Nutritional Solutions to Recover from Irritable Bowel Syndrome Guest: Dr. Janice Joneja

Transcription

1 Nutritional Solutions to Recover from Irritable Bowel Syndrome Guest: Dr. Janice Joneja The purpose of this presentation is to convey information. It is not intended to diagnose, treat, or cure your condition or to be a substitute for advice from your physician or other healthcare professional. Donna: Dr. Janice Joneja is a researcher, educator, author, and clinical counselor with over thirty years of experience in the area of biochemical and immunological reactions involved in food allergy and intolerances. Dr. Joneja holds a Ph.D. in medical microbiology and immunology and is a registered dietician. She's been a member of the faculty at several Canadian universities, starting her career as an assistant professor in the department of microbiology, the faculty of science and then the faculty of dentistry at the University of British Columbia in Vancouver. For twelve years she was head of the Allergy Nutrition Program at Vancouver Hospital and Health Services. Dr. Joneja is the author of six books and a dietetic practice manual on food allergy, also a textbook on irritable bowel syndrome. Her most recent books include The Health Professional's Guide to Food Allergies and Intolerances, Dealing with Food Allergies, and Dealing with Food Allergies in Babies and Children. Her work has been published in peer-reviewed, scientific and medical journals as well as in popular magazines. She is a respected lecturer at universities, colleges, and hospitals internationally, and she regularly appears on television and radio call-in shows as an expert in her field. Her website, if you'd like to go to that right now is AllergyNutrition.com. We're very lucky to have her on the gut summit. Welcome, Dr. Joneja Axe Wellness, LLC. All rights reserved. 1

2 Dr. Joneja: Thank you very much. I'm very happy to speak to you, Donna. Donna: That is a long and very prestigious bio. Wow. Dr. Joneja: It's actually a very short one. I gave you the short version! Donna: Well, I wanted people to realize that you're an expert, and we're very fortunate to have you. And I've got lots and lots of questions prepared. So I wanted to, we were talking earlier about the early days twenty-five/thirty years ago when we both were, of course, into diet and fascinated by food as medicine, basically. And yet nobody in those days believed that diet had anything to do with your illnesses. So if you had acne or you had say diabetes or anything wrong with you, doctors didn't think diet mattered. Can you tell me about your early experience with that? Dr. Joneja: Well, yes. Actually if you read the preface to any of my books, especially the ones for, what we would call the lay audience, I have given in detail my experiences with the whole aspect of adverse reactions to foods. I was fortunate to have my children, of course. But they had the most awful allergies. I knew being in my own profession interestingly being in the field of allergy, I actually did my early training at the University of Birmingham in England where the mechanisms for allergy, the immunological processes that were involved in the various allergic reactions were delineated. And I was very fortunate to start right at the bottom of the immunology and go right through as immunology evolved through the decades to in the understanding of how the body responded in an allergic reaction. Now having said that, all of the research that was being undertaken was the allergy of respiratory diseases such as hay fever. Later, believe it or not, in the 2016 Axe Wellness, LLC. All rights reserved. 2

3 early days it wasn't even accepted that asthma was an allergic disease. But that was accepted finally that there was an allergic component to asthma. So you can imagine that right in the beginning we knew very little about exactly the way in which the immune system really acted when it encountered materials that were not in themselves disease producing like the virus or bacterium, but in fact were safe. In other words, we breathe in pollens, they themselves cannot cause disease. It's the way that the body responds to them that causes the problem. And that's an immunological response, of course. So this was in the early days of understanding how the body did that to inert materials like pollens. And at the same time, doctors, clinicians, even researchers were denying that food had any part to play in the triggering of that allergic response. My first book actually was on the immunology of allergy, not food allergy, allergy itself because that's all we understood. Now, when I had my own children, I found that they were extremely allergic, particularly my son born in the 1970s. And I knew that when he ate certain foods he had a very visible allergic reaction. He was anaphylactic. He had several anaphylactic reactions, severe asthma, very incredibly severe eczemaall of the signs that one now accepts as being part of the food allergy spectrum. Took him to his pediatrician, and I was told categorically food absolutely does not cause allergies. It's a product of a neurotic mother, overprotective, neurotic mother. That was allergy, per se, sort of oh my goodness. One pediatrician even told me that it was the result of marital discord causing stress, and that's why my son had severe asthma and eczema and so on. So knowing the science of allergy and realizing what was going on in the body but being completely unable to do anything about it because I wasn't a clinician, I went back to school. I learned become a dietician, a registered dietician, in order to apply what I knew scientifically that was actually going on in the body Axe Wellness, LLC. All rights reserved. 3

