This week we talk with Dr. Mike Stierstorfer, MD., licensed Dermatologist. He has made advancements in helping patients suffering from IBS. He talks with us about how it all started, with him not feeling well. From there he went on to research food allergies utilizing skin patch tests to help himself and others feel better. He shares his insights and the success he's experienced in figuring out that IBS can be caused by an allergic reaction to the foods people are eating. For more information visit Dr. Stierstorfer's website: podcast.stopmyibs.com.
Dr. Mike Stierstorfer Website: podcast.stopmyibs.com
Transcription:
Intro00:02
Welcome to changing the rules, a weekly podcast about people who are living their best lives and advice on how you can achieve that too. Join us with your lively host, Ray Lowe, better known as the luckiest guy in the world.
Ray Loewe00:17
Good morning, everybody. And welcome to changing the rules. Changing the rules is a weekly podcast where every week we try and highlight what we think is one of the luckiest people in the world. So the luckiest people in the world are people who redesign their own lives, under their own terms and live them the way they want. And they're usually people who think outside of the box when they address problems and issues. And they don't, they're not constrained to the rules of life. You know, one of the things that we find is that all through our lives were given rules that we're supposed to live with. And we're given them by our parents, and then by the schools. And sometimes we get saddled with so many rules that they become barriers to doing what we want to do and what we need to do. And we have with us today, one of the luckiest people in the world, and you're gonna see that he just attacks problems in an entirely different way. He doesn't let himself be constrained by the norms. And because of that, he has successes that other people don't have. So, Mike, Mike Stierstorfer did I pronounce that right today, Mike? You did. That's amazing in itself. Okay. But welcome to changing the rules. And let me give people a little background on you. I found out something unusual. I live in a little town called Lancaster, Pennsylvania. And I asked Mike if he had heard about it. Then he said, Well, I have to go to school there. He went to Franklin and Marshall. So he knows more about this place than I do. And then he went from there on to Temple to get his MD and set up his own practice as a dermatologist, which is really interesting, because of the work he's doing is an entirely different area. And he's been on the staff at the University of Pennsylvania Hospital for a long time teaching interns, teaching residents, is that correct? Mike? Dermatology residents? Yes. Okay, so so he's got incredibly great credentials for what he's doing. And so let's start off, Mike with an event that occurred, I think, was on July 3, 2008.
Dr. Mike Stierstorfer 02:39
That was the exact day that it happened. And I remember it so well because it was a beautiful day, the day before Fourth of July. And I had lunch at a Mexican restaurant. And within an hour or so after lunch, I started getting an upset stomach, some nausea, and belly pain. And I assumed it was from something I had just eaten and that it would go away by the next day like things usually do. Turns out those same symptoms persisted for the better part of the following year, accompanied by some other symptoms that pretty much qualified for criteria that are used to diagnose irritable bowel syndrome. And that's where everything started. That day, I remember it well, because that night I was walking around, everybody's having a nice time and I'm walking around with an upset stomach, not too happy that I was missing out on all the fun.
Ray Loewe03:35
Okay, so let's take a minute and talk about this thing called irritable bowel syndrome. It's not it's not something we enjoy talking about on the air. But it is a problem that many, many, many people have, and is not easily diagnosed and solved. So give us a little bit of the background and then we're gonna go into some of the unique solutions that you've been able to come up with.
Dr. Mike Stierstorfer 04:01
Yes, so irritable bowel syndrome is extremely common. It affects 10 to 15% of Americans or 30 to 45 million Americans. And over 50% of those people with IBS report that foods aggravate their symptoms. It's been felt to be what's called a functional disorder. In other words, one of the in which there's nothing physically wrong. There are several criteria that make up the diagnosis of IBS. You have to have belly pain at least once a week for the past three months, once at least six months prior to that. And it needs to be accompanied by things like onset of the symptoms being associated with changing the way your stool looks either looser or harder. Also, or accompanied by the pain getting better or worse with a bowel movement and also, the bowels moving more or less frequently. Um, upon onset of the symptoms, so there's very strict criteria that are used to make the diagnosis.
Ray Loewe05:06
Okay? And the cure for this is a traditional process is you go to a gastroenterologist, and they have a process for diagnosing this, which is not necessarily the most pleasant thing in the world to go through right?
Dr. Mike Stierstorfer 05:20
Yeah, they pretty much want to rule out other things that could have a more detrimental long-term consequence to your health. They want to rule out things like inflammatory bowel disease, Crohn's disease, ulcerative colitis, gluten sensitivity, celiac disease, things like that even colon cancer. So they want to make sure you don't have that. And sometimes they can do that just clinically by asking you questions and examining you. But often these people go through a lot of testing with various types of scopes, and blood tests and radiographic tests, even CAT scan. So there's a lot often that goes into the evaluation before they come to the conclusion it's just IBS. I shouldn't say just IBS, because it can be a serious problem, too. Yeah.
