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- Herausgeber: John Wiley & Sons
- Kategorie: Ratgeber
- Sprache: Englisch
Spot the triggers and handle IBS at home or work Get control of your symptoms and improve your quality of life Are you or a loved one suffering from IBS? This plain-English, reassuring guide explains all aspects of this frustrating condition and helps you find the right doctor and treatment plan. You get up-to-date information on the latest tests, healthy nutrition guidelines, diet and exercise plans, and the newest medicines and therapies to bring you much-needed relief. Discover how to * Get an accurate diagnosis * Recognize the warning signs * Reduce your stress * Weigh treatment pros and cons * Adopt an IBS-friendly diet * Help children with IBS
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Seitenzahl: 625
Veröffentlichungsjahr: 2011
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IBS For Dummies
by Carolyn Dean, MD, ND and L. Christine Wheeler, MA
IBS For Dummies®
Published byWiley Publishing, Inc.111 River St.Hoboken, NJ 07030-5774www.wiley.com
Copyright © 2009 by Wiley Publishing, Inc., Indianapolis, Indiana
Published by Wiley Publishing, Inc., Indianapolis, Indiana
Published simultaneously in Canada
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Library of Congress Control Number: 2005932583
ISBN-13: 978-0-7645-9814-2
ISBN-10: 0-7645-9814-7
Manufactured in the United States of America
10 9 8 7 6
1O/RV/RR/QY/IN
About the Authors
Carolyn Dean, MD, ND: Carolyn Dean is a rare breed of medical doctor. She is one of a handful of doctors who has received dual degrees in medicine and naturopathic medicine and bridges the gap between the two. Dr. Dean graduated from Dalhousie Medical School in Nova Scotia in 1978. She is also a graduate of the Ontario Naturopathic College and presently on the board of the Canadian College of Naturopathic Medicine in Toronto, Canada.
Dr. Dean is licensed to practice medicine in California, but her base is in New York, where she publishes, writes, consults, and travels frequently to present rousing lectures to eager listeners on health and wellness issues.
In her private practice, which she ran for 12 years in Toronto (from 1979 to 1992), Dr. Dean treated thousands of patients who came to her with symptoms of IBS. Having seen similar symptoms in her own family and she, herself being sensitive to wheat and dairy, Dr. Dean understands the impact of diet, exercise, and stress on the bowel.
Dr. Dean has written many books, including Natural Prescriptions for Common Ailments, Menopause Naturally, Homeopathic Remedies for Children’s Common Ailments, The Miracle of Magnesium, Death by Modern Medicine, and Hormone Balance. She has also coauthored Women’s Book of Natural Health and The Yeast Connection and Women’s Health. She is an advisor to Natural Health magazine and the medical advisor for www.yeastconnection.com. Dr. Dean is a regular guest on TV and radio, appearing many times on The View as well as Fox, CBS, and NBC, and she has her own radio show.
Christine Wheeler, MA: Christine has been a freelance researcher and writer for 15 years. For the past seven years, she has focused mainly on health and medical topics, including extensive research on the health benefits of nutritional products. She has especially enjoyed providing writing and editorial support to Dr. Dean on various book projects.
In 1999, Christine discovered Emotional Freedom Techniques (EFT). After extensive training and preparation, she opened her private practice in 2002. She has worked with hundreds of people to help them alleviate stress, anxiety, emotional traumas, and the accompanying physical manifestations, including IBS symptoms.
Having had a brush with IBS herself, and using EFT to alleviate the condition, cowriting this book seemed to be a perfect fit and a unique opportunity to help others suffering with this condition.
Dedication
Carolyn would like to dedicate this book to the memory of our parents, Rena and Harold Wheeler. To Mum for her wry sense of humor and amazing spirit, and to Dad for his way with words. And to both of them for giving us early insight into the world of IBS.
Christine would like to dedicate this book to her sweetie, husband, partner, and spouse, Ken Lawson, a constant support and source of fun and inspiration while she worked on what was affectionately known as “the poo book.”
Authors’ Acknowledgments
First of all, the authors would like to acknowledge each other — this sisterly collaboration made for a sometimes riotous voyage through the research and writing on this serious yet scatological topic.
We thank our agent, Jacky Sach of Book Ends, for offering the opportunity to do this project and helping to get it underway. We have great appreciation for Stacy Kennedy, our acquisitions editor at Wiley, who felt we had what it took to get to the bottom of IBS. We thoroughly enjoyed working with Joan Friedman, our editor at Wiley. She took great care of our words while patiently guiding us through the Dummies process.
We would also like to thank Dr. Irene Grant, our professional reader, for her input and kind words about the book. And thanks to Pam Floener for her insights on the topic of mercury poisoning and mercury detoxification.
We especially appreciate our past and current patients and clients with IBS who, in their efforts to find relief from their condition, have given us the gift of learning. We hope that this book is helpful and that we can continue the dialogue as they delve into this material.
Christine would like to thank Therese Dorer for her limitless friendship, crystal clear insights, and the great rounds of laughter. And to her in-laws, Doug and Sherry Lawson, thank you for understanding when she couldn’t come out to play.
Publisher’s Acknowledgments
We’re proud of this book; please send us your comments through our Dummies online registration form located at www.dummies.com/register/.
