So, you’ve got localized prostate cancer, you’ve decided to get it treated with either surgery or radiation, and you have steeled yourself to just bite the bullet and get on with it.

You’ve been through a lot already: the PSA and physical exam, the biopsy, and just coming to terms with the fact that you have prostate cancer.   You did your research, decided on the right treatment, found a good doctor, and you’re all ready to go – and, looking past the treatment and recovery, you’re looking forward to getting on with the rest of your life.

And now there’s a global pandemic.  OMG! 

At many hospitals around the country, non-emergency procedures have been bumped, including treatment for localized prostate cancer.  And maybe you’re feeling a little stressed by this, or even flat-out panicky, thinking that cancer’s ticking away inside your body like a time bomb – or like the creature that burst out of John Hurt’s chest in “Alien.”  You’re not alone.  I recently wrote about this for the Prostate Cancer Foundation’s website,, because so many men are worried about treatment delays.

Hold up there, friend:  a few weeks is not going to mean that your golden opportunity for a cure has closed.  Let’s take a deep breath and think about this:

First, nobody, ever, has instant treatment for localized prostate cancer.   The reason is that your prostate must heal after the supreme insult of having multiple needles stuck in there and little bits of tissue removed.  After the biopsy, the prostate is riddled with tiny holes – like perforated paper.  And, like perforated paper, it’s easier to tear, which means it will be more difficult to remove that damaged tissue in surgery.  Also, it’s inflamed; it’s not going to respond the same way to radiation, and it’s going to be a lot more difficult for a surgeon to operate.  If there’s swelling, or if the tissue inside the prostate is adherent to the rectum – a common, temporary occurrence after biopsy – the surgeon may inadvertently leave cancer cells behind.   The inflammation needs to heal and the punctures need to heal.   That’s why you have to wait a minimum of six to eight weeks after biopsy before you can get surgery or radiation.

“We have studied hundreds of patients who underwent surgery and evaluated the delay between diagnosis and cure,” says my longtime coauthor, Johns Hopkins urologist Patrick Walsh, M.D.  “With long follow-up, we found no significant difference in the 10-year cancer control rates of these men.”  This is reassuring: “There is no immediate urgency to perform surgery after you are diagnosed with prostate cancer, especially if you have stage T1c disease and a biopsy Gleason score lower than 7.”

Second:  every single statistic about men being cured of prostate cancer you’ve ever seen:  those men all had to wait a few weeks or months, and they did great!  Many of those men got repeat biopsies.  They got second opinions.  They took their sweet time just wrapping their minds around the fact that they had cancer.  They still had their cancer cured.  If you were diagnosed by a change in PSA, here’s more good news:  PSA screening has given us a five- to ten-year lead time in diagnosis.  It used to be that prostate cancer wasn’t diagnosed until it had grown big enough to be felt in an exam, or until it caused symptoms.  You’re already ahead of the game!

Third, the average prostate tumor at diagnosis has been growing for years.  Prostate cancer tends to grow very slowly within the prostate.  It has a slow doubling time.  So, even if it’s an aggressive cancer that needs to be treated, just remember:  that sucker has been in percolating away in there for a long time.  It’s not going to suddenly take off and sprint out of the prostate in the next few weeks.  You are going to get it treated; it’s just not exactly when you planned.

Two more things to consider:  Stress is bad for the prostate.  Worrying about not getting your treatment right away is not good for you.  And finally, you may want to take advantage of this brief delay to lose a few pounds.  The prostate is not terribly accessible in the best of situations, because of its location deep in the pelvis.  If you have a lot of belly fat, it can make it more difficult for a surgeon to perform a good cancer operation, preserve urinary control, and preserve potency.  “The best advice I can give an overweight man seeking radical prostatectomy is to lose weight through a healthy program of diet and exercise,” says Edward Schaeffer, M.D., Ph.D., contributor to our book and director of urology at Northwestern University.  “For those who are severely overweight, robotic surgery is extremely challenging and should be performed only by experienced surgeons.  In men who are very overweight or morbidly obese, it can be very difficult for the anesthesiologist to ventilate the lungs because of the weight of the abdomen pressing on the diaphragm.”  If this applies to you, your best bet – besides having an experienced surgeon – is to take this time to change your diet and get some exercise.

