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Research suggests that low FODMAP diets reduce IBS symptoms in 85% of people. Learn how to implement a low FODMAP diet for IBS or SIBO, low FODMAP product options, and conventional and alterative treatments for IBS on this podcast sponsored by Casa de Sante with Onikepe Adegbola, MD on The Perfect Stool Podcast with host Lindsey Parsons, EdD. Listen below or find the podcast version at: https://link.chtbl.com/theperfectstool-IBS

Impact of Diet on Symptoms of the Irritable Bowel Syndrome by Robin Spiller NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK Academic Editor: Massimo Bellini Nutrients 2021, 13(2), 575; https://doi.org/10.3390/nu13020575 Irritable bowel syndrome (IBS), with its key features of abdominal pain and disturbed bowel habit, is thought by both patients and clinicians to be strongly influenced by diet. However, the complexities of diet have made identifying specific food intolerances difficult. Eating disorders can masquerade as IBS and may need specialist treatment. While typical food allergy is readily distinguished from IBS, the mechanisms of gut-specific adverse reactions to food are only just being defined. These may include gut-specific mast cell activation as well as non-specific activation by stressors and certain foods. Visceral hypersensitivity, in some cases mediated by mast cell activation, plays a key part in making otherwise innocuous gut stimuli painful. Rapidly fermented poorly absorbed carbohydrates produce gaseous distension as well as short-chain fatty acids and lowering of colonic pH which may cause symptoms in IBS patients. Limiting intake of these in low FODMAP and related diets has proven popular and apparently successful in many patients. Existing diet, colonic microbiota and their metabolic products may be helpful in predicting who will respond. Wheat intolerance may reflect the fact that wheat is often a major source of dietary FODMAPs. It may also be either a forme fruste of coeliac disease or non-specific immune activation. Wheat exclusion can be successful in some of these patients. More research is needed to fully understand the mechanisms of food intolerances and how to best ameliorate them in a personalised medicine approach to diet in IBS. >> View full research paper © 1996-2021 MDPI (Basel, Switzerland)

Behavioral and Diet Therapies in Integrated Care for Patients with Irritable Bowel Syndrome Authors: W.D. Chey, L. Keefer, K. Whelan, P.R. Gibson Irritable bowel syndrome (IBS) is a common, symptom-based condition that has negative effects on quality of life and costs healthcare systems billions of dollars each year. Until recently, management of IBS has focused on over the counter and prescription medications that reduce symptoms in fewer than half of patients. Patients have increasingly sought natural solutions for their IBS symptoms. However, behavioral techniques and dietary modification can be effective in treatment of IBS. Behavioral interventions include gastrointestinal-focused cognitive behavioral therapy and gut-directed hypnotherapy, to modify interactions between the gut and the brain. In this pathway, benign sensations from the gut induce maladaptive cognitive or affective processes that amplify symptom perception. Symptoms occur in response to cognitive and affective factors that trigger fear of symptoms or lack of acceptance of disease, or from stressors in the external environment. Among the many dietary interventions used to treat patients with IBS, a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) is the most commonly recommended by healthcare providers and has the most evidence for efficacy. Patient with IBS who choose to follow the low-FODMAP diet should be aware of its 3 phases: restriction, reintroduction, and personalization. Management of IBS should include an integrated care model, in which behavioral interventions, dietary modification, and medications are considered as equal partners. This approach offers the greatest likelihood for success in management of patients with IBS. Keywords cognitive behavioral therapy, hypnosis, FODMAPs, ARFID © 2020 by the AGA Institute

