A Dietary Treatment for Irritable Bowel Syndrome

Image Credit: Sally Plank

A Dietary Treatment for Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a chronic, episodic intestinal disorder characterized by abdominal pain and altered bowel habits. It affects 1 in 7 Americans, although most go undiagnosed. IBS can have a substantial impact on well-being and health, but doctors underestimate the impact the disease can have, particularly the pain and discomfort. Using some measures, the health-related quality of life of irritable bowel sufferers can rival that of sufferers of much more serious disorders, such as diabetes, kidney failure, and inflammatory bowel diseases. The first step toward successful treatment is for doctors to acknowledge the condition and not just dismiss the patient as just hysterical or something.

Another reason sufferers often don’t seek medical care may be the lack of effectiveness of the available treatments. There is a huge unmet therapeutic need. Since IBS has no cure, treatment is targeted to alleviate the symptoms. Typical antispasmodic drugs can cause side effects, including dry mouth, dizziness, blurred vision, confusion, and fall risk. New drugs now on the market, like Lubiprostone and Linaclotide, can cost up to $3,000 a year and can cause as many side effects as symptoms we’re trying to treat.

Antidepressants are commonly given but may take weeks or even months to start helping. Prozac or Celexa take 4 to 6 weeks to help, and Paxil can take up to 12 weeks. They also have their own array of side effects, including sexual dysfunction in over 70% of the people who take these drugs.

There’s got to be a better way.

Acupuncture works, but not better than placebo. Placebo acupuncture? That’s where you poke people with a fake needle away from any known acupuncture points. Yet that worked just as well as real acupuncture, showing the power of the placebo effect.

I’ve talked about the ethics of so many doctors who effectively pass off sugar pills as effective drugs, arguing that the ends justify their means. There’s actually a way to harness the placebo effect without lying to patients, though. We tell them it’s a sugar pill. Patients with irritable bowel syndrome were randomized to either get nothing or a prescription medicine bottle of placebo pills with a label clearly marked “placebo pills” “take 2 pills twice daily.” I kid you not.

Lo and behold, it worked! That’s how powerful the placebo effect can be for irritable bowel. They conclude that for some disorders it may be appropriate for clinicians to recommend that patients try an inexpensive and safe placebo. Indeed, sugar pills probably won’t cost $3,000 a year. But is there a safe alternative that actually works?

As you can see in my video, Peppermint Oil for Irritable Bowel Syndrome, nine randomized placebo-controlled studies have indeed found peppermint oil to be a safe and effective treatment for irritable bowel syndrome. A few adverse events were reported, but were mild and transient in nature, such as a peppermint taste, peppermint smell, and a cooling sensation around one’s bottom on the way out. In contrast, in some of the head-to-head peppermint versus drug studies, some of the drug side effects were so unbearable that patients had to drop out of the study. This suggests it might be a reasonable approach for clinicians to treat IBS patients with peppermint oil as a first-line therapy, before trying anything else.

The longest trial only lasted 12 weeks, so we don’t yet know about long-term efficacy. The benefits may last at least a month after stopping, though, perhaps due to lasting changes in our gut flora.

The studies used peppermint oil capsules so researchers could match them with placebo pills. What about peppermint tea? It’s never been tested, but one might assume it wouldn’t be concentrated enough. However, a quarter cup of fresh peppermint leaves has as much peppermint oil as some of the capsule doses used in the studies. One could easily blend it into a smoothie or with frozen berries to make something like my pink juice recipe. You can grow mint right on your window sill.

We doctors need effective treatments that “are cheap, safe, and readily available. This is particularly relevant at the present time as newer and more expensive drugs have either failed to show efficacy or been withdrawn from the market owing to concerns about serious adverse events.” Just like it may be a good idea to only eat foods with ingredients you can pronounce, it may be better to try some mint before novel pharmacological approaches, such the new dual mu-opioid agonist delta-antagonist drug with a name like JNJ-27018966.

I have some other mint videos: Enhancing Athletic Performance With Peppermint and Peppermint Aromatherapy for Nausea. Lemon balm is also in the mint family; so, check out Reducing Radiation Damage With Ginger & Lemon Balm and Best Aromatherapy Herb for Alzheimer’s.

You can also sprinkle dried mint on various dishes. See Antioxidants in a Pinch.

What else might work for IBS? See Kiwifruit for Irritable Bowel Syndrome and Cayenne Pepper for Irritable Bowel Syndrome and Chronic Indigestion.

Irritable bowel symptoms can overlap with problems with gluten; so, make sure your physician rules out celiac disease. These may be helpful:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


109 responses to “A Dietary Treatment for Irritable Bowel Syndrome

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    1. hi Bill Edwards, Dr Esselstyn was asked that same question and his response is posted here, next to last question on the page
      http://www.dresselstyn.com/site/faq/ Basically he is advocating a plant based diet for the many benefits it offers in general though he says A Fib is largely independent of diet. Hope that helps.




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      1. I read Dr Esselstyn’s book and visit his site periodically but some of what he says is his opinion or experience and not scientifically proven. For example, he does not recommend nuts/seeds or avocado and requires no added fats to reverse heart disease. Well, his method does work but it does not prove that is the only method to reverse heart disease.
        I think also there is room for more research on his opinion of smoothies. I can not say I know the answer or where to find the answer but maybe this will help: http://www.quickanddirtytips.com/health-fitness/healthy-eating/know-your-nutrients/does-blending-destroy-fiber




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    2. Bill,

      Low dose of caffeine (tea) may be helpful:

      https://nutritionfacts.org/video/coffee-and-mortality/ (you may find what you are looking for at about fourth minute).

      High blood pressure is also risk factor for atrial fibrillation, so lower your salt intake and be sure to get enough potassium (fruits and vegs).

