The previous list is not all-inclusive for circumstances that predispose a person to IBS. A combination of several triggers - a special recipe designed for your own body - may also create IBS.

REMEMBER

Here's our theory: Whatever the original trigger may be for you, after it's set in place in your bowel and in your mind, then a food, an environmental trigger, or another stress can create the tipping point that leads to IBS. The process seems simple enough, but on an individual basis there is no way of telling specifically what is causing what.

Getting the Terms Straight

People with IBS think about food all the time. "What can I eat?" and "What can't I eat?" are huge concerns.

Before we discuss specific food triggers that affect many people with IBS, we want to be clear on how we use various terms associated with how people respond to food. In the following sections, we explain the difference between a food allergy, a food intolerance, and a food sensitivity - all of which can be triggers for IBS. These terms are sometimes used interchangeably by people who experience problems with food, but they don't mean the same things.

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In short, food allergy is defined by the medical community as a reaction to foods involving a specific immune system response. Food intolerance is generally used to describe a physical reaction to lactose or to gluten (a protein in wheat). Food sensitivity is not an allopathic medical term and is difficult to define scientifically, but most doctors agree that it usually involves an inability to break down and digest a food.

Food allergy

Many people use the word allergy whenever they notice that their bodies react badly to certain foods. But the medical community is much pickier about how it uses the term. It relies on seeing an immediate reaction, such as hives, asthma, shortness of breath, or swelling, and on finding a certain level of immune cells or antibodies on blood tests.

TECHNICAL STUFF

Medically, the term allergy is usually limited to those conditions in which there is an immune reaction on a skin test or blood immunoglobulin E (IgE) antibody test. Your body thinks a particular food is harmful and sets up a massive outpouring of histamines and other chemicals to try to wash it out of your system. IgE food allergy reactions tend to occur within a few hours of ingesting an offending food.

With some food reactions, diarrhea serves to flush out the offending substance. The clue to identifying a food allergy as the culprit for diarrhea is the presence of other histamine hitchhikers like hives, asthma, eczema, and nasal discharge. If you have a double or triple whammy of symptoms after eating certain foods, the simple solution is to give them a pass at the dinner table. (We talk more about how to survive an elimination diet in Chapter 10.)

The most common forms of IgE-mediated food allergens, which doctors believe are true food allergies, are shellfish, nuts, and strawberries. IgE-mediated food allergies, however, are fairly rare. Fewer than 5 percent of all children and 1 percent of adults have these actual food allergies.

Integrative medicine practitioners define food allergies slightly differently from allopathic practitioners. That's because they recognize that it's possible to have a delayed food allergy - one that's mediated by a cousin of IgE, the IgG antibodies. Such a reaction could take up to 48 hours to appear. Because it is next to impossible to remember what you ate two days ago, integrative medicine practitioners routinely order blood allergy tests and have patients remove the foods that have high IgG levels. There is mounting clinical evidence that high levels of IgG antibodies in particular foods are associated with IBS, and removing those offending foods decreases IgG antibodies and IBS symptoms. Common foods with high IgG levels are dairy products, wheat, soy, and corn.

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Allopathic medicine is the term given to modern medical practices that focus on finding a diagnosis and offering a drug or surgical therapy that fits the diagnosis. Integrative medicine is practiced by allopathic medical doctors who are also trained in nutrition and vitamin therapy and may practice other traditional medicine healing arts, such as acupuncture, herbology, and stress management.

Food intolerance

The medical definition of food intolerance is wrapped around lactose and gluten. These two conditions, lactose intolerance and gluten intolerance, are usually inherited but can be acquired, and they involve a deficiency in the enzymes needed to break down these foods. We talk about these two conditions in Chapter 2 and reveal that they are often mistaken for IBS. Although not as well-defined, fructose intolerance also affects some individuals who have symptoms of IBS. (Fructose is the sugar found in fruit.)

So how do you develop a food intolerance? In the case of gluten, the intolerance is genetic and often reveals itself during childhood. But all three types of food intolerance may actually be brought on by a bowel infection.

