[phnofive]

The comparatively effective treatment for IBS was essentially a taped hypnotherapy session - is the rest of the Nerva platform undergoing review? Will you discourage users who’ve used FODMAP, even inadvertently, from signing up?

[alexnaoumidis]

Great question! The approach used in the study also used psychoeducation and breathing exercises as well and we’re in the early stages of an observational study into the Nerva program. What do you mean re discouraging users who’ve tried FODMAP?

[graeme]

I read their comment as perhaps meaning that the study showed fodmap + hypnotherapy was no more effective than fodmap + hypnotherapy. A result I found surprising. (Unless it means the problem was effectively solved in both case, so no more improvement was possible)

[alexnaoumidis]

Ahhh I understand - that’s a good point. Many people follow the low FODMAP diet without the direction of a dietitian (against the recommendation on how to do it) and likely aren’t getting the full result so GDH will still provide benefit, as well as helping the psychological side of IBS.

Interestingly, it’s possible they both help with visceral hypersensitivity - FODMAPs ferment in your gut causing gas and your gut to expand and hypersensitive nerves could then be alerting the brain to potential (but false) danger, so by avoid FODMAPs you avoid this process. Hypnotherapy could potentially be coming at the same process but from the top down instead.

[graeme]

Yeah. Your final point could be true if both interventions fully resolved the issue, or at least as much as could be done. If not, it’s puzzling the combo didn’t lead to more improvement.

But certainly I don’t see it as a cause to exclude low fodmap people from trying the app.

[graeme]

Do you have a link to the studies on ibs being caused by hypersensitive nerves? Just going through onboarding in the app and was curious about that.

[alexnaoumidis]

Yeah, no worries you can read a study about the role of visceral hypersensitivity in IBS here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5056566/

[TACIXAT]

Please, if you have IBS try concrete treatments like elimination diets with a focus on FODMAPs. Hypnotherapy will not heal your gut.

[alexnaoumidis]

The FODMAP diet is a great dietary option for managing IBS but gut-directed hypnotherapy has been shown to be just as effective as the diet for people who prefer a non-dietary option. The study we reference that found this result was run at Monash University who created the Low FODMAP diet.

[TACIXAT]

As a celiac who cannot digest some FODMAPs this sounds like complete snake oil. The answer is not eating the foods. I meditate. It would be really reckless if someone told me if I just meditated hard enough I could eat gluten again. You don't know what underlying condition causes the IBS and continuing to consume a food that makes you sick could lead to untold damage.

[graeme]

Gluten isn’t a fodmap. Instead, fodmaps are present in almost all gluten containing foods. But sourdough bread has low fodmaps, but does have gluten.

So I think you’re conflating two issues. Celiac is an absolute intolerance of gluten, whereas fodmap ibs is based on being unable to digest large quantities. No one really knows why, and it’s not implausible some mechanism such as stress reduction or hypnotherapy would help.

Whereas for a celiac no such solution would work, there’s a real inability to digest. Perhaps in your case this extends to some fodmaps, but gluten isn’t a fodmap.

Also fodmap diets are generally elimination + reintroduction.

[TACIXAT]

I am aware that gluten is not a FODMAP, I can not eat high fructose foods. Gluten causes my body to attack itself which has damaged my small intestine. That has caused fructose malabsorption.

[graeme]

Makes sense. I would note that people with celiac are much smaller than the group of people with IBS. For instance, I have a negative celiac test, no bowel inflammation, but do have IBS. And IBS in these cases is often linked to stress.

So while the app is inapplicable to your case, you’re overgeneralizing from your case to all cases.

(I would of course encourage anyone with IBS issues to get a gluten test. It’s important to rule out!)

[alexnaoumidis]

I am actually Celiac as well and follow a strict gluten free diet so I know where you’re coming from. Although the cause of IBS is unknown, it’s a functional condition which means it’s problem with how the gut works but doesn’t lead to any damage. Instead, it’s thought that visceral hypersensitivity could be at play, where the nerves in the gut are overreacting to the gas and expansion caused by the fermentation of FODMAPs. IBD (and Celiac disease) on the other hand leads to gut damage and we would definitely recommend against using Nerva for that - it will not work.

[TACIXAT]

Someone looking to fix their gas or regular diarrhea isn't going to be able to distinguish between gut inflammation and not. They're just going to be searching how to fix IBS. I don't see how your app would distinguish between these either, before posing as a treatment.

[alexnaoumidis]

Nerva is for people have been diagnosed with IBS, not for people who have self-diagnosed themselves. Many conditions present similar symptoms like IBD, celiac disease etc so it’s important people are properly diagnosed before attempting any management options including the low FODMAP diet and GDH.

Nerva isn’t a treatment, it’s a program that teaches people self-regulation skills and relaxation exercises that can help them self-manage their symptoms.