Your Lifestyle Is Your Medicine
“Your Life Style Is Your Medicine” is a podcast that focuses on how a person's lifestyle can be the key to health and happiness. Routed in the principles of lifestyle medicine, Ed Paget, osteopath, and exercise scientist, interviews area-specific experts on how lifestyle impacts well-being, focusing on purpose, physical activity, nutrition, sleep, and stress, which could lead to a longer, happier life. Edward now runs immersive lifestyle medicine retreats, with the purpose of helping others take back control of their lives to live longer and healthier.
Your Lifestyle Is Your Medicine
Is IBS a Misdiagnosis? Harvard-Trained GI Expert Reveals the Truth | Dr. Mohamed Farivar
Dr. Mohamed Farivar, a Harvard-trained gastroenterologist with nearly 50 years of experience, reveals that true Irritable Bowel Syndrome (IBS) is extremely rare, with most cases being misdiagnosed digestive issues that have specific, treatable causes.
• True, IBS affects only about 5% of those diagnosed, while the remaining 95% have identifiable, treatable conditions
• Over 40 different conditions can cause IBS-like symptoms, including food intolerances, enzyme deficiencies, and bile salt malabsorption
• Doctors often lack knowledge about proper diagnosis, and the medical system doesn't incentivize physicians to spend time investigating root causes
• FODMAP-rich foods (including many "healthy" vegetables and fruits) can cause digestive discomfort, but shouldn't be completely eliminated
• Bile salt malabsorption is a particularly serious yet commonly missed diagnosis, causing urgent bowel movements and occasional incontinence
• Probiotics are generally unnecessary as we already have trillions of beneficial bacteria in our gut - yogurt and kefir provide better natural alternatives
• Many patients suffer unnecessarily for years before discovering simple solutions through proper diagnosis
For more information, visit Dr. Farivar's website at gerd-ibs.com or his new site isitibsoryourdiet.com, where his book will be available for free.
I'm interested in why you said that the probiotics are a waste of money. People spend a lot of time researching those and obviously the consumers spend a lot of time trying to get the right ones. What's your take on probiotics then?
Speaker 2:I'm one of these people that is opinionated. I'm sorry about to say that and it's true, those bacteria are probiotics as opposed to antibiotics, but those are regular bacteria in our intestine. We have billions and billions and billions of them. By adding something that you don't even know whether it's going to make it to your colon or not, because acid in your stomach may destroy them and even when they get there, there are a few, as opposed to trillions of bacteria of the same thing that are in your colon. What is that going to do?
Speaker 1:Welcome to the your Lifestyle is your Medicine podcast, where we do deep dives into topics of mind, body and spirit. Through these conversations you'll hear practical advice and effective strategies to improve your health and ultimately add healthspan to your lifespan. I'm Ed Padgett. I'm an osteopath and exercise physiologist with a special interest in longevity.
Speaker 1:Today's guest is Dr Mohamed Farivar, or Dr Mo as he likes to be called. He's a semi-retired board-certified gastroenterologist with nearly 50 years of experience. He's a former fellow of the Harvard Medical School and has practiced in Boston since 1975 and has been recognized as a leading expert in gastrointestinal disorders. His mission is to educate both patients and doctors about the role of IBS, empowering individuals to take charge of their digestive health. He's written a book it's called Is it IBS or your Diet, in which he explores over 40 common IBS misdiagnoses and he explores the role of diet and symptom management, what true IBS is and effective treatment strategies. Today we're going to do a deep dive into some of those common misdiagnoses and learn about his treatment approach. Dr Mo, welcome to the show, well thank you.
Speaker 1:Lloyd, now I've done a quick introduction for you, but I don't think I've done you a service in there. Can you just explain a little bit more about your credentials when it comes to being a physician?
Speaker 2:Sure, I am a board certified gastroenterologist, previously a fellow of American College of Physicians and American College of Gastroenterology, professor at Boston University, lecturer in medicine at Harvard Medical School. Seen thousands of patients with IBS in the past. That really has been mismanaged and that was the incentive for me to write my book Is it IBS or your Diet? Which is Amazon bestseller book.
