How to Eat to Relieve IBS and Heal Your Gut with Dr. Angie Sadeghi

hello hello hello we are back for another edition of the forks over knives webinar series today we are here with none other than dr angie sadeggy dr sadeggy how are you today i'm doing excellent how are you uh i'm doing fantastic i'm doing fantastic um i'm actually very excited to hear the talk that you're going to give today i heard little snippets of it last week about gut health and how you can improve your gut health using a whole food plant-based diet uh i've been following your work for the past couple of years and personally i find gut health to be fascinating so uh i feel like there's a lot of people in today's world who really don't know that much about gut health are sort of like heard murmurs about the fact that your diet definitely influences your gut health so i'm hoping that we can get into a lot of detail today and learn a lot about it i'm excited fantastic so uh today's webinar is going to be specifically about ibs and gut health and dr sedeghi is a world's expert on ibs and many other aspects of gut health and she's going to go into a lot of detail here about what is ibs what causes it and how you can actually change or manipulate ibs to your advantage she always comes prepared to share a ton of evidence-based information so if you don't have a notepad and pen handy then go grab one right now because trust me when i say there's a lot of information that's going to come into this webinar and even if you have an opportunity to take a couple of notes or draw a couple of pictures it'll help you retain the information uh into the future so there's already a total of uh over 1100 people here and i'm sure we're gonna get even more than that so um if you are here with us right now um first of all thank you for being here with us in the middle of the day um do me a favor in the chat box and tell us your name and where you are from we love to see just how diverse of an audience we have and from what different parts of the country and maybe even what other countries are coming from so don't be shy angie uh can you see the chat box by any chance i i can see things flashing through thousands of people riding in this is exciting new york arizona texas look at that wow sometimes i don't even know why i ask people to write things because it comes in so fast it's impossible to read kind of cool you can look at these later and yeah okay so uh now another thing that i would like you guys to do is if you are plant-based write the number one in the chat box if you are not plant-based write the number two in the chat box and then if you're somewhere between plant-based and not plant-based right 1.5 and that will give us a good idea here of the approximation of what you guys are currently eating and what you guys are currently following again even just single numbers is hard to look at but i see a lot of 1.5 is coming in there were a lot of ones originally if i had to take a guess i would say that the audience is at an average of like 1.4 maybe like 1.3 something like that so so okay so we're gonna have a lot of fun here today uh we're with dr sadeghi uh she is an integrative gastroenterologist and a diplomat of the american board of internal medicine and the american board of gastroenterology in other words she's incredibly smart uh she's the president and the ceo of the brand new health institute uh known as the institute of plant-based medicine and that is in newport beach california and she is the co-author of a book called the trifecta of health she's got extensive training from the university of southern california and she and her entire career has been committed to the excellence in treating diseases specifically of the digestive tract uh so today dr sadeggy is going to teach us a couple of things number one what is ibs uh are you going to be able to by the end of this you'll be you guys will be ibs pros and you'll be able to understand the causes and the effects and most important what are the actual symptoms of ibs because if you're living with some type of gastro uh gastrointestinal discomfort gas bloating constipation diarrhea you name it some of those might be linked to ibs some of those might not be number two you're going to learn about food allergies how food allergies and food sensitivities and ibs are actually linked together and you're going to get dr sedeggi's take on the low fodmap diet i'm sure you guys have probably heard about the fodmap diet before and in case you haven't she's going to give you some insight into that uh we're also going to learn about how integrative medicine can treat ibs by blending evidence-based nutrition and lifestyle changes with cutting edge medical approaches so there's a lot to be learned today um dr sedeggi how is life in southern california right now sunny warm and beautiful that's awesome so yeah you guys have been uh creating your uh the the health center over the past year now is that right yes um it's so exciting we brought all these evidence-based practitioners who are passionate about helping people integrate nutrition into their practice and i'm just feeling amazing about this because we are going to help so many people prevent disease reverse disease and um you know we're not against the western medicine and um medications but we want to minimize that as much as possible so we want to integrate nutrition to help people improve their disease process without the use of medicines hopefully you know it's always funny to me how the term reversal disease reversal is like this new concept in the world of medicine and there's a lot of traditional doctors who don't necessarily understand what what that really means and and how you can actually reverse pathological processes like hypertension high cholesterol diabetes uh you know diseases of the gastrointestinal tract so the fact that you guys are focused on not just managing but reversing is incredible thank you yeah that's the goal absolutely so uh just a quick rundown and for those of you guys who don't know who i am my name is uh cyrus kombata uh i have a phd in nutritional biochemistry i've been hosting these webinars for the last couple of years i have been living with type 1 diabetes myself since the year 2002 so that's 18 years and in the process of transitioning to a plant-based diet even before forks over knives was a thing back in 2003 i found incredible benefits to not only my blood glucose values but my insulin use also went down dramatically in addition to that my energy levels are through the roof i can exercise as much as i want i feel like a million bucks i'm the co-founder of a business called mastering diabetes and we teach people living with all forms of diabetes how to transition to a plant-based diet to improve their overall health uh i'm going to be your host today so dr sedeghi is the expert i'm just going to be here to make sure that this whole thing goes down exactly the way we would like we could not vote for a better host thank you why thank you so much uh so before we get into the presentation today let's see let's just check the we got a total of about 1500 people here right now which is fantastic so um before we get into our presentation which again is going to be action-packed uh i'm going to show you guys uh the forks overnight meal planner because i really want you guys to to learn about what it is and see how we can actually make a huge difference in your life so i'm gonna switch over right now and i'm gonna share my screen and uh see if you guys can see this here we go okay so one of the things that i love about the forks over knives team is that they are truly committed to making uh it possible for people living with all forms of for people living around the world either living with chronic disease or not living with chronic disease transition to a plant-based