Frequently Asked Questions about the IBS Diet

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Frequently Asked Questions about the IBS Diet

http://www.helpforibs.com/diet/faq.asp

 

 

How can I break the cycle of IBS attacks?

How can the same diet work for diarrhea AND constipation?

How can foods can have both soluble and insoluble fiber?

Should I take a soluble fiber supplement? How much?

I have really severe bloating from IBS. What can I do?

Won't eating all these high carb soluble fiber foods make me fat?

I need to gain weight. How can I do that with the IBS diet?

Is the IBS diet suitable for diabetes?

Is wheat safe for IBS or not?

Can I eat dairy if it's skim or lactose free? What about yogurt?

How can I stay stable while traveling or on holiday?

What about a diet for IBS and Fibromyalgia?

What about taking vitamins and minerals?

Can I still drink alcohol?

What about coffee? Isn't decaf okay for IBS?

Is it okay to just avoid insoluble fiber foods altogether?

What about Atkins and a low carb diet?

What are the Seven Sneaky Sins of the IBS Diet?

What about soy foods? Do they cause gas and bloating?

How can I break the cycle of attacks?

 

Diarrhea and pain should resolve in just a few days. Constipation,

especially if it's been chronic, can take over two weeks. Please hang in

there.

 

The best thing to do to break the cycle is to really restrict your diet for

a few days (and only a few days - this is a short-term diet only) to

nothing but soluble fiber foods and soluble fiber supplements, and lots of

strong hot peppermint tea (if you're prone to acid reflux, try fennel or

chamomile or anise instead of the mint). Peppermint is a powerful muscle

relaxant and a painkiller. Fennel is the best for bloating and gas - it can

really help. Try to be mildly active, even if just around the house, as

gentle exercise will work the muscles of the bowels and help get them back

into a pattern of normal contractions. Walking or stretching or an easy

yoga practice is ideal. Exercise is especially crucial for constipation.

 

The soluble fiber will stabilize the GI contractions that are going haywire

with IBS and causing pain, and will normalize bowel function from either

extreme (diarrhea/constipation) as well. So stick to foods like plain white

rice, plain instant oatmeal, cream of rice cereal, dry corn or oat or rice

cereals, pasta, white breads or toast, peeled potatoes, etc. Boring, I

know, but it's just a few days. Make sure you've added in a soluble fiber

supplement like Acacia, Equalactin, Citrucel, Benefiber, or Fibercon too -

this is crucial. If you're at all prone to bloating or gas avoid Metamucil

(and psyllium) and try the other varieties instead. Start with 1/2 - 1

teaspoon twice a day of the powders, and then gradually increase until

you're at 2 tablespoons twice a day, or whatever dose will give you 10-12

grams of soluble fiber per day (fiber grams per tablespoon dose will vary

by supplement brand). For the pills, start with two taken twice daily, and

work up to 10-12 grams of soluble fiber daily (again, the grams of fiber

per pill may vary by brand). Have plenty of fresh water or the herbal teas

with the supplements. For soluble fiber to normalize your bowel function

you must drink enough water - aim for at least 128 ounces of water each day.

 

After a few days, you should be feeling much better, and your gut will have

stabilized. Start carefully expanding your diet - the recipes for zucchini,

banana, pumpkin breads work well here, and so does the jok rice porridge

soup. Begin to incorporate insoluble fiber foods - carefully! - by blending

fresh fruit with soy or rice milk into smoothies, and blending cooked

veggies into soups or pasta sauces. Have the smoothie with rice cereal or

oatmeal, and the soup with rice or polenta. Try a bit of grilled fish or

skinless chicken breast with your pasta/rice. Safe treats are the recipes

for vanilla or chocolate puddings, peppermint fudge cake, banana cream pie.

Keep your fat content very low and be extra careful with insoluble fiber.

As you stay stable, you can expand to all the other IBS recipes, and just

follow the general guidelines (still low fat, no triggers, careful with

insoluble fiber) but you'll be back to a healthy diet overall and not just

plain soluble fiber. You should always continue to make soluble fiber the

basis of your diet, though, and have those foods as the foundation of your

meals and snacks.

 

 

How can the same diet work for diarrhea AND constipation?

 

The same diet (as well as supplements like Equalactin, Citrucel, Fibercon,

Benefiber, etc.) will work for diarrhea and constipation BOTH, because the

basis of the diet is soluble fiber. Soluble fiber works to alleviate all

symptoms of IBS, from diarrhea to constipation to painful cramps and gas -

it's magic.

 

Why is soluble fiber so special? Because unlike any other food category, it

soothes and regulates the digestive tract, stabilizes the intestinal

contractions resulting from the gastrocolic reflex (which go awry in people

with IBS due to a brain-bowel miscommunication), and normalizes bowel

function from either extreme. This means it regulates both over-motility

and under-motility of the colon (people with IBS suffer from one or the

other, or even fluctuate between the two). So, 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. Once you're stabilized soluble

fiber will also help prevent further problems.

 

Both soluble fiber supplements (like Acacia, Equalactin, Citrucel,

Fibercon, Benefiber) and soluble fiber foods (like rice, pasta, oatmeal,

potatoes, white bread) will work. Insoluble fiber (like bran, raw fibrous

veggies, salad greens, unpeeled fruits) will also relieve constipation, but

at the risk of triggering violent GI spasms that can be very painful. These

spasms can actually seize up the colon muscles in a type " charley horse " ,

which then results in no motility and constipation once again. For this

reason, the soluble fiber base is key, and insoluble fiber (which should

absolutely be eaten) needs to be treated with care, and eaten according to

the guidelines. Also drink lots of fresh water and exercise, of course -

but you already know that.

 

Fats of all kinds are also triggers for constipation as well as diarrhea,

because fats are a very powerful GI tract stimulant just like insoluble

fiber. Fats can cause the same type of rapid spasms or " charley horse "

muscle contractions in the colon, and again result in either diarrhea or

constipation. The major trigger foods - red meats, dairy, egg yolks, fried

foods - are high in fat and, for the meat, dairy, and eggs, also have

proteins that are very difficult for the body to digest. They can basically

grind digestion to a halt for IBS-constipation folks, or send it spasming

out of control for the diarrhea-prone, and result in severe attacks either

way. Coffee (even decaf) is a powerful GI tract irritant, and can have the

same effect.

