Diet Therapy for IBS

Irritable bowel syndrome (IBS) is a chronic and complex disease that occurs in patients with recurring abdominal pain and changes in bowel habits. The disease can be debilitating on a person’s quality of life. We still do not understand the root cause of the disease, but I believe there are many factors. Common treatments of IBS include pharmacologic, psychologic and dietary therapies. It is important to discuss these options with your physician before embarking on a targeted therapy or combination therapies.

Some patients are interested in using diet alone to treat their illness. Aversion to pharmacologic agents and avoidance to see a psychiatrist or psychologist play a major part of this. Ingestion of food triggers may induce symptoms in more than half of patients with IBS. It has been suggested that dietary therapy may regulate the “gut-brain” signaling. Therefore, in my opinion, it is reasonable to start with dietary therapy to reduce this driving cause.  Clinical studies suggest that low FODMAP diet may improve symptoms of IBS. FODMAP stands for Fermentable Oligosaccharies, Disaccharides, Monosaccharides and Polyols. They are carbohydrates found in the diet: fructose (fruits, honey, high fructose corn syrup, etc), lactose (cow’s milk, yogurt, pudding, custard, etc), fructans (grains, onion, garlic, inulin, etc.), galactans (beans, lentils, soy products, broccoli, etc.) and polyols (sweeteners containing sorbitol, mannitol, xylitol, maltitol and fruits such as avocado, apricots, cherries, nectarines, peaches, plums, etc). FODMAPs can swell the intestine and produce gas. If one is sensitive to the effects of FODMAP, symptoms of discomfort, cramping, gas, bloating or diarrhea may occur. Low FODMAP diet may help improve pain, bowel satisfaction and quality of life. There are apps available on smart phones to help guide which foods are high or low in FODMAPs.

Some patients without Celiac disease may report a possible diagnosis of gluten sensitivity due to improvement of their symptoms while on gluten-free diet. The diagnosis of gluten sensitivity is quite challenging. The reason being is that there is no measurable indicator available to diagnose the disorder. Although there is good symptom response self-reported by patients, who are undergoing a gluten-free diet, researchers have suggested that this is likely due to reduction of fructans and other FODMAPs that may co-exist with gluten in wheat, barley, and rye. Therefore, evidence does not support a role for gluten-free as first line dietary therapy. More studies are needed to define the role of gluten-free diet in IBS and other gastrointestinal disorders.

It is also common for patients with IBS to embark on a restrictive diet to improve their symptoms. I also see this commonly done in patients with Inflammatory Bowel Disease or Functional Dyspepsia. A major concern for this is that restrictive diet may lead to nutritional deficiencies and/or weight loss that can result into worse health outcomes. Therefore, I do not recommend this dietary approach without a proper discussion and guidance with a dietitian.

A low FODMAP diet, supported by growing body of evidence, is effective in IBS but should be delivered by healthcare professionals with expertise in diet management. Further studies are also needed to prove the effectiveness of a gluten-free diet, lactose restriction or probiotics in the treatment of IBS.

Learn more about Dr. Pacana’s approach to caring for patients and schedule an appointment at

Colonoscopy: Have No Fear

Colonoscopy is a test use to examine the lining of large bowel or colon. The instrument has a light source, and a lens attached to a video monitor. The test is used for colon cancer screening and for diagnosis of various other diseases involving the colon in patients who may have bowel symptoms like bleeding or diarrhea.

Is the test as bad as it sounds? The answer is no. Fears and misconceptions persist like “will I be able to drink the prep”, or “it may hurt”, “complication may occur”, “I am not the one who will get colon cancer.” The fact is, colonoscopy is one of the safest procedures performed by a gastroenterologist.

Each year, 150,000 new cases of colon cancer are diagnosed and 50,000 people die from it. 60% of these lives can be saved by increasing awareness for screening of colon cancer. Colonoscopy not only helps detect precancerous growths called polyps but also gives the ability to remove them there and then. This prevents colon cancer in future.

