Brian (0s):
What are some of the symptoms that people might get that have IBS
Mohammad (4s):
By definition is called Rome four criteria, which I think is the best and worst definition. They say that if you have stomach discomfort and changing bowel habits, that happens at least one day a week. In the last three months you have IBS. That's the, okay, so the symptoms are usually gas, bloating, stomach discomfort, frequent bowel movements, constipation, mucus in their stool, urgency to go fecal incontinence. So it goes from one end of the spectrum to the other. It goes from mild that everybody has it and must have it. Otherwise, we're not healthy to severe, which depends on what other problems we have associated with this.
Brian (44s):
This week I interviewed Dr. Mohammad Farivar, a gastroenterologist with decades of experience diagnosing and treating gastrointestinal disorders, especially Irritable Bowel Syndrome. We discussed the truth about IBS and ways to overcome it along with the role of diet in managing IBS symptoms, problems with modern day sweeteners in our diet. What are FODMAPs and how do they impact individuals with IBS? The value of breath testing, and much, much more. I really enjoyed my interview with Dr. Var. I know you will too. Thanks so much for listening and enjoy the show. All right. Welcome to the Gitlin EATCLEAN podcast. My name's Brian Gryn, and I have Dr. Mohammad Farivar.
Brian (1m 23s):
Welcome to the show. Thank
Mohammad (1m 25s):
You, Brian. Good to see you.
Brian (1m 27s):
Good to see you. And leading gastroenter. And I should be able to pronounce that gastroenterologist, right? How did I say that? Good.
Mohammad (1m 36s):
Yes, that's great. You said it better than I do.
Brian (1m 39s):
Well, I've been practicing. So how long have you been practicing for?
Mohammad (1m 43s):
I've been a doctor since 1971. I've been practicing since 1975. So 50 years.
Brian (1m 49s):
Things have changed a bit in those 50 years.
Mohammad (1m 52s):
Practice has changed a lot. It has, of course it has changed for better in some as aspects and not so good in others, but basically it has changed a lot. It's not the same as it used to be 50 years ago.
Brian (2m 4s):
And why is that? Why
Mohammad (2m 6s):
Is it Because government has, and insurance companies have their hands into manage managing patient's care a lot. When I see a patient and I order a medication that I think is best for that patients ulcerative colitis or Crohn's disease, the insurance companies, they don't approve it. I can't get my hands on things which are even better because they say, no, you have to try this and this and that before we can allow this. And have you tried those? So make it basically impossible to do anything. So they have taken the spontaneity and out of, you know, out of practice of medicine. So, and things have become also a lot more expensive. Medications are a lot more, we have, you know, better medicines, but more expensive.
Mohammad (2m 49s):
A lot of people can't afford it, even though we have good, good stuff around. So I've been, see, I've been around long enough to have seen all of those, the good days and the bad days and not so good days. So, but you know, the technically managing patients have become a lot better. A lot better. The medications have developed for like, things like acid reflux that when I practice started practice, other than anti-acid, nothing else was available. And then came H two blockers, like Zantac antagonist and then KMP And now has come the different kind of medication, which of course insurances don't approve it. So, and same thing for colitis patient and same thing for heart patients with their, you know, kind of surgeries and valves and so forth.
Mohammad (3m 33s):
So there's goods and goods and bad, but overall it's progress.
Brian (3m 37s):
Yeah. And when it comes to like your patients, have you seen more cases through the years of like IBS And what would you say the basis behind that is? Is that been just the diet or, or some other influences that are, that are taking, that are getting people into, into your office?
Mohammad (3m 57s):
Okay. Yeah. Irritable bowel syndrome basically has become an in type of problem for people to have. Everybody that I see, they complain, even though they come to see me for something else, they, at the end, they touch their irritable bowel syndrome too. So yes, it's, they say that at least 25% of people in this country, they complain about irritable bowel syndrome. 5% of them, they see physicians. Last year, 20 million people saw gastroenterologists for irritable bowel syndrome. And the budget, the money that was spent by insurance companies and the government on those was about more than $30 billion. And a lot of money was spent outta people's pocket.
Mohammad (4m 37s):
And a lot of other market has developed around this, like people who are selling probiotics and prebiotics and symbiotics and IBS diets and IBS psychotherapy. So a huge market has developed around that and is really all, I think that is a disservice to patients because all irritable bowel syndrome is, is symptoms that are produced by good food that we are eating. We have started to eat healthier instead of, you know, what we used to eat, which was hamburger and hot dogs and steaks And you know, ribs and those kind of things. Now we are eating more grains, more legumes, more fruits and vegetables, more, you know, cauliflower and broccoli and so forth in our diet, onion and garlic.
Mohammad (5m 24s):
And of course those are all stuff that produce symptoms that are called irritable bowel syndrome. So yes, do we see it more often? Yes, of course. Is it a disease? No, it, it's a manifestation of the food that we are eating and the good food that we are eating and is necessary. So what we have started to do is just tell people, oh, you have IBS, you know, let's do a colonoscopy and endoscopy and do this and that. And then because it's their diet and we don't know what is causing it, we send them in different directions. See acupuncture, see psychologists, see do, do this, do that. So
Brian (5m 56s):
What are some of, of the symptoms that people might get that have IBS
Mohammad (6m 1s):
By definition of is called Rome four criteria, which I think is the best and worst definition that it is. They say that if you have stomach discomfort and changing bowel habits, that happens at least one day a week in the last three months you have IBS. That's the, okay, so the symptoms are usually gas, bloating, stomach discomfort, frequent bowel movements, constipation, and those kind of frequent bowel movements, mucus in their stool, urgency to go frequent incontinence. So it goes from one end of the spectrum to the other. It goes from mild that everybody has it and must have it, otherwise we're not healthy to severe, which depends on what other problems we have associated with this good food that we are eating with the high food.
