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Dr. Andrew Rynne

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Suggest treatment for IBS with micro vascular disease

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Dr. Shafi Ullah Khan

General & Family Physician

Practicing since :2012

Answered : 3614 Questions

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Posted on Tue, 2 Sep 2014 in Diet Plans
Question: I have IBS, am lactose intolerant and have now been diagnosed with Micro Vascular Disease, My head is spinning and I need a diet to keep all of these in line! HELP!!!
doctor
Answered by Dr. Shafi Ullah Khan 20 hours later
Brief Answer:
Diet mentioned in details,

Detailed Answer:
Thank you for asking
No doubt diet and lifestyle modifications always help in the management of any disease and is a key ingredient of it.
Lets discuss the dietary modifications disease by disease.

1-IBS
1 a- Don'ts of IBS
foods that are high in fat, fried foods, spicy foods, alcohol, and caffeinated coffee and tea can be problematic. Some foods, such as beans, cabbage, broccoli, Brussels sprouts, cauliflower, peas, onions, and bagels, that can cause minor discomfort in a normal GI tract can cause significant bloating, gas, and abdominal pain in IBS sufferers and thus should be avoided.
1b-Do's for IBS
There is no one-size-fits-all diet. A proper diet for IBS is highly individualized.

A high-fiber diet was thought to be the best diet for almost everyone with IBS, but recent studies have shown that this isn’t true for everyone.

For people with constipation, it's common to try a high-fiber diet of 25 grams daily for women and 38 grams for men to see if that helps. People should eat as much dietary fiber as they can tolerate, and understand that a certain amount of gas production is a sign of healthy gut microbes at work.

The challenge is finding an acceptable fiber intake without experiencing debilitating abdominal pain and bloating, and frantic dashes to the toilet. And sometimes focusing on fiber alone doesn’t address the removal of potential trigger foods from the diet.

Eating smaller, more frequent meals spread throughout the day instead of larger meals can lead to less discomfort for some people. What is really important is to identify the foods that are causing the symptoms.

For individuals with diarrhea, gas, or bloating, or if a high-fiber diet fails, I suggest a two-week trial FODMAPS elimination diet. (FODMAPS stands for fermentable oligo-, di-, and monosaccharides and polyols.)

You'll work with your physician and registered dietitian to eliminate all foods that contain the five forms of carbohydrates (lactose, fructose, fructans, sugar alcohols, and galactans) for a trial period of 1-2 weeks. If FODMAPS carbs are causing the symptoms, relief can occur in just a few days.

You follow the elimination period with a challenge of reintroducing one of the FODMAP carbs and observe symptoms. Additional FODMAP carbs are slowly added back, one at a time. At the end of the reintroduction phase, a final diet emerges with only those FODMAP carbs that are fairly well tolerated.


The goal is to find the most liberal and varied diet possible that still keeps symptoms under control. Most people find they can still include their favorite foods if they exercise care. For example, a person who discovers that fructans (found in wheat) cause a lot of distress might find they can’t tolerate wheat at every meal, but may be able to tolerate one portion of wheat without a problem.

2-Lactose intolerance diet
Lactose intolerance is easily treated. People with the condition can usually find a level of lactose-containing foods that will not produce symptoms. Through trial and error, you can determine what amount and type of lactose-containing products you can tolerate.

In addition, you may try consuming small amounts of milk or dairy products with meals because lactose may be better tolerated when eaten with other foods. Also, you may be better able to tolerate certain dairy products that contain less sugar, including cheese, yogurt, and cottage cheese. The active cultures in yogurt produce some lactase enzymes to help digestion.

For people who get symptoms from very small amounts of lactose, over-the-counter lactase enzyme replacement (Lactaid) can be used. Lactase enzyme replacement converts lactose into its more digestible simple sugar components: glucose and galactose. The enzyme replacement is taken along with food to help digest lactose. Lactose-free milk, cheese, and other dairy products are also available at many supermarkets.
People who are lactose intolerant don't necessarily have to consume milk and dairy products to get the calcium they need to maintain proper nutrition. The following nondairy foods are good sources of calcium and don't contain lactose:


Vegetables

Broccoli
Pinto beans
Lettuce greens such as spinach and XXXXXXX
Seafood

Tuna, canned
Sardines, with edible bones
Salmon, canned with edible bones
Other foods

Calcium-enriched fruit juice
Soy milk
Tofu (calcium-enriched)
Eating 2-4 servings of these calcium-rich foods a day will help ensure that you are getting enough calcium in your daily diet.

Vitamin D will help your body use calcium. You can get adequate amounts of vitamin D from exposure to the sun, and by consuming fortified milk, eggs, and fish. If you are concerned you may have a vitamin D deficiency, ask your health care provider to check your 1,25 hydroxy vitamin D level. You may need to take a vitamin D supplement.

If you have trouble consuming enough calcium-rich foods in your daily diet, talk to your health care provider or a dietitian about taking a calcium supplement. The amount of calcium supplement you will need depends on your individual daily needs and how much calcium you get through food sources.

