ShawnEric or Syl - What do you think of this information?
#352350 - 11/17/09 04:17 PM
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I just read this article about a study done eliminating foods with IgG antibodies that showed symptom reduction as compared to the control group. Is this study out dated or useful? Thanks!
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frygurl, I have already done a lot of research on this study and highly respect Dr Whorewell a lot, but this won't do you any good. IBS is for one not caused by food, food allergies or food intolerences, they are triggers to the underlying disorder just like someother things are, like hormones and stressors, but not the cause or pathophysiology of IBS.
But second from actual allergy specialists, this one if from Australasian Society of Clinical Immunology and Allergy, but the USA postion paper is the same on this.
Unorthodox Techniques for the Diagnosis and Treatment of Allergy, Asthma and Immune Disorders
"Food specific IgG, IgG4
Use: Diagnosis of food sensitivity / allergy.
Method: Antibodies to food are measured using standard laboratory techniques.
Evidence: Level II
Comment: IgG antibodies to food are commonly detectable in healthy adult patients and children, independent of the presence of absence of food-related symptoms. There is no credible evidence that measuring IgG antibodies is useful for diagnosing food allergy or intolerance, nor that IgG antibodies cause symptoms. In fact, IgG antibodies reflect exposure to allergen but not the presence of disease. The exception is that gliadin IgG antibodies are sometimes useful in monitoring adherence to a gluten-free diet patients with histologically confirmed coeliac disease. Otherwise, inappropriate use of food allergy testing (or misinterpretation of results) in patients with inhalant allergy, for example, may lead to inappropriate and unnecessary dietary restrictions, with particular nutritional implications in children. Despite studies showing the uselessness of this technique, it continues to be promoted in the community, even for diagnosing disorders for which no evidence of immune system involvement exists."
http://www.allergy.org.au/pospapers/unorthodox.htm
I take you you have D IBS?
You might also be interested in reading this short writing from Dr Drossman writing to me on foods and IBS. He is the chairman of the Rome conmmitte to diagnose Functional gi disorders and one of the major recognized leaders in IBS.
http://www.ibshealth.com/ibsfoods2.htm
I can try to show and explain something to you much more important however if your interested.
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My website on IBS is www.ibshealth.com
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Frygirl, also just so you know I have been a chef for 25 years at a highend establishment, actually the number 1 seafood chain in the country, although they do a lot more then seafood. I am not doing that now however. There restaurants are all over the country and can be IBS friendly.
http://www.mccormickandschmicks.com/
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My website on IBS is www.ibshealth.com
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I predominately have IBS-C, but with the wrong foods (especially high fat) and/or an emotional upset, I can have a D attack with lots of pain that can last for a few days.
I understand that food is not the cause of IBS, but diet can do a lot to manage the symptoms. My diet is super restricted right now, and I am still quite symptomatic. I wonder if there is something I am eating regularly that I am reacting to, but I can't figure out what it is.
What makes the study Dr. Whorewell did less useful than the one you posted from the allergy specialists? The study Dr. Whorewell did was on IBS patients after all. I always find it difficult to make sense of information when there are so many contradictory studies out there.
I am interested in thoughts about diet beyond the EFI recommendations. I am following those to a T and as I said I am still symptomatic nearly 24 hours a day.
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Thanks for this! I live near one and may just try it out. Eating out is SO frustrating. I just found out today that the tasty new restaurant that opened in my neighborhood marinates their grilled chicken breast in a sauce with butter. Aack!
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Frygirl, the first thing is a food allergy reaction might cause D. It sounds slightly that you lean to c, but alternate. This has to do with serotonin being released from cells in your gut, not food.
Part of this I think your missing is emotional upset, but even more then that is how it physically works, because it triggers the same cells food allergies do and that is what I was going to help you with.
Diet of course can help a lot, but there is a lot more to it all, for one its well know the act of eating itself triggers symptoms. There is a lot of info on this
"Dr. Drossman: Shawn - eating causes stretching of the stomach when the stomach strecthes it releases hormones or peptides that stimulate the lower bowel. Because people with IBS overrespond to stimuli (like peptide release) you get an exaggerated motility response and pain, so smaller meals reduce this"
So the act of eating stimulates the large colon to go, not the food itself, this is in Heathers book as well. I have a lot more on this.
To restricted of a diet can cause problems you have to be careful about.
"What makes the study Dr. Whorewell did less useful than the one you posted from the allergy specialists"
The allergy specialists wasn't a study it is well known in allergy research from allergy specialists.
