By Melody Khorrami, PharmD, RPh, INHC
Confused about the difference between IBS and gluten intolerance? This blog post explores the similarities and differences between these two conditions, including their symptoms, causes, and treatment options. While their gastrointestinal symptoms can overlap, it's essential to identify the root cause to determine the right treatment plan. Bio-individuality plays a role, meaning that there's no one-size-fits-all approach to addressing these conditions.
Irritable bowel syndrome (IBS) is a chronic functional disorder associated with the gastrointestinal tract. It is associated with abdominal pain, discomfort, gas, and bloating, and can change a person’s bowel habits. It is a common condition amongst the general population with various causes ranging from early life stress, changes in the gut microbiome leading to dysbiosis, severe infections or overgrowth of bacteria, and nervous system dysregulation. Triggers such as food sensitivities, and stress can also worsen the condition. Food allergies such as dairy, beans, and wheat can trigger symptoms and stress can worsen the symptoms of IBS.
Risk factors for IBS include age, gender, and mental health status. It occurs more frequently among people under the age of 50 years old. It is more predominant in females, and those with anxiety, depression, or other mental health conditions, as well as having a family history of the condition.
Treatment for IBS includes the following: avoiding certain foods that are triggering the condition and your symptoms, eating high-fiber foods, increasing fluids, regular exercise, and sleeping. Some foods that you may consider eliminating include foods containing gluten, and FODMAPS. FODMAPS contain carbohydrates like fructose, lactose, and fructans. They are found in certain vegetables, dairy products, and grains.
Over-the-counter medications that might be considered include, fiber supplements, and laxatives. Prescribed medications might include anticholinergic medications and antidiarrheals, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), or pain medications. Some medications target specific areas of the colon and small intestines that can be considered.
Gluten is a protein that is mainly found in wheat, barley, and rye. Gluten intolerance, also known as non-celiac gluten sensitivity (NCGS) is a condition where the patient experiences gastrointestinal and non-gastrointestinal symptoms after ingesting the protein gluten. These patients do not have any evidence of celiac disease or wheat allergy. The condition includes symptoms like IBS, diarrhea, abdominal pain, discomfort, bloating, and flatulence. Other symptoms which are not like IBS include headache, attention-deficit hyperactivity disorder, depression, skin conditions that cause itchiness, oral ulcers, and fatigue.
Gluten sensitivity or intolerance is typically diagnosed by ruling out wheat allergies and celiac disease. Gluten intolerance has been linked to an abnormal immune system response to gluten. Some research points to certain genetic factors that may be related to gluten intolerance and imbalances in the gut microbiome, which may make a person more sensitive to gluten. There are no specific tests or biomarkers currently to diagnose the condition. Gluten intolerance is not considered an autoimmune disorder, and while the immune system may be involved in it, it does not cause the intestinal damage and inflammation that celiac disease causes. It is also important to differentiate between celiac disease and gluten sensitivity or intolerance. Celiac disease is an autoimmune disorder that can damage the small intestines when gluten is consumed. Gluten intolerance, however, does not cause the same intestinal damage. The symptoms of both can be similar.
The causes and the risk factors for gluten sensitivity and intolerance are not clear, but there is a link between consuming gluten and certain symptoms. Going gluten-free can help alleviate some of these. If your healthcare provider thinks you might have a gluten intolerance they may recommend a “rule out” diagnosis, which is looking to make sure there aren’t any other root causes of your condition such as celiac disease or wheat allergy. There is no way to prevent gluten intolerance, which can sometimes appear later in life.
It is also important to note that health conditions like irritable bowel syndrome might also increase the risk of gluten intolerance, and people with gluten intolerance may have additional inflammation in the gut, which could increase intestinal permeability. This increase in intestinal permeability may create an environment where toxins and other harmful substances might leak into the bloodstream and contribute to the symptoms of IBS. People who have IBS can also have alterations in their gut microbiota which might make them more prone to developing gluten intolerance. People with gluten intolerance are also more likely to have food sensitivities which could also contribute to IBS symptoms. Stress also contributes to IBS symptoms and gluten intolerance. While not everyone with gluten intolerance will have IBS, and vice versa, it is important to work with a licensed healthcare provider to address symptoms and other issues related to these health conditions.
