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Ask Heather
Stevia & IBS?




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August 23, 2005

This week - Stevia and IBS

Hello to everyone -

This week we have a special picnic recipe for chicken sandwiches with a rosemary fig chutney. They're rich and smoky with a slightly sweet edge that's utterly irresistible, and they pack beautifully for work if you can't get away for one last summer outing. They're a terrific example of how to use a safe soluble fiber base (from the bread) to add small amounts of insoluble fiber (from spinach leaves and figs). They also demonstrate how to add a wealth of great flavor without using triggers (red wine evaporates as it's cooked with the chutney, leaving only the taste behind, and rosemary - a digestive aid - adds a delicious savory note).

In response to our last newsletter's "Ask Heather" column on Splenda and IBS, I was overwhelmed with questions about stevia. Is it natural or artificial? Is it safe for IBS? Check out this week's column and find out! As always, we've also got the latest IBS news and research. Enjoy!

Best Wishes,
Heather Van Vorous

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Sandwiches of Rosemary Fig Chutney and Smoked Chicken Breast

Make the chutney ahead of time, and these sandwiches are a snap to prepare.

Makes 4 Servings

1 lb. organic shaved smoked chicken breast
8 thick slices of rosemary sourdough bread, toasted
8 large fresh spinach leaves, washed, stems removed

Chutney:
1 cup dried figs, finely chopped
1/2 cup red wine
1/2 cup water
1/4 cup honey
2 teaspoons dried rosemary, crushed

In small heavy saucepan simmer all chutney ingredients over low heat, covered, for 30 minutes. Uncover and simmer, stirring frequently, until liquid evaporates and mixture thickens. Cool to room temperature. Assemble each sandwich with 1/4 lb. smoked chicken, 2 tablespoon chutney, and 2 spinach leaves.

The chutney recipe makes about 1 1/4 cups, or ten 2-T servings. Chutney will keep in fridge for two months, or it may be frozen in an airtight container for up to 6 months.

For oodles of other delicious recipes, come visit the IBS Recipe Exchange board!

Are you just learning how to eat for IBS? A little intimidated at the thought of special IBS recipes? Not quite sure just what makes these recipes special in the first place? Don't worry! Come see the IBS Diet pages, and find the answers to all your questions.

Fennel Tummy Tea Peppermint Tummy Tea
Fennel & Peppermint Tummy Teas - Now in New Jumbo Teabags!

Fennel is terrific for bloating & gas, Peppermint is great for IBS pain & spasms.

divider Role of Carbon Dioxide-Releasing Suppositories in the Treatment of Chronic Functional Constipation
A recent study in Clinical Drug Investigations noted that treatment of chronic functional constipation is difficult. Both oral and topical laxatives may fail to adequately relieve symptoms, and there is risk of adverse effects such as functional or structural changes in the intestine, together with electrolyte disturbances. The aim of this study was to evaluate the efficacy and safety of a suppository that combines sodium bicarbonate and potassium bitartrate in a polyethylene glycol base to generate approximately 175mL of carbon dioxide (CO2). This release distends the rectal ampulla, thereby stimulating peristalsis and a subsequent bowel movement. The study concluded that the CO2-releasing suppository may represent an alternative to rectal laxatives for the relief of chronic functional constipation. The data obtained in this study indicate that CO2-releasing suppositories may be usefully and safely employed in the treatment of patients at risk for electrolyte disorders such as the elderly or patients with renal or cardiovascular disorders. Go here for more information about this study...

Clinical Epidemiology of Inflammatory Bowel Disease
Several important advances regarding the clinical epidemiology of inflammatory bowel disease (IBD) were presented during this year's Digestive Disease Week (DDW) meeting. Among the advanced imaging techniques examined, computed tomography (CT) enterography, chromoendoscopy, and magnetic resonance (MR) colography appear to be the leading technologies, whereas wireless capsule endoscopy appears to be less useful than previously believed. Additionally, genetic linkages in IBD are being discovered or confirmed at a very rapid rate, as highlighted in key discussions during these meeting proceedings. Investigators are also elucidating the natural history of IBD from large, meticulously maintained databases to confirm incidence and surgery rates, associations with other diseases, and risk of complications, such as pouchitis or cancer. As further evident from the focus of key sessions at this year's meeting, cancer surveillance in IBD remains a hotly debated topic with somewhat conflicting studies to sort through. Go here for more information about this study...

