# Book: What Your Doctor May Not Tell You About IBS by Richard N. Ash, M.D.



## anniev (Jan 30, 2008)

I have been having a flare up of my IBS-D lately. It started during a trip to Florida last month. I stopped by my local health food store today to pick up some digestive enzymes and picked up a book by Richard N. Ash, M.D. It's called "What Your Doctor May Not Tell You About IBS." Has anyone read it? If not, I highly recommend it. I have read most of it and plan to follow the guidelines. I am so sick of having this problem.


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## TexasMom (May 27, 2006)

Yes Annie, you are on the right track. I have not read this book personally, but looked it up on the internet just now and was able to read part of it. Yes , yes , yes! One of many doctors who are getting it. It's all about food sensitivities. I've had about 400 IBS and migraine patients now that I've helped in similar fashion as this doc seems to........ all of them got well except 3 (2 migraine and 1 IBS). You can do it the old fashioned way by doing an elimination diet to find out what your food triggers are, or food sensitivity testing (not just IgG, but cell-mediated reactions too) and then doing an elimination diet eating ONLY your NON - reactive foods............. when you don't eat anything reactive, your body quits reacting within days........ I hope you get better and then reach out and help someone else! Regards,Susan


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## anniev (Jan 30, 2008)

Susan (Texas Mom)Thanks for replying. I wish that more people would read this book. I finally feel that I have some hope in getting over this condition. I have to get up 3 hours before I plan to leave my house in the morning and know where all of the restrooms are. The drugs and over the counter medications that people are taking just make their condition worse. It has had such a negative impact on my life. Travel is a nightmare. I have never had an accident but I have been close hundreds of times.I plan to start by eliminating all dairy and this will be hard because I love cheese. And, giving up my glass of wine in the evening will be very difficult. I hope to finish the book tomorrow.Annie


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## eric (Jul 8, 1999)

anniev, the book is kind of out of date now on IBS.There is also a lot of conflicting dietary advice out there for IBS. Foods and IBS are multifactoral, including the act of eating, calories in a meal, fat, chemicals in the food, food allergies, food intolerences and many other reasons. A person can have food allergies and intolerences on top of IBS as well, but they are not the same conditions. Also an intolerence is not an immune reaction.With IBS the gut is reactive to foods stress hormones and even the weather can effect some people. Cold water can effect some people with IBS. There is mild, moderate and severe IBS. Its the gut reactivity to all these things that is the problem, not foods. Don't lose hope though and there maybe somethings that can help from the book. Eating raw vegetable though can be problemtic in IBS as well as nuts.Nuts are on one of the top four foods in studies not to eat in IBS. But nuts don't cause IBS even if you were allergic to them. He runs an alternative medicine center in New York.They now have better evidence of why there is D and c and d/c and pain in IBS. Texas mom, you need to study IBS and not just food allergies. I hope you think about the information you are provinding to people with IBS without doing any studying of IBS, because that is really a big problem. For one it is classified as a functional disorder and there are some thrity functional disorders that can also overlap. IBS is NOT caused by food allergies!!!!!!!!!!! Do some better research on the subject. This is a dicussion on this recently.IgG Food Allergies/Anyone have experience?http://www.ibsgroup.org/forums/index.php?showtopic=94055This is more accurate information and is from one of the leading researchers from the UK, Dr Whorewell. One of the UK's top doctors on IBS. From the International Foundation for Functional Gastrointestinal Disorders"IBS DietDiet, food and eating can affect symptoms in IBS. Many people with irritable bowel syndrome (IBS) notice that their symptoms appear to get worse following a meal. They may wonder if they have a dietary allergy or intolerance. More confusing, they may notice that a food seems to upset them on one day but not another. Among the most common questions IBS patients have is what food to avoid. This can drive a person to go looking for a diet or a test that might help sort all this out. A bewildering amount of often conflicting advice is available, especially on the Internet. Much of it is associated with a considerable cost.Diet and IBS symptoms*There are a variety of factors that affect IBS, and diet is just one of these. If other factors, such as stressors or hormonal changes, are more active on a particular day, then diet is more likely to push your symptoms "over the edge." "*http://www.aboutibs.org/site/about-ibs/management/ibs-dietIt is important if you have IBS to recognize all these factors.This is brand new state of the art information on IBS.7th International Symposium on Functional Gastrointestinal Disordershttp://www.ibsgroup.org/forums/index.php?showtopic=92806These videos will be very helpfulhttp://www.aboutibs.org/site/learning-center/video-corner/Excellent IBS information resourcesTHE JOHNS HOPKINS UNIVERSITY Gastroenterology and HepatologyIBS Informationhttp://hopkins-gi.nts.jhu.edu/pages/latin/...3&lang_id=1UNC Center for Functional GI & Motility Disorders.http://www.med.unc.edu/wrkunits/2depts/med...n_materials.htmCharacteristics and treatment from the International Foundation for Functional Gastrointestinal Disorders.http://www.aboutibs.org/UCLA Center for Neurovisceral Sciences & Women's Healthhttp://www.ibs.med.ucla.edu/PatientArticles.htmThere more herehttp://www.ibsgroup.org/forums/index.php?showtopic=94095


