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an interview with heather van vorous
Heather Van Vorous is widely known as an IBS patient-expert. She is the author of best-selling books The First Year - IBS and Eating for IBS, and she runs the very popular Help for IBS website. Her Eating for IBS diet has helped many IBS patients get their symptoms under control.
Heather, welcome. I know you have suffered badly from IBS yourself - how did the symptoms start for you?
I was nine years old, and my first attack struck out of the blue while I was playing in a neighbor's garden. The pain was so severe it quite literally took my breath away. I was unable to move or speak, and I eventually blacked out.
When I recovered and made my way home, my parents took me to my pediatrician, who announced without running a single diagnostic test that my symptoms didn't fit any disorder she'd ever heard of. She refused to refer me to a gastroenterologist and told me to 'stop whining'. For years she dismissed my symptoms, ignored the fact that the attacks were so severe they sometimes woke me from a sound sleep in the middle of the night, and didn't even believe me when I told her I actually lost consciousness from the pain.
When did you receive an IBS diagnosis?
It was seven long years later before I finally saw a doctor who was able to diagnose me, and by that time I had come to realize that while the attacks probably weren't going to kill me (though the pain did make me want to die), they were also not going to simply disappear (no matter how fervently I hoped and prayed).
Unfortunately, while my diagnosis did at long last give me a name for my problem, it didn't come with much information about what was physically wrong with me, and beyond a recommendation to use soluble fiber supplements I wasn't offered any advice at all about how to prevent or stop attacks.
Once again, I was left to deal with the pain all alone and try to find the answers to my questions, blindly hoping that if I just searched long and hard enough I would be able to successfully overcome the disorder through my own attempts. Though it was difficult and at times extremely frustrating, over the course of many years that's exactly what happened.
I am sure a lot of IBS sufferers can identify with the inadequate treatment you received.
My favorite doctor comment relayed by people is 'It's just all in your mind - stop worrying about it and it will go away!'. Sometimes I don't know whether to laugh or cry. Personally, I once had a family doctor tell me (on my first visit, which was just for an annual check-up no less) that IBS is connected to childhood sexual abuse.
That was the first time I'd ever heard that, and I was really taken aback. I said something like it was fortunate that this wasn't the case for me. Her exact response was 'You should see a psychiatrist to help you deal with your denial'. Thank God I knew enough about IBS at that point to just get up and walk out on her, but I can only imagine how that could have affected her other IBS patients.
Personally, I simply couldn't wait for my doctors to get their acts together - I had to get mine together without them. IBS would have seriously compromised every single area of my life otherwise. So gradually, painfully, I did just that. And so can other sufferers - I promise. One of the most difficult aspects for me was feeling like I was all alone in the world with this problem, but other sufferers should never feel the same way. You are definitely not alone.
From your research, what do you think causes IBS?
The key problem seems to be with the gastrocolic reflex. Research has found that many IBS patients have highly abnormal ones. Our colons have significantly more violent and prolonged contractions (leading to diarrhea), or almost no contractions at all (resulting in constipation). Amazingly, researchers have found that while healthy people have six to eight peristaltic contractions in their colon within a 24-hour period, IBS sufferers with diarrhea have as many as 25 peristaltic contractions per day, and constipation-prone IBS patients have almost none.
Add to this bowel dysfunction the heightened pain perception resulting from our abnormal brain-gut interaction, and you've got the recipe for disaster - spelled I-B-S.
Can you explain how your Eating for IBS diet works?
There are, in fact, very clear guidelines to follow for how to eat safely for IBS, based on the well-established effects certain categories of foods have on the GI tract. The key word here is categories - most people with IBS drive themselves
bonkers trying to find that one specific food that is triggering their attacks. The problem is, it isn't a single food that causes attacks. It's any food that is high in fat, insoluble fiber, caffeine, coffee (even decaf), carbonation or alcohol.
Why? Because all of these food categories are either GI stimulants or irritants, and can cause violent over-reactions of the muscles in your colon, which can lead to pain, diarrhea, and/or constipation.
Many of the worst IBS triggers (red meat, dairy, fried foods, egg yolks, coffee, soda pop, and alcohol) can simply be eliminated from your diet altogether. I'm not suggesting this will be easy, but it can make a tremendous improvement in your IBS.
For fats in general, minimize your intake to 20-25% of your diet, maximum, and focus on heart-healthy mono-unsaturated oils. Never eat high fat foods, even in small portions, on an empty stomach or without soluble fiber. You want to go low fat, but not fat free.