4 So I was very fortunate to be able to establish the first food allergy clinic, definitely in Canada and probably in North America, in Vancouver General Hospital. And here I was able to do research and counsel patients. It became a very, very busy practice within the hospital. And I was seeing more and more people, not just with allergies but with irritable bowel syndrome because they were convinced, of course, that food was causing a great deal of the distress that they were experiencing. But the gastroenterologist along with still some very skeptical physicians denied that food had any role to play whatsoever. So not only did we have the denial of food allergies which now is a very, very big topic within medicine and food services and everything to do with food, but not only were they denying that but they also denying that irritable bowel syndrome had anything whatsoever to do with food. So gastroenterologists saying, No, no, no, it's got nothing to do with food. It's the mechanical processes within the digestive tract that are responsible for the symptoms. Several other events can impact and stress was, of course, and still is a big factor. And so they were saying, "No, it's a psychological disease. It's really got nothing whatsoever to do with food." I tried very hard to recruit local gastroenterologists in research projects that I was undertaking. But actually it became obvious it was peer pressure within their profession that prevented them from looking at foods. So we were faced with this amazing scenario where we know that the sole function of the digestive tract is to process food from the mouth to the anus. We've got all of the enzymes and processes, mechanical processes and so on that are involved in food digestion, absorption, and utilization. And yet here we have the specialists denying that food had any impact whatsoever in the dysfunction within the digestive tract. So there's a long answer to a short question. I do apologize for that, but it gives you a 2016 Axe Wellness, LLC. All rights reserved. 4

5 background as to where we are actually moving within the last thirty years. Donna: So we've come a really long way because now, especially the doctors that are trained in functional medicine, the first place they go is to with the person they're working with is to please change their diet, eliminate certain foods, which I want to talk to you about. But just getting back to a more personal note, as you begin to learn more and more about this field, what did you do in your own home with your children to help them recover so they didn't have the allergies? Dr. Joneja: Oh, yes, of course. The problem was very interestingly when I wrote my first book on allergy. It came out in Rutgers University Press so it was sort of a textbook, but it was also written for the average reader. The educated reader would certainly understand it. This was before I became a dietician, obviously. I tried to write a chapter on food allergy, found there was absolutely nothing when it came to evidence-based research, and looked for someone who would write a chapter for me on the aspects of allergy to foods. No dietician, certainly anyone that I could find, had any training or knowledge about food allergy. And I thought this is unbelievable because, after all, dieticians deal with food. So they certainly should understand how the body would react adversely to any component of food. And it was at that point that I realized, well, there's no one there. I d better fill in the gap. And that's when I went back to school to become a registered dietician. I went back and did all the courses required and then an internship and became a registered dietician myself so that I could apply the science. Now, until that point I had been really working in the dark when it came to my own children because I had very little understanding of food in those days. I was a scientist. I knew the mechanisms that were responsible for 2016 Axe Wellness, LLC. All rights reserved. 5

6 immunological, microbiological processes. So certainly. But I knew just the same as everyone else. I knew very little about food. So I then made it my business to look at the actual science of food. So I took courses. I researched the science of food and the ingredients within food at the molecular level and how these would impact on the immune system within the body. Having done that and having tried very hard by hit and miss processes with my own children, I certainly learned an incredible amount about how the immune system would interact with these food molecules. To answer your question specifically on how I handled my children, as I said, it was really working in the dark because I had no one with whom to work with the physicians denying the role of food in allergies, dieticians not understanding either how food would impact adversely in the body. It was really walking in the dark for me, trial and error and watching my own children's responses. Donna: That's an amazing story. So what were some of the first changes that you made in their diet? Dr. Joneja: Well, I've always been even before I was a dietician, as a scientist, I always hated the idea of anything processed. Now, by processed I mean where the food has gone through a manufacturing plant and has had additives. You really need additives when food is being changed from its natural form. So it's being changed into something else. And in order to have a shelf life, it has to contain preservatives, otherwise it's not safe. As it goes through the process, it changes in texture. So texturizers had to be added. Some of the ingredients wouldn't make, so we have to have emulsifiers. And then of course it comes out a different color, which may not be attractive to the average consumer. So we've got colors added. And then in order to enhance its palatability, we have to have flavors Axe Wellness, LLC. All rights reserved. 6

7 So being a scientist, I'm looking at all these artificial things that are being added to the food and said, "That's it! My children are not going to exposed to any of that." I knew very well that my son was extremely allergic to chocolate. He was anaphylactic to peanuts and all nuts. Later on we recognized the he being steroid-dependent asthmatic was very sensitive to sulfates. And so looking at the science of the molecules of the additives, I realized that this is the worst thing that I could give my children is anything manufactured. And so of course my first and most important change was no packaged foods, nothing with a label. If it has a label, it's been through a manufacturing plant, and that I will not allow in the home. So everything was made from scratch. Donna: Did they feel deprived? Dr. Joneja: I don't know. Let's put it this way, take Halloween. Donna: Oh, yes! Dr. Joneja: That was a really, because of course it's part of the culture of the country. You go around with your trick or treating and your costumes, and you expect candies. Now, candies were absolutely not allowed because, of course, everything in a candy is manufactured. And so I developed a system. My son Luke was into Star Wars figures and football helmets. I spent some time in Denver in Colorado. I took him to the National Answer Center. And I was doing some research at the University of Colorado Medical School there. And he was into collecting football helmets. In those days you could get them out of little machines. You put in a quarter, and you get a football helmet, tiny little football helmet. So what we did was a system of barter which means that, okay, one candy bar or one chocolate bar, one candy bar this size are equivalent to Luke Skywalker figure or something else that he wanted Axe Wellness, LLC. All rights reserved. 7

