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Over 1 out of every 5 Americans suffers from either IBS or IBD – digestive conditions that can lead to gas, bloating, diarrhea, constipation, and other symptoms. While neither condition is caused by diet, your food choices can significantly impact symptoms and overall well-being. An overview of IBS and IBD is provided below, followed by a discussion of the role of diet in managing these conditions.
What is IBS?
IBS, or Irritable Bowel Syndrome, is the term used to describe a group of symptoms affecting the large intestine, or colon. Symptoms may include abdominal pain, cramping, bloating, gas, diarrhea, and/or constipation. Unlike IBD (described below), IBS is considered a functional disorder rather than a disease. This means that while the colon is not functioning as it should, it is not damaged or diseased. IBS is also much more common than IBD, affecting 1 out of every 5 Americans. The cause of IBS is unknown.
While there is no “cure” for IBS, a number of medications and lifestyle changes have been shown to help improve symptoms. A doctor might prescribe laxatives to treat constipation, antispasmodics to reduce abdominal pain, or antidepressants to treat other symptoms. In many cases, lifestyle changes such as stress relief techniques and diet modifications (discussed below) can reduce or eliminate the need for medications.
What is IBD?
IBD, or Inflammatory Bowel Disease, describes a group of disorders in which the small and/or large intestines become inflamed. Ulcerative Colitis and Crohn’s Disease are the most common types of IBD. Ulcerative Colitis causes inflammation of the inner lining of the large intestine and rectum. Crohn’s Disease can affect any part of the gastrointestinal tract, but most often manifests as swelling deep in the lining of the ilium (the lower part of the small intestine). IBD affects about 1 out of every 200 people in the United States.
Although the exact cause of IBD is unknown, the most likely culprit is an immune reaction the body has against its own intestinal tissue. There is currently no medical cure for IBD, but several types of treatment are available to help control or alleviate symptoms. The major aim of any type of IBD treatment is reducing the intestinal inflammation that causes symptoms.
There are several major classifications of medications used to treat IBD, including corticosteroids, antibiotics, and immunomodulators, among others. While these medications have helped many people attain and/or maintain remission from disease symptoms, they can also have significant side-effects. Thus, the main focus of this post is on lifestyle changes (namely diet) for managing symptoms and improving overall well-being.
The Role of Diet
While IBS and IBD are not caused by diet, different foods can aggravate symptoms or promote healing. A healthy, balanced diet is especially important for people with these conditions, as nutrient absorption and immune system functioning may be compromised. The six most important diet-related considerations for IBS and IBD are:
- Vitamins and minerals
Inflammation, triggers and fiber are discussed below. Macro- and micro-nutrients, vitamins, and minerals will be discussed in the second installment in this series.
Some foods cause inflammation in the body, some have anti-inflammatory effects, and others are relatively neutral. Avoiding inflammatory foods can help minimize the symptoms of IBS and IBD. Some of the more common inflammatory foods (and worst offenders) include:
- Beef, pork and organ meats
- Eggs (egg yolks in particular)
- Dairy products (especially full-fat milk and cheese)
- Trans fats and partially hydrogenated oils
- Refined sugars and carbohydrates (white sugar, white pasta, white bread, etc.)
- Common allergens, including casein and gluten
Other foods can actually decrease inflammation in the body. A diet emphasizing anti-inflammatory foods is key to health and wellness for anyone, but especially for those of us with IBS or IBD. Some of the anti-inflammatory foods you may want to incorporate into your diet include:
- Fresh fruit – especially blueberries and other berries
- Fresh vegetables – especially broccoli and sweet potatoes
- Healthy fats, such as olive oil, avocado, walnuts and other nuts and seeds
- Whole soy foods, such as tofu, tempeh and edamame
- Beans and legumes
- Whole grains, such as brown rice and quinoa
- Green and white tea
Through observation, trial and error and probably a bit of learning the hard way, you will likely find that certain foods are problematic for you while others are relatively easy to digest. There is no perfect diet for IBS and IBD sufferers, because a food that causes gas, bloating, diarrhea, constipation, or even a flare-up for you may be perfectly suitable for someone else.
