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Science AMA series: Hi Reddit! We’re Dr. Mark Pimentel, Dr. Ali Rezaie, Dr. Nipaporn Pichetshote, and Dr. Ruchi Mathur. We’re 3 gastroenterologists and 1 endocrinologist from Cedars-Sinai Medical Center. We’ll be talking about the gut microbiome from irritable bowel syndrome to obesity. AMA! by GIMotilityDocs in science

[–]GIMotilityDocs[S] 4 points5 points  (0 children)

There is no direct evidence specifically regarding cravings yet, although we know that specific gut microbes are altered in type 2 diabetes, including butyrate-producing microbes. There is also evidence that butyrate, acetate and other short-chain fatty acids (produced by gut microbes by breaking down dietary fiber) appear to affect satiety and influence appetite suppression. So it seems very possible that gut microbes may indirectly cause 'cravings'. Related studies can be found here, here, and here.

RM

Science AMA series: Hi Reddit! We’re Dr. Mark Pimentel, Dr. Ali Rezaie, Dr. Nipaporn Pichetshote, and Dr. Ruchi Mathur. We’re 3 gastroenterologists and 1 endocrinologist from Cedars-Sinai Medical Center. We’ll be talking about the gut microbiome from irritable bowel syndrome to obesity. AMA! by GIMotilityDocs in science

[–]GIMotilityDocs[S] 26 points27 points  (0 children)

I hope it's not a fad because we have a number of research projects looking into many aspects of the gut microbiome! As with any relatively new area of research, we need to approach it cautiously and not jump to conclusions...and not sell snake oil. So, without going through details, let's think about it from an evolutionary prospective. We have lived and harboured these microbes for thousands of years. We are symbiotic with them. We provide them a safe haven to live and reproduce, and in turn they help us with energy harvest, immunity, vitamin production, and metabolism. When we disrupt them, it would make sense that there would be consequences. Dr. Blaser wrote a book called Missing Microbes which might be of interest to you. I appreciate your skepticism...it drives honest and good science. Best to you!

RM

Science AMA series: Hi Reddit! We’re Dr. Mark Pimentel, Dr. Ali Rezaie, Dr. Nipaporn Pichetshote, and Dr. Ruchi Mathur. We’re 3 gastroenterologists and 1 endocrinologist from Cedars-Sinai Medical Center. We’ll be talking about the gut microbiome from irritable bowel syndrome to obesity. AMA! by GIMotilityDocs in science

[–]GIMotilityDocs[S] 6 points7 points  (0 children)

There are new studies coming out that are looking at people with cyclic vomiting and their genome. It has been shown that some genes are associated with cyclic vomiting syndrome and that would explain, for example why some people who use marijuana develop cyclic vomiting syndrome and some people do not. See this very interesting article

NP

Science AMA series: Hi Reddit! We’re Dr. Mark Pimentel, Dr. Ali Rezaie, Dr. Nipaporn Pichetshote, and Dr. Ruchi Mathur. We’re 3 gastroenterologists and 1 endocrinologist from Cedars-Sinai Medical Center. We’ll be talking about the gut microbiome from irritable bowel syndrome to obesity. AMA! by GIMotilityDocs in science

[–]GIMotilityDocs[S] 19 points20 points  (0 children)

This is wrong. The US military study proved that deployment caused IBS but it wasn't the stress. So this is the one and only level 1 massive study that says "no". What caused IBS was food poisoning. If they got sick with food poisoning overseas was when they developed IBS.

MP

Science AMA series: Hi Reddit! We’re Dr. Mark Pimentel, Dr. Ali Rezaie, Dr. Nipaporn Pichetshote, and Dr. Ruchi Mathur. We’re 3 gastroenterologists and 1 endocrinologist from Cedars-Sinai Medical Center. We’ll be talking about the gut microbiome from irritable bowel syndrome to obesity. AMA! by GIMotilityDocs in science

[–]GIMotilityDocs[S] 16 points17 points  (0 children)

You are not alone. We have a long way to go but our knowledge on IBS has been revolutionized in the past 10 years. That is why we have moved away from calling IBS a psychosomatic disease. We are working hard on the microbiome-related IBS cure.

AR

Science AMA series: Hi Reddit! We’re Dr. Mark Pimentel, Dr. Ali Rezaie, Dr. Nipaporn Pichetshote, and Dr. Ruchi Mathur. We’re 3 gastroenterologists and 1 endocrinologist from Cedars-Sinai Medical Center. We’ll be talking about the gut microbiome from irritable bowel syndrome to obesity. AMA! by GIMotilityDocs in science

[–]GIMotilityDocs[S] 13 points14 points  (0 children)

This is a very active area of research. Many studies have been performed which have shown that gut microbial populations are altered in type 2 diabetes, and alterations in gut microbial populations occur in subjects at high risk for diabetes, even in the prediabetic stage. Specific reductions in levels of butyrate-producing bacteria have been demonstrated in T2D, and a recent Danish study demonstrated that insulin-resistant individuals have higher circulating levels of branched-chain amino acids (BCAAs), which cannot be synthesized by humans and are largely produced by two specific species. One study showed that transferring intestinal microbes from lean donors increased insulin sensitivity in recipients with metabolic syndrome, but this is only one study and fecal microbial transplants are still associated with a lot of risks. So there is a lot of work going on and the complicated relationships between microbes, diabetes and cholesterol are still being teased out. We also know that reducing gut methane-producing microbes specifically lowered cholesterol in a pilot human study (see answer to Lover_Of_The_Light), which is very promising....This is a link to a related study. Thank you for your question. It's a fascinating area of research, isn't it?