      You may also want to avoid fish consumption:

      https://nutritionfacts.org/video/omega-3s-prostate-cancer-and-atrial-fibrillation/

      I hope that this was helpful :)




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    3. Hi Bill – This might sound really bizarre, and I don’t know if it will work for you, but I’ll share my experience. For over 40 years I have dealt with an arrhythmia, first diagnosed by gp in my 20’s. Shows up on an EKG. He offered beta blockers. After I read all the side effects I declined that treatment. Over the years I learned more about magnesium and started taking that. Magnesium citrate (not oxide) I found to be helpful over the years and I noticed that if I took my magnesium (400mgs/evening) my arrhythmia calmed down. If I got off my routine, back it came. That worked fairly well for decades. More recently I fell in love with San Pellegrino mineral water and have been consuming that or Fiji water (also a mineral water). This is purely anecdotal but my arrhythmia has gone away – I cannot feel the palpitations at all.
      Coincidentally, I just happened to catch a PBS Nova show that I thought was going to be boring but I watched anyway. It turned out to be more than interesting. This show explained how we, as biological beings, co-evolved alongside earths minerals. It immediately struck a cord with me and has really made me wonder if my arrhythmia problem was a lack of needed minute amounts of naturally-found minerals. I consume about a half bottle of San Pellegrino per day (750mgs) over ice and it seems to have made a huge difference in my arrhythmia. I also have stopped taking my magnesium since the mineral water contains magnesium. Here is the link to the Nova show I watched:
      http://www.pbs.org/wgbh/nova/earth/life-rocky-start.html I hope you get this post Bill. If you try this, I hope you will report back and let us know if it is helpful to you. Take care.




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  1. What about a low FODMAP diet for IBS? It is treated as an evidence-based treatment here in the UK, but I haven’t seen much evidence of low FODMAP vs placebo. What is your take on it?




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    1. For what it’s worth, I’ve got IBS and low FODMAP has really helped me! I’ve found a particular sensitivity to oligosaccharides and since cutting them out (and cutting out cruciferous veggies), my symptoms have basically disappeared. That said, I really need to figure out a way to incorporate these foods back into my diet (onions, garlic, cruciferous, etc. for obvious health reasons). I’m working with an RD to find the right balance of treatments and/or probiotics to allow me to re-incorporate them.




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      1. I’ve had IBS nearly all my life and taking a sugar pill would NOT have helped with any of my symptoms, I find this suggestion very insulting for the people that suffer for years with this. No kind of pill is a solution, the only way I have found to ease symptoms dramatically is to have a FODMAP diet. As mentioned here. It took me until I was in my 30s to discover it and I’ve been suffering since I was 14. Once the FODMAP diet is followed it’s down to the person to tweak what they can and can’t tolerate but it’s been the best guide for me to live an almost IBS symptom free life. To all th sufferers, please give this a go. It helped me so much.




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        1. how much fruit do you consume on your low fodmap diet. What fruits, do you
          personally find, are the most tolerable for you?

          nuts, seeds? coffee?

          Any chickpeas, and if you have garlic, raw or cooked?

          Thanks.




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          1. I recommend the Monash university app. There aren’t a lot of fruits allowed, but mercifully, blueberries, raspberries, strawberries, oranges and bananas are allowed. Which I eat almost every day.

            For nuts, similar story. Walnuts tend to be fine, small amounts of almonds or peanuts too. And I still do my once a week brazil nut. Cashews are sadly out. I handle coffee fine.

            They say you can do 1/4 cup canned, rinsed chickpeas, but I don’t. I do do canned, rinsed brown lentils though. No garlic or any other allium in any form *except* green onion tops, which you can do fresh or dried. You can also use garlic infused oils since FODMAPs are water soluble, not fat.




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      2. I am so heartened by the success stories and while I am in the continuing process of converting to WFPBD I am struggling with meal preparations.  Wondering how others approach incorporating veggies and fruits and grains, etc. into meals.  Are there tips that you can provide to newbies like me?  Any particular menus or cookbooks that you would recommend.  I really don’t want to spend hours preparing meals and then cleaning up.  Yes, it is important to see to my health and hopefully improve or eliminate digestive issues but honestly can’t invest huge blocks of time on meal preps.  Any help would be most appreciated.
        Lee




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        1. Lida: Good for you for making this journey. Trying to figure out what to make is a common problem. Based on your post, I have a couple of recommendations for you:

          1) Get a copy of Jeff Novick’s first fast food DVD: Jeff is a famous RD who shows how to make tasty, healthy (whole food plant based) meals in minutes. http://www.jeffnovick.com/RD/Fast_Food_Vol_1.html

          2) Check out the free on-line program from PCRM (Physician’s Committee for Responsible Medicine) called 21 Day Kickstart. The program will “hold your hand” for 21 days, including meal plans, recipes, videos, inspirational messages, and a forum (moderated by a very respected RD) where you can ask questions. This program may be more intense than you want right now, but it will give you ideas for going forward, and you can do as much or as little as you want.
          http://www.pcrm.org/kickstartHome/
          (Click the green “Register Now” button.)

          There are a lot of really great resources out there. I just didn’t want to overwhelm you. If these ideas don’t appeal to you, don’t give up. We have lots of ideas here and eventually you will find plenty of tasty dishes that meet your convenience needs. Good luck.




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        2. I found these very healthy whole food plant based diet 5min. meals that are also delicious. Done by young twin brothers. They are a lot of fun to watch & you’ll learn a lot. I posted it on my FB account & other tried it AND love the food. Good luck.

          </a




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        3. I basically buy a lot of frozen veggies and make soups. Also salads. Make a whole wheat muffin. Recently making summer tacos…soft white corn tortillas with beans…lettuce…onion…olives…tomatoes…and hot sauce. Nuts…an assortment. If it’s mostly unprocessed…it ends up as food…if you are an unprocessed person…stand back. I’m male…never really learned to cook…so I cook to eat.




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    2. What about a low FODMAP

      Some of us are acronym challenged. Good writing will assume that not everyone will recognize the acronym and will at least once during a post, spell out what the acronym stands for.

      Thank you in advance for posting responsibly. ‘-)




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        1. TFTLSA, but someone in a later post actually remembers how to write in longhand and following good rules for writing, posted the acronym’s meaning.




