For My Tummy

Coffee for Irritable Bowel Syndrome? Puroast sale.

Puroast is one of a few brands of low acid coffee. Since coffee is my “Essential Food Group” and since my tummy is now pretty stable, I ordered it and tried it a couple of times, using 1/2 measure Puroast and 3/2 measure Rocamojo Soy Coffee. Both were in mocha flavor, and the resulting chocolate flavor was nice. No adverse effects on my stable tummy with one 12 oz. cup, each five days apart. I haven’t tested the “second-day rule” with this, though, so beware.

I’d welcome a guest review for this product; no freebies, but here is an announcement of their sale, with a promo code, that I received in the mail. So, for me and sixty of my good friends or so, here’s the sale:

PUROAST® LOW ACID COFFEE -

First Fall Promotion!
25% Off All Items
Promotional Code - 09132007

25% Off All Items Until

September 27th, 2007

Click Here or www.puroast.com

All Shipping in the USA is Free with FedEx GROUND

GREAT TASTE, 50% LESS ACID!

Puroast® Low Acid Coffee
First Fall Promotion! -
25% Off All Items

Type in “09132007″ where is asks for the the promotion code at Check Out -
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|See Below: |
| Have a coupon? Enter the code here: |
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| Click Here to Order |
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To Order By Phone:

Call 1-877-LOW-ACID EXT. 101

September 20th, 2007 Posted by tummyblogger | coffee, general, IBS, IBS-C, Soy Coffee, IBS Diet | no comments

Irritable Bowel Syndrome - The Three Rules

I have been fixing up the inner workings of For My Tummy. This involved going back over two months of posts, and that gave me the chance to notice that I had posted once on two rules for IBS, here. And then, ten days or so before that, I had posted on the one rule for IBS.

The rules in reverse order are:

• Never Drink Ice Water
• Never Eat on an Empty Stomach
• The Second-Day Rule<

“The Second-Day Rule” needs a little explaining. If you try a new food and have no problems with it on the first day, don’t scarf it up on the second day, thinking “Oh, boy. Now it’s okay to eat xyz!” It will come back to bite you. In other words, some foods–like the IBS triggers–are ok for one day at a time, but not for day-in, day-out use.

Taken together, the three rules make life sound like hard work for people with Irritable Bowel Syndrome. That’s true! I don’t want to coat it with Stevia to make it easier to swallow–actually Stevia would taste bitter if you used it in that way! What I want to do is to give you some sign posts so that what is happening in terms of Irritable Bowel Symptoms, whether constipation or diarrhea or cramps or alternating stuff–so that these symptoms make some kind of sense and potentially can be controlled.

September 12th, 2007 Posted by tummyblogger | Gastrocolic Reflex, IBS, Irritable Bowel Syndrome, IBS Triggers, IBS-C, IBS-D, IBS Diet, IBS Symptoms | no comments

Digestive Advantage - IBS Suggestion

This recent post about IBS probiotic Align has a comment from David at Ganeden Biotech, makers of Digestive Advantage ™IBS. They would like me to repeat the review process that I did with Align, using their product for IBS. Their product is widely available in stores, and has one good clinical test of its efficacy.

I am going to respond and thank them. I will have to suggest that I do the review month with their product for Constipation, rather than the one labeled IBS. DA-IBS contains sucralose (Splenda), one of the IBS triggers — at least one of my triggers. Their http://www.ganedenbiotech.com/prod_constipation.html is labeled as using sugar, rather than sucralose.

So, we’ll see. Again, the only compensation is two months of free product. I will also ask for a discount specifically for readers of this blog. They already offer free samples on their web site, although I don’t know how many that would be sent to each customer.

There are some interesting and good reviews of Digestive Advantage ™- IBS on ePinions, which will server for starters.

September 1st, 2007 Posted by tummyblogger | Probiotics, IBS, Irritable Bowel Syndrome, IBS-C, IBS-D, Align, Digestive Advantage - IBS, Digestive Advantage - Constipation, IBS Symptoms | 2 comments

IBS and the Three Nervous Systems

The Second Brain
There is an actual physical finding in Irritable Bowel Syndrome (IBS), that indicates that IBS is not “all in the head.” All in the nerves, maybe, but not all in the head.

The Three Nervous Systembs
To begin with, we need to understand that our bodies have three nervous systems:

1. CNS - The Central Nervous System
2. PNS - The Peripheral Nervous System
3. ENS - The Enteric Nervous System, or the “second brain”

The CNS - Central Nervous System - consists of the brain and spinal column.
The PNS - Peripheral Nervous System - consists of the very long nerves that run along our arms and legs to our hands and feet.
The ENS - Enteric Nervous System - is the nerve tissue that lines our gut = the viscera = (mostly) small and large intestine.