Speaker 1:So that's All right. So safe to say you know what you're talking about. When it comes to IBS and the misdiagnosis that happens.
Speaker 2:Yes.
Speaker 1:Perfect. Okay, this is what I want to get into. And, for those of you who don't know, ibs is called is a short form of irritable bowel syndrome, and it seems to be a collectible diagnosis that a lot of people get when they have some sort of stomach upsets, and Dr Mo is going to talk to us about why that's not always true and what are the triggers behind it. So can you tell us about why people are so commonly diagnosed as having IBS, when maybe they don't?
Speaker 2:when maybe they don't Okay. So basically, the actual IBS is very rare. I have, in really my more than 50 years of practice, I have seen probably a handful only of patients that have had real IBS. The IBS symptoms, which includes bloating, abdominal discomfort, having gas, change in frequency of bowel movements and the shape of bowel movements, and pain that either gets worse or get better with bowel movements, fecal incontinence, mucus in the stool, all of those symptoms they come under the umbrella of IBS and those symptoms they have many, many reasons for it and if you find the basic, the root of those symptoms, then there is no such a thing as IBS. You correct the root and the problem goes away. Ibs is when there is no cause for it and people have symptoms.
Speaker 1:But there are more than 40 different reasons for these symptoms and it's up to individuals, patients and doctors to find the cause of it and why do you think the doctors aren't looking for the cause of IBS in the medical system that you're working in within the US?
Speaker 2:Yeah, it's beside me really, and I'm perplexed at why this is the case. My guess is that one people with IBS have many complaints and when they come and take your time and you only get paid 30 bucks by insurance companies, the doctors, really they don't want to take their time, even if they have the knowledge. But my feeling is that majority of them 99% of them really they don't have the knowledge. But my feeling is that the majority of them 99% of them really they don't have the knowledge that it takes to figure out what is causing the patient's problem, and so lack of knowledge is the main thing, and then poor reimbursement, at least in the US, by insurance companies is the other reason for it.
Speaker 1:I've also heard and I want to see whether this is true or not that many physicians in the US would prefer to prescribe drugs than ask difficult questions about the person's diet.
Speaker 2:Yes, of course, as I said, the main reason is lack of knowledge, because if they had the knowledge and I say based this, based on experience, when patients come to me and they've been to several doctors and come and no one has asked them questions so if they had the knowledge they would ask the question. So lack of knowledge is really the main reason. And those people who have knowledge, they have a superficial knowledge, they know. For example, nowadays the majority of specialists at least know about FODMAP diet and they throw at the patient oh okay, stay away from FODMAPs. Without knowing really what FODMAP is and what the nitty-gritty of FODMAP diet is, and when and how, and restriction and reintroduction and so on and so forth should be. So lack of knowledge is the main reason.
Speaker 1:Okay, for those of you who don't know, dr Mo was just talking about FODMAPs, which I might butcher this, but it stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols, which means foods that are high in these fibers that can get fermented in the digestive system and cause sort of digestive upset. And it seems to me that that is very trendy to tell people don't eat foods high in FODMAPs and then go away and live your life. But when you look at it, lots of foods have high FODMAPs and it go away and live your life. But when you look at it, lots of foods have high FODMAPs and it's very hard to do. Is that right?
Speaker 2:Yes, it is. Lots of food have. All of food basically should have FODMAPs. Fodmaps are energy source Energy source that we needed to create energy for colon cells and also to save energy from all the salads and so forth that we eat. So lots of food have FODMAP to a different degree. Some are high in FODMAP and some are not high in FODMAP, but not everything is high in FODMAP.
Speaker 2:There are people that they have malabsorption of things that should be absorbed, like lactose. So lactose, which 30% of people in the US at least have lactose intolerance, lactose intolerance lactose is not FODMAP. Lactose is a disaccharide that needs to be absorbed if you have lactase in your intestine. If you don't have that lactase in your intestine, it's not going to get absorbed. It's going to act like FODMAP. There are also other disaccharides, like maltose and things that are present in different foods that 10% of people have deficiencies of those enzymes that it takes to digest those disaccharides. So if you have those disaccharides you will have. It will act like FODMAP, even though it's not FODMAP.
