Treatment for IBS in autism affected families and others....long

[Guest guest]

I am posting this info as I think it may be useful to many on this

site. This same forensic nutritionist/researcher will be publishing

about diahrea predominant IBS in June....

IRRITABLE BOWEL SYNDROME

by Konstantin Monastyrsky

This guide debunks universally accepted view that the causes of

irritable bowel syndrome are unknown, describes them one by one, and

explains how to eliminate each one safely and permanently. This

information is particularly important for persons in high-risk group

for ulcerative colitis, Crohn's disease, and colon cancer because the

conventional diagnostic and treatment of IBS raises these risks

considerably.

According to the 2007 edition of the world's leading medical

reference — The Merck Manual of Diagnosis and Therapy— the causes of

irritable bowel syndrome are still unknown, as you can clearly see

from this illustration (modified to fit this page, click picture to

view actual page):

Though it's hard to accept that in the era of routine heart

transplantation the causes of IBS are still a mystery(1), it's even

harder to stomach that the recommended treatment makes IBS

worse. " Patients with IBS may subsequently develop additional GI

disorders, " — says the Merck Manual.

By additional they mean inflammatory bowel disease (IBD) — the

progenitor of ulcerative colitis and Crohn's disease. In these cases,

close to half of all patients end up needing colectomy — a surgical

removal of the large intestine. This is the only way to stop these

patients from bleeding to death.

Even when patients do get spared these uncontrollable bleedings with

aggressive medical therapies(2) , such as immunodepressants,

antibiotics, and steroids, those nasty IBDs increase the risk of

colon cancer up to thirty two times (3,200%).

To prevent almost inevitable cancer, patients are commonly

recommended a prophylactic colectomy " just in case. " When choosing

between an almost certain death from cancer and an undergarment

colectomy bag, most chose the bag.

Live by the book, die by the book, literally...

The Merck Manual represents what's known as " standards of care. "

These standards, in turn, are scrupulously followed by doctors who

wish to deliver " the best possible care " to their patients. The

problem is — when a standard is wrong, as is the case with IBS, the

best possible care invariably turns into the worst possible nightmare.

If you happens to have IBS, and are uninsured or have limited access

to medical care, you are safer and better off untreated than those

well insured and, presumably, more fortunate, who will be on the

receiving end of the Merck-recommended treatment:

I realize, you may find this information disturbing, but, so far,

unsubstantiated. So lets begin by deconstructing this doctor-speak

with surprisingly bad grammar into plain English (3):

Q. What has " support and understanding " to do with bowel disease?

According to the Merck Manual, IBS is a partially " psychosocial "

condition. Essentially, this means that patients with IBS are

psychotic individuals, whose own mental attitudes contribute to

intermittent constipation, diarrhea, and abdominal pain.

This is junk science at it's worse — irritable bowel syndrome is a

100% physiological condition, not psychosocial. If anything, the

constant pain, suffering, and bad treatment may turn IBS victims into

psychotic wrecks, but not the other way around.

It's true that stress plays a role in IBS unfolding (as well as in

practically all other human ills), but not in ways that can be

effectively treated by psychological (hypnosis, counseling) or

psychiatric (prescription drugs) intervention. You can learn more

about the role of stress in IBS, and how to counteract its impact on

digestive disorders here.

Q. What does " normal diet, avoiding gas-producing and diarrhea-

producing foods " mean?

The primary " gas-producing " foods are indigestible carbohydrates,

that get fermented in the large intestine by innate, beneficial, and

essential gut bacteria (microflora). Two of the most prominent

indigestible carbohydrates are dietary fiber and lactose (milk sugar)

[link].

The primary " diarrhea-producing " foods are sugar alcohols, such as

sorbitol, found in bananas and prunes; soluble fiber, such as pectin

found in apples and oranges; beta-D-glucan found in oats, numerous

unnamed polysaccharides found in most plants and psyllium laxatives;

and fiber fillers and stabilizers found in practically all processed

food, such as guar gum, carrageen, cellulose gum, inulin, and

numerous others [link].

In essence, this advice means to avoid the following: dairy because

of lactose and fiber stabilizers (yogurt, ice cream, sour cream,

cream cheese); fruits rich in pectin (oranges, apples); fruits rich

in sugar alcohols (bananas, prunes, prune juice), and food rich in

fiber (oatmeal, morning cereals, bran, whole wheat bread, pasta),

fiber laxatives; and all processed food with fiber additives.

This is good and easy advice to follow until you consider their next

recommendation...

Q. How come they recommend " Increased fiber intake for constipation, "

if fiber is a well-known gas- and diarrhea-producing substance?

To me, that's either the biggest " medical mystery " , or the

biggest " medical idiocy, " or simply outrageous negligence, or,

perhaps, all of the above. In fact, to unravel this mind-boggling

incongruity for myself and others, I wrote a book entitled " Fiber

Menace: The Truth About the Leading Role of Fiber in Diet Failure,

Constipation, Hemorrhoids, Irritable Bowel Syndrome, Ulcerative

Colitis, Crohn's Disease, and Colon Cancer " , and you are welcome to

read it.

If you are a skeptical medical professional reading this, and, all

things considered, I don't blame you a bit for being skeptical,

consider the following two quotes from the American College of

Gastroenterology Functional Gastrointestinal Disorders Task Force

[link]:

" Fiber doesn't relieve chronic constipation and all legitimate

clinical trials demonstrated no improvement in stool frequency or

consistency when compared with placebo. "

" In the management of IBS, psyllium is similar to placebo. In fact,

the bloating associated with psyllium use will likely worsen symptoms

in an IBS patient. "

Psyllium is a source of soluble and insoluble fibers found in

Metamucil-type laxatives, and their digestive properties are

identical to all other types of fiber.

Q. Will Loperamide (Imodium) enable IBS recovery?

No, it will not. It may temporarily stop diarrhea by literally

paralyzing your intestines, but only to cause severe constipation,

because, along with " dizziness, drowsiness, [and] tiredness " ,

constipation is the most immediate and prominent side effect of

Imodium.

Of course, for me — a former pharmacist — there is no surprise here.

Imodium is a synthetic opioid (opium-like drug). Just like all

opioids, it " kills " the contraction of circular and longitudinal

smooth muscles, which line up the stomach, esophagus, intestines,

bowel, and major blood vessels. This effectively stops the propulsion

of food and feces throughout the entire digestive tract, and, in

turn, causes more constipation, more indigestion, more bloating, more

flatulence, and stronger cramps.

Just like all opioids, Imodium diminishes blood circulation and

oxygen delivery to the brain. This causes dizziness, drowsiness, and

tiredness — depression-like symptoms.

Q. Would " tricyclic antidepressants " help my depression and IBS?

Well, since your doctor may think that you are affected by IBS

because you are psychotic, and you are miserable from incessant

abdominal pain caused by more fiber, and you are depressed from

Imodium, these potent antidepressant drugs may indeed keep you away

from the psychiatric ward [link].

Funnily enough, constipation is one of tricyclics' most common side

effects along with more drowsiness, dizziness, fatigue, and muscle

and joint aches. So you quickly return to your doctor for even more

support and understanding, more fiber to relieve constipation, more

painkillers, more Imodium, and even more antidepressants.

Q. Why does the conventional diagnosis of IBS increase the risk of

colon cancer?

Not just the colon, but any cancer! A visual examination of the large

intestine (i.e. colonoscopy) requires a bowel prep — a thorough

cleansing with synthetic laxatives. This procedure damages intestinal

flora, disrupts stools, makes resuming normal bowel movements

difficult, and may cause intestinal inflammation — the precursor of

colorectal polyps and cancers.

In addition to all of the side effects from a bowel prep for

conventional colonoscopy, a single virtual colonoscopy (CT scan)

exposes patients to radiation 2,000 to 3,000 times more potent than a

single dental X-ray. This dose of radiation, according to the Federal

Drugs Administration [link], increases a person's lifetime risk of

any cancer to 20%, or one chance in five.

With minor variations, these ineffective and risky diagnostic and

treatment guidelines are repeated in endless medical textbooks,

references, how-to books, and health-related web sites. Not

surprisingly, according to the International Foundation for

Functional Gastrointestinal Disorders, " irritable bowel syndrome

(IBS) affects approximately 10-20% [30 to 60 million – ed.] of the

general population. " Lets hope you aren't one of them, and if you

are — lets get you out of this tangle before it's too late.

***

At this juncture, you have three choices: (1) Do nothing, and get by

with this or that irritating your gut for the rest of your life; (2)

Continue with the conventional treatment I just described above, and

face the music; or (3) Study this page, follow its recommendations,

and recover from IBS.

" Recover " doesn't mean that you'll be able to eat and drink with

reckless abandon just like your happy-go-lucky buddies.

Unfortunately, you won't and you can't because an extended history of

IBS and, particularly, its conventional treatment causes damages that

aren't completely reversible. So if eating and drinking with reckless

abandon are your objectives, don't bother reading this any further —

alas, I am not a magician.

But if you are a realist, then to " recover " means that by following

my recommendations: (1) you'll be free from abdominal pain and

discomfort associated with IBS; (2) you'll be able to attain normal

stools without laxatives in case of constipation, or fiber and

medication in case of diarrhea; (3) you'll boost your immune system,

energy, stamina, and overall health, and (4) you'll significantly

reduce your chances of getting colorectal cancer.

Depending on your age and overall health, you may also enjoy several

unexpected benefits:

Improved quality of life. Your energy levels and stamina may increase

substantially, particularly from the elimination of pain-relievers,

antibiotics, antidepressants, laxatives, and anti-diarrheal drugs.

Most of these medicines are systemic, which means they affect your

body and mind just as strongly as your bowels.

Healthier children. If you have young children, you own positive

experience will teach you and them the habits of colorectal health

(gut sense), and they will grow up healthier, stronger, and well

prepared to today's demanding and competitive world.

Higher income. Your work performance and career will enjoy a

considerable boost because it's next to impossible to be productive,

efficient, and sociable while suffering from insomnia, or

experiencing day-long abdominal discomfort and flatus, or being

affected by mind-altering drugs.

Reproductive health. If you are a woman, you may find relief from

PMS — an oftentimes IBS-related condition. If you can't conceive a

child without any organic cause, or have been experiencing

spontaneous miscarriages, you may be able to overcome these two

devastating problems as well.

Better sex life. If you are sexually active, your sex life will

improve dramatically, because you'll be free of bloating, flatulence,

and abdominal pain, which are particularly bothersome during

intercourse. You'll also may experience stronger orgasms because

you'll be sufficiently relaxed to enjoy them without fearing

embarrassing flatus (gases).

Significant savings. You'll be able to save a bundle of money related

to treatment of IBS-related symptoms and side effects, such as

constipation, diarrhea, hemorrhoids, diverticular disease, and

numerous others.

Reduced cancer risk. Finally, you are less likely to succumb to

colorectal cancer — the second leading cause of cancer-related deaths

in the United States. This is particularly important for high-risk

individuals for colorectal cancers. And with less x-rays and drugs

thro — the same applies to all other cancers.

With all those prudent goals in mind, here are the detailed stage-by-

stage description of IBS causes, followed by step-by-step recovery

guidelines. It will take you less time to study this page than a

single visit to a GI specialist. On top, this information is free to

read, safe to use, and a ton more effective.

***

The Causes of

Irritable Bowel Syndrome

The following stage-by-stage narrative deconstructs the etiology and

unfolding of irritable bowel syndrome. Once IBS is no longer a

mystery, you'll have more confidence and motivation to proceed toward

your complete recovery, and avoid the relapse.

You may not experience some of the symptoms and/or stages described

below, but, with minor variations, this is the most common scenario:

Stage 1. Loss of intestinal flora

The loss of indigenous (innate) intestinal flora (bacteria) precedes

IBS, and is, in general terms, its initial and primary cause. All the

other problems (and causes) get layered in the stages that follow.

Intestinal bacteria are an essential component of normal colon

ecology. They form stools, protect the intestinal membrane from

bacterial and viral pathogens, govern the primary immune response

(phagocytosis), and produce a range of micronutrients, essential for

health and longevity.

The two best known byproducts of intestinal flora biosynthesis are

vitamin K (responsible for blood coagulation) and biotin (vitamin B-

7). Vitamin K deficiency is behind internal bleedings, pernicious

anemia, inoperable ulcers, and strokes. Biotin deficiency is behind

hair loss, connective tissue disorders (i.e. dermatitis,

osteoarthritis, weak nails), and diabetes.

The common " killers " and causes of intestinal bacteria are all well

known. These are ubiquitous antibacterial medicines and compounds

(antibiotics and synthetic agents, such as isoniazid, sulfonamide,

methenamine, rifampin, hexachlorophene, etc.); antibiotic-laced meat

and diary; dental amalgams (black fillings); mercury in fish and

seafood; chlorine, arsenic and lead in drinking water; lead in paint

and environment; silverware, common laxatives, food colorings,

artificial sweeteners, infectious diseases, intestinal inflammations,

colonoscopies, x-rays, radiation, chemo treatments, and numerous

others.

Any one of the above factors may lead to partial or complete

evisceration of intestinal bacteria, a pathology known as

disbacteriosis (dysbiosis). In turn, disbacteriosis results in hard

stools, either small or large. These two conditions — disbacteriosis

and hard stools precipitates irritable bowel syndrome. Enters Stage

2.

Stage 2. Hard stools

Bacteria are single-cell microorganisms. Just like all cells in

nature, they hold water, and hold it tight. Intestinal mucus binds

those " wet " bacteria with dry inorganic food remnants into moist,

soft, and pliable stools. But without bacteria, stools become small,

dry, and hard. The transformation of succulent grapes into weathered

raisins is a telling analogy:

The raisin-like small stools are a problem because the large

intestine wasn't designed to move around small objects, so they get

stuck — as in constipation. Unlike raisins though, small stools dry

up even more and become as hard as pebbles.

The pebble-like stools are an even bigger problem because your anus

isn't made of steel, but of delicate and sensitive tissue — similar

to the inside lining of your nose. Thus the human anus wasn't meant

for passing " pebbles " through any more than your teeth were meant for

opening beer bottles (even though some of you probably can...)

If you are affected by disbacteriosis, and your diet is low in fiber,

then the hardened stools remain small and dry. If fiber is present,

then the hard stools are larger, because fiber adds bulk.

You may experience hard stools and still remain regular, because you

are an " expert " strainer, or can tolerate pain better than others, or

the degree of hardness is still tolerable, or all of the above.

Stage 3: IBS-related constipation

Constipation means irregular stools. A person is

considered " officially " constipated when bowel movements are absent

over three days. Diagnosing constipation is like reporting a missing

person—don't bother calling the police until 24 hours have passed.

Ditto, don't bother calling your doctor until 3 days have passed. If

it's only 2.5 days—sorry, you are still fine...

For this reason I prefer using the terms impacted stools, hard

stools, or costivity—slow in moving hard stools — instead of

constipation, which refers to not having stools over three days. This

way it's easier to convince people who pass hard stools in " under

three days, " (i.e., who are still technically regular) to seek

treatment.

Hard stools, costivity, and constipation are commonly reported by

people trying out low-fiber diets, such as Atkins'. Obviously, it

isn't the diet's fault that people run into these problems. The cause

is rather having disbacteriosis before commencing the diet.

If you consume plentiful fiber or fiber laxatives, stool hardness may

be less apparent. That's, incidentally, why fiber is recommended in

the first place. As in the next stage, of course.

Stage 4. Treatment of constipation with fiber

Medical professionals and Dr. Moms alike recommend dietary fiber and

fiber laxatives to " naturally " alleviate hardness, particularly when

stools are small and dry. Fiber bulks up (enlarges) and moisturizes

stools by either retaining water, blocking water absorption, or both.

The most apparent damages from fiber in enlarged stools are

mechanical, related to its sheer physical bulk. Fiber is the only

commonly consumed nutrient that reaches the large intestine

undigested and expanded up to five times (500%) its original weight.

On the other hand, proteins, carbohydrates, and fats leave behind

less than 5% of undigested solids.

Here is the same math in weight units: once in the colon, 100 g of

fiber turns into 500 g of undigested residue, while 100 g of

proteins, fats, and carbohydrates digest down to less than 5 g of

solids. Thus, per unit of weight, undigested fiber is 100 times more

dense than all other nutrients (500 g / 5 g = 100 ). That's why

doctors refer to fiber-free diet as low density, and high-fiber—as

high bulk diet or roughage.

Historically, indigenous diets, even plant-based, were low-density.

That's because prehistoric people didn't have the means and skills to

grow, process, and prepare high-fiber food. For these evolutionary

reasons, human digestive organs haven't adapted to high-bulk diets,

and remain as vulnerable today as they did millennia ago.

Unfortunately, enlarged stools require straining, particularly as you

get older. Welcome to Stage 5.

Stage 5. The hallmark of IBS: Straining

Younger people can expel large stools without apparent difficulties

because they still have much better control of pelvic and abdominal

muscles, stronger intestinal peristalsis, and less resistance from

internal hemorrhoids.

Normal defecation requires just as much effort as urination—zero. If

straining is necessary, however moderate, it means that the size of

stools exceeds the optimal spread of the anal canal.

The anal canal aperture maxes out at 35 mm or 1.4 " . For normal,

notice-free passing, soft and moist stools shouldn't be much wider

than one's index finger or a nickel (21 mm, U.S. currency 5 ¢ coin),

and correspondingly smaller in children.

If you need convincing that your anal canal is that narrow, you can

perform a digital rectal self-exam. No, you don't need a computer.

Just lubricate your pointing finger with petroleum jelly, and slowly

insert it into the anus. You will immediately realize just how tight

and narrow it is. (This test is called a digital test,

because " finger " in Latin is " digit. " )

Straining applies strong force by abdominal and pelvic muscles on the

colon and rectum to squeeze out stools — just like you would squeeze

out the last bit of toothpaste from a spent tube below:

Yes, that's pretty much what happens to the colon and rectum when you

strain extra hard. The damage isn't far behind: internal and external

hemorrhoidal disease, loss of urge sensation because of anal nerve

damage, stubborn anal fissures (skin tears inside anal canal) that

won't heal, loss of muscle tone and ensuing " lazy gut " syndrome,

rectal prolapse, rectocele (rectal wall prolapse into vagina),

diverticular disease, usually lethal colon perforation, and others.

Also, straining wrecks havoc " above and beyond " the colon and rectum—

strong abdominal pressure affects all organs situated in the lower

abdominal and pelvic cavity: the rest of the colon, small intestine,

uterus, bladder, and others.

This damage may manifest itself as obstruction of the small

intestine, reflux of fecal matter back into the small intestine,

abdominal and inguinal (men's) hernias, pelvic cramps, spontaneous

abortion (miscarriage), vaginal bleeding, symptoms of PMS, the

blockage of fallopian tubes, and other mechanical damage of internal

organs.

Straining may also temporarily constrict major blood vessels and

cause blood clotting. Stray clots may cause pulmonary embolism, heart

attack, or stroke. Elevated blood pressure related to straining may

cause cardiac arrest, aortic rupture, internal hemorrhages, strokes,

heart attacks, and other major cardiovascular calamities. Even eyes

aren't spared from a vessel rupture and related retinal and macular

damage.