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    3. Hey Petya, thanks for writing! a recent meta-analysis of clinical studies (see https://www.ncbi.nlm.nih.gov/pubmed/28846594) concluded that a low FODMAP diet is indeed superior for reducing pain and bloating. However, this conclusion was based on the comparison of a low FODMAP approach to a standard diet – which is probably unhealthy enough to cause stomach problems in many, if not most people! The comparison to diets specific to the treatment of IBS was not done. There may be a strong placebo effect here; when people try things on themselves, just the act of taking ownership of one’s health can have a healing effect. So try it, and if you get LASTING relief you’ll know it’s more than a placebo effect!




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  2. Wondering if you could send out information on gastroparesis. Doctors at Dartmouth think my daughter has I.B.S. but in fact we are thinking gastroparesis. The western diet for gastroparesis is a nightmare so we are using a Chinese Doctor and following a brown rice diet.




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    1. As one of the moderators on this site, I wanted to be familiar with general information on and recognized treatment for gastroparesis, so please review the following if you don’t have that general information yet:
      https://health.clevelandclinic.org/2015/09/gastroparesis-know-the-risk-factors-for-this-mysterious-stomach-condition/
      http://www.mayoclinic.org/diseases-conditions/gastroparesis/symptoms-causes/dxc-20323133
      https://www.niddk.nih.gov/health-information/digestive-diseases/gastroparesis

      The last resource speaks about nutrition :
      ” Eating, Diet, and Nutrition
      Changing eating habits can sometimes help control the severity of gastroparesis symptoms. A health care provider may suggest eating six small meals a day instead of three large ones. If less food enters the stomach each time a person eats, the stomach may not become overly full, allowing it to empty more easily. Chewing food well, drinking noncarbonated liquids with a meal, and walking or sitting for 2 hours after a meal—instead of lying down—may assist with gastric emptying.

      A health care provider may also recommend avoiding high-fat and fibrous foods. Fat naturally slows digestion and some raw vegetables and fruits are more difficult to digest than other foods. Some foods, such as oranges and broccoli, contain fibrous parts that do not digest well. People with gastroparesis should minimize their intake of large portions of these foods because the undigested parts may remain in the stomach too long. Sometimes, the undigested parts form bezoars.”

      It would seem a whole food plant based diet would indeed help regulate blood sugar and minimize fat. Perhaps experimenting with minimizing suspect raw fruits/vegetables might help. Some also suggest the fodmaps diet. You may want to check this out also: http://www.fodmapliving.com/wp-content/uploads/2013/02/Stanford-University-Low-FODMAP-Diet-Handout.pdf
      Best of health for your daughter.




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  3. Hi Dr. Greger……..my integrative, plant based Dr. recommended a low fodmaps diet for IBS, SIBO, and difficulty digesting a plant based diet. Also, sprouting grains and legumes. Has worked great for me!!




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  4. In terms of efficacy and cost, nothing beats treating IBS with drinking a quart of warm water first thing in the morning before eating or drinking anything else. I heard a radio discussion about following this practice for the treatment and prevention of upper respiratory infections and, desperate to avoid running through my sick leave at work–one good episode of flu or a nasty cold was enough to accomplish that–I gave it a try. My alarming rate of incidence for colds and flu moderated to almost nothing, and as a pleasant “side effect” my doctor diagnosed IBS went away. I started this at about age 25, I’m now 65, and I’ve had perhaps one episode of something like IBS since starting, and that shortly after I began the practice. This is a no-brainer: a leg up on daily hydration; dramatically decrease the incidence and severity of colds, flu and bronchitis; AND knock out IBS at very nearly no cost or bother.




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  5. What if you are unlucky enough to have reflux and diverticulosis in addition to chronic indigestion. Wouldn’t peppermint result in greater aggravation to those conditions?




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    1. I thought so too, but the best solution for me has been a total shift to a plant based diet. Now I no longer take anything and am so much happier. Mint tends to settle my tummy but I am only doing tea or fresh mint in a smoothie.




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    2. Hello Lee,
      Thank you for your question. I am a family doctor with a private practice in lifestyle medicine and also a volunteer moderator for this website. First, I need to clarify that Dr. G. is writing about irritable bowel syndrome, not about “chronic indigestion” which is not necessarily the same thing. “Chronic indigestion” could mean lots of things, including chronic gastroesophageal reflux, or even chronic excessive gas.

      You are correct that peppermint can contribute to reflux. Here is an article I found about this in PubMed (a free database of medical articles): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4223119/

      However, I have never heard of any association between peppermint and diverticulosis. In fact, when I looked in PubMed, there were ZERO articles that came up when I looked for “peppermint” and “diverticulosis.”

      I hope this helps.
      Dr.Jon
      PhysicianAssistedWellness.com




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      1. Thank you, Dr. Jon, for your information.  I have used the term chronic indigestion very loosely  since I have read that IBS can cover a host of symptoms and is often used as a term by people who suffer from a variety of abdominal disorders even SBIO for which I have been diagnosed inferentially.  I suffer from frequent abdominal pain both upper and lower.  I have had reflux issues for many years and do now have one area for certain of diverticulosis.  In trying to eat plant foods and increase fiber I have been beset by serious bloating and gas which is incredibly uncomfortable.  Cruciferous vegetables, onions, garlic and so many of the “healthy” foods which I enjoy eating are definite culprits.  I am struggling to understand what I can eat that will give me the healthful benefits without those issues.  I do not want to be on antibiotics for the SBIO nor the PPI which my gastroenterologist favors.  Do you have any advice for my predicament?  How do I adopt a healthier lifestyle through food while avoiding the pitfalls that I have mentioned?
        Lee




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        1. Lee, thank you for this extra input. Indeed, both “chronic indigestion” and “irritable bowel syndrome” can mean many different things, so it helps to know your specific symptoms. I think you mean “SIBO” (small intestine bacterial overgrowth) and not SBIO.

          First, for reflux, it has been my experience (both personal, and with several patients) that switching from animal foods, which are more acidic, to plant foods which are less acidic, almost always helps with reflux symptoms. Taking PPIs chronically concerns me. Here is a link to one of Dr. G’s videos about reflux:
          https://nutritionfacts.org/video/diet-and-gerd-acid-reflux-heartburn/
          It is often fatty foods that contribute most to reflux.