Some of the people who helped bring this book to market include the following:
Acquisitions, Editorial, and Media Development
Project Editor: Joan Friedman
Acquisitions Editor: Stacy Kennedy
Technical Editor: Irene H. Grant, MD, CAC
Editorial Supervisor: Carmen Krikorian
Editorial Manager: Michelle Hacker
Editorial Assistants: Hanna Scott, Nadine Bell
Cover Photos: © Max Dannenbaum/ Getty Images/The Image Bank
Cartoons: Rich Tennant (www.the5thwave.com)
Composition Services
Project Coordinators: Adrienne Martinez, Shannon Schiller
Layout and Graphics: Andrea Dahl, Lauren Goddard, Stephanie Jumper, Barbara Moore, Barry Offringa, Heather Ryan, Brent Savage
Special Art: Kathryn Born, MA
Proofreaders: Leeann Harney, Jessica Kramer, Joe Niesen, Carl Pierce, Sossity R. Smith
Indexer: Aptara
Publishing and Editorial for Consumer Dummies
Diane Graves Steele, Vice President and Publisher, Consumer Dummies
Joyce Pepple, Acquisitions Director, Consumer Dummies
Kristin A. Cocks, Product Development Director, Consumer Dummies
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Kelly Regan, Editorial Director, Travel
Publishing for Technology Dummies
Andy Cummings, Vice President and Publisher, Dummies Technology/General User
Composition Services
Gerry Fahey, Vice President of Production Services
Debbie Stailey, Director of Composition Services
Contents
Title
Introduction
About This Book
Conventions Used in This Book
What You’re Not to Read
Foolish Assumptions
How This Book Is Organized
Icons Used in This Book
Where to Go from Here
Part I : Just the Facts about IBS
Chapter 1: IBS Is Real
Hiding the Evidence
Knowing IBS Is Real
Recognizing Your Symptoms
Finding a Doctor Who Knows about IBS
Diagnosing IBS
Considering Causes and Triggers
Treating IBS
Coping with IBS
Chapter 2: Classifying the Condition
Defining Our Terms
Trading Theories about Causes
Faulty Functioning
Roaming the Criteria
Living the Symptoms
Mistaking Identity
Letting Genes Off the Hook
Separating IBS from IBD
Chapter 3: How Your Digestive System Works
Getting to Know Your Gut
Getting to Know the Food You Eat
Eating and Digesting
It Takes a Village: Keeping Good Bacteria in Your Gut
Leaking in the Gut
Rejecting Foods: Vomiting and Diarrhea
Loving Your Liver
Pleasing Your Pancreas
Timing Is Everything
Becoming Stool Savvy
Chapter 4: Targeting Triggers
Identifying Original Triggers
Getting the Terms Straight
Watching What (and How) You Eat
Feeling the Effects of Blood Sugar
Running in the Family
Solving the Candida Crime
Making the Chemical Connection
Facing Up to the Stress of IBS
Leaving No Trigger Unturned
Chapter 5: Who Gets IBS and Why
Stating the Statistics
Singling Out Women
Associating Other Conditions with IBS
Experiencing Psychological Distress
Having Hypersensitivity
Part II : Getting Medical Help
Chapter 6: Finding a Doctor
Knowing When to Get Help
Identifying the Right Doctor for You
Relying on the Doctor Within
Chapter 7: Making a Diagnosis
Preparing for Your First Appointment
Talking to Your Doctor
Differentiating Your Diagnosis
Having a Physical Examination
Responding to Your Situation
Chapter 8: Medicating IBS Symptoms
Considering the Effectiveness of Drug Therapies
Medicating IBS-Diarrhea
Medicating IBS-Constipation
Dealing with IBS Pain
Part III : Healing and Dealing with IBS
Chapter 9: Considering Dietary Supplements and Homeopathy
Treating Symptoms with Supplements
Getting Help from Homeopathy
Chapter 10: Eating an IBS-Friendly Diet
Making Smart Food Choices
Eliminating Possible Food Triggers
Challenging Each Food
Translating Your Results into Better Habits
Taking Additional Steps for Diarrhea and Constipation
Chapter 11: Alleviating IBS with Exercise
Defining Exercise
Benefiting from Exercise
Taking the First Steps
Loosening Up Your Lymph System
Loving Yoga
Exercising Choices
Chapter 12: Treating Stress and Symptoms with Caring Therapies
Pinning Down IBS with Acupuncture
Emotional Freedom Techniques (EFT)
Meditating for IBS
Changing Your Behavior
Part IV : Living and Working with IBS
Chapter 13: Getting Out of the House: Living with IBS
Taking Steps Toward Better Health
Surveying the Effects of IBS
Counting the Costs
Tackling Social Situations
Trying EFT to Overcome Anxiety
Connecting with Others
Chapter 14: Working with IBS
Facing Facts about IBS on the Job
Making Your Workday Bearable
Talking to Your Boss and Coworkers
Working from Home
Regaining Power in the Workplace
Chapter 15: Helping Children Cope with IBS
Realizing a Tummy Ache Is Something More
Overcoming the Stress of IBS
Maintaining Balance at Home
Using Homeopathy for Your Child’s Emotions
Chapter 16: Keeping Up-To-Date with IBS
Raising Awareness of IBS
Surfing the ’Net
Seeing Possibilities in Serotonin Research
Considering a New Line of Research: The Continuum of Illness
Implementing What We Know: IBS Clinics
Part V : The Part of Tens
Chapter 17: Ten IBS Triggers to Avoid
Avoiding Antibiotics
Countering Candida
Reducing Chemical Exposure
Fending Off Family Predisposition
Eliminating Problem Foods
Focusing on Food Habits
Balancing Blood Sugar
Fighting Infections
Considering the Role of Hormones
Getting a Grip on Stress
Chapter 18: Ten Things to Do for IBS
Taking Charge of Your Body
Working with a Knowledgeable Doctor
Developing a Good Attitude
Listening to Your Body
Developing a Healing Diet
Exercising for Health
Taking Supplements
De-stressing Your Life
Starting a Support Group
Planning Your Next Move
Chapter 19: Ten Things to Avoid When You Have IBS
Abstaining from Alcohol
Crushing Out Cigarettes
Reducing Sugar
Getting Off the Couch
Leaving Large Meals Alone
Forgetting Fatty Foods
Leaving Aspartame Behind
Cutting Back On Medications
Releasing Anger
Weeding Out Worry
Chapter 20: Ten Key Medical Tests for IBS
Physical and Rectal Exam
Pelvic Exam
Sigmoidoscopy and Colonoscopy
Barium Enema
Upper GI Series
Hydrogen Breath Test
Tests for Gluten Intolerance (Celiac)
Food Antibody Assessment
Comprehensive Digestive Stool Analysis (CDSA)
Chapter 21: Ten (Plus) Additional Sources of Help
IBS Organizations and Support Networks
Diet Web Sites
Exercise Resources
Stress Relief
Information on Other Diseases
Caring Therapies
Integrative Medicine
Chiropractic
Clinical Nutrition
Herbal, Homeopathic, and Naturopathic Medicine
Appendix A: Soluble and Insoluble Fiber Chart
Appendix B: Glossary
Introduction
I rritable bowel syndrome (IBS) is a functional medical problem that's something of a well-kept secret, even though up to 20 percent of the population suffers from it. Why do we use the word functional to describe IBS? Because it doesn't cause structural changes in the body, and there are no laboratory tests that can diagnose it. Why do we call it a well-kept secret? Because even though up to 60 million people in the United States alone may suffer from its condition, you don't hear much about it in the media.
