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By Barbara Beltrami

Backyard barbecues are fine, but there are times, particularly on a hot summer evening, when even the most dedicated grill meister doesn’t want to stand over a hot grate and flip and baste, no matter how cold the beer or how chilled the martini in their other hand. This is the time to turn to cold sliced meat or poultry or maybe some poached fish. Preceded by a cold soup and accompanied by homemade potato salad, coleslaw or a crisp green salad laced with fresh herbs it’s a dinner that will please your family as well as company and keep you from the heat of the grill and the kitchen.  

Marinated Grilled Steak

YIELD: Makes 6 servings

INGREDIENTS: 

One 3-pound flank or boneless sirloin steak

1 cup dry red wine

1/4 cup sweet vermouth

1/4 red wine vinegar

1/3 cup olive oil

1 medium onion, chopped

1/2 cup tomato sauce

3 garlic cloves, minced

2 bay leaves

1 teaspoon freshly grated ginger root

Salt and freshly ground pepper to taste

DIRECTIONS:

Preheat grill to high; brush steak with a little of the olive oil; grill, turning once, until it reaches an internal temperature of 140-145 F and is pink inside for medium rare; cook longer for more well done. Transfer to a shallow nonreactive dish. In a medium nonreactive saucepan combine wine, vermouth, vinegar, oil, onion, tomato sauce, garlic, bay leaves, ginger root and salt and pepper; bring to a low simmer for 5 minutes, then pour over hot steak. Let cool completely, then cover tightly and refrigerate, turning occasionally, at least 6 hours. When ready to serve, slice, arrange on a platter and spoon marinade over it. Serve with rice salad, snow peas and scallions.

Wine-Poached Salmon with Dill-Cucumber Sauce

Wine-Poached Salmon with Dill-Cucumber Sauce

YIELD: Makes 4 servings

INGREDIENTS: 

3 cups dry white wine

1 small onion, chopped

3 celery ribs with leaves, chopped

3 flat leaf parsley sprigs

Four 6-8 ounce salmon fillets, skin on

1 1/2 cups plain Greek yogurt

1/3 cup minced peeled and seeded cucumber

1/4 cup minced red onion

1 garlic clove, minced

1 1/2 tablespoons freshly squeezed lime juice

3 tablespoons minced fresh dill

Salt and freshly ground pepper to taste

DIRECTIONS:

In a deep skillet combine the wine, onion, celery and parsley; add 3 inches water and bring to a boil, then lower to a simmer. Carefully place the salmon fillets in the liquid (be sure they are fully submerged) and bring liquid back to a simmer. Cover and cook gently until salmon is the same shade of pink on the inside as the outside, about 5 to 10 minutes. With a slotted spatula, carefully remove the fillets, peel off their skin and place them on a platter, dab off any white bits and let sit 15 minutes to cool slightly. Cover and refrigerate until ready to serve. In a medium bowl combine the yogurt, cucumber, onion, garlic, lime juice, dill, and salt and pepper; cover and refrigerate. 

Nutty Grilled Chicken Salad

YIELD: Makes 4 to 6 servings

INGREDIENTS: 

1 cup mayonnaise

1 tablespoon freshly squeezed lemon juice

1 tablespoon prepared Dijon mustard

Salt and freshly ground pepper to taste

4 cups diced grilled boneless, skinless chicken breasts

1 cup finely diced celery ribs

2 tablespoons minced shallot

2 tablespoons chopped fresh dill

2 tablespoons chopped flat leaf parsley

1/2 cup fresh snipped chives

1/2 cup finely chopped sweet pickles

1 cup chopped walnuts

1 cup halved seedless green grapes

1 cup cooked fresh or frozen peas 

DIRECTIONS:

In a small bowl whisk together the mayonnaise, lemon juice, mustard, and salt and pepper. In a medium bowl toss together the chicken, celery, shallot, dill, parsley, chives and pickles; add mayonnaise mixture and toss to evenly coat, then fold in the walnuts, grapes and peas. Cover and place in fridge until chilled. 