And don’t despair!


In addition to the book, I have written about this story and much more about prostate cancer on the Prostate Cancer Foundation’s website, The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.

©Janet Farrar Worthington


Here we are in a global pandemic; we’re all stressed, and we all need to fight it.  If you have prostate cancer, you need to fight it even harder, because the stress hormone, cortisol, may be affecting your cancer, AND because lowering your stress may help your cancer respond better to treatment.  

Having prostate cancer is stressful, even today, when there is more hope of successful treatment than ever before.  But it’s not just the cancer itself.  It’s the hassle of wrangling with an insurance company, and the worry about medical bills or taking time off for treatment; it’s frustration over a slower-than-expected recovery of urinary continence or sexual potency.  It’s anxiety about the next PSA test.  It’s unanswered questions and uncertainty, and worry that life will never get back to normal.  Yes, there’s stress, and plenty of it.    

Does stress make prostate cancer worse?  This one’s not so easy to answer.  “Everybody has an individual response to stress,” says medical oncologist Suzanne Conzen, M.D., Chief of Hematology and Oncology at the University of Texas Southwestern Medical Center in Dallas.  And that’s the key, she adds:  it’s not so much the stress itself but the physiological response that can take a toll, and that may hinder our ability to fight cancer.  Conzen is studying stress pathways in cancers, including prostate cancer.  I recently interviewed her for the Prostate Cancer Foundation (PCF), which is funding some of this research.

The body responds to stress with a surge of corticosteroids; primarily cortisol.  When our ancient ancestors were running for their lives from a savage beast, it was this stress hormone, cortisol – along with adrenaline – that kicked in and saved their bacon.  “We are hard-wired to respond to stress with this ‘fight or flight’ response.”  Unfortunately, many of us react to everyday troubles with the same surge of stress hormone as if we were facing a sabertooth tiger – as if we were under attack.  Our hypothalamus, located in the most primitive part of the brain, tells our adrenal glands, “This is the big one! Go to Defcon 3.”  And cortisol, revving up in its effort to save us – a chemical version of someone running around in a panic, shouting, “Ohmygod, ohmygod,” can cause harm instead, affecting normal functions including the immune system, and even changing genes that are expressed in cancer cells.

“Some people have a higher stress response than others.  It could be an inherited tendency; or they haven’t necessarily developed effective ways of coping with exposure to stressors,” says Conzen.  “However, not all people who have a high stress response get cancer; and a lot of people are under stress and don’t get cancer.  But that’s the complexity: not everybody who smokes gets lung cancer, but smoking is a risk factor.  What you want to do is reduce your risk factors,” and your response to stress – like a bad diet, or smoking, or being overweight – is a risk factor for prostate cancer that can be changed.

“We think high cortisol levels are probably not a good thing in men who have prostate cancer.  At least a subset of those men may have tumors that respond to high levels of stress because the prostate cancer expresses a protein, the glucocorticoid receptor (GR), that is activated by cortisol,” and although Conzen is working on how to determine who these men are, right now, there’s no way to know for sure.

Cortisol, a hormone, attaches to a protein called the glucocorticoid receptor (GR) in cells throughout your body, and this is like flipping a switch that activates stress in all those cells, including cancer cells.  In ovarian cancer, Conzen has shown, higher levels of these receptors in the tumor tissue are linked to more aggressive, even lethal, disease.  And in prostate cancer, she has found that the GR “is more highly expressed in cancer that is resistant to androgen deprivation therapy (ADT).”

But it’s complicated, she adds:  “We think it’s not only how much GR your tumor has, it’s how active it is.”  With PCF funding, Conzen and colleagues in her lab are working to find a way to measure how active cortisol and GR are in a prostate tumor, “whether it’s turning on and off a lot of genes, or just a few genes.  The amount of GR does not necessarily correlate with the activity of the protein.”