Mohammad (6m 53s):
Like if we have lactose intolerance or fructose intolerance or SIBO or celiac, that adds to the basic problem. There are all still due to basically lack of digestion and absorption of carbohydrates that they go into our large intestine and get fermented there and produce all of those. So the basic tenet is the same, but we could have added factors like those that makes people symptom more serious. But the treatment is basically the same, which
Brian (7m 23s):
Is And what Yeah, go
Mohammad (7m 23s):
Ahead. Which is, you know, finding out or having the knowledge that what is causing this problem. So once you have the knowledge, it's very easy to take care of it. You know, I had a patient recently that, you know, headmaster of one of the schools in, in area where I practiced in Cambridge, mass, that she comes to me and for 12 years she's been to four different doctors, four different Harvard professors and has had four colonoscopies, four times been tested for celiac and so on and so forth. And she was riding bike to her work because of the fact that she didn't know if she needs, you know, help to go to the bathroom or find a toilet.
Mohammad (8m 6s):
If we did public transportation, she couldn't do it. She was taking Uber to go and see her friends because of lack of control. And nobody ever ask her, what do you eat? What is your diet? And I'm s serious. So she comes to me and I, I ask her, I say, well, every study has been done and everything's been negative, so there's something obvious that's been made. So I said, well, what's your diet? What do you eat? She said, oh, healthy diet. I eat this. And this said, okay. I said, well, it's your diet. You stop all of those that you did for one week and change your diet and gimme a call after a week. We'll do a televisit and see how you're doing. And after a week she calls says, I haven't had any of these symptoms and I can't believe it in this so many years.
Mohammad (8m 46s):
Nobody ever asked me what was I was eating. And nobody ever told me that this could be related. So I dunno whether I answered your question or not, because I keep going. And, but that's
Brian (8m 58s):
No, I mean, obviously the role of diet is, is important. And when you talk about, like with, with that patient that you just mentioned, right? Eliminating, so you, she pretty much told you what she was eating and you told her to eliminate a lot of the things that could be causing her gut to have Yes, this discomfort. And a lot of this is what are so-called healthy foods, but perhaps she's not able to digest these foods easily. Like
Mohammad (9m 25s):
So all of us all, there are a bunch of food which call fat bath food, which is fermentable, oligo dye and polysaccharide and also pos or oligosaccharides. These are foods that we have. It is in all of our fruits and vegetables and beans and those kind of things, right? And when we eat them, and there's a purpose that God has provided those things in our diet because they are, they become the food for bacteria in our colon, which are the main source of energy production in our immunity. And they need food. So those kind of things, we cannot digest them and ab absorb, we don't have enzyme to digest and absorb them in our small intestine.
Mohammad (10m 11s):
They'll go to our large intestine and the bacterias that reside there, they start consuming those. And by consuming those first they produce calorie. So people eat salad and they, oh, I'm not losing weight, I'm eating so much salad. I tell them, okay, cows eat grass too. And they become a ton. So, you know, don't think that eating salad has no calorie. Of course it does. It has 2.5 to three calories, even grass does. Because what it happens is that once food gets to our large intestine, the bacteria produce, they analyze it, they ferment it, they produce calorie, and they produce good food that is good for our immunity and for the health of our color.
Mohammad (10m 52s):
That and then gas. And the gas is hydrogen, carbon dioxide and methane. And this hydrogen and ga methane and carbon dioxide, they start dis descending large intestine li balloon that gets distended. Of course, once it gets distended in a limited space, especially in thin female with small frame, this distension causes discomfort. So it has nothing to do with the brain, gut axis. Okay? You distain something, you blow air into it, it is gonna have discomfort. And then cause also changing bowel habits and everything else that goes with it. So is the food that in everybody cause symptom. But a man walks around and passes gas and goes and doesn't mind it.
Mohammad (11m 34s):
And somebody else that's health conscious, neurotic, nervous, or a female that is not, you know, doesn't want to have gas at work or a day their dates, they think, oh, well I have a IBS. And they go from one doctor to another one probiotic to another probiotic, and they don't get any help. And so as a result of that, everything else develops, then they become, you know, depressed and anxious and self isolating and everything else that goes with it, you know, is consequences. This thing that is, is not a problem is lack of education. So,
Brian (12m 10s):
Yeah, you know, it's interesting, I was looking up sort of FODMAP foods and one of on on there is the sweeteners. I noticed these, these sweeteners are now everywhere. You know, they're in like a lot of foods or bars that people are eating, xylitol, sorbitol, I I mean this could cause discomfort in the gut as well.
Mohammad (12m 31s):
Absolutely. A lot.
Brian (12m 32s):
Yeah. Yeah.
Mohammad (12m 33s):
A lot be, and, and they, you know, they're in the prepared food and all the diet type of food and all the diabetic supplements and none of those monohydrates, they, they don't get absorbed. And that's why they say that they have no calories and then they go to large intestine antibacteria, they love it. So they start producing all that gas and bloating and so forth that, that goes with it. So yes, plus I think that 80% of people in the world have lactose intolerance. Okay? People like you, Northern Europeans, white, probably 80% don't have lactose intolerance. Everybody else in the world, 80% have lactose intolerance.
