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Mike,Per our conversation about Leap working or not in the other thread:First thank you for taking the time to write a rather lengthly answer. However… It has not really helped me at all. As I stated, I do understand the reasoning behind screening the people that are then introduced into the LEAP program. However, what I was saying is that it seems to be toted on these boards as a possible cure or rather treatment for IBS. Which I don’t believe it is. It is a treatment for food sensitivities. There is a big difference. I understand you saying they go hand in hand. But I don’t think that is exactly true either. It sounds more like the SYMPTOMS of IBS can be the same as those of Food sensitivities. Otherwise how do you explain those with the C type of IBS? You say that usually does not indicate the person is suffering from some type of food sensitivity. Your answer to my questions seemed somewhat jumbled with technical terms that I obviously would have no knowledge of, and I must admit that due to the length and complicity of the message, may have just scanned through some of it (sorry!) Anyway, I agree it sounds like an EXCELLENT program, for those it can help!! I also agree I need more parasite testing! I am pushing for that after this gallbladder test that was insisted upon. It is very interesting to me that you say food sensitivities can by cyclical. I had no idea. This and other people’s posts only make me wonder further why I was dismissed for consideration so quickly. I guess I will suffer along for a year or so and do whatever tests the doctor recommends then maybe if all else fails talk to those in LEAP again. I really do not know what else to do. I honestly believe it is not my gallbladder, not Chron’s, not Celiac’s or anything else I have read about. I have such varying and changing symptoms, I just think this may be how I have to live from now on. I must admit it consumes my whole life and has thrown me into quite a depression. Thank you so much for trying to help with your responses, and please understand that I do understand that screening is the right thing to do. But being on the end where they are saying they can’t help you. Well it sucks to put it quite bluntly : ) I posted back in the original thread that I agree it sounds very helpful to others and that I have not heard of anyone having it fail them. I was just trying to explain that should be expected, as they are prescreened and already it is assumed they will have success. So people should not think because it works for everyone that is in the Program, that it will work for everyone…. Thanks for your insight. So as far as you know Parasites would not cause these cyclical symptoms and changing symptoms??? I have seen your posts many times before and you seem very caring and helpful, and have obviously read about this condition and experienced it much longer than I.Sara
 

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SaraHiI just wanted to say there is no cure yet for IBS..I can say my symptoms have really improved but I am not cured...because if I eat something today (and I have) that come back on my MRT test results as being sensitivity to I will be right in the bathroom...
and at times I do have temptations and I know the results..So that has to be self-deciplin for me..Oh just alittle wont hurt
I wish I could help you out about parasites but I dont have alot of knowledge about that...I am sure your questions will be answered here ...In your statement you said that LEAP has not helped you at all...but I dont think that is fair to say when you havent had the bloodtest or have had a dietary plan to follow up with after working with LEAP...Just because they suggested to check out some other avenues before working with them only seems helpful to meI dont know why it dont work with people that has constipation but Mike will be able to help you with that question...Like I said hang in there and hopefully you will get some help and relief very soon.
 

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Hi Arrggh,Sorry, I am not Mike, but I have often wondered that myself. This is just my opinion...IBS is a term given basically to symptoms that do not fit any other disorder or known medical illness. Whether it be Bacteria Overgrowth, Parasites, food intolerence, Yeast Overgrowth...etc. it seems that IBS is based on symptoms...not what causes it...Much like the term nausea, which one can get from a certain food, pregancy, a virus, a rough amusement park ride, being on a boat... etc. This is just my opinion.What I have always pondered is why people with D and C are all called IBS-C or IBS-D. I am C, but I feel that the two are somewhat different....someone with D may suffer poor absorbtion of vitamins and nutrients since things go right through them, many have anxiety of leaving their house because for many the fear of an accident is always there, and even the receptors and meds are different for C and D. Labelling one C and one D to me doesn't really define the larger differences. They just define it as a change in bowel movements, so I suppose in that way it fits. Either way, they are both horrible, but in different ways, I feel.Just my 2 cents. Hope you don't mind my rambling here.