The vascular problems are made worse by poor blood coagulation—

disbacteriosis results in acute deficiency of vitamin K—a clotting

factor. Normally, vitamin K is synthesized by intestinal bacteria.

Women are expert strainers, because they have far greater voluntary

control of pelvic muscles than do men. In some respects, straining is

similar to what's happening during natural childbirth. Not

surprisingly, women are affected by major colorectal disorders —

particularly hemorrhoidal and diverticular diseases — more often than

men.

On the other hand, men have stronger abdominal muscles, and are more

likely to develop abdominal wall or inguinal (groin) hernias. If you

look at weightlifters pumping heavy iron, their facial expressions

and grunts aren't that different from those of guys having a hard

time in the loo. But unlike an average Joe in the john, weightlifters

wear abdominal binders and groin trusses to prevent herniation. (This

may be a good gift idea for the `constipated man' in your life.)

Even children aren't spared from the aftermath of straining—nowadays,

hemorrhoids are becoming commonplace even among preschoolers. Just

ask any pediatric gastroenterologist.

As you can see, there are plenty of reasons not to strain, and even

more reasons not to encourage children to strain. Otherwise it's a

straight path to hemorrhoidal disease.

Stage 6. The inevitable side effect of IBS: Internal hemorrhoids

Hard stools and straining, even moderate, cause gradual enlargement

of internal hemorrhoids. That's due to the pressure applied by

passing stools on the inner walls of the anal canal inside, and

abdominal and pelvic muscles from the outside.

Internal hemorrhoids aren't a " disease, " but a part of the anal canal

anatomy—small collagenous pads that cushion passing stools. Their

enlargement is akin to calluses on your palms from shoveling snow.

According to the experts, by age 50, most adults have asymptomatic

enlarged internal hemorrhoids without realizing it.

External hemorrhoids are dilated, varicose veins of the hemorrhoidal

plexus. The thrombosis of external hemorrhoids causes swelling and

severe pain, but rarely bleeding. They do not affect defecation per

se, but may cause stool withholding and incomplete emptying because

of fear of pain and bleeding.

Anal intercourse damages the anal canal in a way similar to hard

stools and straining, only in reverse. Lubrication may help to

protect the anal canal from laceration, but not from the enlargement

of internal hemorrhoids, nerve damage, and the loss of muscle tone of

anal sphincters. Because of the latter, anal intercourse is more

likely to lead to fecal incontinence than constipation. This fact is

well known to gastroenterologists, who specialize in anorectal

restorative surgeries for men and women who engage in anal

intercourse.

(Yes, I realize that some penile implements are wider than 1.4 " (35

ml), and have a hard time explaining how it's possible to insert them

into the anus. But, then, I tell myself—if some people can swallow

swords and others can swallow fists, then, with practice, patience,

and disregard for common sense, everything is possible.)

The very first symptoms of anal canal damage are pain and

bleeding. " Welcome " to the next stage!

Stage 7. Hemorrhoids-related pain and bleeding

The enlargement of internal hemorrhoids from straining causes further

constriction of an already narrow anal canal. While passing through a

constrained anal canal, hard stools lacerate its delicate skin.

Laceration causes bleeding or " streaking " of stools with bright red

blood.

Anal pain may differ in intensity, depending on the degree of nerve

damage. Older adults and diabetics may no longer feel any pain

because the nerve damage is complete. But when it isn't, the anal

plexus region is quite sensitive, and the pain, even from a slight

pressure, may be quite sharp.

Seeing blood and experiencing pain brings about the next problem—the

sometimes conscious, sometimes unconscious decision to withhold

stools in order to avoid or prevent an unpleasant experience. This

causes incomplete emptying of bowels, and is particularly common

among toddlers, who can tolerate pain the least.

Stage 8. The hallmark of IBS: Incomplete emptying

The large intestine of an average adult is 4.5 feet (1.5 m) long, and

can easily accumulate significant amounts of feces. Because of

incomplete emptying, many people routinely retain 5-10 or more lbs of

impacted stools without realizing it.

If a person isn't overweight, an experienced physician may detect

retained stools during a manual exam of lower abdomen. Because

minerals aren't 100% transparent to the imaging source, retained

stools can be seen with various degrees of clarity on imaging scans,

such as x-ray, ultrasound, computed tomography, and MRI.

A person affected by disbacteriosis and on a fiber-free diet can go

without a single bowel movement for a month or more, and not

experience noticeable side effects. With just 100 to 200 grams of

stool generated daily under these conditions, the large intestine has

enough holding capacity to store many weeks worth — particularly

after those stools dry up.

When the colon is filled to capacity, retained stools are pushed down

and out into the rectum, where they may stimulate painful defecation.

This way, more room is freed on top for the newer feces to pile up,

and repeat this cycle again and again.

When defecation is no longer attainable, the situation is called

fecal impaction. In this case, there are four possible outcomes, and

none of them are very good: (1) elective manual disimpaction or

surgery; (2) colon perforation; (3) fecal reflux (feces flow back

into small intestine; (4) intestinal obstruction and ensuing necrosis.

Okay, enough scarecrows... Normally, the large intestine should

contain well under 2 lb (1 kg) of retained feces, or two to three

days worth. A healthy stool shouldn't exceed 100-120 grams per bowel

movement*, usually twice daily.

People on high-fiber diets expel on average 300 to 500 g per bowel

movement*, usually once daily. Longer intervals between bowel

movements increase total stool weight, but not linearly, because of

stools' drying out. (*Source: R.F. Schmidt, G. Thews; Human

Physiology, 2nd edition. 29.7.)

As incomplete emptying progresses, retained stools compress, enlarge,

harden up, dry out, and let newer feces pile up on top to do the

same. Incomplete emptying results in impacted stools, described in

the next stage of irritable bowel syndrome evolution.

Stage 9. The hallmark of IBS: Impacted stools

This process of stool impaction is similar to sausage manufacturing—a

butcher uses a stuffing machine to fill in the casings, ties the

ends, and hangs them to dry. That's why impacted stools and certain

brands of dry sausages look very much alike:

This is a " stage nine " cured dry chorizo sausage. Only the " sausage "

inside one's gut is longer—around 3 to 4 feet, and correspondingly

heavier. And that braided shape of the sausage mirrors the haustra

pattern (small pouches) along the colon's walls. (Type 2 on Bristol

Stool Scale].

Looking at this picture, it's easy to understand why between 25 and

40 million Americans suffer from the ravages of irritable bowel

syndrome. Try imagining this kind of " sausage " inhabiting your colon

years on end, and not getting your bowel irritated and cramped.

Impacted stools often bypass anal sinuses (the folds between colon

and rectum) and enter the rectum (normally, the rectum chamber is

empty). This condition can be determined via rectal self-exam. The

presence of stools in the rectum may cause pain, discomfort, and the

feeling of incomplete emptying—the condition known as levator

syndrome (from levator ani muscle).

When the colon and rectum can't accumulate any more stools, the

incoming digestive fluids may seep over, and cause a diarrhea-like

condition, which is called " paradoxical diarrhea. " But the real

paradox in this, pardon the pun, " shitty " situation is that very few

primary care physicians are familiar with it.

Thus, instead of disimpacting a sufferer (removing impacted stools by

hand, a specialized procedure usually performed in hospitals),

doctors may recommend even more fiber to " restore stools. " When

additional fiber has no place to go, it causes obstruction,

perforation, or necrosis of the small intestine. These conditions are

rarely survivable, and always require massive abdominal surgery in

order to excise affected sections.

Here is even more bad news: unlike small, soft, and moist normal

stools, impacted stools cause mechanical abrasions of mucous

membranes. In turn, these abrasions open a pathway to various

pathogens into the inner reaches of intestinal membranes, and seed

precancerous polyps. Along with lack of protective bacteria, this, I

believe, is the PRIMARY cause of colorectal cancers. One more reason

to restore proper colon ecology! Only then can you avoid impacted

stools, prevent disbacteriosis, and restore intestinal flora.

Stage 10. The hallmark of IBS: Abdominal cramps

The enlarged stools fill up the large intestine, and produce

considerable pressure on internal organs, particularly the bladder,

uterus and fallopian tubes among women, and prostate gland among men.

Since all of these organs have strong innervation and quite

sensitive, you may feel in considerable pain, specific to

premenstrual syndrome (PMS) before and during periods. Men may

experience heightened sexual tension from the pressure on the

prostate gland. Both genders may be affected by frequent urination

but without any significant volume of urine.

At this point many people turn to " nutritionally-oriented " doctors

and " natural " web sites, which enthusiastically recommend restoring

bacterial flora with all sorts of preparations. Great and well-worn

advice by now, except for one little detail: mixing fiber with

bacteria in one's gut is like making compost in one's backyard.

Household compost pile. Look familiar?

The incessant, round-the-clock fermentation of the " compost pile "

produces copious gases, sharp acids, and toxic alcohols. Gases expand

the large intestine. The expansion causes bloating. The bloated

intestines squeeze neighboring organs and may cause obstructions,

gastritis, heartburn, genital cramps, and so on. Acids irritate

mucosal membranes and may cause inflammation. Methanol—one of the

alcohols—seeps into the blood and causes hangover-like side effects.

Alas, not enough ethanol is produced to at least enjoy the

experience.

The degree of suffering from abdominal cramps and intoxication varies

greatly depending on one's age, gender, health, occupation,

character, genetics, amounts of fiber, types of fiber, sources of

fiber, and a whole load of other factors itemized in minutiae in

throughout this site and in Fiber Menace.

For as long as all of the above is tolerable, it's broadly accepted

as a part of living. Between 10% and 15% of all Americans endure

diagnosed or undiagnosed irritable bowel syndrome as just described.

When the going gets tough, the tough... go to see their doctors.

Stage 11: Medical treatment of IBS

A conservative treatment for severe abdominal distress relies on

antibiotics — along with more fiber and/or fiber laxatives. First,

antibiotics kill any remaining intestinal bacteria,

terminate " composting, " and alleviate intestinal inflammation. This

stops bloating and flatulence caused by gases and acidity produced by

the fermentation of fiber. Antibiotics don't reduce stool size or

relieve constipation. They may help to arrest diarrhea by removing

and/or reducing its causes.

Next comes fiber: " Dietary fiber can help many patients by absorbing

water and solidifying stool. It may benefit patients with either

constipation or diarrhea. " So advises The Merck Manual of Diagnosis

and Therapy, an unquestionable " gold standard " reference for most

American doctors.

And so we go: cramps—antibiotics—fiber—cramps—antibiotics—fiber… In

other words you become dependent on fiber and/or laxatives.

The absence of bacteria requires more fiber or laxatives to deal with

impacted stools. Newly consumed insoluble fiber acts as a plunger by

pushing them out. That's essentially what fiber is — a plumber's

plunger. And the straining is its handle.

To make the passage possible, soluble fiber or laxatives lubricate

and break down hardened stools, just like Drano® would hair clog.

They soften them up somewhat, and, when consumed in excess, stimulate

diarrhea.

Too bad your " plumbing " isn't made from cast iron. Even then, this

stage may last and last — until one unfortunate day your gut " can't

take it anymore, " and hits you " on the head " with a leak...

Stage 12. A nasty side of IBS: Intermittent diarrhea

At one point impacted stools, or inflammatory disease, or both, may

cause profuse diarrhea—an innate physiological reaction to " self-

cleanse " the affected large intestine, similar to vomiting.

After a while the colon becomes " as clean as a whistle, " but the

diarrhea disrupts the colon's ecology. Fiber is recommended

to " restore formed stools. " Formed stools usher back constipation and

impacted stools, and this cycle repeats itself over and over again.

Of course, these well known outcomes describe the classical symptoms

of irritable bowel syndrome—round-the-clock abdominal distress

accompanied by alternating patterns of constipation and diarrhea,

while, according to the doctors, " there is nothing wrong inside. "

Back to " square one, " unless... unless you follow my suggestions and

break out from this trap, otherwise it's down to Stage #13. Oh, how

appropriate...

Stage 13. Inflammatory Bowel Diseases (Ulcerative colitis and/or

Crohn's disease)

The vicious cycles of intermittent constipation and diarrhea repeat

over and over again until more serious complications arise. It may be

hard-to-treat ulcerative colitis, or a devastating Crohn's disease,

or excruciatingly painful hemorrhoids, or dreadful appendicitis, or

gut-piercing diverticulitis, or a rarely survivable perforated colon,

or a deadly colon cancer, and God only knows what else.

When a person recovers from the initial treatment, more fiber is

prescribed again to prevent all these conditions. Not surprisingly,

up to 40% of ulcerative colitis victims undergo proctocolectomy—a

surgical removal of colon and rectum. Otherwise they may bleed to

death or die from colon cancer.

In this case, no colon—no problem…

It's the exact same pattern for Crohn's disease, for hemorrhoidal

disease, for diverticular disease, for cancer survivors, and pretty

much for everything else. Fiber, more fiber, more darn fiber, until

one day, no patient—no problem. And it all started with the

accidental death of some " dirty little bugs " in the Stage 1.

The next section explains how to reverse the causes of IBS naturally,

and to roll-back your state of health to pre-stage 1 status — proper

colon ecology, normal stools, and no symptoms of IBS.

This approach may not make you again " as good as new " — some of the

above damages, unfortunately, are irreversible, but it certainly

beats becoming " as good as dead, " if you follow the conventional IBS

treatment.

***

IBS Recovery Guidelines

As I already remarked in the introduction, the IBS treatment

guidelines in The Merck Manual represent what's known as standard of

care, or " a diagnostic and treatment process that a clinician should

follow for a certain type of patient, illness, or clinical

circumstance, " according to the Webster's Medical Dictionary.

This " standard of care " approach is taught in medical schools and

residencies, and followed closely by the majority of the U.S. medical

doctors, who (a) may not know another (or better) approach, and/or

( use it to insulate themselves from malpractice lawsuits by

deferring to their own training, peer-reviewed protocols, and said

standard of care.

It's important to note that the " standard of care " doesn't mean " best

care, " " effective care, " or even " good care. " At best, it reflects

the current consensus and prevailing groupthink of individuals and

institutions, which profit from the treatment (or mistreatment in the

case of IBS) of GI disorders.

Unlike The Merck Manual and similar references, this page enumerates

in plain language the exact physiological causes of irritable bowel

syndrome and offers effective, inexpensive, and self-administered

treatment guidelines which provide full and rapid recovery, assuming

your condition hasn't progressed far beyond IBS.

Even then, you still will find excellent (if not full) relief from

bloating, flatulence, constipation, diarrhea, cramps, and pain,

except it may take you longer, and you'll need to manage intercurrent

conditions, such as hemorrhoids, anal fissures, or diverticulosis,

more attentively.

I encourage you to share the information on this site and in Fiber

Menace with your physicians. They won't find anything contradictory

in these texts to the tenets of human anatomy, physiology, biology,

biochemistry, and pathology. To help them (and you), this site as

well as my books, are all thoroughly referenced and, with few

exceptions, accessible over the Internet.

Throughout the years, scores of medical professionals have read my

books, heard my radio talk shows, attended my seminars, and

scrutinized my web publications, and not one, I repeat, not a single

one has ever sent me a note pointing out an error in my analysis or

recommendations.

If anything, I am hearing back praise and encouragement — doctors and

nurses are people too, and they suffer from digestive disorders just

as much or more (because they are more likely to follow Merck-type

advise) as the general population.

There are no risk or side-effects associated with any of my

recommendations because I do not propose drugs, lopsided diets, or

invasive procedures. Your only risk is to ignore them, and progress

to inflammatory bowel diseases such as ulcerative colitis or Crohn's

disease, or degenerative diseases of the GI tract, such as enlarged

hemorrhoids, diverticulosis, or colorectal cancers.

Some readers, particularly medical professionals trained in the so

called evidence-based medicine, may respond to these claims with a

well-expected challenge: Mr. Monastyrsky, prove it!

Actually, it would be against the laws of medical ethics (as well as

civil and criminal statutes) to conduct a randomized controlled

medical trial with a known negative outcome (for patients in the

control group who would follow the Merck's guidelines).

IBS is classified by Merck as constipation-predominant or diarrhea-

predominant. Some people are diagnosed with IBS without experiencing

either constipation or diarrhea. Your steps to recovery will depend

on your particular type:

Step 1. Wean yourself off fiber. If you have been consuming dietary

fiber or taking fiber laxatives, you'll have to break the dependence

on these substances first because it's impossible to overcome IBS

while consuming fiber. Skip this step if it isn't applicable in your

case. Follow the recommendations in the Overcoming Fiber Dependence

guide.

Step 2-A. Normalize stools for constipation-predominant IBS. Follow

the recommendation in the Constipation guide. As soon as you complete

this step, you'll find substantial relief from flatulence, bloating,

abdominal pain, and cramps.

Step 2-B. Normalize stools for diarrhea-predominant IBS. Follow the

recommendations in the Diarrhea guide (will be released mid-June

2008). Your diarrhea will abate shortly after commencing this step,

but this time around you won't have to face constipation.

Step 2-C: Normalize stools for IBS without either constipation or

diarrhea. This condition is common in younger people, and explained

here. In this case, proceed with the Colorectal Recovery Program.

Step 3. Restore intestinal flora and heal bowel inflammation (if

any). This step restores proper colon ecology and stool morphology,

and protects you from IBD, polyps, and colorectal cancer. Follow the

recommendations in the Restoring Intestinal Flora guide.

Step 4. Restore anorectal sensitivity. This step is essential for

late stage IBS, particularly constipation or diarrhea-predominant,

because both conditions damage anorectal sensitivity, so you don't

experience the defecation urge sensation. This sensation is important

to maintain regularity and enjoy a complete emptying of the bowels.

Follow the recommendations in the Restoring Anorectal Sensitivity

guide.

Step 5. Stabilize and maintain your recovery. This isn't, really, a

step, but a final and ongoing process. Use all of the available

information on this site and in Fiber Menace to prevent an IBS

relapse.

You should see and feel improvements soon after you start. Depending

on your age and degree of acquired, organic (irreversible) damage, it

takes from three to six months to become completely free from IBS and

its most bothersome and offensive symptoms.

It takes considerably more time to desynthesize hypersensitive nerves

(visceral hyperalgesia) inside your abdomen; to reverse

unconditional, endocrine reflexes (excessive secretion of certain

substances in the anticipation of food and stress); to reduce

autoimmune reactions to common food allergens; and to readjust to a

new style of nutrition. Just as with IBS itself, the actual length of

time will depend on your age, health, and a degree of commitment and

compliance with proper diet and supplements.

If you are relatively young and healthy, you won't have to think much

about IBS after full recovery. For older people with a long history

of IBS, staying free from IBS will require life-long commitment and

vigilance. Whatever it takes, it's better to be healthy and a bit

preoccupied with your diet and colon, than to be in pain, unhealthy,

miserable, on a diet, and preoccupied with your colon even more. That

is, if you still have it!

Nutritional Guidelines for IBS

The optimal nutrition for IBS depends on your age, health, and extent

of your condition. " Optimal nutrition " means not just " best "

or " permitted " nutrients, but also the frequency of eating, food

preparation techniques, meal composition, and your ability to

properly digest consumed food.

