Book Excerpt: Eating for IBS
by Heather Van Vorous
The fundamental idea of eating for IBS is to avoid foods that over-stimulate or irritate the colon (via the gastrocolic reflex that occurs when food enters the stomach), and eat foods that soothe and regulate it. This will relieve and prevent both diarrhea and constipation, as well pain, gas, and bloating. This is best accomplished by strictly limiting the amount of dietary fat (the single most powerful digestive tract stimulant), eating soluble fiber consistently with every snack and meal, eliminating coffee, carbonated beverages, and alcohol, being very careful with insoluble fiber, and avoiding overeating by having frequent small meals instead of large ones. It is also important to avoid cigarettes, as tobacco wreaks havoc on the digestive tract.
Trigger Foods - Warning! Eat at Your Own Risk
The most difficult foods for the body to digest are fats and animal products. As a result, they are the most powerful IBS triggers, and you must strictly limit or, preferably, eliminate altogether these foods from your diet. Will this require an enormous change in the way you eat? Probably. But it is a change for the better, and we will walk together through the steps needed to make this change as easily and deliciously as possible.I sympathize tremendously with people when they are told of the dietary changes they need to make to control their IBS. At first glance these changes can seem overwhelming and just too difficult, as by nature most of us are resistant to any great transformations of our lives. It is almost always easier to not alter a habit, simply because inertia takes less effort than action. However, I really cannot stress enough that the changes in diet required for IBS do NOT equal deprivation. You will not be expected to simply give up all the foods you love, and offered a tasteless starvation diet in return. These changes are in fact a terrific opportunity for a better life, as you can easily learn how to eat safely for IBS without giving up an ounce flavor, fun, favorite restaurants, or delicious home cooking. It is simply a matter of substitution, of replacing trigger foods with safe choices. Remember that the only thing you're really giving up here is the constant worry and dread of attacks, as well as the pain and agony they cause. Please note that individual tolerances for IBS trigger foods may vary. The following list is comprehensive and should include all potential dietary sources of trouble. You may find through experimentation that you have a higher degree of tolerance for some of these foods than others. Red Meat (Beef, Pork, Lamb, etc.) Poultry Dark Meat and Skin. Dairy Products. Egg Yolks. Fried Foods. Coconut Milk. Oils, Shortening, Butter, Fats. Solid Chocolate. Coffee, Regular and Decaffeinated. Alcohol. Carbonated Beverages. Artificial Sweeteners. Artificial Fats.
What's All This About Fiber?
One of the most troublesome pieces of advice routinely given to people with IBS is the dictate, 'Eat more fiber!' It prompts the question - what kind of fiber?Most people are never even told that there are actually two types of fiber. The term 'fiber' in general refers to a wide variety of substances found in plants. Some of these substances can be dissolved in water ('soluble fiber'), and others do not dissolve ('insoluble fiber'). Insoluble fiber is 'rough'; it passes intact through the intestinal tract, increasing the frequency, water content, and looseness of bowel movements. Insoluble fiber, and particularly wheat bran, decreases the transit time of fecal matter in the G.I. tract. Although this has the crucial benefit of reducing the colon's exposure to carcinogens, thus inhibiting colon cancer development, it can also trigger painful attacks in IBS sufferers, with severe cramping that can result in diarrhea or constipation. Soluble fiber, in contrast, is 'smooth', and soothing to the digestive tract. It regulates the digestive tract, stabilizes the intestinal contractions resulting from the gastrocolic reflex triggered by eating, and normalizes bowel function from either extreme. That's right - soluble fiber prevents and relieves both diarrhea and constipation. Nothing else in the world will do this for you. How is this possible? The 'soluble' in soluble fiber means that it dissolves in water (though it is not digested). This allows it to absorb excess liquid in the colon, preventing diarrhea by forming a thick gel and adding a great deal of bulk as it passes intact through the gut. This gel (as opposed to a watery liquid) also keeps the GI muscles stretched gently around a full colon, giving those muscles something to easily 'grip' during peristaltic contractions, thus preventing the rapid