Because of spam, I personally moderate all comments left on my blog. However, because of health issues, I will not be able to do so in the future.

If you have a personal question about LI or any related topic you can send me an email at I will try to respond.

Otherwise, this blog is now a legacy site, meaning that I am not updating it any longer. The basic information about LI is still sound. However, product information and weblinks may be out of date.

In addition, my old website, Planet Lactose, has been taken down because of the age of the information. Unfortunately, that means links to the site on this blog will no longer work.

For quick offline reference, you can purchase Planet Lactose: The Best of the Blog as an ebook on or Almost 100,000 words on LI, allergies, milk products, milk-free products, and the genetics of intolerance, along with large helpings of the weirdness that is the Net.

Sunday, November 19, 2006

IBS Book: A New IBS Solution

Mark Pimentel, MD, FRCPC is Director of the Gastrointestinal Motility Program and Laboratory at Cedars-Sinai Medical Center. Dr. Pimentel also serves as Assistant Professor in Residence for the David Geffen School of Medicine at the University of California, Los Angeles (UCLA).

Those are gaudier credentials than most people who write books about IBS, even though many good doctors have written on the subject.

Dr. Pimental has recently published IBS: A New Solution, as shown on his web site

He's a firm believer in the "bacterial overgrowth" theory behind IBS.

The final, most recent theory defines IBS as a bacterial disease. Patients with IBS inevitably complain of gas and bloating. While this was once considered a major hallmark of IBS, the failure to understand this component led investigators in the 1980’s to emphasize what was more easily grasped; hence the focus on diarrhea and constipation. Still, even as most members of the scientific community were distracted by the emphasis on bowel function, others investigated the bacterial component of IBS. In the 1990’s, research showed that IBS patients (over a given time) produced 5 times more gas than did people without IBS. Since the only source of those gases was bacterial, the initial presumption was that IBS patients had excessive bacteria in the colon, where bacteria were expected to be. Subsequent studies showed that IBS patients had excessive quantities of gas in the small bowel; these data were the catalyst for studying small bowel bacteria in IBS.

Normally the small intestine contains a very small quantity of bacteria. In published studies, indirect measures of small bowel bacteria suggest that 84% of IBS sufferers have excessive quantities of bacteria typically found in the colon.

Intuitively, higher bacterial levels in the small bowel, where absorption takes place, would ferment the nutrients from the food into gas. Further work in this area has determined that these bacteria could produce both constipation and diarrhea, depending on the types of bacteria that have moved into the small bowel. These results have led to studies showing that antibiotics can almost completely relieve IBS symptoms if successful in eliminating the intestinal bacteria. This is called the “bacterial overgrowth theory of IBS.”

He also talks about the connection between IBS and lactose intolerance on the FAQ page on his site:
Why do I feel worse with milk products, yet even when I’m off dairy products entirely, I still have IBS?

There has been some research from Europe suggesting that part of IBS development may be due to lactose intolerance. Among my own patients, if I were to quantitate lactose intolerance symptoms, approximately 80 percent of them either avoid milk and dairy products altogether or recognize that milk and dairy foods are an issue in terms of creating more bloating for them. Yet, even when they eliminate milk and dairy products from their diets, they still have IBS. The only difference is that, when they drink milk, their bloating symptoms become worse. One part of the reason is that most bacteria rely on sugar as their main nourishment. If bacteria could only have one food, sugar would be the one thing they would want.


[E]liminating milk and other dairy products will not, in and of itself, resolve the problem of IBS. In many instances, however, it can help to reduce the symptoms of bloating associated with IBS, because doing so will reduce the amount of sugar the bacteria have to feed on. A better solution, of course, would be to address the bacterial overgrowth directly. See Chapter 6 in the book for dietary suggestions that may help.

The book is available at with a direct link through my Milk-Free Bookstore on the IBS Books page.

Thanks to David Knight for sending me the news about Dr. Pimentel's book and a link to his site.

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