What helps in D-IBS?
#364690 - 05/11/11 10:22 AM
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boron
Reged: 05/11/11
Posts: 47
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I'm writing an article about nutrients and I'm dealing with fiber now. Can anyone diagnosed with D-IBS say if taking or avoiding any food/supplement has helped him/her?
I've read that avoiding insoluble fiber and taking partly hydrolyzed guar gum (PHGG) may help.
I would also appreciate any link about diet in D-IBS from a reliable site (evidence based).
I'm asking about specific nutrients (fibers) that may help, not only foods.
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I don't have IBS.
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You may find some useful information in the following references:
Brandt, L. J. et al. An Evidence-Based Systematic Review on the Management of Irritable Bowel Syndrome - American College of Gastroenterology Task Force on IBS . The American Journal of Gastroenterology 104 (2009).
Spiller, R. et al. Guidelines on the irritable bowel syndrome: mechanisms and practical management. Gut 56, 1770-1798 (2007).
John Hopkins Gastroenterology and Hepatology article on IBS
Sanjeevu, A. & Kirby, D. The Role of Food and Dietary Intervention in the Irritable Bowel Syndrome . Partical Gastroenterology, 33 (2008).
Tan, K. Y. & Seow-Choen, F. Fiber and colorectal diseases: Separating fact from fiction . World Journal of Gastroenterology 13, 4161-4167 (2007)
International Foundation for Functional Gastrointestinal Disorders IBS Diet
If you have access to a University library I might be able to provide you with some other sources too.
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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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Thanks.
I've got impression authors of the articles think adding fiber to meals is not effective much. Do you have any positive personal experience with any fiber-rich food or fiber supplement?
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I don't have IBS.
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I believe both the US and UK guidelines for managing IBS (first two references) suggest soluble fiber is moderately effective while insoluble fiber can make things worse.
Personally, I find insoluble fiber and insoluble fiber supplements particularly from cereal grains such as bran produces D even in small amounts. Psyllium which is 67% soluble and 33% insoluble fiber produces D too. I find soluble fiber and soluble fiber supplements reduce the speed of gastric emptying as reported in the literature and they reduce D symptoms. However, some rapidly fermenting soluble fibers, particularly those in the FODMAP class, such as inulin and FOS cause serious D too. Soluble and functional fibers that act as soluble fibers (such as resistant starches) that ferment at a moderate or slow rate don't seem to have any negative effects.
Who are you writing your article for?
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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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You are giving psyllium a bad rap here. It is allowed on the fodmaps diet. I have seen posts by you saying you used it for years with no problems. I find that it produces solid stools (pseudo-d) and less urgency. Acacia, Benefiber, and possibly others give me loose stools with sometimes incontinence and increased urgency.
Cheers
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ibs-d (pseudo)with pain and bloating
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I used psyllium for a couple of years with no problems about 25 years ago before my IBS took a turn for the worse about 12 years ago. I gave it a try again about 8 years ago it and it gave me loads of problems so I discontinued it. At the moment I don't use any SF supplements.
The FODMAP diet allows lots of things that are restricted by the EFI diet and other dietary approaches. Also, the FODMAP approach makes no mention of known GI triggers such as caffeine, alcohol, fat, insoluble fiber, etc. In one of the research articles on FODMAPs the authors state that management of these triggers are left to the GP or dietitian to guide the patient.
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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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Psyllium is not a magic bullet, that's for sure. It certainly does not solve all my problems such as bloating and pain. But I have not found anything that does - on this board or anyplace else. I have seen you defend psyllium on this board within the past 1 or 2 years (much less than 8 years ago). There is an article in the library here posted by Heather where the title was changed to something like "psyllium causes bloating" from "fiber causes bloating" and you said you pointed this out to Heather and to me.
The other supplement I rely on is Heather's peppermint oil which reduces the pain for me significantly,
Cheers
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ibs-d (pseudo)with pain and bloating
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Indeed I have. Many people like yourself can tolerate psyllium I would guess primarily because it contains more SF than IF. On the other hand others cannot handle it at all.  Also the US and UK guidelines (first two references in previous posting) say clinical trials show it is useful for some people.
Yes - the posting concerned this abstract where in the title the word "fiber" is replaced with "psyllium" and throughout the text the word "pysllium" has been placed before the word "fiber". This posting had to do with the ethics of changing the wording of an abstract from its original form and the fact that many SF supplements can cause gas/bloating.
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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-d (pseudo)with pain and bloating
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I will either publish my article on my (new) blog or sell it. I'm trying to collect all important issues (effectiveness, side effects, food sources...) of all main nutrients.
Syl, does any particular food high in soluble fiber help you?
I've also read about some (few) bad reactions to psyllium. As you all probably know, IBS-D is not "one particular disorder" so reactions may differ from person to person.
EDIT: Green plantain is high in insoluble, not soluble fiber
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I don't have IBS.
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Ah - ha! Interesting. Maybe some one will buy it.
I will respond more completely to your question shortly. Are you familiar with functional fibers such as resistant starches that act like soluble fiber? Their amounts are not reported on food labels or given in most food databases. You can read more about them here. Their consideration is key to my response
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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 am one of those that would never again use psyllium  My doctor suggested it and I used it for several months, trying desperately to have it work. It did bulk up my IBS-D, however, the terrible gas pains were not worth it. I agree with Syl that inulin (FOS) is also very problematic. The only thing I can use is Citrucel and I only use a small amount (about half of what the dose says). Otherwise basically, try to follow Heather's diet and that helps alot.
