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Irritable Bowel Syndrome

More than 37 million Americans suffer from Irritable Bowel Syndrome, or IBS, a condition that affects the movement of food through the intestines. For some, the movement is too slow, causing constipation. For others, the movement is too fast, causing diarrhea. In still others, the movement alternates between too fast and too slow causing both diarrhea and constipation. When there is an infection or damage, or when the intestines become too full from gassy food, the nerve cells are activated and it is felt as pain.

Irritable bowel syndrome affects around 15-22% of the people in the United States. It usually starts in people in their 20s and 30s and tends to affect women more than men. Fortunately, these symptoms are not caused by physical damage to the intestines. Although once thought to be due to stress, it is now known that many factors contribute to IBS, including certain foods, eating habits, and imbalances in intestinal flora. Healthy food choices can be very helpful in alleviating the symptoms of this painful and inconvenient condition.

Eat more

  • Whole grains for their high fiber content
  • Organically grown fruits and vegetables
  • Yogurt

Avoid adverse food reactions, caffeine, excessive fructose (sugar from fruit), sorbitol (sugars found in plums, peaches, pears and apples) and lactose found in milk and cheese.

Description

What is Irritable Bowel Syndrome?

Irritable bowel syndrome affects around 15-22% of the people in the United States. It usually starts in people in their 20s and 30s and tends to affect women more than men.

IBS accounts for up to 3.5 million doctor visits and 2.2 million prescriptions for medication every year. Although symptoms are not caused by physical damage to the intestines, IBS sufferers are much more likely than others to have had surgeries such as appendectomies and hysterectomies, as well as multiple abdominal surgeries. The good news is that dietary changes can really help to reduce symptoms in IBS sufferers.

Symptoms

IBS typically strikes the small and large intestines, which leads to symptoms that occur in the lower abdominal area of the body. The main symptoms include changes in bowel movements.

Symptoms of irritable bowel syndrome include:
  • Periods of constipation, diarrhea, or switching between the two
  • Crampy lower abdominal pain that is better after bowel movements
  • Excessive amounts of gas
  • A feeling of fullness or bloating in the lower abdomen

Note: If you are experiencing any of the following: severe abdominal pain, pain that is constant and not relieved by bowel movements, pain or diarrhea that wakes you from sleeping, unexplained weight loss, vomiting, bleeding from the bowels or blood in the stools, anemia or general weakness, or bowel changes plus a family history of colon cancer, you may have a more serious condition and should see a doctor for a more thorough evaluation.

The Disease Process

For many years, doctors believed that IBS was just a psychological condition, or “all in your head.” It is now known that this is not the case. IBS is a real physical ailment that causes very real suffering.

The good news is that there's nothing physically wrong with the intestines. Basically, there are no lesions or deformities or signs of damage that would explain the problem. Instead, the problems seem to be caused by altered intestinal motility and sensation.

The large and small intestines are like big tubes. The insides of the tubes are where the food passes through. Wrapped around the outside of the tube are many layers of muscles. These muscles contract in a certain pattern in order to help squeeze food through the digestive tract. The contraction of these muscle is referred to as motility. Within the layers of muscle cells are the nerve cells that detect pain in the intestines. This is sensation.

When there is an infection or damage, or when the intestines become too full from gassy food, the nerve cells are activated and it is felt as pain. Normally, the muscle cells move food through the small intestines to the large intestines. When it starts to fill the rectum, the final portion of the large intestine, it signals to the brain that it's time for a bowel movement, and we head to the bathroom.

In people with IBS, however, there are problems with motility and sensation. The muscle cells in the large intestines of some patients don’t contract as well as they should, which leads to constipation. In others, the muscles contract more than they should, causing diarrhea. In still others, the muscles alternate so that there are periods of constipation and periods of diarrhea.

At the same time, the nerve cells seem to be hypersensitive. They feel pain much more easily than the nerve cells of other people, so that even the slightest amount of bloating or gas causes a great deal of discomfort. When the patient has a bowel movement, the rectum is emptied, the intestinal contents shift, and the pain subsides.