Speaker 2:Fodmaps are mostly oligosaccharides, those which are 3 to 10 based carbohydrates. That those they don't get absorbed. They have no enzyme, there's no deficiency of those and they need to go and get fermented in the large intestine by bacteria and once they get fermented, of course they produce butyrate and other amino acids fatty acids that are good for intestine, but also CO2 gas, hydrogen gas, methane gas that causes bloating and discomfort and also, by breaking these things down, it can cause diarrhea as well frequent bowel movement. So it's, as you mentioned, fermentable oligo di poly and monosaccharides di poly and monosaccharides. So disaccharides are basically the one that they're supposed to get absorbed. But if you have enzyme deficiency.
Speaker 1:They're not gonna so okay. And so how does someone go about correcting their um, their sort of gut efficiency, like if they're not being broken down properly, is it a microbiome problem? Can they work on their microbiome to change that? Or should they avoid these specific foods?
Speaker 2:no I think that first of all, uh, having fat by food and having gas and bloating is excellent for your health. Okay, these are foods. This is basically with fat back food when you are producing gas and bloating and those things you are growing probiotics in your intestine. Those are good bacterias that you are growing there and the good bacterias are producing are working and they are doing their job. So my point to patients are always that, listen, this is you're basically generating and culturing good bacteria in your intestine. So first know that this is what your problem is and then, second is, try to adjust how much you can tolerate.
Speaker 2:So I never tell people don't eat those. I say those are the cause of your problem. See how much you can tolerate and then adjust it accordingly. So one day don't have several things which are high in FODMAP or they're disaccharides. And some people also don't eat like food high in FODMAP but they eat disaccharides food that contains disaccharides that they don't eat like food high in FODMAP, but they eat disaccharides food that contains disaccharides that they don't have the enzyme Congenitally they're born without enzyme to digest those. So and those are the trigger foods. So they say, well, I'm not eating high in FODMAP, but I'm eating such and such food and I still have a problem. Those are trigger foods that they need to find out.
Speaker 2:So FODMAP foods are not bad. They are good because they're all healthy foods. I mean, if you go over the list, everything is healthy. So it's not that don't eat it. It's just adjust yourself, adjust your system so you can tolerate and you are not going to complain. And the level of tolerance in people is different.
Speaker 2:Complain and the level of tolerance in people is different. If you're a large person and a man, usually they can tolerate a lot of gas and get rid of it and not worry about it and bear for whatever it takes and get rid of gas. If you are a thin female in a workplace in a small office that there are two or three other people sitting there, you're not going to pass that gas, you're going to keep it and it's going to stain you and it's going to cause cramps and pain and bloating. And that's why most of our patients are well-educated. In my area that I practice in Cambridge Massachusetts, they are well-educated in health concern females that are vegetarian or on high FODMAP food in their salads and with their meats and everything else and then they get those bloatings and they worry and they say, oh, what's wrong with me?
Speaker 2:And they go from one doctor to another, to another and have one colonoscopy and second colonoscopy and one test for gluten-free and the second and third test for gluten to see if they have celiac, and eventually they end up going on gluten-free diet, which is a very expensive diet to go on, but it helps them because it's low in FODMAP, because a lot of things that have gluten, they also are high in FODMAP. So you eliminate things that have gluten by eliminating FODMAP. You feel better. Eliminate things that have gluten by eliminating FODMAP. You feel better. And you say that, oh, I have gluten sensitivity, I'm allergic to gluten, and no matter how much you tell them, no, you don't, they're not going to listen. They're going to say no, I feel better when I don't have it, even though it is really the FODMAP.
Speaker 1:Yeah, I remember well. You're quite well known for saying stop eating healthy foods. No, stop eating good food. And not good food is like rich in cream, or like the French eat the cheeses, but actually the foods that we consider healthy, like the kales and the broccolis and that kind of thing. Am I misquoting you there? Is that true?