Dr. Whorewell study was useful, but its way more complex then you realize and a preliminary study, which doesn't apply yet. A lot of these foods are already known triggers for a lot of reasons. It can be hard to understand them if you don't know much about them or the purpose or read a lot about IBS or even allergy and food intolerences which is what I ended up doing. This is also done under close supervision. Have you ever seen a dietian, not a nutritionist, but a registered dietian?
Dr Whorewell is also an expert on Hypnotherapy for IBS and has had major success with that, did you knw that?
"It's well known that patients expend large sums of money on a variety of unsubstantiated tests in a vain attempt to identify dietary intolerances," say the authors. This is not to say that diet is the be-all-and-end-all. "IBS is multifactorial so food is not the whole answer," says Dr Whorwell. But the right diet goes a long way. "When a patient responds to the diet the [improvement] does not wear off," says Dr Whorwell. "However, other factors can still make patients worse."
"I'm going to deal with these endorsements separately. Although it isn't clear from the quotation attributed to her, Muriel Simmons may be relying upon a study into IgG testing and an elimination diet in a group of people with irritable bowel syndrome (IBS). In the abstract for that paper, the authors quite properly restrict the scope of their conclusions: Food elimination based on IgG antibodies may be effective in reducing IBS symptoms and is further biomedical research. [Emphasis added.]
Dr. Hunter, who has research interests and publications in IBS, made the following comments about the value of the findings from that study: Food Elimination in IBS: The Case for IgG Testing Remains Doubtful.
The percentage of patients showing substantial benefit from this diet is disappointing. In studies using a well conducted and rigorous elimination diet, the "number needed to treat" is between 1.5 and 2.2 [refs]. The "number needed to treat" in this study was 9. (The value of 2.5, calculated on the basis of those who fully complied with the diet, abrogates the intention to treat principle.)
This seemingly poor response to an IgG based diet confirms the widely held view to date that IgG testing for food intolerance is not of value. [refs] These results suggests that if IgG testing identifies food intolerances at all, it does so fortuituously and with an apparent low degree of accuracy.
Not advise for patients to use, but for further biomedical testing.
Something to note here is a cell called the mast cell, which is involved in IBS and food allergies and directly to a physiologic stress responce all humans have, it is very important in IBS and can cause d and pain, which is why I wanted to point it all out to you.
What else do you do besides diet for IBS management?
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My website on IBS is www.ibshealth.com
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You might want to read this also
"We reviewed the scientific evidences of these tests (specificity, sensibility, rationale, reproducibility). According to most studies none of them had to be recommended as useful for the diagnosis of food allergy or intolerance. Physicians should alert patients about the risk of an indiscriminate use of these test in the diagnosis of food allergy. In fact the use of an incorrect diet could be dangerous, particularly in childhood, as recently shown."
http://breathspakids.blogspot.com/2007/02/why-igg-testing-for-food-intolerance-is.html
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My website on IBS is www.ibshealth.com
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You can basically ask the to give you plain food or whatever you want there.
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My website on IBS is www.ibshealth.com
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Shawneric, I do understand that emotional upset is a huge factor for IBS. I am doing things to manage that side of things as well including yoga, meditation, anxiety support group, and I am also seeing a psychologist who is working with me on cognitive behavioral therapy.
I've done Michael's hypnosis tapes one time through a couple years ago (with no noticeable symptom reduction), and started them again a few months ago. But I found myself tense and upset while listening - when I was feeling vulnerable a lot of emotional troubles would come to the surface and distract me from Michael's voice. I asked for Marilyn's opinion, and she said that I should take a break and see if those issues resolve. They are complex, stemming from a chaotic childhood, so I am working with my therapist on that piece. For now, I am holding off on the hypnosis until my mind is more able to focus on addressing IBS. Then I will start over again.
I also understand the act of eating itself can trigger symptoms. And as I said, I don't believe the diet to be a be all, end all answer, but I wonder if I am doing the best I can in that department, thus my question about the study. You answered my question about the study - that the IgG antibodies are not a clear indicator of anything.
I met with a registered dietitian just last week. She was surprisingly knowledgeable about IBS, compared to most medical professionals I've worked with, including my two GI doctors. She said no two IBS patients are alike in terms of what foods they can tolerate, that's a very individual thing. She did recommend I try eating a little dairy since I've been off it for three months. I did this and the next day I had D and nausea all day.
