Food Cures (62 page)

I
rritable bowel syndrome (IBS) is common, affecting about 20 percent of Americans, and yet it is a mystery. No one knows exactly what causes it and there is no way for a doctor to make a definitive diagnosis. There is no single trigger, and no single set of identifying symptoms, which can come and go in a day, or plague sufferers for months or years. So much uncertainty attached to very real physical discomfort makes coping with IBS frustrating in the extreme.

IBS is called a
functional bowel disorder
, and not a disease, because it doesn’t cause permanent damage, it doesn’t progress to serious illness, and it can usually be controlled with diet and lifestyle changes. There’s another reason to be hopeful if your case is a persistent one—people with chronic symptoms like yours have been successfully treated with new medications, making the condition less disabling than ever before.

WHAT AFFECTS IBS?

The agony of IBS comes from the pain, discomfort, and embarrassing inconvenience of symptoms, which include diarrhea or constipation, cramping, bloating, excess gas, and mucus in the stool. To understand what happens in IBS, imagine a football stadium full of spectators doing “the wave.” If everyone cooperates, you can see the forward progress of the wave as each section stands and then sits again—it’s amazing to see so many bodies working in concert. Now imagine that you have some very nervous spectators…they see the wave coming at them, and they stand up too early, starting a secondary wave, so now there are two competing waves. The rhythm is disrupted. Or, imagine that one group stands up for the wave but doesn’t sit back down again. The wave is “stuck,” unable to move forward until the disrupting group decides to sit back down again.

Our intestines are lined with muscles that contract and relax in waves (ah-ha!) called
peristalsis
, which push the food you eat through the system. Along the way, nutrients are absorbed, and the residual is eventually eliminated in feces. In people with IBS, normally rhythmic waves are disrupted. Sometimes, the nervous bowel contracts too much or too forcefully, so food moves through the intestines too quickly, resulting in diarrhea.

Other times, the intestinal muscles contract but don’t relax again, or they contract very slowly, resulting in constipation. These crazy, out-of-sync muscle movements are behind the pain of IBS, much like muscle spasms in your leg cause the pain of a charley horse. We all have intestinal gas, but for people with IBS, it can become trapped inside, resulting in bloating and distention. Some of my clients with IBS have admitted to buying two wardrobes—an everyday wardrobe and another specifically for their bloated, symptomatic days. Makes perfect sense—who wants to wear a snug pair of jeans or a fitted dress when they feel like the Pillsbury Dough Boy? In addition, the intestinal nerves of people with IBS are highly sensitive, so that even minor bloating can have them doubled over in pain.

An individual with IBS might experience just a few of these symptoms, or all of them. Although most sufferers have either diarrhea-predominant IBS or constipation-predominant IBS, some people alternate between diarrhea and constipation. No matter what type of IBS you have, the underlying problem is that the rhythm of intestinal muscle contractions periodically get messed up. There is no test for messed-up intestinal waves, however, and the symptoms of IBS are common to many other diseases, so arriving at a diagnosis of IBS is lengthy and full of guesswork. Your doctor will want to rule out all other possible disorders through a physical examination, blood tests, ultrasound, x-ray of your bowels, and sigmoidoscopy or colonoscopy, in which a lighted flexible tube is inserted into your lower intestines to get an up close and personal look at your intestinal lining. If there are no other problems, it’s IBS by default. Once you have a diagnosis, you and your doctor can get to work to find a treatment that works for you—IBS
can
be controlled. It’s important to remember that although IBS can be uncomfortable, and strictly speaking there is no “cure,” it also won’t turn into anything more serious.

We don’t know what disrupts the workings of the intestines in the first place, but we do know what can trigger flares of the disorder. Food is a biggie, and I’ll address that in the next section. Aside from food and eating issues, the only other significant IBS trigger is stress.

Stress can trigger a flare of IBS, and it can make food-triggered IBS symptoms worse. That’s why many health experts recommend that people suffering from IBS actively explore a variety of ways to de-stress—there might be a terrific way to relax that you just haven’t tried yet. Some doctors even talk about an
IBS personality
, one that is noticeably tense and anxious. I’ve seen this is my own practice. The client that comes to mind is Amy, a kindergarten teacher. The first time I saw Amy, I was struck by her rigid body language—every move she made told me she was a very controlled person—sitting or standing her posture was perfect, and she held her arms close to her body using minimal gestures. She spoke in a clipped, drill-sergeant sort of way. Everything Amy did, she did quickly. She was always on the run doing things for the kids in her class, running errands for her family, setting up the classroom, and gobbling down her food. Amy didn’t sit down to eat. If she couldn’t wolf down a meal in five minutes it wasn’t worth eating. The challenge with Amy was getting her to recognize her food triggers, and also—perhaps more importantly—helping her to understand that her stressful, on-the-go lifestyle was only making her IBS worse.

