magazine by Andrea du Plessis
Living with IBS often turns food choices into a fatiguing challenge. New information on FODMAPs may help IBS sufferers select the foods that work best for them, while avoiding those that aggravate symptoms.
Irritable Bowel Syndrome (IBS) is one of the most frequently diagnosed gastro-intestinal disorders and accounts for almost a third of all cases seen by gastro-enterologists. Among adolescents, 5% of males and 14% of females are affected by IBS, while among adults, 19% males and 24% females are affected.
WHAT IS IBS?
IBS is a functional disorder that affects the bowel or parts of the gastro-intestinal tract.
IBS could present as one or more gastro-intestinal symptoms, such as abdominal bloating, indigestion, cramping, pain, flatulence, diarrhoea, constipation and changes in normal bowel habits. IBS should be diagnosed by a medical practitioner and is done through the elimination of all bowel conditions with related symptoms.
The eating process already stimulates bowel contractions, resulting in movements in the bowel. IBS could accelerate and aggravate these movements, potentially causing cramps and diarrhoea. Caffeine, as well as fatty foods, could also increase colonic contractions after a meal. Naturally gas-forming foods cause colonic discomfort, such as soft drinks, beans, the cabbage-family vegetables, and the FODMAP foods (fermentable short-chain carbohydrates found in certain fruits, vegetables, dairy products and grains).
Abnormal intestinal bacteria
The use of antibiotics causes disturbances in the balance of natural colonic bacteria that may trigger or aggravate IBS symptoms. The regular use of probiotics may help bring relief from IBS symptoms in those cases where abnormal gut bacteria plays a role.
Women seem to have aggravated symptoms of IBS during their menstrual periods, suggesting that female sex hormones could affect IBS symptoms.
MANAGEMENT OF IBS
Some medicines help to control colon muscle spasms, while others slow down intestinal contractions. Occasionally, antidepressants are prescribed, but lifestyle changes and relaxation to relieve stress is important.
Fibre supplements and laxatives are often prescribed to help treat constipation. Laxatives should be used with caution, as some laxatives are habit-forming and may cause a ‘lazy gut’ by damaging the nerves of the digestive system, impairing digestive contractions.
It is important to realise that diet cannot be singled out as a cause of IBS. However, since some dietary factors affect the symptoms of IBS, dietary changes could help in the management of IBS.
With an elimination diet, all foods that potentially cause or aggravate symptoms are avoided or restricted for a period of 10 to 14 days, while digestive symptoms are monitored and noted. Thereafter, foods that were eliminated could be re-introduced one by one, to try and establish which are likely to trigger symptoms.
The foods that are potentially responsible for the symptoms of IBS are listed below. It is important to note that all the foods listed below are not known to aggravate the symptoms of all IBS sufferers, all the time.
Keeping a food diary could help to identify:
- Which foods to avoid most of the time
- Which foods to avoid during times when symptoms are more severe
- Which of the suspected foods do not trigger or aggravate symptoms, and can therefore be included back into the regular diet.
With the guidance of a dietitian, it is important to maintain adequate nutritional intake, especially during the initial phase of eliminating a large number of nutritious foods.
WHAT ARE FODMAPs?
FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) include a collection of short-chain carbohydrates and sugar alcohols found in foods naturally, or in the form of food additives (Table 1).
FODMAPs are osmotically active and poorly absorbed, resulting in rapid fermentation in the digestive system. During fermentation, an accumulation of fluid and gas causes digestive distention, which aggravates the symptoms of IBS, such as bloating and digestive pain and cramps.
RESEARCH ON FODMAPs
A diet low in FODMAPs was introduced about 10 years ago in Australia. Following research trials showing the success of a low FODMAP diet in the treatment of IBS, this dietary strategy has gained popularity.
The low FODMAP diet is not a ‘one-size-fits-all’ approach, as individual responses in sensitivity to FODMAPs differ, resulting in a different diet plan according to individual responses.
AVOIDING FODMAPs: WHICH FOODS AND FOR HOW LONG?
A low FODMAP diet is recommended for a duration of four to six weeks only, as long-term avoidance of all FODMAP sources could compromise the balance of intestinal bacteria. With a dietitian’s support, the initial low FODMAP diet can be adapted to a more varied diet, but excluding the particular foods that are known to most aggravate the symptoms of IBS for that individual.
