Fatty Foods Causing Gut Pain, Remedies – Listener Question

Fatty Foods Causing Gut Pain, Remedies – Listener Question

Hey, everyone. This is Dr. Ruscio. And let’s cover a listener question today
which essentially asks what to do about gut pain that usually occurs secondary to consumption
of rich or fatty foods. So here I will play the question. Listener: Hello, Dr. Ruscio. I am inquiring about a question regarding
my daughter who’s 22 years old. She was diagnosed with IBS by a gastroenterologist
about four years ago, I want to say. He put her on VSL 3 probiotics which did help
for… DrMR: And just as a note, VSL 3 is a Lactobacillus/Bifidobacterium
predominated probiotic. It’s what I would organize in our three-category
system as a category one probiotic which is a blend of Lactobacillus and Bifidobacterium
probiotics, very similar to the Lacto/Bifido blend probiotic that I recommend in our store. And it’s definitely one of the more well-studied
probiotics, VSL 3. And again, that’s from category one, the
Lactobacillus/Bifidobacterium predominated mixture. So that’s a good place to start. Listener: For a year or so. She was very good about taking them and so
forth. Anyway. Fast forward now to present time. She is having the same symptoms of gut pain. She does not have diarrhea. She does not have constipation. I’m not sure she has IBS. I think she could have possibly been misdiagnosed. He did do a gamut of tests. Not a breath test. He did blood test, stool tests, and an endoscope. And so, anyway. So now, she’s been off the VSL for a while. She did feel some improvement but not ever
complete relief. And her main problem is, as it was before
and still is, whenever she eats especially rich foods and fats, but not always, it happens
almost—I don’t know. Pretty much with everything, but mostly rich,
fatty, creamy foods, oils, grease, that type of thing. DrMR: And pause there for one more second
to touch on something that was important which is the fact that her gastroenterologist performed
an endoscopy. That’s important because one of the things
that can cause gut pain is either gastritis or ulcers. And most gastroenterologists will not miss
a case of ulcers or gastritis after they’ve done an endoscopy. So that’s important to have that on the
table because that’s one thing that could potentially be causing this problem. With the previous endoscopy negative, then
that makes it fairly unlikely that gastritis or ulcers are present. Listener: But she gets immediate gut pain. Makes her not feel good. And it starts within a matter of minutes of
eating the meal. So she’ll feel perfectly fine or whatever. And then all of a sudden sit down to eat a
meal, she feels this pain. And she continues to eat or stops, whichever,
but either way it lasts probably a good hour or something like that. And then it will go away, and she’s fine. So this happens all the time, and she’s
tried elimination of foods and different things. And the only thing she can ascertain is that
it is related to rich, fatty foods. DrMR: Ok. Which it very well may be. Now, there’s more that we want to look into
here, and I’ll let the rest of the question play before we come to any conclusions. But we do know that, of course, FODMAPs, foods
that are high in fermentable substrates and are prebiotic rich have probably the best
documentation to cause gut pain. But if you remember back, we had Tarek Mazzawi—he
was a gastroenterologist—on the podcast who’s done some pivotal work in establishing
some of the mechanisms that underlie why a low FODMAP diet is helpful for those with
IBS. But one of the things that he did in some
of his studies with his group was they also infused fat into the intestine and showed
that fat can also stimulate a reaction, a pain-type reaction as FODMAPs can. Now, there’s more data showing that the
low FODMAP diet can be helpful. But it’s not to say that some people may
not do better on a lower fat and a higher carb diet. And all this may come down to what’s known
as visceral hypersensitivity. So there may be hypersensitivity to gas and
to pressure in the intestines. And that can happen even when gas levels are
normal. So you mentioned SIBO a moment ago. SIBO very well could be something to investigate
and to treat. However, it is possible that a SIBO breath
test could be negative, yet she could still improve from a low FODMAP diet if she hasn’t
tried that yet. The low FODMAP diet and reducing high amounts
of fat in the diet may work synergistically for those who are hypersensitive. And it’s my thinking that if you can find
a diet that works and an approach that works, with time that hypersensitivity should become
less. But let’s continue forward with her question. Listener: Primarily. Again, not always because sometimes she’ll
eat something that typically doesn’t bug her and then it does. But that’s rare. It’s usually the greasy stuff. She’s not lactose intolerant. She’s not glut—I’m sorry. Allergic to wheat or celiac. I can’t think of the name. Gluten-intolerant. None of that. But anyway, we just cannot figure out through
elimination of foods what could be the problem and why she gets a pain in the same spot all
the time when she eats right when she’s eating, within minutes. Not digestion. It can’t possibly be digestion, I don’t
think, because it hasn’t been long enough. So anyway, I wondered if you could comment
on what that might possibly be. DrMR: So regarding diet, we don’t know if
she’s tried a low FODMAP diet yet. She’s gone dairy-free apparently and gluten-free. Good places to start. But low FODMAP would also be very important
because that, again, probably has the best documentation in terms of a dietary intervention
for reducing gut pain. Listener: If so, you can email me, reply or
