blood rather than directly through neural connections. The hypothalamus directs the pituitary gland to produce hormones that travel in the blood to the adrenal glands, where they cause the release of cortisol and other steroids as well as epinephrine (adrenaline) and its chemical relative norepinephrine (both of which also serve as neurotransmitters in the sympathetic system). These stress hormones influence the immune reaction through receptors on immune cells. Adrenaline, which prepares the body for immediate action, stimulates the immune system. One function of cortisol and related hormones (glucocorticoids) is to serve as a feedback mechanism that conserves energy by tuning down the emergency reaction when it is no longer needed. Rising cortisol levels signal the brain to shut down an immune response that threatens to become overactive. Thereï¿½s evidence that stress is associated with depressed immune function in one or another part of the system. In one study, the activity of NK cells declined in medical students preparing for an examination. Those who felt calmer and had a slower heart rate also showed fewer immune changes. In another study, unemployment slowed the multiplication of white blood cells in response to antigens. A survey found that unhappily married women had lower numbers of certain immune cells than women with happy marriages. Elderly people caring for relatives with Alzheimerï¿½s disease have higher than average levels of cortisol and low levels of antibody response to influenza vaccine. Stress delays the production of antibodies in mice infected with influenza virus and suppresses the activity of NK cells in animals inoculated with herpes simplex virus. Social stress can be even more damaging than physical stress. In a report published last year, some mice were put into a cage with a highly aggressive mouse two hours a day for six days. Other mice were kept in tiny cages without food and water for long periods. Both groups of mice were exposed to a bacterial toxin, and the socially stressed animals were twice as likely to die. Severe depression resembles a chronic stress response, and depressed patients often lack the normal daily variation in the production of cortisol. Depressed patients seem to have lower NK cell activity than healthy controls, possibly because of high cortisol levels. In one study, the lymphocytes (a type of white blood cell) of depressed and bereaved persons responded sluggishly to the substances that normally stimulate them to proliferate. Isolation can also suppress immune function. Infant monkeys separated from their mothers, especially if they are caged alone rather than in groups, generate fewer lymphocytes in response to antigens and fewer antibodies in response to viruses. Some studies have found lower NK cell activity in separated and divorced than in married men. NK cell activity also has been found to be lower in medical students who say they are lonely. In a year-long study of people caring for husbands or wives with Alzheimerï¿½s disease, changes in immune function were greatest in those who had the fewest friends and least outside help. In general, good social support is associated with better immune function in the elderly, even after correction for health habits, depression, anxiety, and life stress. The effect of traumatic stress on the immune system has been studied occasionally. According to one report, four months after the passage of Hurricane Andrew in Florida, people in the most heavily damaged neighborhoods showed red uced activity in four out of five immune functions. Similar results were found in a study of hospital employees after an earthquake in Los Angeles. And a report published last year suggested that men with a history of posttraumatic stress disorder (PTSD), even long after apparent recovery, had lower numbers of various immune cells and lower levels of immune activityï¿½possibly indicating a long-lasting suppression of the system. Another study found lower lymphocyte activity in abused women. But itï¿½s not easy to generalize about the effect of stress hormones and sympathetic nervous system activity on immune functioning. Much depends on the individual, the timing, the kind of stress, and the part of the immune system under consideration. The results of studies on depression, for example, are conflicting; it does not consistently suppress any part of the immune system except NK cells. Animal experiments suggest that the nervous system responds differently to acute and chronic stress. The acute stress reaction is often a healthy response to a challenge. But chronic stress may cause the feedback controls to fail, turning the emergency response into a condition that persists when it no longer has any use. Stress hormones and sympathetic activity remain at high levels, suppressing immune function and possibly promoting illness. The immune systems of people who are under chronic stress may also respond abnormally to acute stress. The Difference it MakesWhat matters most is whether the mindï¿½s influence on the immune system has the power to raise or lower the risk of illness or injury. On that issue only a little evidence is available. Healing of injuries. One study found that the wound from a biopsy healed more slowly in women under high emotional stress. In another experiment, a wound healed more slowly in students when it was inflicted before an examination rather than just before vacation. Slow healing has also been found in people caring for Alzheimerï¿½s patients. Colds and flu. Both observation and experiments suggest that stress makes people more susceptible to colds and other respiratory infections. In a one-year study, researchers asked 100 people to keep a diary recording their feelings and events in their lives. They were examined periodically for bacteria in throat cultures and virus antibodies in the blood. Stressful events were four times more likely to come before rather than after new infections. And people who developed a cold or other infection had often been feeling more angry and tense than usual. In an English study published in 1991, 420 people were given nose drops containing a cold virus after answering questions about their personality, health practices, and behavior. They were asked about feelings of frustration, nervousness, anxiety, and depression and about events such as loss of a job or deaths in the family. When the subjects were quarantined and monitored for nine days, those under greater stress were more likely to catch a cold. Researchers have continued to confirm this connection. In a study conducted in the late 1990s at the University of Pittsburgh, 276 healthy adults were given nose drops containing a cold virus. The symptoms were most severe in those who reported a high level of stress in their livesï¿½but only when it was prolonged stress caused by such problems as unemployment and troubled marriages. Resistance to the virus was correlated with strong social support, especially a variety of contacts with family, neighbors, friends, workmates, and fellow members of voluntary organizations. This effect was independent of smoking, alcohol consumption, and quality of sleep. People with the weakest (least diverse) social ties were four times more susceptible to colds than those with the strongest ties. Stress can also interfere with the response to a vaccine. In one study, flu shots were given to 32 people under high stress and 32 under low stress, matched for age, sex, and social class. The vaccine produced higher levels of antibodies in the low-stress group, and the high-stress people were more likely to become infected. The University of Pittsburgh researchers found a close association between difficulties in coping with stress, flu symptoms, and a specific immune response. Fifty-five volunteers were given nose drops containing a flu virus after answering questions about their ability to handle stress in their lives. The people with the most stress-related problems produced higher concentrations of interleukin-6, a chemical messenger that attracts immune cells to the site of an infection. They also produced more mucus (had stuffier noses) and generally developed more serious symptoms in direct proportion to the rise in their interleukin-6 levels. www.health.harvard.edu/hh....do?id=537Stress and the Gastrointestinal TractV. Stress and irritable bowel syndrome "Different types of stress play important roles in the onset and modulation of irritable bowel syndrome (IBS) symptoms. The physiological effects of psychological and physical stressors on gut function and brain-gut interactions are mediated by outputs of the emotional motor system in terms of autonomic, neuroendocrine, attentional, and pain modulatory responses. IBS patients show an enhanced responsiveness of this system manifesting in altered modulation of gastrointestinal motility and secretion and in alterations in the perception of visceral events. Functional brain imaging techniques are beginning to identify brain circuits involved in the perceptual alterations. Animal models have recently been proposed that mimic key features of the human syndrome. ""A VARIETY OF STRESSOR TYPES play a role in the development of irritable bowel syndrome (IBS). Stress, defined as an acute threat to the homeostasis of an organism, real (physical) or perceived (psychological) and posed by events in the outside world or from within, evokes adaptive responses that serve to defend the stability of the internal environment and to ensure the survival of the organism. Numerous reports in the literature provide evidence for a prominent role of stress in the pathophysiology (3 and clinical presentation of IBS symptoms (Refs. 23, 24, 27 and detailed references therein). A model that summarizes the possible role of different types of stressors in the development and modulation of IBS symptoms is shown in Fig. 1. According to this model, different types of stressors play a role in 1) permanent enhancement of stress responsiveness (pathological stress), 2) transient symptom exacerbation, and 3) symptom perpetuation (symptom-generated stress). Early life stress and trauma, in the form of abuse, neglect, or loss of the primary caregiver, play a major role in the vulnerability of individuals to develop functional gastrointestinal (GI) disorders later in life. Acute, life-threatening stress episodes in adult life (rape, posttraumatic stress syndrome) are also important risk factors in the development of functional GI disorders. In the genetically predisposed individual, both early life stress and severe life-threatening stress (referred in this article as "pathological stressors") can result in permanent, irreversible enhancement of the responsiveness of central stress circuits and therefore vulnerability to development of functional (as well as affective) disorders later in life. Other types of stressors occurring throughout the life of an individual, which may result only in transient changes in stress responsiveness, clearly play a role in symptom exacerbation. For example, psychosocial stressors in the form of sustained, threatening life events have been associated with onset and symptom exacerbation in IBS. "Physical" or interoceptive stressors of the digestive system, such as enteric infections, trauma, and surgery, may play a similar role in symptom exacerbation in the predisposed individual. Finally, in the affected patient, fear conditioning and interoceptive conditioning are likely to play important roles in triggering stress responses to situations and contexts that by themselves are not threatening or stressful (14). For a large number of IBS patients, the positive-feedback loop of conditioned fear responses to interoceptive stimuli or contextually conditioned stimuli of symptom-generated stressors may play a primary role in symptom chronicity. "ajpgi.physiology.org/cgi/...280/4/G519Enterochromaffin cells and 5-HT signaling in the --------------------------------------------------------------------------------FYI, another cell problem in IBS.Curr Opin Investig Drugs. 2004 Jan;5(1):55-60. Links Enterochromaffin cells and 5-HT signaling in the pathophysiology of disorders of gastrointestinal function.Crowell MD, Shetzline MA, Moses PL, Mawe GM, Talley NJ.Mayo Foundation and Mayo Clinic, GI Physiology & Motility, Division of Gastroenterology & Hepatology, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA. crowell.michael###Mayo.eduDisorders of gastrointestinal function are common and significantly reduce quality-of-life, as well as negatively impacting healthcare costs. Consequently, there is much interest in understanding the pathogenesis of these disorders. Increasing, albeit as yet limited, evidence has implicated alterations in 5-hydroxytryptamine (5-HT) release, and the subsequent interaction of 5-HT with specific 5-HT receptor subtypes, in the altered gut function of patients with irritable bowel syndrome (IBS) and other functional bowel diseases. Alterations to enterochromaffin cells and/or 5-HT signaling can result in gastrointestinal dysmotility, visceral hypersensitivity and secretomotor abnormalities in the gut. Evidence is beginning to link disturbed 5-HT physiology with the pathophysiology of diarrhea and constipation in IBS, and with slow-transit constipation. This review discusses the current evidence on the pathobiology of these systems.PMID: 14983974 P&S Journal: Fall 1996, Vol.16, No.3Research ReportsSerotonin and Digestion Researchers have identified a molecule in the digestive system that inactivates secreted serotonin (5-HT, 5-hydroxytryptamine). The discovery of the molecule, a transmembrane 5-HT transporter identical to one found in the brain, was the latest in a series of crucial pieces of evidence supporting the role of a serotonergic system in controlling peristalsis in the digestive tract. "We have postulated that serotonin was responsible for initiating and propagating the peristaltic reflex, but without an inactivating mechanism we couldn't say for sure that 5-HT served this function," says Dr. Michael D. Gershon, professor and chairman of anatomy and cell biology. The finding has implications for the control of gastrointestinal side effects of drugs aimed at serotonin receptors in the brain and, more importantly, for the development of new drugs to treat ailments of both gut and brain. In a paper published in an April issue of The Journal of Neuroscience, Dr. Gershon; Dr. Paul R. Wade, associate research scientist in anatomy and cell biology; and researchers from Tulane and Vanderbilt universities identified the molecule in the gut and demonstrated that blocking the 5-HT transporter dramatically affected colonic motility. In previous work, Dr. Gershon and many others have found the GI tract contains a virtual second brain, complete with "huge numbers" of neurons equipped with receptors for all of the classes of neurotransmitter also found in the brain. These findings, along with the current research, demonstrate that many drugs aimed at the brain may also affect the GI tract. For instance, the gastrointestinal side effects of fluoxetine (Prozac) and other selective serotonin reuptake inhibitors are the direct effects of fluoxetine on the gut's serotonin transporter. In addition to serotonin receptors, GI receptors for other neurotransmitters also could be affected by various medicines. "There are a whole range of compounds that deal with psychoses and psychoneuroses that have not been tried for GI disease but that could possibly have beneficial effects on such diseases," says Dr. Gershon. Likewise, says Dr. Wade, compounds used to treat GI problems, such as medications to treat functional bowel disorders, in which GI motility is abnormal, might have effects in the central nervous system. The researchers are now working on the details of how pressure and chemical stimuli release the serotonin that activates intrinsic sensory nerves to initiate enteric reflexes. http://cpmcnet.columbia.edu/news/journal/j...v16n3_0013.html Complex and Hidden Brain in Gut Makes Bellyaches and ButterfliesEver wonder why people get "butterflies" in the stomach before going on stage ? Or why an impending job interview can cause an attack of intestinal cramps ? And why antidepressants targeted for the brain cause nausea or abdominal upset in millions of people who take such drugs ? The reason for these common experiences, scientists say, is that the body has two brains - the familiar one encased in the skull and a lesser known but vitally important one found in the human gut Like Siamese twins, the two brains are interconnected ; when one gets upset, the other does, too. The gut's brain, known as the enteric nervous system, is located in sheaths of tissue lining the oesophagus, stomach, small intestine and colon. Considered a single entity, it is a network of neurons, neurotransmitters and proteins that zap messages between neurons, support cells like those found m the brain proper and a complex circuitry that enables it to act independently, learn, remember and, as the saying goes, produce gut feelings.The brain in the gut plays a major role in human happiness and misery. But few people know it exists, said Dr. Michael Gershon, a professor of anatomy and cell biology at Columbia Presbyterian Medical Center in New-York. For years, people who had ulcers, problems swallowing or chronic abdominal pain were told that their problems were imaginary, emotional, simply all in their heads. Dr. Gershon said. They were shuttled to psychiatrists for treatment. Doctors were right in ascribing these problems to the brain. Dr. Gershon said, but they blamed the wrong one. Many gastro-intestmal disorders like colids and irritable bowel syndrome originate from problems within the gut's brain, he said. And the current wisdom is that most ulcers are caused by a bacterium, not by hidden anger at one's mother.Symptoms stemming from the two brains get confused. Dr. Gershon said. "Just as tlie brain can upset the gut, the gut can also upset the brain" he said. "If you were chained to the toilet with cramps, you'd be upset too." Details of how tlie enteric nervous system mirrors the central nervous system have been emerging in recent years, said Dr. Gershon, who is considered one of a new field of medicine called neurogastroenterology. Nearly every substance that helps run and control the brain has turned up in the gut. Dr. Gershon said. Major neurotransmitters like serotonin, dopamine, glutamate, norepinephrine and nitric oxide are there. Two dozen small brain proteins, called neuropepddes, are in the gut, as are major cells of the immune system. Enkephalins, one class of the body's natural opiates, are in the gut And in a finding that stumps researchers, the gut is a rich source of benzodiazepines - the family of psychoacrive chemicals that includes such ever popular drugs as Valium and Xanax. In evolutionary terms, it makes sense that the body has two brains, said Dr. David Wingate, a professor of gastrointestinal science at the University of London and a consultant at tlie Royal London Hospital. The first nervous systems were intubular animals that stuck to rocks and waited for food to pass by. Dr. Wingate said. The limbic system is often referred to as the "reptile brain". As life evolved, animals needed a more complex brain for finding food and sex and so developed a central nervous system. But the gut's nervous system was too important to put inside the newborn head with long connections going down to the body. Dr. Wingate said. O-ffsprmg need to eat and digest food at birth. Therefore, nature seems to have preserved the enteric nervous system as independant circuit. Inside higher animals, it is only loosely connected to the central nervous system and can mostly function alone, without insructions from topside. This is indeed the picture seen bydevelopmental biologists. A clump of tissue called the neural crest forms early in emblyogenesis. Dr. Gershon said. One section turns into the central nervous system. Another piece migrates to become the enteric nervous system. Only later arte the two nervous systems connected via a cable called the vagus nerve. Untill relatively recently, people thought that the gut's muscles and sensory nerves were vyired directly to the brain and that the brain controlled the gut through two pathways that increased or decreased rates of activity. Dr. Wingate said. The gut was simply a tube with simples reflexes. Trouble is, no one bothered to count the nerve fibers in the gut. When they did, he said, they were surprised to find that the gut contains 100 million neurons - more that the spinal cord has. Yet the vagus nerve only sends a couple of thousand nerve fibers to the gut. The brain sends signals to the gut by talking to a small number of "command neurons", which in turn send signals to gut intemeurons that cany messages up and down the pike. Dr. Gershon said. Both command neurons and interneurons are spread throughout two layers of gut tissue called the myenteric plexus and the subrnuscosal plexus. ("Solar plexus" is actually a boxing term that refers simply to nerves in the abdomen.) Command neurons control the pattern of activity in the gut. Dr. Gershon said. The vagus nerve only alters the volume by changing its rate of firing. The plexuses also contain glial cells that nourish neurons, mast cells involved in immune responses, and a "blood brain barrier" that keeps harmful substances away from important neurons. Dr. Gershon said. They have sensors for sugar, protein, acidity and other chemical factors that might monitor the progress of digestion, determining how the gut mixes and propels its contents. "It's not a simple pathway", he said. "It uses complex integrated circuits not unlike those found in the brain." The gut's brain and the head's brain act the same way when they are deprived of input from the outside world. Dr. Wingate said. During sleep, the head's brain produces 90-minute cycles of slow wave sleep punctuated by periods of rapid eye movement sleep in which dreams occur. During the night, when it has no food, the gut's brain produces 90-minute cycles of slow wave muscle contractions punctuated by short bursts of rapid muscle movements. Dr. Wingate said.The two brains may influence each other while in this state. Dr. Wingate said. Patients with bowel problems have been shown to have abnormal REM sleep. This finding is not inconsistent with the folk wisdom that indigestion can produce nightmare. As light is shed oA the circuitly between the two brains, researchers are beginning to understand why people act and feel the way they do. When the central brain encounters a frightening situation, it releases stress hormones that prepare the body to fight or flee. Dr. Gershon said. The stomach contains many sensory nerves that are stimulated by this chemical surge - hence the "butterflies". On the battlefield, the higher brain tells the gut brain to shut down. Dr. Gershon said. "A frightened, running animal does not stop to defecate", he said. Fear also causes the vagus nerve to "turn up the volume" on serotonin circuits in the gut. Dr. Gershon said. Thus overstimulated, the gut goes into higher gear and diarrhea results. Similarly, people sometimes "choke" with emotion. When nerves in the oesophagus are highly stimulated, people have trouble swallowing. Even the so-called "Maalox moment" of advertising fame can be explained by the two brains interacting, said Dr. Jackie D. Wood, chairman of the department of physiology at Ohio State University in Columbus. Stress signals from the head's brain can alter nerve function between the stomach and oesophagus, resulting in heartburn.In cases of extreme stress. Dr. Wood said, the higher brain seems to protect the gut by sending signals to immunological mast cells in the plexus. The mast cells secrete histamine, prostaglandin and other agents that help produce inflammation, he said. "This is protective. If an animal is in danger and subject to trauma, dirty stuff in the intestines is only a few cells away from the rest of the body. By inflaming the gut, the brain is priming the gut for surveillance. If the barrier breaks, the gut is ready to do repairs". Dr. Wood said. Unfortunately, the chemicals that get released also cause diarrhea and cramping. Such cross talk also explains many drug interactions. Dr. Gershon said. "When you make a drug to have psychic effects on the brain, it's veiy likely to have an effect on the gut that you didn't think about", he said. Conversely, drugs developped for the brain could have uses in the gut.For example, the gut is loaded with neurotransmitter serotonin. When pressure receptors in the gut's lining are stimulated, serotonin is released and starts the reflexive motion of peristalsis. Dr. Gershon said. Now a quarter of people taking Prozac or similar antidepressants have gastrointestmal problems like nausea, diarrhea and constipation, he said. These drugs act on serotonin, preventing its uptake by target cells so that it remains more abundant in the central nervous system.In a study to be published soon. Dr. Gershon and his colleagues explain Prozac's side effects ont the gut. They mounted a section of guinea pig colon on a stand and put a small pellet in the "mouth" end. The isolated colon whips the pellet down to the "anal" end of the column, just as it would inside an animal. Dr. Gershon said. When the researchers put a small amount of Prozac into the colon, the pellet "went into high gear". Dr. Gershon said. The drug doubled the speed at which the pellet passed through the colon, which would explain why some people get diarrhea. Prozac as been used in small doses to treat chronic constipation, he said.But when researchers increased the amount of Prozac in the guinea pig colon, the pellet stopped moving. The colon froze up. Dr. Gershon said, which is why some people get constipated on the drug. And because Prozac stimulated sensory nerves, he said, it can also cause nausea. Some antibiotics like crythromycin act on gut receptors to produce oscillations. Dr. Gershon said. People experience cramps and nausea. Drugs like morphine and heroin attach to the gut's opiate receptors, producing constipation. Indeed, both brains can be addicted to opiates. Victims of AIzheimer's and Parkingson's diseases suffer from constipation. The nerves in their gut are as sick as the nerve cells in their brains. Just as the central brain affects the gut, the gufs brain can talk back to the head. Dr. Gershon said. Most of the gut sensations that enter conscious awareness are negative things like pain and bloatedness. Dr. Wingate said. People do not expect to feel anything good from the gut but that does not mean such signals are absent, he said. Hence, the intriguing question : why does the human gut produce benzodiazepine 7 The human brain contains receptors for benzodiazepine, a drug that relieves anxiety, suggesting that the body produces its own internal source of the drug, said Dr. Anthony Basile, a neurochemist in the Neuroscience Laboratory at the National Institutes of Health in Bethesda, Md. Several years ago, he said, an Italian scientist made a startling discovery. Patients with their liver failure fall into a deep coma. The coma can be reversed, in minutes, by giving the patient a drug that blocks benzodiazepine. When the liver falls, substances usually broken down by the liver get to the brain. Dr. Basile said. Some are bad, like ammonia and mercaptans, which are "smelly compounds that skunks spray on you", he said. But a series of compounds are also identical to benzodiazepine. "We don't know if they come from gut itself, from bacteria in the gut or from food". Dr. Basile said. But when the liver falls, the gut's benzodiazepine goes straight to the brain, knocking the patient unconscious. The payoff for exploring gut and head brain interactions is enormous. Dr. Wood said. For example, many people are allergic to certain foods, like shellfish. This is because mast cells in the gut mysteriously become sensitized to antigens in the food. The next time the antigen shows up in the gut. Dr. Wood said ; the mast cells call up a program, releasing chemical modulators that try to eliminate the threat. The allergic person gets diarrhea and cramps, he said. Many autoimmune diseases like Krohn's disease and ulcerative colitis may involve the gut's brain. Dr. Wood said. The consequences can be horrible, as in Chagas disease, which is caused by a parasite found in South America. Those infected develop an autoimmune response to neurons in their gut. Dr. Wood said. Their immune systems slowly destroy their own gut neurons. When enough neurons die, the intestines literally explode. A big question remains. Can the gut's brain learn 7 Does it "think" for itself 7 Dr. Gershon tells a story about an old Army sergeant, a male nurse in charge of a group ofparaplegics. With their lower spinal cords destroyed, the patients would get impacted."The sergeant was anal compulsive". Dr. Gershon said. "At 10 A.M. eveiyday, the patients got enemas. Then the sergeant was rotated off the ward. His replacement decided to give enemas only after compactions occured. But at 10 the next morning, everyone on the ward had a bowel movement at the same time, without enemas". Dr. Gershon said. Had the sergeant trained those colons?The human gut has long been seen as a repositoiy of good and bad feelings. Perhaps emotional states from the head's brain are mirrored in the gut's brain, were they are felt by those who pay attention to them. The "brain in the gut" takes the form of two networks of neural connections in the lining of the gastrointestinal tract, called the myenteric plexus and the subrnucosal plexus. The nerves are highly interconnected and have direct influence on things like the speed of digestion, the movement and secretions of the finger-like mucosa that line the intestines and the contractions of the different kinds of muscle in the gut wall. Diagram # 1 GUT-BRAIN HIGHWAY: A 2-WAY STREET:The gut has a mind of its own, the enteric nervous system. Just like the larger brain in the head, researchers say, this system sends and receives impulses, records and experiences and responds to emotions. Its nerve cells are bathed and influenced by the same nerotransmitters. The gut can upset the brain just as the brain can upset the gut. Diagram #2Diagram of wall of small intestine, with layers cut away to show two networks of nerves that make up enteric nervous system, or "brain in the gut". One network, called the subrnucosal plexus, is just under the mucosal lining. One, the myenteric plexus, lies between two coats of muscle. Diagram # 3 Sandra BLAKESLEE, The New York Times, Januaiy 23rd, 1996. http://www.aikidoaus.com.au/dojo/docs/2nd_braina.htm "Bi-directional signals pass between the gut and the brain. Signals from the gut to the brain may indicate abdominal pain, even in the absence of recognized pathology. Research in this theme area is important for understanding IBS, the most common condition treated by gastroenterologists. Recent IDRP research indicates that signals, sent from the brain to the gut during stressful situations, alter normal GI functions and may even induce relapses in certain diseases. Conversely, signals from the gut to the brain under certain conditions may induce changed behaviours, such as reduced food intake." http://www-fhs.mcmaster.ca/idrp/brain.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 Mi


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## Talissa (Apr 10, 2004)

Calid--thanks for the warm welcome. I've enjoyed your posts here.Kel--thanks for the tip on the Holosync tapes. I'm a huge fan of Dr. Mercola. I'll try to chew on that price tag for a while. You've seen a difference in your condition since using them? I agree with you about adding some type of meditation, along with the diet & supplements to help. I also agree with the Centre for Digestive Diseases when they say, "It is no longer acceptable to suggest that the cause of IBS in someone has been caused by anxiety, stress, or by a psychological abnormality. Such concepts are now out of date." http://www.cdd.com.au/html/expertise/diseaseinfo/ibs.html OK, one more paste. The above is an excellent article on IBS.Jenny--I'd have to quit my Metamucil and vits cold turkey, scary stuff! I'm hoping to be adding onto the DA-IBS thread with good news once I try it. If not, then I will give Dr. D's a shot. I imagine if I haven't truly gotten the bad bacteria/fungus in check, the DA won't work. Anyways, that's really terrific you're able to stick with it and it's working for you..


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## SpAsMaN* (May 11, 2002)

Eric i can't read a big scroll.Tell me how to feel better(spastic bowel) with no hypnosis.I allow med. treatment.With all the researchs you know,...


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## eric (Jul 8, 1999)

I would have to say that article has left out a lot of information on cuureent research on IBS and is somewhat misleading.Also probiotics in the research have shown to be helpful, but the jury is still out on them. It is thought they will be more preventitive then cure."It is no longer acceptable to suggest that the cause of IBS in someone has been caused by anxiety, stress, or by a psychological abnormality. "Stress is not the cause of IBS! But is it very well known now its a presciptaing factor for some. However, it is well know it is a contributing factor in post infectious IBS, not everyone with bacterial enteritis comes down with IBS.Also it is well known stress is a major factor in triggering IBS, but its not stress in the normal sense, but a threat to the organism. For years now a lot of research has shown this pathways. The pathways for the brain fighting infection are some of the same pathways for the fight or flight!!! The HPA axis!An expert, probably the worlds leading Expert is Dr Robin Spiller in the UK.Post Infectious Irritable Bowel Syndrome"Risk FactorsMost patients with bacterial gastroenteritis recover fully and only a small minority develop post-infective Irritable Bowel Syndrome. Female sex, hypochondriasis and adverse life events in the previous year all give an increased risk 6 7 with a relative risk of 3.4, 2.0 and 2.0 respectively. A much stronger risk factor is the duration of the initial illness, with a steadily increasing relative risk for each week of illness, reaching 11.4 for those with diarrhea lasting more than 21 days. Bacterial factors are likely to be important since we found around 1 in 10 of Campylobacter infected individuals developed post-infective IBS compared with just 1 out of 100 with Salmonella. It is likely therefore that the severity of tissue damage and ulceration is a major predictor."The increase in cells they infection are mast cells and ec cells that store serotonin."Post-Dysenteric IBSGorard D. Maxwell P. Mendall M. Hambidge DM. Barber R. Blakey A. Neal KR. Hebden J. Spiller RC. Prevalence of gastrointestinal symptoms after bacterial gastroenteritis (multiple letters) [2]. British Medical Journal. Vol 314(7098) (pp 1902-1903), 1997. Spiller RC. Postinfective bowel dysfunction. Current Opinion in Gastroenterology. Vol 13(2) (pp 85-89), 1997. Abstract : Infectious diarrheal illnesses are extremely common, and although most viral gastroenteritides are short lived, as many as 25% of patients suffer from postinfective bowel dysfunction following bacterial enteritis. Possible mechanisms include disturbed colonic flora, leading to altered cecal metabolism; persistent low-grade inflammation, especially in the inaccessible distal small bowel and proximal colon; or increased Gut permeability due to the action of inflammatory mediators such as nitric oxide, tumor necrosis factor, or interferon gamma. Finally, long-lasting alterations in mucosal and muscular innervation leading to altered gastrointestinal reflexes have been demonstrated in animal models of gastrointestinal infections. Similar changes with increased rectal sensitivity have been observed after infectious diarrhea in humans, and this visceral hypersensitivity is a prominent and consistent feature in the irritable bowel syndrome. New evidence suggests that inflammatory cytokines such as interleukin-1 may play a key role in these alterations in neural function. It seems likely that these changes account for some of the many patients seen in clinical practice with unexplained diarrhea. References: 67 Neal KR. Hebden J. Spiller R. Prevalence of gastrointestinal symptoms six months after bacterial gastroenteritis and risk factors for development of the irritable bowel syndrome: Postal survey of patients. British Medical Journal. Vol 314(7083) (pp 779-782), 1997. Abstract : Objective: To measure the prevalence of gastrointestinal symptoms six months after bacterial gastroenteritis and determine risk factors and associations with postdysenteric symptoms. Design: Postal questionnaire. Setting: Nottingham Health Authority. Subjects: 544 people with microbiologically confirmed bacterial gastroenteritis between July 1994 and December 1994. Main outcome measures: Prevalence of gastrointestinal symptoms and relative risks for development of the irritable bowel syndrome and self reported altered bowel habit. Results: A quarter of subjects reported persistence of altered bowel habit six months after an episode of infective gastroenteritis. Increasing duration of diarrhoea, younger age, and female sex increased this risk, whereas vomiting as part of the illness reduced the risk. One in 14 developed the irritable bowel University of syndrome with an increased risk seen in women Nottingham, (relative risk 3.4; 95% confidence interval 1.2 to 9.8) and with duration of diarrhoea (6.5; 1.3 to 34 for 15-21 days). Conclusions: Persistence of bowel symptoms commonly occurs after bacterial gastroenteritis and is responsible for considerable morbidity and health care costs. References: 15 " http://www.nottingham.ac.uk/~muztf/Consult...abs/rcsabs1.htm Basic Principles -- Brain-Gut Moderators: Emeran Mayer MD; Robin Spiller MD. Panel: Robin Spiller MD; Jackie Wood PhD; George Chrousos MD; Yvette Tachï¿½ PhD; Lisa Goehler PhD; G.F. Gebhart PhD; Emeran Mayer MD. "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 "


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## gt0854a (Feb 22, 2000)

Holy Heavens Eric, CALM DOWN.Is there anyone on this website who happens to be successful in life but didn't graduate from college or high school? Thus far your arguments seem to indicate that all that matters is credentials. I'm sure that would offend most of us.As a diabetic, I can tell you right off that an MD can tell me the big picture, but a CDE (with much less education) is the one who will really help me.I can also tell you that there is nothing medically a MD can do for my cervical arthritis -- however both a chiropractor and a physical therapist (one or the other) can provide extreme relief thru manipilation that I am unable to perform on myself.Why does it antagonize you so that people may have a difference of opinion? Yes, he is a salesman. Yes, he is making money. Yes, he is not an MD. But you know how penicillin was discovered right? Not all methodologies and treatment protocols are discovered in a lab. Not all patents come from Ivy League grads with PhDs. Often what is casually proved in practice is later simply verified in a controlled study.Each of us, as an adult, are competant to make our own decisions. Being a scientist, I am ALSO disinclined to believe any 100% claim when the limitations of the program are not spelled out. Does that mean I don't believe in it at all? No, of course not... it means I don't agree with his pitch. His responses are also sometimes questionable in their tone; none of us is perfect!I will research it, and ****I**** will decide what is best for MYSELF. You continually post the same information over and over, which will not 'win' anyone to your cause. Must we continue to flog the same dead horse? Can we not simply agree to disagree and let this thread go back to that for which it was intended?Respectfully yours,gPS: For those on dialup, the length of yours posts, including your signature, is rather overwhelming. It is also difficult to find your words interspersed with the content of the articles, and nearly impossible to print said articles for later reading. Would you consider simply html linking them so that we can print them out for ourselves? That way we can also find your comments on why the article was included.