Mohammad (13m 14s):
So if you come from a culture that is not western and northern European, and you are from, you know, Mediterranean area, middle East, India, Asia, south America, central America, you have lactose intolerance too on top of these things. So now you eat high fat, you are eating your beans and broccoli and everything else, but also you're drinking a glass of milk. And then what's gonna happen? You're gonna have cramps, you're gonna have gas, you are gonna be bloated, you're gonna have frequent bowel movements. And if you eat a lot of those the same day, then you're gonna have mucus in their stool. You're gonna have urgency, you're gonna have the feeling that you haven't emptied completely.
Mohammad (13m 55s):
And so all of those other feeling that goes with it, it depends on how much FFA you consume And what other problem you have. There are some people, Brian, that they cannot absorb more than three gram of fructose. Now fructose isn't fruits, right? The sugar of fruits is fructose, honey is fructose, watermelon full of fructose, apple, a lot of fructose and pears and so forth. You know, stone fruits like cherries and dost sticks. So if you only can tolerate three grams of fructose, you eat a bunch of fruits like that, you are gonna have problems. And so you got to know that what your limit is. And those are easy to find out. You can do a breath test and find out about a lot of those things that unfortunately is not being done in doctors' offices.
Mohammad (14m 44s):
And this is really one of the things, I mean, my, I've made it my mission. I'm 80 years old almost in a few months. So I made my mission really to educate people in this country about what IBS is And what they need to do. And when they go to the doctor after they have eliminated fought back, if they still have problems, ask them for a breath test. Ask them to check and see if you have fructose intolerance, lactose intolerance, sibo, celiac, rapid gas, intestinal transit, chronic pancreatitis, because all of those, the breath tests will be positive. It will show that you are too much food is getting to your colon and they get fermented and they're producing a lot of hydrogen. And hydrogen comes outta your breath and it can be measured.
Mohammad (15m 25s):
It is not being done. You know why it's not being done.
Brian (15m 29s):
It's not covered by insurance. Am I right? No,
Mohammad (15m 32s):
Yeah. The payment is minimal. Exactly. The payment, they cover it, but the payment is minimum. For example, you need three hours, three hours of your technician in your office. Oh wow. To do this breath test. Right? And the insurance pays Medicare this year pays $67 for it. 67. The subrate that I have to buy to give it to the patient is cost at least 25 bucks, three hours of my technician time. Right? So I rather go and do four colonoscopy and make $4,000. Wow. Make nothing. So when you go to GI offices, gastroenterologist offices, 99 outta a hundred, I would, I wanna say 99, 999 outta thousand, they don't have this breath test equipment because, you know, it's, it's not, it's gonna be a waste of their time.
Brian (16m 21s):
Yeah. It's, it's not worth their time and, and resources. Right?
Mohammad (16m 26s):
So what we need to do, again, educate public to be asking for it. I mean, these are our rights, is my, is my right to know that I don't need to suffer for the rest of my life with all those symptoms and going, going from one doctor to another to find out what's wrong with me, which they don't have the information, they don't have the knowledge. And even if they did, they don't have the equipment to tell me what's wrong with me and suffer and spend so much money. The second cause of work absenteeism in this country is IBS. Okay? So a lot of money we are spending on this, and we are not, nobody's thinking about it. Nobody's talking about it. I have tried to get on your friend's podcast, which is about IBS.
Mohammad (17m 10s):
Nobody wants to talk to me, of course, because we are getting paid or we are advertising some things that I say, well, is not necessary. Well, who the hell wants to talk to me? A person like that, that is go, that is advocating these kind of things. So it is hard
Brian (17m 25s):
To, so let me ask you this, doctor. So what steps would you take someone through in your office? Is, would you apply the breath test right off the bat? I mean, obviously you mentioned you'd ask them what they're eating, right? And then where would you take, but
Mohammad (17m 37s):
Somebody I was, I was in private practice from 76 to 19 to 1917. I'm in 2017. I'm 2017, right? Yeah. From 1970 2017, I had three of this equipment to do breath test. So when patient come to me on Fridays, I wouldn't, I was not working. So Friday was the day that they come, 10, 12, whoever that I've seen that needed breath test, they'll come to the office and the front desk people. So it doesn't need, you know, they, you drink a glass of milk and three hours later you breathe it into a little machine and it, it go, if it goes to 20, it's positive, and if it doesn't go to 20, it's negative. So it's simple as that.
Mohammad (18m 17s):
So it's not a difficult thing. So they would do it, but no, see, it depends. When the patient come to the office there, they don't have a sign saying that I have IBS. They come complaining. And it depends on their complaint. If they have alarm symptoms, like somebody that IBS has started is 55 years old and is just getting an IBS and every day pain is getting worse and is losing weight and is seeing blood in their stools and so on and so forth, which indicates that this is a serious problem. No, that's not IBS. I evaluate that patient for colitis, for cancer for this. And that younger patient comes with those kind of symptoms. I evaluate them first to make sure that they don't have celiac and dosing.
Mohammad (18m 59s):
So if they don't have this, so, and is is a blood test and a stool test, simple thing to do. If they don't have this, then I will ask about their diet and about their symptoms. And if, if it fits the criteria for IBS that I have for myself, then I put them through breath test and find out what is the cause of their problem. I have in the same department that I am, there are three gastroenterologists. I do order breath test. And of course in our hospital, even though it's a Harvard teaching hospital, we don't do it. And I have to send patients someplace else to get it done. And before I was another teaching hospital in Boston, I was practicing, I was working there as a consultant.