And Serotonin
Serotonin is a neurotransmitter that plays an active role in the activity of neurons in the brain (CNS) and in the gut (ENS) . This activity, to simplify it all, either speeds impulses along the nerve pathways, or (as lack of activity) slows down nerve impulses.

Motility and Serotonin
What do you suppose that would do for motility–the ability of the gut to move its contents along easily, nicely, and calmly to the desired end. That’s right. The role of serotonin and the balanced action of serotonin affects both the speed of thought and the motility of the gut.

“Chemical Imbalance”
Depression is the major chemical imbalance in the brain that reflects an unbalanced serotonin activity. Not exactly similarly, just in somewhat the same fashion, IBS (IBS-C and IBS-D) are in part the result of a “chemical imbalance” of the Enteric Nervous System (ENS), the nerves that operate your gut, which rely on serotonin to transmit signals from one nerve ending to the next.

Balancing Serotonin
That’s why a gastroenterologist (gut doctor) may prescribe a tricyclic antidepressant, not because she or he is treating your head or thinks you are depressed. It is, rather, because he or she wants to give your Enteric Nervous System (ENS) more serotonin to work with for a better-balanced ENS.

August 27th, 2007 Posted by tummyblogger | Medical, IBS, Irritable Bowel Syndrome, IBS-C, IBS-D, Digesting Information, IBS Symptoms | no comments

Fiber 101b - Fiber for Irritable Bowel Syndrome (IBS)

The following material is designed specifically for people with Irritable Bowel Syndrome (IBS). It may be useful to people who have occasional constipation or diarrhea or non-specific tummy pain. As usual, this is not medical advice. It will be helpful to read the Fiber in IBS Glossary, posted two days ago, and you might want to reread the post titled Fiber for IBS 101a.

There are three points in this follow-up post. I will be talking about how the role of fiber in establishing a real comfort level with your tummy. The three points, as questions, are:

• What does fiber do in your body?
• What kind of fiber do you need to have that beneficial effect?
• How much of the right kind of fiber do you need each day?

What Does Fiber Do in Your Body?
As your background reading indicates, there are two kinds of fiber, soluble and insoluble.

First, insoluble fiber (IF) is bulk, or roughage. It increases the size of the stool as the stool is forming and passing through the large intestine (=large bowel). This is the kind of fiber that many doctors are suggesting you take when they say eat more fruits and vegetables, and take Metamucil ™ or another psyllium laxative/fiber. IF is also the kind of fiber that many many people with IBS have tried and given up on, because it makes things worse.

Second, Soluble Fiber (SF). Soluble fiber in supplement form (SFS) dissolves completely in water, and when it reaches your large intestine it blends with the contents of your digestive system as it comes from the small intestine, and *there* it forms a gel. I will tell you that the following comparison may gross you out. Still, please read on.

The gel that’s formed in your large bowel has somewhat the consistency of a tube of toothpaste, and your large bowel squeezes it along until the gel-like stool is eliminated. This is the result of taking a Soluble Fiber Supplement (SFS).

The effect of taking adequate amounts of SFS is very easy passage of formed stools, not too loose and not too hard, dry, or painful. The gel-forming effect of SFS works with the loose and watery stools of diarrhea (IBS-D) as well as with those of IBS-C.

What Kind of Fiber Do You Need to Have that Beneficial Effect?

In order to have the help of fiber to change the nature of the stools you pass, you need adequate amounts of a soluble fiber supplement (SFS) for your IBS-D or IBS-C. Right now in the U.S. the available supplements are FiberSure ™ and Heather’s Organic Acacia Tummy Fiber ™, and perhaps some store brands.

• FiberSure is pure powderedinulin, made from chicory root. It is also FDA approved for use in treating constipation.
• Heather’s Organic Acacia Tummy Fiber is pure powdered acacia. It may be classed by the FDA as a “medical food.”
• Store brands that are still in place that mimic the old form of Benefiber, ™ and have guar gum as their active ingredient. (I have tried to check out a report that Wal-Mart has such a store brand SFS, with no success.)

How much of the right kind of fiber do you need each day?

How much SFS do you need, and how do you get there? How do you change over from Metamucil ™ or FiberCon ™ or Konsyl ™? Do you also need Metamucil ™?