diet they truly just want to make everyone healthier it's just that simple and just like dr sedeggi they understand that adopting a whole food plant-based diet can result in a number of positive changes to your body so one of my favorite tools that they make is this forks organized meal planner which i'm going to run you through here in a second this is a tool that i've been using for myself and have been recommended to all of my clients living with all forms of diabetes it's completely free to try for two weeks and i want to show you guys exactly what it's all about so let me show you what it looks like on the inside uh the first thing you're gonna do when you get inside of the meal planner is select your goal uh and then you're going to select how many people this meal plan will be for you can select whether you have any food intolerances or any preferences i don't so i'm just going to say next next you'll create an account by typing in your email address and then you'll enter your name and write down your password the this account is free and there's absolutely no credit card required you'll get two weeks for free to try it out and this is 100 risk-free trial uh now when you get inside the meal planner the first thing that you're going to see is your meal planning dashboard every week the chefs of forks over knives will send you a five-day meal plan with delicious recipes that can all be prepared within 35 minutes or less you can also add the sixth and seventh days if you choose another great thing about the meal planner is it is 100 customizable so as an example i can simply click to remove this spinach artichoke dip because i don't want it okay it's not part of my meal plan i'm not excited about it right and if i'm really not feeling like the veggie fajitas on any particular day i can just click swap and i can choose something else so the meal planner is going to let me browse for a recipe or i can even type in the ingredients that i have in the fridge which is truly unique so in my fridge right now i have tomatoes i have lentils and i have carrots now you'll see a whole bunch of recipes that are presented and we can scroll through all these delicious recipes and personally i like the lentil bolognese right here in the top and i'm going to click on that guy because i really want that in my meal plan so when it gets to the meal plan if i want to switch that out with the green goddess bowl because you know i want to split-flop their positions i can literally just drag and drop the little bolognese for the green goddess bowl and that's that and there you have it that's my entire meal plan for the day but something that's really cool about this is that this meal planner auto generates my grocery list and my weekend prep cheat sheet so let's go into the grocery list next don't forget you can try all this stuff out for two weeks for free okay in this grocery list it has all the ingredients that i need for my meal plan and it's already added so i can check off the items that i already have at home and then i can access this meal planner when i'm shopping uh for the items at store i can also add my own ingredients to the list if i need other things so in today's world everyone needs toilet paper so there you go i'm just gonna add that right there okay now uh one of the features that i think really sets this meal planner apart from everything else besides the fact that you can also get toilet paper is that there's a weekend prep cheat sheet and here you'll get the weekend prep guides that teach you how to cook how to bake and how to freeze everything so that you can really use everything to it in the most efficient manner and you can do this and it'll save you time and it'll save you a lot of money okay the weekend prep streamlines things so i can literally just throw meals together to save myself a lot of time on busy days and with one click i can even print everything out to a pdf and then i can take that pdf and i can do whatever i want with it so there's plenty of stuff to explore in the meal planner but hopefully you guys get a little flavor for how it works if you're considering joining the meal planner or even if this is your first time hearing about it be sure to take advantage of the 14-day free trial there's no credit card required to try it out and therefore you have nothing to lose so simply just go to forksovernive.com love plants and get started for free this is going the link is also in the chat box for you as well you're going to be amazed just like i was and how easy and fun it is to create delicious meals every single day and the plant the forks overnight team is here to make your transition to a plant-based diet a success so with that in mind now we can transition over to dr sedeggi you ready to uh take this webinar to the next level yes that was pretty cool i know it's really important i was like is it gonna spread out a recipe with toilet paper yeah that's next week's meal plan actually advanced all right let me find this presentation here really quick okay so for those of you who are interested in learning about gut health there's there's a few gut health experts on the planet that i personally consider to be uh the smartest people in the world when it comes to gut health dr angie sedeggi is absolutely one of them so you guys are very fortunate to be here with her today and uh any questions you guys have thrown in the chat box and we're going to do a q a at the end and hopefully we can get to as many of those questions as possible all right i'm going to talk about irritable bowel syndrome here's our website if you guys are interested um thank you for inviting me today i'm really excited to talk about irritable bowel syndrome because it is a chronic disorder of the gi tract and so many people suffer from irritable bowel syndrome the prevalence rate in north america is reported as 12 i would say more than half of my practice is irritable bowel syndrome it usually occurs in patients younger than 50 years of age i put this up here for you because look just looking at this you'll see how a doctor considers irritable bowel syndrome as your diagnosis there's something called the room for criteria for ibs and so if you qualify for this um they give you um this diagnosis of irritable bowel syndrome usually you have to have some kind of a pain abdominal pain that is chronic longer than six months that occurs um one time per week or more the pain is related to defecation there is a change in the frequency of stooling and a change in the form or appearance of stool there are some red flag signs that must be considered so your doctor will make sure that if you're older than 50 they would do a colon cancer screening test for you to make sure it's not colon cancer manifesting as pain and changing the bowel habits uh they would make sure that there's no bleeding such as red blood or black blood which is called melanoma and those things need immediate attention if the passage of stools at night that's a little bit weird usually irritable bowel syndrome with the bowel habits uh problems occur during the day if there's unintentional weight loss family history of colon cancer and some other things so your your doctor will evaluate all these things before they say oh you have irritable bowel syndrome if you want to know what irritable bowel syndrome feels like imagine someone's like putting their hands and fists inside your belly and squeezing your colon this is a very painful condition the pain comes can come suddenly and feel a cramping pain and it's just awful it really lowers people's quality of life um and people usually have alteration in bowel habits where the bowel bowels can be the stool could be a type 1 which is like rabbits pellets very hard stool hard to val evacuate people get a feeling of incomplete evacuation type 2 which is also hard and