Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine (colon), commonly causing cramping, abdominal pain, bloating, gas, diarrhea and constipation. IBS is a chronic condition that you will need to manage long-term.

I was diagnosed with irritable bowel syndrome when I was very young. I was constantly dealing with alternating bouts of constipation and diarrhea, cramping and bloating. I have always been a “high-strung”, or nervous person. But keeping those feelings hidden away inside to the point of causing illnesses. I’m learning, as I age, to let those feelings go and get rid of them so not to cause any more problems, or flare-ups, with any of my, already long list, of illnesses.

The signs and symptoms of irritable bowel syndrome can vary widely from person to person and often resemble those of other diseases. Among the most common are:

  • Abdominal pain or cramping
  • A bloated feeling
  • Gas
  • Diarrhea or constipation — sometimes alternating bouts of constipation and diarrhea
  • Mucus in the stool

For most people, IBS is a chronic condition, although there will likely be times when the signs and symptoms are worse and times when they improve or even disappear completely.

It’s not known exactly what causes irritable bowel syndrome, but a variety of factors play a role. The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm as they move food from your stomach through your intestinal tract to your rectum. If you have irritable bowel syndrome, the contractions may be stronger and last longer than normal, causing gas, bloating and diarrhea. Or the opposite may occur, with weak intestinal contractions slowing food passage and leading to hard, dry stools.

 Abnormalities in your gastrointestinal nervous system also may play a role, causing you to experience greater than normal discomfort when your abdomen stretches from gas or stool. Poorly coordinated signals between the brain and the intestines can make your body overreact to the changes that normally occur in the digestive process. This overreaction can cause pain, diarrhea or constipation.
I was told by a gastroenterologist that the colon can be cut to pieces and you will not feel it, but if you expand the colon it becomes uncomfortable and begins to cause severe pain. He also explained the movement of the muscle contractions, sometimes they counter act and work against the muscles further up or down the line of the colon causing great discomfort and constipation.

Triggers vary from person to person

Stimuli that don’t bother other people can trigger symptoms in people with IBS — but not all people with the condition react to the same stimuli. Common triggers include:

  • Foods. The role of food allergy or intolerance in irritable bowel syndrome is not yet clearly understood, but many people have more severe symptoms when they eat certain things. A wide range of foods has been implicated — chocolate, spices, fats, fruits, beans, cabbage, cauliflower, broccoli, milk, carbonated beverages and alcohol to name a few.
  • Stress. Most people with IBS find that their signs and symptoms are worse or more frequent during periods of increased stress, such as finals week or the first weeks on a new job. But while stress may aggravate symptoms, it doesn’t cause them.
  • Hormones. Because women are twice as likely to have IBS, researchers believe that hormonal changes play a role in this condition. Many women find that signs and symptoms are worse during or around their menstrual periods.
  • Other illnesses. Sometimes another illness, such as an acute episode of infectious diarrhea (gastroenteritis) or too many bacteria in the intestines (bacterial overgrowth), can trigger IBS.

For me, I think it is stress that triggers my problems. I can eat about anything I want to without too much discomfort, but let a stressful situation arise and I may be bent over in pain.

A healthy diet

This includes:

  • Plenty of fruit and vegetables.
  • Plenty of starchy carbohydrates. Examples include bread, rice, cereals, pasta, potatoes, chapatis and plantain.
  • Some milk and dairy products (2-3 portions per day). If you are lactose intolerant include dairy alternatives such as soy, rice or oat milk and yogurts that are enriched with calcium.
  • Some protein foods: meat, fish, eggs and alternatives such as beans and pulses.
  • Limited amounts of foods high in fats and sugars. Limit saturated fat that is found in animal products such as butter, ghee, cheese, meat, cakes, biscuits and pastries. Replace these with unsaturated fats found in vegetable oils such as sunflower, rapeseed and olive oil, avocados, nuts and seeds.
  • Drink plenty of fluid – at least two liters daily, such as water or herbal teas.

Lifestyle changes to improve symptoms

  • Have a regular meal pattern.
  • Take time when eating meals.
  • Try not to skip meals.
  • Sit down to eat; chew food well.
  • Try to avoid eating too late at night.
  • Exercise regularly, such as walking, cycling, or swimming. If finding time is difficult, incorporate it into your day. For example, cycle to work, get off a train a stop early and walk, and use steps instead of lifts when possible.

De-stress

If you have a hectic lifestyle, stress and anxiety may also be causing IBS symptoms. There are many complex connections between the brain and the gut. Psychological factors, the nervous system, and muscle contractions in the gut all interact with each other, causing IBS symptoms. This is known as the brain-gut axis. Therefore, stress management can be effective in easing symptoms.

