The owner of IBS Tales, Sophie Lee, has written a new book called “Sophie’s Story” which chronicles her life dealing with Irritable Bowel Syndrome.

I want to tell the absolute truth about IBS, because the reality of this disorder is so often clouded by embarrassment and myths. Perhaps the most pervasive myth is that IBS means mild diarrhea and nothing more. Many people with no experience of IBS wonder why we have such difficulty in coping with our condition. This book shows why. - Sophie Lee, “Sophie’s Story”

It would appear that “Sophie’s Story” is aiming to be an accurate & detailed account of what life with Irritable Bowel Syndrome is like, even if the truth about IBS isn’t pretty. Her story will probably resonate with many who have had similar frustrating & painful experiences while dealing with Irritable Bowel Syndrome.

Sophie has been kind enough to provide me with a review copy that I will read  & then review at a later date. You can purchase the book right now on Amazon, Amazon UK. For international orders it’s best to check the IBS Tales website for further details.

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The tainted cantaloupes were sold by Jensen Farms located in Colorado & distributed all over the country. The Center for Disease Control has reported Listeria related illness in Alabama, Arkansas, California, Idaho, Illinois, Indiana, Montana, North Dakota, Texas, Virginia, West Virginia, Wisconsin & Wyoming. Jensen Farms recalled the cantaloupes in mid-September.

At the same time this was happening, listeria also popped up on romaine lettuce that was being sold by True Leaf Farms of Salinas, California. Currently there have been no reports of illness from this lettuce as not much of it was distributed & what did get distributed was recalled quickly.

How the listeria got on the cantaloupes & the lettuce is still not clear. Some suspect that listeria got into the fertilizer that was being used on the farms or in the water that was being used for irrigation. Cantaloupe have a semi-porous rough exterior that may allow for bacteria to hide more easily on the outside of the cantaloupe. While the exterior was probably thick enough to prevent listeria from penetrating directly into the fruit, upon cutting open the cantaloupe the knife used would spread contamination from the outside rind onto the inner fruit. Making things more complicated is that listeria is a very hardy bacteria. It is not easily killed by heat or cold & washing produce thoroughly may not be enough to remove the bacteria. Some have suggested using an antibacterial soap & to thoroughly scrub your fruits before consuming. If you do have known contaminated fruit you should dispose of it immediately & sanitize the area the fruit was being stored such as countertops or fridges.

Those most at risk of serious infection are the usual suspects: children, elderly, pregnant women or those who are ill. A miscarriage has been blamed on the cantaloupe listeria outbreak. People who have chronic digestive illness should be especially cautious, such as those with Irritable Bowel Syndrome, Crohn’s Disease, Ulcerative Colitis or Gastroparesis as listeria infection will most likely exacerbate their symptoms. Also it’s important that those who are healthy not “poo poo” the risks of listeria as it’s been shown that infection is often key to triggering a chronic digestive problem like IBS or Gastroparesis or that if you do get sick & need antibiotics, they could put you more at risk of developing Crohn’s Disease.

Food producers may be in a bit of a bind when it comes to preventing food-borne illness as there is no silver bullet. While some may suggest bulk washing on the farm is key, this may actually accelerate the spread of bacteria between different batches of produce. Harsher chemicals could be used to try & sanitize the produce but this may damage the produce or cause consumers to balk at the use of more chemicals coming in contact with their food. Others have suggested food irradiation as a way to destroy harmful pathogens, but the same problems with sanitizing via chemicals exist with irradiation as it can have an impact on the quality of the produce & there is rampant consumer fear regarding anything that might involve radiation. Costco is looking to implement a “hold until tested” methodology which prevents produce from going on sale until it has been tested. Testing could  take up to 48 hours which is a long time considering produce is often very perishable.

