Low carb, low fat for IBS
#351608 - 11/04/09 08:46 AM
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Last night in the UNC chat, Dr. Drossman said the best diet for IBS patients is one that is low fat (which we already do) and low carb. He said he did a study where patients ate no more than 30 grams of carbohydrates a day and there was improvement in their symptoms. He also said, when asked if there is benefit to avoiding dairy, that he doesn't believe in any 'undue' dietary restrictions. I take that to mean he doesn't have any evidence that dairy negatively impacts IBS.
Does anyone adhere to a low carb diet? If so, I wonder if you would share your general daily meal plan because I feel at a loss - I am dropping weight already and I feel that if I cut way down on carbs that I will lose more weight because I simply won't be consuming enough calories. But I also want to find the best diet to manage my IBS symptoms. Thanks!
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Hey- I have the same question. I'm not sure if this is the place to address it though, since it does go against Heather's diet... I know there have been lots of discussions about dairy before that have been locked, so just a warning-we might not get answers about it here. Personally, I will probably try dairy again when I am stable...which certainly isn't now.
As for gaining weight, it's really common with GP. My doc had me pick up some ensure/boost drinks. They are lactose free, but do have milk proteins. I've been too much of a wuss to try them, but she said I should have 1 a day as a 'snack' to get my calories and nutrients. She said liquids are much better tolerated.
This is a very helpful website I found:
http://www.healthsystem.virginia.edu/internet/digestive-health/nutrition/GASTROPARESIS-DIET.pdf
But I don't know what to do about the low carb, since SO many of my foods with this new GP diet are carb based. I feel like I snack on graham crackers/vanilla wafers/etc all the time... 
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IBS-A
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Aly, thanks for the reply. Maybe this thread would be better suited under The Living Room or Lifestyles and Fitness. I don't mean to oppose Heather's diet, because in some ways it has helped me. Low fat has truly helped my symptoms be less severe. But...I'm going on nearly 3 months on the diet and I'm still symptomatic every single day. And I am definitely not getting enough nutrients. Thanks so much for the link. There is a lot of helpful information in there and it's very specific. Maybe the reality is that it's not realistic to go low carb with GP. I wish I knew the answer.
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I have been confused lately about the same issue. The low carb eating has been showing that it helps with ibs but I can't eat high fat it just really upsets my stomach, so I pretty much eat carbs but still have issues every day if I don't take my lomotil.
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I eat carbs from unlimited veggies and berries, most meat/poultry, some yeast-free millet bread but try to stay away from the carbs from grains, sugar and processed foods. I think it is the processed foods (most foods we eat nowadays)with additives and chemicals that cause me my IBS symptoms. I have read of studies where low-carb diets can be beneficial.
http://www.ncbi.nlm.nih.gov/pubmed/19281859?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
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Kim, where do you find the yeast-free millet bread? I am trying to cut out as many carbs as possible, except for the veggies and fruits, and cannot find a bread. Of course, moderation with the bread too. Thanks for the link, too. Thanks. Geri
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It would be so hard to get a SF base for meals without having carbs. If you mean simple carbs, that is easier but still challenging.
I definitely feel reducing sugar and processed type carbs helps IBS. It is really hard to cut the sugar out.
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IBS-A for 20 years with terrible bloating and gas. On the diet since April 2004. Remember this from Heather's information pages:
"You absolutely must eat insoluble fiber foods, and as much as safely possible, but within the IBS dietary guidelines. 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." Please eat IF foods!
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I personally eat diary and it doesn't bother me much. It does have fat in it, so that is an issue, as well as if your lactose intolerent or rarer an allergy to it. Some of this depends on how much you consume and how it effects you personally.
Carbs breakdown to serotonin, hence why they may help some people on a low carb diet.
Sugars can create more gut bacteria and heance more gas, chocolates can also increase the release of serotonin in the gut and can upset both gerd and IBS, although it might make c people go more perhaps, it could also contribute to pain.