abnormal type 3 same thing type 4 is supposed to be normal and ibs patients can often have normal stools but it will fluctuate from type 1 to type 7 which is watery stools um so people with ibs will come with extremes some people will have type 1 and 2 all the time some people will have type 6 and 7 all the time and then there are other people who just kind of fluct fluctuate on a daily or weekly basis so there are a lot so about approximately 40 to 60 percent of patients experience comorbid psychological disorders such as depression and anxiety i'd say i only have a handful of patients in my clinic who have ibs who don't have um either depression or anxiety so it's very common so if you have this you're not the only one there's also higher levels of somatization compared to patients without ibs um this is placing significant focus on physical symptoms which is such as pain and weakness that result in major distress the the individuals have excessive thoughts feeling and behavior related to their physical symptoms um not surprisingly um ibs has been shown to negatively impact patient patients quality of life people spend a ton of money on treating their ibs um you know most people start with their family physicians then they end up going to one two three or four gastroenterologists then when they continue to have ibs symptoms they usually go to alternative medical practitioners and um they spend tons of money and today i want to kind of teach you what ibs is about and how it's caused and teaching pathophysiology of ibs and once you've had some work up i want to reassure you that you're going to be okay so you don't fall into the same trap of spending hundreds of thousands of dollars trying to treat your disease and at the end of the day by doing some of these non-evidence-based uh practices you could actually ruin your health now to help your health so i want to i want to hopefully walk you through this most people with ibs have had imaging studies laboratory studies stool studies breath tests and um everything under the sun and they're still having problems and you know so it's really important for you to get some kind of reassurance and not keep doctor shopping or practitioner shopping um so pathophysiology of ibs which causes gut dysfunction there are one two three four five six here that i'm going to go through with you slowly and teach you every single one of these six things that can that cause ibs and one may have one not the other but most people have um everything going on at the same time which causes the symptoms and then i'll talk about diet i know you've all been waiting for that so after the pathophysiology i'll dive into diet a little bit and um i'll conclude um with certain treatments so if you look at the epithelium of the gut so it's it's a long tube that has blood vessels coming into it that bring blood for oxygen and drain blood with nutrition nutrients for away from the gut inside the gut it's so exciting there's these villi which are like they look like finger projections inside the gut that line the guts lining um if you look at the villi um under the microscope it's just these uh peaks and valleys and these peaks and valleys increase the surface area of the gut and allow all these nutrients to get absorbed into the blood vessels and away from the gut and into the rest of the body so if you actually look under the microscope at it add the villi but just pay attention to all the cells like we're just getting very cellular and very microscopic here these cells are joined together via these things called the tight junctions um so i i wish i could like point to things i don't know if you can see my pointer but these are tight junctions and what they do is they hold these cells together so these cells are holding hands via these tight junctions um on top of the cells or the epithelium are these vely which i told you grab the nutrients on top of the villi is this healthy mucous layer that protects the villi and the rest of the cells from pathogens so there's all kinds of pathogens good bacteria unhealthy bacteria viruses everything that lives on top of these this mucous layer the health of this mucous layer is important because if that mucous layer is gone what happens is the bacteria and food particles and toxins can freely find access into the blood vessels and that is called leaky gut so the mucous layer is important so are these tight junctions between the cells and so the figure on the right shows what happens if the tight junctions are gone and the mucous layer is destroyed things just free flow inside the blood vessels and and that is called leaky gut but how does that cause inflammation in this cartoon what you're looking at it's actually was in a paper where it talks about what happens if you eat a high fat diet not just any fat but saturated fat um you look at these this these cells are all tightly bound together these goblet cells which are producing that mucus layer i was talking about these um there's microbes living out on top here but over here underneath the cells we're getting a little bit more detail now and i'm going to show you what happens when you get leaky gut and how you develop inflammation over here normally you have these white cells living under here these are lymphocytes but these are um these lymphocytes are in in in a stat state of health right now and they're producing cytokines that are anti-inflammatory so this is all if everything's going well things are good but this is what happens when you get that leaky gut where you get the the tight junctions are severed and the mucous layer is almost gone what happens is you get these fatty acids that free flow inside the submucosa or the laminopropyl it's called and all these um bile acids that come in here and guess what those nice lymphocytes that were sitting there and they were anti-inflammatory suddenly get angry because they're encountering lipopoly saturates bile acids and oxidized fatty acids and the lymphocytes get stimulated angry and they spilling out or are spitting out all kinds of cytokines and pro-inflammatory molecules and that's how you develop inflammation here this was a high saturated fat model that i adopted from this paper but we'll talk about more about nutrition in the in a little bit but what happens if you're eating a fiber free diet so in this schematic diagram the authors here showed that if you're eating a fiber-rich diet um their steady state here the cells are happy the they're tightly bound together by the junctions the mucous layers uh is intact uh the organisms are living under on top of the mucus very nicely here's what happens if you take fiber away in a fiber-free diet these organisms that um love fiber stuff start eating the mucous layer and when they eat the mucous layer the mucosa gets exposed to bad pathogens so it's really important a high fiber diet is key for a healthy gut the gut microbiome is not just bacteria there is bacterial viruses fungi archaea and protozoa collectively the genome contains at least a hundred thousand hundred times as many genes as our own eukaryotic genome um in this figure you can see the gut microbiome living on top of the villi there are a hundred trillion of them living in there in a symbiotic relationship with humans um and there's there are some in the stomach there are some in the small bowel here and the majority of them reside in the colon or the large bowel if this balance is um somehow disturbed and there is more bacteria than normal living in the small bowel that's a condition called small intestinal bacterial overgrowth which is very closely related to irritable bowel syndrome and i'll talk about that in a little bit so um there are remember i told you that there are um several mechanisms that cause ibs and we talked about ibs being caused by um the tight junctions being severed but