By Elaine Magee, MPH, RD
WebMD Weight Loss Clinic - Live Events Transcript
For those who suffer with IBS, decisions about what to eat can make a world of difference. In observance of IBS Awareness Month, learn to eat well with WebMD's "Recipe Doctor," Elaine Magee, MPH, RD, author of Tell Me What to Eat If I Have IBS. She joined us on April 20, 2005.
If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
MODERATOR: Welcome back to WebMD Live, Elaine. Thank you for joining us today. For those who may not know, you have IBS (Irritable Bowel Syndrome), don't you?
MAGEE: Yes, I am a third generation IBS recipient. My mom had it and it sounds like, from stories, that her father had it. It is genetically passed, much like diabetes. I have the diarrhea predominant type. I've never been constipated during my life, even during two pregnancies. But I'm happy to say that it's definitely -- of the conditions you can get -- one of the more workable ones. I haven't had an attack, so to speak, for a very, very long time. It's just about learning how to eat and what to do in extreme circumstances, like high stress or traveling.
I wrote a book called Tell Me What to Eat If I Have Irritable Bowel Syndrome. It's a couple years old and it's been selling quite well and it's translated into Spanish and Chinese. It's my pleasure to be here today to talk about this very common condition.
MEMBER QUESTION: How many grams of fiber should I eat to not get too bloated and stay regular? Less or more than a normal person?
MAGEE: A normal person, in America anyway, is eating about half of the fiber that's recommended per day. The American Dietetic Association recommends 20 to 35 grams per day. So for somebody with IBS constipation you probably want to get toward the higher end of that range.
It's really about figuring out what works best for your body. You're not going to want to eat all your fiber for the day in just one meal, you want to space your fiber out over the day. Ideally you want a variety of fiber, not just bran, not just oats, but you want fiber from all of the plant groups -- fruits, vegetables, whole grains, beans, etc.
Another important key is to not increase your fiber suddenly; you need to do it gradually. For example, increase your fiber by 2 to 3 grams per day, making sure to drink plenty of water through the day and slowly work your way up to the 30 gram mark.
MEMBER QUESTION: How do you avoid constipation? More fiber? Less?
MAGEE: That's a tricky question. It's generally going to be more fiber. We just talked a little bit about that. Another step you might want to take is to keep an IBS symptom journal, where you write down the types of foods you eat, when you ate it, the amount, any emotion or stress going on, and any symptoms throughout the day.
Besides increasing fiber, here are some other things to consider:
- Plums, prunes and prune juice, sort of naturally encourage loose bowels.
- Ground flaxseed has been thought to ease constipation symptoms for some; if you're interested in that, feel free to check out my book called The Flax Cookbook. I do have to say that did seem to help me with those issues, as well, having a little bit of ground flaxseed every day.
- Drink liquids throughout the day -- this encourages bowel movements.
- Consider limiting coffee and alcohol, because they can have a dehydrating effect and dehydration can make constipation worse.
- That high-protein, low-carb diet that is on its way out is thought to worsen constipation.
- Psyllium is in some of the fiber supplements you might see over the counter that you blend with water. There's some good evidence to support that can help people with constipation as well.
MEMBER: That's funny about coffee because it gives my son and other people I know diarrhea.
MAGEE: Caffeinated drinks in general are intestinal stimulants, so it's quite possible that is potentially contributing to diarrhea. I know people with constipation sometimes use it to get things moving, but for people with diarrhea predominant it's something to watch out for. More than likely the caffeine in coffee will be a trigger, more than a diet soda that doesn't have as much caffeine.
MODERATOR: Can you explain what you mean by an IBS symptom journal?
MAGEE: There's one in my book and it's called the FFS diary: F ood, F eelings, and S ymptoms. Feelings, stress and our emotions can play a big role in IBS symptoms. A diary is your best way of tracking what's going on with your intestines and determining what your triggers are.
You're basically writing down the time you ate, what foods and drinks you consumed and in what amounts, any symptoms and how severe they were, and what your stress and feelings were. I encourage people to keep a log for at least a couple of weeks. It's a great way to identify foods and eating patterns that are triggering your symptoms. There's a one-day diary sample form in the book that you can make copies of for the two to four weeks that you're keeping it.
MEMBER QUESTION: What about diarrhea? I'm so sick of eating food with no flavor so I don't flair up.
