people welcome to the dr joy show your prescription for the total wellness and i am your host dr joy today's topic is your digestive health yes i have an expert yes i'm going to introduce him but last one inhaled exhale how do you feel i know i feel great well without further ado i want to introduce my guest dr  out with a fact and i'm going to read this according to the international foundation for functional gastrointestinal disorders i d i d as is the most common functional gastro intestinal disorder with worldwide prevalence ranging from ten to fifteen percent yeah actually in this country it's at least ten percent so that means at least thirty million americans have started taping you had said something about the role for criteria can you tell me more about sure so the room for criteria is what they use and research studies for irritable bowel syndrome for because the people that voted on this  had their conference in rome and this was the fourth time they did it but basically the current criteria is that if you had symptoms at least once a week for a minimum of three months including pain and usually some alteration in how you go to the bathroom you know much too little it's changed in shape it's changed in texture that's the basic working definition but i want to reiterate that that's mostly for research studies as a way to try to quantify it and every day life when i see patients i don't necessarily try to think  this meet room for criteria you basically just develop a comfort level with the types of people you see the types of symptoms that they described and how to begin to care for those people ok so we don't talk too much about bowel movements because it's it sounds nasty disgusting to people but is there is very important right because we're releasing our toxins so now let's touch what is i b s so irritable bowel is overall considered as you said what they call a functional disorder right and this means that people have legitimate symptoms and those symptoms can be quite severe and yet when you go to examine the individual organs such as the colon or the stomach either by an endoscopy or a cat scan or bloodwork the test always come up normal and the reason for that is because your edible dollars due to a complex set of factors that are occurring on a microscopic level and so they break down irritable bowel into several categories in terms of its contributing factors ok so the most common factor that we talk about is what is technically known as visceral hyper sensitivity but is really just mean sensitive nerve endings are a sensitive got really yes and so they've done a number of research studies over the years that have proven that about have more sensitive intestines compared to people that don't ok some of the research studies are very interesting don't ask me why they did this but at some point they did a study where they took regular people and people with irritable bowel and they  water balloons inside their backend really and they inflated them and the people with irritable bowel were much more sensitive felt much more pain at a much smaller size balloon than the people that did it so that was one of the earliest examples they had of people being more sensitive ok but we've seen this in a number of nerve type conditions diabetic foot pain migraines and another example i sometimes give my patients is unfortunately with the wars in afghanistan and iraq several of our armed service troops have lost limbs and explosions and you may or may not have heard of the condition known as phantom limb pain yes and so that is a condition where people can have burning pain in a leg or arm that no longer exists so if you can start to understand how someone can have pain and an arm that's not there right you can start to understand how people can have abdominal pain and yet when you go to look at those organs they seem perfectly fine right there is some inflammation in the wall of the intestines that seems to be going on with these people and that's probably related to how their gut and their underlying genetics and neuro underlying environment factors interact with their gut flora we all have flora and bacteria in our gut right supposed to be there right for whatever reason and you're too about patients that interaction is not as friendly as it should be so the question no one really knows there is a subcategory of people in my face wait so we wait let me back up because you said something along the lines that thirty million americans have b s but we don't know what the cause again i'm giving you some of the examples of what we believe leads to the condition right why people get this hypersensitivity why people get a bad interaction with their floor and why people's motility changes that we still don't know we don't know what sugar is it we just know what the end result as we know what causes the symptoms and if these things i've described but for most people we don't have a trigger now there is a subset of people that are what we call post infectious irritable bowel know so those people are people that have been triggered to have irritable bowel because of an original stomach bug infection ok and there also is a similar group that has been triggered by getting antibiotics for a long period of time to treat a variety of disorders but that antibiotics seems to trigger and irritable bowel and we believe in both reasons it's because there is an alteration between certainly an association with type a personalities and with people that tend to run on the more anxious and the spectrum although i want to iterate this is not considered to be purely an anxiety disorder only that there is an association with those types of patients so based