Is Your Food Making
You Sick?
Diet and IBS
Michal Hogan, RD, LD, CLT
NutritionResults.com
(614) 944-5123
NutritionResults....
What Is Irritable
Bowel Syndrome?








Symptom Based
Diagnosis of Exclusion
Diarrhea Predominant
IBS
Constipation P...
Rome III Criteria for IBS





Relief after defecation
Onset associated with a change in
stool consistency
Onset associ...
Rome III Continued
 


Bowel Movements

Greater that 3 per day
Less than 3 per week


Abnormal Stool
–
–
–



lumpy/har...
Danger signs
Profound weight loss, anemia or
blood/occult in stool
 Travel to places with parasitic endemics
 Hx of colo...
Consequences of IBS
These average overall unhealthy days
exceeded those of respondents with
arthritis, diabetes, heart dis...
Case Study- IBS
•39 yo M
• IBS, GERD, and intestinal parasites
•8 Months
•Extreme stomach/intestinal pain, gas,
•cramping ...
Case Study- IBS pg 2
•Before therapy: In 8 months only felt “ok” ½ of a day
•. Elimination Diet @ 5 days:
•Remission of di...
The IBS Employee’s Average
Combined Work Time Lost to
Absenteeism and Work Cut Backs due
to IBS Symptoms was found to aver...
Traditional Therapies





Medication
Side Effects
diarrhea, constipation, pain, sleep
disruption or drowsiness
Band-Ai...
IBS is not a distinct entity but
a collection of disorders

“Food intolerance represents an

important proportion of
condi...
IBS not only symptom
Lancet 2000 Jul 29;356(9227):400-1

“We found that food provocation in food
intolerant patients was c...
FOOD INTOLERANCE CAUSES
IBS SYMPTOMS IN CERTAIN PATIENTS
Merck Manual
pg 1051
“ Food Intolerance “was found to
be responsi...
NutritionResults.com

(866) 396-4438
15

NutritionResults.com
(866)396-4438
NutritionResults.com

(866) 396-4438
Adverse Food Reactions
Food
Sensitivity

Food Allergy

Food
Intolerance

Usually
airways, skin,
or GI tract

Usually GI tr...
Trial and Error
“But through ‘Trial and Error’ many people find they feel
better when they stop eating certain foods. Thes...
IBS and Caffeine







Nervousness
Panic
Headache
Insomnia
Noises in Ear
Diarrhea
NutritionResults.com

(866) 396-4...
IBS and Food Colorings






Asthma
Eczema
Migraines
Itching
Diarrhea

NutritionResults.com

(866) 396-4438
IBS and Lecithin






Sore Muscles
Headaches
Stiff Neck
Sore Throat
Diarrhea

NutritionResults.com

(866) 396-4438
IBS and MSG







Dehydration
Thirst
Headaches
Irritability
Diarrhea
Anaphlaxis
NutritionResults.com

(866) 396-443...
Phenylethylamine







Migraine
Sleepiness or
Hyperactivity
Wheezing
Fatigue
Diarrhea
NutritionResults.com

(866) 39...
American Gastroenterological
Association Position Statement






“Education and Reassurance”
“Dietary and Lifestyle ...
Typical Recommendations












Caffeinated drinks
Tyramine and phenylethylamine- pressor amines
Histamine
...
Avoid the Full Moon a
High Tides and never nd the
sun during a solar ec look at the
lipse
IF food Intolerance IS important to
IBS symptoms, WHY do most Diets
fail to make much difference?
Unlike allergies, food s...
Other Triggers




2500+ additives approved for use in
foods
Staple food items can also be triggers

NutritionResults.co...
Migraine Case Study







9 yr old, 57 #
Common migraine with vomiting from 1-5
hrs. Mom said he was “stressed” prior...
Migraine Case Study p2



But the high reactive item was “soy”
Mom had been giving him an energy
bar with soy in it, pri...
Migraine Case (cont)

NutritionResults.com

(866) 396-4438
Back to migraine case






Patient went back to being a normal
active boy…
Toward the end of therapy, the mom
called m...
Should we test for allergies
(IgE)?
Double blind, placebo controlled food reactions do
not correlate to IgE allergy in the...
Anatomy of a Food Sensitivity
DBPCFC Studies- Gold
Standard


Hard to do oral challenge that is
– Double blind
– Placebo-...
Intestinal Perfusion
Studies
Stomach

Jejunum
Catheter

Balloon
Balloon
Knutson et al, J. of Allergy and Clin. Immunology ...
Anatomy of a Food Sensitivity
Intestinal Perfusion
Studies
 Biopsy Results
– Sensitive Pts: Increased, WBC/T-cells
Cytoki...
Full thickness biopsy of patients with IBS reveal
inflammatory infiltration of white blood cells in the
nerve plexus of th...
Digestive Disease Week 2000: First
Quantification of the Abnormal
Inflammatory Response
Low Level Inflammation in IBS
•6 p...
They also found abnormalities in
the interstitial cells of the Cajal
(the pacemakers of the gut) in
5/6 patients!