Ray Loewe06:04
So so here you are in an entirely different field. Okay. And unfortunately, you're having these symptoms. So what happened here? What did you do you know, what's the new way you look at this thing?
Dr. Mike Stierstorfer 06:21
So for the better part of the year, I had these symptoms, I had the big evaluation that didn't find anything. And finally, about a year later, I was trying to determine whether foods are playing a role I avoided gluten, I avoided lactose things that are known to cause GI issues. Nothing helped about a year into it, I got a lucky break, really, I ate Indian dinners at the same restaurants twice within a week of one another. And both times, my symptoms flared up severely worse than normal, but they're the same kind of symptoms I was usually getting. So I knew it was something in the food I was eating for the first time. And I knew it wasn't the Indian spices because I in general, don't eat them that often. And I was having these symptoms, on average, probably half the days. So the thing that I thought about because it's in pretty much everything we eat unless we're intentionally trying to avoid it was garlic. So I just stopped eating garlic. And literally the next day, my symptoms were completely gone. At that point, I felt that this had to be a new allergy to garlic because you can become allergic to something at any point in time, it doesn't have to be something new, repeat exposure, you could come allergic to it. So I set out to try to determine what type of allergy this was. I didn't really know much about IBS, I wasn't really interested in GI as a medical student, I'm a dermatologist. So I first tried a blood test that would look for a peanut type allergy, which everybody's pretty familiar with. And that test was negative for garlic. That's the same kind of test that the allergist says with a prick and scratch test. So that's called a type one allergy, that was negative, I still was convinced it was an allergy. And in Dermatology, we do a type of allergy test called a patch test, frequently for people who have a rash called eczema and we suspect that their Eczema is being caused by something that's touching their skin, in other words, an allergic reaction causing their eczema type of rash. So that's a different type of allergy than the peanut allergy completely different. It's called a type four allergy skin kind of allergy just causes poison ivy, and I decided to do a patch test on myself to garlic. And the patch test was positive I got a red itchy spot on my skin after leaving the garlic there for two days. So my thought at that point was likely the same type of inflammation I was getting in the skin from the patch test from the garlic was occurring in the lining of the intestine when I ate any foods containing garlic. So another point I should mention is that until the early 2000s IBS was felt to be something where there was nothing physically wrong. But in the early 2000s, inflammation has been identified and a lot of people with IBS, both with biopsies of the intestine and with blood tests that show that there's inflammation going on in the body. So most of the time though this inflammation, they don't know what's causing it. So my thought was likely this allergic reaction caused by the garlic in the intestine was causing inflammation causing the IBS symptoms. At that point, I wanted to figure I wanted to find out who else had looked into this. So I googled it and I found that no one ever investigated patch testing the foods for irritable bowel syndrome. So that's when I started with the research on it. I've done several clinical trials now that have been published. And the conclusion of these studies was that by identifying specific foods not just garlic-like but because to overwhelm 80 things now was in the studies up to 117 or 120 Different foods, that over 50% of people we test get either moderate or great improvement in their IBS symptoms by limiting the foods that they identify are identified by the patch testing. So this was completely new information. If you ask the gastroenterologist about food allergies, and IBS, they say they don't play a role. And the reason for that is that it's been taught to them because of other studies that have looked at type one food allergies. And there's another type of allergy called a type three allergy to but those types of testing are not helpful for IBS. So it's ingrained into gastroenterologists that food allergies don't play a role with IBS type four allergy testing by patch testing had never been done for IBS before. So essentially, those prior studies looking at the other types of allergies were like, barking up the wrong tree looking for the wrong type of allergy, you wouldn't be able to check my garlic allergy by doing a type one allergy test.
Ray Loewe11:06
Okay, so now we have a whole new series of ways to investigate a problem that people had. Now there. First of all, let's talk a little bit about your successes here. So you are telling me when we did our prep call about an 11-year-old girl that you had some success with. And once you go through that particular description, and let's find out what happened.
Dr. Mike Stierstorfer 11:35
This was one of the most gratifying experiences I had using this testing. This girl was missing school two or three days a week. And her mom somehow learned about this testing that I was doing. And later, she mentioned that she didn't really think it was going to help but she thought I tried she tried anyway, because it was such a desperate situation. And this girl was allergic to benzoyl peroxide, which is used to bleach flour and some cheeses. And she was also allergic to something called pining alpha, which is a naturally occurring chemical that's found in parsley, carrots, parsnips, and celery. So these allergies were identified, she went on to eliminate those foods from her diet and she's 100% Better, she hasn't missed a day of school. And her mom said that when the girl gets sick, she would make her vegetable soup with all those vegetables. And she said I was poisoning my daughter. So yeah, this is an example where like, for me, it was, I was lucky because it was garlic. It was something I could figure out by the process of elimination just from what I had eaten and what I knew I didn't eat that often. But something like pining alpha, you would never be able to figure that out just by the like elimination diet or process of elimination. So this is where the patch testing really becomes useful.