NanoSalad is offering a free trial of their FODMAP and IBS friendly product for US-based IBSpatient Community members. 95% of Americans don't eat enough veggies and fiber. Each packet contains 100% organic fruits and vegetables. Nothing added. Just all the plant solids, de-juiced, dried and shrunk, from 20 times the weight of ingredients. The Savory recipe contains kale, celery, parsnip, carrot, and apple (tuned to minimize changes to the taste of the savory foods you love). The 2 Veg recipe contains kale and carrot (it has a bold veggie flavor, and both ingredients are low FODMAP and IBS friendly). The Fruity recipe contains apple, pear, strawberry, and carrot (suits sweeter dishes, adding clear fruity notes and sweet fiber). More info: https://www.bodzoo.com/ibspatient-trial.html

These are my notes from the online course for Patients about the low FODMAP diet from Monash University, the academic center where the low FODMAP diet was developed. The Monash FODMAP online course for Patients contains five (5) modules delivered entirely online with dialog, videos and quizzes. You have twelve (12) months to complete the course at your own pace. The course is not meant to be a replacement for healthcare professionals like your Physician or Dietitian. The course is intended to help you better understand your condition. It is important to have a proper medical diagnosis by a doctor before proceeding with any treatment. The course is not meant to self-diagnose yourself with IBS. According to Monash University, these are the aims of the course for Patients: All about IBS, including symptoms, causes, the importance of getting a proper medical diagnosis, red flags symptoms, common tests and treatments. What FODMAPs are and how a 3 step FODMAP diet can reduce IBS symptoms How to follow Steps 1, 2 and 3 of the FODMAP diet What to do if you do not experience symptom improvement on this diet I completed the course in about two (2) weeks. The course filled in a lot of gaps in my knowledge about FODMAPs when I thought I already knew everything! It really helped me understand how to better use the Monash University FODMAP app and how to better utilize a Dietitian that has been certified to manage the low FODMAP diet. Some background on the low FODMAP diet The team at Monash University in Australia developed the low FODMAP diet showing that FODMAPs could trigger symptoms of IBS and research which acknowledges that diet could be responsible for IBS symptoms. In turn, limiting dietary FODMAPs became an effective treatment for 3 out of 4 people for treating their symptoms of IBS. The FODMAP acronym was coined to classify groups of carbohydrates (sugars and fibers) found in foods and beverages, that are similar in length and structure. These, “short-chain” carbohydrates have been shown to be poorly absorbed in individuals living with digestive sensitivities, including Irritable Bowel Syndrome (IBS), and resulting in a common set of gastrointestinal symptoms including abdominal pain, bloating and gas, constipation and/or diarrhea. More information about the low FODMAP diet is here. Course outline The course is delivered in five (5) modules broken down as follows. There are some pop-quizzes (True/False and Multiple choice questions) during the lessons which give you immediate feedback on the material covered. Module 1 – Understanding IBS Great overview of what IBS is Insight as to possible causes How is a diagnosis made? What are red flags and why they are important? Common tests to diagnose IBS Common and current treatment options including diet like the low FODMAP diet Module 2 – Introduction to FODMAPs FODMAPs have similar effects in the gut of a healthy person and someone with IBS; however, people with IBS are thought to experience symptoms when they eat high FODMAP foods because they have a more sensitive intestine FODMAP composition food guide (downloadable) Learn to identify high FODMAP foods and what are possible alternatives A fun FODMAP identification game challenges you to place foods under the right FODMAP group The low FODMAP diet is a 3 step diet. If you do not improve after step 1 then you need to look for other ways to manage your IBS symptoms. If you do, FODMAP intake will gradually increase over the 3 steps of the diet until you find the right levels of FODMAP that you can tolerate Module 3 – Step 1 Low FODMAP Diet Learn what’s it like from a patient’s experience to follow the low FODMAP diet Learn to use a Dietitian as a resource for what does and doesn’t work (Find Monash FODMAP Trained Dietitians on the Dietitian Directory) Tour of the Monash University FODMAP Diet app Understand the traffic light rating system for foods Serving size matters with FODMAPs