Speaker 2:No, that's true. I mean good food is. I always tell people that, listen, junk foods are good for you if you don't want to have gas and bloating and so forth, because they're not high in FODMAP. They're not healthy food. Healthy foods which are, you know, beans and apple and pears, and dry fruits and plums, and broccoli and Brussels sprout and onion and garlic and mushroom. They're all healthy, good foods, but they're all high in fat. You eat those.
Speaker 2:rest assured, you're going to have symptoms if you overdo it. And then, on top of it, a lot of people are lactose intolerant, especially Northern European, eastern Western Europeans and the United States white people. They don't have much lactose intolerance, but everybody else Chinese, middle Eastern, african Americans, south Americans and so forth a very high percentage of them they have lactose intolerance and so forth a very high percentage of them they have lactose intolerance. And you know, consuming milk and cheese and butter and pizza and subs and so on and so forth, they're going to have symptoms. And on top of it, the beans that goes with it is going to increase their symptoms.
Speaker 2:So that's and especially especially you know we like watermelon, so watermelon is very high in fat, among other other fruits that is interesting.
Speaker 1:I eat a lot of watermelon. I'm in Central America at the moment and watermelon every day for breakfast good, so you don't have any problem.
Speaker 2:I don't have any problem well, you don't have, you don't eat much of it. No, you don't have, you don't eat much of it.
Speaker 1:No, probably don't.
Speaker 2:Okay, you know a slice or two watermelon is okay, especially if you don't have other other problems and you're active and you walk around and the gas that we produce by walking more blood goes into our intestine and intestine becomes active. So a lot of it comes out of our breath okay, gets absorbed into our bloodstream and comes out of our breath so it doesn't stay there. So this is. You know, if you're sedentary and not moving, if you're constipated, so gas can get trapped behind constipated stools, those are people that get more into problems. So, as I said, everybody produces gas and clothing and those kind of things with high FODMAP. Not everybody has symptoms. Only 5% of people will get severe symptoms. One out of 7% have IBS symptoms. Only 5% of those they get severe symptoms. So there's a lot of other percent have IBS symptoms. Only five percent of those they get severe symptoms. So there's a lot of other conditions that goes with it, other situations that creates the symptoms.
Speaker 1:Okay, you've shared an interesting picture of one of your sort of clients. Is a female, thin, health conscious, maybe vegetarian, sedentary desk job, produces gas because that's what we do when we eat high FODMAPs food but doesn't want to expel the gas because they're a lady and they end up getting digestive symptoms and coming to see you Exactly. Can you give us some case examples of people you've helped who have been through the medical system and ended up with you?
Speaker 2:Yeah, I can give you many samples, but I'm going to give you two examples to illustrate how bad IBS could be. A lady came to me that had been a dental hygienist and she said that she has quit her job and now is a real estate agent because she was getting bloating, gas cramps, fecal incontinence a few times when she was taking care of clients because of urgency and she had been the last, like several, many years, to different hospitals in Boston area and has had like three colonoscopies, four times blood tests for celiac, all sorts of stool tests and so forth, and they never found out what her problem was and that's why she quit her job and became a real estate agent. And she was telling me that. You know, I loved to be a dental hygienist but a real estate agent I'm making more money, but it's not what I love. I love what I had before.
Speaker 2:And the second lady was a high school principal, a teacher same thing. She came to me and she says that she's gone through the same thing, 12 years of exactly the same. And a good thing. Now we have a system which is called epic medical records that you can go and look and see where they have been and what kind of tests they've had. So is that your fingertip, especially for me, that you know I can sort of go in boston area and most hospitals have epic system so I can look when a patient comes to me, it's my duty to do that, and so that the same thing. And so she says that she's riding bike to work, even though she could take public transportation. In Cambridge mass public transportation is very good, she's right. And she says even when she wants to go somewhere, she takes Uber so she can control go somewhere, she takes uber so she can control. And she knows bathroom every between her home and wherever she's going.
Speaker 1:Sorry, I just wanted to clarify. She doesn't take public transport in case she needs to go to the bathroom. That's why she takes ubers and her and her bike yes, right.
