Posted on September 16 2021
IBS can be crippling. Having to plan your routine based on your unpredictable bathroom routine can be tricky. All doctors only tell you that a proper diet, adequate sleep and regular exercise can control IBS symptoms. However, this might be much easier said than done for someone struggling with IBS.
Irritable bowel syndrome is a very uncomfortable disorder. It characterises by dramatic changes in bowel movements. While some people experience constipation, others might have diarrhoea.
Globally, nearly 10% of the population suffers with IBS.
Yes, medical intervention is essential to treat IBS. But making lifestyle and nutritional changes can also have a major role in reversing symptoms.
Let's explore some of these nutritional changes. I will walk through this article and explain steps to recovery like I would work with any of my clients struggling with IBS.
Dairy and IBS
The first and most important thing to understand is the root cause of your IBS symptoms. IBS is multi-facial, meaning, there could be multiple reasons for the same. Food allergies, food sensitivities, small intestinal bacterial overgrowth (SIBO) and gut dysbiosis could be some of the reasons.
One of the biggest irritant to the gut might just be lactose- milk sugar. As infants, we have an enzyme called lactase, that helps us breakdown and digest lactose (milk). But after about the age of two years, humans tend to lose this enzyme. This makes digesting dairy impossible for adults and present in IBS symptoms. Some people are affected more than others.
Not only this, dairy also attacks the beta cells of the pancreas, leading to type 2 diabetes, and the thyroid gland, leading to low thyroid hormone function. Read the below for more:
In fact, for a large number of my clients, IBS symptoms disappears within weeks of just dropping dairy from the diet. This might also be indicative of the fact that most people are probably suffering from lactose intolerance and not IBS in the first place.
Either ways, it is worth a shot to drop dairy from your diet for a few weeks and monitor progress. Regardless to say, this include milk, curds, ghee, butter, paneer and cheese.
So the first step would be to familiarise yourself with dairy alternatives and start switching your dairy chai for soy milk chai and dairy curds for peanut and rice milk curds. The alternatives are widely available globally to purchase or can be easily made at home.
Low- FODMAP diet
Once you have successfully switched to dairy- free alternatives, the next step would be to start re- building the good bacterial population of the gut.
Gail Cresci, PhD, RD, recommends a low- FODMAP diet for IBS patients.
FODMAP stands for ‘Fermentable Oligo Di Monosaccharides And Polyols.
Dr Cresci explains that high FODMAPs are harder to digest. As a result, the intestinal bacteria metabolize the undigested foods, leading to the production of excess gas, diarrhea, abdominal pain, and constipation.
Have a look at some common FODMAP breakdown here to get a better idea:
The above chart is by Dr. Will Bulsiewicz, author of Fiber Fueled.
Depending on the IBS symptoms, I will work with my clients on a low- to- medium FODMAP diet for a few weeks. It is absolutely essential to note here though that high- FODMAP foods are NOT bad and should definitely not be avoided for anything longer than a few weeks.
Cutting down so many food groups for a long period will only lead to more gut dysbiosis.
A low FODMAP approach is like plastering a wound, one can experience improvements in your symptoms. But a low FODMAP diet gives short-term relief, and it does not address the real issue of a weak functioning gut.
Slowly introducing high FODMAP foods is the only way you increase gut bacterial diversity and start healing the gut.
Does a Low-fiber diet work?
Fiber can help some people with IBS. But it can also worsen the symptoms of IBS if you have gas and diarrhea. However, symptoms are not related to fiber itself, but a poorly functioning gut. Guess what is food for the good gut bacteria- fiber!
I will often work with a client to slowly include soluble fiber first, then insoluble fiber. Start with 25 grams of fiber per day and slowly building your way upto 60 grams is ideal.
Recent studies have shown that embracing fibre can support your gut microbiome.
Fiber supplementation also give rise to higher Bifidobacterium (good bacteria) levels. These levels are an essential family of gut bacteria that not only help with gut motility, but also immune function, insulin resistance and maintain an optimal body weight.
For severe SIBO symptoms, mild prebiotic supplements comes in handy alongside antimicrobial protocols. For example, in a clinical study conducted on people with SIBO, the combination of the antibiotic rifaximin and guar gum eliminated SIBO in 87.1% of cases compared to 62.1% when using antibiotics alone.
I often will start the clients on Psyllium Husk or Benafiber and simultaneously make lifestyle changes.