Mohammad (19m 40s):
And they wouldn't do it. They, they weren't doing it there either. So it's not easy to, to get that done. So, you know, you do the, these tests to find out what the issue is and take care of them. I think that I was gonna tell you something else and I just lost train my thought. So that's, that's when you are 80. That's what,
Brian (19m 59s):
Hey, hey, I'm 40, I'm in my forties. And it happens to me. So don't worry. So once an individual eliminates maybe foods that are causing issues, can they eventually reintroduce these foods down the line?
Mohammad (20m 12s):
They have to, they're the best food, they're necessary. Right?
Brian (20m 17s):
Like if a, if a person is getting a reaction to an apple, I would imagine that perhaps one, like once the gut heals, they would be able to eat an apple. Right?
Mohammad (20m 27s):
Two, two things. Brian here. God, there's nothing wrong with gut. Gut is healthy. The gas that's producing is a good sign. It's telling us, wow, great. Send more. Okay. That's what we are having problem with the symptom. We are reacting to it. So I tell people usually that I'm not talking about allergy. Now I think you, you may be mistaken with allergy. Allergy to apple is different. No, yeah. Than this kind of issues. This God is healthy, we are is doing the right thing. Apple is good for us. And Apple a day keeps the doctor away. They have said it before and it's true because what Apple produces in our large intestine, it produces butyrate. Butyrate is the best thing to enhance our immunity, okay.
Mohammad (21m 10s):
And our health. So there's nothing wrong with that. But it produces gas too. So what I tell people is that, listen, this is what your problem is. This food that you are eating, they're causing your problem. You can educate yourself about this. I give them, usually send them to my website that there's a list there to print. I says, go and print this and website is free and it's been free for 30 years. I says, go and print this list, put the refrigerator so you know, these are the things that's gonna give, give you gas and those things. So the same day, don't eat several of the same, these kind of foods. Mm. Okay. And modify your diet is not, don't eat it, don't eat it at all.
Mohammad (21m 50s):
It is the wrong thing to eat it, but know what causes your problems.
Brian (21m 54s):
Okay. So it's just being aware and making sure that you're not, if it is causing an issue, don't have a bunch of it. Like baked beans and all this, all these things that could be causing issues. Exactly. So what about endotoxin buildup? Is that something you, you do, do you find people come in with high levels of endotoxin?
Mohammad (22m 13s):
I have never measured endotoxin. I don't really believe in that Endotoxins. If you have conditions like Crohn's disease or ulcerative colitis that everything is ulcerated and bacterias can get into your system and toxins can get into your system, that's a different story. We are not in IBS. We are talking about an intact system. Everything is good. Everything is healthy. As a matter of fact, people who have IBS, if you measure their intestinal microbiome, they have the healthiest intestinal microbiome. They have the best bacterias in their, in their microbiome. The healthiest one of those. So there is no such a thing as endotoxin in people with who have symptoms of irritable bowel syndrome.
Mohammad (22m 58s):
Any reason for it, there is a leaky gut that, you know, people who take like too many aspirin or too many ibuprofen for example, and there are ulcerations and their gut, you know, bacteria can enter it then fine. That that's a different story. That's could be a super imposition to, to your IBS symptoms.
Brian (23m 17s):
Yeah. It And do you, do you help individuals who, who might have leaky gut? Is this something that you come across or do you mainly deal with IBS?
Mohammad (23m 24s):
Okay. The people who have leaky gut, it's, there is a test called manitol lactose test that measures if how leaky their gut is. I haven't found any place to do that. There is one lab that does it. I think that once was a, an educated person patient that came and educated me about it and told me about the lab that they do it in the, in the country. I think I had the name. So not many do it because again, you have to drink something and then they, me they collect urine for five hours and blood and they measure those kind of things. So Don, once I listened to a PBS talk about a doctor, amen, A MEN in California, I think he was talking about leaky gut.
Mohammad (24m 6s):
And he had made a supplement, which is called Leaky Gut plus supplement, which is I think glec Glec, glutathione, zinc and other things which repairs the leaky gut. And so I tell patients when I suspect somebody has leaky gut, which is, that's a different thing than IBS. IBS symptoms. But then they could have skin problems, joint problems, they could have, you know, fatigue being cloudy, mental wise and so forth. That's a different issue. I tell them that, okay, try that, you know, and they tell me that it's effective. I mean, I've had several patients that they have told me that that's been, that's been very effective using glec glutamine and zinc and other things that are in their supplement.
Mohammad (24m 52s):
I don't know why it is. That's really the only thing that I, I recommend to patient from supplements are available on internet for IBS patients.
Brian (25m 1s):
What about a colonoscopies? Is that something that you, colonoscopies
Mohammad (25m 5s):
Is a good idea. If somebody comes at age 40 or 50 and is having IBS symptom and just started, of course I do colonoscopy. If somebody has blood in this stool, of course I do colonoscopy to make a diagnosis of IBS in somebody. 28-year-old female that comes to see me and is eating healthy and trying to lose weight and have symptoms. No, I won't look. So the colonoscopy, if there's indication, yes. And I have seen patients that they have had four colonoscopies just for IBS symptoms because the doctor didn't know any better. So I, I've see, I see it as a matter of frequently, every day I see about 12 patient in the office. Three or four of these patients are second and third opinion about their IBS.
Mohammad (25m 46s):
And so I see things that is unbelievable, but way that's
Brian (25m 50s):
Side and for colonoscopies. Do you recommend whether you have symptoms or not, that people should get them still around 45 or so,
Mohammad (25m 57s):
Huh? Absolutely. Okay. Absolutely. Colonoscopy is the best screening since colon cancer is the second type of cancer. After lung cancer in men and after breast cancer in female. So it is, and every year about 30, 63,000 people die from colon cancer. And it is, it is very preventable doing colonoscopy, finding out a polyp that in five or 10 years turns into cancer and removing it is the best preventive things that you can do. So my recommendation is everybody should have colonoscopy at age four, beginning at age 45. But if there is a family history or if you, one of your parents have had polyps or something, then age 40 or less. So yes, colonoscopies is definitely yes.