 

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Hi ARRGGGH>This is at the root of the conundrum of what is LEAP good for, or who, and who not... ________________________________________"However, what I was saying is that it seems to be toted on these boards as a possible cure or rather treatment for IBS. Which I don't believe it is. It is a treatment for food sensitivities. There is a big difference. " _________________________________________The dogma that "food sensitivities" and "IBS" are mutually exclusive is the problem in s=the semantic discussion. The fact si that they are not mutually exlsuive. In the diarrheic propulationm "non-allergic food sensitivities are integral to the syndrome. It is one of the primary symptom generating mechanisms, and can be isolated by determining which foods or chemcils provoke an abnormla reaction of the circulating immunocytes which results in release of the mediators which upregulate the gut nerves directly, smooth muscle directly, exocine glands directly, and which affect other bodily functions (even temperature control) directly thus cuasing the systemic symptoms people experience.So it is a disease management process...no more claimed to be a cure than a diabetes managment pogram cures diabetes...both put the condition under control, so the patient suffers minimal problems fro the disease thus is able to experience a higher quality of life and reduction in health care costs.It also happens that, for example, patients with IBD (such as Crohns') also suffer from "food sensitivities" as a consequence of the underlying problem which causes Crohns...the abnomrla inflamatory processes become aggrvated by certain foods or chemicals...so if you isolate them you do not cure the Crohns but you can help the person, through patient specific dietary therapy, reduce their symptoms and even their medication dependency...sort of stop rubbing salt in the wound affect. This is also treu of migraine and several other conditions where various forms of aberrant immune system activation are involved.Since, at least in the 2/3 of IBS patients who suffer a diarrheic-component, this is also true (aberrant immunocyte activity) a protocol combining patient specific dietary therapy and effective stress-anxiety repsonse managment can and does restore those patients who respond to this...and who will adhere to the protocol...to a mcuh higher quality of life. While the underlying causal basis of the aberrant immunocyte activity still remains a puzzle (though it is being narowed down to things like dysbiosis, for example, will iekly turn out to be ione of the smoking guns...this cause disrupted digestion thus alters the immunocytes ability to perform their job properly)...if you know a train wreck will cause death, while you may not be able to find all the things that can go wrong which will make a car not stop at the crossing at thus cause a wreck and death, if you contrive a menas of preventing the car from entering the vicinity of the crossing while a train is present, then the outcome can be avoided. So Disease Managment programs are like the crossing gates and flashing lights...they warn you "enter here at your own risk of being smashed b a train". Don't enter and you will be OK. best analaogy that comes to me on the fly.
______________________________"This and other people's posts only make me wonder further why I was dismissed for consideration so quickly" ________________________________The protocols that the doctors and dieticians who developed them on over 1,000 patients in the two beta clinics require that if a person interested in the LEAP homecare program ahs a history and symptoms which suggest that active parasitic infection may be the causal basis for their symptoms, and if it has not been properly ruled out by their physician, tey are to be directed to a physician and this be ruled out beofre being admitted to the program. Why?if you have an active parasitic infection, you will indeed liekly test positive for cell mediated reactions to certain foods, and diatary therapy might reduce ypur symptoms BUT the underlying causal basis of the lost oral tolerance will remain and you will simply lose more oral tolerance as the condition remains or progresses and the patient will have been directed AWAY from proper medical care. This is unethical and also could potentially make the dietician, the supervising physcian, and the company liable, when their sole function is to provide dietary counselling to those people who are known to benefit from it. If the dietician did not follow this protocol, as approved by the aforementioned medical directors and advisors, and a patient suffered as a consequence we wouldhave to fire the dietician. This does not look good in the old resume.This is all designed to protect you, the sufferer, from barking up the wrong tree, and not do wrong to you.These are some of the reasons. Now if you were, for example, seen with that history and the possibility of infectious disease had been ruled out, then the discussion would likely have been different. I was not there so I cannot say, excopet to say that Jan is a highly respected RD aming her peers, and has an excellent reputation with patients and with patient care. She is also a hard a-- occassionally, when appropriate, which is required sometimes when dealing with tough