the second mechanism is dysbiosis the gut microbiome is disturbed um there are microbiota species that are increased in patients with irritable bowel syndrome such as the ones listed here and there are microbiota species that are decreased in irritable bowel syndrome such as the ones found here so there's definitely dysbiosis going on in irritable bowel syndrome besides the tight junctions being suffered um there's organisms called archaea rk are not bacteria they're their own um little um they're in their own little world and they act very differently than bacteria and they don't get killed by antibiotics but usually the intestinal gasses are removed by these methanogenic archaea organisms they produce methane gas normally these archaea remove the gases but there seems to be a deputy depletion of these archaea organisms in patients with ibs so the gas perhaps hangs around longer and um they're negatively correlated with presence of loose tools so basically if there's a lot of archaea methagenic producing bacteria there is more constipation if there is less of them there's more diarrhea so less archaea means more loose stools um abundance of archaea's um is is what causes a lot of um constipation and patients usually with irritable bowel syndrome with constipation have abundance of archaea species um so there's definitely um dysbiosis going on um but you know maybe it's not ibs maybe it's sibo and that is uh something that has to go through every person's mind if every gastroenterologist who's evaluating patients with irritable bowel syndrome because a significant majority of patients with ibs have concomitant sibo and sibo is a condition where there's over abundance of bacteria or organisms in the small bowel where it doesn't belong and there's over production of gas and this causes people to feel super bloated um and you see this patient is feeling super bloated but a lot of times they don't even look bloated but it's the feel that counts people feel so bloated they feel like a balloon they they tell me that they wake up in the morning with a flat stomach and during the evening they feel like they're pregnant and they show me before and afters and it's pretty significant um but you know then so we talked about tight junctions being severed we talked about dysbiosis uh we talked about sibo but the third way that you could have ibs has to do with the immune response so how do we know the immune response is even involved in people with ibs because infectious gastroenteritis is a strong risk factor for development of ibes in fact 20 of ibs patients describe an acute infectious gi syndrome uh several months or years before um and occurs uh between 40 to 30 percent after bacterial or viral enteritis uh it's usually diarrhea predominant and you know i can tell you i have about five patients listening right now who had this happen to them um and so the typical story someone goes down to to it goes to a country like let's just say mexico because we're close to mexico and a lot of people travel there they have some kind of a traveler's diarrhea uh they come back they get rid of their diarrhea and their infection and they get stuck with ibs for the rest of their life so this is called post-infectious ibs and many people describe this happening to them having had happen to them before they got diagnosed with ibs um as far as the immune response so then you may say okay fine there's a history of some kind of an infection but how do we really know there's an immune response involved well if you look at the mucosa of patients with ibs you will find t-cells and mast cells hanging around and i found this in a study where shows there's all these mast cells uh left side it's normal right side there's more purple there's mast cells sitting in there and so what happens exactly these mast cells are kind of cool they have these um granules um basically inside of them and when they get angry they release these granules it's basically considered a centennial strategically located in the interface between the host and the external environment so what happens is there's a there's two ways where they get activated if there is ige the sun immunoglobulin that has recognized an allergen in the past and is swimming in your blood and as soon as it sees an allergen it can bind to this receptor and cause the release of these granules or it could just be a neural hormonal stimulation like stress that causes release of these granules when they get activated these mast cells release these biologically active granules such as histamine serotonin and proteases cytokines and other metabolites and so depending on what kind of granules are being released you'll have different allergic responses histamine causes itching serotonin can cause diarrhea um you know proteases i'll talk about later can um can break stuff down in the gi tract cytokines and other metabolites can cause pain so so these mast cells are very important to play an important role in allergies and and ibs so let me show you what happens if you look at this purple cell if this is a mast cell this muscle is sitting right under those cells that we talked about and they produce histamine and proteases these histamines and proteases can really irritate these visceral efferent nerves these are the nerves that are traveling um right underneath the cells of the gut and they're actually also communicating with the muscles of the gut so these muscles release these uh histamines and proteases and really activate these uh nerves and irritate these nerves so you can see there's so much going on underneath the gut cells and um and these food particles here imagine if there's no tight junctions right if the tug junctions are severed these food are particles can come become irritate these mast cells mast cells do produce these granules release these granules and that causes the nerves to get damaged not damaged irritated so but but you know perhaps there is this um sensitivity of the enteric nervous system and that has been studied and there is a basically it shows that perhaps the nervous system in in irritable bowel syndrome patients is just overreacting you know i put the picture of this woman overreacting you know and that's true that perhaps there's more mucosal neurons sitting in inside the bowel of someone with ibs compared to someone who doesn't have ibs and that's where this exaggerated nervous response comes from but if you look at this study what they did is they put gas and fat lipids inside people's bowels and they looked at what happens with healthy patients and ibs patients it turns out that there is more more gas retention in ibs patients than healthy individuals the abdominal distention was worse in patients with ibs rather than healthy people compared to healthy people and the patients actually reported more um abdominal pain and symptoms compared to healthy people so there's ex definitely an exaggerated response this other study shows that if they took people with no ibs and patients with ibs and they put gas inside both people equal amounts of gas the patients with ibs are like ouch this hurts people with no ideas have if they're indifferent and they just don't even feel pain so there's definitely an exaggerated neuronal response um what about the brain gut access could the brain gut access be involved absolutely why how do we know that well number one ibs is nearly always associated with increased anxiety and depression patients have co-morbidities such as chronic pain psychiatric conditions fibromyalgia um and so there is more of a widespread dysregulation of the immune system and nervous system that that that you think of the brain absolutely influences the gut you you know the brain influences the intestinal motility or movement fluid secretions um epithelial permeability or leakiness immune function and a gut microbiome