Brian (26m 39s):
And then I know we talked a little bit about that.
Mohammad (26m 42s):
I have done probably, sorry, I've done probably 50,000 colonoscopies in the last 50 years.
Brian (26m 47s):
Really?
Mohammad (26m 48s):
Yeah. Yeah. At least 50,000.
Brian (26m 51s):
Wow. And what about getting back to IBS and things like that, like probiotics and prebiotics are, do you recommend any of those or no, just,
Mohammad (27m 1s):
No, no, I don't. Okay. No, I don't. See, basically our colon mic microbial, the intestinal bacteria, they are 30% of those bacterias are probiotics. Okay. They're all probiotic. They're bacterias. That probiotic means they are digesting, they're fermenting the food that didn't get digested. Okay. And we are eating it. So, so if you become a grain eater type of a person, then the bacteria that is necessary for grains, they develop it. They are all in our colon. They're sitting there. The population may be low if there's not enough food. Once there's enough food, they increase, they multiply.
Mohammad (27m 41s):
So we don't need to, if we eat the right food, we don't need to take probiotic if we don't eat the right food. Probiotic that we take is useless because each gram of a stool has 10 billion, 10 billion bacteria. Okay. A lot of bacteria, those bacteria in probiotic that we take, a lot of them, they get destroyed by acid in our stomach, by enzymes in our small intestine. And once they get there, there's a drop in the bucket. Yeah. Okay. So this is the biggest things I think medicine, this service that the medicine has done for their own benefit. And it started from Tufts University in Boston for their own benefit. And people have bought into it.
Mohammad (28m 21s):
And it is, is a difficult thing, I think to, when I tell patients come to me and they're taking six or seven different probiotics and I say, throw them away. You know, you don't need that. Just eat, eat a cup of yogurt today or get kefi, you know, are you familiar with kefi? Yeah, yeah. ISIS eight K has, I think 18 different bacteria in it. And it's fermented and it's great. I say eat that if you really want to do something, but, but if you change your diet, you don't need to do that. You know, your diet is going to multiply the good bacterias in your intestine related to that. So, so no, I don't recommend probiotics. I do recommend it if you have taken antibiotic And now you have diarrhea as a result of that, because antibiotic has destroyed all the good bacteria in your intestine And now you need to take bacteria to replace it.
Mohammad (29m 10s):
But what I do then I tell them, eat a lot of activa yogurt or Greek probiotic yogurt. I tell them, eat that. And that's good enough.
Brian (29m 19s):
Okay. Yeah. 'cause it's a, it's a big market, probiotics and a lot of money spent in that, in that arena. Yeah.
Mohammad (29m 27s):
And every day, and when I, when I look at the, because I, you know, I give lectures about IBS and so forth for students and doctors at medical school. When I look to see what's new, I see every day the probiotics are growing like weeds. Oh, more and more everybody comes with a little bacteria. And of course they're all probiotic. They're all probiotic. Everything that ferments food that comes to our intestine and doesn't let it go to waste is a probiotic. Okay. So, so, you know, they have come up with, oh, this bacteria, that bacteria in combination of these three, one and combination of five And now is prebiotic with the two. And now they're symbiotic. I mean, I mean this is such a ridiculous thing that has developed.
Mohammad (30m 9s):
But unfortunately they're not controlled by FDA. Nobody has control over those. So they can come and as long as it's not harmful, they can bring it to the market. And of course these are, these are normal bacteria in your stool. So like, like, you know, eating a gram of stool in a little capsule. So
Brian (30m 26s):
You know a lot. Yeah. What, what about, so if someone's having issues, let's just say, you know, once a month, maybe twice a month they're getting abdominal pain and they have to go to the bathroom in order to relief it and they're on the toilet for 30 minutes, let's say, is this could be a sign of IBS, is that correct?
Mohammad (30m 45s):
A sign of IBS also, it's something like this could be allergy to food allergy. Like for example, you eat something, and I've seen that a few times. You eat something that you ordinarily don't eat. But when you go to a restaurant and order some food, the ingredient in that food, you are allergic to. You eat that and you go home and you are gonna have cramps and gas and bloating and you have to go to the bathroom and have to sit until you get rid of that completely. Until you feel better. Or sometimes you're up to 24 hours, you may have a stomach discomfort and everything else. The, and this is, I usually tell people like that, that find out what kind of food you may be allergic to. And not necessarily, it doesn't have to be the food.
Mohammad (31m 26s):
It could be an ingredient like cinnamon or ginger for example, or garlic. So just find out what you ate, ask them what was in it, and try to figure out what's causing this, this problem. So that's some sort of allergy.
Brian (31m 39s):
Yeah. To, because that's happened to my wife a few times. I mean, we eat a lot at home. We, we know what we're eating, but like, we were just in Nashville, went out to dinner and then she had like an episode where, you know, she's on the toilet for 30 minutes and doesn't feel good. Yeah. And
Mohammad (31m 54s):
Yeah, she was, she, she was allergic to something in that food. Yeah. Maybe, maybe you had too much barbecue rib with the sauce with,
Brian (32m 1s):
I mean, who knows? I mean,
Mohammad (32m 3s):
You never know what's in those things.
