IBS (the irritable bowel syndrome) affects 30% of Americans, everyone somewhat differently. Cramps and other abdominal pains, gas, nausea, bloating, constipation, and diarrhea are the most common symptoms. Twenty years ago we just knew IBS was due to stress. Now, although stress certainly plays a role with many, other factors turned out to be important in most. Here is what to do and what to look out for.

The irritable bowel syndrome (IBS) is the name given to a number of abdominal symptoms with one common feature: they don’t indicate a serious physical disease, but they can make you miserable. In a sense, IBS is the abdominal equivalent of a headache: extremely common, rarely serious.

One cause of IBS is sensitivity to certain foods. As we’ll see shortly, certain people can’t tolerate dairy products. Others have trouble with beans or with certain vegetables. Still others get into trouble by eating irregularly or overdosing on sodas.

Stress is still one of the more common reasons people get IBS and can make your response to a food intolerance worse. If we could put video cameras in your stomach and intestines, we’d see that your entire digestive tract will respond to whatever you’re feeling. If you become angry or extremely upset, your gut goes into spasms and contractions. If you are sad, your digestive tract “plays dead,” barely moving at all.

An Upset Stomach (cartoon)

Let’s look at the different causes of IBS in more detail.

Lactose Intolerance

Lactose is milk sugar, which many humans cannot digest in adulthood, with the exception of those of European heritage. Giving the average African or Asian a tall, frosty glass of milk is like giving him or her a tall, cool glass of ExLax! Most people with a violent reaction to milk products (severe cramps and diarrhea) figure it out right away, but many with less intense symptoms never realize what the problem is. (It’s possible that lactose intolerance isn’t hereditary but develops if your normal diet doesn’t contain dairy products.)

If you think lactose intolerance might be your problem, stop all dairy products for two weeks and see if your symptoms go away. That means no cheese, milk, cream, pizza, ice cream, yoghurt, etc. If your symptoms are gone, you’ve found the cause! Then try out dairy products many mildly lactose-intolerant people can handle, such as aged cheese, Lactaid (milk preprocessed to remove the lactose) and yoghurt.

Gas-Forming Vegetables and Other Foods

Five vegetables are famous for abdominal cramps and gas: cauliflower, broccoli, cabbage, asparagus, and brussels sprouts. Beans can also certainly cause problems. These vegetables contain certain complex sugars that most of us can’t digest. This undigested food then hits the colon, where your intestinal bacteria have a field day at your expense.

Beano is one possible solution to symptoms due to these vegetables; it comes in a little bottle you can buy in a supermarket. It contains a naturally occurring food enzyme. One or two drops digest these complex sugars and mostly clear up gas symptoms. One potential problem: there is no proof that using a concentrated natural product of this sort is entirely safe.

One of the best treatments for IBS can also cause gas: as I describe below, avoid taking too much of your fiber supplement.

An Irritable Bowel (cartoon)

The Nibble-Gorge Syndrome

Many people race around all day and never eat a real meal before dinnertime: they nibble a little here and there. In the evening they finally get a chance to eat and really pig out (i.e., gorge). This is a prescription to have an upset stomach much of the time. The solution is simple: take the time to have three square meals a day, and don’t snack between meals.

Too Much Fructose

Occasionally, we encounter individuals who consume more than a six-pack per day of regular soda or other soft drinks sweetened with high-fructose corn syrup, which can also cause IBS if taken in excess. If this sounds like you, stop all sodas for a while and see if you improve. (Note that diet drinks sweetened with artificial sweetener don’t cause a problem that we know of.)

Alcohol, Tobacco, and Coffee

Most people know that too much regular coffee can upset your stomach. Few realize that decaf coffee is just as irritating (it’s what’s in the coffee, not the caffeine per se). Alcohol and tobacco can irritate your gastrointestinal tract severely, as well.

OK, I have the irritable bowel syndrome. Now what?

Try the dietary modifications noted above.If you get only incomplete relief, you’re still likely to be able to benefit from the following measures:

    • Fiber. Be sure you get plenty of bulk in your diet. Mostly, this means eating a fiber supplement. If you prefer, you can use Metamucil, Fiber-All, Uni-Fiber, or another brand of fiber product you purchase in your drug store.The simplest and cheapest fiber supplement is plain, generic, uncooked, ordinary wheat or oat bran, which costs roughly 50¢ a pound. Sprinkle about a tablespoon a day of bran in your food (don’t cook it!). Fiber is not a laxative: it tends to correct whatever the problem is, whether constipation or diarrhea. (Warning: don’t rely on processed bran in cereal, bread, pills, or other products; it doesn’t work. You need the raw ingredient.)An alternative is Metamucil or one of the dozens of fiber supplements in your pharmacy. Don’t overdo it — too much bran or other fiber causes cramps or gas.
    • A hot water bottle on your tummy can soothe cramps and pain quite nicely.
    • Chronic constipation can sometimes be tough to treat, particularly if it’s a side effect of antidepressants, opiates, or other medications. You may need a mix of several over-the-counter medications. Start with fiber. If needed, add docusate (Colace) 100-500 mg/day. If you’re still constipated, add a small amount of Miralax (polyethylene glyxol 3350).
  • Certain medications may be helpful, particularly if you are having symptoms on a regular basis. I often use a tiny dose of tricyclic antidepressants, whether or not you’re depressed, since it works so well with so few side effects. We’ll discuss other possibilities with you if it seems they may help.

How do I know I don’t have an ulcer or cancer or another serious illness?

Be sure that you and I have discussed this issue with you to your satisfaction. The hallmarks of irritable bowel syndrome are crampy abdominal pains, gas (either belching or lower abdominal gas), abdominal bloating, and constipation or diarrhea or both (constipation alternating with diarrhea). Pains from a stomach or duodenal ulcer are more apt to be burning, up high in your abdomen (just beneath the breastbone), and to awaken you at night. Cancer only occasionally causes pain and is primarily a problem in people over 50. Dozens of other illnesses can cause abdominal pain; the list is too extensive to cover here. “Red flag” warning signs you must pay attention to are fever, trouble swallowing, repeated vomiting, weight loss, prolonged loss of appetite, or blood, pus, or worms in the stool. If you have any of these symptoms you must see a physician immediately.

What about probiotics?

Everyone’s heard of antibiotics, chemicals that kill bacteria. What are probiotics? They’re good bacteria in capsule form. So they’re not a chemical or drug, and I’ve never heard of any side effects from them. They help put good bacteria back into your gut, which is especially helpful if you’ve recently taken antibiotics. Probiotics can be quite helpful for irritable bowel syndrome, too. My favorite brand is VSL#3 . It can be expensive and hard to find but often works wonders. They may be worth a try.