diet and ibs 2012

Michal Hogan, RD, LD, CLTMichal Hogan, RD, LD, CLTNutritionResults.comNutritionResults.com(614) 944-5123(614) 944-5123

Is Your Food Making Is Your Food Making You Sick?You Sick?

Diet and IBSDiet and IBS

NutritionResults.com (866) 396-4438NutritionResults.com (866) 396-4438

What Is Irri table What Is Irri table Bowel Syndrome?Bowel Syndrome?

Symptom Based Symptom Based Diagnosis of ExclusionDiagnosis of Exclusion

Diarrhea Predominant Diarrhea Predominant IBSIBS

Constipation Predominant Constipation Predominant IBSIBS

Cyclic IBSCyclic IBS

Rome III Criteria for IBSRome III Criteria for IBS

Relief after defecationRelief after defecation Onset associated with a change in Onset associated with a change in

stool consistencystool consistency Onset associated with a change in Onset associated with a change in

stool frequencystool frequency


Rome III ContinuedRome III Continued Bowel Movements Bowel Movements

Greater that 3 per dayGreater that 3 per day Less than 3 per weekLess than 3 per week

Abnormal StoolAbnormal Stool– lumpy/hard lumpy/hard – loose/watery stoolloose/watery stool– MucousMucous

Abnormal stool passageAbnormal stool passage– Straining or feeling of incomplete evacuationStraining or feeling of incomplete evacuation– Urgency and relief by defecationUrgency and relief by defecation

Source: International Foundation of Functional Gastrointestinal DisordersSource: International Foundation of Functional Gastrointestinal Disorders


Danger signsDanger signs

Profound weight loss, anemia or Profound weight loss, anemia or blood/occult in stoolblood/occult in stool

Travel to places with parasitic endemicsTravel to places with parasitic endemics Hx of colon cancerHx of colon cancer Skin abnormalitiesSkin abnormalities Signs of malabsorptionSigns of malabsorption Thyroid dysfunctionThyroid dysfunctionThis list is not exhaustive, but is helpful…This list is not exhaustive, but is helpful…


Consequences of IBSConsequences of IBS

These average overall unhealthy days These average overall unhealthy days exceeded those of respondents with exceeded those of respondents with arthrit is, diabetes, heart disease/stroke, arthrit is, diabetes, heart disease/stroke, cancer, and class III obesity (body mass cancer, and class III obesity (body mass index > or =40 kg/m2) index > or =40 kg/m2)

Source: U.S. surveySource: U.S. survey


•39 yo M• IBS, GERD, and intestinal parasites•8 Months•Extreme stomach/intestinal pain, gas, •cramping diarrhea, constant pain•Off work, demoted once• Symptom Score : 68• 20 + pills per day. •Abdomen was “rock hard” with bloating•difficulty sleeping, always feeling fatigued and miserable.

Case Study- IBS


•Before therapy: In 8 months only felt “ok” ½ of a day

•. Elimination Diet @ 5 days:•Remission of diarrhea and bloating•With total symptoms scoring only 11 (start 68)•Able to return to work

•Within 1 month:•Able to isolate foods that were GERD triggers.

•Within 2. 5 months• GERD also dissipated.•Able to go off of all medication at that point

Pt was successfully discharged from therapy

Case Study- IBS pg 2


The IBS Employee’s Average Combined Work Time Lost to

Absenteeism and Work Cut Backs due to IBS Symptoms was found to average ONE WEEK per MONTH, for a total of

12 WEEKS per YEAR of lost productivity.

This represents a loss of nearly 25% of productivity PLUS the costs of

accompanying sick leave pay.*

Tradit ional TherapiesTradit ional Therapies

MedicationMedication Side EffectsSide Effects

diarrhea, constipation, pain, sleep diarrhea, constipation, pain, sleep disruption or drowsinessdisruption or drowsiness

Band-Aid solution- only addresses Band-Aid solution- only addresses symptom of diarrhea, not designed to symptom of diarrhea, not designed to treat underlying causetreat underlying cause


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IBS is not a distinct entity buta collection of disorders

““Food intolerance represents an Food intolerance represents an important proportion of important proportion of conditions which together make conditions which together make up IBS”up IBS”

John Hunter, MD, FCRPDirector or Gastroenterology

“Food Allergies and Food Intolerance”Brostoff & Challacombe, Second Edition, 2002


IBS not only symptomIBS not only symptomLancet 2000 Jul 29;356(9227):400-1Lancet 2000 Jul 29;356(9227):400-1

“We found that food provocation in food “We found that food provocation in food intolerant patients was characterized by intolerant patients was characterized by

a a general and systemic immune general and systemic immune activation accompanied by an activation accompanied by an

increase in systemic symptoms…increase in systemic symptoms…important for the understanding of the important for the understanding of the

mechanisms involved in the mechanisms involved in the pathogenesis of “food intolerance.”pathogenesis of “food intolerance.”