issues. _____________________________"But being on the end where they are saying they can't help you. Well it sucks to put it quite bluntly : ) " _____________________________I understand...went thorugh it for 30 years nd is why, when these people helped me many years ago and were working on developing better technology, I saw the value in it and became involved. I wnet into healthcare education after 10 years in my hospital career so as to use my experience to help others improve the quality of their lives by training for healthcare careers themselves. Over 10 year my schoold trained thousands of gradutes (mostly diveorced ladies with dependents struggling to make it, who neede a new life)...and then went into this area of healthcare (developing disease management solutions for people whose lives sucked as bad as mine did from IBS) because I could bring something to the "technology team" I met of research immunologists, biomedical engineers, dieticians and clinicians...all of whom lacked the one thing that I had...they NEVER LIVED WITH IBS so there was no way that they could collectively develop something that fit IBS sufferers needs as weel as they could if they had an IBS sufferer with healthcare training coordinating all their collective work.But if you turn the glas over and look at it as half full instead of half empty, I think you know in your heart that the RD's intent was not to not-help, but TO HELP in th best way seh could at that time. It would have been easeir to just either wave you off with a "not for you" and let it go at that, OR to simply take you, take your money, put you in the program and when your results were good but not great, do what all doctors do "I do not guarantee any results...I can only guarantee that you get the time you paid me for".Instead, to try to help, she dirested you to something that the medical literature even agrees with...there is something esles that shopuld be checked carefully first because IF that IS the probelm it can be treated and yor problem will go away PERMANENTLY as it was NOT IBS but a pathogen. Pathogens can present like IBS clinically and have been known to be tough to isolate...you must rule it out before assuming the symptoms are definitelty from loss of oral tolerance and proceeding.
_____________________________________"Thanks for your insight. So as far as you know Parasites would not cause these cyclical symptoms and changing symptoms???" ____________________________________On the contrary this is one of the things that is intersting....giardia, crypto, hysto, cyclo and the whole ugly family can be tricky to isolate and the symptoms can wax and wane...depends in part how well your gut immune system and flora are doing at "contianing" the organism. If you have a Merck manual suggest reading the pararsite section (uh, starts..w.ait a minute here...page 1237) and it shows the different ways of isolating the little buggers...and even that sometimes one may need to do a simple sigmo to get what is need to isolate an elusive passenger.If your history was not what it is, I would not mention this all so persistently as something that one should just make sure of.Sara, you are right, I really want to see you, and everyone, helped. :love: Butdue to my profession I am compelled sometimes to help in ways that people would rather not have me help in. But if I diod not think it was the right thing to do, I would not suggest for any sick person to do it...whatever it is.Does that make some sense? Soemtimes I get so convoluted the message gets lost in the mess of my prose.
Oh my time to go make a living....later! Sorry I did not clean up the typos this time...MikeNLPS To IBS-Hater: __________________________________"Just my 2 cents. Hope you don't mind my rambling here." _________________________________hey ramble on....Bob Seger did it and look where it took him!
[Age betrayal]
 

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Discussion Starter · #5 ·
Donna- I meant Mike's response had not really helped me at all, not LEAP has not helped me at all
I_h8_IBS- Don't mind your "rambling" at all. It does seem like to me that doctors have no clue. IBS is a made up term that encompasses so many different symptoms, I don't believe it really exists. I think there are many things causing these symptoms. And they are all getting thrown together because no one understands them yet. That's my feeling anyway. It seems Mike is talking about some sort of tests that show something or other behind the D type, but I have no idea what he is talking about as he uses technical terms and I am nothing but an accountant LOL not a doctor! But it's just my feeling that numerous things are really causing these symptoms. For example some people later find out they really had a Thyroid problem, or Chron's, or a Gall bladder problem etc. Mike- Okay that message was a little less convoluted LOL. It seems you are still concerned with me saying I wasn't helped by the people at LEAP. As I stated before, and maybe not clearly, I do understand they have to screen people, as not to waste their money etc. I can only say the phone call I receive lasted maybe 3 minutes and as soon as she saw I had gone to Aruba right when the worst of all this hit, it was like I was dismissed. I don't know. As I said I have no idea what's wrong with me. Only that it is driving me insane LOL. I