 

In general, people with constipation are afraid to eat the soluble fiber

foods (for some reason I've never gotten to the bottom of they're thought

of as " binding " ), but not afraid of the supplements because they're usually

marketed as laxatives (though they're technically not). On the other hand,

people with diarrhea are comfortable with the soluble fiber foods but

terrified to try the supplements, because they feel (quite understandably)

that a " laxative " is the last thing they need. I spend a lot of time

volleying back and forth trying to convince both groups of folks that a

diet based on soluble fiber, avoiding the trigger foods, and carefully

incorporating insoluble fiber, will only help and not hurt them, no matter

what their specific IBS symptoms.

 

 

How can foods have both soluble and insoluble fiber?

 

Most all grains, cereals, legumes, and tubers have an outer insoluble fiber

layer, and a soluble fiber interior (and the same is true for some fruits

and vegetables, such as apples and zucchini). It's very easy to actually

see this with your own eyes. If you take a cooked grain of brown rice,

wheat berry, kernel of corn, potato, or bean you can separate the tough

exterior (the bran, skin, or shell) from the creamy interior. When the bran

is removed from wheat berries and they're milled the result is white flour;

when the bran is removed from brown rice the result is white rice. There

aren't many similar common commercial processes that remove the insoluble

fiber exterior from legumes, fruits, or vegetables, but finely blending,

pureeing, or peeling these whole foods will greatly minimize their trigger

risk. Oatmeal, brown rice, and corn meal (polenta) tend to be the

best-tolerated whole grains for IBS.

 

 

Should I take a soluble fiber supplement? How much?

 

Most (but not all) soluble fiber supplements (such as Acacia, Equalactin,

FiberChoice, Citrucel, Fibercon, Benefiber, Fybogel, Regulan, Metamucil)

are marketed as over-the-counter laxative and anti-diarrheal products, so

they are bound by the FDA prescribing guidelines for those products. This

means that the supplements must have the dosage limitations on their

packaging that apply to OTC anti-diarrheal and laxative drugs, even though

they are not drugs but fiber supplements. The FDA packaging guidelines for

this category do not discriminate between the drugs and the fibers. This

explains why the dosages for these products that your doctor recommends for

IBS may conflict with the package information.

 

The dosage information for IBS that I have been given by doctors and fiber

supplement manufacturers, and that I believe works best for preventing IBS

symptoms, is as follows: For the powders (Acacia, Citrucel, Benefiber,

Metamucil) start at 1/2 - 1 teaspoon twice a day and over the next week or

two (or three or four) work up to 2 tablespoons twice a day, or whatever is

the equivalent of 10-12 grams of soluble fiber per day. If you're using

pills (Equalactin, FiberChoice, Citrucel, Fibercon) start at 2 pills twice

daily and work up to 2 pills six times daily, or the equivalent of 10-12

grams soluble fiber per day. You can also mix and match the powders and

pills (for example, take the powders at home but keep the pills on you at

work or for taking before restaurant meals). If you're combining powder and

pill supplements, I think it's definitely best to make sure that your total

daily dosage is equal to what it should be for just the pills or fibers

alone. You don't want to take the maximum dose for the pills and then take

the maximum dose for the powders on top of this. Please note that the

supplements are not meant to be the main source of fiber in your diet -

they are an addition to the fiber you need to be eating (both soluble and

insoluble) from foods.

 

If you do not see a measurable improvement in your IBS symptoms within one

week (for diarrhea) or two weeks (for constipation) of using the maximum

dosage of a soluble fiber supplement, this could certainly point to a

problem other than IBS, and you should see your doctor again. If you have

any questions or concerns about the dose and frequency of taking soluble

fiber supplements, check with your own physician.

 

For all fiber supplements, make sure you have a large glass of water with

each dose, and drink fresh water frequently throughout the day as well.

Soluble fiber needs plenty water to work - this is essential. I believe you

can take soluble fiber supplements every day for the rest of your life and

it will only help your IBS.

 

If you're at all prone to bloating or gas avoid Metamucil and Fybogel

(psyllium) and try Acacia, Equalactin, FiberChoice, Citrucel, Fibercon, or

Benefiber instead. Outside the USA, look for Benefiber (avoid Normacol,

which contains a laxative), or order Acacia online. Also, be aware that the

sugar-free versions of the supplements can contain artificial sweeteners,

which can trigger IBS attacks. In addition, citric acid is often added to

orange-flavored supplements, and this can cause acid reflux in some people.

If these are concerns for you, choose a sugar-sweetened or unsweetened,

unflavored variety of supplement. Aside from the concerns about psyllium,

there doesn't seem to be one type of soluble fiber supplement that is more

or less likely to be well-tolerated by people in general. There is a great

deal of individual variation here in how someone responds to any particular

supplement. So if you have gas or bloating from starting a supplement that

doesn't disappear after a week or so, don't be discouraged, just try a

different brand and perhaps a different formulation (the pills instead of

powder, or vice versa). It may take several different tries to find the

supplement that works best for you, but the results can be well worth the

effort.

 

The USDA recommended minimum fiber intake for adults is 25 to 35 grams

daily, and soluble fiber should account for one third of this amount. Some

scientists actually recommend up to 60 grams of fiber a day, so the USDA

recommendations are not maximum dosage limitations. The typical American

eats only a meager 10-15 grams of fiber daily. For comparison, the average

fiber intake in China is 33 grams of fiber a day, and it ranges as high as

77 grams per day in some regions.

 

Dosages and fiber content for common soluble fiber supplements:

 

Acacia provides 4.5 grams of organic soluble fiber per tablespoon dose.

 

Benefiber provides 3 grams of soluble fiber per tablespoon dose.

 

One tablespoon of Metamucil smooth texture orange and original texture

orange (these are not the sugar-free varieties) contains 2 grams of soluble

fiber and 1 gram of insoluble fiber.