Please note: This article is for informational purposes only, please talk to your healthcare provider if you have any questions related to your health regimen or if you plan to make any changes to your health plan.
By Dr. Melody Khorrami, PharmD, RPh, INHC
Probiotics are live microorganisms that are intended to have health benefits when they are consumed. They can be found in fermented foods, and yogurts, as well as certain dietary supplements. Some of these bacteria can help to digest food and produce vitamins. Knowing the different types of bacteria and fungi and their different characteristics is an important part of understanding the role of these microorganisms.
In this article, we delve into the world of probiotics and the different types of bacteria and fungi. From yeast-based products to spore-based, and lactic acid bacteria, we explore the unique benefits of each type and how they can improve your digestive health, play a role in the immune system, and overall well-being.
Yeast-based probiotics come from a group of microbes called fungi. Some fungal species live in our gut, so it makes sense that yeast-based probiotics could be helpful. The most abundant genera of fungi in the human gut according to the Human Microbiome Project are Saccharomyces, Candida, and Malassezia. One popular yeast-based probiotic is Saccharomyces boulardii, often used for short-term stomach problems, bacterial diarrhea, and even inflammatory bowel diseases. It may also play a role in conditions like H-Pylori and C-difficile.
Spore-based probiotics from the Bacillus species are also used as probiotics. These species are dormant and are typically in a desiccated state. It is believed that they are not natural colonizers of the human gut, meaning they don’t originate in the human gut, and they usually colonize after a person eats certain vegetables or raw ingredients. They are typically available in supplement form for mild gastrointestinal disorders like diarrhea, or for conditions like leaky gut, or gut permeability. They are also used in the agricultural space as a possible alternative to antibiotics. There is a theory that most probiotics do not survive the environment of the digestive system and a person could be getting dead bacteria. Spore-based probiotics, however, may be able to survive this environment and be viable and reach the small intestines alive. Bacillus strains also have higher stability in heat conditions. Spore-based probiotics are also very resilient and can even resist some antibiotics. A downfall of spore-based probiotics is that they can be opportunistic especially in immunocompromised people, potentially causing infections.
Lactic acid bacteria are one of the most common groups of probiotic bacteria and are often used in fermented dairy products. Some of the benefits of these bacteria include stimulating the immune system, and helping with symptoms of irritable bowel syndrome, ulcerative colitis, and diarrhea. They are commonly used in the fermented food industry.
Lactic acid bacteria are also responsible for synthesizing vitamins in the body. Common lactic acid bacteria include Lactobacillus and Bifidobacterium. One of the problems with these strains of bacteria is that they are very sensitive to heat and light. They are also transient in nature, meaning they do not permanently stay in the gut, and typically probiotics containing these bacteria need to be taken consistently to see a positive effect. Some of the benefits of Lactobacillus and Bifidobacterium include supporting inflammatory bowel disease, potential benefits in anxiety, allergic and inflammatory conditions, as well as bacterial overgrowth.
Each of the three types of probiotics can be beneficial and can help with certain health concerns. When choosing a probiotic, there are some key components to look for, including the species and colony forming units (CFU) listed, the manufacturer information and expiration date, certification for following good manufacturing practices (GMP), and verification of potency by a third-party analysis of the lab used. You should always talk to your healthcare provider regarding the risks and benefits of using each type of probiotic.
By Melody Khorrami, PharmD, RPh, INHC
Dating in the modern world is incredibly difficult. It is hard to find the right person, but it is even harder when you have a lot of gas and pain in the abdomen. People with irritable bowel syndrome (IBS) may also face challenges in feeling comfortable in a romantic relationship.
What is IBS?
IBS is a chronic gastrointestinal disorder. It affects up to 23% of people. 80% of affected people are female. It impacts a person’s quality of life and affects health care costs. The condition can also include many environmental and genetic factors.
How can I help my IBS?