Food sensitivities ushered in by Food sensitivities ushered in by IBS lead to feeling bad all over…IBS lead to feeling bad all over…


FOOD INTOLERANCE CAUSESFOOD INTOLERANCE CAUSES IBS SYMPTOMS IN CERTAIN PATIENTSIBS SYMPTOMS IN CERTAIN PATIENTS

Merck Manual pg 1051

“ Food Intolerance “was found to be responsible for symptoms of some patients with the IRRITABLE BOWEL SYNDROME


http://images.amazon.com/images/P/0911910182.01._SX150_PC_PIdp-schmoo2,TopRight,-27,-26_PE04_.The-Merck-Manual-of-Diagnosis-and-Therapy-18th-Edition._SCLZZZZZZZ_.jpg

1515 NutritionResults.com NutritionResults.com (866)396-4438 (866)396-4438

Adverse Food ReactionsAdverse Food Reactions

Food Allergy Food Intolerance

Food Sensitivity

Usually airways, skin, or GI tract

Usually GI tract Any organ system can be affected

Seconds to 1 hour

Within a couple of hours

45 minutes to 3 days

Immunological Non-immunological

Immune and non-immune

Trial and ErrorTrial and Error

““But through But through ‘Trial and Error’‘Trial and Error’ many people find they feel many people find they feel better when they stop eating certain foods. These foods better when they stop eating certain foods. These foods cause the intestines to contract, which can aggravate cause the intestines to contract, which can aggravate IBSIBS in people who have in people who have diarrheadiarrhea as their main as their main symptom.” symptom.”

Nicholas Talley, MD., Patrice Burgess, MD Nicholas Talley, MD., Patrice Burgess, MD ““Controlling I.B.S. With Diet” Controlling I.B.S. With Diet”

Healthwise Information LibraryHealthwise Information Library

But meanwhile, l i fe goes on….. Without remission….But meanwhile, l i fe goes on….. Without remission….NutritionResults.com (866) 396-4438NutritionResults.com (866) 396-4438

IBS and CaffeineIBS and Caffeine

NervousnessNervousness PanicPanic HeadacheHeadache InsomniaInsomnia Noises in EarNoises in Ear DiarrheaDiarrhea


IBS and Food ColoringsIBS and Food Colorings

AsthmaAsthma EczemaEczema MigrainesMigraines ItchingItching DiarrheaDiarrhea


IBS and LecithinIBS and Lecithin

Sore MusclesSore Muscles HeadachesHeadaches Stiff NeckStiff Neck Sore ThroatSore Throat DiarrheaDiarrhea


IBS and MSGIBS and MSG

DehydrationDehydration ThirstThirst HeadachesHeadaches IrritabilityIrritability DiarrheaDiarrhea AnaphlaxisAnaphlaxis


PhenylethylaminePhenylethylamine

MigraineMigraine Sleepiness or Sleepiness or

HyperactivityHyperactivity WheezingWheezing FatigueFatigue DiarrheaDiarrhea


American Gastroenterological Association Posit ion Statement

““Education and Reassurance”Education and Reassurance” ““Dietary and Lifestyle Modifications”Dietary and Lifestyle Modifications” ““Symptom Monitoring”Symptom Monitoring” ““Symptom-Directed Medication PRN”Symptom-Directed Medication PRN” ““Psychological Treatment” Psychological Treatment”

http://aolsearch.aol.com/aol/imageDetails?invocationType=imageDetails&query=psychiatrist&img=http%3A%2F%2Fwww.the-funneled-web.com%2Fimages%2FLucy%2520the%2520psychiatrist.gif&site=www.the-funneled-web.com&host=http%3A%2F%2Fwww.the-funneled-web.com%2FN%26V_2006%28Jan-Dec%29%2FN%26V_0602%2Fnews__views_item_feb_2006-060209.htm&b=image%3Fquery%3Dpsychiatrist%26page%3D2%26userid%3D450cd25a-000ba-06e5f-6489bccd%26ie%3DUTF-8%26invocationType%3Dsmartbox_search%26clickstreamid%3D-8062281459027047698

