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The first step in learning to control IBS symptoms is recognizing the factors that may trigger symptoms. A diary that records IBS symptoms along with all foods and beverages ingested and stressful events can help pinpoint possible culprits. A woman should determine whether symptoms flare up during certain times of her menstrual cycle. When tracking lBS symptoms, jot down the nature and location of any pain, as w as the frequency and consistency of stools and any related problems, such as headaches. Your diary should also note all medications taken, including supplements. A doctor should review this diary to help identify specific con tributing factors.

DIETARY MODIFICATION
Because IBS differs from person to person, it’s essential to develop an individualized regimen to treat your symptoms. To begin, avoid foods that your diary suggests are causing problems. Eat several small meals a day instead of large ones. This can reduce the meal-stimulat ed increase in bowel contractions and diarrhea. Eat slowly. Eating too quickly may increase swallowed air, which promotes irritating intes tinal gas. Also, poorly chewed foods can be more difficult to digest. Drink lots of water. To maintain adequate fluid, drink at least eight glasses of water or other beverages daily, hut avoid such potential bowel irritants as alcohol and caffeine. Avoid fatty foods. Most doctors advise against eating fried and other fatty foods because fat is the most difficult nutrient to digest. Many people find that it helps to avoid beans and other gas-producing foods.

Watch your fiber intake. Whole-grain products and other high-fiber foods can pose problems for some lBS sufferers who have chronic diarrhea. On the other hand, if constipation is the predominant symptom, a diet that includes ample fresh fruits and vegetables, whole-grain breads and cereals, nuts and seeds, and other high-fiber foods is usually recommended. Insoluble fiber (see Fiber) helps to bulk up stools and ease elimination, relieving lBS-associated constipation. Foods high in soluble fiber absorb water and are helpful for bouts of diarrhea. If constipation is pe ask your doctor about ãking seeds or another high- fiber laxative. Avoid chronic laxative use, which can lead to problems with vitamin and nutritional deficiencies. Avoid sugar alcohols. The sugar substitutes sorbitol, lactitol, mannitol, and maltitol are used in a variety of foods and can trigger lBS symptoms in some people. For others, the lac tose in dairy pr and possibly fructose can exacerbate sym

Afflicting up to 20 percent of all adults, irritable bowel syndrome (IBS) is often characterized by abnormal muscle contractions in the intestines, resulting in too little or too much fluid in the bowel. Symptoms vary markedly from one person to another. Some people experience urgent diarrhea.

Others experience the type called spastic colon, with alternating bouts of diarrhea and constipation, as well as abdominal pain, cramps, bloating, gas, and nausea, particularly after eating. Still other symptoms may include mucus in the stool and feelings 0f incomplete evacuation after moving the bowels. Some people may also complain of fatigue, anxiety, headache, and depression.

There are no tests for IBS, which is diagnosed by ruling out colitis, cancer, and other diseases, Although it may be aggravated by food intolerances or allergies, no specific cause has been established. It may be worsened by stress and emotional conflict, but it is not a psychological disorder. Various dietary factors can play a major role in exacerbating or calming IBS. A doctor may prescribe medications to quell it muscle contractions and alleviate diarrhea.

However, self-care, stress reduction, and dietary modification are the mainstays of therapy. Some recent research suggests that bacterial overgrowth in the bowel may be a cause or cbs. In one study, 78 percent of lBS patients were found to have bacterial over growth in the small intestine, and antibiotics eliminated the disease in half of the patients who got rid of the overgrowth.

The body can utilize two types of iron—heme, which comes from animal sources, and nonheme, which comes from plants. The body absorbs 20 to 30 percent of heme iron, compared with 5 to 10 percent of nonheme. When the body’s iron reserves are low, the absorption of nonheme iron increases. Consuming iron-rich plant foods with meat or with good sources of vitamin C boosts nonheme iron absorption. By the same token, some substances for example, tea, bran, and the oxalates found in spinach and kale—decrease the body’s absorption.

Genetic factors influence iron absorption. About 10 percent of whites and up to 30 percent of people of African descent carry a gene that predisposes them to store extra iron. The presence of a single gene does not cause problems, but if a person inherits the gene from both parents, he is likely to develop iron overload, or hemochromatosis. Men and postmenopausal women are especially vulnerable.

An iron overload does not produce symptoms until a damaging amount has accumulated in muscle tissue (including the heart), the liver, bone marrow, the spleen, and other organs; this usually occurs during middle age. One of the first indications is a ruddy complexion; the person may also suffer fatigue, joint and intestinal pain, and an irregular heartbeat. As the liver becomes damaged, jaundice may develop.

