Authors: Carol Svec
Food Cures (63 page)
When you have an IBS attack, consult your diary to see which foods you ate in the previous 24 hours and start a list of your potential triggers. Keep eating normally, always noting which foods you ate in the 24 hours prior to an attack and adding new items to your potential trigger list. When a food already on your list precedes an attack, make a hatch mark next to it each time it comes up. After a few weeks, those marks should tell you which foods are most likely to trigger an episode. Narrow down your list to the three most likely triggers, and avoid those foods entirely for two weeks. Continue to keep your IBS journal, and repeat the process. Every once in a while, test your trigger foods again (one at a time) to make sure you’re not avoiding them for no reason. Over time, you’ll have a good handle on which foods you need to avoid to feel well, and which you can eat safely. NOTE: If you find yourself with more than five main trigger foods, see a dietitian to make sure that the rest of your diet is making up for whatever nutrients you’re missing by eliminating those foods.
For everyone fighting IBS, there are a few mealtime guidelines that can make your life easier:
- Try to eat meals at the same time each day to get your body used to a schedule.
- Eat smaller, more frequent meals so you don’t overload your gut at any one time.
- Slow down—sit, relax, and take time to chew your food. Think of it as time invested in training your digestive system to behave.
GOOD FOODS TO CHOOSE
The best foods for IBS health are those that are gentle on the digestive system, and which encourage “smooth passage” through the intestines. Thus, vegetables, fruit, and whole grains—
it pains me to say
—should be limited until your symptoms subside and you identify foods that are problematic for you. It’s hard to imagine I just said that! Truth be told, these healthful foods are a bit hard for the body to break down, but remember I’m only recommending you watch your intake
until
you’ve got a handle on your triggers—even with diarrhea-predominant IBS, you should eventually be able to tolerate moderate amounts of all three groups, although you’ll probably need to cook vegetables.
SOLUBLE FIBER
Fiber comes in two main varieties: soluble and insoluble. Soluble fiber dissolves in water and turns into a kind of gooey, gummy consistency—think what happens to oatmeal after it sits in a pot of water for a time. Insoluble fiber is tougher. It doesn’t dissolve, and pretty much keeps its form.
Although insoluble fiber is generally healthy, it can be hard on the intestines of people with IBS. Insoluble fiber speeds food through the colon, something that many diarrhea-predominant IBS sufferers want to avoid. People with constipation-predominant IBS may want to experiment with how much insoluble fiber they can eat without experiencing too much gas and bloating.
Soluble fiber, on the other hand, promotes gentle regularity, regardless of the type of IBS you have. That’s why you’ll find plenty of soluble fiber integrated into my Elimination Diet with Added Fiber (it doesn’t, however, include soluble fiber-rich foods that also act as potential triggers, such as beans, lentils, broccoli, and cabbage).
Most foods high in soluble fiber are considered safe for people with IBS. The trick is to eat a variety of foods in moderation, without eating too much of one particular food, or too much food in general at one time. If you have diarrhea-predominant IBS, I recommend slowly adding more foods high in soluble fiber to your diet. If you experience too much bloating or pain, back off a little, wait a few days, then add fiber again. The key is to eat just a little bit of extra fiber, building up to about six servings a day over a course of weeks, not days. However, for constipation-predominant IBS, you can be more aggressive, fiber-wise. The Elimination Diet with Added Fiber (for constipation-predominant IBS) works in three to six (or more) daily portions of soluble fiber, depending upon the meals and snacks you chose. Of course, even then you’ll want to moderate the portions and spread them throughout the day—as opposed to eating them all at one sitting—to avoid the risk of excess gas. And…remember to drink plenty of water to help move it along.
LACTOSE INTOLERANCE VERSUS IBS
Milk can trigger IBS, that’s why you’ll find dairy on the list of foods to initially avoid. But sensitivity to dairy foods may also be a sign of lactose intolerance. Lactose intolerance is not IBS. In fact, it’s a completely different problem and one that’s easily remedied. If you suspect you’re lactose intolerant, make dairy the first thing you test.
