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