8 So he's got a fantastic collection even now of Star Wars figures. He guards it very carefully. Of course, he's got children of his own now, small children, but it's a big thing for him, his Star Wars collection. And then he started on he's got all the helmets of the American Football League. Oh no, it's called NFL? Something. I got that. Donna: Yes, I think so. Dr. Joneja: He would be cross with me for that. And then we got soldiers and all this sort of thing. So it was a matter of barter. So it became a game. He loved it. So yeah. Donna: This is such a cool story. I'm sure everyone at this point realizes well, you're this brilliant scientist. You've accomplished all this much over a lifetime, but you're also a real mom who struggled like lots and lots of parents are struggling right now. Dr. Joneja: Oh, yes! Yeah. And the other thing was I don't think, I should ask them, I never heard them actually say they felt deprived or anything. But I would never allow a package of breakfast cereal, of course. They're all manufactured. And sometimes I say, "Well, you know, breakfast cereals. You might as well eat the cardboard that they come in because after all it's good fiber. It's got a good plant source. It comes from trees probably. And it's got some artificial colors and everything else. Why don't you eat the box, too? Donna: So you were educating right along with changing the Dr. Joneja: Yes, so what I would do for breakfast cereals is buy all of the grains like rolled oats and wheat flakes and every grain and then make my own granola. So, yeah, that s the sort of thing that I did. Donna: And today they eat well? I mean they didn't rebel when they grew up and eat pizza every day? 2016 Axe Wellness, LLC. All rights reserved. 8

9 Dr. Joneja: No. In fact, they are even in some respects worse than I am. No, I'm not eating that. It's got to be made perfectly from foods, and you don't want that rubbish. Yeah. My son's children then are a bit sort of rebelling. Donna: Oh, interesting. Well, I think that's very true. Same thing with me. I fed my kids. I tried to feed them really healthy. They did rebel. But today they are all very, very conscious about what they eat. So it does matter. What you teach them in the beginning sticks. And it does matter, I would say. Well, let's get into irritable bowel because I know that's an important specialty of yours and also it's a real key issue. And I want you to know that we have a couple hundred thousand people listening to the gut summit interviews, and a lot of them are healthcare professionals. So while we want to keep the interview simple, we also want to be sure that the experts and practitioners that are listening are really going to get some real meat to use, too. So I'm going to ask a combination of both types of questions here. Some basics though just to get started, what is irritable bowel syndrome? Because I honestly think people don't really know for sure what it is because there's these other conditions like Crohn's and colitis. And so what exactly is irritable bowel syndrome? Dr. Joneja: That is a really good question because there is really no specific definition. We have several different approaches to this. Years and years ago when we were talking about irritable bowel syndrome, I could say that it was actually a diagnosis of exclusion. And what I mean by that is that when inflammatory bowel diseases such as Crohn's disease, ulcerative colitis, various types of colitis, and the gastrointestinal diseases that can be identified by specific tests. As far as Crohn's and ulcerative colitis there, it's very specific histologically. That means you can look at the cells and look at the various parameters of diagnosis, and 2016 Axe Wellness, LLC. All rights reserved. 9

10 it was pretty clear there. As far as irritable bowel syndrome was concerned, there really were no and still are not laboratory tests that would identify that condition as irritable bowel syndrome. So to a certain extent, it is still a diagnosis of exclusion. Now, what happened was that gastroenterologists found, and they're perfectly correct, that this wasn't really acceptable because they needed criteria on which to base their diagnosis, not just, Well, it isn't this and it isn't that therefore it must be, which is more or less what it was before. And so there were various meetings of gastrointestinal and societies and these took place in Rome in Italy. And so we had a series of what are called Rome Criteria. There's Rome 1, 2, 3, and now 4. And it is a list of the symptoms that would be used to identify the condition as irritable bowel syndrome. And those are in my books, and you can look at those for the lists. I could list them all now, but it's much more efficient for people to go to the lists. And you can go online on PubMed or one of the other sites, the National Institute of Health sites, where the Rome Criteria are listed. And it is really symptomatic, a simple thing, for example, night sweats. That would not be a criterion for irritable bowel syndrome. It would be indicative of something like Crohn's disease, things like this, the type of symptoms that one would be looking for. So it's still not exactly what we would like as far as medicine is concerned which means we want a definitive laboratory test. But because we now have these more specific symptoms to look for, gastroenterologists feel they're in a better position now to identify digestive tract symptoms as irritable bowel syndrome. Donna: Well, now obviously something has to trigger the beginning of this problem. If we went out on the street and we asked a bunch of people just say we had a mic with us and we started asking people, "What do you think 2016 Axe Wellness, LLC. All rights reserved. 10