Causes

The cause of IBS is still considered to be unknown. Although stress can make the condition worse, it is not the only factor involved. Some cases of IBS occur after a bout of intestinal infection, suggesting that infection may play a role for some. Many women report that their symptoms are worse around their menses, suggesting that hormones may play a role for some.

One factor that seems related for many people is the balance of flora in the gut. The large intestines normally contain a variety of friendly bacteria. These beneficial bacteria live on fiber and undigested food and protect us against harmful bacteria and viruses.

Sometimes, however, more harmful bacteria can start to live in the intestines. These can cause symptoms of diarrhea and can create a lot of gas and bloating. Studies have shown that patients with IBS tend to have more of the harmful bacteria in their intestines than others, which can contribute to symptoms.

Whatever the exact cause of the IBS symptoms, be it past infection, hormones, stress, or flora imbalance, dietary changes can have a significant impact on the pain and discomfort experienced by so many people.

Dietary Causes

When constipation is the main symptom of IBS, researchers believe the condition is caused by too little fiber in the diet. It's recommended that people eat from 25-30 grams of fiber a day. Unfortunately, the average American only gets about half of this. Without fiber, there is little bulk to the stools, which makes it more difficult to have a bowel movement.

Sugar maldigestion is another possible dietary cause of IBS. Sugars are normally broken down by specific enzymes in the intestines and then absorbed. Some people, however, don’t produce some of these enzymes, so the sugars don’t get broken down properly. If these sugars wind up in the large intestine, the bacteria there will gobble them up and produce large amounts of gas as a result.

Lactose intolerance, the most common form of sugar maldigestion, occurs in people who can’t digest the lactose sugar found in milk. (Milk is the only naturally-occurring food known to contain lactose.) Another form is called sorbitol intolerance, which involves the sugar sorbitol. Less common, but still occurring, is fructose intolerance, a condition in which some people have trouble digesting large amounts of fructose at once.

Adverse food reactions may also contribute to irritable bowel syndrome. Some people experience a worsening of their symptoms after they eat certain foods. It is unclear why this happens, but eliminating these certain foods from their diets can do wonders to improve symptoms.

The good news is that simple dietary changes can help to alleviate symptoms of IBS. Eating foods like vegetables, legumes, and whole grains that are rich in fiber or yogurt, which is rich in friendly bacteria, may reduce symptoms like constipation, diarrhea, and bloating. In addition, avoiding certain food items like high-fat meals and caffeine can also have a beneficial effect.

Nutrient Needs

Foods That May Help Include:

Whole Grains

Whole grains are much more than a small, flavorless, rock-hard bran muffin. Imagine a plate of hot brown rice under a sizzling baked salmon fillet, or a warm piece of honey whole wheat bread with some fresh pumpkin butter, or a hearty serving of beef and barley stew, or a steaming bowl of oatmeal with raisins, diced apple, and banana slices.

Whole grains can add substance and variety to many different meals. They're high in a number of different vitamins and minerals, as well as health-promoting fiber. The fiber found in whole grains has been shown to have very beneficial effects in people suffering from IBS.

Whole grains can help to relieve the pressure and pain caused by constipation. They also help to feed the friendly bacteria to protect against gas and bloating. Refined grain products like white rice and white bread have been stripped of their vital nutrients and fiber, and are not much help for IBS patients. Replacing these over-processed products with some rich, whole grain foods can turn a fiber and nutrient deficient diet into a healthy one.

Fruits and Vegetables

If munching on plain, raw celery all day doesn’t appeal to you, try something different like teriyaki stir-fried vegetables with chicken strips, or a warm bowl of butternut squash soup, or a hot baked potato smothered in spicy chili, or a cool mixed-greens salad with tuna.

