I Have IBS – Now What? by Dr Ashkan Farhadi was first released in 1996, but a brand spanking third edition has just come out so it’s a good time to give it a review.
This book uses a simple question and answer format to tackle the main concerns of IBS patients. The first section explains the basics irritable bowel, including how common it is, what a functional disorder is, how IBS is diagnosed using the Rome Criteria, and so on.
The second section looks at possible causes of IBS (or the ‘etiology’) and covers subjects such as what triggers IBS symptoms (certain foods, stress, menstrual cycles etc) and why these triggers vary from patient to patient.
This kind of chapter is always a difficult one in IBS books because you get into the realms of the brain-gut axis and serotonin and neurotransmitters. On the one hand I do think that it’s valuable to learn everything you can about IBS, but on the other I think that 99% of people who buy books about IBS are looking for treatment ideas and relief, and perhaps especially so if you have just been diagnosed.
Still, it’s a bit harsh to criticize the author for being careful to explain the science behind IBS, and he earns bonus points for giving a clear answer to my litmus test for IBS doctors – do you believe that IBS is all in our heads or psychological? Here’s how the book covers that old chestnut…
Q. “I have been referred to several physicians and after extensive evaluation they told me “you are healthy and everything is in your head”. But I am sure that there is something wrong with me. So I kept changing doctors to figure out my problem. Are you telling me now that I have a real problem in my GI tract?”
A. Yes. Actually, acceptance and understanding of your disorder is one of the key steps in your successful treatment.
Q. “Finally, after all these years, I feel a little bit better now that I know that I have a common, treatable disorder. Everybody thought that everything was in my head and that I think I am sick, or “psycho” or that I like to play the sick role. So they were wrong!”
A. Yes. Your disorder, IBS, is very well-known to most physicians. It is even possible to observe the abnormalities in GI motility when certain sophisticated types of tests are conducted.
The author also addresses the vicious circle of IBS (stress causes symptoms causing more stress) and says that it could well be the IBS that makes us nervous and anxious, rather than the preferred explanation of many doctors who like to believe in a typical weedy IBS patient whose symptoms are caused by her pathetic personality.
Again, perhaps a little too much explanatory science in this section, with a lot written on mast cells and cytokines and dysmotility, which is all very interesting but only if your stomach isn’t killing you.
The third section describes the typical symptoms of IBS, as well as outlining what symptoms are not generally part of IBS and should be investigated further. It also looks at common stimulants for symptoms, including different foods, smoking and alcohol.
Section four looks at how IBS is diagnosed and describes some of the tests that you might need to undergo. It also covers alternative diagnoses such as celiac disease.
Section five describes the treatments that are available for IBS, and this for me is the most important part of any IBS book for patients. Dr Farhadi suggests that reducing the stimuli that set off IBS should be the foundation of a treatment approach, and that means avoiding trigger foods and reducing stress. And that’s fair enough.
He also mentions treatments such as hypnotherapy, fiber, some commons laxatives and anti-diarrheals, herbal remedies, anti-depressants and aloe vera. A fairly good chapter then, but as it only covers 21 pages of the book I wouldn’t describe it as exceptional, and I would have liked to have seen far more detail in some of the answers.
The sixth chapter is called “Living with IBS” and looks at some miscellaneous issues such as whether IBS affects sleep (apparently a recent study has shown a link between IBS and sleep problems) and whether pregnancy affects IBS.
The final chapter is titled “IBS Latest News” and is intended to cover the latest research and treatment options for IBS, but I found some of the info here pretty irrelevant – to be honest I’m not that interested in whether chronic fatigue syndrome is an infectious disease or not, even if it does have ties to IBS, and if video capsule endoscopy can detect undiagnosed cases of Crohn’s Disease then that’s super but it’s not going to help my IBS.
So – this was a clear, and interesting book, if a little short for my taste in some sections and long in others (and overall it’s on the short side as well, just 119 pages). Dr Farhadi is clearly a fan of patient education and the power of knowledge, and that’s great – I would just argue that knowledge of complex gastrointestinal processes is less important in a book like this than a comprehensive run down of all possible IBS treatments. It’s tough to concentrate on neurotransmitters and mast cells when your gut is having a breakdown.
You can read more about I Have IBS – Now What? on the author’s website.
In terms of my best ever IBS book recommendation I would have to go for IBS – Answers at Your Fingertips for UK sufferers, and probably The First Year – IBS for US sufferers (also available as a UK edition). But let me know if you disagree!