All about swapping high FODMAP foods for low FODMAP alternatives for meals and recipes Cooking and food processing techniques that involve water may lower FODMAP content because preparing a FODMAP ingredient by boiling may dissolve the high FODMAP content into the liquid. Fermentation or pickling of some ingredients also lower FODMAP content. Shopping tip: The Monash FODMAP Diet app has a shopping list feature Understand what FODMAP stacking is, ie: can you eat multiple Green rated foods in a single sitting? Module 4 – FODMAP Reintroduction Wait until your symptoms are well controlled before beginning the FODMAP reintroduction step Food challenges help you to understand which FODMAPs you tolerate and which are your trigger symptoms. You do this for only 2-6 weeks. Use the diary function in the Monash Fodmap app to record symptoms from food challenges The long term effects of an exclusive low FODMAP diet are unknown as the diet reduces prebiotic intake and it is unknown the effect this will have on the growth of beneficial bacteria. Additionally you will be missing out on important nutrients a strict low FODMAP diet. Having a less restrictive diet is more enjoyable and likely easier to maintain Only challenge yourself with high FODMAP foods over 1-3 days while staying on a safe diet so you do not confuse the results Use a break of 2-3 days between challenges IBS symptoms during the challenges are unpleasant, but limited Minor tolerable symptoms may be just usual digestion and not a need to stop challenging yourself Module 5 – FODMAP Personalization Personalization is about introducing your successful challenge FODMAP foods from step 2 with your safe FODMAP foods from step 1 Aim to develop a diet with a Dietitian which is as least restrictive as possible that helps to minimize IBS symptoms Tolerance may change over time; re-challenge in 3-6 months Strategies are presented that you can try if you flare while maintaining a personalized FODMAP diet Filters within the Monash FODMAP App help personalize your sensitives to FODMAPs by adjusting the Food Guide You can always return to a more restrictive FODMAP diet during a flare for a short period of time In summary: I highly recommend this well organized and informative course from Monash University. Monash University allows you to enjoy 2 weeks free access to Module 1 of the 5 module course. Learn more or sign-up for the Patient course here. Note: We have not received any payment from Monash University to review or recommend this Patient course. We strongly believe that it provides education about a treatment option that may be beneficial for some IBS sufferers.

Fructan can cause symptoms in non celiacs ingesting wheat products Another important slide to understand mechanisms why we have symptoms by ingesting wheat and have negative diagnosis of celiac #ACG2019 by @umfoodoc Ironwood Pharmaceuticals, Inc. (IRWD), a GI-focused healthcare company, today announced the presentation of clinical data for linaclotide and MD-7246, as well as results from a survey for patients with persistent gastroesophageal reflux disease (GERD), from Ironwood and its collaborators during the American College of Gastroenterology (ACG) 2019 Annual Scientific Meeting being held in San Antonio, TX, October 25 through October 30, 2019. A linaclotide poster at the meeting was recognized by the ACG as a Presidential Poster Award recipient. Every year less than 5% of accepted abstracts receive this distinction for high quality, novel, unique, and interesting research. The abstract features safety and efficacy data from a Phase II trial of linaclotide in pediatric patients aged six to 17 with functional constipation. Linaclotide, a guanylate cyclase‐C (GC‐C) agonist, is activated by a mechanism pioneered by Ironwood scientists. Phase I data demonstrating the limited effect of MD-7246 on bowel frequency and stool consistency in healthy volunteers will be presented in a poster session. MD-7246, an investigational product, is being evaluated as an oral, intestinal, non-opioid, pain-relieving agent for patients suffering from abdominal pain associated with certain GI diseases, including IBS with diarrhea (IBS-D). MD-7246 is a delayed-release formulation of linaclotide designed to provide targeted delivery of linaclotide to the colon, where the majority of the abdominal pain associated with IBS-D is believed to originate, and to limit fluid secretion in the small intestine