This document discusses irritable bowel syndrome (IBS) and provides an overview of a comprehensive approach to treatment. It begins with an example case study of a patient named Paul who has suffered from chronic diarrhea for 20 years. It then covers topics like the mind-gut connection, the gut immune system, criteria for an IBS diagnosis, potential causes, and associated conditions. The bulk of the document outlines a holistic treatment approach that includes dietary changes, lifestyle modifications, identifying food intolerances, testing and treating for small intestinal bacterial overgrowth, addressing neurotransmitter imbalances, and using probiotics, prebiotics, nutrients, and herbal medicines. It concludes by noting that these treatments were successful for Paul in stopping his

1. Your Digestive Health: IBSJewish Community CenterAugust 19, 2009 By Adam Rinde, ND

2. Today’s Talk An IBS perspective Background information on IBS A comprehensive approach to IBS

3. IBS Overview Paul: 40 years old, Father of 4, Software executive Chronic Diarrhea X 20 Years Colonoscopy, Sigmoidoscopy, Endoscopy all negative. Has experimented with dietary modification with limited success Road Trips

4. Normal Digestive Health Questionnaire Bowel Movements/Day Abdominal Pain Flatulence Constipation Diarrhea Reflux

5. The Mind Gut Connection Lemons Brain Gut Peptides VagusNerve (sympathetic Tone) Stress Sleep

6. Gut Immune System (Galt) GALT Gut Barrier Healthy Gut Bacteria Immune Signaling

7. IBS Background: Definition Irritable bowel syndrome (IBS) refers to a complex disorder of the lower intestinal tract. It is mainly characterized by a pattern of symptoms that is often worsened by emotional stress. It is not the same as inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis

8. IBS Background: symptoms May be associated with Loose watery stools Mucus in stools Abdominal bloating Urge and uncontrollable need to make a bowel movement Constipation

9. IBS Background: Criteria Recurrent abdominal Pain or discomfort >3 months associated with two of the following relieved by defecation Onset associated with change in frequency of stool Onset associated with change of appearance of stool.

10. IBS: Cause Unifying theories Stretch Receptor sensitivity Infectious causes Altered Gut Immunity Others: Neurotransmitter imbalance Food Allergies Stress

11. IBS Background: Other Criteria Abnormal stool frequency Abnormal stool form Straining Urgency incomplete evacuation; Passing Mucus Bloating (Videlock, 2007)

12. IBS: Associated Conditions Depression Fatigue (36%–63%) Urinary Frequency (21%–61%) Myalgias(29%–36%) Headache (23-45%) Back Pain (27-81%) (Videlock, 2007)

13. IBS: Complications Depression Malnutrition Dehydration Hemorrhoids Interference with work, family, social life (Natural Standard, 2009)

14. Red Flag Digestive complaints Vomiting Bile Blood In Stool Constipation >3 days Awakened by GI complaints Unintended weight loss Increased concern with Family of Colon Cancer Hx. Onset of symptoms after 50 (Whitehead, 2006)

15. A comprehensive Approach Diet Lifestyle Gut Repair Neurotransmitter Balance SIBO Food Allergy Identification and Avoidance Probiotics/Prebiotics Specific Nutrients/Botanical Medicine

16. Diet A fiber deficiency? Soluble Fiber Insoluble Specialized Diet Specific Carbohydrate Diet Avoidance of fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs)

17. Lifestyle Stress Reduction Sleep Improvement Exercise Yoga/Meditation Biofeedback

18. Food Intolerances/Allergies Food allergy testing Most common Casein/Dairy Gluten/Wheat Soy Eggs

19. SIBO Small intestinal Bowel overgrowth Diagnosed by Lactulose Breath Test Currently treated with Rifaximin followed by probiotics

20. Neurotransmitter Testing Urine testing Questionnaire Profile of brain chemistry Treated with specific Amino Acids

21. Prebiotics Prebiotics Oatmeal .Flax . Barley . Other whole grains Onions , Garlics Greens (especially dandelion greens, but also spinach, collard greens, chard, kale, and mustard greens) Berries, bananas, and other fruit Legumes (lentils, kidney beans, chickpeas, navy beans, white beans, black beans, etc.) Japanese miso, tempeh, kefir, raw milk, kombucha, bananas. (IFIC, 2009) (Natural Standard, 2009)

22. Probiotics Probiotics can occur naturally in fermented foods such as yogurt, buttermilk, sour poi, and miso. (Heizer, 2007). BifidobacteriumInfantis (Videlock, 2007)

23. Nutrient/Botanical Therapies Melatonin Enteric Coated Peppermint Oil Roberts Formula Eight parts Althea officinalis Four parts Baptisiatinctora Eight parts Echinacea angustifolia Eight parts Geranium maculatum Eight parts Hydrastiscanadensis Eight parts Phytolaccaamericana Eight parts Ulmusfulva Eight parts cabbage powder Two parts pancreatin One part niacinamide Two parts duodenal substance

24. Road Trip continued Paul: SIBO diagnosis Treatment Currently successful Diarrhea stopped Road Trips are now an option!

25. Summary The importance of healthy digestion The Mind Gut Connection Gut Immunity A holistic approach

26. Questions?

27. Contact Information Adam Rinde, ND Visit www. Soundintegrative. Com for more information Call (425) 889-5894 to schedule a meet and greet or an appointment.