While the symptoms of IBS can affect the quality of life, making intentional life choices can be helpful for people with IBS. You could try to:
- Eat small meals several times a day
- Stay hydrated
- Manage stress
- Regulate or avoid negative emotions
- Move mindfully, being aware of your condition
Dietary adjustments with the above lifestyle modifications can also be helpful in managing the symptoms of IBS. Following the low FODMAP diet for a short time can help to identify foods that may trigger symptom flare-ups in IBS. The low FODMAP diet is designed to eliminate the key trigger foods for a couple of weeks before slowly introducing them back into the diet. This can help a person identify which foods are most triggering to them. Adding the right probiotics may also help with the bloating, flatulence, and abdominal pain associated with your IBS symptoms.
It may be helpful to work with a licensed therapist or to consider gut-directed hypnotherapy. Gut-directed hypnotherapy is a fairly new technique used for managing irritable bowel syndrome (IBS). It is a form of deep relaxation that sets the mind up to certain prompts and suggestions. This form of hypnotherapy trains the areas of the brain that we don’t typically have conscious control over. The gut and brain are more connected than most people think. When the brain enters a deeply relaxed state, it is open to the suggestions that are made to improve the IBS symptoms. This form of therapy can also help to relieve stress. Stress can be a trigger for IBS and can make a person’s symptoms worse than they are.
How do you live a normal life with IBS?
Social activities and dating can be challenging when a person suffers from IBS. Having a plan for the unexpected is important to avoid awkward situations in social outings. Here are a couple of helpful tips:
- Always know where the restrooms are when you are at a social event or on a date.
- Avoid your trigger foods for meals. Some dairy products, foods in the broccoli family, and beans can cause gas and discomfort.
- Avoid sugary, fried, or unhealthy fatty foods.
- Don’t consume alcohol, caffeine, or soda. Stay away from artificial sweeteners in general.
- Try to make your outings and dates at times when you will be feeling your best.
How do I talk about IBS with my partner?
Bringing up your IBS diagnosis with a new romantic partner may be difficult initially. It may take some time to share that with someone you are dating and that is perfectly fine. Take some time to process and decide for yourself when the right time is to have the conversation. Working to remove the shame you may have associated with your IBS condition is important. Move through it with grace and compassion for yourself.
You will have good days and bad days with your IBS flare-ups. Plan dates and outings around your IBS triggers. If you are more prone to flare-ups in the evening after dinner, then you may want to consider an earlier date. Sometimes IBS symptoms can occur earlier in the day. If you notice symptoms earlier, plan to meet later in the day. If your IBS symptoms occur after eating food, suggest activities to your partner instead of a romantic dinner. However, don’t suggest a long hike through the woods or any other place without easy bathroom access.
Stay calm! Dating can be stressful. Stress can also cause IBS symptoms. Do some calm breathing exercises. Find an exercise regimen or mindfulness practice that works for you. These general healthy practices can be good for managing the stress associated with this process.
Learn to put yourself first when it comes to your health and wellness. We all have busy lives and many responsibilities, but taking care of ourselves is often neglected. Being mindful of ways to improve wellness and feeling better is an important part of living a healthy life. Listen to your body. Think about why you feel ashamed of your IBS diagnosis and symptoms. You don’t have to be! There are many resources available for people who struggle with managing their IBS. Create a supportive environment where you can manage your condition and live a fulfilling life.
Please note: This article is for informational purposes only. Please talk to your healthcare provider before making any changes to your diet or health regimen.
Dr. Melody Khorrami, PharmD, RPh, INHC
1-16-2023
The human body isn’t just made up of our own cells. We host around 100 trillion microbes. Over 500 species of bacteria reside in the gut. The bacterial composition of each human is unique. Various factors can affect the composition of the gut, including lifestyle, diet, antibiotic use, exposure to toxins, and the initial colonization that occurs at birth. All these components affect the intestinal bacterial composition.
Probiotics can help you get a healthy gut microbiome. There are many proven ways to support a healthy gut microbiome. Lifestyle methods include:
- eating a balanced diet
- increasing fiber consumption
- reducing stress
- managing emotional health
- getting enough sleep
- minimizing unnecessary exposure to antibiotics
- using certain probiotics.