How Do IBS-Constipation and Chronic Constipation Differ?
A recent Medscape Clinical Update noted that IBS is characterized by abdominal discomfort or pain, bloating, and disturbed defecation. This disturbed defecation can take the form of constipation (IBS-C), diarrhea (IBS-D), or mixed/alternating bowel habits (IBS-M) with roughly equivalent distribution of the 3 subtypes. The Rome criteria for IBS were developed by an international group of experts to provide a uniform means of identifying patients for clinical trials, though more recently, their use in clinical practice has been encouraged. The Rome II criteria for IBS include at least 12 weeks (which need not be consecutive), in the preceding 12 months, of abdominal discomfort or pain that is accompanied by at least 2 of the following symptoms: the abdominal discomfort or pain is (a) relieved with defecation, (b) associated with a change in the frequency of defecation, and/or (c) associated with a change in the form or appearance of the stool.

In contrast to IBS, the Rome Committee defined functional constipation as 2 or more of the following: straining during more than 25% of defecations; lumpy or hard stools at more than 25% of defecations; a sensation of incomplete evacuation during more than 25% of defecations; manual maneuvers to facilitate more than 25% of defecations; and/or fewer than 3 defecations per week for at least 12 weeks in the past 12 months.

There can be no doubt that there is substantial overlap between CC and IBS-C, but the cardinal feature for diagnosis and the most bothersome symptom in patients with IBS-C is abdominal discomfort or pain. However, it is important to note the absence of abdominal pain or discomfort from the Rome definition for CC. It can be argued that depending on the enthusiasm of the interviewer, many patients with severe constipation will have a history of at least mild abdominal pain or discomfort. However, in IBS, the abdominal discomfort or pain should be a critical symptom, while in patients with CC, abdominal discomfort or pain is typically only an aside to the stool-related complaints. Go here for more information about this study...


Interactions Between Bacteria and Gut Sensorimotor Function
A recent article in American Journal of Gastroenterology notes that commensal bacteria inhabiting the human intestine (i.e., intestinal microflora) participate in the development and maintenance of gut sensory and motor functions, including the promotion of intestinal propulsive activity. On the other hand, intestinal motility represents one of the major control systems of gut microflora, through the sweeping of excessive bacteria from the lumen. There is emerging evidence indicating that changes in this bidirectional interplay contribute to the pathogenesis of gut diseases, such as small intestinal bacterial overgrowth and intestinal pseudo-obstruction.

Recent interest has also been directed to the potential role of intestinal microflora in the pathogenesis of the irritable bowel syndrome. Although the status of intestinal microflora in the irritable bowel syndrome remains unsettled, small intestinal bacterial overgrowth (as detected with breath testing) and increased fermentation of foods with gas production, provide indirect evidence that microflora may contribute to symptom generation in irritable bowel syndrome. The potential benefit of antibiotic and probiotic therapy is currently under investigation and opens new perspectives in irritable bowel syndrome treatment. Go here for more information about this study...

Looking for more IBS research and news? Check the IBS Research Library!

~ Heather's Tummy Tamers ~
For the Dietary Management of Abdominal Pain &, Bloating
IBS Peppermint Caps
Peppermint Oil Caps with Fennel and Ginger Are Amazing!

Because our Peppermint Oil Caps have the added benefits of fennel and ginger oils, they are truly unbeatable for preventing abdominal pain, gas, and bloating!

divider Stevia and IBS?
"Is stevia a natural and IBS-safe replacement for refined sugar?"

