3. Toast directly on a wire rack for 8 to 9 minutes, until the spices give off fragrance and the pita is crispy. Eat whole, or cut into wedges.

PER SERVING.

70 calories, 3.5 g protein, 16 g carbohydrate, 0 g fat, 0 mg cholesterol, 500 mg sodium, 3 g fiber BANANA-MANGO PARFAIT.

You'll love the rich, decadent flavor in this sleepy-time snack. And because it's comprised of three fabulous ingredients-banana, mango, and fat-free ricotta cheese-your body gets a blast of nutrition before bed. I like it super cold, chilled for at least an hour.

Makes 3 servings

1.

ripe medium mango, peeled and cubed

2.

tablespoons sugar

1.

cup fat-free ricotta cheese .

cup mint leaves, finely sliced, plus 3 whole sprigs for garnish

1.

large banana, thinly sliced

1. Puree the mango and sugar in a blender until smooth. Transfer to a large bowl and stir in the ricotta and sliced mint.

2. Spoon 2 tablespoons of the ricotta mixture into each of 3 parfait gla.s.ses. Top with half of the banana slices, and another layer of ricotta. Top with the remaining banana, and then the remaining ricotta mixture.

3. Garnish each gla.s.s with a sprig of fresh mint. Serve immediately, or chill up to 4 hours.

PER SERVING.

164 calories, 8 g protein, 33 g carbohydrate, 0 g fat, 20 mg cholesterol, 201 mg sodium, 2 g fiber

CHAPTER 17.

IRRITABLE BOWEL SYNDROME.

Irritable bowel syndrome (IBS) is common, affecting about 20 percent of Americans, and yet it is a mystery. No one knows exactly what causes it and there is no way for a doctor to make a definitive diagnosis. There is no single trigger, and no single set of identifying symptoms, which can come and go in a day, or plague sufferers for months or years. So much uncertainty attached to very real physical discomfort makes coping with IBS frustrating in the extreme.

IBS is called a functional bowel disorder functional bowel disorder, and not a disease, because it doesn't cause permanent damage, it doesn't progress to serious illness, and it can usually be controlled with diet and lifestyle changes. There's another reason to be hopeful if your case is a persistent one-people with chronic symptoms like yours have been successfully treated with new medications, making the condition less disabling than ever before.

WHAT AFFECTS IBS?.

The agony of IBS comes from the pain, discomfort, and embarra.s.sing inconvenience of symptoms, which include diarrhea or constipation, cramping, bloating, excess gas, and mucus in the stool. To understand what happens in IBS, imagine a football stadium full of spectators doing "the wave." If everyone cooperates, you can see the forward progress of the wave as each section stands and then sits again-it's amazing to see so many bodies working in concert. Now imagine that you have some very nervous spectators...they see the wave coming at them, and they stand up too early, starting a secondary wave, so now there are two competing waves. The rhythm is disrupted. Or, imagine that one group stands up for the wave but doesn't sit back down again. The wave is "stuck," unable to move forward until the disrupting group decides to sit back down again.

Our intestines are lined with muscles that contract and relax in waves (ah-ha!) called peristalsis peristalsis, which push the food you eat through the system. Along the way, nutrients are absorbed, and the residual is eventually eliminated in feces. In people with IBS, normally rhythmic waves are disrupted. Sometimes, the nervous bowel contracts too much or too forcefully, so food moves through the intestines too quickly, resulting in diarrhea.

Other times, the intestinal muscles contract but don't relax again, or they contract very slowly, resulting in constipation. These crazy, out-of-sync muscle movements are behind the pain of IBS, much like muscle spasms in your leg cause the pain of a charley horse. We all have intestinal gas, but for people with IBS, it can become trapped inside, resulting in bloating and distention. Some of my clients with IBS have admitted to buying two wardrobes-an everyday wardrobe and another specifically for their bloated, symptomatic days. Makes perfect sense-who wants to wear a snug pair of jeans or a fitted dress when they feel like the Pillsbury Dough Boy? In addition, the intestinal nerves of people with IBS are highly sensitive, so that even minor bloating can have them doubled over in pain.