on your based on the research out there and based on your experience who gets it men vs women children anyone can get it it's certainly tends to be more common in younger people by which we mean under age thirty  it tends to be slightly more common in women and again it tends to be more common in those type a borderline anxious type patients so i can have seen it started for the first time in the elderly i've seen it started men but those tend to be kind of a broader category symptom symptoms although again we discussed with the room for criteria primarily abdominal pain and changes and bowel habits there can exist a large variety of symptoms which can include abdominal pain and that can be in multiple different areas and your belly the way the second you know what i had i had a heroic i'm actually were keep moving keep rolling rick then there's a there's a child out there can you bring irritable bowel are generated within the large intestine or the colon which is what the fox is trying to indicate but the large intestine runs down the left up the left side across the top and down the right side so people can experience pain literally throughout the entire abdomen based on the course of this large intestine ok so that is something to consider and in fact when i hear patients that say that they have pain in multiple sites right right that makes your double down more common because otherwise you're going to have to argue that people are having multiple diseases occurring simultaneously in different organs you know their gallbladder right kidney you know if you're having pain up here a pain here but since the colon runs through that entire area the colon would explain all those symptoms when i hear someone's having multiple pain that's young maybe it's female i start to right off the bat think maybe this is in fact going to be irritable bowel wow so ok so now that we cleared that up how do you diagnose it because i know for it says has the criteria but what does mark please so in my experience if someone comes in and they have chronic symptoms and yet overall they look like a healthy person coming in the door that's a strong suggestion is probably irritable bowel because although irritable bowel can cause a lot of pain and problems going to the bathroom it is not a true auto immune disease or inflammatory condition is not something that turns in the cancer and so ultimately although these are and yes and so ultimately although these patients have chronic symptoms they don't progress in the way someone that let's say had crohn's disease or cancer would progress they're not fully losing weight they're not malnourished they're not bleeding and so most of the times they come in and they look like you or i they look like people that would otherwise be healthy you don't look at them and think wow that person looks like they're going to be bad news they tend to be younger again that they might have already proven to be diagnosed depression anxiety again not that that's the sole cause but it's certainly an association and a common factor and then when they start to talk about thems again they're going to have a variety of symptoms they're going to have pain all over the place they're going to have rare triggers they're going to have all kinds that they're going to say that they have diarrhea sunday and then a constipated the other dogies they're going to say they are seeing cats give them heartburn and eating potato chips given the donald payne you know symptoms that don't really right always make a lot of sense right away when that have all these symptoms and yet they look healthy you have to think ok what idea it certainly comes in your mind absolutely so ok so wait a minute you said stress and i say what distress have to do with it it's just has a lot to do with a lot of things i would argue that stress is a major influence on our health in general yeah matter what disease you have or what symptoms you have there's always a certain amount of actual pain that's caused by the disease itself and let's say that it's here but then your emotional stress over it is going to make it feel like it's here right because the anxiety makes you focus on the symptoms more makes you obsess about the symptoms makes you anxious as to what the symptoms represent you nervous that you're sick and so that just always tends to overblow how bad the disease is so and i think that's true for any disease anyone that's had a long term illness has a component that things are really driven  and that happens to be especially true with functional disorders such as irritable bowel but again irritable bowel is still due to nerve endings that are sensitive beyond the patient's control ok this is not symptoms they are making up it's just symptoms that are  worsening the symptoms and worsening their experience interaction with the symptoms and so if you can take that ng's idea and move it away that's definitely a great way to help patients achieve better relief or better control of the symptoms even if you can't provide a tr that in terms of reducing the stress rate getting enough rest absolutely the word exercise absolute right drinking enough water so if a person did just those three things do you think that they can reduce their chance of having i d s again it's not about reducing your chance of getting the disorder because again the disorder is still independent of anxiety but if you can practice these healthy lifestyle habits you can certainly reduce how much you suffer of the digger the severity of the symptoms from irritable bowel ok and addition in the things you said we often will actually recommend yoga meditation and as ways to treat the symptoms will sometimes