IBS and Your Gallbladder
One of the most frequent questions I get from readers has to do with experiencing nausea alongside their bowel symptoms. My answer is always the same; "I am not a medical doctor, but when I hear nausea, I always think of the gallbladder." If you are experiencing upper abdominal symptoms alongside your IBS, you will want to learn more about this vital organ. This article will educate you as to what your gallbladder does and how to recognize symptoms of a gallbladder problem.
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Study: Possible Biomarkers for IBS
The treasure hunt for those elusive biomarkers for IBS may have just seen a little positive progress. A new study published in The American Journal of Gastroenterology took a look at some specific proteins and their association with IBS to see if they might be possible candidates as diagnostic markers of the disorder.
According to the study abstract, the researchers looked at "chromogranins" and "secretogranins", two proteins found in the "enteric, endocrine, and immune systems". Fecal samples were provided by 82 IBS patients and 32 control subjects and analyzed for the presence of these granins. The results indicated that levels of some of the sub-types of the granins were able to identify the IBS patients.
This small study appears to offer some nice promise for the future. For most IBS sufferers, confirmation of the disorder through the use of a stool sample would be very reassuring, as it can be quite disheartening to feel so awful, yet be told that all tests are coming back as normal. I look forward to seeing continued research along this vein.
Related Reading from Dr. Bolen, Your IBS Guide:
Source:
Ohman, L., et.al. "Altered Levels of Fecal Chromogranins and Secretogranins in IBS: Relevance for Pathophysiology and Symptoms?" The American Journal of Gastroenterology 2012 107:440-447.
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May Digestive Health Round-Up
My fellow guides here at About.com continue to publish excellent articles covering all aspects of digestive health. I have picked out some that I think may be of special interest to you, my loyal readers:
From Amber Tresca, Guide to Inflammatory Bowel Disease:
From Julie Wilkinson, Guide to Colon Cancer:
From Jane Anderson, Guide to Celiac Disease:
From Sharon Gillson, Guide to Heartburn/GERD:
- Acid-Reflux Diet
- Avoiding Foods That Cause Heartburn
- Dining Out without Heartburn
- Natural Remedies for Heartburn
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What Is Your IBS IQ?
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SIBO and IBS
When I first read Dr. Pimental's book "A New IBS Solution" about small intestine bacteria overgrowth (SIBO), I was thrilled! It seemed as if the answer to the IBS puzzle had finally been found. I couldn't wait to tell all of my patients about it. Then, I started to hear rumblings - the IBS research community wasn't convinced. Dr. Pimental's research findings were not being replicated in other places. I was SO disappointed. The SIBO theory makes so much sense - how could it be that it was being discounted?
As with many things, the pendulum has swung to somewhere in the middle. Research on the subject remains mixed. The current IBS party line is that SIBO may be the problem for a certain sub-set of IBS patients. Are you one of them? My article on SIBO and IBS may help you to figure that out:
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Dealing with IBS Urgency Discussion
A reader named "Bill" recently posted a counter-argument to my theory on using delay to help reduce diarrhea urgency. (See, "Calming IBS Diarrhea Urgency" to see my full thoughts on the subject.) In response to my sentence, "I always advise my patients to focus on calming, not emptying. My rationale for this is not based on any hard science, but rather my general knowledge of how the intestinal system works.", Bill wrote:
"Doc, I'd have to disagree with you. I understand what you are saying, but your premise is based upon a normally functioning bowel. I work from the emptying idea and I came upon this on my own without speaking to anyone else. I submit that if numerous independent people come to the same conclusion, there might be something to it. Remember, there is something wrong with our bowel functioning, otherwise we'd be normal. We just don't know what is wrong. I found something that says the human intestines are 10 times longer than the body (17ft - 35ft). We are not going to empty all of that, just the portion near the end. For me this is between 4 - 6 movements a day, generally in the morning. Once that occurs I'm usually "safe" to go out; that also seems to be when the pain stops."
I certainly respect Bill's point of view and goodness knows, there does not seem to be any one right thing for everyone. What I want to say in response is that my premise is not based on a "normally functioning bowel", but certainly takes into account that a "normally functioning bowel" is the direction that all IBS sufferers should be steering their bodies toward. My premise about the use of delay is based on the fact that for many of the urges that humans struggle with (i.e. repeatedly checking the stove to be sure it is off, shoplifting, cocaine, etc.), giving in to the urge when it is at its strongest reinforces the strength of the urge, causing it to come back even stronger the next time. I don't see why this would not be relevant for bowel urgency as well. Therefore, once the "firmer" stuff is out, further movements should not be necessary and perhaps the urge would be better soothed with relaxation rather than repeated trips to the toilet. However, without any research specifically focused on the subject, my thoughts are at this point are mostly theoretical. If anyone out there is looking for a dissertation subject, please feel free to use this one.
