 Hi this is Dr. Rishow and let's discuss healing the cause of IBS and SIBO. IBS or irritable bowel syndrome and SIBO have much overlap and the symptoms can include things like bloating, abdominal pain, and altered bowel function meaning either constipation or diarrhea or perhaps a mixture of the two. And it can be a very debilitating condition and fortunately as we're learning more about the gut we are learning some of the underlying changes that can occur in the intestines that can cause IBS and cause SIBO. And excitingly one diet in particular has been shown to have the ability to at least in part repair some of what may be the underlying changes in the intestines that causes IBS and or SIBO. Now the diet is the low FODMAP diet and a low FODMAP diet essentially restricts carbohydrates, forms of carbohydrates, predominantly, that encourage or feed bacteria. And these are sometimes seemingly healthy foods like broccoli and asparagus. However for some people these foods can feed bacteria in the gut and that may be problematic especially for people with IBS and for SIBO because the low FODMAP diet does have an impressive number of clinical trials that have shown benefit. But what happens in the intestines? Well one study in particular has shown the ability of a low FODMAP diet to increase serotonin cells in the intestines and actually make the number of serotonin cells proximate or become more like that of healthy controls. Now why is serotonin important? Well for IBS, irritable bowel syndrome, serotonin can be important because serotonin is involved in what's known as notiception or pain and it's also involved so the pain that pain signaling or lack of serotonin and its influence on pain may account for the abdominal pain that is reported in IBS or the bloating because sometimes people report a bloating type discomfort pain and it also may account for slowed motility. And serotonin in the gut is partially responsible for motility or the ability of food to move through your intestinal tract at the appropriate pace. When this does not happen you can have a condition known as small intestinal bacterial overgrowth and some of the medications that are used to prevent SIBO small intestinal bacterial overgrowth from coming back once it's been cleared are actually agents that help to facilitate the release in the function of serotonin in the gut. So interesting that the low FODMAP diet has been shown at least in one study to have the ability to increase serotonin receptors. Now this the the study I'm referencing that show this show this change in serotonin receptors occurred in the colon. It would be ideal if we had data showing that this change occurred in the small intestines but it's it's much harder to perform biopsies of the small intestine. I'm I'm going to make an assumption I think is a fairly safe one that this would also occur this increase in serotonin cells would occur in the small intestine in addition to the colon. Now if you zoom way out it it's not a large stretch to say that a diet that has been shown to be very helpful for those with IBS and with SIBO namely the low FODMAP diet would probably cause a repair or healthy changes in the intestines in the people who went on it. Hence the increase in the serotonin cells in the gut. This is important because sometimes the low FODMAP diet is criticized which I'm open to but it's criticized for potentially causing a decrease in bacteria in the gut and the data here are not all consistent that hasn't been conclusively shown but it may be that for people with IBS and certainly for people with SIBO that they need an approach that may dampen or decrease or trim the microbiota back. So this is very exciting news and it I think illustrates one important principle that if something is working for you if something has a good clinical outcome for you then be confident in that because if you look at mechanisms like for example bacteria counts may go down in the low FODMAP diet and if you've been told that's bad it would really be unfortunate if you stopped using a diet that helped you the low FODMAP diet because at the same time you may actually be repairing and allowing the growth of additional serotonin cells in your intestines which are very important to help your intestines function properly. So this is where you can get into the debate regarding mechanism and it's why I always recommend that we look at clinical trials and outcome data to steer the recommendations that we make. So a low FODMAP diet for those with IBS and SIBO can be very helpful. Remember you don't have to be on a highly restrictive low FODMAP diet in perpetuity. You start low and then you try to broaden your diet to the broadest diet that you can tolerate. But remember that evidence is showing at least according to this one preliminary study which is very exciting in my opinion that a low FODMAP diet can help heal and repair the intestines via a very interesting mechanism which is that of allowing an increase in serotonin cells in the gut. So this is Dr. Ruscio and I hope this information helps you get healthy and get back to your life. Thanks.