also did not mean you and people associated with LEAP are the ones that treat LEAP like a cure, but that other members of the board are not very clear when the speak of it, making it sound like it works for anyone etc. I should have made that clear. That's human nature, you are happy it worked for you and want to spread the news, but don't fully explain the program when doing so….I guess that's all I really have to say about it J Thanks for the information about parasites. As I mentioned I plan on getting the three-test thing done. I believe you mentioned in previous posts that I see a different type of doctor, but cannot remember what type now… Well unfortunately I have to go with what my insurance will pay for. Right now I am seeing a GI and have had an upper endoscopy done and am having a gallbladder scan tomorrow. It's so hard for me because my symptoms change so much. When I saw him originally I had horrible heartburn and pains in my chest. Since being on an acid reduction medicine, those have almost disappeared. So had my soft frequent urg. Bm's. But they have now come back with no rhyme or reason. I don't know that I have a parasite, as I don't often get full fledged D. I don't seem to fit into any symptoms I have heard of, but fluctuate etc. from the things I have read, I would think a parasite would 'cause much worse D etc. But then even though I did have D occasionally before the trip to Aruba, that is where the Urg. Freq. Soft stools started. And have been hanging around off and on (more on than off!) since then…
 

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IBSers either over react or under react to serotonin released in Gut receptors, of which foods can be only one of many many different triggers, but food sensitivites ARE NOT IBS and yes there ARE exclusive conditions that can overlap in some people.Take some time register to Medscape and read this thouroughly. http://www.medscape.com/viewprogram/1985 A very important an little understood aspect in all this is also an altered gastro colonic reflex in IBS. Which can cause D directly after eating.
 

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Clarification: _________________________________"....but food sensitivites ARE NOT IBS " _________________________________Since there is no definition of specifically what IBS IS, other than a set of syptoms, it is not possible for anyone to say what is or is not IBS. IBS according to the Rome Committee is defined as a set of symptoms, and an"empirical" approach to the care of the patient is advocated by adherents to this view. So, this is what the symptom-based diagnosis advocates promote. There is no universal agreement on this approach as there are plenty of others who seek and have found some underlying causal mechanisms for those symptoms...so if it were openly and objectively examined from an integrative perspective, it would become a debate of whether these people should be removed from the IBS population, or considered one of the subpopulations (like COPD has) with a specific pathogenisis. This debate has not yet reached any such levels of significance. It may never.The correct and factual thing to say is that "food and chemical sensitivies and intolerances of multiple types" are primary mechanisms of symptom generation in those patients who are symptomatically diagnosed as diarrheic-type IBS patients.There are certain food sensitivity mechanisms which in fact elicit a primary cell-mediated inflammatory response in the small bowel and systemic circulation which results in the upregulation of the nerves a smooth muscle which has been observed and quantified to occur in this population. the specific chemical mediators effects are well known and self-evident whne placed at the site of insult.There are also types of food reactions which appear to be similar to IgE allegric reactions as they activate mast cells in the gut directly in the absence of circulating antibodies to the foods which provoke degranulation. There are others which donot involve immunocytes at all. These must all be accounted for and assessed to achieve optimal dietary therapy.These phenomena are integral to how and why symptoms are generated. When avoided the symptoms subside. What IBS is, by definition, is not yet known...only what some of the symptom generating mechanisms are, and what some "physical activities" are. These do not define pathogenesis rather illuminate what that may or may not be. And they all must be examined collectively before issuing edicts about what so called IBS is or is not. Preferably of course within the same patients....which has yet to occur.What we do have are theories and postulates formed from various interpretations of the clinical presentation and some of the data, set forth by different people at different times, often in a vacuum from other data and which have a spin which is indigenous to the area of expertise of the person setting forth the theory or postulate on the table at the moment.In conclusion, if IBS at present is a set of symptoms by definition of the "opinion leaders" then we can only speak of symptom-generating mechanisms and address them. There will be a time, s there alwys is eventually, when the underlying patholgies will be clearly elucidated and only at that time will medicine be able to come to a concensus of "THIS is 'IBS' and THIS