food matters, Spotlights on Autoimmune Diseases, Uncategorized

Food Spotlight on Irritable Bowel Syndrome

Written by: Bonnie Feldman, DDS, MBA, Anna Simon, Ellen M. Martin 

As knowledge of nutrition and food as medicine expands, using foods as health enhancers and therapy agents has become increasingly popular. Many patients are following dietary guidelines to help mitigate symptoms, based on the growing understanding that diet and nutrition can either exacerbate or reduce symptom severity.

Irritable Bowel Syndrome (IBS) is a non-autoimmune chronic condition. IBS is not technically an autoimmune disease, but rather a functional bowel disorder characterized by symptoms that overlap with autoimmune disorders. A functional disorder impairs normal functioning; in IBS, functions such as impaired bowel processes and pain or discomfort are common. Unlike Inflammatory Bowel Disease (IBD), no damage is apparent under physical examination or through other tests, such as blood tests or biopsies.

What is IBS?

IBS affects the large intestine; symptoms include bloating, abdominal cramping, gas, diarrhea and/or constipation. IBS can cause extreme discomfort but does not appear to harm the intestines. Causes are still unknown, but theories point to hormonal changes, colon hypersensitivity, and a heightened response to stimuli such as stress and infection. Potential causes of symptoms also include altered gastrointestinal motility and sensation, as well as poor stress and coping strategies. Many physical, environmental, and genetic factors interact to exacerbate and induce symptoms. Although there is no cure, symptoms can be managed through diet, probiotics, stress management, and relaxation exercises.

Are There Best Foods For IBS?

Certain foods and food components may help manage IBS symptoms. The Internet offers an overwhelming amount of diet recommendations, including the Autoimmune Protocol (AIP) and Gut and Psychology Syndrome (GAPS) diets for inflammatory diseases, as well as the low-FODMAP diet to aid in identifying trigger foods. Diets such as gluten-free, Paleo, or Specific Carbohydrate may work for certain IBS patients. While we do believe that following a diet that emphasizes anti-inflammatory and antioxidant-rich foods should help people with IBS, we don’t believe in a one-diet-for-all approach, because IBS affects people differently and symptoms vary among patients. For this reason, we recommend starting with the low-FODMAP diet to help you identify your specific trigger foods, then personalizing it based on how your body feels when you eat certain foods. Check out our article on immune boosting foods to learn more.

We recommend keeping a food diary to track any potential foods that trigger your symptoms or any foods your body responds well to. A food diary is useful in low-FODMAP trials, food reintroduction, and as an ongoing tool to correlate what you eat with what symptoms you experience. A mood and stress diary can be a useful add-on to a food diary to help you sort out triggers that interact with food. For example, if stress leads you to eat junk foods that trigger symptoms, finding other ways to cope with stress may help keep you on an even keel.

That being said, there is some scientifically-backed evidence to support certain foods over others for IBS patients. This table offers a great starting point for any IBS patient. We have constructed this table to highlight the abundant information on food and IBS. In addition to a wide variety of scientific articles (1), we used information from Personal Remedies, which harnesses a knowledge base backed by science to suggest which foods to avoid and consume based on specific diseases. This service is offered to all and shows individual food items and supplements that are the “best” for IBS patients, in order of strength of scientific support. By combining their guidelines with our own knowledge, scientific research, and other scholarly tables, we’ve crafted our best food recommendations for IBS patients.

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In general, following a generic autoimmune diet that broadly focuses on eliminating processed foods, dairy, and added sugar, while increasing consumption of vegetables, fruits, fish and other whole foods may be helpful for IBS patients. Drinking plenty of fluids is important in keeping your body functioning as best as it can. Keeping your body on a consistent routine by eating meals at around the same time every day, eating smaller meals, and eating only until you feel full can minimize stomach pain.

Besides these general tips for keeping stomach pain at bay, there are some dietary guidelines more specific to IBS patients. Slowly increasing fiber to 20-30 grams/day may help reduce symptoms. Ground linseed or psyllium seed consumed with fluids can supplement the fiber intake from the foods you normally eat (2).

The Worst Foods for IBS

In contrast to anti-inflammatory foods, there are also proinflammatory foods that should be avoided. These include processed meats, sodas and sugared beverages, salty snacks, packaged sweets, and refined carbohydrates. Unfortunately, these foods are also easy to reach for when stress eating or snacking. If you suffer from IBS, these types of food are likely to intensify any symptoms you’re already experiencing.

In addition to these generic proinflammatory foods listed in the table below, there are some specific foods that might be harmful to IBS patients. For example, spicy foods can trigger symptoms, as well as the fructans (a type of FODMAP) in onions and garlic. Consumption of fatty foods can lead to bloating, so cutting down on high-fat foods may improve symptoms. Some IBS patients may be sensitive to dairy and/or gluten, although not everyone with IBS should necessarily avoid dairy and gluten products completely. Alcohol and caffeine can disrupt gastrointestinal processes as well (3), so pay attention to your gut reaction to coffee (in which chemicals other than caffeine can trigger gut reactions), tea, wine, beer, and spirits. If you are gluten-sensitive, beer may be a trigger since it contains trace amounts of barley. Likewise, some people are sensitive to sulfites in wine. Cocktail drinkers should pay attention to ingredients other than spirits, such as fruit liqueurs, fruit juices, bitters, and carbonated mixers. Listen to your body to determine what foods and beverages your body agrees/disagrees with.