 

Two Metamucil wafers provide 2 grams soluble fiber and 1 gram insoluble fiber.

 

Two Fibercon tablets contain 1 gram soluble fiber.

 

Two Equalactin tablets contain 1 gram soluble fiber.

 

Two FiberChoice tablets contain 4 grams soluble fiber

 

One tablespoon of Citrucel provides 2 grams of soluble fiber.

 

Two Citrucel caplets provide 1 gram of soluble fiber.

 

Fiber supplements have health benefits in addition to controlling IBS

symptoms. Soluble fiber (both foods and supplements) not only normalizes

bowel function, it also helps stabilize blood glycemic levels, slows the

rate of carbohydrate absorption, improves regulation of blood sugar, and

lowers insulin requirements. Soluble fiber also decreases LDL ( " bad " ) blood

cholesterol levels, and therefore reduces the risk of heart disease.

Studies have also shown that fiber helps prevent colon cancer.

 

 

I have really severe bloating. What can I do?

 

Bloating is one of the most frustrating IBS symptoms, and unfortunately one

of the most difficult ones to treat. There is good news, though. Fennel tea

can work wonders to ease both bloating and gas. You can buy fennel seeds in

bulk from the spice section of a health food market or at a spice shop.

Just brew a tablespoon or so of the seeds in a tea strainer and drink

several cups a day. Fennel tastes like licorice and has anti-gas as well as

anti-spasmodic properties, making it especially helpful for IBS. It's also

a very safe herbal remedy that you can use daily without any risks.

 

The other factor to consider in treating bloating with IBS is your choice

of soluble fiber supplement. Soluble fiber is a miracle worker for many

people in managing all IBS symptoms, whether cramping, diarrhea, and/or

constipation. However, one of the most common soluble fiber supplements is

psyllium (sold as Metamucil, Konsyl, Fibrogel, or as bulk husks). Psyllium

can cause bloating for some IBS patients, and if this happens to you try an

alternate supplement. Acacia, Equalactin, FiberChoice, Citrucel, Benefiber,

and Fibercon are all effective soluble fiber supplements that do not

contain psyllium and should not cause bloating. In fact, Acacia is a

prebiotic fiber, which means that it increases good gut flora, and helps

reduce bloating and gas.

 

Avoid chewing gum if you're prone to bloating - it can cause you to swallow

a lot of air. And one last thing to try is eliminating all carbonated

beverages from your diet. Carbonation in general is a potential trigger for

IBS attacks, and it's particularly likely to exacerbate bloating. Have a

nice hot cup of the fennel tea instead of soda pop or sparkling water.

 

 

Won't eating all these high carb soluble fiber foods make me fat?

 

No - they won't. You're more much more likely to lose weight with the IBS

diet than gain. The high soluble fiber foods at the foundation of the IBS

diet (rice, pasta, oatmeal, potatoes, white bread) should not cause weight

gain as you're also going to be eliminating high fat foods such as red

meats, dairy, egg yolks, and fried foods. Soluble fiber (and insoluble

fiber, which you'll be incorporating carefully but as much as possible) is

calorie-free as it passes through the body undigested, and it is also quite

filling. Soluble fiber also stabilizes blood glycemic levels because it

regulates the rate at which food leaves the stomach, which helps keep

appetite levels under control and is very helpful for diabetes. If you wish

to avoid the soluble fiber foods with that are high on the glycemic index,

you can use brown rice, oatmeal, buckwheat (soba) noodles, corn meal

(polenta), quinoa, and barley (the whole grains that are safest for IBS),

plus root vegetables, instead of white rice or potatoes. Many people who

are overweight actually find that they effortlessly lose weight with the

IBS diet because the decrease in fats and increase in soluble fiber foods

results in a calorie reduction. The nice corollary to this is that for

people with IBS who are underweight, the diet can let them gain weight and

maintain it because they no longer have to be afraid that eating will

trigger an attack, so they end up eating more food in sheer terms of

quantity than they've been able to in the past.

 

Soluble fiber foods are always plant foods, and almost always high

carbohydrate foods, but it is simply untrue that a higher carb/lower fat

and protein diet is unhealthy or leads to weight gain or diabetes.

Americans average only 45-55% of their diets from carbohydrates, and our

obesity rate is now 35%. In contrast, Asian countries average 60-75% of

their diets from carbs (with white rice as the staple) and their obesity

rates are 1-2%. They also have lower colon cancer, heart disease, diabetes,

and osteoporosis rates. For glucose concerns, your body eventually breaks

down all carbohydrates (simple and complex, and no matter what the source

or how much/which type of fiber they contain) into glucose, as this is the

only fuel the brain can use.

 

It is always more nutritious to eat whole grain foods such as brown rice

and whole wheat breads than refined grains such as white rice and white

bread, because it is the bran portion of the grain that is removed during

the refining process, and the bran is high in vitamins and minerals.

However, the bran is also pure insoluble fiber, and thus a trigger for IBS

attacks. This doesn't mean that you won't eat any whole grains on the IBS

diet - in fact, you will incorporate as many of them as you can tolerate

into a high soluble fiber foundation, but you'll do so very carefully.

You'll also be adding many fresh fruits, veggies, beans, and nuts to the

soluble fiber foods, but again with care. This will dramatically increase

the safety of these insoluble fiber foods in terms of the strength of the

gastrocolic reflex they trigger (people with IBS suffer from irregular

gastrocolic reflexes, and are prone to having the muscle contractions

triggered by this reflex go violently out of control, resulting in cramps,

diarrhea, and/or constipation). Insoluble fiber (and fats) are the single

greatest stimulants of the gastrocolic reflex.

