Irritable Bowel Blog

Adding red to your diet

2011-11-12T10:05:00.000-08:00

We are always happy receiving nice e-mails from users. Here is a recent letter:

Dear Aurametrix,

I would like to share with you some interesting results that really surprised me, even though they're a little embarrassing.

I've been using Aurametrix now about 2 months but mostly on days when I experience a symptom (2 entries for diarrhea). So about 20 entries in all, including food, a few feeling good plus these symptoms:

Diarrhea, experienced 1 bout around 2:30 PM PDT on September 18, 2011

Diarrhea, experienced 1 bout around 3:30 PM PDT on October 30, 2011

I did an analysis on the second day: Diarrhea relative to Feeling Good, 12 hours

These are the results copied from the tool:

Based on your Aura entries, the following may be contributing to "Diarrhea" in a 12 hour timeframe:

Lycopene (when consumed more than 5.9 micrograms, up to 2650.6)

Orange or Yellow fruits and veggies (when consumed more than 0.1 foods, up to 1.0)

I looked up lycopene and it's a chemical in orange-colored fruits. It so happens that I ate mango one day and a raw papaya on the other day I experienced the symptoms. I think I will avoid these fruits in the future (I haven't had any since I learned about it from Aurametrix)

You can post this if you want since I think it's worthwhile to let other people know that the tool really works and I don't have symptoms.

Regards,

Aurametrix User :)

Lycopene is a carotenoid, a pigment that gives fruits and vegetables a red color. It is found in some red, pink, orange and yellow fruits and vegetables such as tomatoes (especially skins), watermelons, grapefruits, apricots, papayas, and guavas.

Lycopene is an antioxidant, but in the human body it converts into lycopenoids with the help of carotenoid monooxygenase (CMO) enzymes. Lycopene metabolism depends on the person. It is more efficient in those with more active CMOs, higher testosteron and those not restricting dietary intake.

A number of studies have suggested that a higher intake of lycopene-containing foods decreases the risk of heart disease, prostate cancer, other cancers and infections, even cataracts and asthma. Lycopene is thought to prevent male infertility, osteoporosis, varicose veins and eye disease. Lycopene may also reduce or prevent the side effects of chemotherapy.

What are the potential side effects? In one Mayo Clinic study (Jatoi et al, 2007), the most common side effect for patients who took 15,000 micrograms of lycopene twice per day was diarrhea (41% of patients), followed by nausea (26%), abdominal distension (17%), and flatulence (4%).

The same effects were also observed by IBS sufferers - like this case of massive diarrhea from fresh tomato on a sandwich or this bad gut reaction to tomato sauce. Mangoes and Papayas are usually considered safe for IBS, yet occasional incidents are posted on the web.

So, should you limit your Lycopene intake if Aurametrix indicates it may cause your diarrhea? Take a note about it and keep analyzing your diet. Analyses that start from "Aura entries" examine food combinations and will tell you if there is something that negates the effect. Perhaps there was a day when you ate it and felt OK. You might not remember it, but Aurametrix will.

REFERENCES

Jatoi A, Burch P, Hillman D, Vanyo JM, Dakhil S, Nikcevich D, Rowland K, Morton R, Flynn PJ, Young C, Tan W, & North Central Cancer Treatment Group (2007). A tomato-based, lycopene-containing intervention for androgen-independent prostate cancer: results of a Phase II study from the North Central Cancer Treatment Group. Urology, 69 (2), 289-94 PMID: 17320666.

Kelkel M, Schumacher M, Dicato M, Diederich M. (2011) Antioxidant and anti-proliferative properties of lycopene. Free Radic Res. 2011 Aug;45(8):925-40. Epub 2011 May 26.

Brian L. Lindshield, Kirstie Canene-Adams, John W. Erdman Jr (2007) Lycopenoids: Are lycopene metabolites bioactive? Archives of Biochemistry and Biophysics. Volume 458, Issue 2, Pages 136-140.

Hold the Starch?

2011-08-14T18:00:00.000-07:00

Starch is that stuff that stiffens your shirts. It's also what most people eat for fuel. Wheat, rice, corn, oats, potatoes are all very starchy foods. Many popular diet plans call starch a second-rate food that should be avoided at all costs. No-starch and low starch diets are favored by irritable bowel communities, while former Weight Watchers, Jenny Craig and Atkins enthusiasts love the new Carb Lovers Diet praising starch. Yet, there may be something good about starch even for those with sensitive stomachs.

Starch is a mixture of long and intermingled molecules digested with different rates and outcomes. Our bodies' response to eating starch depends on its amount and types along with our nature [1] and nurture, including intestinal microbes eating the leftovers [2].

Resistant Starch (RS), also called Functional Fiber, is a type of starch that may have beneficial physiological effects. It is further classified into four or five classes, like RS2 in potatoes or RS3 (maltodextrin on food labels) formed when starchy foods are cooked and cooled. Resistant starch is not digested in the small intestine of healthy individuals. It is an effective prebiotic as it feeds and stimulates specific bacteria in the gut [3]. Bacteria consuming resistant starch raise levels of short-chain fatty acids (SCFA) and derivatives that can act as a source of energy [2,4] and provide other benefits like protection from inflammatory conditions of the bowel.

