Unfavorable changes made in dietary habits over the last few decades, in particular diets with a lot of meat and foods low in fibre are being considered as a contributory cause for the development of Irritable Bowel Syndrome. It is indisputable that a suitable diet can positively influence the course and symptoms of this illness. Proper nourishment can, however, be individually quite different; whereas a diet containing foods high in fibre has proven effective for the majority of affected people, others experience success only through a special diet of light food with fermented fibres.
In the following, both nutrition forms are described. You will also be given tips and advice on which foods, for example, are best to stay away from, which can only be enjoyed in moderation and which can, on the other hand, have an alleviating effect. It is important to find out which foods and drinks you can tolerate, and which you cannot tolerate. You should take some time, for one, in reading through this brochure, but mostly in finding a diet that is most suitable for you and if necessary, in individually testing your tolerance for certain foods.
How does our digestion work?
First we will take a look at our insides in order to track the path our food goes along, from the first bite all the way to excretion.
1. Station: Mouth
The food goes through its first changes in the mouth. It is mechanically reduced to small pieces and prepared for further digestion. On top of this, saliva is added. Not only does saliva make the food glide better, but it also contains substances for the first digestive step.
2. Station: Stomach
The food now goes further along the esophagus into the stomach. Everything is stored here until there is again room in the subsequent stations. Not only this, but the mush is further blended and enriched with additional digestive aids in order to "crack" the protein substances and to kill off germs– it is also strongly acidified.
3. Station: small intestine
The food then goes, batch by batch, further into the small intestine, where the bulk of digestion and the intake of released substances are carried out. Protein, carbohydrates, fats, vitamins and minerals are all prepared in such a manner that they can leave the intestine and enter the body fluids, and from there, can get to all the various parts of the body.
4. Station: large intestine
Only that, what could not be used in the small intestine ever reaches the large intestine. This includes dietary fibres, which supply the residents of the large intestine, the intestinal bacteria, with nutrition. The leftovers of the food mush are then concentrated in the large intestine and transported further along. This happens, just as in the small intestine, through the cooperation of both ring and longitudinal muscles. The stool is then collected in the straight intestine, from which it will eventually exit.
Patients with Irritable Bowel Syndrome react more sensitively
The first phase of digestion works normally by patients with Irritable Bowel Syndrome. For this reason, the patients do not often show any signs of illness-related nutritional deficiencies or a lack of nourishment. However, it is assumed that the function of the ring and longitudinal muscles are affected – even when no changes can directly be seen. This musculature likely reacts especially sensitively to (certain) foods and to the collecting of gas and pressure– these changes of the muscle activity can then lead to diarrhea or constipation.
Nutrition suitable for Irritable Bowel Syndrome has the main goal of supporting the bowel in its primary function, while also calming it down to the greatest possible extent by leaving out foods that cannot be tolerated.
To start: general recommendations
There are different tips that are not just for Irritable Bowel Syndrome, but can contribute to helping us better tolerate our meals.
Eat Slowly
A truism? Observe yourself once, and count how many times you chew a bite. Especially when we do something else while eating (watching TV, reading a newspaper, talking), one bite after another disappears into our mouth and, in no time at all, lands in our stomach. Peace while eating, and thoroughly chewing food not only better prepare the food for digestion, but also result in relaxation for body and soul.
Do not swallow too much air unnecessarily
This happens mostly while eating and drinking too quickly, but also when our mouths are too full. Also, try doing without carbonated drinks.
Eat only smaller sized meals
This way the stomach and bowel can function better and are not unnecessarily overloaded. It is best to have three main meals and two snacks in-between.
Drink enough
Alongside with solid foods, the body also needs enough fluids. This is especially true for Irritable Bowel Syndrome patients. If you suffer from frequent constipation, for example, you definitely need a lot of fluids so your intestines can leave more water in the stool (through which it becomes softer). If, on the other hand, you suffer from diarrhea more frequently, you should also drink a lot, due to the loss of liquids through watery stool.
Avoid extremes
A diet by Irritable Bowel Syndrome should be as balanced as possible, not one-sided, and without extremes. In other words: Do not eat too sweet, too salty or too fatty, and avoid strong spices (chili, curry, ground pepper). Drinks with a lot of carbonation, sugar or alcohol are also unsuitable. Also, foods and drinks should have a moderate temperature – neither too hot, nor ice cold. The most important points are summarized again here.