even run recommend acupuncture who needles but again if you believe in the concepts of acupuncture or terms of trying to help your shockers right the way we translate in the western medicine is that most acupuncture sites on the body earth centrally areas have been shown to be nerve bundle and since i've said that this is a condition of sensitive nerve endings it does seem to be a way to influence the sensitivity of the nerve endings directly puncture and so that is one way that actually works for some people so that would you know holistic approach then would be acupuncture acupressure meditation yoga polarities any exercise in general exercise in general all of those behaviors and then of be your advice for how many times to consume you did during the week again so for those people that are sensitive to probiotics meaning that they don't probiotics a minimum of four to six weeks and feel that that is improving their in symptoms and those patients that benefit from probiotics are usually gonna be patients where their one of their main complaints is bloating or gas not as opposed to the abdominal pain issues of rights but if you have some that's like that and they've given probiotics to try then really we were talking about daily there might be some bad interaction that's happening between those bacteria and your personal god so the idea probiotics is that your want to slowly change out the bacteria that you have with the bacteria in the probiotics which are designed to in general be less gas produc more tolerant to more people and so if you're going to try to change out this population you to be constantly feeding those bacteria in if they're going to have any chance of overtaking regime ok well that makes sense so greek yogurt would grow on a daily basis  couple teaspoons tables bones you know the amount is really up to the person because some people too much yogurt and that's going to do them into well yeah so it went with moderation so let's talk about the whole diet thing let's get more let's pull the onion back more short so what food do you recommend the person let me from that please don't say red wine that agrees we had this conversation no wine is maybe a in moderation can have beneficial effects on irritable bowel symptoms but you might get better you might get more pernicious out of it i know about that in terms of diet the only universal diet that's been shown in research studies to be a benefit to also basically what it means is certain carbohydrates and starches that are found in a variety of foods and those types of carbohydrates and starches often our own body can't break them down as well and therefore those types of foods are going to get more likely consumed by the bacteria inside of us when the bacteria consume them they're going to produce more gas as a result of their own metabolism that gas is going to lead to bloating it's going to lead destruction of the intestines which can cause pain categories and then over time you slowly back back in the food groups to find out which ones are truly bothersome for you with the idea that hopefully we'll be able to add back so that's the one diet that has been shown in research to be truly acceptable now i am most never put people on and then i ask that question how do you yeah i only have ten to treatment i usually don't do it because it's such an extreme elimination diet that most people aren't going to stick to it if people could stick to diets we wouldn't have the obesity problems we have concretely and so and also i find that eating is certainly one of my most enjoyable things in life and i really hate to take food away especially from the young men or women that in high school or college where eating is not only well for nutritional reasons but also is a very positive social interaction with right all friends family et so i really try to get into some of the other more homeopathic ways or if i'm going to put people on a diet even if we find those are not truly gluten allergic many patients with irritable bowel are gluten sensitive ok and so i will start by trying to that don't want to give up their diet and i actually think you need they say give me a pill right i had patients that are like that and so i try to keep an open mind for all ends of the spectrum and i cut try to keep myself up to date on all ends of the spectrum of life and custom fit my approach towards each patient so talked about yes and we also talked about see the what's the relationship between its source so as we've been discussing this whole time bacteria in our gut tend to be a major contributing factor to the irritable bowel condition right and so in the early to thousands there was a dr mark penn mintel who is a gastroenterologist at the time he was working out of the university of washington in st louis he's now at cedars sinai in l a and he started doing research studies where he sent people with your tip about conditions for what they call bacterial overgrowth breath tests which became a small intestinal bacterial overgrowth condition so if we hold it up we have the large intestine going across down and so th when we talk about good bacteria in all of us that is usually bacteria that are in the colon ok most of us do not have significant levels of bacteria in the small intestine his argument though is that a substantial portion of patients with  have extra bacteria in the small intestine and so he started routinely testing his irritable bowel patients for bacterial overgrowth those patients that primarily had symptoms of bloating and diarrhea ok and the argument was is that if you have bacteria in the small intestines because it's in the small intestines where the majority of our digestion