Over 200 nutritional studies showed that resistant starch increases satiety, reduces food consumption and can prevent weight regain, acting almost like exercise. It also lowered insulin levels and reduced the deposition of fat.

How much resistant starch do we need to eat?

Adults in most developed countries consume between 3-7 grams of resistant starch per day. The Carb lovers diet recommends 10-15 grams. According to an earlier Australian study [5], 20 grams per day may be even more beneficial. However, optimal levels of resistant starch in diet are very individual, depending on body weight, metabolism, microbial makeup and dietary preferences. Flatulence and belching are among potential side effects.

Resistant starch is like other types of fiber and prebiotics – everybody has their own individual threshold and every extra gram leads to production of excessive gas [6].

Fructooligosaccharides (FOS) and inulin, prebiotics selectively stimulating bacteria in the colon, usually lead to mild flatulence starting from about 10 grams per day. Isolated individuals experience discomfort even at 5 grams. 14-15 grams per day usually mark the threshold for significant increase in flatulence, stomach growling and cramping. Resistant starch may have slightly higher sensitivity thresholds [6].

Source	Total starch, per 100 g	Resistant starch, per 100 g
Lentils	53.3	25.4
Red kidney beans	42.6	24.6
Black-eyed peas	53.9	17.7
Potato chips	29.5	4.8
Long-grained rice, parboiled	25	3.7
Spaghetti, cooked for 9 mins	22	2.9
Mashed potatoes	8.5	2.4
Boiled potatoes	15	2
White bread	46.7	1.9
Rye crisps	67.4	1.4
Puffed wheat cereal	67	1.2
Medium-grained rice, boiled	25	0.6
Spaghetti, cooked for 12 mins	22	0.9
Oatmeal (Oat porridge)	9	0.3

Understanding what amounts are right for you takes careful analysis and evaluation Don’t forget about the digestible starch that accompanies indigestible starch. Ideally, our enzymes can efficiently break down the digestible starch into glucose, but the process is so lengthy (5-7 hours) that overload could result in more starch leaking through pores in the small intestine before it has a chance to be digested. This leads to endotoxins and an excess of methane and carbon dioxide, in addition to other metabolic end products, in your system.

So remember: there are different types of starch and they usually come packaged with other food components for which you might have separate sensitivities. In other words, your mileage may vary.

REFERENCES

[1] Perry GH, Dominy NJ, Claw KG, Lee AS, Fiegler H, Redon R, Werner J, Villanea FA, Mountain JL, Misra R, Carter NP, Lee C, Stone AC. Diet and the evolution of human amylase copy number variation. Nat Genet. 2007 Oct;39(10):1256-60. Epub 2007 Sep 9.

[2] Bird AR, Conlon MA, Christophersen CT, & Topping DL (2010). Resistant starch, large bowel fermentation and a broader perspective of prebiotics and probiotics. Beneficial microbes, 1 (4), 423-31 PMID: 21831780

[3] Gray, G. Dietary fibre – from definitions to public health messages (pages 159–161). Article first published online: 13 Aug 2008 | DOI: 10.1111/j.1467-3010.2008.00702

[4] Donohoe, DR, Garge, N, Zhang, X, Sun, W, O'Connell, TM, Bunger, MK, Bultman, SJ. (2011). The Microbiome and Butyrate Regulate Energy Metabolism and Autophagy in the Mammalian Colon. Cell Metabolism 13 (5): 517–26

[5] Baghurst PA, Baghurst KI, Record SJ, Dietary fibre, non-starch polysaccharides and resistant starch – a review. Food Australia, 1996 Vol 48, No. 3:S1-S35.

[6] Brighenti F, Pellegrini N, Casiraghi MC, Testolin G (1995) In vitro studies to predict physiological effects of dietary fibre. European Journal of Clinical Nutrition 49, Suppl. 3, S81±S88

[7] Elmståhl, L.H. Resistant starch content in a selection of starchy foods on the Swedish market. European journal of clinical nutrition: 2002 Jun;56(6):500-5.

Tryptophan in food: Will it make you happy, sleepy or smelly?

2011-05-30T18:25:00.000-07:00

And the answer is ... either or all of the above. And this is not a complete list of all that can happen. In some rare conditions, for example, tryptophan could also make your pee purple.

Tryptophan supplements were used as a popular sleeping aid until negative press in 1989. The FDA banned dietary tryptophan supplements from the market, just days before the arrival of Prozac rising as the new promise for chemical happiness. Further investigation showed that ill effects of tryptophan were actually due to a contaminant in the supplement not the amino acid itself.
Today you can find tryptophan at many supplement retailers. You can also get it from food - from chocolate or red meat, for example. What does it really do in our bodies?