It is also suggested to start with mostly soluble fiber first and then move to insoluble fiber. Soluble fiber dissolves in water unlike insoluble fiber that adds extra bulk. Sources of soluble fiber rich foods are citric fruits, barley, peas and apple.
Does a Gluten-free diet work?
Gluten is a protein found in grain products like wheat, rye and barley. Gluten can be problamatic only if you have gluten intolerance, like incase of people with Celiac's disease. A gluten-free diet can help reduce symptoms in such cases.
However, wheat (just like any other grains) actually reduces inflammation. According to Harvard Medical School, avoiding gluten when you do not have a diagnosed sensitivity will cause more harm than good as it further reduces plant- diversity. Plant- diversity, is the number one predictor of gut health.
Does a Low-fat diet help?
Chronic consumption of high-fat foods contributes to a variety of health issues including obesity. Fats are broken down in the body by an enzyme called lipase. IBS could also be associated with low lipase production, thus inability of the body to breakdown fats. This leads to aggravating symptoms.
The other problem is that high-fat foods are generally low in fiber. The Cleveland Clinic report states that Fatty foods are bad for people with mixed IBS. Adopting a low-fat diet is good for the heart and improves uncomfortable bowel symptoms.
But what about healthy fats?
Aim to consume no more than 30- 40 grams of nuts/ seeds spread through the day. Whenever you can, add olives and avocados to your diet. This is all the fat you need. When working with clients, I also help them explore oil- free cooking techniques.
Foods that make your IBS worse.
Here's a breakdown of the foods you need to limit:
- Lactose: It is present in milk and milk products like cream cheese, cottage cheese, ice cream, and sour cream. If you consume more of these than your intestine can handle, you will get abdominal pain gas. Approximately half the global population have lower levels of lactase, which metabolizes dietary lactose.
- Meat: Meat like poultry and fish are often high in fat content and difficult to digest for those suffering with IBS. Lean meats like chicken and turkey come with a lot of growth hormones and toxins, causing a hormonal havoc in the body. It is best to keep the animals off your plate.
- Eggs: Eggs are high in sulphur content, leading to the rise in inflammatory bacteria in the gut. Eggs triggers the release of TMAO which leads to leaky gut symptoms. They are also very high in cholesterol and not the most ideal source of proteins.
- Vegetables: Certain vegetables can cause gas and abnormal bowel habits. High FODMAP vegetables like garlic and onions must be avoided for a short term before adding them back. It is important to note here not to completely eliminate these vegetables as they do have health benefits.
- Oils: Oil's are pure fats, no fiber, and basically empty calories. They do not provide any benefits but add onto body fat and an uneasy gut. Explore oil- free cooking when possible.
- Polyols: Polyols are sugar substitutes found in candy and sugarless gum. These can create problems for people with severe IBS symptoms. Additionally, avoid the consumption of jaggery, stevia, maple syrup, mannitol, sorbitol, maltitol, isomalt, and xylitol. Watch out for hidden sugars in packaged foods.
Foods to include:
- Lactose-free milk: Rice milk, oat milk, soy milk. These are suitable alternatives to cow milk. Also including dairy- free curds such as coconut yogurt or peanut curd is wise.
- Low/ Medium fructose fruits: Fruits have antioxidants and phytosterols to heal the body. They are also highly anti- inflammatory. I suggest 3-5 servings of fruits per day at-least. Banana's, pineapples, cantaloupes and berries are great options.
- Low/ medium FODMAP vegetables: Eat vegetables like green beans, carrots, eggplant, celery, yam, spinach, sweet potato, squash, and zucchini.
You can enrich their flavours with herbs. Use chilli, basil, ginger, coriander, mint, lemongrass, marjoram, oregano, rosemary, parsley, and thyme for different flavours.
- Lentils/ Pulses: If there is one food group that makes your good gut bacteria celebrate, it is lentils. Lentils trigger the release of SCFA's in the gut, healing it and strengthening it from within.
Initially, if lentils are hard to digest, make sure to soak them overnight, wash throughly and rinse out the wash water. Then cook them (really well done) in fresh water and sprinkle lemon before consuming them. This helps break down phytic acid which can be difficult to digest. Aim to consume 2-3 servings of lentils per day.