11 triggers irritable bowel or any digestive disease?", I have a feeling a lot of people would say gluten because gluten's gotten a lot of press. As a matter of fact, 50% of Americans supposed to be gluten free today, which I find a little hard to believe because when I look at people's shopping baskets, I see gluten in them. So I don't know if they even know what they're supposed to be avoiding on the gluten free diet. But that's what they think, and they buy gluten free products. So gluten and is that a trigger? Could we talk about the trigger that would start a bowel disease? Dr. Joneja: Yes, the thing is that you already brought up the fact that it's a component of diet. That's important because some of the triggers for irritable bowel syndrome are not diet related. In fact, stress is an enormous trigger for irritable bowel syndrome. And this is because what happens is that stress, being a physiological process, actually you can see this again in my books. It goes through what we call the hypothalamic-pituitary-adrenal axis. And what happens within that process is that stress triggers a variety of components, chemical mediators, that actually can lead to an inflammatory process within the digestive tract. Now, the digestive tract is lined with nerves, with immunological cells that are going to respond. And a lot of these components will trigger the release of chemicals within the digestive tract that in fact start the irritable bowel syndrome. In fact, it may have nothing whatsoever with food going through, but it could be precisely and exactly a response of the different mediators released in the stress response. Now, having said that, of course, then because the digestive tract itself is now irritated And we won't say inflamed because although inflammation is involved, inflammation associated with inflammatory bowel disease is quite different histologically from that that you would expect to see in irritable bowel 2016 Axe Wellness, LLC. All rights reserved. 11

12 syndrome. And then food components can interact with that already irritated system. That can lead to a variety of dysfunction within the digestive tract itself, all very complex mechanisms. But then in this case, food could be secondary to an initial event. Another initial event, of course, can be infection. We can start with an infection within the digestive tract, and we have an irritable bowel syndrome as a consequence of infection within the digestive tract. Donna: So that infection might be something like a yeast infection in the gut? Dr. Joneja: No, what I would expect much more than that would be a viral infection. There are many, many intestinal viruses and bacterial. The yeast infection, I hope someone else will take that one as the topic because I could talk about that for a long time. But, no, I'm talking about infections such as infective viruses and bacteria. Donna: And how does one get to be infected in the gut from a virus? Because I think people tend to think of a viral infection say in the wintertime when they have the flu is more of the whole body's involved, not the gut. Dr. Joneja: Well, the norovirus is notorious. The norovirus. You hear about that on, for example, cruise ships. And everybody is ill and vomiting and terribly ill from a norovirus. The intestinal viruses are vicious. Donna: That's caught from person to person? Where does the norovirus come from? Dr. Joneja: Yes, that's definitely person to person, but usually from infected hands. And you know how viruses are passed. Donna: I just thought I'd paint a nice picture here for people so they were real clear everywhere we go Axe Wellness, LLC. All rights reserved. 12

13 Dr. Joneja: No, that's only one of many, many intestinal viruses. And then of course there are bacteria. And we all know what is called food poisoning, but isn't really. It's, say, salmonella, shigella, any one of these bacteria. They are terrible within the digestive tract. I'm sure everybody knows about salmonella. Irritable bowel syndrome, of course, can follow that. A lot of irritable bowel syndrome is what we call post-infection. Donna: Well, getting back to stress though since that's a major cause. The microbes in the gut, can you say a little about that? The fact that stress is actually destroying the microbes in the gut, and how does that would then lead to the inflammation that would then go on? Dr. Joneja: No, no. That's very confused. No. Let's get this straight. The microorganisms in the colon, we need. We could not live without them. In fact, research shows that what we call They've done experiments where rats, for example, are not allowed to develop microorganism flora within their colon. They're kept germ free. So we have germ free animal research. Those rats will die. And the reason is and for us humans we require our microflora to protect us in many ways. In one way, we get nutrients from it. We get vitamin K, a variety of different B vitamins are released from our food residue, released and altered in such a way that we then absorb these nutrients. For example, vitamin K we need for blood clotting. So we need the microorganisms in our colon to allow us to have vitamin K and blood clotting efficiently. So we first of all need them for a variety of nutrients. To a certain extent, they will break down material that we can't as in digestion. We can't break down fiber so we rely on microorganisms to a certain extent to break down fiber. Most of it passes through without being digested at all. We also need it for what we call the integrity of the digestive tract. Immunologically we depend on the microorganisms and their products to allow a healthy digestive tract 2016 Axe Wellness, LLC. All rights reserved. 13

