View Heather's IBS Newsletter Online ~ January 13, 2009

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For IBS patients with constipation or diarrhea, to alleviate general symptoms, and to improve quality of life

In this Issue...

Food & Recipes

Special Letters

Rx News & Research

Ask Heather

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Heather's IBS Newsletter ~ For Irritable Bowel Syndrome

Why you'd tell the world your symptoms are gone!

New IBS treatment guidelines from the AGA.

Plus, a delicious roasted salmon recipe!

Prescription medications for IBS - what's new?

Enjoy this week's news!

Best Wishes,
Heather Van Vorous

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Mustard Dill Glazed Salmon with Roasted Potatoes and Greens

This is a wonderfully hearty winter dinner, with a delicious combination of flavors. Salmon and dill are a classic match, and the high soluble fiber foundation of potatoes allows for the addition of fresh greens. The rich and tangy mustard glaze is simply fabulous!

Makes 4 Servings

1/3 cup Dijon mustard
1 tablespoon canola oil
1 tablespoon dill weed
1/4 cup packed brown sugar
1 tablespoon Acacia Tummy Fiber
1 1/2 pounds new potatoes, cut into 1/4 inch slices
1 lb. wild salmon fillet
1 small bunch mustard or spinach greens, stems removed, roughly chopped

Preheat oven to 350 F. Mix mustard, oil, dill, brown sugar, and Tummy Fiber in a small bowl. Place sliced potatoes in a large bowl and drizzle with 1/4 cup of mustard sauce. Toss until evenly coated. Arrange potatoes in a single layer in a 9 x 13" baking pan sprayed with cooking oil. Bake 35 minutes.

Remove pan from oven and push potatoes to one side of pan. Place salmon fillet in center of pan and top with 1 tablespoon mustard sauce. Bake, uncovered, until salmon is just cooked through and potatoes are golden and tender, about 20-25 minutes.

While the salmon bakes, place greens in a large non-stick skillet. Toss with 2 tablespoons mustard sauce and saute over medium high heat until greens are wilted, about 4-5 minutes. Divide greens among three plates, and top with baked salmon and potatoes. Top with remaining sauce.

For a wonderful drink to accompany this dinner, have a cup of hot Fennel Tummy Tea!

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.

~ Heather's Tummy Fiber ~
For the Dietary Management of Abdominal Pain, Diarrhea, &, Constipation

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divider Symptoms are Eliminated and She's Trying to Tell the Entire World!

Dear Heather,

I cannot express in words, or any other way, how thankful I am. You have eliminated most of my symptoms of IBS, from which I had been suffering for six years or longer.

What I found amazing was that the symptoms pretty much disappeared after only one day of following part of your IBS curative suggestions.

I don't know which product is working since I take the Tummy Fiber, the Fennel Tummy Tea, and Peppermint Oil Caps, but I don't care. It's inexpensive and easy to follow the protocol.

Of course I wouldn't mind if you use my comments on the website or IBS Newsletter. I've been trying to tell the entire world!

You know what else I've been trying to tell people, especially older women? All about kegel exercises. First, doing kegels changed my life for the better, then your IBS protocol changed it for the better. I am a new person.

Thanks again so much, Heather. I think you are an angel.


Thank you so much, Tooty! ~ Heather

Did you miss the recent letter from Rochelle, who found relief from bloating in just 3 days?

~ Heather's Tummy Tamers Peppermint Oil Capsules ~
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divider New Recommendations for IBS Therapies
The American College of Gastroenterology recently published a new evidence-based systematic review on the management of Irritable Bowel Syndrome. Highlights of ACG's new recommendations on IBS therapies include:

In general, treatments for IBS are directed towards the patient's predominant symptoms. There are a wide variety of available therapies, many of which improve individual IBS symptoms. Only a small number of therapies have been shown to be of benefit for global symptoms of IBS.

- Trials suggest soluble fiber, certain antispasmodics, and peppermint oil capsules are effective in IBS patients.

- Evidence suggests that some probiotics may be effective in reducing overall IBS symptoms.

- Anti-diarrheals reduce the frequency of stools but do not affect the overall symptoms of IBS.

- 5HT 3 antagonists (such as the prescription drug Lotronex) are efficacious in IBS patients with diarrhea and the quality of evidence is good. Patients need to be carefully selected, however, because potentially serious side effects include constipation and colon ischemia. Current use of alosetron is regulated by a prescribing program set forth by the FDA.

- 5HT 4 agonists (such as the prescription drug Zelnorm) are modestly effective in IBS patients with constipation and the quality of evidence is good although the possible risk of cardiovascular events associated with these agents may limit their utility. Currently, there are no 5-HT 4 receptor agonists available for use in North America.

- Tricyclic anti-depressants and selective serotonin reuptake inhibitors have been shown to be effective in IBS patients of all subtypes. The trials generally are of good quality but the limited number of patients included in trials implies that further evidence could change the confidence in the estimate of effect and therefore the quality of evidence was graded as moderate.

- Non-absorbable antibiotics are effective, particularly in diarrhea-predominant IBS.

- The selective C-2 chloride channel activator, lubiprostone, is efficacious in constipation-predominant IBS with a moderate quality of evidence.

- Psychological therapies also may provide benefit to IBS patients.

Go here for full information about IBS treatments.

Go here for more information about this review...

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

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divider IBS Treatments & Cheat Sheet - Part 5
While I usually use this column to look at one aspect of IBS in detail, this time I thought it would be helpful - especially if you're still struggling - to step back and take a look at the big picture. What exactly are all the best treatment options for IBS? How do you decide which options would be best for you, and what you should try first? Is there an easy way to overview all of this information?