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Pixabay photo
Different dietary approaches may help modulate the immune system

By Dr. David Dunaief

Dr. David Dunaief

Autoimmune disease is when the body’s immune system attacks the organs, cells and tissues and causes chronic inflammation. However, this umbrella term refers to more than 80 different diseases (1). Some are familiar names, like type 1 diabetes, lupus, rheumatoid arthritis (RA), psoriasis, multiple sclerosis, and inflammatory bowel disease. Others, like Lambert-Eaton myasthenic syndrome and Cogan syndrome, are less well-known.

Chronic inflammation is the main consequence of immune system dysfunction, and it is the underlying theme tying these diseases together. Unfortunately, autoimmune diseases tend to cluster (2). Once you have one, you are at high risk for acquiring others. They disproportionately affect women, although men are also at risk.

Treating autoimmune diseases with meds

The primary treatment is immunosuppressives. In RA, for example, where there is swelling of joints bilaterally, a typical drug regimen includes methotrexate and TNF (tumor necrosis factor) alpha inhibitors, like Remicade (infliximab). These therapies seem to reduce underlying inflammation by suppressing the immune system and interfering with inflammatory factors, such as TNF-alpha. Disease-modifying anti-rheumatic drugs (DMARDs), a class that also includes Plaquenil (hydroxychloroquine), may slow or stop the progression of joint destruction and increase physical functioning.

However, there are several concerning factors with these drugs. First, the side-effect profiles are substantial. They includes risks of cancers, opportunistic infections and even death, according to black box warnings (the strongest warning required by the FDA) (3). Opportunistic infections include diseases like tuberculosis and invasive fungal infections.

It is no surprise that suppressing the immune system would increase the likelihood of infections. Nor is it surprising that cancer rates would increase, since the immune system helps to fend off malignancies. In fact, a study showed that after 10 years of therapy, the risk of cancer increased by approximately fourfold with the use of immunosuppressives (4).

Second, these drugs were tested and approved using short-term clinical trials; however, many patients are prescribed these therapies for 20 or more years.

So, what other methods are available to treat autoimmune diseases? Medical nutrition therapy using bioactive compounds and supplementation are being studied. Medical nutrition therapy may have immunomodulatory (immune system regulation) effects on inflammatory factors and on gene expression.

Managing inflammation with nutrition

Raising the level of beta-cryptoxanthin, a carotenoid bioactive food component, by a modest amount has a substantial impact in preventing RA. Several studies have also tested dietary interventions in RA treatment (5). Included were fasting followed by a vegetarian diet; a vegan diet; and a Mediterranean diet, among others. All mentioned here showed decreases in inflammatory markers, including c-reactive protein (CRP), and improvements in joint pain and other quality of life concerns.

Fish oil’s effects

Fish oil helps your immune system by reducing inflammation and improving your blood chemistry, affecting as many as 1,040 genes (6). In a randomized clinical study, 1.8 grams of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) supplementation had anti-inflammatory effects, suppressing cell signals and transcription factors (proteins involved with gene expression) that are pro-inflammatory.

In RA patients, fish oil helps suppress cartilage degradative enzymes, while also having an anti-inflammatory effect (7). A typical recommendation is to consume about 2 grams of EPA plus DHA to help regulate the immune system. Don’t take these high doses of fish oil without consulting your doctor, since fish oil may have blood-thinning effects.

Probiotic supplements

Approximately 70 percent of your immune system lives in your gut. Probiotics, by populating the gut with live beneficial microorganisms, have immune-modulating effects that decrease inflammation and thus are appropriate for autoimmune diseases. Lactobacillus salvirus and Bifidobacterium longum infantis are two strains that were shown to have positive effects (8, 9).

In a study with Crohn’s disease patients, L. casei and L. bulgaricus reduced the inflammatory factor TNF-alpha (10). To provide balance, I recommend probiotics with Lactobacillus to my patients, especially with autoimmune diseases that affect the intestines, like Crohn’s and ulcerative colitis.

Increasing fiber intake

Fiber has been shown to modulate inflammation by reducing biomarkers, such as CRP. In two separate clinical trials, fiber either reduced or prevented high CRP in patients. In one, a randomized clinical trial, 30 grams, or about 1 ounce, of fiber daily from either dietary sources or supplements reduced CRP significantly compared to placebo (11).

