Irritable bowel syndrome (IBS) affects 10 to 20 percent of all American adults and is the most common gastrointestinal complaint, although 75 percent of people who have it never seek a physician’s help—they just learn to live with it.

Over the years, IBS has had a variety of names: spastic colon, spastic bowel, mucous colitis, colitis, and functional bowel disease. It accounts for 10 percent of all doctor’s visits and 50 percent of referrals to gastroenterologists. Associated symptoms are abdominal pain and spasms, bloating, gas, and abnormal bowel movements.

Diarrhea alternating with constipation is the most common pattern. Bowel movements usually relieve the discomfort. It’s called functional bowel disease because people who have irritable bowel syndrome do not have any obvious changes in bowel structure or other serious complications and rarely require hospitalization.

Nonetheless, IBS can significantly restrict one’s lifestyle. Most of my IBS clients know where every public restroom is in town. They can’t make morning appointments because of the unpredictability of the bowels and eating away from home can be tricky.

Twice as many women as men seek medical help for IBS, and it often appears in the teen years or early adulthood. Anemia, weight loss, rectal bleeding, and fever are not symptoms of irritable bowel syndrome. Bowel changes accompanied by these symptoms need to be checked out by a physician to discover the cause.

Irritable bowel syndrome has many causes. IBS can be caused by food sensitivities, stress, lactose intolerance, infection, mindbody interaction, malabsorption of nutrients, hormonal imbalances, endometriosis, AIDS, environmental sensitivities, and more.

Many studies are flawed because they only test one factor at a time and generalize about results. There is no single cause for IBS, but hopefully we can find the causes for each person and work with him or her individually in response to the biochemical uniqueness.

For instance, some people with IBS improve when they eliminate wheat from their diets, while the majority won’t notice any benefit. Other people have an insulin rise after meals, causing an increase in serotonin, which can cause diarrhea.

New medications for women with diarrhea-type IBS are based on lowering serotonin, also called 5-hydroxytryptamine (5-HT), levels. IBS is originally triggered in about 25 percent of people by infection. The infection causes inflammation in the mucosal tissues, which stimulates T-cell mediated and smooth muscle changes.

When this inflammatory response continues over time the bowels learn to be over- or underreactive to stimuli. People with postinfection IBS are more likely to have the diarrhea-type, have less psychiatric illness, and have an increase in enterochromaffin (EC) cells that secrete serotonin.

There is usually a good response in postinfectious IBS with use of probiotic supplements. COX2 inhibitors decrease smooth muscle hypersensitivity and decrease bowel motility. Natural COX2 inhibitors include turmeric, boswellia, and Kaprex (a product by Metagenics).

Women may experience a flare-up in their symptoms around their menstrual period. The most common symptom associated with menstruation is pain. Because chronic pelvic pain can lead to hysterectomy, physicians need to be clear that IBS is not causing the pain.

When IBS is the culprit, a hysterectomy won’t eliminate it. Low-fat, high-fiber diets are best. Eat small meals, and chew your food well. Dietary recommendations need to be tailored to your personal reactions. It is commonly advised to avoid alcohol and monitor sugar intake, coffee, beans, and cabbage family foods (broccoli, brussels sprouts, cauliflower) because they can be difficult to digest.

You need only avoid those foods if they bother you. Food sensitivities are found in half to two-thirds of people with IBS and are more prevalent in those who have allergies or come from allergic families. The most common foods that trigger IBS are wheat, corn, dairy products, coffee, tea, citrus fruits, and chocolate.

In a study in which people were put on a food elimination diet for a year, bloating and distension was relieved by 88 percent, colic pain was reduced by 90 percent, diarrhea was reduced 85 percent, and constipation improved in 54 percent.

Also, 79 percent of people who had other symptoms, such as hay fever, asthma, eczema, and hives, saw these symptoms improve. Undiagnosed lactose insufficiency is often the cause of IBS. In a recent study of 242 people, it was found that 43 percent had total remission of IBS when they excluded dairy products from their diet, and another 41 percent had partial improvement.

Taking the lactose hydrogen breath test is a valuable way to discover who would benefit from a lactose-free diet. You can also discover this by avoiding all dairy foods and products that contain dairy foods for at least two weeks to see how you feel. If you have only moderate improvement, other foods may also be playing a role in your symptoms.

Lactose is not the only sugar to cause problems. Our cells use single sugar molecules (monosaccharides), but many foods contain two-molecule sugars (disaccharides) that must be split. New research suggests that many people are unable to split mannitol, sucrose, sorbitol, fructose, and other disaccharides, and a high percentage of IBS sufferers are intolerant of one or more of these sugars.

The result is diarrhea, gas, and bloating. These people find that fruit, especially citrus fruit, aggravates their symptoms. Hydrogen breath tests are being experimentally used to diagnose fructose and sugar intolerance but are not on the market at present.

You can do a self-test by avoiding all fruit and sugar for at least ten days. Be sure to read labels carefully and avoid any product that contains glucose, sucrose, malt, maltose, corn syrup, fructose, brown sugar, honey, maple syrup, molasses, and lactose.

You’ll find that sugar is everywhere, but if disaccharides are the cause of your IBS, it is worth the time and trouble. If sugars and fruits make you feel worse, do the self-test and a blood or stool test for candida infection. People with candida often feel worse after eating sugars and fruits.

Recent technology has provided new insight into the causes of IBS. High levels of methane shown in hydrogen breath tests are associated with IBS and indicate an infection in the small intestine, most commonly Clostridium difficile. C. difficile often responds to Saccharomyces boulardii supplementation.