However, some foods are certainly much more difficult to digest than others, and are therefore more likely to be problematic for anyone. Certain foods are both difficult to digest and detrimental to health and well-being, and should be minimized or ideally eliminated from the diet. These foods include:
- Meat – especially beef, lamb, poultry, and fatty fish (due to protein concentration and saturated fat content)
- Dairy Products – milk, cheese, ice cream, yogurt and eggs (due to lactose and saturated fat content)
- Fried foods
- Artificial sweeteners – especially sorbitol, mannitol, maltitol and xylitol
Other foods may be difficult to digest for certain people, or at certain times (e.g. during a flare-up or on an empty stomach) but are health-promoting and should be incorporated into the diet when possible. These foods include:
- Raw vegetables, especially the cruciferous family (e.g. broccoli, cabbage, cauliflower)
- Beans and legumes
- Citrus – due to high acidity
Cooked vegetables are generally easier to digest than raw vegetables, so you may find that lightly steaming or stir-frying them is enough to reduce or eliminate gas and bloating. Beans and legumes are often easier to digest if soaked before cooking, and certain types are easier to digest than others. Experiment with different types of beans, peas and lentils to see which ones work best with your system. Cooked red lentils are high in protein and fiber and are relatively easy to digest.
Spicy foods and gluten-containing grains including wheat, barley and rye can be quite problematic for some people (or at certain stages), but are easily digested by others. Because there is no definite health benefit or risk from these foods, they should be included in the diet as desired and tolerated.
Coffee, alcohol, solid chocolate and coconut milk are also common triggers for many people. A few tips related to these widely-enjoyed items: avoid drinking coffee or alcohol on an empty stomach to minimize GI distress, and drink in moderation; try using cocoa powder in recipes and smoothies for easier-to-digest chocolate flavor; and use light coconut milk in recipes and avoid high-fat coconut products like coconut ice cream.
Fiber can be a tricky issue for those of us with IBS or IBD. Getting enough fiber in your diet is key to maintaining regularity, reducing cholesterol, controlling blood sugar, and possibly reducing your long-term risk for colon cancer. But too much (or too much of the wrong type of) fiber can also cause gas, bloating and even diarrhea.
Fiber is typically classified into two categories – soluble and insoluble. Soluble fiber dissolves in water to form a gel-like material that can help lower blood cholesterol and glucose levels. Soluble fiber is found in oats, beans, apples, citrus fruits, carrots, and some starchy vegetables.
Insoluble fiber does not dissolve in water, and promotes the movement of material through your digestive system (i.e. helps maintain regularity). It also controls acidity in the intestines, which may help prevent colon cancer. Insoluble fiber is found in green leafy vegetables, fruit and vegetable skins, whole wheat, and nuts and seeds.
A low-fiber diet is typically recommended during an IBD flare-up or during bouts of diarrhea. However, it is important to re-establish a healthy and varied diet with adequate fiber intake. Although it may seem as though adhering to a bland, low-fiber diet would help manage symptoms, incorporating “whole foods” like leafy greens, cooked vegetables, a variety of fruits and whole grains, and lean protein sources will promote health, healing and regularity.
It is worth noting that animal products, including meat, eggs and dairy, are among the poorest choices for IBS and IBD sufferers. They often cause or contribute to inflammation in the body, are common trigger foods, and provide no fiber, which is beneficial for digestion and overall health. In contrast, many whole, plant-based foods are among the best choices. Fresh fruits and vegetables are key for controlling inflammation, and provide heart- and colon-healthy soluble and insoluble fiber.
The second installment in this series on IBS, IBD and Diet will discuss the role of macro- and micro-nutrients, vitamins and minerals in promoting health and well-being.
Image Credit: sk8geek/Flickr