Probiotics are microscopic live organisms. When used correctly, they give their host health benefits. Probiotics work by competing with pathogens that try to enter the body. They produce anti-bacterial effects by making bacteriocins. Bacteriocins are antibiotics that are produced by certain bacterial species. Once produced for a particular strain of bacteria, bacteriocins can work on similar or related species. By producing bacteriocins, probiotics can:
- destroy some toxins entering the body
- strengthen your gut’s barrier
- control muscle movements and sensations in the gut
- enhance immunity
- play a role in immune and cytokine modulation
- help the metabolism function, including the drug metabolism
- control the microbiota-gut-brain axis
- break down food
- produce usable nutrients in the form of vitamins and minerals for the body to use
What makes a good probiotic?
There are a couple of essential criteria to consider when choosing good probiotic products. They include:
- showing a proven benefit—requesting clinical studies for the intended use(s)
- proof that they survive the intestines after ingestion
- no pathogenicity
- no transmissible drug resistance
- acid and bile resistance
- defined antibiotic sensitivity
Additionally, there should always be 2 to 4 hours between administering antibiotics and ingestion of probiotics.
Generally, probiotics will not take up permanent residence in the gut after they are administered. Requesting clinical studies related to the exact probiotic product being used is important. Some observational studies have shown that within one to two weeks of stopping probiotics, they can no longer be found in the stool. Another study showed that after one month of discontinuing probiotics, fecal concentrations of lactobacilli, Bifidobacterium, and Streptococcus reached their original levels before probiotic consumption. However, this does not mean they are not beneficial to the host. As probiotics travel down the gastrointestinal tract they interact with the immune system. Probiotics also react with the variety of microbes that reside in the different parts of the body. Colonization is not required for health benefits to occur.
How do I know if I need probiotics?
As with all therapies, everyone may react differently when starting probiotics. It can take a few days up to a full month to notice the health benefits of probiotics. Each person is unique and listening to your body and its responses is important.
You can take some steps to determine whether probiotics are helping you. First, you should understand what symptoms you have and whether you want to see improvement in those symptoms with the probiotic you are using.
- Do you have digestive issues?
- Are you experiencing diarrhea with your IBS symptoms?
- Do you have bloating and gas?
- How severe are your symptoms?
- Are you currently on antibiotics or have you just finished a course of antibiotics?
- When did your symptoms start?
- Do you want a daily use probiotic for general gut support?
It is important to notify your healthcare provider of unusual symptoms you may be experiencing. Pay attention once you start a probiotic. Only use the recommended amount. Notice how you are improving during the first couple of weeks. Some people may need to start at a lower dose due to side effects like bloating until the body adjusts. Listen to your body and its needs. Within about four weeks you should start seeing improvements. Although, it may take 12 weeks or longer to see to full benefits.
Which probiotic is right for me?
When choosing a probiotic, it is important to look carefully at the product label. Probiotic labels should contain the genus, species, and strain designation, the number of CFUs (colony forming units), expiration date, recommended dosage, and storage requirements, according to guidelines issued by the Joint Food and Agriculture Organization of the United Nations and World Health Organization (2002) and the International Probiotics Association in its partnership with the Council for Responsible Nutrition (2017).
The side effects of probiotics are generally mild. Some of the common side effects associated with probiotic use include bloating and gas, but they typically disappear in the first couple of days. Adverse effects from probiotics are rare and typically limited to people with underlying diseases. If you have any underlying diseases, you should discuss whether probiotics are appropriate for you, with your licensed healthcare provider.
Please note: This article is for educational purposes only. Always check with your licensed healthcare provider before starting any new therapies or changing your health plan.
There has been a lot of attention in the last couple of years over the concept of gluten-free. It is hard to differentiate between fads and necessary health practices around certain nutritional advice.
The gluten-free diet has been promoted for various health goals. Some supporters of the diet believe that gluten triggers inflammation in the body and can contribute to certain health conditions.
While many people can tolerate gluten and have no problems consuming it, some people should consider avoiding it.
As consumer use of probiotics increases, the need for education around choosing the right probiotic combination and which strains are most valuable for specific health conditions is also expanding. When choosing the right probiotic, two important factors to consider are strain specificity and disease specificity as they relate to the usefulness for a particular medical condition. There is evidence to suggest that the practicality of probiotic use is related to both strain and disease specificity.
