In this Issue...
Food & Diet
Rx News & Research
Eating for IBS is the
life changing cookbook for good digestive health. Discover the delicious
that controls IBS!
Tell a friend
the IBS newsletter!
First Year: IBS
First Year: IBS is an essential guide that covers the
core issues of
symptom prevention on a daily basis, including: stress
management, yoga, hypnotherapy, travel, work concerns,
social events, restaurants, holidays, children with IBS, support groups, and more!
Special News - IBS Message Boards!
December 30, 2002
Rum Raisin Bread Pudding
Makes 6-8 servings
6 C. stale white bread, in1" cubes
1/3 C. chopped raisins
3 1/2 C. soy or rice milk
6 T. rum or 1 T. rum extract
4 egg whites, whisked till foamy
1/3 C. brown sugar
1 T. vanilla
1 t. cinnamon
1/2 t. nutmeg
1/2 t. salt
Lightly spray a 2 quart casserole dish with cooking oil. Place the bread cubes in the dish and scatter the raisins over.
In a large bowl, whisk together all remaining ingredients, and pour over bread cubes.
Press bread down a few times so tops are coated with liquid. Cover and refrigerate at least one hour, or overnight.
Preheat oven to 350F. Uncover and bake bread pudding for 30-40 minutes, until golden brown on top. Remove from oven and let stand for
10 minutes before serving. Delicious!
Hello to everyone! |
This issue of the IBS Newsletter brings controversy, and a
special New Year's recipe. Let's start with the fun stuff...
Ring in a
New Year morning with a delicious bread pudding!
childhood favorite, but with the sophisticated twist of rum and raisins.
This is a wonderful breakfast recipe, and it couldn't be faster and easier. You can whip
everything together in just minutes the night before, refrigerate overnight,
and then pop the dish in the oven the next morning.
Bread pudding is the perfect comfort food for a chilly day,
but traditionally it's made with trigger foods like dairy and egg yolks.
Happily, this recipe uses soy milk and egg whites instead. The high soluble fiber basis
comes from the bread, and gives a foundation for digestive stability that allows
you to safely add a splash of rum and the insoluble fiber of raisins.
If you're not a rum raisin fan, try one of the following variations instead:
Dried apricots and Grand Marnier
Dried pineapple and rum
Pecans and bourbon
Dried cherries and Creme de Cacao (omit spices)
Dried apples and Calvados
All of these versions are equally wonderful, so enjoy!
With best wishes for a Happy New Year,
Heather Van Vorous
Coming very soon, there will be IBS Diet and IBS Recipe Exchange message boards at the
Eating For IBS website. These
interactive boards will be friendly, supportive places with two separate
focuses. One is for everyone following the IBS Diet, so that they may share
dietary ideas, questions, and suggestions. The other is just for all you cooks
out there (from beginner to gourmet!) who have asked to share IBS recipes. Both
boards will have several moderators who are personally experienced with the IBS
diet, and who will help me ensure that board messages have accurate information
and remain supportive and focused. The boards will go live shortly!
Celiac Disease: More Common Than You Think
Recent population studies indicate that celiac disease is
more common than was previously thought. Some patients have minimal or no symptoms and are unlikely to be referred to a
gastroenterologist unless the disease is considered. Hence, family physicians
need to be familiar with the diagnosis and management of gluten-sensitive
enteropathy. Gluten-sensitive enteropathy or, as it is more commonly called, celiac disease,
is an autoimmune inflammatory disease of the small intestine that is
precipitated by the ingestion of gluten, a component of wheat protein, in
genetically susceptible persons. Exclusion of dietary gluten results in healing
of the mucosa, resolution of the malabsorptive state, and reversal of most, if
not all, effects of celiac disease. Recent studies in the United States suggest
that the prevalence of celiac disease is approximately one case per 250 persons.
Click here for more information...