composition and i'll show you that in a diagram here um so the the brain sends orders uh to the uh so here's the brain it sends all kinds of signals through the spinal cord and the spinal cord through thousands and billion millions and billions of trillions i should say of nerves sends signals to the gi tract and and the adrenal gland so the brain spinal cord and the gi tract are absolutely connected uh the signals from the g the brain comes down to the gi tract these are called the enteric nerves and the enteric nerves produce molecules that um basically influence the gut microbiome which produce other molecules and that circles back to the brain so it goes from the brain to the spinal cord to the enteric nerves stuff gets produced the gut microbiome is influenced signals get produced by the cells and by the gut microbiome and signals circle back into the brain so this is called the brain gut axis and it's a circuit and everything comes into the gut uh things get influenced and influences go back into the brain that's the brain gut access and imagine all these enteric nerves that sit under the cells and are being influenced by the gut microbiome by the nutrients that you're eating uh by everything else these nerves influence the muscles that are sitting right underneath the uh the epithelium layer there's more nerves so there's tons of nerves that are just traveling through the gut under the cells influencing the muscles so for example if you're having um some kind of a diarrhea disorder perhaps these are excitatory nerves that are being um producing a lot of excitatory neurotransmitters which excite these muscles that are traveling under the cells which move fast and that gives you diarrhea the opposite is true too if you have inhibitory stuff going on and these nerves slow down the gut then what happens is the muscles don't move fast enough then you don't have enough peristalsis going on and you get constipation so what about bile acids um that was the last mechanism that i had listed under pathophysiology and yes there there it seems like bile acids have something to do with it as well so that's why a low fat diet is always recommended my dietitians and i put all my patients with our patients with irritable bowel syndrome on a low fat diet meaning low in saturated fat uh not good fats so you do want to eat more of the good fats like avocados and nuts and seeds there's a picture of fish here i'm not condoning that you eat fish um morally speaking i i'm not for that but um you know the fats if you're gonna eat uh meat um i hope it's not one that is uh contains a lot of saturated fat um you want to consume a lot of the omega-3 fatty acids rather than saturated fat found in beef and cheese ice cream and french fries and all those so-called bad fats what happens is that when you eat a high-fat diet cck gets produced and stimulates your gallbladder to produce a ton of bile acids and bile acids um so this is a study that shows that the bile acids are tremendously higher in when you eat a high fat diet especially saturated fats i'm talking about and these bile acids convert with via the gut microbiome um the enzymes by the gut microbiome turn into secondary bile acids which are toxic to the gut so the lower the fat content which is bad fats in your diet the better off you are so i know you've been all waiting for me to dive into diet it's like okay we understand what causes ibs but what do we do about it all right well there's this low fodmap diet that has been studied in ibs um which is low dietary content of fermentable oligosaturates disatroids monosaturates and polyols obviously that's very difficult to repeat so we call it the fodmap low fodmap so low levels of all these things it can improve symptoms of some but not all ibs patients um i can tell you i'm not very i'm not a big fan of this uh diet i'll show you why um these are really good stuff that you're eliminating out of your diet and um and i'll show you some other things so pretty much common foods uh containing fodmaps tons of fruits uh vegetables grains legumes and uh a lot of these things happen to be very good for us and they actually uh inside the gut uh lead to the production of short chain fatty acids which i'll show you are really good for us so when you avoid these great foods um based on the low fodmap diet you're actually perhaps hurting you're not not helping now very very early in my career i looked at this and i was like oh look at this there's lactose here so maybe people feel better when they do the low fodmap because they're avoiding the lactose and the dairy so i started asking my patients not to do the full fodmap but just avoid the dairy and lo and behold people felt so much better some people still continue to have problems so if you're having ibs symptoms the very first thing you want to do is avoid lactose and all dairy and see what happens um of course you know there are people with other things but i'm just saying that's one of the first things you should do but what are the limitations of the fodmap diet eliminates a lot of prebiotic rich foods decreases the gut microbiome diversity some people end up end up eating a lot more animal products with saturated fat which i showed you is not good for you because they're so limited on the low fat map diet it does not cure ibs it's merely a band-aid therapy it's a short-term solution even the authors of the paper who introduced the loaf of map diet said not to go on beyond six weeks reintroducing of foods is so difficult it's like how do you know what to bring back right it's just very difficult and they compared this low fodmap diet to this traditional dietary advice for ibs and guess what this was a large study randomized control trial both did the same so really there's nothing special about the low fodmap diet compared to the traditional advice which was hey eat less legumes and cauliflower and eat smaller portions so there's nothing special about the low fodmap diet and honestly the very first thing people should do is avoid dairy so why not avoid all these uh fodmaps so i'm sorry why am i saying not to avoid the fodmaps and why am i saying don't do the low fodmap diet well simply because fiber-rich foods and fodmap foods uh basically get digested by or fermented by the gut microbiota and produce short chain fatty acids such as butyrate proprionate and acetate these are called short-chain fatty acids which actually stimulate the cells of the gut to produce all these anti-inflammatory products and molecules which cause the inflammation under the mucosa to go away so these short-chain fatty acids are so essential for the health of your gut furthermore besides their anti-inflammatory effects they keep those tight junctions between the cells very tight and intact and they remember i showed you the goblet cells they stimulate the gulp with goblet cells to produce mucus that nicely uh shown um schematic thing in the blue shows that this is like the mucous layer that's nicely covering the cells so they these short-chain fatty acids are so essential for the integrity of the gut lining and so whenever a diet asks you to eat less fiber you have to realize that it may not be a good long-term solution um in this study they showed the most common food sensitivities and most common food allergies are as such all right so i see a lot of people come to my clinic and they say you know i was having problems i wasn't i'm i was a vegan and people told me to eat fish and eggs really because that's like two of the most common food allergies fish and eggs right there um dairy yes i agree a hundred percent now what i do is i test my patients for uh weed sensitivity and wheat allergy and tree um nuts um allergies and i always tell people do not eat dairy it is bad for you um the the if you i mean obviously morally speaking eating dairy is is in my opinion