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## missC (Oct 16, 2002)

thankyou, gt0845a. now there's a model of an informative post based on digested, processed, considered information with a conclusion personally drawn rather than borrowed from other sources. rather than ...eric, i've had medical doctors promise me significant relief from specific medications. which then didn't happen. what do you think my comeback should be, for the terrible, agonizing, psychological damage i suffered due to their irresponsibility? myself, i think i should sue and get their arses struck off the medical register. don't you? eric? eric?you are patronizing people because this argument suits your campaign. ibsers are well used to disappointment from treatments. it goes with the condition. would anybody here disagree with me when i say that before i consider a treatment, i decide if i can afford to lose that kind of money on something that may not work? what about conventional doctor's bills in the us for evidently extremely frequently ineffective treatments, eric?


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## BobW (Jan 2, 1999)

Let me add my voice to those who say Eric needs to get off this site. I have most definitely been helped by Dr. Dahlman's low carb diet. (The last 30 days) I am a 15 year IBS sufferer and I am much more interested in what helps than in endless text. I am self-employed and I don't have the time to debate over Eric's endless garbage. He can post it somewhere other than here. My brain fog & the sick feeling has greatly improved. I plan to contact Dr. D. to see if his advice can help further.Linda, thanks for staying around to help with the Caltrate. It didn't help me but I have observed that she helped a number of people. But Eric you are hurting this thread a lot more than you are helping.


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## SpAsMaN* (May 11, 2002)

BobW,you are here from the beginning(99)and you still Junior?







How this can be credible?







I respect that you suffer since 15 years BobW.


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## calid (Aug 4, 2003)

Well, I am on day 7 of the antibiotic recommended by the LAB that did my cultures. I have had 6 days now of perfect bowel movements, formed stools, no cramping, no urgency. 6 days in a row, I haven't been that good in years. I've had 2 or 3 days while on the program that were good, but I always drifted back to bad. I'm keeping my fingers crossed, but so far VERY good results!!!!! Thank you Dr. Dahlman.


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## kel1059 (Feb 28, 2003)

this would be amazing. i hope that it holds out. i assume that you are still taking the probiotics? i'm wondering if dr d has additional strategies that might dramatically decrease the chances of the bad bugs returning.i think the key for you is that the lab recommended the antibiotic that you should use. mainstream doctors are clueless on these issues. first of all they use the local hospital lab for stool analysis and my experience is that those labs are borderline worthless for most stool analysis.


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## calid (Aug 4, 2003)

Kel: yes I'm taking the probiotics. You're right about the antibiotics and doctors, I've taken rounds before that have had absolutely zero effect on what I was given it for. Then they say, Oh sorry, that one must not have been right for that bacteria. This lab shows exactly what works for what bacteria. No experimenting, no mistakes. I also hope this holds, it would be WONDERFUL!!!!!!!!!!!!!!!


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## conserv101 (Apr 11, 2004)

I have read this site for years, and I have learned so much about IBS. It is a great site. One reason I donï¿½t post is because of people like Eric. Some people on this board are so abusive, and I feel it would hurt me more than help me, but I just need to respond to his behavior. Eric, you make me so sad when you try to hurt other people. Any ideas that are different from yours it seems like you need to destroy at all costs. Is it possible that you are causing people to not get better because of your attacks? How would you like someone to go after your beloved hypnotherapy? Here are a few sites that do just that. This is exactly what you seem to do to others. Youï¿½re obsessed and seem to stalk other people on the board. Maybe self-reflection is needed on your part. http://www.rapidnet.com/~jbeard/bdm/Psychology/hypno.htm http://skepdic.com/hypnosis.html http://thingy.apana.org.au/~fun/scn/gov/an...n-hypnosis.html


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## eric (Jul 8, 1999)

*"Hypnosis is a naturally occurring phenomenon. We go in and out of hypnosis constantly, while watching an interesting program on television, reading a book, driving a car, or day dreaming, just to name a few."* Consev, here is a hypnosis site by a born again Chritian, who has overcome the fear of it and uses it for years now.Chaplain Paul G. Durbin, Ph.D.Director of Clinical HypnotherapyMethodist Health System Foundation, affiliated with Methodist Hospital, New Orleans, LA http://www.durbinhypnosis.com/ First of all I am not attacking any person indivdually, but DR D's IBS information, if you want to attack me and show me my informations is inaccurate and his is accurate fine. Nobody even DR D has not done that yet? But to attack me through HT is worng. Becuase its a fact it works and is recommended for IBS and has been for over 15 years and its a safe natural treatment, an most people I believe would like a safe natrual treatment for IBS that is effective.It is a fact that gut direct HT helps IBS!Its bad information above on HT, driven by certain religion's people and there innacurrate information and thier being scared of it which they have been for years because of the lack of understanding on it. It was the same thing in the past with religion and Anesthesia. But that has dramtically changed.HEALTH: Hypnosis gaining respectability among doctors, patientsBY MICHAEL WALDHOLZWall Street Journal"Hypnosis, often misunderstood and almost always controversial, is increasingly being employed in mainstream medicine.Numerous scientific studies have emerged in recent years showing that the hypnotized mind can exert a real and powerful effect on the body. The new findings are leading major hospitals to try hypnosis to help relieve pain and speed recovery in a variety of illnesses." http://www.twincities.com/mld/pioneerpress/6974868.htm so you tell me conserv101, how the above information you posted, is inaccurate to the truth? You should fine more accurate and up to date papers then that. Plus they are all very old, one 1984.These are IBS researcher and experts. Z Gastroenterol 2003 May;41 5:405-12Hauser W.Medizinische Klinik I, Klinikum Saarbrucken gGmbH, Saarbrucken. w.haeuser###klinikum-saarbruecken.deHypnosis is one of the oldest remedies against physical diseases and mental disorders of mankind. The term hypnosis is used for the description of a technique as well as for the description of an altered state of consciousness which is induced by this technique. Hypnosis is a scientific tool in psychophysiological studies of gastrointestinal functions secretion, motility, visceral sensitivity and their processing in the central nervous system. *Hypnosis is an empirically validated treatment of the irritable bowel syndrome even refractory to medical treatment which is recommended by international expert groups Rome II and the British Society of Gastroenterology. * "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 Clinical hypnosis: Something for you? http://www.ibshypnosis.com/hypnosisabout.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 The Effects of Hypnosison Gastrointestinal Problems http://www.med.unc.edu/medicine/fgidc/hypnosis.htm Hypnosis Treatment of Irritable Bowel Syndrome By: Olafur S. Palsson, Psy.D., Research Associate, Department of Medicine, University of North Carolina at Chapel Hill 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 I emailed the pope one time and got a cardinal who replied and he said he used Hypnosis.What the helll did Ron Hubburd know about HT for IBS????????? Pretty shaky information from that source for sure. I actually connacted them in the past and they could not give a good reason why they were agaisnt it. They said Ron had researched it, but he has been dead for years now and modern research is begininng to understand it and prove its effectiveness.BBC Hypnosis works for bowel pain. http://news.bbc.co.uk/1/hi/health/3207972.stm The American physcotherpay and medical hypnosis association.Definition of the Process of Hypnosis and Trance StatesHypnosis is a process during which an individual, usually with the aid of another, allows themselves to become more suggestible. One can experience changes in sensations, perceptions, thoughts, or behavior. Hypnosis is generally established by an induction procedure. Although there are different hypnotic inductions, they are based on imaginative involvement with focused attention and concentration. People respond to hypnosis in different ways. Some describe their experience as an altered state of consciousness. Others describe hypnosis as a normal state of focused attention, in which they feel very calm and relaxed. Regardless of how and to what degree they respond, most people describe the experience as very pleasant. A person's ability to experience hypnotic suggestions can be inhibited by fears and concerns arising from some common misconceptions. Everyone has a conception of hypnosis. It probably comes from depictions of hypnosis in books, movies or on television. Those who have been hypnotized do not lose control over their behavior. They remain aware of who they are and where they are, and unless amnesia (the inability to recall past events, in this context the inability to recall what has occurred during the hypnotic session), has been specifically suggested, they usually remember what transpired during hypnosis, the only exception to this is what is called a somnambulist. A somnambulist is an individual who has the ability to go very deeply into hypnosis. A somnambulist will have total amnesia. Hypnosis makes it easier for people to experience suggestions, but it does not force them to have these experiences. Although scientists have different theories about the nature of hypnosis, all seem to agree that hypnotized people report changes in the way they feel, think, and behave, and these changes are in response to suggestions. People vary in their of responsiveness to hypnotic suggestions, what is called their hypnotizability or hypnotic susceptibility, but most people can be hypnotized to some degree. Hypnosis is a naturally occurring phenomenon. We go in and out of hypnosis constantly, while watching an interesting program on television, reading a book, driving a car, or day dreaming, just to name a few. People who appear to be low in hypnotizability often can improve their response to suggestions with practice. If an individual is unable to use all of their hypnotic ability during a testing session, it might appear that they are a poor subject, but with improved rapport, many are able to improve hypnotic ability. Most clinical uses of hypnosis have been designed for the average individual, and a deep state of trance is not usually needed for most clinical treatment. http://psychhypno.tripod.com/page8.htm You can bash me and what I am trying to say here, but bashing HT, because of what I am saying is flat out wrong and could hurt people that could get very much better from trying it. Its a done deal it works for most people and IBS!HT works on the ACC part of the brain in IBS as well, and that is a problem seen in IBS."PET Scan HYPNOSIS MIGHT ALLEVIATE pain by decreasing the activity of brain areas involved in the experience of suffering. Positron emission tomography (PET) scans of horizontal (top) and vertical (bottom) brain sections were taken while the hands of hypnotized volunteers were dunked into painfully hot water. The activity of the somatosensory cortex, which processes physical stimuli, did not differ whether a subject was given the hypnotic suggestion that the sensation would be painfully hot (left) or that it would be minimally unpleasant (right). In contrast, a part of the brain known to be involved in the suffering aspect of pain, the anterior cingulate cortex, was much less active when subjects were told that the pain would be minimally unpleasant (bottom). " http://jan.ucc.nau.edu/~gaud/webex/PET.htm I won't supply anymore information to this thread if someone can start showing real connections and research to Bacteria and IBS? Lets talk about that through the IBS research, anyone care to post it and discuss it and its role? Lets see some info, because that is something DR D has not provided at all?Lets actually see a case for its role in IBS, even I am the one posting that, as well as all IBS information.Yes, doctors also have a long way to go in treating all IBSers effectively, I concur. They need to do more research and no what the problem problems are, but they have already done a lot an know a lot of problems as it stands now. For example they know there is a problem with the hap axis and that it also ties into Fibro and CFIS and they know there are a problem with nmast cells and that ties into IBS and bladder problems.They know there is a problem with serotonin and that ties into why people have motility problems and c and d and c/d in the first place and why people's sleep, appeitie, anxiety and other problems are tied into serotonin effects in IBS patients.


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## Talissa (Apr 10, 2004)

Eric,I think you missed the point of Conserv's post. There was no need to defend hypnotherapy--Conserv was just trying to show others could do what you do, to you, and try to make you see it only serves to inflame, not inform. I thought it was a good, clear post; it's strange you couldn't get it. You are coming across as obsessive/compulsive, and it is sad. Please consider everyone's advice here-- relax, get a better perspective, agree to disagree, maybe do some yoga, but for goodness sake, get a grip. Wishing you peace, T-


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## Jenny Snell (Sep 14, 2003)

Eric, go get a life! You really are VERY obsessed and are constantly trying to get your own very- tunnel-visioned-views across to people who now are fed up with your cut and pastes!


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## daisysp (Jan 13, 2004)

PLEASE PLEASE PLEASE WILL EVERYONE WRITE TO JEFFERY AND DEMAND HE REGULATE THESE THREADS AS IT SEEMS HE DOES NOT. WE HAVE ASKED AND ASKED ERIC TO STAY OFF HERE WITH NO AVAIL. IF WE ALL WRITE, MAYBE, JUST MAYBE SOMETHING WILL GET DONE. I am going to research someone else to talk to about this as I have gotten nowhere with my letters to Jeffery.Thanks to all.


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## Kacebece3 (Apr 17, 2002)

I agree with the others on this thread about Eric.Eric this thread is not the place for your posts go somewhere else. Ken


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## gt0854a (Feb 22, 2000)

Eric darling, I understand your venom.I always try to find a similar situation that pertains to myself. For example, if someone told me to stop taking insulin, that a new chinese herb would cure me, well, I would respond as you are with medical research showing that I would die without it. In fact, I'd be pretty damn obstinate about it too.However, it is also conceivable that this new herb could lower and stablize blood sugar enough for a type II diabetic to stop taking medication. There are two sides to any story, and one of your main complaints against the bacterial imbalance theory and Dr. D's methodologies is that no two people are alike. How can one program fix us all?Well, since we all are different, heck some of us are C some D, some neither... it is conceivable that more than one treatment might work - one might work for me, another for you. Maybe each other's methodology would if only we would give it a chance.There is another thread online eric discussing hypnotherapy. This thread is to discuss bacterial and chemical imbalances. Please respect that, and we in turn will respect your right to your beliefs and promise not to sabatoge THAT thread.g


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## Gret (Sep 23, 2003)

Calid! Hooray for you! I really hope you've turned the corner towards better health! I am so happy for you! I expected troubles for myself on Easter with all the huge music, etc. However, I didn't think of it till halfway through the service and I couldn't believe I was doing so well. It's still amazing, considering how IBS ruined everything for me for so long. I'm keeping my fingers crossed for you, hang in there!


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## calid (Aug 4, 2003)

Gret: this just shows you how different techniques work for different people. What worked for you didn't work for me, what worked for me wouldn't have worked for you. That's why there is no one cure or treatment and that's why Dr. Dahlman is so successful with his patients. I'm still cautiously optimistic, but it looks good at this point. I even ate some "off my safe diet" foods yesterday and did just fine.


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## eric (Jul 8, 1999)

What does bacteria and leaky gut and dysbosis have to do with this?PREVALENCE AND EPIDEMIOLOGYIrritable bowel syndrome (IBS) is the most commonfunctional gastrointestinal (GI) disorder with worldwideprevalence rates ranging from 9-23%. Functionaldisorders are conditions where there is an absence ofanatomical or biochemical abnormalities on diagnostictests which could explain symptoms. IBS is a chronicfunctional bowel disorder characterized by abdominal painor discomfort and alterations in bowel habits. It is the mostcommon disorder diagnosed by gastroenterologists andaccounts for up to 12% of total visits to primary careproviders Gender appears to play an important role in IBS.Two-thirds of individuals with IBS are female with anestimated prevalence in women ranging from 14-24%. Ofthose who seek healthcare services including tertiary andambulatory care for IBS and other functional boweldisorders, women lead men by a ratio of 2-2.5:1 whileothers estimate the rate to be higher at 3-4:1. However, thegender distribution appears to be less than 2:1 among IBSnon-patients (individuals with symptoms of IBS but whohave not sought health care) in the community. It is notknown if this increased female prevalence represents areporting bias, i.e. if female patients are more willing thanmen to disclose that they have IBS-related symptoms, or ifit represents a biological difference. Not all individuals with IBS symptoms seek medical carefor their symptoms. Based on different epidemiologicalstudies performed in different countries, 20-75% ofindividuals meeting symptom criteria for IBS will seekmedical care for their symptoms at some point in theirlives. There are between 2.4 and 3.5 million annualphysician visits for IBS in the United States, during which2.2 million prescriptions are written. The cost to society interms of direct medical expenses and indirect costsassociated with loss of productivity and work absenteeismis considerable. It has been estimated that the total cost ofIBS is 30 billion dollars per year which includes 20 billiondollars for indirect costs and 10 billion dollars for directcosts.SYMPTOMS OF IBSGastrointestinal (GI) symptoms.The hallmark symptomsof IBS are chronic abdominal pain and/or discomfort andalterations in bowel habits, such as diarrhea, constipationor alternating diarrhea and constipation. Abdominal painhas been reported as primarily crampy or as a generalizedache with superimposed periods of abdominal cramps,although sharp, dull, gas-like, or nondescript pains are alsocommon. The intensity and location of abdominal pain inIBS are highly variable, even at different times within asingle patient. The abdominal pain and/or discomfortexperienced by IBS patients is often severe enough tointerfere with daily activities. Several factors exacerbate orreduce the pain of IBS. Many IBS patients reportincreased symptoms during periods of stress or emotionalupset such as job or marital difficulties. Defecation mayprovide temporary relief from the abdominal pain of IBS,whereas ingestion of food may exacerbate the discomfortin a subset of patients. Based on bowel habits, patients are commonly sub-classified into those having mainly diarrhea, mainlyconstipation, and those alternating between the twopatterns. IBS patients with constipation may experienceinfrequent bowel movements (3/week), hard stools,straining, and sensation of incomplete evacuation. IBSpatients with primarily diarrhea report frequent bowelmovements (3/day), loose and/or watery stools frequent,and urgency. The prevalence of the difference subgroupsbased on bowel habits is similar. Other common IBSsymptoms include bloating, visible abdominal distension,and mucus in the stool.Upper gastrointestinal symptoms are commonly reportedby IBS patients with 25% to 50% of patients reportingheartburn, early satiety, nausea, abdominal fullness, andbloating. Up to 87% have reported intermittent upperabdominal discomfort or pain (dyspepsia) byapproximately 40% of patients. Extra-intestinal symptoms and overlap with othercommon pain syndromes.Many IBS patients also reportextra-intestinal (non-gastrointestinal) symptoms such asfatigue, muscle pain, sleep disturbances, and sexualdysfunction. Up to two-thirds of IBS patients report extra-intestinal symptoms compared to less than 15% of healthyindividuals. These extra-intestinal symptoms may be dueto IBS co-morbidity with other stress-related syndromessuch as fibromyalgia, chronic fatigue syndrome, andinterstitial cystitis. Epidemiological studies have confirmedthe clinical impression that IBS frequently overlaps withthese other conditions in the same patient, suggestingshared pathophysiologic mechanisms. Psychological symptoms.Some IBS patients also havepsychological distress symptoms such as anxiety anddepression particularly in those with severe symptoms andhealth care seeking behavior. Somatization, anxiety anddepressive disorders are also more commonly seen in IBSpatients than in healthy controls. Psychosocial trauma andearly adverse life events (e.g., parental separation orphysical/verbal/sexual abuse history) may profoundlyaffect symptom severity, daily function, and healthoutcome. Although these adverse events such as abusemay be quite prevalent in IBS patients, a significantnumber have not discussed this with anyone and a smallernumber will actually inform their physicians.DIAGNOSIS OF IBSThe diagnosis of IBS is based on identifying characteristicsymptoms and excluding organic disease. An earlyconfident diagnosis permits tests to be minimized andreassures the patient that there is no lethal disease. Thereare no physical findings or diagnostic tests that confirm thediagnosis of IBS. Therefore, diagnosis of IBS involvesidentifying certain symptoms consistent with the disorderand excluding other medical conditions which may have asimilar clinical presentation. The symptom-based Rome IIdiagnostic criteria for IBS (Table 1) emphasize a ï¿½positivediagnosisï¿½ rather than exhaustive tests to exclude otherdiseases. A validation study of the Rome criteria afterexcluding patients with symptoms suggestive of othermedical conditions other than IBS (ï¿½alarm signsï¿½ e.g.bloody stools, weight loss, family history of colon cancer,refractory and severe diarrhea) showed that 100% ofindividuals who met the diagnosis of IBS based on theRome criteria truly had IBS rather than an alternativediagnosis. At 2 years follow-up, none of the IBS patientsrequired a change in diagnosis.Other medical conditions which may present withsymptoms similar to those seen in IBS includeinflammatory bowel disease, GI infections, lactoseintolerance, thyroid disease, microscopic or collagenouscolitis and malabsorption syndromes such as celiac sprue(Table 2). A medical history and physical examination,laboratory and GI tests can help to exclude these otherdiagnoses. These tests include routine blood tests, stoolstudies for infection, and endoscopic procedures such asupper endoscopy, sigmoidoscopy and colonoscopy. Inpatients 50 years of age who meet diagnostic criteria forIBS and have no ï¿½alarm signsï¿½ suggestive of diseases otherthan IBS, initial screening tests such as a complete bloodcount to check for anemia and a chemistry panel can beobtained. Other screening tests to consider are a thyroidtest (TSH) and a blood test for celiac sprue. However,further tests and procedures such as a colonoscopy are notgenerally recommended. Patients 50 years of age withIBS symptoms should undergo a screening colonexamination with either a colonoscopy or flexiblesigmoidoscopy and barium enema if these tests have notbeen done previously, regardless if they have alarm signs(see Figure 1).In some centers, the presence of bacterial overgrowth isoften determined because this condition may causesymptoms similar to those of IBS. It is most commonlydiagnosed by a lactulose hydrogen breath test. Two studiesfrom the same research group found that 78% to 84% ofpatients with IBS had bacterial overgrowth. In patientswith evidence of bacterial overgrowth, those treated withan antibiotic such as neomycin had a greater reduction intheir GI symptoms compared with placebo. Although thesedata are intriguing, there are some methodologiclimitations in these studies and, therefore, the use ofwidespread hydrogen breath testing for bacterialovergrowth is still not generally advocated. PATHOPHYSIOLOGIC MECHANISMS OF IBSAlthough psychological and physiological abnormalitieshave been described, the overall pathophysiology of IBS isnot well understood. Similar to other chronic medicalconditions, a multi-component conceptual model of IBS,which involves genetic, physiologic, emotional, cognitive,and behavioral factors, has been formulated (Figure 2).Although all factors are closely interconnected, theimportance of individual factors in the generation of IBSsymptoms may vary greatly between individuals.Previously, IBS was considered primarily a disorder ofaltered gut motility. Currently, increased bowel sensitivity(visceral hypersensitivity) and altered brain-gutinteractions are felt to play a principal role in thepathophysiology of IBS. Recently, it has been found thatgenetic and environmental factors are important in IBS butfurther studies are needed to understand the importance ofthese factors in the prevalence, symptoms, physiologicresponses and response to treatment in IBS.Altered intestinal motor function.Altered intestinalmotility has been found in IBS, particularly exaggeratedcontractions (motor response) in the lower (sigmoid) colonto psychological stress and food intake. These alterationsmay explain why many IBS patients experience typicalIBS symptoms following meals and develop exacerbationsduring stressful life events. These changes in bowelmotility are likely due to alterations in the autonomicnervous system outflow to the intestine. Increased gut sensitivity.There has been compellingevidence that IBS patients have enhanced perception ofbowel (visceral) stimuli such as food or distensions of thegut wall. The initial clinical observations that led to thehypothesis that patients with IBS have visceralhypersensitivity included the presence of recurringabdominal pain as a principal symptom, the presence oftenderness during palpation of the sigmoid colon (leftlower abdominal area) during physical examination inmany patients, and excessive pain often reported bypatients during endoscopic examination of the sigmoidcolon. Published studies measuring visceral sensitivitysuggest that a variety of abnormal sensations orperceptions in relation to bowel stimuli may be morefrequent in IBS patients. At least two perceptualalterations can be distinguished, a hypervigilance(increased attention or vigilance) towards expectedaversive events arising from the bowel, and hyperalgesia(lowered threshold to pain) which is inducible by sustainedpainful visceral stimulation. These findings are paralleledby similar findings of target system hypersensitivity inother disorders such as fibromyalgia and myofascial paindisorder. In contrast to their enhanced perception ofvisceral pain, most IBS patients have normal or evendecreased pain sensitivity and tolerance for painful coldand mechanical stimulation of somatic (skin and muscle).However, there is a recent study that has demonstratedincreased somatic sensitivity to thermal heat in IBSpatients. Patients with IBS who also have co-existing fibromyalgia have increased somatic sensitivitycomparable to patients with fibromyalgia alone.Increased stress mediators in IBS.There is increasingevidence to support the prominent role of stress in thepathophysiology and in the clinical presentation of IBSsymptoms. There are few published reports on alterationsin stress mediators, such as catecholamines and cortisol tostress or visceral stimulation in IBS. Several studies havereported increased in catecholamines (norepinephrine andepinephrine) and cortisol levels in IBS patients. However,it remains to be determined whether these neuroendocrinealterations play a direct role in gut function and symptomgeneration. Altered brain-gut communication in IBS.A unifyinghypothesis to explain the functional bowel disorders is thatthey result from a dysregulation of the brain-gut axis. Anevolving theory is that normal gastrointestinal functionresults from an integration of intestinal motor, sensory,autonomic and CNS activity and GI symptoms may relateto dysregulation of these systems. Brain imaging studiessuch as functional magnetic resonance imaging (fMRI) andpositron emission tomography (PET) have been performedin IBS patients to measure brain activation patterns tovisceral stimuli. These studies suggest that brainactivation responses to visceral stimuli are distinctlydifferent in IBS patients compared to healthy individuals.IBS patients may have different emotional and cognitiveprocessing of sensory information from the gut comparedto healthy individuals. Post-infectious IBS.Symptoms suggestive of IBS occurin approximately 7-30% of patients following acute GIinfections, often persisting for years following completeresolution of the infection. A large cohort study identifieda self-reported history of acute gastroenteritis as a majorrisk factor for the development of IBS. Reported riskfactors for the development of post-infectious IBS includefemale sex, the duration of the acute diarrheal illness andthe presence of sustained psychosocial stressors around thetime of infection. Post-infectious IBS is not restricted to aparticular organism and has been documented with avariety of bacterial infections (Salmonella, Campylobacterand E. coli) as well as parasitic infection. However, therole of acute viral gastroenteritis in this condition isunknown.In post-infectious IBS, low grade GI inflammation orimmune activation may be a basis for altered motility,and/or nerve and mucosal (lining of bowel) function of thegut in IBS. Recent studies have also shown that in a subsetof unselected IBS patients (no documented history of apreceding gut infection), there is evidence of increasedinflammatory cells in the colon mucosa. It remains to bedetermined if altered gut immune function is a generalcharacteristic of IBS patients. The implication of stressfullife events in the development of post-infectious IBSsuggests a convergence of central (brain) and peripheral (gut) mechanisms in the clinical presentation of thissyndrome.Gender differences.In addition to IBS, many functionalGI disorders and other chronic visceral pain disorders (e.g.interstitial cystitis and chronic pelvic pain) and somaticpain disorders (e.g. fibromyalgia, myofascial paindisorder) are more common in women than in men.Increasing evidence suggests that gender differences existin the symptoms, pathophysiologic responses and responseto certain treatments in IBS. Female IBS patients are morelikely to be constipated, complain of abdominal distensionand certain extra-intestinal symptoms. Studies have alsosupported an influential role of ovarian hormones (e.g.estrogen and progesterone) on bowel function and painsensitivity which can in part explain the gender differencesin IBS. Several investigators have reported a variation inGI symptoms during different phases of the menstrualcycle, particularly increased abdominal pain and loosestools at the perimenstrual (just prior to and at time ofmenses) phase. TREATMENTTreatment of IBS includes both non-pharmacologic andpharmacologic therapies. An important component of non-pharmacologic treatment for IBS is a successful physician-patient relationship. The physician should strive toestablish effective bi-directional communication with thepatient, gain the patientï¿½s confidence with a concise,appropriate medical evaluation and offer reassurance andeducation that IBS is a real medical condition with apotential impact on health related quality of life butwithout significant long/term health risk. Some IBSpatients, especially those presenting with new onset ofsymptoms, express relief that their symptoms are notcaused by a serious condition such as malignancy. Othercomponents of non-pharmacologic treatment of IBSinclude diet recommendations, lifestyle modifications, andpsychosocial intervention if needed. Patients with mild IBS symptoms comprise the mostprevalent group, and are usually treated by primary carepractitioners, rather than specialists. These patients haveless significant functional impairment or psychologicaldisturbance. These patients do not see a clinician veryoften, and usually maintain normal daily activities.Treatment is directed toward education, reassurance, andachievement of a healthier lifestyle and occasionalmedication. Dietary advice may include avoidingoffending foods which can trigger symptoms (e.g. lactoseor fructose products, fatty foods, caffeine, gas-producingfoods). Fiber supplementation has been shown to beeffective for symptoms of constipation. Pharmacologic therapy is best used in IBS patients withmoderate to severe symptoms refractory to physiciancounseling and dietary manipulations. First line treatmenthas traditionally been aimed at treating the mostbothersome symptom because of the lack of effectivetreatment for the overall improvement of multiplesymptoms in IBS patients. However, new therapies forIBS have been recently introduced and have been shown toeffectively treat multiple symptoms of IBS.Anticholinergic/Antispasmodic agents.After fiberpreparations, antispasmodic agents are the next mostcommonly prescribed group of medications for thetreatment of IBS. However, several studies do not providefirm evidence that anticholinergic agents are efficacious inthe IBS population as a whole. Only a few of theseantispasmodics have been shown to be more effective thanplacebo in relieving abdominal pain in high quality clinicalIBS trials but these are not currently available in the U.S. Antidiarrheal agents.In IBS patients with diarrhea,antidiarrheal agents such as loperamide and diphenoxylatecan be effective in decreasing bowel movement frequency,improving stool form by enhancing intestinal water and ionabsorption, and increasing anal sphincter tone at rest.These physiologic actions seem to explain theimprovement in diarrhea, urgency, and fecal soilingobserved in patients with IBS. These medications do nottypically relieve abdominal pain and may causeconstipation.Psychotropic medications.The rationale of using thisclass of drugs in IBS may relate to several factors, such asthe prominent co-morbidity of IBS with psychologicdistress symptoms and the effects of these agents on gutmotility and pain sensation. Among the classes ofantidepressant medications, the tricyclics have been mostextensively evaluated in IBS. At lower doses than thoseusually used to treat depression (starting at 10 mg and upto 75 mg nightly), amitriptyline and desipramine have beenfound to be significantly more effective than placebo inpatients with IBS. Antidepressants have analgesic (painrelief) properties, which may benefit patientsindependently of the psychotropic effects of the drugs.Treatment with tricyclics should begin with low doses(e.g., 10 mg/day) and increased as needed up to fulltherapeutic doses. Selective serotonin reuptake inhibitors(SSRIs, e.g. paroxetine, citalopram) and selective serotoninand noradrenergic reuptake inhibitors (SNRIs, e.g.venlafaxine) have not been well studied for treatment ofIBS, and are more expensive, but have less side effectsthan tricyclics and empirically may help reduce painfulsymptoms and improve general well-being and quality oflife.Novel serotonin agents.The prominent role of serotoninin GI motility and sensation has led to the development ofnovel serotonin agents such as alosetron and tegaserod inthe treatment of IBS. Most of serotonin (also known as 5-HT) in the body resides in the bowel wall withinenterochromaffin cells lining the gut (mucosa) and nervecell bodies. Serotonin is released from theenterochromaffin cells and acts on receptors on the nerveswithin the bowel wall. These nerves may be part of the nervous system which resides completely within the bowelwall, known as the enteric nervous system, or may benerves that transmit painful and non-painful informationby projecting from the bowel to the spinal cord and brain.Activation of these nerves by serotonin leads to the releaseof other neurotransmitters and through their actions, itplays a major role in gut motility, secretion and sensation.Alosetron (Lotronex&#63194