So, how to fix it – if a man has aggressive prostate cancer, and high cortisol/glucocorticoid receptor activity?  “One hypothesis would be, deprive that tumor of your body’s stress hormone receptor activity, by keeping the stress hormones relatively low.”  This could happen with some type of medication – or, it could happen with stress reduction.  What is that, exactly?  It could mean making changes in your life, so there are fewer stressful factors in it.   It also could mean making changes in you – with the help of such things as exercise, yoga, meditation, and counseling, and other things to help reduce stress, like having a pet, and reaching out to family, friends or a support group, so you’re not coping with this alone.

Note:  Conzen does not believe that stress, all by itself, causes prostate cancer.  “My guess is that GR-mediated stress signaling in the tumor cells probably has more to do with promoting aggressiveness and progression of cancer,” and perhaps recurrence of cancer.   When Conzen talks about stress, she doesn’t mean a single traumatic incident, such as a car crash:  “The kind of stress we’re talking about is daily unremitting stress.”  Those countless little things that add up, day after day.

Also with PCF funding, Conzen and colleagues are working to identify which genes in prostate cancer cells are involved with the stress response, and what those genes are doing when the tumor cell GR is activated in a man who already has prostate cancer.  “If we knew that, we would know when it would be useful to give a drug (a GR-modulator) to block it,” especially if they could find a drug that would only work in prostate cancer cells.  Glucocorticoid receptors are expressed in a subset (about 20 percent) of castration-resistant prostate cancer.  Conzen and colleagues have initiated clinical trials testing GR-modulating drugs in breast cancer, prostate cancer, and other cancers. In advanced prostate cancer, there are at least three ongoing clinical trials testing GR-modulators: 1) enzalutamide alone vs. with the GR-modulator mifepristone; 2) the GR-modulator CORT125134 plus enzalutamide; and 3) the GR-modulator CORT125181 plus enzalutamide.

In the meantime, stress reduction may help achieve similar results for men with prostate cancer, by lowering circulating cortisol activity.  Clinical trials are needed, Conzen notes, to show the effectiveness of stress response-reducing measures including cognitive behavioral therapy, medication, yoga, and mindfulness in prostate cancer patients.  Such trials have been done in breast cancer, she says, “and have shown that there is a beneficial effect.”


In addition to the book, I have written about this story and much more about prostate cancer on the Prostate Cancer Foundation’s website, The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.

©Janet Farrar Worthington



You’re minding your own business and happily living your life, as most of us are when there is a diagnosis of cancer.  What do you do now?

For Ric Siler, an actor and writer who was diagnosed with prostate cancer at age 64, the easy answer is that he went to Italy and wrote a one-act play that beautifully combines both of these life-changing journeys.  He has performed it in the New York area and a reading of it here.  His message is resiliency — a timely message for all of us, as I’m writing this during the global pandemic.

I was lucky enough to interview Ric for the Prostate Cancer Foundation’s website,, and we have stayed in touch.  Ric did what many doctors believe is the most important thing you can do in a medical crisis:  he remained upbeat.  He practiced gratitude – for his wife and daughter, for a chance conversation that resulted in finding just the right surgeon, for the kindness and support of friends and the many medical professionals he would soon come to know, and especially for the beauty of nature and art, which he began noticing all the time.  He also kept his sense of humor.

Why does attitude matter?  Nobody understands the mind-body connection completely, but scientist Suzanne Conzen, M.D., has shown that stress involves the same pathways as cancer.  The stress hormone is cortisol, and just about every single cell in our bodies has a receptor for cortisol (this is called the glucocorticoid receptor, or GR).  There are many important implications to her work, but one of them is that decreasing stress lowers cortisol, and this can slow the growth of cancer.

Out of the blue:  When Ric’s prostate cancer was diagnosed, in June 2018, “I had no symptoms,” Ric says, “no idea that anything was wrong.  I had gone to my doctor for something completely unrelated, and he said, ‘We haven’t taken your blood for a while.  Maybe we should.’”  It turns out that in a year and a half, Ric’s PSA had doubled, from 4 to 8.

He went to a urologist near his home, in Rockland County, New York, and didn’t much care for him.  “He did nothing to instill confidence; I didn’t feel right about him.  There were four doctors at the practice, so I picked the one who was, available.  Funny how that works.”  The biopsy came back: cancer was present in all 12 tissue samples, and his Gleason score was initially thought to be 8; it later turned out to be 9.

