IRRITABLE BOWEL SYNDROME AND IC
Practical Suggestions To Help IC/IBS Patients Manage Their Bowel Symptoms
Speakers: Heather Van Vorous
Author of "First Year: IBS ," "Eating For IBS " and
Founder Of HelpForIBS.com, the largest support group for IBS in the world
Moderator: Jill Osborne, M.A. President & Founder
Interstitial Cystitis Network, Santa Rosa, CA USA
Event Date & Description: June 20, 2006 - 2006 IC & PBS On-Line Patient Conference
Welcome to the fifth special event in the 2006 IC & PBS On-Line Patient Conference, the only free lecture series available to interstitial cystitis and painful bladder patients on the web. Our goal is to bring the worlds best researchers, clinicians and activists directly into the homes and offices of patients who are unable to travel and/or afford to attend a national or regional conference. Most patients have no choice but to stay home and hope to read transcripts or watch DVD's of the various IC events. The internet, however, changes this dynamic. We can now bring the conference directly to thousands of patients at one time. This would not happen without our generous sponsors, including: Akpharma (Makers of Prelief), Desert Harvest (Makers of DH Aloe), AstraTech (Makers of the Lo-Fric Catheter) & Algonot (Makers of Algonot, Cystoprotek & Prostaprotek). We thank them for their support and encouragement of IC patients throughout the world.
It is my pleasure to introduce Heather Van Vorous, author of First Year: IBS and Eating for IBS, two of the best selling books on irritable bowel syndrome on the market today. A tireless patient advocate and national spokeswoman, Heather began her struggle with IBS in childhood. For the past seven years, she and her husband Will have devoted their lives to creating new resources for patients struggling with IBS, including the website “helpforibs.com” and the “Heathers Tummy Care” line of products. Her newsletter currently has 60,000 subscribers.
As an IBS patient for the past twenty years, I want to share that it wasn’t until I found Heather’s information that I truly understood IBS, why it occurs and how it can be managed with diet. For example, most of the foods that I was encouraged to eat were the worst things that I could have eaten as an IBS patient. Once I began to follow her suggestions, I improved dramatically. Thus, it is with gratitude that I welcome Heather to our lecture series this evening.
Heather Van Vorous - It's wonderful to be here.
Jill Osborne - Tell us what led you to write your book and get so heavily involved in IBS outreach.
Heather Van Vorous - It was the internet. When I first started getting involved in 1997, I stumbled on a few IBS sites and I realized that I wasn't the only person in the world with IBS. What struck me about those websites was how sick the people were and how desperate they were. They were struggling so badly, especially about diet. It really hit me hard because, first of all, there were other people who had my problem and I couldn't believe that they didn't know more about how to help themselves. I had figured out much about diet by then for myself through trial and error and a lot of research. It took me about ten years to figure that part out. By the time that I was on the internet I had had my IBS under control for about ten years. So, I started helping people, posting diet information, sending out emails to patients who needed help.
The response was overwhelming. That first email on diet grew to my first book, "Eating for IBS", and then our second book and company. I still run the largest IBS support group on the web at http://www.helpforibs.com, and we also sponsor IBS support groups around the country.
Jill Osborne - What exactly is IBS??? Could you explain this for us simply??
Heather Van Vorous - IBS is a disorder not a disease and it's defined by its symptoms.There are no tests that come up positive for IBS, but it can't be self diagnosed because there are a lot of other problems that mimic IBS that must be ruled out. So, IBS is not an inflammatory bowel disease. It is not celiac disease or candida. It's not a build up of toxins in your gutand it's not leaky gut syndrome. It's not psychological, although a lot of doctors still think it is.
IBS is defined by something called the ROME criteria. In a nutshell, you have to have lower abdominal pain or discomfort in association with bowel dysfunction. That can be diarrhea, constipation or both conditions alternating back and forth. You have to have the combination of pain and one of these dysfunctions. If it's just pain, then it's not IBS. There are other functional bowel disorders and IBS is just one of those, such as functional abdominal pain, functional constipation, etc. etc.
IBS is considered a brain gut disorder and there are two aspects of that. The enteric nervous system is dysfunctional in people who have IBS. But, so is the way that the brain interprets messages from the enteric nervous system. We actually have PET scans of the brain of people with IBS and their brains react to normal stimuli, such as eating, as if they are in pain.