 

The difference in soluble vs. insoluble fibers in foods can be confusing

because many foods contain both. Grains and cereals especially have

insoluble fiber in their outer layers (the bran, husk, or hull of wheat

berries, rice grains, corn kernels, etc.) but soluble fiber in the

interior. This is actually true for many fruits, vegetables, beans, and

lentils as well (the skins are insoluble, the interior flesh soluble). You

are going to be eating these whole foods, but their insoluble fiber makes

them too risky to eat alone, on an empty stomach, or in large quantities at

once. That's where the plain soluble fiber food choices (the white rice,

pastas, white bread, potatoes, etc.) can act as safe foundation foods for

people with IBS. It's as much a matter of how you eat as it is what you

eat. So do make sure you get the whole foods in your diet, but recognize

that their insoluble fiber (and fructose in the fruit, sulfur in the

cruciferous vegetables, etc.) pose challenges to IBS folks and don't be

afraid to eat the high soluble fiber foods first and foremost. They will

address all the symptoms of IBS across the entire spectrum, and they won't

pile on the pounds as a result, I promise.

 

Anecdotally, I get many letters from people who have lost weight

effortlessly as a result of the IBS diet - anywhere from 5 to 150 pounds.

In most cases this was a happy fringe benefit for people who were much more

concerned with getting their IBS under control, but some letters are from

people who heard about the diet from friends with IBS, and started using it

themselves purely to lose weight without giving up great food.

 

 

I need to gain weight. How can I do that with the IBS diet?

 

It is hard to gain weight quickly with the IBS diet because it is so low

fat. But, you should definitely be able to reach and maintain a healthy

weight (and you shouldn't be losing weight past a healthy point for you).

The best thing is to snack on the soluble fiber foods all day long, so

you're eating as much as possible but not in large quantities in one

sitting. Try to also incorporate the dessert recipes after lunch and

dinner. The sugar, while certainly not a health food, will get you some

extra calories. Make sure that you are adding healthy fats (olive, canola,

flax, avocado, nuts, fatty fish like salmon and tuna, etc.) and safe

proteins (fish, skinless chicken breasts, egg whites, soy, etc.) to your

soluble fiber staples - not in huge quantities, but enough to keep your

diet balanced. You want to go low fat but not fat free. Once you're

stabilized, you should be able to have a high soluble fiber snack/meal that

is up to 30% healthy fats. If you're at all touchy, keep things around 20%.

If you cook, try snacking on the fruit breads and dreamy lemon rice

pudding. They're very stabilizing but will add calories for you and they're

nutritious too.

 

Ironically, weight lifting is also a great way to gain and maintain muscle

mass and thus body weight. I have heard from a lot of people who have found

weight lifting to be one of the few things that will let them keep their

weight up at a safe level. Other forms of exercise don't seem to do this,

but there's something special about weight lifting that really works in

this situation.

 

 

Is the IBS diet suitable for diabetes?

 

It's usually pretty easy to adapt the IBS diet guidelines to the needs of a

diabetic. As a precaution, one of the best things to do is see a local

nutritionist or dietician and give them the dietary guidelines for both IBS

and diabetes that you are following, and ask for their guidance. But in

general, the high soluble fiber foundation, careful incorporation of

insoluble fiber, low fat content, and avoidance of trigger foods such as

red meats and dairy that are crucial to managing IBS are very helpful for

diabetics as well. Soluble fiber (both foods and supplements) not only

normalizes bowel function, it also helps stabilize blood glycemic levels.

Soluble fiber slows the rate of carbohydrate absorption, improves

regulation of blood sugar, and lowers insulin requirements. Soluble fiber

also decreases LDL ( " bad " ) blood cholesterol levels, and therefore reduces

the risk of heart disease, which is a serious risk for diabetics. The

extremely low saturated fat content of the IBS diet also helps reduce the

risk of heart disease.

 

People who are trying to balance the IBS diet with low glycemic foods for

diabetes can choose brown rice, oatmeal, buckwheat (soba) noodles, corn

meal (polenta), quinoa, and barley - the whole grains that are safest for

IBS - plus root vegetables for their soluble fiber staples, instead of

higher glycemic index foods like white rice or potatoes.

 

One common area of uncertainty in following a diet for both IBS and

diabetes is how to handle sugar and desserts. Most people with IBS do not

have problems with plain refined sugars (like white or brown baking sugar),

which means that IBS-safe dessert recipes simply depend on a low fat,

dairy-free foundation. However, this is an area of much more serious

concern for diabetics. Unfortunately, simply using artificial sweeteners as

an alternative is likely to be problematic for IBS. Artificial sweeteners

in general can cause all sorts of gastrointestinal side effects, from gas

and diarrhea to severe cramping. This is particularly true for sorbitol,

which is the artificial sweetener most commonly used in commercial diabetic

candies and cookies. Some of the newer artificial sweeteners, such as

Splenda, are supposedly free of GI side effects, but I would personally

still be quite cautious as people with IBS often seem to be more sensitive

than most folks to food chemicals, additives, and preservatives.

 

For home cooking, it can be very difficult to significantly reduce the

sugar content of dessert recipes. Sugar is crucial to the food chemistry of

many desserts, particularly baked goods. Sugar affects not just the taste

but the texture of cakes and sweet breads, and altering the sugar content

of these recipes to any great extent can drastically change the outcome.

Often, the best solution to this issue is to simply avoid desserts

altogether. If this is a sad prospect for you because you have a sweet

tooth, check with the doctor who manages your diabetes about the

advisability of having just an occasional small portion of an IBS-safe

dessert made with real sugar.

 

 

Is wheat safe for IBS or not?

 

Wheat causes confusion for many, many people with IBS who are unsure about

whether or not it is a safe food for them. There is no flat yes or no

answer to this concern because it depends. Whole wheat, with its outer

layer of bran, is high in insoluble fiber. This means that it's a trigger.

That's why whole wheat bread, whole wheat cereals, and bran can cause such

awful problems for people with IBS.

 

However, when you remove the bran from whole wheat you end up with white

flour (the regular kind you can buy in any grocery store, that you use for

home baking breads, muffins, etc.). Though this is still wheat flour, it is

not whole wheat flour, and this makes a world of difference. White flour

contains no insoluble fiber but it does have soluble fiber, which is the

stabilizing force of the IBS diet (just picture the thick gel that results

when you dissolve a piece of white bread in a glass of water). This is why

white breads are such great safe staples.