Ric’s daughter, Laurette, suggested that he get a second opinion.  “I hadn’t even thought of that,” says Ric.  But he didn’t know what to do, or how to find a good urologist.  “The next morning, I was working out at the Y,” and without realizing it, he networked.  The PCF recommends both of these strategies.  It is very important to find a doctor in whose clinical abilities you feel confident.  And networking – to find the right doctor, or to talk to men who are or have been in your same boat – can make a huge difference in how you approach your cancer treatment and look forward to your life after cancer.

Ric talked to his friends, Peter and Steve.  Steve said he knew men who had survived prostate cancer, and offered to ask around for a good surgeon.  And “Peter said, ‘Talk to Jerry.’  Jerry is the founder and CEO of the company Peter and I work for, and is a prostate cancer survivor.”  Ric talked to Jerry that same day.  “I saw Jerry in his office with the door open.  I asked if he had a minute,” and explained the situation.  “It just came out in a flood.  I hadn’t planned to be emotional;” in fact, “a sort of stoic resolve is usually my default mode.”  But Jerry understood, and said had felt the same way with his own diagnosis of prostate cancer.  “He said, ‘When I heard the news, I thought my life was over.’  And then he said, ‘A year from now, we’ll be laughing about it.’  It was great to talk to someone who had been in my shoes and come out the other side.  He offered any help, any time I needed to talk, and said, ‘You’ll do the same for people someday.’  Yes, I will.”

The next day, Steve texted Ric with a referral from one of his buddies to urologist Ash Tewari, M.D., at Mount Sinai.  “Time for a second opinion!  I was reading Don Quixote at the time, and I saw this quote the same day, a Latin phrase that translates into, ‘After the darkness, I hope for light.’”

While he waited to see Tewari, Ric, who had started to keep a written record about his experience, made a note of how he was feeling:  “Keeping it as normal and real as possible.  Not dwelling on it.  Staying positive, or trying my best to.  I never completely lose sight of what’s happening, but I am not letting it get me down.”

The date for the operation was September 17.  “I asked about the hospital stay, and he said that he did three surgeries yesterday, and they were all going home today!”  Ric recalls.  He mentioned the big trip to Italy, scheduled for November, that he and his wife, Bette, had been planning for years.   Tewari said it should be fine, and it turned out to be a wonderful trip.

Ric’s play, “How Do You Say Prostate in Italian?” covers what happened next in some detail:  the MRI, which had radio music piped in, including ad for Dunkin’ Donuts in between soothing classical music pieces; the hospital, where he was delighted to have a private room (“It could spoil a guy!”); walking the hospital floors after surgery, with his catheter, “pee bag,” and abdominal drain; important milestones, from passing gas after surgery to getting the catheter removed, to buying pads, getting biofeedback and learning to do Kegel exercises while he dealt with temporary urinary incontinence.  And it’s funny!  And enthusiastic, and full of gratitude.

Not so fast:  Ric’s PSA started to go up again after his surgery.  “I had thought I was out of the woods… not so fast, Kimosabe!  I had thought the PSA being elevated post-surgery meant that maybe there is cancer… nope.  It means yep, there’s cancer, and we have to deal with it.’”

Christmas of 2018 was a time for reflection.  Ric made a note:  “I’ve lived my life mostly feeling kind of indestructible, so it’s sobering to feel, well, destructible.  One thing that I know for sure as I sit here quietly with the dog and a beautiful tree with presents arrayed around it, under it and on it, and my wife and daughter sleeping peacefully upstairs, is that I want to be here next year to do it again, and the next and the next… and I’ll do whatever it takes to make that happen.”

Under the care of medical oncologist William Oh, M.D., and with the goal of “total eradication of the cancer,” Ric had a short course of hormonal therapy and eight weeks of external-beam radiation therapy, which had its own challenges.  When the eight weeks ended, Ric was surprised to find he had mixed feelings.  He wrote: “While the treatments have been happening, there has been a sense of rock-solid purpose.  We’re working together to eradicate this cancer.  I do my part by coming in with a full bladder, no gas and on time, and I get really good at it.  Now that it’s over, we have to wait six weeks – only then will we know for sure.  It’s all about PSA levels at this point.”  Laurette surprised him on his last day of treatment by showing up to ring the official bell – a rite of passage at many radiation therapy centers to say, “I made it through!”