So, it's like two different things, a problem with the gut and a problem with the brain. We call it a hypersensitivity of the gut. That's why stress and food are the two greatest triggers. They both affect the gut and the gut overacts to both of those things, creating the symptoms of IBS. It's important that you realize that stress and diet doesn't cause IBS but they definitely trigger the symptoms just like IC.
Jill Osborne - This is one thing that really struck me about the similarities between IC and IBS. We clearly see a process of neurosensitivity. IC patients often feel as if their bladder is desperately full even though it might only have a small amount of urine in it. That's pretty similar to what you're describing with IBS.
Heather Van Vorous - Yes. It makes sense because they are all connected to the nervous system and involve smooth muscle tissue. Hormones too are playing an integral role. I don't think it's a coincidence that most people with IC and IBS are women.
Jill Osborne - Definitely true! So, a diagnosis is based almost entirely upon symptoms and the exclusion of these other disorders that can mimic IBS.
Heather Van Vorous - They need to do some basic testing and blood work at a minimum to confirm a diagnosis of IBS. Perhaps a colonoscopy, etc. etc. It depends upon a person's age, too!
Jill Osborne - Is there some type of triggering event for IBS? In IC, for example, many patients report that their symptoms began after a fall, a childbirth, antibiotics, infection, etc. etc.
Heather Van Vorous - It's very much the same for IBS, though we call it an "insult to the gut." Not in all patients but many patients can point to that one day that they had food poisoning, or surgery, or childbirth. Anything that dramatically upset the functioning of the gut can lead to IBS and the nerve hypersensitization that we've been talking about.
Jill Osborne - Tell us about that and why certain foods trigger such an embarrassing or painful response...
Heather Van Vorous - Most people don't know what the gastrocolic reflex is. It's a very simple reflex. When you eat or drink something, your stomach then sends a message to the colon to start it contracting. Simplistically, it's your body's way of saying if something is coming in then something should be going out.
In people with IBS this reflex goes haywire. Their colon is contracting too much, too hard, too fast, or it's in spasms or not contracting enough. They may have too few contractions, not strong enough, or be irregularly timed. This can then cause abdominal pain, diarrhea, constipation, bloating, and trapped gas. And that's all stemming from the hypersensitive gastrocolic reflex.
There are two categories of foods that stimulate the gastrocolic reflex more than anything else. (1) Fats and (2) Insoluble fibers. Fats most people figure out for themselves that these are problem. Your gut doesn't care what type of fat it is. They are all equally GI stimulants, including lard, olive oil, etc. etc. Obviously, the rest of your body cares about this but people with IBS must follow a low fat diet and the fats that they do eat need to be the heart healthy monounsaturated type. It's actually very easy to work around this...
Jill Osborne - Is this why chocolate is notorious for trigger painful bowel spasms??
Heather Van Vorous - Yes and no. Yes, if you're talking about solid chocolate which is very high in fat. But unsweetened cocoa powder has the fat and the caffeine removed and so you can bake with this and have a lot of really great chocolate cakes that ARE IBS friendly. With chocolate, there is a big difference between a solid bar versus cocoa powder. You should never feel deprived that you can't have chocolate again. That's not true. You just have to eat a low fat form of it. Quantity makes a big difference. The little miniature candies are going to be a lot more tolerable than a gigantic candy bar.
What's much harder for patients is understanding the fibers and how they help or hurt IBS. Almost all IBS patients are told to eat more fiber. Bad advice because the question then is what kind of fiber. Most patients don't know that there are two different kinds of fiber: soluble and insoluble fiber.
What most people think of fiber (bran, greens, kernel corn or roughage) is insoluble fiber. Insoluble fiber is a huge GI stimulant. It sends the gastrocolic reflex out of control and can trigger spasms, cramps, and diarrhea. This is an important point, it can also exacerbate constipation. If you don't have IBS, insoluble fiber is great for constipation. If you do have IBS, it can make your gut spasm and make those contractions so irregular that it interferes with motility and worsens constipation.
Soluble fiber is the foundation of the IBS diet. Soluble fiber is found in foods that most people don't think of as fiber as all, such as oatmeal, pasta, rice, potatoes, tapioca, bananas, things that people think of as starches. The Atkins diet was the kiss of death for patients with IBS because it removed the soluble fiber from their diets and it's really high fat.