In Chapter 2, we explain that some people who suffer bowel infections can end up having symptoms of IBS. (We also note that there are steps you can take to try to avoid that fate when you get a bowel infection.) Acute episodes of infectious diarrhea, like dysentery, can scrape off layers of cells from the delicate mucus lining of the gut. That lining contains enzymes that digest wheat, dairy, and fruit. The inability to make these enzymes causes an acquired lactose or gluten intolerance. When wheat, dairy, and fruit aren't properly digested and absorbed, the undigested mush just keeps moving through the small intestine to the large intestine (as we explain in Chapter 3). Fermentation and putrefaction add to the nastiness of the mush and feed bacteria and yeast, which multiply and overpopulate the bowel with millions of gas-forming organisms.

In some people, a bowel infection is severe enough to throw them into genuine food intolerance from protein deficiency, lactose intolerance, and/or fructose intolerance. And, if you have the genetic predisposition for gluten intolerance (celiac disease), a gastrointestinal infection may be enough to bring it out of the closet.

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To try to prevent future IBS symptoms or food intolerance when you have a gastrointestinal infection due to bacteria or parasites, stop eating wheat, dairy, and fruit. Usually you can go back to eating these foods after your symptoms subside.

REMEMBER

Sometimes when we have flu-like symptoms, we are tempted to turn to our comfort foods. But having a milkshake can keep you sicker, longer when your flu is actually a gastrointestinal infection due to bacteria or parasites.

Food sensitivity

Some people who have neither an IgE food allergy or a diagnosable food intolerance can still find themselves suffering with food reactions. These reactions are usually jumbled up under the heading of food sensitivity. (Some people may be diagnosed with a delayed food allergy, as we mention in the "Food allergy" section.)

Some foods are just hard to digest and can cause gas and bloating. A plateful of broccoli, Brussels sprouts, cauliflower, onions, and cabbage produces a lot of sulfur in the intestines because this mineral is found in very high amounts in these healthy vegetables. Sulfur foods can produce a very odiferous result, and the gas can trigger an episode of IBS. (Sulfur is essential in the body, especially for liver detoxification maneuvers, so you need to choose the time and place to indulge and only eat small quantities.)

Some people react very negatively to pesticides and herbicides found in some foods, or to artificial dyes, colors, sweeteners, and other additives. We talk about some of the worst offenders, such as aspartame and MSG, later in this chapter. Your best defense against food additives is to read labels and not eat anything that you can't pronounce!

As if the above list wasn't long enough, we also have to point the finger at fats. Because fats in the diet trigger a flood of bile from the gall bladder, and bile can have a strong laxative effect on the intestines, for some people with IBS fat is the enemy. The same goes for spicy foods: The heat and irritation they produce can be too much for a sensitive IBS bowel.

Watching What (and How) You Eat

What's food got to do with it? Food has so much to do with IBS that it can make your head - or your bowel - spin. And food is the thing that people with IBS obsess about, because even the act of eating can turn on the valves and gears in your gut and make things move way too fast.

Here are some of the IBS triggers that involve the simple act of eating:

In Chapter 2, we discuss common food reactions that are often mistaken as IBS: allergies or intolerances to gluten, wheat, lactose, and casein in dairy. In the following sections, we discuss other foods that are triggers for IBS.

The reason we list these food triggers is because eliminating them from your diet may alleviate your IBS symptoms. One study found that a group of IBS sufferers who strictly followed an elimination diet of potentially allergic foods had an 88 percent reduction in painful abdominal cramps, 90 percent elimination of diarrhea, 65 percent less constipation, and 79 percent improvement in miscellaneous allergy symptoms. In various surveys and studies, on average half of IBS patients report having one or more food intolerances.

REMEMBER

There are so many different triggers that affect IBS sufferers in different ways and to different degrees. It is important that you know what your triggers are and make every effort to avoid them. Don't let anybody tell you that something should or shouldn't trigger your IBS. You are the expert on what is happening with your body.