These days, most medical conditions and diseases have networks of fund-raisers and public events to help raise money for research. But not many celebrities want to be identified with a bowel disease. (Cybill Shepherd is an exception; she has become the poster girl for IBS-constipation.)
Having IBS can be a very isolating experience, so we want you to know up front that you aren’t alone. Most people with IBS don’t talk about their problems — not even to their families or doctors.
Luckily, the Internet has really opened up the dialogue on IBS. More people are seeking information and help on IBS Web sites than ever before. And you can even order books like this online, which may prevent some embarrassment.
What’s it like to have IBS? Chances are you know all too well! IBS is a condition of bowel disruption. Constipation, diarrhea, or alternating constipation and diarrhea are the hallmarks. Abdominal pain, gas, and bloating make people miserable and unable to function normally. If you don’t have IBS (maybe you’re reading this book to better understand what a loved one is going through), recall a time when you had food poisoning or a stomach flu and you couldn’t stop running to the bathroom. Or think about the worst constipation you’ve ever experienced. Now, multiply those sensations by 100, and you have some idea what it’s like to have IBS.
We dispel two persistent myths in this book:
IBS is all in your head.
There is no cure.
Because IBS doesn’t cause structural damage, and because no lab tests can confirm it exists, some doctors have a hard time accepting it as a valid diagnosis. And some dispute the degree of disability and suffering it creates. But we’re here to tell you that IBS is real, and it causes real pain and hardship. And, despite what you may have read or heard, stress does not cause IBS. Stress can certainly aggravate your symptoms, so you want to keep stress to a minimum, but you aren’t to blame for bringing IBS upon yourself.
And regarding a cure for IBS, well, the myth is true to some degree: There is no one cure that works for everyone. However, there are many remedies, which we discuss in detail in this book. Knowledge is the first remedy, because if you can identify what triggers your IBS, you have the means to halt your symptoms. (And you may even discover that your symptoms aren’t the result of IBS at all but a condition that’s been hiding from you for years.)
About This Book
Our goals in writing this book are to confirm that IBS is real and to show you the many ways you can successfully deal with your symptoms. Because there is no wonder drug to cure IBS, people desperate for help try all sorts of therapies to find relief. We sort through the good, the bad, and the ugly and present you with the best of the best remedies and therapies for IBS.
While reading this book from beginning to end would make you an IBS genius, you don’t really have to do that. You can read Chapter 1 and get a great overview of the book. You can check out the Part of Tens chapters at the end of the book for some great food for thought. Or you can use the table of contents or index to locate chapters and sections that interest you most.
Although there is nothing funny about having a chronic condition, we try to keep things light for one major reason — laughter really is the best medicine.
Conventions Used in This Book
The following conventions are used throughout the text to make things consistent and easy to understand:
New terms appear in italics and are closely followed by an easy-to- understand definition.
Bold is used to highlight key words in bulleted lists.
All Web addresses appear in monofont.
What You’re Not to Read
Although we’re really fond of this book and obsessed over every word, we recognize that you don’t need to read every word in order to benefit from it. If you’re looking for just the facts you need to start managing your IBS effectively, you can skip two types of text without missing crucial information:
Sidebars, which appear in shaded gray boxes, include information that may interest you but isn’t critical to your understanding of IBS.
Paragraphs that appear next to the icon called “Technical Stuff” may contain a bit more detail than you want, depending on how intense you want to get in your study of IBS.
Foolish Assumptions
In writing this book, we made some basic assumptions about you. We assume that
You have IBS, think that you may have it, or have a friend or family member with IBS.
You want information that can help you or a loved one manage IBS more effectively.
You want to understand how your bowel works.
You want to know if your symptoms could be caused by something other than IBS.
You want information on the latest treatments for IBS.
You want to work with your doctor to obtain optimal care — and yes, you want to impress him.
You want to take charge of your body.
You like books with black and yellow covers.
How This Book Is Organized
We have divided this book into six parts so you can skip directly to the ones that draw your interest. Following is a brief overview of each part.
Part I: Just the Facts about IBS
IBS is not something you would wish on your worst enemy, but the more you know about it, the better your quality of life can be. In this part, we first explain what IBS is, what it isn’t, and how it differs from bowel conditions that have similar symptoms. Next, we give you the rundown of how your gastrointestinal tract is supposed to work and what can go awry.
Identifying what triggers your IBS symptoms is crucial to improving your health, and in this part we offer a comprehensive discussion of known IBS triggers. Finally, we explain who is most at risk for having IBS and why. (Here’s a hint: We’re guessing that most of the people reading this page are women!)
Part II: Getting Medical Help
We all want doctors who are knowledgeable and up-to-date on the current research, have great bedside manners, and work with us to provide the best care possible. That goes double for someone with IBS. Because this is a functional condition, your doctor first has to understand that IBS is real and know how to diagnose it. Then, she needs to be willing to help you sort through various treatment options to find the one(s) that make the most sense for your situation.
In this part, we offer advice on what to look for in a doctor, and we explain steps you can take to make your doctor’s job easier. We also discuss how IBS is diagnosed so you can talk knowledgeably with your doctor about the tests he orders.
Finally, we devote a chapter to current pharmaceutical treatments for IBS that you and your doctor may consider. No wonder drug exists to alleviate IBS symptoms in everyone, so you need to think long and hard about whether medication is the right avenue for you. We provide the pros and cons so you can make the decision more easily.
Part III: Healing and Dealing with IBS
Healing is a powerful word, and in this part, we aim to give you power over your IBS symptoms.