A blood test can be used to diagnose an iron overload; in some cases, a liver biopsy may also be ordered. Treatment involves periodic removal of a pint (0.5 liter) or so of blood, which reduces iron levels by forcing the body to use some of its stores to make new red blood cells.

Even moderately elevated iron levels may set the stage for heart disease. One study reported that men whose blood iron levels were in the high-normal range were more likely to develop coronary artery disease than those with low-to-normal levels. This supports the theory that excessive iron may injure the artery walls and promote the formation of fatty deposits. This damage may be due to iron’s ability to catalyze oxidation processes. Controversy continues over iron and heart disease risk, with some studies showing that only heme iron was linked with heart disease and others finding no link. Some researchers also think that iron may contribute to the joint pain and damage that many women endure following menopause. The message continues to be that you should only take supplements if you are iron deficient.

Foods high in vitamin C, which enhances iron absorption, should not be consumed with iron-rich plant foods by those who are predisposed to store extra iron. Unless prescribed by a doctor, supplements containing iron and large doses of vitamin C should not be taken. Some experts now advise that anyone who is contemplating taking a vitamin C supplement should first have a blood test to measure iron levels.

A low sperm count is the major cause of male infertility, and for unknown reasons, men worldwide are producing fewer sperm than few decades ago. Some scientist believe certain pesticides, which have estrogenlike effects, may be linked to the declining count. Alcohol and tobacco use lower sperm production and should be avoided if there is difficulty conceiving.

Zinc. Inadequate zinc may lower male fertility; a recent study found that men who consumed 1.4 mg daily produced fewer sperm and had lower levels of the male hormone testosterone than men whose daily zinc intake was 10.4 mg—the zinc Recommended Dietary Allowance (RDA) for adult men is 11 mg.

Vitamin C. Inadequate intake of vitamin C may impair male fertility. One study correlated low levels of vitamin C with an increased tendency of sperm to clump together, a problem that all but disappeared after 3 weeks of taking vitamin C supplements. Researchers studied a group of healthy men who had low intakes of fruits and vegetables and did not take supplements. Their study suggests that low levels of folic acid in these men were associated with decreased sperm count and decreased sperm density. The vitamin’s role is unclear, but researchers believe normalizing folate levels through diet may offset diminished sperm levels. The best food sources of folic acid are dark green vegetables (such as broccoli, spinach, romaine lettuce, peas, and brussels sprouts), orange juice, liver, dry peas, and beans, Other evidence suggests that vitamin B12 (found in all animal products) may improve sperm count and motility, eyen in men who are not B12 deficient.

Women who take oral contraceptives are likely to experience temporary infertility until their hormonal levels return to normal and they again start to ovulate. Long-term use can result in reduced reserves of folate (a B vitamin that is especially important in fetal development); vitamins B6, B12, C, and E; and calcium, zinc, and other minerals. Therefore, the woman’s diet should emphasize foods that are rich in these nutrients—fruits and vegetables for vitamin C; milk for calcium; and fortified breads and cereals, lean meat, poultry, and seafood for the B vitamins as well as iron, zinc, and other minerals. Alcohol and smoking are known to reduce fertility in both women and men; a recent study indicated that coffee may have a similar effect,

The leading cause of female infertility is the failure to ovulate, which may be influenced by the diet, hormonal imbalances, and a variety of other factors. Women who are very thin or markedly overweight often do not ovulate because the amount of body fat is closely associated with estrogen levels, Women who have very little body fat— professional athletes, dancers, models, and chronic dieters— often stop menstruating and ovulating. Women who are obese may have abnormally elevated levels of estrogen, which can also result in a failure to ovulate. Conception and weight. Any woman who is considering becoming pregnant should try to achieve her ideal weight before conception. This should be done by eating a balanced diet; a woman who is underweight when she conceives is likely to have such problems as anemia during pregnancy. The baby may be smaller than normal and is mote at risk for health problems. Conversely, dieting during pregnancy could be dangerous to the fetus. An overweight woman should diet before trying to conceive; this also lowers her risk of developing high blood pressure or diabetes during pregnancy.

Defined as the inability to achieve a pregnancy after at least a year of trying, infertility affects more than 20 percent of North American couples. Experts cannot explain why the infertility rate has almost doubled in the last 25 years, but at least three factors stand out: the growing trend for couples to delay marriage and parenthood until their most fertile years are past, the rise in sexually transmitted diseases, and a puzzling drop in sperm production. Many couples assume that infertility rests with the woman; in fact, men are just as likely to be infertile. In 40 percent of cases, the problem lies with the male, and in 40 percent of cases, with the female. The cause can’t be identified in the remaining 20 percent, or both partners may be contributing factors, While nutrition is not a leading cause of infertility, consuming a healthful diet enhances the chance of conceiving and delivering a healthy baby.