is [x disease or condition]". That time has not yet arrived.A study of these books wil help keep this in its proper perspective:IBS: A DOCTORS PLAN FOR CHRONIC DIGESTIVE TROUBLESBy Gerard Guillory, M.D.; Vanessa Ameen, M.D.; Paul Donovan, M.D.; Jack Martin, Ph.D. http://www.amazon.com/exec/obidos/search-h...9085785-1742301 "FOOD ALLERGIES AND FOOD INTOLERANCE: THE COMPLETE GUIDE TO THEIR IDENTIFICTION AND TREATMENT", Professor Jonathan Brostoff , M.D.. Allergy, Immunology and Environmental Medicine, Kings' College, Londonhttp://www.amazon.com/exec/obidos/ASIN/089...r=2-1/102-64875 08-3420903[/URL]and this article will also help a little....Alimentary Pharmacology and Therapeutics Vol. 15 Issue 4 Page 439 April 2001 Food hypersensitivity and irritable bowel syndrome S. Zar, D. Kumar, M. J. Bensonhttp://www.blackwell-synergy.com/servlet/userag ent?func=synergy&synergyAction=showFullText&doi=10.1046/j.1365-2036.2001.00951.x[/URL]as will the Merck manual help establish the proper perspective: http://www.merck.com/pubs/mmanual/section1...ter148/148b.htm "Recently Food Intolerance was found to be responsible for symptoms of some patients with the IRRITABLE BOWEL SYNDROME, confirmed by double-blind food challenge. An increase in rectal prostaglandin levels was noted when a reaction occurred.Preliminary information suggests the same phenomenon may take place in patients with chronic ulcerative colitis."Are these reactions primary to the pathognesis, or are they a consequence of the pathognesis, or coincident to it....no one can yet say. All we can say is that they DO exist, WHAT they are, what elitis them, what the consequences are and why, and then provide protocols for isolating them and managing them so as to reduce or eliminate symptoms in the population of IBS-diagnosed people who suffer them...the diarrehaic subpopulation, which is the predominant subpopulation. One cannot ignore work done elsewhere on patients with the same symptom sets and form a postulate in a vacuum and then morph it into dogma. But people do it anyway.ONE simple example....An example of taking a hypothesis qualified with "suggesting" and "may play a role" and morphing it into dogma:"We know that 5-HT release is actually increased in IBS patients with the diarrhea-dominant component, suggesting that, again, 5-HT may play a role in subsets of patients with IBS."This says no more than it says. Look at the words.It says, clearly, that it "suggests" that 5HT "may" play a role.Well, I think everyone would agree that it does but that is a far cry from some of the dogm about 5ht receptors and the trole of 5ht[x] in so called 'IBS". For example, if specific immunlocytic reactions occur in response to food provocation in the small bowel which results in release mediators which then activate platelets within the systemic circulation and gut microvasculature and these 5HT "reservoirs" dump mass quantities of 5HT, could this be maybe one reason, he queries rhetorically? . Of course. One mechanism, accounting for the observation, of what we "see" occurring. Since it happens, the answer is yes. But it was not evaluated in the subjects from whom the data of the investigator was extracted...it has been seen elsewhere...if not integrated the info remains fragmented and firm conclusions are not being made even by those who observe the presence of the mediator in question (one of a mere 100 or more which may be directly or indirectly involved). Further that is by o means the sole mechanism either, and no one claims that.The "debate where there is no debate" always reminds me of something Groucho once said: "A child of five would understand this. Send someone to bring me a child of five!"
MNL
 

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We have been around and around on this Mike its pretty old really, your continued "everything is studied in a vacuum is just plain bull. There does need to be more work done however for sure."The correct and factual thing to say is that "food and chemical sensitivies and intolerances of multiple types" are primary mechanisms of symptom generation in those patients who are symptomatically diagnosed as diarrheic-type IBS patients."No "are primary mechanisms of symptom generation in those patients who are symptomatically diagnosed as diarrheic-type IBS patients."They are one mechanism perhaps that triggers IBS in some people and are diagnosed as food allergies or sensitivites, or intolerences (if its a qualified doctor doing the diagnoses and the right tests are done) and can overlap with people who can also have IBS. When you start looking at the condition with and without the role of JUST foods and all the mechanisms and triggers, then we can "get out of the vacuum."You seem at least to me to postulate all this in your own vacuum and rarely mention any other issues or mechanisms in IBS such as the alter gastro colonic reflex, the role of stress on the nervous system, some of the reasons people get IBS in the first place.In my opinion your really not even explaining "ALL" the roles foods can play, physically/chemically, mentally, in a person that would even cause them to be triggers or to be other misdiagnosed or comorbid conditions or problems.Its pointless to talk more about 5ht receptors and cells with you as you seem to just extrapluate what you want to hear and how it related to foods.