resulting in minimal impact on bowel function. Salix Pharmaceuticals to Present New Clinical Data at the American College of Gastroenterology (ACG) Annual Meeting Published: Oct 28, 2019 TRULANCE® (plecanatide) Poster Presentation Recognized with Presidential Poster Award Distinction TRULANCE® (Plecanatide) Darren M. Brenner, MD. "Impact of Plecanatide on Symptoms and Quality of Life for Patients with Chronic Idiopathic Constipation: Analysis of PAC-SYM and PAC-QOL From Two Phase III Clinical Trials." Poster #P0341; Sunday, Oct. 27, 3:30 p.m. – 7:00 p.m. CT; Exhibit Halls 3 and 4 (street level); Recipient of the Presidential Poster Award Gregory Sayuk, MD. "Plecanatide for Patients with Chronic Idiopathic Constipation and Irritable Bowel Syndrome-Constipation: Analysis of Abdominal Bloating from Four Randomized Phase 3 Clinical Trials." Poster #P2157; Tuesday, Oct. 29, 10:30 a.m. – 4:00 p.m. CT; Exhibit Halls 3 and 4 (street level) XIFAXAN® (Rifaximin) Brian Lacy, PhD, MD. "Impact of Colonoscopy Timing on Rifaximin in Patients with Irritable Bowel Syndrome with Diarrhea (IBS-D)." Poster #P2164; Tuesday, Oct. 29, 1:00 p.m. – 2:15 p.m. CT; Exhibit Halls 3 and 4 (street level) PLENVU® (polyethylene glycol 3350, sodium ascorbate, sodium sulfate, ascorbic acid, sodium chloride and potassium chloride for oral solution), also known as NER1006 Michael S. Epstein, MD, FACG; "Electrolyte Shifts of NER1006 Bowel Preparation for Colonoscopy in the Elderly Are Transient and Well-Tolerated." Poster #P0368; Sunday, Oct. 27, 3:30 p.m. – 7:00 p.m. CT; Exhibit Halls 3 and 4 (street level) Michael S. Epstein, MD, FACG, "1 L NER1006 Improves High-Quality Colon Cleansing and Mean Polyp Detection versus Oral Sulfate Solution and 2 L Polyethylene Glycol Plus Ascorbate." Poster #P2030; Tuesday, Oct. 29, 10:30 a.m. – 4:00 p.m. CT; Exhibit Halls 3 and 4 (street level) Michael S. Epstein, MD, FACG; "In Patients with an Overall Cleansing Success the 1L Polyethylene Glycol NER1006 Achieves More High-Quality Cleansed Segments per Patient Than Three Standard Bowel Preparations." Poster #2031; Tuesday, Oct. 29, 10:30 a.m. – 4:00 p.m. CT; Exhibit Halls 3 and 4 (street level) Brooks D. Cash, MD, FACG. "Patient Experience with NER1006 as a Bowel Preparation for Colonoscopy: A Prospective, Multicenter U.S. Survey." Poster #P0372; Sunday, Oct. 27, 3:30 p.m. – 7:00 p.m. CT; Exhibit Halls 3 and 4 (street level) Avoidant/Restrictive Food Intake Disorder May Be Underdiagnosed Gastroenterology patients with avoidant/restrictive food intake disorder (ARFID) are less likely to be taking psychotropic medications, have less-severe body image concerns, and are frustrated with being unable to eat what they want compared with patients without ARFID, according to study findings presented at the American College of Gastroenterology (ACG) 2019 Annual Scientific Meeting and Postgraduate Course. The findings suggest the need to appropriately screen gastroenterology patients for ARFID and the importance of a using a multidisciplinary treatment approach. >> https://www.consultant360.com/exclusive/gastroenterology/insights-american-college-gastroenterology-2019/avoidantrestrictive-food >> https://www.healio.com/gastroenterology/nutrition/news/online/{eda3e067-5b29-40d5-90bd-8f999c2a1c9f}/avoidant-food-intake-disorder-rarely-connected-with-body-image-concerns Plenary Session at ACG 2019 Conference Reports Unique Blend of HMOs Significantly Improves IBS Symptoms A nationwide multi-center, open label trial on human milk oligosaccharides (HMOs) found that daily intake of a unique formulation of glycans can significantly improve patients' IBS symptoms. “Human Milk Oligosaccharides Improve All the Central Symptoms of Irritable Bowel Syndrome: A Multi-Center, Open Label Trial” will be presented by Magnus Simrén, MD, PhD, Professor and Senior Consultant at the Department of Internal Medicine & Clinical Nutrition for the Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden. Dr. Simrén is also an adjunct professor of medicine at the University of North Carolina School of Medicine in Chapel Hill. Patients were given daily doses of a proprietary blend of HMOs — 2’-FL (2’-fucosyllactose) and LNnT (lacto-N-neotetraose) — found in Holigos® (hōly-gōs) IBS, a medical food to be taken under medical supervision, available without a prescription. The trial results demonstrated significant improvement in overall symptoms (fecal consistency, abdominal