Typical RecommendationsTypical Recommendations Caffeinated drinksCaffeinated drinks Tyramine and phenylethylamine- pressor aminesTyramine and phenylethylamine- pressor amines HistamineHistamine Solanine: naturally occurring toxicant in the Solanine: naturally occurring toxicant in the

nightshade plant familynightshade plant family Nitrates and Nitr itesNitrates and Nitr ites Benzoic Acid: also benzoin, gum benzoin, benzoate Benzoic Acid: also benzoin, gum benzoin, benzoate

and naturally occurring diet.and naturally occurring diet. Sorbitol Family: sorbitol, sorbitan, polysorbate 80,

polysorbate 60 Lectins (in beans, lenti ls, peas, peanuts, snails,

wheat). Peptides: small protein-l ike molecules Proteolytic Enzymes (raw pineapple, raw papaya

most common Eating Habits Scrutinized : Too much at one time

and too high fat content too much stress especially when you eat

Avoid the Full Moon and the Avoid the Full Moon and the High Tides and never look at the High Tides and never look at the sun during a solar eclipsesun during a solar eclipse

IF food Intolerance IS important to IBS symptoms, WHY do most Diets fail to make much difference?

Unlike allergies, food sensitivity reactions are:

1. Dose Dependent

2. Delayed Onset (up to 72 hours post ingestion)

3. Multiple foods can cause symptoms (single elimination trials are useless)

4. NO Universal Bad Food- Very patient specific

Without some help it can be hard to find those triggers NutritionResults.com (866) 396-4438NutritionResults.com (866) 396-4438

Other TriggersOther Triggers

2500+ additives approved for use in 2500+ additives approved for use in foodsfoods

Staple food items can also be triggersStaple food items can also be triggers


Migraine Case StudyMigraine Case Study

9 yr old, 57 #9 yr old, 57 # Common migraine with vomiting from 1-5 Common migraine with vomiting from 1-5

hrs. Mom said he was “stressed” prior to his hrs. Mom said he was “stressed” prior to his baseball games, got migraine, had to go baseball games, got migraine, had to go back home.back home.

Started suspecting food sensitivity to Started suspecting food sensitivity to peanuts and asked the doctor for testing peanuts and asked the doctor for testing and therapyand therapy

Test, peanuts were LOW reactive….Test, peanuts were LOW reactive….NutritionResults.com (866) 396-4438NutritionResults.com (866) 396-4438

Migraine Case Study p2Migraine Case Study p2

But the high reactive item was “soy”But the high reactive item was “soy” Mom had been giving him an energy Mom had been giving him an energy

bar with soy in it, prior to each bar with soy in it, prior to each baseball game thinking she was baseball game thinking she was helping his performance.helping his performance.


Migraine Case (cont)Migraine Case (cont)


Back to migraine caseBack to migraine case

Patient went back to being a normal Patient went back to being a normal active boy…active boy…

Toward the end of therapy, the mom Toward the end of therapy, the mom called me: Her son placed 3called me: Her son placed 3 rdrd in the in the state of Texas for wrestling state of Texas for wrestling

Less need for analgesicsLess need for analgesics


Double blind, placebo controlled food reactions Double blind, placebo controlled food reactions do do not correlate to IgE allergynot correlate to IgE allergy in the diagnosis in the diagnosis

of staple food related gastrointestinal symptoms.of staple food related gastrointestinal symptoms.

Bengtsson U, Nilsson-Balknas U, Hanson LA, Ahlstedt SBengtsson U, Nilsson-Balknas U, Hanson LA, Ahlstedt SAllergy Centre, University of Goteborg, SwedenAllergy Centre, University of Goteborg, Sweden

Gut. 1996 Jul;39(1):130-5.

In adult patients with staple food induced gastrointestinal symptoms, objectively verified by DBPCFC, there were no indications of IgEno indications of IgE mediated allergy to the relevant foods, suggesting other mechanisms in adults than in children.

Should we test for al lergies Should we test for al lergies (IgE)?(IgE)?


DBPCFC Studies- Gold DBPCFC Studies- Gold StandardStandard

Hard to do oral challenge that is Hard to do oral challenge that is – Double blindDouble blind– Placebo- controlledPlacebo- controlledBecause the amount is usually too large to Because the amount is usually too large to

hide in a pill or in a puree.hide in a pill or in a puree.

