This week, I’ll begin to finish up my series on irritable bowel syndrome (IBS). Last week (in "Irritating Irritable Bowel Syndrome [Part 3]"), I mentioned that there are some similarities between IBS and diabetes, and one of those similarities is the approach to treatment.
A lot of people balk at having to take medication for anything. People often worry about the side effects of medication. Others are concerned about cost. However, with both diabetes and IBS, there is definitely a place for medication. It’s wonderful if one can manage diabetes or IBS with lifestyle therapies (diet, exercise, stress management) alone. But there may come a point when lifestyle approaches aren’t enough, and that’s where medication can be helpful. The point is that if you aren’t meeting your treatment goals or controlling your symptoms, don’t hesitate to at least talk with your health-care team about other options.
That said, if you have IBS, there are effective, nondrug approaches to help you manage your condition. The goal of therapy is to help manage your bowel symptoms (such as spasms, diarrhea, and/or constipation) and control other symptoms, too, including bloating and pain. Let’s look at the role of diet and nutrition in managing IBS.
Fiber: We all need fiber, and most of us don’t get enough. But someone with IBS really does need to focus on getting enough fiber, which will help soften stool passage, ease and prevent constipation, and reduce bowel spasms. Aiming for at least 20 to 35 grams of fiber daily from whole grain breads, cereals and pasta; legumes (beans and peas); and fruits and vegetables is the goal. Fiber supplements may help, too. Psyllium-based supplements, such as Metamucil, contain soluble fiber and may help with diarrhea. Always increase fiber intake slowly and drink plenty of fluids.
Lactose: Lactose, the carbohydrate found in milk and other dairy foods, can be a culprit for some. A fairly high number of people have lactose intolerance, which is the inability to completely digest lactose. Resulting symptoms include gassiness, bloating, and diarrhea. Lactose doesn’t cause IBS, but if you have these symptoms, try cutting out milk, yogurt, cheese, and other foods that contain milk or lactose for a while to see if your symptoms improve. You can also ask your physician for a lactose tolerance test.
Sugar alcohols: If gas, bloating, and diarrhea are your primary symptoms, think about what you’ve been eating lately. Foods that contain sugar alcohols, such as sorbitol, mannitol, and xylitol, are sweeteners that are only partially digested. They can have a laxative effect and lead to the above symptoms. You’ll find sugar alcohols in sugar-free candies, gum, cookies, and other desserts. Check the ingredients list to find out if any are in the food you eat.
Probiotics: Probiotics are microorganisms (usually bacteria) that reside in your gut (yes, they’re supposed to be there!) and help maintain the immune system and fight off the “bad” bacteria, viruses, etc. that can cause disease. When probiotics are “killed off” by antibiotics, for example, other unfortunate consequences can occur. Scientists have lately been looking at how probiotics can help with several conditions, such as infectious diarrhea, Crohn disease, ulcerative colitis, and IBS. There are different strains of bacteria that make up probiotics; some may help with constipation while others may help alleviate diarrhea. Probiotics are found in certain brands of yogurt, kefir (a cultured milk beverage), some cereals, and even some snack/energy bars. Probiotics are also available in supplement form. (I’ll do a future post focusing on probiotics.)
Fat and caffeine: Eating high-fat foods may worsen IBS symptoms, especially diarrhea and cramping. Caffeine may do the same. Both fat and caffeine can cause the large intestine to contract. Fat is found in red meat, fried foods, whole milk, butter, margarine, oils, cheese, desserts, and snack foods. Caffeine is found in coffee, tea, cola, and some energy drinks.
Other possible culprits include alcohol and spicy foods. And some people find that food containing yeast, peanuts, soy, nuts, shellfish, potatoes, and tomatoes are problematic. But before you despair of having something left to eat, it’s helpful to realize that controlling your IBS symptoms involves a bit of trial and error. Keeping a record of your food and beverage intake, as well as symptoms, is extremely helpful. You can then begin to link certain foods with symptoms. Also, consider eating smaller meals more often during the day.
More on other therapies and resources next week.