 

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Comment: ___________________________________"We have been around and around on this Mike its pretty old really, your continued "everything is studied in a vacuum is just plain bull. " ____________________________________
...and round she goes where she stops no one knows!First, are you not able to distinguish the semantics between what I wrote, which was:"...often in a vacuum from other data..."This is quite different than quoting me as saying:"...everything is studied in a vacuum ...""Often" and "everything" are hardly synonymous. Indeed to say "EVERYTHING" would be bull. But nobody, once again, said that. Including but not limited to myself. The word "often" denotes a realtively high "frequency" not an "absolute value".But this is just symptomatic of the real perpetual problem: selective and/or biased thinking. Morphing what someone says into something else,and then using that as the basis for a railing against the person with a diatribe is symptomatic of that behavior. Or, it is evidence that the person has probably been successful currently or previously in seeking public office. Especially at the state or federal level. Mastery of such thinking and behavior is mandatory to success in politics.But something is not "bull" when it is a fact, and nothing I said is non-factual. Sometimes there are facts that people may have scotomas to, or that do not fit their paradigm, or touch a nerve, or hit too close to home, ergo they deign to reject them, yet they remain what they are. True and false are attributes of speech, not things, according to Thomas Hobbes, so where there is no speech neither is their truth or falsehood. It is sometimes hard to see the difference.Most of the statements I see made in the denouncement posted simply reflect selective thinking....again someone suggesting I do not do that which is exactly what I do. Methinks though protesteth too much, sometimes.The clearest example.... _________________________________"In my opinion your really not even explaining "ALL" the roles foods can play, physically/chemically, mentally, in a person that would even cause them to be triggers or to be other misdiagnosed or comorbid conditions or problems." ________________________________On the contrary, if you actually read the books I reference people to, if you actually studied even the few cases that people have posted with objectivity, if you actually did a thorough study of all the literature without filtering, which is clearly a problem, and if you payed attention to the very protocols that the researchers, clinicians, and dieticians who developed the LEAP protocol USE and PROVIDE to physicians in the form of a Disease Managment Program on adaily basis you would know that what you just wrote is the polar opposite of that which is true. Until that happens, you may truly beleive that what you just stated is true. That does not make it so.In fact, the entire process is designed to address and if possible isolate every known mechanism of symptom generation in the selected population with a specific method for each. Further it is consistent with what "the literature" states a DM program for IBS must consist of (the elements that should be included). It is comprehensive and complete to the extent that current technology and ability and understanding will facilitate. Should a new modality emerge which is efficacious this would be incorporated into the protocols.What does grow tedious is wastinmg precious time responding to pronouncements about what something is or is not which are issued by sources who self-evidently do not know what something is or is not, or who utilize selective reasoning or analysis to make position statements intended to influence others, said statements being ill-informed or biased.But, then again, such actions are not restricted to IBS, nor even healthcare in general for that matter. It is just part of the nature of the human mind. Just look at the public corporations and the market lately for shining examples of same, and the consequences in a different area of the realities of human interraction. _________________________________"Its pointless to talk more about 5ht receptors and cells with you as you seem to just extrapluate what you want to hear and how it related to foods. " _________________________________Again, false. Anyone who reads the literature I recommend which is designed to provide people explanations of the integrative approach to IBS, both physiologically and therapeutically, would know this denouncement to also be false. besides, if it is pointless to tlak to me then why do you? There must be, then some point to it beyond the obvious. As far as what I personally stand "accused of", I think the inverse is more true. With few exceptions, when we read most of the tutorials and CME programs created in the good old USA, and which are set forth to "teach" about IBS, and which are created by visible opinion leaders of IBS "study" in this