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Media, PA 19063

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Frequently Asked Questions

The following commonly asked questions by patients are already included in the book:

  • I was told that bowel movement once a week is alright. Is this really true?
  • I get diarrhea every time I eat. Before, the antidiarrheal medications were working, but now they do not. Why does this happen?
  • I get pain relief on the left side after I poop but the pain on the right side worsens after I poop. How come?
  • It is so confusing that constipation is presenting as diarrhea. How is it even possible?
  • My doctor gave me laxatives but it worsened my pain. Why does this happen to me?
  • I was diagnosed with Irritable Bowel Syndrome and the pain is there all the time. However, I experience constipation sometimes. How can you explain that?
  • I was asked to take fiber to help with constipation but it ended up making my symptoms worse. Why did this happen?
  • Why does fiber help constipation in some patients and not in others?
  • Are all fiber supplements the same?
  • Do I need to drink eight glasses of water every day?
  • Will I get addicted to the laxatives?
  • Does the retention of stool in the colon lead to toxin generation that in turn, leads to feeling ill?
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Questions from Readers

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Gluten free diet (Celiac Diet) and symptoms of irritable bowel syndrome
It is a well-known fact that Dietary fiber can affect symptoms in irritable bowel syndrome. Whether fiber helps or hurts people with irritable bowel syndrome is a different question. There are people who will benefit from a high-fiber diet when their suffering from irritable bowel syndrome and there are people who will experience more pain if they take high-fiber diet. The improvement in symptoms vary from person to person and time to time in an individual person fiber may help or hurt during different stages of the disease. 

With all this confusion how do we make sense of whether to take the fiber or not?

To understand this confusing interaction we need to understand colonic physiology. During early phases of constipation when the colon is not dilated, the fiber speeds up the movement of stool through the colon. This prevents excessive absorption of water from the stool and prevent the formation of dehydrated hard stool, thus preventing symptoms. As constipation progresses the colon starts to dilate. Once the colon is dilated fiber distends the colon further causing worsening of symptoms. At this stage fiber will worsen the symptoms of irritable bowel syndrome. Low fiber will be helpful as it decreases the total volume of stool in the colon.

Coming back to gluten-free diet, majority of fiber in our diet contains gluten. Once you eliminate gluten from your diet, you practically eliminate significant amount of fiber from your diet. Once the fiber is eliminated patients with dilated colon will experience improvement in their symptoms. However if the colon is not dilated removal of fiber from the diet will worsen the constipation hence the symptoms will become worse. Some of these concepts were reviewed in my previous book “demystifying digestive tract symptoms” including what to do in these situations.

Regardless gluten-free diet is for patients who have documented allergy to gluten and have a diagnosis of celiac disease. The benefit provided by low fiber diet in patients with dilated colon is often thought to indicate subtle celiac disease. This assumption is incorrect. If you have been tested for celiac disease and are diagnosed with the disease, celiac diet will have a role. Otherwise, the results will be unpredictable and more based on association than causation.


As you are aware body has many backup plans which control its functioning. One of such plans is called Gastro-Colic Brake (Chapter 2). Briefly when colon is filled with stool it sends a signal to the stomach not to send food forward. If it can not send the food forward where will it go? You guessed it right, it will reflux back into the food pipe making the reflux worse and difficult to mange with acid suppression medicines. Constipation is one of the most common missed cause of worsening acid reflux symptoms despite increasing the dose of acid suppression medicines. Many of these patients will be able to control their acid reflux symptoms if their constipation is corrected.

Interesting still is the fact that many people will not notice constipation at all and will be completely focused on the acid reflux. When was the last time you were taught what is constipation? We just guess or assume what we have is normal.

Demystifying Digestive Tract Symptoms: Abdominal Pain, Diarrhea And Constipation In The Language Of Gut

Abused (Irritable) Bowel Syndrome: What causes IBS and What To Do About It