In the second trial, which was observational, participants who consumed the highest amount of dietary fiber (greater than 19.5 grams) had reductions in a vast number of inflammatory factors, including CRP, interleukin-1 (IL-1), interleukin-6 (IL-6) and TNF-alpha (12).

Immune system regulation is complex and involves over 1,000 genes, as well as many biomarkers. Dysfunction results in inflammation and, potentially, autoimmune disease. We know the immune system is highly influenced by bioactive compounds found in high-nutrient foods and supplements. Therefore, bioactive compounds may work in tandem with medications and/or may provide the ability to reset the immune system through immunomodulatory effects, treating and preventing autoimmune diseases.

References: 

(1) niaid.nih.gov. (2) J Autoimmun. 2007;29(1):1. (3) epocrates.com. (4) J Rheumatol 1999;26(8):1705-1714. (5) Front Nutr. 2017; 4: 52. (6) Am J Clin Nutr. 2009 Aug;90(2):415-424. (7) Drugs. 2003;63(9):845-853. (8) Gut. 2003 Jul;52(7):975-980. (9) Antonie Van Leeuwenhoek 1999 Jul-Nov;76(1-4):279-292. (10) Gut. 2002;51(5):659. (11) Arch Intern Med. 2007;167(5):502-506. (12) Nutr Metab (Lond). 2010 May 13;7:42.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.

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Cartoon by Kyle Horne: kylehorneart.com @kylehorneart

As citizens of a free nation, we have the right to make our voices heard at the ballot box. 

This coming Tuesday, Aug. 23, we will cast our votes for congressional and state senatorial primary elections. But democracy doesn’t end when we leave the polling place. In fact, that is only where
it starts. 

Cartoon by
Kyle Horne:
kylehorneart.com
@kylehorneart

Recently, TBR News Media has witnessed a flurry of popular energy within our coverage area. Look no further than Port Jefferson Station/Terryville to learn what democracy looks like while in motion. 

Since the inception of councilmanic districts in the Town of Brookhaven in 2002, Port Jefferson Station/Terryville has fallen within Council District 1. However, two maps on the Brookhaven Redistricting Committee’s website propose dividing that community across separate council districts.

For three weeks running, the people of the united hamlet of Port Jefferson Station/Terryville have turned out in numbers, eager to keep their community intact under a single council district. In the face of uncertainty, the Greater Comsewogue community has stood up to power, spoken out and may make a difference.

While the redistricting process remains ongoing, Port Jefferson Station/Terryville has illustrated the power of a united public. Through their mobilized efforts, the people have demonstrated what democracy can and
should be. 

Politicians are in office to carry out the will of the people. When they defy the popular will in favor of their own agendas, it is the right and obligation of the people to correct course. 

Though democracy may die in darkness, it shines brightest when ordinary citizens light the way. In their moment of history, the people of Port Jefferson Station/Terryville remind us that there is no greater force in nature than a united people. 

Communities across Long Island should learn from this example. Through their actions, we uncover the formula for positive change in our own communities. If we all take a page out of their playbook, then there is no end to what we can achieve together. The redistricting commission and Town Board should take careful note of the wishes of We the People.

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Blaze. Photo from Smithtown Animal Shelter

Shelter Pet of the Week

This week’s shelter pet is Blaze, a long time resident at the Smithtown Animal Shelter.  A 9-year-old pit mix, he is a very protective dog and will need a home that can manage this. His trust can be easily bought with treats and a person he trusts doing the introductions.  Once Blaze loves you, it is forever. He likes to play ball, carry toys around, go for walks, splash in the pool and, above all, eat! He is a regular tough guy until it’s cold and rainy, then he becomes a little baby. Blaze would be best suited to an adult only home with no other pets.

If you would like to meet Blaze, please call ahead to schedule an hour to properly interact with him in a domestic setting.

