Diet for IBS

Diet for irritable colon

Irritable bowel syndrome (IBS) affects 11% of the world’s population and is one of the most frequent reasons for digestive consultations. Patients summarize it as “even though I have nothing, everything feels bad and I don’t know what to eat anymore”.

IBS is characterized by:

the presence of recurrent abdominal pain,
change in bowel habits (in the form of constipation, diarrhea or both);
is often accompanied by bloating and abdominal distention.
The term “functional” is incorrectly used to describe a disorder without a known cause, making IBS sufferers appear well with a fictional illness.

This is why the 2017 Rome IV medical criteria classify IBS as a gut-brain communication disorder.

Unlike pain when you break a leg or inflammatory pain linked to ulcerative colitis or Crohn’s disease, long-term abdominal pain in a person with IBS is not always easy to identify.

Some of the factors that may support a diagnosis of IBS are:

Young age (< 50 years) and female gender.
Stress-related, gastroenteritis-related, or intestinal flora-related digestive issues. .
Variable stool pattern (change in stool consistency throughout the week).
Coexistence of other extradigestive disorders (fibromyalgia, chronic fatigue syndrome or autoimmune disease, among others).

Lack of symptoms and warning signs (if present, the doctor must rule out organic disease): recent beginning, fever, anemia, unintended weight loss, blood in stool not related to hemorrhoids or fissures, and family or personal history of colon cancer, inflammatory bowel disease, or celiac disease.

Interruptions in brain-intestine connection might cause IBS symptoms.

Today, irritable bowel illness cannot be cured, but it can be managed with diet, medication, and behavioral therapy with a psychologist.

Good and Bad Foods for Irritable Bowel: Low FODMAP Diet

IBS persistent stomach pain is linked to food. In fact, up to 84% of IBS patients have reported that digestive symptoms worsen with food intake.

Foods that tend to worsen digestive symptoms include dairy, legumes, vegetables, fruits, fermented foods and beverages (aged cheese, red wine), and fried and high-fat foods.

Before trying a restrictive diet for IBS, follow the UK National Institute for Health and Clinical Excellence and World Gastroenterology Organization’s advice:

Spread meals fractionally throughout the day (5 or 6 meals) and take as much time as you need to eat.
Avoid skipping meals or long fasts between meals.
Drink at least 8 glasses of liquid throughout the day, especially water or other non-caffeinated beverages such as Rooibos or berries infusions.

Restrict tea and coffee to 3 cups per day.

Reduce the intake of alcoholic and carbonated beverages.
Avoid spicy foods, fried and grilled foods and foods with a high fat content.
If you have diarrhea-predominant IBS, avoid light products with sweeteners such as sorbitol that have a laxative effect.

Assess your individual tolerance to high-fiber foods. While some people may find it helpful to limit intake of high-fiber foods to reduce IBS symptoms and improve stool frequency and consistency, some people can tolerate food sources of soluble fiber (such as Psyllium and flaxseed).

In general, people with IBS tend to tolerate soluble fiber (found in foods such as carrots, apples, oats and quince) better than insoluble fiber (found in whole grains and vegetables, among others). Here the practical advice is to adjust your fiber intake according to your symptoms.
If you have gas and bloating it may be useful to incorporate oats and flax seeds, starting with low doses and gradually increasing your intake.

In IBS patients, galacto- and fructo-oligosaccharides at 3.5-7 g/day reduce gas and bloating.
To avoid digestive problems like flatulence, introduce them gradually.

Several studies identified gut-soothing second-generation prebiotics such apple pectin and partially hydrolyzed guar gum.

The World Gastroenterology Organization

Although the low FODMAPs diet has become very fashionable for treating IBS, a clinical trial has shown that it is just as effective in reducing symptoms as the traditional recommendations of the UK’s National Institute for Health and Clinical Excellence that I mentioned above.

In addition, the low FODMAPs diet limits your gut flora’s favorite foods (fruits, vegetables and legumes) and leaves both it and you unprotected, because being such a strict diet it is not free from nutritional deficits.

The main negative effects of the low FODMAPs diet are:

The restrictive stage reduces the abundance of beneficial bacterial species of the intestinal flora, such as bifidobacteria.

Start with a high-dose live bifidobacteria probiotic and avoid the initial stage.

A dietitian-nutritionist must supervise the low FODMAPs diet to avoid fiber, iron, and calcium shortages.

It entails reading food labels and eating low-nutrition, low-FODMAP packaged foods.

20–50% of patients will not improve on a low FODMAP diet.
The low FODMAPs diet’s severe fiber restriction also harms constipated IBS patients.

As shown, the reduced FODMAPs diet has pros and cons for IBS.
For this reason, it typically makes more sense to follow traditional dietary guidelines that do not eliminate entire food groups and to maintain a soluble fiber intake adapted to individual tolerance, starting low and increasing to 20-30 g/day.

The low FODMAPs diet, lactose-free, and gluten-free diets help IBS digestive problems.

Lactose and irritable bowel

IBS patients are more sensitive to lactose ingestion and have more severe digestive symptoms, therefore they have more lactose intolerance than healthy persons.
These findings imply that avoiding lactose may help IBS symptoms.

If dairy symptoms or lactose malabsorption are present, lactose exclusion is advised.
Start with a comprehensive lactose-free diet and check improvement after 4-8 weeks.

After lactose is tolerated, the normal diet can be resumed.

Lactose-containing foods include cow’s and other mammalian milk, butter, fresh cheeses, cream, cream, purees, béchamel sauces, sliced bread, ice cream and fruit smoothies.

Gluten and irritable colon

If a gluten-free diet improves IBS, gluten-related illnesses should be checked out.
Before eliminating gluten from the diet, check for celiac disease using Professor Carlo Catassi’s novel Protocol for Early Diagnosis of Celiac Disease (4 of 5 criteria or 3 of 4 without a genetic test):

Compatible symptoms:

include digestive symptoms (diarrhea, recurring abdominal discomfort, heavy digestions, etc.) and atypical or extra-digestive symptoms including overweight, chronic weariness, anemia, bone and joint pain, and neurological symptoms. Sometimes celiac disease is asymptomatic.Celiac disease can occur even without normal symptoms.

Anti-transglutaminase, anti-endomysial, and anti-gliadin deamidated peptide blood tests: if high, gastroscopy with duodenal biopsies. . In most adults with long-standing celiac disease, antibodies are usually negative. The only way to rule out or confirm celiac disease is by biopsy.

Duodenal biopsy shows gluten-induced intestinal damage.
Dilated crypts and an intraepithelial lymphocyte count greater than 25 per 100 enterocytes indicate celiac disease. In the presence of clinical and serological findings suggestive of celiac disease, intestinal biopsy confirms

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