 

When you read the ingredients on packaged foods they might not specify if

the wheat flour used is " white " or " whole " , but it's usually pretty easy to

tell. For breads, a brief glance will tell you if there is whole wheat in

it (you'll see little brown flakes). If the bread is pure white, like

French or sourdough, you're safe. For most crackers, pretzels, muffins,

etc. only white flour will be used. The exception is health food store

products, which are likely to use whole wheat. However, they will almost

always tout this fact so you won't be left wondering.

 

The whole wheat (and other insoluble fiber) intolerances so common to IBS

are markedly different from true food allergies. If you're allergic to

wheat, it will make no difference if the grain is left whole or refined by

removing the bran. In addition, with many allergies even minuscule

quantities of the trigger, whether eaten with other foods or alone, can

trigger violent reactions. Fortunately, with IBS this is rarely the case,

so we just have to be careful with whole wheat and other insoluble fibers.

If we do take care we can easily and frequently eat them in small

quantities when they're combined with high soluble fiber foods. In

addition, with wheat, once the bran has been removed so has the risk of an

IBS attack, and this gives us great dietary freedom when it comes to white

breads and other refined wheat flour foods.

 

 

Can I eat dairy if it's skim or lactose free? What about yogurt?

 

To keep your IBS stable it's best to eliminate all dairy products from your

diet completely. Dairy is an IBS trigger even if you're not lactose

intolerant. It's simply not just the lactose. It's also not just the high

fat content of most dairy products that can cause your IBS to flare. Even

skim and lactose-free dairy can trigger IBS attacks. In addition to fat and

lactose, dairy contains components such as the proteins whey and casein,

which can cause severe digestion problems. Though yogurt is traditionally

recommended as an " easily digestible " dairy product because fermentation

has reduced the lactose levels, even non-fat versions contain whey and

casein, and should be avoided. You're much better off using soy or rice

milk substitutes for dairy. If you want the benefits of the live cultures

in yogurt choose a soy yogurt instead.

 

 

How can I stay stable while traveling or on holiday?

 

As usual with IBS, the best defense is a good offense, and for traveling

this just means taking some time to think things through in advance. It

will be well worth your while to make careful but flexible plans, take some

simple precautions, and prepare to ask questions or make special requests

on your trip to get your dietary and stress management needs met. By the

way, feeling guilty about somehow being " difficult " in this regard is not

allowed. Taking care of your health is a legitimate priority and that's that.

 

For the travel itself, whether car, plane or train rides, bring your own

food and a soluble fiber supplement such as Acacia. Do not assume that the

meals being provided by travel services, or the tourist restaurants along

your route, will offer any safe choices whatsoever. Odds are they won't.

It's very important that you are extra careful to follow the IBS dietary

guidelines from the first day of your trip to the last, as travel is

virtually always upsetting to your body even if you're not immediately

aware of the effects. This physical stress can quickly rear its ugly head

in the form of an IBS attack if you allow it, so concentrate on prevention

at all costs. The power of precautionary measures is what will enable you

to enjoy your vacation, not suffer through it.

 

In addition to taking dietary precautions, maintain your stress management

program while traveling, or at least a modified version of it, to the best

of your ability. You may have to replace morning aerobics with evening

walks, find a quiet corner of your bedroom to regularly practice meditation

or yoga, or ensure in advance that if you're staying in a hotel room it's

in a quiet location so your sleep is uncompromised. Do whatever it takes,

and feel free to substitute any alternative that works for you.

 

If exercise is key to your IBS management as well, make it a priority of

your trip. Take your work out clothes and shoes with you and unpack them

first so they're staring you in the face. If you don't have the option of

exercising as planned once you're actually on holiday, change tactics and

adapt - find any variation that works and run with it. Maintenance is the

key here and flexibility will get you everywhere.

 

Disruptions to your sleep cycle are common when traveling, particularly if

you change time zones. Make an extra effort to overcome this potential

trigger as quickly as possible. If you can, pack your own pillow whenever

you travel, and you'll likely sleep much better. As a daily rule, try to go

to sleep earlier than you think necessary and get a little extra rest -

this will definitely minimize your risk of attacks. Even scheduling a few

naps here and there can make a world of difference. After all, family

holidays are supposed to leave you happily well-rested!

 

For special holiday meals, be careful with what you drink, not just what

you eat. If you're splurging a little with wine or champagne, make sure

you've had a soluble fiber snack or soluble fiber supplement first so your

stomach isn't empty. Better still, have the alcohol with your meal or

dessert. Don't turn to sparkling cider as an alternative to alcohol. The

high fructose content plus the carbonation is a deadly ticket to digestive

distress. The safest drink is an herbal tea (such as peppermint or fennel)

or just fresh water.

 

Remember that although it's an annual rite on some holidays to stuff

yourself like a Thanksgiving turkey, too much of any food is a bad idea.

Keep your digestion stable by keeping your meal size reasonable. You can

always have seconds later. To help prevent overeating in the first place,

have a good sized breakfast of a soluble fiber staple such as oatmeal or

cream of rice. At dinner, take just a little of everything and enjoy every

bite!

 

Bundle up and go for a walk outside after your meal. Keeping gently active

will keep your digestive tract functioning properly. Even if the rest of

the family settles down for a post-meal nap, take that walk alone and savor

the quiet time.

 

If there's a special treat that you know is a trigger but you just can't

resist, try this: limit yourself to a small amount, have the treat after

you've eaten some soluble fiber foods, and have a soluble fiber supplement

with a glass of water right beforehand. This will help keep your digestion

stable even as you splurge.

 

Take things easy the day after a big feast. Have light meals and lots of

herbal tea, get extra sleep, and go for another long walk. Give your body a

chance to recover from any indulgences and congratulate yourself on staying

healthy for the holidays!

 

For in-depth travel advice check The First Year: IBS for comprehensive

information on staying safe while on the road, in the air, and on vacation

with IBS.

 

 

What about a diet for IBS and Fibromyalgia?