Tryptophan is a complex aromatic amino acid - one of eight "essential" amino acids that have to be taken with food as they cannot be created by the human body. Tryptophan metabolism is complex - KEGG pathway shows the multitude of reactions it participates in.
One of tryptophan metabolites - Kynurenic acid - is involved in the regulatory function of the gastrointestinal system and the modulation of the inflammatory response. Another metabolite is neurotransmitter Serotonin which has a calming and sleeping-inducing effect on the brain.
L-Tryptophan administration (2 g) as a single dose before a meal has been found to decrease subjective hunger ratings, food intake, and alertness in men (Hrboticky et al., 1985), but not women (Leiter et al., 1987). Babies were also found to get sleepier (20 mg supplementation, Yogman and Zeisel, 1983, 1985). Tryptophan can be used by the body to create 5-hydroxytryptophan (also known as 5-HTP and oxitriptan). 5-HTP is sold as a dietary supplement as an antidepressant and sleep aid. It is marketed under many different trade names such as Cincofarm, Levothym, Oxyfan and Triptum. Studies showed that 5-HTP provides benefits with regard to depression, blood pressure and regular sleep patterns. So even though that fact that the Thanksgiving turkey is responsible for sleepiness is an urban legend, tryptophan could definitely contribute to calmness and happiness.

Yet, according to a study by British researchers, irritable bowel syndrome sufferers have an increase in gastrointestinal symptoms after ingestion of a large dose of tryptophan, in addition to having fewer symptoms of anxiety and depression. One of the reasons: tryptophan metabolism mostly happening along the kynurenine and not 5-HT pathway. Increased tryptophan catabolism was recently shown to be associated with depression, reduced motivation and pessimism in the elderly. According to earlier studies (like the referenced 1998 articles by Austrian scientists), people with fructose malabsorption have abnormal tryptophan metabolism too, leaving them with less available tryptophan, and it seems to be responsible for mental depression (Ledochowski et al., 1998). Overdose of tryptophan in healthy adults (5 g in a double-blind, placebo-controlled study) induced severe nausea and headache and increased drowsiness soon after ingestion (Greenwood et al., 1975).
What happens to tryptophan abnormally accumulated in intestines? Here come more bad news - it is utilized by intestinal bacteria (e.g. Lactobacillus) and converted into indole and skatole - metabolites responsible for strong fecal smell. The rate of production of these smelly compounds depends on the acidity - it is greatest at pH 6.5 and less at pH 5.0 and 8.0. Food-food interaction could lessen or enhance the "smelly"effects. The suppression of tryptophan degradation by propolis, for example, could contribute to beneficial health properties. Preliminary results were also reported for cocoa extracts, Fructooligosacharides (FOS) and resistant starch, but more studies are needed.

So, how much tryptophan do you really need? Half a gram, 2 grams, even more? It depends on your metabolism, your life style and your diet. It may be a good idea to watch your wellbeing along with tryptophan intake, to find your own optimal daily value.

REFERENCES

Capuron L, Schroecksnadel S, Féart C, Aubert A, Higueret D, Barberger-Gateau P, Layé S, & Fuchs D (2011). Chronic Low-Grade Inflammation in Elderly Persons Is Associated with Altered Tryptophan and Tyrosine Metabolism: Role in Neuropsychiatric Symptoms. Biological psychiatry PMID: 21277567

Christmas DM; Badawy AAB; Hince D; Davies SJC; Probert C; Creed T; Smithson J; Afzal M; et al. (Oct 2010). Increased serum free tryptophan in patients with diarrhea-predominant irritable bowel syndrome. NUTR RES. 30:678-688. DOI.

Hood SD; Hince DA; Davies SJC; Argyropoulos S; Robinson H; Potokar J; Nutt DJ. (Feb 2010). Effects of acute tryptophan depletion in serotonin reuptake inhibitor-remitted patients with generalized anxiety disorder. PSYCHOPHARMACOLOGY. 208:223-232. DOI.

Shufflebotham J; Hood S; Hendry J; Hince DA; Morris K; Nutt D; Probert C; Potokar J. (Nov 2006). Acute tryptophan depletion alters gastrointestinal and anxiety symptoms in irritable bowel syndrome. Am J Gastroenterol. 101:2582-2587. DOI.

Ledochowski M, Widner B, Murr C, Sperner-Unterweger B, Fuchs D. Fructose malabsorption is associated with decreased plasma tryptophan. Scand J Gastroenterol. 2001 Apr;36(4):367-71.

Ledochowski M, Sperner-Unterweger B, Widner B, Fuchs D. Fructose malabsorption is associated with early signs of mental depression. Eur J Med Res. 1998 Jun 17;3(6):295-8.

Xu ZR, Hu CH, Wang MQ. Effects of fructooligosaccharide on conversion of L-tryptophan to skatole and indole by mixed populations of pig fecal bacteria. J Gen Appl Microbiol. 2002 Apr;48(2):83-90.

Jones HE, Johnson RE, Bigelow GE, Silverman K, Mudric T, Strain EC. Safety and efficacy of L-tryptophan and behavioral incentives for treatment of cocaine dependence: a randomized clinical trial. Am J Addict. 2004 Oct-Dec;13(5):421-37.

Jensen MT, Cox RP, Jensen BB. 3- Methylindole (skatole) and indole production by mixed population of pig fecal bacteria. Appl Environ Microbiol. 1995 Aug;61(8):3180-4.

Celenza JL. Metabolism of tyrosine and tryptophan - new genes for old pathways. Curr Opin Plant Biol. 2001 Jun;4(3):234-40.

Mohammed N, Onodera R, Khan RI. Tryptophan biosynthesis and production of other related compounds from indole and L-serine by mixed ruminal bacteria, protozoa, and their mixture in vitro. Curr Microbiol. 1999 Oct;39(4):200-4.