absolutely criminal however um if you don't care about the moral reasons look at how um the prevalence of lactose intolerance is so much higher in patients with ibs than the controls so dairy is definitely not a good thing what about a high protein diet so should you eat a lot more protein and lower your carbs because you don't want gas production well let's look at the data it turns out that people with ibs may have problems with protein degradation the luminal content of patients with ibs shows that there is a lot of proteases these proteases break down protein and so this could be due to the increased secretion of proteases from the microbiome or it could be because people are eating a ton of protein and that increases the production of proteases nevertheless these proteases are not good because they can break down those tight junctions inside the gut and cause potentially leaky gut so eating a high protein diet is not necessarily good again i'm going back to saying look eat a lot of fiber yes you may have a little bit of a hard time with the gas production because you're more sensitive to it but eating more protein may be a short-term uh treatment because you're not getting as much gas but you could be causing harm to your gut um so serine protease inhibitors are produced by a lot of the bacteria including also serum protease inhibitors are these guys that actually uh uh break down the action of these um proteases but they're usually produced by the bifidobacteria which actually is deficient in ibs patients so um pretty much these um these proteases which are supposed to break which are um they're supposed to be cleared out of your gut they're not cleared out uh efficiently so um they're hanging out breaking down the tight junctions and they're not getting cleared as well because of dysbiosis in irritable bowel syndrome patients and decreased levels of bacteria such as bifidobacter that clear out these proteases so another way of showing you how a high five a high protein diet is actually could be bad for you is that when excess protein is consumed it goes inside the colon inside the large bowel and actually gets fermented by the gut microbiome to things like ammonia and amines and hydrogen sulfide and phenols indoles and these are actually literally toxic to the gut so when my patients come in and they say you know i switch to a high protein diet because carbohydrates are just not good for me because they cause problems i i feel bad for them and i have to sit there and counsel them don't do that a high protein diet is not the uh treatment choice you should uh choose i'm not saying eat a low protein diet however you should eat a whole food plant-based diet which contains right about the amount of uh protein that you should consume what are some of the testing diagnostic testing for ibs well when you meet your doctor they'll do a comprehensive blood count stool for blood because if you have blood in the stool you need a colonoscopy you will have a routine colon cancer screenings has to make sure this pain and diarrhea and conservation is not due to some kind of a colon cancer you'll have inflammatory markers to make sure that you don't have some kind of a inflammatory bowel disease calprotectin does indicate whether there is inflammation you'll have stool cultures to make sure it's not some kind of an infection you may have a colonoscopy to make sure you don't have microscopic colitis other types of colitis and that is just ibs so red flux signs will have to be ruled out and your doctor will do that for you but once they give you reassurance i do not want you to go doctor shopping and keep spending thousands and thousands of dollars on um alternative stuff you know colonics which destroy your government by um i mean i've heard it all people do all kinds of stuff that is just uh futile and and and actually um unnecessary and it's just draining your pocketbook uh there's this new test for iabs anti-cstb antibodies and vinculin antibodies the specificity and sensitivity of these tests have uh these tests are not promising they're expensive and they don't add anything to um the clinical picture of ibs so they're unnecessary so then what is the therapy for ibs well you know number one i i think it's so important that um once you have had the world cup that your doctor gives you reassurance that this condition is not going to kill you it is extremely painful it's extremely uncomfortable but it's a chronic disease and we have to get along with it somehow um and we may have to first go the nutrition round and we should always go to the nutrition round eat a high fiber diet with the help and guidance of a registered dietitian who knows what they're doing my registered dietitian is probably listening right now she's trained in treating you with ibs sibo and can make sure intelligently um help you avoid things that you should be avoiding and introducing things that you should be introducing in your diet she will not take away the fod maps she would help you design a program that has all the nutrients that you need without hurting your gut microbiome balance so nutrition therapy is number one first and foremost the first thing you should do um some people will continue to have problems and once you've had medical therapy nutrition therapy and you have the diagnosis of ibs i suggest that even though nobody likes to be on medications that you should try the medicines because the your poor quality of life is it's not good to go on having a poor quality of life and suffer and this suffering will go on and on and on and believe me there is no magic pill so um this is where people start trying weird like super weird herbs that actually hurt their gut they do all kinds of strange things like detox programs which are terrible for you i mean i've seen it all you guys don't try these things in fact you should try clinical clinically proven evidence-based medications that have worked this is if nutrition therapy fails um anti-spasmotic drugs such as bental and hyacine have shown to help low-dose antidepressants are very helpful if in particular if you have um depression and anxiety um if you're super constipated and you're eating the whole food based diet i don't know what to tell you you've got to intervene with some kind of laxatives or motility agents um and i see people load themselves up on magnesium and they that's not a good idea either i think it's you you should talk to a gastroenterologist and get some help if you have severe diarrhea some anti-diarrheals are helpful um and of course manipulation of the gut microbiota is so key and how do you do that you have to eat a high fiber diet albeit sometimes you will have a lot more gas but just remember that this gas production doesn't mean that it's hurting you it's just basically a little bit less the gas is staying around a little bit longer and it's not evacuating as as readily as it should uh compared to normal people and that you will be fine i'm gonna have to wrap up um psychotherapy is actually super important if nothing else helps after 12 months i would highly recommend a cognitive behavioral therapy because the brain and the gut are completely connected and all the stress hormones can aggravate your symptoms and so definitely um this approach is definitely completely appropriate um so in conclusion uh ibs is a chronic disorder of the gi tract it's very common and associated with psychological disorders it's not genetic it's mostly environmental and nutrition has a lot to do with it and if you ever get a gastrointestinal infection that has a lot to do with initiation of ibs eating a healthy nutritious um diet is important controlling inflammation balancing your gut microbiome and repairing the gut lining but it doesn't cure ibs in many cases you should try some kind of medication to control your symptoms um