The short answer to this is yes, stevia is all-natural, and it certainly seems to be safe for IBS. But what is stevia? Stevia is an herb in the chrysanthemum family which grows wild in parts of Paraguay and Brazil. There are compounds in its leaves called Steviosides, which are calorie-free but taste incredibly sweet. In its natural form, stevia is approximately 10 to 15 times sweeter than common table sugar. Extracts of stevia can be 100 to 300 times sweeter than table sugar. Stevia has likely been in use as a sweetener in its native countries since Pre-Columbian times; its first recorded use was in the 19th century. In modern times, stevia usage has become widespread in Japan, Brazil and the whole of South America; South Korea, China and the whole of the Pacific Rim; and Europe, Australia and North America.

Since 1995, the FDA has allowed stevia and its extracts to be imported as a food supplement but not as a sweetener. It defines stevia as an unapproved food additive, and it has not conferred GRAS status (Generally Recognized as Safe) for its use in the United States. What does this mean? Stevia can be sold legally in the United States, but only as a "dietary supplement." It can be found as a powder or liquid extract at most health-food stores, and it's also used in drinks, teas and other products that carry a "dietary supplement" label. Because of its FDA status, stevia cannot be labelled a "sweetener", however. While other countries have allowed stevia to be used as a sweetener in foods for dcades, the FDA has so far turned down three petitions to use stevia in foods in the U.S. As a result, stevia cannot be marketed as a sugar replacement or as any kind of sweetener, and can only be sold as a dietary supplement. The FDA has stated that there is not enough data to conclude that stevia's use in food is safe.

There's actually quite an ongoing controversy about stevia in the US. Supporters claim that the herb has been used by millions of people in many parts of the world for many years, without any adverse reactions being reported. They believe that the FDA has been pressured by industry lobbyists to block stevia's use as a "sweetener", as this could have a tremendous financial impact on sugar and artificial sweetener manufacturers. On the other hand, the European Union has also concluded that stevia is unacceptable as a sweetener because of unresolved concerns about its toxicity, and Canada does not permit stevia to be used as a sweetener. The World Health Organization has not been able to quantify an Acceptable Daily Intake (ADI) of stevia because of inadequate data on its composition and safety.

I haven't found any reports of gastrointestinal upsets, side effects, or problems from stevia use, or any information that would suggest stevia could worsen, in any way, the symptoms of IBS or the underlying pathology of the syndrome. It certainly seems to be a much better option than any artificial sweetener on the market, particularly for people who do not want refined sugar in their diet. Stevia can be used to sweeten drinks, to cook with, and with a little extra care, to bake with as well. If you'd like to experiment with stevia in the kitchen, drop by the IBS Recipe Board and post or request recipes. If you'd like to stick to plain old sugar, you'll find plenty of traditionally-sweet recipes there, too!

Are you looking for other frequently asked questions about eating for IBS? Come check Heather's Diet FAQ for answers!

Heather's Tummy Store for IBS
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divider Heather & Company for IBS, LLC is dedicated to serving people with Irritable Bowel Syndrome. Our mission is to provide education, support, and products that allow people with IBS to successfully manage their symptoms through lifestyle modifications.

We offer extensive information and tangible help for IBS, including the world's best-selling and best-reviewed books for the disorder. We provide the internet's top IBS web site resources; a twice-monthly IBS Newsletter; seminars and classes; dietary brochures for patient distribution by health care professionals; an IBS Research Library; and Heather Cooks!, a healthy cooking show on Seattle television. Much of our work is based on Heather's development of the first and only comprehensive IBS dietary guidelines and recipes, an achievement which has earned numerous awards and accolades as well as thousands of thank you letters from IBS sufferers.

Heather & Company also provides the only patient-expert moderated IBS Message Boards on the internet with forums for diet, recipes, hypnotherapy, yoga, plus Crohn's and Colitis. In addition, we support and coordinate the formation and continuation of local in-person IBS support groups across the USA, Canada, the UK, Australia, and New Zealand. We will soon have other IBS services and products available.

Our website receives nearly 3 million visits each year, and our newsletter is sent to over 42,000 people. We are regular exhibitors at the Digestive Disease Week and American Dietetic Association conferences.

Sponsorship opportunities are available for the message boards and this newsletter for companies and/or products that have been legitimately established as helpful for digestive disorders. Please contact us for information.
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