Study: Children with IBS found to be deficient in vitamin D

Image: Study: Children with IBS found to be deficient in vitamin D

As many as one in six children suffer from irritable bowel syndrome (IBS) and its uncomfortable symptoms, including cramps, bloating, diarrhea and constipation. However, it appears that many children with IBS are also deficient in vitamin D.

A study published in PLOS ONE revealed that more than 90 percent of children with IBS lack vitamin D.

Being deficient in vitamin D likewise increases their risk for decreased bone mass, as having adequate vitamin D levels is important for the growth and development of bones of children.

In the study, the researchers analyzed the medical records of 55 children with IBS and compared their data to 116 healthy controls. The results revealed that one out of every two children with IBS is deficient in vitamin D compared to one out of every four healthy children and adolescents without IBS.

The study further looked into the association between vitamin D status and the presence of anxiety, depression, and migraine headaches that often come with IBS. Patients with IBS and migraine had significantly lower vitamin D levels compared to controls, which suggests that supplementing with Vitamin D might improve their headache symptoms.

With these findings, the researchers recommend pediatric IBS patients to monitor their vitamin D status and supplement with vitamin D if they are deficient in the vitamin.

More on vitamin D

Vitamin D helps the body absorb calcium, which is one of the building blocks of bone. Vitamin D also plays a role in the nervous, muscle, and immune systems. There are three ways to get vitamin D: through the skin, from food, and from supplements. Foods that are naturally rich in vitamin D include fatty fish like salmon and tuna, beef liver, raw cheese, mushrooms, and egg yolks. After being exposed to sunlight, the body naturally produces vitamin D. However, too much exposure to the sun can result in skin aging and skin cancer, which is why many people try to get their vitamin D from other sources.

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The amount of vitamin D a person needs every day depends on their age. The recommended amounts of vitamin D are the following:

  • Birth to 12 months: 400 international units (IU)
  • Children 1 to 13 years: 600 IU
  • Teens 14 to 18 years: 600 IU
  • Adults 19 to 70 years: 600 IU
  • Adults 71 years and older: 800 IU
  • Pregnant and breastfeeding women: 600 IU

Unfortunately, many are deficient in vitamin D. In the U.S. alone, approximately 42 percent of the population is vitamin D deficient. People can become deficient in vitamin D for various reasons. Some may not get enough vitamin D in their diet or have a malabsorption problem, in which they could not absorb enough vitamin D from food, while others may not get enough sunlight exposure. Some people may also have problems with their liver or kidneys that these organs cannot convert vitamin D to its active form in the body. Taking certain medicines can also interrupt the body’s ability to covert or absorb vitamin D. (Related: Vitamin D deficiency is widespread among U.S. population, expectant mothers are deficient and giving birth to deficient infants.)

As mentioned earlier, vitamin D is important for bone growth and development. Severe vitamin D deficiency can result in bone density loss, which can contribute to osteoporosis and fractures. Vitamin D deficiency can also result in many other diseases. In children, it can cause rickets, which is a rare condition that causes the bones to become soft and bend. In adults, it can result in osteomalacia, which causes weak bones, bone pain, and muscle weakness.

Read more news stories and studies on the importance of vitamin D by going to

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Antidepressants, Psychotherapy May Help Ease Irritable Bowel Syndrome

People struggling with irritable bowel syndrome (IBS) might feel better with antidepressants or psychotherapy, a recent study suggests.

While in some people, IBS improves with customized diets, this approach doesn’t help everyone and some emerging research suggests that the condition may also be influenced by processes in the brain.

For the current analysis, researchers examined data from 53 trials that compared the effects of antidepressants or psychotherapy, either alone or in combination, versus placebo treatments or usual care.

Rates of “no relief” were highest with placebo treatments. People were 34% less likely to have no relief from antidepressants and 31% less likely to get no relief from psychotherapy, the study found.

“One component of IBS is increased sensitivity to the functions of the bowels; simply summarized, this means either the nerves taking messages from the bowel to the brain are more sensitive or that the brain is more attentive or reacts in a more emotional manner to the normal messages arising in the bowel, or both,” said Dr. Michael Camilleri, a researcher at the Mayo Clinic College of Medicine and Science in Rochester, Minnesota, who wasn’t involved in the current study.

“Since there are really no medications to reduce the nerve sensitivity, some doctors give medications that modulate the function of the brain in the hope that this approach will reduce the ability to sense or emotionally react to the signals or messages arriving from the bowels,” Camilleri said by email.

Psychiatric conditions including depression, anxiety, and somatization are common among people with IBS, researchers noted online September 3 in the American Journal of Gastroenterology.

Although the use of antidepressants is common among IBS patients, psychotherapy is not, the study authors note.