Colonic Pacing in the Treatment of Patients with IBS
A recent study demonstrated that IBS patients exhibited a "tachyarrhythmic" electromyographic
pattern; the wave rhythm of their colons was irregular and wave variables were higher than those
of healthy volunteers. A colonic pacemaker was implanted in the IBS patients, and the resulting colonic pacing succeeded in normalizing the tachyarrhythmic pattern and
relieving their IBS symptoms. No complications were encountered and the
method was well accepted and tolerated.
Click here for more information...
Rice Demonstrates a Preventive Effect on Constipation
There has been little accurate data regarding any association in the general
population between defecation and lifestyle factors such as diet and exercise.
This study evaluated the relationship between these lifestyle
factors and defecation. Of the dietary factors examined, only rice, which accounted for the largest proportion
of daily dietary fiber intake among the study participants, demonstrated a preventive effect on
constipation in both sexes
Click here for more
Increased Prevalence of IBS in Patients with Bronchial Asthma
In a recent study, the IBS prevalence in asthmatic females was 51.8% vs. 28.1% in females
patients with other pulmonary disorders, and 26.5% in healthy female subjects. None of the asthma medications were
associated with increased or decreased likelihood of IBS. It was concluded that
patients with bronchial asthma have an increased prevalence of IBS. Further
studies are needed to clarify the potential pathogenetic mechanisms underlying
the association between IBS and asthma. Click here for more
Biofeedback a Successful Treatment for Intractable Constipation
The symptomatic improvement produced by biofeedback in constipated patients is
associated with an improved psychological state and quality of life. Click here for more
Controversy Over New Physician Guidelines for Management of IBS
"Dear Heather: I have a question regarding an article you included in your last
newsletter. In the article, "American Academy of Family
Physicians Releases New Guidelines for Management of IBS," it says that there is "no association between IBS and food
intolerance." Why are you endorsing this view by publishing it to thousands of people who have found in their own experience quite
the opposite? Many have found that once they eliminate certain problem
foods, their symptoms improve, just like your books purport. Certainly
you do not take the view of the author of this article, otherwise you
be making a mockery of your own books and cooking show. I am all for having
both sides of a story told; however, you alienate your readers by
including an article which tells them the symptom relief they have found
eliminating certain foods is all in their heads. This article also
undermines all the hard work you've put forth to change the opinions of
people like the author and effect change in IBS research. Can we have a
more enlightened view, please?
Thank you very much, Sheila, for your letter. I was hoping to receive
responses exactly like yours as a result of the Academy article in the last
newsletter. I, too, was completely dismayed by the Academy's "updated"
guidelines, but their release is fairly significant news and
warranted inclusion in the IBS Newsletter. I report all legitimate IBS
news and research stories in the newsletter, and don't want to exclude
stories altogether just because I find fault with them. I want my readers
to draw their own conclusions on the current state of affairs in the
field, and they need to be aware of what's going on in order to do that. I hope
everyone understands why I included the article in my newsletter, even though I
certainly do not agree with their dietary guidelines nor do I consider them to be
at all helpful for doctors to use in treating IBS patients.
As a follow up to the article, I have written a response to both the primary
author of the guidelines, Anthony J. Viera, and to the editor of American Family
Physician. My letter to them is as follows:
"Dear Dr. Viera and the American Academy of Family Physicians:
I'm an author who writes on the subject of Irritable Bowel Syndrome. I send a twice-monthly newsletter to over 11,000 people with IBS, and in a recent issue I included reference to your November article "Management of Irritable Bowel Syndrome." Many readers let me know that they were quite upset by the Dietary Recommendations section of this article, and, in my opinion, rightly so.
In fact, I would like to take this chance to express my own dismay with your article. As it seems to be intended for use by family physicians in their diagnosis and treatment of IBS, you had a tremendous opportunity to address the lack of information and outright misinformation that has characterized dietary recommendations for IBS in the past. Unfortunately, you failed to seize this opportunity, quite likely to the severe detriment of IBS patients across America. I hope that you will redress this situation so that your article may instead live up to its honorable intentions.