Stress management is an important area that is discussed during GI visits for patients who are dealing with irritable bowel syndrome. The relationship between the brain and the digestive system is important to consider when developing a plan for managing irritable bowel syndrome (IBS). Certain emotions such as stress, depression and anxiety can activate signals in the gut (the stomach and intestines) which cause gastrointestinal distress. Improving psychological and emotional health can also help to improve digestive conditions such as IBS. This may require that you work with not just your doctor but also a nutritionist and a therapist.
Experiencing stress and negative emotions are a part of the human experience, but if they are not processed in a healthy manner they can lead to manifestations of physical health problems. The gut-brain connection is revolutionizing our understanding of what the trillions of bacteria, are doing in the gut.
By Melody Khorrami, PharmD, RPh
As we enter a new year, it is always helpful to take a moment to reflect on the past year. Journaling about your personal progress, both professionally and socially, and re-examining your life vision can help you set new goals. As you assess the past, try to practice grace and gratitude for all the twists and turns of life. Many of us will use this time of renewal to focus on health and wellness goals. Here’s a thought: start with your gut!
Research in the gut microbiome space has erupted in the last couple years. Our gut is home to trillions of microbes that create a dynamic environment which influences so much of our health and well-being. These microbes are responsible for the digestion process, metabolism, and immune function. There are a variety of factors that can affect the gut microbiome which include your diet and lifestyle, environmental changes, the aging process, stress, and the use of unnecessary antibiotics.
Individual variations in the human microbiota are always present, that is why bio-individuality is important in this space. Research has suggested a link to an imbalance of gut bacteria and some common health conditions. These include, irritable bowel syndrome, inflammatory bowel disease, obesity, diabetes, as well as possible links to mental health conditions through the gut-brain axis.
So now you might ask yourself: How can I support my gut health in the new year? Starting slowly and sustainably is key, and as always, be patient with yourself as you make these changes!
Tip 1: Manage your stress
The gut-brain axis has been an important area of research the last couple years. There is increasing evidence that dysbiosis, or an imbalance of gut microbiota, can contribute to anxiety, and depression. Excess stress can also be a trigger for negative digestive symptoms. Research has shown that using mind-body techniques such as mindfulness-based stress reduction practices can assist with managing stress that could be contributing to digestive issues and other conditions.
Incorporating movement in your everyday life can help reduce stress, this includes practices like yoga, which has been shown to lower cortisol, the primary stress hormone. As always, if you feel like your stress and anxiety have gotten to unmanageable levels seeking professional counseling or psychotherapy is an important measure to take. In fact, therapy can be a wonderful way to explore and reflect on the root cause of your emotions and stress and find the tools to learn more about yourself.
Tip 2: Adjust your diet
Have you heard the term you are what you eat? Our gut microbiome is heavily influenced by the foods that we eat. Eliminating processed and high sugar content foods and incorporating more nutrient dense foods are a great first step that will help your beneficial gut bacteria thrive. Some studies have shown that altering your diet can create temporary microbial shifts within just 24 hours. Incorporating prebiotic foods such as garlic, artichoke, onions, asparagus, leeks, bananas, flaxseeds and oats and more fiber into the diet can help modulate the gut microbiota. Some examples of high fiber foods include, pears, berries, chia seeds, avocados, brussels sprouts, lentils and chickpeas.
Working with a nutritionist or dietician can be a great way to figure out food sensitivities, and to find sustainable ways to include more nutrient dense foods into your diet and find a plan that works for your lifestyle.
Tip 3: Consider a probiotic
As research increases around the relationship between the gut microbiome and different diseases the interest around probiotics has also increased.
While you should always start with lifestyle and diet when approaching gut health, incorporating a well-studied probiotic can also be beneficial in certain circumstances. The most used strains are from the Lactobacillus and Bifidobacterium genera. Other strains such as the Enterococcus and Streptococcus genera are also used in probiotic products.
With so many probiotics on the market it can be challenging to find a product that has its own clinical studies and is a multi-strain product. Probiotics can help your body maintain a healthy community of microbes and can have an influence on your body’s immune response and digestive process. Here are a couple questions to consider when choosing a probiotic:
- Does this specific product have clinical trials to show a health benefit?
- How does this probiotic brand ensure potency of product?