One limitation of the current study is that the smaller studies used in the analysis had a wide variety of designs and methods for testing the success of treatment, researchers note. Another drawback is that these studies weren’t designed to prove how antidepressants or psychotherapy might directly improve IBS symptoms.

Still, a psychological evaluation may make sense for IBS patients because it’s possible their symptoms might be a byproduct of untreated depression, said Dr. Agnieszka Kulak-Bejda, a psychiatry researcher at the Medical University of Białystok in Poland who wasn’t involved in the study.

Antidepressants may work better for certain types of IBS, and the study findings also suggest that the type of medication may matter, Kulak-Bejda said by email.

Tricyclic antidepressants were more effective at relieving global symptoms of IBS, the analysis found. But selective serotonin reuptake inhibitors (SSRIs) were better than a placebo for easing symptoms like pain and bloating and improving quality of life.

“The decision to use antidepressants as a form of therapy should be taken individually,” Kulak-Bejda said. “The decision should be made after considering all the pros and cons.”

Fecal Profiling May Predict Dietary Response in IBS

Fecal profiling of volatile organic compounds (VOCs) may provide a low cost, non-invasive tool to predict the responses of irritable bowel syndrome (IBS) patients to probiotics and diets low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), according to British researchers.

Modeling baseline fecal VOCs, and using key features of VOC profiles, correctly predicted response to a low-FODMAP diet in 100% of patients and in 89% of patients receiving a probiotic, reported Megan Rossi, PhD, RD of King’s College in London, and colleagues.

This approach can potentially shed light on the pathophysiology of IBS, and advance its clinical management with more precisely personalized nutrition regimens, they wrote in Clinical Gastroenterology and Hepatology.

Multiple randomized trials have indicated that the low-FODMAP diet is effective in 50%-80% of IBS patients. “However, predicting response is clinically important because the diet requires intensive dietary counselling and impacts on both the gut microbiota and nutrient intake, and, therefore, avoiding this intervention in the 20%-50% who are unlikely to respond would be an important clinical advance,” Rossi’s group noted.

New approaches are definitely needed, according to William D. Chey, MD, of the University of Michigan in Ann Arbor.

“Only about half [of patients] get better on the diet, which has associated shopping costs and inconvenience to the patient, plus input from a dietitian and an extended three-step period of time to work through its stages,” Chey told MedPage Today. “This often gets glossed over but it’s not a trivial thing.”

Chey, who was not involved in the study, further explained that little is known about the long-term nutritional and microbiotic downsides of this restrictive diet. “By excluding prebiotic carbohydrates, you are very likely to have effects on the microbiome, so it’s important to identify strategies that enrich the likelihood of response and maximize choosing the right treatment for the right patient,” he said.

Rossi’s group used data and samples from patients with IBS-diarrhea, IBS-mixed, and IBS-unsubtyped treated at two major London hospitals and participating in a previous clinical trial. A total of 95 patients (majority white), whose age ranged from early to late 30s, completed the study. Of these, 93 (63 women) provided sufficient fecal sample for analysis and were randomized for 4 weeks to a low-FODMAP diet (n=46) or a sham diet plus dietary advice (n=47).

In 2-by-2 factorial fashion, patients in both dietary groups also received either a multi-strain probiotic supplement (n=49) or a placebo supplement (n=44).

Gas chromatography assessed VOCs in fecal samples at baseline and at study completion. The clinical endpoint was the IBS Severity Scoring System (IBS-SSS), which records abdominal pain, distension, stool frequency and consistency, and interference with life over a 10-day period.

All 93 participants were deemed compliant with diet, and 86 were classified as compliant with supplementation. At the end of the study, those in the low-FODMAP arm had a significantly lower total FODMAP intake (20+8 g/day) compared with those on the sham diet (33+16 g/day, P<0.001).

In terms of response, more patients reacted clinically to the low-FODMAP diet (37/46, 80%) than the sham diet (21/47 45%, P<0 .001), with a mean change in IBS-SSS score of –130 and –49 (P<0.001), respectively.

There was no difference in clinical response between patients given the probiotic (31/49, 63%) versus placebo (27/44, 61%, P=0.850), with no synergistic or antagonistic effects observed with supplementation. In addition, there was no difference in the mean change in IBS-SSS score between recipients of probiotic (–88) and placebo (–90, P=0.921).

The researchers found that baseline VOC profiles contained 15 features that explained 25% of response variation to the low-FODMAP diet with a mean accuracy of 97% (95% CI 96%-99%), as well as 10 features that explained 30% of response variation to the probiotic, with a mean accuracy of 89% (95% CI 86%-92%). At end of treatment, nine observed compounds explained 31% of variation in response to low-FODMAP and 11 compounds explained 27% of variation with the probiotic.