Source: Costco Urges Stricter Safety Measures on Cantaloupes, Listeria recalls: You still have to eat fruits and vegetables

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Measuring 26 mm x 13 mm, about the size of a multi-vitamin, the SmartPill device should be easy enough for most patients to swallow. Once swallowed the device gets to work measuring statistics about the patients digestive system. The information collected is useful for measuring motility within the stomach, small bowel & colon along with temperature & pressure throughout the entire gut. A data monitoring device is worn by the patient which the SmartPill communicates with wirelessly. Data is collected for 4 – 5 days & then the patient returns to the doctors office to have the data downloaded & analyzed. Only the data monitoring device is recovered as the SmartPill itself is a single use device & passes through the digestive system along with other waste products.

While the SmartPill is not currently in widespread use, there are various locations within the United States where the SmartPill system may be available. In June 2011, the SmartPill was granted the CE mark by the European Medical Devices Directive, allowing it to be used within European markets. It is currently being used at the Princess Grace Hospital in London.

The main benefits of the SmartPill include the possibility of more accurate readings with more data available at different times of the day combined with the ease of using the device. The downsides include the fact that the SmartPill lacks a camera & the device manufacturer considers it a complimentary procedure to go along with an endoscopy. So while it may prevent people who have already had an endoscopy from undergoing yet another one, it may not prevent the need for an endoscopy for those who have never had one. Additionally cost & availability have to be taken into account.

It is still an interesting technology which could prove very beneficial down the road once it has widespread availability.

Sources: The Princess Grace Hosptial, SmartPill Website

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1. Canadian Woman’s Struggle To Get Gastric Neurostimulator for Gastroparesis
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Researchers gave 817 patients who were exposed to Giardia lamblia mail-in questionnaires which asked them to explain any current symptoms they were experiencing. These patients infection was the result of a waterborne outbreak of Giardia which occured three years prior. They compared these patients answers with those from a control group containing 1128 people.

The results of the study showed that those within Giardia lamblia patient group had a 3.4 times higher likelihood of developing Irritable Bowel Syndrome along with a 4 times higher chance of developing Chronic Fatigue Syndrome compared to the control group. The study was lacking in some data such as a lack of information about previous IBS, CFS or related health problems. The lack of this data does reduce the usefulness of this study somewhat.

I personally became ill with Irritable Bowel Syndrome after swimming in a river & I’ve wondered if perhaps some sort of waterborne illness like Giardia was the cause of my future digestive problems.

Giardia is a parasitic  infection which is usually obtained via contaminated food, water or soil. The parsite lives within the intestine of the host animal. Symptoms usually include chronic diarrhea, cramping & excessive gas. Weight loss &  dehydration can occur. The body can often rid itself of Giardia infection over a few weeks time, but in some cases antibiotics like Metronidazole may be used to treat the infection, although recent studies suggesting a link to Crohn’s Disease from excessive antibiotic use might put patients between a rock & hard place.

Source:  Irritable bowel syndrome and chronic fatigue 3 years after acute giardiasis: historic cohort study

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Almirall is the licensee of Linaclotide for European markets. They along with Linaclotide manufacturer, Ironwood Pharmaceuticals, submitted a Marketing Authorization Application to the European Medicines Agency in a bid to gain access to European markets. Along with the application they submitted the results of their Phase III trials showcasing the benefits they feel Linaclotide provides patients who are dealing with Irritable Bowel Syndrome. If approved the drug would be sold under the brand name of Constella.

Linaclotide is a drug that aids those dealing with constipation related to Irritable Bowel Syndrome. It is an agonist of the guanylate cyclase type‐C receptor which is found in the surface structure of the intestinal system. Studies on Linaclotide in the US suggest that it aids constipation by increase intestinal fluid secretions, reducing visceral hypersensitivity & accelerating transit through the digestive system. Usually it’s well tolerated, but in some cases caused adverse reactions, such as chronic diarrhea, requiring approximately 5% of the trial participants to stop taking it.

Ironwood Pharmaceuticals is still awaiting approval from the United States’ FDA after they submitted a request for final approval following their Linaclotide Phase III trials. The FDA is not expected to make a decision until 2012.

Ironwood’s stock hit a 52-week low on Oct 4th, 2011, although this may have more to do with the current bearish market rather than the state of their business ventures.