The Smithtown Animal & Adoption Shelter is located at 410 Middle Country Road, Smithtown. Visitor hours are currently Monday to Saturday from 10 a.m. to 3 p.m. (Sundays and Wednesday evenings by appointment only). For more information, call 631-360-7575 or visit www.townofsmithtownanimalshelter.com.

 

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METRO photo

By Daniel Dunaief

Daniel Dunaief

Have you seen images of the Greek gods on Mt. Olympus?

Sure, some of them looked like they were having fun, like Dionysus, while others were out hunting or frolicking, annoying their spouses and causing all kinds of havoc on the Earth below.

But when they weren’t getting ready for an intractable war with each other or with the Titans, they seemed bored.

Perfection wasn’t all that inspirational, peaceful or enjoyable.

Maybe the Greeks knew a thing or two about perfection. Maybe we shouldn’t crave or want perfection from our kids, particularly on the verge of the new academic year.

Mistakes provide an opportunity to learn, while adversity also offers a chance to grow and develop resilience.

Failing, striking out, falling down, biting our lips or tongue, saying the wrong thing at the wrong time, and getting a question or two wrong on a test provide opportunities to learn.

Your kids and mine are bound to get something wrong. The question doesn’t need to be a reflexive, “why did you get that wrong?” The better question is: “how will you respond to that moment?”

I have been at baseball games where parents are at their worst when their children don’t perform as they (the parents) would like. One parent, who coached with me when his child was around 11 years old, screamed at him for not swinging at a called third strike.

The other kids on the bench looked horrified, while the child sat off by himself at the corner of the bench.

The error didn’t happen between the lines. It happened on the bench when the father made a potential learning experience uncomfortable.

Change and growth can be painful. Parents, teachers and friends shouldn’t compound the discomfort.

I definitely live in a glass house. When I evaluate my parenting skills, I recognize deficiencies and have tried to improve.

I have told my children that I recognize that I made mistakes when I’ve said the wrong thing to them.

Maybe, before the new academic year begins, it’d help to have a conversation with our kids about the role they would like us to play. This may turn into something of a negotiation, as interactions with children often are, but at least we can have an idea before we repeat patterns that may not work for our children, of what they’d prefer.

It took me a long time to ask my daughter what she’d like me to say in response to moments of adversity.

Letting our children make every decision won’t always lead to the best outcome. They might, for example, prefer to eat cookies for breakfast and cake for dinner.

Giving them a chance, however, to suggest ways we can do exactly what we’re trying to accomplish, by supporting them, encouraging them, and helping them improve, may create a better and healthier dynamic for them.

The pursuit of perfection is tiring and is bound to lead to disappointment. Chasing ways to be better, however, and seeing growth opportunities can be rewarding.

We as parents made countless mistakes when we were our children’s age. We can’t prevent them from making mistakes. While we might also share stories about the discomfort brought on by our errors, we can’t even prevent them from doing the same stupid, inappropriate, ill-advised and awkward things we did, no matter how much we plead with them to learn from us.

What made those Greek gods so compelling were the stories of their imperfections. I’m not sure they learned from their mistakes, but, as the Greek chorus suggests in tragedies, maybe we can.

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Megan Bomgaars. Photo from Facebook

By Leah S. Dunaief

Leah Dunaief

“Born to Sparkle” is a book written, to my surprise, by a young woman with Down syndrome. The rest of the book title is “A Story About Achieving Your Dreams.” A review of the book appears in our Arts and Lifestyles section on page B23 in this issue, and it tells a heartwarming story about the author, Megan Bomgaars, who is 29 and lives in Denver. In the words of our reviewer, Melissa Arnold, the book “teaches kids that all of us are unique and have something special to share with the world, and if you dream big and work hard, you can achieve anything.” 

Why am I surprised? Because my sister, who was two years younger than I, also was born with Down syndrome, and like Megan, on Thanksgiving Day but 50 years earlier in 1942. While she was clever and wonderful in many ways, Maxine could never have written a book, in part because she would never have been imagined to do so. What a difference that half-century makes.

