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Discussion Starter · #1 ·
Hi,I'm still in the process of diagnosis, but I've probably got IBS-D.My question is, if you eat every day how can you tell which food is making the symptoms worse? For example, if I only eat spaghetti for lunch on Monday and feel lousy on Tuesday with D, would it be the spaghetti or could it be what I ate on Sunday? Also, my doctor said to stay off coffee for a while -- would it be the caffeine or the coffee itself? I love to drink Sanka as an alternative to coffee.Thanks
Fiona
 

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Discussion Starter · #4 ·
Hey flux!While free speech is alive and well, and you may say as you please...STOP AGGRAVATING THE GUY, will ya'?C'mon - your comment had absolutely no informative, productive, or positive value, and only serves to inflame some of the folks on this board (me, for one, obviously).Like many others here, I do believe you can add (and have added) informative content to the board. In fact, your most recent post to the thread that I continued on about the "snake oil" issue is a good example. My compliments there - it was well considered, phrased, and crafted. Problem is, every once in a while you go into this "one liner" or graphic response that can detract from your good moments.I'm not defending MNL, he can rise to that occassion himself and doesn't need my help. And, I am pretty much decided that his LEAP stuff needs to be further scrutinized. Anyway, at this point I think that topic has been beaten to death.All that said, I would certainly defend your right to speak as you wish, and am not presuming to alter your behavior, but consider some common courtesy here. It's like you're trying to pick a fight. One that we've already seen and discussed in other threads.Ease up on the cheap shots, bud.Fiona,OK...I've vented. Now to your question. I kept a food diary for almost a year and was similarly confounded by things like your spaghetti example. Sometimes I could clearly see a reaction to some foods (or so I thought), but the next time I couldn't. The only thing the food diary really showed me was that volume of food, not type, seemed to correlate most readily to IBS symptoms (I'm D).BJ[This message has been edited by BobJ (edited 08-24-2000).][This message has been edited by BobJ (edited 08-24-2000).]
 

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HI FIONA:Still runnin around so I am going to post a couple things I already did, but which can help start you thinking one one angle. I will also post the primary source of the information._________________________________________-INFORMATION SOURCE:"FOOD ALLERGIES AND FOOD INTOLERANCE:THE COMPLETE GUIDE TO THEIR IDENTIFICATION AND TREATMENT"Professor Jonathan BrostoffSee AMAZON for your copy)________________________________________Unimpressive Physician's Credentials_________________________________________Professor Jonothan Brostoff, MA, DM, DSc. FRCP, FRCPath.CURENT APPOINTMENTS:professor of Immunology, Allergy & PathologyUniversity College London Hospitals Medical SchoolDirector of Clinical Immunology and AllergyUniversity College London Hospitals, (Middlesex and Associated Hospitals)Director, Diagnostic Laboratory: Autoimmunology, Immunology, and AllergyUniversity College London Hospitals------------------------------------------VITAE------------------------------------------EDUCATION:Graduated Oxford University 1957St. Marys Medical School 1960CURRENT COUNCILS:Council Member and Past President Clinical Immunology and Allergy Section Royal Society of Medicine, LondonCommittee MemberBritish Society for ImmunologyCouncil Member, Past SecretaryBritish Society for Allergy and Clinical ImmunologyEDITORIAL BOARDS OF PUBLICATIONS:Clinical Reviews in AllergyClinics in Immunology and AllergyPerspectives in ENT-AllergyAllergologia et ImmunopathologiaClinical ImmunotherapeuticsCURRENT SCIENTIFIC SOCIETIES:British Society of ImmunologyBritish Society for Allergy and Clinical ImmunologyBritish Society for Allergy and Environmental MedicineCollegium Internationale AllergologicumItaian Societyfor Allergy and Clinical ImmunologyRoyal Society of MedicineHarvein SocietyHellenic Society for Allergy and Clinical ImmunologyAmerican Association of ImmunologistsAmerican Academy of Allergy and ImmunologyAmerican Academy of A;;ergy and Environmental MedicineAmerican College of AllergyInternational Association for the Study of AsthmaMEDICAL ADVISORIES: UNITED KINGDOMTo the Minister of Agriculture, Food and Fisheries (Food and Chemical Sensitivity)To The National Eczema Society(Medical and Research Committees)To The Myalgic Encephalomyelitis Association(Medical Advisory Panel)Allergy Research Foundation(Chairman)Anaphylaxis Campaign(Medical Advisor)INTERNATIONAL ADVISORIES:International Council of Scientific Unions:(National Member for the U.K; Scientiic Committe on the Problems of the Environment)International Association of Allergy and Clinical Immunology(National Member-U.K.; teaching