, which is a 5-HT3 antagonist, hasbeen shown to be effective in relieving pain, normalizingbowel frequency, and reducing urgency in non-constipatedIBS female patients. This medication was approved by theFDA last year but was later withdrawn because of theadverse events of constipation and ischemic colitis, thelatter being observed in 0.1%-1% of patients receiving themedication. Future studies are being planned to determineif there is a causal association of alosetron and ischemiccolitis. However, alosetron has recently been re-approvedand now is available for the treatment of women withsevere diarrhea-predominant IBS under the Restricted UseProgram. Alosetron is indicated only for women withsevere diarrhea-predominant IBS who have: chronic IBSsymptoms (generally lasting ≥ 6 months), no evidence ofanatomic or biochemical abnormalities of the GI tractwhich could explain their symptoms, and failed to respondto conventional therapy. IBS is considered severe if itincludes diarrhea and ≥ 1 of the following: frequent andsevere abdominal pain/discomfort, frequent bowel urgencyor fecal incontinence, or disability or restriction of dailyactivities due to IBS. Physicians must enroll in theRestricted Use Program in order to prescribe alosetron.Patients should discuss with their physicians about therisks and benefits of the medication before beingprescribed it. Both should sign the Patient-PhysicianAgreement form. The starting dose of alosetron is now 1mg orally once daily. If the patient does not experiencecomplete relief of their symptoms after 1 month, the dosecan be increased to 1 mg orally twice daily which was theoriginally approved dose. Any patient who experiencesincreased abdominal pain, blood in their stool and/orconstipation should immediately stop their medication andcontact their physician. Tegaserod (Zelnorm&#63194







is a partial 5-HT4agonist, whichhas been shown to be effective in relieving the globalsymptoms of IBS with constipation. It has been recentlyapproved for the treatment of IBS with constipation inwomen. Tegaserod has been shown to accelerate GI transittime in IBS patients and therefore would increase stoolfrequency, and increase electrolyte secretion in the boweland thus improve stool form. In addition to its motilityenhancing properties, tegaserod has been shown to havepain inhibitory properties in animal studies and thereforemay reduce abdominal pain although human studies areneeded to confirm this effect. Unlike other currentlyavailable medications for IBS with constipation, tegaserodappears to be effective in treating the multiple symptomsof IBS. The subjectï¿½s global assessment of relief of IBSsymptoms, change in number of bowel movements, abdominal pain and bloating are all reportedly improved infemale patients with IBS with constipation takingtegaserod as compared to placebo. The only adverse eventswhich were seen at a small but significantly higher rate inpatients taking tegaserod compared to placebo wereheadache and transient diarrhea. Psychological treatments.Referral for psychologicaltreatment can be recommended as part of a multi-component treatment program to help the patient bettermanage the symptoms, or to address psychosocialdifficulties (e.g., abuse, loss) that may be interfere withdaily function and ability to cope with the illness. Ingeneral, these treatments are reserved for patients withmoderate to severe symptoms, particularly if theyexperience psychological distress. However, the patientmust be motivated and see this type of treatment asrelevant to their personal needs. Psychological treatmentsused to treat IBS include psychotherapy (dynamic andcognitive-behavioral therapy), relaxation therapy,hypnotherapy, and biofeedback therapy. Psychologicaltreatments can also be combined. Review of well-designedtreatment studies of IBS supports the superiority ofpsychological treatment over conventional medicaltherapy. Follow-up studies (duration 9-40 months), havedemonstrated that psychological treatment maintainedsuperiority over placebo, indicating that these methodshave lasting value. The choice of treatment will depend onpatient requirements, available resources and theexperience of the therapist. CONCLUSIONSIBS is a common, chronic disorder characterized byexacerbations and remissions, which presents withsymptoms of abdominal pain and/or discomfort and alteredbowel habits. It has a chronic relapsing course and canoverlap with other functional GI (dyspepsia) and non-GI(fibromyalgia) disorders. The clinical diagnosis of IBS is based on identifyingsymptom criteria with a ï¿½positive diagnosisï¿½ and excludingorganic disease with minimal diagnostic evaluation.Clinicians should feel secure with the diagnosis of IBS, ifmade properly, because it is rarely associated with otherexplanations for symptoms. Although there are manyexpensive and sophisticated tests available for theevaluation of IBS symptoms, these are generally notneeded for patients with typical symptoms and no featuressuggestive of organic diseases.An integrated diagnostic and treatment approach firstrequires an effective physician-patient relationship. Acareful history will also identify the need for diagnosticstudies and treatments as determined by the nature andseverity of the predominant symptoms, and the degree andextent of influencing psychosocial and other factors. The fact that definite structural or biochemicalabnormalities for these disorders cannot be detected withconventional diagnostic techniques does not rule out thepossibility that neurobiological alterations will eventuallybe identified to explain fully the symptoms of mostfunctional disorders. Examples of such a shift inperspective from symptom-based disorders withoutdetectable abnormalities to medically treatable diseasesbased on specific neurobiological alterations includeaffective disorders (depression, anxiety) and migraineheadaches. Similar to other chronic illnesses, amulticomponent model that involves physiologic,affective, cognitive, and behavioral factors can beformulated for IBS. Although all factors are closelyinterconnected, the importance of individual factors in thegeneration of IBS symptoms may greatly vary betweenindividuals. Physiologic factors implicated in thegeneration of IBS symptoms include hypersensitivity ofthe GI tract to normal events, autonomic dysfunctionincluding altered intestinal motility response to stress andfood intake, alterations in fluid and electrolyte handling bythe bowel, and alterations in sleep. Many of the traditional therapies have been used to treatspecific IBS symptoms because they have not been shownto significantly relieve global symptoms, which wouldimprove an overall sense of well-being. However, thediscovery of novel serotonergic agents such as tegaserodand alosetron have been shown to be effective in treatingglobal symptoms in patients with IBS compared withplacebo. More recently published studies evaluating theefficacy of antidepressants, such as tricyclics and SSRIs,suggest that these medications may help improve generalwell-being in addition to treating psychological co-morbidity in affected individuals but further studies areneeded. Psychological and behavioral therapies have alsobeen showed to be effective for IBS however it potentiallycan be limited by the availability of experienced therapists.Instituting a multidisciplinary approach using non-pharmacologic and pharmacologic therapeutic modalitiesmay result in the most effective outcome. Future studieswill further enhance our understanding of this conditionand lead to newer, more effective treatments. http://216.109.117.135/search/cache?p=lin+...&yc=15315&icp=1


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## calid (Aug 4, 2003)

OMG Eric, don't you get it at all? I don't care how many articles you cut and paste trying to discredit the bacteria aspect of my personal IBS, so far the treatment recommended by Dr. Dahlman IS WORKING...........you should be happy, not trying to discredit both him and myself. I've given up being respectful to you, you are totally inconsiderate and narrow minded.


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## overitnow (Nov 25, 2001)

Whew!Well I tried to read through it, but ended up skimming. I did notice that IBS patients can have bacterial overgrowth and IBS patients can be lactose intolerant and have specific food triggers, so I guess these do, at least peripherally, have something to do with the condition. Also, the high percentage of people diagnosed with IBS probably means the "garbage can" diagnosis is still an accurate term when it is convenient for raising profile, rather than something more limited.If it is so that this is a name for the endproduct of a number of conditions, then we have the "right" to be here and to discuss the many approaches to recovery. It goes without saying that Dr. D may well get his remarkable numbers by drawing his patients out of that same garbage can. If, as eric suggests, we really are suffering from a variety of biochemical disorders that are treatable in a variety of specific ways, then we should probably butt out, start our own Garbage Can non-IBS site and leave this to eric and his experts.In the meantime, calid, I am glad that you have found a doctor who does take the time to work with your condition, rather than wedge you into a treatment that he has read about, or been given a bunch of free pills to try out. Would that all doctors were as concerned as that.Mark


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## missC (Oct 16, 2002)

so how many of dr d's original experimental group are now showing significant improvement?


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## missC (Oct 16, 2002)

let's hypothesize, people. say, ooh, '78 to 84%' of 'IBS' patients have bacterial overgrowth. (now where did i get that figure from?) Maybe 10% with FI. Leaving, shall we say, 6% with lactose intolerance. anybody good at mental arithmetic?heheheheheheh.


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## SpAsMaN* (May 11, 2002)

Calid:So you did the stool analysis from Great smokies rigth?They suggest antibiotic?I was not aware that they give treatment advice.What is your treatment and your "bacteria"?


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## calid (Aug 4, 2003)

MissC: I believe there is an unknown in regards to food intolerances/allergies. Also add to that percentage those that are Celiac.Spas: Great Smokies Lab knows what antibiotics are useful for each bacteria, they culture each one before recommending which prescriptive agents will be successful in treating that particular bacteria. Antibiotics such as ampicillin wouldn't have worked for the Citrobacter bacteria. I actually had two bacterias show up, Citrobacter Freundii and Proteus Mirabilis. They had actually increased since my last test, which didn't surprise me as even my safe foods were not working to keep me stable.


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## kel1059 (Feb 28, 2003)

-----"Citrobacter Freundii and Proteus Mirabilis. "i was very curious as to what showed up. i am glad you posted this. someone else mentioned citrobacter i am wondering if it was pete or steveE?? i am going to do a search.


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## calid (Aug 4, 2003)

Kel: I looked at the comments made by the lab and found this very interesting. Remember we discussed in depth arthritis and IBS? Well, turns out that Proteus Mirabilis has been suggested as an etiological agent in Rheumatoid Arthritis. The mechanism may be related to the molecular cross reactivity between the P. Mirabilis and the HLA antigens, specifically HLA-DR4 (above my head).


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## kel1059 (Feb 28, 2003)

calid, simply unbelievable. i sure hope that everyone reads this thread. this really is an incredible learning experience. thank you dr dahlman for having the courage to come here and put up with the attacks. you have made a difference in my life, gret's, calid's and i am sure many others. i did some reading on Citrobacter Freundii and Proteus Mirabilis and it sounds like these can be VERY troublesome. http://gsbs.utmb.edu/microbook/ch026.htm i remember very well the arthritis thread. sometimes i can not believe that we can put men on the moon but no one can agree that infection can be the source of so many of our ills.


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## SpAsMaN* (May 11, 2002)

So you experience a vengeance?Arthritis have ruined my life last year.My knees strart to swell and i could'nt even walk.Apparently,it was cause by a virus(salads unwashed).But i'm not sure it was a virus.I had stool analysis in microbiologist labs here but normal.Do you think Great smokies can help me?I talk to them often.


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## calid (Aug 4, 2003)

Spasman: My gastro ordered 2 stool samples from local labs at two different times, neither showed anything abnormal.I believe the GSL is geared to looking for the un-obvious while the regular labs are just looking for what is usually a problem in this country. Every country is no doubt different with their strains of bacteria. My IBS and my arthritis started in earnest when we returned from Rome. Maybe I picked up a strange strain of something there that our labs wouldn't pick up on because it's not normal to find them here.


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## SpAsMaN* (May 11, 2002)

Intestinal flora are misunderstood.That is what it sucks the most.Calid,do you have any benefits from the treatment suggested by Great Smokie?Yes or No.I become frustrated to get tested everywhere and to always doubt about the results.


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## calid (Aug 4, 2003)

Spasman: I have been on this antibiotic now for 8 days and for the past 7 days I have had no diarrhea, no cramping, I have felt great. My problem though may not be what your problem is, have you earnestly tried to follow one of the Dr.'s diet plans?You can't just say it's too hard and look for a pill to take, you have to try 100% each diet. No gluten or no fructose or no dairy means 0, zip, nada, not "I've cut down" or "it's too hard". One of those foods may be causing your problems. One bite of gluten can ruin you for days. So, try the diet first and try it 100% as he asks you to. Then you can try testing as it's not inexpensive.


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## SpAsMaN* (May 11, 2002)

Thanks Calid,IBS-D seems "easier" to control than altered motility and trapped gas.Restricted diet dosen't seems an option for me because of my hypoglycemea issue.This one is scary.


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## SpAsMaN* (May 11, 2002)

Large screen irritate me.Calid,i will try to learn more about the bacterias you have mentionned.Do you think these bacteria can cause others symptoms than liquid D?I don't feel that a 2 or 3 months treatment will eventually paid.This is just my feeling.


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## daisysp (Jan 13, 2004)

Spasman, I have listened to your postings here for months and never really responded to any, yet I must. How about you take the advice of Calid and try a program 100%? A restricted diet does not mean not enough food intake to keep your blood sugar up. You should be eating primarily proteins and vege's for diabetes anyhow, that is the easiest fix for blood sugar. Cut out all gluten, all sugars and most all fruits if you get any reactions to them. I must say, I do not have D, yet from what I have read, I wouldn't trade it for my C........they are both awful in their own special ways. I am so thrilled to hear Calid is having some great relief from symptoms. I will check into the link to see what it was, Dr D found in your sample. I am so curios about what mine will produce. I did a few samples with regular doctors over the years also, they found nothing. A naturopathic chemist found the Ecoli and Blastitis, none of the MD's did.I have been feeling better lately, and I believe Calid was right about even a bite of gluten can be harmful. If I dont' even have a bite, I feel so much less bloated, tired and crampy. I hope Dr D is reading this so he can see all the appreciation here. I want to say to MissC, Dr Dahlman is not experiementing with folks from this website. He's been in business for years and has helped thousands.........try reading his bio and info on his website.Kel, happy to see you back here writing !! Can we get some details on how you are doing ??


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## eric (Jul 8, 1999)

Understanding IBS (Irritable bowel Syndrome): A Primer for Patients Chapter 7: * Some Common Conditions Where Diarrhea and Gas with Bloating Can Be Misinterpreted as Evidence of IBS* James Christensen, M.D. and Robert W. Summers, M.D.Peer Review Status: Internally Peer Reviewed-------------------------------------------------------------------------------- Organisms growing in the Gut that should not be there Intestinal Parasites, Especially Giardia Bacterial Overgrowth in the Small Intestine Abnormalities in the Lining of the Intestine Intolerance to Lactose Celiac Disease, or Sprue Inflammatory Bowel Disease Things You Eat and Drink When Your Gut is Normal Intolerance to Fructose Unconscious Intake of Laxative Substances http://www.vh.org/adult/patient/internalme...html#overgrowth IBS PublicationsAnother look at bacteria and IBSBy Douglas A. Drossman, M.D."Is this a dramatic new finding? Breath testing when considering a diagnosis of IBS has been around a long time. A preliminary diagnosis of IBS is based on the absence of warning signs for other known diseases, a complete history, and description of specific symptoms (e.g., a symptom pattern consistent with the Rome criteria, which have recently been revised as Rome II). Depending on the presentation, a physical examination and limited laboratory studies are performed before a confident diagnosis of IBS may be made. A breath test is considered if indicated by features in the patient history, or if the screening studies point to another diagnosis. *Small intestinal bacterial overgrowth is known to cause symptoms of abdominal pain, bloating, and diarrhea. While similar to IBS, it points to another diagnosis. * Our clinical experience among patients with IBS shows a much smaller prevalence for a positive breath test result than the Pimentel study showed. Furthermore, our success rate for treatment in practice is much less than indicated in the study. In the face of this contradictory clinical experience, what then does this study tell us?" http://www.aboutibs.org/Publications/bacteria.html


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## Arnie W (Oct 22, 2003)

Eric, if calid is gaining improvement in symptoms thanks to Dr D's guidance, it doesn't matter what the diagnosis was. Let's just be thankful that Dr D is giving results which have eluded all sorts of other practitioners whom calid visited. Calid, I've searched through the screeds of cut and pastes and might have missed something you've stated, but I'm wondering who actually prescribed the cipro for you. I imagine that Dr D or GSDL wouldn't be able to do it. Interestingly enough, when I first joined this board I received a pm from someone who strongly recommended I should try cipro.


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## calid (Aug 4, 2003)

The lab results contain information that tells us what antibiotic to use for these particular bacterias. I took the results from the lab to a doctor for review and I was given the recommended antibiotic. I'm almost afraid to STOP taking the Cipro.........lol. I wouldn't take the Cipro w/o taking a stool test though AND I would make sure I was taking the recommended dosage of probiotics.


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## eric (Jul 8, 1999)

"Eric, if calid is gaining improvement in symptoms thanks to Dr D's guidance, it doesn't matter what the diagnosis was"Yes it does and gaining imporvement, she is just about to start a course of antibiotics? So she has not killed the bad bugs yet? So where is the imporvement coming from? Perhaps diet? Perhaps the emotional component or even the fact that she is doing something? There are numerous reasons, do you know them all?The problem is a bunch of people here, along with DR D and a lot of Kels posts who is clearly bateria phobic, are all talking about all IBS symptoms as a bacterial in origin.How many real doctors have put there patients on antibiotics with IBS without a confimred diagnoses of a pathogen? If there is a pathogen confirmed to be the problem, its not IBS. Or there is more then one problem, which is often the case.Many people have altered gut flora and don't have IBS. Some people with IBS have gut permeability, but it does not define IBS.These are also some reasons for it.Lets then seperate SIBO as SIBO and IBS as IBS and other gi disorders for what they are, not lump them all together, as DR Dahlamn suggests. This blurs the conditions and hurts everyone.That's the point, I am very happy Calid feels better and all people feel better.Although I am concerned about her taking antibiotics if she really has IBS, and hope she really does get better long term and its not just short lived from some antibiotics that have prokentic effects. I also hope she is discussing these treatments with her real doctor who has her medical history. This also very much concerns me for everyone and I know people have said were all adults and can make our own decisions, but frankly sometimes its better to have the information first from all avenues before a decision is made, and that is something I am trying to do with the information on IBS.Also if stress causes leaky gut, how come I am the only one saying that? What would be the root cause in that case?"Inflammation Moderator: Robin Spiller MD; Panel: Jackie Wood PhD, Mary Perdue MD, Robin Spiller MD The last few years have led to a greater understanding of the role of inflammation in influencing intestinal hypersensitivity in the functional GI disorders. For example, a well-defined subgroup (up to 25% of IBS patients) appear to develop their IBS after an infectious illness. Jackie Wood from Ohio State University, discussed how inflammation alters the neurophysiology of the enteric nervous system (ENS) by activating nerves within the ENS. There are a variety of ENS neurons that can direct responses within the body leading to altered motility, sensation and secretion, and ultimately, symptoms of diarrhea, constipation, and pain. Mary Perdue from McMaster University, Ontario discussed the importance of the epithelial intestinal barrier to maintain immune tolerance to potentially harmful matter, such as bacteria, ingested when we eat or drink. (Everything that enters the human body must pass through an epithelial layer. Various types of epithelial tissues line not only the body cavities, blood vessels, and most organs, but also our outer surface-our skin. Within the intestines, epithelial tissue forms an intestinal barrier involved with absorption, secretion, sensation, contractility, and protection.) Studies in animal models show that psychological stress can disrupt this barrier, leading to the penetration of bacteria into the gut, inflammation, an immune system response (inflammatory cytokines), and ultimately sensitization of neural signals from the gut to the brain that can heighten the perception of pain. Robin Spiller from the University of Notingham, UK brought this basic information to the human model of post-infectious IBS. The predictors of post-infectious IBS include increased life events and psychological distress, female sex, and longer duration of diarrhea episode. In response to bacterial infection, there is an increase in certain gut (enterochromaffin) secretory cells (5HT producing) and inflammatory cells (cytokine producing) leading to prolongation of pain and diarrheal symptoms, and this may be aggravated by the presence of psychological stressors. These findings suggest ways in which infection-induced inflammation might interact with chronic stress to produce long lasting bowel dysfunction. They also suggest possible treatments that need study. " http://www.iffgd.org/symposium2001.html They actually have done a ton of research on this area and there are problems for sure in IBS, which connect to all IBS research and the case is getting stroger and stronger. With some of it confirmed!IF motility issues cause altered flora, what is the root cause then, altered flora or the motility problems that set it up in the first place?Also"The theory of intestinal permeability is that some agent or combination of agents initiates an inflammatory response in the digestive tract. "Inflammation does not explain IBS!Regardless if these people were misdiganosed or their doctors did not help them, and DR D is, by using even recommended IBS treatments like peppermint and probiotics, we don't need to be calling IBS leaky gut. In the years and years of IBS research the experts do not call IBS, leaky gut and there is a major reason for that!There is a major researched history on IBS and functional disorders in general and there overlappiung and molecular cell changes in the digestive system and abnormalities both in the gut and the brain in IBS.Why don't you ask DR Dahlman to set up a bb on his site where people can discuss leaky gut or altered bowel flora?There he can explain to people how altered bowel flora or leaky gut creates rectal sensitivity, brain abnormalities in the ACC pain centers, hypersensitivity of bowel nerves, the feeling of incomplete evacuation, C ? which sibo does not cause and d and d/c motility problems, dyspepsia, Gastroesophageal Reflux Disease (GERD)Globus - 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 Functional bowel disorders and abdominal pain (symptoms generally attributable to the mid or lower gastrointestinal tract)Irritable bowel syndrome (IBS) - a group of bowel disorders characterized by abdominal discomfort or pain associated with defecation or a change in bowel habitFunctional abdominal bloating - a group of functional bowel disorders dominated by a feeling of abdominal fullness or bloatingFunctional constipation - a group of functional disorders characterized by persistent difficult, infrequent, or seemingly incomplete defecationFunctional diarrhea - continuous or recurrent passage of loose or watery stools without abdominal pain Functional abdominal pain - continuous or frequently recurrent abdominal pain, either not or infrequently related to gut function, and associated with some loss of daily activitiesFunctional 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 durationand more?Dr Dalhman has called all those items IBS?IBS is any "gi symptoms"?What is wrong with that picture?Not what is wrong with people feeling better?I have asked this to many times now, someone show some real research or studies on IBS and leaky gut? Then lets discuss them? Where is the evidence, even the people studying it believe it to only be a small part of the big picture?And at that believed to be caused by altered moltility for one, along with a whole bunch of reasons nobody has mentioned here yet?Dr D would not supply that here? Who will? I see a lot of complaining about my posts, and a whole lot of misunderstanding, but no one showing any research or science and just guessing at something that does not add up entirely to IBS.


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## Jhouston (Nov 9, 2003)

Eric, what are you talking about? It seems you are misreading or have missed Calid's post....probably from scrolling past your own! You stated incorrect info above regarding Calid Joann


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## eric (Jul 8, 1999)

I stand corrected, she is already taking them and hence the comment prokentic effects. Also that she reviewed it with her doctor, I am relieved to hear that she did the right thing. Calid, we maynot agree on this thread, but I am glad you feel good and hope it continues to be better for you and for everyone. Joann, thanks for pointing out the mistakes, my error.


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## kel1059 (Feb 28, 2003)

What an interesting little "GAME" eric has going on here. Whoever gets better does NOT have "IBS".also there seems to be a lot of double-talk, changing the subject, making excuses, and misdirection. fortunately he is not very skilled at pulling it off. Unbelievable. Daisy,I am doing really good. I am shocked and a bit nervous about the whole thing. I actually fear that it is all an illusion. I think that is only because after 20 years of suffering you tend to think the worst.


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## calid (Aug 4, 2003)

Personally I believe IBS is a catch all term. As MissC pointed out earlier, you have the bacteria caused IBS, Fructose Intolerant IBS, Lactose Intolerant IBS, which all would be contained in the IBS basket. IBS is not a confirmed, pinpointed disease that you can say you have like you do with Diabetes, there can be many reasons for having IBS. Your bowel is irritable, why it's irritable could be one of the many reasons stated above, even Celiacs are lumped in that basket if they eat gluten. How many doctors have not taken the time to find out if there is an allergy to gluten? My friend only found out by accident during an endoscopy for something else. Her doctor never considered Celiac for her as she was a C. So when my gastro says I just have IBS, he's just not willing or able to take the time to find out WHY I have it. That's what Dr. D does, he finds the cause of it and removes it. Hopefully my irritable bowel will be much less irritable after I finish with the Cipro.