14 immunologically. And so, yes, we desperately require these microorganisms in order to be healthy. And I think you were perhaps confusing this with the idea that there can be an overgrowth of microorganisms that are not quite as healthy as we would wish. For example, we can get an overgrowth of certain strains that are very highly fermentative. So we get a lot of fermentation going on in the lower bowel. And the products of fermentation can be very irritating. So, yes, we can get things that go wrong after, for example, having courses of oral antibiotics which can change the nature of the microorganisms in the bowel and then allow the faster growing ones to establish themselves, cause fermentation, and in the products of fermentation being the irritants again for irritable bowel syndrome. Donna: But the loss of these microbes, say, through an antibiotic, that wouldn't be a precursor to some type of gut dysbiosis like IBS? Dr. Joneja: Yeah, that's what I said that the antibiotics will kill off certain strains and allow others to establish themselves. Donna: I know that a high saturated fat diet destroys bifidous bacteria and the wadsworthia. I've got several studies on this. Wadsworthia grows much more of the wadsworthia. And that bacteria causes inflammation, too. That's why I thought. Dr. Joneja: No, what happens is that when the antibiotic does It depends on the antibiotic, of course. Certain antibiotics will kill certain strains of bacteria. That's what they're designed to do. And so what we're dealing with is establishment of other organisms. We call them opportunists that will then take their place. And so probiotics are really trying to introduce strains that will normalize or make the resident microflora more, we would say, less fermentative and therefore less irritating Axe Wellness, LLC. All rights reserved. 14

15 Donna: So can we talk more about fermentation in the gut? Because I think people are very confused between fermentation in the gut. They read that, and they think oh, but I'm eating fermented foods and that's fermentation. I'd just love to explain, have a better picture in people's mind, of that process, that fermentation that's happening in the gut. Dr. Joneja: Yes, you're eating fermented foods, for example, I suppose if you think about it And I think they're fermented like vinegar, wines, certain any alcohol beverages, cheese and so on and so forth. Yogurt itself is fermented, and that's used as a substrate for probiotics. And so really what we're dealing with our different types of fermentation. In the digestive tract, we've got many, many, many different strains of bacteria that can lead to the production of different products. All fermentation isn't the same. Some enzymes, of course, will produce products that are different from others. And what we have in the bowel is a microflora that will utilize any of the residual food that isn't digested and absorbed in the small intestine and convert it to a variety of products. Most of the products that we see are the result of fermentation would be gases such as hydrogen, carbon dioxide, methane, others as well, depending on the composition of the foods that actually go into the bowel that aren't absorbed. And then there are short chain fatty acids. There are a variety of organic products, some of which are very, very healthy for us. So this process of the metabolism, the breaking down of the residual food is what we call fermentation in a broad sense. But when everybody thinks of fermentation, they think of that's fermenting something or other with lots of gas bubbles and so on. But the process of metabolism within the digestive tract is very important to us. Fermentation we could say really would be the excessive production of things that we don't want, which is a lot of gas which can then result in bloating. And the bloating results in pain as the bloating causes pressure on very sensitive nerve endings 2016 Axe Wellness, LLC. All rights reserved. 15

16 within the digestive tract. And the organic acids can lead to two things. One can be a dysmotility, which means that the food can move either more slowly or more quickly through the digestive tract. But then we've got diarrhea, for example, where we've got a lot of residual fluid/water being actually either drawn in from the outside to balance the osmotic pressure or remaining within the bowel because, again, because of the osmotic imbalance. Donna: I'm sure you've hit a nerve with the word "pain," "gas," "bloating" because that's a lot of people. I think everybody experiences that often throughout their life. So I know, of course I work with people with gut dysbiosis. And I've looked at the different bacteria and fascinated by this category of microbes. They're not bacteria any longer. They used to be called, put there, but they're the archaea in their own class because they produce the methane. And that causes constipation in a lot of people. Could you talk a little bit about the archaea and the problems that they cause in the gut and the fact that not everybody has the archaea. I've read that here in the U.S., it's about 50/50. Dr. Joneja: Yeah, there's a lot of research remains to be done around that. So it isn't something that we're concentrating on solely because we can take any group of microorganisms and say, Well, these are doing such and such and those are doing this and they're responsible for... But there isn't enough evidence-based research to specifically point to them as acting, how would we say? Autonomously. You have to remember that this is a very, very complex microsystem, ecosystem. And none of them work solely alone. Yes, some of them will be producing methane, anything actually. There are many methane producers, bacterial methane producers. Any one of these may influence the motility of food passing through the digestive tract. And that, in some cases, can be a 2016 Axe Wellness, LLC. All rights reserved. 16

