| Irritable bowel syndrome is the most common | | | | that diagnosis is established.More recently, food |
| gastrointestinal diagnosis yet it is not really a disease | | | | intolerance other than gluten or wheat have been |
| nor does it have confirmatory diagnostic tests. | | | | suggested as a treatable cause of IBS. Blood tests |
| Rather, it is diagnosed based on a constellation of | | | | for a type of antibody known as IgG have been |
| symptoms and the absence of other diagnoses. | | | | advocated by several researchers as being helpful for |
| Common symptoms attributed to IBS are abdominal | | | | advising people about eliminating or avoiding certain |
| pain, cramping, diarrhea, bloating and excess gas. | | | | foods as a treatment of IBS. Recent evidence |
| Celiac disease or gluten sensitivity is a common but | | | | suggests that a significant reduction of IBS |
| frequently missed gastrointestinal diagnosis. Ingestion | | | | symptoms can be achieved in people who avoid |
| of gluten containing foods in affected individuals | | | | foods based on elevated IgG antibodies to foods. |
| commonly causes symptoms attributed to IBS that | | | | Atkinson et. al 2004 reported 10-26% improvement |
| are relieved with gluten-free diet in at least 10-20% | | | | in symptoms in patients compared with controls. |
| of people misdiagnosed with IBS. Other food | | | | Deterioration was noted in those who relaxed their |
| intolerances are also a likely a cause of IBS | | | | dietary restriction of foods they had avoided |
| symptoms that may improve with avoidance of | | | | because of elevated antibody levels. These findings |
| certain foods.IBS is a diagnosis of exclusion. Other | | | | require further validation and are facing significant |
| causes of symptoms of abdominal pain, diarrhea, | | | | resistance to acceptance by many in the medical |
| constipation, or alternating constipation and diarrhea | | | | community, especially in the U.S. However, elimination |
| should be excluded by doctor's review of medical | | | | diets have long been reported effective by many |
| history, a physical exam and some screening | | | | people. The possibility of food intolerance as a |
| laboratory tests and arguably a colonoscopy. The | | | | reversible cause of symptoms attributed to a |
| other conditions that traditionally doctors are most | | | | syndrome with little other effective treatments |
| concerned about excluding include inflammatory | | | | except mostly ineffective treatments in the past and |
| bowel diseases (ulcerative colitis, Crohn's disease) and | | | | very new medications with limited efficacy and |
| cancer. Less worrisome but treatable conditions that | | | | unproven long term safety should prompt further |
| need to be excluded include lactose intolerance, | | | | studies and an openness to dietary trials.If you have |
| intestinal infections especially parasites like giardia, and | | | | been diagnosed with irritable bowel syndrome I |
| food intolerance. Celiac disease though now known to | | | | recommend you confirm that Celiac disease has been |
| be very common, affecting approximately one | | | | excluded. Food intolerance should also be considered |
| percent of the U.S. population, has been largely | | | | though testing may not be covered by your |
| ignored as a possible cause of IBS symptoms. Most | | | | insurance and/or accepted by your doctor as valid. |
| primary care physicians are aware that diarrhea is a | | | | Elimination of common foods and their proteins |
| common symptom of Celiac disease but not that it | | | | causing intolerance, wheat, barley and rye (gluten); |
| may present in adults and be associated with | | | | cow's milk protein (casein); soy; and peanuts is worth |
| constipation. Most doctors are unaware that the | | | | a try. Be sure to keep a food-symptom diary and |
| prevalence of Celiac disease in IBS patients may be | | | | re-introduce one food or food protein back into your |
| as high as 20%.Typical lab tests ordered by doctors | | | | diet at a time. One diet that effectively eliminates all |
| screening for more serious intestinal diseases that | | | | the major food proteins causing intolerances but may |
| may mimick IBS include a complete blood count | | | | be difficult to follow is the paleo diet ( Hoey. "Irritable |
| (CBC) looking for signs of blood loss or anemia (low | | | | Bowel Syndrome: Could it be Celiac Disease?" Can |
| hemoglobin or hematocrit), signs of inflammation or | | | | Med J. 2002; 166:479-802. Sander et al, "Association |
| infection (high white blood cell count and/or platelet | | | | of Adult Coeliac Disease with Irritable Bowel |
| count) and stool tests for blood (fecal occult blood | | | | Syndrome: A Case-Control Study in Patients Fulfilling |
| test or FOBT) or white blood cells (WBCs or fecal | | | | Rome II Criteria Referred to Secondary Care." |
| leukocytes). The stool tests are looking for signs of | | | | Lancet. 2001; 358:1504-82. Atkinson W; Sheldon TA; |
| bleeding, infection or inflammation of the intestine. | | | | Shaath N; Wharwell PJ. "Food elimination bsed on IgG |
| IBS does not cause bleeding or intestinal inflammation | | | | antibodies in irritable bowel syndrome; a randomised |
| whereas inflammatory bowel disease, infection or | | | | controlled trial." Gut 2004; 53:1459-1464.3. Isolauri E; |
| cancer may. Normal tests are reassurring though do | | | | Rautava S; Kalliamaki M. "Food allergy in irritable bowel |
| not exclude more serious disease. Most | | | | syndrome: new facts and old fallacies." Gut 2004; |
| gastroenterologists believe a colonoscopy should be | | | | 53:1391-3.Dr. Scot Lewey is a physician who is |
| performed.However, most doctors, even many | | | | subspecialty trained and board certified in |
| gastroenterologists, fail to test for Celiac disease | | | | gastroenterology (diseases of the digestive tract) |
| though it is common and screening blood tests exist. | | | | that has over 20 years of experience as an expert |
| The reasons for this are many and are more fully | | | | clinician, researcher, lecturer and author of more than |
| explained elsewhere. However, the common | | | | twenty articles, book chapters, and scientific |
| incidence, presence of screening tests and available | | | | abstracts. His special interests include Celiac disease, |
| treatment should make screening for Celiac disease | | | | food intolerance and allergies, colitis, Crohn's disease, |
| part of the standard evaluation of all patients | | | | irritable bowel syndrome & reflux. |
| presenting with symptoms suggestive of IBS before | | | | |