We start by discussing dietary supplements, herbs, and homeopathic remedies that may improve your IBS symptoms. Next, we move to the all-important topic of diet; an IBS-friendly diet is the cornerstone of any IBS treatment plan. Exer- cise is also key to good health, especially if you suffer from IBS-constipation, gas, and/or bloating.
We round out this part by presenting information on therapies that can reduce your stress, thus eliminating a possible trigger of your IBS symptoms. We cover acupuncture, the Emotional Freedom Techniques, the relaxation response, biofeedback, transactional analysis, and hypnotherapy.
Part IV: Living and Working with IBS
Having IBS can make you feel isolated, embarrassed, and afraid. It can greatly affect how you interact with your family, your coworkers, your friends, and the world at large. In this part, we offer specific advice on how to tackle your worst fears about public embarrassment so you don’t feel trapped in the house. We also discuss how to minimize IBS’s impact on your work life.
Children with IBS require special care. The emotional trauma from having such a debilitating condition can potentially cause lifelong strain. In this part, we offer tips for parents so they can help a child with IBS cope.
Finally, we show you some of the most promising current research on IBS, which may translate into an improved quality of life in the near future.
Part V: The Part of Tens
This part is a standard in the For Dummies series. The chapters are short and chockfull of crucial information. We present ten common IBS triggers to avoid, ten things you should do when you’re diagnosed with IBS, and ten things you don’t want to do.
We talk about ten medical tests you should know about so you and your doctor can work together to secure a diagnosis of IBS. And finally, we offer ten resources you may want to check out for even more information on IBS.
Appendixes
The first appendix is a chart that shows you common sources of two types of fiber: soluble (which you want to eat lots of) and insoluble (which you may want to avoid). The second appendix is a handy glossary of IBS-related terms.
Icons Used in This Book
We use icons in the margins of this book to help you find specific types of information. Here’s what each icon means:
We use this icon when we tell a story about a client or patient.
This string around the finger highlights information you may want to tuck into your mental filing cabinet for future reference.
The paragraphs next to this icon contain material that’s a little more detailed than the rest. You don’t need to read these paragraphs to effectively manage your IBS, so you can skip it if you prefer.
This icon points out practical information that you can put into use immediately.
When you see this icon, be on alert: The text next to it warns of potential problems or threats to your health.
Where to Go from Here
This book is designed to be so user-friendly that you can dive in anywhere that interests you and get valuable information. It’s a reference book, so you don’t have to worry about keeping up with the plot. You can even read the last chapter first if you like!
Part I
Just the Facts about IBS
In this part . . .
We wish it were easy to give you a list of facts about IBS and move on. But it’s not an easy topic. IBS is a functional disease, which means it doesn’t create structural symptoms in your body to help with diagnosis. Neither does it have a specific medical treatment. And IBS is sometimes mistaken for other conditions.
In this part, we classify IBS and distinguish it from inflammatory bowel disease and other bowel conditions. We give you a peek at your gastrointestinal system, show you how digestion is supposed to work, and tell you why it can go wrong. Triggers for IBS, which we discuss in detail in this part, are especially important to know about because you can avoid many of them and decrease your IBS symptoms. Finally, we let you in on who gets IBS and why.
Chapter 1
IBS Is Real
In This Chapter
Getting some basic facts
Exploring treatment options
Making lifestyle improvements
I BS is a reality for many people. Up to 20 percent of the North American population suffers IBS symptoms, and no single, definitive cure is in sight. That’s quite a double whammy.
But here’s the good news: We know a whole lot more about this condition today than we did even five or ten years ago. And while there is no miracle drug that can cure IBS, a lot of treatment options exist that can provide relief if you’re willing to take some time to figure out what works for you.
In this chapter, we paint a picture of IBS with a broad brush. We give you an overview of what it’s like to have IBS (in case you don’t have first-hand knowledge). We talk briefly about possible causes and IBS triggers — a variety of things that can spark symptoms in someone who has IBS. We also touch on ways you can adjust your diet and take advantage of other remedies and therapies, all of which we cover in-depth in later chapters.
Hiding the Evidence
Even though up to 20 percent of the population has symptoms of IBS (that’s an amazing 60 million people in the United States alone), many people won’t even mention it to their doctors. Why? Partly the culprit is embarrassment, and partly it’s a perception that nobody can help. A majority of people with IBS suffer in silence.
If you have been to a doctor and mentioned your symptoms, you may have been told not to worry. (That’s easier said than done when you have pain and your bowels are acting like they’re inhabited by alien beings.) Or maybe you were told to just increase the fiber in your diet, which made you feel even worse. Or maybe you were given medications that didn’t work. These types of experiences can affect your attitude toward your condition, perhaps making you feel that your situation is hopeless and nobody can help.
As we discuss in Chapter 2, some doctors don’t quite grasp the seriousness of IBS or the fact that it’s a real medical condition. And even those doctors who really want to help and do understand IBS are limited in the medications that they can prescribe. Unless they spend time counseling you about diet, exercise, stress reduction, and how to handle the emotional impact of IBS, they aren’t giving you the best tools available to manage your condition. Throughout this book, we give you those tools.
If you read this entire book, you may actually find yourself educating your doctor about IBS. You will know everything from how IBS is defined (see Chapter 2) to how it’s diagnosed (see Chapter 7) to the key role that diet plays in your health (see Chapter 10). You’ll be aware of medications that are available to help you through times of acute crisis (see Chapter 8), as well as over-the-counter herbs and homeopathic medicines that can boost your long-term health (see Chapter 9). You’ll even find out about stress-reducing therapies, many of which you can do yourself (see Chapter 12).
So, you see, you are in good hands. And there is a wealth of information about IBS at your fingertips that will help change your life.
Knowing IBS Is Real
IBS is a functional condition. That means it doesn’t cause structural damage to your body, the way a disease does. As a result, there is no laboratory test that your doctor can order to get a quick, easy diagnosis. To diagnose IBS, your doctor must rule out a whole list of other possible bowel conditions and diseases first. All this uncertainty makes IBS seem unreal to some people, who may wonder whether this condition is all in your head.
But you know that IBS couldn’t be more real; you have daily symptoms that impinge on your life. Having to urgently go to the bathroom may wake you up in the morning. Or you may wake up feeling fine but be gripped by painful gas and bloating as soon as you eat your first bite of breakfast. If you have constipation, you may have incredible discomfort, and even though you always feel a certain pressure that makes you think your bowels are about to move, nothing ever seems to happen to alleviate your discomfort.