Ric is cancer-free now, and getting on with the rest of his life.  “I was so fortunate,” he says.  “If I hadn’t mentioned my cancer to these guys at the Y, I wouldn’t have met Dr. Tewari,” and through Tewari, Dr. Oh.  “Everything fell together beautifully for me.  If I hadn’t gotten that blood test done, I’d be sitting here a year and a half later none the wiser, and the cancer would have continued to grow.

“The whole point of my play, aside from the personal reflections on living to see the art in Italy, and what it meant to me, and being here after this brush with cancer, is that early detection is really important.  You’ve got to get checkups regularly, and if something’s not right, you have to take the steps to see what’s wrong, go to the best people you can.  I wasn’t really going into this with any great message; I didn’t know what would come out of it or what the next step would be.  It is a cautionary tale for doing what you need to do, as soon as you can.  Silence is not golden when it comes to the prostate.”

Ric has not been silent; one man he spoke to about his experience said, ‘Wow, my wife wanted me to make an appointment with the doctor.  I didn’t go.  I’m going to do it right now.”  He hopes such encounters will be like “ripples in the pool,” men helping each other to be healthy.  When Jerry first told him that one day, he would laugh about his experiences, Ric didn’t believe him.  “I hoped he was right – and he is!  But it’s been quite a ride.”

Recently, Ric did a reading of his play in New York.  Afterward, a woman came up to him; her husband is a prostate cancer survivor.  “She took me aside and said, ‘This is very important, because men don’t talk about this stuff except in whispers.’”


In addition to the book, I have written about this story and much more about prostate cancer on the Prostate Cancer Foundation’s website, The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.

©Janet Farrar Worthington


Got irritable bowel?  As many as 40 percent of people who go to the doctor with gastrointestinal problems suffer from irritable bowel syndrome (alternating diarrhea and constipation); dyspepsia (uncomfortable fullness or pain in the upper abdomen, heartburn, or other digestive problems); or gastroparesis (the stomach muscles or the nerves that drive them stop working, and food doesn’t move out of the stomach the way it should).

These conditions are motility disorders, and they involve the enteric nervous system, the massive highway of nerve cells lining the muscular walls of your esophagus, stomach, intestines, and rectum.  The enteric nerves control peristalis, the conveyor-belt series of muscle contractions — think of toothpaste being squeezed through a tube — essential for swallowing, for digestion, absorption of food, and for pooping (literally, movement of the bowels).

The treatment of motility disorders really requires the art as well as the science of medicine, because every patient responds differently,” says Pankaj Jay Pasricha, M.D., gastroenterologist and neuroscientist, director of the Center for Digestive Diseases at Johns Hopkins Bayview.  Pasricha created the Johns Hopkins Center for Neurogastroenterology and Gastrointestinal Motility Disorders to explore this gut-brain axis, which I wrote about here.

Diagnosing and treating these disorders can take time, dedication, creativity, and patience.  My husband, Mark, an excellent gastroenterologist, was on the faculty at Johns Hopkins and the University of Virginia before he went into private practice here in his home state of Arizona.  Many of his patients have difficult diseases, and he works with them – sometimes for months or even years – to find the right treatment to improve their lives.  By the time they get to him, these patients may be feeling frustration or even despair because they haven’t gotten the help they need.  For years, irritable bowel was the fibromyalgia of GI disorders, misunderstood and misdiagnosed.  If you are suffering from irritable bowel symptoms, you probably already know this.  Maybe you’ve also had a doctor get frustrated or impatient with you when you didn’t get better – like it’s your fault, or it is all in your head!  Or maybe the doctor has done a colonoscopy or endoscopy and, not finding anything striking, has seemed to lose interest in your care.  You’re not alone.

