Irritable Bowel Syndrome (IBS) is a functional disorder of the large intestine with no evidence of accompanying infection or structural defect. Though the causes for IBS are not completely clear, physiological, psychological and dietary factors have all been linked to this condition, including excessive numbers of bacteria in the intestines.
Dietary Treatment Considerations
The goals of a therapeutic diet for IBS include:
1. Increasing dietary fiber (includes adequate water and exercise)
2. Identifying and eliminating foods that cause the symptoms (food allergies/intolerances)
3. Support the integrity and function of the intestinal mucosa to optimize digestion and absorption
Several studies indicate that as many as two-thirds of people with IBS will improve or even become symptom-free if they identify (via an elimination diet) and avoid the foods to which they are intolerant. The foods that most commonly cause symptoms seem to be dairy products, onions, wheat, chocolate, coffee, eggs, nuts, citrus, tea, rye, potatoes, barley, oats and corn.
Identifying and Eliminating Foods That Cause the Symptoms
Food allergies and intolerances
This involves the use of a 3-week elimination diet (sometimes longer), during which time a hypoallergenic diet is followed. After 3 weeks of avoiding the potentially "offending foods", foods are individually reintroduced every 3 days. This food reintroduction process is called "rechallenge". If symptoms worsen or return when a food is "rechallenged", that food should not be eaten.
It is important to note that it is possible, during the food rechallenge phase, to experience a strong/sharp increase in allergy/intolerance/sensitivity symptoms, as compared to the degree of those symptoms prior to the elimination diet. In rare cases of severe food allergy, the individual could potentially (during the food rechallenge trial) have an anaphylactic reaction that is life threatening. Therefore, an elimination diet and rechallenge should be done under the care of a health care practitioner.
Dietary Fiber
The dietary fiber found in complex carbohydrates (foods found in their whole form that have not been refined) is useful in normalizing bowel function. It consists of both water-soluble and insoluble fiber types. Patients with diarrhea as part of their IBS symptom-picture should focus on soluble fiber foods (which form a viscous gel and slow transport through the intestine and ease contractions or cramps). Soluble fibers are water-soluble fiber types (found in vegetables, fruits, oat bran, guar and legumes (beans and peas)) and psyllium seed powder. Examples of high-fiber fruits are apples, bananas, mangoes and papayas and avocadoes. High-fiber vegetables include sweet potatoes, carrots, squash and pumpkins, beets, beans, and legumes. High-Fiber grains: quinoa and quinoa pasta, rice and rice pasta, flour tortillas and rice cereals. Wheat and other grains are also excellent sources of fiber, however, their protein components are often implicated as the cause of various malabsorption and allergic conditions (gluten/gliadin intolerance or celiac’s disease, etc.)
Nutrition Guidelines 1.
2. Try to limit "stand-up, eat-on-the-run" type meals.
3. Chew thoroughly and eat at a leisurely pace – if you must eat in a hurry, only eat a small amount at a time.
4. Eat a balanced and varied diet.
5. Gradually increase your intake of fiber.
6. When your stomach is empty, eat soluble fiber foods first. Make soluble fiber foods a large component of every meal (see fiber sources above).
7. Drink plenty of fluids, especially water (at least 6 - 8 glasses a day).
8. Eliminate all red meat, dairy, fried foods, egg yolks, coffee, soda, and alcohol from the diet. These are the most common triggers of IBS.
9. Limit foods that you are sensitive to or do not tolerate well. Possibilities include dairy products, chocolate, eggs, and wheat products.
10. Limit foods high in fat. If you know you will be having high-fat foods, eat a source of soluble fiber first – never eat high fat foods on an empty stomach.
11. Eat green salads at the end of the meal (small portions with non-fat dressing).
Bitter foods
can improve the whole upper digestive system’s function and enhance the absorption of nutrients. Try adding some bitters to meals, which include chicory, endive, radicchio, and dandelion greens.
Herbal and Nutritional Supplements
have been shown in research studies to be helpful in the treatment of IBS.
1. Enteric coated peppermint oil capsules are used to inhibit intestinal contractions and relieve abdominal pain and gas.
2. Chamomile and valerian aid in decreasing gas.
3. Slippery elm soothes the intestinal lining and decreases inflammation.
4. Lemon balm decreases intestinal cramping and spasms.
5. Nutritional supplements such as glutamine, beta-carotene, and zinc aid in the healing of the intestinal lining.
Lifestyle Guidelines
2. Daily practice of yoga, Tai Chi, or meditation can significantly reduce stress-related symptoms.
3. Pay attention to your body’s signals. When you feel the urge to move your bowels, take the time to do so.
4. Make sleep a priority – inadequate sleep reduces the body’s ability to manage stress effectively.
Emotional Components
such as depression, insomnia, fatigue, and anxiety are often associated with IBS sufferers. Increased contractions of the colon have been shown to occur in patients with IBS in response to stressful situations, which can lead to uncomforatble symptoms. Various methods of treatment that may be helpful to reduce stress, anxiety, depression, and fatigue include biofeedback, individual counseling, guided imagery, and physical activity. If necessary, seek the help of a professional to manage stress or other emotional factors.
ABOUT ANGELA PIFER, CERTIFIED NUTRITIONIST
Angela Pifer is a Certified Nutritionist, with a MS in nutrition from Bastyr University, in private practice, specializing in food sensitivities, emotional eating, digestive conditions & weight loss. She founded Nutrition Northwest Co in 2005; the premier provider of sound nutrition and wellness advice in the Northwest with offices in Seattle and Kirkland. Angela has a unique approach to helping her patients create new healthier habits: offering customized nutrition programs that inspire & educate along with a high degree of support & accountability to help them become fit & fabulous from the inside out.
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