Ray Loewe13:01
Okay, so so we have uncovered largely by chance, because you were the patient, right? You had a series of issues, and you wanted to solve them for yourself. So how does this figure it out into where the medical community is going with taking care of IBS?
Dr. Mike Stierstorfer 13:23
Well, this is really very early. We're just trying to get the message out there to doctors and to patients about this. That's not an easy task. The goal is that eventually, we hope that the first thing that we've done with people with IBS is this patch testing before subjecting them to all these invasive procedures and radiographic studies where they get radiation and not to mention the cost of those procedures and then putting them on all these different medications that may or may not help at some are quite expensive. Some of them are up to $1,000 a month. So we feel that this testing should be a first-line option for patients with IBS. It's a very simple solution, it identifies specific foods, it's much easier to typically avoid foods found here than doing something like the low FODMAP which is a popular diet for people with IBS, which is very difficult to fall involve lots of different foods here with the patch so you can avoid one or two specific foods or three or four whatever we find and potentially get better. So the goal is that this will be a first-line option for people with IBS and save them a lot of aggravation, testing, and treatments that don't work and expense that goes along with it.
Ray Loewe14:43
and this isn't stuff that has to go through FDA approval and stuff because the tests are, are approved. It's just a question of getting the medical community to look at this as an option for treating and cure, right?
Dr. Mike Stierstorfer 14:57
So the tests are done with what are called compounded allergens and compounded. And these are considered medications by the FDA So, but because they're compounded, there are a set of guidelines using compounded medications for patients where they don't actually have FDA approval, they have to be prescribed for a specific patient and a patient's name. And they have to the manufacturing of these allergens has to be done by a licensed compounding pharmacist following what are called USP guidelines. So it's accessible to properly licensed doctors and other providers now, as long as they do it in a specific patient's name.
Ray Loewe15:41
Yeah. And what percentage, you know, IBS is caused by a whole lot of things, right. But when you look at the kinds of things that you're trying to address here is do you have any idea of what percentage of the IBS community or what communities are the wrong word, but,the problems that can be fixed by this?
Dr. Mike Stierstorfer 16:04
Well, yeah, you're right. IBS probably is caused by a lot of different things. But our studies have shown that a significant percentage of these people have these food allergies. In my studies, within the patients who have long-term follow-up, were getting an eight to 10 improvement on a scale from zero to 10, of about a third of the patients and moderate improvement or five to seven on a scale of 10 and another 25%. So I don't know the exact number, but I would venture to guess that probably at least 25%, if not higher than that conservatively, have food allergies that are contributing are completely causing their symptoms.
Ray Loewe16:43
Well, cool. You know, we're unfortunately, we're near the end of our time already. And I find it fascinating to talk to people like you because you think outside the box. And that's why you are one of the luckiest people in the world. You're not constrained to normal things. You know, you're thinking outside the box, and you're making progress. So where are you going to go from here? What's the next step?
Dr. Mike Stierstorfer 17:08
Well, I do, I do want to just follow up on that comment, right. And I do feel in a lot of ways that I have been extremely lucky to make this discovery really was a very lucky setup circumstance, I pretty much followed my nose. This was not an epiphany that I came up with. But it involves a lot of luck. To make the discovery IBS has been described since 1944. And no one ever before recognize this connection between this type of allergy type four food allergy detectable by patch testing and IBS symptoms. So the luck involved. The fact that first of all, I developed irritable bowel syndrome, some people may call it bad luck, but in a lot of ways, for many people with IBS, it was very good luck. And even for me that I was able to find something that relieve my symptoms. Also, it was lucky that it happened to be garlic and that I ate those two Indian dinners within a week of one another was able to make the connection to garlic was also lucky that I was a dermatologist and I had the tools and the knowledge and the resources to pursue this further. And was also lucky that it turned out to be a type of allergy that in Dermatology we deal with all the time, like for allergies, for allergic contact dermatitis. So there was a perfect storm of circumstances that created this lot that involve that enabled me to make this what I feel is a significant discovery in medicine.
Ray Loewe18:35
Yeah, but it takes some knowledge and it takes some effort and it takes some you got to follow the luck. Otherwise, the luck never materializes. So, you know, thank you so much for being with us. If people want more information, where can they go to find out more about you and more about what you're doing? And we'll post this, by the way in the notes on our podcast, so they'll be able to see it. But where do they go?
Dr. Mike Stierstorfer 19:01
Thank you. There's a URL. It's podcast.stopmyibs.com. And patients will be able to get and doctors get a lot of information there. And if they have questions beyond that, our contact information is available there on the website. So we're very happy to talk to anybody who'd like to discuss this further.
Ray Loewe19:24
Oh, cool. Well, thank you so much for being with us. And continue your great work. And maybe we'll uh another six months or so we'll have you back again. And we'll find out what's happened and where the progress has been. So have a great day. And thanks so much for being with us.
Dr. Mike Stierstorfer 19:41
Thank you very much.
Outro 19:45
Thank you for listening to changing the rules. Join us next week for more conversation, our special guest, and to hear more from the luckiest guy in the world.