Question on insoluble fiber and IBS-C
#356168 - 02/26/10 08:59 AM
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eisaachsen
Reged: 03/20/07
Posts: 21
Loc: northern VA, USA
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I'm IBS-C and I originally tried Heather's IBS diet a few years ago, but it only seemed to make things worse. I'm retrying it again, because nothing else I've tried since then has worked. 
From reading some of the older posts on the subject of fiber and IBS-C, it sounds to me like I need to take as much insoluble fiber as I can but buffer it with even more soluble fiber to reduce the insoluble fiber's "trigger" effects. From what I understand, I need to eventually be taking *alot* more insoluble fiber than someone with IBS-D, because it is the insoluble fiber that gets the colon to move things along more quickly. I often suffer from gas and bloating, so for the soluble fiber supplements I plan to stick to products like Fibercon (calcium polycarbophil) and Citrucel (methylcellulose) and Heather's acacia. My question is, should I rely entirely on my diet to supply the insoluble fiber, or is there an insoluble fiber supplement I could take, of course well buffered by the various soluble fiber supplements I listed, that does not also cause gas and bloating?  I had started to take some psyllium with the acacia, because that has some insoluble fiber, but I am going to stop that because of the gas problem.
It seems like the majority of the info on the web site is geared mainly toward IBS-D types, but, from what I've gleaned from the message boards, the IBS-C's typical diet/supplement program needs alot more tweaking and casting about. Thanks for any advice and insight anyone can provide... 
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IBS-C, gas, bloating
female, age 48
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It is best to rely on your diet for insoluble fiber and take a soluble fiber supplement. It is important to stay away from the insoluble fiber from cereal grain bran and whole grain products in general. You should be able to get all of the insoluble fiber you need from fruits and vegetables particularly if you don't peel them when they are edible with the peel. Although eating peels could worsen symptoms.
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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
Edited by Syl (02/26/10 01:19 PM)
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Hi Syl -
Thanks for your quick reply!
Quote:
It is important to stay away from the insoluble fiber from cereal grains in particularly whole grain products. You should be able to get all of the insoluble fiber you need from fruits and vegetables...
Why is it imperative that one avoid the IF in cereal grains? How is the IF from grains different than that from fruits and vegetables? Or maybe it is just that fruits and vegetables have so many important nutrients (not that cereal grains do *not* have any, just that fruits/veggies have a richer assortment?) that one should add them in before going to the grains?
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IBS-C, gas, bloating
female, age 48
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There have been a number of clinical IBS studies on the use of fiber. One of significant findings is that cereal bran doesn't improve IBS and in fact may exacerbate IBS symptoms. If you feel a piece of wheat bran compared to say an apple skin you will notice it feels different. There are a number of different types of insoluble fiber (e.g. cellulose, lignin, hemicellulose). The insoluble fiber in cereal bran has a different composition the insoluble fiber in many fruits and veggies.
You may find Heather's discussion in one of her newsletters Effect of Bran in Bloated Irritable Bowel Syndrome of interest. There is also a considerable amount of information on Heather's FAQ page. with statements like "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." This page has a good discussion of the problems and precautions you should use when eating insoluble fiber of any kind.
Below are to a couple of clinical IBS studies and the use of cereal bran with links to the abstracts. The first study which was the earliest in 1994 concluded "The results of this study suggest that the use of bran in irritable bowel syndrome should be reconsidered. The study also raises the possibility that excessive consumption of bran in the community may actually be creating patients with irritable bowel syndrome by exacerbating mild, non-complaining cases." The second study shows concluded that "Soluble and insoluble fibres have different effects on global irritable bowel syndrome symptoms. Indeed, in some cases, insoluble fibres may worsen the clinical outcome."
There is a fairly good discussion of soluble and insoluble fiber in the ezine article Soluble versus insoluble fiber and IBS
I hope this helps
References
Francis, C. Y., & Whorwell, P. J. (1994). Bran and irritable bowel syndrome: Time for reappraisal. Lancet, 344(8914), 39
Bijkerk, C. J., Muris, J. W. M., Knottnerus, J. A., Hoes, A. W., & De Wit, N. J. (2004). Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome . Alimentary Pharmacology & Therapeutics
Alimentary Pharmacology & Therapeutics, 19(3), 245-251
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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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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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Thanks for the info. So, like soluble fiber, not all insoluble fiber is created equal. I will stick to the veg/fruit IF, esp. at first as I try to figure out how to feel better.