pain, and bloating) as well as improved quality of life as measured by IBS Severity Scoring System (IBS-SSS). The findings in this new study support the growing acceptance in the medical community of microbiota-directed therapies, such as the inclusion of prebiotic HMOs in IBS dietary planning. Glycom is a global biotechnology company dedicated to the scientific, clinical, and commercial development of human milk oligosaccharides (HMOs) for a broad range of health applications. Glycom, headquartered in Hørsholm, Denmark, is the world’s leading supplier of HMOs and has a U.S. facility located in Covington, La. Glycom is privately held. For more information about Glycom, visit glycom.com. Additional info from MD Magazine >> https://www.mdmag.com/conference-coverage/acg-2019/human-milk-oligosaccharides-may-help-ease-irritable-bowel-syndrome-symptoms >> https://www.prnewswire.com/news-releases/study-shows-human-milk-oligosaccharides-significantly-improve-ibs-symptoms-300947860.html >> https://www.gastroenterologyadvisor.com/irritable-bowel-syndrome-ibs/effects-of-human-milk-oligosaccharides-on-gastrointestinal-symptoms-in-ibs-qa-with-dr-magnus-simren/ >> https://www.medpagetoday.com/meetingcoverage/acg/83031 Celiac disease patients diet is perceived to be higher burden than patients with HTN, DM2, GERD, IBD or IBS. #ACG2019

Breath tests are used to detect gases which are produced by bacterial fermentation of unabsorbed carbohydrates and then passed through your breath. Breath tests are used in the diagnosis of carbohydrate malabsorption and small intestinal bacterial overgrowth or SIBO. Malabsorption of carbohydrates has been seen as a key trigger of irritable bowel syndrome-type symptoms such as diarrhea or constipation, bloating and excess gas. FoodMarble AIRE is a portable breath test device that can measure gases which might be able to identify which foods you are not absorbing which are causing you IBS-like symptoms. FoodMarble AIRE measures your body’s response to how it digests food by analyzing your breath and giving you immediate results. It also helps you to identify possible trigger components in different foods by tracking and trending your results over time using the smartphone app. The FoodMarble AIRE works by analyzing hydrogen in your breath similar to how labs do it. Listen to our podcast with Aonghus Shortt,PhD Co-Founder & CEO, and Claire Shortt,PhD Chief Scientist from FoodMarble who were my guests while at Digestive Disease Week in San Diego 2019. They explained what was the purpose in creating the AIRE breath test device, how does it work and how this might benefit an IBS sufferer especially when it comes to analyzing foods in a low FODMAP diet. https://www.ibspatient.org/podcasts What's in the box: AIRE portable breast test device: FODMAP Program (optional):

Chey: non-celiac responders to gluten is a subset group of patients Chey: Numerous RCT’s (randomized control trials) for low FODMAP most consistently for pain and bloating Chey: low FODMAP diet real live data is different than clinical trials as we don’t know long term elimination and reintroduction Chey: FODMAP Elimination is the beginning, not the end! Great message for all these doctors to hear. It’s a *process*, not just a list of low-FODMAP foods. See https://www.ibspatient.org/lowfodmap/ for more info. Chey: Can we utilize the microbiome to indicate who will do well on the low FODMAP diet for IBS? Chey: Fecal microbiome predicts IBS patients response to a low FODMAP diet Chey: Congenital Sucrase-isomaltese deficiency (CSID) is under diagnosed in IBS-D patients Chey: Supplementation (prebiotic) had same response as low FODMAP diet. Suggest that it might be beneficial in some patients eg: Glutamine for PI-IBS (post infectious IBS) Chey: Dietary manipulation is a critical part of the treatment strategy in patients with IBS. Food is complicated. Caterina Oneto: Several trials have shown the benefit of low #FODMAP diet in #IBS . Mechanism not entirely clear, but we do know that the low FODMAPs diet is associated with a) decreased total bacterial abundance and b) increased microbial diversity Premysl Bercik: Bacterial production of histamine may be an important factor in mechanism behind the benefit of a low FODMAP diet in reducing pain in IBS Shanti Eswaran: Reports lower response to low FODMAP diet in IBS patients with sucrase isomaltase gene defects. Something to consider in low FODMAP Diet non-responders.