and providing reassurance is very key because um people spend thousands and thousands of dollars on ibs um and that's it i just want to show you my dietitians i'm so proud of james and dalia marin because we've been working together from uh day one of institute of plant-based medicine and even before that and they are experts in gut health if you need any help um they're here to help you dr siddagi that was incredible um one thing i i actually fell asleep at the very beginning so could you start over at the beginning so i was going to quiz you then i won't in that case no that was actually fantastic uh there were the chat box was going crazy uh as you were going through this whole thing and i know that you had to cut it down a little bit short but we just want to be respectful of people's time uh so uh let's do for basically the next like seven minutes or so let's try and rapid fire questions are you cool with that totally cool with that and i'll try to answer quickly so we can get to as many questions as possible yeah i have the same problem as you were i'm like well i'm glad you asked and then half an hour later i'm like does this make sense okay uh people are asking uh does it help to take a fiber supplement and or do you recommend taking a prebiotic or pro sorry eating prebiotic foods or taking probiotics or both so eating prebiotic rich foods are absolutely key because of the short-term acid per uh short-term fatty acid production that heals the gut taking probiotics um is not most of the time not recommended because it's very hard to find the right uh it's just the research is not available yet to know what kind of probiotics to take so just focus on taking prebiotic rich foods okay this is fantastic so uh i heard uh on the internet and in the blogosphere that lectins are bad for me because that's what i'm being told by the you know people who espouse a low or carbohydrate intake what's the truth about lectins is that is that true should i be avoiding them and where it's not evidence-based and i um you know most of the lectins get for example you'll find those in legumes but when you cook them they're pretty much essentially eradicated so um that is uh those those non-evidence-based stuff are totally floating around on the internet ignore it um you know um it's it's it's basically um i don't know i mean i think in the interest of selling some supplements um out there and um i it's not even a space so i don't know what to tell you yeah i mean i think that's a that's a perfect uh perfect answer um another thing too is that you you mentioned that saturated fat is something that can be actually uh very detrimental to your gut health for a number of reasons um in the world of low carbohydrate nutrition which seems to be very popular these days um they're telling you that saturated fat is not correlated with increased ldl cholesterol saturated fat is not bad for you saturated fat does not cause insulin resistance saturated fat does not harm your gut in fact saturated fat actually heals your gut they're saying the opposite thing is you so why is that being said and why people notice i laughed so saturated fat has shown to cause increased bile acid production which turns into secondary viruses as i showed you and uh it's toxic to the gut causes diarrhea saturated fat has been correlated to breaking down the tight junctions between the cells again not good for you now good fats like avocado fats and nuts and seeds fats those actually repair the gut alternatively saturated fat actually harms the gut okay um quick follow-up question why do people claim or why do people report that when they switch to a diet that is high in fat low in plant material low in fiber in general that they get a lot of resolution of their digestive symptoms absolutely you see i showed you that um gas clearance in ibs patients is a little bit delayed and there is dysbiosis so there may be more gas producing bacteria in the gut of patients with irritable bowel syndrome um so they get a little bit more exaggerated response than someone without ibs um so there's no question that they may suffer a little bit more than normal people with no ibs when they eat um high uh carbohydrate-rich foods right but uh the fact is that they should continue eating that way because that those short-term fatty acids are actually helping heal the gut and that excess gas production can be controlled by certain medications or certain um certain ways of eating um for example maybe eating a smaller meal so you shouldn't shy away from eating carbohydrates because of the gas um if you eat a high protein diet high fat diet temporarily because there's less carbohydrates in there you may temporarily have a little bit less gas production but in the long run you're shooting yourself in the foot because you're causing more dysbiosis more um damage to the gut okay so let's take a patient who currently has either ibs or sibo and has a significant amount of discomfort in their gastrointestinal tract you're recommending that they eat a more fiber-rich plant-rich diet which i am on board with but a lot of people find that once they start to integrate more fiber into their diet it triggers their symptoms and all of a sudden they start to feel worse okay so if somebody's already living with one of these conditions how can they actually transition to a plant-based diet without experiencing more pain yeah so number one it's uh very widely recommended that you slowly increase the fiber-rich foods so legumes may not be the first things you may want to try you know so you want to slowly ease yourself into it um eating cooked foods seems to be more tolerable um and you should always do this with the help of a diet registered dietitian and um slowly incorporate these uh fiber-rich foods into the diet where you are not like blowing up on day one if you ate um a ton of fiber and you're not used to it you will get super bloated so it's a slow transition with the help of a registered dietitian i always tell people it's very hard to do it yourself and lastly if you're getting excessive gas and bloating that does not mean that you're making yourself worse see that's key because a lot of people the alarm goes off and like oh my god i just ate uh let's just say i ate a big piece of meat and i didn't have bloating but i ate that broccoli and i had a ton of bloating so therefore this is bad for me look it's not like that just because you had a little bit of gas production it doesn't mean you're being harmed or you're harming yourself it's just get a little bit more gas production so i want to give people reassurance that just because you're eating more fiber-rich foods it's not like you're harming yourself right it's just the gas doesn't get cleared as fast and you may have more bacteria in your gut that produces a little bit more gas than usual you're not harming yourself so um that's what i wanted to get across that's a very good distinction actually i remember speaking with james and dahlia at a medical conference about a year ago where they walked me through verbally the protocol for how they would transition someone to a higher fiber diet and they were explaining to me that it has to be a very stepwise introduction of various foods because not all fibers created equal certain foods have different types of fibers certain types of foods are more complex to digest than other types of foods and so just like you're saying if you work with a registered dietitian who can really transition you in a step-by-step manner you can get to a point where you're not eating very much fiber to eating substantial amounts of fiber correct absolutely and that is always the goal the goal is to eat more fiber not be restrictive so cyrus i have a lot of patients who come to me and they're like down to eating two foods like they're eating bananas and avocados and