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## eric (Jul 8, 1999)

"Personally I believe IBS is a catch all term. As MissC pointed out earlier, you have the bacteria caused IBS, Fructose Intolerant IBS, Lactose Intolerant IBS, which all would be contained in the IBS basket"Calid this is incorrect.LI is not IBS and fructose intolernce is not IBS, celiac is not IBS. And if a specific bacteria is found that is not IBS. Those conditions have there own reasons for causing symptoms, which can mimick some IBS symptoms and point to a seperate diagnoses. The diganoses of IBS is done my ruling out other conditions and by a specific set of symptoms that are not explainable by other causes or conditions.Conditions can overlap as well.These are major points and why there needs to be more education on IBS."Gastroenterology Expert ColumnDiagnosing Irritable Bowel Syndrome: What's Too Much, What's Enough?Posted 03/12/2004 Susan Lucak, MD IntroductionIrritable bowel syndrome (IBS) is the most common gastrointestinal disorder diagnosed in clinical practice in the United States. Because there is no biological marker to confirm the diagnosis of IBS, it is a diagnosis that has challenged clinicians for decades. In the past, IBS was a "waste-basket" diagnosis given to patients with unexplained gastrointestinal symptoms. It was considered to be "the diagnosis of exclusion" when extensive work-up for organic disease yielded no diagnosis.In recent decades, it was recognized that patients with IBS experienced a constellation of specific gastrointestinal symptoms. Manning criteria were described in 1978,1 followed by Rome I in 1989 2 and Rome II criteria in 1999.3 Rome I and Rome II criteria were initially developed by multinational working groups to provide a framework for the selection of patients in diagnostic and therapeutic trials. These criteria are being continuously modified as we gain new knowledge about functional bowel disorders.Recently published diagnostic guidelines 4,5 recommend using symptom-based criteria in making the diagnosis of IBS in clinical practice. Using these criteria in conjunction with "alarm features" allows a physician to minimize the extent of diagnostic testing needed to make the diagnosis of IBS. Furthermore, recent systematic review of the literature indicates that performing a number of diagnostic tests did not result in a significant increase in the diagnosis of organic gastrointestinal disease.6This column discusses" http://www.medscape.com/viewarticle/465760


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## eric (Jul 8, 1999)

IBS is not celiac sprueFYIMayo Clin Proc. 2004 Apr;79(4):476-82. Related Articles, Links Celiac disease serology in irritable bowel syndrome and dyspepsia: a population-based case-control study.Locke GR 3rd, Murray JA, Zinsmeister AR, Melton LJ 3rd, Talley NJ.Division of Gastroenterology and Hepatology and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA. locke.giles###mayo.eduOBJECTIVE: To determine whether undiagnosed celiac disease is associated with irritable bowel syndrome (IBS) or dyspepsia in the community. SUBJECTS AND METHODS: A self-report bowel disease questionnaire was mailed to a random sample of Olmsted County, Minnesota, residents aged 20 to 50 years. All respondents who reported symptoms of dyspepsia or IBS (cases) and all respondents without notable gastrointestinal symptoms (controls) were invited to participate (260 eligible subjects; 150 58% were studied). Each respondent was examined by a physician, and the medical records of each were reviewed (3 subjects did not meet the criteria for dyspepsia or IBS at the time of the physician interview). Serum was obtained to measure antiendomysial antibodies and tissue transglutaminase (TTg) IgA antibodies using validated assays. RESULTS: A total of 34 subjects had dyspepsia (20 had ulcerlike dyspepsia), 50 had IBS (19 had diarrhea-predominant IBS), and 15 met criteria for both dyspepsia and IBS; 78 were asymptomatic healthy controls. The overall prevalence of positive TTg serology was 4% (95% confidence interval CI, 1.5%-8.5%). The number of subjects who were seropositive for TTg was 2 of 34 (5.9%) with dyspepsia (95% CI, 0.7%-19.7%), 2 of 50 (4.0%) with IBS (95% CI, 0.5%-13.7%), and 2 of 78 (2.6%) of asymptomatic controls (95% CI, 03%-9.0%) (P = .64 IBS vs controls; P = .58 dyspepsia vs controls). No subjects had positive antiendomysial antibodies. CONCLUSION: In this community, celiac disease did not explain the presence of either IBS or dyspepsia.PMID: 15065612IBS is not FI or LI although those conditions can and do overlap with IBS and fructose can be a problem in IBS, even for those Not fructose intolerent.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."Gastroenterology. 2002 Jun;122(7):2032-48. Related Articles, Links Evolving pathophysiologic models of functional gastrointestinal disorders.Mayer EA, Collins SM.CURE Neuroenteric Disease Program, UCLA Division of Digestive Diseases and Brain Research Institute, Los Angeles, California 90073, USA. emayer###ucla.eduIn 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. At the same time, animal models of functional gastrointestinal disorders in which to test pathophysiologic hypotheses are lacking. The aim of this report is to critically review recently proposed conceptual as well as animal models of functional gastrointestinal disorders. Converging disease models have been proposed that postulate an enhanced responsiveness of neural, immune, or neuroimmune circuits in the central nervous system or in the gut to exteroceptive (psychosocial) or interoceptive (tissue irritation, inflammation, infection) perturbations of the organism's homeostasis. The enhanced responsiveness results in dysregulation of gut motility, epithelial function (immune, permeability), and visceral hypersensitivity, which in turn produce irritable bowel syndrome symptoms. These conceptual models provide plausible mechanisms for irritable bowel syndrome symptom generation and are consistent with extensive epidemiologic and pathophysiologic data. Several animal models have recently been proposed that mimic key features of these conceptual disease models. They fall into models triggered by centrally targeted stimuli (neonatal stress, post-traumatic stress disorder) or those triggered by peripherally targeted stimuli (infection, inflammation). Depending on the timing of the trigger (neonatal vs. adult), the changes induced in the animal may be permanent or transient. Future development of existing and novel models involves the use of transgenic and knockout animals, as well as the demonstration of predictive validity in terms of responsiveness to candidate drugs.Publication Types: Review Review, Tutorial PMID: 12055608 Curr Gastroenterol Rep. 2003 Aug;5(4):331-6. Related Articles, Links Current insights into the pathophysiology of irritable bowel syndrome.Schwetz I, Bradesi S, Mayer EA.Center of Neurovisceral Sciences and Women's Health, CURE: Digestive Diseases Research Center, David Geffen School of Medicine at UCLA, VAGLAHS, Bldg. 115, Room 223, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA. emayer###ucla.eduRecent reports have emphasized the possible role of mucosal immune activation and inflammation in neuropathic changes in the pathophysiology of irritable bowel syndrome (IBS). However, novel findings using functional brain imaging techniques have underlined the importance of altered perception of visceral stimuli to symptom generation in IBS. These new developments have rekindled an old debate on peripheral versus central mechanisms in the pathophysiology of IBS. In this review we discuss the latest findings in light of these two concepts. In addition, we provide evidence for the hypothesis that, in the absence of alterations in endogenous pain modulation systems and changes in visceral perception, chronic inflammatory mucosal changes in the gut are not a plausible mechanism to explain the presence of chronic abdominal pain, a cardinal IBS symptom.Publication Types: Review Review, Tutorial PMID: 12864964


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## missC (Oct 16, 2002)

"I want to say to MissC, Dr Dahlman is not experiementing with folks from this website. He's been in business for years and has helped thousands.........try reading his bio and info on his website."eh? Daisy, where did that come from? if i'm thinking of the same posting you are, i was just teasing eric, not dr d...oh, no, i see what you mean. i didn't mean 'experiment' in that sense - not like a mad scientist with a manic laugh! i meant, um, jeezy, first day back at work and i have to struggle with definitions now i'm home putting my feet up... i meant more of a joint venture, you know? a willingness to travel a road together, a journey undertaken ... i'm getting poetic ... i was attributing an experimental and curious spirit more to the subjects of the venture, rather than dr d. all right, perhaps 'study of self-selected treatment subjects' or some such might have put it better, but much more drily!


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## calid (Aug 4, 2003)

Eric, do you think I'm an idiot? Of course Celiac Sprue isn't IBS, but many times it's lumped into the IBS basket because it's not diagnosed. I am so tired of you telling people they're wrong, you are NOT the only one who is right in this world.Try reading the posts better, you have had to apologize many times for mis-reading posts, you've done it again here. I have every right to my opinion without you claiming I'm wrong. It's my opinion and in this country it's legal, no matter what you think.


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## kel1059 (Feb 28, 2003)

> quote: "Personally I believe IBS is a catch all term. As MissC pointed out earlier, you have the bacteria caused IBS, Fructose Intolerant IBS, Lactose Intolerant IBS, which all would be contained in the IBS basket"Calid this is incorrect.


she is not incorrect. this is exactly what happens to so many of us. the true causes are never discovered by our doctors because they don't really know what they are doing."IBS" for the most part means "we don't know what is the matter with you". However, if the doctors did their job and took patients through a systematic program designed to uncover a series of potential problems then they would see patients getting better. In the future the cases of "IBS" will shrink and shrink and shrink until there are few if any cases remaining. this is because --at least in theory-- researchers and medical professionals will (hopefully) get better and better at diagnosing, understanding, and treating people who have "IBS". As soon as the patient is given their true cause or causes then they slip out of the ranks of "IBS" and into the correctly named diagnosis.In the meantime, millions of people are stuck with the wastebin diagnosis of IBS.*********************************I find it odd that a person would claim that there are no cures for IBS yet sell HT tapes for profit saying that it will reduce symptoms. At the same time they are fighting like crazy to stop another person from helping people to reduce or eliminate symptoms.It is like he is saying that the only way to reduce symptoms of IBS is by doing it "MY" way and this includes buying something from me (HT tapes). If a person gets cured in other ways then all of a sudden it is NOT IBS. I have seen this behavior before. it is like the person is able to construct some version of the truth and hang onto it for dear life so long as it serves his specific purpose. i think part of the purpose is financial. so long as eric has a financial stake in IBS he will do as he pleases. 100 people from this board could be cured over the next year and it would do no good at all to change this person's model of IBS.


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## Talissa (Apr 10, 2004)

Calid,I'm not certain, but I'm pretty sure the folks at John Hopkins would be more inclined to agree with you. It's kind of like Eric is screaming "The earth is flat! The earth is flat!", & unfortunately, his ego is tied up in it & he won't let go.Back to the (slightly more educated & practical than Eric) folks at JH--"Some symptoms of IBS are now understood to result from abnormal colonic fermentation subsequent to damaged gut flora by antibiotics or gastroenteritis. ""....Therefore, there appears to be little benefit in separating lactose malabsorbers from others with IBS.""....Fructose alone, or in combination with sorbitol, may produce significant symptoms in IBS patients. " http://www.hopkins-gi.org/pages/latin/temp...12&pagenum=1872 Of course what you said was a sensible conclusion to draw from known facts. "they are all part of the IBS basket" Proving your intelligence & your sanity....


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## kel1059 (Feb 28, 2003)

calid,i think almost everyone here knows there is something wrong with him. the spelling errors, the grammar errors, the irrational logic. http://www.ibsgroup.org/ubb/ultimatebb.php...t=037154#000009 (recent thread on cannabis)ERIC: STEP AWAAAY FROM THE BONG!


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## Talissa (Apr 10, 2004)

Okay guys,I've got a sick kid at home, so I've the time to do this. I think you'll like this one. Remember himself's article entitled "Diagnosing IBS: What's Too Much, What's Enough?", if you didn't skip over it? Well I got curious, & here's what's on page 8 of 9 of the article:"Legal Risks in Diagnosing IBS"Some physicians who see patients with IBS are concerned about the risk of malpractice. Feld[21] recently described sources of risk under which physicians may be sued, including negligence, duty to provide care to a patient, and medical practice below standard of care, among others. But the idea that more testing is better in IBS may not always be the case. For example, colonoscopy leads to a change in diagnosis about 1% to 2% of the time and may represent performance of substandard care based on testing guidelines for IBS diagnosis recommended by gastroenterological associations in the United States. Therefore, any complication resulting from "unnecessary" testing may expose a physician to a malpractice suit. Alternatively, if a physician explains to a patient why only limited testing is necessary, this allows a patient to participate in the process and understand inherent uncertainties and thus share in the responsibility when a reasonable decision results in an adverse outcome.[21] Feld's risk management recommendations are outlined in Table 7.Apparently our MDs weren't in fact lazy, they're simply afraid of being sued!!! Well, I got a kick out it, even though it's a really, really sad state of affairs....


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## calid (Aug 4, 2003)

Thanks guys, I am insistant on not being in that waste basket. I can't imagine anyone not wanting to find out what their particular problem is so so they can climb out of that basket. I BELIEVE there is a specific reason behind each person's problem, it's just a matter of finding out what it is. Most western doctors do not have the time or inclination to find out personal causes. Of course if we find out what everyone's problem actually is, there would be no reason for HT tapes (maybe that's the entire problem with Eric as he seems to want us to stay sick)!


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## calid (Aug 4, 2003)

Talissa: That food diary page included in the JH website is great! I've never seen one like it!


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## missC (Oct 16, 2002)

"a lot of Kels posts who is clearly bateria phobic, are all talking about all IBS symptoms as a bacterial in origin."um, maybe i've read Kel wrong, but this seems to be just untrue. if i went back and counted the number of Kel's posts in which she expressed an interest in HT (well, each to their own), the brain's role in IBS, and ones in which she expressed the view (common enough around here, though unfortunately not everybody seems to subscribe to it) that she hasn't got all the answers and somebody else's problems might be susceptible to different treatments.... well, i would be surprised if there were less than 30, maybe more.


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## SpAsMaN* (May 11, 2002)

I heard many sufferers who claims to have been cured of IBS-D.The products was Cipro,Questran or fibersmart.But for IBS-C or spastic that is very very rare to find a cure.Maybe the link from Eric few weeks ago was true."IBS-C(and that probably include spastic),is an entire entity"Yeah,and this "entity" sucks to death.


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## Talissa (Apr 10, 2004)

Miss C--I believe that what they call the condition "IBS"(syndrome= something with unknown origin & unknown cure) has a bacterial origin. It's not the standard mainstream belief, but it took 30 years for mainstream to believe the research done in Australia proving that ulcers' origins are from the bug Helicobactor Pylori. I could definitely be wrong here, but I believe it in my "gut."It's also true that with the vast complexities of the human body, w/ individually unique biochemistries, different pathogens, different lifestyles...that different combinations of treatment (antibacterials, relaxation techniques, dietary changes, digestive enzymes taken at diff. times for diff. bodies, & probiotic re-population) at diff. stages may be necessary for each one of us. Therein lies the mystery. If it doesn't come easy, we need to keep at it until we are well again. Whew, sorry, I just don't think that believing something that could turn out to be true is a bad thing.I've gotten back to a normal life, after being in IBS hell, by treating it as a bacterial problem, using most of Dr. D's protocol--w/o knowing of Dr. D or his protocol. He didn't pull his treatment out of a hat, it comes from research. (but again, I'm only at about 92%, have just a bit more go to be completely normal, which I really, really want). If I could just give up cheese & onions, truly have no dysbiosis, and allow my digestive tract to heal! Still waiting on the DA-IBS, who knows.Anyways, I also believe HT has very strong treatment merit, along with polarity treatment & meditation. But it isn't enough on its own, from what I've read. (I'm a yoga enthusiast, so I'm a big believer in the mind-body connection.)Calid--it is a really good form. JH folks are ahead of their time!Bet you all can't wait for my daughter to get rid of the flu, so I'll no longer be so housebound & , well, talkative--me, too!







She'll be pretty happy as well, poor baby. Love, T-


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## Talissa (Apr 10, 2004)

Hi Spas--Just so you know, with the exception of Cipro, which will help those w/ a specific type of pathogen over-population, those are band-aids that mask symptoms. Questran, for example, is a drug that causes tumors in mice(check out side effects), but not yet in humans, so it's on the market, for lowering cholesterol. The FDA is so bought & paid for...Another questran side-effect is constipation so it's being rx'd for those w/ IBS-D.I could say I was cured by Metamucil(soluble fiber), because I have formed stools now & no pain. But I know it's not so because if I ever miss taking it, I'll be getting to know my bathroom real well again-not like in the beginning, but still, no fun. I also did alot of natural antibacterials, followed by probiotics which I still take, & got half way there, before starting the hi-dose Metamucil. And maybe the enzymes are in the picture too. You get the point...(>>>Without fail, if I eat anything containing high fructose corn syrup, I pay for it in spaaades. Nothing helps me then.)IBS-D & IBS-C are quite diff., but I totally disagree with you that IBS-C's very rarely get back to normal. That's too defeatist. You just have to keep researching & trying diff. things while listening to your body, which you need a clear mind for--where meditation, etc. comes in.I've read your posts Spas--think your personality is great, very funny! Very sorry you're in pain, though.T-


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## kel1059 (Feb 28, 2003)

talissa i enjoy your posts. nevis must be like paradise. i think that bacteria explains a lot of it. I am sure that other factors exist also. polarity therapy caught my interest about 4 years ago. at first i thought it was ridiculous but the more times that i had different people test me the more convinced i became. missC, thanks.the only reason i am interested in the brain approach is because i am like talissa in that i am almost there. i think that my brain is benefiting from the meditation CD.However, i did try hypnosis and meditation many years ago for my IBS problems and it did nothing. i am almost certain that i needed to take care of dysbiosis issues and food allergies and that is why it did not help.


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## Jhouston (Nov 9, 2003)

Spasman, Yes, I think the C types and D types are different. My guess is D is more likely bacteria and C is more likely too much florabacteria has been wiped out. that is my guess. I have read others with diverticulitis have been prescribed Floxin or Cipro along with Flagyl. Recently, this past month I took Floxin.....my C is so worse. cannot desribe.


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## SpAsMaN* (May 11, 2002)

Good personality?Mmmm,maybe that is the cause of IBS?I'm ridiculous!


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## daisysp (Jan 13, 2004)

Talissa, great info on the sue/scare of our western doctors. I can see that having maybe being the case with me and the few 'regular' doctors I saw. They didn't want to perform any tests, I had to keep hounding them and they didn't offer any help or information for me to find some options. At least in the alternative field, they tried and tried to help (although I had to pay cash, haha).To my other friends.....glad you are all able to start catching Eric on his mistakes and realizing he's so needing this stimuation in order to keep going on. I still believe if no one responds to him, he'll slink away. There is so little true and real information in his cut/pastes, and I have not got the time (or interest) to read it. I have a life outside IBS, he does not.Kel, thanks for your posting on feeling better. Keep meditating on the lasting power of your experience ! Meditation works great for me when I find, or make the time to do it. I have had a month or so of no symptoms in the last 8 yrs and was so scared the whole time of it being dream..........then the good changed with stress being added to my life. Now I regulate the stress along with the wheat, sugars and dairy. I know how you are feeling yet at least you know the reasons you are feeling better. You worked hard to be in this wonderful space, it's not just an out of the blue situation like I had those few times.Spasman, you are still not going to accept that you have to actually stick to a program to get better are you ? Not only D IBS is curable, or somewhat fixable, C is also, you need to get on a schtick and give it 100% effort. We all like you here and are pulling for you. Don't allow the IBS to control you, find a way to eliminate it !Miss C, you make some great points here.I need to check out the JH program, or information, sounds very interesting. I have been feeling better the last few days, yet am eating very little to get those results. I still say it feels like I have a colony of aliens in my gut. They get upset when I eat, get upset when I don't eat for too many hours, and get nauseas when I eat just a bit too much (about any more than 2 cups of food). I can't seem to totally win, unless I don't eat, haha. I feel like I am a hotel right now, so will be happy to get them out of there, whatever they are. Was thrilled to not have to scroll as much on this page...........nice !!


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## daisysp (Jan 13, 2004)

Ok, where was that JH website ? I keep scrolling and can't see it, want to check it out.Kel, so funny about the Bong comment, I laughed hard on that one !!


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## kel1059 (Feb 28, 2003)

http://www.ibsgroup.org/ubb/ultimatebb.php...t=037154#000009 I can see it now. "Northwest Territory Kingpin arrested...claims he was brainwashed by HT tapes -- Oregonian Times"


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## AlphaMale (Jan 21, 2004)

kelnothing justifies such posts.


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## BackFire44 (Nov 19, 2003)

I've been out for a couple of days, and boy have I missed another heated debate. If anyone was directing anything directly to me, please let me know if I don't answer you -- I might have missed it. I just skimmed a lot of the posts.Daisy, I don't believe that Dr. D really understands IBS. I think Dr. D understands about triggers, about good and bad bacteria in the gut, about food intolerances, and a host of other things. I wouldn't go to him, though, if I wanted to know exactly what was happening to someone's body who had IBS. I think where the real argument is concerns what IBS is. Modern medicine invented the term IBS. It was invented to describe a host of gastrointestinal symptoms that does not have to do with bacteria imbalences or food intolerance. I didn't come up with the term IBS and thus I'm only reporting what those that did come up with the term say. These things are separate from IBS. The fact that Dr. D focuses on bacteria levels and tries to give you optimum levels is totally separate from IBS. If you have a bacteria problem, its not technically speaking an IBS problem. Who cares, though? What people want is to feel better -- whatever doctors label their problem. This is where eric and I differ. I agree with eric that Dr. D does not understand IBS as defined by the medical community. However, I agree with you and other that think that Dr. D can be helpful to people who have gastrointestinal problems (even though I think he comes off as a used car salesman at times). Its really a matter of terminology. What's important to me is that he has helped people on this board with their gastrointestinal symptoms. Although I would be concerned if a person with such symptoms didn't get fully checked out by their doctor first.BackFire44


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## missC (Oct 16, 2002)

uh, talissa, i meant it was untrue (to the best of my knowledge) that kel has asserted that all ibs symptoms are always bacterial in origin - not untrue that they could in some cases be so. something on which i have almost no opinion, when the answer rests so heavily on semantics, on what we choose (or our doctor chooses) to call 'ibs'. (shh, whisper - you never know when eric may be lurking!).


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## Gret (Sep 23, 2003)

IBS has been defined so many ways by so many. It is a garbage can definition, but it gives a patient somewhere to start. (After all the tests, etc.) It basically means that we are not in any danger of dying from this condition, but it IS a big pain in the neck! And we all feel differently and have different triggers, and we all hate it. So if it can't even be defined, how can anyone truly understand it? Whatever it takes to feel better, do it! Personally, I did not want to take medication my whole life. So I found a way out that eliminated the use for drugs.Does it really matter what it is? Sometimes I think some of us have too much time on our hands!Just feel better, everyone! (Easy for me to say? I don't think so!)


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## eric (Jul 8, 1999)