FODMAPs – Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols – are molecules in food that tend to be poorly absorbed in some people, especially those with gastrointestinal conditions. These foods are listed in the table below, but can also be found here. Doctors typically recommend that IBS patients try a low-FODMAP diet to identify foods that trigger their symptoms. Once you identify your trigger FODMAPs, you can resume eating the FODMAPs your body didn’t have a reaction to and just avoid the ones you are sensitive to.

Conventional products have more artificial chemicals (4), which may have greater effects on those with autoimmune diseases or related conditions.

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Other Tools for Managing IBS

Engage in Mindful Eating

Other aspects of eating are important besides the best and worst foods for your body. Eating smaller, nutritionally-balanced meals could help ease digestion and help fight flare-ups. Chewing your food slowly and engaging your jaw can help activate your oral microbiome and promote better oral health. A key aspect of mindfulness is paying attention to your body’s short and long-term response to a food – if it stings or produces cramping, or diarrhea the next day, consider it a likely bad actor in your diet.

What you drink matters too! Water normalizes the pH of your mouth – healthy human saliva has a pH of 7.4. When we consume acidic foods and beverages, such as fruit juice and soda, oral pH is thrown out of balance (not to mention the additional sugar and calorie intake). When the pH within our mouths falls below 5.5, demineralization occurs, making us more susceptible to oral diseases, such as dental caries and periodontal disease. Drinking plenty of water daily can help maintain a healthy mouth pH, in addition to keeping you hydrated. When drinking tea, coffee, juice, or alcohol, we recommend drinking water as well for optimal oral health.

Exercise, Exercise, Exercise

Staying active is incredibly important to maintain healthy living. It is even more important for those who suffer from IBS and other gastrointestinal conditions because it can help reduce inflammation and alleviate symptoms. Exercise can take on many forms, from higher-intensity training like running or playing sports to lower-intensity exercises like walking, yoga, Pilates or other movement therapies. Get our free ebook on movement therapy to explore more options!

Relax and Reduce Your Stress

Constant stress is one of the negative by-products of modern life. While our stress responses were beneficial in helping our ancestors avoid predation and other life-threatening situations, constant but not life-and-death stressors brought about by modern society can be extremely harmful to our bodies. While helpful in short bursts, our flight-or-fight responses, as part of our sympathetic nervous system, can have harmful consequences when constantly activated by non-life-threatening stress. These consequences can include triggering or exacerbating flare-ups. It is therefore important for those with IBS to reduce overall stress.

One of the easiest ways to do this is to make sure you are getting enough sleep. Most people do not get the recommended 7-9 hours of sleep daily. Whether taking an afternoon nap, going to bed earlier, or (if scheduling permits) sleeping later, emphasis should be on consistent restful sleep. As with food, regular sleep habits are helpful in reducing insomnia and encouraging deep, restful sleep. Relaxation throughout the day is also important. This could mean an early morning workout, an afternoon yoga class, or even taking 15 minutes in the middle of the day just to focus on your breathing. Figure out what works best for you and do it. Take the time to be the best version of yourself: your stress will go down, your body will feel better, and your productivity may even increase!

In Summary

Irritable Bowel Syndrome is a condition that affects each patient differently. Following some sort of anti-inflammatory and low-FODMAP diet may help mitigate your symptoms. What worked for your friends, family, or spouse might not work for you. Everyone is unique and experimenting with food therapy for IBS may not be an easy fix. Try not to be overwhelmed by all of the recommendations and information out there, go slowly and trust yourself. At the end of the day, you are your greatest advocate and you know your body best. Fearlessly experiment with your dietary options and be mindful of your reactions. Stay tuned for our new ebook on food therapy to learn more about what makes you unique and how to kick-start your journey to finding your optimal diet.


Reference

  1. Cozma-Petruţ, Anamaria et al. “Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients!” World journal of gastroenterology vol. 23,21 (2017): 3771-3783.
  2. McKenzie YA, Bowyer RK, Leach H, Gulia P, Horobin J, O’Sullivan NA, Pettitt C, Reeves LB, Seamark L, Williams M, et al. British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update) J Hum Nutr Diet. 2016;29:549–575. [PubMed]
  3. Capili, Bernadette et al. “Addressing the Role of Food in Irritable Bowel Syndrome Symptom Management” journal for nurse practitioners: JNP vol. 12,5 (2016): 324-329.
  4. Smith-Spangler, C et al. “Are organic foods safer or healthier than conventional alternatives?: a systematic review” Annals of Internal Medicine. Vol 157(5). 2012. 348-366. https://www.ncbi.nlm.nih.gov/pubmed/22944875

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