As you are well aware, and as you explicitly state, a "strong physician-patient relationship is paramount in an effective management strategy for irritable bowel syndrome." This relationship simply must include accurate and effective dietary information for preventing and alleviating IBS symptoms, or it is of limited value to the patient. You surely know from your own personal experience treating IBS patients that dietary questions are always foremost among their concerns. If patients do not receive legitimate dietary guidance from their physicians, there is no foundation (or trust) on which to build a strong physician-patient relationship in the first place. Unlike in the very recent past, doctors today are actually in a position to address these concerns and provide detailed, comprehensive, and accurate answers to their patients' dietary questions. They are in this position, that is, if they have been made aware of current research and publications in this area. Your article was the perfect forum for giving family physicians notice of these new advances in dietary information for IBS; how unfortunate that it failed to do so. I find this very disheartening, and I know for a fact that thousands of other IBS sufferers feel the same way. I hope that you would like to rectify this situation.
To begin, you state outright that "in general, there is no association between IBS and food intolerance." This is simply false. Your earlier note that patients are often advised to "limit alcohol, caffeine, sorbitol, and fat intake" actually contradicts the lack of association you assert, and rightly so. You could have then elaborated on these common IBS food intolerances, explained why these foods should be limited or avoided entirely (there are valid and logical reasons, and I'm confident that you are aware of them), and expanded the list to include other well-known offenders (such as acidic and sulfur-containing foods).
I'm sure you do actually realize that alcohol, caffeine, sorbitol, and fats are in fact problematic for IBS because they are all either powerful GI tract stimulants or irritants. Clearly, a digestive disorder you accurately describe as characterized by "an exaggerated gastrocolic reflex and increased small bowel contractions exacerbated by food intake" will not respond well to foods that are stimulants and irritants. Why you did not explain this connection does, however, give me pause. Why, also, you neglected to mention the fact that insoluble fiber (again, a powerful GI tract stimulant) is another common offender puzzles me as well. Your statement that "lactose should be eliminated only in those with proven lactase deficiency" is, I must admit, outright surprising. There is no advantage whatsoever to including lactose in the diet, and lactose is in fact just one of many potential IBS triggers found in dairy (fat, casein, and whey are among the others). Why not simply state this and make it clear that avoiding dairy altogether is helpful for almost all IBS patients, and at the very least not remotely harmful? If, perhaps, there was a low comfort or confidence quotient dealing with the dietary arena in managing IBS (and this is understandably not a chosen field of in-depth study for most physicians), why not assign this particular portion of the article to a co-author with dietary expertise? Or, simply refer your readers to a more comprehensive and accurate outside source of dietary guidelines for IBS. I really do feel that this whole issue was instead sidestepped, and dismissed altogether after just a few sentences of generalities. I hope you would agree that this does a grave disservice to the IBS patients who are the intended beneficiaries of your article.
I am most disappointed of all in your fiber information, which should have been one of the most helpful sections of your article. Unfortunately, you make no distinction made between soluble and insoluble fibers and their (often dramatically) different effects upon IBS. There is voluminous and ongoing clinical research in this area. There is also no note that soluble fiber therapy is just as useful for diarrhea as constipation, and can help alleviate IBS pain as well. While this speaks specifically to soluble vs. insoluble fiber supplements, there is also a world of soluble and insoluble fiber foods that you neglected to address entirely. This is crucial information for IBS patients, and had your article included this information doctors could now be disseminating it and helping patients as you obviously intended.
I honestly don't know what to make of the assertion that, "If dietary advice and fiber supplementation do not adequately relieve abdominal pain, a short-term trial of an antispasmodic agent may be tried." It would be quite surprising indeed if any patient given the
scarce dietary and fiber information in this article experienced relief from their abdominal pain. I must say it again: IBS patients need real help in this area, and despite your good intentions you failed to provide it.
