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January 16, 2003

Sweet Treat!
Strawberry Banana Smoothie

Makes 2 Servings (easily doubled)

2/3 c. vanilla soy or rice milk
1 tablespoon honey
1 large firm-ripe banana
1 1/2 c. frozen strawberries, very slightly thawed

Puree all ingredients in blender until smooth. Serve immediately.

Nutrient Analysis Per Serving:
Calories: 160
% Calories from Fat: 10.22
Total Dietary Fiber (g): 5.06

Hello to everyone!

This newsletter issue brings a sweet treat recipe and lots of Lotronex news!

First, here's a wonderful breakfast or snack shake that will bring a touch of summer to a chilly winter day. For breakfast, the shake is delightful with a bowl of oatmeal or toasted sourdough English muffins. The banana gives a good soluble fiber foundation, and pureeing the strawberries minimizes their insoluble fiber risk.

This shake is super fast and easy to whip up, and if you keep frozen strawberries on hand the other ingredients are common kitchen staples. Both soy and rice milk give equally creamy results for this shake. The real secret to its rich, thick texture comes from blending the strawberries while they're still fairly frozen (just run the berries under cold water in a strainer till slightly thawed). You can easily substitute frozen peaches or cherries for the strawberries - any one of these fruits will lend a luscious sunny sweetness to a cold gray morning. Delicious!

Best Wishes,
Heather Van Vorous
Special News - IBS Message Boards!
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!

The Gut Has a Mind of its Own
Operating like the cranial brain and looking uncannily similar to it, the gut brain is continuously active, whether we're aware of it or not. This "second brain," known as the enteric nervous system, is located in the digestive tract and holds about 100-million nerve cells - more than in the spinal cord. Researchers now studying the enteric nervous system are offering insights into malfunctions of both brains. Scientists have discovered that the gut brain may be involved in gastrointestinal disorders like IBS, ulcerative colitis, and Crohn's disease.

For many years, individuals (mostly women) with IBS, a functional disorder characterized by abdominal pain, bloating, flatulence, diarrhea and/or constipation, suffered in silence. Doctors believed the illness was imagined -- all in the head. "We now know IBS is not psychosomatic. We've been finding out that the nerves in the gut independently regulate gut function, but do so in a dialogue with the nerves in our head. It's a nerve-to-nerve discussion," says Keith Sharkey, physiology and biophysics professor at the University of Calgary. Click here for more information...

Ibuprofen and Other NSAIDs and Acute Diarrhea
Recent non-steroidal anti-inflammatory drug intake is a definite risk factor for acute diarrhea. A recent study suggests that acute diarrhea seen in general practice, and not just acute colitis seen by gastroenterologists, should be considered as a potential complication of recent NSAID intake. Click here for more information...

Inflammatory Bowel Disease in Pregnancy
Evidence suggests that women with IBD can expect to have a normal pregnancy outcome provided they have inactive disease. They have an increased risk of having a small or premature baby but the majority will have a normal outcome of pregnancy. The commonly used drugs appear to be safe and well tolerated in pregnancy. Click here for more information...

Patient Satisfaction with Lotronex - A Report
The efficacy and tolerability of Lotronex (alosetron) in women with diarrhea-predominant irritable bowel syndrome have been established in trials. However, the degree to which Lotronex fulfills the needs of those suffering from IBS has not been thoroughly examined from the patient's perspective. This study conducted in women with diarrhea-predominant IBS evaluated patients' overall satisfaction with treatment as well as their satisfaction with respect to several specific medication attributes. The study concluded that women with diarrhea-predominant IBS are satisfied with Lotronex treatment overall and also with respect to specific attributes of IBS medication they consider most important. Click here for more information...

Lotronex is Back - Should I Use it to Treat My IBS Patients?
New guidelines for physicians prescribing Lotronex specify that the drug should only be used if:

- The patient is a woman
- She has severe diarrhea-predominant IBS, with continuous symptoms lasting more than 6 months
- You have tried other treatments and these have failed
- She has no contraindications to the drug, particularly certain structural diseases of the gut
- You register with the manufacturer to give the drug
- You educate the patient about the drug and she signs a patient-physician agreement.