To my way of thinking, you need to gradually add an SFS to your daily routine, while also gradually reducing the amount of any IFS you have been taking. Carrots and apples and other vegetables and fruits that are sources of SF should be switched to steamed or blended forms, with no sugar added.

Basically, you are going for a daily intake of 30 to 45 grams of soluble fiber. That varies from individual to indivual according to size, weight, and age. To find the right amount, you gradually increase your SFS intake until your stools are the kind of softened and formed “gel” that I described above.

If you reach 40 or 45 grams of SF per day, without getting these results, please consult your doctor.

Bottom Line
The bottom line is that in taking an SFS you take it every day, and build up until the amount is adequate for a comfortable, formed stool.

August 23rd, 2007 Posted by tummyblogger | fiber, Irritable Bowel Syndrome, IBS-C, IBS-D, FiberSure (tm), Heather's Organic Acacia Tummy Fiber (tm), Benefiber (tm), Digesting Information | 2 comments

IFFGD- International Foundation for Functional Gastrointestinal Disorders

The AboutIBS Organization
As their URI indicates, the IFFGD is aboutibs.org, an organization and web site devoted to Irritable Bowel Syndrome (and, perhaps, other functional GI disorders). I’ve just added a link to their web site in the sidebar.

Patient Advocates for Irritable Bowel Syndrome (IBS)
The IFFGD organization is, I think, the closest to a “patient-advocacy” group as people with IBS are likely to find. As noted in my post about IBS in England and Wales, we as people with IBS need to be aware of opportunities to impact public policy on our own behalf. That can be, as in last Friday’s post (08-17-07), either through direct input, or as part of a stakeholder organization which is regularly consulted.

Medical Needs Survey
Right now, the IFFGD is conducting an online survey “designed to measure the impact of IBS and the needs of those affected,” their unmet medical needs. There is a signup blurb on their home page along the left-hand side. The survey is very detailed and asks about your experience of IBS, your history with IBS, how it currently affects your life, and the kinds of treatment you have received, and to some extent the kinds of treatment you want.

The IFFGD survey is completely anonymous–I will disclose that I’ve just taken it, with full confidence that someone from the organization reading this could not pick out my survey from others taken today. It takes between 20 to 40 minutes, and is one way to be involved in patient advocacy without

• disrupting your routine
• moving out of your comfort zone
• being identified as a person with ibs

Appreciation
Of course, you don’t get hugs that way, but, well, it’s still a good thing to do. And I’ll give you a virtual hug {x} and a TIA - Thanks in Advance, for completing the survey.

Call for Comments
Comments from those who take the survey are welcome.

August 21st, 2007 Posted by tummyblogger | general, IBS, Irritable Bowel Syndrome, IBS-C, IBS-D | no comments

Yogurt for Irritable Bowel Syndrome - No?

Moderators in one of the IBS Forums often suggest trying Dannon Activia ™. I have not. That’s because lactose is sometimes a trigger for Irritable Bowel Syndrome (IBS)–and lactose is an ingredient in milk and milk products such as yogurt. Of course Activia ™ is a food–yogurt–and not a medicine.

Now comes this FAQ from the Chicago Tribune health reporter Julie Deardorff. On her blog she asks and answers this question about Activia and other probiotics:

Q. What’s the deal with yogurt?
A. All non-heat-treated yogurts do contain live active cultures, which include the bacteria used as starter cultures to make the yogurt [Lactobacillus bulgaricus and Streptococcus thermophilis], Sanders said. “Yogurts may also contain added cultures, including probiotics. A wider range of health benefits have been documented for some of these added probiotic strains,” Sanders said. But “many of the organisms in yogurt cannot survive in the acidic environment of the stomach,” said Sri Komanduri, an assistant professor of medicine in gastroenterology and nutrition at Rush University Medical Center. “In addition, yogurt contains lactose, which can be a potent gastrointestinal irritant and may only add to the patient’s symptoms [if the person is lacatose intolerant].

Sanders also suspects many yogurts marketed as “probiotics” with added strains don’t contain enough bacteria to be effective or haven’t been studied. “I also bet there are many yogurts that contain probiotics that have little if any efficacy studies done on them,” she said.¹

What do you think? Has anyone tried Activia, ™ or do you know someone who has tried Activia? Is the advertising for Activia helpful at all in “normalizing” the tummy problems of Irritable Bowel Syndrome (IBS)?