Colonoscopy may be inconvenient but it’s not painful. It takes less than 45 minutes and you are sedated during this time. Colon prep these days are split into two halves, first half is taken the night before the procedure and the other half in the morning of the procedure, making it tolerable. In fact, lower volume prep solutions are also available these days.

Chances of someone having colon cancer over their lifetime is 1 in 20 which is high. This can be prevented by timely screening. Bottom line is, do not skip out on screening. Although colonoscopy is one of the most accurate test for colon cancer screening, there are other stool based tests which you may qualify for. So, talk to your doctor and get screened today.

Snow Much Fun: Shovel Safe

This winter has been a long one for Midwesterners. Between the ice, snow, and bitter cold it seems to be never ending. But at last February is here although, it doesn’t look like the snow is over yet. Here are some things to remember before heading out to shovel this winter.

Warm up properly

Shoveling is a very physical activity. It takes a lot of lower body and core strength. Just like you warm up and stretch before you work out you should do the same for shoveling. Make sure to stretch out your legs, hips, shoulders, and back before you head out to shovel.

Dress warm/wear proper footwear

Make sure before you head out to shovel you are dressed in layers. Covering your face and hands is very important.  Wear proper shoes or boot with good treads. Having snow or ice spikes/boot grips can improve your traction and more importantly prevent a fall or injury. 

Dr. Deepak Patel shovels this driveway this winter.

Proper technique

First, make sure you pick a shovel that is the correct, weight, height, and shape. When you shovel, focus on lifting with your legs and not your back. Hold your core tight to protect your back when you are lifting the shovel. Square up your shoulders and hips to the area you are shoveling. Pivot your entire body to the move the snow instead of twisting your upper body. Shovel small amount of snow at a time to decrease the weight of the shovel. Take breaks when need to avoid fatigue causing poor form.

Put on your coat

Sparkling snow. Christmas lights. Hot chocolate topped with marshmallows. Winter can be a magical time for both adults and children alike. That is, until you have to try to convince a three year old to wear his puffy winter coat at 7 in the morning. You plead, you beg, you tell him about how he is going to catch a cold. Which technically isn’t true since the common cold is transmitted through a virus. But research is on your side as some studies suggest that feeling cold might actually make us more vulnerable to getting sick if we already have a virus in our system. So, you do have a good case. But unfortunately, he doesn’t care. A coat is bulky, restricting, and down right not cool. Being a mom, I have a few tricks under my sleeve that I would like to share with you.

  • Find a jacket that isn’t so “puffy.” It is amazing how advanced jacket makers have become with finding thin material that still keeps you warm.
  • Take your child shopping with you to help choose a jacket he/she likes. As much as we adults love the brown and black sleekness of our coats, kids like bright colors and cartoon characters. If Elsa is what it takes to get them to enjoy wearing a coat, then so be it.
  • Let them learn to put on their own jacket. Kids love being independent and rather than you grabbing them and forcing the jacket on them, letting them have control over it, makes the experience so much better for both of you.

Now you have finally gotten the dreaded jacket on your child. I have good (note the sarcasm) news for you. After all that work, you now have to make sure to take off their jacket before putting them in their car seat! Learn more about how to navigate winter coats and car seat safety from the American Academy of Pediatrics. 

Flu – The “Hulk” Version of a Cold

The seasons are changing – warm summer days at the pool will turn into cool fall days. As a pediatrician, I can tell the seasons have changed as my appointments go from nearly all school physicals to sick visits. This also means flu season is almost here.

The flu, or influenza, is “the Hulk” version of a cold – it is longer lasting and more intense than your typical illness. If you get the flu, you can expect to be sick with fevers, body aches, coughing, runny nose or congestion, a stomach ache and possible vomiting. These symptoms with typical colds last for 7-10 days. With the flu, you tend to have more intense symptoms for longer – 14 days is more typical.