transit time and explosive bowel movements of diarrhea as well. By the same token, the full gel-filled colon (as opposed to a colon tightly clenched around dry, hard, impacted stools) provides the same 'grip' during the muscle waves of constipation sufferers, allowing for an easier and faster transit time, and the passage of the thick wet gel also effectively relieves constipation by softening and pushing through impacted fecal matter. If you can mentally picture your colon as a tube that is squeezing through matter via regular waves of contractions, it's easy to see how a colon filled with soluble fiber gel is beneficial for both sides of the IBS coin. As a glorious bonus here, normalizing the contractions of the colon (from too fast or too slow speeds) prevents the violent and irregular spasms that result in the lower abdominal cramping pain that cripples so many IBS patients. This single action alone is the reason I don't eat anything on an empty stomach but soluble fiber. Ever. The only foods I want to trigger my gastrocolic reflex are soluble fiber, as that's the only way I can keep those contractions (and thus my life) normal. Soluble fiber also lowers LDL ('bad') blood cholesterol levels and the resultant risk of heart disease, helps prevent colon cancer, and improves glycemic control in diabetics by slowing the digestion of carbohydrates and the subsequent release of glucose into the blood. In addition, soluble fiber may help prevent blood vessel constriction and the formation of free radicals (both risk factors for heart attacks) by slowing the absorption of fat and carbohydrates into the bloodstream. Metamucil, made from psyllium husks, and Citrucel, made of methylcellulose, are both soluble fiber, and can be extremely helpful when taken daily (make sure they are NOT the sugar-free varieties, which have artificial sweeteners in them, and can trigger attacks). Please be aware that although both of these products are marketed as laxatives, they actually help treat and prevent diarrhea as well as constipation. Soluble fiber alone has this remarkable ability to normalize colonic activity from either extreme. Foods that are naturally high in soluble fiber include oatmeal, pasta, rice, potatoes, French or sourdough bread, soy, barley, and oat bran. These starchy foods are also high in complex carbohydrates, which are an important source of readily accessible fuel for energy. Nuts, beans, and lentils are also good sources of soluble fiber but should be treated with care, as nuts are high in fat and both lentils and beans contain some insoluble fiber. Soluble fiber should ALWAYS be the first thing you eat on an empty stomach, and it should form the basis of EVERY snack and meal. Your goal is to keep your colon consistently stabilized by providing it with a regular supply of soluble fiber.
Insoluble Fiber - How Can Healthy Foods Hurt You?
Insoluble fiber, although crucial for good health, can be a powerful IBS trigger. It needs to be incorporated into your diet in the largest quantities possible, but with great care. Insoluble fiber should NEVER be eaten alone or on an empty stomach.Remember that it is much better to have a wide variety of insoluble fiber foods in small amounts than to not eat any at all. You are also likely to find that your tolerance for insoluble fiber will increase if you are consistently eating it, even in tiny portions. However, it's important to note that individual tolerances vary. The following list is comprehensive and should include all potential insoluble fiber sources of trouble for a hyperactive colon; you may have a degree of tolerance for some of these foods and absolutely none for others. IBS is a highly personalized problem, so you will need to learn your own food tolerances and work around them. Raw fruits, raw vegetables, raw greens, raw sprouts, and seeds (including those from fresh fruits or vegetables), are all very high in insoluble fiber. Be particularly careful with fruits and vegetables that have tough skins or hulls such as blueberries, cherries, apples, grapes, peas, corn, bell peppers, celery, etc. It helps tremendously to peel and cook these fruits and vegetables until tender, as this makes their fiber content dramatically less likely to trigger attacks. It is also a healthy habit to routinely incorporate fruits and veggies as secondary ingredients in recipes with soluble fiber foods as the main ingredients. If possible, buy organic produce only, as the chemical pesticides and herbicides used on fruits and vegetables can have adverse health effects. Two categories of fruits and vegetables, those that are acidic and sulfur-containing, require extra precautions. Citrus juice and cooked tomatoes have very high acidity