This leads me to another question relating to IF, SF and IBS-C. With my problems being C, never D, with gas, bloating and pain from all of the above, how long should I stay on the BTC (Break the Cycle) diet where you severely limit IF. From Heather's FAQ:
"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 several weeks after you initially calm down your gut. 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). "
So, on the one hand, it could take weeks for the gut of an IBS-C'er to start responding, but on the other hand you should not use the BTC diet for more than a few days. It sounds like the typical IBS-D knows when to end the strict BTC diet because they usually start feeling better in a few days, but how would the typical IBS-C proceed? I'm just trying to get a picture of what has worked for others in my boat so I can have some place to start. I know my mileage may vary.
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IBS-C, gas, bloating
female, age 48
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Never mind. I found some posts on this subject and also Heather's newsletters from June 7 and 22, 2005.
Thanks anyway.
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IBS-C, gas, bloating
female, age 48
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I've been adding acacia to my diet and trying to follow all of the EFI guidelines. Last two days I have not been able to sleep because of the gas and bloating, plus daytime has been a nightmare too. I'm only just up to 1 tsp acacia 2x/day. Started at 1/2 tsp 2x/day about a week ago. Thinking of dropping all supplements except acacia (or maybe I should change to a different SFS)--I am on Align and Digestive Advantage Gas formula, each 2x/day, 450 mg Ca Citrate, 500 mg Magnesium. I may have precipitated this current attack by adding a Vit C fizzy powder to my banana(SF)/pear (IF) smoothie the other day (yeah, I know, dumb, but I was feeling pretty good and wanted to see if I could tolerate it since I'm fighting a cold). I also take a full dose of Miralax AM and PM, which could also be causing a problem--I've noticed in the past that I cannot take this every day for a long time without a break and I've been taking it for awhile now. I'm starting to lower the doses; wondering if I should just go off it cold turkey, but that could cause other problems, like no BM or hard to pass. I'm wondering about all the wheat I've been eating, too, in the sour dough bread, etc. Maybe I should drop that too. Sigh. Too many variables. My life sucks. I'm in pain all the time and sleep deprived. I've also developed a sciatica thing (totally unrelated to digestive issues, of course) out of the blue which really flares up at night. And I have to go out of town on business the end of next week. Joy.
I just want to feel better. Being able to sleep more than a few hours at a time would be a nice.
Right now I'm trying to make myself eat some lunch. I'm hungry but I don't know what is attacking me so I'm afraid to eat anything.
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IBS-C, gas, bloating
female, age 48
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Something you might consider is that some soluble fiber supplements cause IBS individuals bloating and gas while others don't. This happens because some soluble fibers are more readily fermented by bacteria in the colon than others. You might try a soluble fiber supplement that contains calcium polycarbophil which is suppose to be a non-fermentable soluble fiber supplement. Equalactin and Fibercon as I recall contains this soluble fiber.
Vitamin C fizzy could definitely be a problem.
Something else you might try for a couple of weeks and see if there is an improvement is removing fruits and foods with excess fructose (i.e. contains more fructose than glucose) such as pears, apples, grapes, melons, honey, etc from your diet. Heather has a note on fructose as IBS trigger in this newsletter titled "How can I avoid fructose and sorbitol". There is a fairly good list of foods to avoid in this posting. This problem is known as fructose malabsorption and has been shown to occur in up to 50% of the IBS population. It can cause serious gas, bloating, D and C.
You might also try restricting your consumption of wheat products to about the equivalent of two thin slices of bread per day. Wheat contains fructans which are part of the fructose malabsorption problem too.
Tell us how it goes.
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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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Have you tried digestive enzymes? Amylase, Lipase, cellulase and protease. They will really help your food move through quicker, and relieve your gas and bloating.
NO probiotics, though. Those will constipate you worse.
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FancyMom
IBS-A,Constipation predominant, GERD
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