country, there is an appalling lack of information concerning exactly what you are tlaking about. The role of diet and dietary componenents as symptom generating mechanisms is barely touched upon, and only in the most general ssnes, as the author has little information to convey to the reader in this area. This is due the simple fact that the dietary symptom management protocols used in general are based upon inadequate tools, or are so non-specific to the patient or overly broad thus overly restrictive, lacking an effective means of doing just what you say...isolating each possible offending substance due to each possible mechanism... that their outcomes are mediocre. So it is dismissed as ineffective, or steered around in the most general manner possible to get to what the authors do understand. That is why you need people working in this other area to supplement the information. Most ofthis work, not all but most lets be very clear about the quantitative attributions, has been done by European physicians.It is just simply not an area of intense study nor experience for most of the folks who are paid to develop said programs. Their perspective often is by nature different than, say, someone who has spent many years approaching patients from the primary position of treating all the possible mechanisms of symptom generation via diet in an integrative fashion FIRST, then seeing what is left afterwards....the polar opposite of what is typically done with IBS patients here. There is a different paradigm indeed if you are first selecting diarrheic IBS patients and putting catheters into their small bowel and introducing blind food challenges, then recovering the effluvia and analyzing it for inflammatory response patient by patient, then biopsying the small bowel wall to study the cellular repsonses. And ahost of other methodologies which interest you not in the least so "not worth talking about" as you would say. But This type of activity assures that there will be people approaching the problem from a different perspective, and this work is not often incorporated. fact.If practitioners and researchers and clinicians and people in general would not resist integrating these experiences fully, rather than trying to establish their own perspective as the imaginary high ground, progress in understanding fully why people present with and suffer the symptoms we associate with IBS could be accelerated further. But it's sort of like trying to get Ford and GM to develop a joint alternative fuels vehicle. Not gonna happen. Emphatic pronouncements perpetually interjected into discussions of dietary therapy et al in IBS patients, especially if they involve this particular DM Program (designated LEAP), such as "..food sensititivty is NOT IBS...", with caps included so as to shout it, are symptomatic of this problem which plagues clinical care of the IBS victim. It is dogma and it is counterproductive to patient care. Especially when it is refuting something that nobody said. Often follows discussions where some have gone to great lengths to state that such things as food sensitivities generate IBS symptoms, not that it "IS" IBS. Nobody knows what "IS" IBS. About the only thing everyone can at least agree upon, mostly, is what the symptoms are. No one can possibly form a concensus of what IBS actually will end up being when all the causal bases are rooted out...some will be set aside as individual diseases, some may be comorbiditiies, some may be consequences of an underlying pathogenesis (ie, for example non-IgE mediated cellular inflammatory responses may be a consequence of some underlying dysfunction, not the primary dysfunction, or it may be a primary dysfunction sometimes and secondary other times....just one example of many possible examples...we do not know for sure yet except that it appears it may be both). All that is knonw is that they do occur and can be isolated and can be avoided thus therapy can be enhanced. This bothers some folks in the "field" just terribly, especially when it is somone who is a care giver who cannot do that with the tools that they have. This is sometimes symptomatic of NIH Syndrome (Not Invented Here)as well. And that is a fact too, not "bull". One will not find me or my associates interjecting such agitated, shouted statements and remarks into discussions of HT and CBT as our perspective, and that of the providers I work with, is integrative. These modalities (stress reduction therapy in its myriad forms)is integrated into the belief system and is one of the recommended modalities. It's even kind of funny to me sometimes to see such "accusations". One of the LEAP users is one of the Mind-Body Institutes established by a hospital outpatient integrative medicine center. Every pt. gets an HT CD with their lifestyle program. Facts not bull.If one is operating from this position, objective integrative therapeutic approach, then one does not feel compelled to behave in that fashion.Too nice a day to fritter away bantering.