Is IBS ...
What about IgG testing?
Food elimination based on IgG antibodies in irritable bowel syndrome: a randomized controlled tria...
What about IgG Testing? p2
Food elimination based on IgG antibodies in irritable bowel syndrome: a randomized
controlled t...
IgG –Based Elimination
Well, yes, statistically significant but

Only 10% improvement in 12 weeks?
Reason:
NutritionResult...
World Allergy
Organization 2003
“ food specific IgG antibodies in
serum are not of clinical
importance but merely indicate...
Other symptoms….
15% identified muscle and joint
pain, not IBS symptoms, as the
major cause of their activity
limitation.
...
Comorbid to IBS
Migraine
 Fibromyalgia
 Sinusitis
 Rheumatoid Arthritis
 GERD
Some of these symptoms persist long
afte...
Why measure mediators?
Because they are agents of chemical warfare released
by White Blood Cells to fight off invaders or
...
Human Plasma Cytokine Levels

Healthy Controls (upper bars) vs. IBS-D Subjects (lower
bars)
Plasma Cytokines: IBS-D vs Nor...
Indirect Measuring of
Mediators
Mediator Release Indirect Measure
of inflammation.
 Plasma to solids ratio (indirect mea...
Sample Results
(partial panel)

NutritionResults.com

(866) 396-4438
Short Term
Data-Driven Protocols


Symptom Survey
– Did we address the
chief complaints?
– Did the symptoms
that respond ...
Long-Term
Data-Driven Protocols


SF-36
– Does the person
have better
functioning?
– Can the person
have a life?
– Is the...
Case study 800VB






Female 60 yr old
Complaints: fibromyalgia, carpal
tunnel surgery, knee surgery, back
surgery, a...
Case Study 800 p2







Meds- Trazadone, Flexeril,
Effexor XR, Neurontin,
Naproxin, Actonel, Clonidine,
HCTZ, Nexium...
Dietary Protocols-Case
Study 800 p 3


Suspended all supplements for
individual testing later except
glucosamine chondroi...
Her personal list of
sensitivities
Broccoli
Spinach
Cauliflower
Lettuce
Mushroom
Millet
Spelt
Apple
Plum
Olive

Papaya
Pea...
Symptoms Case study
800




Started out at 121
First follow-up 36
Second follow-up 2

NutritionResults.com

(866) 396-4...
Anecdotal commentsFrom “Functioning
Survey”







Patient was able to go off Aleve, reduced
intake of Flexeril (didn...
Stats on 127 Patients





In therapy for 1 month
One baseline survey and two follow-up
on schedule, to provide us an o...
Protocol Diet Therapy

Decreases in symptom survey
scores

-100%
-80%
-60%
-40%
10 day change
1 month change

-20%
0%

Pat...
Statistics -updated

NutritionResults.com

(866) 396-4438
RECENT Research
S. Boulardi can help inhibit T-cells.
Helpful for patient with inflammation that
are controlled on elimina...
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Diet and ibs 2012

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  • Irritable Bowel Syndrome is a diagnosis of exclusion. You rule out other disorders then lable the problem IBS. There are three types of IBS: IBS-D, IBS-C and IBS-C and D or cyclical IBS.
  • The positive diagnostic criteria for IBS is called the Rome II criteria, provided to us by a group of gastroenterologists that are called the Rome Coordinating Committee that met in Rome to form a consensus on what is IBS.
  • These are other symptoms that tend to support IBS but not essential for physician diagnosis.
  • Meanwhile life goes on while the folks trying to help you try to find out what is bothering you.
    Many of my patients at the time of commencing diet therapy were in peril of losing their jobs, independence and relationships.
  • Malabsorption – fructose malabsorption
    Accidental ingestion of toxins (natural and chemical)- food poisoning
    Enzyme deficiencies – lactase deficiency
    Medication reactions
    SIBO – Small intestinal bacterial overgrowth
    Candida or Yeast overgrowth
    Direct provocation of the GI tract with lectins or histamines (which is borderline immunological since it involves mast cells)
  • Trial and error generally takes 1 yr + to track down all delayed symptoms to their culprits.
  • One trial and error thing
  • Segment of jejunum is endoscopically isolated by placement of two balloons
    Segment of jejunum between balloons is perfused with potential food allergen and then jejunal contents are collected
    Patients with known sensitivity to the allergen had increased production histamine and prostaglandin E2.
    No response seen in controls
    IgE RAST Negative
  • The World Allergy Organization Summarizes well:
    IgG tells you what you ate.
  • And here we have a human plasma cytokine profile of a healthy control on top and a subject with IBS-D just to illustrate this point
  • Diet and ibs 2012