Anatomy of a Food Sensit ivityAnatomy of a Food Sensit ivity


Intestinal Perfusion Intestinal Perfusion StudiesStudies

BalloonBalloon

JejunumStomach

Catheter

Knutson et al, J. of Allergy and Clin. Immunology 93; 91(2): 553-9


Intestinal Perfusion Intestinal Perfusion StudiesStudies

Biopsy ResultsBiopsy Results– Sensitive Pts: Increased, WBC/T-cells Sensitive Pts: Increased, WBC/T-cells

Cytokines/MediatorsCytokines/Mediators– Control Pts: No increaseControl Pts: No increase

IgE Blood DrawIgE Blood Draw– Negative for both groupsNegative for both groups– Not an IgE reactionNot an IgE reaction

Knutson et al, J. of Allergy and Clin. Immunology 93; 91(2): 553-9

Anatomy of a Food Sensit ivityAnatomy of a Food Sensit ivity


Myenteric Myenteric plexusplexus

GanglionGanglion

Full thickness biopsy of patients with IBS reveal Full thickness biopsy of patients with IBS reveal inflammatory infi l tration of white blood cells in the inflammatory infi l tration of white blood cells in the nerve plexus of the small intestinenerve plexus of the small intestine

MucosaMucosa

Sub-MucosaSub-Mucosa

Circular MuscleCircular Muscle

Longitudinal MuscleLongitudinal Muscle

SubmucousalSubmucousalplexusplexus

InterganglionicInterganglionicfiber tractfiber tract

Digestive Disease Week 2000: First Digestive Disease Week 2000: First Quantification of the Abnormal Inflammatory Quantification of the Abnormal Inflammatory

ResponseResponseAnd……And……

Digestive Disease Week 2000: First Digestive Disease Week 2000: First Quantif ication of the Abnormal Quantif ication of the Abnormal Inflammatory ResponseInflammatory Response


Low Level Inflammation in IBSLow Level Inflammation in IBS

•6 patients: severe IBS. 6 patients: severe IBS. • Biopsied Small IntestineBiopsied Small Intestine•Inflammatory infi l tration of WBC in myenteric Inflammatory infi l tration of WBC in myenteric plexusplexus

Is IBS an arrhythmia of the gut, Is IBS an arrhythmia of the gut, which gradually worsens to which gradually worsens to constipation? constipation?


They also found abnormalit ies in They also found abnormalit ies in the interstit ial cells of the Cajal the interstit ial cells of the Cajal (the pacemakers of the gut) in (the pacemakers of the gut) in 5/6 patients!5/6 patients!

Food elimination based on IgG antibodies in irritable bowel syndrome: a randomized controlled trial.Food elimination based on IgG antibodies in irritable bowel syndrome: a randomized controlled trial.Atkinson W, Sheldon TA, Shaath N, Whorwell PJ.Atkinson W, Sheldon TA, Shaath N, Whorwell PJ.

150 outpatients with IBS 150 outpatients with IBS Randomized X 3 months Randomized X 3 months Test: diet excluding all foods which raised IgG Test: diet excluding all foods which raised IgG Control: sham diet excluding the same number of Control: sham diet excluding the same number of

foods but not those to which they had antibodies. foods but not those to which they had antibodies. Outcome measured: IBS and global symptomsOutcome measured: IBS and global symptoms

Gut. 2004 Oct;53(10):1459-64.

What about IgG testing?What about IgG testing?


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Food eliminat ion based on IgG antibodies in irr i table bowel syndrome: a randomized Food eliminat ion based on IgG antibodies in irr i table bowel syndrome: a randomized controlled tr ial.controlled tr ial.Atkinson W, Sheldon TA, Shaath N, Whorwell PJ.Atkinson W, Sheldon TA, Shaath N, Whorwell PJ.

In 12 weeksIn 12 weeks Elimination diet resulted in a 10% greater Elimination diet resulted in a 10% greater

reduction in symptom score than the sham reduction in symptom score than the sham dietdiet

CONCLUSION: Food elimination based on CONCLUSION: Food elimination based on IgG antibodies may be effective in reducing IgG antibodies may be effective in reducing IBS symptoms and is worthy of further IBS symptoms and is worthy of further biomedical research.biomedical research.

Gut. 2004 Oct;53(10):1459-64.