On seasonal allergies and IBS

2011-05-09T08:25:00.000-07:00

Irritable Bowel Syndrome is nothing to sneeze at. Especially during the sneezing season.

As a matter of fact, you are more prone to have irritable bowel if you have a seasonal allergy. The likelihood of IBS is 3 times higher in patients reporting atopic symptoms (2.67 times higher in patients with seasonal allergic rhinitis and 3. 85 times higher in patients with allergic eczema, according to Tobin and his colleagues who administered questionnaires to 125 patients). So some of that abdominal pain may be part of allergic disease. Almost any other symptom of IBS may owe to it, too. See for example this case involving leaky gut and diarrhea or this case of bloating and constipation.

It is May and grass pollen is adding to flowering trees in most of the US. Europe is experiencing high birch pollen counts with grasses ready to pop up. The Mediterranean region is dominated by the pollination of grasses and olive trees. Allergy season is over in Japan, Australia and South Africa but new pollen sources will be soon waking up.

Seasonal allergies are common. It is estimated that 15-20% of Americans suffer from seasonal and perennial allergies. Numbers of sufferers have been increasing over the years.

The best way to control allergies is to avoid the triggers - stay indoors, wash hands and take showers after coming in from outdoors. Of course, there are also drugs. But relief from allergies could come in more natural ways. For example, from probiotics.

A recent study showed that Lactobacillus paracasei, commonly found in our orifices (oral and rectal mucosa to be more precise) could help with grass allergies. This is not news - earlier research showed it was effective against diarrhea in infants and helped some patients with chronic fatigue syndrome and seasonal allergies.

The research was sponsored by Nestle, one of several manufacturers already adding L. paracasei to their products. Their results, based on a randomized, double-blind, placebo-controlled study, show that the ability of the nose to combat allergies significantly improves (NCT01150253). Where are these probiotics found? Lactobacillus bacteria are involved in dairy fermentation and are present in fermented milk products and cheeses. Irish Cheddar, hand-made Spanish cheeses, Ricotta, Italian hard cheeses and Mozzarella harbor many different strains of lactobacilli. Many of these products, however, are not tolerated well by the IBS population about half of which is lactose intolerant.

The good news is that probiotics are not only in dairy products. Lactobacillus paracasei LMGP22043 found in artichokes was recently shown to be carried into the human gut and challenge the bad guys there (E.coli and Clostridium). And even though European food safety authority believes that LMGP22043 does not relieve gastrointestinal discomfort, there were studies showing that artichokes do help those with alternating IBS. So enjoy your vegetables and lets do more research!

Source

REFERENCES

Valerio F, de Candia S, Lonigro SL, Russo F, Riezzo G, Orlando A, De Bellis P, Sisto A, & Lavermicocca P (2011). Role of the probiotic strain Lactobacillus paracasei LMGP22043 carried by artichokes in influencing faecal bacteria and biochemical parameters in human subjects. Journal of applied microbiology PMID: 21447019

Wassenberg J, Nutten S, Audran R, Barbier N, Aubert V, Moulin J, Mercenier A, & Spertini F (2011). Effect of Lactobacillus paracasei ST11 on a nasal provocation test with grass pollen in allergic rhinitis. Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology, 41 (4), 565-73 PMID: 21395878

Tobin MC, Moparty B, Farhadi A, DeMeo MT, Bansal PJ, Keshavarzian A. Atopic irritable bowel syndrome: a novel subgroup of irritable bowel syndrome with allergic manifestations.

Ann Allergy Asthma Immunol. 2008 Jan;100(1):49-53.

Sarker SA, Sultana S, Fuchs GJ, Alam NH, Azim T, Brüssow H, Hammarström L. Lactobacillus paracasei strain ST11 has no effect on rotavirus but ameliorates the outcome of nonrotavirus diarrhea in children from Bangladesh. Pediatrics. 2005 Aug;116(2):e221-8.

Bundy R, Walker AF, Middleton RW, Marakis G, Booth JC. Artichoke leaf extract reduces symptoms of irritable bowel syndrome and improves quality of life in otherwise healthy volunteers suffering from concomitant dyspepsia: a subset analysis. J Altern Complement Med. 2004 Aug;10(4):667-9.

Finding the Right 'Them': Internet Support Groups for IBS

2011-04-13T19:42:00.000-07:00

There is no cure for IBS and no definite causal links between bacteria, genes, lifestyles and health effects. Yet most people eventually learn how to manage their conditions and improve their health. The Internet has emerged as a key source of information for over 65 per cent of sufferers, with much of the knowledge coming from social media and ads.

Researchers are actively looking into the ways internet support groups help sufferers. Most studies find support groups are among the most successful approaches to managing chronic conditions and rare diseases. In fact, the more the members of these groups share common IBS symptoms, the better the outcomes.

According to other studies, however, over 60% of IBS sufferers would be better off if they "ignored the ‘wacky’ advice flooding the Internet. An example: someone who tried unsuccessfully to relieve cramps and help constipation using a mixture of vinegar, ginger and egg. Interestingly, neither of those who commented on the article thought that the Internet was the problem: physicians could also provide insufficiently personalized advice.

"There are no quick fixes, just common sense," comments another observer. After all, it takes time and effort to find the right "them" who are just like "us" in hopes of getting the right advice.