- Does this product contain an appropriate CFU count? (CFU is the unit used to estimate the concentration of microorganisms in the product)
- Does the product have diversity in strains that are used?
Asking the right questions can help you and your healthcare provider make informed choices related to choosing the right probiotic for your needs.
Please note: This article has been written for informational use only. Please consult your doctor before making any changes to your health and diet regimen.
By Melody Khorrami, PharmD, RPh
As the holidays approach, many of us look forward to gathering with family and friends to celebrate and enjoy delicious meals. We are eager to feast on seasonal treats like turkey, stuffing, potatoes, and rolls; not to mention all the desserts! While all this food and company is wonderful, it can be overwhelming to our digestive systems. Fear not! There are steps you can take to help ease the digestive process. This is supposed to be a fun day and you shouldn’t feel any stress or shame about indulging and enjoying the festivities!
Starting your morning off with fiber rich foods can help keep your bowels moving regularly and feed the good bacteria in your gut to help keep your microbiome healthy. Having regular bowel movements is important in eliminating toxins, keeping your hormones balanced, and reducing constipation. The last thing you want is to be constipated on the holidays, right before enjoying your meal. Fiber is naturally found in most fruits and vegetables. So, make sure to include a variety of these in your meals!
Drinking enough filtered water throughout the day is an important step in preventing dehydration, keeping your bowels moving, and digestion. According to
studies inadequate hydration has also been linked to elevated BMI and obesity. Starting your morning with a glass of filtered water or lemon water upon waking is one of the best things you can do you start your day. This is because your body is in a fasted state while sleeping and can be dehydrated upon waking. Lemon water can help with digestion by increasing the production of HCL, also known as hydrochloric acid. Our stomach secretions are made up of
hydrochloric acid, and digestive enzymes that help us digest and absorb nutrients such as proteins in our foods.
Need I say more? Finding the right movement for your body is important to many aspects of your overall health and wellness. Improved digestion is just one!
Take a walk the morning of your dinner plans and perhaps a second one with family and friends about
15 minutes after eating.
Daily walking can help reduce bloating, aid in digestion, and help balance your blood sugar after a meal.
Incorporating movement such as yoga not only can be beneficial for mental health but can also help with constipation, insomnia and
healthy aging.
Consider a quick yoga session during the day or in the evening! Certain poses can aid in regulating the bowels and decrease bloating. Some
yoga poses that could be helpful for the digestive system include:
- Child’s pose, camel pose
- The twisted lunge
- Revolved chair pose
- Bridge pose
- The supine twist
If certain poses are uncomfortable, you should not overextend yourself, there are usually modifications to the movement you can do and still receive great benefits!
Yoga can help manage the stress of Holiday season by reducing the sympathetic response of the nervous system which is our “fight or flight response”, when we go into “fight or flight” it can
negatively affect our digestive system and in turn cause the digestive system to function improperly. When the stress response is activated, the central nervous system shuts down digestion which causes the slowing down of the digestive muscles and decreased secretions necessary for optimal digestive processes. This can lead to bloating, gas, and constipation.
The digestive system cannot work optimally if the body and mind are constantly stressed.
Practicing a mix of yoga and breath work techniques have many benefits for mental and physical health and this includes aiding in proper digestion. So, grab a yoga mat, and start moving and breathing!
The gut microbiome houses trillions of microbes that play important roles in our digestion and overall health. These microbes help us breakdown the foods we eat and help with absorption of critical vitamins. When there are more bad bacteria than good bacteria present, it results in a condition known as dysbiosis. When you experience dysbiosis, digestion can become harder and you may have more negative GI symptoms after eating such as bloating, gas, and burping.
Probiotics can help ease the discomfort associated with bloating, and gas and help your body digest the foods that you eat. Before you start taking a probiotic remember that each person is different, and your needs may not match the needs of the people around you.
Bio-individuality is key in determining which probiotic strains are best for you. Probiotics have very little regulatory oversight, so it is important to identify reputable brands that offer evidence-based research related to their specific product.
I hope you find these GI tips useful on Turkey Day, stay safe, and enjoy!
***The following article is not medical advice. Please talk to your doctor before making changes to your wellness routine. ***