Speaker 2:So my first question is that. So I said that, okay, she's done everything and nothing they found. I said what's your diet, what do you eat? And I always ask IBS patient my first question is what do you eat for breakfast? What do you eat for lunch? What do you drink? What do you eat for dinner, for snacks, so on and so on.
Speaker 2:And I saw that she really is overloading herself in high FODMAP food. She was, you know, all bean and broccolis and kale and cauliflowers and asparagus and Brussels sprouts and so on and so forth vegetarian. So I said this is what your problem is. You just go and for one week don't eat those and then call me back and we'll see if we need to do anything else. And so she calls a couple of weeks later and she tells me Dr Farah, after so many years, this is the first week that I've had no problem, that I feel fine and I can't believe it that so many years nobody ever asked me about what I eat.
Speaker 2:And to associate this with my problem, the other lady that I mentioned that picture of urgency and fecal incontinence to the point that you can't control yourself.
Speaker 2:That is related to people that make a lot of bile acids and bile salt in their liver and the bile salt has that characteristic that once in a while it comes in a large amount and there's nothing else that can cause that other than the bile salt malabsorption. But if you don't know it and I've seen so many patients a lot of times that with this condition and I've seen so many patients a lot of times with this condition that they've been suffering and they have gone into social isolation because of that, because they can't go anywhere, because all of a sudden they have to go and run and find a bathroom, otherwise they have no time. And that's why I said lack of knowledge is sometimes the reason for it. And that other lady I told her this is typical of that gave her some pills that absorb extra bile salt and she was done, she was fine, and that was the end of her problem and she went back to her job of being dental hygienist and I still see her.
Speaker 1:So so that's brilliant. So both of those people have been diagnosed as having IBS and there's no real treatment, and you managed to help them, one simply with some drugs and the other one simply with a diet change.
Speaker 2:Yes, and both of these people also when they come to see you. They've tried multiple probiotics, multiple other supplements like digestive enzymes and IB guard and this, and that there are about more than 100 of them on the internet, that people can buy and try gas eggs and activated charcoals and this and that, and none of them are helpful on a long-term basis. Maybe they temporarily help you take it. You take gas eggs and okay, for a long-term basis, maybe they temporarily help you take it. You take gas x and okay, for a couple of hours, maybe you'll have less gas. This is not a treatment. You take digestive enzyme with that food that you eat. A lactate enzyme may help, right, then, this is not a treatment. So, and they spend so much money and the other thing is that they have those, their labs, and you can't believe it. I see patients that they come with the record really this thick uh that a lab has sent them. They charge them 2,500 dollars, uh, to analyze their blood and their stool centers and they come up with 200 different reasons. Okay, these are the things that is causing your problems and these are the bacteria or funguses or things that are candida that you have, and so don't eat this, eat that. And so patients tell me says we have spent all this money and they've told me don't eat those. But things that they say don't eat, I eat it and I don't have any problem.
Speaker 2:And things that they say don't eat, I mean don't eat, I eat no problem. Things that they say eat, I eat it, and I have problems. And I say, well, okay, you know, congratulations, they robbed you of all your money and you know these are useless. So I usually take this and throw it in the wastebasket. I say, okay, just, you know this was useless, you spent your money. This is what your problem is and that's what you need to do. So unfortunately, unfortunately, this IBS really a lot of shortcomings by doctors, lack of knowledge by hospitals, lack of equipment to diagnose, like the isacharyotes, deficiencies and SIBO and those things that patients may have. By companies that are benefiting from these people, by enzymes and probiotics which are totally useless and people are spending so much money on them, by labs that they do those tests on these people. So IBS is a multi-billion dollar business, okay, and it's even going to get bigger because now big pharma, which are supposed to be legitimate, they're getting into that and they're coming up with medication. You know you have IBSD. Use this antibiotic.
Speaker 1:And they're true.