An individual with IBS might experience just a few of these symptoms, or all of them. Although most sufferers have either diarrhea-predominant IBS or constipation-predominant IBS, some people alternate between diarrhea and constipation. No matter what type of IBS you have, the underlying problem is that the rhythm of intestinal muscle contractions periodically get messed up. There is no test for messed-up intestinal waves, however, and the symptoms of IBS are common to many other diseases, so arriving at a diagnosis of IBS is lengthy and full of guesswork. Your doctor will want to rule out all other possible disorders through a physical examination, blood tests, ultrasound, x-ray of your bowels, and sigmoidoscopy or colonoscopy, in which a lighted flexible tube is inserted into your lower intestines to get an up close and personal look at your intestinal lining. If there are no other problems, it's IBS by default. Once you have a diagnosis, you and your doctor can get to work to find a treatment that works for you-IBS can can be controlled. It's important to remember that although IBS can be uncomfortable, and strictly speaking there is no "cure," it also won't turn into anything more serious. be controlled. It's important to remember that although IBS can be uncomfortable, and strictly speaking there is no "cure," it also won't turn into anything more serious.

We don't know what disrupts the workings of the intestines in the first place, but we do know what can trigger flares of the disorder. Food is a biggie, and I'll address that in the next section. Aside from food and eating issues, the only other significant IBS trigger is stress.

Stress can trigger a flare of IBS, and it can make food-triggered IBS symptoms worse. That's why many health experts recommend that people suffering from IBS actively explore a variety of ways to de-stress-there might be a terrific way to relax that you just haven't tried yet. Some doctors even talk about an IBS personality IBS personality, one that is noticeably tense and anxious. I've seen this is my own practice. The client that comes to mind is Amy, a kindergarten teacher. The first time I saw Amy, I was struck by her rigid body language-every move she made told me she was a very controlled person-sitting or standing her posture was perfect, and she held her arms close to her body using minimal gestures. She spoke in a clipped, drill-sergeant sort of way. Everything Amy did, she did quickly. She was always on the run doing things for the kids in her cla.s.s, running errands for her family, setting up the cla.s.sroom, and gobbling down her food. Amy didn't sit down to eat. If she couldn't wolf down a meal in five minutes it wasn't worth eating. The challenge with Amy was getting her to recognize her food triggers, and also-perhaps more importantly-helping her to understand that her stressful, on-the-go lifestyle was only making her IBS worse.

FAQSI've read that I should take fiber supplements for my IBS. Are they helpful?

Many experts recommend fiber supplements, but they are not always the best medicine. I say this because many of my clients have complained they've become more bloated and ga.s.sy after taking them. And this goes for both types-soluble and insoluble fiber supplements. That's because people with IBS are very sensitive to fiber. When I treat clients, I start by asking about their symptoms. If it's predominantly diarrhea, I'll have them take a rest from most fiber-rich foods. Then, ever so slowly, we start adding it back-focusing first on the soluble type. If a client complains of persistent constipation, I immediately incorporate soluble fiber-rich foods (along with some insoluble fiber) evenly sprinkled throughout the day. When my clients feel well enough, we add more. I can't explain why, but when it comes to fiber, I've had much more success with food than supplements. Skip the pills and instead, add fiber-rich foods (slowly!) along with lots of flat water to your diet.

On a very basic level, eating quickly is risky because you are more likely to swallow air, which can directly lead to bloating and distention. But stress can also stimulate spasms in the gastrointestinal tract-like feeling b.u.t.terflies in your stomach when rumors about impending layoffs start flying around the water cooler. In people with IBS, those b.u.t.terflies are on a rampage. Amy's IBS was certainly made worse by her tense, never-stop, full-of-stress lifestyle. Fortunately, we were able to get her symptoms under control in pretty short order. We identified her food triggers (soy-based foods, raw vegetables, gum, and coffee), which eliminated most of her problems, but stress education was the biggest eye-opener for her. Amy had no idea how much her driven personality affected her bowels. Although she still has a way to go, it's easier for her to relax now that she doesn't have to worry about whether her diarrhea will strike unexpectedly and she's made a determined effort to be more relaxed. Ironically, she's as driven about finding time to de-stress as she is about everything else, but she's on her way to achieving the type of balanced life that can keep her IBS symptoms to a minimum.