Brian (32m 4s):
No. In the sauce, what they're cooking it with. Yeah, yeah,
Mohammad (32m 7s):
Yeah. I understand. I'm just saying it. So,
Brian (32m 9s):
Yeah. So, so it's probably not a bad idea to keep a food log for a bit. Yes. If you are experiencing those things.
Mohammad (32m 17s):
Yes. If it happens infrequently. And is that severe? That's what it is. You're gotta figure out what, what caused it.
Brian (32m 24s):
Yeah. Excellent. I like to ask this question and this'll be good for you. 'cause you've been in practice for a long time. What's one thing you've changed your mind on?
Mohammad (32m 33s):
What's one thing I changed my mind on? In being in practice?
Brian (32m 37s):
Yeah, in practice or, you know, the way you Yeah. In practice maybe with clients, or excuse me. Yeah, with clients or with just your practice in general.
Mohammad (32m 47s):
I, you know, one thing that I've come to realize is that there is a, I realize that there's a big mafia in medicine, okay? Big mafia in medicine, that you cannot get into it. And they are supporting each other and they are on board of different publications, different things, and doing a study for drug companies and making a lot of money. And anybody who comes against it can get into it, can say anything because they are the people who are benefiting from it. A huge mafia, even in great schools, doesn't matter. They all know. They all know each other. And I have, I have, I mean, proof of all of those things when, when I'm saying that they all know each other And, you know, things will show up.
Mohammad (33m 33s):
Like I think that I said 18 years before, for example, 18 years later, the same thing shows up. But for 18 years it was abused by these people. I have at least three example of those in my own practice, my own research that it took 18, 20, 25 years before what I said many years ago turned out to be true. And, and it was applied. But before that, several people have made professors based on false information. Okay? So what I have come to realize, and it's very difficult is, is that you can't believe everything that they're telling you. Doctors in research in big places, you know, famous universities, but people have no choice.
Mohammad (34m 17s):
People have no choice. And even, I'll give you an example. When these PPIs came out, you know, PPIs like omeprazole and pantoprazole and rool and all of those, those, okay? When they came out for acid reflex, I did a study and it showed that one of these zones was really not effective and not any more effective than H two blockers. Right? And I presented that in a conference in me mid eighties. And that everybody said, no, no, because people have made a lot of money that this is the most effective medication. Hmm. That most effective medication became approved.
Mohammad (34m 58s):
And it still is as the best medicine that when you get admitted to the hospital with GI bleeding or anything else, and they wanna give you a PPI, they put you on intravenous pantoprazole, like say the name of that. And all the GI doctor even they use intravenous, they use pantoprazole by mouth instead of other PPIs because they have been told that this is the best. Mm. Right now, it took about 20 years before the studies were done that showed that the pantoprazole is not any better than, I mean 20 is 20 milligram pantoprazole is equal to I think eight or nine milligram omeprazole. So less than half effective. Okay.
Mohammad (35m 38s):
But by now it's too late. Because I give talk also about gerd, GRD, even for GI doctors. Gerd.
Brian (35m 45s):
Yeah.
Mohammad (35m 45s):
And GI doctors, they haven't, they don't change their attitude. It's, it is in their mind that pantoprazole is the strongest. So they're still using it. So if you have GERD and you use pantoprazole, you have symptom. They make it twice a day instead of moving to something like omeprazole once a day, which is even cheaper. Right. So, and why, because I was going to, I think 1992, I was gonna be professor at Boston University, I was associate professor. And because of this things that I had with, with the directors and so forth, and everybody was benefiting from it, I le left the place. Basically I went to Harvard. But, but what I'm saying is that things like this, I've seen it, I have several other examples.
Mohammad (36m 29s):
So that's the thing that, you know, it's, it exists and is a big elephant in the room, and there's nothing you can do about it. There's nothing you can, and it's same thing with IBS. Now that I've been saying the same thing. Why are we not doing breath test in the, you know, the Harvard University Hospital in a Tufts medical school hospital? Why are, why are we not doing breath test for all these patients that they're coming? Why are we all doing their colonoscopy and endoscopy and blood and stool test and send them on their way home? But, but that's the way it is. So I'm hoping that by talking maybe if I live long enough, I can at least make a difference in this area.
Brian (37m 7s):
Yeah. And you know, you gotta follow the money trails, right?
Mohammad (37m 11s):
Yes. Exactly. Exactly. And promotion is not, is not only the money because people with money, they are at the top, but other people that go along and write papers and so forth, they get promoted. They go from assistant professor to associate professor, this and that. So both, it is both. And
Brian (37m 29s):
It, it's like when you read a study, I mean, there's so many studies, right? It's like, so it probably makes sense to see who's funding that study. Yeah,
Mohammad (37m 38s):
Yeah. Well always, yeah, it does make sense to, to see who's funding the study for sure.
Brian (37m 43s):
Because I'm assuming a lot, a lot of the pharma, a lot of the pharmaceutical companies are funding these studies.
Mohammad (37m 49s):
Yes. And then they have one or two doctors, like for example, American Society of Gastro, no, American College of Gastroenterology, 2024, I think 2022, they had came out with a position paper that irritable bowel syndrome is very common and 25% of people have it. And if you have irritable bowel syndrome with diarrhea use, rifaximin is effective. And if with constipation, use Linac think and that's effective. Okay. Now, Rifaximin is an antibiotic, is a GI antibiotic. So if you have irritable bowel syndrome, quote unquote means they have too many good bacterias and you are eating too many, too many good food.