These considerations are commonly ignored or overlooked in the

routine treatment of IBS. Consequentially, most people consume

presumably a " healthy " diet, but only to dig themselves into even

more problems.

Here are the principal recommendations:

Reduce frequency of eating to two, maximum three times daily. Do not

snack or drink fluids between meals. Do not chew gum. Why? Any time

you open up your mouth, and begin chewing and swallowing, the body

goes though the motions of the gastrocolic reflex and mass

peristalsis, or a contraction of the entire digestive tract. These

contractions are the primary cause of cramping and abdominal pains.

The common dietary advice for people with IBS is the complete

opposite — eat smaller portions more often, snack between meals,

drink plenty of fluids, etc. This commonplace ignorance has little to

do with either IBS or the physiology of digestion.

Eliminate hard-to-digest proteins. These are casein — a protein found

in dairy (milk, ice cream, cream cheese) and gluten — a protein found

in wheat, oats, bran, barley, malt, ice creams, processed meats

(chicken nuggets), gravies, brewer's yeast, and derivative products

(bread, pasta, morning cereals, beer, soy sauce, cakes, pastries,

etc.)

Why? Because humans lack enzymes to digest these proteins, and they

are highly allergenic, particularly for people with digestive

disorders. When undigested proteins pass into intestines, they

petrify (rot), cause gases, bloating, and low-level poisoning

expressed as severe fatigue, foul mood, muscle pain, nausea, and so

on.

Adapt your diet content and volume to your age. Most adults past 45-

50 years old, particularly in the United States, suffer from age

onset gastric deficiency (AOGD, a term I coined), or a low level of

digestive enzymes and gastric acid in the stomach.

This condition causes indigestion, heartburn, delayed stomach

emptying, hiatus- hernia, gastritis, duodenitis, peptic ulcers,

stomach and esophageal cancers, and so on. AOGD is exacerbated by

antacid medication, alcohol, mixed meals, overeating, frequent

eating, inadequate chewing (habitual bad teeth, poor fitting

dentures), and overhydration. AOGD starts a chain of events which

lead to a condition known as gastroenterocolitis, or an inflammatory

disease of the entire GI tract.

There is only one way to adapt to AOGD: reduce the number of daily

meals to two, maximum three; do not eat mixed meals (i.e. proteins

and carbohydrates); eat protein-containing meals once daily (the last

meal is best), and follow other rules described on this site and in

my books. This approach is described in detail in Fiber Menace,

chapter X...

Always consume fluids 30 to 60 minutes before meals. This allows

water to pass the stomach chamber into the small intestine and get

assimilated there almost immediately. Any fluids consumed after meals

remain " locked " in the stomach until digestion is complete, hence you

can't easily satisfy thirst even if you drink plenty of fluids.

Excess fluids dilute already deficient gastric juices and cause

indigestion or delayed digestion. Healthy children and young adults

can consume plentiful fluids with meals or after with apparent

impunity because they have smaller (less stretched out) stomachs, so

the excess fluids are " pushed " out into the small intestine; they

enjoy better teeth, and have a much higher level of acid and enzymes

in the digestive juices.

Take recommended professional-grade supplements and, if necessary

digestive enzymes. They are essential to augment nutrients and

enzymes missing from any restricted diet; to recover from long-term

malnutrition caused by IBS and IBD; and to compensate for age- and

disease-related problems with the assimilation of micronutrients.

There is a great deal of talk going on about supplements causing

harm. If you consider the sub-par quality of consumer-grade

supplements that most people are taking, this talk is fully

justified. [link]

Maintaining proper nutrition is one of the most difficult tasks for

any person affected by digestive disorders. It isn't because there is

anything specific or particular about it, but because eating (and

overeating) became social phenomena; because it's so hard to keep a

separate diet from a healthy partner; because restaurants don't cater

to people with digestive disorders; because most presumably healthy

foods are atrocious, industrial junk; because the art and habit of

simple and nutritious home cooking has been lost by most Americans

born and raised in the fast-food era; because there are so many

enticements to overconsume; and because so many people refuse to

acknowledge their aging bodies, and fail to adjust to new realities.

In any event, when confronted with the choice of " keeping up with the

es " vis-à-vis living without IBS, drugs, and fear of colon

cancer, I hope you'll chose the latter. And if you are still

relatively young, and your experience with IBS is brief and fleeting,

most likely you'll be able to continue eating with blissful (or

reckless) abandon for a good chunk of time. Assuming, of course, that

you fix the IBS first, stay off fiber, and guard your gut from foxes.

The FAQ section below expands nutritional guidelines considerably. I

also recommend to review the rest of this site, and the discussion of

transition away from fiber-dependent diet in the Chapter 11, Avoiding

the Perils of Transition of Fiber Menace.

***

Frequently Asked Questions about IBS

Q. Why doctors can't find anything wrong with IBS patients?

Q. What is the difference in treatment between diarrhea- and

constipation-predominant IBS.

Q. How come I was diagnosed with IBS while I have never been

constipated or had diarrhea?

Q. How can I distinguish IBS from IBD?

Q. What's the difference between just " bloating " vis-à-vis " bloating

and flatulence? "

Q. Why do antibiotics reduce cramping and bloating related to IBS and

IBD?

Q. What's a difference between the role of soluble and insoluble

fiber in the pathogenesis of IBS?

Q. Why people with IBS are advised to avoid fats?

Q. Does stress contribute to IBS? Is there indeed a psychosocial

aspect to IBS?

Q. So what's the role of psychotherapy in all this? Is it a fluke or

it has some role?

Q. Is smoking bad for IBS?

Q. What about alcohol? Is it bad for IBS?

Q. What's so special about table wines, and what it has to do with

IBS?

Q. Why do you know all this and doctors don't?

Q. Why doctors can't find anything wrong with IBS patients?

Doctors, particularly in the United States, are trained to look for

physical manifestations, such as inflammation, obstruction, or

bleeding. But, for a while, IBS displays none, particularly in

younger patients.

Despite this common knowledge, the diagnosing of IBS allows for a ton

of billable services to seek out " the clues: "

" CBC [complete blood count], biochemical profile (including liver

tests), ESR [erythrocyte sedimentation rate], stool examination for

ova and parasites (in those with diarrhea predominance), thyroid-

stimulating hormone and Ca for those with constipation, and flexible

sigmoidoscopy or colonoscopy should be done " — advises Merck, and

piles up even more tests to " test the tests: "

" Additional studies (such as ultrasound, CT [computer tomography],

barium enema x-ray, upper GI esophagogastroduodenoscopy, and small-

bowel x-rays) should be undertaken only when there are other

objective abnormalities " .

All in all, that's several thousand dollars worth of mostly

irrelevant testing, which in the case of " true " IBS will reveal

little or nothing, and in all cases will cause even more colorectal

damage from x-ray radiation, laxatives used to lavage the intestines

before colonoscopy or CT, and anesthesia administered during

colonoscopy.

Merck even says this much: " Many patients with IBS are overtested " .

But the only true and relevant diagnostic criteria of IBS —

disbacteriosis, stool size, stool density, and internal hemorrhoids

and straining (both may be absent in younger patients)— aren't

considered.

Q. What is the difference in treatment between diarrhea- and

constipation-predominant IBS.

In general terms, diarrhea-predominant IBS is a greater problem than

constipation-predominant, because diarrhea suggests the presence of

inflammatory disease in the large intestine. Whenever the mucosal

membrane is affected by inflammation, it fails to remove fluids from

feces and form stools. The ensuing accumulation of fluids causes

diarrhea.

In terms of actual recovery, patients with diarrhea-predominant IBS

require a guarded diet to eliminate food allergens and inflammation

triggers, such as soluble fiber, pectin, sorbitol, and others.

Also, these patients must be screened for fecal impaction (a cause of

paradoxical diarrhea), Clostridium difficile (a bacterial cause of

colitis), parasites, viral infections, biliary and pancreatic

disorders, and undergo the required medical treatment. That's where

the value of a skilled and attentive physician is paramount.

Some individuals, particularly children and young women, may

experience stress-related diarrhea for reasons explained here.

Obviously, it's impossible to eliminate stress, but it's possible to

learn how to redirect and reduce your response to it. More about it

here.

Q. How come I was diagnosed with IBS while I have never been

constipated or had diarrhea?

Constipation and diarrhea are late stage complications of IBS. When

IBS develops in younger people, they rarely experience constipation

or diarrhea, because they still have taught, supple, and functional

colons and rectums, sensitive anorectal plexes, undamaged anal

canals, and so they move their bowels like clockwork.

IBS itself begins with the gradual enlargement of stools either from

fiber, or from a mild inflammation of the intestinal mucosa caused by

the by-products of fiber fermentation, or from evolving food

allergies, or from the loss of intestinal flora, or from all of the

above.

At one point or another enlarged stools require moderate straining.

This, in turn, enlarges internal hemorrhoids (unbeknown to most until

late or at all) and constricts an already narrow anal canal even

more. This leads to incomplete emptying, further hardening of stools,

further enlarging of hemorrhoids, and more straining. Then, one day,

a person can't strain hard enough to move bowels at all for more than

three days. That's — no stools for more than three days — what The

Merck Manual calls constipation, and that's the definition that most

doctors and patients are saddled with.

It may take you 5, 10, 20, 30 or more years to reach that day,

depending on your doctor's directions, age, gender, diet, toilet

habits, degree of luck, and multitude of other factors discussed

throughout this site.

If prior to that moment you had uncomfortable stools every other day

or so, technically you were not constipated. Medically speaking, you

are " healthy " until day four! Before that — don't bother the doctors,

and take more fiber.

All of this would be really funny if it wasn't so tragic. You can

learn more about this charade doctors " play " with constipation here.

The role of fiber in the pathogenesis of colorectal disorders,

including IBS, is explained here.

Q. How can I distinguish IBS from IBD?

The " syndrome " in IBS stands for collection of symptoms that make up

this condition. Its' interpretation varies from textbook to textbook,

from reference to reference, and from doctor to doctor. In other

words, diagnosing IBS is a " free-for-all " enterprise, because there

are no actual physical attributes (i.e. inflammation, bleeding, high-

temperature, blood tests, etc.) to cling too.

Most of the IBS symptoms are also present in IBD (i.e. inflammatory

bowel disease). The primary distinguishing characteristics of early

stage IBD (i.e. before endoscopy shows inflammation) are: stools

close to diarrhea; excess mucus in stools; sustained, round-the-clock

bloating, but with less flatulence, typical for IBS because by this

time most of the bacteria are dead, and fermentable matter (i.e.

fiber, the source of gases) is rapidly disposed off during diarrhea.

Q. What's the difference between just " bloating " vis-à-vis " bloating

and flatulence? "

The absence of flatulence (i.e. gases) points out to disbacteriosis.

When flatus is present, the bloating results primarily from gases.

The bloating without gases (or with very little) indicates

inflammation of the mucosal membrane of the small and large

intestine.

This inflammatory condition traps gases and fluids (i.e. prevents

their absorption into blood), and increases the diameter of

intestines, particularly the small intestine. Because this organ is

so large (around 14 to 22 feet in adults) and so tightly packed

inside the abdominal cavity, even a small increase in its diameter

distends (pushes out) the abdominal wall, hence the " bloating. "

The gases in the small intestine are always naturally formed when the

acidic content of the stomach moves in, and gets neutralized by

pancreatic juices (bicarbonate).

The petrifaction (rotting) of undigested proteins may form gases too.

The gases in the large intestine are formed when undigested

carbohydrates (fibers, lactose, polysaccharides, sugar alcohols) get

fermented by bacteria.

Bacteria are often present in the lower small intestine (ileum), and

may form profuse gases there from fermentation too. These are usually

the most bothersome, because they have no place to escape.

The gases from large intestine may also escape into small intestine

whenever the ileocecal valve opens up to let the content of the small

intestine to pass into the large intestine.

Q. Why do antibiotics reduce cramping and bloating related to IBS and

IBD?

Antibiotics kill bacteria in the small and large intestine, and

terminate fermentation of undigested carbohydrates. This stops

fermentation and production of gases, alcohols, and fatty acids, and

helps subdue an inflammatory condition. In turn, the intestines

shrink and reduce internal pressure on internal organs.

Unfortunately, antibiotics also ruin normal colon ecology, and cause

problems, ranging from severe diarrhea to an equally severe

constipation. They also strip the intestinal membrane from it's

natural protectors (i.e. bacteria), reduce primary immunity

(phagocytosis), blood clotting, vitamin synthesis, and so on. So,

logically, you are better off excluding fiber and other sources of

undigested carbs to stop fermentation, rather than use an " atomic

bomb " approach to wipe out bacteria.

Besides, there are always some antibiotic-resistant mutant bacteria

(such as methicillin-resistant Staphylococcus aureus, MSRA) left

behind, and they are the ones who may eventually kill you,

particularly in the hospital settings. At this point, you have nobody

to thank, but the profit-driven " Big Pharma " and careless doctoring.

Q. What's a difference between the role of soluble and insoluble

fiber in the pathogenesis of IBS?

Insoluble fiber (bulking agent) makes stools large. Large stools

induce straining, straining causes the enlargement of internal

hemorrhoids, enlarged hemorrhoids cause incomplete emptying,

incomplete emptying causes impacted stools, impacted stools cause

abdominal cramps.

Soluble fiber (hydrophilic mucilloid) blocks the absorption of

digestive fluids. Blocked fluids, including astringent bile and

omnivorous enzymes, slip down into the large intestine, and wreak

havoc there. To cleanse itself of irritants and impacted stools, the

large intestine responds with profuse diarrhea. When the diarrhea is

over, the colon's examination shows no visible damage. Back on fiber,

and the cycle starts again.

Both fibers are fermentable. If the bacteria level is normal, soluble

fiber ferments 100%, insoluble — about 50% with normal motility,

almost 100% with slow motility (common in IBS).

In the overall scheme of things, soluble fiber is by far more

damaging then insoluble, except in the cases of (a) inflammatory

bowel disease (caused primarily by soluble fiber), and (

obstruction in young children and older adults. In the case of IBD —

because inflammation prevents water absorption and narrows the

passageway; in young children — because their internal organs as so

tiny and so easy to obstruct; and in older adults — because of slow

and inefficient peristalsis, often made worse by the indiscriminate

use of the systemic drugs, which may affect peristalsis even more.

Q. Why people with IBS are advised to avoid fats?

Along with advice to use fiber, this is one of the most damaging

recommendations in all of IBS-related dietary dogma. In fact, the

absence of fats makes IBS and its' side-effects much worse, and turns

it into IBDs. You can read more about the role of fats in digestion

and colorectal disorders here.

If anything, the absence of fats will cause more damage to your

entire digestive tract, health, and cause severe constipation (i.e. a

primary symptom of IBS), because dietary fats are essential for

regularity. You can read more about the role of fats in constipation

here.

It's true that dietary fats precipitate the gastrocolic reflex and

peristaltic mass movement — two conditions essential for normal

propulsion of food through the GI tract, normal stool formation, and

normal defecation. Indeed, this normal physiological effect of fat

precedes pain and cramping in impaired individuals, and results from

normal peristalsis encountering large stools and gases — an effect

similar to giving a shiatsu massage to your abdomen in the midst of

IBS relapse.

In the long-term, the " killing " or reducing of peristalsis by

restricting fats makes all IBS-related constipation even worse — more

constipation, more fecal impaction, larger stools, more gases, more

pain, more sensitivity to pain, stiffer, smooth muscles, and impaired

muscle contraction from severe calcium deficiency, because calcium

doesn't get assimilated without fat in the diet.

Q. Does stress contribute to IBS? Is there indeed a psychosocial

aspect to IBS?

Stress contributes to practically all disorders, not just IBS,

because the chemistry behind the stress response isn't merely mental

or perceptual, but endocrine — meaning any stress or even the

anticipation of stress elicits an unconscious secretion or over-

secretion of multiple stress hormones, which govern physical aspects

of the stress response. These are adrenalin, noradrenalin, cortisol,

and some others.

In the case of IBS, stress hormones inhibit gastric digestion and

intestinal propulsion (peristalsis). These two conditions predispose

people to a broad range of functional GI disorders. The most typical

ones are: nausea, vomiting, indigestion, heartburn, GERD, peptic

ulcers, bloating, abdominal cramps, and constipation or diarrhea,

depending on stress intensity and duration.

There are two core reasons behind all these happenings:

Elevated blood pressure compensation. Rapidly elevated blood pressure

in response to a sudden, strong stress event causes a near instant

release of excess blood plasma into the stomach and large intestine

lumen to normalize it. This is the body's " safety release valve " ,

essential to prevent blood vessels and capillaries from rupture.

Unfortunately, rapid stretching of the stomach with fluids stimulates

the vomiting center which causes nausea and vomiting. Similarly,

excess fluids in the colon flow downwards, stimulate the anal plexus

and provokes profuse diarrhea.

Impact on digestion and motility. Moderate or even low-level

sustained stress inhibits digestion and motility (peristaltic

propulsion of food and stools) in order to mobilize energy for a

flight-or-fight type of response. Sustained, long-term stress leads

to indigestion " on the top, " and constipation " on the bottom " because

nothing, literally, moves. Both conditions — indigestion and

constipation — contribute mightily to IBS and related digestive

disorders.

Can you do anything about it? Yes, you can. In cases of major stress

events, it's a matter of training and conditioning. Professional

soldiers don't soil their pants or vomit when they get fired at —

they duck, evade, and respond. If they can be trained to ignore

bullets, so can you to evade mother-in-law, ignore obnoxious co-

worker, and duck away from rude drivers, and there is plenty of

specialized literature, dedicated to this subject.

Moderate and/or extended stress must be managed with proper

nutritional " hygiene. " When exposed to stress of any modality or

duration, use the following rules:

Restrict proteins. While under severe or even moderate stress,

protein may not digest fully because stress hormones inhibit gastric

secretion and peristalsis. Restricting proteins allows you to prevent

indigestion, dyspepsia, food poisoning, and related complications.

This particular advice often elicits scorn and disdain from low-carb

zealots, particularly young turks with no formal training in medicine

or nutrition. One such turk wrote on his blog about my similar advice

to people with gastritis: " Smart and intelligent people can be very

stupid. " Well, kid, I'd rather be stupid and healthy, than smart and

dead. And so are my readers. This page (or my books) aren't about low-

carbing, but chronic digestive disorders.

Always hydrate (drink water) yourself on empty stomach. Stress causes

thirst because, initially, high level of stress hormones blocks

salivary glands, raises blood sugar, and this kicks in kidney to turn

gobs of blood plasma into urine. If your stomach is full with food,

don't flood it with more water because (a) it will inhibit digestion

even more; ( it may cause nausea and vomiting; and © it will not

satisfy your thirst because water can't get down into the intestines

to get assimilated. Instead, place something sweet into your mouth,

sweetness stimulates saliva secretion and this will make the thirst

less apparent.

Normalize blood sugar. After an initial spike of stress hormones,

blood sugar dives down considerably, and you may experience strong

cravings for sweets. If your stomach is already full, don't stuff it

with more food to get your sugar fix — they won't give you any

more " blood sugar " until carbs get down into the intestines. Instead,

use near instant sublingual glucose tablets, or dissolve a sugar

cube, or piece of chocolate under the tongue. You only need 2-3 grams

of glucose to stabilize low blood sugar, and, in this case, the

sublingual path is the fastest available (other than an I.V. drip).