If you’re looking for some solid evidence that IBS is real, skip right to Chap-ter 16. Look for our discussion about the new research into IBS that indicates this condition is related to a biochemical difference in people with IBS: an imbalance of serotonin in the digestive system. Even researchers who used to suspect IBS was a condition of the mind now realize it’s a condition firmly rooted in the gut.
What’s serotonin got to do with it? Serotonin is a mood-enhancing neurotransmitter, which can be affected by drugs like Prozac. Amazingly, more than 90 percent of the serotonin in the body is actually produced and found in the intestines. Serotonin affects the movement of food and feces through the intestines.
Recognizing Your Symptoms
IBS is defined by the following symptoms, which most people have in some measure at some point in their lives. What distinguishes IBS from an occasional bout of stomach upset is the degree of the symptoms. Having IBS doesn’t mean that once a month you have a loose bowel movement after eating too much fruit. Having IBS means you’re chronically affected by one or more of these symptoms:
Diarrhea
Constipation
Alternating diarrhea and constipation
Abdominal cramps and pains
Intestinal gas
Abdominal bloating
To make it easier for you to identify your IBS symptoms, we present a questionnaire in Chapter 7 that you can complete and take to your doctor.
We should warn you up front that if you’re female, you have a much greater chance of having IBS than if you’re male. As we discuss in Chapter 5, hormones may be partly to blame. Also, young people (even children, who get our full attention in Chapter 15) are more at risk for IBS than older people. After you hit the age of 40, your chances of having IBS decrease significantly. In fact, at menopause, many women with IBS see a significant drop in their IBS symptoms.
Finding a Doctor Who Knows about IBS
Unfortunately, there is no IBS specialty in medicine — and there should be. The next best thing is a doctor who believes IBS is real, listens to your symptoms, does a thorough history and physical exam, rules out all other conditions and diseases, offers you advice on diet and lifestyle, and supports you while you manage your IBS on a day-to-day basis. How do you find such a person? We give you lots of suggestions in Chapter 6.
Half the worry about IBS can be wondering if your symptoms are indicative of something worse. If your doctor does a thorough job diagnosing you (as we explain in the next section), you can be reassured that it’s IBS. When you know what you’re dealing with, you can focus on treating it.
Diagnosing IBS
Diagnosing IBS is tough, and many people see more than one doctor before getting an accurate diagnosis. Luckily, a group of researchers has created something called the Rome II Diagnostic Criteria that outlines the common symptoms of IBS, as well as the frequency and duration of their occurrence, so doctors can know just from your symptoms whether IBS is a possibility. You can find the Rome II Diagnostic Criteria in Chapter 2.
Tangled up in the difficulty of diagnosing IBS are a couple key factors: First, there is no single known cause of IBS, so your doctor can’t just look for the existence of some troubling gremlin in your bloodstream or intestines. Second, IBS doesn’t cause structural damage to your body, so your doctor can’t just look inside you and get a clear picture of what’s happening.
Instead, the diagnostic process, which we detail in Chapter 7, involves ruling out a host of other possible diseases and conditions that could be mirroring IBS. Here’s a partial list of what your doctor needs to rule out:
Food intolerances: Lactose intolerance, gluten intolerance (celiac disease), and fruit intolerance fall into this category. In plain English, these intolerances mean you can’t digest dairy, you can’t digest wheat, or you can’t digest fruit. We discuss these conditions in Chapters 2 and 4.
Inflammatory bowel disease (IBD): There are two IBDs: Crohn’s disease and ulcerative colitis. They are more serious conditions than IBS, and they cause structural damage to the intestines, such as strictures or ulcerations. Their symptoms often mirror those of IBS but also include rectal bleeding. Crohn’s can give symptoms outside the intestines, such as ulcers in the mouth and fissures and fistulas around the anus. We introduce you to both IBDs in Chapter 2.
Cancer: Bowel cancer may take the form of a tumor that gradually blocks off the intestines and causes cramping pain that worsens over time. The symptoms of cancer differ from IBS because they can be more localized and more severe.
Considering Causes and Triggers
There is no single cause of IBS that we can pinpoint. We do know that some people develop IBS after having an intestinal infection — a nasty bout of stomach flu, food poisoning, or traveler’s diarrhea. But we don’t know whether the germs themselves or the antibiotics used to treat these infections act as the catalyst to create IBS. And we don’t know if the people who get IBS after an infection had a case of smoldering IBS all along.
Quite a few theories exist about why other people get IBS, and we present some of them in Chapter 2. Just keep in mind that these are theories, and all need further investigation before we can know for certain whether they are true causes.
Triggers for IBS are a little easier to identify. A trigger is something that causes you to have symptoms after you’ve already got IBS. We devote Chapter 4 to a discussion of known triggers. Here, we want to just alert you to some of the main culprits:
Antibiotics: These medications kill off both good and bad bacteria, leaving room in your intestines for yeast to overgrow. An overgrowth of yeast can invade and irritate the intestinal lining, causing micropunctures and the absorption of yeast toxins into the bloodstream. Gas and bloating can also result, triggering additional IBS symptoms.
Yeast: The overuse of antibiotics, a high sugar diet, stress, cortisone, hormones, and other factors can all lead to an overgrowth of yeast in your gut, which has the nasty effects we describe in the previous bullet.
Food: Spicy and fatty foods irritate the gastrointestinal tract. Coffee, alcohol, and food additives such as aspartame and MSG also do damage and trigger IBS attacks.
There is far more to the food picture than these triggers. You need to know about conditions that can masquerade as IBS, including food allergies and food intolerances. You may discover that you cannot eat dairy or wheat, or even fruit. (If the thought of giving up any of those foods seems depressing, we urge you to focus on the positive — the reduction in symptoms you’ll experience if you can eliminate problematic foods from your diet.)
Stress: Stress is a major trigger for IBS because many of us hold tension in our guts. That tension causes muscle cramping and can easily escalate into an episode of IBS.