levels, which can cause GI distress, so they must be eaten with care. Incorporate them into meals (or drinks served with meals) with a high soluble fiber content, and don't eat them on an empty stomach. They must not be eliminated from your diet altogether, however, as they contain crucial vitamins and anti-oxidants. Tomatoes are also very high in lycopene, which prevents some forms of cancer. Garlic, onions, leeks, broccoli, cauliflower, cabbage, and Brussels sprouts, though among the most nutrient-packed of all vegetables, can also pose problems. In addition to their high amounts of insoluble fiber, all contain sulfur compounds, which produces gas in the GI tract and can thus trigger attacks. As with other vegetables, cook these until tender, combine them with soluble fiber, and don't eat them when your stomach is completely empty - but do make sure and eat them. To incorporate raw fruits and veggies into your diet, peel and eat them in small quantities (just two or three bites) finely chopped, as additions to high soluble fiber foods such as French breads, pastas, rice, etc. It should also help to eat them towards the end of a meal. This is especially important when it comes to green salads. Eating them as is customary in America, on an empty stomach at the beginning of lunch or dinner, is likely to trigger an attack. Eating them at the end of a high soluble fiber meal is typically quite safe. For fruit salads follow the same guidelines. At breakfast have a bowl of oatmeal or toasted French bread first, then the fruit, and at lunch or dinner have the fruit for dessert. Whole wheat and bran are extremely high in insoluble fiber, and foods such as whole wheat breads and cereals need to be eaten with great care. For a daily safe staple, French and sourdough breads are safe, but whole wheat breads are not. Whole wheat breads are more nutritious, because the outer coating of bran on the grain has not been removed as is the case in white breads. However, this bran is also very high in insoluble fiber, and can thus trigger attacks. For this same reason bran cereals are not a safe choice, though rice, corn, or oat varieties are. Does this mean you should never eat whole wheat bread or bran cereal? It most emphatically does not. As with fruits and vegetables, the more whole grains you can eat the better. It cannot be stressed enough that overall good health is dependent on insoluble fiber. However, whole wheat and bran need to be eaten just as carefully as green salads. Do not eat them on an empty stomach, in large quantities, or without soluble fiber foods. Whole nuts are not only high in insoluble fiber, they are also high in fat. Although this fat is monounsaturated and lowers your risk of heart disease, it is still an IBS trigger. Like other high insoluble foods, nuts are crucial for good health, but must be eaten carefully. Finely grinding nuts and incorporating them into recipes with soluble fiber is a very safe way to eat them. Small amounts of nut butters on toasted French or sourdough bread are usually very tolerable as well. Popcorn is full of hard kernels that are pure insoluble fiber. There is no great nutritional value to popcorn so it can simply be eliminated from your diet. I realize this may make movies a lot less fun, but having to bolt from a theater for the bathroom halfway through a film is a worse alternative. Sneak some pretzels or baked potato chips into the theater instead, and console yourself with the thought that you'll actually get to see the end of that movie. Fresh fruit juices, especially apple, prune, and grape, are sky high in fructose, which can trigger cramps and diarrhea. Fruit juices in general should be avoided on an empty stomach. Cranberry juice is usually a safe choice. Rhubarb, prunes, figs, licorice are all natural laxatives. As with fresh fruits in general, you may be able to safely incorporate these foods into recipes with soluble fiber. Just beware that they pose additional risks.
Eating for IBS has benefits far beyond controlling your bowel symptoms. The IBS diet follows the FDA Food Pyramids, which means that while eating safely for IBS you'll also lower your risk of heart disease, cancer, arthritis, diabetes, high blood pressure, and obesity.
© 2001 Heather Van Vorous
Heather Van Vorous has had IBS for more than twenty years, beginning in childhood. She is now an author and food writer specializing in healthy gourmet recipes for people with bowel disorders. As a result of the publicity her two books, "Eating for IBS" and "The First Year: IBS" have received, she has become the best-known IBS patient-expert in the USA, with an audience of over 250,000 people a year. Visit the author's web site at https://www.helpforibs.com.