 Irritable bowel syndrome is a chronic gastrointestinal disorder that affects about 1 in 10. You may have heard about those low FODMAP diets, but they don't appear to work any better than a standard advice to avoid things like coffee and spicy and fatty foods. In fact, you can hardly tell which is which. But most IBS patients do seem to react to specific foods, such as wheat, dairy, soy sauce, or eggs. When you test them for typical food allergies, they may come up negative on the skin prick test. But what you want to know is not what happens on their skin, but inside their gut when you eat them. Enter confocal laser endomicroscopy. How cool is this? You can snake a microscope, down someone's throat into their gut, and drip on some foods, and watch in real time as the gut wall becomes inflamed and leaky. You can actually see the cracks forming within minutes, but it had never been tested in a large group of IBS patients until now. Using this new technology, researchers found that more than half of IBS sufferers have this kind of reaction to various foods, what they call an atypical food allergy, that flies under the radar of traditional allergy tests, exclude those foods from the diet, and you get a significant alleviation of symptoms. But outside of a research setting, there's no way to know which foods are the culprit without trying your own exclusion diet. And there's no greater exclusion diet than excluding everything. A 25-year-old woman had complained of abdominal pain, bloating, and diarrhea for a year, and drugs didn't seem to help. But after fasting for 10 days, her symptoms improved considerably and appeared to stay that way at least 18 months later. And it wasn't just subjective improvement, they took biopsies that showed the inflammation go down, directly measured her bowel irritability and stuck expanding balloons and electrodes and erect them to actually measure changes in her sensitivity to pressure and electrical stimulation. Fasting seemed to kind of reboot her gut, but just because it worked for her doesn't mean it works for others. Case reports are most useful when they inspire researchers to put it to the test. Despite research efforts, medical treatment for this condition still unsatisfactory. I mean, we can try to suppress the symptoms with drugs, but what do you do when even that doesn't work? 84 IBS patients, 58 of whom who failed basic treatment, which consisted of pharmacotherapy and brief psychotherapy, 36 of the 58 who were still suffering underwent 10 days of fasting, whereas the other 22 stuck with the basic treatment. And those in the fasting group experienced significant improvements in abdominal pain, diarrhea, loss of appetite, nausea, anxiety, and interference with life in general, which was significantly better than the control group. The researchers concluded that fasting therapy could be useful for treating moderate to severe patients with IBS. Unfortunately, patient allocation was neither blinded nor randomized, so the comparison to the control group doesn't mean much. They were also given IV vitamins B1 and vitamin C, which seems typical of these Japanese fasting trials, even though one wouldn't expect to get vitamin deficiency syndromes, berry barrier, or scurvy to present within just 10 days of fasting. And they were also kept isolated, and maybe that made the psychotherapy work better. It's hard to tease out just the fasting effects. Psychotherapy alone can provide lasting benefits. 101 outpatients with irritable bowel syndrome were randomized to medical treatment, or medical treatment with three months of psychotherapy. After three months, the psychotherapy group did better, and the difference was even more pronounced a year later, a year after the psychotherapy ended. Better at three months, and even better at 15 months. Psychological approaches appear to work about as well as antidepressant drugs for IBS, but the placebo response for IBS is on the order of 40%. And that's whether we're talking about psychological interventions, or drugs, or alternative medicine approaches them. Essentially, nothing, a sugar pill, improves symptoms 40% of the time. So I figure one might as well choose a therapy first that's cheap, safe, simple, and side-effect-free, which extended fasting is most certainly not. But if all else fails, it may be worth exploring under close physician supervision.