  • Create time for relaxation.
  • Make the most out of leisure time.
  • Try relaxation therapies such as mindfulness.
  • Exercise – try yoga or taking a walk.
  • Get enough sleep.
  • Seek support or counseling.

Sometimes, a healthy balanced diet and lifestyle changes aren’t enough to improve symptoms. It may be that more specific changes to the diet are needed. Many people report that what they eat affects their symptoms. Therefore, modifying what you eat can help to manage symptoms.

  • Reduce caffeine
  • Limit alcohol
  • Limit fizzy drinks

    Reduce intake of foods containing resistant starches

    • Processed foods such as crisps, oven chips, supermarket pizza, biscuits and cakes, breakfast cereals.
    • Foods that have been cooked and left out to cool – for example, cold potato/pasta salads.
    • Ready meals.
    • Partially baked bread – for example, garlic bread or pizza bases.
    • Whole grains, pulses, sweetcorn, green banana and muesli that contains bran.
    • Dried pasta (use fresh instead).
    • Pastry.
    • Savory snacks.

Cook fresh food whenever possible and eat food that you’ve cooked straightaway. This will help to reduce intake of resistant starches.

Modify your fiber intake

Fiber can be a confusing subject for many of those affected by IBS. For some people, reducing high-fiber foods can help to improve symptoms. For others, increasing fiber can help to improve symptoms, so it is very much dependent on the individual.

Insoluble fiber
This type of fiber does not dissolve in water and is not readily broken down, so it passes through the digestive system mostly intact. It absorbs water, adds bulk to stools (feces) and allows waste to be passed through bowels more quickly. Reducing this type of fiber may help to improve symptoms of diarrhea. Foods to reduce or avoid:

  • Skin, pith and pips of fruit and vegetables.
  • Wheat and bran.
  • Corn (maize).
  • Nuts and whole grains.

Soluble fiber
This type of fiber dissolves in water and is broken down by the natural bacteria in the bowels. It softens stools and makes them larger. Increasing this type of fiber may help to improve symptoms of constipation. Foods to include are:

  • Oats
  • Barley
  • Psyllium and ispaghula
  • Nuts and seeds
  • Fruit and vegetables
  • Beans and pulses

Whole grains (for example, wholemeal bread, brown rice and whole wheat pasta) may also help with constipation. Although increasing fiber may help to improve symptoms, it may also generate gas and cause pain and bloating. Monitoring is important to help identify this and to adjust your fiber intake according to your symptoms.

Drink Plenty of Water

Fiber needs water, so aim to drink at least 8-10 cups of water daily or other fluids such as herbal teas. People with diarrhea will need to make sure they are replacing these lost fluids. Drinking water will also help to improve constipation.

Reduce fatty foods

Some people find that fatty foods are difficult to digest and can cause symptoms of diarrhea; therefore, reducing fat in the diet may help:

  • Limit cakes, biscuits, chocolates and pastries.
  • Cut down on fatty meat products such as sausages, pies and pasties.
  • Use lower-fat dairy products – for example, low-fat yogurt, cottage cheese, semi-skimmed milk.
  • Choose tomato-based sauces rather than creamy sauces – although some tomato sauces can be oily so check the label.
  • Use small amounts of cheese (a matchbox size is a portion) – stronger-flavored cheeses may help you to use less.
  • Take care when using dressings and sauces such as mayonnaise and salad dressing. Use small amounts and try the reduced-fat versions.
  • Cut off visible fat from meat and choose leaner cuts of meat.
  • Use minimal oil/butter when cooking (use an oil spray, or measure using one teaspoon of oil per person, per meal).
  • Try different cooking methods such as steaming, boiling, microwaving, grilling and poaching rather than frying.

Reduce fructose

Fructose can cause diarrhea in some people, particularly when eaten in large quantities. Sometimes fructose is not well absorbed; it can draw water from the body into the bowel, causing osmotic diarrhea. If fructose is not well absorbed, it is fermented in the colon and gases are produced, causing wind and bloating in some people with IBS.

Avoid sorbitol

Sorbitol is poorly absorbed and has a laxative effect when it enters the colon, so this can cause symptoms of bloating and diarrhea. People with IBS may be sensitive to smaller amounts of sorbitol.

Sorbitol is found in artificial sweetener, low-sugar sweets, drinks, mints and gum and often found in diabetic or slimming products. Also check the labels of these products for mannitol and xylitol, which have a similar effect.

I have found that stevia and artificial sweeteners cause me great distress, bloating, gas and sometimes diarrhea.