There is a broad spectrum of Down diagnoses, and Maxine was pronounced “profoundly retarded,” which surely limited expectations for her life. While Megan’s motto is, “Don’t Limit Me!”, and she has become a motivational speaker and the owner of a business, the professionals who examined my sister Maxine told my parents to institutionalize her “because she won’t live very long anyway with that condition.” She lived to be 65.

It was my sister’s bad luck to be born five decades earlier, when mental retardation was considered a stigma for a family, and the response to such a birth was to hide the innocent person. Megan Bomgaars, by comparison, shared her life’s story on television with six others in the A&E docuseries “Born This Way.” The show went on to win an Emmy in 2016.

It was my sister’s good luck to have two parents who recognized her as a fully entitled member of our family and tried to give her every advantage that existed then, which were very few. When the principal of the elementary school that I attended refused to accept her into first grade, my mother asked for the “Dick & Jane” series with which first graders were taught to read and patiently worked with my sister at home for many hours a day. Eventually, Maxine could proudly read that primer. She could also do simple arithmetic, adding and subtracting, and she was very verbal. 

In fact, that was the only difficult part of life with Maxine. She talked constantly and in a loud voice, as if she were on one side of a telephone conversation. Only two things could make her quiet down: music and baseball.

Maxine would sit quietly in the back of the room while I took piano lessons from a teacher who came to the apartment. After he left and I got up, she would slide onto the piano stool and play the melodies of the different pieces I had gone over with the teacher. We’re talking here Bach, Czerny and Mendelsohn. She also adored music that she would hear on the radio, especially show tunes that she could sing. And sing she did, in a Jimmy Durante voice. One of her favorites was “Oklahoma!”

Also, she loved to listen to baseball games on the radio and watch them played on our Sunday outings with our dad to Central Park. I don’t know if she followed the intricacies of the game, but she knew when to cheer and probably loved being part of the crowd.

Megan Bomgaars loved going to school and was a cheerleader in high school. My sister also attended a school in Brooklyn that was operated by Catholic Services. A bus would pick her up, along with my mother, each day and drive them to Brooklyn. Incidentally, my mother never let her out of her sight. My parents protected Maxine from a world that could not always be kind and safe. But for Megan, a person who incidentally has Down syndrome, today society learns from her.

 

 

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Photo courtesy of Michael Ardolino

By Michael Ardolino

Michael Ardolino

Strong seller’s market? Yes, historically it’s still a strong seller’s market. So, let’s get moving. 

Ready or not

Grab the opportunity now. While it still takes time to prepare your home to go on the market, homes are still selling quickly once the For Sale sign goes up. Once an offer is accepted, there are negotiations, inspections, and contracts to be signed.

The one tip that I believe is always worth repeating is price your house according to current real estate market conditions. This piece of advice can help you sell your home quicker and at a higher price. You want to find a price that doesn’t deter potential buyers which may lead to a price drop. 

Some buyers may see such a move as a red flag leaving them to wonder if there is something wrong with the house, when it could have been as simple as it was priced too high for the current market.

For those planning to upsize, downsize, retire, or simply start fresh, why wait? Now is the time to get your house ready to sell.

Seller’s choice

The supply of houses is still behind demand, which means homes continue to appreciate. The market is experiencing an extended period where supply cannot keep up with demand, leaving behind practically nothing to choose from, and it’s still rebounding. The appreciation is still rising. Those selling their house will still make a nice profit on a sale and did not miss the boat. The median price of Suffolk County homes in July 2022 was up nearly 10% since the same time last year. Within the last month or so, more than 65% of homes were sold over the asking price. 

What’s going on with buyers

Buyers are adjusting to the current market. Homebuyers understand that mortgage rates are still excellent and don’t want to miss a smart financial move, even though they are acting more cautiously. 

The recent intense market and rising and falling mortgage rates this year have kept things interesting. In the near future, experts are expecting a strong continued growth market. Get ahead of it by selling now.

Takeaway

There is no such thing as perfect; timing is everything. When your future includes a move, start discussions with a local real estate professional sooner rather than later. They will help you prepare your home and list it at the right price. So … let’s talk.

Michael Ardolino is the Founder/Owner-Broker of Realty Connect USA.