Eat only if hungry. Don't eat your regular meals if you aren't

hungry — most people under stress aren't, except to satisfy their

sugar cravings. If you do eat, you aren't likely to digest those

foods anyway. So if you crave sugar, then get some sugar, not a

turkey sandwich.

Don't skip regular bowel movements. You aren't likely to experience

the defecation urge because stress inhibits intestinal peristalsis.

But missing even one bowel movement dries out and enlarges stools

already in the colon — a prescription for constipation. To stimulate

stools without straining, use the " helpers " described here.

As you can see, it isn't the stress per se, that causes IBS, but the

lack of knowledge and readiness to deal with it and its aftermath.

Well, now you know!

Q. So what's the role of psychotherapy in all this? Is it a fluke or

it has some role?

Yes, in a very limited way, but absolute " no " in all substantive

ways. Here is the drill:

— No, because psychotherapy can't eliminate the underlying, physical

causes of irritable bowel syndrome by pep talk and/or hypnosis alone.

— No, because psychotherapy can't completely rewire the innate,

evolutionary, fight-or-flight type of stress response even in the

most sophisticated, dedicated, and motivated individuals.

— No, because a shrink isn't a substitute for a normal poop.

— No, because wishful thinking is the worst treatment for internal

disorders with clear-cut physiological causes.

— Yes, because many cases of stress response are self-perpetuating —

i.e. fear breeds more fear. Assuming you can find and afford a

skilled enough psychologist to break that endless loop, yes, it helps

a great deal.

— Yes, because you can learn (or be taught) to respond to stress in a

less self-destructive and agonizing way.

— Yes, because psychotherapy and related approaches (yoga,

meditation, prayer, controlled breathing, chants, etc.) do offer a

palliative, temporary release from acute pain. This effect results

from the general relaxation and temporary reduction of stress

hormones.

But, as I have already said, you can't chase away excess gases and

large stools, or plant back missing bacteria by using palliative

psychology any more than you can fill a cavity with hypnosis or

reverse breast cancer with motivational therapy.

Q. Is smoking bad for IBS?

Yes, it is, because smoking stimulates saliva secretion. In turn,

smoke-laced saliva gets swallowed, and stimulates the secretion of

gastric juices, gastrocolic reflex, and peristaltic mass movement —

the precursors to abdominal cramps and/or diarrhea. That's,

incidentally, why people are told not to smoke on empty stomach.

Interestingly, my own bout with severe IBS started soon after I quit

smoking in 1984, but for exactly the opposite reasons — I no longer

had sufficient stimulation of intestinal peristalsis to initiate

regular bowel movements, skipped few, became chronically constipated,

and started to rely on fiber laxatives, such as Metamucil, to move my

bowels.

Q. What about alcohol? Is it bad for IBS?

In general, yes, it's bad for IBS, particularly during acute stages.

Lets review the reasons:

First, alcoholic beverages in themselves are fluids which inhibit

gastric digestion when consumed in excess with or after food. The

side effects of indigestion and related complications inevitably

boomerang to IBS.

Second, excessive alcohol (whenever you feel the buzz) inhibits

digestive tract peristalsis. For this reason you may actually feel a

temporary relief from abdominal pain and cramping. But, just like in

the case with Imodium, poor contraction contributes to constipation.

Third, alcohol in excess causes dehydration and sodium loss because

large intestine is very effective at recovering every bit of moisture

and sodium from stools. This particular aspect of alcohol-related

dehydration dries out stools, causes constipation, and may contribute

to IBS.

When dehydration and sodium loss become extreme, you may actually

experience diarrhea because of sodium-potassium blood disbalance. To

compensate, the body dumps excess potassium (along with gobs of

plasma, of course) into the colon's lumen. This, in turn, causes

profuse diarrhea, which dehydrates you even more.

A similar chain of events (sans alcohol) causes runner's diarrhea.

Western athletes listen to that stupid advice and load themselves up

with Gatorade — a potassium- and sugar-rich drink — before and while

running. No wonder, the diminutive Kenyans win all these darn

marathons — they don't have sports medicine doctors or Gatorade in

Kenya yet to compromise their health and performance. To be fair,

Gatorade contains sodium, but not enough to compensate its losses

with sweat during actual races.

To my amazement, the cause of runner's diarrhea is still (2008)

considered unknown. Well, not anymore. To prevent dehydration and

diarrhea, load up on salt before the race because sodium is essential

for water retention. That's why the hospital I.V. drip contains 0.9%

of sodium chloride, not potassium. For the same reasons, pickles and

brine are so " therapeutic " after a sauna or for a hangover. Who, but

the Russians, would know all that...

Fourth, alcohol affects the liver function. This, in turn, may cause

a profuse release of bile — the body's way of removing offensive

metabolites. This action causes an almost immediate diarrhea, which

may lead to constipation, and contribute to IBS.

Fifth, some alcoholic beverages are highly allergenic to sensitive

individuals. The biggest offenders are: beer for gluten-sensitive

individuals (most people with IBS are); tonic mixed with gin from

allergies to quinine; sulfites in wines, cognacs, and aged scotch,

which may cause diarrhea; loads of fiber in V-8 added to `Bloody

,' and probably many others.

Six, alcohol lowers blood sugar (this, actually, causes drunkenness).

In turn, low blood sugar raises the levels of insulin and that's what

makes some drunk people so angry and aggressive, as it raises their

levels of stress hormone. These two simultaneous actions stimulate

appetite on the one hand, and inhibit digestion on the other, and

that's what is causing nausea, vomiting, and hangovers. One bad binge

may easily precipitate IBS, particularly in middle-aged persons who

aren't adept at hard drinking. Younger people are less vulnerable,

because, for a while, they enjoy " guts of steel. "

Will you get harmed by a glass of wine along with dinner? Probably

not, for as long as you are drinking French or Italian table wines,

vin de table and vino da tavola, respectively.

Q. What's so special about table wines, and what it has to do with

IBS?

Vintage (or quality by the European Union definition) wines are aged

in oak casks. New wine casks are treated with sulfites to prevent

expensive oak wood from rotting. Aging infuses wines with these

sulfites. Unlike vintage, table wines are made and kept in stainless

steel vats, and they never get exposed to oak impregnated with

sulfites.

The less scrupulous producers of inexpensive table wines (and often

vintage wines too), add extra sulfites to prevent spoilage, so these

wines can be shipped, sold, and stored without regard to temperature

almost indefinitely.

This practice is widespread outside of the European Union, but

particularly in the United States and Latin America. For this reason

I never touch American wines, unless the label says " Organic. " This

way I am assured of having good night sleep and clear head

the " morning after. "

Sulfites are very strong allergens. Just like MSG, they produce a

very unpleasant " histamine flush, " which is what causes its' nasty

after-effects, such as migraine, insomnia, nausea, dizziness,

sweating, tachycardia, wheezing, hives, pale skin, and even

anaphylaxis in hypersensitive individuals. Unfortunately, histamine

intensifies inflammatory conditions, which are prevalent in people

with IBS.

It's not such a big deal in the United States where the culture of

daily wine drinking was all but non-existent until very recently and

the drinking age is 21. But it is (big deal) for French or Italians

who drink table wines with practically every meal and literally from

birth (though diluted).

No wonder they can't afford experiencing daily hangovers or

anaphylactic shock, particularly among children. For these reasons

adding sulfites to table wine intentionally may get one into prison

in France, while in the United States it's taught in winery courses

as " good business. "

You'll still see the " Contains Sulfites " statement on practically all

wine labels, table or not, because, apparently, they occur in wines

naturally. I say " apparently, " because I don't believe this is true.

But it's cheaper for the E.U.-based winemakers and distributors to

comply with the U.S. labeling regulations, than to certify their

wines as " organic " or " sulfites-free. " After all, table (a.k.a. jug)

wines are bought mainly on price, not the quality or purity of

content.

Histamine receptors (H2) play an important role in the secretion of

gastric juices, and, correspondingly, in digestion. For these reasons

sulfites and alcohol may cause dyspepsia — a general term for

unspecific stomach distress. This condition is particularly harmful

to people already affected by irritable bowel syndrome or

inflammatory bowel diseases.

In general, if you have already developed an allergic reaction to

sulfites in wines, you may react adversely even to " clean " wines —

immune system commonly produces antibodies to other wine components,

and retains this " body memory " for a considerable length of time. In

this case, you are better off skipping alcoholic beverages aged in

casks, such as wines, ports, champagnes, vermouths, sakes, cognacs,

whiskeys (scotches), and others.

— What's left? Any good triple-distilled vodka, such as Smirnoff. And

don't waste your money on all those " gourmet " vodkas in artisan

bottles. Many of those have that discerning taste precisely because

they are inadequately distilled and are more likely to cause

hangovers. Only this time around, it isn't from added sulfites, but

from toxic alcohols other than ethanol (i.e. pure alcohol).

So, show me some wine (scotch, cognac, etc.) `cognoscenti' — those

snobbish and oftentimes arrogant guys, and nowadays, gals too — who

swoon over aged bottles of expensive grape juice or malted barley,

and discuss " notes " the way mere mortals deconstruct Angelina Jolie

of early vintage, and I'll show you a fool in the high-risk group for

IBS, IBD, peptic ulcers, and digestive cancers.

How come the French get away with it? Well, actually, they don't. The

rate of digestive cancers in France is quite high as well, but it has

to do more with smoking than wine. Besides, even when the French

drink vintage wines on special occasions or after dinner, they do so

by the sip, not by the goblet, the way the `nouveau riche' drink

nowadays.

— What do I drink? Lately, I don't, because alcohol interferes with

my writing, energy, mood, and sleep. The only exception — when we are

going out for sashimi. In this case, I'll have a glass of sake in

order to sterilize raw fish with alcohol. I also always take with me

MSG and gluten-free soy sauce. Just like sulfites, both of these

substances are an absolute no-no for people with IBS, IBD, or a past

history of both.

Q. Why do you know all this and doctors don't?

I don't know any more about " all this " than most doctors,

particularly board certified gastroenterologists, gastric

oncologists, or endoscopists, except that I am better trained to

research and analyze broadly available information and research,

investigate inconsistencies, connect the dots, and describe my

findings in accessible language.

All of the background information I rely upon is described in

exceptional depth in primary medical texts as well as medical

references, including The Merck Manual, which I quote so often. I

learned most of these basic facts back in the seventies in medical

schools from textbooks authored decades earlier, and from professors

trained before World War II.

If a medical doctor doesn't know " all this " basic information about

human digestion, he/she wouldn't be able to pass a licensing board

exam. So this question should really ask: " Why doctors don't use all

this information to treat patients? "

Well, some do, particularly outside of the United States. Since most

of the healthcare delivery in the United States is orchestrated by

pharmaceutical companies, which publish the majority of textbooks and

references, administer continuous medical education (CME) courses,

design and administer licensing exams, and own or sponsor most of the

medical publications and web sites, doctors are trained to rely more

on tests and drugs, than on inexpensive and truly effective solutions.

Besides, it's faster and easier to write prescriptions; drugs offer

quick relief to patients and create an aura of competence; and the

drugs' side effects bring a ton more repeat business soon thereafter.

So why kill the bonanza writing web pages (such as this), or waste

valuable " face " time teaching patients the fine points of stools?

In the doctors' defense, I have to say this: the majority of their

patients don't give a damn about the causes of their diseases; don't

care to learn how to eliminate these causes, don't want to change

anything in their lives and diets, and prefer an instant fix with

this or that pill, ideally for free.

Naturally, doctors, insurers, and pharmaceutical companies respond

to " market pressures " just like any other business worth its salt

would — they give their customers what they want! It's good business,

and, besides, it's great for business.

If you have read this page this far, you are a welcome exception. So

don't be a dupe, do the right thing, don't dwell far too long over

things outside of your circles of control and influence, and show

others the way simply by getting well. It sure beats popping pills,

wearing a colectomy bag, or bleeding to death.

***

Author's note

I suffered from IBS most of my adult life. I can easily trace its

origins to my mother's insistence that I never use public restrooms,

to indiscriminate use of antibiotics before I became aware of their

perils, to dental amalgams that I briefly had, to fiber laxatives

that I took for chronic constipation, and, finally, to years of a

high-fiber, vegetarian diet.

I am IBS-free for almost a decade now, but not entirely out of the

woods. By the time I had learned all this, lots of internal damage

had already been " set in stone: " irreversible hemorrhoidal disease,

anorectal nerve damage, hypersensitivity to gluten, and the remnants

of Crohn's disease easily triggered by traces of gluten, stress, or

fatigue.

So my interest in and the knowledge of this subject is far from

abstract — I am not exactly a nun teaching sex education class from

textbooks written by a celibate monk.

Still, one man's journey through hell isn't enough to plot a path to

heaven for another... That's why my work is so explicitly thorough,

referenced, and detailed, and why it took me almost ten years after

my own complete recovery from IBS to contemplate, research, and write

this page.

Good luck and be well,

Konstantin Monastyrsky

Commentaries

[1] Re: " the causes of IBS are still a mystery "

There is nothing mysterious about IBS. Its causes are well-known and

well-studied functional conditions, such as disbacteriosis,

suppression of stools, hard stools, excess dietary fiber, common food

allergens, laxatives, the side effects of medications, and some

others. All of them can be reversed reasonably well, with minimal

effort, and without a doctor.

The Merck Manual, on the other hand, recommends screening patients

for inflammations, ulcers, polyps, and other pathologies with IBS-

like symptoms.

This approach is similar to using radiology (x-rays) and endoscopy to

diagnose indigestion, while ignoring to check for inadequate acidity,

low enzymes, bad diet, and poor-fitting dentures — the four principal

causes of bad digestion. No wonder then, when gastritis or ulcers

aren't found, indigestion too becomes a mystery.

None of it is surprising. In the general paradigm of allopathic

medicine (which forms Merck's diagnostic and treatment framework),

the disease isn't a disease, unless it has a diagnostic procedure or

drug treatment attached to it.

Unfortunately for patients with IBS — a functional condition

completely outside of Merck's framework — this reality introduces

harmful diagnostic procedures, the side effects of unnecessary drugs,

and more health problems down the road.

[back]

[2] Re: Aggressive medical treatment of inflammatory bowel disease

A nutritional approach to GI disorders described on this site and in

Fiber Menace may be effective for the early stages of ulcerative

colitis, and should always be tried before starting " shock and awe "

treatment with antibiotics, steroids, and immunodepressants.

It may also enhance the treatment and improve the outlook of Crohn's

disease, but not really " fix it, " because this condition has a

significant autoimmune component that can't be controlled by diet

alone.

This approach works well because a great deal of U.C.-related

intestinal inflammation may result from gastroenteritis, so a gradual

recovery must begin at the very top of the digestive tract.

Later stages of U.C. require a more thorough and intensive therapy,

determined by your physician. But the nutritional approach is the

same.

Originally, I described nutritional intervention for ulcerative

colitis in my earlier Russian-language books. According to limited

accounts from readers who followed it, they have recovered and

remained in remission for as long as they maintained vigilance —

ulcerative colitis may be easily set off again by preexisting trigger

factors.

[back]

[3] Re: " Criticism " of The Merck Manual of Diagnosis and Therapy

Some people may get mad at me for suggesting that their revered Merck

Manual may be wrong, and who am I to criticize it?

Most of the Merck Manual's shortcomings and biases are heavily

influenced by the drugs-driven ways of it's publisher and a charter

member of the Big Pharma — Merck & Co. Inc. The borderline between

influence and profit is a very narrow one, and it forms an approach

that may initially have good intentions, but not necessarily good

outcomes.

Besides, if Merck & Co. could err so " deadly " with Vioxx or Fosamax,

they can err just as much with The Merck Manual, because its

editorial and professional scrutiny is nowhere near the hoops

reserved for prescription drugs prior to their review by the FDA.

To be truly credible, trustworthy, and useful to doctors and patients

alike, The Merck Manual should be fully divested from its ignominious

parent, and obliged to follow rules of disclosure and transparency

similar to the rest of the academic medical press.

[Guest guest]

That was an good read for me this morning. I'm a little tired,

though, being that I was at the ER until 4 am! because of my IBS! I

thought there was a possibility of appendicitis, but x-rays revealed

it to be backed up formed stool in my ascending colon. which was

leading to the pain in my right side. boy, I'm more messed up that I

thought I've been on the specific carb diet for about 6 months and

thought that I was making good progress until this weekend. we

traveled and I was probably neglecting to drink enough water. couple

that with 2 picnics yesterday and bam...dehydration. which has

probably made the constipation more severe

So, when I'm a little more awake, I plan to read that whole article.

right now, though, I " m off to bed. Thank goodness school is still in

session...that takes care of ryan and I have a really understanding

neighbor entertaining my 3 year old.

Kari

>

> I am posting this info as I think it may be useful to many on this

> site. This same forensic nutritionist/researcher will be publishing

> about diahrea predominant IBS in June....

>

> IRRITABLE BOWEL SYNDROME

>

> by Konstantin Monastyrsky

>

> This guide debunks universally accepted view that the causes of

> irritable bowel syndrome are unknown, describes them one by one, and

> explains how to eliminate each one safely and permanently. This

> information is particularly important for persons in high-risk group

> for ulcerative colitis, Crohn's disease, and colon cancer because the

> conventional diagnostic and treatment of IBS raises these risks

> considerably.

>

> According to the 2007 edition of the world's leading medical

> reference — The Merck Manual of Diagnosis and Therapy— the causes of

> irritable bowel syndrome are still unknown, as you can clearly see

> from this illustration (modified to fit this page, click picture to

> view actual page):

>

>

>

> Though it's hard to accept that in the era of routine heart

> transplantation the causes of IBS are still a mystery(1), it's even

> harder to stomach that the recommended treatment makes IBS

> worse. " Patients with IBS may subsequently develop additional GI

> disorders, " — says the Merck Manual.

>

> By additional they mean inflammatory bowel disease (IBD) — the

> progenitor of ulcerative colitis and Crohn's disease. In these cases,

> close to half of all patients end up needing colectomy — a surgical

> removal of the large intestine. This is the only way to stop these

> patients from bleeding to death.

>

> Even when patients do get spared these uncontrollable bleedings with

> aggressive medical therapies(2) , such as immunodepressants,

> antibiotics, and steroids, those nasty IBDs increase the risk of

> colon cancer up to thirty two times (3,200%).

>

> To prevent almost inevitable cancer, patients are commonly

> recommended a prophylactic colectomy " just in case. " When choosing

> between an almost certain death from cancer and an undergarment

> colectomy bag, most chose the bag.

>

> Live by the book, die by the book, literally...

>

> The Merck Manual represents what's known as " standards of care. "

> These standards, in turn, are scrupulously followed by doctors who

> wish to deliver " the best possible care " to their patients. The

> problem is — when a standard is wrong, as is the case with IBS, the

> best possible care invariably turns into the worst possible nightmare.