FYI
Be Choosy About Carbs
http://www.berkeleywellness.com/html/fw/fwNut03Carbs.html
simple carbs like fructose can be probelamtic.
also fyi
Since I have suffered for thirty nine years with IBS I wonder what role foods play in IBS. So I asked Dr Douglas Drossman at the UNC Center for Functional GI and Motility disorders and here was his response. This is not a substitute for seeking medical advise from your doctor on any specific conditions you may have, but for educational purposes only.
Dr. Drossman is a Co-director of the Center and Professor of Medicine and Psychiatry at UNC-CH. He established a program of research in functional gastrointestinal disorders at UNC more than 15 years ago and has published more than 250 books, articles, and abstracts relating to epidemiology, psychosocial and quality of life assessment, design of treatment trials, and outcomes research in gastrointestinal disorders.
Dr Drossman's comments on foods for IBS Health.
Shawn,
To say that people with IBS may get symptoms from food intolerances is an acceptable possibility, since the gut will over react to stressors of all types including food (high fat or large volumes of food in particular). Furthermore, there can be specific intolerances. So if you have a lactose intolerance for example, it can exacerbate, or even mimic IBS. Other examples of food substances causing diarrhea would be high consumers of caffeine or alcohol which can stimulate intestinal secretion or with the latter, pull water into the bowel (osmotic diarrhea). The same would be true for overdoing certain poorly absorbed sugars that can cause an osmotic type of diarrhea Sorbitol, found in sugarless gum and sugar substituted foods can also produce such an osmotic diarrhea. Even more naturally, people who consume a large amount of fruits, juices or other processed foods enriched with fructose, can get diarrhea because it is not as easily absorbed by the bowel and goes to the colon where it pulls in water. So if you have IBS, all of these food items would make it worse.
However, it is important to separate factors that worsen IBS (e.g., foods as above, stress, hormonal changes, etc.) from the cause or pathophysiology of IBS. Just like stress doesn't cause IBS, (though it can make it worse), foods must be understood as aggravating rather than etiological in nature.
The cause of IBS is yet to be determined. However, modern research understands IBS as a disorder of increased reactivity of the bowel, visceral hypersensitivity and dysfunction of the brain-gut axis. There are subgroups being defined as well, including post-infectious IBS which can lead to IBS symptoms. Other work using brain imaging shows that the pain regulation center of the brain (cingulate cortex) can be impaired, as well as good evidence for there being abnormalities in motility which can at least in part explain the diarrhea and constipation. So finding a specific "cause" of IBS has grown out of general interest in place of understanding physiological subgroups that may become amenable to more specific treatments. Hope that helps.
Doug
http://www.ibshealth.com/ibsfoods2.htm
--------------------
My website on IBS is www.ibshealth.com
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So this might be a silly question but I'm a little confused. Carbs break down to serotonin? So how would that help someone who is ibs-d on a low carb diet? Just trying to understand this a little better.
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Serotonin is a neurotransmitter found in the brain & gut. It is involved in the regulation of the motility of the gut. The IBS drugs Zelnorm and Alosetron affect serotonin levels. Carbohydrates affect serotonin levels in a complicated way too.
There is a brief description of how serotonin works on the gut in the NIH web site on IBS. It says "Recent research has reported that serotonin is linked with normal gastrointestinal (GI) functioning. Serotonin is a neurotransmitter, or chemical, that delivers messages from one part of your body to another. Ninety-five percent of the serotonin in your body is located in the GI tract, and the other 5 percent is found in the brain. Cells that line the inside of the bowel work as transporters and carry the serotonin out of the GI tract. People with IBS, however, have diminished receptor activity, causing abnormal levels of serotonin to exist in the GI tract. As a result, they experience problems with bowel movement, motility, and sensation—having more sensitive pain receptors in their GI tract."
Dr. Drossman and his colleagues study was done on a very small population of 13 patients. Approximately 51% of calories were from fat, 45% from protein, and 4% from carbohydrates. The study concluded that a very low carbohydrate diet (20 grams/day or 1/2 cup white rice per day) provided relief, and improved abdominal pain, stool habits, and quality of life in IBS-D. This study and diet was originally designed for overweight/obese IBS-D patients to loss weight.
While the results look promising the study was small and more research is required.