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IBS-D. Eating gluten and dairy free.
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Quote:
Are you familiar with functional fibers such as resistant starches that act like soluble fiber?. Their consideration is key to my response
Yes, I have something about resistant starches.
Here's a long, detailed article:
http://onlinelibrary.wiley.com/doi/10.1111/j.1541-4337.2006.tb00076.x/pdf
One study has shown that adding resistant starches to oral rehydration solution can shorten the duration of diarrhea in children:
http://www.ncbi.nlm.nih.gov/pubmed/16641573
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I don't have IBS.
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For me, a diet restricting sugar, yeast, and limiting grains helps with my symptoms. Actually, I try to limit any processed foods with additives.Whole and natural works best for me.
http://www.ncbi.nlm.nih.gov/pubmed?term=ibs-d%20very%20low%20carbohydrate%20diet
http://www.ncbi.nlm.nih.gov/pubmed/15647635
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Glad to hear a low sugar, yeast and grains diet helps. It could be the FODMAPs in the grains that maybe partly causing symptoms.
In discussion with Dr. Drossman one of the key authors of the first paper, he said he did not recommend this diet for anyone unless they are under the supervision of a doctor. The reason he gave was that the carbohydrate restriction (<20 g/day) is severe and not particularly healthy. In addition the study was done on a very small number of subjects (13).
Regarding the second study and Candida. In 1992 (see reference below) it was conclusively shown that "C. albicans is not involved in the aetiology of the irritable bowel syndrome." A follow-up letter to the editor of said "Middleton and colleagues' are to be congratulated in demonstrating that there is no conclusive link between overgrowth of intestinal Candida albicans and the symptomatology of irritable bowel syndrome (IBS). Sadly, I suspect that the popular health magazines and alternative practitioners who persuade patients that these symptoms are directly linked to the pseudoscience of 'leaky bowels' and candida toxins' are unlikely to alter their views."
Reference
Middleton, S. J., Coley, A. & Hunter, J. O. The Role of Fecal Candida-Albicans in the Pathogenesis of Food-Intolerant Irritable-Bowel-Syndrome Postgraduate Medical Journal 68, 453-454 (1992).
Shepherd, C. The Role of Candida-Albicans in the Pathogenesis of Food-Intolerant Irritable-Bowel-Syndrome. . Postgraduate Medical Journal 69, 80-80 (1993).
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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 have that article. It is an excellent reference.
I don't use any particular soluble fiber foods. My strategy is to eliminate as much insoluble fiber from bran and veggies/fruit skins and peels as possible. I stick with foods that have a fair amount of soluble and functional fiber. I try to make sure that foods that do contain some insoluble fiber such as white rice and flour that I offset it with roughly an equal amount of soluble and functional fiber. For example, I add glutenous rice to Basmiti rice to increase the resistant starch so that the total functional and soluble fiber is greater than insoluble fiber.
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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 experimented with cooked and cooled rice, potatoes or pasta? One type of resistant starch is formed this way.
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I don't have IBS.
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Yes - I have. Generally speaking when I make a food that contains resistant starch I cool it and then general reheat it until it is just warm to keep as much of it as possible.
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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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what kind of fiber/supplement do you take with psyllium? i'd like to try something other than acacia..thanks...
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I cut out all wholegrains except for oatmeal and occasionally quinoa and eat veggies peeled and well cooked and only v few raw fruits occasionally, that comply with FODMAP guidelines and are not too high on the glycemic load scale either.
http://huhs.harvard.edu/assets/File/OurServices/Service_Nutrition_Fiber.pdf
is something quite helpful and
I use Benefiber (from the UK, ie without inulin) to balance out IF in all those foods, usually dissolved in tap water, drink before the meal but sometimes also put into veggie soups. I try to ensure that I have around equal amount of SF and IF. I don't have D as a result. (Too much IF causes me D, with BM-frequency in excess of 3 per day on average.)
'Benefiber is a convenient, 100% soluble fibre supplement. It's made from wheat dextrin'
http://www.benefiber.co.uk/facts.html
I tried psyllium beforehand too, helped me as well, gave me more solid stools but there was a lot more urgency. Moreover, I now don't take Benefiber in one go but spread it out through the day. I don't see the point of taking a SFS that has IF in it as I'd rather get all the IF from a nutritious and delicious fruit/veggie than a supplement. Most difficult part for me regarding IBS was the fact that I now have to restrict vegetable/fruit intake. I am really health conscious.
SFS in general is a godsend.
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now: stable through EFI+FODMAP dieting (no lactose/no fructose/some fructans and some polyols)
before: IBS-D(pseudo-diarrhoea), bloating, often unbearable pain esp from too much fat: Apr 2007- Dec 2010
FODMAPs: http://www.todaysdietitian.com/newarchives/072710p30.shtml
[I've tried VSL#3 -> I could tolerate v good amounts of IF (even with less SF), it worked great (but overall I find it too expensive)]
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Psyllium is a fiber supplement (e.g. Metamucil) compose of 67% soluble fiber and 33% insoluble fiber
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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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