Diarrhea and pain should resolve in just a few days. Constipation, especially if it's been chronic, can take several weeks after you initially calm down your gut. Please hang in there.
The best thing to do to break the IBS 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 Tummy Fiber, too - this is crucial. Start with 1/2 level teaspoon twice a day, and then gradually increase until you stabilize. Have plenty of fresh water or the herbal teas. 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 soluble fiber supplements like Acacia Tummy Fiber 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 Tummy Fiber 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 Tummy Fiber, 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 Tummy Fiber, 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 Tummy Fiber, Equalactin, FiberChoice, Citrucel, Fibercon, or Benefiber instead. Outside the USA, look for Benefiber (avoid Normacol, which contains a laxative), or order Acacia Tummy Fiber 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:
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 Tummy Fiber, 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 actively 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.
Using a soluble fiber foundation and following the guidelines for HOW to successfully eat insoluble fiber 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.
One thing to watch out for is that, if you are finally able to eat without fear of an IBS attack, you may start eating a lot more food than you were. This means a higher caloric intake from the quantity of food alone, and more calories eaten without extra calories expended through exercise means you will gain weight. If this is an issue, watch your portion control, and stick to frequent small meals and snacks. As you start to feel more stable you should hopefully be able to increase your activity level as well, and get extra exercise if needed. Do watch out for too much sugar, as even though it is not an IBS trigger it is a common source of empty calories and it's easy to eat too much of it.
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.
Are artificial sweeteners safe for IBS?
Unfortunately, there is no such thing as a "natural" artificial sweetener, and there is no such thing as an artificial sweetener that is proven safe for IBS. Virtually all artificial sweeteners (as well as other chemical additives and preservatives) can provoke gastrointestinal upsets in people with IBS, as by definition we have more sensitive guts.
Saccharine, Equal and Nutrasweet (both aspartame), sorbitol and other sugar alcohols (xylitol, malitol), and Splenda (sucralose) are the most popular artificial sweeteners in the US. They can all cause digestive side effects ranging from gas and bloating to severe abdominal cramps and urgent diarrhea. In some cases, they can provoke these symptoms in people who don't even have IBS, so imagine what they can do to you.
Sorbitol (and other sweeteners ending in "ol") are sugar alcohols, chemically extracted from fruits and vegetables but very poorly absorbed by the gut. It's this malabsorption that results in the low calorie count of sugar alcohols, but also in the dramatic digestive upheavals they can cause. Sugar alcohols are so likely to cause gas, cramping, and bowel dysfunction that foods containing these sweeteners are labeled with a warning about their side effects, and cautions against eating a large amount. Personally, I would caution you against eating any amount of a sweetener that's virtually guaranteed to wreak havoc on your gut.
Splenda is the newest artificial sweetener on the market, and it's misleadingly marketed as "natural" because it's engineered from real sugar. In fact, the deceptive "natural" label has resulted in nine consumer class-action suits in several states and three federal commission complaints, and is also being disputed by the American Sugar Association, which is suing Splenda's manufacturer. Splenda is a laboratory engineered altered molecule of sugar that replaces three hydrogen-oxygen groups on the sugar molecule with three chlorine atoms. Yum! Splenda is not recognized by the body as a food substance, and it passes through the gut without being digested. This is about as far from a "real" food as you can get, and there is nothing remotely natural about it.
Saccharine has had carcinogenic warnings about its use for years, and aspartame has generated thousands of consumer complaints to the FDA about side effects from its use. Aspartame must also carry a warning label for people who do not effectively metabolize the amino acid phenylalanine, one of aspartame's components. There aren't any clear cut long-term studies on saccharine's or aspartame's effects on gastrointestinal health, but there is a lot of anecdotal evidence that they can cause digestive upsets, particularly if you're already susceptible to these problems.
In general, anyone with IBS has a lot to lose and nothing to gain by using artificial sweeteners in even small amounts. The risks range from possible to guaranteed cramps, bloating, and diarrhea, and as everyone with IBS knows, once you provoke symptoms it is much more difficult to regain stability. If you're craving something sweet, you're better off savoring a small portion of a treat made with real sugar. Sugar is not a health food, and if you want to indulge it should certainly be eaten in moderation. For IBS, however, sugar is a much safer option than any artificial sweetener.
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. For diabetes and other diseases, there are terrific advantages to a diet high in soluble fiber.
Soluble fiber also decreases LDL ("bad") blood cholesterol levels, and therefore reduces the risk of heart disease, which is a serious risk for diabetics. PCOS patients are often found to have insulin resistance, and soluble fiber can help to stabilize their blood sugar levels by slowing the absorption of food sugars into the bloodstream, and therefore decreasing the insulin secretion of the pancreas. 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. In general, be quite cautious with all artificial sweeteners, including saccharine, NutraSweet, and Splenda, as people with IBS 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.
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 Tummy Fiber. 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.
Is it okay to just avoid fruits, veggies, and 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 or Bean Zyme 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 Tummy Fiber 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!
Are meal replacement drinks safe for IBS?
