Tell Me What to Eat If I Have Irritable Bowel Syndrome, Revised Edition: Nutrition You Can Live With
160
Tell Me What to Eat If I Have Irritable Bowel Syndrome, Revised Edition: Nutrition You Can Live With
160Paperback(First Edition, Revised)
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Overview
If you have IBS, you are undoubtedly familiar with the link between your condition, your comfort, and what you eat or drink. Elaine Magee gives you positive advice about what foods you should eat almost every day, and whether you suffer from IBS constipation, IBS diarrhea predominant, or the type of IBS that includes both conditions. Easy-to-use tables list what foods are good for diarrhea, and for constipation, and which foods cause bloating or gastrointestinal distress.
This new edition of Tell Me What to Eat If I Have Irritable Bowel Syndrome contains an updated review of all the possible causes of IBS, including hormones and certain medications. It also includes nuggets of wisdom from Dr. Christine Frissora, MD, associate professor of gastroenterology at New York Presbyterian Hospital.
Also included are practical tips such as "The 5 Quickest Ways to 25 Grams of Fiber;" dozens of healthful, mouth-watering recipes; and practical supermarket and "eating out" advice from someone who has suffered from IBS for more than 20 years—the author.
Product Details
| ISBN-13: | 9781601630209 |
|---|---|
| Publisher: | Red Wheel/Weiser |
| Publication date: | 12/15/2008 |
| Series: | Tell Me What to Eat Series |
| Edition description: | First Edition, Revised |
| Pages: | 160 |
| Product dimensions: | 5.10(w) x 8.20(h) x 0.70(d) |
About the Author
Read an Excerpt
CHAPTER 1
Everything You Ever Wanted to Ask a Gastroenterologist
So you think you may have an irritable bowel? Depending on where you live, you may have to wait as long as a few months to see a gastroenterologist to confirm it. And when you do see one, chances are you'll forget to ask a few of your questions. Also, as time goes on, you might think up new questions. That's what this chapter is for.
Q: What is Irritable Bowel Syndrome (IBS) and what are the symptoms?
The "irritable" bowel is more sensitive and reactive than a "regular" bowel. It begins to spasm after only mild stimulation or in situations that a normal bowel would not react to, such as:
• Eating (see tips on changing your eating style in Chapter 4). The simple act of eating causes contractions of the colon, normally causing an urge to have a bowel movement 30 to 60 minutes after a meal. With IBS, the urge can come sooner, along with cramps and diarrhea.
• Distention from gas or other material in the colon (for tips on avoiding gas-producing foods, see Chapters 3 and 4).
• Certain medicines.
• Certain foods (see tips in Chapters 3 and 4).
• Stress, which stimulates colonic spasms in people with IBS.
Some people have diarrhea (or several soft bowel movements) right after they wake up in the morning or right after they eat a meal. IBS symptoms may worsen in the presence of stressors such as travel, big social events, or changes in daily routine. For some, symptoms seem to get worse when they do not eat right or if they eat a big meal.
Q: Will my IBS eventually go away?
Part of the nature of IBS is that it varies from person to person. Generally though, IBS symptoms fluctuate through time. In one study, more than half the IBS patients still had symptoms five years after they were first diagnosed. Some researchers report that almost one-third develop IBS after a bout of the stomach flu or food poisoning. In these cases, the symptoms are usually milder and can diminish during a 3-to-5- year period.
Q: What causes IBS?
IBS continues to mystify the experts. When colons of IBS sufferers are examined, there are no signs of disease. Yet IBS can cause much pain and distress to the people who have it. Researchers are getting closer to the truth, though. They have discovered that the colon muscles of people with IBS begin to spasm after only mild stimulation. Their colons appear to be more sensitive, reacting strongly to events that would not bother most people, such as eating a large or rich meal or having a bit of gas in the colon.
Are you one of the women out there who seems to suffer from IBS-like symptoms only during menstruation? One-third of women who otherwise don't have gastrointestinal (GI) symptoms have them only during their periods. Researchers suspect that reproductive hormones help trigger IBS symptoms, because about half of women with IBS report worsening symptoms — most often diarrhea — during their periods (American Journal of Gastroenterology 93[10]: 1867, 1998 and British Journal of Obstetrics and Gynaecology 105[12]: 1322-25, 1998).