Influenza does not discriminate – it infects the young, middle aged and old, male and female, those who eat healthy and those who don’t. It is spread by respiratory secretions: sneezing, boogers and coughing basically! It tends to cause the worst illness in the very young (newborns, infants, toddlers) and the elderly.

While for most, the flu will be a miserable few weeks of illness, those who are less lucky may have complications. These complications can require hospitalization and range from ear infections, pneumonia, meningitis, and most terribly, death. Last season, hundreds of thousands of people were hospitalized and deaths reached record numbers: nearly 200 children were among those who died after contracting the flu.

I’ve painted a pretty bleak picture, I know. So what can you do about this for you and your family? While I can’t offer much to prevent the common cold that will start to frequent our communities soon (other than hand washing and staying away from sick people), influenza is something I can offer some protection from: with the flu shot! Everyone with a working immune system (i.e. not fighting cancer for example) from ages 6 months and upward can and should get a flu shot yearly.

I know, I know…no one likes shots. And the flu shot gets a really bad reputation – I hear all sorts of reasons people don’t want to get the flu shot. People tell me it made them sick, it didn’t work, they are afraid of the side effects of the shot, or they haven’t gotten sick after skipping the shot in the past so don’t see the need for the shot of prevention. So let’s talk about the vaccine a little bit…

The flu shot is a killed vaccine – it cannot give you the illness. Most viruses, though, hide in our body for 3-5 days before producing any symptoms. So many people who get sick after getting the flu shot were already harboring their illness before they got their shot. In other words, it wasn’t the shot that got them sick.

Vaccines don’t work immediately either – to build full protection from the flu vaccine, you need to give your body 2 weeks to respond – this is why we recommend vaccination by November at the latest to protect yourself well before flu is heavily circulating. In kids 8 years old and younger, the first year getting the vaccine will require 2 shots separated by 1 month. Every year after that is only one booster.

Now I’m going to be honest with you: the flu shot isn’t perfect. There are multiple strains that circulate and the virus is smart and can morph mid-season. These facts make it hard to make a perfect vaccine. It also means the vaccine is only moderately good at fully preventing the flu.

Even so, if you come down with the flu after receiving your flu shot, your illness should be milder since your body has some awareness of the virus already.

Additionally, while full prevention may only be modest, prevention of severe illness and complications is excellent in those who receive the flu shot. In those who died of flu, more than 80% were NOT vaccinated. That’s a powerful statistic.

Beyond this, comparing risks versus benefits of getting the flu over getting the flu shot, the benefits of the vaccine WAY outweigh the risks. Risks of the flu shot may include allergic reaction (which is so rare that even people with allergies to components of the shot are recommended to still get the vaccine), redness, welt, soreness at the site. Other more scary reactions are so rare that they are hard to even quantify. On the other hand, risks of influenza are easily measured (remember all the complications I mentioned above), and occur to thousands of people across the globe annually.

Here’s the thing. You probably won’t get the flu every year – some estimates are that people contract the flu every 5-10 years. So sure, you could try to get lucky and not get your flu shot. But, you getting your flu shot not only gives you a chance at prevention, it also helps stop the spread of flu in the community. You getting your shot helps keep the newborn next door, your grandma, your friend with cancer and the rest of your family from getting the flu too. The more people that get protection, the less the flu will take hold of our community.

On a final note, I choose to have my family vaccinated every year from the flu. This is my choice. I would never recommend anything to my patients that I wouldn’t do for my family. We all got our family flu shots this year together! I’m pregnant as well which means my baby will have some protection via the womb after birth. Yes – pregnant women should also get the flu shot to protect themselves and their growing babies.

So here’s the message: get your flu shot and get it now. For yourself, your family, your pregnant friend, those with compromised immune systems (everybody knows someone with cancer, right?), the newborns and the elderly. Encourage others to get protected as well. Not only will the vaccine help you stay well, it will help keep others well too! As always, if you have questions, talk to your doctor about your specific health situation.