Soluble fiber does two really important things. It regulates the gastrocolic reflex, thus regulating the muscle contractions of the gut and normalizing them. It also regulates water content in the bowel. Soluble fiber resolves the pain and cramping of IBS and it resolves both diarrhea and constipation. People get so confused. I spend my life telling people with constipation that soluble fibers won't make them worse and that they aren't “binding.”
Jill Osborne – So the BRAT diet for patients with diarrhea (bananas, rice, applesauce and toast) can actually help normalize the gut?
Heather Van Vorous - Right! Soluble fiber does this for everyone.
Jill Osborne - When I was treating my IBS by eating a hard bran cereal twice a day and having lots of salad at lunch, this would explain why I suffered for months last fall.
Heather Van Vorous - Exactly. There are clinical studies that show that bran makes people with IBS WORSE! But, it's still something that a lot of doctors recommend. Even psyllium, which is often recommended, is not the first choice for IBS. For one thing, it's 1/3 insoluble fiber so it's not pure soluble fiber. It's also a type of fiber that is really likely to cause a lot of gas and bloating. People with IBS are already susceptible to that so they want a slowly fermenting pure soluble fiber for their supplement, such as acacia fiber.
Jill Osborne - One point that your books and website taught me was that salads at the beginning of a meal were the kiss of doom. I can't tell you how many times that salads made me ill for hours afterwards.
Heather Van Vorous - Me too. But, if you have them after your soluble fiber foods, they are a lot more tolerable. That's the rule for eating with IBS. You need to make soluble fiber the foundation for your meals and snacks because that is what will let you safely add in an insoluble fiber and fat. So, a little chocolate as dessert after a high soluble mealis pretty tolerable.
Jill Osborne - What about fresh fruits and veggies?
Heather Van Vorous - You've got to eat them. You need to eat as much as possible but you need to eat them carefully. For example, never have insoluble fiber alone, on an empty stomach, or in large quantities all at once. Always have insoluble fibers with soluble fibers. Make yourself fried rice and add some veggies to thator a put vegetable sauce on pasta. Try cooking some fresh fruit in your oatmeal. Cooking breaks down insoluble fiber and so does cutting it up and pureeing it in the blender, which makes it a lot more tolerable. Cooked veggies are safer than raw. A fresh fruit smoothie is safer than a big, raw fruit salad.
Jill Osborne - What about meat?
Heather Van Vorous - Red meat tends to be the single greatest trigger probably because of the super high fat and the red meat proteins that are very hard to digest. Dairy is the second greatest trigger and it's not just the lactose, it's the fat and proteins. Those are the two hardest foods for your body to digest and most patients with IBS can't tolerate them well. Fortunately, you can have a healthy diet without these foods.
The better proteins to eat are seafood, skinless chicken or turkey breast, egg whites. Egg yolks can be a trigger. Try to buy organic. It can't hurt. Soy is okay, soybeans or lentils. Nuts if they are finely ground. There is no shortage of protein.
Jill Osborne - What about peanut butter and other nuts??
Heather Van Vorous - Nuts are high fat and that tends to be a problem, but in small quantities when combined with soluble fiber they are fine. I bake with ground nuts all of the time.
Jill Osborne - What's your take on sugars and/or artificial sugars??
Heather Van Vorous - Well, I would take real sugar over any artificial any day. All artificial sweeteners tend to have really bad GI side effects. Sorbital is the worst. But, I would avoid splenda, nutrasweet or anything made in a lab.
Jill Osborne - Why is it that certain foods bother us sometimes and then not at other times?
Heather Van Vorous - That drives a lot of people with IBS crazy. It's not just what you are eating but how you are eating it. Did you have that raw salad on an empty stomach or at the end of the meal? It helps to just know the guidelines. The light bulbs go on and you solve 90% of your questions. It's usually HOW you eat it and HOW MUCH of it you eat. Quantity makes a difference and it could be the ingredients too.
Jill Osborne - MSG??
Heather Van Vorous - There's no need to eat it... therefore you can pass it up. In general, the foods that irritate IBS are either stimulants or irritants .Fats and insoluble fibers are stimulants.
Jill Osborne - Coffee?
Heather Van Vorous - Coffees, caffeines, tobacco, alcohol are irritants. Acidic foods bother some people.
Jill Osborne - What have you found to be the most helpful??
Heather Van Vorous - Soluble fiber supplements, such as acacia. You want to keep your gut filled with soluble fiber 24 hours a day. The more that you can stay stable with IBS, the better. It's easier to stave IBS attacks off. People with IBS tend to do well with moderation, with stability. They need to be gentle with their guts.