Calid, you stated lactose intolernce IBS or fructose intolernet IBS, they are not IBS. They know what causes them and they have a name. Those conditions can mimick SOME IBS symptoms or they can effect a person who has more then one condition. It is well know many IBSers have IBS and dyspepsia and that these conditions overlap and share common pathologies. A ton of work has been done in this and digestive probelms. They also have seen molecular cell changes in IBS.Very few people are misdignosed with celiac and IBS and celiac has symptoms IBS does not have and IBS has symptoms celiac does not have."The fact is, "irritable bowel syndrome is an illness," just as diabetes and heart disease are illnesses," says Schuster. (That said, it is also true that stress triggers about half of the episodes of IBS. More on that later.)In diagnosing IBS, a physician should first rule out other diseases that share similar symptoms, such as ulcerative colitis, colon cancer, diverticulosis, parasites, and dysentery and other infectious illnesses, says Schuster. Once those conditions have been excluded, a brief checklist called the Rome Criteria for IBS is used to diagnose the condition. "Talissa. what does this mean?"if a physician explains to a patient why only limited testing is necessary."why is limited testing necessary if they use the rome criteria to diagnose? Do you know the reason?And believe me I have studied JH IBS information and Dr Schusters work with IBS, he was an expert researcher on the condition, who has retired now.bowels in an uproar http://www.jhu.edu/~jhumag/0497web/gastro1.html John's Hopkins and IBS http://www.hopkins-gi.org/pages/latin/temp...se=43&lang_id=1 Backfire, it is the information, which many people here are misinformed on in regards to IBS. They don't understand the role of bacteria in IBS and are calling all kinds of things that are not IBS, IBS. Dr Dahlamn does not help educate on this, since he does the same thing and calls all gi disorders IBS.I do not believe he keeps up to date with current IBS research and we know here at least he never discussed any of it?IBS is define by a cluster of symptoms, that they cannot find the cause of, however modern research on IBS, has gotten to problems in subgroups of IBS and commonalities in majorities of IBS patients.This thread isn't even discussing them, its all about bacteria and there is a major problem here.Also if you want to talk about altered flora in IBS, you better add stress itno the equation, as its one cause of permeability in IBS.This is why accurate information is important for diagnoses and symptoms and treating the right problem problems!!!!!!So you know what your treating.Anybody can see anyone they want, but they don't have to post all kinds of confusing and inacurate information to the bb about IBS, Certain people here are posting inacurate info about IBS. There needs to be more accurate information, not less.Some of you are promoting bacteria causing IBS and sympotms in IBS, without even knowing what IBS is or the role of bacteria in IBS. That is a problem. Its to bad DR D can not and does not try harder to educate his patients about IBS, since he is treating people with IBS and says he can cure everyone and says he knows so much about it all. Clearly he does not. I believe backfire is right he is treating a broad range of triggers. This adds to worry that a IBSers have bacteria causing their IBS and then they go through treatmnets that are not needed and not all IBSers have bacteria problems. IF someone has LI, all they have to do it stop diary or fructose, stop eating fructose. There are simple tests for these things out there.You guys can yell at me all you want. But get the information right.You can also catch a mistake or two I have made, but let me tell you I have seen tons of mistakes and errouneous errors on this thread with information.I have also asked anyone to supply information on IBS and bacteri and dybosis and altered flora, not one of you has stepped up to the plate, but many of you continue to post inacurrate information about it.So WHERE IS THE INFORMATION?Then lets discuss that?I will start *"Bacteria and IBS Many have wondered if IBS is caused by an infection. To date, no virus, bacteria, or parasite has been found to directly cause IBS."* http://www.aboutibs.org/Publications/resea...ml#anchor143049 Characteristicsof IBS "The symptoms of IBS are produced by abnormal functioning of the nerves and muscles of the bowel. In IBS there is no evidence of an organic disease, yet, something -- a "dysregulation" between the brain, the gut, and the central nervous system -- causes the bowel to become "irritated," or overly sensitive to stimuli. Symptoms may occur even in response to normal events. IBS is not caused by stress. It is not a psychological or psychiatric disorder. It is not, "All in the mind." IBS is not caused by stress. It is not a psychological or psychiatric disorder. It is not, "All in the mind." Because of the connection between the brain and the gut, symptoms in some individuals can be exacerbated or triggered by stress -- whether physical, emotional, or environmental. Dietary and hormonal factors can affect symptoms of IBS.IBS is not an indication of another more serious disease, like cancer. Irritable bowel syndrome can, however, seriously compromise a person's quality of life. Chronic and recurrent symptoms can disrupt personal or professional activities, upset emotional well being, and limit individual potential.""Where is the Problem in IBS?The definition of IBS suggests that all routine investigations such as blood tests, endoscopy, and radiological imaging should be normal. The condition is diagnosed on the basis of symptoms, elicited through history and physical examination, in the absence of obvious gut abnormality. So what is the problem?" *Much work has been done to explain the underlying pathology * (disease characteristics or cause) in IBS in the hope that treatment could be directly targeted to an abnormality. This approach could be hugely beneficial compared to available treatments that work symptomatically. *In IBS, we know the problem is not only in the gut but is also in the brain-gut axis and the autonomic nervous system.* Is the problem in the gut? Increased perception of sensations in the gut, or visceral hypersensitivity, has consistently been observed in IBS. Mertz and colleagues from California checked the discomfort threshold in IBS patients and in a control group. In response to balloon distention of the rectum, almost all (94%) of IBS patients showed lowered pain thresholds. The investigators proposed that increased rectal perception could be used as a reliable biological marker for IBS.Is the problem in the brain?Silverman and colleagues from UCLA used a special brain imaging technique, positron emission tomography (PET), to measure the changes in the pattern of blood flow in the brains IBS patients and a control group in response to balloon distention of the rectum. They found that different areas of the brain were activated in IBS patients when rectal stimuli were delivered. This suggests that the brains of people with IBS process signals from the gut differently.Is the problem in the general autonomic nervous system?Monga and colleagues from London checked bladder and esophageal perception and pain thresholds and found that women with IBS have both lower bladder and esophageal sensory thresholds. They suggested that IBS is part of a generalized disorder of smooth muscles. These women also had "irritable bladders." Francis and colleagues from Manchester, UK found that a higher proportion of patients who are seen in the urology clinic have IBS compared to patients seen in other clinics (dermatology; and ear, nose, and throat).There seems to be increasing evidence that the pathology in IBS is not limited to the gut, brain, or autonomic nervous system only. Rather there may be an involvement of all three systems. Therefore, any potential new therapy should be aiming at this widespread pathology. http://www.aboutibs.org/Publications/resea...ml#anchor147531 Stress can cause colonic permeability and people who go through Post infectious IBS have stress as a contributing factor in getting IBS in the first place and the system that fights infections and gut invaders is connected to the same system the HPA aixs and the fight or flight stress responce system. Gastroenterology. 2003 Sep;125(3):795-804. Related Articles, Links Stress-induced disruption of colonic epithelial barrier: role of interferon-gamma and myosin light chain kinase in mice.Ferrier L, Mazelin L, Cenac N, Desreumaux P, Janin A, Emilie D, Colombel JF, Garcia-Villar R, Fioramonti J, Bueno L.Neuro-Gastroenterology and Nutrition Unit, Institut National de la Recherche Agronomique, Toulouse, France.BACKGROUND & AIMS: Stressful life events are supposed to be involved in various diseases such as inflammatory bowel diseases and irritable bowel syndrome. Impairment of the intestinal epithelial barrier function is a suspected consequence of stress, but the underlying mechanisms remain unclear. This study aimed to determine the mechanisms through which stress modulates the colonic epithelial barrier. METHODS: Cytokine messenger RNA (mRNA) expression was evaluated in murine colon, liver, and spleen by competitive reverse-transcription polymerase chain reaction after 1-4 days of daily 2-hour stress sessions. Colonic paracellular permeability was measured as the in vivo lumen-to-blood ratio of (51)Cr-ethylenediaminetetraacetic acid. The effect of a myosin light chain (MLC) kinase inhibitor (ML-7) was assessed on stress-induced interferon (IFN)-gamma mRNA expression and colonic epithelial barrier impairment, and MLC phosphorylation was determined by immunoblot. Finally, the incidence of repeated stress sessions on bacterial translocation was determined. RESULTS: Repeated stress induced an overexpression of colonic IFN-gamma. In the liver, higher levels of IFN-gamma, interleukin (IL)-4, and IL-10 mRNAs were detected and were associated with bacterial translocation, inflammation, and apoptosis. Stress increased colonic permeability of control mice, but not of SCID and IFN-gamma-deficient mice. ML-7 inhibited the stress-induced increased permeability, bacterial translocation, and cytokine overexpression in the liver and restored a normal histology. Larger amounts of phosphorylated MLC were detected in stressed animals. CONCLUSIONS: Repeated stress sessions drive organ-specific cytokine expression patterns and alter colonic mucosal barrier functions associated with bacterial translocation. This effect depends on the presence of CD4(+) T cells and requires IFN-gamma production and MLC phosphorylation.PMID: 12949725 J Physiol Biochem. 2000 Sep;56(3):259-74. Related Articles, Links Effect of psychogenic stress on gastrointestinal function.Martinez-Augustin O, Sanchez de Medina F Jr, Sanchez de Medina F.Department of Biochemistry and Molecular Biology, University of Granada, School of Pharmacy, Spain.This review summarizes the studies published over the last twenty years on the effects of psychogenic stress on gastrointestinal function, using animal models. The effects of stress on gastric ulceration have received wide attention and the central and local mechanisms of mucosal damage have been, for the most part, clearly delineated. In comparison, relatively few studies have focused on the impact of stress on intestinal and colonic physiology, even though its influence on intestinal motility, mucosal permeability and inflammation has been established. More work is necessary in this field, especially considering the importance of irritable bowel syndrome in modern society.Publication Types: Review Review Literature PMID: 11198163altered colonic contractions of the digestive system can also trap food materials in areas of the gut and cause fermentation and altered gut flora issues. Serotonin Signaling and Visceral Hypersensitivity in IBS-------------------------------------------------------------------------------- FYIFrom 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-11CMethyl-L-Tryptophan, Positron Emission Tomography and Statistical Parametric MappingNakai A, Kumakura Y, Boivin M, et alCan J Gastroenterol. 2003;17:191-196Background: Irritable bowel syndrome (IBS) is the most common functional bowel disorder and has a strong predominance in women. Recent data suggest that the brain may play an important role in the pathophysiology of IBS in the brain-gut axis. It is strongly suspected that serotonin (5-HT), a neurotransmitter found in the brain and gut, may be related to the pathophysiology of IBS. It is reported that a 5-HT3 antagonist is effective only in female patients with diarrhea-predominant IBS.Objective: In the present study, 5-HT synthesis was measured using positron emission tomography, with alpha-11Cmethyl-L-tryptophan as the tracer, in patients with IBS. The aim of the present study was to compare 5-HT synthesis in the IBS patients with that in the controls, and to compare 5-HT synthesis between male and female IBS patients.Methods: Six male and six female nonconstipated IBS patients were scanned. Age-matched healthy volunteers were scanned as controls. Eighty minute dynamic scans were performed. Functional 5-HT synthesis images were analyzed using statistical parametric mapping.Results: 5-HT synthesis was greater only in the female IBS patients in the right medial temporal gyrus (multimodal sensory association cortex) compared with the female controls (P 0.001).Conclusions: The greater brain 5-HT synthesis in the female IBS patients than in the controls may be related to the pathological visceral pain processing of the IBS patients, a larger female predominance of the disorder, and the sex difference of the efficacy of the 5-HT3 antagonist in treatment.Sex-Related Differences in IBS Patients: Central Processing of Visceral StimuliNaliboff BD, Berman S, Chang L, et alGastroenterology. 2003;124:1738-1747Background & Aims: Women have a higher prevalence of irritable bowel syndrome (IBS) and possible differences in response to treatment, suggesting sex-related differences in underlying pathophysiology. The aim of this study was to determine possible sex-related differences in brain responses to a visceral and a psychological stressor in IBS.Methods: Regional cerebral blood flow measurements using H(2)(15)O positron emission tomography were compared across 23 female and 19 male nonconstipated patients with IBS during a visceral stimulus (moderate rectal inflation) and a psychological stimulus (anticipation of a visceral stimulus).Results: In response to the visceral stimulus, women showed greater activation in the ventromedial prefrontal cortex, right anterior cingulate cortex, and left amygdala, whereas men showed greater activation of the right dorsolateral prefrontal cortex, insula, and dorsal pons/periaqueductal gray. Similar differences were observed during the anticipation condition. Men also reported higher arousal and lower fatigue.Conclusions: Male and female patients with IBS differ in activation of brain networks concerned with cognitive, autonomic, and antinociceptive responses to delivered and anticipated aversive visceral stimuli.Functional Brain Imaging in Irritable Bowel Syndrome With Rectal Balloon-Distention by Using fMRIYuan YZ, Tao RJ, Xu B, et alWorld J Gastroenterol. 2003;9:1356-1360Aim: Irritable bowel syndrome (IBS) is characterized by abdominal pain and changes in stool habits. Visceral hypersensitivity is a key factor in the pathophysiology of IBS. The aim of this study was to examine the effect of rectal balloon-distention stimulus by blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI) in visceral pain center and to compare the distribution, extent, and intensity of activated areas between IBS patients and normal controls.Methods: Twenty-six patients with IBS and eleven normal controls were tested for rectal sensation, and the subjective pain intensity at 90 ml and 120 ml rectal balloon-distention was reported by using Visual Analogue Scale. Then, BOLD-fMRI was performed at 30 ml, 60 ml, 90 ml, and 120 ml rectal balloon-distention in all subjects.Results: Rectal distention stimulation increased the activity of anterior cingulate cortex (35/37), insular cortex (37/37), prefrontal cortex (37/37), and thalamus (35/37) in most cases. At 120 ml of rectal balloon-distention, the activation area and percentage change in MR signal intensity of the regions of interest (ROI) at IC, PFC, and THAL were significantly greater in patients with IBS than that in controls. Score of pain sensation at 90 ml and 120 ml rectal balloon-distention was significantly higher in patients with IBS than that in controls.Conclusion: Using fMRI, some patients with IBS can be detected having visceral hypersensitivity in response to painful rectal balloon-distention. fMRI is an objective brain imaging technique to measure the change in regional cerebral activation more precisely. In this study, IC and PFC of the IBS patients were the major loci of the CNS processing of visceral perception.Role of Visceral Sensitivity in the Pathophysiology of Irritable Bowel SyndromeDelvaux MGut. 2002;51(suppl 1):i67-i71Visceral hypersensitivity has been recognised as a characteristic of patients with irritable bowel syndrome (IBS). It may be involved in the pathogenesis of abdominal pain/discomfort, and seems to result from the sensitisation of nerve afferent pathways originating from the gastrointestinal tract. From a clinical point of view, hypersensitivity, although frequent, is not a constant finding among patients with IBS and cannot therefore be considered as a diagnostic marker of the condition. The advances made in understanding visceral hypersensitivity in patients with IBS are reviewed: the factors that influence abdominal distension are defined and different therapeutic perspectives are examined.www.medscape.com/viewarti...02/7001/-1 Mast cells and EC cells that store serotonin are players in IBS. There is an increase of these cells also seen in PI IBS.FYIDistinctive Features of Postinfective Irritable Bowel Syndrome Laurie Barclay, MDJuly 25, 2003 ï¿½ Patients with postinfective irritable bowel syndrome (PI-IBS) have more diarrheal symptoms, fewer psychiatric symptoms, and a greater increase in serotonin-containing enterochromaffin (EC) cells than those whose IBS did not start after an infectious disease, according to the results of a study published in the July issue of the American Journal of Gastroenterology. The investigators speculate that subclassifying patients may allow for better and more specific therapies for some patients with IBS. "IBS patients are heterogeneous, both in symptoms and in etiology, and progress in understanding pathogenesis has been limited for lack of objective measures to allow meaningful subdivision," write Simon P. Dunlop, MSc, from University Hospital in Nottingham, U.K., and colleagues. "Recently there has been progress in defining one subgroup of patients, i.e., those developing IBS symptoms after an episode of infective gastroenteritis."In this study, 75 consecutive IBS outpatients and 36 healthy controls completed a questionnaire and had a full diagnostic workup including rectal biopsy. Of the 75 patients with IBS, 23 had onset of symptoms after an infectious illness and 52 did not.Predominance of diarrhea occurred in 70% of PI-IBS patients and in 42% of nonï¿½PI-IBS patients (P = .03), and previous treatment for anxiety or depression occurred in 26% of PI-IBS patients and in 54% of the nonï¿½PI-IBS group (P = .02). Using conventional criteria, biopsy results for all patients were normal, but there were increased EC cells in the PI-IBS group compared with the nonï¿½PI-IBS group (P = .017) and with controls (P = .02). Lamina propria T lymphocytes were increased in PI-IBS (P = .026) and in nonï¿½PI-IBS (P = .011) patients compared with control patients, and mast cells were increased in nonï¿½PI-IBS patients (P = .054) compared with control patients.The authors do not recommend rectal biopsy in all patients, but they note that "these group differences are important, as they suggest that different types of IBS may have different pathogenic mechanisms. By defining different 'key players' such as mast cells, lymphocytes, and EC cells, they suggest new specific pharmacological targets for therapy. They also suggest new objective measures such as plasma serotonin or serum tryptase with which we can seek to subclassify IBS and to identify those individuals who will respond to specific therapies."AstraZeneca supported this work through an educational grant.Am J Gastroenterol. 2003;98:1578-1583Reviewed by Gary D. Vogin, MDThey also have other reasons to believe serotonin plays and important role in gut function and communication between the enteric nervous sytem and the brain inIBS, specifically motility. Much work has been done in this area as well and a lot more being done.FYIPathophysiologyAltered Serotonin Signaling?The pathogenesis of IBS remains obscure, and in particular, an explanation for alternating diarrhea and constipation has been elusive. In arguably one of the most important papers presented during this year's meeting, Moses and colleagues[21] studied potential deregulation of the gut's serotonin transporter in IBS. It is known that serotonin (5-hydroxytryptamine or 5HT) is released from enteroendocrine (or enterochromaffin) cells in response to either chemical or mechanical stimulation of the gut mucosa. Serotonin in turn initiates peristalsis, and then the serotonin released is taken up in health by a highly selective serotonin transporter (SERT). One potential mechanism that could explain altered bowel function in IBS is an abnormality in the serotonin transporter itself. The study authors evaluated this hypothesis in patients with IBS with constipation and IBS with diarrhea compared with patients with ulcerative colitis and healthy controls. They were able to convincing show on blinded review that SERT immunoreactivity was less intense in patients with IBS with constipation and patients with ulcerative colitis. If these findings are indeed correct, they represent a landmark observation. The findings suggest that patients with constipation and IBS may have a reduced capacity to reuptake serotonin, leading to excess free serotonin and then desensitization of these receptors, thus reducing motor function. In contrast, in the setting of diarrhea, serotonin uptake was normal. If the underlying abnormality in serotonin transporter function alternated, then this would in turn explain alternating constipation and diarrhea. These data strongly suggest that IBS is a "real" gut disease and a potential diagnostic disease marker. They also suggest that it is valid to subdivide IBS into constipation and diarrhea symptom subgroups. This study also provides additional rationale for the use of serotonin-modulating agents in IBS and provides a new target for drug modulation. Confirmation of these very exciting initial findings in larger patient samples is awaited with great interest.Ask The Expert.Image of a cadeusus. .General Medical Questions.Q: I have suffered from irritable-bowel syndrome for many years. I get diarrhea. The doctors I've seen have offered little help. Recently, my daughter suggested I try an over-the-counter medicine called "5-Hydroxy-tryptophan," made by a company called Natrol Inc. My daughter says it is a mild antidepressant. It seems to have helped quite a bit, but it also seems to slow me down and make me feel tired. Can you give me any information on this? What is it, exactly, and are there any serious side effects? The only other medicine I take is Synthroid....The Trusted Source..Harold J. DeMonaco, M.S.Harold J. DeMonaco, M.S., is senior analyst, Innovative Diagnostics and Therapeutics, and the chair of the Human Research Committee at the Massachusetts General Hospital. He is author of over 20 publications in the pharmacy and medical literature and routinely reviews manuscript submissions for eight medical journals...June 19, 2001.A:Irritable bowel syndrome is now recognized as a disorder of serotonin activity. Serotonin is a neurotransmitter in the brain that regulates sleep, mood (depression, anxiety), aggression, appetite, temperature, sexual behavior and pain sensation. Serotonin also acts as a neurotransmitter in the gastrointestinal tract.Excessive serotonin activity in the gastrointestinal system (enteric nervous system) is thought to cause the diarrhea of irritable-bowel syndrome. The enteric nervous system detects bowel distension (expansion) on the basis of pressure-sensitive cells in the bowel lumen (opening). Once activated, these pressure-sensitive cells promote the release of serotonin, which in turn promotes both secretory function and peristaltic function (the contractions of the intestines that force the contents outward). At least four serotonergic receptors have been identified to be participants in the secretory and peristaltic response.Patients with diarrhea-predominant IBS may have higher levels of serotonin after eating than do people without the disorder. This recognition led to the development of the first drug used specifically to treat diarrheal symptoms of IBS, alosetron (also known as Lotronex). Alosetron blocked the specific serotonin receptors responsible for recognizing bowel distention. In doing so, it blocked the effects of serotonin and reduced both bowel secretions and peristalsis. Constipation was the most common side effect seen. (Note: Alosetron was removed from the market by the manufacturer after repeated reports of a dangerous condition known as ischemic colitis became known.) Tegaserod (Zelmac) is another drug under development and under review by the U.S. Food and Drug Administration for approval. Tegaserod is indicated for the treatment of constipation-predominant IBS and works to increase enteric nervous system serotonin activity.So, increasing serotonin activity in the enteric nervous system produces increased bowel secretions and peristalsis (and potentially diarrhea), whereas depressing serotonin activity produces reduced secretions and reduce peristalsis (and potentially constipation). Increasing serotonin activity in the brain would increase awareness and, in higher doses, produce anxiety, insomnia and restlessness. So I would have expected exactly the opposite effects of those that you experienced.I am unable to identify any possible drug interactions between 5-HTP and Synthroid (levothyroxine) but the symptoms described suggest a check with your doctor may be in order. Persistent feelings of tiredness and constipation may be signs of an underactive thyroid (hypothyroidism).June 19, 2001 Levels of 5-Hydroxytryptamine Increase After Meals in Women With Irritable Bowel SyndromeNEW YORK Reuters Health May 05 - Platelet-depleted plasma 5-hydroxytryptamine 5-HT levels increase after meals in women with diarrhea-predominant irritable bowel syndrome d-IBS whose symptoms increase following food ingestion, according to a report in the May issue of Gut.In small studies, 5-HT concentrations in platelet-poor plasma appear higher in women with d-IBS than in healthy women, the authors explain, suggesting a possible link between 5-HT and postprandial symptom exacerbations or IBS itself.Dr. L. A. Houghton from University Hospital of South Manchester, UK and colleagues assessed 5-HT and 5-HIAA its metabolite concentrations, 5-HT turnover, and platelet 5-HT stores in 39 women with d-IBS and 20 healthy female volunteers before and after a standard carbohydrate meal.Although there was no difference in the ratio of postprandial to fasting 5-HT levels between d-IBS patients and healthy controls, the authors report, d-IBS subjects did have higher postprandial concentrations of 5-HT with earlier peak 5-HT levels than did healthy women.Women with d-IBS who reported symptoms following the meal also tended to have higher 5-HT concentrations and higher peak concentrations than did other women, the report indicates, though there was no difference in the time to peak levels compared with asymptomatic women with d-IBS.Fasting 5-HIAA levels were higher in d-IBS women than in healthy controls, the researchers note, but postprandial concentrations did not differ.Fasting and postprandial 5-HT turnover the ratio of 5-HIAA to 5-HT levels did not differ between healthy controls and women with d-IBS, the results indicate, but d-IBS subjects with postprandial symptoms tended to have a lower 5-HT turnover than did d-IBS women without symptoms.Women with d-IBS had significantly higher platelet 5-HT stores than did healthy women, the investigators find, though levels did not differ between d-IBS patients with and without postprandial symptoms."Our results have shown for the first time that symptom exacerbation following meal ingestion in female subjects with d-IBS is associated with increased levels of plasma 5-HT, together with a reduction in 5-HT turnover," the authors conclude. "In addition, baseline platelet stores of 5-HT are elevated in female subjects with d-IBS compared with healthy subjects, supporting increased exposure of platelets to 5-HT in the systemic circulation.""Platelet 5-HT concentrations may have a potential role to play as a marker in the diagnosis and management of d-IBS," the researchers suggest. "This would be similar to the way glycosylated hemoglobin is used to reflect mean blood glucose concentration over a prolonged time period in patients with diabetes mellitus."The investigators add, "Further studies addressing both mucosal 5-HT concentrations and enteroendocrine cell numbers in subjects with d-IBS, as well as similar studies to the present one conducted in subjects with constipation predominant IBS and assessing the transient relationship between symptoms and the 5-HT system need to be performed."Gut 2003;52:663-670.www.medscape.com/viewarticle/453489Curr Opin Investig Drugs. 2004 Jan;5(1):55-60. Links Enterochromaffin cells and 5-HT signaling in the pathophysiology of disorders of gastrointestinal function.Crowell MD, Shetzline MA, Moses PL, Mawe GM, Talley NJ.Mayo Foundation and Mayo Clinic, GI Physiology & Motility, Division of Gastroenterology & Hepatology, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA. crowell.michael###Mayo.eduDisorders of gastrointestinal function are common and significantly reduce quality-of-life, as well as negatively impacting healthcare costs. Consequently, there is much interest in understanding the pathogenesis of these disorders. Increasing, albeit as yet limited, evidence has implicated alterations in 5-hydroxytryptamine (5-HT) release, and the subsequent interaction of 5-HT with specific 5-HT receptor subtypes, in the altered gut function of patients with irritable bowel syndrome (IBS) and other functional bowel diseases. Alterations to enterochromaffin cells and/or 5-HT signaling can result in gastrointestinal dysmotility, visceral hypersensitivity and secretomotor abnormalities in the gut. Evidence is beginning to link disturbed 5-HT physiology with the pathophysiology of diarrhea and constipation in IBS, and with slow-transit constipation. This review discusses the current evidence on the pathobiology of these systems.PMID: 14983974Gastroenterology. 2004 Mar;126(3):693-702. Links Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome.Barbara G, Stanghellini V, De Giorgio R, Cremon C, Cottrell GS, Santini D, Pasquinelli G, Morselli-Labate AM, Grady EF, Bunnett NW, Collins SM, Corinaldesi R.Background & Aims: The mechanisms underlying abdominal pain perception in irritable bowel syndrome (IBS) are poorly understood. Intestinal mast cell infiltration may perturb nerve function leading to symptom perception. We assessed colonic mast cell infiltration, mediator release, and spatial interactions with mucosal innervation and their correlation with abdominal pain in IBS patients. Methods: IBS patients were diagnosed according to Rome II criteria and abdominal pain quantified according to a validated questionnaire. Colonic mucosal mast cells were identified immunohistochemically and quantified with a computer-assisted counting method. Mast cell tryptase and histamine release were analyzed immunoenzymatically. Intestinal nerve to mast cell distance was assessed with electron microscopy. Results: Thirty-four out of 44 IBS patients (77%) showed an increased area of mucosa occupied by mast cells as compared with controls (9.2% +/- 2.5% vs. 3.3 +/- 0.8%, respectively; P 0.001). There was a 150% increase in the number of degranulating mast cells (4.76 +/- 3.18/field vs. 2.42 +/- 2.26/field, respectively; P = 0.026). Mucosal content of tryptase was increased in IBS and mast cells spontaneously released more tryptase (3.22 +/- 3.48 pmol/min/mg vs. 0.87 +/- 0.65 pmol/min/mg, respectively; P = 0.015) and histamine (339.7 +/- 59.0 ng/g vs. 169.3 +/- 130.6 ng/g, respectively; P = 0.015). Mast cells located within 5 microm of nerve fibers were 7.14 +/- 3.87/field vs. 2.27 +/- 1.63/field in IBS vs. controls (P 0.001). Only mast cells in close proximity to nerves were significantly correlated with severity and frequency of abdominal pain/discomfort (P 0.001 and P = 0.003, respectively). Conclusions: Colonic mast cell infiltration and mediator release in proximity to mucosal innervation may contribute to abdominal pain perception in IBS patients.PMID: 14988823Mast cells connect and are effected by infection, stress and foods!


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## eric (Jul 8, 1999)

New from Harvard health"Understanding irritable bowel syndrome Irritable bowel syndrome (IBS) affects an estimated 24 million people in the United States. Experts aren't sure why, but 70% of sufferers are women. IBS causes recurrent constipation or diarrhea (or alternating bouts of each) along with cramps, bloating, and gas. Symptoms often interfere with work and other activities. Some women hesitate to leave their homes because they're embarrassed or don't want to be very far from a bathroom. A diagnosis of IBS requires the presence of abdominal pain or discomfort for 12 or more weeks (not necessarily consecutive) in the past 12 months, plus at least two of the following: relief of abdominal discomfort with defecation, a change in the frequency of bowel movements, or a change in stool appearance or form. Other symptoms that suggest IBS include abnormal stool frequency, consistency, or passage; passage of mucus; and bloating. Some experts suspect disturbances in the nerves or muscles of the gut cause IBS. Others believe that abnormal processing of gut sensations in the brain may be responsible. Some patients may have irregularities in the muscle activity of the colon. And research suggests that a bout with an intestinal virus may set off IBS, particularly when a stressful event follows the illness. An emerging theory focuses on the neurotransmitter serotonin. Some research suggests that IBS patients who suffer mainly from diarrhea may have increased serotonin levels in the gut, while those with constipation-predominant IBS have decreased amounts. Stress often worsens symptoms, and studies suggest that cognitive behavioral therapy, relaxation therapy, and hypnotherapy can help relieve pain and symptoms. Stress management, diet, and exercise have also proven useful. One of the most promising medical approaches to IBS involves medications that alter the action of serotonin in the colon. " Editor's note: Harvard Medical School publishes a report, The Sensitive Gut, that provides more detailed information about this topic. For more information or to purchase it, go to www.health.harvard.edu/SG.


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## Talissa (Apr 10, 2004)

Hi Eric--that's a quote from an article YOU posted, you should know what it means.("if a physician explains to a patient why only limited testing is necessary.") And btw-your article, "Bacteria and IBS: Many have wondered if IBS is caused by an infection. TO DATE, no virus, bacteria, or parasite has been found to directly cause IBS." To date. It has not been definitively ruled out.To have it DIRECTLY cause IBS, definitively, is a very hard thing to pinpoint. But I believe one day it'll happen.I also have the belief, founded on research, that intestinal dysbiosis has different etiologies, and thus different strains of pathogen over-populations are involved, making definitive treatment of bacterial imbalances very difficult to treat in blanket studies. Thus the inconsistencies in results of treating IBS as a bacterial/viral/fungus problem at heart. I'm not the only one. This is from Joseph Mercola's site, and there's a reason this pioneering MD believes the following to be true: He's successfully treated patients using this underlying reasoning.Here it is:"Everyone has about 100 trillion bacteria in their gut; ideally, beneficial bacteria should make up about 85 percent of the intestinal tract, and harmful bacteria about 15 percent. However, most Americans have the inverse ratio of 15 percent good bacteria to 85 percent bad. This can seriously compromise the immune and digestive systems, leading to a number of chronic diseases, and likely plays a large role in the estimated 100 million Americans who suffer from some form of digestive disease.Typically, when you hear about the benefits of ï¿½friendly bacteriaï¿½ it has been assumed that the bacteria must be live in order to boost your digestive system. However, the researchers of a study in the February 3, 2004 edition of Nature say that live bacteria arenï¿½t necessary. They tested the effects of good bacteria on mice with colitis, a condition similar to inflammatory bowel disease in humans, and found the bacteria were just as effective when inactivated with gamma-ray radiation as when live cultures were used. This means that probiotics would yield health benefits regardless of whether or not they were live. Here is just a partial list of symptoms that can often result from an imbalance of bacteria in the intestinal tract:Gas, Bloating and Indigestion IBS (Irritable Bowel Syndrome) Diarrhea and/or Constipation Skin problems such as Acne, Eczema & Psoriasis Bad Breath and Body Odor Delayed development in children Candida Yeast Infections High Cholesterol Levels Chronic Fatigue & Fibromyalgia Frequent Colds and Flu "I respectfully disagree with you & most of the medical community, who are relying on research largely funded by powerful pharmaceutical companies that're hoping they can come up with a new band-aid drug or anti-depressant that they can make billions on, from the millions who suffer from "IBS"--the no. 1 diagnosis by GIs.Further, re: your quote, "In IBS, we know the problem is not only in the gut but is also in the brain-gut axis and the autonomic nervous system." Of course it involves the ANS & brain-gut axis. Enzymes, hormones, carriers, neurons, etc all are manufactured in the body by nutrients(mainly protein/amino acids & fatty acids) via the digestive system. When the digestive system gets imbalanced in flora, it doesn't work right. Proper manufacturing of body chemicals doesn't occur-- your whole system, even your muscles, along with the brain-gut connection & hormones, etc get muddled. Hence irritablity, which you seem to be a good example of, stress overload, etc.As I said before,isn't it possible that having imbalanced intestinal bacteria would by its very existence mess up the brain-gut connection? MOST IMPORTANTLY, I believe this debate, while intellectually-stimulating at times, should be on a seperate thread, & I really wish Dr D could be here instead of you Eric. He would be here helping those who want to be helped, if you hadn't made it a debate & taken up time he can't spare, because he's into helping people genuinely get better, unlike you seem to be. Other than that, I think you're swell! Respectfully agreeing to disagree for now,Talissaps--kel--it is paradise, if you come for 2 weeks. Living here is another matter entirely! But, it has its perks, like anywhere....


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## BackFire44 (Nov 19, 2003)

Uh-oh. Someone else armed with medical research. I think we have a full out war now.







I'm glad, actually, that we have moved away from the "I'm right -- no I'm right" duldrums and Talissa has posted information from an MD that may back up her claim. Eric, quick suggestion for you. Most people I think don't have time to read through every article that you post -- many times I come to this board just for a few minutes during a quick break. Perhaps instead of posting the full article, you could just post your own message at top and then post links for the rest or direct us to a point on your website where we can read more. I know you want to post accurate information to help people, but I think that format will enable more people to read the important part of your posts instead of just scrolling past everything when they don't have the time.Oh, and also I noticed a bit back that there was a discussion of hypnotherapy again. I know many of you feel eric might be biased about hypnotherapy because he works to promote Mike's tapes. I can tell you that I have no affiliation with Mike or eric whatsoever and have been on the tapes for about three weeks now. I've noticed a definite positive change in my coping strategies and my general overall health. For those that have read the hypnotherapy thread, you'll know that I'm not convinced what exactly is evoking this change, but there is no doubt that it is helping me. I have not completed the course by far, but so far the tapes have really been based on relaxation and developing a positive dialogue in your head about IBS. I see it as a mix between meditation and cognitive behavior therapy right now. In any event, the positive results that have been scientifically proven from hypnotherapy leave really nothing to be discussed -- it does help people with IBS.BackFire44


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## overitnow (Nov 25, 2001)

You guys can carry on this way forever...It's kind of like a "political correctness" discussion. If I had depended on the medical system I certainly wouldn't have the treatment I have found and I certainly wouldn't have the level of recovery that I enjoy. (Can you say 100%?)So do carry on discussing who belongs here, what can be talked about, and how many angels can dance on the head of a pin. I'm going to invite Gret over for a slice of chocolate cake. "Hey, Gret!"Mark


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## Gret (Sep 23, 2003)

I'm there, Mark! No one has to ask me twice for anything chocolate! I have at least four pieces of good chocolate every day! But, really, don't you find all this conversation interesting stuff? (I mean, once you finish scrolling.) Talissa, love your comments. You seem well-informed and intentional in your quest to find your "CURE".


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## daisysp (Jan 13, 2004)

I agree Dr Dahlman has his expertise in a certain area concerning the treatment of the IBS....and I have to agree that IBS is a catch all term used so widely. So, you can say Dr D does not understand IBS yet how can you really say anyone does ? It is different enough for us all that there is no perfect protocol to follow for diagnosis or 'cures'. We can just say GI issues, and eliminate the term IBS ! How would that sit with Eric ? He'd have so little to argue about, yet just think how few pages would be on every thread !I have so eliminated every ounce of wheat, sugar and dairy the last few days and feel so much better. I was not eating them anyhow in their most obvious forms, yet was not being careful about sauces, soups and little items here and there. I decided I really want to eat protein and am trying to find ways to do so without the negative reactions I have had for the last 8 yrs...............so I got extreme and took out every bite (Calid said something about even a bite of Gluten sending you into pain for days and that got me). I feel plenty of C cause I am slow transit and protein is slowest.........so I am going to drastically reduce the amounts tomorrow that I have been trying, and see if I can keep going with it. I am eating my vege's still. So, like I said, plenty of C, yet no pain and that is a huge step. I don't get that instant intestinal cramp when I begin eating...maybe that is psycological when I eat foods I know I react to, yet maybe it's physical also as my body knows whats coming down after I chew it up and the recognition takes place. I had said in previous postings about how it feels like I am feeding a colony in my intestines when I eat, as I get a reaction immediately. With just protein and vege's there isn't that reaction.........so interesting if nothing else ! Tomorrow I call Dr D about my poop so am anxious to find out what he's got to offer me in the way of test results.I really want to join Calid and Mark in that chocolate cake, so need to get this 'IBS' gone !


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## gt0854a (Feb 22, 2000)

Ah the commitment difficulties. I suck at fully committing to anything - whether it be taking care of my diabetes, physical therapy, or eating diligently.Does anyone else suffer from this apparent lack of commitment? Any words of wisdom or suggestions on how to MAKE yourself take better care of yourself? I'm considering getting a shrink


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## overitnow (Nov 25, 2001)

gf: I was never any good at taking care of myself until my condition(s) were becoming life threatening and I then I started seeing a positive change in my health. I went from the "you must get your nutrients from your food" school to becoming a supplement pig almost overnight in reaction to the change. Nothing keeps me from taking my pills each morning and evening, and the greatest payback came from my last doctor's appointment: there was not a single worry from any condition covered in the blood test, even 20 year problems like cholesterol and high blood pressure are gone. GI problems? Not any more.Gret: I'm so pleased that you are able to eat chocolate again. Now we will have to start talking about dieting...I wrote a Dr. Gershon, one of eric's experts, re my experience with Provex, all of the stuff about brain circulation and my experience, and actually got back a reply that didn't try to dismiss the changes that I have undergone. He had the following comment, that I thought was particularly telling about how research works, and why all of us out on the "Noni branches" of IBS treatments are generally ignored by the mainstream, and indeed, why, if these things work, your doctor has never heard of them:"I have no experience with flavenoids and I cannot begin to do research myself without funds. I get research funding from NIH but they only fund grants proposals that are accompanied by a great deal of preliminary data. I realize that sounds like a "Catch 22" situation. First you find out what you want to know, they they fund you to prove it. Still, I did not design the system.In your case, skeptics might ask how one knows that it was the Provex CV that worked. Perhaps you took it and just got better for other reasons. Maybe you did something else at the same time that you think could not have helped, but which really provided the cure. There was no placebo control. You did not re-challenge by stopping the Provex CV and seeing if the diarrhea returned, and then retreat and show that Provex CV continued to work. [Actually, I did do that.] I do not mean to imply that your experience was not meaningful without all that, but those are the kinds of elements that would have to go into a scientific study that proved efficacy. At the moment, your experience would be classified by scientists as an "unconfirmed anecdote".These anecdotes accumulate and when they reach a critical mass, stimulate research. I would like to thank you for sharing your experience with me. I will keep it in mind and use the information if an opportunity arises."So it probably is pointless to keep pushing this rock along...Give them all Immodium, I say.Daisysp: I think you are just down the road from Victoria. Come on up and I'll buy you a cake. (But you have to be better, first.) There was a major feature in my Saturday paper on diet and brain health; and it turns out that those who continue eating large quantities of red meat as they age--and I am not suggesting that you would qualify as old (as me) or that you are getting your protien from the side of a cow--will tend to higher rates of dementia and Alzheimers. Just thought that was worth adding to the discussion.It's 10 o'clock and I have to go to work in the morning (37 more days and counting...).Good night,Mark


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## Talissa (Apr 10, 2004)

Hi Gret, my hero! I do have my fingers crossed that all this studying about nutrition & digestion will get me to your's & Mark's 100% status, no question. I really envy your will power. I'm off now to investigate how many angels can in fact dance on the head of a pin. Of course it depends on many factors--do angels really exist? Has it been proven in double-blind placebo studies by large corp's with a financial interest in their existence/non-existence? How big is the head of pin? Is there a wind blowing? Does wind definitively affect angels? So many Q's, so little time.....