She also recommended that I have a RAST test done by an allergy doctor to check for actual food allergies, so I am scheduled for that Friday. Other than that, she said I need to do my best to incorporate protein and fruits and veggies with my complex carbs, and continue taking a multivitamin to cover any deficiencies I may be missing in my diet.
I suppose I am looking for an answer that isn't there. I don't know.
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Okay Frygirl this is very important. Long yes I know, but I can't post a link. I will also help explain it to you, because it is extremely important.
Dr Wood is a leading IBS researcher and also a food allergy specialist. He is the one the coined the term, "Brain in the gut", or the ENTERIC NERVOUS SYSTEM, that runs digestion, there is actually like a mini brain in the gut that runs digestion have you ever heard of it?.
"Dr. Jack Wood, a renowned physiologist at The Ohio State University calls the ENS the little-brain-in-the-gut.
"Dear Shawn:
Sorry for the delayed reply to your question. I generally agree with Dr. Drosssman's response. A subgroup of individuals when they become sensitized to specific molecules in certain foods respond to ingestion of the molecules with symptoms of cramping abdominal pain, fecal urgency and explosive watery diarrhea. These are also the primary symptoms of diarrhea-predominant IBS. Enteric mast cells, by mechanisms we don't understand, become sensitized to the food molecule and respond to its presence by releasing a signal to the brain-in-the-gut (ENS) which is interpreted as a threat. The ENS responds by running a program which organizes secretion and motility into a behavior pattern of the bowel, which rapidly clears the threat from the lumen. Because to be effective secretion occurs in large volumes and the contractions that accomplish rapid propulsion are strong, running of the program has the side effects of diarrhea and cramping pain.
Big brain input to mast cells during stress activates the mast cells to evoke the symptoms resulting from exposure of the mast cells to sensitizing food antigens. Aside from food allergens and mast cells, certain chemicals such as those in hot peppers, stimulate sensory nerves in the ENS and we are beginning to understand how this can also lead to food-related symptoms that might mimic or exacerbate IBS.
Hope this helps,
Jackie (Jack) D. Wood "
You have two brains: one in your head and another in your gut. Dr. Jackie D. Wood is a renowned physiologist at The Ohio State University. He calls the second brain, "the-little-brain-in-the-gut." This enteric nervous system is part of the autonomic nervous system and contains over one hundred million neurons, which is as many as are in the spinal cord. This complex network of nerves lines the walls of the digestive tract form the esophagus all the way down to the colon. This little brain in the gut is connected to the big brain by the vagus nerves, bundles of nerve fibers running from the GI tract to the head. All neurotransmitters, such as serotonin that are found in the brain are also present in the gut.
Dr Wood has discovered that this little-brain-in-the-gut has programs that are designed for our protection and which are very much like computer programs. They respond to perceived threats in the same way that the limbic system or the emotional brain does. So the threat of a gastrointestinal infection can activate the program that increases gut contractions in order to get rid of the infection. The symptoms are abdominal cramping and diarrhea.
Dr. Wood has determined that a type of cell found in the body and the gut, called the mast cell, is a key to understanding the connection of the big brain in the head with the little-brain-in-the-gut. Mast cells are involved in defense of the body. In response to certain threats or triggers, such as pollen or infection, mast cells release chemicals, such as histamine, that help to fight off the invader. Histamine is one of the chemicals that causes the symptoms of an allergy or a cold. When an infection of the gut occurs, such as food poisoning or gastroenteritis, the mast cells of the gut release histamine. The little-brain-in-the-gut interprets the mast cell signal of histamine release as a threat and calls up a protective program designed to remove the threat at the expense of symptoms: abdominal pain and diarrhea.
The brain to mast cell connection has a direct clinical relevance for irritable bowel syndrome and other functional gastrointestinal syndromes. It implies a mechanism for linking allostasis and the good stress response to irritable states (e.g., abdominal pain and diarrhea) of the gut. Mast cells can be activated to release histamine in response to perceived psychological stress, whether the stressor or trigger is consciously perceived or not. So the end result is the same as if an infection activated the program in the-little-brain-in-the-gut: abdominal pain and diarrhea."
"Mast cells can be activated to release histamine in response to perceived psychological stress, whether the stressor or trigger is consciously perceived or not."
This system is connected to what is called the fight or flight responce, which goes off in normal people around 200 times a day and more in IBSers, because they preceive threats, such as pain and d, which then triggers pain and d.
I know this is complex, but it is a very important thing to learn in IBS and can be use practically, everyday when you learn about it.
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My website on IBS is www.ibshealth.com
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