MAGEE: Let's talk about tips for people with diarrhea predominant IBS. The first thing I want to mention, though, is some people get this type of IBS as a result of a bout with food poisoning. For these people, their IBS can actually disappear after three to five years. And I've met quite a few people that this happened to. For those of us with the IBS gene, it ain't never going away, but by living and eating better we can certainly make ourselves more comfortable.
You could do what I do, and that is I have medication that I carry for extraordinary circumstances, like traveling and flying, because that's really the only time that I need help. There are several good over-the-counter and prescription medications available now for diarrhea predominant IBS.
From a food standpoint, by keeping track with this FFS diary, you will have a better idea about what your triggers are -- the types of foods and beverages and the amounts. It's really different for every person. I'll just give myself as one example. I can't eat very rich or greasy food. My body tells me, within half an hour, that I'm in trouble. But I can have half an order of tempura at a Japanese restaurant and not get into trouble. If I eat the whole order, I'm done for. That's just something I've learned about myself. I will never order Alfredo sauce at a restaurant because it's too rich for my system, but I have zero problems with my homemade version that's delicious and light. Spicy food, again, Thai restaurants, you'll never see me there, because spicy food is a trigger for me, but it may not be for you.
Some other tips to consider:
- You may try emphasizing some soluble fiber sources. These add bulk to the colon but they're more gelatinous or gel-like and gentler to overly reactive intestines. You'll find soluble fiber in oats, barley, psyllium, and some fruit; half of the fiber in ground flaxseed is soluble.
- It may not be a good idea to drink fluids with your meals. Space your meals and fluids about an hour apart. The liquid can make everything run through more rapidly. Together they may be overloading your system, so alternate beverages with your meals.
- You might see if you have a reaction to the gassy vegetables: broccoli, onions and cabbage. They can cause gas in some people and it can make diarrhea sufferers feel worse. This is one of those instances where amounts can be important, so maybe half a cup of broccoli is no big deal but a cup and a half will cause problems.
- Fried foods can send some people over the IBS edge. I happen to have written a book about this called Fry Light, Fry Right! where our favorite fried foods have gotten a makeover for extra fat and calories. It's a totally cool cookbook. This would help people with IBS to still have some of the fried foods, just made light at home.
- Fructose can be a trigger for some people, so keep that in mind when you're looking through your food diary, if you're consuming foods with high fructose, like high fructose corn syrup in soda, for example. Let me add a statistic to this. A recent study found that 30 to 58 percent of people with IBS symptoms, particularly those with the diarrhea type, were fructose intolerant.
- Large meals can trigger your symptoms, so try to eat less at each meal so that you're not overwhelming the system at any one time. Eat small, frequent meals.
MEMBER QUESTION: Stress seems to play a big part with my IBS. Is that the case with most?
MAGEE: In a word, yes. There is a subgroup of people with IBS that are mostly triggered by stress and not so much by what they eat. I would say from my experience though, that the majority are able to more easily control their symptoms through diet and lifestyle changes although stress plays a role for them as well. There's a subgroup where it's stress only that triggers their symptoms and a larger group of people where it's diet and stress.
It's important to identify your source of stress. Is it work, is it family stress, is it staying up late and not getting enough sleep, is it worrying when you're traveling, is it traveling in general because your body is somewhere outside its safe home space? For me it's being outside my home space and it's also flying in an airplane that changes my constitution. Everybody's a little bit different.
At the same time that we are trying different ways to make ourselves more comfortable with our diet, it's helpful to look at different techniques to reduce the stress. In my case I can't change some of the situations that come my way, like flying on an airplane or going on television, and those are times when I slow down my intestines with medication.
MEMBER QUESTION: It seems I have problems generally after restaurant dining.
MAGEE: There could be a couple things going on when you're eating out at restaurants. We tend to eat foods higher in fat when we eat out, let's just face that. Part of that could be we're served larger portions and we know from studies that the more food that's put in front of you the more food we tend to eat in that meal. Remember how one of the triggers is the larger size meals? We're overwhelming our system with too much at one time. Part of it could be we are treating ourselves, celebrating, so we may be choosing foods we don't normally eat. Any or all of these things can spell disaster.
So the trick is really trying to stick to a smaller-sized meal -- remember you can always take leftovers home and enjoy them tomorrow. We can try to choose menu items that aren't too high in fat and stick to the dishes we tend to do well with. We tend to eat at the same restaurants over and over again anyway, so when you find an entree you enjoy and it doesn't give you a reaction, you can order it in comfort from then on.
MODERATOR: Are there any food groups in general that you should avoid when you have IBS?