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## Gret (Sep 23, 2003)

Talissa, We need your fresh humor here!Check out this site, everyone. It's a brief article about some of the stuff we've been discussing. Take note on the last paragraph! http://www.medicalpost.com/mpcontent/artic...321_163831_4140


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## BackFire44 (Nov 19, 2003)

Talissa, you're turning out to be quite a competitor with the posts. First battling eric's research; and now Gret says you're funny. I used to be the funny one. Oh well, guess I'll have to find another niche for myself.







I think I have still have the title of peacemaker, right Gret? I love chocolate cake. overitnow, I'm glad you continue to do great. Scientific research is a strange entity. Its a relatively slow process that has to be paid for by someone. Sometimes the government pays for things, sometimes drug companies, and sometimes just donations can do the trick. We sit by the sidelines, waiting for something to happen that will finally validate a cure for us. However, you and others are perfectly right in trying out all the cures before science has a chance to validate them. I'm glad you found yours -- and that Gret, you found yours. I think we would do away with a lot of confusion if we stopped calling things IBS and just said we ahve unexplainable gastrointestinal health (UGH for short). Who knows -- perhaps in the years to come, scientists will discover that what we now call IBS can really be divided into a dozen separate problems that are all treated different ways. BackFire44


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## Gret (Sep 23, 2003)

Backfire, you most certainly are the peacemaker around here! I like that, I'm always the peacemaker in my family and sometimes I don't want to be! Thanks for your insights.Mark, just curious..... when you started the Provex CV, did you start or stop anything else at the same time? I guess that's why scientific testing gets so costly, all of the variables. Still, I think each person knows their own body better than anybody else. People could say I was having a placebo effect, but I knew better! I do know that I had way too much chocolate yesterday! You might be right about that diet!How's Calid doing today? Arnie? Daisy? Anybody heard from mtbike?


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## calid (Aug 4, 2003)

Calid's still doing very well!!!!


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## overitnow (Nov 25, 2001)

When I started taking Provex that was a singular change in my routine. I was looking only for help with my cholesterol and knew nothing about the flavonoids' effects other than that they lower blood platelet movement which keeps it from depositing on arterial walls. (I have what appear to be two small blockages on my x-rays.) I knew nothing of its abilities to increase blood circulation nor to permeate the blood brain barrier. Within two weeks, two interesting things happened. The first was I stopped having the gas that turns out to be d and the second was that I started to awaken with erections every night. (This was remarkable in that I had long suffered from male smoker's erectile dysfunction, probably for 10-15 years.) They were clearly related, in that they both occurred within the same time frame. A urologist was able to explain the relationship between the flavonoids and penile blood circulation; but it was not until three years later, when I read here of the Australian study that linked IBS with brain circulation that that piece of the puzzle became clear. The same circulatory improvement that took two weeks to show up in my sexual function presumable took two weeks to show up in my brain circulation. (This also explains why it works for ADD, Fibro, and CFS, as they seem to share the same perfusion problem in different areas of the brain with different symptomology. We know that Fibro/CFS often display IBS as well. I wonder if there is a similar relationship between these conditions and ADD. I have heard of one person successfully treating their Fibro with Ritalin.)Interestingly, when I stopped taking Provex for a month to see if I was "cured" of this, it took two weeks for the first symptom--the irritated gut ache--to return, another week for the urgent and very soft bms, and a fourth week for full out diarrhea. They all reversed within the next month after redosing with Provex and have not returned since. This is some placebo!(But Gret, the real question is do you know "Spem in Alia" by Thomas Tallis? I have just discovered this piece of music this year and find it absolutely transcendant.)Mark


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## Talissa (Apr 10, 2004)

Gret--Great article, thanks for sharing. The dots are starting to connect. On the chance that this thread is all you've got time to read, Bonniei also posted it on the "intestinal permeability thread."Quick question--did you really & truly follow Dr. D's program to the letter while taking the probiotics, etc? Gave up, temporarily, dairy, vitamins, etc, drank the H20 correctly re: meals, and so on? Mark--Thanks for all the good info, very interesting. Do you think all you needed was the anti-inflammatory affects from that flavonoid/anti-oxidant mix? I couldn't find much info on the web about Provex CV...BackFire--I don't think you have to worry about your status as the "funny one." I only get flashes of funny every so often


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## overitnow (Nov 25, 2001)

Talissa--There was a study out of U Adelaide to which I referred, which indicated in the population studied, all of those with FM who also showed IBS had lowered blood circ in that part of the brain that controls digestion. (I wrote the author of the study to confirm that at the time.) The ginko and grape seed in the Provex both effect blood circ, ginko is known to penetrate blood brain barrier, grape seed is believed to do the same. Provex CV also contains some co-enzymes to boost it's absorbancy over 4 times that of plain flavonoid mixture. I believe increasing that circulation changed my digestive processes. Whether that works through the enteric system or not, I do not know. What studies have been done have been paid for by the manufacturer, Melaleuca Inc. They have all been directed at cardio health, to my knowledge, and have been published in a couple of scientific journals. You can read more at the Melaleuca website.Mark


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## Talissa (Apr 10, 2004)

Mark--I can't remember where I read this off the top of my head, but someone out there has a theory that IBS is caused by poor blood circulation through the digestive tract. A lone wolf crying in the wind. It's all very complex in these amazing bodies of ours!Have a good night, Talissa


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## calid (Aug 4, 2003)

Hm, interesting info. My blood pressure is extremely low and my circulation is also pretty poor. The poor circulation runs in my family, so does low blood pressure.


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## daisysp (Jan 13, 2004)

I had read alot recently about Cortisol being low in folks having slow transit. So I ordered some cortisol supplements and am going to try them (if I get the o.k. from Dr D). I have heard about it over the years from various sources (before reading up on it), so when I heard an ad on the radio for a few days in a row, and then reasearched the company, I took it as a sign. I do love the effects from the Rhodiola I take, which increases the Serotonin levels.Am doing well if I eat not even one bite of sugar, flour or dairy. Had one bite today of my son's carrot cake........just the topping, and felt it, so I backed way off. As long as I keep vege's in me and workout so I don't get hungry, I am feeling out of pain. I called DrD today and left a message, hope to talk to him before the weekend as to my 'sample' results. Want to hear something encouraging about what to do next. I feel like I am waiting on pins and needles.Backfire, Talissa, Calid and OveritNow,Gret, gf, Kel and Arnie; love your postings. It's a joy to sign on now and read such interesting information and check out some websites that provide puzzle pieces. I agree we need to call this GI issues, not IBS, if folks are going to get hung up on the definitions.


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## Gret (Sep 23, 2003)

Daisy, I agree, this thread has been interesting lately! Mark, Do you think Provex CV would work for Raynoud's since that is a circulatory problem? My doctor prescribed blood pressure medication which I have never taken! I'd be curious if there have been any studies here.Talissa, I followed the program to the letter! It was difficult at first. I started it on Dec. 17 and had to get through the holidays. I remember on Christmas Day thinking "WHAT can I eat?" I ended up eating white bread for appetizers! I lost weight because my main snack had always been cheese! I was so careful! Now I still do not take any supplements because I'm afraid of rocking the boat. But I know I should get back to vitamins, etc. I just haven't. Dr. Dahlman said to stop everything while on the program, it all worked, and now I'm not sure what my body needs! I have gained some of my weight back (chocolate!!!) and I feel terrific, but I suspect I need calcium and other nutrients because I don't have a perfect diet! (Who does?) I knew anything was possible for a three month period. I knew I could handle that. I wasn't too careful with alcohol though. My sister and I put away some wine over the holidays, but it didn't seem to bother me. I kept getting better so it became easier to stick to the rules! Now I eat whatever the heck I want and I've got to get back to healthy eating!Mark, Thomas Tallis is so meditative and spiritual. Our choir has a couple of his anthems that we love. If you like piano music, you may also like Erik Satie. Chocolate cake and Tallis! Good taste!


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## overitnow (Nov 25, 2001)

Hi Gret,As far as I know, the only studies for Provex have been for cardio issues. If Reynaud's syndrome is circulatory in nature it ought to help. (If there is a test for this, I can have a bottle sent to you and you can take it for a couple of months and see. There is nothing in it that ought to cause you any problems.)You really should talk with Dr D about reintroducing vitamins. There was a study reported in the Toronto Globe and Mail a couple of years ago that highlighted the disappearing vitamins and minerals from our food supply and the enormous servings it would now take to replicate what was nutritionally available in the '50s. The reducto ad absurdum was that the potato had been relegated to a starch source with no other nutrients, not even in the skin. (The butter alone is better for you.) And do make sure you get chelated minerals as they will absorb about 40%, whereas the non-chelated are under 10%.Chocolate cake, Tallis and champaign, to be specific. I'm also very big on Wagner, but it is so hard working in those horns and carrying around a spear all day.Mark


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## eric (Jul 8, 1999)

Parts of this thread are sending IBS back to the dark ages.and"I agree we need to call this GI issues, not IBS, if folks are going to get hung up on the definitions. "Defintions are extremely important to diagnoses and treatments!and cortsol, which is involved in the fight or flight and the hap axis and infection. IS also more involved in d predominate IBS.They know this can trigger IBS symptoms and is an important part of the vicious cycle in IBS. There is a ton of research on this in the last five years and it is very important to IBS.Its also one reason why people have problems in the mornings, because that is when cortisol a stress hormone is at its highest.and this is on the GSDL site.The Fight or Flight 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" sympathetic nervous system - signaled in part by the heightened release of the stress hormone cortisol after eating - may play a key role in triggering their symptoms. Researchers evaluated a group of 24 patients with IBS and a group of healthy controls, measuring their salivary cortisol levels, their heart rates, and their heart rate variabilities at different times of the day. Compared to the controls and to IBS patients with constipation, IBS patients with chronic food-induced diarrhea "demonstrated a significant increase in cortisol" soon after eating - with levels nearly doubling. This subset of patients also showed a more dominant sympathetic nervous system response, as evidenced by their heart rate variability ratios.The sympathetic nervous system tends to mobilize the body's stimulatory "fight-or-flight" response. Normally it's kept in check by the dampening effects of the parasympathetic nervous system. In patients with IBS with diarrhea, however, this muting response (mediated by the vagus nerve) appears weaker - a condition called "vagal withdrawal." "Notably, this vagal withdrawal was significantly associated with patients' reports of gastrointestinal symptoms," the researchers pointed out. These included bloating, abdominal pain, indigestion, and heartburn.A heightened, stimulatory stress response, characterized by overactivation of both the HPA-axis and sympathetic nervous system, may be triggered by "abnormal ascending feedback from the gut," the researchers speculated. http://www.gsdl.com/news/connections/vol12/conn20010530.html It can also cause permeability.Its an abnormality in blood flow to certain parts of the brain that are involved with anxiety and emotions for one and pain for the other and is connected to the messages sent up from the gut to the brain, for one via serotonin a neurotransmitter connected to messages from the enteric nervous system to the brain which is involved in pain.Hence these pictures"Neuroimaging has provided evidence of physiological differences between normal individualsand those suffering from IBS in the way a visceral stimulus (ie, rectal distention) is processed inthe brain.14,15 Initial data from positron emission tomography (PET) scans demonstratedincreased activation of the anterior cingulate cortex (ACC) among normal individuals, comparedto IBS patients. The ACC is a cerebral cortical area that is rich in opiate receptors and is thoughtto be a major component of cognitive circuits relating to perception as well as descending spinalpathways involving pain. More recently, fMRI was used to demonstrate increased activity in theACC, prefrontal (PF), and insular cortex areas, and in the thalamus of IBS patients compared tonormal individuals."














{img]http://webpotential.com/falcon/uploadpic/slide08.gif[/img]IBSers process information from the gut differently then controls, when they are stimulated through the rectum with a ballon.Talissa, okat what are all the causes of gut permeability.also with all due respect, Dr mercola is not a top IBS expert and does not do IBS research. What your disagreeing with, is Mayo, UCLA, John's Hopskins, UNC, the top IBS center in the country, the clevceland clinic, experts in motility and researh from IBS around the world, along with the rome criteria and 60 international gastroenterologists.Dr gershon, is the father of neurogastroenterology.Here is a lecture on serotonin and IBS.Serotonin: The Peristaltic Reflex and IBS Presenter: Michael Gershon, MD http://www.conference-cast.com/ibs/Lecture...cfm?LectureID=3 So while you might not personally agress, all the researchers no serotonin is involved in IBS. Is it the only part, no.These are other top IBS researchers. You might want to look into who they really are and all the fields they cover. http://www.conference-cast.com/ibs/Lecture...dRegLecture.cfm You might also want to look at the shear volume of studies here. There is page after page here. http://www.docguide.com/news/content.nsf/A...52568880078C249 you might also want to look at the Internation Foundation for functional gi disorders symposiums for the last five years. here4th International Symposium on Functional GI Disorders, 20013rd International Symposium on Functional GI Disorders, 19992nd International Symposium on Functional GI Disorders, 19971st International Symposium on Functional GI Disorders, 1995and the newest oneReport on the 5th International Symposium on Functional Gastrointestinal DisordersApril 4, 2003 to April 7, 2003 Milwaukee, Wisconsin http://www.iffgd.org/symposium2003report.html as well as the history of themwith permissionHistory of Functional Disorders Douglas A. Drossman, MDCenter-Co-DirectorMelissa Swantkowski New York UniversityPrintable formatTHE PASTHISTORICAL PRECEDENTSHistorians 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/medicine/fgidc/hist...aldisorders.htm alsoThe "Organification" of Functional GI Disorders:Implications for Research http://www.med.unc.edu/medicine/fgidc/organification.htm


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## calid (Aug 4, 2003)

Just ignore the little man behind the curtain.


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## Talissa (Apr 10, 2004)

Calid--LOL!!!! Congrads on your improvement, T


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## calid (Aug 4, 2003)

Thank you Talissa, I just worry it's temporary........lol......keep the great informative posts coming!!


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## eric (Jul 8, 1999)

questions to ask?What does permeability have to do with all this on IBS? What symptoms does it cause itself? Do they match IBS?How many IBSers have rectal sensitivity?How many IBSers are there in the population?How many are women compared to men?How many have impairment of the Anterior cingulate cortex?How many have impairment of the HPA Axis?How many have pain on their left side as opposed to right?How many have the specific symtoms used to diagnose IBS clustered together?How many have overlapping symptoms and what are the most common ones.How many people do they know come down with IBS after an enteric infection and why? They know quite a bit about it all.How many have IBS aftr surgeries?Or other shocks to the digestive system?and why?How do hormones effect IBS?How does pain itself differ in IBS as opposed to other conditions?How many have altered stress circuits and why?How is the d and c and d/c seen in IBS related? And How does that relate to other conditions that can mimick these these symptoms.How much reaserch in Inflammatory bowel diseases is used to help understand IBS using microscopes?How many animal models to they have on IBS? And what do they show?How much is already understood about IBS?What is the meaning of common non gi symptoms seen in IBS? How are they related to neurotransmitters, hormones, stress, the weather, the nervous sytems,pain and the communication between the gut and the brain and back?IBS - Beyond the Bowel: The Meaning of Co-existing Medical Problems"Table 1. Non-gastrointestinal symptoms more common in irritable bowel syndrome patients than in comparison groups(5). 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 in mouth15. 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 twitching" http://www.med.unc.edu/medicine/fgidc/beyond_the_bowel.htm


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## Gret (Sep 23, 2003)

I think we've seen all that stuff before, eric.Thanks, Mark. Dr. Dahlman gave me some vitamin information so I'll look into that. I'm curious about the Provex CV and circulation. My Raynoud's doesn't bother me much now that it's warming up. The winter is especially tough on my hands. I play the flute and it's tough with Raynoud's and Carpal Tunnel. I'm brushing up on the Doppler: Fantaisie de Hongroise - lots of fast stuff and the hands don't hold up for hours of practice anymore! Wagner, eh? Pretty heavy stuff! Majestic!


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## Jhouston (Nov 9, 2003)

Calid, Happy for you. How long did/are you taking Cipro? Since you are taking it for bacteria I think it will be long term benefir if not permanent. Joann


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## daisysp (Jan 13, 2004)

Calid, you made me laugh so hard, funny !!I read two of his first sentences and realized he's responding to my posting to start with. Why bother ? I am the last one to read his postings.Am still waiting for Dr Dahlman to return my calls or e-mails. I know he's busy, don't want to bother him too much, just want to get my next set of orders. I have a mission to accomplish here. I am so low on foods I can eat without reaction, I feel so isolated.


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## eric (Jul 8, 1999)

Why does heat usally make the pain better?Why does IBS effect REM Sleep?Why can symptoms start 15 minutes after eating and in some before eating? If the food is still in the throat?Why does it usally stop at night while asleep?Why does laying down usally make the pain better, especially laying on the left side?Why are there and increase in EC cells That store the majority of the guts serotonin and mast cells after an infection in Post infectious IBS?What do mast cells in the digestive tract have to do with stress and foods in IBS? What do they have to do with the HPA axis?Medical journals from around the worldIBSHoward Mertz"Volume 349:2136-2146 November 27, 2003 Number 22Irritable Bowel SyndromeHoward R. Mertz, M.D.Irritable bowel syndrome, a common disorder in which bowel habits are altered in association with abdominal pain or discomfort, has a prevalence of 12 percent among adults in the United States and a similar prevalence worldwide.1 By definition, no mechanical, biochemical, or overt inflammatory condition explains the symptoms. Validated, symptom-based criteria for the diagnosis of irritable bowel syndrome are highly predictive in the absence of alarming symptoms such as weight loss, fever, and intestinal bleeding.2,3,4 The pain or discomfort experienced by patients with irritable bowel syndrome often leads to health care use and a decreased quality of life.5,6,7 Diarrhea is a symptom that often leads to medical consultation,5 since it can be inconvenient and, if associated with urgency, may be accompanied by fecal incontinence, an altered lifestyle (owing to frequent trips to the bathroom), and anxiety. Constipation may be associated with bloating, discomfort, and an altered body image. The quality of life was reported as impaired in people with irritable bowel syndrome who sought medical care but only marginally reduced in those who did not seek medical care.8,9 The therapeutic goal is both a reduction in the severity and frequency of symptoms and an overall improvement in the quality of life.The age at onset of irritable bowel syndrome varies, but the incidence appears to increase during adolescence and peaks in the third and fourth decades of life. An onset after the age of 50 years is unusual. Women have a higher prevalence of symptoms than men (2:1 ratio). Patients seen in clinics, particularly those who are referred for irritable bowel syndrome, appear to have a high frequency of psychosocial stress or dysfunction associated with the condition. However, persons with irritable bowel syndrome who do not seek medical care have no more psychological symptoms than unaffected controls.5,10 Since psychosocial stress appears to predict both the use of health care and the persistence of symptoms, the patient's social history is relevant to therapy, and clinicians should attempt to determine what has triggered each consultation.11PathophysiologyThe cause of irritable bowel syndrome is unknown, though associated pathophysiology includes altered gastrointestinal motility and increased gut sensitivity (Figure 1). Some studies,12,14 but not all,15 reported increased small-bowel and colonic contractions temporally associated with abdominal pain. Heightened sensitivity to visceral distention, particularly that which is perceived as noxious, has been described in numerous studies.13,16 Interplay between motor and sensory dysfunction appears to explain the symptoms of irritable bowel syndrome. The gastrointestinal effects of stress in animals and humans include increased small-bowel and colonic motility and increased visceral sensitivity.17,18 These effects appear to be exaggerated in patients with irritable bowel syndrome, as well as in animals previously sensitized by either visceral inflammation or psychological trauma.19,20,21View larger version Figure 1. Alterations in the Colonic Motility Index (Panel A) and Gut Sensitivity (Panel







in Irritable Bowel Syndrome (IBS).The gastrocolic reflex is augmented in patients with irritable bowel syndrome. As indicated in Panel A, the mean (ï¿½SE) motility of the sigmoid colon is greater after meals in patients than in control subjects as measured by manometry. Data have been adapted from Rogers et al.12 Patients with irritable bowel syndrome also have hypersensitivity of the gut. As a rectosigmoid balloon is progressively inflated, a greater proportion of patients report pain than do control subjects (Panel







. This distention often reproduces the pain of irritable bowel syndrome. Data have been adapted from Ritchie.13 Patients with irritable bowel syndrome have been reported to have an increased colonic motor response to corticotropin-releasing factor, a stress hormone, consistent with the occurrence of an increased gastrointestinal stress response.22 The gastrointestinal sensory-motor dysfunction in irritable bowel syndrome is consistent with an up-regulation in neural processing between the gut and the brain, termed the "brainï¿½gut axis." Indeed, therapies for irritable bowel syndrome are generally directed at gastrointestinal motor, gastrointestinal sensory, or central nervous system processing. " http://www.medical-journals.com/r031128b.htm Rev Gastroenterol Mex. 2003 Jan-Mar;68(1):55-61. Related Articles, Links Post-infectious irritable bowel syndrome. A review based on current evidence Gomez-Escudero O, Schmulson-Wasserman MJ, Valdovinos-Diaz MA. Departamento de Gastroenterologia, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Vasco de Quiroga 15, Tlalpan, C.P. 14000 Mexico, D.F. INTRODUCTION: Pathophysiology of irritable bowel syndrome (IBS) is multifactorial. Recent investigations have associated episodes of infectious gastroenteritis with development of IBS. This condition is named post-infectious IBS (PI-IBS). The role of inflammation-infection in IBS pathogenesis is not well understood. AIM: To review published scientific evidence on PI-IBS regarding risk factors, causal agents, histopathological changes, and treatment. MATERIALS AND METHODS: An electronic search in MEDLINE and abstracts presented at national and international GI meetings was performed, looking for information published in the past 50 years including animal studies, cohort studies, case-control studies, and series of cases and case reports, using the key words post-infectious enteritis, post-dysenteric or post-infectious irritable bowel syndrome (PI-IBS), and post-infectious colitis. RESULTS: Fifty one papers were included. These studies were classified according to pathophysiologic mechanisms, infectious agents involved, animal or human studies, and treatment. CONCLUSIONS: Current evidence shows a strong association between colonic infection and inflammation with development of IBS. Approximately 25% of patients with IBS have a history of infectious enteritis. Microbial agents related with PI-IBS include bacteria (Campylobacter, Salmonella) and parasites (Trichinella spiralis). Increased number of enteroendocrine cells, CD3 lymphocytes and mast cells within the colonic muscle wall, release of pro-inflammatory substances, and increased number of inflammatory cells with intestinal nervous endings are the most common histopathologic findings. Patients developing PI-IBS have a higher frequency of psychological disorders and stressful events prior to the gastroenteritis episode. Therapeutic interventions with steroids, COX-2 inhibitors, antibiotics and probiotics require further investigation. Publication Types: * Review * Review, Tutorial PMID: 12940101 astroenterology. 2003 May;124(6):1662-71. Related Articles, Links Postinfectious irritable bowel syndrome. Spiller RC. Division of Gastroenterology, University Hospital, Nottingham, United Kingdom. robin.spiller###noittingham.ac.uk A small but significant subgroup of patients with irritable bowel syndrome (IBS) report a sudden onset of their IBS symptoms after a bout of gastroenteritis. Population-based surveys show that although a history of neurotic and psychologic disorders, pain-related diseases, and gastroenteritis are all risk factors for developing IBS, gastroenteritis is the most potent. More toxigenic organisms increase the risk 11-fold, as does an initial illness lasting more than 3 weeks. Hypochondriasis and adverse life events double the risk for postinfective (PI)-IBS and may account for the increased proportion of women who develop this syndrome. PI-IBS is associated with modest increases in mucosal T lymphocytes and serotonin-containing enteroendocrine cells. Animal models and some preliminary human data suggest this leads to excessive serotonin release from the mucosa. Both the histologic changes and symptoms in humans may last for many years with only 40% recovering over a 6-year follow-up. Celiac disease, microscopic colitis, lactose intolerance, early stage Crohn's disease, and bile salt malabsorption should be excluded, as should colon cancer in those over the age of 45 years or in those with a positive family history. Treatment with Loperamide, low-fiber diets, and bile salt- binding therapy may help some patients. Serotonin antagonists are logical treatments but have yet to be evaluated. Publication Types: * Review * Review, Tutorial PMID: 12761724And this is very important, leaky gut is associated with autoimmune disorders and Inflammation and inflammation alone does not explain IBS!!!There is no inflammation on routine investigations. It is only when they use powerful microscopes in IBS do they see and inflammatory process and it is specific cells inflammed. They have done a lot of work and more being done in inflammation and IBS.Inflammatory Mediators in Irritable Bowel Syndrome Maria O'Sullivan, PhDDepartment of Gastroenterology, Adelaide & Meath HospitalTrinity College, Dublin, IrelandIrritable bowel syndrome (IBS) is a chronic condition characterized by abdominal pain and altered bowel habit, in the absence of demonstrable structural gastrointestinal abnormality. Essentially the gut functions abnormally - people experience symptoms of pain, diarrhea and/or constipation but no abnormality of the bowel can be identified by standard medical tests. Numerous research studies have now documented physiological changes, including altered motility and hypersensitivity, in the gastrointestinal tract of IBS patients. The mechanisms underlying these events, however, remain unclear. There is growing evidence that inflammation in the gastrointestinal mucosa may play a role in the pathogenesis of at least a sub-set of IBS 1-3. Importantly, overt colonic inflammation precludes a diagnosis of IBS. The challenge for researchers therefore, is to record subtle changes in inflammatory mediators that are not identifiable by usual routine processes. INFLAMMATION AND IBS - THE EVIDENCEExperimental (animal) data show that inflammation, even if mild, could lead to persistent changes in gastrointestinal nerve and smooth muscle function, resulting in dysmotility, hypersensitivity and gastrointestinal dysfunction 1, 4-6. In humans, the role of inflammation in the generation of IBS symptoms is less well studied, although there are important findings from people with 'post-infective IBS'. After an acute gastrointestinal infection up to one-third (7-29%) of individuals develop persistent symptoms compatible with IBS 7, 8. In these post-infective IBS subjects, a persistent increase in rectal sensitivity8 and in inflammatory cells (specifically enteroendocrine cells and lymphocytes)9 have been documented. To put this in context, however, the majority (over 70%) of people who develop gastroenteritis fully recover and do not develop persistent bowel symptoms. Factors that may predict those who develop post-infective IBS include specific psychological factors, female gender and a longer duration of the initial illness. While there is now reasonable evidence to support a low-grade inflammatory response in those who develop IBS following an acute episode of gastroenteritis, there is still little know about inflammation in IBS patients who have no obvious recent evidence of acute infection. The role of inflammation in non post-infective IBS has been a particular research interest of our group and began with an interest in studying mast cells in IBS. MAST CELLS AND IBS The mast cell has potential to be a key player in IBS. Although mast cells are most widely known for their role in allergic responses, these cells are normally present throughout the gut and are involved in a range of physiological and pathological activities including mucosal defense mechanisms and inflammation. Mast cells may release an array of inflammatory mediators that act on smooth muscle, nerves and immune cells, which may ultimately result in gastrointestinal dysfunction and symptoms. In addition, mast cells in the gut are located close to nerves providing a structural basis for communication between the gut and the nervous system. In 1993, Weston and colleagues reported increased mast cell numbers in the mucosa of IBS patients10 - these changes were identified in tissue from the end of the small bowel (terminal ileum). Similarly we identified significant increases in mast cells in IBS patients compared to controls in the colon (specifically at the caecum)11. There were also trends for increases in other regions of the colon (ascending and descending colon) but no differences could be seen at the rectum. The lack of changes in mast cell infiltration in the rectum has since been confirmed by others9. Collectively these studies suggest that mast cells were increased in IBS patients - this may be part of a low-grade inflammatory response, although the components and nature of this response remain poorly understood. NITRIC OXIDE AND IBSWe hypothesized that inducible nitric oxide synthase may be a novel and important marker of inflammation in IBS. Enzymes from the nitric oxide synthase family are responsible for the synthesis of nitric oxide (NO) from the oxidation of L-arginine. While at least three enzyme sub-types (isoforms) have been described, our study focussed on one specific isoform, namely inducible nitric oxide synthase (iNOS). This enzyme is thought to be capable of producing large amounts of nitric oxide and to be expressed during inflammation12. In the human colon, upregulation of iNOS has been implicated in inflammatory processes and increased expression has been documented in inflammatory bowel disease. In colonic mucosa from IBS patients, we found a significant increase in iNOS expression compared to control patients 13. We also measured nitrotyrosine, which is considered a by-product of nitric oxide generation. Overall the nitrotyrosine data in IBS paralleled that of iNOS almost exactly. iNOS could be detected in epithelial cells, lymphocytes (CD3+ T and CD20+ B lymphocytes) and macrophages. Mast cells did not appear to express the iNOS. Overall we demonstrated an increase in iNOS, an enzyme that catalyses the production of nitric oxide, combined with an increase in nitrotyrosine, a by-product of nitric oxide generation. In terms of factors that may affect iNOS expression, there was a trend towards higher iNOS levels in the diarrhea compared to the alternating group although this was not statistically significant. Elevated iNOS may be a marker of general low-grade inflammation in IBS. Induction of iNOS and the generation of NO, could have several other potential roles in IBS - for example NO may have direct effects on intestinal nerve and motor function and intestinal on permeability. OTHER INFLAMMATORY CELLS IN IBSWhile there was some tentative evidence of an associated involvement of other inflammatory markers in our study, these were not striking or clear-cut. On average there were trends for increases in CD3+ lymphocytes and the proportion of lymphoid tissue. Similarly in IBS there was a trend for increased expression of nuclear factor kappa B (NF-?







