Personal Health MD - mainstream meets functional?

[CarbShark]

Most likely from the food choices.

When I first looked on pub med years ago LCHF was the only dietary option that had been found effective.

In the last few years other diets, especially  FODMAP, have also shown good results.

Even though symptoms for IBS can differ, it’s the same issue and most respond to the same treatments.


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IBS is a set of conditions without a recognisable disease, such as coeliac disease.  Or inflammatory bowel disease.  It’s a diagnosis of exclusion.  It’s pretty obvious that what you take in through your mouth is going to affect what comes out the other end.  If you get symptoms consuming one particularly food, or type of food, then it makes sense to avoid it.  I know from experience that one of my no-noes is oatmeal, despite my loving bircher muesli.  I have to restrict to only an occasional treat, otherwise...  could I have IBS?  I don’t know.

The primary and most common symptom of IBS is acute and sometimes severe pain in the lower abdomen. Usually it's not a single food (although some are suggesting that sucrose or just fructose may be a cause) but a broad range of foods avoided on diets like LCHF or FODMAP.

[bachfiend]

Most likely from the food choices.

When I first looked on pub med years ago LCHF was the only dietary option that had been found effective.

In the last few years other diets, especially  FODMAP, have also shown good results.

Even though symptoms for IBS can differ, it’s the same issue and most respond to the same treatments.


Sent from my iPhone using Tapatalk

IBS is a set of conditions without a recognisable disease, such as coeliac disease.  Or inflammatory bowel disease.  It’s a diagnosis of exclusion.  It’s pretty obvious that what you take in through your mouth is going to affect what comes out the other end.  If you get symptoms consuming one particularly food, or type of food, then it makes sense to avoid it.  I know from experience that one of my no-noes is oatmeal, despite my loving bircher muesli.  I have to restrict to only an occasional treat, otherwise...  could I have IBS?  I don’t know.

The primary and most common symptom of IBS is acute and sometimes severe pain in the lower abdomen. Usually it's not a single food (although some are suggesting that sucrose or just fructose may be a cause) but a broad range of foods avoided on diets like LCHF or FODMAP.

No.  IBS isn’t a single condition, nor does it have a single set of symptoms.  As I’d noted, some people have diarrhoea.  Some have constipation.  Some have alternating diarrhoea and constipation.  Some have abdominal pain.  There’s no common set of symptoms.  It’s a diagnosis of exclusion.  It’s necessary to exclude ‘real’ diseases, such as coeliac disease and inflammatory bowel disease.

Some people have noted that it’s diet related, and eliminating certain foods is helpful.  Your LCHF diet works only because it’s a highly restrictive diet, eliminating a whole range of carbohydrates, including some which have been noted to worsen the symptoms.  It’s a good reason for you to persist with it, but it’s not a good reason for you to be proselytising for it.

[Billzbub]

Megan had her initial appointment with this clinic, and she felt pretty positive about it.  The doctor uses conventional medicine as much as possible, but also tries cutting edge treatments that haven't yet been clinically researched.  He doesn't buy into acupuncture, reflexology, homeopathy, chiropractic, etc.  I'm still on the fence because, if something is not clinically proven, how does he know how safe or effective it will be?  Megan said she's willing to be a guinea pig since the doctors she has seen so far haven't helped.

The great news is that she put me and her dad on her consent form and asked the doctor to conference call with us.  They have e-mailed me and set up an appointment for this afternoon.  I get to ask my questions personally!  *hold my beer*

So, I went ahead and sent my question via e-mail because I want the doctor's best answer.  Here's my e-mail:

(click to show/hide)

Dr. Donahue,

When a treatment undergoes a clinical trial, researchers use double-blinding, control groups, and peer review as a decent way to determine if the treatment is safe, effective beyond placebo, and what dosages should be employed.  Megan has told me a lot about your practice, and that you use treatments that have been researched in this way as much as possible (conventional medicine).

However, I see on your web site the following excerpt:

Functional Integrative Medicine
At Personal Health MD we foresee the cutting edge of 21st Century medicine being a marriage between the best of modern Western Medicine and the best of emerging Functional Integrative Medicine as a way to promote health and longevity. While Conventional medicine, with its ongoing scientific breakthroughs can be life saving for life threatening diseases, Functional Integrative Medicine better fine tunes your health by treating the origin of a symptom, the upstream biochemical imbalance that will result in a disease.

The term “Functional Integrative Medicine” has a reputation for including pseudo-scientific treatments like acupuncture, homeopathy, iridology, reflexology, some chiropractic, fad diets, and the like.  Megan says that you do NOT use this kind of woo in your practice, and that when you say “the best of emerging Functional Integrative Medicine”, you are talking about science-based approaches that have not yet been fully researched in clinical trials but that attempt to treat the source of problems rather than just the symptoms.