HOW FOOD AFFECTS IBS.

A sensitive gut needs to be treated like a fussy baby-you have to put it on a regular feeding schedule, keep it calm, and protect it from potential irritants.

IDENTIFYING TRIGGER FOODS.

Identifying your particular trigger foods can be difficult. Even people without IBS will have a gastrointestinal reaction to certain foods once in a while. It just happens, and it's perfectly normal. But people with IBS have a heightened sensitivity to foods; they know the awful consequences of a trigger food so they might eat a spicy bowl of chili, for example, have a reaction, and condemn chili to a list of foods to be avoided forever. But what if the reaction was really due to unusual stress, or a mild case of food poisoning, or just one of those normal gut reactions? You might avoid a food forever for no good reason. By the time some clients come to see me, they're downright food phobic. They are so afraid of an attack of diarrhea, constipation, or horrific gas that they err on the side of caution...but too much caution can result in low blood sugar, weight loss, malnutrition, and another kind of socially awkward situation-they can become afraid of eating with friends and going out for fear of an attack.

For people with extreme extreme IBS, the simplest way to identify the right trigger foods is to first follow an elimination diet for five to seven days-a meal plan which avoids IBS, the simplest way to identify the right trigger foods is to first follow an elimination diet for five to seven days-a meal plan which avoids all all potential offending foods, then slowly reintroduce those same foods one by one. Along the way you keep track of reactions to foods you are reintroducing in a food diary. Depending upon your symptoms, my guidelines for an elimination diet vary slightly. Please note: Following an elimination diet can be very difficult. It's just a week, but you still need to be pretty committed to put up with such a limited selection of food. Then again, if you're currently suffering, better to put up with a week of discomfort than a lifetime of untreated abdominal pain. potential offending foods, then slowly reintroduce those same foods one by one. Along the way you keep track of reactions to foods you are reintroducing in a food diary. Depending upon your symptoms, my guidelines for an elimination diet vary slightly. Please note: Following an elimination diet can be very difficult. It's just a week, but you still need to be pretty committed to put up with such a limited selection of food. Then again, if you're currently suffering, better to put up with a week of discomfort than a lifetime of untreated abdominal pain.

If you have severe diarrhea-predominant IBS, your five-to seven-day elimination diet will avoid all trigger foods plus plus all fiber, including soluble fiber (instructions are provided in my 4-Step Program under Extreme Elimination Diet-No Fiber, Chapter 17). all fiber, including soluble fiber (instructions are provided in my 4-Step Program under Extreme Elimination Diet-No Fiber, Chapter 17).

If you have severe severe constipation-predominant IBS, your elimination diet will avoid all trigger foods, but constipation-predominant IBS, your elimination diet will avoid all trigger foods, but incorporate incorporate foods rich in soluble fiber and small amounts of insoluble fiber (those instructions are provided in my 4-Step Program under Elimination Diet with Added Fiber, Chapter 17). The addition of soluble fiber can help encourage your intestines to "wave" more effectively. foods rich in soluble fiber and small amounts of insoluble fiber (those instructions are provided in my 4-Step Program under Elimination Diet with Added Fiber, Chapter 17). The addition of soluble fiber can help encourage your intestines to "wave" more effectively.

Whichever plan you follow, after about a week you'll be ready to test some of the potential trigger foods. I recommend trying one new food every two to three days, and carefully doc.u.menting what you eat and how you feel during the 24 hours afterward. Although this chapter provides all the instruction you need to do this on your own, it's a big job. If you try on your own and find it unmanageable, I encourage you to work with a registered diet.i.tian who specializes in gastrointestinal issues.