>

> If you happens to have IBS, and are uninsured or have limited access

> to medical care, you are safer and better off untreated than those

> well insured and, presumably, more fortunate, who will be on the

> receiving end of the Merck-recommended treatment:

>

>

>

> I realize, you may find this information disturbing, but, so far,

> unsubstantiated. So lets begin by deconstructing this doctor-speak

> with surprisingly bad grammar into plain English (3):

>

> Q. What has " support and understanding " to do with bowel disease?

>

> According to the Merck Manual, IBS is a partially " psychosocial "

> condition. Essentially, this means that patients with IBS are

> psychotic individuals, whose own mental attitudes contribute to

> intermittent constipation, diarrhea, and abdominal pain.

>

> This is junk science at it's worse — irritable bowel syndrome is a

> 100% physiological condition, not psychosocial. If anything, the

> constant pain, suffering, and bad treatment may turn IBS victims into

> psychotic wrecks, but not the other way around.

>

> It's true that stress plays a role in IBS unfolding (as well as in

> practically all other human ills), but not in ways that can be

> effectively treated by psychological (hypnosis, counseling) or

> psychiatric (prescription drugs) intervention. You can learn more

> about the role of stress in IBS, and how to counteract its impact on

> digestive disorders here.

>

> Q. What does " normal diet, avoiding gas-producing and diarrhea-

> producing foods " mean?

>

> The primary " gas-producing " foods are indigestible carbohydrates,

> that get fermented in the large intestine by innate, beneficial, and

> essential gut bacteria (microflora). Two of the most prominent

> indigestible carbohydrates are dietary fiber and lactose (milk sugar)

> [link].

>

> The primary " diarrhea-producing " foods are sugar alcohols, such as

> sorbitol, found in bananas and prunes; soluble fiber, such as pectin

> found in apples and oranges; beta-D-glucan found in oats, numerous

> unnamed polysaccharides found in most plants and psyllium laxatives;

> and fiber fillers and stabilizers found in practically all processed

> food, such as guar gum, carrageen, cellulose gum, inulin, and

> numerous others [link].

>

> In essence, this advice means to avoid the following: dairy because

> of lactose and fiber stabilizers (yogurt, ice cream, sour cream,

> cream cheese); fruits rich in pectin (oranges, apples); fruits rich

> in sugar alcohols (bananas, prunes, prune juice), and food rich in

> fiber (oatmeal, morning cereals, bran, whole wheat bread, pasta),

> fiber laxatives; and all processed food with fiber additives.

>

> This is good and easy advice to follow until you consider their next

> recommendation...

>

> Q. How come they recommend " Increased fiber intake for constipation, "

> if fiber is a well-known gas- and diarrhea-producing substance?

>

> To me, that's either the biggest " medical mystery " , or the

> biggest " medical idiocy, " or simply outrageous negligence, or,

> perhaps, all of the above. In fact, to unravel this mind-boggling

> incongruity for myself and others, I wrote a book entitled " Fiber

> Menace: The Truth About the Leading Role of Fiber in Diet Failure,

> Constipation, Hemorrhoids, Irritable Bowel Syndrome, Ulcerative

> Colitis, Crohn's Disease, and Colon Cancer " , and you are welcome to

> read it.

>

> If you are a skeptical medical professional reading this, and, all

> things considered, I don't blame you a bit for being skeptical,

> consider the following two quotes from the American College of

> Gastroenterology Functional Gastrointestinal Disorders Task Force

> [link]:

>

> " Fiber doesn't relieve chronic constipation and all legitimate

> clinical trials demonstrated no improvement in stool frequency or

> consistency when compared with placebo. "

>

> " In the management of IBS, psyllium is similar to placebo. In fact,

> the bloating associated with psyllium use will likely worsen symptoms

> in an IBS patient. "

>

> Psyllium is a source of soluble and insoluble fibers found in

> Metamucil-type laxatives, and their digestive properties are

> identical to all other types of fiber.

>

> Q. Will Loperamide (Imodium) enable IBS recovery?

>

> No, it will not. It may temporarily stop diarrhea by literally

> paralyzing your intestines, but only to cause severe constipation,

> because, along with " dizziness, drowsiness, [and] tiredness " ,

> constipation is the most immediate and prominent side effect of

> Imodium.

>

> Of course, for me — a former pharmacist — there is no surprise here.

> Imodium is a synthetic opioid (opium-like drug). Just like all

> opioids, it " kills " the contraction of circular and longitudinal

> smooth muscles, which line up the stomach, esophagus, intestines,

> bowel, and major blood vessels. This effectively stops the propulsion

> of food and feces throughout the entire digestive tract, and, in

> turn, causes more constipation, more indigestion, more bloating, more

> flatulence, and stronger cramps.

>

> Just like all opioids, Imodium diminishes blood circulation and

> oxygen delivery to the brain. This causes dizziness, drowsiness, and

> tiredness — depression-like symptoms.

>

> Q. Would " tricyclic antidepressants " help my depression and IBS?

>

> Well, since your doctor may think that you are affected by IBS

> because you are psychotic, and you are miserable from incessant

> abdominal pain caused by more fiber, and you are depressed from

> Imodium, these potent antidepressant drugs may indeed keep you away

> from the psychiatric ward [link].

>

> Funnily enough, constipation is one of tricyclics' most common side

> effects along with more drowsiness, dizziness, fatigue, and muscle

> and joint aches. So you quickly return to your doctor for even more

> support and understanding, more fiber to relieve constipation, more

> painkillers, more Imodium, and even more antidepressants.

>

> Q. Why does the conventional diagnosis of IBS increase the risk of

> colon cancer?

>

> Not just the colon, but any cancer! A visual examination of the large

> intestine (i.e. colonoscopy) requires a bowel prep — a thorough

> cleansing with synthetic laxatives. This procedure damages intestinal

> flora, disrupts stools, makes resuming normal bowel movements

> difficult, and may cause intestinal inflammation — the precursor of

> colorectal polyps and cancers.

>

> In addition to all of the side effects from a bowel prep for

> conventional colonoscopy, a single virtual colonoscopy (CT scan)

> exposes patients to radiation 2,000 to 3,000 times more potent than a

> single dental X-ray. This dose of radiation, according to the Federal

> Drugs Administration [link], increases a person's lifetime risk of

> any cancer to 20%, or one chance in five.

>

>

> With minor variations, these ineffective and risky diagnostic and

> treatment guidelines are repeated in endless medical textbooks,

> references, how-to books, and health-related web sites. Not

> surprisingly, according to the International Foundation for

> Functional Gastrointestinal Disorders, " irritable bowel syndrome

> (IBS) affects approximately 10-20% [30 to 60 million – ed.] of the

> general population. " Lets hope you aren't one of them, and if you

> are — lets get you out of this tangle before it's too late.

>

> ***

>

> At this juncture, you have three choices: (1) Do nothing, and get by

> with this or that irritating your gut for the rest of your life; (2)

> Continue with the conventional treatment I just described above, and

> face the music; or (3) Study this page, follow its recommendations,

> and recover from IBS.

>

> " Recover " doesn't mean that you'll be able to eat and drink with

> reckless abandon just like your happy-go-lucky buddies.

> Unfortunately, you won't and you can't because an extended history of

> IBS and, particularly, its conventional treatment causes damages that

> aren't completely reversible. So if eating and drinking with reckless

> abandon are your objectives, don't bother reading this any further —

> alas, I am not a magician.

>

> But if you are a realist, then to " recover " means that by following

> my recommendations: (1) you'll be free from abdominal pain and

> discomfort associated with IBS; (2) you'll be able to attain normal

> stools without laxatives in case of constipation, or fiber and

> medication in case of diarrhea; (3) you'll boost your immune system,

> energy, stamina, and overall health, and (4) you'll significantly

> reduce your chances of getting colorectal cancer.

>

> Depending on your age and overall health, you may also enjoy several

> unexpected benefits:

>

> Improved quality of life. Your energy levels and stamina may increase

> substantially, particularly from the elimination of pain-relievers,

> antibiotics, antidepressants, laxatives, and anti-diarrheal drugs.

> Most of these medicines are systemic, which means they affect your

> body and mind just as strongly as your bowels.

>

> Healthier children. If you have young children, you own positive

> experience will teach you and them the habits of colorectal health

> (gut sense), and they will grow up healthier, stronger, and well

> prepared to today's demanding and competitive world.

>

> Higher income. Your work performance and career will enjoy a

> considerable boost because it's next to impossible to be productive,

> efficient, and sociable while suffering from insomnia, or

> experiencing day-long abdominal discomfort and flatus, or being

> affected by mind-altering drugs.

>

> Reproductive health. If you are a woman, you may find relief from

> PMS — an oftentimes IBS-related condition. If you can't conceive a

> child without any organic cause, or have been experiencing

> spontaneous miscarriages, you may be able to overcome these two

> devastating problems as well.

>

> Better sex life. If you are sexually active, your sex life will

> improve dramatically, because you'll be free of bloating, flatulence,

> and abdominal pain, which are particularly bothersome during

> intercourse. You'll also may experience stronger orgasms because

> you'll be sufficiently relaxed to enjoy them without fearing

> embarrassing flatus (gases).

>

> Significant savings. You'll be able to save a bundle of money related

> to treatment of IBS-related symptoms and side effects, such as

> constipation, diarrhea, hemorrhoids, diverticular disease, and

> numerous others.

>

> Reduced cancer risk. Finally, you are less likely to succumb to

> colorectal cancer — the second leading cause of cancer-related deaths

> in the United States. This is particularly important for high-risk

> individuals for colorectal cancers. And with less x-rays and drugs

> thro — the same applies to all other cancers.

>

> With all those prudent goals in mind, here are the detailed stage-by-

> stage description of IBS causes, followed by step-by-step recovery

> guidelines. It will take you less time to study this page than a

> single visit to a GI specialist. On top, this information is free to

> read, safe to use, and a ton more effective.

>

> ***

>

> The Causes of

> Irritable Bowel Syndrome

>

> The following stage-by-stage narrative deconstructs the etiology and

> unfolding of irritable bowel syndrome. Once IBS is no longer a

> mystery, you'll have more confidence and motivation to proceed toward

> your complete recovery, and avoid the relapse.

>

> You may not experience some of the symptoms and/or stages described

> below, but, with minor variations, this is the most common scenario:

>

> Stage 1. Loss of intestinal flora

>

> The loss of indigenous (innate) intestinal flora (bacteria) precedes

> IBS, and is, in general terms, its initial and primary cause. All the

> other problems (and causes) get layered in the stages that follow.

>

> Intestinal bacteria are an essential component of normal colon

> ecology. They form stools, protect the intestinal membrane from

> bacterial and viral pathogens, govern the primary immune response

> (phagocytosis), and produce a range of micronutrients, essential for

> health and longevity.

>

> The two best known byproducts of intestinal flora biosynthesis are

> vitamin K (responsible for blood coagulation) and biotin (vitamin B-

> 7). Vitamin K deficiency is behind internal bleedings, pernicious

> anemia, inoperable ulcers, and strokes. Biotin deficiency is behind

> hair loss, connective tissue disorders (i.e. dermatitis,

> osteoarthritis, weak nails), and diabetes.

>

> The common " killers " and causes of intestinal bacteria are all well

> known. These are ubiquitous antibacterial medicines and compounds

> (antibiotics and synthetic agents, such as isoniazid, sulfonamide,

> methenamine, rifampin, hexachlorophene, etc.); antibiotic-laced meat

> and diary; dental amalgams (black fillings); mercury in fish and

> seafood; chlorine, arsenic and lead in drinking water; lead in paint

> and environment; silverware, common laxatives, food colorings,

> artificial sweeteners, infectious diseases, intestinal inflammations,

> colonoscopies, x-rays, radiation, chemo treatments, and numerous

> others.

>

> Any one of the above factors may lead to partial or complete

> evisceration of intestinal bacteria, a pathology known as

> disbacteriosis (dysbiosis). In turn, disbacteriosis results in hard

> stools, either small or large. These two conditions — disbacteriosis

> and hard stools precipitates irritable bowel syndrome. Enters Stage

> 2.

>

> Stage 2. Hard stools

>

> Bacteria are single-cell microorganisms. Just like all cells in

> nature, they hold water, and hold it tight. Intestinal mucus binds

> those " wet " bacteria with dry inorganic food remnants into moist,

> soft, and pliable stools. But without bacteria, stools become small,

> dry, and hard. The transformation of succulent grapes into weathered

> raisins is a telling analogy:

>

>

>

> The raisin-like small stools are a problem because the large

> intestine wasn't designed to move around small objects, so they get

> stuck — as in constipation. Unlike raisins though, small stools dry

> up even more and become as hard as pebbles.

>

> The pebble-like stools are an even bigger problem because your anus

> isn't made of steel, but of delicate and sensitive tissue — similar

> to the inside lining of your nose. Thus the human anus wasn't meant

> for passing " pebbles " through any more than your teeth were meant for

> opening beer bottles (even though some of you probably can...)

>

> If you are affected by disbacteriosis, and your diet is low in fiber,

> then the hardened stools remain small and dry. If fiber is present,

> then the hard stools are larger, because fiber adds bulk.

>

> You may experience hard stools and still remain regular, because you

> are an " expert " strainer, or can tolerate pain better than others, or

> the degree of hardness is still tolerable, or all of the above.

>

> Stage 3: IBS-related constipation

>

> Constipation means irregular stools. A person is

> considered " officially " constipated when bowel movements are absent

> over three days. Diagnosing constipation is like reporting a missing

> person—don't bother calling the police until 24 hours have passed.

> Ditto, don't bother calling your doctor until 3 days have passed. If

> it's only 2.5 days—sorry, you are still fine...

>

> For this reason I prefer using the terms impacted stools, hard

> stools, or costivity—slow in moving hard stools — instead of

> constipation, which refers to not having stools over three days. This

> way it's easier to convince people who pass hard stools in " under

> three days, " (i.e., who are still technically regular) to seek

> treatment.

>

> Hard stools, costivity, and constipation are commonly reported by

> people trying out low-fiber diets, such as Atkins'. Obviously, it

> isn't the diet's fault that people run into these problems. The cause

> is rather having disbacteriosis before commencing the diet.

>

> If you consume plentiful fiber or fiber laxatives, stool hardness may

> be less apparent. That's, incidentally, why fiber is recommended in

> the first place. As in the next stage, of course.

>

> Stage 4. Treatment of constipation with fiber

>

> Medical professionals and Dr. Moms alike recommend dietary fiber and

> fiber laxatives to " naturally " alleviate hardness, particularly when

> stools are small and dry. Fiber bulks up (enlarges) and moisturizes

> stools by either retaining water, blocking water absorption, or both.

>

> The most apparent damages from fiber in enlarged stools are

> mechanical, related to its sheer physical bulk. Fiber is the only

> commonly consumed nutrient that reaches the large intestine

> undigested and expanded up to five times (500%) its original weight.

> On the other hand, proteins, carbohydrates, and fats leave behind

> less than 5% of undigested solids.

>

> Here is the same math in weight units: once in the colon, 100 g of

> fiber turns into 500 g of undigested residue, while 100 g of

> proteins, fats, and carbohydrates digest down to less than 5 g of

> solids. Thus, per unit of weight, undigested fiber is 100 times more

> dense than all other nutrients (500 g / 5 g = 100 ). That's why

> doctors refer to fiber-free diet as low density, and high-fiber—as

> high bulk diet or roughage.

>

> Historically, indigenous diets, even plant-based, were low-density.

> That's because prehistoric people didn't have the means and skills to

> grow, process, and prepare high-fiber food. For these evolutionary

> reasons, human digestive organs haven't adapted to high-bulk diets,

> and remain as vulnerable today as they did millennia ago.

>

> Unfortunately, enlarged stools require straining, particularly as you

> get older. Welcome to Stage 5.

>

> Stage 5. The hallmark of IBS: Straining

>

> Younger people can expel large stools without apparent difficulties

> because they still have much better control of pelvic and abdominal

> muscles, stronger intestinal peristalsis, and less resistance from

> internal hemorrhoids.

>

> Normal defecation requires just as much effort as urination—zero. If

> straining is necessary, however moderate, it means that the size of

> stools exceeds the optimal spread of the anal canal.

>

> The anal canal aperture maxes out at 35 mm or 1.4 " . For normal,

> notice-free passing, soft and moist stools shouldn't be much wider

> than one's index finger or a nickel (21 mm, U.S. currency 5 ¢ coin),

> and correspondingly smaller in children.

>

> If you need convincing that your anal canal is that narrow, you can

> perform a digital rectal self-exam. No, you don't need a computer.

> Just lubricate your pointing finger with petroleum jelly, and slowly

> insert it into the anus. You will immediately realize just how tight

> and narrow it is. (This test is called a digital test,

> because " finger " in Latin is " digit. " )

>

> Straining applies strong force by abdominal and pelvic muscles on the

> colon and rectum to squeeze out stools — just like you would squeeze

> out the last bit of toothpaste from a spent tube below:

>

>

>

> Yes, that's pretty much what happens to the colon and rectum when you

> strain extra hard. The damage isn't far behind: internal and external

> hemorrhoidal disease, loss of urge sensation because of anal nerve

> damage, stubborn anal fissures (skin tears inside anal canal) that

> won't heal, loss of muscle tone and ensuing " lazy gut " syndrome,

> rectal prolapse, rectocele (rectal wall prolapse into vagina),

> diverticular disease, usually lethal colon perforation, and others.

>

> Also, straining wrecks havoc " above and beyond " the colon and rectum—

> strong abdominal pressure affects all organs situated in the lower

> abdominal and pelvic cavity: the rest of the colon, small intestine,

> uterus, bladder, and others.

>

> This damage may manifest itself as obstruction of the small

> intestine, reflux of fecal matter back into the small intestine,

> abdominal and inguinal (men's) hernias, pelvic cramps, spontaneous

> abortion (miscarriage), vaginal bleeding, symptoms of PMS, the

> blockage of fallopian tubes, and other mechanical damage of internal

> organs.

>

> Straining may also temporarily constrict major blood vessels and

> cause blood clotting. Stray clots may cause pulmonary embolism, heart

> attack, or stroke. Elevated blood pressure related to straining may

> cause cardiac arrest, aortic rupture, internal hemorrhages, strokes,

> heart attacks, and other major cardiovascular calamities. Even eyes

> aren't spared from a vessel rupture and related retinal and macular

> damage.

>

> The vascular problems are made worse by poor blood coagulation—

> disbacteriosis results in acute deficiency of vitamin K—a clotting

> factor. Normally, vitamin K is synthesized by intestinal bacteria.

>

> Women are expert strainers, because they have far greater voluntary

> control of pelvic muscles than do men. In some respects, straining is

> similar to what's happening during natural childbirth. Not

> surprisingly, women are affected by major colorectal disorders —

> particularly hemorrhoidal and diverticular diseases — more often than

> men.

>

> On the other hand, men have stronger abdominal muscles, and are more

> likely to develop abdominal wall or inguinal (groin) hernias. If you

> look at weightlifters pumping heavy iron, their facial expressions

> and grunts aren't that different from those of guys having a hard

> time in the loo. But unlike an average Joe in the john, weightlifters

> wear abdominal binders and groin trusses to prevent herniation. (This

> may be a good gift idea for the `constipated man' in your life.)