As to how VOCs predict response, the authors pointed out that many of these compounds are created from indigestible food substrates in the colon through both microbial metabolic activity and diet. VOC patterns at baseline may reflect the pathophysiology of an individual’s IBS and eating a high-FODMAP standard diet may, in the presence of IBS-associated dysbiosis, generate fermentation products that cause symptoms. Once the normal diet has been replaced, there is less substrate for bacterial metabolism and gas production and associated symptoms are reduced.

Study limitations included the relatively small sample size, its exploratory nature and the lack of data to inform a power calculation. Also, since the device that assessed fecal VOCs identified patterns of VOCs, not individual VOCs, detailed investigation of the potential mechanisms of individual VOCs could not be done. Finally, the 2-by-2 factorial design may have clouded the results.

Chey noted that, in his experience, about half of patients improve on the low-FODMAP diet, a remarkably high rate of success for a dietary therapy. Also, some of his patients have been following a reduced-FODMAP diet since his institution began introduced it in 2008.

“And up to 85% can move to a less restrictive diet after the phase of determining sensitivities,” Chey said.

Saving Steve Jobs

Second Opinions Are Critical: Learn how Steve Jobs fought cancer with the right diagnosis, extending life expectancy when Apple needed him the most.

The trouble with misfits, as Steve Jobs would say, was that they refused to comply. As an entrepreneur who pioneered successive revolutions in personal computing & portable devices, Jobs will always be remembered as an aggressive creator and visionary innovator, who never settled for what the world believed to be a norm.

Of course – we know him as the man who famously put a thousand songs in your pocket and gave the world exceptionally efficient and beautiful gadgets; we have admired his ideas on life and debated endlessly about his arguments. We have smiled at his antics and shed tears at his interpretation of Gandhi. But there is another story – one that runs parallel to his tales of entrepreneurial excellence, and sadly, the one that gets misrepresented the most.

As is the case with volatile urban legends, it is widely speculated that Steve Jobs outlived the general life expectancy of a terminal pancreatic cancer patient. He was diagnosed, after all, in 2003!

Myth: Steve Jobs Had Pancreatic Cancer.

It is common knowledge that Jobs was never too vocal about personal issues. At the helm of a publicly traded computing giant however, he was answerable to his board, shareholders, and members of the Apple tribe. Even so, Steve usually refrained from focusing on the specifics of his diagnosis, which led many to believe that he suffered from pancreatic cancer.

However, there is a general consensus within the medical fraternity that pancreatic cancer (Adenocarcinoma) would have translated into an expedited death, shortly after his diagnosis was confirmed in 2003. What really allowed Jobs to live reasonably well for the next 8 years, was an accurate diagnosis.

Pancreatic Cancer vs Neuroendocrine Cancer

Among a very few instances where Jobs decided to throw some light to his diagnosis, he referred to his affliction as a “hormonal imbalance” as opposed to your regular, run-of-the-mill Pancreatic Cancer.

In a convocation speech at Stanford University in 2005 (now popular, thanks to YouTube), Jobs reflected back on the discovery of a tumor in his pancreas in 2003, and the initial reaction of his doctors who were almost certain at the time, that it was an ‘incurable’ type of cancer, giving him a probable life expectancy of 3 to 6 months.

I lived with that diagnosis all day. Later that evening I had a biopsy, where they stuck an endoscope down my throat, through my stomach and into my intestines, put a needle into my pancreas and got a few cells from the tumor. I was sedated, but my wife, who was there, told me that when they viewed the cells under a microscope the doctors started crying because it turned out to be a very rare form of cancer that is curable with surgery. I had the surgery, and I’m fine now.

-Steve Jobs, Stanford Convocation, 2005

It is confirmed today, that Jobs suffered from Neuroendocrine Cancer. Due to a lack of clear public understanding and widespread awareness about the disease (It is reported that as few as 10 cancer specialists in the world fully understood Neuroendocrine Cancer in 2001), its symptoms were often mistaken for Pancreatic Cancer, Irritable Bowel Syndrome or Crohn’s Disease.

While most forms of pancreatic cancer arise from pancreatic cells, neuroendocrine tumors arise from hormone-producing islet cells that happen to be in the pancreas. Unlike regular pancreatic cancer, where patients are likely to die within weeks or months after diagnosis, neuroendocrine cancer grows slow, and can be controlled and contained with an early, accurate diagnosis.

Fact: Steve Jobs Had Access To Specialists.

Following his surgery, Jobs lived for 8 more years, and during this time, administrative responsibilities at Apple were gradually handed down to the right personnel.

It isn’t hard to understand that a man of Jobs’ stature had access to the absolute best that the medicare industry had to offer at the time, and that his diagnosis and subsequent surgery were accelerated by the availability of dedicated on-call specialists whenever required. In other words, Jobs didn’t have to worry about the credibility of the treatment he was receiving.

