Dr. William Davis, Wheat Belly Author, Talks IBS

William Davis, M.D.
William Davis, M.D., Wheat Belly Author. Photo Courtesy of William Davis, M.D.

This is the first part of my interview with William Davis, M.D., Author of Wheat Belly Total Health. In this part of the interview, Dr. Davis discusses the role that he believes the consumption of grains plays in IBS. Click here to access the second part of this interview, in which Dr. Davis discusses his views on the  overall health benefits of a grain-free diet.

Dr. Davis is a cardiologist who has written and spoken extensively about the benefits of wheat-free living.

In addition to Wheat Belly Total Health, he is also the author of Wheat Belly, , and Wheat Belly 30-Minute (or Less!) Cookbook. He also hosts the blog wheatbellyblog.com.

Q. Although you have covered the topic extensively in your book, can you please give a brief overview of your view on the relationship between grains and IBS?

"It is becoming clearer that the majority of IBS cases are caused by wheat and grain consumption. This is not just my observation, but was recent consensus opinion of a group of gastroenterologists, all experts in celiac disease who have come to recognize that the adverse effects of wheat and grain consumption involve more than celiac disease. For all practical purposes, IBS = wheat/grain intolerance. The cause-effect relationship can be easily tested, even without the involvement of a doctor: just banish all wheat and grains from the diet. If this is going to result in relief from IBS symptoms, it nearly always occurs within the first 5-7 days-it's that fast.
But there is another layer of issues with IBS: the majority of people with IBS also have varying degrees of disrupted bowel flora, or "dysbiosis." It is therefore important for complete relief of IBS symptoms, as well as for recovery of overall health (since the composition of bowel flora is critical for metabolic and bowel health, even responsible for improvements in blood pressure, blood sugar, cholesterol values, even quality of sleep and mood), that steps are taken to restore healthy bowel flora. After removing all wheat and grains, I therefore advocate that everyone recovering from IBS then follow up their efforts with a high-potency probiotic (e.g., 50 billion CFUs) for at least several weeks, if not months, and to then nourish these bacterial species with prebiotic fibers/resistant starches. This second component-nourishing bowel flora with prebiotic fibers-is often overlooked but is crucial for full recovery. (The details on how to do this are discussed in detail in my book, Wheat Belly Total Health, also summarized in my Wheat Belly Blog, which you can access by clicking here".

Q. What changes have you seen personally when IBS patients remove grains from their diets?

"I have witnessed dramatic relief from IBS symptoms, whether of the bowel urgency/diarrhea variety or of the intermittent constipation and bloating variety, that develop within 5-7 days in nearly everyone. I also witness further relief of any residual symptoms over several weeks to months by taking steps to cultivate healthy bowel flora, as mentioned above."

Q. I noticed that you used the terms SIBO and dysbiosis interchangeably. I was under the impression that SIBO referred to the small intestine while dysbiosis referred to the large intestine. Can you clear up any confusion?

"All forms of dysbiosis, including small intestinal bacterial overgrowth, or SIBO, involve the colon. SIBO simply refers to a form of dysbiosis-disruption of bowel flora species, number, and location-in which microorganisms have ascended above the farthest ileum and colon (where they normally belong) and up the jejunum, duodenum, even into the stomach. SIBO is a severe form of dysbiosis but assigned this misleading label of SIBO because the diagnosis is made via upper endoscopy, i.e.., a scope introduced from above that can only reach into the duodenum for a specimen. Dysbiosis may or may not involve SIBO, often determined by whether or not a specimen was obtained via endoscopy to examine for microorganisms. Both are unhealthy conditions, both are very common though occurring to varying degrees of severity, both are caused by a number of factors, with wheat and grain consumption at the top of the list. Wheat and grain elimination therefore begins the process of reversing dysbiosis/SIBO."

Q. What role do you think that SIBO/dysbiosis play in IBS?

"Because dysbiosis is so common in IBS (though estimates vary, depending on the definition and the methods used to diagnose), it is not clear whether dysbiosis is a cause or an effect of IBS, or both. The science is simply not clear on this. Nonetheless, the fact remains: If you hope to reverse all the phenomena of IBS, start by removing the disrupters of intestinal health and bowel flora. This includes wheat and grains, minimizing antibiotic use, perhaps used filtered water to minimize chlorine and fluoride exposure, avoiding sweeteners such as aspartame and sucralose, and minimizing exposure to emulsifying agents such as carrageenan and polysorbate-80 in processed foods. Then take the steps (above) to restore healthy bowel flora."

Q. In contrast to Paleo diets, you recommend the consumption of legumes. Why the disparity? What do you think about legumes for a person who has IBS, particularly in light of their FODMAP content?

"The "Paleo Diet" is whatever one or another author says it is; there is no one single definition for the wide range of eating behaviors practiced by pre-Neolithic (pre-agricultural) people 10,000 years ago and earlier. Some authors in the "paleo" world believe that the phytates of legumes block nutrient absorption, which is true. However, it is my belief that consumption of modest quantities of legumes is harmless, does not substantially block nutrient absorption to be a concern, and provide modest quantities of prebiotic fibers to nourish bowel flora. I do suggest maintaining small portion sizes, however, e.g., no more than 1/4 to 1/2 cup per meal to avoid extravagant blood sugar rises and provocation of small LDL particles leading to heart disease.

The FODMAP content of legumes tends to be disruptive only if substantial dysbiosis is present and resistant to the natural efforts detailed above to restore healthy bowel flora. Then a FODMAP-restricted diet minus legumes can help starve unhealthy bowel flora that allows a return to healthy bowel flora over time."

Q. When acutely symptomatic, many people with IBS turn to easily digestible foods such as crackers and rice, etc. What would you recommend as a grain-free alternative?

"You can now appreciate how such short-term comforts create long-term deterioration, as grains contain direct bowel toxins, such as gliadin, gliadin-derived peptides, wheat germ agglutinin, and others, while also modifying bowel flora-the "treatment" is actually part of the problem. Because so many people obtain relief within days of following this wheat- and grain-free lifestyle, it is uncommon to even have to talk about finding such comfort in foods. However, it can be helpful to make bone broths and soups or steamed mashed cauliflower (that tastes like mashed potatoes without the blood sugar/carb problems). The majority of people will rarely have to use such crutches, however. Think of reversing IBS as allowing the gut to heal by removing all the things that should never have been in your diet in the first place."

Click here to read the second part of my interview with Dr. Davis, in which he discusses his views on the overall health benefits of a grain-free diet.

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