    1. 1. Is Your Food Making You Sick? Diet and IBS Michal Hogan, RD, LD, CLT NutritionResults.com (614) 944-5123 NutritionResults.com (866) 396-4438
    2. 2. What Is Irritable Bowel Syndrome?     Symptom Based Diagnosis of Exclusion Diarrhea Predominant IBS Constipation Predominant IBS Cyclic IBS
    3. 3. Rome III Criteria for IBS    Relief after defecation Onset associated with a change in stool consistency Onset associated with a change in stool frequency NutritionResults.com (866) 396-4438
    4. 4. Rome III Continued    Bowel Movements Greater that 3 per day Less than 3 per week  Abnormal Stool – – –  lumpy/hard loose/watery stool Mucous Abnormal stool passage – Straining or feeling of incomplete evacuation – Urgency and relief by defecation Source: International Foundation of Functional Gastrointestinal Disorders NutritionResults.com (866) 396-4438
    5. 5. Danger signs Profound weight loss, anemia or blood/occult in stool  Travel to places with parasitic endemics  Hx of colon cancer  Skin abnormalities  Signs of malabsorption  Thyroid dysfunction This list is not exhaustive, but is helpful…  NutritionResults.com (866) 396-4438
    6. 6. Consequences of IBS These average overall unhealthy days exceeded those of respondents with arthritis, diabetes, heart disease/stroke, cancer, and class III obesity (body mass index > or =40 kg/m2) Source: U.S. survey NutritionResults.com (866) 396-4438
    7. 7. Case Study- IBS •39 yo M • IBS, GERD, and intestinal parasites •8 Months •Extreme stomach/intestinal pain, gas, •cramping diarrhea, constant pain •Off work, demoted once • Symptom Score : 68 • 20 + pills per day. •Abdomen was “rock hard” with bloating •difficulty sleeping, always feeling fatigued and miserable. NutritionResults.com (866) 396-4438
    8. 8. Case Study- IBS pg 2 •Before therapy: In 8 months only felt “ok” ½ of a day •. Elimination Diet @ 5 days: •Remission of diarrhea and bloating •With total symptoms scoring only 11 (start 68) •Able to return to work •Within 1 month: •Able to isolate foods that were GERD triggers. •Within 2. 5 months • GERD also dissipated. •Able to go off of all medication at that point Pt was successfully discharged from therapy NutritionResults.com (866) 396-4438
    9. 9. The IBS Employee’s Average Combined Work Time Lost to Absenteeism and Work Cut Backs due to IBS Symptoms was found to average ONE WEEK per MONTH, for a total of 12 WEEKS per YEAR of lost productivity. This represents a loss of nearly 25% of productivity PLUS the costs of accompanying sick leave pay.*
    10. 10. Traditional Therapies    Medication Side Effects diarrhea, constipation, pain, sleep disruption or drowsiness Band-Aid solution- only addresses symptom of diarrhea, not designed to treat underlying cause NutritionResults.com (866) 396-4438
    11. 11. IBS is not a distinct entity but a collection of disorders “Food intolerance represents an important proportion of conditions which together make up IBS” John Hunter, MD, FCRP Director or Gastroenterology “Food Allergies and Food Intolerance” Brostoff & Challacombe, Second Edition, 2002 NutritionResults.com (866) 396-4438
    12. 12. IBS not only symptom Lancet 2000 Jul 29;356(9227):400-1 “We found that food provocation in food intolerant patients was characterized by a general and systemic immune activation accompanied by an increase in systemic symptoms… important for the understanding of the mechanisms involved in the pathogenesis of “food intolerance.” Food sensitivities ushered in by IBS lead to feeling bad all over… NutritionResults.com (866) 396-4438
    13. 13. FOOD INTOLERANCE CAUSES IBS SYMPTOMS IN CERTAIN PATIENTS Merck Manual pg 1051 “ Food Intolerance “was found to be responsible for symptoms of some patients with the IRRITABLE BOWEL SYNDROME NutritionResults.com (866) 396-4438
    14. 14. NutritionResults.com (866) 396-4438
    15. 15. 15 NutritionResults.com (866)396-4438
    16. 16. NutritionResults.com (866) 396-4438