17 cause of constipation. Others it can be a cause of diarrhea, depending on how quickly the food actually moves through the digestive tract. So pinpointing one group and saying, Well, this is causing constipation, I think is misleading. I truly do. And also that this one is causing the production of methane because there are many others that do it. And so I think that's a little bit misleading to separate out that and say that must be the major cause. Certainly it may be. But at the present time and at the level of our understanding, I don't think we can go that far. I honestly don't. And you must remember another thing that happens is that the products of one type of microorganism can strongly affect what happens with another group because the products of one microorganism may actually be nutrients for another one. And so we've got an ecosystem that's interdependent, as well as being dependent on the material that's coming into the bowel from food residue and from residue from break down of cells within the body. There's so many sources of nutrients there. And each of the strains or the species and strains of microorganisms are not only doing their own thing, but they're interdependent on each other as well. And I think, yes, we get the research that shows us there's another group of organisms that we hadn't recognized before, and we start to look at those. But we have to look everything within the context of an ecosystem. Very, very important. Donna: And this concept of dysmobility, which is constipation or stagnation basically is so common. It seems to be as people get older, it's just part of what you experience as you get older. Can we talk about that some more? I know obviously there's lots of causes. And stress is one of them and low thyroid and not getting enough sleep, so you're fatigued and all that. But as far as what's going on in the gut, can you just teach us some things about that? 2016 Axe Wellness, LLC. All rights reserved. 17

18 Dr. Joneja: Well, I suppose you can say it's aging, but then we've got constipation in little ones, as well. So it isn't really although it becomes more a problem as people age. It can be a problem right from the beginning. And dysmotility has got more to do with neurological function than it has to do with food or the digestive tract itself. You have to remember that they're all dynamic systems, all controlled by different stimuli. And the motility through the digestive tract like everything else is controlled by many different chemical mediators. The peristaltic movement through each of the sections of the digestive tract is controlled by the nervous system. So you have to remember this is all part of the neurological system of the body. You have to think outside of the digestive tract for the triggers and controls that are coming from the nervous system. So any motility within the body is controlled by the nervous system's signals, whether it's slow or fast or is initially triggered through the stimuli from the nervous system. Then, of course, there's a series of stops, gates within the digestive tract. So the food would move to, say, the stomach and then in a series of openings and closings there are the various areas that it doesn't go straight through, for example. We've got movement through different portals, if you like. I'm trying to make this simple so that people can understand that we've got the opening and closing which actually is also controlled by different signals. So it isn't just a matter a food moving through a tube. This tube is very, very carefully controlled by a very complex system of signals from the nervous system. I've got that in my book too if people want to look at the way that food actually moves through the digestive tract. Donna: Well, with six books there's so many choices. Where would you start? Which one do you buy first? 2016 Axe Wellness, LLC. All rights reserved. 18

19 Dr. Joneja: The one for this one. Yeah, for IBS. Digestion, Diet, and Disease. That's the one. And you'll find a chapter on the way that the food actually moves through the digestive tract and the signals that are responsible for it moving and the different ways in which it's controlled as the food does move through. Digestion itself is a complex process because we've got a series enzymes that act at different parts in different parts of the digestive tract. And then we've got a change in the ph as food moves through. We start off, for example, in the mouth with saliva and amylase which is a starch enzyme that will act on starch. And it is a fairly neutral ph. And then we move through the esophagus into the stomach, which is highly acidic. And we need that acid to start protein digestion. So we've got starch digestion starting in the mouth until it reaches the stomach. Then we've got protein digestion and a certain amount of amylase there too, protein breakdown. It's what we call amalyosis, where the molecules are loosened a bit. So as the food then moves into the small intestine, where we have a change to an alkaline environment, the molecules are then more available for all the enzymes that we have in the small intestine that's coming from the pancreas. And all of these are churned up as they move through the digestive tract. So all this motility. We've got in the mouth we've got the movement within the mouth. Of course, that's mechanical. And then we've got movement of peristalsis through the esophagus. Then we've got the movement into the stomach and the churning there. And then the movement into the small intestine where we've got peristalsis being undertaken through the whole length of the small intestine and the churning motion, as well, that allows all the food to be mixed with the enzymes. And it's very important that the food molecules are exposed to the enzymes because that's where they're broken and when they're small enough 2016 Axe Wellness, LLC. All rights reserved. 19