Unfortunately, most meal replacement or supplemental nutrition shakes have ingredients that can seriously worsen IBS. Among the most common brands, virtually all Boost drinks contain dairy, and most varieties have artificial flavors, artificial colors, and can be very high in fat as well. Ensure brand drinks contain dairy, most are fairly high in fat, and some varieties have caffeine and artificial flavors. Both Boost and Ensure also typically use corn syrup as a sweetener, which can cause problems for IBS folks who are sensitive to fructose. Even Modulen, a nutritional drink marketed for inflammatory bowel disease patients, contains casein (a dairy protein), milk fat, and a fat content that is far too high for maintaining digestive stability in IBS. Modulen also contains Transforming Growth Factor-�2 (TGF-�2), from cow's milk, which doesn't sound like something I'd like to drink.
The best choice among the canned drinks, though not a great one, seems to be SlimFast soy fruit shakes. These contain no dairy and are very low in fat, and they also have a decent amount of soluble fiber. Unfortunately, they're sweetened with fructose. This means that while they may be a tolerable drink for some, for others who are prone to diarrhea, gas, or bloating from fructose, they're not a safe bet.
The optimal solution for a meal replacement beverage is to simply make your own. While this isn't as convenient or quick as buying a canned drink, at least you can control the ingredients and ensure that your digestion stays stable. Try whipping up a fast fruit smoothie in the blender with soy, rice, oat, or almond milk (and additional soy powder for extra protein if you like), bananas or mangoes, peaches, cherries, blueberries, or strawberries. Choose whatever combination of fruits you find most tolerable, and add a bit of sugar, stevia, or honey for extra sweetness. No drink will ever really replace the complete nutrition you should get from a full meal, but if you're trying to add extra calories to your diet or simply need some fast energy, a homemade smoothie is a much healthier and safer choice than any of the commercial canned beverages.
Is the IBS diet suitable for GERD or acid reflux?
People with Irritable Bowel Syndrome are statistically more likely to have upper GI problems (like GERD or reflux) as well. The good news is that the vast majority of dietary changes that help IBS will also help prevent or minimize heartburn - there are just a few special considerations you'll need to take.
The general IBS diet guidelines of low fat, high soluble fiber, and the careful addition of insoluble fiber, are well-suited to reflux as well. In particular, going low fat will be very beneficial for IBS and reflux both, so make sure you're avoiding the high fat trigger foods. While acidic foods can sometimes (but not always) bother IBS, they are very hard on reflux, so be careful with citrus, vinegars, and cooked tomatoes.
Coffee is an acidic food that is also a powerful GI tract irritant and it will wreak havoc on both your lower and upper digestive tract - please avoid it completely (even decaf!) Tea is not a safe replacement beverage, however; both black and green teas contain caffeine (problematic for IBS) and tannins (not good for reflux). Carbonated drinks and chewing gum increase the amount of swallowed air in your GI tract, and are also bad news for reflux and IBS both.
Herbal teas are an excellent option instead, with one big exception: peppermint, which is one of the single best herbs for IBS (particularly pain and cramping), is such a powerful smooth muscle relaxant (which is why it helps IBS) that it can seriously exacerbate heartburn. Choose fennel, chamomile, or anise teas instead. You may also be able to use peppermint in the form of enteric coated peppermint oil capsules, which do not dissolve in the stomach. Instead, they pass through the digestive tract intact until they reach the intestines, so they are often very helpful for people with both reflux and IBS who cannot tolerate peppermint in other forms (such as teas or candies). If you do have reflux and want to try peppermint oil capsules, it's usually best to take each capsule on an empty stomach, about one hour before a meal. The "no alcohol, no tobacco" rule for IBS also applies to reflux, so if you have both digestive problems it's time to change any hard-partying ways (sorry).
Sulfur-containing vegetables (garlic, onions, leeks, broccoli, cauliflower, cabbage, asparagus, and Brussels sprouts), can produce significant gas in the GI tract and this can trigger IBS attacks, and the sulfur can also exacerbate reflux. As with all other fruits and veggies, however, these are extremely nutritious foods with significant health benefits, so they need to be treated with caution but, if at all possible, not simply eliminated from your diet.
Chocolate, in the form of unsweetened cocoa powder used for baking, is usually very tolerable for IBS (both the fat and caffeine have been removed). Unfortunately, chocolate in any form can worsen reflux, so you may well have to forego this particular treat altogether. Why the discrepancy? Chocolate contains theobromine (a compound that's also found in tea and coffee), which relaxes the esophageal sphincter muscle (just like peppermint), and triggers reflux. So chocolate, like peppermint, is one of the few foods that can be perfectly safe for lower, but not upper, GI problems. Other foods in this category are hot peppers, which contain capsicain. While they can be tolerated, especially in smaller amounts, by some folks with IBS, the capsicain can dramatically trigger reflux and you'll probably want to avoid hot peppers (such as jalapenos, habaneros, cayenne, etc.) altogether. This does NOT mean you have to avoid all herbs and spices - to the contrary, most are actually digestive aids, and it's only the capsicain family you need to avoid. There's no need to stick to bland foods unless you actually want to!
Some other general guidelines that are helpful for IBS are equally beneficial for reflux, particularly eating small meals frequently and taking soluble fiber supplements. Keeping your GI tract filled with soluble fiber throughout the day will make a world of difference in helping your digestion (both upper and lower) stay stable. When it comes to your soluble fiber supplement, be extra careful to avoid citric acid, which makes many "orange" flavored supplements taste, well, orange. Citric acid is, rather obviously, acidic, and this can make a soluble fiber supplement highly problematic instead of helpful for your digestion. Choose a plain, unflavored soluble fiber supplement like Acacia Tummy Fiber instead of a citric acid variety, and you'll get all the benefits without any risk.
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