    17. 17. Adverse Food Reactions Food Sensitivity Food Allergy Food Intolerance Usually airways, skin, or GI tract Usually GI tract Any organ system can be affected Within a couple 45 minutes to 3 of hours days Seconds to 1 hour Immunological Nonimmunological Immune and nonimmune
    18. 18. Trial and Error “But through ‘Trial and Error’ many people find they feel better when they stop eating certain foods. These foods cause the intestines to contract, which can aggravate IBS in people who have diarrhea as their main symptom.” Nicholas Talley, MD., Patrice Burgess, MD “Controlling I.B.S. With Diet” Healthwise Information Library But meanwhile, life goes on….. Without remission…. NutritionResults.com (866) 396-4438
    19. 19. IBS and Caffeine       Nervousness Panic Headache Insomnia Noises in Ear Diarrhea NutritionResults.com (866) 396-4438
    20. 20. IBS and Food Colorings      Asthma Eczema Migraines Itching Diarrhea NutritionResults.com (866) 396-4438
    21. 21. IBS and Lecithin      Sore Muscles Headaches Stiff Neck Sore Throat Diarrhea NutritionResults.com (866) 396-4438
    22. 22. IBS and MSG       Dehydration Thirst Headaches Irritability Diarrhea Anaphlaxis NutritionResults.com (866) 396-4438
    23. 23. Phenylethylamine      Migraine Sleepiness or Hyperactivity Wheezing Fatigue Diarrhea NutritionResults.com (866) 396-4438
    24. 24. American Gastroenterological Association Position Statement      “Education and Reassurance” “Dietary and Lifestyle Modifications” “Symptom Monitoring” “Symptom-Directed Medication PRN” “Psychological Treatment”
    25. 25. Typical Recommendations            Caffeinated drinks Tyramine and phenylethylamine- pressor amines Histamine Solanine: naturally occurring toxicant in the nightshade plant family Nitrates and Nitrites Benzoic Acid: also benzoin, gum benzoin, benzoate and naturally occurring diet. Sorbitol Family: sorbitol, sorbitan, polysorbate 80, polysorbate 60 Lectins (in beans, lentils, peas, peanuts, snails, wheat). Peptides: small protein-like molecules Proteolytic Enzymes (raw pineapple, raw papaya most common Eating Habits Scrutinized : Too much at one time and too high fat content too much stress especially when you eat
    26. 26. Avoid the Full Moon a High Tides and never nd the sun during a solar ec look at the lipse
    27. 27. IF food Intolerance IS important to IBS symptoms, WHY do most Diets fail to make much difference? Unlike allergies, food sensitivity reactions are: 1. Dose Dependent 2. Delayed Onset (up to 72 hours post ingestion) 3. Multiple foods can cause symptoms (single elimination trials are useless) 4. NO Universal Bad Food- Very patient specific Without some help it can be hard to find those triggers NutritionResults.com (866) 396-4438
    28. 28. Other Triggers   2500+ additives approved for use in foods Staple food items can also be triggers NutritionResults.com (866) 396-4438
    29. 29. Migraine Case Study     9 yr old, 57 # Common migraine with vomiting from 1-5 hrs. Mom said he was “stressed” prior to his baseball games, got migraine, had to go back home. Started suspecting food sensitivity to peanuts and asked the doctor for testing and therapy Test, peanuts were LOW reactive…. NutritionResults.com (866) 396-4438
    30. 30. Migraine Case Study p2   But the high reactive item was “soy” Mom had been giving him an energy bar with soy in it, prior to each baseball game thinking she was helping his performance. NutritionResults.com (866) 396-4438
    31. 31. Migraine Case (cont) NutritionResults.com (866) 396-4438
    32. 32. Back to migraine case    Patient went back to being a normal active boy… Toward the end of therapy, the mom called me: Her son placed 3rd in the state of Texas for wrestling Less need for analgesics NutritionResults.com (866) 396-4438