and Specialism in Allegry and Clinical Immunology)California Medical Association(Advisory Committee on Allergy)Ontario, Canada Special Advisor to the Ministry Of Health and Allergy ServicesEuropean Academy of Allergy and Clinical Immunology(Council member; Committee On Adverse reactions To Foods; Committee On Standardization Of In Vitro tests For Allergy)Institute of Thoracic Medicine, Sciena Italy(Visiting Professor)BOOKS PUBLISHED:Clinical Immunology-Allergy in Pediatric Medicine (1974)Food Allergy: Clinics In Immunology and Allergy (1982)Introducing Immunology (1985-English 1987-German 1987-Japanese 1988-Italian SECOND EDITION-1993 German #2-1994ImmunologyEditions #1 through #3 In English, French, Spanish, german, italian, Portugese Korena and Greek published during 1986, 1987, 1988, 1989, 1990, 1991, 1993, 1995)Food Allergy and Intolerance* (1987)*Physician Guide to Diagnosis and TreatmentCooking and Eating for Allergies (1987)The Complete Guide to Food Allergy and Intolerance (3 editions, 5 languages; 1990. 1991. 1992, 1993, 1995, 2000)Clinical Immunology (1991)Hayfever-A Complete Guide (1993)Clinical Immunology; An Illustrated Outline (1994)Case Studies in Immunology (1996)Autoimmune Disease: Aetiopathogenesis, Diagnosis,and Treatment (1994)Food Allergy and Intolerance* (New Edition)*Physician Guide to Diagnosis and Treatment (Being Compiled and Edited as of 6/2000)PEER REVIEWED PAPERS PUBLISHED: 163 papersCHAPTERS AND INVITED REVIEWS IN OTHER MEDICAL TEXTS: Don't have a current count-------------------------------------------DIETARY MANAGEMENT I: FOODS THAT BITE BACK-------------------------------------------As we have all read, once a correct diagnosis of IBS is made (all the post-infection, inflammatory bowel disease, enzyme deficiency, and traditional "rapid onset" allergy causes of bowel dysfunction have all been evaluated and ruled out or treated) what is left is a problem of a hyperactive/reactive gut combined often with systemic symptoms (that can manifest themselves a number of ways). Diet, mental state, and overall health at any given time influence symptoms. Mental state is managed with various "affective" therapies depending upon the disease management approach of the particular clinician/patient combo (some prefer cognitive therapies, meditation or yoga, hypnotherapy, and/or pharmacotherapy).Interventional pharmacotherapy and dietary supplement therapy is used to manage direct GI symptoms as dietary therapy is often frustrated by inconsistency. Why? Diet affects everybody, healthy and unhealthy alike, since your largest interface with the outside world is the digestive tract and it is designed to differentiate the good (nutrients) from the bad (pathogens, toxic chemicals, foreign substances)and then process each accordingly. The good stuff is supposed to be broken down into specific components far enough that it can be safely assimilated into the body through the intestinal absorption structures (see villous anatomy) and the waste leftovers disposed of competently. The bad stuff, once identified, can be attacked or other wise processed within the normal gut, or if it gets into the bloodstream by other organs like the liver, and then disposed of. This involves evoking various protective mechanisms that are components of the immune system which are managed by a chemical management system (mediators) and linked to the nervous system (peripheral and central )which also contributes to controlling the process. Under normal circumstances and with a normal immune-neuro-gut structure interface, this whole complicated process works along fine processing your food and sorting out the wastes and foreign invaders. from time to time a person gets a bout of nausea, vomiting, diarrhea, chills, flushing, dizziness, maybe even body pains and inflammation in the upper respiratory mucosa at the same time, fevers, and all combos thereof. Which is nothing more than the immune system detecting (either quickly in the upper digestive tract or more slowly as the objectionable pathogen or chemical makes its way down into the intestines) a pathogen or potentially harmful chemical and then taking steps to isolate it and then remove it from the body. -----That simplified explanation in place, the first thing to explain is how if you did not have IBS or any allergy of any type whatsoever, you would still get sick digestively or otherwise from time to time from something you ate. Some foods, especially vegetable matter, developed genetically just like animals. HUH? Animals do not want to be killed and eaten so they develop defense mechanisms. We humans went from sticks and rocks to guns and grenades. Someone attacks you, nuke 'em.Animals develop camouflage, or teeth and fangs and claws not just for eating but for defense. A lot of plants that we eat do not want to be eaten either so they have their own defenses. These include plants (fruit, veggies) that produce chemicals designed to be in sufficient concentration to make a little animal sick if they eat