Speaker 2:You kill the good bacteria in the intestine and so you eat something and it's not gonna get fermented and you're not gonna have as much symptoms and you think that this is it. You take antibiotics which are very expensive. So big pharma is getting into it and my feeling is that this is all because of lack of knowledge. Nobody is doing this intentionally. Everybody means well, but this meaning well, I mean they say the road to hell was paved with good intention.
Speaker 2:Okay, so it's not a good intention, and I think it's duty of mass media to bring this to attention of people, attention of consumers, that when you go to and see your doctors, don't be satisfied with oh, you have lactose intolerance, stay away from lactose, because, first, the other thing is that in people, in everybody with IBS, diet has a role in it, maybe the only reason, or maybe a major reason, and there could be other reasons to it too. So, with finding one thing, don't walk away, they say, because then you're going to feel somewhat better, but not completely better, because they're often more than one reason for the symptoms of IBS. So patients need to be educated, so they can educate their doctors and they can demand things that needs to be done to find out what else is wrong with them.
Speaker 1:Can you tell us some of those other things that go along with diet and IBS Dr?
Speaker 2:Yeah, IBS you know you can have. Like you can be taking medication that delays gastric emptying Food sits in your stomach. You can be taking medication that gets rid of acidity so more bacteria gets into your intestine to cause that. You can take medication that is slowing down the GI system, so, again, digestive. You can have difficulty.
Speaker 2:Alcoholic, with chronic pancreatitis, that pancreas is not making enough enzyme to digest your food. You can have celiac that things don't get absorbed because of celiac. You can have leaky gut syndrome. You can have inflammatory bowel disease like Crohn's and colitis. You may have had surgery of gastric bypass cholecystectomy, gallbladder surgery, hiatus, hernia repair, crohn's surgery. So there are a lot of different reasons that they all can cause exactly the same symptom. Anything that causes maldigestion or malabsorption of food can cause the same symptoms and there are many reasons in the GI tract that causes malabsorption and maldigestion of food. So you need to sort of be cognizant and inform about those and in history taking you're going to get asked these questions and then try to put up the pieces of puzzle together and take care of patients.
Speaker 1:I'm interested in why you said that the probiotics are a waste of money. People spend a lot of time researching those and obviously the consumers spend a lot of time trying to get the right ones to. You know help with different problems. What's your take on probiotics then?
Speaker 2:so see my take on probiotics has always been.
Speaker 2:I mean, I'm one of these people that is opinionated I'm sorry about to say that, uh, we, for a while in my 50 years of practice, for a while the practice practice was colonics. They called it colonics that people go and there are centers that they go and get enemas to get rid of all the bacteria in their colon. Okay, that was the thing that was going on. Then somebody came up with the bacteria that, oh, if you take this, you get less bloating and less gas. And the probiotic business came through. And it's true, those bacterias are probiotics as opposed to antibiotics, but those are regular bacteria in our intestine.
Speaker 2:We have billions and billions and billions of them by adding something that you don't even know whether it's going to make it to your colon or not, because acid in your stomach may destroy them. Things in your small intestine, enzymes will destroy them and even when they get there, there are a few as opposed to trillions of bacteria of the same thing that they're in your colon. What is that going to do? Plus, I always tell people that eat yogurt. Yogurt is the best probiotics we got, at least minimum. You need minimum of three to four bacteria, but most yogurts nowadays, in US at least, have five to seven bacterias in it, and kefir has about 12 bacterias in it and they're all probiotic, they're all good bacterias.
Speaker 2:Okay, so it does. Why are you going to waste your time and pay money and get something, at least kefir and yogurt? They have some proteins and other things too. That's good for you and there's so much bacteria in them that some of them is going to make it there, and even milk, for example, if you have lactose intolerance, drinking milk. Milk is a prebiotic prebiotic for a person with lactose intolerance, because it's going to get into large intestine and all the lactobacilli are going to come and eat the lactose and grow and get more and produce all this gas and bloating. So, okay, you want probiotic, you want lactobacillus, you want probiotic. You have lactose intolerance? Drink half a glass of milk, okay, and then okay, it's going to do the same purpose. So this is why I really, you know, don't buy that idea of use probiotics. And for how long are you going to use it? Every day, spend money. Some probiotics are $3, $4, vsl-3, I'm not gonna name that. Some probiotics are very expensive and they bring it to people's home frozen to charge them on a weekly basis. This is such a huge market, an unnecessary market really.