Jill Osborne - What are your thoughts on bowel cleansing? This has become popular in recent years.
Heather Van Vorous - You can't cleanse IBS out of your colon. You can't beat your colon into submission. Colon cleansings are bad, bad, bad! They are virtually always some type of laxative.
Jill Osborne – What can you suggest for patients struggling with gas and bloating?
Heather Van Vorous - For gas and bloating, fennel is terrific as a spice and as a tea. It's easier to get more of it as a tea, but you can definitely cook with it.
Soluble fiber helps constipation and diarrhea.
Fennel helps bloating and gas.
Peppermint helps reduce pain, spasms and cramps.
Peppermint is a smooth muscle relaxant and has pain killing properties. It actually works on some of the brain opiate receptors to help reduce pain. You can mix and match all of those as you need to. So, one nice thing about this approach is that there are no side effects, risks, etc. etc.
Peppermint and fennel can be used as needed, but the acacia soluble fiber supplements should be used every day. Soluble fiber supplements should also be started at a low dose and then be gradually increased until you get to a dose high enough that can stabilize the gut. Patients can go too fast which can give them gas and bloating and overwhelm them. Be patient and go slow. Be kind to your body.
Jill Osborne - Your thoughts on probiotics?
Heather Van Vorous - Good idea. We have some research studies that show that probiotics really help IBS. In general, I would ask at a health food store for recommendations on what brands work well. Soy yogurt is also a good source, but I don't have any brand recommendations for you. You can also take a prebiotic, which can help encourage the growth of probiotics, such as the acacia.
Jill Osborne - Katrina asks about fasting???
Heather Van Vorous - Fasting is a bad idea for IBS. Feast or famine doesn't work well for IBS. That's going to an extreme. One thing, if you're fasting is that you're not using soluble fiber in your gut to keep it stable and the emptier that someone's gut gets, the more hypersensitive they tend to be when they finally eat or drink again. Ideally it's better to snack and eat small meals frequently.
Jill Osborne - Chanepat mentions that while fruit is good for IBS, it can hurt the bladder.
Heather Van Vorous - You still have to be careful with insoluble fiber foods, like fruits, but eat them carefully according to your IC guidelines.
Jill Osborne - IC patients struggle with high acid fruits, therefore we suggest that you start first with pears, thena very mild sweet apple, some melon and then try the tropical fruits like mango and papaya.
Heather Van Vorous - This is true for IBS too about high acid fruits and other high acid foods like cooked tomatoes. For most fruits, it helps to take the skin off because it's the skin that contains most of the insoluble fiber. A potato is a good example of this where the skin is insoluble but the inside is soluble. Same for an apple.
Jill Osborne- Any thoughts of Benefiber??
Heather Van Vorous - It's a soluble fiber but I think it's very overpriced. It's partially hydrolyzed so it’s not in its naturally occurring state.It's guar gum.
Jill Osborne - What about patients who are sensitive to the acacia tree?? Can they use acacia fiber??
Heather Van Vorous - It's totally different. It’s acacia gum. There are over 1000 types of acacia trees and the acacia fiber comes from the acacia gum trees. Gum arabic is another word for it. So if you can chew altoids then you should be able to use the acacia fiber.
Jill Osborne - Does it help to eat slowly?
Heather Van Vorous – Yes and calmly too! Eating with someone stressed out and rushed is more likely to cause your gut to overreact.
Jill Osborne - Someone asks "what is the gut?"
Heather Van Vorous - The gut is your GI tract from your mouth to your rectum.
Jill Osborne - Can pain be associated with just one side of the belly or the other??
Heather Van Vorous - Yes, definitely. More people with IBS struggle with the left side as their source of pain.
Jill Osborne - What about water intake??
Heather Van Vorous - Very important. Soluble fiber needs water in the gut to work. For constipation this is especially critical. I tell people to drink water throughout the day all day long. Try to drink as much as you can without exacerbating your bladder.
Jill Osborne - Judy asks “What do you do when you're in major IBS pain but the pain medications constipate you?”
Heather Van Vorous - The single best thing to stop an IBS attack is really STRONG HOT cup of peppermint tea. This can work really well and it's the only thing that I personally found that helps stop the attack once it starts. If you are taking pain meds, make sure that you're getting enough soluble fiber to help counteract that. If you're struggling with spasms try the peppermint oil capsules. Those are very strong antispasmodics but they don't cause constipation or the dry mouth, dry eyes.
