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Susan: In mid-2008, I had a severe food poisoning incident with lots of diarrhea and vomiting. Later that year, I broke a toe and took Advil every day for a month. In October 2009, I started having problems being regular with my digestion. I saw a physician who gave me a course of antibiotics and proton pump inhibitors (PPIs). After taking them I was still experiencing abdominal pain and bloating. Dr. Chutkan: An episode of food poisoning can be the triggering event for small intestinal bacterial overgrowth (SIBO) because the gut flora is thrown out of balance. The pathogen crowds out a lot of the beneficial gut bacteria, and even after the infection is over people are often still symptomatic because their healthy gut bacteria remain depleted and other species start to overgrow. Non steroidal anti inflammatory drugs (NSAIDs) like Advil compound things because they make tiny holes in the intestinal…

Because food is such effective medicine, there are very few supplements I actually recommend. But over the last 20+ years of working with patients, I find myself returning to a handful of products that work well with minimal side effects. Ground psyllium husk is one of those. Psyllium is a form of water-soluble plant fiber with prebiotic effects that can help alleviate symptoms of many different digestive conditions by encouraging healthy bowel movements. Psyllium forms a viscous gel in the intestine to bulk the stool and move the products of digestion through in a timely fashion. You can think of psyllium like a broom that sweeps debris out of your colon and keeps things moving through efficiently. Psyllium is most helpful for constipation, but it also works for conditions where incomplete evacuation can be a problem, including dysbiosis (gut bacteria imbalance), irritable bowel syndrome (particularly in constipation-predominant IBS), parasites (helps to remove…

Low FODMAPs Diet For SIBO – Is It Worth It? FODMAPs (fermentable oligo-, di-, mono-saccharides, and polyols) are difficult to digest or poorly absorbed sugars. In searching for an elimination diet to treat hives in the 1970‘s, Australian researchers created the beginnings of the low FODMAPs diet. In 2005 the diet was introduced as a diagnostic tool for irritable bowel syndrome (IBS) – if a patient felt better when eliminating FODMAPs from the diet, they most likely had IBS. The low FODMAPs diet has become the most commonly prescribed dietary intervention to treat IBS, and now SIBO – but this doesn‘t necessarily mean it‘s the most successful. Why Low FODMAPs? The poorly absorbed sugars highlighted in the low FODMAPs diet can play a role in IBS (and SIBO) symptoms. The hallmark of IBS is visceral hypersensitivity when the GI tract is distended or enlarged – which occurs when anything (food,…

Ultra-processed food and drinks (fish sticks, chicken nuggets, cookies, sweetened drinks, etc.) increase the risk of irritable bowel syndrome (IBS) and functional dyspepsia (FD or chronic indigestion). A recent French study analyzed dietary data from over 33,000 participants and found that approximately 16% of food consumed (by weight) was made up of ultra-processed foods, which account for more than 50% of caloric intake in the US, Canada, and the UK. The more processed foods consumed, the higher the risk of IBS and FD. The American Journal of Gastroenterology →Takeaway: If you suffer from IBS or chronic indigestion, eliminate processed foods from your diet by crowding them out with additional fruits and vegetables. If you have a craving for cookies, chicken nuggets, or any other processed food favorite, make a healthier version at home!

Prebiotic supplementation could replace the low FODMAPs diet as a treatment for functional gut disorders (IBS, constipation, functional dyspepsia, etc.). A 4-week study compared the effects of a prebiotic supplement plus Mediterranean-type diet, versus a placebo supplement plus low FODMAP diet for 2 weeks. Fecal microbiota composition, intestinal gas production, and digestive sensations were measured outcomes. After 4 weeks, both groups showed improvements in GI symptoms but only the prebiotic group showed significant improvements in microbial composition. (The FODMAP group actually showed an increase in pathogenic-associated bacteria). Two weeks after the intervention, improvement persisted in the prebiotic group but not in the FODMAP group. Gastroenterology →Takeaway: Based on 20+ years of clinical experience, Dr. Chutkan does not recommend the low FODMAP diet in her practice, including in those patients with functional GI disorders. The low FODMAP diet was created as a diagnostic tool for IBS, not as a therapeutic diet. While it may…