If you suffer from IBS and want to consider supplements in addition to in addition to the food fixes, I recommend: the food fixes, I recommend: 1. Multivitamin. I recommend a multivitamin to ensure that you always get the basic nutrition you might otherwise miss if you're tip-toeing around a sensitive stomach. Unfortunately, many people with IBS find that vitamins upset the delicate balance of their digestive systems. Look for liquid or chewable multivitamins-any brand, even children's chewables, are great for people with IBS. Read the label, and take the amount recommended for adults. I recommend a multivitamin to ensure that you always get the basic nutrition you might otherwise miss if you're tip-toeing around a sensitive stomach. Unfortunately, many people with IBS find that vitamins upset the delicate balance of their digestive systems. Look for liquid or chewable multivitamins-any brand, even children's chewables, are great for people with IBS. Read the label, and take the amount recommended for adults.

2. Calcium and vitamin D3. If you have IBS triggered by milk products, you may not get enough calcium in your diet to stay healthy. Women may want to consider taking a calcium supplement with added vitamin D If you have IBS triggered by milk products, you may not get enough calcium in your diet to stay healthy. Women may want to consider taking a calcium supplement with added vitamin D3 (cholecalciferol, the most potent form). The vitamin D is necessary, otherwise your body can't absorb and use the calcium. I recommend taking 500 to 600 milligrams of calcium (plus 100 to 400 IU of vitamin D) twice a day. (If you are a man, talk with your doctor before taking a calcium supplement. There is some evidence that too much calcium may be related to an increased risk of developing prostate cancer.) I recommend brands that contain calcium citrate (instead of the more common calcium carbonate), because it is easier on the stomach. One of my favorite brands is Citracal Plus, which also contains vitamin D and magnesium (take two tablets twice a day). If you can't swallow a pill, look for chewy supplements. (cholecalciferol, the most potent form). The vitamin D is necessary, otherwise your body can't absorb and use the calcium. I recommend taking 500 to 600 milligrams of calcium (plus 100 to 400 IU of vitamin D) twice a day. (If you are a man, talk with your doctor before taking a calcium supplement. There is some evidence that too much calcium may be related to an increased risk of developing prostate cancer.) I recommend brands that contain calcium citrate (instead of the more common calcium carbonate), because it is easier on the stomach. One of my favorite brands is Citracal Plus, which also contains vitamin D and magnesium (take two tablets twice a day). If you can't swallow a pill, look for chewy supplements. Important note: Important note: Some chews contain lactose, so if milk bothers your stomach, avoid the chews. Instead, buy the pill form, crush them with a pill crusher, and mix with natural applesauce to help them go down more easily. Some chews contain lactose, so if milk bothers your stomach, avoid the chews. Instead, buy the pill form, crush them with a pill crusher, and mix with natural applesauce to help them go down more easily.

3. Probiotics. Our intestines are full of microorganisms, but that's not necessarily bad. Some of the bacteria and yeast microorganisms are good for us, and can help keep us healthy. Some experts believe that people with IBS don't have enough of the good microorganisms, which is why their intestines seem to be out of balance. Probiotics are supplements that provide more of the good stuff, which can prevent the bad stuff from causing diarrhea or constipation. There are many varieties of probiotics, but the brand I recommend most often for IBS is Florastor (which contains Our intestines are full of microorganisms, but that's not necessarily bad. Some of the bacteria and yeast microorganisms are good for us, and can help keep us healthy. Some experts believe that people with IBS don't have enough of the good microorganisms, which is why their intestines seem to be out of balance. Probiotics are supplements that provide more of the good stuff, which can prevent the bad stuff from causing diarrhea or constipation. There are many varieties of probiotics, but the brand I recommend most often for IBS is Florastor (which contains Saccharomyces boulardii Saccharomyces boulardii), a non-harmful yeast. You should take one capsule twice a day, morning and evening. Although most probiotics require refrigeration, the Florastor brand should not not be stored in the fridge-always read labels. Research shows that other probiotics, including be stored in the fridge-always read labels. Research shows that other probiotics, including Lactobacillus plantarum Lactobacillus plantarum (Lp299v) and (Lp299v) and Bifidobacterium infantis Bifidobacterium infantis, also help reduce pain, bloating, and abnormal bowel movements. Another respected brand to consider is VSL#3-take to 1 packet per day for IBS. When taking probiotics, keep in mind that for the first two to seven days, your symptoms may worsen. Don't panic, the supplements are just doing their job. Your body will soon adjust and you'll most likely feel better than baseline. Florastor and other probiotics are often sold behind the pharmacy counters at mainstream drug stores. Speak with your local pharmacist if you have trouble finding them.

