Irritable Bowel Syndrome (IBS) is a functional disorder of the large intestine with no evidence of accompanying infection or structural defect. Though the causes for IBS are not completely clear, physiological, psychological and dietary factors have all been linked to this condition, including excessive numbers of bacteria in the intestines.

The goals of a therapeutic diet for IBS include:

1. Increasing dietary fiber (includes adequate water and exercise)

2. Identifying and eliminating foods that cause the symptoms (food allergies/intolerances)

3. Support the integrity and function of the intestinal mucosa to optimize digestion and absorption

Several studies indicate that as many as two-thirds of people with IBS will improve or even become symptom-free if they identify (via an elimination diet) and avoid the foods to which they are intolerant. The foods that most commonly cause symptoms seem to be dairy products, onions, wheat, chocolate, coffee, eggs, nuts, citrus, tea, rye, potatoes, barley, oats and corn.

have often been linked to the symptoms experienced by patients with IBS. Roughly two thirds of patients have some type of food intolerance or allergy. Therefore, it is imperative that patients address these causes and eliminate the offending agents. Talk to your nutritionist about identifying potential food allergens through a process known as "the elimination diet."

This involves the use of a 3-week elimination diet (sometimes longer), during which time a hypoallergenic diet is followed. After 3 weeks of avoiding the potentially "offending foods", foods are individually reintroduced every 3 days. This food reintroduction process is called "rechallenge". If symptoms worsen or return when a food is "rechallenged", that food should not be eaten.

The dietary fiber found in complex carbohydrates (foods found in their whole form that have not been refined) is useful in normalizing bowel function. It consists of both water-soluble and insoluble fiber types. Patients with diarrhea as part of their IBS symptom-picture should focus on soluble fiber foods (which form a viscous gel and slow transport through the intestine and ease contractions or cramps). Soluble fibers are water-soluble fiber types (found in vegetables, fruits, oat bran, guar and legumes (beans and peas)) and psyllium seed powder. Examples of high-fiber fruits are apples, bananas, mangoes and papayas and avocadoes. High-fiber vegetables include sweet potatoes, carrots, squash and pumpkins, beets, beans, and legumes. High-Fiber grains: quinoa and quinoa pasta, rice and rice pasta, flour tortillas and rice cereals. Wheat and other grains are also excellent sources of fiber, however, their protein components are often implicated as the cause of various malabsorption and allergic conditions (gluten/gliadin intolerance or celiac’s disease, etc.)

Eat at regular times. Try not to skip meals or go long periods of time without food. The emptier your stomach, the more sensitive it may be.

2. Try to limit "stand-up, eat-on-the-run" type meals.

3. Chew thoroughly and eat at a leisurely pace – if you must eat in a hurry, only eat a small amount at a time.

4. Eat a balanced and varied diet.

5. Gradually increase your intake of fiber.

6. When your stomach is empty, eat soluble fiber foods first. Make soluble fiber foods a large component of every meal (see fiber sources above).

7. Drink plenty of fluids, especially water (at least 6 – 8 glasses a day).

8. Eliminate all red meat, dairy, fried foods, egg yolks, coffee, soda, and alcohol from the diet. These are the most common triggers of IBS.

9. Limit foods that you are sensitive to or do not tolerate well. Possibilities include dairy products, chocolate, eggs, and wheat products.

10. Limit foods high in fat. If you know you will be having high-fat foods, eat a source of soluble fiber first – never eat high fat foods on an empty stomach.

11. Eat green salads at the end of the meal (small portions with non-fat dressing).

can improve the whole upper digestive system’s function and enhance the absorption of nutrients. Try adding some bitters to meals, which include chicory, endive, radicchio, and dandelion greens.

have been shown in research studies to be helpful in the treatment of IBS.

1. Enteric coated peppermint oil capsules are used to inhibit intestinal contractions and relieve abdominal pain and gas.

2. Chamomile and valerian aid in decreasing gas.

3. Slippery elm soothes the intestinal lining and decreases inflammation.

4. Lemon balm decreases intestinal cramping and spasms.

5. Nutritional supplements such as glutamine, beta-carotene, and zinc aid in the healing of the intestinal lining.

1. Exercise regularly – 30 to 60 minutes of moderate exercise every day.

2. Daily practice of yoga, Tai Chi, or meditation can significantly reduce stress-related symptoms.

3. Pay attention to your body’s signals. When you feel the urge to move your bowels, take the time to do so.

4. Make sleep a priority – inadequate sleep reduces the body’s ability to manage stress effectively.

such as depression, insomnia, fatigue, and anxiety are often associated with IBS sufferers. Increased contractions of the colon have been shown to occur in patients with IBS in response to stressful situations, which can lead to uncomforatble symptoms. Various methods of treatment that may be helpful to reduce stress, anxiety, depression, and fatigue include biofeedback, individual counseling, guided imagery, and physical activity. If necessary, seek the help of a professional to manage stress or other emotional factors.