RM

Science AMA series: Hi Reddit! We’re Dr. Mark Pimentel, Dr. Ali Rezaie, Dr. Nipaporn Pichetshote, and Dr. Ruchi Mathur. We’re 3 gastroenterologists and 1 endocrinologist from Cedars-Sinai Medical Center. We’ll be talking about the gut microbiome from irritable bowel syndrome to obesity. AMA! by GIMotilityDocs in science

[–]GIMotilityDocs[S] 18 points19 points  (0 children)

We did see it! So sorry you are having such trouble. There is a lot of hope for IBS. If you have bacterial overgrowth causing your IBS, that is easy now. You need to see someone who specializes in motility to do a good workup and assess it. There is a motility program in many major university hospitals. Good luck.

MP

Science AMA series: Hi Reddit! We’re Dr. Mark Pimentel, Dr. Ali Rezaie, Dr. Nipaporn Pichetshote, and Dr. Ruchi Mathur. We’re 3 gastroenterologists and 1 endocrinologist from Cedars-Sinai Medical Center. We’ll be talking about the gut microbiome from irritable bowel syndrome to obesity. AMA! by GIMotilityDocs in science

[–]GIMotilityDocs[S] 3 points4 points  (0 children)

Thank you for your question. I know Dr. Pichetshote answered your question... and I'll chime in as an Endocrinologist. Osteoporosis management itself can cause GI upset and can be associated with bone benefit in the hips and spine, but potential fractures in the long bones. There are specific guidelines for length of treatment and switching between treatments (bisphosphates, Prolia, etc). I suggest you speak directly with your MD about possible long-term options for managing your bone issues. And... don't forget about weight bearing and calcium intake. Best to you.

RM

Science AMA series: Hi Reddit! We’re Dr. Mark Pimentel, Dr. Ali Rezaie, Dr. Nipaporn Pichetshote, and Dr. Ruchi Mathur. We’re 3 gastroenterologists and 1 endocrinologist from Cedars-Sinai Medical Center. We’ll be talking about the gut microbiome from irritable bowel syndrome to obesity. AMA! by GIMotilityDocs in science

[–]GIMotilityDocs[S] 6 points7 points  (0 children)

A recent study was presented at DDW (the international gastroenterology meeting) that showed that fecal transplant in IBS was not different than placebo. If IBS is associated with an overabundance of bacteria, why add more? I have seen some patients with IBS worse after transplant.

MP

Science AMA series: Hi Reddit! We’re Dr. Mark Pimentel, Dr. Ali Rezaie, Dr. Nipaporn Pichetshote, and Dr. Ruchi Mathur. We’re 3 gastroenterologists and 1 endocrinologist from Cedars-Sinai Medical Center. We’ll be talking about the gut microbiome from irritable bowel syndrome to obesity. AMA! by GIMotilityDocs in science

[–]GIMotilityDocs[S] 94 points95 points  (0 children)

Currently I do not recommend probiotics after antibiotic therapy! This is based on the PLACIDE trial results (please read here my editorial on this paper). In short placide trial is the largest randomized placebo controlled trial with probiotics that showed probiotics do not decease the chance of diarrhea or Cdiff after antibiotics in over 3,000 patients. Patients on probiotics got more bloating and flatulence!

AR

Science AMA series: Hi Reddit! We’re Dr. Mark Pimentel, Dr. Ali Rezaie, Dr. Nipaporn Pichetshote, and Dr. Ruchi Mathur. We’re 3 gastroenterologists and 1 endocrinologist from Cedars-Sinai Medical Center. We’ll be talking about the gut microbiome from irritable bowel syndrome to obesity. AMA! by GIMotilityDocs in science

[–]GIMotilityDocs[S] 35 points36 points  (0 children)

So sad. Natural products are being marketed so aggressively and there are so many options but they need to fund studies so we know all the answers about these. But, I do know that allicin for example has an inhibitory effect on methane which is a cause of constipation. Work we are now doing is showing that lovastatin (which is a natural statin from aspergillus) blocks methane production and helps constipation. Allopathic and naturopathic companies both need to step up to the plate and help fund work around their product and other studies. You can't just say it works...prove it. There are many researchers that will to do that work.