20 will be absorbed into circulation. Now, as a result of all that, what we have when we reach the bowel is a very well digested amount of food material and the residue that is left which is quite, quite different from the way that it started in the mouth is then the substrate for the microflora, the ecosystem of the bowel to act upon and release again nutrients that we require. So you can see that the movement and the peristalsis, the churning, everything is very, very carefully controlled by the nervous system. Donna: You're such a fantastic teacher. I'm sure at this point everybody's immediately thinking, I've got to have this book in my basic library. I've got to understand digestion. But let's say that a person is in a lot of pain, suffering, doesn't digest, losing weight or whatever, and they also realize that this is complex. It's not something I'm going to figure out immediately. There's guidance in the book for exactly where you begin. So I'm sure. So we could talk about that and give some solutions here for people so we don't leave them feeling just overwhelmed and feeling like oh my gosh, this is so complicated. Where do I start? Can I get well at all? Dr. Joneja: Yeah, the science is extremely complicated. And the question is what can we do about the results. And that's what I was concerned about, of course, in my practice when I became a dietician is how can we apply what we know so that we get the best possible outcome for each individual sufferer. That's exactly what my aim has been right from the very beginning. And in the book you will find that chapter fourteen describes all the things that we see within the problems in irritable bowel syndrome and what can we do about it as far as diet is concerned. So you will see that I've developed a diet, which interestingly turns out to be a low residue diet in the sense that there isn't a lot of fermentable material that is going to go into the colon Axe Wellness, LLC. All rights reserved. 20

21 And now we've got a lot of interest in what is called the FODMAPs diet. And this came after actually that my book came out. This is quite a few years after that where practitioners have developed a diet that is very low residue because it's a low fiber diet in the sense that there's not a lot of fermentable substrate within it. So this really supports my work that I did years before that. And you'll find the diet in my book. There's meal plans, recipes, and all the basis for why these foods are selected. And people have found it a great benefit to follow that diet and then to find out the foods that they specifically react to so that they can liberalize their diet later. So they start with the basic IBS diet which removes all of the foods that can act as irritants within an irritated system, taking into account what triggers are responsible for the symptoms that I've described. Donna: Could you give a few examples of those? Dr. Joneja: Of what? The symptoms or the foods? Donna: No, I'm sorry, of the foods. The foods that are some of the really, good, safe things to eat. And doesn't this vary from person to person, one man's food is another man's poison? Dr. Joneja: Absolutely. So that's why we start with the basic IBS diet, which is actually very similar to the gastroenterologists are now handing out this FODMAPs diet to a lot of their patients. Donna: I've seen that, too, yeah. Dr. Joneja: And it's very similar to the diet that I developed earlier. And they start with that where they're taking out all the foods with high residue, cutting down on fermentation. They immediately find a great deal of relief because no longer do they have all the gases and organic acids and so on that are acting 2016 Axe Wellness, LLC. All rights reserved. 21

22 as irritants and pressure and pain and so on. And then they are able to by a process of challenge, which you'll find in the book too, they will be able to find out which foods they can actually tolerate. But it's important to start with any allergy diet, it's very important to start by taking out all of the suspect foods and then adding them back one at a time. You can never take out one and say, Oh, this is what's causing the problem. Oh, no, it's not. So I'll try another one. No, it's not, because you've got a whole, how would we say, we've got a lot of foods many of which could be causing irritation because of the ingredients within the food itself. So you start by a very basic diet and then individuals will then be able to add back foods and at the same time monitor their reaction and thereby find the ones that they tolerate well. Donna: And do you think that after a certain period of time like a year, eighteen months, it can greatly widen out even further, or do you think some people are always going to have to be on a more careful restricted diet and certainly never go to the processed foods? Dr. Joneja: Oh, no, I wouldn't go to processed foods any way even if one was healthy. No, what I would expect, of course, is that because everybody's trigger for their IBS is probably different, it will depend on how well they've been able to control that trigger. Now, for example, people who are experiencing post-infection IBS are likely to find that their IBS does resolve over time because the results of the infection are being dealt with by the body and no longer cause a problem. And so postinfective IBS often will settle down. Stress, this depends on how well a person can handle their stress, how they can manage their stress in times of acute stress and chronic stress, we see different responses. Interestingly, during acute stress people are often fairly healthy. It's afterwards when everything is settled down stress wise and they 2016 Axe Wellness, LLC. All rights reserved. 22

23 go in to a chronic stressed state that we see the irritable bowel syndrome symptoms appearing. So it's a matter of looking at the initial trigger and addressing that as well as addressing the symptoms of irritable bowel syndrome. Donna: Now, I'm sure the genes, when you look at genes, because everybody I know is starting to look at their genes. It's definitely going to be something we look at for the rest of our lives is nutritional genomics. I'm sure that's something that you're deeply into, too. There's supposed to be like 150 different genes that are related to irritable bowel. And I know some that I was familiar with when I was reading this research is the FUT2 gene and the NOD2 gene. But then there's the comp gene which I've seen a lot of people genetic reports, and I'm finding that a lot of people have one or two copies of this COMT gene. And that is a gene that for everybody listening, that's a gene where when you are stressed, you have trouble clearing it because your dopamines goes up. Your adrenaline goes up. It doesn't clear easily. Those people have to be in that category of throughout their life even as children they're going to struggle with more gut dysbiosis, inflammation, irritation - everything - constipation, all of that. So can you just speak a little bit about the genes? They're supposed to be playing a huge role in this, and I can see that. Do you have anything you want to teach us about that? Dr. Joneja: Well, yeah. Let's look at this realistically. We're looking at genes and what genes are present, the ones that we can identify any way. It's in its infancy. This research is very, very basic. We can identify a certain number of genes. We can certainly show that people have this gene, that gene, and the other one and therefore they have the potential to do this, that, and the other thing. That's genomics. Now, then there's the next process, which is called proteomics which is what 2016 Axe Wellness, LLC. All rights reserved. 23