On a very basic level, eating quickly is risky because you are more likely to swallow air, which can directly lead to bloating and distention. But stress can also stimulate spasms in the gastrointestinal tract—like feeling butterflies in your stomach when rumors about impending layoffs start flying around the water cooler. In people with IBS, those butterflies are on a rampage. Amy’s IBS was certainly made worse by her tense, never-stop, full-of-stress lifestyle. Fortunately, we were able to get her symptoms under control in pretty short order. We identified her food triggers (soy-based foods, raw vegetables, gum, and coffee), which eliminated most of her problems, but stress education was the biggest eye-opener for her. Amy had no idea how much her driven personality affected her bowels. Although she still has a way to go, it’s easier for her to relax now that she doesn’t have to worry about whether her diarrhea will strike unexpectedly and she’s made a determined effort to be more relaxed. Ironically, she’s as driven about finding time to de-stress as she is about everything else, but she’s on her way to achieving the type of balanced life that can keep her IBS symptoms to a minimum.

HOW FOOD AFFECTS IBS

A sensitive gut needs to be treated like a fussy baby—you have to put it on a regular feeding schedule, keep it calm, and protect it from potential irritants.

IDENTIFYING TRIGGER FOODS

Identifying your particular trigger foods can be difficult. Even people without IBS will have a gastrointestinal reaction to certain foods once in a while. It just happens, and it’s perfectly normal. But people with IBS have a heightened sensitivity to foods; they know the awful consequences of a trigger food so they might eat a spicy bowl of chili, for example, have a reaction, and condemn chili to a list of foods to be avoided forever. But what if the reaction was really due to unusual stress, or a mild case of food poisoning, or just one of those normal gut reactions? You might avoid a food forever for no good reason. By the time some clients come to see me, they’re downright food phobic. They are so afraid of an attack of diarrhea, constipation, or horrific gas that they err on the side of caution…but too much caution can result in low blood sugar, weight loss, malnutrition, and another kind of socially awkward situation—they can become afraid of eating with friends and going out for fear of an attack.

For people with
extreme
IBS, the simplest way to identify the right trigger foods is to first follow an elimination diet for five to seven days—a meal plan which avoids
all
potential offending foods, then slowly reintroduce those same foods one by one. Along the way you keep track of reactions to foods you are reintroducing in a food diary. Depending upon your symptoms, my guidelines for an elimination diet vary slightly. Please note: Following an elimination diet can be very difficult. It’s just a week, but you still need to be pretty committed to put up with such a limited selection of food. Then again, if you’re currently suffering, better to put up with a week of discomfort than a lifetime of untreated abdominal pain.

If you have severe diarrhea-predominant IBS, your five-to seven-day elimination diet will avoid all trigger foods
plus
all fiber, including soluble fiber (instructions are provided in my 4-Step Program under Extreme Elimination Diet—No Fiber, Chapter 17).

If you have
severe
constipation-predominant IBS, your elimination diet will avoid all trigger foods, but
incorporate
foods rich in soluble fiber and small amounts of insoluble fiber (those instructions are provided in my 4-Step Program under Elimination Diet with Added Fiber, Chapter 17). The addition of soluble fiber can help encourage your intestines to “wave” more effectively.

Whichever plan you follow, after about a week you’ll be ready to test some of the potential trigger foods. I recommend trying one new food every two to three days, and carefully documenting what you eat and how you feel during the 24 hours afterward. Although this chapter provides all the instruction you need to do this on your own, it’s a big job. If you try on your own and find it unmanageable, I encourage you to work with a registered dietitian who specializes in gastrointestinal issues.

As I said, these elimination plans are only for very severe cases of IBS. For less debilitating IBS, feel free to skip the elimination meal plan altogether and go straight to keeping an IBS journal. Your journal should list exactly what you eat, when you eat, what symptoms you experience, as well as your emotional state for the day. Make a special note if you feel particularly tense, anxious, or stressed.