Source: Almirall announces regulatory filing of linaclotide for the treatment of irritable bowel syndrome with constipation in Europe

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It’s all too often that patients with chronic conditions find themselves in the position of treatment manager, coordinating communications between their general practitioner & the multiple specialists they may have to see. Patients in this situation will often feel lost in a sea of doctors appointments, ensuring tests & medical records get transferred properly as well as researching & managing their own illness. Those patients may also feel as though no one in the medical community is really taking a lead in ensuring their wellbeing as often doctors who don’t work within the same medical practice(or even those who do) are distant, with communication not being their strong suit.

Stanford’s GI Pain Program looks to change this by closely integrating two overlapping treatment programs, their Gastroentrology program & their Pain Management program. By requiring that Gastroenterologists & Pain Management specialists work closely with each other to craft a treatment management plan, patient outcomes can be improved & patient stress can be reduced.

[Prof. Ravi] Prasad said, patients “can feel lost in the system. People were getting helped, but that lack of communication was distressing. Now, when they know that their providers are talking with each other, they’re a lot more satisfied. You can feel like you’re getting the runaround when you’re shuttled back and forth.”

The program is coming into full swing at the same time that a recent pain management study by the National Academies’ Institute of Medicine suggests that many doctors are not well versed in pain management & more needs to be done to improve both research & doctors understanding. Dr. Linda Nguyen who works in the GI Motility & Neurogastroenterology division at Stanford has concerns over doctors ignoring long term pain in their patients who have digestive illnesses.

“…if you look at patients who come to me with chronic GI pain, half of them will also be experiencing anxiety and depression because of that pain. And we know that very common disorders like irritable bowel syndrome are made worse by that anxiety and depression.”

The Stanford GI Pain Program sounds like a step in the right direction to improving patient care & may be a model that can be replicated elsewhere as well.

Source: New GI Pain Program Pairs Experts for Coordinated, Collaborative Care

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Lexicon Pharmaceuticals’ LX1033 is a Irritable Bowel Syndrome drug meant for those with diarrhea predominant Irritable Bowel Syndrome symptoms or mixed symptoms that include diarrhea. LX1033 works by targeting the hydroxylase enzyme which is also known as TPH. TPH is essential for the production of serotonin within the body & it comes in two forms TPH1 & TPH2. TPH1 lives mainly in the digestive system, while TPH2 lives in the nervous system & the brain. LX1033 specifically targets TPH1 only & leaves TPH2 alone to avoid nervous system or psychoactive effects. Serotonin levels do seem to play a role in Irritable Bowel Syndrome, but how much is not fully understood.

LX1033 is actually more potent & targeted form of Lexicon Pharmaceuticals’ earlier drug LX1031. LX1031 made it to Phase IIa trials, which is usually where they trying to determine effective dosage levels. It would appear they felt they could do better than the results LX1031 was achieving & thus reintroduced it as LX1033. LX1033 appears to be more effective at the same dosage levels of LX1031.

Lexicon Pharmaceuticals’ plans to pursue Phase II trials soon.

Sources:

• Lexicon’s IBS Drug Candidate, LX1033, Successfully Completes Phase 1 Clinical Trial
• The Tryptophan Hydroxylase Inhibitor LX1031 Shows Clinical Benefit in Patients With Nonconstipating Irritable Bowel Syndrome

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The new regulations will now list FGIDs as being a “presumed” result of military service during operations within Southeast Asia during the Persian Gulf War that occurred in the early 1990s. This essentially means that a veteran making a disability claim should have an easier task of claiming that their Irritable Bowel Syndrome or Functional Dyspepsia(chronic indigestion) was a result of their service, even if symptoms developed after they had left the military. In the past a veteran had to prove that their symptoms were apparent while they were actively serving during the Gulf War. This made it complicated for many veterans who developed severe gastrointestinal disorders after their tours of duty ended.