It is also possible that a lack of hormones could encourage IBSlike symptoms in some women. A recent study suggests that peri-and post- menopausal women have a high prevalence of IBS-like gastrointestinal complaints (Women's Health 27[4]: 55-56, 1998).
Experts also suspect that many people have a genetic predisposition to IBS. All I know is that I have a mild form of IBS, my mother has it, and her father had it. Sounds like a genetic link to me! New research also suggests that about one-third of IBS sufferers have a genetic mutation that is also linked to panic disorder.
Although scientists aren't certain why, childhood constipation and colic (as well as childhood physical or sexual abuse) increase the likelihood of developing IBS as an adult.
Q: When would surgery help me?
(answered by Christine Frissora, MD)
Sometimes there are true structural problems in the colon that cause a change in bowel function. If you are a woman or man in a high-power position, doctors may say "it's just stress." But the truth is that stress can exacerbate any problem, including IBS — but it is often not the entire cause of the problem. So how do you know if something needs to be done?
Of course, if there is a family history of colon cancer, bleeding, or a personal history of colon cancer, it may be time for your colonoscopy (yes, again!). If women need to use their finger, "digital manipulation," to defecate, then that is called "vaginal splinting," and it may be due to a structural problem and may improve with surgical intervention. Conversely, if you have given birth or received an episiotomy (the vagina opening is deliberately cut to allow the baby to come out without tearing the opening) and cannot hold stool, and suffer from fecal incontinence (feces or stool or liquid stool leaking into the underwear), then it may be possible that the rectal muscle is torn, severed, or atrophied and needs to be repaired. In this case, you need to see a surgeon who specializes in the rectum.
A warning here: there is no problem that surgery cannot make worse. If you are doing well on your medications and diet, proceed with the appropriate testing and screening but do not seek surgical intervention. Do not try to fix something that you can deal with by changing your diet, or taking simple medications. If you truly need surgery due to a stricture or a rectal tear, you need a very thoughtful, meticulous surgeon.
There are many in the country — the doctor I refer patients to in my New York practice is Dr. Toyoki Sonoda. Dr. Sonoda treats a wide variety of colon and rectal diseases, such as colon and rectal cancer, inflammatory bowel disease, diverticular disease, benign conditions of the anus, and functional problems such as rectal prolapse and incontinence. He has completed specialty training in laparoscopic colon and rectal surgery, and performs laparoscopy for many of these conditions. He can be contacted at (212) 746-6030.
For women with bladder and GYN issues with prolapse I use Lauri Romanzi, MD (212) 935-4343, contact@urogynics.org
Urogynics was founded by Dr. Laurie Romanzi in 1998. Dr. Romanzi and her team bring insight and innovation to the field of women's health. Dr. Romanzi is a clinical professor in the Department of Obstetrics and Gynecology at New York Presbyterian Hospital — Weill Cornell Medical College, and a board certified gynecologist and fellowship-trained specialist in urogynecology and pelvic reconstructive surgery.
Q: Can medicines I take for other things be making my IBS worse?
(answered by Christine Frissora, MD)
Sucralfate, calcium channel blockers, bismuth subsalicylate, and antacids containing aluminum can sometimes aggravate constipation. Other medicines can do the opposite and induce diarrhea. Magnesium- containing antacids, lactulose, and sometimes psyllium and other fermentable fibers used as bulking agents (which can also worsen bloating) may all cause diarrhea.
Q: How do stress and anxiety affect IBS?
Stress may worsen IBS symptoms, plain and simple. Stress stimulates colonic spasm in people with IBS. We don't completely understand why this happens, but we do know that the colon is controlled in part by the nervous system and that the nervous system reacts to stress.
Stress-reduction (relaxation) training or counseling and support help relieve IBS symptoms in some people. But please understand you don't have IBS because you have a psychological problem. Remember, IBS is in large part a result of hypermotility and hy-persensitivity of the colon.
One study showed that people with IBS scored higher in measures of anxiety and obsession, but not in measures of phobia, depression, somatic anxiety, and hysteria. The anxiety and obsession are thought to be the consequences, and not the causes, of the IBS symptoms (Lancet 340[8833]: 1444-48, 1992).