Mohammad (38m 32s):
So you know, it's too much. So cut back. Instead, they're recommending a very expensive antibiotic. I think it's 12 each to use to kill those good bacteria. So when the food goes there, there's no bacteria to ferment it. So there is no gas. So you have no symptoms, okay? This is a crime,
Brian (38m 51s):
Right? It's, it's causing a loop that they're, it's gonna cause something else, right? So they're gonna have to get on another prescription,
Mohammad (38m 58s):
Right. Either on the, per, on the prescription or you know, the good bacteria goes. So the food that they're eating, you know, it just goes waste. And the colon gets starved from, from things. So this is what basically is, and they know it. I I, I am sure they're not that stupid, the people that come up. But the same people are people who are benefiting from all the studies about IBS. And they are the board and they speak for them. So, And now this antibiotic is a very good thing for sibo, for people who are bacterial overgrowth in their small intestine is the best thing. But you write that they don't approve it, they don't, insurance doesn't approve it. They say it is not indicated for this, it is indicated for irritable bowel syndrome with diarrhea.
Mohammad (39m 42s):
If you, if patient has that, we'll give will approve it. Otherwise, no, it's not approved. Totally reversed. Totally reversed it. Okay. So, and that, you know, I have looked into it with three or four different insurance companies in the, all over the country. And everybody's position on this is position of American College of Gastroenterology, which is recommending this. So they wanna prove, I mean, you know, I have to like put patients on things which is less effective after spending time and going two or three times trying to override their denial and not being able to do it. Eventually you go to something else. But that's,
Brian (40m 18s):
And I know you've said it a few times, but like sometimes eating a lot of these quote unquote healthy foods could cause issues just to make sure that you don't overdo it with those things. Right? Is that, like, would a recommendation be like trying to eat perhaps like easy to digest carbohydrates in?
Mohammad (40m 36s):
No.
Brian (40m 37s):
Okay.
Mohammad (40m 38s):
No, because you need, you need all of those. You see the good bacteria on your intestine, they need this food, it is their food, right? And they want to produce butyrate for you and they want to keep you healthy and they need food. Eat those. Don't overdo it. And if you, you know, so the same day that you had apple, you know, don't have avocado and cheese sandwich and don't have a couple of scoops of ice cream at night And you know, you know, things like that. And so just modify what you are eating. And if in spite of that, if you still have problems, then it is time to find out, have the breath test to find out what other problem you have.
Mohammad (41m 19s):
Which is related to the same thing related to carbs not being absorbed. Because sometimes things are digestible, lactose is digestible in our small intestine, but if you are lactose intolerance, if you don't have the enzyme, it's not gonna get digested. It is gonna go right into the colon and act like fo Right. Fructose too much. Okay. Is we, we can absorb more than 25 grams, three grams. Some people fructose, intolerant, people with three grams, they have problem, normal people with 25 grams, they have problem. If you have chocolates and caramel and those kind of things, which has a lot of fructose in it, or then you are eating or high fructose corn syrup in something and you're eating those, then you are gonna be in, you know, in trouble.
Mohammad (42m 2s):
So, so breath test to find out what other issues we have with carb, that's the right thing to do and then to modify it. So,
Brian (42m 13s):
Okay. Are you familiar with an MR and test
Mohammad (42m 15s):
Is available?
Brian (42m 16s):
Yeah, I was gonna say, are you f familiar with an MRT test or is or is that not something,
Mohammad (42m 21s):
What is MRM RT test? No, I'm not.
Brian (42m 23s):
Okay. No, it's just a way to find if you have any type of like inflammatory response to, to specific foods or chemicals.
Mohammad (42m 30s):
I am not sure if they Yeah, sort of Brian, you, I, I don't believe in this kind of test. You know, you know, you go the, their labs on the internet, right? That they charge and a patient have brought this much, this thick of records to me that the labs have done the hair test, blood tests, stool test on them, charging them $2,500 and telling them also the food that they're allergic to, that the IgG level is high in them, that they have this para test para and so forth. And they say, okay, the thing that they say don't eat, I eat and I don't have any problem. And it's thing that they say, you know, I mean, and the reverse, and nobody controls And you know, they, you, you get a lot of useless information from these companies because this is how they can sell their tests to you.
Mohammad (43m 16s):
And those are not FDA approved and they're not approved by any kind of medical societies either. So a lot has developed, I mean, I go on the internet to look about IBS, what it is. Yesterday I was, I saw something about brain got hypnotherapy or brain got something that, you know, oh, you do this and there are a lot of apps now that they're teaching you how to do this kind of thing. So when you suffer, you don't suffer really. And you can, you accept what it is. I mean, just so there's so many ridiculous things that is being developed by people that I guess wanna benefit.
Brian (43m 51s):
So you're, you're the only testing that you would recommend in, in, in general is, is the breath test.
Mohammad (43m 57s):
The only thing test that I right for IBS patient, that they go on a low fom lactose free diet. Okay. Because I'm gonna assume that that person is lactose intolerant anyway, depending on where they're from, a low fom, lactose free diet. I tell them, stick to it for one week and if there is a problem, gimme a call. Then they call and they say, I had this day and say, what did you it? And then I put them through breath test, which is four different tests, four different breath tests for lactose, for fructose, for sibo, and for high fodmap like fibers for fiber, you know, soluble fibers, inin, and those types.
Mohammad (44m 37s):
And these four different tests will show you if they have, if they have additional issues too with other foods that is causing this. And then so I tell them, you know, that modified this variant. That's it.
