August 2008 Archives

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 criticise 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 to know 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!

Trufree, the UK manufacturers of wheat and gluten-free foods, have just released some new products, and I'm pleased to say that I've been sent some samples for review. I'm even more pleased to say that the samples were of Cookie Bites, Chocolate Brownie Bites and Choc Dippers. Mmmmmm. (Pause for Homer Simpson-esque gargling noise).

When you're following a gluten-free diet, like I have done for the past seven or eight years, there are so many foods that you have to cut out from your diet. Luckily in recent years there has been an explosion of good quality gluten-free foods, and although they are often pricier than their glutenful counterparts, and sometimes can't match the taste and texture of the standard foods, they are still very useful.

I use a range of gluten-free foods, and I tend to think of them as being in two different categories - the staple stuff and the fun stuff. Staple foods include bread and pasta, boring necessities, and the fun stuff covers things like biscuits, cakes and doughnuts. Gluten really does get in everywhere, and if you're wiping it out completely from your diet then it means foregoing a whole stack of scrumptious goodies.

So that's where the gluten-free alternatives come in. I should tell you that all of the products mentioned in this review are gluten and wheat-free, and no, gluten and wheat are not the same thing. Gluten is a protein that is found in wheat, rye and barley (and to a lesser extend oats, oats always cause a big argument for some reason). So if a product is labelled wheat-free but not gluten-free then it could well contain rye or barley, and therefore gluten.

OK, first up, the Cookie Bites. These are mini versions of the classic chocolate chip cookie, in a cute little resealable tub rather than a packet. They were certainly very tasty, although in common with other gluten-free biscuits I have tried they were a little on the dry side, but that's no doubt due to the limitations of the rice, potato and other flours that the manufacturers have to use instead of normal flour. Still, they disappeared very quickly nonetheless. I would give these a seven out of ten.

Next, a Choc Dipper, which is not something that I thought would ever be available for us gluten avoiders. The Choc Dipper comes in a little pot, and you get small breadsticks to dip into some Nutella-like chocolate spread. Again very tasty, and a generous portion of the choc spread was appreciated. Another seven out of ten.

And finally, another cute little tub, this time containing Brownie Bites, another mini version of a traditional chocolate recipe. These were my favourite of the lot. They were nicely soft and squidgy with a proper cake consistency, and plenty of choc pieces to boot. Highly recommended, and I'd give these a nine out of ten.

You can find these new products in branches of Waitrose and Asda, and you can also check out the range of Trufree products on their site at http://www.trufree.co.uk (the products I have reviewed are so brand spanking new they're not on the website yet, but you can see lots of other stuff there including breads, other biscuits, pasta and more).

Do you guys have any favourite gluten-free products, or do you recommend any of the Trufree range? Let me know by leaving a comment.