Ginger for Irritable Bowel Syndrome
The anti-inflammatory and antioxidant effects of ginger could ease IBS symptoms. PubMed Central studies show that ginger has potential benefits for digestive health. These include:
- Reducing intestinal cramping
- Preventing indigestion
- Reducing bloating
- Reducing gas
Ginger is effective for many kinds of nausea and vomiting. It also applies for curing diabetes, menstrual cramps, osteoarthritis, and migraine headaches. Yet, there is limited evidence on some of the benefits .
A 2020 animal study found that ginger reduced symptoms of diarrhoea (predominant IBS in rats). Additionally, researchers established that ginger might release IBS symptoms. it does that by inhibiting the body's inflammation reaction in the gut.
Research states that 500-2000 mg ginger powder during the first 3-4 days of menstrual cycle help decrease menstrual pain. Certain studies also show that ginger works as pain medications like ibuprofen, mefenamic acid, and Novafen. Further, adding ginger to medicines like mefenamic acid seems to be helpful.
When it comes to IBS, ginger alone doesn't seem to improve IBS symptoms. However, taking ginger along with other herbal ingredients can help. More research is required to understand potential benefits of ginger treating IBS symptoms. There's no consensus as of now on the best dose or form. Many studies suggest using daily doses of 1 to 2 grams of ginger powder per day.
I ask my clients to grate a thumb of ginger and squeeze the juice out. Mix this with lemon and water and sip on the same 30 minutes after meals.
Peppermint Oil for Irritable Bowel Syndrome
IBS is ubiquitous among Indians. The exact cause of IBS is unknown. But IBS can lead to uncomfortable symptoms like gas, bloating, stomach cramps and pain, diarrhoea, and constipation.
Natural solutions like peppermint oil may make digestion more tolerable for IBS patients.
The complementary treatments for IBS include dietary changes, supplements, herbs, and behaviour changes.
Scientific evidence points towards the efficacy of peppermint to help treat IBS symptoms. Further, plenty of anecdotal evidence is available online. They show peppermint oil may help fight IBS symptoms.
In 2014, researchers concluded that peppermint oil is a safe and effective short-term treatment for IBS. It is because it gave minimal side effects, the most common being heartburn.
Like some essential oils, Peppermint oil is inhalable. However, do not apply it directly to the skin. Instead, you should always dilute them in a carrier oil, like mineral oil or sweet almond oil.
Cayenne Pepper for IBS and Indigestion.
Effective treatment for IBS and chronic dyspepsia (or indigestion) is ingestion of cayenne pepper powder.
PubMed Central researchers evaluated whether the red pepper oral administration can decrease symptoms of visceral hypersensitivity in IBS patients.
The study on 50 patients with IBS showed the following. The final evaluation of the treatment showed red pepper group scoring better than placebo.
The result from the preliminary study indicated that "the chronic administration of red pepper powder in IBS patients with enteric-coated pills was more effective than placebo. It decreased the intensity of abdominal pain and bloating". Further, the patients considered cayenne pepper more effective than a placebo.
While I do not tell my clients to eat more pepper, I sprinkle of the same on a soup or sabzi wont hurt.
Diet Triggers for IBS Constipation
According to Dr Nayana Ambardekar, some foods can make IBS-related constipation worse. These include:
- White bread and cereals made from refined grains.
- Processed foods like chips and cookies.
- Alcohol, coffee, and carbonated drinks.
- High animal protein diets.
- Milk products, particularly cheese.
Diet Triggers for IBS Diarrhea
According to Dr Minesh Khatri, some foods can make IBS-related diarrhea worse. These include:
- Too much fiber added suddenly to the diet.
- Food and drinks with alcohol, chocolate, caffeine, fructose, or sorbitol.
- Carbonated drinks.
- Large meals and/ or infrequent meal timings.
- Fried and fatty foods.
- Milk products.
- Wheat for people with Celiac's disease.
Drugs That Can Trigger IBS.
Often times when working with clients, it is the drugs they might be taking that is causing IBS symptoms. Here could be a few once:
- Some antidepressants.
- Medicine made with sorbitol like cough syrup.
- Certain supplements like iron can also lead to constipation.
How to Choose Better Meds:
Consult your doctor about switching to a drug that will not make your symptoms flare. Ask them so before you stop taking your meds.
Be careful while choosing antidepressants. The older ones, known as tricyclic antidepressants, can cause constipation.
The standard ones, or selective serotonin reuptake inhibitors like fluoxetine (Prozac, Sarafem) and sertraline (Zoloft), can cause diarrhea. Collaborate with your doctor to find the right antidepressant.