As a supporter of science-based medicine, where scientific plausibility and clinical trial results determine whether a treatment should be used, I am on the fence about your practice.  On one hand, you respect science-based medicine FAR more than other practices with the “Functional Integrative Medicine” label.  On the other hand, you are employing cutting-edge treatments that haven’t been clinically proven.  I don’t believe that doctor intuition and anecdotes are a reliable gauge of the effectivity of a treatment because human beings (including doctors and patients) cannot help but apply their various biases to the evaluation.

So, my questions that I’d love to discuss during our conference call today or via e-mail are all about your treatments that go beyond clinically proven treatments:
1.  What treatments do you offer that are not yet clinically proven (that may apply to Megan)?
2.  What evidence shows you that these treatments are safe?
3.  What evidence shows you that these treatments could be effective?

Remember, every naturopath, acupuncturist, and chiropractor out there will answer, “Because I consistently see my patients get better with some treatments and not others.”  How can I tell the difference between your treatments and those treatments?

Megan’s description of her initial interview give me hope that you understand where I’m coming from with these questions and share my concerns.  I very much look forward to what you have to say.

Thanks!

I've already sent it, so I'm not asking for input on the e-mail.  But, I still have 6 hours before the phone call if you have anything else I should ask.

[daniel1948]

You've covered the things I was going to rant about except for: Clinical trials are conducted after a review board makes a determination that the procedure offers reasonable prospects of being useful. Basically, this doctor is conducting clinical trials without an independent review beforehand, and without any sort of blinding to eliminate bias in the results or comparing against placebo. If a patient gets better he has no way of knowing if it was due to the procedure or if the person would have gotten better anyway.

OTOH, in your daughter's place, I'd probably be doing just what she is doing. My step-mother had IBS and I gather it is miserable.

But this is why independent review boards exist: To prevent doctors from throwing dirt at the wall to try and see what sticks, and then having no way of knowing if it stuck because of the dirt or because of the wall.

[CarbShark]

Before your call I would suggest a PubMed search for IBS and diet.

I would be very surprised if diet is not part of the treatment.

FWIW diets (FODMAP;LCHF) have been found effective in clinical trials (better than any other approach) but are not accepted as a mainstream treatment.




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[stands2reason]

My gut reaction is that IBS is just people trying to diagnose a bad diet, especially since irregular bowel movements are a defining symptom. It's not a disease; it doesn't have a pathology; it's not a thing that's confirmed to exist. It's a collection of symptoms under a science-sounding label. The only treatment for IBS that sounds like real medicine is fiber supplements, which is similarly suggestive.

[Billzbub]

...
But this is why independent review boards exist: To prevent doctors from throwing dirt at the wall to try and see what sticks, and then having no way of knowing if it stuck because of the dirt or because of the wall.

I did not mention this in the e-mail but I will keep it in mind during the phone call.  This is an excellent thought.

[CarbShark]

My gut reaction is that IBS is just people trying to diagnose a bad diet, especially since irregular bowel movements are a defining symptom. It's not a disease; it doesn't have a pathology; it's not a thing that's confirmed to exist. It's a collection of symptoms under a science-sounding label. The only treatment for IBS that sounds like real medicine is fiber supplements, which is similarly suggestive.

"Gut reaction," hah!

Irritable Bowel Syndrome is not a disease. It's a syndrome. (that's what the S is). No irregular bowel movements are not a defining symptom. Pain in the bowels are the defining syndrome (that's what the I is for irritable, i.e. pain). The collection of symptoms, which include irregular bowel movements; diarrhea and constipation, vary, sometimes even in the same individual. But there is always pain and at least one other symptom.

It's pathology is unclear, but IBS is confirmed to exist.

[Billzbub]

My gut reaction is...

Well played, sir!

...that IBS is just people trying to diagnose a bad diet, especially since irregular bowel movements are a defining symptom. It's not a disease; it doesn't have a pathology; it's not a thing that's confirmed to exist. It's a collection of symptoms under a science-sounding label. The only treatment for IBS that sounds like real medicine is fiber supplements, which is similarly suggestive.

I have a bad diet, and I'm not doubled over in gut pain a few times a week.  She has a great diet, and is.  So I don't think a bad diet is the sole cause of IBS.  Maybe diet can affect it, but it does not cause it.