 

Irritable Bowel Syndrome is estimated to affect 15-20% of the general

population, but a much higher percentage of people with Fibromyalgia suffer

from IBS. Because fibromyalgia can require some dietary restrictions in its

own right, it's helpful to know that these can easily be incorporated into

the IBS diet. Acid-forming foods such as red meat and dairy that are

problematic for the joint pain of fibromyalgia are completely avoided when

you're eating for IBS. Stimulants like black tea and coffee are easily

replaced with herbal teas that actively aid digestion, such as peppermint,

fennel, chamomile, and anise. Foods in the deadly nightshade family

(potatoes, tomatoes, bell peppers, eggplants) bother some people, but not

others, with fibromyalgia; if they're problematic for you they can simply

replaced with other vegetables. Refined table sugar, a stimulant which can

negatively affect fibromyalgia, is not a problem for IBS (though certain

sugars, such as fructose and lactose, often are) but neither is it helpful,

so it can simply be omitted from your diet. Unrefined sugars such as maple

syrup or honey may be more tolerable, or stevia can be used. Acidic foods

such as citrus and vinegar are often as problematic for IBS as for fibro,

and again easy substitutions can be made. Aside from these considerations,

the general dietary guidelines for IBS (high soluble fiber, low fat, the

careful incorporation insoluble fiber) are quite helpful for Fibromyalgia

as well.

 

 

What about taking vitamins and minerals?

 

Vitamin and mineral supplements in general often cause GI problems for

people with IBS. Ask your local pharmacist about the most tolerable brands

of vitamins in their store. GI upsets are very common with vitamins, and

pharmacists are familiar with this request. Prenatal vitamins may be an

option, as they are sometimes formulated specifically to help minimize the

risk of GI side effects. You may be able to simply phone in a prescription

request for these from your doctor - just explain why you need them.

 

Liquid vitamins or powder caplets may also be more tolerable than pills.

Another thing to consider is the fillers and additives in many vitamins;

check the ingredients for lactose, artificial colors, and preservatives, as

many people with IBS are sensitive to even small quantities of these

substances. A health food store may have a wider variety of additive-free

vitamins than a drug store. It's often helpful to take two or three

smaller-dose vitamin/mineral supplements each day instead of one large

dose. This will not only reduce the risk of GI upsets, but will aid your

body in absorbing the nutrients as well. If you can't find smaller-dose

vitamins, try just breaking a regular pill in half. Always take your

vitamins with a meal, and never on an empty stomach.

 

Vitamin C is particularly notorious for causing gas, abdominal cramps, and

diarrhea. Vitamin C is ascorbic acid, and as the name implies, it's acidic.

When it enters the alkaline environment of the lower intestinal tract it

can create diarrhea and gas. In Germany, vitamin C is actually an approved

laxative, so imagine what it will do to you if you have IBS. The

recommended dose for Vitamin C is generally under 2,000 mg. daily. Over

that, and you really risk the GI side effects. Unless your doctor has

recommended otherwise, make sure your multivitamin does not exceed one

hundred percent of the US RDA for Vitamin C.

 

Calcium, magnesium, and iron all require special consideration as well.

Calcium can have a constipating effect, which can be helpful or hurtful

depending on your symptoms. Magnesium can have a laxative effect, and this

too can either aid or exacerbate IBS, depending on the individual. For many

folks with IBS, it's best to make sure that your mineral supplement is not

giving you a megadose of either one of these ingredients, but simply a

balance of the two. Calcium carbonate contains just calcium and no

magnesium, and is a good choice if you always tend towards diarrhea. If

you're IBS-C (prone to constipation), try calcium citrate instead, which

contains magnesium. With either form of calcium, there should be Vitamin D

included in the supplement as well for the best possible absorption. It's a

good idea to take only 500 mg. of calcium per dose, as your body may not be

able to absorb more than this all at once.

 

Iron can cause stomach upsets and be quite constipating. Iron also blocks

the absorption of calcium. If you aren't anemic or prone to anemia, you may

well not need an iron supplement at all. If you do need to take an iron

supplement and you're also taking calcium, have these supplements with

different meals. Iron is best absorbed in the presence of Vitamin C. If

you're trying to juggle all of these different supplements, it can be

helpful to take your multivitamin with C and iron at one meal, and your

calcium or calcium/magnesium combination with Vitamin D at another meal.

 

If you're also taking a soluble fiber supplement like Acacia, don't worry

about timing your supplement around your vitamins/minerals. Soluble fiber

will not interfere with the absorption of vitamins/minerals any more than

food would. You can also take herbal supplements such as peppermint or

fennel at the same time you have your vitamins/minerals.

 

As a rule, it's always best to get your nutrition from as wide a variety of

fresh fruits, vegetables, legumes, grains, and nuts as possible. There are

many nutrients in whole foods that simply can't be extracted into pills. If

you're struggling to add enough nutrition to your diet, check the IBS

guidelines for incorporating insoluble fiber foods into your meals, and

take a look at IBS safe recipes that offer good examples of how to do this.

Until you're able to stabilize your IBS, you may not want to add in any

vitamin/mineral supplement at all (unless medically necessary); this will

eliminate the risk of the potential GI upsets from the supplements.

 

 

Can I still drink alcohol?

 

Alcohol is a strong GI irritant (and a potential colon carcinogen). Just

one drink can definitely trigger IBS attacks, especially if you drink on an

empty stomach. The worst drinks are those that contain other triggers as

well, such as carbonation (beer, champagne), coffee, dairy (pina coladas,

creme liqueurs), or fruit juices that are high in fructose. However, even a

plain glass of wine or shot of liquor can cause GI problems.

 

If you're unsure whether or not alcohol in small quantities bothers you,

it's best to totally remove it from your diet and get yourself stabilized.

At that point you can very carefully try (if you still want to) adding a

little alcohol back in to see how it affects you. Your tolerance will

likely be greater once you have gotten your gut under control; when that

happens your GI tract is less likely to be continually hypersensitive, so

there is reason to have hope for the future here.

 

However...what you definitely don't want to do is assume that just one

drink won't hurt you, so you never take the step of completely eliminating

all alcohol from your diet. By continuing to drink (especially on a daily

basis) you'll simply keep suffering the consequences. This is a very common

pattern with the foods and drinks people really don't want to give up - a

juicy steak, ice cream sundaes, or that favorite cocktail before dinner.