Treating IBS
Just as there is no one cause of IBS, there is no one treatment. Instead, you have a smorgasbord to choose from: medications, herbs, homeopathy, diet, exercise, acupuncture, hypnotherapy, biofeedback, the Emotional Freedom Technique — the list goes on. We discuss each of these options in detail in Chapters 8 through 12.
By far, the most important aspect of treating IBS is getting a firm grip on your diet. We know what a problem that can be, so we devote Chapter 10 to that topic. We walk you through an elimination and challenge diet that allows you to find out what foods are your friends and what foods are not. We also advise you that there is no one diet that works for everyone with IBS. Each person with IBS needs to find what works for her.
We urge you not to let medication be your only treatment protocol. If your doctor insists that a pill is the only answer to your IBS symptoms, fight back with the knowledge you gain from this book. What you eat, how you move your body, and how you process stress are much more important to your long-term health and to managing this chronic condition. Medication certainly has a role to play in helping people get over their worst short-term IBS symptoms, but it simply isn’t effective in treating IBS over the long haul.
The combination of IBS symptoms is different from person to person. The cause of IBS is different from person to person. The triggers are different from person to person. Our goal in this book is not to tell you exactly what will work for you. Instead, it’s to give you the most complete information possible about what treatments are available, so you can develop your own treatment plan that tackles your particular symptoms.
Coping with IBS
Coping means successfully dealing with a difficult situation. And we have no doubt that if you have IBS, you’ve got a difficult situation to deal with. But we’re here to help you do even more than cope; if you apply the information in this book, you should be able to reduce or even reverse the symptoms that may be plaguing you on a daily basis.
At home, at work, at school — IBS symptoms can strike anywhere. But if you improve your health in the long-term, and if you have plans in place for dealing with even your worst symptoms in the short-term (and even in public), you can break the boundaries that IBS may be placing on your life right now. (If you’ve been stuck in the house because of IBS and want tips for getting your life back, run — don’t walk — to Chapter 13.)
Chapter 2
Classifying the Condition
In This Chapter
Considering possible causes
Listing the criteria of IBS
Naming the symptoms
Identifying culprits that look like IBS
Distinguishing IBS from inflammatory bowel disease
T he cause of IBS is difficult to figure out. In fact, the cause seems impossible to figure out. When you define a disease like the flu, you imagine that a virus is the cause, and you end up with symptoms of fever, chills, nausea, vomiting, and the like. But in the IBS community, the only thing that everybody seems to agree upon is that there's no agreement about what causes IBS.
The symptoms of IBS, however, are easy to name: Does abdominal pain, diarrhea, or constipation sound familiar?
In this chapter, we help you become more familiar with IBS by discussing possible causes and symptoms, as well as diseases that are often misdiagnosed as IBS. The medical community doesn’t yet have all the answers about this condition, but here we provide an overview of what we know so far.
Defining Our Terms
Before we go any further, we want to clarify how we’re using several key terms in this chapter and the rest of the book, such as cause, trigger, and associated condition. Here’s how we’re describing and distinguishing among them:
Cause: An accepted physical reason that your body develops the symptoms of IBS.
Possible cause: A possible reason that your body develops the symptoms of IBS; something still up for debate.
Mistaken identity: A disease or condition that has the same symptoms as IBS but requires a whole different treatment protocol; it is very important to distinguish between the two.
Trigger: A stimulus that sets off an action, process, or series of events. (The event in this case is an episode of IBS, and the action may involve running to the bathroom!) We discuss IBS triggers in detail in Chapter 4.
Associated condition: One of several conditions that seem to occur frequently in people with IBS.
So what are the causes, possible causes, mistaken identities, triggers, and associated conditions revolving around IBS? Fair question. It took us months of research to compile the information you find in this book. Here, in a nutshell, is what you can expect to read about:
Cause: As we explain in this chapter, many theories exist about the cause of IBS. However, only one cause of IBS is currently accepted by doctors and researchers: IBS can occur after a bowel infection, involving either bacteria or parasites. We discuss this cause in detail in the section “Blaming bowel infections” later in this chapter. However, to be clear, not all people with IBS have had a previous bowel infection. So this is not the only cause of IBS — it’s just the only one we know for certain at this time.
Possible causes: Several possible causes of IBS are being considered:
• Use of analgesics: In survey studies, researchers have found that acetaminophen, the ingredient in Tylenol, has been frequently used by people who develop IBS-diarrhea. This drug is known to cause elevated levels of serotonin, and research indicates that serotonin may become elevated in patients with IBS-diarrhea after eating. In Chapter 16, where we talk about current research on IBS, we discuss serotonin-blocking drugs that are being used to treat IBS-diarrhea.
• Brain-bowel chemical imbalance: The brain and the gut are intimately connected by both the nervous system and by neurotransmitter chemicals, such as serotonin and norepinephrine. Both chemicals may be involved with the production of IBS symptoms.
So far, we know that diarrhea can occur when high amounts of serotonin inhibit norepinephrine and cause levels of acetylcholine to increase. On the other hand, when norepinephrine levels increase, the result is constipation, as well as a lowering of serotonin levels and blockage of acetylcholine.
For IBS patients, this chemical dance may lead to the fluctuating bowel symptoms of constipation and diarrhea. But we must ask what the cause of the imbalance is in the first place. We talk more about the brain-bowel connection in Chapter 12, where we discuss stress and how to manage it.
• Female hormones: Considering that men don’t have high amounts of female hormone, and men do suffer from IBS, female hormones are not the cause of IBS. However, women have twice the incidence of IBS as men. In Chapter 5, we pay particular attention to that discrepancy and discuss how female hormones may play a role.
Mistaken identity: The four most common conditions that are mistaken for IBS are covered in this chapter:
• Gluten enteropathy (celiac disease)
• Wheat allergy
• Lactose intolerance
• Dairy allergy
Triggers: In Chapter 4, we address possible triggers of IBS, which come under the following headings:
• Food allergy or sensitivity
• Antibiotics
• Stress
• Candida albicans
Associated conditions: In Chapter 5, we outline a number of conditions that seem to occur in higher numbers in IBS sufferers:
• PMS
• Fibromyalgia
• Insomnia
• Painful periods
• Urinary frequency
• Chronic pelvic pain
These conditions are experienced mostly by women (especially the painful periods!). Fortunately, most experts agree that IBS is not associated with inflammatory bowel disease (Crohn’s disease or ulcerative colitis, which we discuss in this chapter) or cancer.