Successful treatment starts with a meticulous history and careful physical exam.  “About 80 percent of the time,” says Mark, “the key to the diagnosis is right there in the history.”  But just knowing the underlying cause of a motility disorder doesn’t necessarily mean the problem can be fixed right away.  Everybody’s different, and there is no cookie-cutter approach to making this better; treatment that helps one person won’t necessarily help someone else with the same diagnosis.  “If we’re trying a new medicine, it can take four weeks, or longer, to see if it works,” says Mark. “And if it doesn’t, then it’s another several weeks with the next medicine, and the next.  There’s a lot of trial and error, but if the doctor and patient are determined, and if they have patience to keep trying, we can often make it better.  The art is managing the symptoms, such as diarrhea, without simply converting it to chronic constipation, which is just as miserable in its own way.”

Not all treatment requires a prescription:  There are some very good over-the-counter products that can help reduce symptoms.  (Note: Heartburn and gastro-esophageal reflux disease (GERD), and acid reducers and proton pump inhibitors, are discussed here.)  Here are four:  For dyspepsia, Mark often recommends FDgard, whose ingredients include peppermint oil and caraway oil.  For irritable bowel, IBgard is a similar product — except it works in the gut, instead of the stomach.  Iberogast, an herbal medicine from Germany, works on both the stomach and gut: just put 20 drops into a glass of water or tea.  Equalactin helps ease irritable bowel by evening things out:  it treats constipation by adding bulk and also increasing the amount of water in your poop, making it easier to pass; at the same time, the bulking agent treats diarrhea by making it less runny and more solid.

What else?  You may need to take a good, close look at your diet. “Foods can be a major issue,” says Mark. “Many people have food allergies and don’t know it, and the way we figure this out is to remove one type of food (like dairy products) from the diet at a time and see if it makes a difference.  Celiac disease is not an allergy but an immune reaction to gluten, and the treatment is a gluten-free diet, which is harder than you may think,” because many products, from soy sauce to shampoo, have wheat.  Shampoo??  Yes, and to people with celiac, or people who are very sensitive to gluten, even absorbing it through the skin can cause cramping, bloating, and diarrhea.  If you have a food allergy or celiac disease, “you need to change the diet permanently to get lasting relief.  This requires a commitment,” and vigilance to check every single label of every packaged food you buy.  It also requires discussions with the server at every single restaurant you go to.  This can get old – trust me; in my family, in addition to GERD and irritable bowel, we’ve got celiac disease, lactose intolerance, and an allergy to milk and butter (from cows, but not from goats; go figure!).  It’s a pain, but the consequence of not being vigilant about what my family members eat is sickness.  In the case of celiac disease, prolonged exposure can actually lead to cancer in the small bowel — but prolonged avoidance of gluten means a healthy life!  It’s a no-brainer.

“Many patients have a sensitivity to FODMAPs, which are fermentable things in foods we eat.”  Every time I hear the word, “FODMAP,” I think of the old song, “RaggMopp,” by the Treniers.  Just putting that out there.  FODMAP is an acronym for Fermentable Oligo-, Di-, Mono-saccharides And Polyols.  And what are these fine fellows, you may be wondering?  Basically, they’re carbs.  Notorious carbs that may not do villainous things to other people, but if you are sensitive to them, they trigger bloating, gas and stomach pain.

The key word here is fermentable: Sugars, sugar alcohols, high-fructose corn syrup, lactose, sugars in fruits, especially stone fruits (pears, plums, peaches, prunes, and probably some others that don’t start with the letter p). “All these foods tend to make everyone produce gas, but the effect is greater on people who have irritable bowel,” says Mark.  Basically, if you have irritable bowel, these foods are a fermentable toot fest.

So that’s the F in FODMAP; what about the other letters?  Oligosaccharides are foods including wheat, rye, legumes, garlic, onions, and some other fruits and vegetables.  Disaccharides are milk, yogurt, and soft cheese.  The sugar they contain is lactose.  Monosaccharides have a different type of sugar, fructose, and include fruits such as figs and mangoes, agave nectar and honey.  Polyols are found in other fruits and vegetables, including blackberries.  They’re also found in sugar-free gum.

The bottom line here, no pun intended, is this:  If you find that you have a lot of gas and discomfort after eating, if you are prone to diarrhea, constipation, or both, if you are feeling like food is not moving through your GI tract the way it ought to, well, it’s quite possible that you have a motility disorder such as irritable bowel.  The good news is that there is help out there — prescription medicine, over-the-counter treatment, and dietary changes.

©Janet Farrar Worthington