This is just human nature and it's easy to understand, and I definitely

sympathize. But, it's always better to know for sure how your body reacts

to a potential trigger instead of blindly assuming that something isn't

bothering you simply because you don't want it to. IBS doesn't often

respond to wishful thinking.

 

As a general rule, unless you're 100% stable and have no IBS symptoms

whatsoever when you drink (either immediately or the following day), it's a

safe assumption that alcohol in all forms is likely to cause GI troubles

for you. Does this mean that you can never drink any alcohol at all ever

again? It might - but it also might not.

 

How you drink as well as what you drink could make quite a difference here.

A single glass of wine enjoyed after a high soluble fiber meal may be very

tolerable for you, especially on an occasional (instead of daily) basis.

Judging by reader feedback on this topic, white wine may be safer for IBS

than red, and beer seems to be particularly problematic. Having a drink

when you're feeling relaxed instead of harried can make a difference as

well. On the other hand, a double martini on an empty stomach after a

stressful day is practically guaranteed to cause trouble.

 

If you do decide to take a chance with alcohol, please make sure to have at

least one glass of water for each alcoholic drink. Alcohol is very

dehydrating, and becoming even slightly dehydrated can seriously impact

constipation and bloating. If you have an inflammatory bowel disease such

as Crohn's or ulcerative colitis, it's best to avoid alcohol altogether.

IBD results in an increased rate of colon cancer, and alcohol is known to

raise your risk of colon cancer as well.

 

On a happy note, cooking with alcohol is usually very tolerable, as the

alcohol evaporates and any carbonation will totally dissipate. You'll be

left with all of the flavor but none of the risk!

 

 

What about coffee? Isn't decaf okay for IBS?

 

Nope - just one cup of coffee is all it takes to completely disrupt the gut

of most people with IBS. Coffee is a very powerful GI tract irritant - and

it's NOT the caffeine that's the culprit. Caffeine is a stimulant, so it

can aggravate IBS as well, but this just means that regular coffee has an

awful double whammy.

 

Decaffeinated coffee is still practically guaranteed to trigger abdominal

spasms, diarrhea, and a very unpleasant sense of urgency. Why? Because all

coffee beans, decaf included, contain an enzyme that irritates the entire

digestive tract.

 

Interestingly, though coffee is known for its laxative effect and many

folks with IBS-constipation use coffee for just this reason, the end result

will actually be a worsening of IBS symptoms - including constipation. The

abdominal cramping and GI irritation from coffee increases gut motility

violently and artificially, which is likely to cause a rebound effect of

greatly slowed or halted gut motility if you're constipation-prone. In

other words, the short-term laxative gain from coffee is likely to actually

exacerbate IBS-constipation in the long-run. If you have IBS, your colon

contractions are by definition dysfunctional; using coffee to irritate your

colon to the point of spasms every morning will simply cause more severe,

and chronic, gut motility problems.

 

Coffee is also highly acidic, and acidic foods can aggravate IBS as well as

upper GI disorders such as GERD. Adding insult to injury, drinking coffee

first thing in the morning, on an empty stomach, offers absolutely no

buffer for the acid, irritant, and stimulant effects of the beverage. In

addition, mornings are routinely stressful for many people, as they're

tired, rushed, and trying to get out of the house to school or work. Adding

a deadly dietary trigger like coffee into a hectic morning schedule is

virtually guaranteed to cause IBS problems.

 

If you've been drinking decaf, you can quit cold turkey without caffeine

withdrawal, and you should see improvements in your IBS immediately. Your

first morning without coffee will likely be your first morning without

abdominal cramps. If you're used to coffee with caffeine, quitting can

trigger caffeine withdrawal, and you may suffer headaches for up to two

weeks. You can try to wean yourself onto a half-decaf, half-regular coffee

habit, and then gradually eliminate coffee completely. This will help

prevent the headaches but will also prolong the IBS symptoms, so you'll

have to choose the lesser of the two evils.

 

If you love coffee (and this is often the underlying reason people continue

to drink it - they likely know that it's affecting their IBS, but it's

never easy to give up something delicious) there are some interesting

substitutes to try. Rocamojo is a roasted soybean drink available at health

food stores that satisfies many hard-core coffee drinkers. Teeccino is

blend of herbs, nuts, fruits and grains that are roasted, ground and brewed

just like coffee, and is also available at health food stores. Chai, an

Indian spiced-tea drink (decaf versions are available), is postively

luscious when brewed with soy or rice milk, and has the same hearty quality

that coffee offers. You can buy Chai tea bags, loose leaf tea, or make it

from scratch with very little effort. Or, you could try something

completely different, and switch to a helpful herbal tea for your morning

(and afternoon, and evening) beverage. Peppermint, fennel, chamomile,

anise, and ginger are all digestion-friendly teas that will actively help -

not hurt- your digestive health.

 

 

Is it okay to just avoid insoluble fiber foods altogether?

 

Nope, it's definitely not a good idea to simply eliminate insoluble fiber

foods from your diet. Insoluble fiber is found in fresh fruits, vegetables,

whole grains, legumes, and nuts, and you can tell instantly that these are

among the very healthiest foods in the world. If you don't eat them you're

setting yourself up for serious long-term health problems.

 

However, if you have IBS, insoluble fiber is a huge potential trigger, and

your colon simply can't handle it if you eat these foods with abandon. You

can (and absolutely must) eat insoluble fiber foods, as often and as much

as safely possible, but within the IBS dietary guidelines. This is crucial

not just for normal bowel function, but for overall good health. Treat

insoluble fiber foods with suitable caution, and you'll be able to enjoy a

wide variety of them, in very healthy quantities, without problem.

 

The number one rule here is: Never eat insoluble fiber alone or on an empty

stomach. Always eat it with a larger quantity of soluble fiber, and you

will help keep your IBS stable.