Jill Osborne – Renee asks about aloe vera juice?
Heather Van Vorous - Bad, very bad. Aloe is in the same family as senna and are classified by the FDA as harsh stimulant laxatives. They can literally turn your colon black.
Jill Osborne - Someone asks about the Desert Harvest Aloe, a sponsor this lecture. Desert Harvest removes the laxative causing ingredients, so if you're using that product it should be IBS friendly. Julie asks about chamomile tea.
Heather Van Vorous - It's good. Chamomile calms the gut and it's a bit of a sedative to take before bed. It's not as strong as peppermint or fennel. If you're dealing with pain head right to peppermint. For milder symptoms... chamomile is good.
Meone says that anything with mint bothers her bladder. Any other suggestions??
Heather Van Vorous - Fennel, chamomile, oregano or anise.
Jill Osborne - July asks “Is vulvar pain or vulvodynia common during IBS flares?”
Heather Van Vorous - I haven't seen any studies on that or any anecdotal evidence. Referred IBS pain tends to go up their trunk and sometimes up to their shoulders and down to their legs. It's not super common but it can happen.
Jill Osborne - How can a patient find a support group??
Heather Van Vorous - On our website - http://www.helpforibs.com
Jill Osborne - Do you have plans for a new book?
Heather Van Vorous - Yes, I do! I am working on a third book now.
Jill Osborne – Any comment on papaya enzymes??
Heather Van Vorous - People with IBS aren't lacking in enzymes but they can't hurt. Some people find them really helpful.
Jill Osborne - Someone asks where they can find acacia powder??
Heather Van Vorous - Well, you can buy it from our website or the ICN's, and in many stores across the country. We have created a product line called Heathers Tummy Care, including an acacia fiber, peppermint capsules, peppermint and fennel teas. Our books, newly diagnosed kits and a cooking show that emphasizes that people with IBS can eat great foods!
Jill Osborne - Asilve asks “Are people with IBS more likely to suffer from GERD??”
Heather Van Vorous – Yes. The dietary changes that help IBS are right in line with what will help GERD as well! Fennel can help both!
Jill Osborne - July asks about how she can head off IBS flares first thing in the morning??
Heather Van Vorous - It's always easier to prevent IBS so look at what you're eating the night before. Be careful with your dinner. Take your soluble fiber supplement before you go to bed and have peppermint or fennel tea after dinner and, again, first thing in the morning. The fiber and the teas are very helpful. Morning is commonly the worst time for IBS
Jill Osborne - What about age levels for diagnosis???
Heather Van Vorous - The most common age of diagnosis is late teens to early 20's. You can develop IBS at any point in your life. The older you are when the symptoms start the more diagnostic testing you'll probably need.
Jill Osborne – What about exercise?? Can exercise help IBS??
Heather Van Vorous - Yes, it can. In general, exercise is excellent and helps regulate the gut. Your gut is muscle and exercise helps tone muscle. Exercise is also a GI stimulant itself, so people who are prone to diarrhea may struggle with this. Yoga is probably the best form of exercise for IBS. You get the benefit of specific digestive aid poses, plus the relaxation, stress management and the general exercise.
Jill Osborne - When reading a food label, how can you tell if the fiber is soluble??
Heather Van Vorous - In America, they have to break it out. In the nutrition facts area of the label it should tell you the grams of insoluble versus soluble fiber. In general, anything that has a label on it is probably a processed food. In cereals watch out for whole wheat, bran orthings with a lot of dried fruits and nuts.Look for oats, rice and cornmeal instead.
Jill Osborne - I use cream of rice cereal and it works well.
Heather Van Vorous - That's good and you can add a fruit to that.
Jill Osborne - Any IBS friendly cheeses??
Heather Van Vorous - Look for soy, rice or almond cheeses. Health food stores have them.
Jill Osborne - Thank you Heather, for a wonderful guest lecture. I have no doubt that you have helped many tonight and the thousands who will read this transcript! Thank you so very much for your knowledge, practical experience and, most of all, your compassion for other patients struggling with IBS. We so appreciate your efforts.
Books: First Year: IBS & Eeating For IBS by Heather Van Vorous – available at www.icnshop.com
Heathers Tummy Care Line of Products – available at www.icnshop.com
http://www.helpforibs.com - A website dedicated to IBS information & support
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