HI MATT.Ugh. What a way to start the day. benn there, done that, got the stomach pump and wrist band...ech...Just a quick observation...the stuff you ate last night has so many different things in it that can, alone or in combination, be giving you trouble no one would know where to start. We would have to amke a list of each thing which might be bad for you but fine for someone else.My first recommendation to you is to order Professot Jonathan Brostofs Book FOOD ALLERGIES AND FOOD INTOELERANCE: THE COMPLETE GUIDE TO THEIR IDENTIFICATION AND TREATMENT. He is one of the worlds top immunologists and he and his dietician who co-wrote the book have been working with people like us for decades. the book is $18 and is an excellent investment...and no I have no financial interest in Dr. Brostoffs Book sales.If you want to peek or order, click here onURL FOR DR> BROSTOFFS BOOK ON AMAZON:
http://www.amazon.com/exec/obidos/ASIN/089...6487508-3420903 -------------NUMBER 2 general statement is to first rememeber there is no "one size fits all" eating plan for IBS. Everyone here, while statistically sharing many commonalities (see the clip below) has nuances to their diet resultant by their personal symptoms and responses and complicating factors.The basic principal (nad difficulty) with situation slike yours (assuming you are already under th care of a Board Certified GI doctor and all organic disease has been ruled out) is that there are only a couple of effective ways to go. You have to start from "nothing" (go on a stoneage diet and stay on it until your symptoms subside so you know that ate least what you are eating is not reactive in any way), then start serial oral challenges in a very structured manner.OR one uses one of the modified approaches which Brostoff (and other authors) discusses in his book, for folks not prepared for the hard core approach (diet free of pseudoallergens first, and see you response, then eliminate or add depending upon reaction). Or one takes a shortcut with one or two in vitro tests that are available to help zero-in more quickly on offensing foods.The advantage of doing it yourself is it costs you nothing but time and effort and tries your patience. But I think the disease tried my patience worse than seeking the precipitating factors. The disadvantage is obvious: if it is not dobe in a structured fashion, carefully following procedure, you will get poor results and mor frustration. There is no free lunch or magic bullet yet. Only different routes of getting there depending upon which makes sense to you.I have included here a summary on veggies which can cause "pseudoallergy"...false food allergy. Same symptoms and problems as if one was hypersensitivie otr allergic, but that can happen to anyone due to substances in the food. This is another starter, to which can be added a long list of irritant foods, which varies depending upon who writes it, and by the time one eliminates everything on both lists to start, plus anything you are dead-on certain you are sensitive to, most people are pretty close to one of the "stoneage diets" of three or four starting itmes anyway. So I skippped that part. Someone else can add it to their post to save length of mine, since I put up the pseudoallergy foods first.---------------------------------------------------BACKGROUND----------------------As we have all read over and over, 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 add supportive pharmacotherapy as required.Interventional pharmacotherapy and dietary supplement therapy is often used to manage direct GI symptoms as dietary therapy is often frustrated by inconsistency in results and accurate identification of the actual offending foods and additives.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 and neutralized, or otherwise processed within the normal gut, or if it gets into the bloodstream by other organs like the liver, and circulating structures 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. --------------FOODS THAT CAN BITE YOU.Some foods, especially vegetable matter, developed genetically DEFENSE MECHANISMS 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 today again...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 allergy, becasue your immune system is functioning normally. It has been tricked into reacting by the veggies weapon, and with IBS 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 Dr. Brostoffs Book referenced below 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 some lectins 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 by a compromised gut or both can make you say "AHHHHH there 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 hypersensitive. Add to this the fact that your food "triggers" may be also from one of several types of ABNORMAL "hypersensitivity reactions", (immune mediated, non-immune mediated, or both). 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, absorbs and circulated or all these variables, 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 unless done in a very specific and structured manner, starting with a base diet that is established to be 100% "non-reactive" for that patient.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 various (and at times stringent) dietary regimens have been developed to try to uncover more accurately these triggers. There are (2) general types of approaches as I said before. 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. If not, one must rotate foods OUT of the base diet and allow sufficient time to pass for symptoms to subside...then the patient has a starting point.There are several specific diets to choose from that are layed out as daily menus that follow this approach in Dr. B's Book. 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). Then there is the BRAT diet...each is a variation of a low-reactivity base diet.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 actually another milk-fraction (casein, whey). Or its 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 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 eating patterns and how they realte to constitutional symptoms that have been linked to food and additive sensitivity.------------------------------------------A REPEAT NOTE ON ADDITIVES AND
FLAVORINGS:Additive reactivity is very hard to discriminate with challenges...think of the possibilities...300 additives and 3,000 flavorings (not all are commonly used in all societies...there are usually around 100 or so to dal with and some are of the same chemical family so find one reaction, elimante the others).With IBS we should avoid additives anyway. The 3P's RULE is a good rule: Packaged + Processed = Poison. Many can irritate your colon all by themselves without any allergy due to the reactive nature of the gut. So we always try to direct patients to an additive-free diet.-----------------------Hope that helps get you thinking anyway about some of the alternative wasy to approach the diet problem. After you ahve waded through, I will be back tomorrow (gotta run soon) to answer any questions you may have.Have a DFD Matt.MNL________________________
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