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New Guidelines for Managing Irritable Bowel Syndrome

People with irritable bowel syndrome (IBS) -- an estimated 7 percent to 10 percent of the world's population -- have a lot to contend with. The miserable task of managing unpredictable, uncomfortable and embarrassing lower-bowel activities, from diarrhea and cramps to constipation and excess gas, is bad enough.

On top of that, the name attached to the condition sounds as if it were invented by a condescending doctor just to placate a patient. There's a subtle suggestion of a certain irritability on the part of the sufferer, too.

Add to that the fact that although IBS is perhaps the disease most commonly diagnosed by gastroenterologists, nobody has yet figured out exactly what causes it -- or what to do about it. It's defined by symptoms experienced; it has no known physical, structural manifestation. As with so many poorly understood diseases, stress is among its suspected triggers. It's largely treated through lifestyle and diet adjustments.

The American College of Gastroenterology on Friday released new guidelines for managing IBS. An ACG panel reviewed all the scientific research into IBS therapies and graded each treatment according to the quality of the science behind it. The new guidelines recommend only those treatments supported by solid science; those with weak support are said to require more research before they can make the list.

Much of the information in the new guidelines is equivocal (some probiotics, or "good bacteria," for instance, may be helpful, but more data is needed before they can be recommended outright). Though many and varied treatments are evaluated, in the end very few turn out to be well supported. Among these: tricyclic antidepressants and selective serotonin reuptake inhibitors are largely effective, as are nonabsorbable antibiotics.

But the key development here is the new edict that people suffering symptoms typical of IBS without "alarm" symptoms such as bleeding or weight loss or family history of colon cancer or celiac sprue can be diagnosed without having to undergo extensive diagnostic testing. One of the common complaints from IBS sufferers is that they get the diagnostic runaround, often finding physicians skeptical or dismissive.

Do you or a loved one suffer from IBS? How do you treat it? Do you welcome the new guidelines?

By Jennifer LaRue Huget  |  December 22, 2008; 7:00 AM ET
Categories:  Chronic Conditions  
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IBS can most of the time be solved or controlled by...healthy eating! I highly recommend someone decreasing their milk intake and increasing their fiber intake. They should be eating at least 35 grams of fiber a day and this helps the symptoms wonderfully (for most people).

Posted by: dietitian1 | December 22, 2008 2:45 PM | Report abuse

Dietitian1 - It would be nice if it was that simple.

FYI, insoluble fiber can make IBS worse, much worse. In that case 35 grams or 53 grams or whatever, the more the unmerrier. Yes we agree, eating "healthier" is better, but what is "healthier" may vary. Also, not just milk, but all lactose products intolerance can be part of IBS. Do you have any idea how much stuff has lactose creatively named and buried in the list of contents?

IBS is a strange malady and can be maddeningly (irritatingly??) variable. It is surprising how little we know about what goes on in the gut, or why.

Posted by: cliff6 | December 22, 2008 3:26 PM | Report abuse

I'm symptom free if I eat a simple diet--chicken and potatoes, oatmeal, nuts, dairy, fruit, and no mixes, few additives or spices.

I have celiac and can't eat most things with gluten, but can eat dairy because I'm not lactose intolerant.

However, things made with chocolate and flour give me very few celiac symptoms-- the chocolate must block something in the gut. Floury things without chocolate such as pie crust or coconut cake, however, make me feel that snakes are gnawing on my guts.

Guts are complicated and we're all so different genetically that we'll probably never understand everything about IBS. It took me 4 or 5 years to figure out what works and change my eating habits, but I've found plenty of new favorites and don't feel deprived anymore.

Posted by: reganhollady | December 22, 2008 5:12 PM | Report abuse

I agree with cliff6 that there are few hard and fast rules when it comes to IBS. Fiber seems to help some people with IBS sometimes and make it worse other times. It seems like trial and error is necessary to find out what will work. I'm dealing with this now and feel like stress is probably a factor. There is a certain unpredictability to the symptoms. The one thing I would say is that it seems to help to avoid things in the onion and cabbage families.

Posted by: Karen18 | December 22, 2008 6:25 PM | Report abuse

Me again. I would add to my prior comment that the onions and cabbagey foods probably don't cause the IBS but just make the symptoms more uncomfortable. (If you catch my drift!)

Posted by: Karen18 | December 22, 2008 6:27 PM | Report abuse

In addition to managing stress and eating a high fiber/low fat diet, I have been helped by regular exercise. Just 1/2 hour to 45 minutes on a treadmill every few days helps keep things moving. Water intake too-- dehydration seems to worsen the symptoms. "Mother Nature's gift to women" also can cause a flare up. I think the message everyone should get is what others here have mentioned: everyone is different and while you can give people guidelines, not everything will apply to everyone. Also, people with IBS should be front and center with others in pushing for food packaging labels that fully and clearly identify what is in a product. We may not be faced with a life-and-death situation, like those with peanut allergies, but we still have a right to know what we are eating so we can manage our condition.

Posted by: gareilly | December 22, 2008 7:49 PM | Report abuse

IBS is a very individual condition. I would encourage people to explore some of the online communities for most people "high fiber" can be dangerous - you need the right type of fiber (soluble). Also be careful with processed food and high fructose corn syrup (fructose is a trigger for many). I have had help from peppermint/ginger (I carry ibsuppress), probiotics (the refrigerated ones, they have more live bugs), and managing my diet as is appropriate for me. Good luck to all.

Posted by: stummy | December 23, 2008 2:22 PM | Report abuse

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