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## TexasMom (May 27, 2006)

Eric, I'm a dietitian....... I'm helping people get well without having to struggle to figure out what their reactive foods and chemicals are. I'll leave the theory up to you Susan


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## anniev (Jan 30, 2008)

Eric,Thanks for your reply. What is your background? Have you read the book by Dr. Ash? It was published in 2004 so I wouldn't consider it out of date. In fact often new research is not necessairly superior.I looks at some of the websites that you included - I clicked on and a few of them no longer exist so you might want to check on that.If you haven't read the book, it is a very comprehensive approach. How can it hurt to stop eating sugar, drinking alcohol and cow's milk among other things?I did a food elimination diet about 5 years ago and initially felt horrible and then after about two weeks felt great. I know that certain foods make me ill. I plan to finish reading this book. I believe that it will help me. I haven't found a doctor who can - they just want to do lots of expensive tests, prescribe a drug and send you on your way.Also, I would ask the question about the funding for some of these foundations. Are they funded by pharmaceutical companies??? Many of them are.Annie


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## eric (Jul 8, 1999)

"Eric, I'm a dietitian....... I'm helping people get well without having to struggle to figure out what their reactive foods and chemicals are. "Your are posting inaccurate information on IBS how does that REALLY help people, by misleading them to sell food allergy testing with a test that hasn't even been validated for food allergy testing?Don't you think if your going to treat people with IBS or any disorder to have studied it better.Your using a test that"American Academy of Allergy Asthma & Immunology"1/29/2008 RE: MRT/LEAP Test for Food ReactionsI am a Registered Dietitian with a consult next week with an 80 year old gentleman that, after extensive testing, has received a diagnosis of severe IBS. He has tried many IBS drugs on the market with limited relief. He is being sent to me to evaluate his diet. On setting up this consult, he mentioned the Mediator Release Test, along with the LEAP protocol for food sensitivities. Can you provide guidance on the MRT/LEAP for IBS treatment? *My research into the MRT/LEAP test fails to confirm its validity as a tool useful to evaluate patients with any form of food allergy. It claims to be able to help in the diagnosis of "non-IgE mediated food allergy." A search for this test as validated by any published study via PubMed failed to reveal a single reference to it, and an assessment of the web site, at least in my opinion, failed to validate its value in the diagnosis of adverse reactions to foods.* Irritable bowel syndrome itself is not considered, in most instances, to be related to food allergy. Thus, my opinion is that this test would be of very little help.Thank you again for writing.Sincerely,Phil Lieberman, MD"http://www.aaaai.org/aadmc/ate/category.asp?cat=10069Annie, I have had IBS for over 35 years, that I developed after ameobic dysentary from Mexico. There is something called post infectious IBS that can develop into long term classic IBS do to cell structure changes in the enteric nervous system.. I have read now in the last five years over thousands and thousands of IBS research papers. I have attended IBS education classes from experts in neurogastroenterology, gastroenterology and many other specialites.I have taught IBS classes at two major hospitals in Oregon and am in close communication with the IFFGD and the UNC one of the top IBS research centers in the country as well as other major researcher who I am in direct contact with on a regular basis and have made friends with. The information above is from all of the research centers from around the world. All of them recognize IBS now as a brain gut axis disorder, with different pathological mechanisms leading to the symptoms. There is a bigger picture on all of this that you might releaize, for example why doi more womnen get IBS then men? But that is one of a lot of examples. They have now found structual abnomalities, CNS abnormalities, ANS abnormalities, HPA axis abnormailties, problem with the sympathetic and parasympathetic nervous systems ect.. "Have you read the book by Dr. Ash? It was published in 2004 so I wouldn't consider it out of date. In fact often new research is not necessairly superior."I have not read the book. But have read people's comments on the book. I also can't find IBS research he has done? But I will look some more. The reason is IBS research is moving extremely fast for one and there have been many recent discoveries and this is the thing, they are replicated studies from different IBS centers around