>

> Even children aren't spared from the aftermath of straining—nowadays,

> hemorrhoids are becoming commonplace even among preschoolers. Just

> ask any pediatric gastroenterologist.

>

> As you can see, there are plenty of reasons not to strain, and even

> more reasons not to encourage children to strain. Otherwise it's a

> straight path to hemorrhoidal disease.

>

> Stage 6. The inevitable side effect of IBS: Internal hemorrhoids

>

> Hard stools and straining, even moderate, cause gradual enlargement

> of internal hemorrhoids. That's due to the pressure applied by

> passing stools on the inner walls of the anal canal inside, and

> abdominal and pelvic muscles from the outside.

>

> Internal hemorrhoids aren't a " disease, " but a part of the anal canal

> anatomy—small collagenous pads that cushion passing stools. Their

> enlargement is akin to calluses on your palms from shoveling snow.

> According to the experts, by age 50, most adults have asymptomatic

> enlarged internal hemorrhoids without realizing it.

>

> External hemorrhoids are dilated, varicose veins of the hemorrhoidal

> plexus. The thrombosis of external hemorrhoids causes swelling and

> severe pain, but rarely bleeding. They do not affect defecation per

> se, but may cause stool withholding and incomplete emptying because

> of fear of pain and bleeding.

>

> Anal intercourse damages the anal canal in a way similar to hard

> stools and straining, only in reverse. Lubrication may help to

> protect the anal canal from laceration, but not from the enlargement

> of internal hemorrhoids, nerve damage, and the loss of muscle tone of

> anal sphincters. Because of the latter, anal intercourse is more

> likely to lead to fecal incontinence than constipation. This fact is

> well known to gastroenterologists, who specialize in anorectal

> restorative surgeries for men and women who engage in anal

> intercourse.

>

> (Yes, I realize that some penile implements are wider than 1.4 " (35

> ml), and have a hard time explaining how it's possible to insert them

> into the anus. But, then, I tell myself—if some people can swallow

> swords and others can swallow fists, then, with practice, patience,

> and disregard for common sense, everything is possible.)

>

> The very first symptoms of anal canal damage are pain and

> bleeding. " Welcome " to the next stage!

>

> Stage 7. Hemorrhoids-related pain and bleeding

>

> The enlargement of internal hemorrhoids from straining causes further

> constriction of an already narrow anal canal. While passing through a

> constrained anal canal, hard stools lacerate its delicate skin.

> Laceration causes bleeding or " streaking " of stools with bright red

> blood.

>

> Anal pain may differ in intensity, depending on the degree of nerve

> damage. Older adults and diabetics may no longer feel any pain

> because the nerve damage is complete. But when it isn't, the anal

> plexus region is quite sensitive, and the pain, even from a slight

> pressure, may be quite sharp.

>

> Seeing blood and experiencing pain brings about the next problem—the

> sometimes conscious, sometimes unconscious decision to withhold

> stools in order to avoid or prevent an unpleasant experience. This

> causes incomplete emptying of bowels, and is particularly common

> among toddlers, who can tolerate pain the least.

>

> Stage 8. The hallmark of IBS: Incomplete emptying

>

> The large intestine of an average adult is 4.5 feet (1.5 m) long, and

> can easily accumulate significant amounts of feces. Because of

> incomplete emptying, many people routinely retain 5-10 or more lbs of

> impacted stools without realizing it.

>

> If a person isn't overweight, an experienced physician may detect

> retained stools during a manual exam of lower abdomen. Because

> minerals aren't 100% transparent to the imaging source, retained

> stools can be seen with various degrees of clarity on imaging scans,

> such as x-ray, ultrasound, computed tomography, and MRI.

>

> A person affected by disbacteriosis and on a fiber-free diet can go

> without a single bowel movement for a month or more, and not

> experience noticeable side effects. With just 100 to 200 grams of

> stool generated daily under these conditions, the large intestine has

> enough holding capacity to store many weeks worth — particularly

> after those stools dry up.

>

> When the colon is filled to capacity, retained stools are pushed down

> and out into the rectum, where they may stimulate painful defecation.

> This way, more room is freed on top for the newer feces to pile up,

> and repeat this cycle again and again.

>

> When defecation is no longer attainable, the situation is called

> fecal impaction. In this case, there are four possible outcomes, and

> none of them are very good: (1) elective manual disimpaction or

> surgery; (2) colon perforation; (3) fecal reflux (feces flow back

> into small intestine; (4) intestinal obstruction and ensuing necrosis.

>

> Okay, enough scarecrows... Normally, the large intestine should

> contain well under 2 lb (1 kg) of retained feces, or two to three

> days worth. A healthy stool shouldn't exceed 100-120 grams per bowel

> movement*, usually twice daily.

>

> People on high-fiber diets expel on average 300 to 500 g per bowel

> movement*, usually once daily. Longer intervals between bowel

> movements increase total stool weight, but not linearly, because of

> stools' drying out. (*Source: R.F. Schmidt, G. Thews; Human

> Physiology, 2nd edition. 29.7.)

>

> As incomplete emptying progresses, retained stools compress, enlarge,

> harden up, dry out, and let newer feces pile up on top to do the

> same. Incomplete emptying results in impacted stools, described in

> the next stage of irritable bowel syndrome evolution.

>

> Stage 9. The hallmark of IBS: Impacted stools

>

> This process of stool impaction is similar to sausage manufacturing—a

> butcher uses a stuffing machine to fill in the casings, ties the

> ends, and hangs them to dry. That's why impacted stools and certain

> brands of dry sausages look very much alike:

>

>

>

> This is a " stage nine " cured dry chorizo sausage. Only the " sausage "

> inside one's gut is longer—around 3 to 4 feet, and correspondingly

> heavier. And that braided shape of the sausage mirrors the haustra

> pattern (small pouches) along the colon's walls. (Type 2 on Bristol

> Stool Scale].

>

>

> Looking at this picture, it's easy to understand why between 25 and

> 40 million Americans suffer from the ravages of irritable bowel

> syndrome. Try imagining this kind of " sausage " inhabiting your colon

> years on end, and not getting your bowel irritated and cramped.

>

> Impacted stools often bypass anal sinuses (the folds between colon

> and rectum) and enter the rectum (normally, the rectum chamber is

> empty). This condition can be determined via rectal self-exam. The

> presence of stools in the rectum may cause pain, discomfort, and the

> feeling of incomplete emptying—the condition known as levator

> syndrome (from levator ani muscle).

>

> When the colon and rectum can't accumulate any more stools, the

> incoming digestive fluids may seep over, and cause a diarrhea-like

> condition, which is called " paradoxical diarrhea. " But the real

> paradox in this, pardon the pun, " shitty " situation is that very few

> primary care physicians are familiar with it.

>

> Thus, instead of disimpacting a sufferer (removing impacted stools by

> hand, a specialized procedure usually performed in hospitals),

> doctors may recommend even more fiber to " restore stools. " When

> additional fiber has no place to go, it causes obstruction,

> perforation, or necrosis of the small intestine. These conditions are

> rarely survivable, and always require massive abdominal surgery in

> order to excise affected sections.

>

> Here is even more bad news: unlike small, soft, and moist normal

> stools, impacted stools cause mechanical abrasions of mucous

> membranes. In turn, these abrasions open a pathway to various

> pathogens into the inner reaches of intestinal membranes, and seed

> precancerous polyps. Along with lack of protective bacteria, this, I

> believe, is the PRIMARY cause of colorectal cancers. One more reason

> to restore proper colon ecology! Only then can you avoid impacted

> stools, prevent disbacteriosis, and restore intestinal flora.

>

> Stage 10. The hallmark of IBS: Abdominal cramps

>

> The enlarged stools fill up the large intestine, and produce

> considerable pressure on internal organs, particularly the bladder,

> uterus and fallopian tubes among women, and prostate gland among men.

> Since all of these organs have strong innervation and quite

> sensitive, you may feel in considerable pain, specific to

> premenstrual syndrome (PMS) before and during periods. Men may

> experience heightened sexual tension from the pressure on the

> prostate gland. Both genders may be affected by frequent urination

> but without any significant volume of urine.

>

> At this point many people turn to " nutritionally-oriented " doctors

> and " natural " web sites, which enthusiastically recommend restoring

> bacterial flora with all sorts of preparations. Great and well-worn

> advice by now, except for one little detail: mixing fiber with

> bacteria in one's gut is like making compost in one's backyard.

>

>

>

> Household compost pile. Look familiar?

>

> The incessant, round-the-clock fermentation of the " compost pile "

> produces copious gases, sharp acids, and toxic alcohols. Gases expand

> the large intestine. The expansion causes bloating. The bloated

> intestines squeeze neighboring organs and may cause obstructions,

> gastritis, heartburn, genital cramps, and so on. Acids irritate

> mucosal membranes and may cause inflammation. Methanol—one of the

> alcohols—seeps into the blood and causes hangover-like side effects.

> Alas, not enough ethanol is produced to at least enjoy the

> experience.

>

> The degree of suffering from abdominal cramps and intoxication varies

> greatly depending on one's age, gender, health, occupation,

> character, genetics, amounts of fiber, types of fiber, sources of

> fiber, and a whole load of other factors itemized in minutiae in

> throughout this site and in Fiber Menace.

>

> For as long as all of the above is tolerable, it's broadly accepted

> as a part of living. Between 10% and 15% of all Americans endure

> diagnosed or undiagnosed irritable bowel syndrome as just described.

> When the going gets tough, the tough... go to see their doctors.

>

> Stage 11: Medical treatment of IBS

>

> A conservative treatment for severe abdominal distress relies on

> antibiotics — along with more fiber and/or fiber laxatives. First,

> antibiotics kill any remaining intestinal bacteria,

> terminate " composting, " and alleviate intestinal inflammation. This

> stops bloating and flatulence caused by gases and acidity produced by

> the fermentation of fiber. Antibiotics don't reduce stool size or

> relieve constipation. They may help to arrest diarrhea by removing

> and/or reducing its causes.

>

> Next comes fiber: " Dietary fiber can help many patients by absorbing

> water and solidifying stool. It may benefit patients with either

> constipation or diarrhea. " So advises The Merck Manual of Diagnosis

> and Therapy, an unquestionable " gold standard " reference for most

> American doctors.

>

> And so we go: cramps—antibiotics—fiber—cramps—antibiotics—fiber… In

> other words you become dependent on fiber and/or laxatives.

>

> The absence of bacteria requires more fiber or laxatives to deal with

> impacted stools. Newly consumed insoluble fiber acts as a plunger by

> pushing them out. That's essentially what fiber is — a plumber's

> plunger. And the straining is its handle.

>

>

>

> To make the passage possible, soluble fiber or laxatives lubricate

> and break down hardened stools, just like Drano® would hair clog.

> They soften them up somewhat, and, when consumed in excess, stimulate

> diarrhea.

>

> Too bad your " plumbing " isn't made from cast iron. Even then, this

> stage may last and last — until one unfortunate day your gut " can't

> take it anymore, " and hits you " on the head " with a leak...

>

> Stage 12. A nasty side of IBS: Intermittent diarrhea

>

> At one point impacted stools, or inflammatory disease, or both, may

> cause profuse diarrhea—an innate physiological reaction to " self-

> cleanse " the affected large intestine, similar to vomiting.

>

> After a while the colon becomes " as clean as a whistle, " but the

> diarrhea disrupts the colon's ecology. Fiber is recommended

> to " restore formed stools. " Formed stools usher back constipation and

> impacted stools, and this cycle repeats itself over and over again.

>

> Of course, these well known outcomes describe the classical symptoms

> of irritable bowel syndrome—round-the-clock abdominal distress

> accompanied by alternating patterns of constipation and diarrhea,

> while, according to the doctors, " there is nothing wrong inside. "

>

> Back to " square one, " unless... unless you follow my suggestions and

> break out from this trap, otherwise it's down to Stage #13. Oh, how

> appropriate...

>

> Stage 13. Inflammatory Bowel Diseases (Ulcerative colitis and/or

> Crohn's disease)

>

> The vicious cycles of intermittent constipation and diarrhea repeat

> over and over again until more serious complications arise. It may be

> hard-to-treat ulcerative colitis, or a devastating Crohn's disease,

> or excruciatingly painful hemorrhoids, or dreadful appendicitis, or

> gut-piercing diverticulitis, or a rarely survivable perforated colon,

> or a deadly colon cancer, and God only knows what else.

>

> When a person recovers from the initial treatment, more fiber is

> prescribed again to prevent all these conditions. Not surprisingly,

> up to 40% of ulcerative colitis victims undergo proctocolectomy—a

> surgical removal of colon and rectum. Otherwise they may bleed to

> death or die from colon cancer.

>

>

>

> In this case, no colon—no problem…

>

> It's the exact same pattern for Crohn's disease, for hemorrhoidal

> disease, for diverticular disease, for cancer survivors, and pretty

> much for everything else. Fiber, more fiber, more darn fiber, until

> one day, no patient—no problem. And it all started with the

> accidental death of some " dirty little bugs " in the Stage 1.

>

> The next section explains how to reverse the causes of IBS naturally,

> and to roll-back your state of health to pre-stage 1 status — proper

> colon ecology, normal stools, and no symptoms of IBS.

>

> This approach may not make you again " as good as new " — some of the

> above damages, unfortunately, are irreversible, but it certainly

> beats becoming " as good as dead, " if you follow the conventional IBS

> treatment.

>

> ***

>

> IBS Recovery Guidelines

>

> As I already remarked in the introduction, the IBS treatment

> guidelines in The Merck Manual represent what's known as standard of

> care, or " a diagnostic and treatment process that a clinician should

> follow for a certain type of patient, illness, or clinical

> circumstance, " according to the Webster's Medical Dictionary.

>

> This " standard of care " approach is taught in medical schools and

> residencies, and followed closely by the majority of the U.S. medical

> doctors, who (a) may not know another (or better) approach, and/or

> ( use it to insulate themselves from malpractice lawsuits by

> deferring to their own training, peer-reviewed protocols, and said

> standard of care.

>

> It's important to note that the " standard of care " doesn't mean " best

> care, " " effective care, " or even " good care. " At best, it reflects

> the current consensus and prevailing groupthink of individuals and

> institutions, which profit from the treatment (or mistreatment in the

> case of IBS) of GI disorders.

>

> Unlike The Merck Manual and similar references, this page enumerates

> in plain language the exact physiological causes of irritable bowel

> syndrome and offers effective, inexpensive, and self-administered

> treatment guidelines which provide full and rapid recovery, assuming

> your condition hasn't progressed far beyond IBS.

>

> Even then, you still will find excellent (if not full) relief from

> bloating, flatulence, constipation, diarrhea, cramps, and pain,

> except it may take you longer, and you'll need to manage intercurrent

> conditions, such as hemorrhoids, anal fissures, or diverticulosis,

> more attentively.

>

> I encourage you to share the information on this site and in Fiber

> Menace with your physicians. They won't find anything contradictory

> in these texts to the tenets of human anatomy, physiology, biology,

> biochemistry, and pathology. To help them (and you), this site as

> well as my books, are all thoroughly referenced and, with few

> exceptions, accessible over the Internet.

>

> Throughout the years, scores of medical professionals have read my

> books, heard my radio talk shows, attended my seminars, and

> scrutinized my web publications, and not one, I repeat, not a single

> one has ever sent me a note pointing out an error in my analysis or

> recommendations.

>

> If anything, I am hearing back praise and encouragement — doctors and

> nurses are people too, and they suffer from digestive disorders just

> as much or more (because they are more likely to follow Merck-type

> advise) as the general population.

>

> There are no risk or side-effects associated with any of my

> recommendations because I do not propose drugs, lopsided diets, or

> invasive procedures. Your only risk is to ignore them, and progress

> to inflammatory bowel diseases such as ulcerative colitis or Crohn's

> disease, or degenerative diseases of the GI tract, such as enlarged

> hemorrhoids, diverticulosis, or colorectal cancers.

>

> Some readers, particularly medical professionals trained in the so

> called evidence-based medicine, may respond to these claims with a

> well-expected challenge: Mr. Monastyrsky, prove it!

>

> Actually, it would be against the laws of medical ethics (as well as

> civil and criminal statutes) to conduct a randomized controlled

> medical trial with a known negative outcome (for patients in the

> control group who would follow the Merck's guidelines).

>

> IBS is classified by Merck as constipation-predominant or diarrhea-

> predominant. Some people are diagnosed with IBS without experiencing

> either constipation or diarrhea. Your steps to recovery will depend

> on your particular type:

>

> Step 1. Wean yourself off fiber. If you have been consuming dietary

> fiber or taking fiber laxatives, you'll have to break the dependence

> on these substances first because it's impossible to overcome IBS

> while consuming fiber. Skip this step if it isn't applicable in your

> case. Follow the recommendations in the Overcoming Fiber Dependence

> guide.

>

> Step 2-A. Normalize stools for constipation-predominant IBS. Follow

> the recommendation in the Constipation guide. As soon as you complete

> this step, you'll find substantial relief from flatulence, bloating,

> abdominal pain, and cramps.

>

> Step 2-B. Normalize stools for diarrhea-predominant IBS. Follow the

> recommendations in the Diarrhea guide (will be released mid-June

> 2008). Your diarrhea will abate shortly after commencing this step,

> but this time around you won't have to face constipation.

>

> Step 2-C: Normalize stools for IBS without either constipation or

> diarrhea. This condition is common in younger people, and explained

> here. In this case, proceed with the Colorectal Recovery Program.

>

> Step 3. Restore intestinal flora and heal bowel inflammation (if

> any). This step restores proper colon ecology and stool morphology,

> and protects you from IBD, polyps, and colorectal cancer. Follow the

> recommendations in the Restoring Intestinal Flora guide.

>

> Step 4. Restore anorectal sensitivity. This step is essential for

> late stage IBS, particularly constipation or diarrhea-predominant,

> because both conditions damage anorectal sensitivity, so you don't

> experience the defecation urge sensation. This sensation is important

> to maintain regularity and enjoy a complete emptying of the bowels.

> Follow the recommendations in the Restoring Anorectal Sensitivity

> guide.

>

> Step 5. Stabilize and maintain your recovery. This isn't, really, a

> step, but a final and ongoing process. Use all of the available

> information on this site and in Fiber Menace to prevent an IBS

> relapse.

>

>

> You should see and feel improvements soon after you start. Depending

> on your age and degree of acquired, organic (irreversible) damage, it

> takes from three to six months to become completely free from IBS and

> its most bothersome and offensive symptoms.

>

> It takes considerably more time to desynthesize hypersensitive nerves

> (visceral hyperalgesia) inside your abdomen; to reverse

> unconditional, endocrine reflexes (excessive secretion of certain

> substances in the anticipation of food and stress); to reduce

> autoimmune reactions to common food allergens; and to readjust to a

> new style of nutrition. Just as with IBS itself, the actual length of

> time will depend on your age, health, and a degree of commitment and

> compliance with proper diet and supplements.

>

> If you are relatively young and healthy, you won't have to think much

> about IBS after full recovery. For older people with a long history

> of IBS, staying free from IBS will require life-long commitment and

> vigilance. Whatever it takes, it's better to be healthy and a bit

> preoccupied with your diet and colon, than to be in pain, unhealthy,

> miserable, on a diet, and preoccupied with your colon even more. That

> is, if you still have it!