ABOUT ANGELA PIFER, CERTIFIED NUTRITIONIST

Angela Pifer is a Certified Nutritionist, with a MS in nutrition from Bastyr University, in private practice, specializing in food sensitivities, emotional eating, digestive conditions & weight loss. She founded Nutrition Northwest Co in 2005; the premier provider of sound nutrition and wellness advice in the Northwest with offices in Seattle and Kirkland. Angela has a unique approach to helping her patients create new healthier habits: offering customized nutrition programs that inspire & educate along with a high degree of support & accountability to help them become fit & fabulous from the inside out.

Think of your body as a finely tuned engine, and food as its fuel. If you are not completely digesting the foods you are eating and absorbing their nutrients, you’re not adequately fuelling your body. The lack of adequate fuel, or the inability to use it properly, can lead to a variety of health problems. Poor digestion or imbalances in your intestinal flora (‘good’ and ‘bad’ bacteria) can result in many symptoms, from annoying digestive complaints such as chronic constipation, bloating or flatulence, to abdominal pain and irritable bowel syndrome. It has been stated that 70% of the American population suffers from malabsorption and digestive issues and at least 20% are suffering from food sensitivities; most go undiagnosed. If you avoid eating certain foods because they make you feel uncomfortable or feel that you have a “sensitive constitution,” and you have not addressed the situation, you may be doing long term damage to your digestive system and health. To get a better idea of how this can cause damage, let’s look at the different levels of digestion and absorption and the nutrient interactions that occur along the way.

Once food travels to your stomach, you need adequate amounts of hydrochloric acid to break up dietary proteins. You may be among the millions of people who do not produce enough hydrochloric acid. This can cause vitamin and mineral deficiencies, osteoporosis, hardening of the arteries, arthritis, colon cancer, food allergies and autoimmune diseases.

Hydrochloric acid and other substances trigger your pancreas to release enzymes once food moves to the small intestine. Pancreatic enzymes play an important role in the digestion of proteins, fats and carbohydrates. An insufficient amount of pancreatic enzymes can contribute to many of the same problems as inadequate stomach acid.

Nutrients in your food are absorbed into your bloodstream from both the small and large intestine. Food that isn’t digested completely will not be absorbed. Partially digested proteins can cause significant digestive irritation (such as colitis, gas or nervous stomach) and can lead to food allergies. Digestion of carbohydrates continues in the small intestine. Certain enzymes are released only by the intestinal microvilli and friendly bacteria, and damage to these can also inhibit digestion (as seen with chronically untreated wheat sensitivities, leading to Celiac Disease).

Many different microbes live in your intestinal tract, and it’s normal to have billions of them. Ideally, you have "friendly" bacteria to aid with digestion, vitamin production, immune defense and recycle digestive enzymes. Unfortunately, many common activities can destroy the delicate balance of bacteria. Using antibiotics, steroids or the Pill or HRT, or a diet high in fat and sugar wreaks havoc on bacterial levels, leading to imbalances in bacteria and yeast, which can lead to illness.

Chronic infection, food allergies or inadequate nutrition can result in poor immune deficiencies in your intestine. With lowered resistance, less friendly bacteria are able to colonize, and infection or allergies are more likely to develop.

For proper digestive health, your body must carefully co-ordinate the breakdown, absorption and elimination of food. Bacteria must be in proper balance, and immune function must be adequate.

How healthy is your digestive system?

Quick test:

Add up the questions you say yes to below to see if the symptoms you experience indicate that you might not be digesting and/or absorbing your food properly.

• Do you often feel bloated
• Do you have an extreme feeling of fullness in your stomach, especially after eating?
• Do you often have gas?
• Do you have irritable bowel syndrome, spastic colon, nervous stomach, loose stools or constipation?
• Do you avoid eating certain foods because they make you feel uncomfortable?
• Are you allergic to any foods?
• Have you had any of the following: asthma, allergies, high blood pressure, heart disease, history of strokes, arthritis, pernicious anemia, an autoimmune disease or yeast infection?
• Have you ever taken an antibiotic for more than one month at a time or have you taken antibiotics more than four times in your life?
• Have you ever taken oral contraceptives, HRT or steroids (cortisone, prednisone, etc.) for extended periods?
• Do you have abdominal cramps or pains?
• Do you get heartburn, indigestion or belch after meals?
• Have you had food poisoning and your bowels have not been ‘right’ since?

If you’ve answered yes to two or more of these questions then I highly suggest that you make an appointment with your nutritionist or naturopath to determine the best course of treatment.  Combining a medical intake session with diet analysis and lab testing will offer a comprehensive look at the health of your gastrointestinal tract, with information about digestion, absorption, bacterial balance, yeast overgrowth, inflammation, metabolic activity, and immune function.

Rest assured that there are simple changes you can make to your diet and lifestyle that will have a profound effect on your long term health. Improving your digestion and absorption is the first step to improving your energy, enhancing your mood and reducing inflammation.

Angela Pifer, Certified Nutritionist

Nutrition Northwest Co

www.nutritionnorthwest.com