What about IgG Testing? p2What about IgG Testing? p2


IgG –Based EliminationIgG –Based Elimination

Well, yes, statistically significant butWell, yes, statistically significant but

Only 10% improvement in 12 weeks?Only 10% improvement in 12 weeks?

Reason: Reason: NutritionResults.com (866) 396-4438NutritionResults.com (866) 396-4438

World Allergy World Allergy Organization 2003Organization 2003

“ “ food specific IgG antibodies in food specific IgG antibodies in serum are not of clinical serum are not of clinical importance but merely indicate importance but merely indicate a previous exposure to the a previous exposure to the food.”food.”

Source: Krause’s Food Nutrition and Diet Source: Krause’s Food Nutrition and Diet Therapy 2008Therapy 2008 4343 NutritionResults.com NutritionResults.com

(866)396-4438 (866)396-4438

Other symptoms….Other symptoms….

15% identified muscle and joint 15% identified muscle and joint pain, not IBS symptoms, as the pain, not IBS symptoms, as the major cause of their activity major cause of their activity limitation.limitation.

Psychosom Med. 2006 Mar-Apr;68(2):312-20.Psychosom Med. 2006 Mar-Apr;68(2):312-20.


Comorbid to IBSComorbid to IBS

MigraineMigraine FibromyalgiaFibromyalgia SinusitisSinusitis Rheumatoid ArthritisRheumatoid Arthritis GERDGERDSome of these symptoms persist long

after IBS-D remits if food sensitivity not treated.


Why measure mediators?Why measure mediators?

Because they are agents of chemical warfare released Because they are agents of chemical warfare released by White Blood Cells to fight off invaders or by White Blood Cells to fight off invaders or perceived invadersperceived invaders

Because they can cause collateral damage Because they can cause collateral damage – Smooth muscle contraction (evacuation)Smooth muscle contraction (evacuation)– Inflammation (leak WBC to point of infection)Inflammation (leak WBC to point of infection)– Fever (in total flu-like symptoms)Fever (in total flu-like symptoms)

Cells sometimes attack otherwise benign Cells sometimes attack otherwise benign substances l ike foods and addit ivessubstances l ike foods and addit ives


Plasma Cytokines: IBS-D vs Normals

0 50 100 150 200 250 300 350 400

1

2

IBS

-D v

s N

orm

als

Plasma Cytokine Levels

Human Plasma Cytokine LevelsHuman Plasma Cytokine Levels Healthy Controls (upper bars) vs. IBS-D Subjects (lower Healthy Controls (upper bars) vs. IBS-D Subjects (lower

bars)bars)

4747 NutritionResults.com NutritionResults.com (866)396-4438 (866)396-4438

Indirect Measuring of Indirect Measuring of MediatorsMediators Mediator Release- Mediator Release- Indirect Measure Indirect Measure of inflammation.of inflammation. Plasma to solids ratio (indirect measure of Plasma to solids ratio (indirect measure of

mediator release) is measured on all tested mediator release) is measured on all tested foods to give a ratio. foods to give a ratio.

If the volume of the plasma increases If the volume of the plasma increases dramatically, that's considered a 'highly' dramatically, that's considered a 'highly' reactive food. If there's no or very little reactive food. If there's no or very little volume change, that food is considered volume change, that food is considered 'non-reactive.‘'non-reactive.‘


Sample Results Sample Results (partial panel)(partial panel)


Short TermShort TermData-Driven ProtocolsData-Driven Protocols Symptom SurveySymptom Survey

– Did we address the Did we address the chief complaints?chief complaints?

– Did the symptoms Did the symptoms that respond best to that respond best to elimination elimination disappear with good disappear with good compliance?compliance?


Long-TermLong-TermData-Driven ProtocolsData-Driven Protocols SF-36SF-36

– Does the person Does the person have better have better functioning?functioning?

– Can the person Can the person have a life?have a life?

– Is the person Is the person happier?happier?