    33. 33. Should we test for allergies (IgE)? Double blind, placebo controlled food reactions do not correlate to IgE allergy in the diagnosis of staple food related gastrointestinal symptoms. Bengtsson U, Nilsson-Balknas U, Hanson LA, Ahlstedt S Allergy Centre, University of Goteborg, Sweden In adult patients with staple food induced gastrointestinal symptoms, objectively verified by DBPCFC, there were no indications of IgE mediated allergy to the relevant foods, suggesting other mechanisms in adults than in children. Gut. 1996 Jul;39(1):130-5. NutritionResults.com (866) 396-4438
    34. 34. Anatomy of a Food Sensitivity DBPCFC Studies- Gold Standard  Hard to do oral challenge that is – Double blind – Placebo- controlled Because the amount is usually too large to hide in a pill or in a puree. NutritionResults.com (866) 396-4438
    35. 35. Intestinal Perfusion Studies Stomach Jejunum Catheter Balloon Balloon Knutson et al, J. of Allergy and Clin. Immunology 93; 91(2): 5539 NutritionResults.com (866) 396-4438
    36. 36. Anatomy of a Food Sensitivity Intestinal Perfusion Studies  Biopsy Results – Sensitive Pts: Increased, WBC/T-cells Cytokines/Mediators – Control Pts: No increase  IgE Blood Draw – Negative for both groups – Not an IgE reaction Knutson et al, J. of Allergy and Clin. Immunology 93; 91(2): 553NutritionResults.com (866) 396-4438 9
    37. 37. Full thickness biopsy of patients with IBS reveal inflammatory infiltration of white blood cells in the nerve plexus of the small intestine Myenteric plexus Ganglion Circular Muscle Longitudinal Muscle Submucousal plexus Interganglionic fiber tract Sub-Mucosa Mucosa And…… Digestive Disease Week 2000: First Quantification of the Abnormal Inflammatory Response
    38. 38. Digestive Disease Week 2000: First Quantification of the Abnormal Inflammatory Response Low Level Inflammation in IBS •6 patients: severe IBS. • Biopsied Small Intestine •Inflammatory infiltration of WBC in myenteric plexus NutritionResults.com (866) 396-4438
    39. 39. They also found abnormalities in the interstitial cells of the Cajal (the pacemakers of the gut) in 5/6 patients! Is IBS an arrhythmia of the gut, which gradually worsens to constipation? NutritionResults.com (866) 396-4438
    40. 40. What about IgG testing? Food elimination based on IgG antibodies in irritable bowel syndrome: a randomized controlled trial. Atkinson W, Sheldon TA, Shaath N, Whorwell PJ.      150 outpatients with IBS Randomized X 3 months Test: diet excluding all foods which raised IgG Control: sham diet excluding the same number of foods but not those to which they had antibodies. Outcome measured: IBS and global symptoms NutritionResults.com (866) 396-4438 Gut. 2004 Oct;53(10):1459-64.
    41. 41. What about IgG Testing? p2 Food elimination based on IgG antibodies in irritable bowel syndrome: a randomized controlled trial. Atkinson W, Sheldon TA, Shaath N, Whorwell PJ. In 12 weeks  Elimination diet resulted in a 10% greater reduction in symptom score than the sham diet CONCLUSION: Food elimination based on IgG antibodies may be effective in reducing IBS symptoms and is worthy of further biomedical research. Gut. 2004 Oct;53(10):1459-64.  NutritionResults.com (866) 396-4438
    42. 42. IgG –Based Elimination Well, yes, statistically significant but Only 10% improvement in 12 weeks? Reason: NutritionResults.com (866) 396-4438
    43. 43. World Allergy Organization 2003 “ food specific IgG antibodies in serum are not of clinical importance but merely indicate a previous exposure to the food.” Source: Krause’s Food Nutrition and Diet Therapy 2008 43 NutritionResults.com (866)396-4438
    44. 44. Other symptoms…. 15% identified muscle and joint pain, not IBS symptoms, as the major cause of their activity limitation. Psychosom Med. 2006 Mar-Apr;68(2):312-20. NutritionResults.com (866) 396-4438
    45. 45. Comorbid to IBS Migraine  Fibromyalgia  Sinusitis  Rheumatoid Arthritis  GERD Some of these symptoms persist long after IBS-D remits if food sensitivity not treated.  NutritionResults.com (866) 396-4438
    46. 46. Why measure mediators? Because they are agents of chemical warfare released by White Blood Cells to fight off invaders or perceived invaders Because they can cause collateral damage – – – Smooth muscle contraction (evacuation) Inflammation (leak WBC to point of infection) Fever (in total flu-like symptoms) Cells sometimes attack otherwise benign substances like foods and additives NutritionResults.com (866) 396-4438