Here is a list of support groups for Irritable Bowel Syndrome:

IBSgroup.org: A Community for Irritable Bowel Syndrome and Digestive Health Sufferers

Members: over 41,000
Website launched in May 1995 (charter founded in 1987)

Alternative Medicine Forum - Yahoo group that welcomes "all who search for healing, including those with: ... Irritable Bowel, Leaky Gut..."

Members: over 9,800
Founded: Oct 23, 2001

Body Odor Support - forum for sufferers of Irritable Bowel Syndrome, leaky gut, TMAU and undiagnosed conditions increasing body odor (update: moved to proboards)

Internet group was originally founded in 2000, bodyodorsupport website launched in January 2009, it was moved to proboards in summer 2011

Eating for IBS - Yahoo group

Members: over 8,500
Founded: Jul 19, 2001

Fructose Malabsorption Australia: Yahoo group

Members: over 1,300
Founded: Dec 16, 2006

There are dozens more yahoo groups devoted to IBS, but they are either less active, small or over-spammed so are not listed here.

Local support groups are usually not very popular among IBS sufferers - people are less eager to travel for in-person meetings. Yet a few groups exist:

helpforIBS - forums for local IBS support groups

Largest group in Sacramento, California; followed by Berkshire, UK, Texas and Toronto, Canada
Founded: Dec 16, 2006

http://ibs.meetup.com/

Check also these message boards:

IBS forum at about.com
HelpforIBS message board
IBS community at HealingWell.com
IBS group at Dailystrength.org
IBS Blog forum
Candida and IBS forum
Curezone IBS forum
WebMD IBS community
IBS Group at SupportGroups
Not active since 2010 IBS forum
Colon cleansing and IBS forum
IBS discussions at HealthMessageBoards
I have IBS Chat Board, ExperienceProject

IBS Tales - IBS personal stories

Google IBS support group

References

Ramadas A, Quek KF, Chan CK, Oldenburg B. Web-based interventions for the management of type 2 diabetes mellitus: A systematic review of recent evidence. Int J Med Inform. 2011 Apr 8.

Vilhauer RP. 'Them' and 'us': The experiences of women with metastatic disease in mixed-stage versus stage-specific breast cancer support groups. Psychol Health. 2011 Jan 1:1-17.

Madan G, Stadler ME, Uhrich K, Reilly C, Drake AF. Adolescents with tracheostomies-Communications in cyberspace. Int J Pediatr Otorhinolaryngol. 2011 Mar 14.

Springer A, Reck CA, Huber C, Horcher E. Online hypospadias support group data analysis. J Pediatr Surg. 2011 Mar;46(3):520-4.

Andersson G, Ljótsson B, Weise C. Internet-delivered treatment to promote health. Curr Opin Psychiatry. 2011 Mar;24(2):168-72.

Quality of Life in Irritable Bowel Syndrome

2011-04-06T13:16:00.000-07:00

It's not news that IBS is tough. The unpredictability of symptoms, misunderstanding by peers, fear, misconceptions, desperation, all contribute to discrimination of sufferers and significant impairment of quality of life. In fact, IBS sufferers are affected by greater physiological and physical disturbances than patients of inflammatory bowel disease, proving that wellbeing is not directly associated with observable morbidity.

The most common psychological problems of IBS are anxiety, depression, panic, and post-traumatic stress. According to an Australian study (Mikocka-Walu et al, 2008), anxiety is a greater problem than depression, while a recent Korean study (Hyun Sun Cho et al., 2011) shows the same prevalence for anxiety and depression (observed in 38.6% and 38.6% of IBS patients, and in 24.2% and 16.5% of healthy subjects, respectively). Indeed, different cultural environments enhance or decrease problems associated with IBS - Greeks, for example, take it harder than the Swiss (Faresjö et al., 2006). Differences in IBS prevalence could also be the result of different environments, creating a reluctance to talk about digestive issues. In countries such as United States and UK more people may be suffering in silence.

The questionnaire below was developed by Kaiser Permanente (Longstreth et al., 2005) to capture the impact of irritable bowel syndrome and its treatment on patients’ lives.

&lt;p&gt;&amp;amp;amp;amp;lt;p&amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;am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References

Longstreth GF, Bolus R, Naliboff B, Chang L, Kulich KR, Carlsson J, Mayer EA, Naesdal J, Wiklund IK. Impact of irritable bowel syndrome on patients’ lives: development and psychometric documentation of a disease-specific measure for use in clinical trials European Journal of Gastroenterology & Hepatology 2005, 17:411–420

Groll D, Vanner SJ, Depew WT, DaCosta LR, Simon JB, Groll A, Roblin N, Paterson WG. The IBS-36: a new quality of life measure for irritable bowel syndrome. Am J Gastroenterol. 2002 Apr;97(4):962-71.

Faresjö A, Anastasiou F, Lionis C, Johansson S, Wallander MA, Faresjö T. Health-related quality of life of irritable bowel syndrome patients in different cultural settings. Health Qual Life Outcomes. 2006 Mar 27;4:21.