          Regarding your bloating and gas, it sounds like several plant foods which we normally recommend (cruciferous veggies, garlic, onions) are culprits for you. Your choices are:
          1) avoid all those foods — after carefully confirming by removing and then adding back one food at a time; OR
          2) eat the foods, but try to manage your gas by taking things like Gas-X or Beano.

          Regarding taking antibiotics for possible SIBO, I think that’s a bad idea. If your doctor really thinks you have some type of unfavorable intestinal bacteria populations, there are ways you can test for that. A company called Genova Diagnostics does a “Comprehensive Digestive Stool Analysis”, which can give you some good information.

          I hope this helps.
          Dr.Jon; PhysicianAssistedWellness.com




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          1. Thank you so much for your additional reply.  I have read that L-Glutamine at 1000 mg per day is recommended for leaky gut syndrome.  How do you feel about adding that?  Quercetin at 1000 mg per day also.  If you can bear one more question:  which vegetables do you recommend that are high in fiber without causing issues such as I have mentioned?  I am doing quite well with fruit but veggies have me stumped.  My gastroenterologist recommended the FODMAP plan but it eliminates so many of the foods I have enjoyed over the years.

            Lee




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            1. Lida, – I went WFPB over 10 years ago now. When I made the change I developed a whole lotta gas, especially with beans. The advice from the plant based experts was that this situation would settle down in about 2 weeks as my flora and fauna made the adjustment. My “adjustment” took considerably longer – about 2 years before I could eat all these wonderful plant-based foods and not bloat up like a hot air balloon. But my system did, eventually, adjust and I can now eat anything plant based and have relatively little intestinal problem. I’m not certain that my “problem” is the same as your “problem”, but I thought I’d just share my experience and encourage you to stay the course and see if you can move through your situation.




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              1. Thanks, Rachel I do plan to stay the course and it really helps to know that not all plant foods will agree with everyone. I have to stop seeing it as a failure if I can’t tolerate broccoli for instance without issues. It was infuriating to find that many vegetables that are so healthy may not be tolerated by everyone. Perhaps, like you, in time and gradually they can be added in. In the meanwhile I need to find those plant foods that my system will welcome.

                Lee




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    3. Hi Lee,

      Yes, you are correct. Foods such as fat, chocolate, spearmint, peppermint, onions, spices, alcohol, citrus foods, carbonated beverages, and caffeine can all contribute to reflux, but the best way to know is to try and find out. If you would like to try peppermint I suggest trying it in the morning or afternoon when you will not be lying down shortly afterwards as that would make your reflux worse.




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  6. This is the first good treatment for IBS which I’ve had all of my life. I am gluten sensitive (I was tested) however. Nice to know I’m not a total loon after all. Yes, I’ve used Celexa for years. I just discovered peppermint tea also. This works well also!




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  7. IBS can indeed be agonizing and life altering, even leaving home wasn’t an “option” for me unless there was access to private bathroom facilities. One of the many “side effects” of switching to a whole food plant based diet was that the long standing and disabling IBS that nothing else helped, essentially resolved! Not immediately to be sure, I had to learn what to avoid when I had a flare, (mostly oils), and adding lots of low salt home-made fermented foods was the final solution, but it is rarely a problem if I am compliant. I agree that the gut flora/microbiome has a huge effect on symptoms, and far beyond IBS including agonizing RA that I was taking potent drugs for because I was told by several specialists that was the only solution to “manage” it, and I would always have it. Despite the lack of support from my doctors, (who actually warned me against a carb heavy, meat freem WFPB diet), so many serious health issues and the pharmacopoeia of drugs I was prescribed to “treat” them, including T2 diabetes, went the way of the dinosaurs. (And so did my doctors) It would be great to have some Dr Gregers and/or the other REAL doctors who don’t just push pills and procedures! I see some change in the acceptance of nutrition in relation to our increasingly sick population, but word cannot travel fast enough!




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    1. I always love reading your posts, VegeTater. Your experiences are a testament to how well a WFPB diet can turn someone’s life around. And you articulate them so well.




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  8. IBS has many causes, such as infections, bad gut bacteria, imbalance of healthy gut bacteria, digestive/food issues, emotional issues, histamine issues, SIBO, gluten intolerance, unhealthy diet, eating too often, not enough fiber, etc.

    I’ve been on a vegan diet for over 40 years and have had healthy habits like drinking water first thing in the morning, etc. Peppermint oil did nothing for me, although a certain type is recommended, and does help many people with IBS. Vegan FODMAP (I am a nutrition/cooking instructor and put a vegan FODMAP diet together when the RD couldn’t) didn’t help much. FODMAP works in 50-70% of IBS cases.

    So the problem is: what is the person’s reason for IBS? A person has to find the cause!!

    Based on good medical tests, I have Lyme disease and co-infections which have racked havoc with my whole body including my entire digestive tract. I also have SIBO, gastroparesis, histamine issues, some gut bacteria imbalance, and gluten intolerance. It could be that all of these problems have come from long-term Lyme disease and co-infections mixed up with lots of antibiotics when I was young and then antibiotics for the more recent problems.

    So far a vegan/low histamine/gluten free diet has worked the best for me. But I have yet to irradiate the infections, bad bacteria and the histamine issues, which should go away when the infections and bad bacteria gone.

    For some of us, it’s not just a simple answer to correct the problem.

    Thank you Dr. Greger! I use lots of your information in my food and nutrition classes!!




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    1. I too do a vegan version, found it quite easy once you get the hang of portion sizes, though I still can’t tolerated beans (except green beans).




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    2. I am interested on your vegan FODMAP. My mother suffers similarly and she is trying to do it, but the limitations are great. I don’t know where you could post me information on this site. There are people out here trying to make it work.




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    3. How interesting! I became vegan very recently, only two months ago, and also began the low FODMAP diet. I have found it to be very helpful so far. However I am concerned because beans are definitely out of the picture for me, in the short term, and in the long term I may be able to manage them once every two days. Do you have any advice for me regarding Dr. Gregor’s daily dozen, which calls for three servings of beans per day?