>

> Nutritional Guidelines for IBS

>

> The optimal nutrition for IBS depends on your age, health, and extent

> of your condition. " Optimal nutrition " means not just " best "

> or " permitted " nutrients, but also the frequency of eating, food

> preparation techniques, meal composition, and your ability to

> properly digest consumed food.

>

> These considerations are commonly ignored or overlooked in the

> routine treatment of IBS. Consequentially, most people consume

> presumably a " healthy " diet, but only to dig themselves into even

> more problems.

>

> Here are the principal recommendations:

>

> Reduce frequency of eating to two, maximum three times daily. Do not

> snack or drink fluids between meals. Do not chew gum. Why? Any time

> you open up your mouth, and begin chewing and swallowing, the body

> goes though the motions of the gastrocolic reflex and mass

> peristalsis, or a contraction of the entire digestive tract. These

> contractions are the primary cause of cramping and abdominal pains.

>

> The common dietary advice for people with IBS is the complete

> opposite — eat smaller portions more often, snack between meals,

> drink plenty of fluids, etc. This commonplace ignorance has little to

> do with either IBS or the physiology of digestion.

>

> Eliminate hard-to-digest proteins. These are casein — a protein found

> in dairy (milk, ice cream, cream cheese) and gluten — a protein found

> in wheat, oats, bran, barley, malt, ice creams, processed meats

> (chicken nuggets), gravies, brewer's yeast, and derivative products

> (bread, pasta, morning cereals, beer, soy sauce, cakes, pastries,

> etc.)

>

> Why? Because humans lack enzymes to digest these proteins, and they

> are highly allergenic, particularly for people with digestive

> disorders. When undigested proteins pass into intestines, they

> petrify (rot), cause gases, bloating, and low-level poisoning

> expressed as severe fatigue, foul mood, muscle pain, nausea, and so

> on.

>

> Adapt your diet content and volume to your age. Most adults past 45-

> 50 years old, particularly in the United States, suffer from age

> onset gastric deficiency (AOGD, a term I coined), or a low level of

> digestive enzymes and gastric acid in the stomach.

>

> This condition causes indigestion, heartburn, delayed stomach

> emptying, hiatus- hernia, gastritis, duodenitis, peptic ulcers,

> stomach and esophageal cancers, and so on. AOGD is exacerbated by

> antacid medication, alcohol, mixed meals, overeating, frequent

> eating, inadequate chewing (habitual bad teeth, poor fitting

> dentures), and overhydration. AOGD starts a chain of events which

> lead to a condition known as gastroenterocolitis, or an inflammatory

> disease of the entire GI tract.

>

> There is only one way to adapt to AOGD: reduce the number of daily

> meals to two, maximum three; do not eat mixed meals (i.e. proteins

> and carbohydrates); eat protein-containing meals once daily (the last

> meal is best), and follow other rules described on this site and in

> my books. This approach is described in detail in Fiber Menace,

> chapter X...

>

> Always consume fluids 30 to 60 minutes before meals. This allows

> water to pass the stomach chamber into the small intestine and get

> assimilated there almost immediately. Any fluids consumed after meals

> remain " locked " in the stomach until digestion is complete, hence you

> can't easily satisfy thirst even if you drink plenty of fluids.

> Excess fluids dilute already deficient gastric juices and cause

> indigestion or delayed digestion. Healthy children and young adults

> can consume plentiful fluids with meals or after with apparent

> impunity because they have smaller (less stretched out) stomachs, so

> the excess fluids are " pushed " out into the small intestine; they

> enjoy better teeth, and have a much higher level of acid and enzymes

> in the digestive juices.

>

> Take recommended professional-grade supplements and, if necessary

> digestive enzymes. They are essential to augment nutrients and

> enzymes missing from any restricted diet; to recover from long-term

> malnutrition caused by IBS and IBD; and to compensate for age- and

> disease-related problems with the assimilation of micronutrients.

> There is a great deal of talk going on about supplements causing

> harm. If you consider the sub-par quality of consumer-grade

> supplements that most people are taking, this talk is fully

> justified. [link]

>

> Maintaining proper nutrition is one of the most difficult tasks for

> any person affected by digestive disorders. It isn't because there is

> anything specific or particular about it, but because eating (and

> overeating) became social phenomena; because it's so hard to keep a

> separate diet from a healthy partner; because restaurants don't cater

> to people with digestive disorders; because most presumably healthy

> foods are atrocious, industrial junk; because the art and habit of

> simple and nutritious home cooking has been lost by most Americans

> born and raised in the fast-food era; because there are so many

> enticements to overconsume; and because so many people refuse to

> acknowledge their aging bodies, and fail to adjust to new realities.

>

> In any event, when confronted with the choice of " keeping up with the

> es " vis-à-vis living without IBS, drugs, and fear of colon

> cancer, I hope you'll chose the latter. And if you are still

> relatively young, and your experience with IBS is brief and fleeting,

> most likely you'll be able to continue eating with blissful (or

> reckless) abandon for a good chunk of time. Assuming, of course, that

> you fix the IBS first, stay off fiber, and guard your gut from foxes.

>

> The FAQ section below expands nutritional guidelines considerably. I

> also recommend to review the rest of this site, and the discussion of

> transition away from fiber-dependent diet in the Chapter 11, Avoiding

> the Perils of Transition of Fiber Menace.

>

> ***

>

> Frequently Asked Questions about IBS

>

> Q. Why doctors can't find anything wrong with IBS patients?

>

> Q. What is the difference in treatment between diarrhea- and

> constipation-predominant IBS.

>

> Q. How come I was diagnosed with IBS while I have never been

> constipated or had diarrhea?

>

> Q. How can I distinguish IBS from IBD?

>

> Q. What's the difference between just " bloating " vis-à-vis " bloating

> and flatulence? "

>

> Q. Why do antibiotics reduce cramping and bloating related to IBS and

> IBD?

>

> Q. What's a difference between the role of soluble and insoluble

> fiber in the pathogenesis of IBS?

>

> Q. Why people with IBS are advised to avoid fats?

>

> Q. Does stress contribute to IBS? Is there indeed a psychosocial

> aspect to IBS?

>

> Q. So what's the role of psychotherapy in all this? Is it a fluke or

> it has some role?

>

> Q. Is smoking bad for IBS?

>

> Q. What about alcohol? Is it bad for IBS?

>

> Q. What's so special about table wines, and what it has to do with

> IBS?

>

> Q. Why do you know all this and doctors don't?

>

>

> Q. Why doctors can't find anything wrong with IBS patients?

>

> Doctors, particularly in the United States, are trained to look for

> physical manifestations, such as inflammation, obstruction, or

> bleeding. But, for a while, IBS displays none, particularly in

> younger patients.

>

> Despite this common knowledge, the diagnosing of IBS allows for a ton

> of billable services to seek out " the clues: "

>

> " CBC [complete blood count], biochemical profile (including liver

> tests), ESR [erythrocyte sedimentation rate], stool examination for

> ova and parasites (in those with diarrhea predominance), thyroid-

> stimulating hormone and Ca for those with constipation, and flexible

> sigmoidoscopy or colonoscopy should be done " — advises Merck, and

> piles up even more tests to " test the tests: "

>

> " Additional studies (such as ultrasound, CT [computer tomography],

> barium enema x-ray, upper GI esophagogastroduodenoscopy, and small-

> bowel x-rays) should be undertaken only when there are other

> objective abnormalities " .

>

> All in all, that's several thousand dollars worth of mostly

> irrelevant testing, which in the case of " true " IBS will reveal

> little or nothing, and in all cases will cause even more colorectal

> damage from x-ray radiation, laxatives used to lavage the intestines

> before colonoscopy or CT, and anesthesia administered during

> colonoscopy.

>

> Merck even says this much: " Many patients with IBS are overtested " .

> But the only true and relevant diagnostic criteria of IBS —

> disbacteriosis, stool size, stool density, and internal hemorrhoids

> and straining (both may be absent in younger patients)— aren't

> considered.

>

> Q. What is the difference in treatment between diarrhea- and

> constipation-predominant IBS.

>

> In general terms, diarrhea-predominant IBS is a greater problem than

> constipation-predominant, because diarrhea suggests the presence of

> inflammatory disease in the large intestine. Whenever the mucosal

> membrane is affected by inflammation, it fails to remove fluids from

> feces and form stools. The ensuing accumulation of fluids causes

> diarrhea.

>

> In terms of actual recovery, patients with diarrhea-predominant IBS

> require a guarded diet to eliminate food allergens and inflammation

> triggers, such as soluble fiber, pectin, sorbitol, and others.

>

> Also, these patients must be screened for fecal impaction (a cause of

> paradoxical diarrhea), Clostridium difficile (a bacterial cause of

> colitis), parasites, viral infections, biliary and pancreatic

> disorders, and undergo the required medical treatment. That's where

> the value of a skilled and attentive physician is paramount.

>

> Some individuals, particularly children and young women, may

> experience stress-related diarrhea for reasons explained here.

> Obviously, it's impossible to eliminate stress, but it's possible to

> learn how to redirect and reduce your response to it. More about it

> here.

>

> Q. How come I was diagnosed with IBS while I have never been

> constipated or had diarrhea?

>

> Constipation and diarrhea are late stage complications of IBS. When

> IBS develops in younger people, they rarely experience constipation

> or diarrhea, because they still have taught, supple, and functional

> colons and rectums, sensitive anorectal plexes, undamaged anal

> canals, and so they move their bowels like clockwork.

>

> IBS itself begins with the gradual enlargement of stools either from

> fiber, or from a mild inflammation of the intestinal mucosa caused by

> the by-products of fiber fermentation, or from evolving food

> allergies, or from the loss of intestinal flora, or from all of the

> above.

>

> At one point or another enlarged stools require moderate straining.

> This, in turn, enlarges internal hemorrhoids (unbeknown to most until

> late or at all) and constricts an already narrow anal canal even

> more. This leads to incomplete emptying, further hardening of stools,

> further enlarging of hemorrhoids, and more straining. Then, one day,

> a person can't strain hard enough to move bowels at all for more than

> three days. That's — no stools for more than three days — what The

> Merck Manual calls constipation, and that's the definition that most

> doctors and patients are saddled with.

>

> It may take you 5, 10, 20, 30 or more years to reach that day,

> depending on your doctor's directions, age, gender, diet, toilet

> habits, degree of luck, and multitude of other factors discussed

> throughout this site.

>

> If prior to that moment you had uncomfortable stools every other day

> or so, technically you were not constipated. Medically speaking, you

> are " healthy " until day four! Before that — don't bother the doctors,

> and take more fiber.

>

> All of this would be really funny if it wasn't so tragic. You can

> learn more about this charade doctors " play " with constipation here.

> The role of fiber in the pathogenesis of colorectal disorders,

> including IBS, is explained here.

>

> Q. How can I distinguish IBS from IBD?

>

> The " syndrome " in IBS stands for collection of symptoms that make up

> this condition. Its' interpretation varies from textbook to textbook,

> from reference to reference, and from doctor to doctor. In other

> words, diagnosing IBS is a " free-for-all " enterprise, because there

> are no actual physical attributes (i.e. inflammation, bleeding, high-

> temperature, blood tests, etc.) to cling too.

>

> Most of the IBS symptoms are also present in IBD (i.e. inflammatory

> bowel disease). The primary distinguishing characteristics of early

> stage IBD (i.e. before endoscopy shows inflammation) are: stools

> close to diarrhea; excess mucus in stools; sustained, round-the-clock

> bloating, but with less flatulence, typical for IBS because by this

> time most of the bacteria are dead, and fermentable matter (i.e.

> fiber, the source of gases) is rapidly disposed off during diarrhea.

>

> Q. What's the difference between just " bloating " vis-à-vis " bloating

> and flatulence? "

>

> The absence of flatulence (i.e. gases) points out to disbacteriosis.

> When flatus is present, the bloating results primarily from gases.

> The bloating without gases (or with very little) indicates

> inflammation of the mucosal membrane of the small and large

> intestine.

>

> This inflammatory condition traps gases and fluids (i.e. prevents

> their absorption into blood), and increases the diameter of

> intestines, particularly the small intestine. Because this organ is

> so large (around 14 to 22 feet in adults) and so tightly packed

> inside the abdominal cavity, even a small increase in its diameter

> distends (pushes out) the abdominal wall, hence the " bloating. "

>

> The gases in the small intestine are always naturally formed when the

> acidic content of the stomach moves in, and gets neutralized by

> pancreatic juices (bicarbonate).

>

> The petrifaction (rotting) of undigested proteins may form gases too.

> The gases in the large intestine are formed when undigested

> carbohydrates (fibers, lactose, polysaccharides, sugar alcohols) get

> fermented by bacteria.

>

> Bacteria are often present in the lower small intestine (ileum), and

> may form profuse gases there from fermentation too. These are usually

> the most bothersome, because they have no place to escape.

>

> The gases from large intestine may also escape into small intestine

> whenever the ileocecal valve opens up to let the content of the small

> intestine to pass into the large intestine.

>

> Q. Why do antibiotics reduce cramping and bloating related to IBS and

> IBD?

>

> Antibiotics kill bacteria in the small and large intestine, and

> terminate fermentation of undigested carbohydrates. This stops

> fermentation and production of gases, alcohols, and fatty acids, and

> helps subdue an inflammatory condition. In turn, the intestines

> shrink and reduce internal pressure on internal organs.

>

> Unfortunately, antibiotics also ruin normal colon ecology, and cause

> problems, ranging from severe diarrhea to an equally severe

> constipation. They also strip the intestinal membrane from it's

> natural protectors (i.e. bacteria), reduce primary immunity

> (phagocytosis), blood clotting, vitamin synthesis, and so on. So,

> logically, you are better off excluding fiber and other sources of

> undigested carbs to stop fermentation, rather than use an " atomic

> bomb " approach to wipe out bacteria.

>

> Besides, there are always some antibiotic-resistant mutant bacteria

> (such as methicillin-resistant Staphylococcus aureus, MSRA) left

> behind, and they are the ones who may eventually kill you,

> particularly in the hospital settings. At this point, you have nobody

> to thank, but the profit-driven " Big Pharma " and careless doctoring.

>

> Q. What's a difference between the role of soluble and insoluble

> fiber in the pathogenesis of IBS?

>

> Insoluble fiber (bulking agent) makes stools large. Large stools

> induce straining, straining causes the enlargement of internal

> hemorrhoids, enlarged hemorrhoids cause incomplete emptying,

> incomplete emptying causes impacted stools, impacted stools cause

> abdominal cramps.

>

> Soluble fiber (hydrophilic mucilloid) blocks the absorption of

> digestive fluids. Blocked fluids, including astringent bile and

> omnivorous enzymes, slip down into the large intestine, and wreak

> havoc there. To cleanse itself of irritants and impacted stools, the

> large intestine responds with profuse diarrhea. When the diarrhea is

> over, the colon's examination shows no visible damage. Back on fiber,

> and the cycle starts again.

>

> Both fibers are fermentable. If the bacteria level is normal, soluble

> fiber ferments 100%, insoluble — about 50% with normal motility,

> almost 100% with slow motility (common in IBS).

>

> In the overall scheme of things, soluble fiber is by far more

> damaging then insoluble, except in the cases of (a) inflammatory

> bowel disease (caused primarily by soluble fiber), and (

> obstruction in young children and older adults. In the case of IBD —

> because inflammation prevents water absorption and narrows the

> passageway; in young children — because their internal organs as so

> tiny and so easy to obstruct; and in older adults — because of slow

> and inefficient peristalsis, often made worse by the indiscriminate

> use of the systemic drugs, which may affect peristalsis even more.

>

> Q. Why people with IBS are advised to avoid fats?

>

> Along with advice to use fiber, this is one of the most damaging

> recommendations in all of IBS-related dietary dogma. In fact, the

> absence of fats makes IBS and its' side-effects much worse, and turns

> it into IBDs. You can read more about the role of fats in digestion

> and colorectal disorders here.

>

> If anything, the absence of fats will cause more damage to your

> entire digestive tract, health, and cause severe constipation (i.e. a

> primary symptom of IBS), because dietary fats are essential for

> regularity. You can read more about the role of fats in constipation

> here.

>

> It's true that dietary fats precipitate the gastrocolic reflex and

> peristaltic mass movement — two conditions essential for normal

> propulsion of food through the GI tract, normal stool formation, and

> normal defecation. Indeed, this normal physiological effect of fat

> precedes pain and cramping in impaired individuals, and results from

> normal peristalsis encountering large stools and gases — an effect

> similar to giving a shiatsu massage to your abdomen in the midst of

> IBS relapse.

>

> In the long-term, the " killing " or reducing of peristalsis by

> restricting fats makes all IBS-related constipation even worse — more

> constipation, more fecal impaction, larger stools, more gases, more

> pain, more sensitivity to pain, stiffer, smooth muscles, and impaired

> muscle contraction from severe calcium deficiency, because calcium

> doesn't get assimilated without fat in the diet.

>

> Q. Does stress contribute to IBS? Is there indeed a psychosocial

> aspect to IBS?

>

> Stress contributes to practically all disorders, not just IBS,

> because the chemistry behind the stress response isn't merely mental

> or perceptual, but endocrine — meaning any stress or even the

> anticipation of stress elicits an unconscious secretion or over-

> secretion of multiple stress hormones, which govern physical aspects

> of the stress response. These are adrenalin, noradrenalin, cortisol,

> and some others.

>

> In the case of IBS, stress hormones inhibit gastric digestion and

> intestinal propulsion (peristalsis). These two conditions predispose

> people to a broad range of functional GI disorders. The most typical

> ones are: nausea, vomiting, indigestion, heartburn, GERD, peptic

> ulcers, bloating, abdominal cramps, and constipation or diarrhea,

> depending on stress intensity and duration.

>

> There are two core reasons behind all these happenings:

>

> Elevated blood pressure compensation. Rapidly elevated blood pressure

> in response to a sudden, strong stress event causes a near instant

> release of excess blood plasma into the stomach and large intestine

> lumen to normalize it. This is the body's " safety release valve " ,

> essential to prevent blood vessels and capillaries from rupture.

> Unfortunately, rapid stretching of the stomach with fluids stimulates

> the vomiting center which causes nausea and vomiting. Similarly,

> excess fluids in the colon flow downwards, stimulate the anal plexus

> and provokes profuse diarrhea.

>

> Impact on digestion and motility. Moderate or even low-level

> sustained stress inhibits digestion and motility (peristaltic

> propulsion of food and stools) in order to mobilize energy for a

> flight-or-fight type of response. Sustained, long-term stress leads

> to indigestion " on the top, " and constipation " on the bottom " because

> nothing, literally, moves. Both conditions — indigestion and

> constipation — contribute mightily to IBS and related digestive

> disorders.

>

> Can you do anything about it? Yes, you can. In cases of major stress

> events, it's a matter of training and conditioning. Professional

> soldiers don't soil their pants or vomit when they get fired at —

> they duck, evade, and respond. If they can be trained to ignore

> bullets, so can you to evade mother-in-law, ignore obnoxious co-

> worker, and duck away from rude drivers, and there is plenty of

> specialized literature, dedicated to this subject.

