Irritable bowel syndrome (IBS) is a common gastrointestinal disorder of gut-brain interaction. Before going on any extreme diets or cutting out major food groups, we spoke to dieticians Emily Innes and Sandi van Zyl about how to implement healthy eating and lifestyle changes to curb those IBS symptoms.
What are the typical IBS triggers?
Some of the known trigger foods include dairy products high in lactose (such as regular cow’s milk), foods containing gluten, onion, garlic, high-sugar foods, some artificial sweeteners, fried foods and those containing a relatively high ratio of fructose to glucose (think apples, pears, mango, watermelon, honey, and raisins).
But… weirdly, some of these foods might not trigger any symptoms in some people and can be included in their diets without any problems
The FODMAPS diet is a dietary approach that helps limit symptoms of IBS through avoidance of some of the known trigger foods. “The idea behind it is that once your symptoms have subsided and your gut has had time to restore itself (which can take up to eight weeks), you slowly reintroduce the foods again to see what amount is tolerated. In the interim, it might be necessary to supplement with B vitamins and calcium if you’re unable to meet your daily requirements for these nutrients.
IBS supplements and their benefits
Research shows that a healthy gut microbiome is essential when it comes to maintaining a healthy, well-functioning gut and overall health. Dietician Sandi van Zyl says a diet rich in fiber and antioxidants and low in protein and saturated (animal) fat appears to be optimal when it comes to promoting a healthy gut microbiome. “Ironically, during active flare-ups of IBS, one often has to reduce the overall fiber content of one’s diet in order to best manage symptoms,” she says.
An alternative option is IBS Supplements…
Some people have found relief from IBS symptoms by taking a mixture of digestive enzymes and probiotics. “This is a strategy that might work to relieve symptoms during active bouts of IBS. The strain and dose of bacteria in the probiotics is important and the general consensus is that strains from the Bifidobacterium and Lactobacillus bacteria are the most favorable and most likely to bring about an improvement,” says Sandi. She continues to say that any supplementation with probiotics needs to be supported with good nutrition in order to ensure that the gut environment is suitable for the optimal growth of the healthy bacteria.
Let’s talk about lifestyle changes…
Dietician Emily Innes says many people want to go on ‘elimination diets’ and cut out many foods in an attempt to manage their symptoms, but it’s not great to jump straight into a restrictive diet. “One should first implement some healthy lifestyle changes. IBS may be affected by certain foods, but note that it’s a condition that can also be impacted by stress, depression, and anxiety,” she says.
Here are few changes you can implement…
- Eat regular meals. Don’t skip meals or leave long gaps between eating. Take time to eat your food and chew it properly.
- Drink at least eight cups of water per day.
- Restrict caffeine intake to three cups of tea or coffee per day and limit alcohol and gassy cool-drink intake.
- Reduce your intake of processed foods.
- If you have diarrhea you should avoid sorbitol, an artificial sweetener found in sugar-free sweets (including chewing gum) and drinks, and in some diabetic and slimming products.
- People with wind and bloating may find it helpful to eat oats (such as oat-based breakfast cereal or porridge) and linseeds (up to one tablespoon per day).
- Don’t eat insoluble fiber (for example, bran); rather get your fiber from soluble fiber, like oats.
- Exercise regularly.
- Make sure you’re getting enough good quality sleep.
- Put stress management strategies in place and seek the help of a mental healthcare professional if you’re struggling with anxiety and/or depression. Set aside some downtime for yourself every day, whether it’s walking the dogs, meditating or reading a book.
Prevention is better than cure
As with most things in life, it’s all about finding the right balance. “Often IBS sufferers can manage their symptoms effectively by managing their portion sizes and the combinations of food they eat. For example, having a bowl of watermelon, apple, raisins, and honey all together might not be the best combination for someone prone to IBS, while having just one apple on its own might be perfectly okay.
Get Your Gut Back On Track!
An estimated 110,000 people consume antibiotics daily in Ireland, between December/March. (Source: Health Protection Surveillance Centre).
We asked Nutritional Therapist Rosanna Davison for her Top Tips to get your gut back on track after an illness.
1. Take time out
Don’t push yourself too quickly. Remember your body needs time to rebuild its reserves and regain strength.
Take more rest than usual. If you need to sleep longer, go to bed earlier.
Cut back on non-essential activities; they can wait until you are feeling 100%.
- Embrace fibre-rich foods full of protective nutrients
Fresh vegetables and fruits are rich in dietary fibre, vitamins and antioxidants. Try eating seven to nine portions over the course of each day. Choose different colours so that you nourish your body with a variety of phytonutrients.
Eat a portion of complete protein at each meal, such as poultry, fish, eggs, beans, pulses or tofu.
Consume essential omega-3 fatty acids daily. Avocados, seeds (flax, chia) and oily fish (mackerel, wild and organic salmon), are naturally rich in anti-inflammatory fats.
- Go ‘fermented’
Fermented foods are rich in ‘friendly’ bacteria. Sauerkraut is simple to make at home or buy kefir or kimchi in your local health store.
- Reduce or eliminate sugary foods
Processed foods often contain refined sugars to enhance taste. Excess refined sugar and processed foods may encourage the growth of ‘unfriendly’ bacteria, so aim to buy and eat fresh food.
If you have a sweet tooth, try eating berries (strawberries, blackberries, blueberries, raspberries). They are rich in antioxidants and naturally low in sugar.
If you need a sweetener, try Stevia which is extracted from plant leaves and doesn’t impact blood sugar levels.
Do vegans need to take supplements?
