Eating a healthful diet, exercising, weight control, adequate sleep and stress management are the foundations of good health. Both dietary alterations and exercise have been shown to be of benefit in the management of IBS. Working with a registered dietitian skilled in the dietary management of IBS is usually advised.
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IBS and Eating
Patients with IBS commonly associate their symptoms with eating a meal. Research shows that the vast majority of patients with IBS restrict their diets to improve or prevent symptoms. True food allergies are uncommon in IBS. By contrast, food intolerances or sensitivities are frequently reported.
A healthy diet is a foundation of healthy living and weight control. Furthermore, dietary intervention is now considered to be a component in the primary management of IBS. It is important to include a registered dietitian who is knowledgeable in the dietary treatment of IBS in the patient’s health care team. Three such dietitians provide helpful patient education through their Internet sites and publications: Patsy Catsos (http://www.ibsfree.net/), Kate Scarlata (http://www.katescarlata.com/) and Paula Gallagher (http://thegutsyrd.squarespace.com/).[MR1]
Dietary Intervention in IBS
There is scientific evidence that supports diets for IBS patients that are gluten-free and low in fermentable carbohydrates, including oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs). Lactose restriction can also be beneficial.
Gluten is the protein constituent of wheat, barley and rye. When those with celiac disease ingest gluten, the body reacts with an immune response that ultimately damages the small intestine. Even for IBS patients without celiac disease or a true gluten allergy, symptoms of diarrhea and bloating can improve or resolve on a gluten-free diet. It is not yet clear whether the potential benefit is related to gluten, fructans or other proteins that could be causing symptoms in IBS patients. A “nocebo” response to gluten can also occur, reinforced by widespread negative media reports, which can contribute to perceived adverse effects of eating gluten-containing foods.
Short-chain, poorly absorbed, highly fermentable carbohydrates are collectively known as FODMAPs, which are found in such foods as wheat, onions, some fruits and vegetables, sorbitol and some dairy products. FODMAPs lead to increased small intestinal and colonic water secretion and fermentation, which causes increased production of short-chain fatty acids and gas. FODMAPs are a common trigger of meal-related symptoms in IBS, but they do not typically cause gastrointestinal symptoms in healthy adults, with the exception of increased flatulence.
Approximately 70 percent of IBS patients can see an improvement of symptoms by eating a low-FODMAPs diet, regardless of IBS subtype. The low-FODMAPs diet is not intended to be a lifelong diet. Those who respond to full FODMAPs exclusion should gradually introduce foods containing FODMAPs back into their diets to determine the extent of dietary restriction required to maintain symptom benefit. There are currently few long-term efficacy or safety data for the low-FODMAPs diet.
There are two types of dairy sensitivity: milk allergy to proteins (whey and casein), which is rare in adults, and lactose intolerance, which is common. Lactase is the enzyme that digests lactose, which is the sugar in dairy products. If lactase deficiency is present, restricting lactose-containing foods can be helpful.
Evidence is increasing that diet profoundly influences the gut microbiome. SIBO can respond to fasting or an elemental diet, and eating a low-FODMAPs diet or similar carbohydrate-restricted diet may reduce risk of relapse following any treatment.
Research shows that physically-active people move their bowels more frequently and have more rapid movement of stool through the colon than do individuals who are sedentary. A recent study showed that a structured exercise intervention led to greater improvements in overall IBS symptoms than did usual care. Physically inactive IBS patients should work to increase their physical activity. A simple recommendation to begin is to walk for at least 30 minutes on most days of the week. Distance and pace can be gradually be increased.
EnteraGam is a prescription requiring medical food product for the dietary management of intestinal or bowel problems (also called enteropathy), including IBS-D and inflammatory bowel disease. EnteraGam uniquely binds microbial components, such as toxins that bacteria release that upset the intestinal environment. This helps prevent them from penetrating the intestinal lining, which can cause chronic loose and frequent stools in people with IBS.
EnteraGam is not absorbed and works in the gut to improve function, including absorption, immune function and permeability abnormalities (“leakiness”). The main ingredient of EnteraGam is a protein that works with the body’s defenses in the gut. This protein is serum-derived bovine immunoglobulin/protein isolate (SBI), which is composed of beef proteins (primarily immunoglobulin IgG). EnteraGam does not contain any milk products, such as lactose, casein or whey. It is gluten-free, dye-free and soy-free.