 

The second rule to remember here is that while you should be having lots of

fresh fruits and veggies every day, make sure you cook, peel, chop, seed,

dice, and/or puree most or even all of them. Peeling and seeding fruits and

veggies will remove the toughest insoluble fiber altogether. Chopping,

cooking, and pureeing will mechanically break down the insoluble fiber in

fruits, vegetables, beans, and nuts before you eat it, making it much less

likely to provoke problems.

 

If you're just starting to re-incorporate insoluble fiber into your diet,

you can do this quite safely without having to be afraid of triggering

symptoms. The best way to begin is to blend fresh fruits into smoothies

with a bit of soy or rice milk. Use a base of bananas, mangoes, and/or

frozen peaches for soluble fiber, and add just a handful of strawberries,

blueberries, cherries, and/or pineapple. Blend the drink until totally

smooth and you'll really minimize the insoluble fiber. Blend a big pot of

well-cooked fresh veggies into soups or sauces, and serve over rice or

noodles. This is an especially good way to incorporate greens, which are

highly nutritious but also some of the most difficult insoluble fiber

veggies for most IBS folks.

 

It's also helpful to make sure you're already eating as much of the

healthiest soluble fiber foods as possible: root veggies (sweet potatoes,

pumpkin, beets, rutabagas, carrots, etc.), mangoes, bananas, peeled apples

and peeled pears, peeled peaches and apricots, and avocados.

 

See how do you do with brown rice, oatmeal, buckwheat (soba) noodles, corn

meal (polenta), quinoa, and barley. These tend to be the best tolerated

whole grains for IBS. Try adding in small amounts of well-cooked and pureed

beans or lentils as soup or dip additions to your diet. Take this process

slowly, and you can actually significantly increase your tolerance of

legumes. Your body will produce the enzymes you need to digest bean sugar

(raffinose) if you're eating beans on a regular basis. If beans

consistently give you problems, try lentils instead, as they're often

easier to digest. Finely grinding nuts and adding them to a soluble fiber

foundation is an easy and safe way to incorporate another very healthy

variety of insoluble fiber. Try adding Beano to all of your insoluble fiber

foods, eat these foods in tiny amounts at first, then gradually and

consistently increase your quantities.

 

Try baking easy, low fat quick breads such as zucchini bread, carrot cake,

pumpkin bread - this is a terrific (and delicious!) way to add fruits and

veggies safely.

 

Take this whole process slowly and gradually, and remember that if you've

been totally avoiding insoluble fiber foods you're going to have to start

eating them carefully, and giving your body time to adjust. You will

increase your tolerance for these foods and digest them better the more you

eat them, as long as you follow the guidelines. It's especially important

to emphasize that even people with IBS that is constipation-predominant

need to be careful with insoluble fiber foods. Insoluble fiber is terrific

for relieving constipation if you have a normal gut. If you have IBS,

however, then by definition you do NOT have a normal gut, and insoluble

fiber can trigger symptoms and actually exacerbate constipation. No matter

what your specific IBS symptoms, you need insoluble fiber for healthy bowel

function, so once again, the key here is not to avoid insoluble fiber foods

altogether, but to carefully eat as much of them as possible.

 

It can be tremendously helpful to take Acacia or another soluble fiber

supplement right before you eat insoluble fiber foods. If you find herbal

teas such as peppermint, fennel, chamomile, or ginger helpful drink those

with the foods, and try taking Peppermint Caps as well. All of these things

will help keep your gut stable and let you tolerate the addition of

insoluble fiber foods. For the sake of your overall health, making a real

effort here is well worth it. As always with IBS, the more you can take

pro-active steps to prevent problems in the first place, the better off

you'll be.

 

 

What about soy foods? Do they cause gas and bloating?

 

While soybeans have a terrific nutritional profile, and soy foods allow

people with IBS to greatly expand their diet in many ways, all beans

contain raffinose, a natural complex sugar. The digestive enzymes in the

gastrointestinal tract can have trouble breaking this complex sugar apart

into simple sugars for absorption. As a result, in the lower intestine

raffinose is metabolized by bacteria, and forms carbon dioxide, hydrogen

and methane; this can cause abdominal bloating and gas.

 

Because soybeans contain all the essential amino acids, soy foods such as

tofu and tempeh are great sources of protein. Soy is also a good source of

B vitamins, particularly vitamin B6. Plus, whole soy foods are high in

soluble fiber, which is a necessity for the dietary management of IBS. So,

can you add soy to your diet without exacerbating IBS gas and bloating?

Absolutely!

 

The key here is to start your soybean venture with small amounts, and

increase soy foods in your diet gradually. This will help tremendously to

increase your body's enzyme production. Your body actually produces

different enzymes to digest carbohydrates, fats, and proteins - how you eat

literally affects what you're able to (easily) digest. So, as you eat more

soy or other beans, your GI tract will adapt to larger amounts of raffinose

and become more adept at handling the complex sugar.

 

Eventually, once your gut adjusts to a regular dose of raffinose, eating

soy foods shouldn't cause gas or bloating. But, if you've never had soy in

your diet, you're going to have to go very carefully as you start. This may

mean starting with just half a cup of soymilk a day, or a few small

servings of tofu each week. Take the process slowly and try a variety of

soy foods in your diet as you gradually increase the quantities. You can

also try using Beano when you eat soy - this can really help.

 

So, start slow, increase gradually, and always have soy with a soluble

fiber foundation, and you should be able to make good progress. Remember

that it's much better to have just a little bit of soy on a regular basis

than to have none at all. Over a few weeks your gut should adjust, and once

you're used to digesting it, soy should not be a problem. And, it's well

worth increasing your tolerance to soy as this will give you a great deal

of flexibility in cooking. The wealth of soy foods on the market (from

milks to cheese, ice creams to hot dogs) offer terrific substitutes to

almost every dairy product and red meat imaginable. Having a bit of

patience with your body, and giving it time to adjust to digesting

raffinose, will give you a tremendous payoff in dietary variety.

 

However, if you feel that you just can't eat soy at all, don't worry -

there are a great number of rice, almond, and oat substitutes for dairy

products available, and more are appearing on the market every day. In the

end what really matters is that you're able to eat well and keep your IBS

under control. The trick here may be using soy or it may require other

substitutions - but it never means deprivation!