As I said, these elimination plans are only for very severe cases of IBS. For less debilitating IBS, feel free to skip the elimination meal plan altogether and go straight to keeping an IBS journal. Your journal should list exactly what you eat, when you eat, what symptoms you experience, as well as your emotional state for the day. Make a special note if you feel particularly tense, anxious, or stressed.

COMMON IBS TRIGGER FOODSThe most common IBS trigger foods are: - Milk and dairy products, including milk, yogurt, cheese, b.u.t.ter, cream, cream cheese, sour cream, ice cream, frozen yogurt, sherbet, pudding, custard, prepared foods that contain dairy (i.e., cream soups, creamy salad dressings, mashed potatoes, pancakes), and baked goods that contain dairy (i.e., cake, cookies, m.u.f.fins, and donuts) including milk, yogurt, cheese, b.u.t.ter, cream, cream cheese, sour cream, ice cream, frozen yogurt, sherbet, pudding, custard, prepared foods that contain dairy (i.e., cream soups, creamy salad dressings, mashed potatoes, pancakes), and baked goods that contain dairy (i.e., cake, cookies, m.u.f.fins, and donuts) - Soy foods, including soy milk, edamame, tempeh, tofu, soy crisps, and soy nuts and snack bars that list soy protein as an ingredient. For some people, soy sauce is a trigger. including soy milk, edamame, tempeh, tofu, soy crisps, and soy nuts and snack bars that list soy protein as an ingredient. For some people, soy sauce is a trigger.

- Citrus fruits, including oranges, grapefruits, tangerines, mandarin oranges, tangelos, clementines, lemons, limes, and pomelo including oranges, grapefruits, tangerines, mandarin oranges, tangelos, clementines, lemons, limes, and pomelo - Raw vegetables, all, including lettuce all, including lettuce - Cruciferous vegetables, including broccoli, cauliflower, kale, cabbage, Brussels sprouts, bok choy, turnip greens, mustard greens, and collard greens; also, the nightshade vegetables-eggplant and peppers. including broccoli, cauliflower, kale, cabbage, Brussels sprouts, bok choy, turnip greens, mustard greens, and collard greens; also, the nightshade vegetables-eggplant and peppers.

- Wheat, including all products made with wheat flour such as bread, crackers, pasta, and cereals including all products made with wheat flour such as bread, crackers, pasta, and cereals - Foods high in insoluble fiber: Some people are Some people are only only sensitive to wheat products that are very high in insoluble fiber, such as wheat bran and high-fiber breakfast cereals. sensitive to wheat products that are very high in insoluble fiber, such as wheat bran and high-fiber breakfast cereals.

- Concentrated sources of fructose, such as sugar, honey, fruit juice and beverages, dried fruit, and candies and syrup that contain high fructose corn syrup such as sugar, honey, fruit juice and beverages, dried fruit, and candies and syrup that contain high fructose corn syrup - Beans and lentils - Whole nuts and seeds: Nut b.u.t.ters are typically tolerated, but still test to be certain they are safe for you. Nut b.u.t.ters are typically tolerated, but still test to be certain they are safe for you.

- Corn and popcorn - Garlic and onions - Spicy foods - Carbonated beverages: any drinks that fizz with little bubbles any drinks that fizz with little bubbles - Caffeinated drinks, such as coffee, tea, and colas such as coffee, tea, and colas - Alcohol - Fatty foods, especially fried foods such as French fries, onion rings, fried fish and chicken, or deep-fried anything especially fried foods such as French fries, onion rings, fried fish and chicken, or deep-fried anything - Red meat, particularly steaks, hamburgers, hot dogs, cold cuts, and sausages particularly steaks, hamburgers, hot dogs, cold cuts, and sausages - Sugar alcohol sweeteners: all foods, gums, and candy containing sorbitol, malitol, and mannitol all foods, gums, and candy containing sorbitol, malitol, and mannitol - Olestra (fat subst.i.tute) (fat subst.i.tute) - Chewing gum (sugared and sugar-free) (sugared and sugar-free) - Chocolate (sorry!) (sorry!) - Condiments, including ketchup, mustard, pickle relish, soy sauce, chutney, mayonnaise, and barbecue sauce including ketchup, mustard, pickle relish, soy sauce, chutney, mayonnaise, and barbecue sauce