the world. "If you haven't read the book, it is a very comprehensive approach. How can it hurt to stop eating sugar, drinking alcohol and cow's milk among other things?"I have no doubt there is probably some practivcal advise, however a person can drink milk if they don't have lactose intolerences or milk allergy or small amounts of alcohol or even sugar. None of those foods cause IBS, but reducing the intake of them can be helpful. Both alcohol and certain sugars cause d.Food are not the only answer.This is also from my website on IBS, do you know who Dr Drossman is in IBS researchDouglas A. Drossman, MDhttp://www.med.unc.edu/wrkunits/2depts/med...dc/drossman.htmThe UNC Center for Functional GI & Motility Disorders was established in 1994 by its Co-Directors -- Douglas A. Drossman, MD and William E. Whitehead, PhD -- as a center of excellence within the Division of Gastroenterology & Hepatology, School of Medicine, University of North Carolina at Chapel Hill.The Center has evolved into a multidisciplinary patient care, research, training, and public education initiative with an annual budget of $1.8 million and a base of 32 faculty, investigators and staff, in addition to visiting and collaborating scholars.They train gastroenterologist on IBS and functional disorder research as well as collaberate with all the information from around the world. "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/ibsfoodsinfo.htm"Also, I would ask the question about the funding for some of these foundations. Are they funded by pharmaceutical companies??? Many of them are."All of the funding is disclosed by these organization. However there is a bigger picture to funding.This is one of the links that didn't work and will now. I would read these links before dismissing them, because its some of the most accurate information on IBS on the web, but the experts in IBSTHE JOHNS HOPKINS UNIVERSITY Gastroenterology and Hepatologyhttp://hopkins-gi.nts.jhu.edu/pages/latin/...3&lang_id=1"I haven't found a doctor who can - they just want to do lots of expensive tests, prescribe a drug and send you on your way."Maybe we can help with that since we have listing to many of the top IBS docs around the country, who will take the time and actually help you. What Patients Know About Irritable Bowel Syndrome (IBS) and What They Would Like to KnowNational Survey on Patient Educational Needs in IBS and Development and Validation of the Patient EducationalPosted 09/18/2007Albena Halpert, M.D.; Christine B. Dalton, PA-C; Olafur Palsson, Psy.D.; Carolyn Morris, Ph.D.; Yuming Hu, Ph.D.; Shrikant Bangdiwala, Ph.D.; Jane Hankins; Nancy Norton; Douglas Drossman, M.D.*"The most prevalent IBS misconceptions included (% of subjects agreeing with the statement): IBS is caused by lack of digestive enzymes (52%), is a form of colitis (42.8%), will worsen with age (47.9%), and can develop into colitis (43%) or malnutrition (37.7%) or cancer (21.4%). IBS patients were interested in learning about (% of subjects choosing an item): (1) foods to avoid (63.3%), (2) causes of IBS (62%), (3) coping strategies (59.4%), (4) medications (55.2%), (5) will they have to live with IBS for life (51.6%), and (6) research studies (48.6%). Patients using the Web were better informed about IBS.Conclusion: (1) Many patients hold misconceptions about IBS being caused by dietary habits, developing into cancer, colitis, causing malnutrition, or worsening with age; (2) patients most often seek information about dietary changes; and (3) educational needs may be different for persons using the internet for medical information."**The emerging research typifies IBS as a brain-gut disorder where psychosocial factors (e.g., stress, cognitions, coping, etc.) can alter the symptoms and illness experience for better or worse. Due to these and other disease specific characteristics, that are amenable to education, we believe effective educational interventions may significantly impact the management of this common disorder."*http://www.ibsgroup.org/php/articles.phtml...&toid=90774Facts About IBS Irritable bowel syndrome (IBS) is a disorder characterized by abdominal pain or discomfort, and altered bowel habit (chronic or recurrent diarrhea, constipation, or both - either mixed or in alternation).http://www.aboutibs.org/site/about-ibs/facts-about-ibsThe IFFGD"Welcome to the complete resource for trustworthy gastrointestinal (GI) disorder information, support, and assistance from the International Foundation for Functional Gastrointestinal Disorders (IFFGD), a nonprofit education and research organization."http://www.iffgd.org/John Hopkins is well recognized as well as all the center and information I posted there.Do your self a favor and spend some time reading all those links there has been a ton of research done on IBS in the last five years especially and they are starting to make some real progress.