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  9. Several years ago, at the recommendation of a nurse friend who has studied nutrition and nutritional supplements for decades, I tried L-Glutamine in a desperate attempt to alleviate my reflux symptoms. The results for me were nothing short of miraculous. My internist had just recommended that I increase Prilosec from 1 to 2 tablets/day. Instead, I added a twice daily dose of powdered L-Glutamine mixed with about 8 oz of water–once first thing in A.M. before anything else, and once at night just before bed. Within about a week, I was totally off Prilosec and have never had to take it since. I almost never miss a dose of L-Glutamine because the results are so amazing. Thorne Pharmaceutical sells a very high grade product https://www.thorne.com/products/gastrointestinal-support/dp/l-glutamine-powder My nurse friend recommends this product for her patients who suffer from IBS, Crohn’s, and other GI system disorders. I would love to see some Dr. Greger studies/reviews of this amino acid!!




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  10. Please do more for us celiacs. There is SO much information out there on this disease. Celiac rates have risen ~400% since 1960. And I can attest to the fact that managing this destructive autoimmune disease is not as “simple” as avoiding gluten, as so many well-meaning but uneducated people may say. I happen to have been “gifted” with this gene, passed down from my grandma. Unfortunately, the both of us have a very unruly expression of CD. My grandma can’t tolerate any grains, legumes, soy, or sugars (except for most fruits and honey). I am only 18, but I can see these “allergies” cropping up already. I am “lucky” to be one of the celiacs who cannot have oats – yes precious oatmeal is off my table forever and my heart aches because of it. However, not as badly as my stomach aches when it IS on my table – yikes! My point is, i realize “only” 1 in 133 people have CD (but let’s not forget the prevalence of misdiagnosed folks), but this disease still affects millions and is very much worth delving into the research (as I have done myself). I would be very interested to know your take on this matter, Dr. Greger. Especially considering that a large portion of the foods recommended by you and other plant doctors are ones that my grandma and myself, as well as countless other celiacs, cannot consume. (E.g. Oatmeal, whole-grains, beans, soy, nutritional yeast, etc) The whole rice ordeal has really been disheartening, considering my list of safe foods continues to shrink. I needed to express this concern, and unfortunately I am worried these concerns will remain unnoticed.

    – In (okay) health,
    Claire




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      1. Please add natural treatments for sarcoidosis as a topic. I have sarcoidosis of the liver. Most have it in the lungs. Its a nebulous diease..no known cause or cure. Just prednisone! Please help! Up all night with inflammation and pain in lymph nodes in the chest area with painful enlarged spleen and liver.  I started a plant based diet in February when I was diagnosed by 2 Boston hospitals. 

        Happy Connecting. Sent from my Sprint Samsung Galaxy S® 5




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        1. I had sarcoidosis when I was younger- the only thing that helped me was a very healthy diet and bed rest- took almost three years to recover and I have been left with sensitive lung tissue and my arm muscles are not as strong as they were but I can walk- which having been in a wheelchair and then walking with a frame- I can now walk for miles- good luck




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          1. I took some fennel seeds after each meal yesterday and slept longer than I have in over a year! Thanks for your feedback. Its a daily battle.

            Happy Connecting. Sent from my Sprint Samsung Galaxy S® 5




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    1. Claire,

      I’m curious if you are able to consume Moringa Oleifera with your condition. It is a plant based food with exceptional nutrition.

      Just curious if there is any known disease that is exacerbated by this “wonder” food.




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        1. Claire, The reason I brought up the Moringa is because it has so many nutrients and with your limited menu, thought it might serve you well nutritionally.

          I take it with unsweetened apple sauce and it is palatable, for me at least, taking it that way.

          But to put that in context, I used to take it with applesauce plus a garlic clove sliced thinly mixed in. I would take a spoonful of the moringa/applesauce with a thin slice or two of the garlic and just swallow it without chewing.

          The purpose was to consume the mix rather than to enjoy the fare. ‘-)

          This summer I have had a bountiful watermelon harvest and eat that at least three times a day. Some other things I consume, including supplements, seem to combine to cause a loose stool on occasion. Not sure if hibiscus tea may not be part of the cause as well.

          When that strikes, I combat it preemptively by eating yogurt or yogurt plus ice cream on a hot day. Not a preferred thing to eat (milk product) but seems to firm things up.




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          1. Ah I see! I take chlorella though, and I actually like the tablets very much! I find yogurt helps me a lot also. I buy So Delicious non-dairy kind, as with CD lactose/casein is also a big antigenic food. I will look into moringa, thank you!!




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            1. CHLORELLA!! Thanks for reminding me. I have a half-filled 4 oz bottle in my cabinet. I took it all through the winter by put a long dropper full into whatever tea I was drinking, thinking it was supplying me the greens I needed.

              Watermelon season has just gotten me off my regular feed since I have such a good crop and plenty to eat to keep from going to waste, even after giving many of them away to friends and family.

              Can someone offer any advice on chlorella ? That is, does it provide much nutrition by way of being green?




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              1. Yes! I rely on it greatly, especially since I get upset stomach with leafy greens sometimes. Chlorella is amazing for immune health! I have extremely low IgA levels, so it helps keep my digestive and respiratory health on par. I’m also a competitive distance runner, so I love having this food on hand to support my training and overall health. Start slow with your dosages, and then you can build up to whatever level your body needs. One of the BEST foods I have on hand at all times! :)




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                1. As someone in training (have been for years) as a short to medium distance non-competitive walker, I’m back on the chlorella (just as soon as I finish what appears to be my last watermelon of the season. ‘-)

                  Something you said regarding respiratory health triggered a memory of something I’ve read recently in Science Daily.

                  They now believe (and have proof in a mouse experiment) that humans can exercise 70% longer even if they are sedentary.

                  If that proves out, you may have to join them assuming you can’t beat them. ‘-)




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                    1. Yikes! No good! Thankfully, exercise is enjoyable and so rewarding. In combination with a nutrient-packed diet, we can train for greatness in a fair and safe way. :)




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                    2. But since this last link was for 20-30 year old research, I will continue to follow this since we have a tremendously better research and development culture now than we did then.

                      If they haven’t already, the will eventually figure this out and how to make it work for us.




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              2. Hi Lonie. Great question. I am a volunteer here on NutritionFacts.org and I think you might find these videos interesting, Is Chlorella Good For You? and Treating Hepatitis C with Chlorella.