What do you think? Do you think that using delay after the initial emptying of your colon can reduce further urgency? Please join in the discussion by leaving a comment below!
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Delay for Linaclotide Approval
For those of you who are eagerly awaiting some new IBS medication options, the wait just got a little longer. The FDA has requested a three-month extension before offering drug approval for linaclotide, a potential medication for IBS-C and CIC. The good news is that, as of now, the FDA is not requiring another study, just a little more time to further review the results from the Phase III clinical trial of linaclotide. This review should be completed by September 2012. The manufacturers are optimistically hoping that the medication will be launched before the end of this year.
At least one market watch website is speculating that this is good news for the company that is developing plecanatide, a potential competitor, as it may take away any "head start" advantage for linaclotide. According to this report, plecanatide also has the advantage of having less of a risk of diarrhea as a side effect than linaclotide.
My take on all of this: "Go at it, big pharma!" May your fight to earn the most money translate into superior products for IBS sufferers.
Related Reading from Dr. Bolen, your IBS Guide:
- Linaclotide for IBS-C and Chronic Constipation
- Plecanatide for Chronic Constipation
- IBS Medicine in the Pipeline
- IBS Medication Options
Sources:
"IRONWOOD AND FOREST ANNOUNCE FDA HAS EXTENDED THE REVIEW PERIOD FOR LINACLOTIDE TO SEPTEMBER 2012" Ironwood Pharmaceuticals Press Release April 23, 2012.
"Synergy Pharmaceuticals Strengthened On Ironwood's Setback" Seeking Alpha Website April 24, 2012.
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IBS and Your Sex Life
In his IBS-related memoir "Romance, Riches, and Restrooms", Tim Phelan hilariously and heartbreaking-ly finds humor in his efforts to balance his love life with his IBS. His bare-all tale does a wonderful job of illustrating the impact that IBS has on a person's quality of life. I am sure that many of you can relate to the notion that IBS has a negative impact on your sex life. To help you to manage, I offer you my tips:
Do you have your own thoughts as to how to enjoy a sex life in spite of IBS? Share them here and find out what others do to balance out their intimate life with the demands of their IBS:
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Meta-Analyis on Acupuncture for IBS
Many people have told me how much acupuncture has helped with them to feel better - usually when their health problem involves chronic pain. This would make one naturally wonder, shouldn't acupuncture help with IBS pain? Unfortunately, a recent meta-analysis of relevant research indicates that the answer to that question will require much more research.
According to the study abstract, a total of 17 clinical trials were reviewed. Of the small number of trials that used "sham acupuncture" as a placebo, the true acupuncture treatment did not have a significantly better effect on either IBS symptom severity or quality of life. In the small number of trials without the use of a placebo, acupuncture was more effective than either pharmacological therapy or no treatment in terms of symptom improvement. From the abstract, it appeared that these positive findings were evidenced in studies done in China. The researchers theorize that this improvement may be related to the positive expectations of acupuncture by the participants of those particular studies.
Clearly, much more research needs to be done before any firm conclusions can be drawn. If you have tried acupuncture, please share your experiences by clicking on the following link:
More from Dr. Bolen, your IBS Guide:
Source:
Manheimer, E., et.al. "Acupuncture for Irritable Bowel Syndrome: Systematic Review and Meta-Analysis" The American Journal of Gastroenterology Advance Online Publication April 10, 2012.
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Top Ten Tips for IBS Relief
Have you really tried everything for IBS relief? You may think so, but perhaps there are some IBS tricks you have not yet pursued. In my one-on-one work with IBS patients, I am continually surprised when patients have not heard of what I would consider to be some basic IBS management strategies. Therefore, I have pulled together my top recommendations into one place for you:
As most of you have found out the hard way, IBS is not usually "fixed" by trying just one thing. Often, it takes a comprehensive treatment plan to bring on symptom relief. Take a look at my list to see if perhaps there is a strategy that you did not know about. Give it a try and then let me know whether or not it helped by leaving a comment below or on the IBS discussion forum.
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