Stress and Anxiety Triggers for IBS
According to Dr Gabriela Pichardo, stress and anxiety can worsen IBS symptoms. This is because stress triggers the adrenal glads to release cortisol. Cortisol is inflammatory in nature, leading to more inflammation. Some factors for stress include:
- Your commute
- Problems at home
- Money problems
- A sense of feeling that things are out of your control
How to Manage Stress:
Pick up healthy habits like sleeping as per the circadian cycles (before 11pm and waking up before 7 am) and exercise regularly.
Include some form of non- doing or meditation.
Learn healthier ways to calm down with behavioural therapy. Try out therapies like relaxation therapy, hypnotherapy, biofeedback, psychotherapy, and cognitive-behavioural therapy.
Since everyone is different, not all food can prove effective against IBS. As such, examine your symptoms and talk to your doctor before starting a new diet. Additionally, you may have to tweak the foods you eat. Finally, try to tune how your body reacts to a specific eating pattern.
NIH (National Institutes of Health) recommends that a person should also drink plenty of water, decrease caffeine intake, and exercise regularly to bring in regularity and minimize IBS symptoms.
IBS is treatable with medications, but a change in diet is the first thing one must try. Adopt a healthy lifestyle with a low-fat diet, regular exercise and avoid alcohol and cigarette smoking to create a significant difference. Additionally, diets like a low-FODMAP diet can provide relief to all those who still need help.
Dr Cresci says, "While the low-FODMAP diet is often difficult to follow, it is often worth seeing if it will ease symptoms."
Collaborate with a registered holistic nutritionist who can help you make the best food choices.
Your doctor may find medication is a necessary tool to keep your IBS symptoms at bay. These medicinal therapies have anticholinergic medicines, antidepressants to reduce stress, calm the spasms.
Indian Diet Plan and Lifestyle Changes that help with IBS.
Both diet and lifestyle changes are beneficial for treating and controlling IBS. Before starting to change, you must understand your body. Try to keep a 7 -10 days record of everything you eat and drink and at what time of the day. Record all the symptoms you may experience because food may not be the only trigger.
Let's look at some lifestyle changes you can make before a sample meal plan.
- The essential nutrient to manage IBS is fiber. It would help if you regulated the fiber intake according to your tolerance. When you suddenly increase your fiber intake, it may lead to bloating and gas formation.
- Eat a good amount of seasonal vegetables and fruits and. The recommendation is five servings per day for people with IBS symptoms.
But, fruit juices may aggravate bloating and diarrhea. It is because if fructose is not absorbed, it ferments in the colon.
- Give prebiotics and probiotics a shot. They enhance the colonies of "good" bacteria, and they help the gut become healthy.
- Choose plant- based protein options such as pulses and soy. Dals such as moong whole and masoor whole, when cooked well, are preferable if there is a mild loose motion.
- Cut down on foods high in both sugar and fats. Discontinue the use of Ghee's, butter and oil completely.
- Drink plenty of fluids. Drink at least 2 ltrs water every day. Along with water, add other fluids such as herbal teas, coconut water, etc.
- Both caffeine and alcohol both if consumed in excess, can cause discomfort. Therefore, keep to about not more than two cups of tea or coffee daily. Do not take tea or coffee with or immediately after a meal.
- Do not skip meals. Eat at the same time daily.
- Eat small meals throughout the day with 2-3 snacks. Studies have found that large meals aggravate the symptoms of IBS. While chewing your food, eat them slowly, and relax after every meal.
- Have your dinner early.
- Exercise regularly and engage in activities such as walking, cycling, or swimming.
- Include some form of non- doing activity.
Sample meal plan (low- FODMAP, low fat, high- fiber) for IBS management.
Adopting a plant- centric low FODMAP diet requires a little effort and education. You may need to cut certain foods and add some others. Seeking help from healthcare professionals or nutritionists can help transit to the FODMAP diet.
But the efforts are worth the time. Additionally, changes to the diet, including veganism or a low FODMAP diet, are healthy options.
Seeking help from a professional can help plan a well-rounded diet. It will also cover the nutritional needs.
Remember also that a low- FODMAP diet is not a permanent solution. Do not stay on a lot- FODMAP diet more than a few weeks. This will further weaken the gut. Strategically work on introducing new foods to your gut every week.
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