Q: Which types of psychotherapy might help?
Three types of treatments are yielding some success with IBS patients:
1. Brief psychodynamic therapy is conducted one-on-one with a psychiatrist or psychologist for a short time (such as once a week for two months). The goal of this therapy is to explore and identify potential unconscious factors that may be linked to IBS symptoms and to help the patient bring those factors into consciousness to better understand and control them.
2. Cognitive behavioral therapy is also performed by a psychiatrist or psychologist in either a group or one-on-one format. The purpose of this therapy is to teach people to cope a little less negatively with life's stressors. IBS sufferers are guided into identifying how they send themselves conscious negative messages. Maybe they take on more blame for situations than they should, or maybe they make things out to be worse than they really are. Patients are often asked to explore what areas of their lives are stressful and how they themselves contribute to the stress with their own perceptions. Repeated therapy sessions enable patients to gradually react more positively to the stressors in their lives — which translates into reduced bowel symptoms.
3. Hypnosis teaches people to use imagery to gain control over the muscles in their GI tracts. This can take place in a group or in one-on-one sessions under the direction of a psychiatrist or psychologist with hypnosis experience. Many patients using this method report less pain, bloating, cramping, diarrhea, and constipation.
If you would like to find a psychologist or psychiatrist with experience in treating IBS, the American Psychological Association can direct you to your state associations, which can refer you to a practitioner in your area. Call (800) 964-2000.
Q: Could my symptoms indicate something else?
If there is blood in your stool or if you have been having chills or fever, then you probably have something other than IBS.
A small number of people who think they have IBS could instead be suffering from a new family of disorders caused by hard-to-detect changes in the lining of the large intestine. With these disorders (microscopic colitis, collagenous colitis, and pericrypt eosinophilic enterocolitis), the colon looks normal. But if a bit of the tissue is examined under a microscope, inflammation or scarring can be seen.
Profuse watery diarrhea can be caused by something other than IBS. Frequently, and more often in women, it is actually due to laxative abuse. This is probably far more common than we know because people who abuse laxatives often keep it a secret from their physicians and families. Diarrhea can also be caused by rare, hormone-secreting tumors of the pancreas.
Q: Could I have a food allergy?
Many of the clinical signs typical of intestinal food allergies and intolerance are the same as those that many people experience with Irritable Bowel Syndrome. It is a good idea to find out if you have a food allergy or intolerance. A 1999 study in the American Journal of Gastroenterology found that more than 50 percent of the IBS patients studied were sensitized to some food or inhalant without showing any typical clinical signs. Usually the patients were unable to identify the potentially offending foods.
Q: How long does it take for a meal to move through the digestive tract?
Food passes through the esophagus and into the stomach almost immediately. However, it can take as long as three or four hours after a meal before the stomach completely empties into the small intestine. It can take even take longer, depending on the size and fat content of the meal (larger and higher fat meals stay in the stomach longer). The small intestine will take four to six hours to finish digesting a meal and absorbing its contents. It can take two to three days before food waste is finally formed into a stool and emptied from the rectum.
Q: Why do I seem to have several bowel movements first thing in the morning?
When you wake up in the morning, your bowel wakes up too. Normal nerve connections trigger the large intestine to increase its activity (like after meals), particularly first thing in the morning.
Q: Can lack of sleep bring on symptoms in some IBS patients?
Lack of sleep can result in physical or mental stress, which can trigger the IBS symptoms. If you think about it, the gut is at rest during sleep, so it makes sense that daytime activities continue at night if you are awake or tossing and turning.
Q: Can traveling bring on symptoms?
There are many ways that traveling can trigger IBS symptoms, namely the lack of physical activity while traveling long distances, the disruption of routine due to changing time zones, and eating and drinking differently than we normally do. Keeping up with your fiber goals and exercise routine while you travel can help prevent the constipation that frequently results.
Q: Do some IBS patients suffer from stomach-related symptoms during one of their intestinal "attacks"?
The pain of IBS can be anywhere in the abdomen region. Some patients experience nausea, bloating, and other gut symptoms. If there are additional symptoms, such as vomiting, weight loss, signs of anorexia, fever, gastrointestinal bleeding, fever, fecal incontinence, persistent severe pain, or night symptoms, it suggests there is something other than IBS going on.