Sadly, though – misdiagnosis and incorrect treatments result in a huge number of deaths around the world today.

Not everyone can afford to deploy medical resources like Steve Jobs did, and yet – as many as 1,000 patients are diagnosed with Neuroendocrine cancer each year in the United States alone.

With the right push and timely access to specialists, they can be treated well, treated right, and allowed the same life expectancy extensions as Jobs enjoyed, if not more.

Question: Doesn’t limited access make you vulnerable to an incorrect diagnosis?

Plagued by the deplorable condition of state-sponsored and privately-distributed health insurance providers and non-availability of surplus funds, most cancer patients in the world today have their options severely limited to standard-issue procedures for diagnosis and treatment. While rare cases such as Neuroendocrine tumors require special analysis, it is still extremely common to find misinterpretations of its symptoms.

The general population still doesn’t have enough access to specialists. Even if they go to general physicians and hospitals, they get referred to standard procedures such as chemotherapy and radiation therapy. In fact, credible and qualified second opinions were really hard to source, until a new wave of internet-enabled services made it possible to connect patients with specialists and multidisciplinary panels of oncologists.

The Advantage

At, we offer single consultations with domestic & international oncologists, as well as a tumor-board review for advanced cases, for patients who wish to have their ongoing cancer treatment reviewed. In a reference that Jobs would have probably humored, we are trying to intervene as an ‘Autocorrect’ service for cancer treatments around the world, with the availability of an unbiased consultation/treatment being our top priority.

Any patient, irrespective of the stage of their diagnosis/treatment, can send us their existing medical data and receive an accurate analysis of their treatment, and we will revert with any necessary course corrections, as well as suggestions about possible clinical trial engagements that can really make a difference. Not being affiliated to any hospital or treatment centre allows us to be focused only on the right advice for cancer patients, and lets us push forward into a world where everyone has access to the the diagnostic advantages that helped Steve Jobs live for 8 more years.

References & Bibliography

  1. Reference: Neuroendocrine Tumor Research Foundation
  2. Reference: An article that first appeared in Charlotte Observer
  3. Reference: National Cancer Institute – PDQ on Islet Cell Tumors

Are Carbs Bad for You? What Eating Carbs Actually Does to Your Body

Not all carbohydrates are created equal.
Sliced brown bread on a white background

Thinking about carbs probably conjures up images of anything and everything you’ve been programmed to avoid: pasta, cookies, cake, bread. These foods get a bad rap, so it’s no wonder that so many of us get the impression that carbs are bad for you. Nutritional advice in the past has trained us to almost fear them—and feel guilty for breaking down and indulging in their dense, bready goodness.

But what if we told you you’re thinking about this all wrong? (And not just because food guilt is a waste of time, as well as a harmful way to think about eating.) Yes, some types of carbohydrates don’t have much in the way of nutritional benefits: We’re looking at you, sugar. Sugar is a basic, broken-down carbohydrate, devoid of any nutrients. And as you’ve undoubtedly heard, eating too much added sugar is associated with a host of health problems. It’s reasonable to want to limit the amount of added sugar you consume on a regular basis, from a health perspective.

But complex carbohydrates, like those found in whole grain breads, grains like quinoa and farro, and yes, fruits, veggies, and dairy, are all part of a healthy diet. In fact, your body needs carbohydrates to complete its basic functions.Here’s what’s really happening inside your body when you eat carbs, and why they’re not the villains you’ve been taught to believe.

So, are carbs bad for you or good for you? Well, that’s really not the question you should be asking. Because when you look closely, not all carbs are created equal.

Carbs get a bad rap because we all think of the less-healthy ones—simple carbs like white bread, donuts, bagels, sugary cereal—which aren’t great for our health. But carbs come in two forms: simple and complex. “Simple carbohydrates are made up of short chains of carbon molecules that require little breakdown and go directly into the bloodstream [and cause a blood sugar spike],” Kim Larson, R.D., spokesperson for the Academy of Nutrition and Dietetics, tells SELF. Any simple carbohydrate, or just straight up sugar, really has no redeeming qualities, nutritionally speaking. Sugar is also associated with inflammation, which is connected to a slew of of problems, like heart disease and cancer. If you’re interested in the science around sugar and our bodies, you might want to check out Sugar Science, a (self-described) “authoritative source for the scientific evidence about sugar and its impact on health,” created by a team of health scientists from the University of California at San Francisco.

But about complex carbohydrates. These carbs have longer chains of carbon molecules, so it takes longer for your body to break them down. Which means the sugar isn’t dumped into our bloodstream such as what happens with simple carbs. “We experience a more steady-state infusion of sugar into our bloodstream that supplies longer lasting energy,” Larson says.