it's frustrating because that is exactly what we don't and it actually creates eating disorders it's bad like so when you're having symptoms you eat a meal and a lot of people say oh it must have been that one thing they pick out one ingredient out of the meal and they blame that one ingredient like the onions or the garlic or something else and they stop eating it and then they get this bloating again obviously because they're going to get bloating anyway and then oh that was about two so let's stop that too so then the third ingredient the fourth ingredient the fifth thing slowly they get more and more restricted every time they have a little bit of gas and bloating every time they have a little bit of pain they become more and more restrictive which is the exact opposite of what you want to do right you don't want to get restrictive you want to actually add more foods more fiber-rich foods and not get restrictive and ibs and gas is going to happen you have ibs so don't keep getting restrictive because you have gas and bloating and pain um that's where i always say you this is where you practice integrative medicine where you use medications to give you comfort and so you can eat the foods that that you love and that are helping you you see this is one situation it's like if you have insulin dependent diabetes you should eat a whole food plant-based diet but you shouldn't stop using your insulin right you've got to do both and this is where in the world of gi it's the same thing you can help your gut with eating a fiber-rich diet but you should also use some of these medicines so you can get comfortable so you can eat more of them correct okay very good distinction this is this is extremely helpful uh how would somebody know if they should go get a test for sibo what are the particular symptomology that they should be paying attention to so there was a time where sibo was way under diagnosed and now it's like way over diagnosis i know it's all over the place now everybody has sibo um okay so um sibo it manifests as extreme bloating after eating and excessive flatulence and excessive burping and and people looking pregnant after they eat um so um there is a breath test that your practitioner could your gastroenterologist or whoever your doctor could order and you they give you they let you fast and then you take this sugar solution you blow in a tube and if you have excess gases that means that you're having excess gas production in your gut but so people have to remember that ibs causes bloating too right and so you don't want to get caught like killing the sibo all the time people go i have to kill the sibo and so they do these extreme diets extreme uh detoxes and they keep trying to kill the sibo but they're killing their good gut microbiome too there's no way that you can only kill the bad gut microbiome there's no way and a lot of times people get sucked into these like uh you know uh recurring um alternative medicine ways of doing things and they actually ruin their health even more and trust me herbs are just as potent as antibiotics i mean there are herbs i use for sibo that are just as potent as as antibiotics and they shouldn't be used readily and too too loosely they shouldn't be incorporated in the treatment too loosely it's got to be well thought out i got it so you got to be you got to do it under the under the guidance of a medical professional rather than just saying oh i read about this herb on the internet let me go take this thing you know maybe that's going to help yeah and sometimes they give you temporary relief but what are you going to do live on these herbs for the rest of your life you've got to make sure that everything you do is is is well calculated so i mean you may want to live on those herbs for the rest of your life i don't know but it needs to be discussed with your doctor and it has to be done um on a systematic in a well discussed manner okay last question for you and i know we got a thousand questions we could go through is there a connection between alcohol consumption and ibs is it helpful or is it detrimental um okay so uh alcohol in in my experience i i can induce first of all we know alcohol can cause leaky gut so um you know and and one of the path one of the reasons or the pathophysiology of ibs one of the pathophysiologies that i described was leaky gut and got microbiome um dysbiosis and alcohol can do both so um yeah if you have ibs you may want to stay away from alcohol or minimize the the use of it okay very very helpful uh this has been very eye-opening actually because uh there's the correct if i'm wrong the gut is the root cause of most if not all chronic disease correct i'm very god centric so i'm gonna say yes uh who who wasn't hippocrates who said that way you know back in the day you know i'm not sure actually i'm not sure to be honest with you but you know inflammation um a lot of inflammatory processes start in the gut remember i showed you the cells and the lamina propia right underneath the gut epithelium which has all the white cells hanging around and and whatever you're ingesting can directly cause inflammation which right underneath the gut cell which can spill over into the rest of the body so if you want to have a healthy body health starts in the gut and i think that everyone should respect gut health which is directly associated with good eating and a healthy diet absolutely i think for for people who used to have a poor functioning gut who then ate themselves into a better functioning gut they understand the value of having awesome digestive processes right like it has a an effect on many different systems within your body blood flow how your brain operates how your thyroid gland operates how your insulin production is you name it but for those people who haven't experienced it or maybe you're going in the wrong direction and say oh my gut doesn't work right i have gas bloating constipation diarrhea abdominal pain you name it uh it can feel a little bit like the world is sort of closing in on you very quickly right but uh if you feel like that trust me when i say that dr angie sedeghi's information here is can truly make a big difference in your life so as always try and transition to a plant-based diet specifically when you're dealing with gut issues make sure the transition is slow step by step don't just try and eat a whole bunch of fiber all in one shot and then hope that all of a sudden your symptomology goes away because like you know that could it could act like you're pouring fuel onto a fire and it can actually trigger a bunch of symptomology which would make you feel worse so dr sedeggi thank you so much for being here today really appreciate you guys my absolute pleasure thank you for having me i always like to share information with people you're very good at it too you're very good at it thank you and for those of you that are still here we got another uh you know 1200 of you remember to go check out the forks over knives meal planner if you haven't already taken a look at that right now go to forks over knives.com love plants you can get a two-week free trial there trust me when i say it is without question the greatest meal planner on the market today and i am not paid to say any of this i am telling you my honest opinion it is a phenomenal tool and it can help you really understand what to eat how to eat and how to save time and money in the process so uh forestoranized.com love plants thank you for being here today uh thank you for taking time out of your day and thank you for your interest we will see you guys in the next installment of the forks over knives webinar experience bye everyone you guys

Channel: Forks Over Knives

Views: 64,877

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Id: T-RJQIuwO9E

Length: 67min 53sec (4073 seconds)

Published: Thu Oct 15 2020