Try probiotics

Probiotics may be useful in improving symptoms of IBS, although they do not work for everybody. Probiotics can help to balance our gut bacteria. The ‘good’ bacteria in probiotics compete with ‘bad’ bacteria for space in the gut. This means that there are fewer ‘bad’ bacteria, making it a healthier gut environment. This can help with digestion and to improve symptoms of wind, bloating and diarrhea.

Some people find that even after making these dietary changes, their symptoms are still not improving. Avoidance of single foods or following elimination diets might have some benefit for people with IBS. Such dietary regimes should only be followed with the guidance of a dietician.

Food intolerance

Some people with IBS may have a food intolerance. Some food intolerances, such as lactose, can be diagnosed with a hydrogen breath test, which can be arranged by a doctor. Other food intolerances can be identified by following a diet that excludes suspected foods.

If it is thought that particular foods are causing symptoms, a dietician may advise you to exclude these foods for a certain time period. This is to monitor whether symptoms improve when these foods are taken out of the diet. After this time period (usually 2-4 weeks) the foods are gradually re-introduced to see if symptoms come back. Common intolerances include lactose (found in milk and dairy products), wheat (found in bread, cereals and pasta) and caffeine (found in tea, coffee or cola)

The Low FODMAP Diet

There is a growing body of evidence that the low FODMAP diet is effective in improving symptoms of IBS. FODMAP stands for:

  • Fermentable – meaning they are broken down (fermented) by bacteria in the large bowel
  • Oligosaccharides – “oligo” means “few” and “saccharide” means sugar. These molecules are made up of individual sugars joined together in a chain
  • Disaccharides – “di” means two. This is a double sugar molecule
  • Monosaccharides – “mono” means single. This is a single sugar molecule
  • And Polyols – these are sugar alcohols (however, they don’t lead to intoxication!)

These are a group of short-chain carbohydrates that are not very well absorbed in the gut (small intestine). These carbohydrates are easily fermented and cause more fluid to enter the large bowel, leading to gas, bloating and diarrhea. Reducing the total amount of these fermentable sugars may improve IBS symptoms. The low FODMAP diet should be tried with the assistance of a dietician.

In common language, if your “gut” reacts to FODMAPs, get ready for a very restrictive diet.  It basically means that you are both gluten and lactose intolerant and don’t absorb fructose properly.  You need to eliminate or at least greatly reduce:

  • gluten products
  • lactose
  • fructose & glucose
  • high fructose corn syrup

Symptoms include: abdominal discomfort, distention, bloating, fullness, nausea and/or pain after eating foods containing FODMAPS.  Symptoms can appear within 30 minutes of consuming FODMAPs or even up to 2 hours after ingestion.

For people with irritable bowel syndrome, a slow-moving gut, or other bowel disorders, you may be able to improve, or even eliminate, discomfort by eliminating FODMAPs.

Common FODMAPS and what to look for on the label

Common FODMAPs in your food include:

  • Fructose: A sugar found in most fruits and vegetables.
  • Lactose: A sugar found in dairy foods like milk.
  • Fructans: Very similar to fructose, found in many vegetables and grains
  • Galactans: Found primarily in legumes.
  • Polyols: Sugar alcohols like xylitol, sorbitol, maltitol and mannitol. You find them mainly in artificial sweeteners and chewing gum.

Best practice is to read the ingredients label for other added FODMAP ingredients such as inulin (chicory root), natural flavors, high fructose corn syrup, agave, honey, etc.

Summary: FODMAPs exist mainly in dairy, legumes, and many fruits and vegetables. While gluten is not technically a FODMAP, gluten-free products are typically lower in FODMAPs anyway.

low-fodmap-diet-food-list-for-shopping-colorful-724x1024

Important Notes About this Low FODMAPs Food List

This list is designed as a tool for those who are following a low FODMAP diet to treat food intolerance or IBS.

Note the serving amounts next to each food refer to how much you can eat per meal. They are based on dry/raw weight unless otherwise specified.

If no amount is given then it’s considered a “free” food. That is, FODMAP levels were undetectable in that food because they were so low.

In any case, moderate portion sizes are still recommended, especially with “free” fruits.

The version above is a PNG image file, best for saving to a phone or tablet. Right click and select “save image as” on computer, or screenshot on your phone or tablet to save.

This is the most comprehensive low FODMAPs foods list available for free.

It’s based on the latest data from the Monash University Low FODMAP Diet app.

http://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/basics/definition/con-20024578
http://patient.info/health/irritable-bowel-syndrome-diet-sheet
http://fodmapliving.com/
https://www.dietvsdisease.org/diy-low-fodmap-diet/

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