A varied, wholesome vegan diet provides almost all essential nutrients in sufficient quantities. I hear you shouting ‘Noooo! It provides absolutely everything we need!’ and you may be right, but only if you regularly eat certain fortified foods. The sad truth is that modern food production systems and lifestyles make it more difficult for everyone – vegans or not – to get all they need from diet alone. It doesn’t mean a vegan diet is unnatural or unhealthy, in fact the opposite is true. It means that how we grow, produce and consume food has changed and, with an ever-growing population, the demands on the systems that produce our food are so high that certain nutrients become harder to obtain.
I get a lot of questions about supplements and understand why people are confused. Over the years, I’ve worked on many vegan research projects and as science and population studies reveal ever more data, the guidelines and recommendations change and evolve. Hence, what we were told 10 years ago may no longer be up-to-date and that’s why different opinions arise, depending on where and when we got our information. It’s my job to keep up-to-date, so hopefully I can bring some clarity to the supplement discussion!
So what’s needed? The trio of nutrients to keep a close eye on are vitamin B12, vitamin D and iodine. You may not need to supplement with all these, all year long, but it depends on several factors. Read on…
Vitamin B12 naturally comes from bacteria in the soil and both people and animals would traditionally have got it from eating unwashed plants. However, we not only wash vegetables before we eat them (and for good reasons), but food production is now so sanitised that most vegetables are washed in chlorine, or other sterilising solutions, so there’s not a trace of B12 left.
People are not generally aware that most farmed animals are given B12 supplements and this is how the vitamin eventually ends up in their flesh. So, the argument that meat is a natural source of B12 doesn’t really stack up as meat-eaters essentially consume B12 supplements recycled by the animals that were given them!
It is absolutely necessary that we have a reliable source of vitamin B12 for our bodies. We need it to make red blood cells, for a healthy heart and circulation, and it’s essential for the nervous system. It takes years to develop a B12 deficiency, so on one hand, you don’t need to worry about not having taken B12 for a while. On the other hand, you do need to pay attention, as when symptoms develop, it’s usually serious.
To ensure adequate intake, you should have at least 5µg (micrograms) daily from supplements or fortified foods. The B12 used in both foods and supplements is produced commercially by growing bacterial cultures in large vats – and it’s always suitable for vegans.
There are two forms of B12 in supplements – cyanocobalamin (cheap) and methylcobalamin (expensive). Cyanocobalamin is the stable ‘inactive,’ form of B12 and is used in supplements and to fortify foods and drinks. Once ingested, it’s activated by your body so it can be used. Methylcobalamin is the ‘active’ form of vitamin B12 as it does not require any metabolic reactions to be activated. It costs more and is not so stable.
So which one to choose? Unless you’re a heavy smoker, have kidney failure or any other serious condition affecting your metabolism, cyanocobalamin – the cheap form of B12 – is perfectly fine. Intakes up to 2,000µg a day are safe and you can take either a lower dose daily or a higher dose a couple of times a week.
We need vitamin D for healthy bones, teeth and muscles and it also performs other essential functions in our metabolism. It is produced in the skin when exposed to sunlight and this is the main source of vitamin D for most people. However, if you always use sun-block, cover most of your skin or live in a country, like the UK, where we don’t get enough sunlight over the winter, you need a supplement, whether you’re vegan or not.
The UK Government now recommends that we all take a supplement from October to April and, if you protect your skin ferociously over the sunnier spring and summer months, you should take a supplement all year long. Otherwise, just 20 minutes of sunlight on the face and arms is all that is required by the body to manufacture sufficient vitamin D.
Fortified breakfast cereals, bread, plant milks and vegan margarines can be useful sources if exposure to sunlight is not practicable, but may not be enough. When it comes to supplements, there are two types and your body can use both, but it’s advisable to check the source – vitamin D2 is always vegan, but vitamin D3 can be of animal origin. Many vegan foods are fortified with vitamin D2 and labelled so, but if not specified, especially on cereal products, vitamin D tends to be of animal origin. If you choose to supplement your diet, there’s a range of quality and affordable vegan supplements with vitamin D2. There are also those made from algae or mushrooms that contain D3 and these are recommended if you need a higher dose. When deciding on your dosage, 10µg per day is enough and you shouldn’t go above 25µg.
Iodine has been a hot topic lately, especially with plenty of tabloid ‘experts’ warning that vegans are missing out. This mineral is necessary for thyroid function and helps to regulate how energy is produced and used in the body.
The amount of iodine in plants depends upon the iodine content of the soil in/on which they are grown. The closer to the sea, the more iodine and therefore vegans can get enough from plant foods, but there’s no guarantee. Seaweed, which of course grows in seawater, is always a good source and includes nori, laver, dulse and the kelp family (kombu, arame, wakame). But be warned – kelp absorbs far more than other seaweeds and you can get too much iodine from it. So, while seaweed consumption is encouraged, kelp should be used only sparingly.
It’s best to use a kelp supplement so you know exactly how much iodine you’re taking – it’s cheap, reliable and you don’t have to worry about taking too much. The recommended daily intake is 140µg and intakes up to 500µg are considered safe. In many countries, iodised salt is commonly used to ensure iodine intake, but it’s not the norm in the UK.
The dairy industry has been boasting about the iodine content of cow’s milk. What they don’t tell you is that it’s not a natural component of milk, but comes from iodinated cattle feed, supplements, iodophor medication, iodine-containing sterilisers of milking equipment, teat dips and udder washes. Cow’s milk is neither a natural nor the best source of iodine, so we can happily leave all that dairy out of our diet.
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