Whatever type of carbohydrates you eat, your body works to break them down to their simplest form: glucose.

“The breakdown of carbohydrates starts in our mouth with salivary enzymes, then goes to the mechanical churning of the stomach using digestive enzymes, along with B vitamins (the helpers), and the journey ends when they are in their simplest form, glucose, which is then absorbed in the small intestine,” Larson explains. Glucose then travels to the liver to be distributed throughout the body. Your cells first use whatever glucose they need for energy, sending it to the muscles and tissues in your body. Some gets stored in the liver as a reserve tank, and any excess is stored as fat, both in the liver and in adipose tissue around your body. We know loading up on sugar is bad for our bodies, and can lead to chronic diseases like obesity and diabetes. Too much of any carbohydrate can do that, too, since it all ends up as glucose.

We need carbohydrates for our bodies to even function.

Carbohydrates are our bodies’ main source of energy. “Glucose is the form of sugar that our brains use,” explains Keri Glassman, R.D. We need a certain amount of it to fuel all of our metabolic processes “so we can have energy to do things like breathe, digest, run, work, think.” Literally, everything. Fat and protein have their jobs, too, but when it comes to getting that basic energy, carbs are key.

So, what about the whole weight-gain thing? “Certainly eating too much of anything (including protein and fat) will cause weight gain,” Larson explains. Just eating more calories than you burn in a day can lead to weight gain. The problem is that simple carbs and sugars won’t keep you full, so they’re really easy to overeat. If you eat healthy carbs, as part of a balanced diet that also includes protein and fat, your body will function the way it should.



Healthy, complex carbs are found in more foods than you think. And you should be eating them every day.

When someone says, “I’m cutting out carbs,” they usually mean they’re cutting out breads and pasta, Larson explains. Many of us forget that milk, whole grains, fruits, and vegetables are all carbohydrates, and also come with essential nutrients like fiber and protein. So when you’re eating cauliflower, peas, bananas, apples, broccoli—the list goes on—you’re indeed eating carbohydrates. And your body is happy about it.

Ditching all carbs isn’t a good move. Instead, eat the good kinds in moderation. “Over half of our daily calories should come from quality carbohydrates, like whole grains, dairy, fruits, and vegetables,” Larson notes. “We cannot support the brain if we are taking in less than 120 grams of carbohydrate per day, and a lack of glucose (like oxygen) to the brain can cause irreversible damage.” So certainly cut out those bad carbs, but you can (and should) eat the healthy ones every single day.

Vitamin D supplements could ease painful Irritable Bowel Syndrome

Here’s Why Your Poop Can Be So Freaking Weird on Your Period

You know what we’re talking about.

Most people are pretty open about the “joys” that come with having a period, like cramps, bloating, and sore boobs. But there’s one period side effect people really need to discuss more often, because maybe sharing the burden can at least make the load a little lighter: period poop.

Everyone’s situation is different, but it’s not uncommon for your regular poop habits to take a temporary vacation when you’re on your period, or be suddenly replaced with a whole lot of diarrhea, or both. “Many women do get bowel changes just before or during their period,” Kyle Staller, M.D., a gastroenterologist at Massachusetts General Hospital, tells SELF.

You’ve probably noticed this and dismissed it as just one of those body things, but there’s an actual biological cause you should know about.

“The reason that this happens is largely due to hormones,” says Dr. Staller. Pre-period constipation could be a result of an increase in the hormone progesterone, which starts to increase in the time between ovulation and when you get your period. Progesterone can cause food to move more slowly through your intestines, backing you up in the process.

So what about that diarrhea, though? Hormone-like substances called prostaglandins could be to blame for that. The cells that make up the lining of your uterus (known as endometrial cells), produce these prostaglandins, which get released as the lining of your uterus breaks down right before and during your period. If your body makes a lot of prostaglandins, they can make their way into the muscle that lines your bowels. There, they can cause your intestines to contract just like your uterus and push out fecal matter quickly, causing diarrhea in the process, Ashkan Farhadi, M.D., a gastroenterologist at MemorialCare Orange Coast Medical Center and director of MemorialCare Medical Group’s Digestive Disease Project in Fountain Valley, California, tells SELF. (Fun fact: These prostaglandins are also responsible for those painful cramps you might get every month.)

Of course, this can all vary in different people. But if you notice you experience constipation or diarrhea right around your period like clockwork, this may be why.

Having certain health conditions can also exacerbate period-related bowel changes.

If you struggle with a health condition like endometriosisCrohn’s diseaseirritable bowel syndrome, or ulcerative colitis, having your period can cause a flare-up of your symptoms. Ultimately, the symptoms you experience depend on your condition, Dr. Farhadi says.