                It should not be used as a source for all your greens. There is no one specific source for all the essential nutrients your body requires. Therefore, consuming a wide variety of vegetables as a source of your greens gives you these required nutrients.




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  11. Good article, but was surprised like others that the Fodmap friendly diet was not mentioned. Monash University in Australia are continuing updating their app which you can follow. I only had to take out a few things out of my diet and felt a dramatic difference within a week.




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  12. I wish Dr. Greger would not list his appearance on the Dr. Oz show. It undermines the quality of his commentary and research because Oz is now just a quack who shills for very questionable entities. Some good docs go to the dark side of quackery using their previously good credentials. It happens a lot.

    Very interesting that so many people have found their own creative solutions to IBS. I work with people who are investigating how gut flora have changed over the last sixty years and how a plant-based diet can improve these functional problems. First thing to try for many people who have IBS is probiotics and prebiotics and going to a strict plant-based diet. Sometimes that’s enough, but many of you mention an array of other solutions that need more public attention.

    As Greger keeps mentioning, a basic deficiency in medical education means that nutritionally ignorant physicians continue this illusion that they know anything at all about human nutrition. Of course it’s in their interest to continue this ridiculous and misleading impression.

    I’ve been in academic medicine for almost 40 years, and in all that time I’ve met only three or four people who know what they are talking about when it comes to human nutrition. The last school where I worked offered only five hours of nutrition education, and it was an elective and was poorly attended.

    No wonder medicine has gone off the rails.




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  13. Dr. Gregor,

    I am currently going through a bout of constipation with a lot of pain.
    Naturally the doctor prescribed medication which are METRONIDAZOLE 500mg tablets, CIPROFLOXACIN 500 mg tablets and over the counter Smooth Lax, Polyethylene Glycol 3350 powder.
    After reading the side effects of the medication I don’t think I want to take it.
    Do you have a natural remedy that I can use.

    Thank you,

    Don Taylor




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    1. Are you eating a whole foods, plant based diet as recommended by Dr. Greger? My guess is, no. It would surprise me if this could happen on a WFPB diet.




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    2. Hi There,
      You can try Psyllium Husk last thing at night. Start with 1 tsp in a glass of warm water. As it has a swelling capacity remember to drink a lot more water.




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    3. Hello Don,
      Thank you for your question. I am a family doctor with a private practice in lifestyle medicine, and also a volunteer moderator for this website. Without knowing your whole medical history, it’s difficult to give you good advice over the internet. For example, I would like to know if you just have a simple case of constipation, or if maybe your doctor thinks you might have diverticulitis, which can be a serious problem — occasionally leads to perforation of the bowel, and can require surgery. Symptoms of diverticulitis include fairly severe pain in the left lower abdomen, nausea/vomiting, and fever. Metronidazole and Cipro are antibiotics often used to treat diverticulitis.

      Polyethylene glycol (known by lots of different names, including MiraLax) is a very strong laxative. It certainly usually works to cause a bowel movement. However, there are gentler ways of inducing a bowel movement, including exercise, more fluids, drinking coffee, and various fruits and fruit juices — especially prunes and cherries.

      If your likelihood of diverticulitis is low, then I would say that treating you with metronidazole and Cipro is overkill. Both of those antibiotics will kill off most of your normal as well as abnormal colonic bacteria. This is generally NOT a good idea. Here is a great video by Dr. G. about the importance of a healthy gut “flora”, and also how to help our bodies develop this healthy flora: https://nutritionfacts.org/video/prebiotics-tending-our-inner-garden/

      I hope I’ve answered your question.
      Dr.Jon
      PhysicianAssistedWellness.com




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    4. I found 2 solutions to my problem of constipation and hard bowels. After much research and experience, I now take Flora Source a probiotic from Nutri-Health. One in morning before breakfast and one at bedtime. I sometimes take a digestion enzyme from Enzymedica if I have skipped one day without a bowel movement. I take it about 1/2 hour before a meal or two. I have solved my problem. Good luck.




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    5. Don Taylor – I have been WFPB for over 10 years. I still, at times, have a bout of constipation and I’m still trying to figure out what might be going on with me. I have to say that overall a WFPB diet has been more than helpful overall, but, as mentioned, I still get an episode of constipation here and there. I am thinking that I have an issue of slow transit time possibly.
      Someone above suggested drinking a quart of warm water first thing in the morning. I’m going to try that. But something else that has been somewhat helpful to me is to build in a 12-hour fasting period each night. If my last meal is at 7pm then I do not consume food again until 7am the next day. If I get a little hungry, I drink a cup of tea – chamomile has a filling sensation but one could try others. My system seems to do better when I give it plenty of time each day to do its work. I am in my 60’s so I am also assuming that my system has slowed over time. Walking, – movement – naturally helps.
      Another trick that helps me is to eat something fairly hot – with red pepper. My system reacts by ‘ramping up’ and moving the hot pepper along fairly quickly along with whatever else is in my digestive tract. I will put red pepper flakes on a potato or vegan pizza or make and consume my own kim chee. I make my own kim chee so I can control the ingredients (salt especially) in it. If you don’t enjoy red pepper, you can always get some gel caps from your health food store (there are vegan gel caps) and consume some red pepper that way with a meal. (I don’t think I would fill the gel cap with red pepper – that’s a lot!)
      Another helpful possibility would be to make sure you are getting enough magnesium in your diet. You can take magnesium up to the point of “loose stool” safely. Over the years I’ve taken 400mgs/nightly and my whole system seems to work better with it – especially my arrhythmia. Carolyn Dean, M.D., N.D., has written a book called The Magnesium Miracle that offers lots of information on that topic.
      Constipation is very uncomfortable and I don’t blame you for not wanting to take medications for it. Me neither especially since it doesn’t solve the problem. Hope you feel better soon.