Milk products contain a form of natural sugar called lactose. In order to digest lactose, our bodies produce a specific enzyme called lactase. For a variety of reasons, including genetic abnormalities, digestive disorders (i.e., celiac disease, Crohn’s disease, IBS), intestinal injury, and/or the natural aging process, some people end up with very low levels of lactase. Depending on how much of the offending food you eat, and how much lactase enzyme your body can produce, symptoms can be mild or severe, and include nausea, cramping, gas, bloating, and diarrhea. Sound familiar? The symptoms can be remarkably like IBS symptoms. So, how do you tell the difference? Simple. Avoid milk and anything containing milk for three to five days (see full dairy list under Common IBS Trigger Foods, Chapter 17). If your symptoms disappear, you’re probably lactose intolerant. If you’re willing to avoid those trigger foods indefinitely, it really doesn’t matter whether you have lactose intolerance or IBS—as long as you don’t eat them you’ll feel fine.
On the other hand, you may want to know definitively which it is—IBS or lactose intolerance, if only to understand your options. Many people with lactose intolerance can enjoy lactose-reduced milk products without any symptoms. Others take lactase enzyme (such as Lactaid) in a tablet or liquid form with their first bite or sip of a milk product and
voila
—no digestive trouble. It’s unlikely people with dairy-triggered IBS can tolerate these reduced-lactose products. But those aren’t diagnostic tests. If you really want an answer ask your doctor about these: the Lactose Tolerance Test, which is a series of blood tests taken over a two-hour period after drinking a lactose-rich test drink; and the Hydrogen Breath Test, which looks for a higher-than-normal amount of hydrogen in the breath, caused by the extra gases produced by the bacteria fermenting the undigested lactose in the intestines.
If you test positive for lactose intolerance and avoid all milk products but
still
have gastrointestinal symptoms, talk with your doctor about whether you need additional testing. In the end, you may have both, lactose intolerance and IBS (I know—oy!).
In my Elimination Diet with Added Fiber, I incorporate at least one serving of soluble fiber-rich food at each meal. If you have diarrhea-predominant IBS, and you’re ready to follow the less extreme Elimination Diet with Added Fiber, you may want to move more slowly…starting with a single serving for the entire day. All foods rich in soluble fiber included in Your Ultimate Grocery List have an asterisk (*), so you’ll know what to include and what to avoid. Everything is explained in the 4-Step Program, Chapter 17.
In addition, raw vegetables—
whether rich in soluble OR insoluble fiber
—tend to be difficult for IBS sufferers to digest and can often trigger diarrhea, gas, and bloating. When you’re ready to introduce vegetables into your diet, I strongly recommend you stick to cooked vegetables.
BEST FOODS FOR SOLUBLE FIBER
:
Psyllium Seeds (ground), oat and rice bran, oatmeal, barley, peas, apple, blackberries, pears, apricots, cantaloupe, strawberries, bananas, peaches, cooked carrots, cooked spinach, sweet potatoes, yams, white potatoes, avocado, raspberries, flaxseed (ground)
LIQUIDS
All people with IBS should strive to drink at least eight 8-ounce glasses of flat water every day. If constipation is your problem, water will help keep your stools moist so they pass more easily; the soluble fiber in your diet will help too. If diarrhea is your problem, you’ll need to replenish the water you lose through loose stools. Plain water and naturally decaffeinated herbal teas should be your first choices. Carbonated beverages are the worst choices because the gas from the carbonation gets trapped in your intestines, causing discomfort. If you have diarrhea-predominant IBS, you’ll also want to avoid drinking caffeinated beverages and alcohol, which can stimulate the intestines and make symptoms worse.
BONUS POINTS
- Rule out other disorders.
Please don’t assume that your symptoms are due to IBS unless your doctor has told you so. You need to get a thorough medical workup to rule out other, more serious diseases, including Crohn’s disease, ulcerative colitis, celiac disease, and colorectal cancer. Even if you’ve had a diagnosis of IBS, be sure to go back to your doctor if your symptoms change or worsen.- Talk with your doctor about medications.