When you have an IBS attack, consult your diary to see which foods you ate in the previous 24 hours and start a list of your potential triggers. Keep eating normally, always noting which foods you ate in the 24 hours prior to an attack and adding new items to your potential trigger list. When a food already on your list precedes an attack, make a hatch mark next to it each time it comes up. After a few weeks, those marks should tell you which foods are most likely to trigger an episode. Narrow down your list to the three most likely triggers, and avoid those foods entirely for two weeks. Continue to keep your IBS journal, and repeat the process. Every once in a while, test your trigger foods again (one at a time) to make sure you're not avoiding them for no reason. Over time, you'll have a good handle on which foods you need to avoid to feel well, and which you can eat safely. NOTE: If you find yourself with more than five main trigger foods, see a diet.i.tian to make sure that the rest of your diet is making up for whatever nutrients you're missing by eliminating those foods.

For everyone fighting IBS, there are a few mealtime guidelines that can make your life easier: 1. Try to eat meals at the same time each day to get your body used to a schedule.

2. Eat smaller, more frequent meals so you don't overload your gut at any one time.

3. Slow down-sit, relax, and take time to chew your food. Think of it as time invested in training your digestive system to behave.

GOOD FOODS TO CHOOSE.

The best foods for IBS health are those that are gentle on the digestive system, and which encourage "smooth pa.s.sage" through the intestines. Thus, vegetables, fruit, and whole grains-it pains me to say-should be limited until your symptoms subside and you identify foods that are problematic for you. It's hard to imagine I just said that! Truth be told, these healthful foods are a bit hard for the body to break down, but remember I'm only recommending you watch your intake until until you've got a handle on your triggers-even with diarrhea-predominant IBS, you should eventually be able to tolerate moderate amounts of all three groups, although you'll probably need to cook vegetables. you've got a handle on your triggers-even with diarrhea-predominant IBS, you should eventually be able to tolerate moderate amounts of all three groups, although you'll probably need to cook vegetables.

SOLUBLE FIBER.

Fiber comes in two main varieties: soluble and insoluble. Soluble fiber dissolves in water and turns into a kind of gooey, gummy consistency-think what happens to oatmeal after it sits in a pot of water for a time. Insoluble fiber is tougher. It doesn't dissolve, and pretty much keeps its form.

Although insoluble fiber is generally healthy, it can be hard on the intestines of people with IBS. Insoluble fiber speeds food through the colon, something that many diarrhea-predominant IBS sufferers want to avoid. People with constipation-predominant IBS may want to experiment with how much insoluble fiber they can eat without experiencing too much gas and bloating.

Soluble fiber, on the other hand, promotes gentle regularity, regardless of the type of IBS you have. That's why you'll find plenty of soluble fiber integrated into my Elimination Diet with Added Fiber (it doesn't, however, include soluble fiber-rich foods that also act as potential triggers, such as beans, lentils, broccoli, and cabbage).

Most foods high in soluble fiber are considered safe for people with IBS. The trick is to eat a variety of foods in moderation, without eating too much of one particular food, or too much food in general at one time. If you have diarrhea-predominant IBS, I recommend slowly adding more foods high in soluble fiber to your diet. If you experience too much bloating or pain, back off a little, wait a few days, then add fiber again. The key is to eat just a little bit of extra fiber, building up to about six servings a day over a course of weeks, not days. However, for constipation-predominant IBS, you can be more aggressive, fiber-wise. The Elimination Diet with Added Fiber (for constipation-predominant IBS) works in three to six (or more) daily portions of soluble fiber, depending upon the meals and snacks you chose. Of course, even then you'll want to moderate the portions and spread them throughout the day-as opposed to eating them all at one sitting-to avoid the risk of excess gas. And...remember to drink plenty of water to help move it along.