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## eric (Jul 8, 1999)

FYI"Fibromyalgia and irritable bowel syndrome: How real must they be?(January 27, 2008) Two weeks ago the New York Times published a front page story about a new drug approval for the treatment of fibromyalgia that questioned the validity of functional disorders and implied that both fibromyalgia and irritable bowel syndrome (IBS) are not "real." In response, IFFGD joined a group of internationally recognized clinicians and scientists in sending a Letter to the Editor at the New York Times. The letter is intended to provide perspective and balance to the article, which was entitled "Drug Approved. Is Disease Real?" We believe it to be a disservice to leave the millions of sufferers with fibromyalgia and IBS with the thought that their medical disorder is not legitimate. The newspaper has not published our response. We present it to you here.""Second is the concept that these disorders are "nebulous" or poorly defined. Over the last two decades there has been an explosion in research in brain-body science, neurotransmitter function, and brain imaging that is precisely defining the location and mechanisms that explain these symptoms. "http://www.aboutibs.org/site/news-events/n...commentary#Real


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## anniev (Jan 30, 2008)

Eric,I'm not really interested in all of the research that's going on by these wonderful doctors and foundations funded by pharmaceutical companies. I could spend all of my time reading this stuff. Please tell me how this will help me? I did enough research when I was in graduate school. I want results and if avoiding certain foods, alcohol, caffeine, and sugar helps me that is more important. I do not have a high opinion of doctors because of past experiences of my own and other family members. I had a neurologist tell me last year that I was having non convulsive seizures when I was actually experiencing floaters. I went to the web, diagnosed myself, and then cancelled all of the expensive tests that he had set up. My symptoms were classic but he had tunnel vision. This is just one example over the years.Sometimes there is no explanation as to why something works. I am going to change my diet and I'll report back to let everyone know if it helps. I am not under any stress in my life and don't have any major psychological problems. Please don't feel that it's necessary to reply but do read the book.Annie


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## eric (Jul 8, 1999)

Your reading a bood by a md for information on IBS, but don't want to watch new vidoes or newer information on IBS, because of pharm companies?It is important that the leading cause of misdiagnoses is self diagnoses.There are billions and billions promoted and sold under alternative otc or whatever, with minor or no regulations."Think It Through: A Guide to Managing the Benefits and Risks of Medicines --------------------------------------------------------------------------------Although medicines can make you feel better and help you get well, it's important to know that ALL medicines, both prescription and over-the-counter, have risks as well as benefits.The benefits of medicines are the helpful effects you get when you use them, such as lowering blood pressure, curing infection or relieving pain. The risks of medicines are the chances that something unwanted or unexpected could happen to you when you use them. Risks could be less serious things, such as an upset stomach, or more serious things, such as liver damage.When a medicine's benefits outweigh its known risks, the U.S. Food and Drug Administration (FDA) considers it safe enough to approve. But before using any medicine--as with many things that you do every day--you should think through the benefits and the risks in order to make the best choice for you."http://www.fda.gov/cder/consumerinfo/think.htmSo there is no place for medications what so ever in the world?"I am not under any stress in my life and don't have any major psychological problems." This is not the kind of stress they are totally talking about and there is way more to it all and you have IBS and no stress or anxiety even from the IBS? That is very rare, no antisipatory anxiety or negative reaction to symptoms from a d attack or pain attack?Were you diagnosed by a gi doctor?"Please tell me how this will help me?"when you read it it will become very clear.


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