The standard of care is to treat IBS with diet and lifestyle changes. But if you can’t get your symptoms under control, and if the pain and other symptoms are affecting your life, ask your doctor about medications that have been approved for IBS. There are a variety of possible medications, including antispasmodics, antidiarrheals, and antidepressants. Yes, antidepressants—for your intestines, not your brain—because they seem to modulate intestinal pain and regulate gut regularity. Many antidepressants regulate the neurotransmitter serotonin and (who knew?) 95 percent of serotonin is found in your gut, where it helps maintain smooth, regular contractions of the intestines. Some scientists believe that the intestines of people with IBS require more serotonin than they’re getting for normal function. The theory is that antidepressants that make more serotonin available (the serotonin reuptake inhibitors—SSRIs—such as Prozac, Zoloft, or Paxil), will fix the problem. More research needs to be done before antidepressants are a first-line treatment, but if you’ve tried everything else, you may want to discuss this possibility with your physician.- Don’t self-medicate without guidance.
You may be tempted to take control of IBS by stocking up on over-the-counter laxatives or anti-diarrhea medication. Don’t do it unless you get the go-ahead from your doctor. IBS is a chronic disorder, and over-the-counter medications are short-term solutions. Laxatives in particular can be hard on the intestines if used inappropriately. If you find yourself relying on over-the-counter meds, talk with your doctor to find a better solution.- Maintain healthy eating patterns.
Eat small meals regularly throughout the day. Try to eat at about the same time each day. Slow down during meal time—try to avoid on-the-run (or over-the-kitchen-sink) eating.- Put a lid on stress.
Stress is a complex problem. Although circumstances outside our control can
feel
stressful, psychologists remind us that events don’t
create
stress. Stress is of our own making. It’s how we interpret events or think about future outcomes that leads to stress. Those perceptions trigger a variety of physiologic responses, including changes in the way our gastrointestinal systems function. That’s how the mind-body connection works—the things we think have very real effects on our bodies. But just as we create stress, we can also learn to respond in different ways to life events. People with IBS can have extreme physical reactions to stress, so relaxation is especially important. Stress can be controlled. Your IBS symptoms may depend on it.
The first thing to try is deep breathing, which is breathing from the diaphragm instead of the chest. To get started: Lie down on the floor on your back. Bend your knees, and put your feet on the floor. Put one hand over your diaphragm, just under your ribs. Keeping your shoulders as flat as possible against the floor, take a deep breath. As you breathe in, focus on letting your diaphragm push your hand up, expanding your abdomen. Exhale naturally, and notice how your hand gently falls as the air leaves your lungs. (After you get the hang of this type of breathing, try it while standing or sitting up straight.) This type of deep breathing triggers a relaxation response in the body.
Along with deep breathing, you can bring in an arsenal of relaxation techniques, including massage, yoga, and meditation. Even taking quiet time for yourself—a half-hour to read, take a bubble bath, garden, or just enjoy nature—may be enough to give your mind and body a much-needed break.
If stress has gotten out of control, you might want to consider a short course of counseling with a psychologist to help you learn how to change the way you respond to the stressful events in your life. There are specific techniques that can help you experience life without tension, anxiety, or that feeling of being overwhelmed. In fact, researchers from Mount Sinai School of Medicine in New York found that people with IBS who were treated by both a gastroenterologist and a psychologist got better faster than those treated by just one type of specialist.- Make exercise a daily prescription.
Exercise is important for two main reasons. First, exercise is a great stress reliever. Dozens of studies have shown that no matter what the cause of the stress, no matter what symptoms the stress causes, regular moderate exercise can help make you feel better. Second, exercise is critically important for the proper functioning of the gastrointestinal system. If your body is sluggish, your gut can follow suit. If your body is fit and active, your gut will be healthier. Although there have been just a few studies that focus on the effects of exercise on IBS symptoms, at least one study found that regular physical activity was protective. If you don’t already exercise, you may want to consider walking for 30 minutes a day, every day at a moderate pace. But really, any activity will be helpful, so choose something fun to do every day.