Trading Theories about Causes
Often, discussion of the cause of IBS overlaps with discussion of its triggers, which can get confusing. We don’t know for certain whether a trigger may be enough to cause IBS in some people — or, if not, whether multiple triggers may do the trick. Is there a recipe for IBS where you have to have a certain amount of triggers to create thesymptoms? And if all the triggers are eliminated, will IBS stop?
Whenever this type of uncertainty exists regarding a medical condition, many theories are thrown about to fill in the vacuum. In this section, we share some theories about the cause of IBS that you may be wondering about.
Moving past the stress test
Karen had been to several general practitioners regarding her symptoms of chronic diarrhea, pain, and bloating. She became increasingly dissatisfied with the treatment she was getting from doctors who were unable to make a diagnosis. As she was waiting for one doctor to come into the office, Karen took a peek at her chart and was alarmed by what she read. She saw the word hypochondriac in the notes. She realized she was never going to be diagnosed by doctors who simply didn’t believe her.
Doctors originally thought that IBS was caused by stress and emotional reactions. There was a yes, but approach to anyone with IBS: Yes, it’s a real condition, but people with IBS are really just anxious, depressed, and upset. The condition was equated with an overzealous nervous stomach, and it didn’t get much respect.
We do know that bouts of IBS may be triggered by stress — we discuss this fact in Chapter 4. However, if stress is the cause of IBS, why wouldn’t 100 percent of the population have IBS instead of 20 percent?
Quite frankly, IBS still doesn’t always get the respect it deserves. We found one 2004 survey of family doctors that indicates the majority of them believe people with IBS and chronic fatigue syndrome are simply slacking off and not pulling their weight in society. That bias can have serious consequences for people trying to obtain a diagnosis and treatment for IBS. (We discuss this topic in detail in Chapter 7.)
But the bias isn’t universal; most gastroenterologists (especially those who stay current with IBS research) now know that IBS is a very real condition. However, because IBS doesn’t have a single trademark sign or symptom to call its own, just knowing that it’s real doesn’t mean a doctor can easily diagnose it.
Blaming bowel infections
Sheila had a horrible stomach flu. She was laid up with vomiting, diarrhea, and fever for a week. After she recovered, she dragged herself to work but couldn’t seem to get her energy back. She was still having bouts of diarrhea four weeks later that didn’t seem to be improving. Her doctor told her not to worry because the problems would eventually go away. But eventually began to seem like forever to Sheila, and three months after the flu she was diagnosed with IBS.
Frank and his wife, Sally, went to Mexico for a much-needed vacation. Within three days they were both getting the runs and fighting for time in the bathroom. They took an antibiotic that the hotel doctor recommended, which seemed to sort things out for Frank. But Sally didn’t get much better. When they got home, Sally’s doctor (after several false starts with antidiarrhea medication) finally diagnosed parasites. The antiparasite medications were harsh, but after several weeks Sally was feeling somewhat better. However, she never completely recovered and was finally diagnosed with IBS.
For some people with IBS, like Sheila and Sally, the cause can be identified definitively as a bowel infection. The infection may be due to either bacteria or parasites, and the IBS that results from it is called post-infectious IBS. (Something to keep in mind: Women seem to suffer more bowel symptoms for a longer period of time after a gastroenteritis attack than men. We compare IBS in women and men in Chapter 5.)
According to a paper published in the journal Gut in 2003, chronic bowel turmoil resembling IBS develops in approximately 25 percent of patients after an episode of infectious diarrhea. The researchers admitted that the research community had previously shown that psychosocial factors operating at the time of, or prior to, the acute illness appeared to predict the development of post-infectious IBS. (As we explain in the previous section, many people have incorrectly placed the blame for IBS on stress.) The new research, however, showed an increased number of inflammatory cells in the rectum persisting for at least three months after the acute infection. The researchers concluded that there is definitely an organic component involved in the development of post-infectious IBS.
How infection can cause IBS
IBS research on why and how infection causes IBS focuses on two areas:
How the inflammation that accompanies a bowel infection damages nerves in the gut lining and alters the way the gut nervous system works
How a low-grade inflammation remains in the gut following the infection
In general, acute GI infections cause inflammation of the mucus membrane lining the intestines. They initiate a cascade of events that don’t stop when they’re supposed to. The inflammatory process seems to have a life of its own where immune cells infiltrate the intestinal lining and become a local irritant to the nervous system.
Consuming probiotics (good bacteria) either in yogurt or in capsule form is a worthwhile preventive measure when you have an episode of infectious diarrhea. Replacing your good bacteria that may be lost with continuous diarrhea may help to avoid the future development of IBS. The best types of probiotics are those that guarantee that each capsule contains one billion live organisms. See Chapter 9 for much more on probiotics.
Bacteria in the small intestine
Doctors have been looking for the cause of IBS in all the wrong places, according to researchers in California. IBS affects the large intestine; however, no studies have shown inflammation or signs of abnormal bacterial overgrowth or bacterial infection in the large intestine. Going a little further up the food digestion chain, researchers have found an abnormal overgrowth of bacteria in the small intestine.
It seems that bacteria that are supposed to reside in the large intestine are immigrating to the small intestine where the grass is greener. Away from their normal confines, these bacteria begin to feed on the rich smorgasbord of partially digested food in the small intestine.
Let this serve as a warning to those of you who chew once and gulp: If not properly digested, that mouthful of food becomes someone else’s dinner.
Feeding, growing, and reproducing, these bacteria release enough bacterial waste to make you feel gassy and bloated. Some of that waste is absorbed into the walls of the small intestine and even into the bloodstream. The immune system is prepared for just such an event and mounts an immune response that leads to flu-like symptoms that are so common in IBS.
With the small intestine under attack, symptoms of joint and muscle pain, headaches, arthritis, chest pain, fibromyalgia, difficult urination, and chronic fatigue are easier to explain. The immune system responds to all these waste products by creating antigen antibody complexes — combinations of a toxic protein and an immune system protein — that sometimes, instead of neutralizing the toxic protein, just add to the amount of foreign substances in the bloodstream and body tissues.