1. August 1, 2007 Chicago Tribune Features Blogs - Julie’s Health Blog 7/07 [↩]

August 2nd, 2007 Posted by tummyblogger | Medical, Probiotics, IBS, Irritable Bowel Syndrome, IBS Triggers, IBS food, IBS-C, IBS-D, Digesting Information, Dannon Activia Yogurt | 4 comments

Return of Zelnorm for Irritable Bowel Syndrome (IBS)

For My Tummy’s IBS-News
If you have been checking the IBS news, on this blog you will see that the top items (in today’s news, July 31, 2007) are about Zelnorm.

FDA Approves Investigational New Drug Status for Zelnorm
The FDA has approved the very strictly controlled and limited use of Zelnorm for women (not men) under 55, who constipation which in the past responded to Zelnorm, or who haven’t tried Zelnorm but for whom other therapies have been inadequate. See the Medical News Article, (http://www.medicalnewstoday.com/articles/78120.php ).

The Marketing of Zelnorm for IBS-C
Novartis, the makers of Zelnorm, as well as other remedies, has been aggressive in defining the population it serves. They are creating a need for their product where there was no apparent need before. I think that worked for the automobile, too! (;-)) The ethical question is about creating a wide pool of people who think they have Irritable Bowel Syndrome (IBS) as the result of a television ad, and therefore need Zelnorm to treat this illness they hadn’t known they had. When does occasional constipation rise to the level of gastrointestinal disorder?

When Marketing Creates the Market
Let me quote (with permission) a good part of the article, and then give you a link to the whole thing:

Zelnorm, a drug that was approved in 2002 for short-term treatment of women with “irritable bowel syndrome” and in 2004 for chronic constipation for men and women under age 65, was withdrawn from the market in March 2007 after studies showed an increased risk of heart attacks and heart problems.

Zelnorm was also very aggressively advertised and promoted, particularly through infamous TV ads showing people with wavy lines and messages written on their stomachs. These ads, and the overall promotional campaign of which they were a part, didn’t just market Zelnorm — they also marketed “Irritable Bowel Syndrome” (IBS) as a condition, working to convince millions of viewers that they have “IBS,” rather than more conventional occasional and symptomatic digestive problems.

By the time Novartis voluntarily withdrew Zelnorm from the market in March 2007, millions of people had taken it, and certainly many who did not truly have IBS or chronic constipation. Novartis racked up $560 million in Zelnorm U.S. sales in 2006 - not technically a “blockbuster” (a term reserved for drugs with at least $1 billion in annual sales), but not too shabby either. As Ed Silverman at Pharmalot pointed out back in March:

The review showed that only 0.1 percent of 11,600 Zelnorm patients, or 13 people, experienced serious heart problems; one died. Of 7,000 placebo patients, 0.01 percent of the patients, or just one person, reported cardiovascular problems. In medical terms, the absolute risk of a serious problem was small, but the relative risk was high.

More than 2.6 million prescriptions were written for Zelnorm in 2006. If the 0.1 percent rate of patients holds true, that would mean that 2,600 of those 2.6 million had heart problems. It’s likely that, due to the aggressive advertising, a significant portion of those 2.6 million did not in fact have IBS. These patients were thus unnecessarily exposed to this heart attack risk - a risk that may be small, but even a small unnecessary risk is still unnecessary. This week, the FDA permitted Zelnorm to return to the market under a very restricted program. The FDA’s press release described it:

The U.S. Food and Drug Administration announced that it is permitting the restricted use of Zelnorm (tegaserod maleate) under a treatment investigational new drug (IND) protocol to treat irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC) in women younger than 55 who meet specific guidelines.

In some instances, patients with a serious or life-threatening disease or condition who are not enrolled in a clinical trial may be treated with a drug not approved by the FDA. Generally, such use is allowed within guidelines called a treatment IND, when no comparable or satisfactory alternative drug or therapy is available.

In addition to the age and gender restrictions, the IND protocol for Zelnorm limits use of the drug to those with IBS-C or CIC whose physicians decide the drug is medically necessary. Patients must sign consent materials to ensure they are fully informed of the potential risks and benefits of Zelnorm.

For this population, the benefits of Zelnorm may outweigh the risks. But the aggressive ad campaign resulted in millions of people taking it for whom the benefits most certainly did not outweigh the risks.

And therein lies one of the main problems with Direct to Consumer Advertising of drugs: Drugs that may be important for a small subset of patients are instead marketed to all consumers, causing many people who don’t need the drug to ask their doctors for prescriptions for it, and for their doctors to prescribe them. By the time side effects that only surface after the drug has been on the market for several years have finally surfaced, millions of people who didn’t need the drug have taken it, and been exposed to that unnecessary risk (not to mention expense).