I have been following the low FODMAP diet for nearly 2 years now and have had times in my life where it has felt really difficult and other times it has been easier. One of the hardest times was over Christmas; people tried to include me and buy me treats that were gluten and lactose free but many of these products were still high FODMAP so not only was I deprived but also now in an even more awkward situation. That's why I've decided to start making Low FODMAP foodie gift box. Whether you are looking to treat yourself or you're after some gift ideas you can rest assured that all items are safe for events elimination phase. For more information on what's inc!used and how to order, take a look at my finder https://www.fiverr.com/swain326/create-a-low-fodmap-gluten-free-lactose-free-gift-box-hamper-12fa

The Low FODMAP Diet: Elimination is the Beginning NOT the End The team at Monash University in Australia, led by Professor Peter Gibson MD, developed the low FODMAP diet. In its strictest sense it is not so much a diet as it is a diagnostic tool for helping to determine whether foods in your diet are involved in contributing to your gastrointestinal symptoms. Some IBS sufferers have unfortunately been using the low FODMAP diet as a forever elimination diet whereas it was designed to be a three phase process. Taking on the three phase diet process by yourself is not recommended. An experienced FODMAP Dietitian is your best ally for using this diet as a diagnostic tool for symptoms. >> Read More

My IBS symptoms started in October 2014.I had constipation, burping and excruciating pain under my ribs.I lost 35 pounds (15.8kg) in weight because I basically stopped eating due to the pain. I was off work for 2 months and spent the best part of 8 months in my bedroom. It was May 2015 before I was diagnosed as having IBS. In June 2015 I discovered the FODMAP diet and started by reducing all FODMAP groups. The symptoms reduced 90% within days. In the next few months I discovered my trigger groups were O (inc. wheat, onion, garlic,sweetcorn,brocolli) and M (inc .apples, pears and anything containing glucose fructose syrup). Over the next year I found my tolerance to O and M foods gradually improved but I still had to limit foods that were very high in these FODMAPs. (wheat, onions and garlic in particular), Then I decided to introduce a potent probiotic that did well in independent clinical trials. Its called VSL3 and it is very expensive. To save cost I only took half the dose but mixed it in a relatively cheap probiotic yogurt drink called Actimel. I took the VSL3 first thing in the morning before eating. This is because stomach acid is low at this point which gives the probiotic bacteria the best chance of surviving and reaching the bowel. This seemed to speed up my recovery and I was been able to eat wheat, garlic, onion and foods containing glucose fructose syrup in surprisingly large amounts without any symptoms. There is no instant cure for IBS. I believe it is predominantly a problem of bacterial species mix in the bowel. Changing the species mix in the bowel does not happen overnight. Both the foods we eat and some probiotics can change the mix but there is no magic formula that fits everyone. For me the mix of the FODMAP diet and VSL3 seems to have brought my IBS to an end. The key to defeating IBS is understanding it. I learnt a lot about IBS from my experience so have shared it in a blog to help others who suffer this awful condition. You can view the blog here.