Dairy: do or don’t?
Lactose, a naturally occurring fermentable carbohydrate present in different concentrations in dairy products, could aggravate some IBS symptoms. A lactose tolerance test is recommended to help drive dietary choices, as some individuals have better tolerance of lactose than others.
Eat more or less fibre?
Eating the correct type of dietary fibre may help bring relief from IBS symptoms such as constipation and indigestion. Fibre absorbs large amounts of water, softening the digestive waste that eases the excretion process.
Eat less insoluble fibre
Insoluble fibres consist of hardened structures that could irritate the intestinal lining, causing gassiness, bloating and discomfort.
Insoluble fibre is found in whole-grain foods (wheat, bran, whole-wheat products, brown rice, rye, etc.), fruit (grape skins, apple skins, pips, etc.) and vegetables (pips, skins).
Eat less wheat products, avoid wheat bran
Wheat products seem to be harder to digest than products made from maize, rice or potato flours. Wheat bran, also known as ‘digestive bran’, has been found to aggravate IBS symptoms.
Rather eat soluble fibre
With severe IBS symptoms, the softer, soluble fibres are more beneficial to promote regular bowel function. Soluble fibres suitable for an IBS sufferer are found in oats, oat bran and vegetables such as pumpkin, baby marrow, gem squash, carrots, potatoes and sweet potatoes.
More foods to avoid
- Too much fat
It has been found that intestinal contractions are exaggerated in people with IBS after eating a high fat meal, such as deep-fried foods, fatty meats and creamy sauces.
As a nerve cell stimulant, caffeine irritates the nerve fibres in the digestive system, which may aggravate digestive discomfort and cramps.
- Gassy cold drinks
- Smoked, cured and processed meats
Chillies and other hot and spicy foods
EAT MORE: POSITIVE DIET TIPS
Eat more low FODMAP foods
- Vegetables: carrots, parsnips, tomato, cucumber, baby marrow, pumpkin, gem squash, butternut, peppers, bean sprouts, potato, sweet potato
- Fruits: banana, orange, grapes, melon
- Protein: meat, fish, chicken
- Dairy: lactose-free milk, hard cheeses
- Gluten-free crackers: rice cakes, corn cakes
- Grains: quinoa
- Nuts and seeds: almonds and pumpkin seedsDrink soothing herbal teas
- Ginger tea is known to reduce bloating and indigestion.
- Fennel tea is recommended to help bring relief from flatulence.
- Mint tea is highly recommended after a meal to help prevent indigestion.
- Chamomile tea is known to help soothe and calm the irritated nerves of the digestive system in cases of IBS.
Why do we need probiotics now? Funny thing is … we used to maintain our gut flora before we had refrigeration and we ate pickled and cured foods. We also didn’t have antibiotics to destroy the good with the bad bacteria. Let’s not forget the various antibacterial products that add to the imbalance of the bacteria in our digestive tract.
Furthermore, the consumption of refined sugar, unhealthy fats, excess salt and various food additives and preservatives upsets our gut health. Adding probiotics to our diet not only restores the flora health, but improves our immune system. Health starts in the gut and the immune system can be given a boost when we restore the gut flora.
We often hear people say ‘You are what you eat’, but the truth is that you are what you absorb. With poor gut health, essential nutrients cannot be absorbed – causing further ill health.
Various other benefits of probiotics include, but are not limited to:
- reduced inflammation and bleeding associated with gum health
- elevated mood due to the production of serotonin
- reduced risk of digestive disorders such as colitis and Crohn’s disease
Research has shown that people in less affluent countries have lower rates of Crohn’s disease, colitis, and other digestive disorders. Scientists believe that exposure to different types of gut bacteria actually strengthens the immune system – 80% of which is located in the digestive tract. In addition to alleviating IBS symptoms such as constipation and diarrhoea, probiotics combat the ulcer-causing Helicobacter pylori bacteria.
In a review published in The Scientific World Journal, probiotics were shown to have positive effects on bone mineralisation and bone density in postmenopausal women, helping to prevent and treat osteoporosis.