, a transcription factor for an array of pro inflammatory cytokines and mediators. In our study, none of these changes were statistically significant. In contrast, others have previously reported significant increases in inflammatory cells, for example an increase in CD3+ lymphocytes in post-infective IBS9 and an increase in overall cellularity in the colonic mucosa in IBS14. CD3 is a 'pan T-lymphocytes marker' and allowed us to estimate the overall number of T-lymphocytes in the lamina propria of the IBS patients. It is possible that specific subclasses of lymphocytes may be altered in IBS (e.g. CD4+ and CD8+ classes). Interestingly, the CD4+ T cell subtype has been implicated in an animal model of inflammation. In this model, stress was shown to reactivate colonic inflammation15 - susceptibility to reactivation of inflammation by stress appeared to specifically require CD4+ lymphocytes. ANTI-INFLAMMATORY MEDIATORS IN IBS The study of inflammation in IBS has largely focused on the role of pro-inflammatory cells and mediators. From other gastrointestinal inflammatory diseases, we know that inflammatory responses involve a complex balance between pro- and anti- inflammatory mediators. There is emerging data to suggest that people with IBS may have a genetic predisposition to produce low amounts of anti-inflammatory cytokines such as interleukin-10 (IL-10) and transforming growth factor-beta (TGF-b)16. Moreover, there is a further preliminary report17 of dysfunctional mucosal protective mechanisms in IBS characterized by reduced numbers of macrophages. While this data is provisional, it is plausible that people who develop IBS could have poorer defense mechanisms to combat infections or other gut insults.A LINK BETWEEN INFLAMMATION AND STRESS *An increase in inflammatory mediators alone is insufficient to explain the pathogenesis of IBS.* From post-infective IBS, we know that the most people who have gastroenteritis and accompanying inflammation do not develop IBS. As discussed earlier, several factors may be important in interacting with the gut insult and in predicting those who develop symptoms - one interesting factor here is the role of stress. Psychological stress is known to affect gut function in normal healthy humans, and in people with IBS stress may trigger or exacerbate symptoms. More recently there is evidence of a link between stress and inflammatory responses. Exposure to stress in both animals and humans has been shown to result in the release of mast cell mediators in the colon18,19 and in a recent study stress was capable reactivating previous inflammation in rats15. An important challenge for future work will be to clarify the interaction between inflammation, stress and IBS symptoms.CONCLUSION We believe that low-grade inflammation may play a role in the pathogenesis of a sub-set of IBS. There is now evidence from several different studies to suggest that a range of inflammatory mediators may be increased in IBS. It is important to point out, however, that most of this evidence, including our data is preliminary and will need to be confirmed by larger research studies. Important challenges for future work will be to demonstrate the role of specific inflammatory mediators in the generation and resolution of IBS symptoms. Continued research into this area is likely to improve our understanding of the underlying mechanisms in IBS and may lead to the development to better therapeutic approaches for this condition. http://www.med.unc.edu/medicine/fgidc/infl...rymediators.htm Maria O'Sullivan, Dublin, IrelandNitric oxide, mast cells and inflammations in the pathogenesis of IBS Summarized by Sara Ewert, Ph.D-student, Dep. of Physiology and Pharmacology, Gï¿½teborg univeristyThe group (Dr. Maria O'Sullivan, Prof. Colm O'Moran) has experimental data, patient-based data and data from post-dysentery IBS patients. Their data shows that IBS is correlated to a low-grade inlammatory process involving the mast cell, type I hypersensitivity and potent inflammatory mediators. The reason to believe that the mast cell might be the link between the brain and gut are the close proximity to nerves and the fact that stress induces degranulation. In parffine embedded sections tryptase the mast cell specific tryptase was labeled. The data showed a significant elevated level of labeling in caecum. There is similar data showing an involvement of the mast-cell in work done by Weston et al. -93 (terminal ileum), Irvine et al. -96 (colon, rectum), Tally et al. -96 (colon).The tryptase attaches to the PARII-receptor on nerve cells, which are involved in release of cytokines.In work done on material collected from patient groups with functional dyspeptic symtoms, with or without H. Pylori infection, there was an increased amount of mast cells, independent of infection, as compared to controls, which was stated by Hall et al. UEGW -99, Rome. In other work from the same group its shown that thereï¿½s a higher percentage of solely tryptase, and not a coexistence of tryptase and chymase in tissue from the antrum of a dyspeptic group of patients. This observation was also independent of H. Pylori infection, and could indicate a higher level of a specific subgroup of mast cells.The Oï¿½Sullivan group has also shown a higher level of iNOS expression in both the lamina propria and the epithelium of all parts of the colon and caecum. The iNOS expression is correlating to levels of tissue nitrotyrosin. The elevation is statistically significant in the diarrea-type IBS group. A chain of events including mast cell activation, release of cytokines and TNFa which results in an increased expression of iNOS could be a cause of disturbances in motility and pain in IBS.Increaed levels of iNOS were also found in cells positive for CD3, CD20, CD68 but not in the mast cells themselves.When antiinflammatory mediators such as IL-10 and TGF- were looked upon low amount were found in tissue fromm an IBS group compared to controls. http://wwwhost.gu.se/cgf/fouschema.html#Maria Robin Spiller, Nottingham, UKost-infectious IBS Summarized by Philip Bergin, Ph.D-student, Institute of Medical Microbiology/Immunology, Gï¿½teborg universityPost infectious IBS refers to cases of IBS, which can be shown to have arisen after a distinct case of gastroenteritis caused by an infection. This lecture gave a comprehensive review of the literature on the subject, including a large amount of data from R. Spiller and his group.Studies have looked at patients with IBS, and shown a large proportion with an acute stage of onset, suggesting an infectious cause:Many IBS studies have been performed on patients seeking medical treatment and within Gastrointestinal units. More recent studies have used databases of patients within the community as a whole, and have suggested that an acute episode of gastritis can lead to IBS. Several studies have focused on communities and the incidence of post-infectious IBS seen within patients visiting their doctors. A study published in the British Medical Journal by Rodriguez and Ruigï¿½mez showed that in the year following an episode of gastritis, patients were 10 times more likely to have IBS then patients in the general population. This study used patients identified using the British General Practice Research Database, containing data on patients recorded by general practitioners (Rodriguez and Ruigï¿½mez 1999, BMJ 318: pp. 565-566), allowing this study to contain 584 308 subjects in the general cohort and 318 in the gastroenteritis cohort.Other studies with smaller patient groups have shown similar results:28 (7%) of the patients went on to develop functional IBS. However, a further 78 of the cases developed altered bowel habits, with similar symptoms to that of the new IBS cases, lacking the pain. As a result they did not meet the Rome criteria for IBS (Neal et al, BMJ 1997, 314(7083): pp. 779-782).Other studies have looked at specific infections; McKendrik (McKendrik and Read, J Infect. 1994; 29(1)







p. 1-3) presented a study of patients with salmonella infections, 31% of the patients acquired IBS post infection. Gwee et al (Gwee et al, Lancet. 1996; 347(8995): pp. 150-3) looked at cases of gastroenteritis, and found that 29% of patients suffered from new IBS after resolution of the infection. One of the major problems with this type of study results from the fact that people often have a bout of vomiting or stomach distress due to food. Consequently few people specifically remember having a bacterial infection that rapidly resolves. This would suggest that the number of cases of IBS resulting from a bacterial infection is actually higher than that shown in studies.Several groups have compared differing factors with an increased risk of IBS. One new method involves using specific cells (e.g. Hep2 cells) and reacting them with bacteria. If you get an increased elongation of the cell, then the bacterial strain used can be considered to be capable of inducing IBS. This induced elongation gives a much higher risk of IBS than other factors, such as gender or life stress.Prospective studies have shown that there are elevated CD8+ lymphocytes in patients with post-infectious IBS after 1 year. This coincides with an increased permeability during a bacterial infection, and an increase in inflammatory cells in IBS patients, suggesting that PI-IBS patients suffer from a lack of down regulation of the inflammatory response. Indeed, some studies have shown that some IBS patients are deficient in TGFb and IL-10.Following infections with campylobacter enteritidis there is an increase in entero-endocrine cells. In the case of IBS patients this increase does not return to normal, remaining up to 10 fold higher then that seen in normal controls.Long-term prognosis for PI-IBS patients:This study, and others like it, suggests that 2/3 of PI-IBS patients recover within 6 years. The majority of recovering patients showed no anxiety, while the persistent sufferers did, suggesting that anxiety impairs recovery from PI-IBS.The take home message from this lecture what that there appears to be significant evidence leading to the role of post-infectious IBS, although host factors play a large role in susceptibility. However, PI-IBS has a reasonably high chance of recovery over the long term, if there are no other contributing factors (such as anxiety). http://wwwhost.gu.se/cgf/fouschema.html#Robin Irritable Bowel Syndrome:How Far Do You Go in the Workup?"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. "Gastroenterology. 2004 Mar;126(3):693-702. Related Articles, Links Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome.Barbara G, Stanghellini V, De Giorgio R, Cremon C, Cottrell GS, Santini D, Pasquinelli G, Morselli-Labate AM, Grady EF, Bunnett NW, Collins SM, Corinaldesi R.Departmentof Internal Medicine and Gastroenterology, and CRBA, University of Bologna, Italy. gbarbara###med.unibo.itBACKGROUND & AIMS: The mechanisms underlying abdominal pain perception in irritable bowel syndrome (IBS) are poorly understood. Intestinal mast cell infiltration may perturb nerve function leading to symptom perception. We assessed colonic mast cell infiltration, mediator release, and spatial interactions with mucosal innervation and their correlation with abdominal pain in IBS patients. METHODS: IBS patients were diagnosed according to Rome II criteria and abdominal pain quantified according to a validated questionnaire. Colonic mucosal mast cells were identified immunohistochemically and quantified with a computer-assisted counting method. Mast cell tryptase and histamine release were analyzed immunoenzymatically. Intestinal nerve to mast cell distance was assessed with electron microscopy. RESULTS: Thirty-four out of 44 IBS patients (77%) showed an increased area of mucosa occupied by mast cells as compared with controls (9.2% +/- 2.5% vs. 3.3 +/- 0.8%, respectively; P 0.001). There was a 150% increase in the number of degranulating mast cells (4.76 +/- 3.18/field vs. 2.42 +/- 2.26/field, respectively; P = 0.026). Mucosal content of tryptase was increased in IBS and mast cells spontaneously released more tryptase (3.22 +/- 3.48 pmol/min/mg vs. 0.87 +/- 0.65 pmol/min/mg, respectively; P = 0.015) and histamine (339.7 +/- 59.0 ng/g vs. 169.3 +/- 130.6 ng/g, respectively; P = 0.015). Mast cells located within 5 microm of nerve fibers were 7.14 +/- 3.87/field vs. 2.27 +/- 1.63/field in IBS vs. controls (P 0.001). Only mast cells in close proximity to nerves were significantly correlated with severity and frequency of abdominal pain/discomfort (P 0.001 and P = 0.003, respectively). CONCLUSIONS: Colonic mast cell infiltration and mediator release in proximity to mucosal innervation may contribute to abdominal pain perception in IBS patients.PMID: 14988823 Gastroenterology. 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.Wolfson Digestive Diseases Centre, University Hospital, Nottingham, England.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: 14724817J 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, USA. theoharis.theoharides###tufts.eduMast 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.Publication Types: Review Review, Tutorial PMID: 14698841Curr Allergy Asthma Rep. 2004 Jan;4(1):47-54. Related Articles, Links The role of mast cells in common gastrointestinal diseases.Siddiqui AA, Miner PB Jr.Oklahoma Foundation for Digestive Research, 711 Stanton L. Young Boulevard, Suite 619, Oklahoma City, OK 73104, USA. digestiveresearch###ouhsc.eduThe gastrointestinal tract is a rich source of mast cells with an enormous surface area that permits a high degree of interaction between the mast cell and the intestinal contents. The active metabolic products of the mast cell influence gastrointestinal secretion, absorption, and motility through paracrine effects of local mast cell activation and also cause systemic effects through the release of cellular products into the bloodstream. Recent advances in our knowledge of the immune system and the recognition that the gastrointestinal immune function might be partially mediated through gastrointestinal mucosal mast cells has opened mast cell research to the field of gastroenterology. Local gastrointestinal proliferation of mast cells in response to recognized or obscure stimuli can alter gastrointestinal function and induce systemic symptoms. Symptoms can arise from the increased number of mast cells, overproduction of specific mast cell mediators, and hyperactivity of the enteric nervous system that induces mast cell activation. The diseases mentioned in this review represent a small proportion of areas where mast cell function might play an important role in the response to disease and generation of symptoms.Publication Types: Review Review, Tutorial PMID: 14680622Zhonghua Nei Ke Za Zhi. 2003 Sep;42(9):611-4. Related Articles, Links The changes of mucosal mast cells and substance P in patients with irritable bowel syndromeArticle in ChineseDong WZ, Li ZS, Zou DW, Xu GM, Zou XP, Zhu AY, Yin N, Gong YF.Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China. wzhdong930###yahoo.com.cnOBJECTIVE: To investigate the changes of the mast cells (MCs) and substance P (SP), and to elucidate their possible roles in visceral hypersensitivity in patients with irritable bowel syndrome (IBS). METHODS: In 22 diarrhea-predominant IBS, 20 constipation-predominant IBS and 19 controls, the biopsies were carried out from the terminal ileum, the ileocecal junction, the ascending colon, and the sigmoid colon. The MCs and the SP-ergic nerve terminals, SP receptor (SPR) cells were stained by histochemistry and immunohistochemistry respectively, and the results were investigated qualitatively and quantitatively by color image analyzer. The biopsies of the ICJ and the sigmoid colon were measured by radioimmunoassay. The structure relation between the MCs and SP-ergic terminals, SPR-ergic cells were studied through an ultramicroscopy using in situ embedding technique and a light microscopic study in serial sections respectively. RESULTS: The number of MCs in the terminal ileum, the ileocecal junction, and the ascending colon were significantly elevated in IBS patients (P 0.01), and the MCs in IBS have great variations. Significantly increased the SP-ergic nerve terminals were found in patients with IBS of intestine compared with the control. The correlation between mucosal MC and the SP-ergic nerve terminals was found, and MCs were close to these terminals in lamina propria, which were demonstrated SP-ergic nerve terminals. Some MCs were demonstrated to be SPR-positive cells. CONCLUSIONS: The MCs and SP of intestinal mucosa may play a central role in the gut hypersensitivity in both motor response and visceral perception in IBS.PMID: 14514386 J Korean Med Sci. 2003 Apr;18(2):204-10. Related Articles, Links Activated mast cells infiltrate in close proximity to enteric nerves in diarrhea-predominant irritable bowel syndrome.Park CH, Joo YE, Choi SK, Rew JS, Kim SJ, Lee MC.Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.Mast cells (MC) may be one factor influencing the response of visceral afferent nerves to mechanical and chemical stimuli. The aim of this study was to evaluate the degree of infiltration and activity of colonic MC in irritable bowel syndrome (IBS). Biopsy specimens were obtained from the cecum and rectum of 14 diarrhea predominant IBS and 14 normal controls. Electron microscopy was used to determine the number of intact and degranulated colonic MC and to quantify these separately according to the distance between MC and enteric nerves. An increased number of MC in both cecum and rectum in the IBS group in comparison with the control group was demonstrated (p 0.05). Activated MC in close proximity to enteric nerves were significantly increased in both cecum and rectum of the IBS group compared to control group (p 0.005). In addition, activated MC were significantly increased in close proximity to the nerves compared to those in the remote area in both cecum and rectum of the IBS group (p 0.0001). MC were significantly increased and activated in both cecum and rectum of the IBS group compared to controls. MC may play a role in the gut sensory hypersensitivity of IBS.PMID: 12692417J Clin Gastroenterol. 2002 Jul;35(1 Suppl):S11-22. Related Articles, Links Neuropathophysiology of irritable bowel syndrome.Wood JD.Departments of Physiology and Cell Biology and Internal Medicine, Ohio State University College of Medicine and Public Health, Columbus, Ohio, USA. wood.13###osu.eduWidespread symptoms associated with the irritable bowel syndrome (IBS) are abnormal defecation and abdominal pain, both of which can be exacerbated by psychogenic stress. Disordered defecation may present as diarrhea or constipation. A subgroup of IBS patients alternate from one to the other over time. Urgency to stool often accompanies the diarrheal-state, and patients with the constipation-predominant form of IBS report straining and the feeling of incomplete evacuation. Basic scientific research aims for improved understanding of the physiology and pathophysiology of the digestive systems from which the arrays of IBS symptoms emerge. The key systems for the defecation-related symptoms are the intestinal secretory glands, the musculature, and the nervous system that controls and integrates their activity. Abdominal pain and discomfort arising from these systems adds the dimension of sensory neurophysiology. This review details current concepts of the underlying pathophysiology in terms of the physiology of intestinal secretion, motility, nervous control, sensing function, immuno-neural communication, and the brain-gut axis.Publication Types: Review Review, Tutorial PMID: 12184133Dig Dis. 2001;19(3):201-11. Related Articles, Links Role of stress in functional gastrointestinal disorders. Evidence for stress-induced alterations in gastrointestinal motility and sensitivity.Monnikes H, Tebbe JJ, Hildebrandt M, Arck P, Osmanoglou E, Rose M, Klapp B, Wiedenmann B, Heymann-Monnikes I.Department of Medicine, Division of Hepatology and Gastroenterology, Universitatsklinikum Charite, Campus Virchow-Klinikum, Humboldt-Universitat zu Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany.Psychological stress is widely believed to play a major role in functional gastrointestinal (GI) disorders, especially irritable bowel syndrome (IBS), by precipitating exacerbation of symptoms. The available data clearly demonstrate that inhibition of gastric emptying and stimulation of colonic transit is the most consistent pattern in the motility response of the GI tract to acute or short-term stress. Thus, one might propose that these alterations might play a pathophysiological role in dyspeptic symptoms and alterations in stool frequency and consistency in patients with stress-related functional GI disorders. Taken together, the above-mentioned studies suggest that the colonic motor response to stress is exaggerated in IBS. There is evidence that an increased emotional response is associated with this difference in colonic, and perhaps also gastric motor responses to certain stressors. However, almost no valid data are available so far from human studies addressing the question if differences in motility responses to stress between patients with functional GI disorders and healthy subjects are due to an altered stress response associated with an imbalance of the autonomic nervous system or increased stress susceptibility. We can summarize that in experimental animals the most consistent pattern of GI motor alterations induced by various psychological and physical stressors is that of delaying gastric emptying and accelerating colonic transit. Endogenous corticotropin-releasing factor (CRF) in the brain plays a significant role in the central nervous system mediation of stress-induced inhibition of upper GI and stimulation of lower GI motor function through activation of brain CRF receptors. The inhibition of gastric emptying by CRF may be mediated by interaction with the CRF-2 receptor, while CRF-1 receptors are involved in the colonic and anxiogenic responses to stress. Endogenous serotonin, peripherally released in response to stress, seems to be involved in stress- and central CRF-induced stimulation of colonic motility by acting on 5HT-3 receptors. Taken together, the limited data available from investigations in healthy subjects and patients with functional GI disorders provide some evidence that stress affects visceral sensitivity in humans. Acute psychological stress seems to facilitate increased sensitivity to experimental visceral stimuli, if the stressor induces a significant emotional change. In summary, studies in experimental animals suggest that stress-induced visceral hypersensitivity is centrally mediated by endogenous CRF and involvement of structures of the emotional motor system, e.g. the amygdala. Stress-induced activation or sensitization of mucosal mast cells in the GI tract seem to be involved in stress-associated alterations of visceral sensitivity. Copyright 2001 S. Karger AG, BaselPublication Types: Review Review, Tutorial PMID: 11752838Neurogastroenterol Motil. 2000 Oct;12(5):449-57. Related Articles, Links Increased mast cells in the irritable bowel syndrome.O'Sullivan M, Clayton N, Breslin NP, Harman I, Bountra C, McLaren A, O'Morain CA.Adelaide & Meath Hospitals, Trinity College Dublin, Ireland.Mast cells (MC) release potent mediators which alter enteric nerve and smooth muscle function and may play a role in the pathogenesis of the irritable bowel syndrome (IBS). The aim of this study was to determine if MC were increased in the colon of IBS patients compared to controls. Biopsy specimens were obtained from the caecum, ascending colon, descending colon and rectum of 28 patients: 14 IBS (Rome criteria); seven normal; and seven inflammatory controls. Tissue was stained immunohistochemically using a monoclonal mouse antibody for human mast cell tryptase (AA1). Tissue area occupied by tryptase-positive MC (volume density of mast cells) was quantified by image analysis. The number of plasma cells, lymphocytes, eosinophils, neutrophils and macrophages were each graded semiquantitatively (0-4) in haematoxylin and eosin stained sections. Mast cell volume density was significantly (P 0.05) higher in IBS (0.91 +/- 0.18; CI 0.79; 1.0) than normal controls (0.55 +/- 0.14; CI 0.40; 0.69) in the caecum but not at other sites. Apart from MC, there was no evidence of increased cellular infiltrate in the IBS group. MC were significantly increased in the caecum of IBS patients compared to controls. The multiple effects of the intestinal mast cell alone, or as a participant of a persistent inflammatory response, may be fundamental to the pathogenesis of IBS.PMID: 11012945I would say mast cells play an important role in IBS, as well as enterochromaffin cells that store the majority of 5HT or serotonin in the gut.The Cleveland clinicIrritable bowel syndrome (IBS) is common in the general population and has significant medical and socioeconomic impact. Its pathophysiology is still not clear, and the diagnosis and management are often challenging. It is desirable to make a positive diagnosis rather than to rely on diagnosis of exclusion. A step-by-step approach for management and a realistic goal of therapy is advocated. An effective treatment strategy should address the dominant symptoms, their severity, and psychosocial factors. DEFINITION IBS is defined on the basis of the recently modified Rome criteria (Rome II criteria) as the presence for at least 12 weeks (not necessarily consecutive) in the preceding 12 months of abdominal discomfort or pain that cannot be explained by a structural or biochemical abnormality and that has at least two of following three features: (1) pain is relieved with defecation, and its onset is associated (2) with a change in the frequency of bowel movements (diarrhea or constipation) or (3) with a change in the form of the stool (loose, watery, or pellet-like).1,2 Although the Rome II criteria were not designed to be a management guideline, it is currently a "gold standard" for the diagnosis of IBS. PREVALENCE IBS is the most commonly diagnosed gastrointestinal (GI) condition and is one of the most common functional GI disorders seen in clinical practice.3 Estimates of prevalence vary, largely due to the differences between epidemiologic studies (eg, the use of different diagnostic criteria, population selection, and data sources). Approximately 10% to 20% of the general adult population in the United States report symptoms compatible with IBS. However, only 15% of those affected actually seek medical attention.4,5 IBS accounts for 12% of primary care and 28% of gastroenterological pra


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## eric (Jul 8, 1999)

Gastroenterology. 2003 Sep;125(3):795-804. Related Articles, Links Stress-induced disruption of colonic epithelial barrier: role of interferon-gamma and myosin light chain kinase in mice.Ferrier L, Mazelin L, Cenac N, Desreumaux P, Janin A, Emilie D, Colombel JF, Garcia-Villar R, Fioramonti J, Bueno L.Neuro-Gastroenterology and Nutrition Unit, Institut National de la Recherche Agronomique, Toulouse, France.BACKGROUND & AIMS: Stressful life events are supposed to be involved in various diseases such as inflammatory bowel diseases and irritable bowel syndrome. Impairment of the intestinal epithelial barrier function is a suspected consequence of stress, but the underlying mechanisms remain unclear. This study aimed to determine the mechanisms through which stress modulates the colonic epithelial barrier. METHODS: Cytokine messenger RNA (mRNA) expression was evaluated in murine colon, liver, and spleen by competitive reverse-transcription polymerase chain reaction after 1-4 days of daily 2-hour stress sessions. Colonic paracellular permeability was measured as the in vivo lumen-to-blood ratio of (51)Cr-ethylenediaminetetraacetic acid. The effect of a myosin light chain (MLC) kinase inhibitor (ML-7) was assessed on stress-induced interferon (IFN)-gamma mRNA expression and colonic epithelial barrier impairment, and MLC phosphorylation was determined by immunoblot. Finally, the incidence of repeated stress sessions on bacterial translocation was determined. RESULTS: Repeated stress induced an overexpression of colonic IFN-gamma. In the liver, higher levels of IFN-gamma, interleukin (IL)-4, and IL-10 mRNAs were detected and were associated with bacterial translocation, inflammation, and apoptosis. Stress increased colonic permeability of control mice, but not of SCID and IFN-gamma-deficient mice. ML-7 inhibited the stress-induced increased permeability, bacterial translocation, and cytokine overexpression in the liver and restored a normal histology. Larger amounts of phosphorylated MLC were detected in stressed animals. CONCLUSIONS: Repeated stress sessions drive organ-specific cytokine expression patterns and alter colonic mucosal barrier functions associated with bacterial translocation. This effect depends on the presence of CD4(+) T cells and requires IFN-gamma production and MLC phosphorylation.PMID: 12949725


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## SpAsMaN* (May 11, 2002)

Portland,If the scientists do all these researchswhy they have no solution?A long scroll is not attractive.A scroll have to be a lifesaver to be read.







Eric why don't you "compact" your scrolls.


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## calid (Aug 4, 2003)

Why does Eric not listen to us when we ask him to not post anything not directly linked with the Dr. Dahlman procedure?Why does Eric continue posting cut and pastes when everyone has told him they don't read them?Why does Eric think he knows everything?Why does Eric think he can tell us we're always incorrect?Why does Eric even think that the above posts have anything to do with our updates on Dr. Dahlman's protocols?Why does Eric even read this thread?


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## AlphaMale (Jan 21, 2004)

> quote: Why does Eric not listen to us when we ask him to not post anything not directly linked with the Dr. Dahlman procedure?


he is not the only one posting material that is not related to dr D


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## Talissa (Apr 10, 2004)

Gret, Calid, Daisy, & others on Dr D's program,The more I read Dr D's protocol, the more sense it makes. I've cut out dairy b4, and it was no fun, and it didn't make a difference. My reactions seem to correlate with high fructose intake. So I was thinking maybe I could try his program, if the DA-ibs doesn't work for me, but just cut out the fructose & let my gut heal. But now I'm thinking just for 3 months, like you said Gret, cutting out dairy as well, would keep the gut inflammation down. The Ultra Clear Sustain is the most intriguing product called for. Maybe that is the key, while taking the probiotics, to heal the intestinal lining...(Thanks for following my random thinking here, if you are







I just want to get this thread back on track since himself is having another pyschotic episode.....We know now that IBS involves varying degrees of inflammation along the intestinal wall. UCS seems to address that. It makes sense: Take the UCS while staying away from inflammatory response foods & re-populating the intestine with beneficial bacteria.Further, with prolonged inflammation comes permeability along the epithial layer of the intestines. This makes the problem cyclical, requiring the 3 months for healing of the intestinal wall.It really does make sense(I'm repeating myself) to treat IBS this way. And I admire Dr D very much for his tenacity and ability to help IBSr's. Let's face it, with all the intestinal problems messing with chemical & hormonal balance, we're not the most stable & sensible lot at times(myself included, esp. at the beginning.)!! ****************************If anyone's interested, here's a blurb about intestinal permeability(also known as "leaky gut" sadly), which tends to result from imbalanced gut flora & inflammation of intestines:"Leaky Gut Syndromes are clinical disorders associated with increased intestinal permeability. They include inflammatory and infectious bowel diseases [14-19], chronic inflammatory arthritides [9, 20-24], cryptogenic skin conditions like acne, psoriasis and dermatitis herpetiformis [25-28], many diseases triggered by food allergy or specific food intolerance, including eczema, urticaria, and irritable bowel syndrome [29-37], AIDS [38-40], chronic fatigue syndromes [Rigden, Cheney, Lapp, Galland, unpublished results], chronic hepatitis [41], chronic pancreatitis [4, 5], cystic fibrosis [42] and pancreatic carcinoma. Hyperpermeability may play a primary etiologic role in the evolution of each disease, or may be a secondary consequence of it which causes immune activation, hepatic dysfunction, and pancreatic insufficiency, creating a vicious cycle. Unless specifically investigated, the role of altered intestinal permeability in patients with Leaky Gut Syndromes often goes unrecognized. "Here are the references to the IBS connection to permeability:36. Barau, E. and C. Dupont, Modifications of intestinal permeability during food provocation procedures in pediatric irritable bowel syndrome. J Pediatr Gastroenterol Nutr, 1990. 11(1): p. 72-7.37. Paganelli, R., et al., Intestinal permeability in irritable bowel syndrome. Effect of diet and sodium cromoglycate administration. Ann Allergy, 1990. 64(4): p. 377-80. http://www.mdheal.org/leakygut.htm *********************************In my case, Intestinal inflammation & dysbiosis(exc info on dysbiosis: http://www.thorne.com/altmedrev/fulltext/micro.html ) were brought on initially by taking the antibiotic Tetracycline ev. day for a year in high school for acne, leaving my system unable to handle the drug to treat a Giardia infection. This left me with --an MD diagnosis of--IBS-D. I had imblanced gut flora, without knowing it, and the Flagyl sent me over the edge.Other than bacterial infections & subsequent treatment with antibiotics, the other causes for dysbiosis & gut inflammation that have been documented are NSAIDs, alcoholism, & prolonged dietary intake of high-sugar, processed foods. I'm sure there are more.This is why I feel so strongly that dysbiosis is at the heart of IBS. ****But maybe all of us with inflammatory IBS, don't really have IBS, and we have NO RIGHT to be on this bb trying to help one another....I'm so grateful to have found all of you here, & even if you don't read my long, rambling posts, it's really nice to have somewhere to talk about these matters, you know?Love, Talissa


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## Talissa (Apr 10, 2004)

Hi again,Justed wanted to add that taking antibiotics like Tetracycline or antibacterials like Flagyl can be absolutely necessary & genuinely beneficial IF you take them in conjuction with good probiotics. Most of you already know this, but just in case, the general rule is to take the probiotic 4 hours after the antibiotic, or if nec.,one hour before the antibiotic.If only I'd known....