Frequently foods / food preparations that are not tolerated
Fatty foods (also watch out for "hidden" fats – e.g. in meat, sausage, cheese)
Foods that cause gas (cabbage vegetables, legumes, beans, artichokes, nuts, coffee, for more see below)
Hot spices like chili, curry and ground pepper
Certain kinds of fruits (figs, dates, bananas, grapes, raisins, berries)
Foods that are too cold or too hot, as well as carbonated drinks and alcohol
Sweets, especially nougat, marzipan and filled chocolates
Delicacies such as shellfish, champagne and caviar
Products made from wheat flour, especially when they are fresh or undercooked
The most common mistake: not enough dietary fibre
Typical diets in the western world have around 15-20g of dietary fibre per day (around the turn of the century this portion was still in the 80-100g range). A daily intake of at least 30g is recommended.
Fibres are indigestible nutritional substrates with different structures and compositions. Since some have fibrous structures, they are also called plant fibre, nutritional fibre or fibrous materials.
The most important dietary fibres are cellulose, semicelluloses, pentosans and pectins. Fibres that are taken in while eating swell up with the absorption of water and by doing so, increase the contents of the bowel (the volume of the stool) and achieve a stimulation of the bowel motor function and a shorter transit time (the time a piece of food needs from intake to defecation). Fibres have even more advantages than this: they bind bile acids, cholesterol, as well as contaminates and have a positive influence on intestinal bacteria.
Fibres can only be found in foods made from plants. Cereals and seed products (oats, corn, spelt, barley, sesame, pumpkin seeds, sunflower seeds, flax seeds, natural rice), vegetables such as lettuce, celery, carrots, legumes, cabbage, asparagus and also raw fruits like apples, pears and plums are all foods that are high in fibre. Moving your diet away from meat and sausage, and more to fruits and vegetables automatically brings with it a higher intake of fibre.
The following table lists examples of foods and their contained amounts of dietary fibre.
Amount of Dietary Fibre in Selected Foods (in g)
Apple
3
Almonds
10
Artichoke
11
Banana
3
Beans, peas
17
Broccoli, fennel
3
Butter
-
Carrots
3
Celery
4
Cheese
-
Corn
4
Eggs
-
Fish
-
Flax seed
35
Green cabbage
4
Hazelnuts
7
Kiwi
4
Meat, meat products
-
Milk, dairy products
-
Muesli with fruits
6
Oatmeal
10
Oil
-
Orange, mandarine
2
Rice, natural
3
Rice, peeled (raw)
1
Sausage
-
Soy beans
12
Sunflower seeds
6
Tea, coffee
-
Vegetable fat
-
Whole wheat bread or rolls
8
Wheat bran
48
Wheat flour (Type 405)
4
Wheat flour (Type 1700)
13
Only slowly increase the amount of fibre consumed
For most patients, the symptoms improve with the daily intake of at least 30g of fibre. Increasing the fibre portion, however, should be done carefully. If you have not eaten a lot of vegetable foods up until now, you should only slowly increase your fibre intake. Very important: drink enough!
Fibre swells up in the intestine, which means that it absorbs and binds water. Therefore, enough water has to be available, and for this reason, if possible, always drink something when eating foods that are high in fibre.
For example: You normally have a dietary fibre intake of 15g each day. This amount comes together e.g., when you eat 2 light rolls in the morning, 1 apple in between, meat with 2 potatoes and 2 spoonfuls of vegetables at midday, 1 piece of cake with coffee during the afternoon and in the evening, 2 slices of mixed wheat bread with butter and cold cuts.
You can increase the daily amount of fibre in the first week by approximately 5g. You can reach this by choosing whole wheat rolls instead of white rolls. This continues: in the second week, whole wheat bread in the evening, in the third week, a smaller portion of meat and as a replacement, 2 additional potatoes (or whole grain rice, whole grain pasta) and 2 more spoons of vegetables, and in the fourth week, a small mixed salad (green salad and cucumber) along with your evening meal – then you have done it, and have reached the 30 g of fibre needed everyday!
If, in the meantime, you get the feeling that the changes in your diet needs some getting used to, just wait a little longer before increasing the amount of fibre in your diet. There is no need to rush, since this will not do your bowel any good either.
The following is an overview of how you can change your diet.
Exchanging low in fibre foods for foods high in fibre
Unfortunately, many foods that are plant based can lead to increased flatulence, something that many irritable bowel patients find very agonizing.
If this applies to you, it is best to first test and see which foods you can tolerate.
At least in the beginning, go without foods that cause gas, such as artichokes, berries, beans, figs, yeast, cabbage vegetables, stone-fruits and nuts. Start off with a limited selection of „fibre carriers“, e.g. whole wheat bread, potatoes, whole grain rice and green salad.
Be careful, however: an increased amount of gas can result just by switching brown bread and wheat bread.