Dietary and lifestyle modifications are commonly recommended for patients with IBS. Agents that have a safer side-effect profile, such as antidiarrheals, antispasmodics, and antidepressants, are usually next in line. Lotronex is indicated only in women with severe, diarrhea-predominant IBS who have chronic symptoms (continuous symptoms lasting more than 6 months) that fail to respond to conventional therapy. Geriatric patients may be at a greater risk for complications, such as constipation. Therefore, we do not recommend using Lotronex in male, pediatric, or geriatric patients. In addition, enrolled physicians must agree to report serious adverse events to GlaxoSmithKline or to the FDA.

Lotronex should NOT be used in patients with:

- Chronic or severe constipation
- A history of intestinal obstruction, stricture, toxic megacolon, gastrointestinal perforation, adhesions, ischemic colitis, impaired intestinal circulation, thrombophlebitis, or a hypercoagulable state
- Current or past inflammatory bowel disease
Click here for more information...

A Diet for IBS and Diabetes
"I was recently diagnosed with IBS but I'm also diabetic. Is there a way to balance both of these dietary needs?" - Jamie Waring

It's usually pretty easy to adapt the IBS diet guidelines to the needs of a diabetic. As a  precaution, one of the best things to do is see a local nutritionist or dietician and give them the dietary guidelines for both IBS and diabetes that you are following, and ask for their guidance. But in general, the high soluble fiber foundation, careful incorporation of insoluble fiber, low fat content, and avoidance of trigger foods such as red meats and dairy that are crucial to managing IBS are very helpful for diabetics as well. Soluble fiber (both foods and supplements) not only normalizes bowel function, it also helps stabilize blood glycemic levels. Soluble fiber slows the rate of carbohydrate absorption, improves regulation of blood sugar, and lowers insulin requirements. Soluble fiber also decreases LDL ("bad") blood cholesterol levels, and therefore reduces the risk of heart disease, which is a serious risk for diabetics. The extremely low saturated fat content of the IBS diet also helps reduce the risk of heart disease.

People who are trying to balance the IBS diet with low glycemic foods for diabetes can choose brown rice and oatmeal for their soluble fiber staples instead of higher glycemic index foods like white rice or potatoes.

One common area of uncertainty in following a diet for both IBS and diabetes is how to handle sugar and desserts. Most people with IBS do not have problems with plain refined sugars (like white or brown baking sugar), which means that IBS-safe dessert recipes simply depend on a low fat, dairy-free foundation. However, this is an area of  much more serious concern for diabetics. Unfortunately, simply using artificial sweeteners as an alternative is likely to be problematic for IBS. Artificial sweeteners in general can cause all sorts of gastrointestinal side effects, from gas and diarrhea to severe cramping. This is particularly true for sorbitol, which is the artificial sweetener most commonly used in commercial diabetic candies and cookies. Some of the newer artificial sweeteners, such as Splenda, are supposedly free of GI side effects, but I would personally still be quite cautious as people with IBS often seem to be more sensitive than most folks to food chemicals, additives, and preservatives.

For home cooking, it can be very difficult to significantly reduce the sugar content of dessert recipes. Sugar is crucial to the food chemistry of many desserts, particularly baked goods. Sugar affects not just the taste but the texture of cakes and sweet breads, and altering the sugar content of these recipes to any great extent can drastically change the outcome. Often, the best solution to this issue is to simply avoid desserts altogether. If this is a sad prospect for you because you have a sweet tooth, check with the doctor who manages your diabetes about the advisability of having just an occasional small portion of an IBS-safe dessert made with real sugar. Heather & Company is dedicated to serving people with IBS. Our mission is to offer education, services, and products that allow people with IBS to successfully manage their symptoms through lifestyle modifications. We currently offer the books
Eating for IBS and First Year IBS, web site resources, seminars and classes, and Heather Cooks!, a healthy cooking 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 founder and president.

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LEGAL DISCLAIMER - This email is not intended to replace the services of a physician, nor does it constitute a doctor-patient relationship. Any application of the recommendations in this email is at the reader's discretion. Heather Van Vorous and Heather & Company are not liable for any direct or indirect claim, loss or damage resulting from use of this email and/or any web site(s) linked to/from it. Readers should consult their own physicians concerning the recommendations in this email.

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