For example, if you struggle with Crohn’s disease, which can often cause diarrhea, or IBS-D (a form of IBS that causes people to have diarrhea), your body’s release of prostaglandins during your period may cause you poop even more than usual. But if you suffer from IBS-C (IBS that causes people to have constipation), you may find yourself struggling even more to have a BM on your period as progesterone further slows your bowels’ activity. Since ulcerative colitis can lead to both diarrhea and constipation, you might experience an uptick in either during your period.

And unfortunately endometriosis can lead to pain during bowel movements around your period, Christine Greves, M.D., a board-certified ob/gyn at the Winnie Palmer Hospital for Women and Babies, tells SELF. Endometriosis is a disease where endometrial tissue that normally grows inside the uterus (or, as is up for debate, tissue similar to endometrial lining) grows outside of the uterus. This tissue can attach to your bowels and start trouble. “You then have bleeding around that area, and that can cause pain when you have a bowel movement,” Dr. Greves explains.

If your poop gets weird on your period, there are a few things you can do to cope.

The most important step is knowing what’s normal for you on your period and doing what you can to minimize any additional triggers. For instance, if you always get diarrhea during your period, and you know that coffee tends to make you poop more, it’s a good idea to cut back a little when you’re actually on your period, Dr. Farhadi says. You can also take Immodium on the first day of your period in anticipation of diarrhea, or carry it with you in case it strikes, he says. If you deal with constipation during your period, try upping your fiber and water intake in the middle of your cycle, when constipation-prompting progesterone levels start rising.

It can also help to pop some non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs, a common class of pain relievers, can block certain enzymes in your body from making prostaglandins. With fewer prostaglandins roaming around, you may get some relief from an achy belly and incessant pooping.

If you’re really having a hard time with poop issues on your period, talk to your doctor. They may be able to recommend next steps or refer you to a specialist who can. Your period is already annoying enough without spending forever on the toilet, either basically pooping water or straining hard to go in the first place.

Living and looking for lavatories – why researching relief is so relevant

Toilets are a source of interaction, social structures, organisation, norms and values. So why aren’t sociologists discussing them more?

Toilets are a private side of life that is rarely discussed, or if we do disclose our habits we do so with hesitation, euphemisms or a nervous giggle. But toilets are a very public issue.
Toilets are a private side of life that is rarely discussed, or if we do disclose our habits we do so with hesitation, euphemisms or a nervous giggle. But toilets are a very public issue. 

It may be a turn of the stomach, a nervous flutter, a morning coffee or a sudden, unpredictable rush. You may look for a sign, if you are lucky enough to live in a society where they are readily available. There may or may not be a queue, often depending on the room of your gender. You may look for disabled access, whether you are in a wheelchair or have an invisible illness. You may select a space based on who is there, or your perception of its cleanliness. For some, it is an unwritten rule that one cannot go next to another person relieving themselves. What are you looking for?

A lavatory.

Also known as a toilet, bog, ladies, gents, pisspot, restroom, dunny, convenience, powder room, and the WC, to name a few alternatives.

Toilets are mundane, an everyday space, a common fixture in the home and the workplace, a thing that we all use, in diverse ways. Toilets have historically been(and continue to be) shaped by our cultures, gender, social class and ethnicity with clear boundaries, distinctions and divisions imposed. This, in turn, shapes our social identities.

Toilets are a personal thing; a private side of life that is rarely discussed. If we do disclose our habits or toilet trips we do so with hesitation, euphemisms or a nervous giggle. However, toilets are a very public issue. They are in department stores, coffee shops, pubs, restaurants and on trains. There is a declining number of public toilets, now often vandalised and abandoned, perceived as unhygienic, or a place of illegal activity and other “hazards”.

Toilets are a source of interaction, of social structures, organisation, norms and values. So why aren’t sociologists discussing them more?

I have a bowel problem. I live with an unpredictable bowel, one that changes every day, with symptoms ranging from abdominal pain to bloating and urgency to find a toilet. Bowel conditions are not socially accepted and discussed conditions: a disclosure is often regarded as “too much information”. The anxiety of the symptoms and the urgent need to use toilets led me to toilet mapping: making mental notes of the nearest toilets, and the quickest way to get to them. Toilets became not just a functional space, but also a place of safety and relief, in more than one sense.

I am not alone. There are a variety of conditions for which knowledge of toilet locations are crucial for managing symptoms – conditions such as bladder incontinence, Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS), for example. My PhD research is focusing on the common condition of IBS. According to NHS Choices, 20% of the UK population lives with IBS – arguably more, given the concealment of the condition. Despite this, bowel conditions and the symptoms of constipation, diarrhoea, flatulence, (in)continence and other activities that take place in the “private” realm of the toilets remain heavily taboo topics in contemporary western society.

