Bowel Issues – Part 3, by Dr. Bob


Irritable Bowel Syndrome (IBS), is a difficult and tricky topic to cover.  First, let’s get some of the politics out of the way and then some pretty interesting facts about IBS to start with, then we will move on to some helpful management tips.  The actual definition of Irritable Bowel Syndrome is this:  a gastrointestinal syndrome characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause.  Obviously, if there is no way to actually test for a disease, then there is a wide interpretation of who has it and why they do; therefore, the politics.  There are some folks that believe that IBS should be labeled as a psychiatric disorder.  Often IBS is treated (sometimes successfully) with anti-depressant medications or even psychiatric medications.  Therefore, there are many out there that just toss IBS on the pile of “made up” diseases and close their minds to other options.  There are others that think IBS will be discovered to be a specific autoimmune disorder as time and research progresses.  Again, some medications that help problems like RA (rheumatoid arthritis) help some of the patients that suffer from IBS symptoms.  Others feel that IBS is a mechanical problem and if treated with the right diet and bowel regularity can be cured.  Still others feel that most IBS is misdiagnosed and if the proper workup were completed, these patient would find many alternate diagnoses instead of IBS.
The facts are interesting though about IBS:
• Prevalence varies widely among countries and is usually higher in developed countries
• Younger patients and women are more likely to be diagnosed with IBS
• Females to males with IBS is 2:1
• Costs estimate to be up to $30,000,000,000 dollars for IBS health care impact [, including missed days of work]
• 2nd most common cause of work absenteeism after the common cold!
• 25 to 50% of all GI (gastroenterologist) referrals
• Emotional stress often worsens the pain
The great thing about IBS is that almost all of us could really be diagnosed with it based on the criteria.  You can have diarrhea, or you can have constipation.  Usually, the pain is accompanied by a change in your bowel habits, but not always.  It can be relieved by a bowel movement, but not necessarily.  The official criteria, call Rome III Criteria, are as follows:
• recurrent abdominal pain or discomfort
• at least 3 days per month for at least 3 months
• associated with 2 of the 3
? improves after defecation
? start of symptoms is with change in bowel frequency (increase or decrease)
? start of symptoms is with change in stool appearance
Now, not to get too personal here, but if we eat enough Thai food or Mexican in my family it’s IBS for everyone!  This is what makes IBS tough for people to live with when they have a bad clinical case of it.  Most of the people around them think:  “big deal, you have stomach cramps and bowel problems, who doesn’t get that?”  The problem, from this Family Practitioner docs view, is how much do the symptoms have a life impact.  Lots of people meet the criteria for IBS and it doesn’t really affect their day to day living.  In fact, estimates are that only 15% of people with IBS criteria actually go to the doctor to do something about it.  There are others though that are basically disabled by IBS.  They have severe pain with bad diarrhea and are suffering every day.  This is why lots of different medications end up being “tried out” on IBS patients with severe disease.  Doctors just want to find something that helps the patient.
All patients will IBS should have already tried to eliminate all lactose from their diets to see if their symptoms improve.  That should be the case now rather than later.  Some patients will notice specific foods that worsen their IBS symptoms, and all IBS patients should keep a food diary for 2-3 months and note all foods and all symptoms in that diary.  The trends can be reviewed and those foods that worsen symptoms be avoided.  Again, this should be done now rather than when there is limited choice in foods.  Food allergies can often be a cause of or exacerbate IBS symptoms, and if you have IBS get your lab panel done now to see if food allergies are one of the causes of your symptoms.  Be sure the panel includes gluten, which is another source of IBS symptoms for some patients.  Some other foods that are thought to worsen some IBS patients include:  fructans, galactans, fructose, sobitol, xylitol, mannitol, and even fiber.  The diary should help to clue a patient in if these worsen or cause their symptoms.

Physical activity does help many, but not all patients with IBS.  Moderate physical activity is recommended for patients with IBS symptoms, and in a study those that did exercise improved and worsened less than the patients that were inactive.  Psychosocial therapies can help some patients, but the politics really kick in when you recommend hypnosis, biofeedback, and psychotherapy to a patient with stomach problems.  These treatments will obviously not be available WTSHTF.
Medications really are a last resort for the management of IBS, and any medicine is only to be used with the lifestyle and diet recommendations already reviewed above.  Any medication would have to be life-long and there is a lack of any convincing evidence of therapeutic benefit.  That being said, there are many IBS patients out there that take medications that truly improve their quality of life.  Again, any management of IBS should be done now as trials of medications and adjustment of doses will not be possible at TEOTWAWKI.
So, what can a person do to plan for the future without a grid if they have moderate to severe IBS.  The plain answer is:  make sure you have completed all the steps to modify and control your IBS symptoms, then continue more of the same.  If you have IBS now and manage it with diet, stress reduction, and fluids; you will need to continue those things WTSHTF.  If you take a medication, either over the counter or prescription, and it helps manage your IBS. You should probably have stockpile quantities of those meds for when the grid is no more.  The message is pretty clear:  get moving on management of your IBS when the grid is up and you will be a lot better off if it does go down.  Like most prepping issues, planning ahead pays off ten-fold compared to the “what do we do now” approach.  Stay strong, – Dr. Bob

JWR Adds: A family member with chronic IBS reported that Peppermint, Anise, and Fennel teas allproved to be a tremendous relief. The great news is that you can grow your own peppermint, anise, and fennel in many climate zones. I recommend that you start growing a patch of each now, so you can help any IBS sufferers in your community. Just be careful not to let the anise spread–it can become a pernicious weed.

Dr. Bob is is one of the few consulting physicians in the U.S. who prescribes antibiotics for disaster preparedness as part of his normal scope of practice. His web site is: