Dr. Mark Pimentel - The Microbiome Connection: Your Guide to IBS, SIBO, and Low-Fermentation Eating

Your Guide to IBS, SIBO, and Low-Fermentation Eating

DR. MARK PIMENTEL & DR. ALI REZAIE

AGATE

GOODL/FE

low fermentation eating

www.thegoodlfe.com

Copyright 2022 by Good LFE LLC

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without express written permission from the publisher.

First printed in March 2022

Printed in the United States

10 9 8 7 6 5 4 3 2 1 22 23 24 25 26

ISBN-13: 978-1-57284-309-7

ISBN-10: 1-57284-309-8

eISBN-13: 978-1-57284-863-4

eISBN-10: 1-57284-863-4

Library of Congress Cataloging-in-Publication Data is available from the Library of Congress

Surrey is an imprint of Agate Publishing. Agate books are available in bulk at discount prices. For more information, visit Agatepublishing.com.

Produced by Exquisite Corp. exqcorp.com

We dedicate this book to all with a chronic invisible illness: to those who suffer but dont look sick; to those who hurt but routine tests are inconclusive; to those who agonize in silence. There is only one roadmap forward: knowledge and awareness!

If you come away with only one notion from this book, let it be optimism! If you have Irritable Bowel Syndrome (IBS), you are not alone, and you can get better. And if you are among the millions of people who have Small Intestinal Bacterial Overgrowth (SIBO), a debilitating condition that occurs when bacteria that normally grow in other parts of the gut begin to grow in the small intestine, we share our expertise along with a unique SIBO diet and treatment plan to help ease your symptoms. We know its already confusing. Are IBS and SIBO the same thing or are they different conditions? Can SIBO occur without IBS? Well guide you through the answers to these questions as you read this book.

The most common gastrointestinal (GI) condition in the United States is IBS, which is characterized by abdominal pain/discomfort, bloating, and altered bowel habits (diarrhea or constipation or both). IBS affects millions of people of all ages, and it appears to be slightly more common among women than men. Economically and socially, the cost of IBS can be significant, as those coping with IBS often miss days of work or school.

Many people who suffer from chronic IBS choose not to travel on planes, trains, and buses, and avoid dates or outings with family or friends for fear of having to explain their bathroom trips and their pain and discomfort. After all, talking about your bowel movements or how bloated you feel is not considered polite conversation in most circles. So the people you spend time with may never know about your struggle.

As IBS becomes a better-recognized disease, it will be easier to discuss. You can and should talk about IBS to your health-care providers, family, and friends. We know so much more about IBS, and we continue to learn more every year. The more you know about IBS, the better equipped you are to talk about it, and the less its burden becomes. By educating your family and friends, you can both broaden support and lessen the stigma of IBS.

Primary care doctors and health-care personnel must keep up with so many illnesses, so its important that we educate them about new IBS information. The more doctorsnot just gastroenterologists, but all health-care providersknow about it, the better off IBS patients will be. As physically challenging as it may be, IBS gut pain can be alleviated with proper diagnosis and treatment. Yet we often see patients suffer as they bounce between Western medicine and alternative medicine, getting differing opinions and advice from physicians, dietitians, nurse practitioners, and naturopaths. In some situations, the advice or treatment may worsen their symptoms.

The primary problem is that no one answers the ultimate question: Whats wrong with me? Patients tell us, All I hear is what I dont have. All my tests are negative. Are there no tests to confirm my illness? or I dont know whats wrong with me; Im starting to believe its all in my head. And when you dont know whats going on, you may be given procedures, tests, or treatments that are potentially harmful.

IBS is not a fatal illness. It wont lead to cancer. It hasnt yet killed anyone, the way heart disease or kidney disease can. But lets be clear just because IBS isnt lethal, doesnt mean its not a problem. Its not a lifestyle condition wherein patients are simply worried about what they eat. Moreover, IBS suffering is intense, as well discuss later. In fact, some studies have shown that people with IBS have a lower quality of life than people with heart disease. The other problem with the notion that IBS is not a deadly disease is that theres less effort to fund research, and therefore our scientific understanding of IBS has been slow to evolve.

IBS is extremely common. If youre reading this book on a bus or train right now, look around you: one in seven of your fellow passengers likely has IBS. Just 10 years ago, people with IBS often felt socially isolated; their symptoms were dismissed by family and friends as being imaginary, and there was little hope that the symptoms would ever disappear, or at least lessen and improve. This is not the case today. Over the last 15 years, research into IBS, gut motility, the guts immune system, and the vast inner workings of the guts microbiome (the trillions of bacteria, fungi, and viruses harbored in the gut) has been groundbreaking. Our work as clinicians and researchers has convinced us that IBS patients can experience an improved quality of life, engage successfully at work, and lead full, active lives. Many, if not most, IBS patients can find partial or complete relief from this often- debilitating disease.

Notice that we just referred to IBS as a disease. Doesnt IBS stand for irritable bowel syndrome? As you read through the chapters of this book youll see that IBS is a legitimate disease and that the word syndrome may no longer apply. In fact, we believe theres hope for a course of action and an IBS-free future. We look forward to a time when IBS is no longer a chronic disease, but a manageable, finite illness that disappears with proper diagnosis and treatment. In this book, we share what we have learned and how we are now treating IBS. Most importantly, we show you how to empower yourself and lead a normal life againa life, we hope, that is entirely absent of IBS or IBS symptoms.

We also wrote this book to increase awareness and understanding among the subgroup of IBS patients who have SIBO. Through our research, we have found that about three-quarters of patientsas many as 30 million Americanswho have met the diagnostic criteria for IBS have taken a breath test that suggests they have SIBO. We hope this book will pave the way to more SIBO research and funding to improve the treatment of this large community. So how do SIBO and IBS intertwine?