My research explores the lived experience of managing symptoms of IBS, particularly in the spaces where symptoms are mostly managed: the bathroom.

My research examines how places such as toilets can be reflective of our practices of privacy and containment of our bodily excretions. We may divide ourselves and our relations to each other in such a way that makes life with conditions such as IBS incredibly isolating. This means that the coping strategies and challenges faced in the day-to-day life of people who live with these conditions are underappreciated, hidden and, crucially, misunderstood.

Some would argue that bathrooms and toilets are the backstage of social life. However, there are many performances still going on within the toilet cubicle: the holding on until another person has left the toilet; waiting until the hand dryer goes on; blaming the time spent in the toilet on a fictional queue. Whilst this may seem an obvious behaviour of privacy and dignity, the strategies of toilet mapping and negotiating toilet spaces to keep one’s IBS identity private question the boundaries of society, the public and the private, the clean and the dirty, self and other.

In discussing my research, I often face a reception of pure horror, a nervous laugh or a joke, but very rarely an open, honest, discussion of our own bowel habits and toilet behaviours. The awkwardness around the topic creates greater challenges for those living with bowel conditions, and reinforces stigma. Some may laugh at the fact I talk about poo and toilets in my academic life. There may be banter about bowels, a joke that I need a colon in my future research papers or conference presentations. But is the difficulty of living with an unpredictable bowel in an unaccommodating society really that funny? It’s time to talk shit.


Researchers Develop Noninvasive Tool That Measures Gut Activity

Irritable bowel syndrome (IBS) continues to vex patients and physicians alike. IBS affects an estimated 10% to 15% of Americans, and many sufferers experience debilitating diarrhea, constipation and abdominal pain. Despite this effect, our understanding of what causes the disorder and how best to manage it is limited.

“Physicians struggle with diagnosing and treating IBS,” said Patricia Sylla, MD, FACS, associate professor of surgery in the Department of Colorectal Surgery at Mount Sinai Hospital, in New York City. “Any way to further our understanding of IBS could have great therapeutic value.”

In 2008, Uday S. Devanaboyina, PhD, founded the startup tech company G-Tech Medical with the concept of building a noninvasive device that could measure electric signals along the digestive tract and identify the gastrointestinal motility issues responsible for these pervasive symptoms.

When Steve Axelrod, PhD, the company’s president and CEO, joined G-Tech in 2011, the idea began to take shape. With funding and support from the Thiel Foundation’s Breakout Labs and later from the Fogarty Institute for Innovation, Dr. Axelrod and his team have developed a thin, lightweight, waterproof wireless patch that can attach to the skin and measure electrical activity from the stomach, small intestine and colon. The design allows patients to wear the patches during their daily activities while data are recorded in real time and uploaded to an online database for analysis.

“Our ultimate goal is to create a patch that can help doctors study patterns of gut behavior and find the underlying cause of a person’s issues,” Dr. Axelrod said.


GutCheck is a wireless patch that attaches to the skin and measures electrical activity from the stomach, small intestine and colon. A team is currently studying whether it can help distinguish patients at risk for postoperative ileus.

Currently, Dr. Axelrod and his team are in the early stages of testing. A recent proof-of-concept analysis, presented at the 2014 annual meeting of the American College of Gastroenterology, showed that it is possible to measure electric signals from the digestive organs noninvasively. In the study, Dr. Axelrod and his team placed EKG patches simulating the GutCheck patch on the bellies of 11 healthy controls and 77 people who suffered from a range of GI symptoms, including constipation, diarrhea, pain and bloating. After recording and analyzing gut activity before and after eating, the team was able to map out signals corresponding to motor activity in the stomach, colon and small intestine. The researchers also found they could differentiate between the gut function of controls and those with GI symptoms.

More recently, the team at G-Tech, led by Anand Navalgund, PhD, and researcher Lindsay Axelrod, presented two posters at the 2016 Digestive Disease Week, which were finalists in the Young Investigator Competition. The two analyses expanded on the original feasibility data: One abstract investigated the optimum placement of the patches based on motor activity signal strength at various locations on the abdomen, and the other examined the data for potentially diagnostically useful signal patterns in patients with gastroparesis and reflux disease.

With this feasibility research in hand, the team is now studying whether the GutCheck patch can help physicians distinguish patients at risk for postoperative ileus. “Postoperative ileus is an ideal first indication,” Dr. Axelrod said, who is currently enrolling two clinical trials to determine how effectively the patch can monitor patients’ intestinal recovery after abdominal surgery and identify those at risk for developing an ileus.

“We hope to find signs in the data that indicate which patients will go on to develop post-op ileus,” Dr. Axelrod said. “If we can pinpoint the early signs of ileus and identify which organ is responsible, we can treat it sooner and provide more targeted therapies.”