When you can tolerate these „fibre carriers“, you can add food after food: only one or two kinds, then wait and see if you can tolerate them or not. If it does not agree with you, continue to leave one out. If it does not cause you any trouble, you can try the next one. As you can see, this method is a little tedious and time consuming, but you will be successful in creating a personal list of ingredients and tolerable foods.
Another little tip: cereal products (especially bread) provide an important source of suppliers of dietary fibres (and of course vitamins and minerals).
However, they are usually most tolerable when they are not eaten fresh. Make sure, in a timely manner, that you always have enough (stored) bread in reserve.
What can be done when high-in-fibre foods cannot be tolerated?
As mentioned already in the beginning, there are patients with Irritable Bowel Syndrome that cannot tolerate any fibres, and for this reason, a diet low in fermentable fibre can be alleviating.
Even when the amount of fibre is slowly increased, but you still have the impression that it cannot be digested, test to see if a diet low in fermentable fibre can be better tolerated (all other recommendations – except for the intake of fibre – also apply, of course!)
In the case of strong discomfort, it can be useful to first switch to simple meals e.g. rice soup, lukewarm unsweetened tea, zwieback etc. When improvement is seen, you can also – as described earlier – try out food after food and test whether or not you can tolerate them. Since a diet high in fibre is fundamentally better for the whole organism than a diet low in fibre, you should still test and see if you can tolerate certain vegetables, fruit and types of cereals from time to time, and find which are suitable for you.
Many herbs and spices can alleviate
Besides problematic foods, there is also a series of ingredients that can be beneficial. This group includes spices such as caraway, fennel, anise, cloves, bay leaves, juniper, garlic, cilantro, thyme and sage. On top of this, teas made with antispasmodic ingredients such as caraway, peppermint, chamomile, lavender or fennel can have an alleviating effect.
When other intolerances also come into the picture By some patients of Irritable Bowel Syndrome, other intolerances or allergies have to be considered. The following list contains foods that most frequently have an allergy triggering effect. If you suspect that you might have an allergy, it is best to ask your doctor.
A limited tolerance of milk can also be a factor in some of the cases of affected people.
Important: Before „Irritable Bowel Syndrome“ is diagnosed, a lactose intolerance should first be ruled out as the case of your complaints.
By lactose intolerance, the enzyme (the excipient) for the division of lactose, which normally happens in the small intestine, is not very active. However, this breaking down is necessary so that the components of sugar can be absorbed. If the lactose is not completely divided, some of it remains in the leftover mush of saliva and can enter into the large intestine. Then, it is taken apart here by the intestinal bacteria, which can cause a large build-up of gas or even severe diarrhea.
If lactose intolerance is present, you should go without milk and dairy products for the time being.
Certain fermented milk products, as well as some types of cheese, however, can usually be tolerated (and they are important for sufficient calcium supply!).
Also true here: the best thing to do is to test this yourself.
It is possible for Irritable Bowel Syndrome and lactose intolerance to both be present at the same time. Thus, it is possible for the symptoms to continue even after having stopped the intake of dairy products. In this case it makes sense to search for more intolerances and/or begin medical treatment.
Gluten intolerance
By a gluten intolerance (celiac disease, Coeliac condition) the small intestine reacts overly sensitive to gluten in certain kinds of cereals (wheat, oats, rye, barley, unripe spelt grains). Here, it can come to serious changes and injuries of the mucous membrane of the small intestine – through flatulence, abdominal pain and diarrhea (mostly with elevated levels of fatty contents). This illness can in some cases also accompany an Irritable Bowel Syndrome. When in doubt, ask your doctor.
Helpful hints and tips for patients with Irritable Bowel Syndrome
Although it is one of the most frequent illnesses of the gastrointestinal tract, Irritable Bowel Syndrome is one of the least researched illnesses of the civilized world. This, among other things, could be due to the fact that Irritable Bowel Syndrome imitates many other illnesses. Because of this, these have to first be ruled out in order to be able to diagnose Irritable Bowel Syndrome. The various appearances of this illness make identifying it a very long and drawn-out process. The same goes for the treatment.
The Deutsche Reizdarmhilfe e. V. is the lobby for affected patients and their families. They help with Irritable Bowel Syndrome through their office by providing information about how to deal with this illness, as well as the treatment options.
You can get more information and advice from:
Deutsche Reizdarmhilfe e. V.
Mörikeweg 2
D-31303 Burgdorf
Germany
Fon (00 49) 51 36/ 89 61 06
Fax (00 49) 51 36/ 87 36 62
e-Mail:Reizdarm@aol.de