MNL
 

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This is from the American Gastroenterological Associations practice Guidelines (published in Gastroenterology) 1997A technical review for practice guideline Development.Since this was published in 97 they are closer to understanding more of IBS.Quote " IBS is now believe to reesult from dysregulation of intestinal motor, sensory, and central nervous system function. Symptoms are due to both disturbances in intestinal motility and enhanced visceral sensitivity. Psychosocial factors, although not part of IBS per se, have an important role in modulating the illness experience and its clinical out come."Annu Rev Med 2001;52:319-38 Related Articles, Links Irritable bowel syndrome. Ringel Y, Sperber AD, Drossman DA. UNC Center for Functional GI and Motility Disorders, Division of Digestive Diseases and Nutrition, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7080, USA. The irritable bowel syndrome IBS is a functional gastrointestinal disorder whose hallmark is abdominal pain or discomfort associated with a change in the consistency or frequency of stools. In the western world, 8% to 23% of adults have IBS and its socioeconomic cost is substantial. Research-generated insights have led to the understanding of IBS as a disorder of brain-gut regulation. The experience of symptoms derives from dysregulation of the bidirectional communication system between the gastrointestinal tract and the brain, mediated by neuroendocrine and immunological factors and modulated by psychosocial factors. The biopsychosocial model integrates the various physical and psychosocial factors that contribute to the patient's illness. This model and the recently revised symptom-based criteria i.e. the "Rome II criteria" form the basis for establishing a comprehensive and effective approach for the diagnosis and management of the disorder. Publication Types: Review Review, Academic PMID: 11160782J Clin Gastroenterol 2002 Jul;35 1 Supp :S7-10 Irritable bowel syndrome: classification and conceptualization. Ringel Y, Drossman DA. Division of Digestive Diseases and Nutrition, Department of Medicine, University of North Carolina at Chapel Hill, 778 Burnett-Womack, CB# 7080, Chapel Hill, NC 27599-7080, USA The irritable bowel syndrome is one of a group of functional gastrointestinal disorders within the Rome classification system that is characterized by abdominal discomfort or pain associated with a change in stool habit. It is a multidetermined biopsychosocial disorder in which physiological, psychological, behavioral, and environmental factors may contribute to the clinical expression of the disorder. These can include: 1 early life e.g., genetic or environmental factors; 2 physiological factors including increased motor reactivity, visceral hypersensitivity, which may be enabled by postinfectious events, and dysregulation of brain-gut communication e.g., altered central pain control mechanisms. In addition, psychosocial factors including psychiatric co-morbidity, major trauma e.g., abuse history, and maladaptive coping may amplify the clinical expression of the disorder and its outcome. Currently, clinical outcome has become understood in terms of global symptom relief and health-related quality of life. PMID: 12184143
 

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1997: "...believed to result from dysregulation"...dysregulation...do we understand what the term dysregulation does and does not denote? etc etc. As I said there is a problem when scotomas exist....and further on by way of example: http://www.med.unc.edu/medicine/fgidc/infl...rymediators.htm Excerpted...."Numerous research studies have now documented physiological changes, including altered motility and hypersensitivity, in the gastrointestinal tract of IBS patients. The mechanisms underlying these events, however, remain unclear.""The challenge for researchers therefore, is to record subtle changes in inflammatory mediators that are not identifiable by usual routine processes.""Collectively these studies suggest....""...this may be part of ...""...the components and nature of this response remain poorly understood.""We hypothesised ....""Elevated iNOS may be a marker ....""NO may have direct effects....""...susceptibility to reactivation of inflammation by stress appeared to ....""There is emerging data to suggest ....""While this data is provisional, it is plausible...""...several factors may be important ...""An important challenge for future work will be to clarify...""We believe that low-grade inflammation may play a role...""There is now evidence from several different studies to suggest that a range of inflammatory mediators may be increased in IBS...""Continued research into this area is likely to improve our understanding ..." Res Ipsa Loquitur. ___________________________________Current Treatment Options in Gastroenterology2002 Aug;5(4):267-278 Irritable Bowel Syndrome.Sach JA, Chang L.UCLA/CURE Neuroenteric Disease Program, 11301 Wilshire Blvd Bldg 115, Room 213, Los Angeles, CA 90073, USAConclusions presented:"IBS is best understood through the biopsychosocial paradigm, and therefore, its effective management requiresa comprehensive multidisciplinary approach based on patient education and reassurance, enhanced by diet recommendations and lifestyle modifications, and complemented by pharmacotherapy and psychosocial intervention in more severe cases. ____________________________________That is all that is being said and implemented effectively by the approach discussed in this thread originally. Nothing more, nothing less."What we have to learn, we learn by doing."[Aristotle]MNL
 
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