Diet Can Make a Difference for Irritable Bowel Syndrome
One in ten people suffer from irritable bowel syndrome (IBS), a chronic condition with symptoms including abdominal pain, bloating and distention, excessive gas, and diarrhea and/or constipation. Although the cause of IBS is unknown, it is recognized that the enteric nervous system (ENS), a complex nervous system that controls the gut, has an intricate role. When the ENS does not function properly, it can cause extra-sensitive nerve response in the gut, known as visceral hypersensitivity and/or disturbances in how food travels though the gut. Genetics, gut infections, psychological factors, stress, and dysbiosis; an abnormal balance of gut bacteria, are all known to contribute to the development of IBS. Certain foods, beverages, irregular eating, overeating, nicotine and alcohol use can worsen symptoms.
Treatments for IBS
IBS is treated with diet, lifestyle modifications, medications and psychological therapies. Although limited in effectiveness, medication may play a role in the treatment of symptoms associated with IBS. Yoga, clinical hypnosis, and cognitive behavioral therapy (CBT) are effective psychological approaches for reducing symptoms in those with and without stress induced IBS. Incorporating healthy nutrition and lifestyle choices are the first steps towards managing IBS. Smoking cessation, limiting alcohol and caffeine, along with exercise are lifestyle changes with positive impact for IBS sufferers. A balanced diet void of known food triggers and limited in processed and high fat foods is advised. Eliminating beverages with high fructose corn syrup (HFCS) such as soda and apple juice/cider containing naturally occurring sugar alcohols are key dietary interventions. Establishing a regular eating pattern with small frequent meals and snacks is recommended. These mini meals should be rich in natural fiber and accompanied with adequate fluids. Meals should be consumed slowly and mindfully in a low stress environment.
The FODMAP Diet
If adequate symptom relief is not achieved with the previously described first line interventions, a trial of the low FODMAP diet is appropriate. Developed specifically for the management of IBS, FODMAP is a collective term for short-chain carbohydrates that are incompletely absorbed in the small intestine. The acronym stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols (FODMAP).
Fermentable refers to the process through which gut bacteria breakdown undigested carbohydrates to produce gas in your intestines leading to abdominal discomfort. Oligosaccharides are made of fructans and galacto-oligosaccharides (GOS). Fructans are found in wheat, rye, onion and garlic. GOS are in legumes and pulses. Disaccharides refers to carbohydrates composed of two sugars. Many people are intolerant to lactose, a common disaccharide found in dairy products. Monosaccharides are simple sugars such as fructose and glucose. Fructose is absorbed optimally in the presence of enough glucose. Consuming foods that are high in fructose but low in glucose (for example, honey, apples and high-fructose corn syrups) can cause fructose malabsorption. Lastly, polyols are naturally occurring sugar alcohols (example, sorbitol and mannitol) that are found in some fruits and vegetables. They are manufactured and used as artificial sweeteners and are in all sugar-free chewing gum mints and some sugar-free candies, medications and toothpaste.
FODMAPs have been identified as some of the most important dietary triggers in those with IBS. In clinical trials, over 75% of people with chronic digestive symptoms gain significant relief by reducing their intake of FODMAPs. It is important to note that the diet is intended for short term use. Strict avoidance of all FODMAPs are recommended for six to eight weeks followed by a systematic reintroduction of foods. The prescription and education of a low FODMAP diet should be done in conjunction with an expert Registered Dietitian-Nutritionist who can review your symptoms, personalize diet choices and provide guidance for food reintroduction.
Gina Barbetta, MS, RD, CD-N is a Registered Dietitian – Nutritionist with over 25 years of experience in pediatric and adult nutrition therapy. She is the owner of Nourish by Gina, LLC. For further information call 203.206.3873. Telehealth Available. Most insurances accepted.