Mikocka-Walus AA, Turnbull DA, Andrews JM, Moulding NT, Wilson IG, Harley HA, Hetzel DJ, Holtmann GJ. Psychological problems in gastroenterology outpatients: A South Australian experience. Psychological co-morbidity in IBD, IBS and hepatitis C. Clin Pract Epidemiol Ment Health. 2008 May 23;4:15.

Cho HS, Park JM, Lim CH, Cho YK, Lee IS, Kim SW, Choi MG, Chung IS, Chung YK.
Anxiety, Depression and Quality of Life in patients with irritable bowel syndrome Gut Liver. 2011 Mar;5(1):29-36.

Much ado about Bowel Movement

2011-04-04T20:31:00.000-07:00

Want to manage your toilet metrics? There's an app for that. Actually, multiple apps - like this one recording precise GPS location of bowel events along with their shapes and odors or IBS symptom tracker and GI monitor, approved and designed by gastroenterologists.

Yet, the lists of metrics provided by these applications are not complete - no options to record color, consistency, texture, effort... And what about total time spent? According to IBS forums, it could range from seconds to ... "long enough to play a full game of Scrabble". An Israeli scientist (Sikirov, 2003) found that times "needed for sensation of satisfactory emptying" range from 50 to 130 seconds for healthy volunteers. He plotted time and effort vs the height of toilet (41cm or 16-inch-high, 31cm or 12-inch-high toilet, and a plastic container) and found notable correlations - the shorter the better. US team (Rao et al, 2006) evaluated internal pressures of subjects with a water-filled balloon or silicone-stool in their rectum, rating their stooling sensation. As one could guess, silicone was more pleasurable and sitting was better than lying flat. Japanese scientists (Sakakibara et al, 2010) measured hip flexon vs angularity of the rectoanal canal and recorded abdominal pressure. Their conclusion was that squatting helps.

This is in line with observations by IBS sufferers: like this one about getting down on hands and knees and rubbing the floor with head before going to bathroom. or keeping knees elevated by placing feet on a footstool.

Daniel Lametti who wrote this well-researched article for Slate (Not a bunch of Internet quackery!) conducted his own squatting experiment - each morning for a week, following a bowl of corn flakes and a cup of coffee . As his 10-minute routine dropped to a minute, he was able to free an hour per week for more productive work.

The moral of the story is that we need not only switch to stand-up desks for work, but also to better-designed toilets - like this one from Japan, adjustable to several different squatting and sitting postures.

Perhaps one day such toilets will make a splash in other parts of the world.

References

Sikirov D (2003). Comparison of straining during defecation in three positions: results and implications for human health. Digestive diseases and sciences, 48 (7), 1201-5 PMID: 12870773

Rao SS, Kavlock R, & Rao S (2006). Influence of body position and stool characteristics on defecation in humans. The American journal of gastroenterology, 101 (12), 2790-6 PMID: 17026568

Ryuji Sakakibara, Kuniko Tsunoyama, Hiroyasu Hosol, Osamu Takahashi, Megumi Sugiyama, Masahiko Kishi, Emina Ogawa, Hitoshi Terada, Tomoyuki Uchiyama, & Tomonori Yamanishi (2010). Influence of Body Position on Defecation in Humans. LUTS: Lower Urinary Tract Symptoms, 2 (1), 16-21

The FODMAP diet

2011-04-01T11:10:00.000-07:00

"Functional gut" symptoms (bloating, wind, abdominal distension,discomfort, pain, altered bowel habits) can be controlled by diet, but most theories of how exactly food components are linked to symptoms are lacking consistency. In 2005, Peter Gibson and Susan Shepard gave us food for thought by defining highly fermentable but poorly absorbed short-chain carbohydrates and polyols as an important dietary factor contributing to these symptoms ( see their original article that coined the term FODMAPs - Fermentable Oligo-, Di- and Mono-saccharides And Polyols).

Their studies of different patient groups (Irritable Bowel Syndrome, Irritable Bowel Disease, celiac disease, fructose malabsorption, patients who underwent colectomy, etc) showed that reduction of the intake of FODMAPs may help to reduce symptoms, depending on other things these people usually eat.

FODMAPs are types of sugars and fiber, found in wheat-based and other foods:

Fructans and Galactins	Polyols
Fructose Lactose Fructooligosaccharides Galactooligosaccharides	Sorbitol Mannitol Xylitol Maltitol

There is a cumulative effect of these foods, of their osmotic (water moving) and fermentative (bacteria feeding) actions, on IBS symptoms such as abdominal pain, bloating, gas, altered bowel movements and lethargy. Irritable Bowel Syndrome symptoms could result from many different (and independent) reasons including low absorptive capacity of the small intestinal epithelium, increased sensitivity of the bowel, rapid transit through the small bowel, and bacterial overgrowth in the distal small bowel.

This means that you may eat some of the problem foods listed in the tables and still fill fine. It's not about the foods eaten in isolation, it's about hundreds of food components that are adding up. To follow the right diet, you need to identify your individual sensitivities and dietary combinations.

For informational purposes only, we are listing candidate dietary components contributing to osmotic load and rapid fermentation thus increasing luminal pressure and distension, along with common high and low FODMAP foods - as listed in scientific publications. Red and green tables were compiled by a FODMAP-sensitive IBS sufferer based on his own experiences - check his post: "Printable FODMAP Diet Chart for your Convenience". Another FODMAP list compiled by trial and error can be found here.