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## Jhouston (Nov 9, 2003)

Talissa, I had the same with Flagyl....it sent me into an explosive d for a day or two plus other symptoms. doc said Flagyl is used for d caused by antibiotic therapy. The solution is another problem? Joann


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## Jhouston (Nov 9, 2003)

Caild, you may have missed my post.....asking how many days on Cipro? also said....Happy for you. think it will last if not permanent recovery since you are taking cipro for a bacteria. Joann


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## eric (Jul 8, 1999)

Talissa , your information is 14 years old now, very much out of date on IBS research.IBS is not leaky gut!!!!!!!!Inflammation in IBS needs to be understood and put into context to IBS. There is a difference in IBD diseases and IBS.Its also important to understand the role of intestinal permeability and IBS and the research. On the bb here "leaky gut" is mainly based on "it makes sense to me" and I believe." This is in part what DR D is telling people he treats.Nor is any one doing a good job here of explaining the many causes of gut permeability or inflammation seen in IBS. These are very important things!Inflammatory Bowel Disease and Irritable Bowel Syndrome: Separate or Unified?Posted 07/15/2003 Sylvie Bradesi, PhD, James A. McRoberts, Ph.D, Peter A. Anton, MD, Emeran A. Mayer, MD Abstract 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.IntroductionInflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) represent two conditions characterized by chronically recurring symptoms of abdominal pain, discomfort (urgency and bloating) and alterations in bowel habits. However, whereas IBD is characterized by inflammation or ulcerations in the small and/or large intestine, such "organic" changes have traditionally not been associated with IBS. IBD is usually classified as ulcerative colitis or Crohn disease, but it also includes forms of microscopic colitis, eg, histologic evidence of mucosal inflammation without macroscopic abnormalities. IBD is characterized by a constellation of patient-reported history and endoscopic, histopathologic, and radiologic findings, often with serologic correlates. Classic signs that reflect the inflammatory process within the gastrointestinal tract are rectal bleeding, diarrhea, fever, and weight loss, occasionally associated with extraintestinal manifestations. Interestingly, in the absence of complications, abdominal pain is not necessarily the most prominent symptom in IBD, despite extensive mucosal inflammation and presumably sensitization of peripheral visceral pain pathways. Genetic predisposition, environmental factors, infectious agents, altered gut epithelial permeability, and impaired immune responses have been incriminated in the still unclear cause of IBD.By contrast, IBS, classified as functional (as opposed to organic) bowel disorder, is currently diagnosed on the basis of a characteristic cluster of symptoms in the absence of detectable structural abnormalities. As a matter of fact, according to the currently used symptom criteria (Rome criteria), once organic changes are detected, a diagnosis of a functional syndrome can no longer be made.1] Because of the nonspecificity of the cardinal symptoms of abdominal pain or abdominal discomfort (the latter including bloating-type symptoms, a sensation of rectal urgency, or incomplete evacuation), the current diagnosis of IBS applies to a heterogeneous group of patients, even after attempts to define subgroups based on predominant bowel habit. Current theories to explain the pathophysiology of IBS include alteration in visceral perception, gastrointestinal motility and gut epithelial and immune function. Considerable evidence supports a role of psychosocial and physical (ie, gastroenteric infections) stressors as central and peripheral triggers, respectively, of first symptom onset or exacerbation.2] As reflected by an increasing number of publications on the subject, considerable interest in the putative role of low-grade chronic inflammation in the pathogenesis of IBS has recently emerged.3 Enhanced responsiveness to psychosocial and physical stressors has been suggested as a plausible mechanism that could explain most clinical and experimental findings in IBS, and that is consistent with the majority of the reported physiologic alterations.4Evidence of Mucosal Immune Activation in Patients Meeting Symptom Criteria for Inflammatory Bowel DiseasesSeveral recent independent studies have demonstrated alterations in the gut-associated immune system. Quantitative assessment in unselected patients with IBS have shown increased mast cell numbers in the ileum 5 and colonic mucosa. 6 Preliminary evidence suggests an increase of overall cellularity in the colonic mucosa 7 and a higher number of mast cells containing tryptase (known to have proinflammatory effects) in the colonic lamina propria of patients with IBS.8 Additional preliminary results indicate a significant increase of inducible nitric oxide synthase (iNOS) expression in the colonic mucosa from unselected patients with IBS compared with control patients.9 In the human colon, upregulation of iNOS has been implicated in inflammatory processes, and increased expression has been documented in IBD.10 More recently, a study by Chadwick et al.11 demonstrated intestinal mucosal immune activation in 77 symptomatic patients meeting the Rome criteria (the authors did not specify Rome I vs II criteria). The study included patients with diarrhea, constipation, or both. In 38 of the patients (50%), a normal conventional histologic appearance was seen, but the immunohistologic results were abnormal (intraepithelial lymphocytes-IEL, lamina propria CD25+ and CD3+ lymphocytes). In 40% of patients, nonspecific microscopic inflammation was seen, whereas immunohistologic results showed similar increases in lymphocyte populations as in the first group. However, in contrast to the first group, they also showed increased numbers of neutrophils and mast cells. Ten percent of patients fulfilled the histologic and immunohistologic criteria for lymphocytic colitis. Even though the magnitude of changes in cell numbers was far less than observed in patients with IBD, the increased numbers of IEL, T cells, IL-2 receptor expressing cells, suppressor/cytotoxic T cells, and NK cells were consistent with an increased inflammatory cell presence in a subset of patients with altered bowel habits who met the symptom-based Rome criteria. Because a significant number of patients meeting the Rome criteria also met the histologic criteria for a diagnosis of lymphocytic colitis, the findings highlight a major problem with the way we currently diagnose IBS. By definition, the diagnosis of an organic disease such as lymphocytic colitis is inconsistent with a diagnosis of IBS. Furthermore, it is unclear whether the patients met the Rome criteria because of the presence of discomfort (urgency, bloating) relieved by bowel movements, or whether they reported abdominal pain. Using the current Rome criteria, a diagnosis of IBS can be made in any patient experiencing abdominal discomfort (for example, in the form of urgency or bloating-type symptoms), that is relieved by a bowel movement. In the absence of mucosal histology to rule out macroscopic or microscopic forms of colitis, such a symptom cluster is likely to include a wide range of syndromes with different causes and pathologic mechanisms.Another study reported neuromuscular and inflammatory abnormalities in the small bowel of 10 patients (8 women; age range 24-55 years) with severe IBS symptoms.12 Surprising for an IBS population, the symptoms apparently were severe and refractory enough to justify a laparoscopic full-thickness biopsy. The durations of IBS symptoms ranged from 2 to 30 years, and the predominant bowel habits included constipation, diarrhea, and alternating bowel habits. In this study, analysis of full-thickness biopsy specimens of the jejunum from IBS patients (diagnosis having been made on the basis of absence of detectable structural lesions and fulfillment of the Rome I criteria for IBS) showed several histopathologic abnormalities. The authors reported in most patients some neural degeneration in the ganglia of the myenteric plexus associated with infiltration of CD3+ T lymphocytes and longitudinal muscle hypertrophy. In some cases, IEL numbers were increased, and the numbers of interstitial cells of Cajal were also increased. There are two major problems with the reported findings. First is the absence of an appropriate control group. For example, the observed mucosal alterations in the proximal jejunum were compared with biopsy specimens obtained from the distal ileum during colonoscopy, and alterations in the jejunal wall were compared with findings obtained in tissues from deceased patients (of unspecified sex and age). Second, as admitted by the authors, the patients in this study represented a highly selected group with severe symptoms that were apparently refractory to current management. Even though it was stated that patients had normal or nonspecific changes on small intestinal manometry, it is conceivable that the patients had a mild or early form of chronic intestinal pseudoobstruction. Analogous to the comments made above about the nonspecificity of the Rome criteria to differentiate microscopic colitis from IBS, the same argument could be made for chronic intestinal pseudoobstruction.Patients in another group, frequently discussed as evidence for a possible role of altered gut immune function in IBS, are those in whom IBS-like symptoms develop after a documented gastroenteric infection (so-called postinfectious IBS PI-IBS] patients). A history of acute gastroenteritis caused by a variety of bacterial infections as well as parasitic infections was found to increase the risk of the development of persistent IBS symptoms. The risk factors associated with PI-IBS include female gender, duration of the acute illness episode, and a major stressful life event at the time of the infection. Patients with PI-IBS have been reported to show changes in gut motility (eg, reduced rectal compliance) and epithelial function and an increase in enterochromaffin cells.13, 14 In addition, mucosal immune parameters in these patients exhibit changes that include altered macrophage (CD68) and T lymphocyte (CD3, CD4, CD8) populations and increased expression of IL-1 mRNA.15 Some of these changes, as well as symptoms of diarrhea, were shown to persist for more than a year in some cases, suggesting chronic immune system activation.15 Although the mechanisms involved in the ongoing inflammation after clearance of the infectious agent remain unclear, it has been suggested that a subset of IBS patients may have a genetic predisposition to inflammatory dysregulation. Preliminary evidence suggests a reduced frequency of the high producer allele for the antiinflammatory cytokines IL-10 and TGF-, suggesting a reduced production of these cytokines in patients with IBS compared with healthy control subjects.16 Several important questions have to be addressed before the existence of a distinct pathophysiologic entity of PI-IBS can be confirmed. (1) Even though persistence of low-grade inflammation has been described in individuals who continued to be symptomatic, a causal role of these mucosal changes with IBS symptoms has not been demonstrated.14, 15 Preliminary reports from a therapeutic trial with an antiinflammatory agent in PI-IBS did not demonstrate any effect on symptoms.17 (2) There is currently no evidence of visceral hypersensitivity in this patient group, and the reported lower volume thresholds for discomfort simply reflect a reduced rectal compliance. (3) It is unclear whether patients who report their first onset of IBS symptoms after an enteric infection have a history of other intestinal or extraintestinal functional syndromes (such as dyspepsia or chronic constipation) or anxiety disorders. In this case, the persistence of bowel symptoms may simply be a reactivation of a preexisting functional syndrome.Tibble et al.18 compared a large population of patients with altered bowel habits meeting the Rome I criteria for IBS and patients with different organic diseases of the intestine, including IBD, cancer, infectious diarrhea, and celiac disease. They observed that markers for intestinal inflammation, such as fecal calprotectin levels, were elevated in the majority of patients with organic gastrointestinal conditions and decreased in the majority of patients with IBS. The sensitivity and specificity of fecal calprotectin levels for organic intestinal disease were 89% and 79%, respectively. However, the authors observed a significant number of IBS patients whose fecal calprotectin levels were above a normal cutoff value, suggesting some degree of inflammation.Taken together, the above findings are most consistent with the concept that in a subset of patients meeting the current diagnostic criteria for IBS, chronic low-grade immune activation may be associated with chronic changes in gut motor and secretory function resulting in chronic abdominal discomfort associated with altered bowel habits. However, a causal relationship between visceral hypersensitivity and chronic immune activation has not been demonstrated.Altered Immune System and Inflammation in Inflammatory Bowel DiseasesClassic histopathologic inspection of tissue from patients with IBD reveals vasodilatation, venocongestion, edema, infiltration of large numbers of inflammatory cells (lymphocytes as well as macrophages and monocytes), and architectural disarray, often with mucosal erosions and/or frank ulcerations. Although the causative triggers remain unclear, the role of a persistent and likely dysregulated mucosal immune response is central to the pathogenesis of IBD. However, it remains unclear whether the persistent inflammation, an intrinsic feature of IBD, reflects a primary aberration in mucosal response or results from an inappropriate persistent stimulation. Accumulating evidence indicates that excessive activation of immunoinflammatory responses in IBD may be initiated by luminal flora. In this regard, recent data showed no difference in the overall composition of mucosal flora in patients with IBD and control subjects but demonstrated a higher concentration of mucosa-associated bacteria in patients with IBD.19 The authors suggest that the changes in the concentrations of mucosal flora in IBD are not secondary to inflammation but result from a host-specific altered immunoinflammatory mucosal response to "self-flora" in susceptible individuals. The role of genetic factors continues to be explored, with disease susceptibility associated with genetic markers for particular subsets of IBD patients. Recent studies using genome-wide screening provided the first link between NOD2 mutations and the clinical characterization of Crohn disease.20, 21 NOD proteins are thought to be cytosolic receptors for bacterial signals, and NOD2 is expressed in monocytes and activates nuclear factor kB (NF-kB). However, the mechanisms by which NOD2 mutations contribute to Crohn disease need further investigation. It has been hypothesized that different concentrations of bacteria in the ileum relative to the colon may contribute to the association between NOD2 mutations and ileal disease. A genetic background was also identified in ulcerative colitis associated with HLA genes and regions of the chromosomes 3, 7, and 12.22 In a recent review, Ardizzone et al.23 compiled the genetic factors recently involved in the pathogenesis of IBD. Considering the central role of cytokines in modulating intestinal inflammation, several studies have focused on cytokine genes, looking for mutations or polymorphisms and expression dysregulation.24 In Crohn disease, an increased expression of T-helper-1 (Th1) cytokines was initially described, whereas an atypical Th2 response was associated with ulcerative colitis, but this assessment is now thought to be too simplistic. Cytokine gene-regulated differences between and within the diseases are clearly more complex. Advances in the understanding of the immune response in IBD have stimulated the development of new therapeutic agents directed against key players in the inflammatory process. A range of therapeutic strategies to block the biosynthesis or action of proinflammatory cytokines, acting directly or though targeting immunoregulatory cytokines, has been developed.25Among specific targets, tumor necrosis factor- (TNF-) was among the first mucosal cytokines identified as critical in the development and amplification of mucosal inflammation in IBD.26 Recent clinical trials showed that anti-TNF- antibodies provide marked clinical benefits in some patients with Crohn disease: a translational insight that has now become commonplace in IBD clinical therapy. 27, 28 An inhibitor of mitogen-activated protein kinase (MAPK) appears to be another candidate in novel therapeutic strategies. A beneficial effect of CNI-1493 (MAPK inhibitor) in patients with severe Crohn disease was recently described. 29 A better characterization of the molecular signaling pathways involved in the activation of key immune and inflammatory cells will indubitably provide new targets for the development of therapeutic agents for IBD.What Unifies and Separates Irritable Bowel Syndrome and Inflammatory Bowel DiseasesPossible Role of Failure to Downregulate Immune ResponseA comparison of published data on the activation of the gut-associated mucosal immune system in IBS and IBD reflects both the similarities and the differences in the altered immune response observed in these disorders. However, the triggering factor initiating the inflammatory response remains unclear. In IBS, an immune response to infection,30 a disinhibition of the immune system during chronic sustained stress (Fig. 1), or a combination of both are plausible mechanisms that could result in the initial immune activation. The persistence of low-grade inflammation after pathogen clearance or after resolution of the psychosocial stressor, in a subset of individuals, may be related to an inability to efficiently downregulate the inflammatory response. This inability may be related to genetic factors or to early programming of antiinflammatory systems, such as the hypothalamic-pituitary-adrenal (HPA).31 For example, a hyporesponsive HPA axis in the Lewis rat has been shown to be associated with exaggerated immune responses to various stimuli, including chemically induced colitis.32 The most recent available data on IBD increasingly emphasize the role of immunogenetics in the predisposition, modulation, and perpetuation of the disease.33 The abnormal amplification and persistence of inflammation leading to tissue injuries likely reflects the continuing presence of the driving stimulus and self-reinforcing activation of mucosal inflammatory cells mediated by increased expression of cytokines. Figure 1. (click image to zoom) Brain-gut immune interactions in irritable bowel syndrome and inflammatory bowel disease: effect of chronic stress on the mucosal immune system. Acute stress causes increases in the activity of the hypothalamic-pituitary-adrenal (HPA) axis and of the two branches of the autonomic nervous system (ANS), the sympathetic nervous system (SNS), and the parasympathetic (vagal) system. In patients with irritable bowel syndrome, the peripherally acting products of each of these pathways (cortisol, CORT; norepinephrine, NE; acetylcholine, Ach) can inhibit the mucosal immune system, especially Th1-type responses. This results in a temporary shift toward Th2 cytokine responses (IL-4 and others) that are not as strongly inhibited and that can further inhibit Th1 responses. In patients with inflammatory bowel diseases, the corticotropin-releasing factor (CRF) response may be blunted, leading to diminished CORT and NE release. These changes favor the production of Th1 cytokines and the proliferation of macrophages, natural killer (NK) cells, and cytotoxic T cells (Tc). TNF, which is produced by activated macrophages but can also be released by activated mast cells, stimulates the production of IL-1 (in the Th1 pathway) and IL-6 (by lymphoid and nonlymphoid tissues). With chronic stress in both types of patients, the shift to a Th1 response becomes predominant, with positive feedback loops developing between the gut and the brain. The restraints on immune cell proliferation and activation are compromised by blunting of the HPA axis response due to downregulation of pituitary CRF1 receptors, decreased vagal tone, and downregulation of 2-adrenergic receptors (2-AR) on Th1 immune cells by chronically elevated catecholamines. Circulating levels of TNF-, IL-1, and IL-6 increase to concentrations that synergistically stimulate CRF production in the PVN of the hypothalamus. In irritable bowel syndrome, TNF and IL-1 sensitize primary afferent terminals through long-lasting effects on gene expression, including the expression of neurokinin receptors. Locally acting mast cell products (tryptase and histamine) and proinflammatory compounds (PGE2) can also sensitize primary afferents. Both IFN (Th1 cytokine), which is produced by NK cells in response to TNF, and IL-4 (a Th2 cytokine) have been shown to decrease mucosal barrier function by increasing epithelial permeability,54,55 thus perpetuating a local inflammatory response by allowing entry of bacteria and bacterial products. Subjective pain responses to peripheral sensitization of visceral afferents in irritable bowel syndrome and inflammatory bowel diseases are likely to be modulated differentially by endogenous pain modulation pathways. DMN, dorsal motor nucleus of the vagus; ACTH, adrenocorticotropin hormone. Increased PermeabilityFor both syndromes, histologic and functional alterations of the mucosal barrier have been recently reported.11, 12, 24, 25 Small intestinal permeability is abnormal in a wide variety of conditions affecting the small intestine, including celiac disease, Crohn disease, and intestinal infections.18 Interestingly, gut permeability assessed by the lactulose/mannitol ratio is significantly elevated in PI-IBS patients.15 This functional alteration of the intestinal barrier function may be a cause or consequence of inflammation, and a direct link between increased intestinal permeability and the exaggerated immune activation in IBD still needs to be confirmed. In addition to a causative role of peripheral factors, gut permeability changes in animal models have also been reported in response to various stressors. For example, in a rat model of chronic stress, an increase in intestinal epithelial permeability, associated with an increase in mucosal neutrophils and mast cells, has been demonstrated.34 In this model, the combination of stress-induced increases in intestinal permeability, allowing easier access of antigens to gut-associated macrophages and dendritic cells, together with stress-induced changes in HPA axis responsiveness and cytokine profiles, resulted in the development of colitis, without any additional chemical or immunologic manipulations. Rats with a history of aversive early life events were more susceptible to these stress-induced changes in gut permeability,35 possibly related to early programming of the HPA axis.31Changes in Luminal FloraA change in intestinal microflora has been implicated, in association with genetic factors, as a putative mechanism responsible for the initiation and persistence of inflammation in IBD. Indeed, it has been suggested that the failure to maintain immunologic tolerance toward the indigenous microflora leads to a disease-associated dysregulation of the gut-associated immune system. Direct and indirect evidence of altered flora of the large and small intestine has been reported in IBS patients. For example, Balsari et al.36 observed a decrease in coliforms, lactobacilli, and, to some extent, bifidobacteria in a small group of IBS patients. More recently, preliminary evidence of an alteration of bacterial concentration in colonic biopsy specimens from IBS patients has been reported.37 Indirect evidence for bacterial overgrowth of the small intestine (in the form of altered hydrogen breath test results) has been reported in patients with IBS, and a recent randomized controlled trial found evidence that antibiotic treatment was beneficial for IBS symptoms of bloating and discomfort.38 Based on the concept of altered interactions between the colonic flora and the gut-associated immune system, probiotics have been proposed as an alternative strategy for the treatment of several gastrointestinal diseases, including IBD 39 and more recently IBS.40, 41 However, the reported results are conflicting, and only a small number of double-blind controlled clinical trials support a beneficial health effect in IBD or IBS.42 The epithelium has recently been recognized as playing an important role in innate immune responses in response to intestinal microorganisms.43, 44 It expresses a variety of receptors (Toll-like receptor) involved in the recognition of a spectrum of microbial products. This recognition capability may enable an appropriate cytokine and chemokine secretion in response to changes in luminal flora.Influence of Sustained Psychosocial Stressors on Mucosal Immune System ActivationEven though stress has been less recognized as a factor in the natural history of IBD, considerable evidence supports a prominent role for it in the pathophysiology and clinical presentation of both IBD and IBS symptoms.45 Patients with IBS seem to have a greater reactivity to stress than do control subjects or IBD patients. Yet, sustained psychologic stressors have been associated with the onset and exacerbation of symptoms in both IBS and IBD.46-48 The development of persistent IBS symptoms after acute gastroenteritis has been associated with major life events around the time of infection.14 Similarly, for IBD, a wide range of clinical studies indicates a strong link between sustained psychosocial stressors and IBD activity.49 Levels of long-term perceived stress have been shown to correlate with changes in mucosal appearance and relapse in ulcerative colitis.50 Further evidence of an influence of stress on inflammatory processes comes from animal studies showing a modulation of the immune function at different levels, including immune cell distribution, cytokine profiles, or susceptibility to infection in naï¿½ve or colitic animals.51 In view of the established concept of an altered immune response in IBD patients, and the suspected low-grade inflammation in some patients meeting the symptom criteria for IBS, it is reasonable to consider a bidirectional model of brain-gut interactions as an important determinant of gut-associated immune activation in both disorders.Chronic Inflammation and Alteration of Sensory-Motor Functions of the Gastrointestinal TractDespite the common assumption that chronic gut mucosal inflammation is associated with sensory-motor dysfunction of the gastrointestinal tract in inflammatory as well as functional intestinal disorders, the relationship between chronic inflammation and the generation of gastrointestinal symptoms remains unclear. The development of IBS-like symptoms in some patients with quiescent ulcerative colitis was suggested as an indication of the role of inflammation on altered sensory and motor function.8 The concept of long-lasting postinflammatory changes in gut motility is supported by the observation of altered anorectal and colonic motility in patients in remission from ulcerative colitis and Crohn disease.52 However, chronic abdominal pain and visceral hypersensitivity-classic features in patients with IBS-do not appear to be a hallmark of ulcerative colitis or Crohn disease. 53 One may speculate that various patient populations with different degrees of intestinal inflammation (patients with IBD and PI-IBS, and possibly small subsets of those with IBS) do not necessarily experience pain and discomfort from these mucosal changes. Whereas the effects of the immune activation are likely to affect enteric nervous system circuits and smooth muscle function, altering intestinal compliance and reflex activity and producing such symptoms as diarrhea and urgency, the effects on visceral perception are less predictable. An important variable in symptom generation is the differences in the ability of the brain and its endogenous pain inhibitory pathways to counteract the changes in peripheral viscerosensory pathways.ConclusionThe recent observation of an activated immune system in some IBS patients associated with persistent low-grade mucosal inflammation provides evidence for the reconsideration of the symptom-criteria-based diagnosis of functional bowel disorders. The development and use of biologic markers identifying low-grade inflammation would improve the characterization of subsets of IBS patients in whom peripheral mechanisms may participate in specific symptom genesis and could be considered in the choice of the therapy.from Current Opinion in GastroenterologyPosted 07/15/2003Sylvie Bradesi, PhD, James A. McRoberts, Ph.D, Peter A. Anton, MD, Emeran A. Mayer, MD http://www.ibsgroup.org/cgi-local/ubbcgi/u...c;f=10;t=000777


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## eric (Jul 8, 1999)

Has Dr dahlman suggested anyone take the GSDL Intestinal Permeability Assessment? http://www.gsdl.com/assessments/ip/index.htm alsoLeaky Gut (Increased Intestinal Permeability)Leaky gut is a disorder associated with an excessive increase in intestinal permeability. The greater-than-normal increase in intestinal permeability results in allowing partially digested foods, chemical toxins, and harmful organisms (bacteria, fungi and viruses) to permeate though the gaps in the lining of the intestinal barrier and enter the blood stream. This is believed to contribute to a growing number of health problems, probably through immune system activation. Leaky gut is believed to be a factor in causing some types of chronic inflammatory arthritis and certain skin conditions such as acne, psoriasis, and eczema. Chronic fatigue syndrome, fibromyalgia and food intolerance conditions may also looked upon as related to the leaky gut phenomena.By itself, leaky gut is a functional disorder, meaning that it is not a disease but an aberration of the gut barrier's normal function. Leaky gut is known to be caused by chronic alcohol intake and NSAID overuse, but also occurs from inflammatory and infectious bowel diseases such as Crohn's disease, ulcerative colitis, irritable bowel syndrome and dysentery.The notion of a leaky gut (correctly termed as increased intestinal permeability or intestinal hyper-permeability) is not new to the health sciences and has fallen in and out of favor during the past century as a credible health concern. However, recent breakthroughs in our understanding of the human immune system and the discovery of the gutï¿½s central role in the immune system appear to have paved the way for acceptance of leaky gut as an important clinical condition. Presently, leaky gut is thought to play a primary role in the evolution of certain diseases as well as causing existing diseases to become worse.How Common Is Leaky Gut?Virtually everyone will experience symptoms of leaky gut during his or her lifetime. Usually, the symptoms are short-lived and do not leave lasting effects.Unless the patient is specifically tested for intestinal permeability, leaky gut often goes unrecognized. Currently, estimates vary about how many people suffer health issues from leaky gut, ranging from less than 10 percent to more than 50 percent of males and females of all ages in the United States.As yet, there is no proven genetic basis for leaky gut. Leaky gut appears to be associated with low quality, highly processed foods heavy in food additives, drug usage and exposure to chemicals in the food chain.What Causes Leaky Gut?Leaky gut usually follows exposure to substances that damage the integrity of the protective intestinal mucosa. A number of factors may cause leaky gut, including: Some prescribed drugs Stressful lifestyle Overuse of antibiotics Overuse of NSAIDS (aspirin, ibuprofen, Tylenol) Overuse of stomach antacids A diet high in processed foods and refined sugars Frequent consumption of alcohol Exposure to environmental chemicals and toxins Intestinal infections How to Deal with Leaky Gut?Compelling research suggests that leaky gut arises in reaction to poor lifestyle habits. This is most relevant to those people who would rather take a pill, potion, or poultice instead of taking the time and effort to correct and improve their lifestyle habits. Simply put, using glutamine supplements, vitamin A and antioxidants to repair the harm caused by a meal consisting of beer, chips and preservative-laden hot dogs is not going to work.The time-tested three pillars of lifestyle improvement appear to be the best medicine at this time. These three pillars are eat healthy foods, stay fit and learn how to appropriately handle stress. In addition, one should:Limit alcohol intake Do not overuse NSAIDs and antacids Take dietary glutamine supplements as it appears to be vital for the normal intestinal wall maintenance Consume more fresh foods Avoid chemical or additive-laden foods and drinks Consult with a dietitian or licensed health care provider for further advice on managing leaky gut REFERENCES http://www.healthyroads.com/mylibrary/data...rt_leakygut.asp People can have intestinal permeability and not IBS, people can have IBS and some intestinal permeability. But IBS is not defined by intestinal permeability!


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## Kacebece3 (Apr 17, 2002)

I am showing some inprovement following Dr. D's methods, been almost 2 mounths now. I seee Eric is still on his fillibuster of this thread. Hey Eric your getting redundant. Ken


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## Talissa (Apr 10, 2004)

Ken,Glad you're seeing things getting better, and the feedback's really helpful. Thanks. JHouston,Exactly! It had been suggested to me a few years ago to try Flagyl again, with probiotics this time--don't think so--would rather have my hand fried in hot oil, I think. I used some natural antibacterials instead w/ probiotics, which took longer, but really brought me back from the nightmare. A new friend of mine here is a GP(general practitioner), and she says it's really very common to develop inflammation & food reactivities after such bacterial infections and treatment. She didn't know what to do about it, however.I'm going to go check out the new thread that gf started. My fingers are crossed!Talissa


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## Gret (Sep 23, 2003)

Talissa, I think the Ultra Clear Sustain is a major key to healing! The L-Glutamine in it helps the intestinal lining, etc. I think it's the major reason I got better so quickly!


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## calid (Aug 4, 2003)

Joann: it was a 10 day regimen of Cipro. 500 x twice a day.


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## overitnow (Nov 25, 2001)

Talissa--To further muddy this thread, what were the anti-bacterials you were taking? I use a bunch of tea tree oil products for my skin and teeth and have found them very helpful; but I am disinclined to be ingesting it.Mark


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## Talissa (Apr 10, 2004)

Hi Mark,I used a product called "Paragone"--it combines a dry herb formula in caps with a liquid formula. It's fairly easy to find in health food stores & online. Here's what's in itaragone IUndecylenic Acid (coconut and castor bean) Black Walnut (hull and seed) Quassia (from wood)Wormwood (leaf and stem) Bismuth Citrate Caprylic Acid (as magnesium caprylate)Cape Aloe (gel) Garlic (bulb)Pau Dï¿½Arco bark (root bark) (5:1 extract)Clove (seed) Grapefruit (seed and rind) Pumpkin (seed)Pippli (seed) (piper longum)Rosemary (leaf and stem) (4:1 extract)Thyme (leaf and stem) (4:1 extract)Proprietary BlendBlack Walnut (from hull & seed) Marshmallow (dry root) Orange Peel Wormwood (leaf & stem) Clove (seed) Paragone IIBlack Walnut (from hull & seed) Marshmallow (dry root) Orange Peel Wormwood (leaf & stem) Clove (seed)


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## Fredjs (Mar 21, 2004)

Hello all,I am wondering if anyone on this thread has talked to anyone that has been "symptom free" for more than a year, as a consequence of using Dr. Dahlman's program. Does anyone like that particpate on this thread, so I can contact them? Please let me know by responding to my email address. Thanks a million.fredjs###ufl.edu-F


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## Gret (Sep 23, 2003)

Fred, I think most of us are newbies here. Perhaps Dr. Dahlman could give a reference of someone he has treated that is still symptom free. You might try reaching him at his website.


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