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Practical Nutrition: Coping with irritable bowel syndrome

One of my clients avoided bananas, while another shunned tuna salad. Still others wouldn’t go near tossed salads, sausage biscuits, fried foods or orange juice. These foods seem to have nothing in common, but were eliminated from the diet because they triggered symptoms of irritable bowel syndrome.

At least one out of 10 Americans suffers from IBS, and it might be as high as one in five. Women are more likely than men to have it, but IBS occurs in men, too. It can surface anytime between the ages of the early 20s to the late 40s.

IBS is a disorder that changes how the large intestine functions, but it doesn’t damage the intestine or lead to other diseases.

It’s not celiac disease (gluten intolerance), Crohn’s disease, ulcerative colitis or colon cancer; these diseases damage the intestines. Because some IBS symptoms may be similar, those diseases should be ruled out by your doctor.

Symptoms include bloating, abdominal pain, cramping, gas, constipation and/or diarrhea, and mucus in the stool. They can be mild to severe, and often come and go. Some people experience discomfort all the time.

IBS affects quality of life because it can interrupt daily routines and limit activities. Sometimes the pain is temporarily disabling.

It’s unclear why people develop IBS. It could be because of a family history of IBS, or it could result from a bacterial infection.

Problems in the intestine may be the culprit. The nerves may be more sensitive, causing gas and stools to be painful. If the intestine contracts too fast or too slowly, diarrhea and constipation worsen. It could be a miscommunication between the nerves in the intestine and the brain, causing irritability.

Stress and anxiety don’t cause IBS, but they can worsen symptoms.

The treatment of IBS is highly individual and might include changes in eating habits, use of probiotics, counseling to decrease stress, and medications, if prescribed by your doctor.

Keeping a food diary is the first step to controlling the symptoms. Record what you eat, any symptoms and when they occur. Note what foods make you feel better, or worse, and eat accordingly.

Sometimes large portions aren’t well-tolerated, so aim for five to six smaller meals each day.

Gradually increasing fiber daily might help control constipation. Select whole grains and high-fiber foods, including fresh fruits and vegetables.

Increasing soluble fiber found in applesauce and oatmeal, along with bulking agents, such as psyllium (Metamucil), might help diarrhea.

Include six to eight daily cups of water along with other beverages to help digestion.

Different foods can be specific triggers for people with IBS. See the accompanying list for foods to avoid and those better tolerated.

Nutrition help for IBS

There seems to be no rhyme or reason as to why one person with IBS tolerates a certain food, but another suffers when eating the same food.

Keep track of the foods you tolerate and problematic ones; it can help your doctor plan your treatment. Also, working with a registered dietitian can help you determine the best foods to eat. These foods are potential triggers for IBS.

Dairy products

Dairy might not be tolerated because of fat or lactose content. If you’re lactose-intolerant, use lactose-free milk, cheese and dairy products. If you tolerate lactose, use skim, 1 percent or 2 percent milk and low-fat dairy products. Avoid heavy cream and rich cheeses.

Fatty foods

Avoid rich, heavy meals. Use lean cuts of meat and poultry, avoiding highly marbled meats and chicken skin. Choose lean deli meats and avoid luncheon meats, bologna, hot dogs, bacon and sausage. Bake, broil, roast and grill your foods instead of frying them.

Gassy foods

Eat any vegetables you tolerate for their fiber. However, these vegetables can cause gas and might need to be limited or avoided: broccoli, Brussels sprouts, cabbage, cauliflower, corn, dried beans and peas, leeks and onions.

Sugar alcohols

Sorbitol is a sweetener used in many products because it doesn’t promote tooth decay, or raise blood sugars of people with diabetes. However, large amounts of sorbitol can cause gas, diarrhea and bloating. Avoid it! You’ll find it in sugarless gum and candies, toothpaste, lower-sugar granola and meal-replacement bars, and some low-calorie desserts and candies.

Beverages

Alcohol might stimulate or irritate your intestines, so avoid it as much as possible.

Sodas and carbonated beverages might produce gas and cause bloating.

Coffee, tea, hot chocolate and chocolate in general contain caffeine, which stimulates the intestines and can worsen diarrhea. Caffeine-free versions are usually tolera

Mary-Jo Sawyer is a registered dietitian with VCU Medical Cente
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