LACTOSE INTOLERANCE VERSUS IBSMilk can trigger IBS, that's why you'll find dairy on the list of foods to initially avoid. But sensitivity to dairy foods may also be a sign of lactose intolerance. Lactose intolerance is not IBS. In fact, it's a completely different problem and one that's easily remedied. If you suspect you're lactose intolerant, make dairy the first thing you test.Milk products contain a form of natural sugar called lactose. In order to digest lactose, our bodies produce a specific enzyme called lactase. For a variety of reasons, including genetic abnormalities, digestive disorders (i.e., celiac disease, Crohn's disease, IBS), intestinal injury, and/or the natural aging process, some people end up with very low levels of lactase. Depending on how much of the offending food you eat, and how much lactase enzyme your body can produce, symptoms can be mild or severe, and include nausea, cramping, gas, bloating, and diarrhea. Sound familiar? The symptoms can be remarkably like IBS symptoms. So, how do you tell the difference? Simple. Avoid milk and anything containing milk for three to five days (see full dairy list under Common IBS Trigger Foods, Chapter 17). If your symptoms disappear, you're probably lactose intolerant. If you're willing to avoid those trigger foods indefinitely, it really doesn't matter whether you have lactose intolerance or IBS-as long as you don't eat them you'll feel fine.On the other hand, you may want to know definitively which it is-IBS or lactose intolerance, if only to understand your options. Many people with lactose intolerance can enjoy lactose-reduced milk products without any symptoms. Others take lactase enzyme (such as Lactaid) in a tablet or liquid form with their first bite or sip of a milk product and voila voila-no digestive trouble. It's unlikely people with dairy-triggered IBS can tolerate these reduced-lactose products. But those aren't diagnostic tests. If you really want an answer ask your doctor about these: the Lactose Tolerance Test, which is a series of blood tests taken over a two-hour period after drinking a lactose-rich test drink; and the Hydrogen Breath Test, which looks for a higher-than-normal amount of hydrogen in the breath, caused by the extra gases produced by the bacteria fermenting the undigested lactose in the intestines.If you test positive for lactose intolerance and avoid all milk products but still still have gastrointestinal symptoms, talk with your doctor about whether you need additional testing. In the end, you may have both, lactose intolerance and IBS (I know-oy!). have gastrointestinal symptoms, talk with your doctor about whether you need additional testing. In the end, you may have both, lactose intolerance and IBS (I know-oy!).

In my Elimination Diet with Added Fiber, I incorporate at least one serving of soluble fiber-rich food at each meal. If you have diarrhea-predominant IBS, and you're ready to follow the less extreme Elimination Diet with Added Fiber, you may want to move more slowly...starting with a single serving for the entire day. All foods rich in soluble fiber included in Your Ultimate Grocery List have an asterisk (*), so you'll know what to include and what to avoid. Everything is explained in the 4-Step Program, Chapter 17.

In addition, raw vegetables-whether rich in soluble OR insoluble fiber-tend to be difficult for IBS sufferers to digest and can often trigger diarrhea, gas, and bloating. When you're ready to introduce vegetables into your diet, I strongly recommend you stick to cooked vegetables.

BEST FOODS FOR SOLUBLE FIBER: Psyllium Seeds (ground), oat and rice bran, oatmeal, barley, peas, apple, blackberries, pears, apricots, cantaloupe, strawberries, bananas, peaches, cooked carrots, cooked spinach, sweet potatoes, yams, white potatoes, avocado, raspberries, flaxseed (ground) Psyllium Seeds (ground), oat and rice bran, oatmeal, barley, peas, apple, blackberries, pears, apricots, cantaloupe, strawberries, bananas, peaches, cooked carrots, cooked spinach, sweet potatoes, yams, white potatoes, avocado, raspberries, flaxseed (ground) LIQUIDS.

