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IBS - food, mental, or both?

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Irritable Bowel Syndrome
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Posted 6/30/2012 11:19 PM (GMT 0)
I am a 30 year old male, and have struggled with IBS-D for 6 years. Within the last year, I finally went to my family doctor as well as a natural health doctor. Family doctor tested stool and blood, found nothing. Said it was IBS and that there was nothing she could do. Natural health doctor wanted me to go through stool and blood testing first, then would begin a series of elimination diets, supplements, etc.. He said IBS isn't a disease, but is just a term modern doctors use when they don't know what it is that causes these stomach issues. He said the American diet today is terrible and causes so many digestion issues. I have yet to have my follow up appointment with him.

So IBS-D. I agree with the national health doctor and feel that the American diet does affect our digestion in a negative way. When I eat pizza, drink pop, have a beer, etc. I have nothing but immediate problems. But there are weeks that I am careful with what I eat, eat very natural and healthy, and still have D. My wife thinks I worry about it all of the time, so that's what causes flare-ups. She thinks 90% of my problem is mental (I admit, I worry about everything). I have spent so much time keeping food diaries, watching what I eat, staying away from trigger foods, but it seems like there are times that just don't make since why my stomach is upset. I also never know if it's what I JUST ate, or something that I ate earlier in the day.

So, is IBS-D food caused? Or is a lot of it mental? How do these two play into each other and cause us so much misery?
Posted 7/1/2012 7:44 PM (GMT 0)
that is a good question. Usually people get an IBS diagnosis when everything else has been eliminated. From what you described, your family doctor's tests of stool and blood were a good start but are certainly not a complete evaluation of all possible diagnoses.

When you think about what comes next in a differential diagnosis process you get to more expensive stool tests (calprotectin) and invasive studies like barium x-rays, CT scans, MRIs with contrast and/or gastroscopy and colonoscopy. Most DRs won't recommend these kinds of tests unless and until your bowel is truly dysfunctional. Are you having trouble maintaining weight and nutrition? Are you having trouble at your job because you have to rush to the bathroom? Are you sleeping alright? Are you passing blood?

Lastly, there are three relatively common and simple causes of diarrhea that you can evaluate yourself at home: lactose, fructose and gluten.

Lactose intolerance is quite common, and develops gradually as we age. Virtually every adult will become lactose intolerant to some degree later in life. Some people are lactose intolerant once they are weaned at age 3! Try to figure this out by drinking a full glass of milk on an empty stomach. If you are lactose intolerant you will get gassy pretty quickly (within 30 minutes) and you may have diarrhea within a couple of hours. You can manage lactose intolerance by eliminating milk, ice cream and soft cheeses (including mozzarella), or using lactase, a digestive enzyme, which you can buy in any drug store or grocery.

Fructose has been identified as a cause of IBS and there are webpages devoted to the kind of dietary restrictions you need to follow to manage this. I'm no expert tho.

Gluten intolerance, and/or celiac disease, affects more people than you might think. To see if you are gluten intolerant, you can have a series of blood tests, or you can follow a strict gluten-free diet for a couple of weeks and see how you feel. You can learn about this on the web also.

Stress and worry cause stomach upset, without a doubt. But that shouldn't cause you to have diarrhea every day for weeks.
Posted 7/2/2012 3:16 PM (GMT 0)
I have lost some weight, but that was due to me just going on a simple diet to rule out some things. By simple, I mean that I ate mostly rice, steamed chicken, and some fruits and vegetables. My calorie intake was extremely low, so of course I lost some weight. When I eat normally, I don't lose weight or anything like that. I sleep through the night, and don't pass blood (the doctor tested for this). I'm not having diarrhea all day every day. I have 5 or 6 good days, then get hit with a bout of diarrhea, usually in the evening. I take Imodium, and that usually works great. Sometimes I go a month or two with no issues. The majority of the time, I know that if I eat pizza, chips, drink pop or beer, eat fast-food or any other high fat/greasy foods, I will have diarrhea.

Probably the worst symptom is the gas. My stomach gurgles a lot, then I have horrible smelling gas. Usually in the late afternoon and evening, though it can creep up in the middle of the day at times. It lasts usually an hour or two. I'd say I have that problem 3 or 4 days every week. I can't pin-point a food that causes it.

I have tried some simple elimination diets. I do think I have a sensitivity to lactose, though I still have gas and diarrhea when I am not taking in any lactose. Gluten doesn't seem to bother me. What I'm starting to wonder about is the fructose.
Posted 7/2/2012 3:54 PM (GMT 0)
Gluten is tricky to evaluate. You really need to be completely gluten free for 2 or 3 weeks to get a good sense of what's due to gluten and what's not. Most of the gluten tolerance info I've read on the web advises you to be gluten free for 3 weeks and then do a gluten challenge, which means planning an entire day full of gluten (breakfast/lunch/dinner). That doesn't mean junk food, that means a bagel for breakfast, a sandwich at lunch and pasta for dinner.

Fructose is tricky too. I'm glad to hear that you're not suffering too much with diarrhea, although I do understand how annoying gas can be.
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