    47. 47. Human Plasma Cytokine Levels Healthy Controls (upper bars) vs. IBS-D Subjects (lower bars) Plasma Cytokines: IBS-D vs Normals IBS-D vs Normals 2 1 0 50 100 150 47 200 Plasma Cytokine Levels 250 NutritionResults.com 300 350 (866)396-4438 400
    48. 48. Indirect Measuring of Mediators Mediator Release Indirect Measure of inflammation.  Plasma to solids ratio (indirect measure of mediator release) is measured on all tested foods to give a ratio.  If the volume of the plasma increases dramatically, that's considered a 'highly' reactive food. If there's no or very little volume change, that food is considered 'non-reactive.‘  NutritionResults.com (866) 396-4438
    49. 49. Sample Results (partial panel) NutritionResults.com (866) 396-4438
    50. 50. Short Term Data-Driven Protocols  Symptom Survey – Did we address the chief complaints? – Did the symptoms that respond best to elimination disappear with good compliance? NutritionResults.com (866) 396-4438
    51. 51. Long-Term Data-Driven Protocols  SF-36 – Does the person have better functioning? – Can the person have a life? – Is the person happier? NutritionResults.com (866) 396-4438
    52. 52. Case study 800VB     Female 60 yr old Complaints: fibromyalgia, carpal tunnel surgery, knee surgery, back surgery, arthritis, depression, hypertension Unable to do moderate activities like sweep the floor NutritionResults.com (866) 396-4438
    53. 53. Case Study 800 p2      Meds- Trazadone, Flexeril, Effexor XR, Neurontin, Naproxin, Actonel, Clonidine, HCTZ, Nexium, Flonase Supplements- B12, Vit C, Noni, Maca, MSM, DMAE, Evening Primrose, Multivitamin for women plus, Silica Milk thistle, dandelion, fiber choice, Rutin, Glucosamine, lecithin, Gogi Juice, CoQ10, L-carnitine NutritionResults.com (866) 396-4438
    54. 54. Dietary Protocols-Case Study 800 p 3  Suspended all supplements for individual testing later except glucosamine chondroitin since she was sensitive to no shellfish and it helped with osteoarthritis. NutritionResults.com (866) 396-4438
    55. 55. Her personal list of sensitivities Broccoli Spinach Cauliflower Lettuce Mushroom Millet Spelt Apple Plum Olive Papaya Peach Egg Nutmeg Honey Poppy Seed Mint Solanine Candida Albicans NutritionResults.com Sodium Metabisulfite Salicylic Acid Acetaminophen Caffeine Lecithin Lentil Garbanzo Almond Coffee Cola Nut (866) 396-4438
    56. 56. Symptoms Case study 800    Started out at 121 First follow-up 36 Second follow-up 2 NutritionResults.com (866) 396-4438
    57. 57. Anecdotal commentsFrom “Functioning Survey”      Patient was able to go off Aleve, reduced intake of Flexeril (didn’t feel as “hung over” in the mornings) Able to get off of Nexium and has no intestinal gas. Lost about 6# Walking 4 miles/6 days/week Playing water volleyball with grand kids Described health as “excellent” NutritionResults.com (866) 396-4438
    58. 58. Stats on 127 Patients    In therapy for 1 month One baseline survey and two follow-up on schedule, to provide us an overall “symptom score” Fit our patient selection criteria (IBS, Fibromyalgia, Migraine) NutritionResults.com (866) 396-4438
    59. 59. Protocol Diet Therapy Decreases in symptom survey scores -100% -80% -60% -40% 10 day change 1 month change -20% 0% Patients RESULTS 10 day 54.89 % Average Symptom Reduction NutritionResults.com (866) 396-4438 1 mo. 74.82 % Average Symptom Reduction
    60. 60. Statistics -updated NutritionResults.com (866) 396-4438
    61. 61. RECENT Research S. Boulardi can help inhibit T-cells. Helpful for patient with inflammation that are controlled on elimination diets but want to protect against a flare up on special occasions…. Source: Journal of International Medical Research 2007; 35:583-589 NutritionResults.com (866) 396-4438

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