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METRO photo

By Matthew Kearns, DVM

Dr. Matthew Kearns

The summer is not over and what better way to spend a hot day than to go to the beach and there is no better friend to bring than your happy canine. Just be aware that there are also hazards at the beach for your dog. 

Saltwater/Seawater: Saltwater is a hyperosmotic. Hyperosmotic means the large amount of salt in seawater pulls fluid to it. Pulling fluid from the body into the gastrointestinal tract not only causes severe vomiting and diarrhea and secondary dehydration, but also can pull water from the tissues surrounding the brain. This will cause a secondary cerebral edema, or brain swelling and neurologic signs like seizures. 

The second concern are the microscopic creatures living in the water. Seawater contains increased levels of bacteria from runoff, as well as cyanobacteria (blue green algae). These microorganisms can cause severe gastrointestinal symptoms, potential sepsis, and neurologic symptoms. If the beach is closed to humans, it is probably not a good day to walk with your dog on the beach even if they want to go into the water.

Cuts/lacerations/burns to feet: Cuts on dogs footpads are quite common on the beaches of the north shore of long island. We usually get 4-5 cases at our clinic alone each summer and we are not even an emergency clinic. Shells, sharp rocks, broken glass can all cut deeply into a dog’s pad. Sand, bacteria and other debris can then get into these open wounds. Also remember that the asphalt in the parking lot can become very hot leading to burning of the pads. 

It is best to purchase some protective booties (if your dog will leave them on) to protect their feet from these sharp objects and excessive heat.

Toxicity: Not long ago this summer a couple brought their 5-month-old puppy into the clinic disoriented and difficulty walking. They had been walking on the beach that evening and the puppy was off leash. He did not return and, when they found him, he was in the condition I described above. 

When the owners arrived, I was not sure what had happened but I knew the puppy needed to be monitored overnight. We immediately transferred this puppy to the emergency clinic and, at the emergency clinic, the puppy was diagnosed with marijuana toxicity. Rotten food and other sharp objects such as bones, etc are a concern for toxicity, intestinal obstructions, or perforations. Therefore, be careful with your dog off leash that they don’t get into anything that may have been discarded. 

Heat stroke/sunburn: There really isn’t any shade at the beach unless you bring a beach umbrella with you. Remember that affects our dogs as well. Make sure to provide them with shade, do not let them run around excessively during the hottest time of the day, and apply sunscreen protection to hairless areas if you will be at the beach all day with your dog.

Please enjoy a day at the beach with your dog, but also take certain precautions to make sure the day is enjoyable for you both. 

Dr. Kearns practices veterinary medicine from his Port Jefferson office and is pictured with his son Matthew and his dog Jasmine.

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Photo by Elisa Hendrey

SUNSET SPLENDOR

Elisa Hendrey of Sound Beach submitted this gorgeous photo taken at the end of July. She writes, ‘Cars were pulling up along the shore of Mt. Sinai Harbor to take photos or simply gaze at what seems to have been one of the most stunning sunsets this summer. I had seen clouds earlier in the day and made a mental note that they might become part of a special sight as the sun went down.

Send your Photo of the Week to [email protected]

 

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Many people suffer from IBS.
Fructose, lactose and gluten may be contributors

By David Dunaief, MD

Dr. David Dunaief

If you suffer from irritable bowel syndrome (IBS), its symptoms can directly affect your quality of life. They include abdominal pain, cramping, bloating, constipation and/or diarrhea.

According to estimates, 10 to 15 percent of the population suffers from IBS symptoms, although only five to seven percent have been diagnosed (1).

Diagnosing IBS is challenging. While the general perception is that IBS symptoms are somewhat vague, there are discrete criteria physicians use to provide a diagnosis it and eliminate more serious possibilities.

The Rome IV criteria comprise an international effort to help diagnose and treat functional gastrointestinal disorders. Using these criteria, which include frequency of pain and discomfort over the past three months, in combination with a physical exam helps provide a diagnosis.

So, what can be done to improve symptoms? There are a number of possibilities that require only modest lifestyle changes.