Case study 800VBCase study 800VB

Female 60 yr oldFemale 60 yr old Complaints: fibromyalgia, carpal Complaints: fibromyalgia, carpal

tunnel surgery, knee surgery, back tunnel surgery, knee surgery, back surgery, arthritis, depression, surgery, arthritis, depression, hypertensionhypertension

Unable to do moderate Unable to do moderate activities like sweep the flooractivities like sweep the floor


Case Study 800 p2Case Study 800 p2

Meds- Trazadone, Flexeril, Meds- Trazadone, Flexeril, Effexor XR, Neurontin,Effexor XR, Neurontin, Naproxin, Actonel, Clonidine, Naproxin, Actonel, Clonidine, HCTZ, Nexium, Flonase HCTZ, Nexium, Flonase

Supplements- B12, Vit C, Noni, Maca, Supplements- B12, Vit C, Noni, Maca, MSM, DMAE, Evening Primrose, MSM, DMAE, Evening Primrose, Multivitamin for women plus, Silica Milk Multivitamin for women plus, Silica Milk thistle, dandelion, fiber choice, Rutin, thistle, dandelion, fiber choice, Rutin, Glucosamine, lecithin, Gogi Juice, CoQ10, Glucosamine, lecithin, Gogi Juice, CoQ10, L-carnitineL-carnitine NutritionResults.com (866) 396-4438NutritionResults.com (866) 396-4438

Dietary Protocols-Case Dietary Protocols-Case Study 800 p 3Study 800 p 3 Suspended all supplements for Suspended all supplements for

individual testing later except individual testing later except glucosamine chondroitin since she glucosamine chondroitin since she was sensitive to no shellfish and it was sensitive to no shellfish and it helped with osteoarthritis.helped with osteoarthritis.


Her personal l ist of Her personal l ist of sensit ivit iessensit ivit ies

BroccoliBroccoliSpinachSpinachCauliflowerCauliflowerLettuceLettuceMushroomMushroomMilletMilletSpeltSpeltAppleApplePlumPlumOliveOlive

PapayaPapaya

PeachPeach

EggEgg

NutmegNutmeg

HoneyHoney

Poppy SeedPoppy Seed

MintMint

SolanineSolanine

Candida Candida AlbicansAlbicans

Sodium MetabisulfiteSodium Metabisulfite

Salicylic AcidSalicylic Acid

AcetaminophenAcetaminophen

CaffeineCaffeine

LecithinLecithin

Lentil Lentil

GarbanzoGarbanzo

AlmondAlmond

CoffeeCoffee

Cola NutCola NutNutritionResults.com (866) 396-4438NutritionResults.com (866) 396-4438

Symptoms Case study Symptoms Case study 800800

Started out at 121Started out at 121 First follow-up 36First follow-up 36 Second follow-up 2Second follow-up 2


Anecdotal comments- Anecdotal comments- From “Functioning From “Functioning Survey”Survey”

Patient was able to go off Aleve, reduced Patient was able to go off Aleve, reduced intake of Flexeril (didn’t feel as “hung over” intake of Flexeril (didn’t feel as “hung over” in the mornings) Able to get off of Nexium in the mornings) Able to get off of Nexium and has no intestinal gas.and has no intestinal gas.

Lost about 6#Lost about 6# Walking 4 miles/6 days/week Walking 4 miles/6 days/week Playing water volleyball with grand kidsPlaying water volleyball with grand kids Described health as “excellent”Described health as “excellent”


Stats on 127 PatientsStats on 127 Patients

In therapy for 1 monthIn therapy for 1 month One baseline survey and two follow-up One baseline survey and two follow-up

on schedule, to provide us an overall on schedule, to provide us an overall “symptom score”“symptom score”

Fit our patient selection criteriaFit our patient selection criteria (IBS, Fibromyalgia, Migraine)(IBS, Fibromyalgia, Migraine)


RESULTS

10 day 54.89 % Average Symptom Reduction

1 mo. 74.82 % Average Symptom Reduction

Protocol Diet Therapy

-100%

-80%

-60%

-40%

-20%

0% PatientsD

ec

rea

se

s i

n s

ym

pto

m s

urv

ey

s

co

res

10 day change

1 month change


Statistics -updatedStatistics -updated


RECENT ResearchRECENT Research

S. Boulardi can help inhibit T-cells. S. Boulardi can help inhibit T-cells. Helpful for patient with inflammation that Helpful for patient with inflammation that are controlled on elimination diets but are controlled on elimination diets but want to protect against a flare up on want to protect against a flare up on special occasions….special occasions….

Source: Journal of International Medical Source: Journal of International Medical Research 2007; 35:583-589Research 2007; 35:583-589


diet and ibs 2012

Health & Medicine

ibs symptoms

ibs relief

consequences of ibs

ibs john hunter

ibs michal hogan

case study ibs pg

symptom of diarrhea

therapy nutritionresults