Yep! In a nutshell, there are five key categories of treatment for IBS. The most successful treatments in general tend to be natural. Even though there is no cure for IBS so far, the strategies summarized below can help significantly to alleviate or even prevent all IBS symptoms.

To go with our summary, there is a really helpful IBS Treatment Cheat Sheet for Tummy Care products as well.

Last time, we addressed number four on the list: stress management. This week, we'll tackle part one of number five:

5. Prescription Medications

Most IBS patients are initially prescribed an anti-spasmodic drug upon diagnosis, though you may have received a low-dose antidepressant, anti-diarrheal, or laxative instead, or even one of the newest (and riskiest) IBS drugs, Zelnorm or Lotronex.

There are actually quite a few different prescription medications available for Irritable Bowel Syndrome symptoms, but their effectiveness can vary greatly from one person to the next.

Which particular drug will work best for you is something you'll most likely have to determine through trial and error. IBS drugs are symptom-specific (aimed at painful abdominal spasms, diarrhea, or constipation), which means they do NOT work on the underlying brain-gut dysfunction of IBS (only gut-directed IBS hypnotherapy can do that). They are meant simply to relieve your IBS symptoms. If the first IBS medication you try doesn't help much (or at all), don't be discouraged. There are other options available.

Remember that there's no one particular prescription medication for everyone (and no single drug is approved for all IBS symptoms) but many different medications to try. You should work in partnership with your doctor to determine which medication best fits your needs. This might take a trial period of a few months and several follow-up visits or phone calls.

With any new medication, always make sure you receive the clinical insert about health risks, side effects, and possible drug interactions. You may have to specifically ask the pharmacist for this insert (it will be produced by the drug manufacturer) if you don't receive it with your prescription.

For Irritable Bowel Syndrome Pain

The most frequently prescribed drugs for IBS pain are Anti-Spasmodics. These drugs affect gut motor activity and reduce the colon's response to both eating and stress. Anti-spasmodics are meant to be taken 30 minutes before eating, but they can also be taken whenever needed. Sublingual (dissolve under your tongue) and oral (swallow whole) varieties are available.

Typically, antispasmodics are prescribed for use four times per day (before each meal and bedtime). Since they have no cumulative effect, however, many patients prefer to take them only as necessary. In general, many people with IBS find soluble fiber supplements, peppermint oil capsules and high volatile oil peppermint tea as (or even more) helpful than anti-spasmodics most of the time. I personally stopped using my prescription anti-spasmodic years ago when I realized I got better results (and no side effects) from taking the peppermint oil capsules before meals, and drinking the peppermint tea after meals.

Low doses of IBS-effective Antidepressants can raise the pain threshold for the painful abdominal cramps of IBS, and they can also either increase or decrease (depending upon the class of drug) the rate of gastrointestinal contractions as well, thus altering bowel function in either direction (and helping diarrhea or constipation). Why would antidepressants help IBS? These drugs are meant to affect the uptake of serotonin - a neurotransmitter directly involved in the development of clinical depression - in the brain. However, the enteric nervous system of the gut is also rich with nerves that contain large amounts of serotonin. In fact, 95% of all serotonin in the body is found in the gut, not the brain. So the effect of antidepressants on the brain is felt as a peripheral result in the gut as well.

It's important to note that the dosage of anti-depressants used for Irritable Bowel Syndrome is typically far lower than that of the drug when used for depression. It is also crucial that the doctor prescribing this type of drug be very familiar with its use for IBS, as different classes of anti-depressants have varying side effects. Some can greatly worsen, instead of help, IBS symptoms such as diarrhea, constipation, and pain, depending on the patient.

In particular, SSRI anti-depressants stimulate serotonin production and can trigger severe IBS attacks in diarrhea-predominant patients, but they may be helpful for constipation. Conversely, tricyclic anti-depressants have the best track record of success for reducing diarrhea-predominant IBS symptoms, but patients with constipation are usually not treated with these drugs because of the possibility of exacerbating this symptom. Tricyclic anti-depressants tend to be anticholinergic – that is, they block the activity of the nerves responsible for gut motion. The long-term consequences of taking low-dose anti-depressants for IBS are unknown, and this is a matter that should be discussed with your physician.

Narcotic Analgesics for IBS are opioid drugs and can be highly effective painkillers. One of their chief side effects, constipation, is actually of benefit to some IBS sufferers. Narcotics also induce a feeling of tranquility and promote drowsiness, both of which can be helpful for relieving stress-related attacks. The chief problem with narcotic drugs is that it's next to impossible to get a doctor to prescribe them for you. Although there is mounting evidence that these painkillers are not nearly as habit-forming as previously thought, from your doctor's point of view the risks of addiction are still likely to take precedence over your pain. You'll have to decide for yourself, based on the severity of your symptoms, what your own priorities are in the matter and, if appropriate, try to find an understanding physician.

Narcotic painkillers work best on an empty stomach and may take up to an hour to halt an attack. They should only be used in the advent of severe pain that occurs despite dietary and stress management precautions, and should not be used as a preventative measure or on a regular ongoing basis as they can be addictive. In addition, the less frequently this medication is used the more effective it tends to be.

To learn more about medications as well as non-drug approaches to successfully managing IBS symptoms, find all you need to know with The First Year: IBS, an essential guide.

You can also check the IBS treatment cheat sheet, with Tummy Care products noted for the best symptom matches. Many products help multiple symptoms, so even if a particular symptom is not checked it may well be a secondary benefit of a product.

Coming next time, prescription medications for IBS diarrhea and constipation.

~ Heather

Did you miss the recent "Ask Heather" and the fourth of the five key treatment strategies?

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