I’m a middle aged male suffering from food-related digestive problems. My stomach-related issues began in my teenage years. I don’t have gluten reactions that were described in your gluten sensitivity column, but am lactose intolerant. I was never formally diagnosed, but I believe I may have irritable bowel syndrome. Can you suggest a diet plan to help me?
Sincerely,
Thinking Irritable Bowel Syndrome?
Dear Thinking Irritable Bowel Syndrome,
Irritable bowel syndrome (IBS) can be managed, but there is no cure. Some people have severe symptoms while others have mild discomfort. It may be worthwhile for you to get an accurate diagnosis even in middle age.
Definitions
1. Irritable bowel syndrome: A disorder affecting the large intestine. There are four types of IBS: IBS-D (diarrhea and stomach discomfort); IBS-C (constipation and stomach discomfort); IBS-Mix (diarrhea, constipation and stomach discomfort); and IBS-Undefined (symptoms vary). In addition migraines, sleep disturbances, anxiety, depression, fibromyalgia and chronic pelvic pain can accompany IBS.
2. Lactose sensitivity or intolerance: The small intestine does not make enough of the enzyme “lactase,” which breaks down milk sugar (lactose). The unbroken lactose is digested by intestinal bacteria, causing stomach ailments.
3. Milk/dairy allergy: An abnormal response by the body’s immune system to milk and dairy products. The allergy is related to milk proteins (casein and/or whey). Reactions may include: skin rashes, digestive symptoms and hay fever. The worst-case scenario is an anaphylactic reaction.
Lactose intolerance and milk allergy have similar symptoms. Therefore, it is important to be properly diagnosed. *Recommendation: Discuss your symptoms with your physician.
Diagnosis: There are no specific tests for IBS. An experienced gastroenterologist can determine if you have IBS by ruling out other stomach disorders. IBS should not be confused with IBD (inflammatory bowel disease, Crohn’s disease or ulcerative colitis). IBS does not damage the colon or increase risk of developing colon cancer.
Etiology: IBS is caused by dysmotility of the digestive tract muscles. They are impaired in speed, strength and coordination. Other components include hypersensitivity of nerves in organs such as the stomach, resulting in pain. Lastly there is brain-gut dysfunction, involving faulty signals between the brain and gut causing intestinal distress. According to the Journal of Molecular and Cellular Pediatrics, there appears to be a genetic component to IBS.
In the article “How Does Alcohol Affect Irritable Bowel Syndrome” gastroenterologist Gregory Seltzer MD, writes that IBS symptoms can be triggered by certain foods, stress and hormones. More women than men suffer from IBS due to hormonal fluctuations.
Diet Ideas
People who suffer from IBS have intolerance to different food items. To develop a “personalized diet plan,” I require an appointment to clarify symptoms, food tolerances or intolerances, eating habits and lifestyle. A carefully rendered doctor’s diagnosis (including laboratory testing) is also essential to creating an individualized plan.
Low-FODMAP Diet
The American Gastroenterological Association and the American Dietetic Association cite many studies that recommend a Low-FODMAP diet for IBS. In my practice, Nutrition Transformations, I work with this type of diet for clients who can benefit from this regimen. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. FODMAPs are carbohydrates that are difficult to digest and absorb, especially by people with IBS. Undigested carbohydrates are metabolized by intestinal bacteria to produce byproducts that cause flatulence, abdominal pain, possible diarrhea and/or constipation. A low-FODMAP diet improves IBS symptoms, and can improve the quality of your life.
Lactose: If you are lactose intolerant with or without IBS: *Recommendations: 1) Avoid milk and dairy products and/or consume only amounts tolerated; 2) Use Lactaid supplements to replace inadequate intestinal lactase production; 3) Consume lactose-free milks such as those made from almonds, oats, rice and soy. Brie and Camembert cheeses are usually better tolerated. Substitute olive oil in lieu of butter.
Fruits: They contain the sugar fructose, which can trigger IBS. Avoid: apples, pears, watermelon, plums, apricots, dried fruit and fruit juices. *Recommendation: Consume berries, unripened bananas, grapes, kiwi, cantaloupe and oranges, as tolerated.