4. Enteric-coated peppermint oil. Peppermint naturally reduces gastrointestinal muscle spasms. It also acts as an antimicrobial agent, capable of stopping the growth of some strains of bacteria-particularly some harmful bacteria. For both those reasons, researchers have studied peppermint oil as a way to control IBS symptoms. The results have been mixed, but there is some strong evidence that peppermint oil may work as well as some smooth muscle relaxant medications (called Peppermint naturally reduces gastrointestinal muscle spasms. It also acts as an antimicrobial agent, capable of stopping the growth of some strains of bacteria-particularly some harmful bacteria. For both those reasons, researchers have studied peppermint oil as a way to control IBS symptoms. The results have been mixed, but there is some strong evidence that peppermint oil may work as well as some smooth muscle relaxant medications (called anticholinergics anticholinergics). Treatment with peppermint oil capsules seem to help reduce abdominal pain, distention, flatulence, and diarrhea. Studies have found that partic.i.p.ants get some relief if they take a total of 0.2 to 0.4 mL, three times a day 15 to 30 minutes before meals for one or two weeks. Choose a brand that is enteric-coated, which means that the supplements are specially designed to bypa.s.s the stomach and dissolve only in the intestines, reducing the possibility of heartburn and stomach distress.

5. Beano. When we eat beans, we get gas. It's a fact of life. That's because we don't have enough of an enzyme called When we eat beans, we get gas. It's a fact of life. That's because we don't have enough of an enzyme called alpha-galactosidase alpha-galactosidase, which breaks down certain components of complex carbohydrates. The bacteria naturally found in our intestines break down the undigested complex carbs, creating gas in the process. The product Beano contains alpha-galactosidase, so it helps break down more of the gas-producing foods. It works with beans, of course, but also with vegetables (including cruciferous vegetables) and whole grains. Follow the directions on the label for best results. I suggest you keep a bottle on hand at all times-you'll thank me when you're unexpectedly dining out at a restaurant of someone else's choosing!

6. Artichoke leaf extract. Studies by researchers in the United Kingdom have shown that artichoke leaf extract ( Studies by researchers in the United Kingdom have shown that artichoke leaf extract (Cynara scolymus) can reduce IBS symptoms of pain and flatulence by more than 25 percent with just two months of use. About half of the IBS patients who claimed to have alternating constipation and diarrhea reported having "normal" bowel habits after treatment with the extract. The recommended dosage is 320 to 640 milligrams, two to three times per day.

JOY'S 4-STEP PROGRAM FOR IRRITABLE BOWEL SYNDROME Follow this program if you have been diagnosed with Irritable Bowel Syndrome.

STEP 1...START WITH THE BASICS These are the first things you should do try to take control of your IBS symptoms: - If you haven't been officially diagnosed with IBS, see a doctor to rule out other possible causes of your discomfort.

- For severe diarrhea-predominant IBS, start the Extreme Elimination Diet-No Fiber on Chapter 17.

- For severe constipation-predominant IBS (along with other persistent types that cause gas, cramping, or pain) start the regular Elimination Diet with Added Fiber on Chapter 17.

- For less debilitating IBS, begin keeping an IBS Diary to keep track of your symptoms, your diet, and your stress levels. Learn to identify which factors trigger your IBS attacks.

- Eat all your meals sitting down. Chew your food thoroughly. Make meals a time of relaxation, not a race.

- Remember, stress hurts. Make relaxation a priority.

- Exercise daily.

- Take Beano at meals to reduce the potential for gas.