MAGEE: Not really, because all of the trouble spots we've talked about are not food groups. We've talked the greasy foods, the fructose, dehydrating liquids like coffee and alcohol, but really in terms of food groups, generally all of those are okay, unless you find a specific trigger for you.
Some people can be lactose intolerant and this can make their IBS worse with the amount of milk, sugar or lactose that they're consuming. So it's possible that dairy foods, especially the ones with more lactose in them, could be problematic. If you're having a reaction to frozen yogurt that could be lactose or fructose, depending on that particular product. If it looks like lactose is making your IBS worse you can try the lactose-free products or the lactase tablets and see if that helps you. Just to give you a range: hard cheese has just 1 gram of lactose per ounce, sour cream has 4 grams of lactose per 4 ounces, ice cream or ice milk have 5 to 7 grams of lactose per 8 ounces, yogurt has 12 grams of lactose per 8 ounces and all of the types of milk -- from skim to whole -- have around 11 grams of lactose per 8 ounces.
We talked about limiting caffeine and we talked about avoiding high-fat meals. You may also need to avoid certain spices and spicy food like chili powder, chili peppers and for some, garlic, curry, and ginger. I have to say for me, those three are not a problem. We talked about not overdoing alcohol and avoiding gassy foods. I have a big list in my book, but it's basically raw vegetables like cucumber and lettuce and other gassy vegetables like the cabbage family and onion family. Some of the beans and certain fruits can cause trouble in some people; and then other kind of quirky foods and drinks, like beer, seeds, hard-boiled eggs, soft drinks, nuts, popcorn, and hot sauce or barbecue sauce.
MODERATOR: So are there certain foods, spices or food groups that seem to help when you have IBS?
MAGEE: Yes. We talked about fiber and a little bit about the different types of fiber. Just to quickly review, here are your soluble fiber sources: psyllium seed and psyllium products; beans, oats, barley, apples, bananas, citrus fruits, carrots, and green beans.
For herbs, some antispasmodic herbs are fresh mint leaves; brewing it into a strong tea can help some people.
Exercise is particularly helpful for people with constipation. Moving your body helps get your intestines moving.
Of course I'll remind everybody about the importance of eating smaller, more frequent meals as being one of the most important styles for people with IBS.
I would say also one of the most important changes people can make is to start cooking light. Try oven frying in a little bit of oil, using lower fat dairy products and less butter or margarine in your cooking. Eating less fat is really pivotal for many people.
MEMBER QUESTION: How do you feel about probiotics?
MAGEE: I personally tried the Lactobacillus supplements years ago and it seemed to have no helpful effect for me. I just read a review of a couple studies and they found that the beneficial microbe Bifidobacterium infantis relieves symptoms of IBS, while the Lactobacillus seemed to have no effect. So it's worth talking to your gastroenterologist if you're interested. It's really about making sure you've got plenty of good bacteria in your intestines.
MODERATOR: Do you think the key to managing you IBS is really identifying your triggers via a journal and working with your GI doctor?
MAGEE: Pretty much. I found it very helpful for me. Most of us will know or suspect what may be causing us trouble. We may not want to admit certain foods or drinks are causing us trouble, but information is power, and the more we know the better off we'll be down the line.
It's awesome that I haven't had an attack for about five years. That's really what a lot of us IBS sufferers are trying to avoid -- the full-blown attacks. We want to live comfortably and we want to be able to travel without issues.
It's really about decreasing stress and eating sort of defensively. I like to call it "defensive eating" to prevent attacks, knowing what our limits are and still enjoying life. For me, there's nothing that I give up, technically, for my IBS. I still have Alfredo sauce, just mine. I still have fried foods, but I make it the light way. I don't miss spicy food anyway, but that's just me. So I feel completely "not deprived."
By going to your gastroenterologist, it's good to check in with the expert and that person can find the medication for you for when you are in situations that are out of the ordinary. Fry Light, Fry Right is my brand-new cookbook and it helps you straighten up and fry light. We pretty much make over every fried food in America -- from corn fritters to corn dogs, from coconut shrimp to pork chimichangas; it's in there -- even chicken fried steak with country gravy. Check it out!
MODERATOR: Our thanks to Elaine Magee, MPH, RD, for joining us today. And thank you, members, for your great questions. I'm sorry we couldn't get to all of them. For more information, please read Tell Me What to Eat IF I Have Irritable Bowel Syndrome, as well as Elaine's other books.