Vioxx is the most famous example of this. More than 20 million people took it, despite the fact that only 1-2% were actually at risk of the ulcers and gastric complications that Vioxx was designed to prevent. Vioxx was never any better at pain relief than pennies-a-pill over-the-counter ibuprofen. Its only advantage was a (somewhat) lower risk of gastrointestinal problems. But the majority of the 20 million people who took it did so not because they had ulcers, but because they saw the ads featuring Dorothy Hammill skating again after taking Vioxx.

. . .
Comment
The author of the blogpost goes on to suggest that there be a lengthy moratorium on direct to consumer advertising (DTCA) when a new drug is introduced, to allow for a sensible time frame for doctors to learn about the new drug and who will benefit.

The author concludes that:

Delays and moratoria might reduce the number of people who are exposed to such side effects, but they don’t address the core problems of DTCA in encouraging people who don’t need expensive and potentially hazardous brand-name prescription drugs to take them. Every other country [but] the U.S. and New Zealand has concluded that advertising prescription drugs directly to the public just doesn’t make sense, and thus [doesn’t] allow them. There’s no doubt that in the more than 50 other countries where Zelnorm is or was sold but without advertising, the number of people who took it, and who had heart problems as a result, was much lower.

The Link is here: the URI written out is http://prescriptionaccess.org/blog/?p=53.

The Problem for People with Irritable Bowel Syndrome (IBS)
Many of us who have IBS take charge of our medical lives and find out what works for us. It seems to me that for society as a whole there would be a benefit in delaying the introduction of new drugs until doctors are more familiar with them. On the other hand, in the subpopulation with Irritable Bowel Syndrome (IBS), if we heard there was a new drug that the FDA had approved, and we couldn’t have because there was a moratorium, we would set the internet on fire - at least metaphorically.

The Question
So there’s a question: could you wait for a new drug to go through the limited use period when it wasn’t advertised or distributed widely? It would be much like the preliminary marketing of Align, although Align is not a drug, but a supplement that does have FDA approval. Some of us would have it, and some would not, and access would be well controlled.
Is that fair for a new drug? What do you think?

Related Posts
FDA Pulls Zelnorm
After Zelnorm

July 31st, 2007 Posted by tummyblogger | Medical, Probiotics, IBS, Irritable Bowel Syndrome, IBS therapy, IBS-C, Align, Digesting Information, Zelnorm | no comments

Taking Align for Irritable Bowel Syndrome (IBS)-Week 3

Into the third week with Align
The state of my tummy is degrading a bit. I am thinking that Align offers less probiotic than the NSI 15-35 formula I had been taking.

What do I mean by “degrading?”
I am more sluggish–that is, constipated. Also, I have had something like four episodes of reflux in five days. I’ve “medicated up” with both Ranitidine 150 (Zantac ™ 150)) and Prilosec ™. That means that the cost of using Align has gone up, from no cost trial sample to the cost of Prilosec. I have also added ginger tea from Yogi Tea, to enhance elimination. It has been effective.

Is there still an advantage to using Align?
Align has many advantages, starting with its

• FDA approval. That means that you will get a consistent product with a lot of quality control along the way.
• Single small capsule taken once a day — not necessary but nice
• Lots of online support, at AlignGI.com.
• Extensive information at various levels, also at AlignGI.com.

In a word, there are advantages to choosing Align.

Related Posts

• Align Arrives
• Reviewing Align
• Second Week of Align

July 30th, 2007 Posted by tummyblogger | Probiotics, IBS, Irritable Bowel Syndrome, IBS therapy, IBS-C, IBS-D, Align, NSI Probiotics | no comments

IBS-C (Constipation) and Music

The last two lines of a dense article on the effects of music on gastric motility (motion) are intriguing, yet raise many questions.

Listening to enjoyable music increases the amplitude of gastric myoelectrical activity in healthy humans.

Music therapy may improve gastric motility and may be used to stimulate gastric emptying.

This is the source for the statements above, accessed on the web on July 24, 2007.

The interesting implication is that listening to music that you like improves your intestines’ ability to move things along–great for people with IBS-C. Does that mean that people with IBS-D should not listen to music they like? Should listen to music they don’t like? This finding is based on testing with 17 normal subjects.

It is a simple thing to try, if you have IBS-C. I would be interested in getting a lot more experiential data from people with IBS. What do you think?

July 25th, 2007 Posted by tummyblogger | IBS, Irritable Bowel Syndrome, IBS therapy, IBS-C, Digesting Information, IBS Symptoms | no comments