STEP 2...YOUR ULTIMATE GROCERY LIST A food plan for IBS is more about avoiding your personal trigger foods than about specific nutrients that will help alleviate your symptoms. The foods on this list are considered generally "safe," avoiding all all known triggers, common allergens, and then some! If you have severe diarrhea-predominant IBS, go easy on foods marked with an known triggers, common allergens, and then some! If you have severe diarrhea-predominant IBS, go easy on foods marked with an asterisk (*). asterisk (*). These foods are rich in fiber, and although they can often help control diarrhea in the long run, they need to be slowly and cautiously introduced into your diet. (See Extreme Elimination Diet-No Fiber, Chapter 17.) These foods are rich in fiber, and although they can often help control diarrhea in the long run, they need to be slowly and cautiously introduced into your diet. (See Extreme Elimination Diet-No Fiber, Chapter 17.) There are so so many potential trigger foods that affect different people in different ways, which is why my grocery list is, unfortunately, both short and limited. This is where many potential trigger foods that affect different people in different ways, which is why my grocery list is, unfortunately, both short and limited. This is where you you come in. Take a few minutes to add healthful foods you know you can personally tolerate without a problem. For example, if you regularly eat whole wheat bread, peanut b.u.t.ter, fat-free yogurt, and pasta without symptoms, add them to your personal grocery list. As you keep an IBS journal or perform an elimination diet, you'll identify many more safe and healthy foods. Use the allotted s.p.a.ces below each food category for your personal notes. come in. Take a few minutes to add healthful foods you know you can personally tolerate without a problem. For example, if you regularly eat whole wheat bread, peanut b.u.t.ter, fat-free yogurt, and pasta without symptoms, add them to your personal grocery list. As you keep an IBS journal or perform an elimination diet, you'll identify many more safe and healthy foods. Use the allotted s.p.a.ces below each food category for your personal notes.

FRUIT.

*Apples*Applesauce, natural unsweetened*Apricots (fresh)*Bananas*Berries (strawberries, blackberries, raspberries)*Cantaloupe*Mango*Nectarines*Peaches*Pears*watermelon

Personal Safe Items

VEGETABLES.

*Avocado*Carrots, cooked*Green beans, cooked*Peas, black-eyed*Peas, green*Potatoes, white and sweet*Spinach, cooked*Yellow squash, cooked*Zucchini, cooked

Personal Safe Items

SEAFOOD.

ALL fresh or frozen seafood with no breading, no sauce (avoid sh.e.l.lfish)FlounderSalmon, wild (fresh and canned)TilapiaSoleTrout

Personal Safe Items

LEAN MEATS/EGGS/SOY FOODS.

Chicken breast, skinlessTurkey breast, skinlessTurkey burgers, lean

Personal Safe Items

NUTS AND SEEDS (PREFERABLY UNSALTED).

*Flaxseed, ground*Psyllium seeds, ground

Personal Safe Items

GRAINS.

*Amaranth*Barley*BuckwheatCereal, puffed riceCereal, hot cream of rice*Oatmeal*Pasta made only from peas, potato, quinoa, or riceRice (white, yellow, brown, wild)Rice cakes, plain and brownTortillas (made only from rice flour)

Personal Safe Items

DAIRY.

Personal Safe Items

MISCELLANEOUS (INCLUDING CONDIMENTS).

Almond extractBaking powderBaking sodaCinnamon, groundFlour, barleyFlour, oatMargarine, soft tub reduced-fat, trans fat-free (no dairy)Nonstick cooking sprayOil, olivePepper, blackPotato chips, plain baked (no olestra)Preserves, strawberry (low-sugar)Rice milk, low-fat plain and vanillaSaltSugarVanilla

Personal Safe Items

STEP 3...GOING ABOVE AND BEYOND If you want to do everything you can to try to alleviate your IBS symptoms while still staying healthy, here are some additional things you might try: - Consider taking a chewable or liquid multivitamin to a.s.sure that you get the basic level of nutrition, even if your food choices are limited.

- If your IBS symptoms are triggered by dairy products, take a calcium citrate supplement that also includes vitamin D3 to make up for any shortfall in dietary calcium. to make up for any shortfall in dietary calcium.

- Consider taking supplements to reduce your symptoms, such as a probiotic, peppermint oil, or artichoke leaf extract.