Brian (44m 48s):
Okay. So first you start 'em on a low FOD map, lactose free diet. And then from there, if they're still having issues, then they, then they can do a, a breath test,
Mohammad (44m 57s):
Right? But you know, but at the beginning with taking a good history, I'll make sure that they don't have anything else that needs to be studied. That this is not a cancer, that this is not Crohn's or ulcerative colitis, that this is not celiac, things like that. And then after talking to, and by talking to them and taking good history, you can figure this thing out. And if I think that it may be the potential that this could be one of those things, then I'll do what I need to do. If I do need to do colonoscopy, I'll do it. If I need to do endoscopy and biopsy, you know, I do whatever it takes to, you know, rule more serious things that needs to be treated before I move to this. And sometimes it is necessary to do that.
Brian (45m 39s):
Okay. Very good, doc. All right, well anything else? Did we miss? Did we hit, we hit on a lot today. We
Mohammad (45m 45s):
Hit on a lot And you know, I'll be happy anytime, anytime you wanna talk about any of those issues. IBS, gastroesophageal reflux, because a lot of mismanagement goes, you know, from doctors,
Brian (45m 58s):
I mean acid reflux, acid reflux, like you mentioned the PPIs, you think they get over Overprescribed?
Mohammad (46m 6s):
Probably not. Probably not. Misprescribed, yes, overprescribed? I don't, I don't think so because acid FL is a, is a problem. I mean, you know, it just, it's just like, like IBS maybe even little more than that. It just ruins the quality of life. You can eat anything, you can sleep at night, you know, so people need to be comfortable. And I think that PPI are probably the best thing that happened in history of medicine and probably probably the safest thing that have been around, you know, they talk a lot, a lot of bad press they get, which is really mis, you know, is blown out of proportion about the side effects of those things.
Mohammad (46m 47s):
And even if something happens is easily manageable. So no, I think that PPIs are probably good, but we don't do enough surgery on those people. Those people, you know, young people. I send a young person that comes to me and needs PPI twice a day and can sleep. And so I send them to surgeon. I said, you know, to, to get this fixed for them. So for the rest of their life they don't have to take PPI and they don't have to be uncomfortable. And this is not something that is not done enough by doctors. I mean they're afraid somehow of sending people to surgery and, but, but no, I use PPI frequently, I send people to surgery frequently because it is a lifelong problem and there is an answer for it.
Mohammad (47m 31s):
And
Brian (47m 32s):
Is there a
Mohammad (47m 32s):
Ppi I the side effect of not treating it are many. So maybe at some point we can talk about this.
Brian (47m 38s):
Is there one that you recommend? I know you mentioned the one that you didn't like was that Omeprazole.
Mohammad (47m 44s):
Omeprazole is the best thing. Gram per milligram. Omeprazole is as good as anything else. And it is the first thing that came out and probably is the cheapest. Okay. Pantoprazole is the one that I don't recommend,
Brian (47m 55s):
Which Okay.
Mohammad (47m 56s):
Pantoprazole. I don't because everybody think that's the best because everybody was told that that's the best because it is still is carried in. The hospitals intravenous, somebody comes in and they get IV razzo, but, you know, but is is about less than half as strong as Omeprazole is.
Brian (48m 14s):
Okay. That's a pri pza.
Mohammad (48m 17s):
Yeah. Pri great.
Brian (48m 18s):
Yeah. All right doc. Well, lots of good information. Where's the best place for people to find you? Where's
Mohammad (48m 24s):
The best place? Call, call me. Oh, if you, if I have your email, I'll send you my media one page, media sheet, okay.
Brian (48m 31s):
Yeah. And, and I'll put the link in the show notes for your website. Gerd IBS dot com.
Mohammad (48m 37s):
Yeah, I have another website called, is it IBS or your diet? That's my book. Okay.
Brian (48m 43s):
This is,
Mohammad (48m 44s):
This is my book. So the website is the same thing. His name, is it IBS or your Diet.
Brian (48m 49s):
Okay. Yeah, I'll, I'll put a link in the show notes. Do you sell that just on your website or is it on Amazon or No,
Mohammad (48m 55s):
It is Amazon.
Brian (48m 57s):
Okay.
Mohammad (48m 57s):
And on my website, is it IBS or your diet is free for anybody who read it? I really not interested in selling books. Okay. This is not, I don't need to sell books. What I'm trying to do is inform people So they won't suffer for the rest of their life. So they won't spend their money and they won't keep having tests and test and test from one doctor to another. So that's what I wanna do. And that's why the site of IBS, ger Dash IBS has been around for 30 years and free. And this, my book is on that side. Is it IBS or your diet? It's free there too if anybody wants to read it, so, you know. Yeah,
Brian (49m 34s):
That's great. I mean, you know what, it's, it's about getting out there and, and telling people, helping people out, right. So, yeah, exactly. All right, Moham. Well, and
Mohammad (49m 42s):
I appreciate what you guys do.
Brian (49m 43s):
No, my pleasure. Yeah, I, I, I've, I learn a lot from interviewing people like you, so I appreciate it and we'll get the, we'll get the message out. So thanks so much Moham, and enjoy the rest of your day.
Mohammad (49m 55s):
You are welcome, Brian. You take care and anytime, you know, you need to talk to me about anything else too on the phone, just gimme a call or so your email, I wanna send you that. Where should I send that one page?
Brian (50m 7s):
Whatever. It's, let me, thanks for listening to the Get Lean Eat Clean Podcast. I understand there are millions of other podcasts out there and you've chosen to listen to mine and I appreciate that. Check out the show notes at Brian Gryn dot com for everything that was mentioned in this episode. Feel free to subscribe to the podcast and share it with a friend or family member that's looking to get their body back to what it once was. Thanks again, and have a great day.
