Irritable Bowel Syndrome – the Problem and the Solution
Majid Ali, M.D.
The Seed, Feed, and Weed Way for Healing the Gut
(Taken from Commentary published online in Journal Nature. Link at the end of the commentary.)
A Listening Ear is an essay written with deep sensitivity that deserves to be read by all physicians interested in gastrointestinal health in general and irritable bowel syndrome (IBS) in particular. The words of Peter Whorwell reflect an abiding passion for his work and a deep compassion for his patients. Readers will benefit from his revealing insights about the nature of the disorder and his treatment philosophy. There are valuable clinical pearls here (dietary fiber, fructose, lactose, fructanes, and benefits of hypnotherapy, for example). This writer, a surgeon (FRCS,Eng)-turned-pathologist-turned integrative clinician, found his perspective enlightening.
Whorwell expresses gloom about what the future might hold for those who live truncated lives with IBS but whose disease is not duly considered by clinicians, researchers, and funders. I am saddened by this state of affairs as well.
Whorwell does not do any laboratory tests in his clinical work. This is a point of divergence between his work and mine. My clinical experience is that certain tests provide quantifiable and modifiable markers in clinical care, both for the clinician and the patient. Specifically, I do tests for: (1) mold allergy; (2) urinary organic acids for measuring products of fermentation, investigating Krebs cycle dynamics, evaluating gut permeability; and (3) insulin homeostasis. Below, I briefly relate how I arrived at this position concerning the use of laboratory methods in the care of individuals with IBS.
In 1980, I published a monograph entitled Altered States of Bowel Ecology (ref.1) to focus on the matters of: (1) gut flora; (2) gut fermentation; (3) gut permeability; (4) mold and food allergy; (5) histopathologic abnormalities encountered in patients with IBS symptom-complexes as well as colitis of various types; (6) disrupted neuro-enteric dynamics; and (7) to put forth my seed-feed-weed guidelines for restoring bowel ecology in IBS, among other chronic bowel disorders. In this approach, seeding is done with probiotics, feeding with foods and spices that favor healthful bowel flora, and weeding with selected food elimination (this was pre-FODMAP), antifungal herbs, spices, and judicious use of pharmacologics, notably Nystatin.
I developed an integrated view of IBS with work in histopathology of chronic gut disorders, including those with clinical diagnosis of IBS, and investigations of IgE-mediated aspects of the disorders (ref.2-4)
In 2004, I presented evidence for respiratory-to-fermentative shift in Krebs cycle in patients with chronic immune-inflammatory and digestive-absorptive disorders (ref.5). These observations were later validated by others (ref.6) as well as by personal follow-up studies (ref.7). Urinary organic acid analyses done for assessing Krebs cycle dynamics also included the measurement measurements of urinary excretion of mycotoxins, such as arabinose, tartaric acid, and furan compounds.
Hyperinsulinism has potent proinflammatory effects (ref.8) and its modification, when it is a comorbidity of IBS, improves clinical results. All of the above issues are presented at length in Integrative Nutrition, the 5th volume of The Principles and Practice of Integrative Medicine (ref.9). I end this commentary on a positive note. With uncommon exceptions, my colleagues and I observe good clinical results with our seed-feed-weed approach to IBS. Whorwell tells us that his general experience with individual patients is also gratifying. Further improvements in clinical outcome can be expected as more clinicians offer robust care for IBS with his broader-holistic philosophy, as well as by addressing concerns which I raise.
- Ali M. Altered States of Bowel Ecology. (monograph). Teaneck, NJ, 1980.
- Ali .M, Ramanarayanan MP: A computerized micro-ELISA assay for allergen-specific IgE antibodies. Am J Clin Pathol, 81:591-601, 1984.
- Ali M. Immunoperoxidase-based diagnosis of allergy and selection of initial therapy dose. Otolaryngologic Clinics of North America, 18:745-759, 1985.
- Ali M. Recent advances in integrative allergy care. Current Opinion in Otolaryngology & Head and Neck Surgery 2000;8:260-266.
- Ali M. Respiratory-to-Fermentative (RTF) Shift in ATP Production in Chronic Energy Deficit States. Townsend Letter for Doctors and Patients. 2004. August/Sept. issue. 64-65.
- Chouchani ET, Pell VR, Guade E, et al. Ischaemic accumulation of succinate controls reperfusion injury through mitochondrial ROS. Nature. 2014;515:431-435.
- Ali M. Succinate Retention. In: Chouchain ET. et al. Nature;2014;515:431 (see data at the end of the article.
- Ali M. Oxygen, Insulin Toxicity, Inflammation, And the Clinical Benefits of Chelation. Part I. Townsend Letter-The examiner of Alternative Medicine. 2009;315:105-109. October, 2009.
- Ali M. Integrative Nutritional Medicine. The Principles and Practice of Integrative Medicine Volume V: (2009) Institute of Integrative Medicine Press.