Parasites and candida overgrowth are overlooked causes of irritable bowel syndrome. One study showed that 18 percent of the study participants had treatable parasitic infections, while another found giardia in 9 percent and parasites in 15 percent of the study population.

Leo Galland, M.D., has found that giardia was responsible for problems in nearly half of his patients with IBS. Even benign pinworms can cause severe colonic cramping at a certain stage of their life cycle. Ask your doctor to order a comprehensive digestive and stool analysis with parasitology to determine if parasites or candida are making you sick.

Antibiotics are well-known causes of temporary diarrhea and GI problems. Steroid medications can also affect the balance of flora. The good flora are eliminated, especially in people who are on repeated doses of antibiotics, which allows other microbes to dominate the intestinal tract.

Acidophilus, bifidobacteria, and Saccharomyces boulardii supplements can help restore intestinal balance. Irritable bowel syndrome has also been treated as a psychosomatic illness—“it’s all in your head”—because there appears to be no other obvious reason for it.

IBS sufferers often have reason to feel stressed, nervous, and depressed about their condition. Stressful situations can trigger IBS symptoms. People with IBS have no greater incidence of depression than others with chronic health problems. IBS can cause social embarrassment and is the second most common cause for missing work, after the common cold.

Healing Options

• Increase fiber intake. Fiber and high-fiber diets are recommended for people with IBS. Focus on eating a minimum of five servings of fresh fruits and vegetables daily, plus whole grains, beans, and peas. You can use high-fiber cereals to boost fiber content, but recent research indicates that wheat bran made the problem worse in 55 percent of cases, whereas it only improved symptoms in 10 percent of patients.

This is not surprising because a significant number of people with IBS have a hypersensitivity to wheat products. If you want to add a fiber supplement, use psyllium seeds. Psyllium seeds were found to be more effective than wheat bran overall.

They caused a decrease in abdominal bloating, whereas wheat bran increased bloating. In a study in which psyllium was given to people with IBS, it improved several parameters by increasing the number of bowel movements per week, enlarging stool weight, and speeding up transit times. No negative side effects were reported.

• Evaluate possible lactose intolerance. Lactose intolerance is often the underlying cause of IBS. Take the hydrogen breath test or eliminate all dairy products and products containing dairy from your diet for at least two weeks to help you determine whether lactose intolerance is contributing to your problem.

• Consider grain intolerance or other food allergies. While you are eliminating dairy, also eliminate wheat, rye, barley, and oats. (See the section on celiac disease for more information.) You may experience a miraculous improvement in your symptoms. Then test to see how much you can “get away with.”

After you’ve tried the dietary approaches, consider these additional options.

• Explore behavioral therapies. Biofeedback, self-hypnosis, and other relaxation techniques are widely used to help people with IBS. Stress often triggers bowel symptoms, and learning stressmodification techniques can alter our reactions. If we don’t react with alarm to a situation, our body doesn’t sense it as stressful.

• Add probiotics. In numerous studies, probiotic supplements have been shown to help regulate IBS. Products with multiple strains of microbes would be best. Make sure they at least include lactobacilli and bifidobacteria. Studies on E. coli Nissle strain have also shown much promise.

• Try gamma oryzanol. Gamma oryzanol, a compound found in rice bran oil, is a useful therapeutic tool for IBS. It acts on the autonomic nervous system to normalize production of gastric juice. (See previous discussion on gastric ulcers and gastritis.) Take 100 milligrams three times daily for a trial period of three to six weeks.

• Add glutamine. Glutamine, the most abundant amino acid in the body, is used by the digestive tract as a fuel source and for healing IBS. Take 8 grams daily for a trial period of four weeks.

• Take EPA/DHA fish oil. Fish oils inhibit the formation of inflammatory prostaglandins and leukotrienes. They may be effective in reducing the pain and inflammation associated with IBS. Take 1,000 to 2,000 milligrams daily in fish oil capsules, or 300 milligrams daily of Neuromins.

• Take peppermint oil. Peppermint oil is a muscle relaxant that is widely used in England for IBS. To get the oil into the intestines intact, use enteric coated peppermint oil. (The coating prevents it from dissolving in the stomach.) Take 1 to 2 capsules daily between meals. During a spasm, you can rub a drop or two of the oil inside your anus with a finger. Caution: it stings!

• Try herbs. Chamomile, melissa (balm), rosemary, and valerian all have antispasmodic properties. They help relieve and expel gas, strengthen and tone the stomach, and soothe pain. Valerian, hops, skullcap, and passionflower are all calming herbs, which can be found in a combination product.

Antidepressant medication is often used by physicians for IBS; these gentle, effective calmatives may give you similar results. Use these herbs in capsules, tinctures, and teas.

• Take ginger. Ginger, either fresh or powdered, helps relieve gas pains. It can be added to foods or used in tea. Within twenty to thirty minutes you’ll be belching and/or passing gas, which will relieve the discomfort. To make a tea, take 2 or 3 slices of fresh ginger or ½ teaspoon dried ginger in one cup of boiled water. Combine it with other herbs, like peppermint or chamomile, to enhance the effect.

• Take a multivitamin with minerals.

• Take calcium-magnesium citrate. Anecdotally, many people have found that calcium-magnesium supplements prevent or alleviate the muscle spasms associated with IBS. Take 500 to 1,000 milligrams calcium, 300 to 750 milligrams magnesium. Be aware that too much magnesium will cause diarrhea.