them, so little animals do not eat them. THIS IS BY NO MEANS A COMPRHENSIVE LIST BUT AN EXAMPLE TO BE CONSIDERED. TIME IS SHORT. One chemical weapon that some veggies have thats real cute is a weapon that causes your immune system to Turn On itself! There are a lot of chemicals found in foods that can do this but one of the most prevalent is a group of similar chemicals called "lectins". In short, lectins are a group of chemicals which trick mast cells in the mucosa of the digestive tract into "degranulating". The mast cells contain chemicals (mediators) which either act directly on an invader or casue things to happen which bring other immune chemicals and cells into the fight to control an invader. And when the mast cell releases these chemicals it also causes local irritation and ven systemic reactions. In the lung, spasm of the muscle and swelling of the local tissues engorged with fluid beraing defensive cells, and an outpouring of secetions can happen. In your gut, smooth muscle spasm, incresed mucous production, swelling, and then systemic effects of mediators that get taken into the lymphatics and blood stream can cause the other symptoms we discussed as the body tries to expel the foul substance. Now most peoples bodies are structurally sound enough to process the results of this defense mechanism sufficiently that the person does not get clinically sick (or very little) from consuming a normal 'dose' (side dish) of these veggies that contain lectin. But a compromised and reactive gut, overreactive central and peripheral nervous sytem combined with the anxiety accompnaying the syndrome which is part of the trigger-loop can make a person with IBS get an "attack" from something another might not. When this happens it is not an alllergy, becasue your immune system is functioning normally. It has been tricked into reacting by the veggies weapon, and it is more reactive than normal (the gut and the rest of the nervous system) and this can be amplified by the stress/anxiety responses. This is sometimes called "false food allergy" or "pseudoallergy".Lectins are found in high concentrations in legumes (peas, beans, lentils, peanuts, etc.)Some contain so much that if they are not prepared properly without a lot of presoaking and cooking even a healthy person can get a diarhea attack. Kidney beans, improperly prepared and put in a dish or salad, or in a slow-cooker instead of the usual high-temp cooking, have been responsible for more than one attack of "I must have an intestinal flu bug". And since it takes a while for the beans to get eaten, processed, start moving through the bowel and releasing quantities of lectin, we are talking many hours or even the next morning (if the persons transit time is slowed as it is in some gut dysfuntion) after breakfast before the dreaded explosion occurs! And lectin response is different in everybody, normal and IBS alike. That is why they are called "lectins". This is from the Latin ,means "to choose" I think (see brostoffs book for a better discussion). Some of the lectins interract differently with different even healthy people due to each persons slightly different makeup of the short-chain carbohydrate molecules that are attached to the bodies cells. Different lectins are specific to specific to certain carbo structures. AGGGHHH! Smart beans! It gets more complicated as some lectins trick the mast cells directly ans ome lectines can bind IgE creating an "antigen" and actually can make a person have a positive skin-prick test for a pea or bean when they are not actually allergic! Some other foods (strawberries, shrimps, crabs, lobsters, tomatoes, fish pork, chocolate and more) contain special types of "peptides" which can also trick mast cells in your gut into losing their integrity and dumping mediators. Again, a normal person might not notice as the body processes these inappropriate mediators without clinical symptoms, or do not notice unless they eat a high concentration of them (plus ketchup and tomato sauce tend to concentrate the chemicals as they are processed). But an IBS or IBD victim might get "killed" once the stuff gets into the gut, and the farther it goes the worse it gets until they reactions finally expel it all. Histamine is another beauty. You know Histamine is one of the main chemical mediators released in allergy (immediate-like hay fever or the severe anaphylactic reaction to peanuts, say) or in other slower allergic reactions, or in tissue reactions which seem delayed because it takes time for the trigger to get in contact with mast cells. But some foods are high in histamine, and if consumed either in larger quantities or ny a compromised gut or both can make you say "AHHHHH ther it goes again!". Red wines, champagnes, even beer and white wine are beverages that can contain can contain histamine. And of course lets have a little party and put some cured sausages out (summer sausage, genoa,and other hard sausages) and some well-ripened cheese and you will get a real good soe of histamine from these. Mackeral and tuna can have histamine in them as well, especially if they are not kept very cold during the processing and canning process. These histamines come from the normal bacterial action in these foods as a byproduct. This direct-release of histamine can trigger fsater responses if the concentration is high, especially in beverages, because it can be directly absorbed through the buccal mucosa (oropharynx-mouth & throat) and bang you with a headache, dizziness, nausea, then just wait as it gets to your reactive gut..BAM ZOOM TO THE MOON.