takes place right if you had bacteria in that area it would be more likely to interfere with appropriate digestion and absorption of nutrients and more likely to lead to the bacteria digesting his food and leading to all these symptoms we've been describing so as a result a lot of patients that have those symptoms we will send them for a breath test which is just like it sounds they come in they drink a sugar liquid they breathe into a bag a bunch of times it gets fed into a local machine and it's but it's not a number if the number shows that in fact they do have more bacteria than what we consider to be normal we sometimes will then try to manage that now we manage it most often with antibiotics that bring down that level of bacteria and therefore reduce the amount of gas and symptoms that are going to be produced and produce people that have a positive breath test that can be a very effective way of managing the condition the only problem with that is that when antibiotics you give addicks the bacteria are eventually going to regrow yeah and so other strategies that we've employed of to maybe not destroy the bacteria but change them out ok and a more recent intervention has been something called and tear again and what's that and here again is labeled as a medical food product so what it is is an antibody that's been purified from cows and it comes in a powder and it's essentially a medical protein and meaning medical that you have to get it by prescription right and the idea is that if people in just this protein this antibody the antibodies going to try to neutralize the toxins that the back two are producing and cancel out the side effects of the bacteria without actually killing them off ok so again it may be a more natural way of eliminating the bacteria's effect on the bow without bombarding them with antibiotics which might lead to more long term the idea is that it does it sounds great in theory i do have to say that i've used it a number of times my clinical results aren't as good as the research trials very few people respond to it now people that respond to it it's a great alternative treatment just that  in with you know any kind of exactly liquid ok and so again for those people that are interested the holistic options i've always given it a try and about ten to twenty percent of patients will find that it's helpful unfortunate majority of patients don't  a day for the second week if you've started to notice a difference you then get a prescription from your doctor to continue one pack a day indefinitely really well let's say it's a natural supplement ok but again you know the art is that if it works you're going just going t canceling out the side effects of the bacteria you're not going to destroy them because all of us we worry about what long term harm antibiotics will do and whether that's going to lead to resistance anabolic when you get a more serious disease in the future like moni and all the sudden my you know you're having other issues yes so you might not push that regimen as much then the antibiotics you know for someone that severely symptomatic i will give them and if it leads to long term improvement which i define it's six months or more right then for the right people can be a great option because they can take antibiotics for two weeks and if they get that long a treatment relief that's almost better than anything else i can currently guarantee and against a lot of people they would rather do that than potentially be taking a daily supplement or medication right on the other hand if i give antibiotics and initially it works great but over time with repeat antibiotics the effects are coming back quicker and quicker and writer of the patients i'm like look we have to abandon this course and we have to go into one of these other courses and that's when we'll introduce some of these other options you know want i'm to let you take a break take a sip for a second and then but i want you to think about this the read tips that you can give the viewers on how to mitigate digestive complications so that's a tough category in general going to ask you this in general it's no secret in this country that we're eating the wrong things reading too much of it and eating things that are too fatty too greasy  right and all the see i think that has a lot to do with not only irritable about but with the majority of reasons that people see someone like me including heartburn irritable bowel stomach illness is and of course the complications from being overweight right fatty liver problems and other issues down the road people eat more sensible diet try to cut away from those fats try to cut down on some of the caffeine try to cut again what used to be a cup of coffee which was eight ounces back when we were younger now is the starbucks you know sixteen twenty two live events the yes so people tell me i have one cup of coffee a day but that's twenty two ounces it's really almost three cups of coffee that they're having for their one cup a day so many people are way over consuming cascine their way over consuming you know high fructose corn syrup so they're way over consuming you know greasy fatty foods and i think that's a lot of it also again a lot of us are living under heightened stress in this area and i think if you can have an activity be it exercise yoga meditation a hobby that you enjoy my wife recently purchased a guitar for me so that i could learn music lessons as a have saturday morning hours and we're always available to see patients for really any and all g i questions that you have and you're there not going away you're not sure what to do please consider coming in seem like someone like us we can hopefully