Addressing your mental state

The “brain-gut” connection refers to the direct connection between mental state, such as nervousness or anxiety, to gastrointestinal issues, and vice versa.

Mindfulness-based stress reduction was used in a small, but randomized, eight-week clinical trial with IBS (2). Those in the mindfulness group (treatment group) showed statistically significant results in decreased severity of symptoms compared to the control group, both immediately after training and three months post-therapy.

Those in the treatment group were instructed to do meditation, gentle yoga and “body scanning” — focusing on one area of the body for muscle tension detection. The control group attended an IBS support group once a week.

Possible link with migraines

A preliminary study has suggested there may be a link between IBS and migraine and tension-type headaches. The study of 320 participants, 107 with migraine, 107 with IBS, 53 with episodic tension-type headaches (ETTH), and 53 healthy individuals, identified significant occurrence crossover among those with migraine, IBS and ETTH. Researchers also found that these three groups had at least one gene that was different from that of healthy participants. Their hope is that this information will lead to more robust studies that could result in new treatment options (3).

Gluten consumption a factor?

In a small randomized clinical trial, patients who were given gluten were more likely to complain of uncontrolled symptoms than those who were given a placebo, 68 percent vs. 40 percent, respectively (4). These results were highly statistically significant. The authors concluded that nonceliac gluten intolerance may exist. Gluten sensitivity may be an important factor in for some IBS patients (5). I suggest to my patients that they might want to start avoiding gluten and then add it back into their diets slowly to see the results.

What about fructose?

Some IBS patients may suffer from fructose intolerance. In a study, IBS researchers used a breath test to examine this possibility (6). The results were dose-dependent, meaning the higher the dose of fructose, the greater the effect researchers saw. When patients were given a 10 percent fructose solution, only 39 percent tested positive for fructose intolerance, but when they were given a 33 percent solution, 88 percent of patients tested positive.

The symptoms of fructose intolerance included gas, abdominal pain, bloating, belching and alternating bowel habits. The authors concluded that avoidance of fructose may reduce symptoms in IBS patients.

According to another study, about one-third of IBS patients are fructose intolerant. When on a fructose-restricted diet, symptoms appeared to improve (7). Foods with high levels of fructose include certain fruits, like apples and pears, but not bananas.

Considering the effects of lactose

Another small study found that about one-quarter of patients with IBS also have lactose intolerance. Two complications are at play here. One, it is very difficult to differentiate the symptoms of lactose intolerance from IBS. The other is that most IBS trials are small and there is a need for larger trials. Of the IBS patients who were also lactose intolerant, there was a marked improvement in symptomatology at both six weeks and five years when placed on a lactose-restricted diet (8).

Though the trial was small, the results were statistically significant, which is impressive. Both the patient compliance and long-term effects were excellent, and visits to outpatient clinics were reduced by 75 percent. This demonstrates that it is probably worthwhile to test patients who have IBS symptoms for lactose intolerance.

Are probiotics part of the solution?

Treatment with probiotics from a study that reviewed 42 trials shows that there may be a benefit to probiotics, although the endpoints, or objectives, were different in each trial. The good news is that most of the trials reached one of their endpoints (9). Probiotics do show promise, including the two most common strains, Lactobacilli and Bifidobacteri, which were covered in the review.

All of the above provides hope for IBS patients. These are treatment options that involve modest lifestyle changes. I believe there needs to be a strong patient-doctor connection in order to select an approach that results in the greatest symptom reduction for a specific patient.

References: 

(1) American College of Gastroenterology [GI.org]. (2) Am J Gastroenterol. 2011 Sep;106(9):1678-1688. (3) American Academy of Neurology 2016, Abstract 3367. (4) Am J Gastroenterol. 2011 Mar;106(3):508-514. (5) Am J Gastroenterol. 2011 Mar;106(3):516-518. (6) Am J Gastroenterol. 2003 June;98(6):1348-1353. (7) J Clin Gastroenterol. 2008 Mar;42(3):233-238. (8) Eur J Gastroenterol Hepatol. 2001 Aug;13(8):941-944. (9) Aliment Pharmacol Ther. 2012 Feb;35(4):403-413.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.

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