Instead of snacking on a low-fat, “diet” cookie, try a juicy orange, or some fresh honeydew melon, or some sweet blueberries. The vast number of different fruits and vegetables available at your local grocery store these days is bound to add some variety to your diet.

Fruits and vegetables are packed with nutrients like vitamin C, vitamin E, folic acid, beta-carotene and many more. Fruits and vegetables also have plenty of fiber, which can help with the symptoms of IBS. Studies have shown that increasing fruit and vegetable fiber intake can significantly reduce abdominal pain and improve the overall sense of well-being. Fresh produce is an exciting and essential part of a healthy, whole foods diet.

Yogurt

Have you ever wondered how plain milk becomes rich, creamy yogurt? Well, the secret is a bacterial culture that gets added to the milk. The bacteria eat the milk sugar and give yogurt its tart flavor and thick texture. Even more interesting is that the bacteria used to make yogurt are the same kind as the friendly bacteria found in our digestive tracts.

By eating yogurt, we are helping to replenish the supplies of beneficial bacteria in our own bodies. These bacteria may not only protect us from infections with harmful bacteria, they may also provide relief from some of the symptoms of IBS. IBS sufferers given foods with these bacteria report less painful bloating and gas than before. Instead of grabbing a sugary snack between meals, try the delicate blend of sweet and sour found in a cup of fruit-enriched yogurt.

Nutrients In Food That May Help Include:

Fiber

Fiber is an essential part of a healthy diet. Fiber adds bulk to the diet and helps stool move easily out of the body. This is especially helpful for people with constipation. In addition, fiber adds substance to the stool, which can help clear up diarrhea. Friendly bacteria in the intestines love fiber and use it as a food source. A diet high in whole-foods fiber will also help the good bacteria to grow and protect us from the harmful bacteria.

It is important for people with IBS to increase their intake of fiber slowly, or symptoms can get temporarily worse before getting better. It's also very important when increasing fiber to also increase your water intake so that stools remain soft and easy to pass.

Some excellent food sources of fiber include raspberries, mustard greens, turnip greens, collard greens, broccoli, cauliflower, and Swiss chard.

Lactobacillus

Lactobacillus acidophilus is one of the friendly bacteria that lives in the intestines. It is also one of the main bacteria used in a number of fermented milk products such as yogurt. When IBS patients eat these products and ingest these bacteria, they can travel to the intestines and crowd out the harmful bacteria that may be causing symptoms of painful gas and bloating.

The best sources of these bacteria are yogurts that contain live, active culture. It's important to look for yogurts that specifically say they contain live culture, as many types of yogurts are heat-treated to kill the bacteria before being sold. For people who either can't tolerate dairy or who choose not to eat dairy, a number of very tasty soy-based yogurts are currently available at many health food stores.

Nutrient Excesses

Substances to Avoid

Fat

High-fat meals can over-stimulate the large intestine. This results in a need to rush to the bathroom right after eating, which can be very unpleasant and inconvenient. Avoiding high-fat meals and eating smaller meals can help prevent this annoying symptom of IBS.

Caffeine

Caffeine in the body is actually considered a type of laxative. Caffeine itself is irritating to the large intestine and can over-stimulate the muscles of the large intestine, leading to painful urgency and diarrhea. It's recommended that patients with IBS limit their use of caffeine products such as soft drinks, chocolate, coffee, and black tea.

Adverse Food Reactions

For unknown reasons, some people find that their IBS symptoms are worse after they eat certain foods. Allergy avoidance diets have been very helpful at relieving the pain and discomfort of irritable bowel syndrome for many patients. Identifying which specific foods are causing the problem and then eliminating these foods can often provide long-term relief.

Adverse food reactions vary according to the individual. Different people may react poorly to completely different foods. Keeping a food and symptom diary or following an allergy avoidance diet may help identify which foods may be problematic.

Sugar Maldigestion

Some sufferers of IBS find that they have problems digesting certain sugars. When these undigested sugars reach the large intestine, the bacteria there eat them up very quickly and then produce extra gas as a result.