Speaker 2:And of course you know IBS is related to your food most of the time. So the definition of IBS is to have those symptoms one day a week in the last three months out of the last six months, in three months out of the last six months. If one day a week you have those symptoms, you have IBS, right? That means, okay, one day a week you probably are going to eat something that is going to give you those symptoms and you're going to complain. You probably are going to eat something that is going to give you those symptoms and you're going to complain. So when you give something frozen things that she's paying $5 for each one of them to take per day and now it's going to pay more attention, oh, I haven't had symptoms for the last five days or four. This is very good, and so it just sort of perpetuates this feeling of safety and effectiveness in the person and they continue to use it. So that's why I don't believe you want to use probiotic. Use Activia probiotic, use Giovanni's or Greek yogurt's probiotic.
Speaker 3:They have all of those bacterias in them and they're very good.
Speaker 2:Okay, you know. The same way Russians and Middle Eastern and Greek and Turks have survived for so many years by eating yogurts.
Speaker 1:Exactly Yogurt. What is your most common misdiagnosis that you see with IBS? Like if you could sort of take all those 40 misdiagnoses you have in your book. Is there one that stands out more than others and is there one solution that's more effective for most people?
Speaker 2:Okay, there's two things. One is most common is the food related and making mistake that they just go with one thing like FODMAP. They don't go for other foods. That, including food allergy, the isaccharides, there is deficiencies and so forth. They don't go for other foods, including food allergy, disaccharides, these deficiencies and so forth. They don't go for those other things. That's the most common. The most serious is what I told you about bile salt. Those are the people that really know every bathroom. Everywhere they get fecal incontinence. They get severe stomach pain. That is the most serious and least known. That picture is typical of bile cells. It gets better with some powders. I mean you have to take the powder on a daily basis or a couple of pills, but the powder is what we used to use for high cholesterol before statins came. So it's a great thing. It doesn't get absorbed. Bring your cholesterol down. It's safe and you take it and you're done with it. What's the name of that medication? It's cholesteramine. Cholesteramine Okay, the pill is Questran or Cholestip cholesterol. These are the other names of it.
Speaker 1:Yeah, and when the bile salts get sort of let down, like that, is there a trigger, like if the person's eating like a fatty food or something?
Speaker 2:Yes, yes, there is a trigger, probably. You know, liver makes the bile cell and the bile cell gets stored in the gallbladder and we also reabsorb almost 95% of bile cell in our small intestine. So if there is any problem the gallbladder, you don't have it, so there's no storage place. Your small intestine, your terminal ileum, is sick because of Crohn's disease or has been removed because of cancer of the cecum and can get reabsorbed. If genetically you're making too much bile salt in your liver, if genetically you're not absorbing enough bile, salt in your terminal ileum.
Speaker 2:Those are all things that cause this problem, problem. So the problem is recognizing. This is the pattern at taking care of it and realize.
Speaker 2:Okay, is the gallbladder out, Is the intestine, terminal ileum has been resected, or it's one of these patients? It doesn't really matter. The treatment is the same, the symptoms are the same, the treatment is the same. So recognize that that's important. And there will be a lot of patients or people that they listen to you and they have had severe IBS and they have since acupuncturist and psychologist and they've taken a lot of medication and yogas and so forth, with exactly this Promise you they take colestepol or questran, their symptoms will go away, their IBS will go away for the rest of their life.
Speaker 1:Yeah, and just listening to that may have changed some people's lives. You know this podcast, listening to you getting you on this podcast, I think that is worth the price of admission right there that knowing that that sort of incontinence that they can have, fecal incontinence they think it's IBS but it's not. It's this bile problem.
Speaker 2:Huge. The true IBS is very, very rare. The true IBS is extremely rare. Everything else has a cause for it. It's up to the doctor to find out.