All people with IBS should strive to drink at least eight 8-ounce gla.s.ses of flat water every day. If constipation is your problem, water will help keep your stools moist so they pa.s.s more easily; the soluble fiber in your diet will help too. If diarrhea is your problem, you'll need to replenish the water you lose through loose stools. Plain water and naturally decaffeinated herbal teas should be your first choices. Carbonated beverages are the worst choices because the gas from the carbonation gets trapped in your intestines, causing discomfort. If you have diarrhea-predominant IBS, you'll also want to avoid drinking caffeinated beverages and alcohol, which can stimulate the intestines and make symptoms worse.

BONUS POINTS.

- Rule out other disorders. Please don't a.s.sume that your symptoms are due to IBS unless your doctor has told you so. You need to get a thorough medical workup to rule out other, more serious diseases, including Crohn's disease, ulcerative colitis, celiac disease, and colorectal cancer. Even if you've had a diagnosis of IBS, be sure to go back to your doctor if your symptoms change or worsen. Please don't a.s.sume that your symptoms are due to IBS unless your doctor has told you so. You need to get a thorough medical workup to rule out other, more serious diseases, including Crohn's disease, ulcerative colitis, celiac disease, and colorectal cancer. Even if you've had a diagnosis of IBS, be sure to go back to your doctor if your symptoms change or worsen.

- Talk with your doctor about medications. The standard of care is to treat IBS with diet and lifestyle changes. But if you can't get your symptoms under control, and if the pain and other symptoms are affecting your life, ask your doctor about medications that have been approved for IBS. There are a variety of possible medications, including antispasmodics, antidiarrheals, and antidepressants. Yes, antidepressants-for your intestines, not your brain-because they seem to modulate intestinal pain and regulate gut regularity. Many antidepressants regulate the neurotransmitter serotonin and (who knew?) 95 percent of serotonin is found in your gut, where it helps maintain smooth, regular contractions of the intestines. Some scientists believe that the intestines of people with IBS require more serotonin than they're getting for normal function. The theory is that antidepressants that make more serotonin available (the serotonin reuptake inhibitors-SSRIs-such as Prozac, Zoloft, or Paxil), will fix the problem. More research needs to be done before antidepressants are a first-line treatment, but if you've tried everything else, you may want to discuss this possibility with your physician. The standard of care is to treat IBS with diet and lifestyle changes. But if you can't get your symptoms under control, and if the pain and other symptoms are affecting your life, ask your doctor about medications that have been approved for IBS. There are a variety of possible medications, including antispasmodics, antidiarrheals, and antidepressants. Yes, antidepressants-for your intestines, not your brain-because they seem to modulate intestinal pain and regulate gut regularity. Many antidepressants regulate the neurotransmitter serotonin and (who knew?) 95 percent of serotonin is found in your gut, where it helps maintain smooth, regular contractions of the intestines. Some scientists believe that the intestines of people with IBS require more serotonin than they're getting for normal function. The theory is that antidepressants that make more serotonin available (the serotonin reuptake inhibitors-SSRIs-such as Prozac, Zoloft, or Paxil), will fix the problem. More research needs to be done before antidepressants are a first-line treatment, but if you've tried everything else, you may want to discuss this possibility with your physician.

- Don't self-medicate without guidance. You may be tempted to take control of IBS by stocking up on over-the-counter laxatives or anti-diarrhea medication. Don't do it unless you get the go-ahead from your doctor. IBS is a chronic disorder, and over-the-counter medications are short-term solutions. Laxatives in particular can be hard on the intestines if used inappropriately. If you find yourself relying on over-the-counter meds, talk with your doctor to find a better solution. You may be tempted to take control of IBS by stocking up on over-the-counter laxatives or anti-diarrhea medication. Don't do it unless you get the go-ahead from your doctor. IBS is a chronic disorder, and over-the-counter medications are short-term solutions. Laxatives in particular can be hard on the intestines if used inappropriately. If you find yourself relying on over-the-counter meds, talk with your doctor to find a better solution.