24 do those genes do. That's number one. And number two what turns them on. You can have a gene that could be actually let's say a cancer gene just to be very broad here. And say that it's a gene that's associated with a type of lymphoma. Now, the question is, are you doomed to have that particular lymphoma? Well, no, you're not. It means that yes, you've inherited a gene that is by research associated with a high number of people who have that lymphoma. It does not mean that you're going to develop that lymphoma just because, let's say, 1,000 people out 1,000,000 have developed that lymphoma and have that gene doesn't mean that the rest of the people with that gene are going to have that lymphoma, not by any means. So okay, you have a gene that many, many people with that lymphoma have. They've got that gene. Okay we know that it may be because of the numbers involved that it is that particular gene that could at some point by some proteomic mechanism, now proteomics means how does the gene translate into a protein and how does that protein affect the outcome, which is the disease. It's a very, very complex series of different mechanisms that are going on. Okay, so having said that, what we're talking about is yes, we can have that gene. But what is going to make it change so that it develops that particular protein and that particular protein then goes on its way and forms that lymphoma? So you can see that just having the gene does not mean that the person is going to get that disease or that person is going to IBS or whatever it might be. Yes, the number of people with IBS that have got that gene, it means that, yes, there's significance there. But I think people are too ready and willing to believe that that's going to be their fate. And we don't have the research that could possibly tell us that yet. It can tell us that yes, you've got the potential and probably it requires two or three other genes to turn on that first one in 2016 Axe Wellness, LLC. All rights reserved. 24

25 order for that first one to actually develop the protein that will go on to produce whatever the disease is. So we must, must remember that although it's very attractive to get our gene profile and know what we might be going to experience in the future, it's only a few hundred. We've got many, many, many more than a few hundred that are going to show us what is going to be possible within our bodies. Every single process that we have in the body is controlled by a gene. Donna: That's very true. But I've been fascinated with certain genes like the FUT2 gene, for example, because I know if you're a non-secretor and you have the FUT2 SNP then you're not secreting your sugar molecules into say your gut lining or if a woman's breastfeeding Dr. Joneja: Yes, but it's not always the case. Everybody with that particular one can't do that. You know? It depends on what turns the gene on, and there has to be another trigger for that to happen. Donna: Well, and after reading and learning about this, I recommended that the bifidus is being fed if that's happening and then taking bifidus is a really good thing for that person to do. Do you think that this is the future for us also that we're going to look at probiotics and recommend certain ones for certain conditions or even genes? Look at the genes. And then as we develop the science more, I 100% agree it's brand new. It's not really. It's like a thirty-year-old science, but we're still really looking. It's just the tip of the iceberg. Dr. Joneja: Oh, yeah, it is still very, very new and in it's application. We knew that we knew that we had genes as soon as Watson and Crick found out what the gene structure. And from then onwards we got the genome, the human genome, is now all mapped. But gosh, it's like looking at the map of the world and seeing every tiny, little thing that we see there is going to be, we know 2016 Axe Wellness, LLC. All rights reserved. 25

26 about it. We don't. It's a matter of what does it mean in individual terms in the individual. So yeah, we've got to go a long way before we can do that. Donna: Getting back to on a more personal note, I know you've been married to a neurologist for a long, long time. Has his work had an influence on your thinking on the gut and the fact that the gut's a brain? The two of you being together, do you have a lot of conversations around this? Dr. Joneja: None. Donna: Really? Dr. Joneja: None. Donna: That's interesting. Dr. Joneja: No. I think this happens with a lot of professional families. Each one is involved in their own work and it just doesn't somehow we keep a home as a family rather than bringing this work to that. I don't know. Donna: That's probably good advice. Well, thank you so much. This has been an amazing interview. I hope everybody goes back again and listens to it several more times with a pen and paper in hand. There are a lot of what the functional medicine doctors refer to as clinical pearls all throughout this interview. And so we just can't thank you enough for taking the time to do this. You can see you're obviously a teacher, and you have been for a long time because you're a great one. The name of the book again I just want everybody to know because this is a must-have in your library. Dr. Joneja, can you just explain how can they buy the book? Dr. Joneja: Well, this is Digestion, Diet, and Disease. It's published by Rutgers 2016 Axe Wellness, LLC. All rights reserved. 26