I would hope that you wish to redress this situation and offer legitimately helpful dietary guidelines to family physicians for treating their IBS patients. As a starting point, for clinical research in the soluble/insoluble fiber area, may I suggest you review "Partially hydrolyzed guar gum: a fiber as coadjuvant in the irritable colon syndrome" [Clin Ter 2001 Jan-Feb;152(1):21-5] and "High-Fiber Diet Supplementation in Patients with IBS" [Dig Dis Sci 2002 Aug;47(8):1697-704]. In addition, you could look specifically to the multiple articles Dr. P.J. Whorwell has published over many years in this area as well. For overwhelming patient feedback regarding specific dietary advice that has been shown to be efficacious, I would invite you to peruse the reader reviews of the books Eating for IBS and The First Year: IBS at amazon.com, as well as the reviews posted in the "Reader Review" section of the Eating for IBS website, at
http://www.eatingforibs.com/reviews.htm. You may also be interested in the ongoing clinical research of Dr. Noel Hershfield, a gastroenterologist in hospital practice in Calgary, Canada, who is conducting trials of the specific dietary advice in Eating for IBS with his patients. His trials were prompted by the dramatic improvement he personally experienced with his own IBS (he now considers himself "an ex-patient") after following the book's dietary guidelines. In addition, there are now over 100 family physicians and gastroenterologists across the US providing their IBS patients with dietary information excerpted from Eating for IBS. This information has also been licensed by Novartis Pharmaceuticals for use in association with their drug Zelnorm. Finally, the specific dietary advice in Eating for IBS has resulted in my inclusion in the 4th Edition of Marquis Who's Who in Medicine and Healthcare. Efficacious is an understatement; the proper IBS dietary information is nothing short of life-saving to patients who suffer from this disorder.
In summary, there is most assuredly a direct association between IBS and food intolerance. Ask any IBS patient and she or he will tell you this. The problem has been that no one had previously pulled together comprehensive and accurate dietary guidelines specifically addressing IBS needs. Eating for IBS has done this, and I hope to see many more clinical trials supporting the book in addition to Dr. Hershfield's. I also hope to see future articles in the journal of the American Family Physician that acknowledge current dietary information and recognize its critical importance in the successful management of IBS. This is my wish not just as an author on the subject, but as an IBS patient. I would not be able to live a normal life without following the proper diet for IBS, and having learned that the same detailed dietary guidelines apply to virtually all IBS sufferers, it upsets me tremendously to see yet another lost opportunity to provide others with the help I have already received but they have not. Patients and doctors both are desperate for accurate dietary information for IBS. You had a chance to provide such information and it truly saddens me that you did not. I hope you understand the importance of correcting these oversights, and that you believe me when I say how many IBS patients will be eternally grateful to you for doing so. The severe pain and debilitation IBS causes so many people continues to be tragically underestimated, and I am pleading with you to use your position to help remedy this situation.
Heather Van Vorous
P.S. Why was hypnotherapy completely unaddressed as a safe and highly effective treatment for IBS? There are so many years of clinical studies in support of hypnotherapy at this point that it has been declared "the treatment of choice for IBS" by the National Women?s Health Network in Washington, D.C. Surely you know this."
would like to urge my readers to write a response to the Academy article as
well, drawing on their own opinions and experiences. Dr. Viera, the article's
author, can be reached at email@example.com.
To submit a letter to the editor of American Family Physician, email Jay Siwek, M.D., Editor, at
Dr. Siwek can also be reached at American Family Physician, 11400
Tomahawk Creek Parkway, Leawood, KS 66211-2672, or at fax number 913-906-6080. Please include your complete address and telephone number.
also writing a press release about the Academy dietary guidelines and will hope to see some
media attention from that.
Heather & Company is dedicated to serving people with
IBS. Our mission is to offer education, services, and products
allow people with IBS to successfully manage their symptoms
through lifestyle modifications. We currently offer the books
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show on the internet and television. We will soon have other IBS services
available. Heather Van Vorous, an IBS sufferer since age 9, is the company
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of Dr. Noel Hershfield in Calgary, Canada
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Information requested by gastroenterologists and family physicians across the USA, Canada, UK, and Australia for IBS patient distribution
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Readers should consult their own physicians concerning the recommendations in this email.
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