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  14. When I went vegan 2 years ago after watching Dr Greger’s videos, I thought it would help me overcome the IBS I suffered from for 30 years. I love being vegan, but it wasn’t until I removed dairy, sugar and any wheat products from my diet, and started taking a top-notch probiotic every morning before breakfast that it ended. I’m still vegan, I just avoid those three things. No more bloating, cramping, or vacillating between diarrhea and constipation. Just regular, healthy daily poops. I’m also careful what beans I eat. I don’t know if Dr Greger addresses it or not, but the lectins in certain beans really give me the bloating and cramps and irregular pooping.




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    1. Hey Bernadette, thanks for writing! Finding one’s own answers to a health problem is so much more valuable than receiving treatment – glad you found yours! I’m wondering though if it’s not the lectins; more recent evidence indicates it may be the fermentable sugars (oligo-, di-, monosaccharides, and polyols, or FODMAPs that are responsible for the effects (see https://www.ncbi.nlm.nih.gov/pubmed/28300773).




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  15. As someone who has dealt with this issue since I was in my teens, I can attest to the helpfulness of peppermint tea in controlling irritable bowel disease. I stumbled on it quite by accident. I learned that drinking hot water would afford some relief, but it was not the total answer. One night in miserable desperation, I brewed a cup of peppermint tea, and lo and behold, things seemed to relax to the point that I was able to get back to sleep. It may not work for everyone, but it has been a blessing for me over many years.




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    1. May W – I saw the most interesting “experiment” a while back (and I’m sorry I can’t remember where exactly or I would share the link so folks could watch for themselves). This had to do with the natural contracting ability of our intestines which is built into the musculature. This is one of the challenges doctors face when performing a colonoscopy, .. working with the natural contractions (cramping) that our colons exert. Anyway, this research showed a piece of intestine that had been removed and showed how the intestine, despite being resected, still contracted and cramped. The researcher applied peppermint oil to the piece of resected intestine and the movement relaxed and stopped. It was quite impressive.
      I thought you might find this piece of information interesting given your success with peppermint.

      For myself, I gave up dairy decades ago (despite everyone panicking that I wouldn’t get enough calcium for my bones!!!). When I drank milk or consumed dairy I was doubled over in sharp crampy pains, bloating, gas, explosive stools. Forty years later my bone density scan shows no bone deterioration or osteopenia on any level. Perfectly healthy bones in my mid-60’s. It is my physical activity – using my muscles and bones – that keeps them healthy, not milk.
      Thank you.




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  16. I have chronic insomnia-D for last 9 years. Every day–at least 3-4 trips to toilet with watery diarrhea almost every time. Cramps, etc. Also have gerd and diverticulosis. I am now in my seventies. Have been throughly tested over the years. Seen many GI doctors. Told it is a motility problem (rapid) that causes this chronic ibs.
    I can’t tolerate any raw veggies except maybe lettuce and seedless cucumbers. No legumes at all. No soy. Too much fat or oil is a problem. Low fodmaps regimen helps a little. Take psyllium every day. I try to eat vegetarian and my husband is vegan. Meal planning is a horror story. It’s so very frustrating as I am not getting enough protein, etc. peppermint aggravates the gerd problem.
    Has anyone tried hypnosisnfor ibs-d?




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  17. I’ve passed this article on to my friend who has IBS.

    On a side note, would like to see clinical studies on nutrition regarding AMD. Speculation that vegetable oils and sugar are the possible agents that has contributed to a explosive rise in AMD since the turn of the 19th century. Has there been any clinical trails since AREDS 2 clinical trail showing diet can slow or reverse AMD? I’ve posted this subject before in one of your YT live streams but no response. Hope you can respond to such!




    1
    1. My mother has AMD, so I’m also very interested in seeing something on this topic. She had cataract surgery a few years before the AMD set in. She did not have cataract surgery on both eyes at the same time. She had them done about 5 or 6 years apart – right eye first, left eye second. The AMD also started up about 5 or 6 years apart – right eye first, left eye second.




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  18. My IBS now only makes a very rare appearance- used to be a daily problem- since I have taken a teaspoon of Inulin powder every evening.




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    1. Yep Snowdrop, I agree with the inulin.. that, and 1 tbsp ground flax in my morning oatmeal works wonders in combo with wfpb diet, For severe cramping I have not found anything better than strong camomile tea – even worked with muscle spasms I suffered these past months due to sports injury. Great stuff!




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    1. Marjorie, FODMAPs is an acronym (abbreviation) referring to Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. These are complex names for a collection of molecules found in food, that can be poorly absorbed by some people.

      No need to feel stupid. I had to look it up, too. ;-)




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  19. In India we use a combination of 3 herbs called Triphala to good effect. And personally I can advise good soft instrumental relaxing music to go to sleep.




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  20. My Dietician just recommended that I take Curcumin for several ailments that I have. It is very expensive & I have never heard much about it. Dr. Gregor, can I have an opinion?




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    1. Currcumin is a spice that is regularly used in every vegetable dish we make in India. It is not expensive but yes in places like India the chances of adulterated product is high.
      It acts as a mild protective immune system regulator and antibiotic. But people are taking too much of it and mostly not correctly. It is best absorbed when cooked in the meal. Thanks and RegardsPradeep MaheshwariFacebook name: Pradeep PK Maheshwarihttp://cleanaircampaign.weebly.com S-164, (LGF)Greater Kailash Part 1, New Delhi 110048, India 0091-9717808721, 011-41730043Please note that we have connectivity issues so please try the landline first.




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    2. Please check out this topic review of Tumeric (curcumin is the pigment in the Indian spice turmeric)
      and you’ll see Dr. Greger indeed has an opinion on this beneficial spice. You can buy curcurmin in bulk and make your own capsules to save money (as described in How Not to Die), Lori, although the spice isn’t that expensive, you’ll find–much less than other common spices. Hope that helps.




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  21. I had suffered from severe IBS systoms for over 15 years. I have changed my diet to wholefood, eliminating dairy, gluten and sugar. I eat a mostly plant based diet and drink a plant based protein shake everyday. My IBS symptoms are completely gone.