Top 10 things most likely to be confused with IBS
There are many diseases that have the same symptoms as IBS — gas, bloating, indigestion, flatulence, discomfort, diarrhea, and constipation. The following are the conditions and diseases that are not IBS but can be confused with IBS, according to Christine Frissora, MD.
1. Celiac disease. A genetic, inherited multifactorial condition that results in a lifelong allergy to gluten — barley, wheat, rye, and possibly oats. The treatment is a lifelong strict avoidance of gluten. The Celiac Center led by Dr. Peter Green in New York is among the best in the world.
2. Mild inflammatory bowel disease. Mild ulcerative colitis or Crohn's disease can be missed because they can show up from time to time. If you have a family history of inflammatory bowel disease, weight loss, bloody diarrhea, or fever, tell your doctor.
3. Lymphocytic or microscopic colitis. Characterized by diarrhea and sometimes weight loss. If you have chronic diarrhea, your doctor must do duodenal biopsies to exclude celiac or other causes of malabsorption, and colon biopsies to exclude microscopic or lymphocytic colitis.
4. Blastocystis. This is a parasite one can get anywhere — from take-out food to a dirty bathroom in an airport. There are different treatments, but a low dose of metronidazole, 375 mg twice a day for 7 days, is usually enough.
5. Giardia. This is a parasite from well water or another contaminated supply that can persist for years and cause gas, bloating, and diarrhea.
6. Chronic cholecystitis (gallbladder disease). There may not be gallstones, but if you have had persistent, vague abdominal pain that worsens with eating and fatty foods, it could have been the gallbladder all this time. Be sure you have an ultrasound — CT scans can miss gallstones.
7. Chronic diverticulitis. There are a few patients that have had recurrent diverticulitis, and the segment of colon is left smouldering and infected. If you have known diverticulosis, severe pain, diarrhea no matter what you do, chills, night sweats, or fever bring this to your doctor's attention immediately.
8. All artificial sweeteners can cause severe nausea, upset stomach, and discomfort.
9. Your supplements can be making you sick. "Natural" health remedies have been known to cause kidney failure, liver failure, and pancreatitis. Do not take any supplement without asking your doctor. In general, with digestive disorders, less is more.
10. Ectopic pregnancy — whether you are on a birth control pill or not, if you have developed bloating, nausea, and abdominal pain, you might be pregnant. Even if you had your period, you could still have an ectopic pregnancy (a pregnancy outside of the uterus).
Dr. Frissora has some final words of advice as you move forward with the rest of this book and with managing and finding relief from your IBS.
Top 9 things you should know if your doctor doesn't
(answered by Christine Frissora, MD)
1. Gallbladder removed?
If you have had your gallbladder removed and in the weeks or months that follow you develop diarrhea, this could be "bile salt diarrhea." It means that the bile drips into the intestine and when it hits the colon can cause diarrhea. The treatment for this is to take something that binds bile acids before you eat, such as carafate (sulcrafate) 1 gram tablets.
2. Calcium supplements and vitamin C.
Calcium supplements that contain magnesium or zinc can cause loose stools. This would be good for someone who is constipated but is not good for someone who has diarrhea.
Vitamin C is a natural laxative and can also cause heartburn, indigestion, and even esophagitis.
(Continues…)
Excerpted from "Tell Me What to Eat If I Have Irritable Bowel Syndrome Revised Edition"
by .
Copyright © 2009 Elaine Magee, MPH, RD.
Excerpted by permission of Red Wheel/Weiser, LLC.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Foreword by Dr. Christine L. Frissora,
Introduction,
Chapter 1: Everything You Ever Wanted to Ask a Gastroenterologist,
Chapter 2: Main Symptoms of Irritable Bowel Syndrome,
Chapter 3: Everything You Ever Wanted to Ask Your Dietitian About IBS,
Chapter 4: The 10 Food Steps to Freedom,
Chapter 5: The 24 Recipes You Cannot Live Without,
Chapter 6: Navigating the Supermarket,
Chapter 7: Restaurant Rules,
Index,
About the Author,