Dietary fiber: This is found in plant foods and is healthy and important to consume in IBS as tolerated. *Recommendation: According to “IBS: Foods to Eat and Avoid” by Gastroenterology Consultants of San Antonio, daily fiber requirements are the following: Women: 21-25 grams; Men: 30-38 grams. Adding fiber to your diet can improve IBS symptoms. Monitor your symptoms and trust your gut.
Vegetables: Certain vegetables can cause gas and abnormal bowel habits with IBS. Avoid broccoli, cauliflower, cabbage, coleslaw, sauerkraut, artichoke, brussels sprouts, onions, shallots, leeks and asparagus. *Recommendation: Consume eggplant, green beans, celery, carrots, sweet potatoes, yams, zucchini and squash.
Legumes: They contain indigestible saccharides (sugars) which can trigger IBS. Consume small amounts of baked beans, chickpeas, lentils, and soybeans. *Recommendation: Consume: rice, oats, millet, quinoa and tapioca, as long as you do not have celiac disease or gluten sensitivities.
Fried Foods: These are common in western diets. Eating too much can cause problems. The high-fat content may be especially hard on the system for people with IBS. *Recommendation: Grill, steam, cook or bake your favorite foods, seasoning with safe-to-use spices. These include: basil, chili, coriander, ginger, lemongrass, mint, oregano, parsley, rosemary and thyme. *Warning: Garlic and onions, cooked or raw, may cause painful gas and cramping with IBS.
Caffeine: Stimulates the gut and may cause diarrhea in IBS. Avoid coffee, soda, energy drinks and certain teas such as: black, pu-erh, oolong, green, white and tea blends. Read labels!
Processed foods: Contain large amounts of: salt, sugars fats, additives, flours, emulsifiers, preservatives and food colorings, negatively impacting IBS. *Recommendation: Consume fresh, unprocessed foods.
Chocolate: Can trigger IBS because of the high fat and sugar content. Chocolates may also contain lactose and caffeine.
Sugar free sweeteners: Are found in candy, gum, diet drinks and mouthwash. Sugar substitutes include sugar alcohols, artificial sweeteners and natural zero-calorie sweeteners (i.e., stevia). Artificial sweeteners that can trigger IBS symptoms include: sucralose, aspartame, sorbitol, mannitol, and xylitol. *Recommendation: If you are diabetic and have IBS, NutraSweet and Splenda may be better tolerated.
Alcohol: Alcoholic beverages irritate the gut and trigger IBS symptoms. Alcohol also causes dehydration, which affects digestion. Beer contains gluten and mixed drinks contain sugar.
Proteins: Fresh lean meats, poultry, fish, eggs and tofu are permitted on a low–FODMAP diet.
Medications: There are prescription and over-the-counter medications that can treat IBS and symptoms. *Recommendation: Consult your physician before taking over-the-counter medications and supplements.
Other Techniques to Manage IBS:
1. Stress reduction: Biofeedback, cognitive behavioral therapy, acupuncture, therapeutic massage and properly prescribed anti-anxiety medications may help to manage IBS.
2. Sleep: Helps the body and brain repair, restore and reenergize. Poor sleep can trigger IBS symptoms. For suggestions on better sleep see my column “Pandemic Dodger” (The Jewish Link, January 13).
3. Exercise: Regular exercise improves IBS symptoms by: reducing stress, improving digestion and bowel function, improving sleep and providing a sense of well-being. The Journal of Bodywork and Movement Therapies recommends 30-minute workouts on a treadmill three times a week to improve IBS.
4. Eating patterns and habit to improve IBS:
a. Eat meals on a regular schedule.
b. Do not skip meals.
c. Chew foods well and eat slowly.
d. Stay hydrated.
e. Do not chew gum. It causes stomach acid and gas.
f. Add fiber to your diet as tolerated.
g. Avoid eating late at night.
Conclusion
IBS can be managed by a combination of: diet, exercise, adequate sleep, and stress reduction. If you require assistance managing your IBS, Nutrition Transformations can help you with IBS menus, exercise routines and the lifestyle that addresses your condition.
Yours in good health,
Jenn
718-644-1387
See my January Blog on SMART GOALS
By Jennifer Chapler, MS RD CDN