Speaker 2:Unfortunately, going from one to another doctor too often is not helpful and I don't really want to sell my book, but I think that people should, should, uh, get this book that I have is it ibs or your diet? I don't know whether you can see it. Yeah, perfect and is and is amazon bestseller and read it. And doctors especially should read that to get informed and know, you know, and demand their hospitals to get the equipment that's necessary to diagnose disaccharides, deficiencies, sibo and things like that, and so be more informed and care more about their patient's well-being and don't just consider it that, oh, this one is nuts. You know, honey, you go and see a psychologist or psychiatrist. This is in your mind. Maybe you had childhood problem, maybe you had PTSD. This is probably related to that. I gave you this muscle relaxant and antispasmodic and you're still complaining and I told you to take Gasex and I'm frustrated and you know you don't need to come back to me. There's nothing I can do about it. This is usually the interaction that goes on and that's what makes me mad. That's what makes me mad and makes me feel bad about this thing, and I really think I can emphasize this more and if you can do that, you should. The public should get to know about what goes on in this system and nobody complains because everybody is making money and everybody is happy.
Speaker 2:I am making a website that is called. My old website is, uh, is, gerd-ibscom, but I'm making a new website, which is going to be up soon, which is my book. Is it ibs or your dietcom? Okay, and the book is available. It's going to be available free for anybody who wants to go there and read it, because Because I did not write this book to make money. I have written this book to be able to be helpful, in the same way that my website, gerd-ibs, has been around for more than 30 years and IBS for, I think, 17 or 18 years, and it's always been free for people to go and see. This is going to be free too. People can go see, read it, get informed and and do something about their problem if they have, if they're suffering from ideas exactly.
Speaker 1:Yes, I went on to your website and there's tons of information on there and it's it's high level information, it's doctor grade information as well, so it's fascinating stuff yeah, yes, and this in this book too.
Speaker 2:I did the same thing. I originally started writing it for patients, but then in the middle of it I realized it's the doctors as at fault, it's not the patients. So I need to educate doctors and that's why I started made it. So this book is both for doctors and for patients, and I don't know whether you were able to read the case histories amazing case histories at the end, which are these are the patients I've seen in the last two years. Amazing cases that has been missed and very interesting.
Speaker 1:Okay, well, thank you very much, dr Mo, for your message of hope and optimism and also for writing the book, which hopefully will help thousands, if not millions, of people around the world.
Speaker 2:Thank you and it was nice talking to you.
Speaker 1:We should talk more in the future about medical issues you know, I would love to talk to you more about, um, some of the things that people do to themselves, like liver cleanses with olive oil and kidney flushes and that kind of stuff, and get your opinion on on these self-help biohacks yeah, sure, uh, yeah, I'll be happy to, and you know, and I think once we should probably talk about the gear acid reflux. We'll do the acid acid reflux podcast as well. We'll definitely set that up. Thank you very much, yeah, because that's.
Speaker 2:That's so because, just like IBS, a lot of people are suffering from gear. You know there's a lot of misinformation about that too, and I think that if we can help that, that would be great as well. Yeah.
Speaker 1:I'd like that, thank you. Thank you so much for joining me in my conversation with Dr Mo. This message of hope for people who have IBS or, more likely, been misdiagnosed for IBS, is something I think a lot of people need to hear. So if you want to find out his book, I put all the information in the description below and you can go pick up a copy of that or jump onto his website and learn more. Hey look, if you've enjoyed listening to this podcast, I would love if you could leave a comment.
Speaker 1:And I don't do this podcast to become well-known or even for it to reach hundreds of thousands of people. You know I'm a realist, but I do it for my patients. I do it to send this podcast to people who I think need to listen to this, and I'm actually sending these episodes myself. But it would do me a great favor if you know of someone who you think would benefit from this podcast if you could send it to them, and to help spread the show organically. If you could leave a five-star review wherever you are getting your podcast, I would really appreciate that. Hey look, if you want my direct help with anything, just send me an email, ed at edpadgettcom, or visit my website edpadgettcom, and then you can learn a little bit more about how I can help you make your lifestyle your medicine.