Fruits:

• Serving size is ½ cup

• Limit to 1 to 2 servings per day.

• Fresh or fresh frozen fruit may be better tolerated than canned fruit.

• Keep in mind tolerance may depend on the amount you eat at one time.

• Limit concentrated sources of fruit--such as dried fruit and fruit juices

• Avoid eating large amounts of any fruit.

Intestine Friendly	Avoid if FODMAP Intolerant	Questionable May Need to Limit
Bananas (could be gas forming), blackberries, blueberry, grape, grapefruit, honeydew, kiwifruit, lemons, limes, mandarin orange, melons, oranges, papaya, passionfruit, pineapples, raspberries, rhubarb, strawberries, tangelos	Apples, apple cider, apple juice, applesauce, apricots, cherries, dates, grapes, lychee, mango, peaches, pears, pear juice, plums, prunes, watermelon	Other fruit juices or drinks, sugar-free jam/jelly, dried fruit, canned fruit in heavy syrup, other fruits

Vegetables:
• Serving size is ½ cup (most vegetables) or 1 cup of leafy green vegetables
• Limit to 1 ½ to 3 servings per day.
• Cooked vegetables may be tolerated best as cooking causes a loss of free sugars.
• Keep in mind tolerance may depend on the amount you eat at one time.

Intestine Friendly	Avoid if FODMAP Intolerant	Questionable
Bamboo shoots, bok choy, carrots, cauliflower (gas forming), celery, cucumber (gas forming), eggplant (gas forming), green beans (gas forming), green peppers (could be gas forming), leafy greens, parsnip, pumpkin, spinach, sweet potatoes, white potatoes, other root vegetables	Artichokes, asparagus, some beans (baked beans, chickpeas, kidney beans, lentils) beetroot, broccoli, Brussels sprouts, cabbage, cauliflower, fennel, garlic, sugar snap peas, leeks, soy products, okra, onions, peas, shallots	Avocado, corn, mushrooms, tomatoes, other beans

Other

Intestine Friendly	Avoid if FODMAP Intolerant	Questionable
Meat, Fat, Yogurt and hard cheeses, Eggs, Aspartame (Equal® and Nutrasweet®), Saccharin (Sweet ‘n Low®), Sucrose (table sugar), Glucose, Maple syrup	Honey, Flavorings with fructose or sorbitol, Desserts (ice cream, candy, cookies, bars, popsicles) sweetened with fructose or sorbitol, Cereal or other processed foods with sorbitol or fructose on the label, Wheat, Sherry and port wine, Sweeteners such as sorbitol, mannitol, xylitol, maltitol, and isomalt used in sugar-free gum, candies and mints	High-fructose corn syrup, Lactose

And here are two more tables with foods already listed above, just to show why they are problematic for FODMAP-sensitive people.

Note that some of the foods listed as intestine friendly may be less friendly for some people inducing functional gut symptoms. Inulins - often included in prebiotic supplements - are longer chain fructans thus are expected to be more intestine-friendlier than fructans with low degree of polymerization. Yet inulins often lead to increased wind.

Scientific publications:

Gibson PR, Shepherd SJ. Personal view: food for thought--western lifestyle and susceptibility to Crohn's disease. The FODMAP hypothesis. Aliment Pharmacol Ther. 2005 Jun 15;21(12):1399-409. Review.

Barrett, J.S., Gibson, P.R. Nutrition issues in Gastroenterology, Series # 52 Clinical Ramifications of Malabsorption of Fructose and Other Short-chain Carbohydrates. Practical Gastroenterology 2007 XXXI:51-65

Gibson PR, Newnham E, Barrett JS, Shepherd SJ, Muir JG. Review article: fructose malabsorption and the bigger picture. Aliment Pharmacol Ther. 2007 Feb 15;25(4):349-63. Epub 2007 Jan 8.

Gibson, P. & Shepherd, S. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. Journal of Gastroenterology and Hepatology 2010 25:252-258.

Biesiekierski JR, Newnham ED, Irving PM, Barrett JS, Haines M, Doecke JD, Shepherd SJ, Muir JG, Gibson PR. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol. 2011 Mar;106(3):508-14. Epub 2011 Jan 11

Rangnekar AS, Chey WD. The FODMAP diet for irritable bowel syndrome: food fad or roadmap to a new treatment paradigm? Gastroenterology. 2009 Jul;137(1):383-6. Epub 2009 May 29.

Other links:

The FODMAP Theory for IBS
Does the FODMAP Diet Help IBS?
IBS and FODMAPs
Wikipedia article on Fructose malabsorption
Center of research on FODMAP diet
A list of individual sensitivities by a sufferer for whom a low FODMAP diet worked
FODMAP update from Crystal Nelson
Low Fodmaps discussion on IBSgroup.org
Foodmap article and discussion on HealthHype.com
Foodmaps discussion on HealingWell.com
Foodmap discussion on Celiac Disease forum
Fodmap questions on Colitis forum
Foodmaps discussed on Crohn's forum (J-Pouch group)
Fodmap diet discussed on Diabetes forum
Foodmap Diet discussed by Wedding community
Low Foodmap diet for IBS on SparkPeople
Foodmap discussions on Fructose Malabsorption Yahoo forum (subscription required)
FODMAP diet on Facebook

Who Blogs about IBS?

