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Janice's summary is wonderful. She is so right about so many things.  I
work as a nurse in a family practice & I know exactly why so many people
are sick as dogs w/ IBS.  Most of our doctors are totally ignorant about
the real causes & effective treatments for IBS.  And, even if they did
know, they wouldn't take the time to help the patient.  We have to be
smart, do our homework & find out how to heal ourselves.  While gluten
intolerance is certainly the root of lots of IBS, I don't believe that it
is the root of ALL IBS.  I don't think I can agree that IBS = CD & vice
versa.  I don't believe there is one single root cause for all IBS, but I
know hypochlohydria can also cause IBS.  Hypochlorhydria (HC) is a
shortage of hydrochloric acid which, as you probably know, is essential
for proper digestion in the stomach.  HC can occur in anyone, regardless
of their genetic predisposition.  HC can ultimately result in pernicious
anemia (vitamin B-12 deficiency, very common among celaics), but can take
many, many years to develop & can cause irritation to the gut which will
bring on gluten sensitivity in many people.  Here's one of the many
possible scenarios [--> means "leads to" or "results in"]:

Lack of stomach acid --->  High pH in Stomach --> Passage of undigested
carbohydrates into the small intestines -->Overgrowth of intestinal
bacteria & yeast --> excess gas, irritated, inflammed GI mucosa --> tiny
holes in gut lining (leaky gut syndrome)--> undigested food particles
entering blood stream --> the immune system being sensitized to various
foods --> multiple food allergies & intolerances  --> Histamine responses
& autoimmune responses (CD etc.) --> more gut inflammaton, more leaky
gut, cytokine release--> Destruction of gut lining; flattened or blunted
villi, destruction important cells in the stomach & intestine that
produce enzymes, digestive juices --> enzyme & digestive juice
difiencies--> indigestion, more yeast & bacterial overgrowth, more gas,
malabsorption  --> Pernicious anemia (B 12 defiency), other anemias,
osteoporosis (calcium), fatigue, muscle pain, etc., other GI maladies &
autoimmune disorders, etc.--> more hypochlorhydria---> etc.

Now I'm not suggesting that hypochlorhydria is the root cause of ALL
disease.  Many diseases have other idiologies, but many, many chronic
diseases will & do spin off hypochlorhydria.  And almost all of them will
cause hypochlorhydria through the mechanism described above.  So that, of
course, leads to the question, "What causes hypochlorhydria?"  There can
be several causes.  Antacid and acid blocking medications are two common
causes.  The use of proton pump inhibitors (PPIs) such as Aciphex,
Nexium, Protonix, etc. has been shown to produce HC in as little as six
months. Some doctors believe that high protein diets exhaust our
stomach's ability to produce hydrochloric acid.  Others believe that a
diet based upon highly refined carbohydrates encourages yeast & bacterial
overgrowth causing irritation & damage to the gut lining which will of
course, result in HC.  Some folks become hypochlorhydric because they
have a genetic autoimmune disorder that destroys the cells that produce
HCl.  Some people have anatomical anomolies such as a redundant colon,
hiatal hernias, soft stretchy intestines with poor tone, which results in
chronic constipation & therefore yeast & bacterial overgrowth, therefore
gut damage, thus HC, etc.  Some families seem to be genetically
predisposed for various food intolerances.  I know one lady who's mother,
grandmother & sisters were all intolerant to onions!  I know of another
woman & her mother that could not tolerate nightshade veggies.  And there
are many of Italian ancestry who can't tolerate Fava beans.  So anyone
who daily eats any food or drug that they shouldn't will eventually end
up with gut damage, hypochlorhydria & IBS.  We also know that abtibiotic
use destroys beneficial bacteria & causes yeast overgrowth which then
results in gut damage & HC.  And, various medications can damage the gut,
such as gout medications, anti-inflammatory meds & many others.  Age is
also considered a contributing factor.  For some reason, as we age our
ability to produce hydrochloric acid diminishes.  In fact there are so
many things that can trigger gut disease especially in the western
industrialized world, it is amazing to me that everyone in the world
doesn't have IBS!

I believe that GI disease is a downward spiraling cycle and that you can
enter that cycle at any point during the cycle by a variety of routes.
Then it becomes a self perpetuating loop w/ more & more diseases
"spinning off."

Some have broken the cycle by following special diets -- specific
carbohydrate diet, paleolithic diet, cave man diet, etc.  Some, like me,
need both dietary intervention, prescription meds, betaine hydrochloride
& digestive enzymes to break it.

I have gluten sensitivity, a redundant colon, pernicious anemia,
eosinophilic gastroenteritis & who knows what else, so I'll likely battle
IBS all my life.  This is the course that I have been following that has
really helped me get the upper hand on IBS.  It's worked very well
considering that I was too ill & depressed to work just 8 months ago &
now I'm well enough to work full time.

(1) Specific Carbohydrate Diet ("Breaking the Viscious Cycle" by Elaine
Gottshall)

(2) GastroCrom (presciption medication)

(3) B 12 injections twice a week for pernicious anemia (Because I do them
myself, it's cheap.)

(4) Food allergy testing & strict abstinance from all reactive foods.
(Not an easy task, but worth it.)

(5) ketokonazole, a powerful anti fungal prescription medication for
yeast overgrowth

(6) Thorne BioGest (betaine hydrochloride & glutamic acid to replace
acidify stomach contents; pepsin & other digestive enzymes)  Really helps
w/ gastritis & indigestion.

(7) Probiotic capsules -one or two w/ each meal or snack. I like
Primadophilus, available in the frigerator section of the health food
store.  Reasonbly priced.  Helps keep gas production under control.

Valerie in Tacoma, WA