whatever if you don’t want to put it on air. I don’t care. I’m just trying to get some insight there. The only thing, like I say, she hasn’t had
is the breath test. So I don’t know if that’s something that
should be done. Ok. I appreciate your help. My email and info will be on the contact information. Thank you. Buh-bye. DrMR: So we’ve covered a few things. But let’s come at this from a hierarchy
of sequences. The hierarchy will give you a system of steps
to work through rather than me through out a bunch of diagnoses and you trying to piece
together how to run through those and in what order and what sequence and what have you. There could be classical IBS. There could be SIBO. Ulcers or gastritis are less likely. There could be this visceral hypersensitivity
which kind of falls underneath the umbrella of IBS and of SIBO. So what do you do? Well, we always want to start with diet. So you’ve already done a good job with eliminating
two major allergens which are gluten and dairy. Great. If you haven’t yet done a low FODMAP diet,
I would recommend performing a low FODMAP diet. And we have a list of those available on our
website. Now, the probiotics, you also took a good
step there. And the fact that she responded to probiotics
could indicate that she has dysbiosis or it could mean that the probiotics are helping
via their anti-inflammatory and immunomodulatory mechanisms. However, what the missing piece there may
be is not having had used a broad enough presentation of probiotics to the gut. So you used category one, the Lactobacillus/Bifidobacterium
blend as VSL 3. Good. I would also add in a category two and a category
three probiotic to see if those may work synergistically to produce a better overall benefit than just
the one probiotic alone. So category two would be a Saccharomyces boulardii
probiotic, and category three would be a soil-based probiotic. And we do have one of each of those probiotics
in our store to help you find a good formulation for each category. Remember—and this is very much so worth
stating—that probiotics have been shown to be efficacious against SIBO. And I’m becoming more and more favorable
toward probiotics, understanding that they not only help with pain and with symptom reduction,
but they are antibacterial and antifungal. So if there is a degree of dysbiosis, whether
it be SIBO, Candida, both, H. pylori, the probiotics have a good chance of helping to
rectify that dysbiosis. So that’d be step two. Now, there’s also the potential that she’s
mal-absorbing fat. And that may be why she’s having the pain. And to the question of why this is such an
instantaneous reaction between eating and then having the pain reaction, it’s not
always when the food gets to a particular spot. There’s also something known as the gastrocolic
reflex, meaning that when food hits the stomach, it causes a reflex in the colon. So this could account for some of that instantaneous
presentation of pain. Now, SIBO can cause fat malabsorption. So this could underlie why she’s intolerant. And that may have been why the probiotics
worked. The probiotics were helping to beat down SIBO,
and the SIBO was then less able to cause fat malabsorption. And she was then more able to tolerate fat. So that’s very well what may have happened. The supplementation with a bile acid may also
help. Those are some of the better places to start. To escalate therapies, you may need even stronger
antimicrobial therapy to address any dysbiosis in the gut. And further yet still, she may even want to
try a short course on an elemental diet to give the gut a chance to rest, for dysbiosis
to quell, for hypersensitivity to kind of unwind. This kind of gives you a few different things
to consider in succession. All of this is laid out in my book Healthy
Gut, Healthy You. It’ll give you exactly what to do, when
to do it, and help you to navigate through this with the most efficiency and precision
possible. So there’s a number of things to consider
there. And I’m hoping that between a dietary modification,
specifically the low FODMAP, and a more robust probiotic intervention you’ll be able to
get there. But if not, there’s a few other things to
consider. And hopefully that helps you and helps your
daughter get healthy and get back to her life. Ok. Thanks.


  1. An informative video DR Ruscio, could you do a video on heavy metals and how to test, treat and effects of them on the body? Have u seen a case where candida/dysbiosis would not go away till heavy metals are reduced?

  2. I have very similar issues with fat as well. Never had ibs in the past but did have issues with my gallbladder. I recently went on a keto diet that inflamed my gallbladder. (Pain/cramping after eating and general ill feeling for 4 hours) i then began to have food intolerances And diarrhea. My gallbladder pain has stopped since getting off keto, but fatty foods will send me to the bathroom. 2 months off keto im still having issues. Bile salts make it worse. My symptoms fit BAM when i eat high fat now. I tried probiotics for several weeks with no help and had to stop due to headache and acne breakout. I dont know what happened during keto or what it has done to my digestion or how to get back to normal.

  3. I've had this dull pain just above the belly putton area for some 20 yrs now.I've had some sucess with low fodmap diet and herbs but meat and fats seems to agravate it so i literally can't find the right diet.I 've done about 10 gastroscopies and no gastritis found except the first time i did a gastroscopy..so not sure although i had a esophagus ulcer.I have sort of delayed gastritis symptomps.Also small amount of foods seems to kind of be better digested but am always hungry and don't know what to eat..Really sucks

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