------------------------------------------That is a quick summary of NORMAL immune finctions and food, as it can make our IBS go-off even if we are NOT immunocompromised. Add to this the fact (for another discussion or see www.leapallergy,com for abnormal immune reactions)that your food triggers may be also from one of several types of ABNORMAL immune reactions, not just regular Type I allergy (immediate reaction) but reactivity that is delayed either by the reaction onset is slow, or by the time it takes the reactive substance to get spread around the area of the GI mucosa so it is "seen" to react to, or both, before the process and symptoms even begin and you can be talking about 12, 24, even 48 hours for full-onset. In this case there is slim chance a standard food and symptom log is ever going to have a HIGH correlation to the onset of symptoms. It could be something or things eaten or drunk 3,4,5 meals ago...and since the consumption patterns fluctuate, as do the amounts consumed (some reactions are not seen as clinical symptoms until a reactive-threshold is passed by a certain dose of the trigger food, just like an asthmatic not going into a full-blown event until a certain dose of antigen is taken in).-------------------------------------------WHAT DOES ALL THIS MEAN?-------------------------------------------This is why some stringent dietary regimens have been developed to try to uncover more accurately these triggers. There are (2) general types of approaches. One is to go on a specific diet that is given, is very structured to remove just ALL KNOWN PSEUDOALLERGIC POTENTIAL FOODS. Then see if the symptoms start to subside over time (not a week...must be followed for NO LESS than 30 days before evaluated). Then if that worked, reinstituting foods one at a time by challenge is done. There are several specific diets to choose from that are layed out as daily menus that follow this approach. See FOOD ALLERGY AND INTOLERANCE by Dr. Brostoff ($18 on AMAZON)for the ones he has found effective in 40 years of practice. ANOTHER way is to start with a stoneage diet regimen which removes all the pseudallergic sources AND all the PROBABLE allergic and delayed-allergic foods. Like the Rice-Lamb-Pear diet. There are several.Ditto the procedure (in general...specifics are explained in the book).In any case of an investigatory diet, because any of the reactions may not be the FOOD but an ADDITIVE , all processed foods, additives, and colorings are forbidden. And nowadays organic is one step better, since there may be an antibiotic in the Chicken you bought that they gave it your immune system reacts to, not the chicken. Or, some people are told or lead to beleive they are "lactose intolerant" when it is another milk-fraction, or not the milk at all. They get diarrhea from Ice cream but when they drink a glass of milk: nothing. Sorbates (polysorbate, sorbitol) in the ice cream may be the culprit. ------------------------------OK summary over. Dr. brostoff's book book is a good one, probably the best for patients written by the top immunologist in the field. I recommend it for people trying to get a grip on their food intake vs their IBS (or any other food-related illnesses).------------------------------POST SCRIPTFIONA:------------------------------When I get a chance tomorrow I will post some tips on food journals and how to make them "work better" based on the characteristics of the bodies responses to foods and additives.Gotta RunHave a DFDMNL-----------------------------Have a DFD
 
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Discussion Starter · #6 ·
MNL,Thanks very much for the info! There's so much to learn about IBS. I appreciate it.Fiona
 
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Discussion Starter · #7 ·
BobJ,Thanks for your input. I haven't had these symptoms for long and nothing seems to make sense.My stomach has definitely shrunk so I'm only eating half as much as I was a month ago (which is ok because I used to eat a lot!). It seems though that no matter what I eat, I have D (well, if you can call it that -- it's like paste really). I only have it twice in the morning, 20 minutes apart, and then I don't go again until the next day. But during the day I keep thinking I have to go.The nausea has gone completely though (it lasted 2.5 weeks).I can't wait to start getting to the bottom of this (tests).Thanks,Fiona
 
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