>

> Moderate and/or extended stress must be managed with proper

> nutritional " hygiene. " When exposed to stress of any modality or

> duration, use the following rules:

>

> Restrict proteins. While under severe or even moderate stress,

> protein may not digest fully because stress hormones inhibit gastric

> secretion and peristalsis. Restricting proteins allows you to prevent

> indigestion, dyspepsia, food poisoning, and related complications.

>

> This particular advice often elicits scorn and disdain from low-carb

> zealots, particularly young turks with no formal training in medicine

> or nutrition. One such turk wrote on his blog about my similar advice

> to people with gastritis: " Smart and intelligent people can be very

> stupid. " Well, kid, I'd rather be stupid and healthy, than smart and

> dead. And so are my readers. This page (or my books) aren't about low-

> carbing, but chronic digestive disorders.

>

> Always hydrate (drink water) yourself on empty stomach. Stress causes

> thirst because, initially, high level of stress hormones blocks

> salivary glands, raises blood sugar, and this kicks in kidney to turn

> gobs of blood plasma into urine. If your stomach is full with food,

> don't flood it with more water because (a) it will inhibit digestion

> even more; ( it may cause nausea and vomiting; and © it will not

> satisfy your thirst because water can't get down into the intestines

> to get assimilated. Instead, place something sweet into your mouth,

> sweetness stimulates saliva secretion and this will make the thirst

> less apparent.

>

> Normalize blood sugar. After an initial spike of stress hormones,

> blood sugar dives down considerably, and you may experience strong

> cravings for sweets. If your stomach is already full, don't stuff it

> with more food to get your sugar fix — they won't give you any

> more " blood sugar " until carbs get down into the intestines. Instead,

> use near instant sublingual glucose tablets, or dissolve a sugar

> cube, or piece of chocolate under the tongue. You only need 2-3 grams

> of glucose to stabilize low blood sugar, and, in this case, the

> sublingual path is the fastest available (other than an I.V. drip).

>

> Eat only if hungry. Don't eat your regular meals if you aren't

> hungry — most people under stress aren't, except to satisfy their

> sugar cravings. If you do eat, you aren't likely to digest those

> foods anyway. So if you crave sugar, then get some sugar, not a

> turkey sandwich.

>

> Don't skip regular bowel movements. You aren't likely to experience

> the defecation urge because stress inhibits intestinal peristalsis.

> But missing even one bowel movement dries out and enlarges stools

> already in the colon — a prescription for constipation. To stimulate

> stools without straining, use the " helpers " described here.

>

>

> As you can see, it isn't the stress per se, that causes IBS, but the

> lack of knowledge and readiness to deal with it and its aftermath.

> Well, now you know!

>

> Q. So what's the role of psychotherapy in all this? Is it a fluke or

> it has some role?

>

> Yes, in a very limited way, but absolute " no " in all substantive

> ways. Here is the drill:

>

> — No, because psychotherapy can't eliminate the underlying, physical

> causes of irritable bowel syndrome by pep talk and/or hypnosis alone.

>

> — No, because psychotherapy can't completely rewire the innate,

> evolutionary, fight-or-flight type of stress response even in the

> most sophisticated, dedicated, and motivated individuals.

>

> — No, because a shrink isn't a substitute for a normal poop.

>

> — No, because wishful thinking is the worst treatment for internal

> disorders with clear-cut physiological causes.

>

> — Yes, because many cases of stress response are self-perpetuating —

> i.e. fear breeds more fear. Assuming you can find and afford a

> skilled enough psychologist to break that endless loop, yes, it helps

> a great deal.

>

> — Yes, because you can learn (or be taught) to respond to stress in a

> less self-destructive and agonizing way.

>

> — Yes, because psychotherapy and related approaches (yoga,

> meditation, prayer, controlled breathing, chants, etc.) do offer a

> palliative, temporary release from acute pain. This effect results

> from the general relaxation and temporary reduction of stress

> hormones.

>

> But, as I have already said, you can't chase away excess gases and

> large stools, or plant back missing bacteria by using palliative

> psychology any more than you can fill a cavity with hypnosis or

> reverse breast cancer with motivational therapy.

>

> Q. Is smoking bad for IBS?

>

> Yes, it is, because smoking stimulates saliva secretion. In turn,

> smoke-laced saliva gets swallowed, and stimulates the secretion of

> gastric juices, gastrocolic reflex, and peristaltic mass movement —

> the precursors to abdominal cramps and/or diarrhea. That's,

> incidentally, why people are told not to smoke on empty stomach.

>

> Interestingly, my own bout with severe IBS started soon after I quit

> smoking in 1984, but for exactly the opposite reasons — I no longer

> had sufficient stimulation of intestinal peristalsis to initiate

> regular bowel movements, skipped few, became chronically constipated,

> and started to rely on fiber laxatives, such as Metamucil, to move my

> bowels.

>

> Q. What about alcohol? Is it bad for IBS?

>

> In general, yes, it's bad for IBS, particularly during acute stages.

> Lets review the reasons:

>

> First, alcoholic beverages in themselves are fluids which inhibit

> gastric digestion when consumed in excess with or after food. The

> side effects of indigestion and related complications inevitably

> boomerang to IBS.

>

> Second, excessive alcohol (whenever you feel the buzz) inhibits

> digestive tract peristalsis. For this reason you may actually feel a

> temporary relief from abdominal pain and cramping. But, just like in

> the case with Imodium, poor contraction contributes to constipation.

>

> Third, alcohol in excess causes dehydration and sodium loss because

> large intestine is very effective at recovering every bit of moisture

> and sodium from stools. This particular aspect of alcohol-related

> dehydration dries out stools, causes constipation, and may contribute

> to IBS.

>

> When dehydration and sodium loss become extreme, you may actually

> experience diarrhea because of sodium-potassium blood disbalance. To

> compensate, the body dumps excess potassium (along with gobs of

> plasma, of course) into the colon's lumen. This, in turn, causes

> profuse diarrhea, which dehydrates you even more.

>

> A similar chain of events (sans alcohol) causes runner's diarrhea.

> Western athletes listen to that stupid advice and load themselves up

> with Gatorade — a potassium- and sugar-rich drink — before and while

> running. No wonder, the diminutive Kenyans win all these darn

> marathons — they don't have sports medicine doctors or Gatorade in

> Kenya yet to compromise their health and performance. To be fair,

> Gatorade contains sodium, but not enough to compensate its losses

> with sweat during actual races.

>

> To my amazement, the cause of runner's diarrhea is still (2008)

> considered unknown. Well, not anymore. To prevent dehydration and

> diarrhea, load up on salt before the race because sodium is essential

> for water retention. That's why the hospital I.V. drip contains 0.9%

> of sodium chloride, not potassium. For the same reasons, pickles and

> brine are so " therapeutic " after a sauna or for a hangover. Who, but

> the Russians, would know all that...

>

> Fourth, alcohol affects the liver function. This, in turn, may cause

> a profuse release of bile — the body's way of removing offensive

> metabolites. This action causes an almost immediate diarrhea, which

> may lead to constipation, and contribute to IBS.

>

> Fifth, some alcoholic beverages are highly allergenic to sensitive

> individuals. The biggest offenders are: beer for gluten-sensitive

> individuals (most people with IBS are); tonic mixed with gin from

> allergies to quinine; sulfites in wines, cognacs, and aged scotch,

> which may cause diarrhea; loads of fiber in V-8 added to `Bloody

> ,' and probably many others.

>

> Six, alcohol lowers blood sugar (this, actually, causes drunkenness).

> In turn, low blood sugar raises the levels of insulin and that's what

> makes some drunk people so angry and aggressive, as it raises their

> levels of stress hormone. These two simultaneous actions stimulate

> appetite on the one hand, and inhibit digestion on the other, and

> that's what is causing nausea, vomiting, and hangovers. One bad binge

> may easily precipitate IBS, particularly in middle-aged persons who

> aren't adept at hard drinking. Younger people are less vulnerable,

> because, for a while, they enjoy " guts of steel. "

>

> Will you get harmed by a glass of wine along with dinner? Probably

> not, for as long as you are drinking French or Italian table wines,

> vin de table and vino da tavola, respectively.

>

> Q. What's so special about table wines, and what it has to do with

> IBS?

>

> Vintage (or quality by the European Union definition) wines are aged

> in oak casks. New wine casks are treated with sulfites to prevent

> expensive oak wood from rotting. Aging infuses wines with these

> sulfites. Unlike vintage, table wines are made and kept in stainless

> steel vats, and they never get exposed to oak impregnated with

> sulfites.

>

> The less scrupulous producers of inexpensive table wines (and often

> vintage wines too), add extra sulfites to prevent spoilage, so these

> wines can be shipped, sold, and stored without regard to temperature

> almost indefinitely.

>

> This practice is widespread outside of the European Union, but

> particularly in the United States and Latin America. For this reason

> I never touch American wines, unless the label says " Organic. " This

> way I am assured of having good night sleep and clear head

> the " morning after. "

>

> Sulfites are very strong allergens. Just like MSG, they produce a

> very unpleasant " histamine flush, " which is what causes its' nasty

> after-effects, such as migraine, insomnia, nausea, dizziness,

> sweating, tachycardia, wheezing, hives, pale skin, and even

> anaphylaxis in hypersensitive individuals. Unfortunately, histamine

> intensifies inflammatory conditions, which are prevalent in people

> with IBS.

>

> It's not such a big deal in the United States where the culture of

> daily wine drinking was all but non-existent until very recently and

> the drinking age is 21. But it is (big deal) for French or Italians

> who drink table wines with practically every meal and literally from

> birth (though diluted).

>

> No wonder they can't afford experiencing daily hangovers or

> anaphylactic shock, particularly among children. For these reasons

> adding sulfites to table wine intentionally may get one into prison

> in France, while in the United States it's taught in winery courses

> as " good business. "

>

> You'll still see the " Contains Sulfites " statement on practically all

> wine labels, table or not, because, apparently, they occur in wines

> naturally. I say " apparently, " because I don't believe this is true.

> But it's cheaper for the E.U.-based winemakers and distributors to

> comply with the U.S. labeling regulations, than to certify their

> wines as " organic " or " sulfites-free. " After all, table (a.k.a. jug)

> wines are bought mainly on price, not the quality or purity of

> content.

>

> Histamine receptors (H2) play an important role in the secretion of

> gastric juices, and, correspondingly, in digestion. For these reasons

> sulfites and alcohol may cause dyspepsia — a general term for

> unspecific stomach distress. This condition is particularly harmful

> to people already affected by irritable bowel syndrome or

> inflammatory bowel diseases.

>

> In general, if you have already developed an allergic reaction to

> sulfites in wines, you may react adversely even to " clean " wines —

> immune system commonly produces antibodies to other wine components,

> and retains this " body memory " for a considerable length of time. In

> this case, you are better off skipping alcoholic beverages aged in

> casks, such as wines, ports, champagnes, vermouths, sakes, cognacs,

> whiskeys (scotches), and others.

>

> — What's left? Any good triple-distilled vodka, such as Smirnoff. And

> don't waste your money on all those " gourmet " vodkas in artisan

> bottles. Many of those have that discerning taste precisely because

> they are inadequately distilled and are more likely to cause

> hangovers. Only this time around, it isn't from added sulfites, but

> from toxic alcohols other than ethanol (i.e. pure alcohol).

>

> So, show me some wine (scotch, cognac, etc.) `cognoscenti' — those

> snobbish and oftentimes arrogant guys, and nowadays, gals too — who

> swoon over aged bottles of expensive grape juice or malted barley,

> and discuss " notes " the way mere mortals deconstruct Angelina Jolie

> of early vintage, and I'll show you a fool in the high-risk group for

> IBS, IBD, peptic ulcers, and digestive cancers.

>

> How come the French get away with it? Well, actually, they don't. The

> rate of digestive cancers in France is quite high as well, but it has

> to do more with smoking than wine. Besides, even when the French

> drink vintage wines on special occasions or after dinner, they do so

> by the sip, not by the goblet, the way the `nouveau riche' drink

> nowadays.

>

> — What do I drink? Lately, I don't, because alcohol interferes with

> my writing, energy, mood, and sleep. The only exception — when we are

> going out for sashimi. In this case, I'll have a glass of sake in

> order to sterilize raw fish with alcohol. I also always take with me

> MSG and gluten-free soy sauce. Just like sulfites, both of these

> substances are an absolute no-no for people with IBS, IBD, or a past

> history of both.

>

> Q. Why do you know all this and doctors don't?

>

> I don't know any more about " all this " than most doctors,

> particularly board certified gastroenterologists, gastric

> oncologists, or endoscopists, except that I am better trained to

> research and analyze broadly available information and research,

> investigate inconsistencies, connect the dots, and describe my

> findings in accessible language.

>

> All of the background information I rely upon is described in

> exceptional depth in primary medical texts as well as medical

> references, including The Merck Manual, which I quote so often. I

> learned most of these basic facts back in the seventies in medical

> schools from textbooks authored decades earlier, and from professors

> trained before World War II.

>

> If a medical doctor doesn't know " all this " basic information about

> human digestion, he/she wouldn't be able to pass a licensing board

> exam. So this question should really ask: " Why doctors don't use all

> this information to treat patients? "

>

> Well, some do, particularly outside of the United States. Since most

> of the healthcare delivery in the United States is orchestrated by

> pharmaceutical companies, which publish the majority of textbooks and

> references, administer continuous medical education (CME) courses,

> design and administer licensing exams, and own or sponsor most of the

> medical publications and web sites, doctors are trained to rely more

> on tests and drugs, than on inexpensive and truly effective solutions.

>

> Besides, it's faster and easier to write prescriptions; drugs offer

> quick relief to patients and create an aura of competence; and the

> drugs' side effects bring a ton more repeat business soon thereafter.

> So why kill the bonanza writing web pages (such as this), or waste

> valuable " face " time teaching patients the fine points of stools?

>

> In the doctors' defense, I have to say this: the majority of their

> patients don't give a damn about the causes of their diseases; don't

> care to learn how to eliminate these causes, don't want to change

> anything in their lives and diets, and prefer an instant fix with

> this or that pill, ideally for free.

>

> Naturally, doctors, insurers, and pharmaceutical companies respond

> to " market pressures " just like any other business worth its salt

> would — they give their customers what they want! It's good business,

> and, besides, it's great for business.

>

> If you have read this page this far, you are a welcome exception. So

> don't be a dupe, do the right thing, don't dwell far too long over

> things outside of your circles of control and influence, and show

> others the way simply by getting well. It sure beats popping pills,

> wearing a colectomy bag, or bleeding to death.

>

> ***

>

> Author's note

>

> I suffered from IBS most of my adult life. I can easily trace its

> origins to my mother's insistence that I never use public restrooms,

> to indiscriminate use of antibiotics before I became aware of their

> perils, to dental amalgams that I briefly had, to fiber laxatives

> that I took for chronic constipation, and, finally, to years of a

> high-fiber, vegetarian diet.

>

> I am IBS-free for almost a decade now, but not entirely out of the

> woods. By the time I had learned all this, lots of internal damage

> had already been " set in stone: " irreversible hemorrhoidal disease,

> anorectal nerve damage, hypersensitivity to gluten, and the remnants

> of Crohn's disease easily triggered by traces of gluten, stress, or

> fatigue.

>

> So my interest in and the knowledge of this subject is far from

> abstract — I am not exactly a nun teaching sex education class from

> textbooks written by a celibate monk.

>

> Still, one man's journey through hell isn't enough to plot a path to

> heaven for another... That's why my work is so explicitly thorough,

> referenced, and detailed, and why it took me almost ten years after

> my own complete recovery from IBS to contemplate, research, and write

> this page.

>

> Good luck and be well,

>

> Konstantin Monastyrsky

>

>

>

>

>

> Commentaries

>

> [1] Re: " the causes of IBS are still a mystery "

>

> There is nothing mysterious about IBS. Its causes are well-known and

> well-studied functional conditions, such as disbacteriosis,

> suppression of stools, hard stools, excess dietary fiber, common food

> allergens, laxatives, the side effects of medications, and some

> others. All of them can be reversed reasonably well, with minimal

> effort, and without a doctor.

>

> The Merck Manual, on the other hand, recommends screening patients

> for inflammations, ulcers, polyps, and other pathologies with IBS-

> like symptoms.

>

> This approach is similar to using radiology (x-rays) and endoscopy to

> diagnose indigestion, while ignoring to check for inadequate acidity,

> low enzymes, bad diet, and poor-fitting dentures — the four principal

> causes of bad digestion. No wonder then, when gastritis or ulcers

> aren't found, indigestion too becomes a mystery.

>

> None of it is surprising. In the general paradigm of allopathic

> medicine (which forms Merck's diagnostic and treatment framework),

> the disease isn't a disease, unless it has a diagnostic procedure or

> drug treatment attached to it.

>

> Unfortunately for patients with IBS — a functional condition

> completely outside of Merck's framework — this reality introduces

> harmful diagnostic procedures, the side effects of unnecessary drugs,

> and more health problems down the road.

>

> [back]

>

> [2] Re: Aggressive medical treatment of inflammatory bowel disease

>

> A nutritional approach to GI disorders described on this site and in

> Fiber Menace may be effective for the early stages of ulcerative

> colitis, and should always be tried before starting " shock and awe "

> treatment with antibiotics, steroids, and immunodepressants.

>

> It may also enhance the treatment and improve the outlook of Crohn's

> disease, but not really " fix it, " because this condition has a

> significant autoimmune component that can't be controlled by diet

> alone.

>

> This approach works well because a great deal of U.C.-related

> intestinal inflammation may result from gastroenteritis, so a gradual

> recovery must begin at the very top of the digestive tract.

>

> Later stages of U.C. require a more thorough and intensive therapy,

> determined by your physician. But the nutritional approach is the

> same.

>

> Originally, I described nutritional intervention for ulcerative

> colitis in my earlier Russian-language books. According to limited

> accounts from readers who followed it, they have recovered and

> remained in remission for as long as they maintained vigilance —

> ulcerative colitis may be easily set off again by preexisting trigger

> factors.

>

> [back]

>

> [3] Re: " Criticism " of The Merck Manual of Diagnosis and Therapy

>

> Some people may get mad at me for suggesting that their revered Merck

> Manual may be wrong, and who am I to criticize it?

>

> Most of the Merck Manual's shortcomings and biases are heavily

> influenced by the drugs-driven ways of it's publisher and a charter

> member of the Big Pharma — Merck & Co. Inc. The borderline between

> influence and profit is a very narrow one, and it forms an approach

> that may initially have good intentions, but not necessarily good

> outcomes.

>

> Besides, if Merck & Co. could err so " deadly " with Vioxx or Fosamax,

> they can err just as much with The Merck Manual, because its

> editorial and professional scrutiny is nowhere near the hoops

> reserved for prescription drugs prior to their review by the FDA.

>

> To be truly credible, trustworthy, and useful to doctors and patients

> alike, The Merck Manual should be fully divested from its ignominious

> parent, and obliged to follow rules of disclosure and transparency

> similar to the rest of the academic medical press.

>