Foods to Soothe Digestive Woes
Approximately 35 million Americans are afflicted with irritable bowel syndrome (IBS), marked by chronic abdominal pain, diarrhea and/or constipation, and often nausea, bloating and excess gas, too. IBS is the most common gut condition diagnosed by gastroenterologists (specialists in digestive tract diseases). There isn’t a test for IBS per se, but tests can help rule out other causes.
“There are a whole host of possible reasons for ongoing digestive symptoms, so the first step is to consult your primary care physician, who may refer you to a gastroenterologist, if appropriate,” says Alicia Romano, MS, RD, at Frances Stern Nutrition Center at Tufts Medical Center. “Although less straightforward than some digestive issues, IBS isn’t something you just have to live with, and newer research suggests strategic dietary changes can help.”
Standard Diet Approach: About 75% of IBS sufferers report that what they eat affects their symptoms. Traditionally, the dietary advice for IBS has been to adhere to a regular meal pattern, avoid large meals, reduce intake of fatty, spicy and gas-producing foods, and limit caffeine, carbonated beverages and alcohol. That’s a good starting point, but some people need an individualized approach.
Romano encourages people to keep a careful food, beverage and symptom log. “That can help identify patterns and is a useful tool to share with a registered dietitian,” she says. The log may reveal that certain foods and/or beverages, amounts or combinations are more commonly associated with your symptoms.
Fermentable Carbs: A major category of foods that may provoke digestive symptoms are those containing FODMAPs, an acronym coined by researchers at Monash University in Australia. It stands for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides And Polyols. These are short chains of poorly absorbed, fermentable carbohydrates (mainly certain sugars and fibers). Two FODMAPs you’re likely familiar with are lactose (in milk), and fructose (in fruits, vegetables and sweeteners).
Romano explains that FODMAPs can cause digestive symptoms because a person lacks or doesn’t have enough of the enzymes needed to break down the carbohydrate (such as lactase needed to digest lactose) or because the digested carbohydrate is absorbed too slowly across the gut wall (such as fructose, specifically when it’s present in greater amounts than glucose in a food).
The FODMAPs attract excess water into the gut and are fermented quickly by bacteria in the large intestine. Bloating, gas, abdominal pain and diarrhea or other changes in bowel movements may result. Individual sensitivity can be significant.
Testing Low-FODMAP: A growing number of studies support a low-FODMAP approach for improving IBS symptoms, and gastroenterologists are more commonly recommending the diet. Recently, a clinical trial conducted through the University of Michigan Health System and involving 84 US adults with IBS (with diarrhea) showed that 51% of those following a dietitian-taught low FODMAP diet for 4 weeks had significant improvement in abdominal pain, versus 23% in the control group, which was instructed by a dietitian to eat small frequent meals, avoid known trigger foods and limit alcohol and caffeine. The low-FODMAP group also had significantly greater improvement in bloating compared to the control group.
Despite this, about 40 to 50% of participants in both groups reported what they deemed to be “adequate relief” of overall IBS symptoms. That assessment also considered stool consistency and urgency, which both groups did experience significant improvement in compared to the study start (although not as much so on the control diet as the low-FODMAP diet). The study was published in the American Journal of Gastroenterology.
Trying Low FODMAP: “A low FODMAP diet is implemented in two stages,” Romano says. “Step one is eliminating all high-FODMAP foods for a short period, typically 6 to 8 weeks, during which time we’re looking for a significant improvement in symptoms. Then we reintroduce each type of FODMAP in a systematic way to find out what a person can tolerate.” You may find that only certain types of FODMAPs bother you. You also may find you can handle small amounts of one or two higher FODMAP foods in the context of an otherwise low FODMAP meal since the effects are additive. The goal is to expand the diet as much as possible without causing symptoms.
The FODMAP elimination diet isn’t for everyone with IBS, but for those who have tried many approaches without relief, it can be a good option, Romano says. First, see your doctor for evaluation of your digestive concerns; if appropriate, you may be referred for diet instruction.
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