- If you can't get relief from dietary and lifestyle changes, talk with your doctor. There are new medications that can help you get control over your worst symptoms.

HYPNOTHERAPY FOR IBSIf nothing else helps relieve your IBS symptoms, you might want to try hypnotherapy. Researchers from Sweden tested 135 people who had IBS that did not respond to any other treatment. After 12 weekly one-hour hypnotherapy sessions, they found significant improvements in abdominal pain, distension, and bloating. People felt better, even though their bowel habits did not change. These improvements held for at least one year. To find a qualified hypnotherapist, check with the National Board for Certified Clinical Hypnotherapists, www.natboard.com or 1-800-449-8144.

STEP 4...MEAL PLANS For severe diarrhea-predominant IBS, follow the Extreme Elimination Diet-No Fiber, which follows.

For severe constipation-predominant IBS, follow the Elimination Diet with Added Fiber, Chapter 17.

EXTREME ELIMINATION DIET-NO FIBER For severe diarrhea-predominant IBS (follow for five to seven days) This elimination diet is extreme and should not be followed for longer than one week. It's designed to help people who suffer from severe persistent diarrhea-predominant IBS determine which foods may be aggravating their condition. It avoids ALL IBS potential trigger foods plus plus additional common allergens (including sh.e.l.lfish and eggs). This plan is very low in dietary fiber and is based on the few foods I've found that clients with this type of IBS can tolerate. Fiber additional common allergens (including sh.e.l.lfish and eggs). This plan is very low in dietary fiber and is based on the few foods I've found that clients with this type of IBS can tolerate. Fiber and nutrition and nutrition will be slowly increased as you introduce new foods. Rice cereal (hot and cold varieties) and rice milk can be purchased at a local health food store or online. Make sure you buy a soft tub reduced-fat, trans fat-free margarine spread that does not contain dairy. will be slowly increased as you introduce new foods. Rice cereal (hot and cold varieties) and rice milk can be purchased at a local health food store or online. Make sure you buy a soft tub reduced-fat, trans fat-free margarine spread that does not contain dairy.

If you're a candidate for this extreme plan, follow it for one week. Every day, choose one one option for each of the three meals-breakfast, lunch, and dinner. Then, one or two times per day, choose from the variety of my suggested snacks. Eat slowly and thoroughly chew your food. Approximate calories have been provided to help adjust for your personal weight-management goals. If you find yourself hungry (and if weight is not an issue), feel free to increase the portion sizes for meals and snacks. Stick with flat water as your beverage, and drink at least 8 cups throughout each day. option for each of the three meals-breakfast, lunch, and dinner. Then, one or two times per day, choose from the variety of my suggested snacks. Eat slowly and thoroughly chew your food. Approximate calories have been provided to help adjust for your personal weight-management goals. If you find yourself hungry (and if weight is not an issue), feel free to increase the portion sizes for meals and snacks. Stick with flat water as your beverage, and drink at least 8 cups throughout each day.

After following this plan for one week, you can start experimenting by adding new foods. You should add one new food every two to three days (it's best to stick with one portion of a new food per day). Keep an IBS diary and write down everything you eat...and everything you feel. Pay close attention to how you feel after eating each new food, which will help you determine if it can be permanently reintroduced into your diet. If any food bothers your stomach, stop eating it and add it to your list of problem foods. Move on to the next food category. You can always retest a problem food at a later date.

At the end of this tough a.s.signment, you will (we hope) have identified most of the foods that aggravate your IBS. Let's hope it's a short list. For the sake of good nutrition and food variety, here's my suggested order for reintroducing new foods: 1. Dairy (fat-free and reduced-fat milk, yogurt, cheese, etc.) 2. Sweet potatoes and/or yams 3. Eggs 4. Wheat products: Stick with white versions of bread, crackers, and pasta. In the future when symptoms subside, you can slowly test small amounts of whole wheat varieties.