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  22. I here to much peppermint can cause an ulcer, is this correct as I had an ulcer when I was 12 and to some extent still think I have an ulcer, same symptoms hungry right after I have eaten no matter how big the meal is…




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  23. Hi warren! too much of something is never a good thing. Peppermint oil is a natural anesthesic that might help. Even though your condition is related with the bowel, ulcerative colitis is a different thing; thus this study has proved effects on IBS which I’ve told you is not the same disease you have. There are several factors that might cause ulcer cancer and pepermint oil is not (when is used in recommended quantity) one of them. Dont be afraid of trying if peppermint oil or peppermint leaves works for you . Let us know what happened.

    Yared Tavares Avila
    Nutritionist
    Volunteer moderator, NutritionFacts.org




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  24. Very interesting. I have a confirmed diagnosis of Autoimmune Enterocolitis. It has the same symptoms as IBS, constant diarrhea. Concerned that peppermint oil, if I can find it, will aggravate the situation. Problem is most everything does, including plain water. Your thoughts?




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  25. John,

    Peppermint oil per the video is based on IBS, which is not an autoimmune disorder. It might be worth trying and is easily available at most health food stores. I would like to suggest that you consider your disorder from a functional standpoint and address the autoimmunity systemically.

    Food, hormones, toxic exposures, stress, your microbiome, exercise, and a host of other inputs can make a substantial difference in your disorder. Please see your healthcare provider and change your environment.

    Look forward to hearing your feeling better.

    Dr. Alan Kadish moderator for Dr. Greger http://www.Centerofhealth.com




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    1. Dr. Kadish, this has been going on for 10 years. Not properly diagnosed until 18 months ago. I’m working with the gastroenterologist that was finally able to diagnose my problem and am on Cell Cept. However I’m still looking for options to help control the constant diarrhea. I’ve tried fodmap diets, gluten free diets, lactose free diets and so far nothing has worked. Foods from every group that I used to eat without a problem are now a problem.

      I’m retired and on a shrinking fixed income. As such, there is no way to change my environment. Exercise brings on diarrhea … Can’t even walk the dog around the block anymore. Can’t afford a nutritionist … they are not covered by insurance.

      Apologize for venting. I’m just very frustrated.




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      1. John so sorry that you are going through this Does your gastroenterologist have any idea what caused this since there was apparently a time when you didn’t have this issue?

        Lee




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        1. Lida, he is probably at least the 10th Gastroenterologist I saw regarding this issue. And he is the first to diagnose it. I am the second person with this disorder he has had in his long career. He has advised that many of his associates have never had a patient with this issue. It is my understanding that the disease affects less than 2% of either the population or of those that contract colitis … not sure which is correct.




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      2. I FIGURED IT OUT!! After suffering from IBS for over 5 years, searching for every natural way to beat it, I figured it out the right combination of supplements and diet.
        1. Diet. For one month, complete the Bulletproof diet. No sugar, bread, carbs, alcohol, all organic meat.
        2. Take a strong pro-biotic after breakfast.Have to rebuild your gut.
        3. Take Turmeric – 1000 mg 3 times a day. This is a natural anti-inflammatory.
        4. Take activated charcoal 30 mins after each meal and supplements.
        5. If you have diahrea after having a few beers, take an Imodium.
        By completing these steps after one month, my symptoms have diminished. Don’t stop trying to figure it out. It can be beat! Any questions, feel free to ask. God Bless!




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  26. I FIGURED IT OUT!! After suffering from IBS for over 5 years, searching for every natural way to beat it, I figured it out the right combination of supplements and diet.
    1. Diet. For one month, complete the Bulletproof diet. No sugar, bread, carbs, alcohol, all organic meat.
    2. Take a strong pro-biotic after breakfast.Have to rebuild your gut.
    3. Take Turmeric – 1000 mg 3 times a day. This is a natural anti-inflammatory.
    4. Take activated charcoal 30 mins after each meal and supplements.
    5. If you have diahrea after having a few beers, take an Imodium.
    By completing these steps after one month, my symptoms have diminished. Don’t stop trying to figure it out. It can be beat! Any questions, feel free to ask. God Bless!




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  27. I am only a sample of one, but I thought I would share my experience. Just switching to a plant base diet has virtually eliminated my IBS which I have struggled with for most of my life. Two years ago I was diagnosed with cororary artery disease and received two stents. I soon discovered dr esselstyn, dr greger and others and decided to give plant based(with no added oil – i do add some nuts) a try to try and stop my heart disease from progressing. I already knew I was lactose intolerant and never had milk, but would eat yogurt and cheese which did not seem to give me a major problem. I also started taking probiotics. I immediately started to feel better overall(i was exercising more as well) and losing weight etc, but after about four months I realized that I had not had any bad IBS bouts for a while, I just hadnt been paying attention. As time progressed I realized that it basically vanished and I assumed it was also due to the probiotics. I decided to stop the probiotics and I still had no issues. In a few weeks I will have been on a plant based diet for two years. I cant really say why my IBS went away, but I assume it is due to my gut bacteria changing and being completely off of dairy( I had done this in the past but not for very long durations because it didnt seem to matter) I would have paid someone thousdands of dollars if they told me years ago to try a plant based diet. I did notice that Dr Garth Davis in his book said that going plant based also cured his IBS but he also doesnt provide any reason. Bottom line is that now two years later I am in probably the best shape of my life( 60 lbs lighter), all my blood markers are great and I hope my arteries are getting better, but the fact that my IBS has been virtually eliminated is amazing.




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  28. B”H

    As a personal chef we have had a customer for 6 years with IBS as well as a more serious matter, MS.

    The IBS disappeared literally within days. She thrives on cooked veggies, soups (especially miso veg, one of the best NATURAL probiotics), whole grains and pbwf desserts we make. She does best with COOKED foods but we do include small amounts of raw food. I took her off of all animal foods. She saves hundreds of dollars a month on medications and supplements.

    The other thing very important for her is NO PEPPER or hot spices. She had a flair up of IBS a few months ago when I was experimenting w hotter spices in our standard foods (due to the benefits Dr G talks about) and when I removed all pepper the IBS immediately disappeared. However she also fessed up that uncharacteristically she had been eating cookies and other stuff not on our successful approach at the same time.

    IMHO IBS is very curable, NOT incurable as mentioned in the article. Like everything else, the person with the condition has to actually eat pbwf with the adjustments that I mentioned above. The cure is food.




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