- Maintain healthy eating patterns. Eat small meals regularly throughout the day. Try to eat at about the same time each day. Slow down during meal time-try to avoid on-the-run (or over-the-kitchen-sink) eating. Eat small meals regularly throughout the day. Try to eat at about the same time each day. Slow down during meal time-try to avoid on-the-run (or over-the-kitchen-sink) eating.

- Put a lid on stress. Stress is a complex problem. Although circ.u.mstances outside our control can Stress is a complex problem. Although circ.u.mstances outside our control can feel feel stressful, psychologists remind us that events don't stressful, psychologists remind us that events don't create create stress. Stress is of our own making. It's how we interpret events or think about future outcomes that leads to stress. Those perceptions trigger a variety of physiologic responses, including changes in the way our gastrointestinal systems function. That's how the mind-body connection works-the things we think have very real effects on our bodies. But just as we create stress, we can also learn to respond in different ways to life events. People with IBS can have extreme physical reactions to stress, so relaxation is especially important. Stress can be controlled. Your IBS symptoms may depend on it. stress. Stress is of our own making. It's how we interpret events or think about future outcomes that leads to stress. Those perceptions trigger a variety of physiologic responses, including changes in the way our gastrointestinal systems function. That's how the mind-body connection works-the things we think have very real effects on our bodies. But just as we create stress, we can also learn to respond in different ways to life events. People with IBS can have extreme physical reactions to stress, so relaxation is especially important. Stress can be controlled. Your IBS symptoms may depend on it.

The first thing to try is deep breathing, which is breathing from the diaphragm instead of the chest. To get started: Lie down on the floor on your back. Bend your knees, and put your feet on the floor. Put one hand over your diaphragm, just under your ribs. Keeping your shoulders as flat as possible against the floor, take a deep breath. As you breathe in, focus on letting your diaphragm push your hand up, expanding your abdomen. Exhale naturally, and notice how your hand gently falls as the air leaves your lungs. (After you get the hang of this type of breathing, try it while standing or sitting up straight.) This type of deep breathing triggers a relaxation response in the body.

Along with deep breathing, you can bring in an a.r.s.enal of relaxation techniques, including ma.s.sage, yoga, and meditation. Even taking quiet time for yourself-a half-hour to read, take a bubble bath, garden, or just enjoy nature-may be enough to give your mind and body a much-needed break.

If stress has gotten out of control, you might want to consider a short course of counseling with a psychologist to help you learn how to change the way you respond to the stressful events in your life. There are specific techniques that can help you experience life without tension, anxiety, or that feeling of being overwhelmed. In fact, researchers from Mount Sinai School of Medicine in New York found that people with IBS who were treated by both a gastroenterologist and a psychologist got better faster than those treated by just one type of specialist.

- Make exercise a daily prescription. Exercise is important for two main reasons. First, exercise is a great stress reliever. Dozens of studies have shown that no matter what the cause of the stress, no matter what symptoms the stress causes, regular moderate exercise can help make you feel better. Second, exercise is critically important for the proper functioning of the gastrointestinal system. If your body is sluggish, your gut can follow suit. If your body is fit and active, your gut will be healthier. Although there have been just a few studies that focus on the effects of exercise on IBS symptoms, at least one study found that regular physical activity was protective. If you don't already exercise, you may want to consider walking for 30 minutes a day, every day at a moderate pace. But really, any activity will be helpful, so choose something fun to do every day. Exercise is important for two main reasons. First, exercise is a great stress reliever. Dozens of studies have shown that no matter what the cause of the stress, no matter what symptoms the stress causes, regular moderate exercise can help make you feel better. Second, exercise is critically important for the proper functioning of the gastrointestinal system. If your body is sluggish, your gut can follow suit. If your body is fit and active, your gut will be healthier. Although there have been just a few studies that focus on the effects of exercise on IBS symptoms, at least one study found that regular physical activity was protective. If you don't already exercise, you may want to consider walking for 30 minutes a day, every day at a moderate pace. But really, any activity will be helpful, so choose something fun to do every day.

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