2011-03-30T09:59:00.000-07:00

The Internet has opened up a whole new world for healthcare consumers. An enormous information imbalance has gradually decreased, giving patients opportunities to cross-check physician recommendations and ask better questions. Perhaps even more importantly, the Internet has provided new venues for support groups and healthcare consumers to join in on the conversation and share their experiences.

Support groups are not a new phenomenon. The power of self-help groups was first demonstrated by alcoholics. Alcoholics Anonymous (founded in 1935) helped many of those considered hopeless, something that the medical establishment was not able to do.

Of course, there have been worries that the Internet might fuel hypochondriacs. But even those critics admitted that "if a computer makes you sick, you can then use it to help you get better."

Computer-mediated communication has added more power to emerging Health 2.0 due in large part to the fact that anonymity can enable discussion of very sensitive issues, and that remote communication helps people separated by great distances get together. Moreover, networking formats have supported information exchange in real time in addition to e-mail, and search engines have helped people identify relevant groups.

What's next? Better personal health records, better search engines, and tools to interpret the wealth of information generated by dynamically-evolving networks that can mirror the subtle details of daily life.

Meanwhile, despite what some people think, blogging is alive and well; there were 10 blog posts by IBS sufferers in the last 7 days!

Of course, willingness to converse depends on the nature of the conversation. Not too many people want to discuss their Irritable Bowel Syndrome on twitter or facebook, but there are constant streams of related posts and constant conversation.

Today, we are announcing a new Irritable Bowel Blog and are listing existing blogs, some old and some recently updated. We will try to keep you updated. You can also perform a google blog search (although it does not capture many recent blogs) or check the IBS Stories and IBS group blogs for current information.

Blog title	Author	Last post in March 2011	Last update
An Tobarin wordpress blog	An Tobairin	Irritable bowel syndrome	March 30, 2011
Irritable Bowel Syndrome @about.com	Barbara Bradley Bolen	FOODMAP diet chart	March 29, 2011
Gena's Blog (IBS group blogs)	Gena	I Want Pizaaaa	March 29, 2011
IBS-Life Blog	Sian, Rick and Kev	Ruled by the bowel?	March 28, 2011
ChrissyLynn's Blog (IBS group blogs)	ChrissyLynn	Not a happy camper	March 28, 2011
Shauni.x's Blog (IBS group blogs)	shauni.x	18 and starting to cope	March 27, 2011
tjesspersen's Blog (IBS group blogs)	tjesspersen	I hate IBS!	March 27, 2011
SickPetals' Blog (IBS group blogs)	SickPetals	I'd welcome cabin fever	March 27, 2011
Em's Blog (IBS group blogs)	em_t	FFS!	March 25, 2011
Tame your tummy trouble	Megan Mountcastle	Food tips to keep your belly stable	March 25, 2011
cherice's Blog (IBS group blogs)	cherice	Never satisfied	March 23, 2011
J_17's Blog (IBS group blogs)	J_17	P.S.	March 22, 2011
IBS (Blisstree.com)	Lia Serbyn	IBS is Why I'm Still Single	March 13, 2010
Emz's Blog (IBS group blogs)	mz	First post because I'm pleased with myself	March 13, 2010
cleung's Blog (IBS group blogs)	cleung	Another episode - mild	March 12, 2010
IBS Tales	Sophie Lee	Sophie's Story	March 12, 2011
carolann's Blog (IBS group blog)	carolann	Fruit	March 9, 2011
Crispypip's Blog ( IBS group blog)	crispypip	Keeping a journal	March 8 ,2011
The foe that controls my life - IBS (IBS group blog)	Lisalashesxxx	Tests, after all this time....	March 1, 2011

Blog title	Author	Latest post	Last update
Misery Loves Company (Everydayhealth blogs)	MiseryLovesCompany	Going on ANOTHER year now...	November 12, 2010
The IBS Blog	à l'adresse	Easy things to improve IBS condirion	October 28, 2010
IBS (Everydayhealth blogs)	Demeritte	My favorite restaurant	May 17, 2010
IBS Web Log	David	Foods that relieve constipation	March 12, 2010
IBS No More	Marlene Stein	I discovered Annato caused my IBS problems	November 19, 2009
Family Health (Everydayhealth blogs)	Astra1547	Ignorant	August 9, 2009
Digestive Health Woes of a Young Adult	LiaEustach	Introducing my digestive health problems...and me	August 3, 2009
Romance, Riches, Restrooms	Tim Phelan	“Award-Winning” IBS Memoir	May 28th, 2008
Life in A Bathroom	Nichole Thomas	It's back!	February 14th, 2008

Twitter Lists	Description
@COEMHealth/irritable-bowel-syndrome
@boweltalk/ibs	People with or supporting those with Irritable Bowel Syndrome (IBS)
@ericbenchimol/gastro-nutrition
@SharedDiaries/digestive-health	Irritable Bowel Syndrome, related conditions, causes and management
@PSCSupportUK/gastro
@DrCesarYaghi/gastroenterology
@boweltalk/gastro	Medical info re: bowel, colon, digestive, gut and gastrointestinal (GI) topics
@IBSgroup/ibs
@IBSgroup/support