5. Oats, oatmeal, and barley 6. Brown and wild rice 7. Nut b.u.t.ters 8. Cooked vegetables (noncruciferous, no corn, no peppers, no eggplant) 9. Fruit (peel fruits with tough outer skins at first; avoid citrus) 10. Sh.e.l.lfish 11. Soy foods 12. Whole nuts and seeds 13. Garlic and onion 14. Citrus fruits 15. Cooked cruciferous vegetables (plus cooked peppers and eggplant) 16. Beans and lentils 17. Raw vegetables 18. Corn 19. Ketchup, mustard, soy sauce, and other condiments (test one at a time) 20. Dried fruit 21. Chocolate 22. Fruit juice, sugar, and honey 23. Alcohol 24. Coffee or tea BREAKFAST OPTIONS.

(Approximately 300 to 400 calories)

Hot Cereal with Banana Slices 1 cups cooked cream of rice cereal prepared with water and 1 tablespoon soft tub reduced-fat trans fat-free margarine spread. Enjoy with 1 sliced banana.

Cold Cereal with Rice Milk 2 cups puffed rice cereal with 1 cups plain or vanilla low-fat rice milk.

Breakfast Potato with Cinnamon Applesauce 1 medium baked potato; serve with 1 cup natural unsweetened applesauce mixed with optional cinnamon. Do not eat the potato skin.

LUNCH OPTIONS.

(Approximately 400 to 500 calories)

Grilled Chicken with Rice 5 ounces grilled chicken breast. Enjoy with 1 cup cooked white or yellow rice.

Turkey Burger with Baked Potato 5 ounces plain turkey burger. Serve with 1 medium baked potato topped with 2 teaspoons soft tub reduced-fat trans fat-free margarine spread. Do not eat the potato skin.

Turkey and Avocado on Rice Cakes 5 ounces sliced turkey breast (or grilled chicken) divided over 3 plain rice cakes, each topped with 1 thin slice avocado. Enjoy with cup natural unsweetened applesauce.

DINNER OPTIONS.

(500 to 600 calories)

Grilled Fish with Rice Easy! 3-Step Microwave Salmon (Chapter 14, omit the garlic) or 5 ounces grilled salmon (or sole, trout, or tilapia) seasoned with 1 teaspoon olive oil and pinch of salt. Serve with 1 cup cooked white or yellow rice.

Rosemary Chicken with Baked Potato 5 ounces Rosemary Chicken with 1 medium baked potato topped with 1 tablespoon soft tub reduced-fat, trans fat-free margarine spread. Do not eat the potato skin.

Roast Turkey with Mashed Potatoes 6 ounces roast turkey breast. Serve with 1 medium baked potato scooped and mashed with 1 tablespoon soft tub reduced-fat, trans fat-free margarine spread (or 1 cup cooked white or yellow rice). Do not eat the potato skin.

SNACK OPTIONS.

100 calories or less - 2 plain rice cakes - cup natural unsweetened applesauce - 1 small banana 100 to 200 calories - 3 to 5 plain rice crackers - 1 ounce baked potato chips (no olestra, check labels) - 1 cup natural unsweetened applesauce - baked potato with 1 teaspoon soft tub reduced-fat, trans fat-free margarine spread; do not eat the potato skin.

ELIMINATION DIET WITH ADDED FIBER.

For severe constipation-predominant IBS, and follow-up for the extreme elimination diet

This elimination diet is extreme and should not be followed long term. It's designed to help people who suffer with persistent constipation-predominant IBS (and other debilitating types that cause gas, cramping, and pain) finally figure out which foods may be aggravating their condition. It avoids all all IBS potential trigger foods IBS potential trigger foods plus plus additional common allergens (including sh.e.l.lfish and eggs). It provides a moderate amount of dietary fiber-with a good amount specifically coming from soluble fiber sources. All foods rich in soluble fiber are marked with an additional common allergens (including sh.e.l.lfish and eggs). It provides a moderate amount of dietary fiber-with a good amount specifically coming from soluble fiber sources. All foods rich in soluble fiber are marked with an asterisk (*) asterisk (*)-if you're feeling ga.s.sy or uncomfortably distended, go easy on these foods. Your total fiber intake (and nutrition!) will slowly increase when you start introducing new foods. Puffed rice cereal and low-fat rice milk can be purchased at your local health food store (or online). Make sure your soft tub reduced-fat, trans fat-free margarine spread does not contain dairy.