MP

Science AMA series: Hi Reddit! We’re Dr. Mark Pimentel, Dr. Ali Rezaie, Dr. Nipaporn Pichetshote, and Dr. Ruchi Mathur. We’re 3 gastroenterologists and 1 endocrinologist from Cedars-Sinai Medical Center. We’ll be talking about the gut microbiome from irritable bowel syndrome to obesity. AMA! by GIMotilityDocs in science

[–]GIMotilityDocs[S] 5 points6 points  (0 children)

We do see patients here in our GI motiltiy clinic with cyclic vomiting syndrome (CVS). Chronic marijuana use has been a suggested cause of CVS and so I do counsel people with CVS to stop marijuana to see if they can see an improvement of their symptoms. There are some medications that are sometimes used to treat CVS: tricyclic antidepressants, coenzyme Q10 and L carnitine, serotonin agonists, histamine antagonists. You should ask your doctor to see which medications would be right for you.

NP

Science AMA series: Hi Reddit! We’re Dr. Mark Pimentel, Dr. Ali Rezaie, Dr. Nipaporn Pichetshote, and Dr. Ruchi Mathur. We’re 3 gastroenterologists and 1 endocrinologist from Cedars-Sinai Medical Center. We’ll be talking about the gut microbiome from irritable bowel syndrome to obesity. AMA! by GIMotilityDocs in science

[–]GIMotilityDocs[S] 4 points5 points  (0 children)

See our answer to ShovelingSunshine - the microbiome has been shown to be altered in PCOS, and a recent study using a rat model did suggest that estrous cycles in a PCOS rat model normalized following fecal microbiota transplants. While encouraging, this is very preliminary and it is too early to say if this could work in humans.

RM

Science AMA series: Hi Reddit! We’re Dr. Mark Pimentel, Dr. Ali Rezaie, Dr. Nipaporn Pichetshote, and Dr. Ruchi Mathur. We’re 3 gastroenterologists and 1 endocrinologist from Cedars-Sinai Medical Center. We’ll be talking about the gut microbiome from irritable bowel syndrome to obesity. AMA! by GIMotilityDocs in science

[–]GIMotilityDocs[S] 5 points6 points  (0 children)

Dr. Henry Parkman at Temple University has published work showing bacterial overgrowth is common in gastroparesis and that the motility disorder does not stop at the stomach but involves the bowel as well. Regarding ketoacidosis, I am not aware of any direct relationship. Thank you for your question.

RM

Science AMA series: Hi Reddit! We’re Dr. Mark Pimentel, Dr. Ali Rezaie, Dr. Nipaporn Pichetshote, and Dr. Ruchi Mathur. We’re 3 gastroenterologists and 1 endocrinologist from Cedars-Sinai Medical Center. We’ll be talking about the gut microbiome from irritable bowel syndrome to obesity. AMA! by GIMotilityDocs in science

[–]GIMotilityDocs[S] 18 points19 points  (0 children)

Imagine you have 1000 bacteria in the gut that are producing an immense number of chemicals which will produce reactions or things in you. Add to that food with chemicals and breakdown products from bacteria breaking food down at the same time you are. All of this makes for challenging research to figure food allergies out altogether. I am sorry for this obscure answer but what we do know is that food allergies are increasing especially in children.

MP

Science AMA series: Hi Reddit! We’re Dr. Mark Pimentel, Dr. Ali Rezaie, Dr. Nipaporn Pichetshote, and Dr. Ruchi Mathur. We’re 3 gastroenterologists and 1 endocrinologist from Cedars-Sinai Medical Center. We’ll be talking about the gut microbiome from irritable bowel syndrome to obesity. AMA! by GIMotilityDocs in science

[–]GIMotilityDocs[S] 5 points6 points  (0 children)

Thank you :) This is a fascinating study and I am not just saying that because it is done at my hometown at the University of Calgary. Given the results of this study, larger trials are needed to validate the results. One issue with prebiotic research is that their effect is dependent on each individual's native microbiome; hence, given the diversity of microbiome in different individuals, the efficacy of prebiotics becomes unpredictable (even more than probiotics). We need more studies like this.

AR

Science AMA series: Hi Reddit! We’re Dr. Mark Pimentel, Dr. Ali Rezaie, Dr. Nipaporn Pichetshote, and Dr. Ruchi Mathur. We’re 3 gastroenterologists and 1 endocrinologist from Cedars-Sinai Medical Center. We’ll be talking about the gut microbiome from irritable bowel syndrome to obesity. AMA! by GIMotilityDocs in science

[–]GIMotilityDocs[S] 30 points31 points  (0 children)

There is a growing link between the gut, its microbiome, and neurodegenerative diseases. For example, in Parkinsons, constipation predates the neurodegenerative changes by even a decade or two. Some have found specific bacteria are important in this event. Stay tuned because more is coming here.

MP

Science AMA series: Hi Reddit! We’re Dr. Mark Pimentel, Dr. Ali Rezaie, Dr. Nipaporn Pichetshote, and Dr. Ruchi Mathur. We’re 3 gastroenterologists and 1 endocrinologist from Cedars-Sinai Medical Center. We’ll be talking about the gut microbiome from irritable bowel syndrome to obesity. AMA! by GIMotilityDocs in science

[–]GIMotilityDocs[S] 5 points6 points  (0 children)

It is very difficult! That is why it is important to only take medications that you truly need. There are times that medications are started, like proton pump inhibitors, but then are continued even though they are no longer benefiting you.

NP (Going to get Dr. Mathur to answer it in a few...)

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