Figuring out if fruit is a problem

Lactose is the sugar found in dairy products, and as we explain in Chapter 2 and in the "Food intolerance" section earlier in this chapter, many people have trouble digesting it. But it's not the only sugar that can cause digestive ills. More than a few people have an intolerance to fruit sugars, such as fructose, sorbitol, and mannitol.

We know that fruit packs a great nutritional punch, so most of us assume that eating fruit and using sweeteners made from fruit sugar (fructose) must also be good. Not necessarily. Have you ever overdosed on juicy, mouth-watering peaches or plums only to find yourself running to the bathroom? The same goes for fructose-laced products and especially high fructose corn sweeteners found in many products labeled sugar-free. The high density sugar can cause fluid to rush into the bowel, triggering episodes of diarrhea.

The incidence of genetic fructose intolerance is about 1 in 10,000 people. However, a lot more than 1 in 10,000 people with IBS seem to have fructose intolerance. In a study of 80 IBS patients, one-third were not able to digest fructose. When fruit and foods sweetened with fructose corn syrup were eliminated, so were their symptoms.

In a study published by the American Journal of Gastroenterology, of 183 patients with IBS symptoms, 101 experienced symptoms of belching, passing gas, bloating, pain, and change in their bowel movements when fed a fructose meal.

REMEMBER

Fructose (fruit sugar), sucrose (cane or beet sugar - table sugar), and high fructose corn syrups are all implicated in fructose sensitivity. Avoiding cane and beet sugar may be difficult but will improve your general health; we discuss this topic more in the next section. High fructose corn syrup is now implicated in causing high blood sugar levels leading to diabetes, so you're wise to avoid it as well. Fruit, however, is as an important source of vitamins and minerals. If you must avoid fruit entirely, you want to pay special attention to Chapter 9, where we talk about dietary supplements and IBS.

Staying away from sugar

If you have IBS, refined sugar is not your friend. Refined sugar in your tea or coffee, in baked goods, candy, chocolate, and all manner of pleasurable treats can be the key to triggering your IBS symptoms. As we discuss later in the chapter, Candida albicans is a yeast that grows into the vacuum left when antibiotics kill off good bacteria in the gut. Candida albicans can also grow out of control if you eat too much refined sugar or too many refined sugar products.

How much is too much? Considering that we have only about two teaspoons of sugar (glucose) in our blood stream at any one time, and one can of soda has about ten teaspoons of sucrose, even one can of soda is too much!

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It costs nothing to give up sugar, but the benefits go beyond the bowel. Increased energy and weight loss can be yours. In Chapter 10 we talk about stevia, a natural and extremely safe sweetener that you may want to consider adding to your pantry.

Stopping the sorbitol

Sorbitol is the trade name for a laxative used to treat constipation. Its evil twin, when it comes to IBS, is marketed by the sugar-free sweetener industry as a "safe" sweetener.

Sorbitol is a sugar alcohol that is only partly absorbed in the body. The unabsorbed part pulls water into the large intestine, causing distention that stimulates the muscles of the bowel and translates into the urge to have a bowel movement - sometimes at a moment's notice. (Not what you want when you're in the middle of the Golden Gate Bridge.) Sorbitol also acts as a fuel that bacteria use to create lots of nasty gas.

WARNING!

Some sorbitol products require an FDA laxative warning but, let's face it, the tiny labels on a one-serving dose of sorbitol don't have room to give you details about the gas, painful cramps, bloating, and diarrhea that this two-timing sweetener can cause. The amount you have to consume to achieve the laxative effect of sorbitol is only two teaspoons a day. It's hardly worth it. If you buy a pack of sugar-free candy weighing 40 grams, about 20 grams could be sorbitol. Low-fat cake mixes, maple syrup, toffee, and caramels can all contain enough sorbitol to make your life miserable. Even regularly chewing sugar-free gum laced with sorbitol can be enough to trigger IBS. One doctor found that of seven adults who were given 10 grams of sorbitol, five experienced gastrointestinal symptoms.

(Continues...)

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Excerpted from IBS For Dummies by Carolyn Dean Excerpted by permission.
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