For insoluble fiber, even though this is a potential trigger, you absolutely must eat these foods for overall good health. You simply have to do so safely, within the IBS dietary guidelines. Treat insoluble fiber foods with suitable caution, and you'll be able to enjoy a wide variety of them, in very healthy quantities, without problem. Never eat insoluble fiber on an empty stomach, in large quantities at one sitting, or without soluble fiber. Cook, peel, dice, or puree insoluble fiber foods to make them safer.
In contrast, soluble fiber is the single greatest dietary aid for preventing IBS symptoms in the first place, as well as relieving them once they occur. Why is soluble fiber so special? Because unlike any other food category, it soothes and regulates the digestive tract, stabilizes the intestinal contractions resulting from gastrocolic reflex, and normalizes bowel function from either extreme.
You can keep your colon stabilized each and every day by basing all meals and snacks on soluble fiber foods, minimizing fats, eliminating triggers, and carefully incorporating insoluble fiber. It's also very helpful to eat small portions frequently, calmly, and leisurely.
For lists of the soluble fiber foods, fats, and insoluble fiber foods visit http://www.helpforibs.com/diet/cheatsheet.asp.
How successful has the diet been for yourself and other sufferers?
For me, eating properly means the difference between being desperately, violently ill every single day of my life, and suffering an attack out of the blue a few times a year. That fits my definition of overwhelming success, and fortunately I'm not alone here. Similar - and even better - results have been reached by literally thousands of other IBS sufferers who have written to me to say so.
I believe that you have started doing clinical trials based on the Eating for IBS diet - are there any results from the trials yet?
No, the doc, Dr Noel Hershfield, is still conducting the study. He had a biostatistician determine how many people he needed to make the study viable, and it was something like 650. He's doing the study himself, in his own GI practice, with his own patients, so I think it's taking a while to get that many patients involved.
Dr Hershfield, a gastroenterologist in Calgary, Canada, has been researching the effects of the IBS diet on his patients for over a year now, and he is looking to expand his study. Final results will be published in a peer-reviewed medical journal.
Interestingly, Dr Hershfield began this study after having a dramatic reduction in his own IBS symptoms after adjusting his diet to the Eating for IBS guidelines. His own personal success at overcoming symptoms through diet, plus the realization that IBS clinical research has so far almost completely ignored dietary influences, sparked his determination to conduct the study.
Dr Hershfield is a doctor who truly understands what you're going through, and who's trying to give other IBS sufferers genuine help. If you live in Calgary, please support the study and share your experiences. To participate in the research, simply contact Dr Hershfield's office at (403) 240-4084 and ask for an appointment.
Do you think that things like 'unfriendly' bacteria and parasites cause symptoms in some IBS sufferers?
I think intestinal parasites can cause symptoms that can be misdiagnosed as IBS. I also think the research shows pretty persuasively that people can develop IBS after an insult to the gut (such as dysentery, gut bacterial infections, food poisoning, abdominal surgery, etc.) and I would imagine that if intestinal parasites are misdiagnosed for a long enough period of time, and cause enough GI trauma, that could lead to the development of IBS.
But I do not think that people with IBS have parasites (or 'toxins', or candida, or anything else that can simply be flushed from their bodies so that they are magically cured). IBS has been pretty indisputably shown to be a brain-gut disorder with heightened visceral sensitivity and a dysfunctional gastrocolic reflex. None of those things have a clearly understood cause at this point, nor a true cure (though some of the studies on gut-directed hypnotherapy show that results last five years and counting, which is extremely impressive).
I think the studies on unfriendly bacteria, or bacterial overgrowth in IBS, show mixed results. The most persuasive evidence I've seen in this area has come from the trials showing that probiotics can dramatically help a wide range of IBS symptoms. More than one strain of probiotic has had this result, and there is ever-increasing research in this area. I don't know how this would tie into the brain-gut dysfunction, but I'll be really interested to see how this area of research plays out.
What do you think the future holds for IBS sufferers?
In general, physicians have had a pretty poor track record when it comes to researching IBS (particularly in comparison to other chronic illnesses), and in fact very few studies were conducted until quite recently. As a result, there is much to be desired in how some medical professionals deal with this problem, and what they have to offer their IBS patients.
Things are finally, fortunately, changing in this area, but it has been a long time coming. We're still nowhere near where we need to be in terms of medical solutions to what is indisputably a physical problem.
You can visit Heather's website at www.helpforibs.com.