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
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I don't believe in this approach. After all you need energy! I lost a lot of weight when I followed the EFI and had lots of carbs. If you were to cut out carbs too that would be like a diet people who compete in bodyfitness follow to lose bodyfat to an extreme level.
Now there are people with IBS who do better on a high fat low carb diet (although it's not very popular to state this on the EFI board). But I think you do need to try one approach strictly at a time and see what works best for you.
I personally believe that neither a low-fat-high-carb diet or a high-fat-low-carb diet is optimal for health. I think the optimum is somewhere in between, but when you have IBS you have to find a balance that works. But going both low fat and low carb does not seem like a good idea to me anyway.
/Ulrika 
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Carbs, breakdown to tryptophan which is an essential amino acid. You can only get this from diet.
"Serotonin (a neurotransmitter), synthesized via tryptophan"
"serotonin is responsible for initiating and propagating the peristaltic reflex" -------Gut contractions
This process seems to be dirupted in IBS pateints.
There are cells embedded in the gut wall called enterochromaffin cells, they release serotonin to start gut contractions. When to much is released you get d, to little c and alternators both. Its is also responcible for signaling pain to the brain from the gut.
"Ninety per cent of the total body content of 5HT is found in the enterochromaffin cells in the wall of the intestine."
Video Corner: Serotonin
Increasingly our understanding of IBS is that it is a heterogeneous disorder – that is, multiple factors contribute to the well defined symptoms of the disorder. One of these suspected underlying dysfunctions involves serotonin, which is a neurotransmitter or messenger to nerves. Most serotonin in the body is in cells that line the gut where it senses what is going on and through receptors signals nerves that stimulate a response. The serotonin must then be reabsorbed (a process called re-uptake) into cells. This process appears to be disrupted in people with IBS
http://www.aboutibs.org/site/learning-center/video-corner/serotonin
In the brain the right level of serotonin is how you feel relaxed. Too high and you get anxiety.
Its not the amount in the body but the regulation or in IBS dysregulation. Serotonin itself doesn't actually go from the gut to the brain, but triggers nerve fibers to send signals to the brain that the gut is in distress and in pain.
Serotonin (pronounced /ˌsɛrəˈtoʊnən/) is a monoamine neurotransmitter. It is found extensively in the gastrointestinal tract of animals, and about 80 to 90 percent of the human body's total serotonin is located in the enterochromaffin cells in the gut, where it is used to regulate intestinal movements.[1][2] The remainder is synthesized in serotonergic neurons in the central nervous system (CNS) where it has various functions, including the regulation of mood, appetite, sleep, muscle contraction, and some cognitive functions including memory and learning.
http://www.answers.com/topic/serotonin
What Foods Produce Serotonin and how
http://www.nativeremedies.com/articles/what-foods-produce-serotonin-and-how.html
You might notice IBsers can have problems with sleep, appetitie, moods, and in regards to pain and IBS, serotonin signaling to the brain and the mode of action to d, c and d/c IBS.
There is another important cell as well the mast cell. Which can be triggered by foods, stressors, both mental and physical,certain medications, which has also been shown to be very important in IBS.
IF you take a look at this picture, you can see where the ec cells and mast cells are located on the bottom right. They are actually embedded in the wall of the colon. When the colon gets distended from food or other reasons, such as gas, it releases chemnicals. Serotonin then starts gut contractions. This is also one reason why gas bubbles or pockets in the colon themselves can be painful.
http://www.webpotential.com/falcon/uploadibspics3/images/gutreceptors.gif
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My website on IBS is www.ibshealth.com
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So if you have to much serotonin in your system then that could cause D and if you have to little that could cause C? Well I have D but I also seem to be happy one minute and the next just feel blah could that have anything to do with the serotonin? How do you get your levels checked or can you?
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There is no way to check serotonin levels for managing IBS.
There are many different type of serotonin receptors in nerves. IBS problems are more related to the type of nerve receptors that are affected and how they are affected not the level of serotonin. The role of serotonin in the GI tract is very complicated and a simply measuring the levels of serotonin will not give you any insight into managing IBS.