It’s pretty impossible to get into the small intestine to count bacteria, so researchers use what’s called a hydrogen breath test. The patient takes a strong drink of milk sugar, and as the bacteria in the small intestine feed on this sugar, they excrete gas that can be measured in the breath over the next several hours. A 2003 study found that 84 percent of patients with IBS had abnormal breath test results suggesting small intestinal bacterial overgrowth. When given either a placebo or antibiotic therapy, breath tests showed that patients who were given antibiotics eliminated their bacterial overgrowth and reported a 75 percent improvement in their symptoms.
But despite these findings, the treatment for IBS is not as simple as taking antibiotics. In fact, antibiotics are also a possible trigger of IBS, as we explain in Chapter 4. They wipe out good and bad bacteria and allow yeast to set up housekeeping in your colon. So before you run out and take antibiotics to wipe out the bacteria in your small intestine, be sure to read Chapter 4 and consider whether you’re trading one problem for another.
One doctor’s experience with parasites
Dr. Marcelle Pick, an obstetrician and gynecologist, says that when she started her practice in the early 1980s, she was shocked at the number of women who came to her clinic suffering from symptoms of intestinal pain and distress including constipation, diarrhea, gas, bloating after eating, and fatigue.
Dr. Pick would refer these women to gastroenterologists who often diagnosed IBS and simply recommended increased fiber in the diet, which brought minimal relief. Referrals to psychiatrists brought little relief as well. Dr. Pick came to the conclusion that IBS was being used as a catch-all diagnosis for a complexity of symptoms that needed deeper exploration.
Tapping into her own experience of traveling in developing nations where she experienced GI distress due to parasites, Dr. Pick began testing every woman with bowel symptoms for parasites. She says that other doctors are shocked when she tells them that 40 percent of her female IBS patients, even some who have never traveled, test positive for parasites.
Dr. Pick also believes that an overgrowth of Candida due to overuse of antibiotics creates a yeast infection in the intestines that leads to symptoms of IBS. We also believe that Candida infection can cause IBS, but we don’t find consensus in the medical community to include it under causes. Instead, we refer to Candida as a trigger and include it in Chapter 4. In Chapter 7, we discuss state-of-the-art tests for Candida overgrowth that will eventually bring Candida into the list of causes of IBS.
Travelers’ precautions: We are not alone
It may come as a shock to realize that most of the cells in our bodies are not our own. We carry around about two pounds of hitchhikers wherever we go. There are fungi on our toes, viruses in our nose, and about 100 trillion bacteria and yeast in between. (The cells of our body only number about 10 trillion!) Quite a lot of diarrhea can happen when these bugs get out of control.
You would be hard pressed to find someone whose bowels stayed completely on schedule while traveling. The U.S. Food and Drug Administration says that traveler’s diarrhea ruins about 40 percent of vacations for Americans. Water, germs, and a change in diet are bound to either speed up or slow down intestinal movement. You may be used to the bugs in your own environment but not the foreign ones in another country.
Montezuma II was the great chief of the Aztec nation in Mexico at the time of the Spanish conquest leading to the decimation of the Aztec population. The revenge of Montezuma comes in the form of debilitating traveler’s diarrhea that almost half the visitors to Mexico take home with them. Water and food may contain bugs that the natives are perfectly comfortable with but that can cause IBS-like symptoms in unsuspecting visitors.
When you are traveling, practice safe eating and drinking habits. Quite simply, that means no tap water:
Do not drink tap water. That means drinking fountains too.
Do not brush your teeth with tap water.
Do not use ice cubes made with tap water.
Do not eat watermelon, which may be injected with local water to increase weight.
Eat raw fruits and vegetables only if you have peeled them yourself. (That’s right; otherwise they may be washed with tap water.)
Do not purchase food from street vendors, because they may not wash their hands (even with tap water).
If tap water, harboring bugs and germs, makes its way into your food, you may be able to avoid a calamity by taking grapefruit seed capsules with every meal. The seeds of grapefruit are very bitter and poisonous to bugs. Another name for these capsules is citricidal, and they can be bought in health food stores and some pharmacies.
Preparing for air travel
If you have IBS with diarrhea, you may hesitate to travel at all. However, if you plan ahead, you can board a plane without having to fear the worst:
Book your flight in advance and choose a seat that is near the washrooms.
Bring a small roll of toilet paper with you on a flight. Sometimes the sheets provided in an airplane washroom just don’t provide the coverage you need.
Pack your own food and water. Take a selection of tried-and-true foods with you on the plane (see Chapter 10 for help figuring out what they may be). Don’t rely on airline foods, which could trigger diarrhea.
Consider wearing an adult diaper during the flight if you’re concerned about having an accident. (See Chapter 13, where we discuss this option in detail.)
Consider whether you may benefit from taking Pepto-Bismol or Imodium before your flight, which some doctors recommend. But be careful with these medications, which are said to bind together the toxins produced by bacteria in your bowel. You don’t want those toxins staying around too long!
Considering possible effects of vaccines
We now know that many children with autism suffer symptoms of IBS. Several prominent researchers indicate that they have true intestinal inflammation, which is caused by the live measles, mumps, and rubella vaccine (MMR). Because most of the U.S. population has received MMR shots, the implications of this research are vast. The possibility that some vaccines may trigger bowel inflammation is being heavily researched.
Dr. Andrew Wakefield in the United Kingdom initiated this research at the request of parents of children with autism. These children almost always suffer from symptoms of IBS and also seem to be allergic to wheat, dairy, and other foods. While a child is under anesthetic, Dr. Wakefield inserts a small scope through the nose, down the throat, and into the intestines to find live measles virus in the lymphatic tissue of almost every child he studies.
The immune system of a child who has a cold or some other infection when he is given a vaccine often cannot identify the vaccine virus and fight against it. There is just too much going on in a child’s little body. Therefore, the measles virus from the vaccine can stay in the gut and start causing mild inflammation that is barely recognized but that starts to cause food digestion and absorption problems.