While this is a step forward, the disability process for veterans may still be an uphill battle when dealing with doctors or claims reviewers who may not be aware, educated or compassionate towards FGIDs. This is unfortunate as many of our soldiers are more at risk of developing Irritable Bowel Syndrome due to stress, poor sanitation, travel & the physical hazards involved with combat operations. Hopefully these new regulations will streamline the process for many of the veterans who have been either suffering in silence or struggling with the current disability process.

Source: Presumptive Service Connection for Diseases Associated With Service in the Southwest Asia Theater of Operations During the Persian Gulf War: Functional Gastrointestinal Disorders

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On Aug 9th, Ironwood Pharmaceuticals formally submitted their application to the FDA for Linaclotide to be allowed for prescription by doctors. Linaclotide is a guanylate cyclase type‐C (GC‐C) agonist drug which is aimed at the treatment of those who have Irritable Bowel Syndrome constipation & pain. Included with the application is data regarding the results of Phase III trials. Ironwood Pharmaceuticals is positive that the results of those trials supports Linaclotide’s efficacy & safety. The FDA often takes up to 60 days just to accept the initial application & they will probably not make an official determination on Linaclotide until sometime in 2012.

Linaclotide does look as though it could offer some benefit to those who have constipation or pain as their predominant Irritable Bowel Syndrome symptoms & who have not found relief from diet change or over the counter laxatives.

Read more about Linaclotide.

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A few months ago I wrote about my negative thoughts on colon cleansing products & how I felt they weren’t healthy, safe or cost effective treatment for digestive system problems. Of all the bogus health products out there colon cleansing is probably at the top of the list for deceiving people about it’s potential benefits.

Dr. Ranit Mishori from Georgetown Universities School of Medicine seems to agree in a recent article he wrote for The Journal of Family Practice. In the article he discusses two case studies where patients had severe reactions to colon cleansing products, he discusses the brief history of colon cleansing fads & also discusses different products.

With names such as Nature’s Bounty Colon Cleanser Natural Detox Formula, Health Plus Inc. Colon Cleanse, and 7-Day Miracle Cleanse, as well as endorsements by movie stars, these colon cleansing products are actively promoted as a natural way to enhance one’s well-being. Advertisements promising that colon cleansing will alleviate fatigue, headache, weight gain, and low energy are ubiquitous on the Internet and in newspapers and magazines.

I bolded the Nature’s Bounty product because I am actually a fan of most of their products. It is kind of sad that they stooped to the level of offering a “Colon Cleansing” product. In fairness, the “Nature’s Bounty Colon Cleanser Natural Detox Formula”(that’s a mouthful), is mainly Psyllium Husk, so I wouldn’t say it’s the worst offender out there, still sad though.

This does bring up the question of just what the heck is considered a “Colon Cleansing” product? There are many colon cleansing products that add weird things like clays or herbs that have a laxative effect, meanwhile others use a lot of fiber while still others offer kits that are essentially super enemas. There really is no consensus on what “colon cleansing” means & with no standards in place & one actually running any clinical trials(or wanting to run any clinical trials) you really do not know if any product actually has any benefit or dangers.

Given the dishonest nature of most of the companies offering such products you should never trust any anecdotes or testimonials on their website. Fake reviews can also be a problem on sites like Amazon.com or even on blogs or community forums, as posters often get a kick back if people buy the product. I’ve had companies contact me via e-mail asking me to promote their goods on this blog. Full disclosure: While I have affiliate links on this blog I have no intention of misleading people just to make a buck & I have no affiliate links to colon cleansing products.

Dr. Mishori also mentions FDA warnings regarding colon irrigation which is sometimes labeled as “colon cleansing” & especially warns against colon cleansing products usage for those those who have had serious digestive system problems such as Inflammatory Bowel Disease or other health issues like kidney or heart problems.

If you’re thinking of trying a colon cleaning product, don’t. Save your money. If you have constipation try fiber, magnesium, prunes or Iberogast. If you’re just trying to detox or lose weight then adjust your diet & exercise, colon cleansing is no miracle cure. If you know someone who is thinking of it, then them Dr. Mishori’s article & my other colon cleansing article as well.

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