--------------------
STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
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I need to add here to
"He also said, when asked if there is benefit to avoiding dairy, that he doesn't believe in any 'undue' dietary restrictions. I take that to mean he doesn't have any evidence that dairy negatively impacts IBS."
The "undue dietary restrictions", has to do with foods not being the actual "CAUSE" of IBS. Diary can effect some people, via fat for one. But that doesn't mean to cut diary completely out if you don't have too.
Since I have suffered for thirty eight of IBS I wonder what role foods play in IBS. So I asked Dr Douglas Drossman at the UNC Center for Functional GI and Motility disorders and here was his response. This is not a substitute for seeking medical advise from your doctor on any specific conditions you may have, but for educational purposes only.
Dr. Drossman is a Co-director of the Center and Professor of Medicine and Psychiatry at UNC-CH. He established a program of research in functional gastrointestinal disorders at UNC more than 15 years ago and has published more than 250 books, articles, and abstracts relating to epidemiology, psychosocial and quality of life assessment, design of treatment trials, and outcomes research in gastrointestinal disorders.
Dr Drossman's comments on foods for IBS Health.
Shawn,
To say that people with IBS may get symptoms from food intolerances is an acceptable possibility, since the gut will over react to stressors of all types including food (high fat or large volumes of food in particular). Furthermore, there can be specific intolerances. So if you have a lactose intolerance for example, it can exacerbate, or even mimic IBS. Other examples of food substances causing diarrhea would be high consumers of caffeine or alcohol which can stimulate intestinal secretion or with the latter, pull water into the bowel (osmotic diarrhea). The same would be true for overdoing certain poorly absorbed sugars that can cause an osmotic type of diarrhea Sorbitol, found in sugarless gum and sugar substituted foods can also produce such an osmotic diarrhea. Even more naturally, people who consume a large amount of fruits, juices or other processed foods enriched with fructose, can get diarrhea because it is not as easily absorbed by the bowel and goes to the colon where it pulls in water. So if you have IBS, all of these food items would make it worse.
However, it is important to separate factors that worsen IBS (e.g., foods as above, stress, hormonal changes, etc.) from the cause or pathophysiology of IBS. Just like stress doesn't cause IBS, (though it can make it worse), foods must be understood as aggravating rather than etiological in nature.
The cause of IBS is yet to be determined. However, modern research understands IBS as a disorder of increased reactivity of the bowel, visceral hypersensitivity and dysfunction of the brain-gut axis. There are subgroups being defined as well, including post-infectious IBS which can lead to IBS symptoms. Other work using brain imaging shows that the pain regulation center of the brain (cingulate cortex) can be impaired, as well as good evidence for there being abnormalities in motility which can at least in part explain the diarrhea and constipation. So finding a specific "cause" of IBS has grown out of general interest in place of understanding physiological subgroups that may become amenable to more specific treatments. Hope that helps.
Doug
http://www.ibshealth.com/ibsfoods2.htm
http://www.ibshealth.com/ibsfoods.htm
--------------------
My website on IBS is www.ibshealth.com
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As syl was explaining, it is the amount of serotonin as much as the release of it from specific cells. Then there are different receptors, like 5ht 3 and 5ht4.
So its the released by these different receptors of serotonin and how they function. 5ht 3 is related to d and 5ht 4 to c, but they are still looking at other receptors as well.
But not the actual amount in the whole body.
Serotonin in the brain can effect how you feel for sure. The gut can also effect the brain and the brain can effect the gut. There is a very complex and very close relationship to the actual way the digestive system functions between the two.
--------------------
My website on IBS is www.ibshealth.com
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I have been IBS-C for over 20 years now and here's what I have found regarding carbs- When I cut out all of the SF carbs (which I realize are supposed to be the safe ones) I have EXTRAORDINARILY less bloat than with them. It doesn't help with my constipation, but I find the constipation is much more tolerable than the bloat. I am laxative dependent regardless, so I'd just as soon do without the bloat. Once in awhile I do go to a completely SF diet so I can take a laxative break, but I find that I am bloated, tired and miserable even tho I can "go" without much laxative use. No easy answer, but everyone is unique in this battle.
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