Just because we don't yet understand what causes the symptoms doesn't mean that there is not a root cause or multiple root causes.  And, whether or not IBS is a clearly-defined thing has no bearing on whether an individual suffering from the symptoms has a clearly-defined thing going on with them.  For example, my daughter may have gut biota that aren't working together correctly, or a tear in her intenstine, or who knows what else.  Just because they diagnosed it as IBS (a general term for these kind of symptoms), doesn't mean the cause can't be found and fixed.

She hasn't yet tried a strict keto diet or a long-term FODMAP diet, and I hope she does try both as low-cost, no risk trials.  I will also ask the doctor about them over the phone.  I will ask about fecal transplants and probiotics, too.  I've heard Steve's take on probiotics and want to know what this doctor things about them.

[stands2reason]

She hasn't yet tried a strict keto diet or a long-term FODMAP diet, and I hope she does try both as low-cost, no risk trials.  I will also ask the doctor about them over the phone.  I will ask about fecal transplants and probiotics, too.  I've heard Steve's take on probiotics and want to know what this doctor things about them.

I'm not saying I'm certain it's not real. But it is a thing that's not confirmed to exist (because there is no confirmed pathology or mechanism of action), and the most likely explanation IMO is not getting enough water & fiber.

In case you're wondering, FODMAP's are often found in beans. Basically, just like bean flatulence, some people have more issue with it than others. The gut flora <---> FODMAP connection isn't absurd, but probably a niche effect.

LCHF, or otherwise avoiding FODMAP's & grains is strongly correlated with getting less fiber (one of the best arguments against those diets), which is likely to make the problem worse. 

Plus, if someone is transitioning back into eating a proper amount of fiber, they are going to get more gas as the fiber causes a bloom in the kind of gut flora that digest it.

[Captain Video]

I have it, nobody can ever tell me whats wrong. I have had a colostomy, upper and lower GIs, nothing.  Diet makes no difference.

I believe it is anxiety related or similar, at least in my case.

[CarbShark]

My gut reaction is...

Well played, sir!

...that IBS is just people trying to diagnose a bad diet, especially since irregular bowel movements are a defining symptom. It's not a disease; it doesn't have a pathology; it's not a thing that's confirmed to exist. It's a collection of symptoms under a science-sounding label. The only treatment for IBS that sounds like real medicine is fiber supplements, which is similarly suggestive.

I have a bad diet, and I'm not doubled over in gut pain a few times a week.  She has a great diet, and is.  So I don't think a bad diet is the sole cause of IBS.  Maybe diet can affect it, but it does not cause it.

Or, maybe, what you think is a "bad diet" may not be all that bad, and what you think is a "good diet" may have interactions that actually cause it. (Also there is a theory that it gut micro biome may have an influence, but that's the dietary equivalent of saying "who knows, maybe it's dragon"

 She hasn't yet tried a strict keto diet or a long-term FODMAP diet, and I hope she does try both as low-cost, no risk trials.  I will also ask the doctor about them over the phone.  I will ask about fecal transplants and probiotics, too.  I've heard Steve's take on probiotics and want to know what this doctor things about them.

And please report the response here!

[CarbShark]

I have it, nobody can ever tell me whats wrong. I have had a colostomy, upper and lower GIs, nothing.  Diet makes no difference.

I believe it is anxiety related or similar, at least in my case.

Have you gone script LCHF or strict FODMAP?

[lonely moa]

An informative article on IBS with enough links to studies to choke on (sorry). 

https://chriskresser.com/5-causes-of-ibs-your-doctor-may-not-be-looking-for/?fbclid=IwAR0UqfngM9aqmOMBuuiFkSylJHxNDpAWlyxQXGY0mdCO4gcGIqS2eE7F7UY

[bachfiend]

I have it, nobody can ever tell me whats wrong. I have had a colostomy, upper and lower GIs, nothing.  Diet makes no difference.

I believe it is anxiety related or similar, at least in my case.

Have you gone script LCHF or strict FODMAP?

Well, when you eat, you’re not just feeding yourself, you’re also feeding the much larger number of cells represented by the bacteria within your gut.  Your gut bacteria are adapted and selected for the diet you consume.  If you change your diet radically, it’s likely that your current gut bacteria aren’t going to ‘like’ it and respond by producing diarrhoea, which is going to eliminate and select against your current gut bacteria.

Going on a LCHF diet often causes diarrhoea or constipation, illustrating that changing your diet often has effects.  It’s probably best to avoid foods that cause symptoms, and to keep your diet as close as possible to constant.  If LCHF diets are effective in managing IBS, then it’s probably because it’s a restrictive diet.  Eventually your gut bacteria adapts or is selected for the food items in the diet, and the symptoms disappear.

I love Bircher muesli, but from experience I know it’s best for me to avoid it.  The oatmeal for me is almost ‘lethal.’