The most common foods that are high in lactose include dairy products such as milk, ice cream, and cheese. Lactose is also added to some foods, such as bread and baked goods, cereals, salad dressings, candies, and snacks.

Foods that contain whey, curds, milk by-products, dry milk solids, and nonfat dry milk also contain lactose.

Lactose is also present in about 20% of prescription medications, such as birth control pills (oral contraceptives), and about 6% of over-the-counter medications, such as some tablets for stomach acid and gas.

3-Microvascular disease is Just demanding for controlled diabetes and diet recommended by ADA. XXXXXXX Diabetes association.
read this articel for ADA diet in details.
http://www.webmd.com/diabetes/guide/diabetes-diet-healthy-diet-basics

I hope it helps. Take good care of yourself and dont forget to close the discussion please.
May the odds be ever in your favour.
regards
Khan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shafi Ullah Khan 29 minutes later
Thank you for your very detailed response. My only question is - my major concern is the MVD which is new to me. I do not have Diabetes - my glucose levels range between 77 and 95. I am trying to stay away from sugar and using whole wheat carbs and a low fat diet. Is there anything else you can think of to help with this problem. Thanks!
XXXX
doctor
Answered by Dr. Shafi Ullah Khan 8 minutes later
Brief Answer:
Explained

Detailed Answer:
Thank you for getting back to me
Most of the times MVD and Diabetes are clinically correlated. There is always a cause for MVD. But irrespective of the cause , Diet and lifestyle management is simple.
First step is to reduce the risk factors
Tobacco use
High cholesterol
High blood pressure
Obesity (body mass index of 30 or higher)
Unhealthy diet
Inactive lifestyle
Diabetes
Insulin resistance
Being female
An estrogen deficiency, in women
Polycystic ovarian syndrome
Increasing age, older than 45 in men and older than 55 in women

Following diets management is advised .
Dietary supplements that may be helpful for people with small vessel disease include:

Coenzyme Q10. This coenzyme, which is naturally present in your body, can improve blood pressure and circulation when taken as a supplement. Coenzyme Q10, taken in daily doses up to 200 milligrams, may improve small vessel blood flow in people with diabetes and coronary artery disease and could have a similar effect in people with small vessel disease.
L-arginine. This amino acid that's normally used by the body to help metabolize protein may help treat symptoms of small vessel disease by relaxing your blood vessels. This therapy shouldn't be used in anyone who's already had a heart attack.
As with any other alternative therapy, talk to your doctor before adding any supplements to your treatment to ensure that they won't interfere with any medications you're already taking.

There haven't been any scientific studies to show what you can do to prevent small vessel disease, but it seems that controlling the disease's major risk factors — high blood pressure, high cholesterol and obesity — can help. Things you can do that may help reduce your risk include:

Don't smoke or use other tobacco products. If you smoke, the most important thing you can do to improve your heart's health is to stop. Quitting other forms of tobacco use can also be helpful. Talk to your doctor if you're having trouble with quitting.
Eat a heart-healthy diet. Too much saturated fat and cholesterol in your diet can narrow arteries to your heart. Follow your doctor's and dietitian's advice on eating a heart-healthy diet that includes plenty of whole grains, lean meat, low-fat dairy, and fruits and vegetables. Also, watch your salt and fat intake. Eating too much salt and saturated or trans fats may increase your blood pressure and cholesterol.
Exercise regularly. Regular exercise helps improve heart muscle function and keeps blood flowing through your arteries. It can also prevent a heart attack by helping you to achieve and maintain a healthy weight and control diabetes, elevated cholesterol and high blood pressure. Exercise doesn't have to be vigorous. Walking 30 minutes a day five days a week can improve your health.
Check your cholesterol. Have your blood cholesterol levels checked regularly through a blood test. If your bad cholesterol levels are undesirably high, your doctor can prescribe changes to your diet and medications to help lower the numbers and protect your cardiovascular health.
Control your blood pressure. Ask your doctor how frequently you need to have your blood pressure checked. Your doctor may recommend more frequent checks if you have high blood pressure or a history of heart disease.
Maintain a healthy weight. Excess weight strains your heart and can contribute to high cholesterol, high blood pressure and diabetes. Losing weight can lower your risk of small vessel disease.
Manage stress. To reduce your risk of a heart attack, reduce stress in your day-to-day activities. Rethink workaholic habits and find healthy ways to minimize or deal with stressful events in your life.
Control blood sugar levels if you have diabetes. If you have diabetes, keeping your blood sugar at appropriate levels can help reduce the risk of complications. Work with your doctor to establish blood sugar goals that are right for you.
If you have polycystic ovary syndrome, ask your doctor if metformin could help. Treatment with metformin (Glucophage, Glumetza), a medication that helps reduce insulin resistance, may reduce the risk of small vessel disease in women with polycystic ovary syndrome.

I hope it helps. Take good care.
Dont forget to close the discussion please.
Khan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shafi Ullah Khan 20 minutes later
Thanks so much. Really appreciate the added info!!
doctor
Answered by Dr. Shafi Ullah Khan 3 minutes later
Brief Answer:
:)

Detailed Answer:
You are welcome.
Please dont forget to close the discussion please.
Khan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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