Dr. Sylla agrees that we need novel methods to observe patients after abdominal surgery. “If we could better monitor patients postoperatively and better anticipate when they are developing signs of bowel dysfunction, such as an ileus or bowel obstruction, it could trigger earlier intervention, and ultimately improve patient recovery, reduce length of stay, readmissions and overall costs,” said Dr. Sylla, who has not used the device. “[The GutCheck patch] is a good concept with potential clinical utility, but only if the technology can be used to accurately predict and capture clinically meaningful changes in electrical signals before patients start experiencing symptoms.”

Although it is too soon to tell how effective the patch will be, if successful, the device could offer a unique glimpse into the function of the digestive tract.

“Once we validate our technology in these early clinical studies, we hope to run extensive tests on many patients to understand how this information can be used to glean the underlying causes of common GI symptoms, and ultimately help physicians develop more targeted therapies to bring better and faster relief,” Dr. Axelrod said.

Irritable Bowel Syndrome Treatments Aren’t One-Size-Fits-All

Irritable bowel syndrome (IBS) is an often misunderstood and underdiagnosed condition that affects about 15.3 million people in the United States.

No one remedy works for all patients, so there’s a great medical need to develop new therapies for IBS, says Andrew Mulberg, M.D., a gastroenterologist with the Food and Drug Administration (FDA). That’s why FDA is working to bring more treatments to the market.

“There’s a lot of new research about the role of carbohydrates, and specifically a nutrient called polyols, in triggering irritable bowel syndrome in some patients,” Mulberg says. “In addition, doctors, scientists and researchers are more closely examining the role of diet in IBS causes and treatments.”

What Is IBS?

IBS is a gastrointestinal disorder that affects the large intestine (colon) but doesn’t cause inflammation or permanent damage. Common symptoms of IBS include:

  • Diarrheas
  • Constipation
  • Abdominal pain, bloating or cramping
  • Gas
  • Mucus in the stool

The symptoms may come and go, and can change in the same patient. Sometimes the pain from IBS can be so severe that it’s disabling and patients can’t do routine things. In addition, severe diarrhea can lead to dehydration and an electrolyte imbalance.

Doctors don’t know what causes IBS, and there is no known cure. Studies estimate that as many as 20% of Americans suffer from IBS. Many people may not know they have this gastrointestinal disorder. They might have occasional diarrhea and constipation and think it’s caused by something they ate, or a virus, so they don’t see a doctor to get a proper diagnosis. When they do, doctors must first rule out that the symptoms aren’t caused by a disease or another condition.

“There are many conditions that have a female or male predominance, but we don’t understand why women have a higher prevalence of IBS,” says Mulberg, deputy director of FDA’s Division of Gastroenterology and Inborn Errors Products (DGIEP).

IBS is most common among people younger than 45, and patients usually first experience symptoms when they’re in their late 20s. People who have a family history of IBS are also more likely to develop the condition.

Depression, anxiety and other psychological problems are common in people with IBS, Mulberg says.

“Some people suffer from depression and IBS. The question is what’s primary or secondary – what came first?” he says. “Either way, antidepressants are not a cure for IBS.”

What You Can Do

Treatments for IBS vary from patient to patient and include changes in diet, nutrition and exercise. Some patients need stool softeners to treat constipation; others need antidiarrheal drugs to treat diarrhea.

“IBS is not like other chronic conditions, such as hypertension, which is constant. IBS is a variable condition. Even without treatment, the problem might go away in some patients. But the symptoms might return after a few months,” says Ruyi He, M.D., an internist and medical team leader with DGIEP.

No one medication works for all people suffering from IBS.

Most recently, FDA approved Linzess (linaclotide) to treat some adults who suffer from IBS with constipation and for chronic idiopathic constipation. Chronic idiopathic constipation is a diagnosis given to those who experience persistent constipation and do not respond to standard treatment. According to the National Institutes of Health, about 63 million people have chronic constipation.

In addition, FDA has approved Amitiza (lubiprostone) for IBS with constipation and one drug for IBS with diarrhea, Lotronex (alosetron).

“Drugs are a last option. Patients should try diet and lifestyle changes, especially exercise, before resorting to medication,” He says.

Certain foods and drinks can trigger IBS symptoms in some patients. The most common are foods rich in carbohydrates, spicy or fatty foods, milk products, coffee, alcohol and caffeine.

IBS and Children

It’s difficult to diagnose IBS in children because its symptoms are so common. The National Digestive Diseases Information Clearinghouse (NDDIC) reports that one study of children in North America found that girls and boys are equally prone to having IBS. The study also found that as many as 14% of high school students and 6% of middle school students have IBS. FDA has not approved any drugs for treating IBS in children.

“We don’t believe that children younger than 6 can be properly diagnosed with IBS,” He says.

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