Sugar maldigestion can therefore lead to symptoms of painful bloating as well as diarrhea. Not all IBS patients have problems with sugar maldigestion, but for those who do, eliminating or limiting the intake of these sugars can really help reduce symptoms.

Lactose Intolerance

Lactose intolerance is much more common in this country than people think, affecting as many as 25% of Americans. Lactose is usually broken down by an enzyme known as lactase. When we are babies and breast feed, lactase is sent to us in our mother's milk to help us break down the milk sugar (lactose) that it contains.

As children, we can produce some lactase of our own, but we tend to lose this ability as we become adults. In many parts of the world such as Asia and much of Africa, close to 100% of adults have stopped producing lactase. In European countries, however, the percentage of adults who don’t produce lactase is closer to 10%. Some studies have shown that as many as 50% of IBS patients may be lactose intolerant without knowing it. A simple test done in your doctor’s office can help determine whether or not lactose intolerance is a problem for you.

Unfortunately, lactose is found in a wide variety of food products such as milk, cheese, yogurt, and ice cream. It may also be hidden in foods such as baked goods, breakfast drink mixes, breakfast cereals, instant potatoes, soups, margarine, breads, non-Kosher lunchmeats, salad dressings, candies and snacks, “non-dairy” creamers and whipped toppings, pancake and cake mixes, and some over-the-counter and prescription medications.

People with lactase deficiency must carefully read labels and avoid products that contain milk, powdered milk, milk solids, cheese, and dried milk, as these may contain lactose.

Sorbitol Intolerance

Sorbitol is a sugar that may cause problems for some people. The sugar itself is named "sorbose," but much more commonly found in food products is an altered form of sorbose, called sorbitol. It's estimated that as much as 43% of Caucasians and 55% of non-Caucasians are sorbitol intolerant.

Sorbitol is found in high amounts in certain fruits and juices such as peaches, pears, plums, and apple juice. It is also added to many dietetic products such as sugarless chewing gum, diet soft drinks, and dietetic jams. Reducing the intake of these foods can really help to eliminate IBS symptoms in sorbitol intolerant patients.

Fructose Intolerance

Most people with “fructose intolerance” can eat some fructose, just not in large quantities at once. Fructose is found in most fruits and many other whole foods. It's concentrated in fruit juices and dried fruits, which may be more problematic than fresh fruits. Fructose is especially a problem when it's mixed with sorbitol, as can happen in dietetic jams. Limiting your fruit servings to fresh, whole fruits instead of juices and avoiding foods that mix sorbitol and fructose may be useful for reducing IBS symptoms.

Recommended Diet

A diet designed to relieve the symptoms of IBS would contain a wide variety of whole grains, fruits and vegetables, and yogurt.

Refined, nutrient-robbed white flour and rice products would be replaced with hearty, healthy whole grains, perhaps served with tasty sauces, colorful vegetables, or succulent meats. They can add flavor and substance to your diet while also improve your health.

The produce sections of major grocery stores are filled with a wide variety of fresh fruits and vegetables. These add color and flavor as well as a wide range of nutrients and fiber to the diet. Try experimenting with different vegetable dishes or even trying out new vegetables. Fresh fruits can easily take the place of many over-sugared or artificially sweetened diet snacks.

Yogurt is another potential addition to an IBS-friendly diet. Choosing yogurts with live culture and fresh fruit added can get you the benefits of helpful bacteria and nutrient-packed fruit.

Removing certain foods from your diet may seem troublesome. But just think of how many other foods are out there, all of the different grains, vegetables, fruits, legumes, meats, and spices. With a little time and creativity, you won’t even notice that they're gone. But you will notice a large reduction in your IBS symptoms that comes from adopting a healthy foods diet.

The Condition Specific Meal Planner for Irritable Bowel Syndrome has menus that cover the nutritional needs of this condition over a four day period.

References

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This page was updated on: 2004-11-21 15:22:25

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