Tag Archives: irritable bowel syndrome

Should You Try the Low FODMAPs Diet for Your IBS or GERD?

You won’t know until you try it, suggests dietitian Melanie Thomassian. These are some of the diagnoses that may respond positively: irritable bowel syndrome (IBS), Crohns disease, and gastroesophageal reflux disease (GERD).

Very low-carb diets also help GERD.

I’ve written before about the low FODMAPs diet and irritable bowel syndrome. The low FODMAPs diet essentially involves limiting the delivery of particular carbohydrates to your intestinal bacteria.

Steve Parker, M.D.

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Does Diet Affect Irritable Bowel Syndrome?

"Dr. Parker, what can I do about these severe belly cramps?"

“Dr. Parker, what can I do about these belly cramps?”

Four weeks of fermentable carbohydrate restriction reduces symptoms of irritable bowel syndrome, according to UK and Australian researchers.

Here’s the theory of how it works.  Our intestines—colon, mostly—are loaded with bacteria.  The food you feed your bacteria—fermentable carbohydrates, for example—may have an effect on the bacteria.  Changes in bacterial populations in response to feeding, in turn, may lead to changes in irritable bowel syndrome and other aspects of health.  This “gut microbiome” is a hot area of research and speculation.

I don’t have irritable bowel syndrome (IBS), but did notice a major decrease in gastrointestinal gas production when I reduced my digestible carbohydrate consumption to less than 50 g/day.  That alone has at least potential to reduce IBS symptoms.

IBS is extremely common, affecting 10–15% of individuals in the developed world. Only 15% of those bother to seek medical attention. Of all referrals to gastroenterologists (stomach specialists), at least 25% are for IBS.  There are few reliable treatments and cures. In some cases it mysteriously resolves on its own.

So I got excited when I ran across the study I reference above.  I’m not going to spend a lot of time on it because I’ve already spent too much trudging through the article, and I don’t have much to show for it.

The way the investigators wrote their report gave me some heartburn:

  • They never bothered to define “fermentable.”  In this context it probably refers to digestion or breakdown of food by gut bacteria rather than by human hosts.
  • They never bother to spell out exactly what foods the experimental subjects were eating as they restricted fermentable carbohydrate consumption.
  • The intervention group (n=19) was instructed to restrict foods “high in fructans (e.g., wheat products, onions), galacto-oligosaccharide (e.g., legumes), polyols (e.g., pear, sugar-free gums), lactose (e.g., mammalian milk), and excess fructose (e.g., honey).”  Does “restrict” mean “cut back a little” or “avoid entirely upon penalty of death”?  Your guess is as good as mine.  (It’s a joke—I know they wouldn’t kill’em.)

Have you heard of FODMAPs?  That seems to be the intervention diet that restricted fermentable carbohydrates. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.

You need a break. Enjoy.

You need a break. Enjoy.

Let me summarize their results simply by saying they found changes in gut bacteria and a reduction in irritable bowel syndrome symptoms, as compared with control subjects.  The particularly responsive symptoms were bloating, borborygmi, and the urge to defecate.  Abdominal pain strongly tended to improve but didn’t quite reach statistical significance.  Diarrhea wasn’t affected.  Also note that the IBS patients allowed into the study were not the type with constipation as a major issue.

So What? 

If you want to try a FODMAP diet for your IBS, you won’t be able to figure out what to eat based on this report. Consult your own physician about it. I wonder whether many of them have even heard of FODMAP.  Barbara Bolen, Ph.D., at About.com says the diet should be undertaken only with the supervision of a qualified nutritionist.

Steve Parker, M.D.

Reference:  Staudacher, Heidi, et al.  Fermentable Carbohydrate Restriction Reduces Luminal Bifidobacteria and Gastrointestinal Symptoms in Patients with Irritable Bowel Syndrome.  Journal of Nutrition, 142: 1520-1518 (2012)

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What Are Nightshades, and Should I Avoid Them?

Rosemary Chicken (garnished with pico de gallo) and Rosemary Potatoes

Rosemary Chicken (garnished with pico de gallo) and Rosemary Potatoes

The nightshade family includes tomatoes, peppers, potatoes (not sweet potatoes or yams), eggplant, goji berries, and even tobacco.  Anecdotal reports indicate that consumption of these either cause or aggravate certain chronic medical conditions, such as arthritis, chronic fatigue, or irritable bowel syndrome.

Georgia Ede, M.D., has an article on medical effects of nightshades at her website.  The potentially offensive chemicals in nightshades are called glycoalkaloids.  I looked into this issue when deciding whether to include potatoes in my version of the paleo diet.  (They’re included).

Dr. Ede’s writes:

As with any food sensitivity, the only way to find out is to remove nightshades from your diet for a couple of weeks or so to see if you feel better.  There are ZERO scientific articles about nightshade sensitivity, chronic pain, or arthritis in the literature, however, the internet is full of anecdotal reports of people who have found that nightshades aggravate arthritis, fibromyalgia, or other chronic pain syndromes.

I bet I could eat a couple potatoes and tomatoes every day without ill effect.  And there’s Chris Voigt, head of the Washington State Potato Commission, famous for his 60-day potato diet.  As they say, your mileage may vary.

Some of the nightshades, such as potatoes, supply a major carbohydrate load that can spike blood sugars too high in many diabetics. Be careful. And  use your home glucose monitor.

Steve Parker, M.D.

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Fiber and Systemic Inflammation

Over three grams of fiber

Over three grams of fiber

High dietary fiber intake helps prevent constipation, diverticular disease, hemorrhoids, irritable bowel syndrome, and perhaps colon polyps.  Soluble fiber helps control blood sugar levels in people with diabetes, and it reduces LDL cholesterol levels, thereby reducing risks of coronary heart disease.

An  article in the journal Nutrition suggests how fiber may have beneficial effects in atherosclerosis (the cause of heart attacks and strokes), type 2 diabetes, and some cancers.  These conditions are felt to be related to underlying systemic inflammation.

Systemic inflammation can be judged by blood levels of inflammatory markers such as interleukin-6, tumor necrosis factor-alpha-receptor-2, and high-sensitivity C-reactive protein.

Researchers looked at 1,958 postmenopausal women in the Women’s Health Initiative Observational Study, comparing inflammatory marker levels with dietary fiber intake.  They found that high fiber intake was associated with significantly lower levels of inflammatory markers interleukin-6 and tumor necrosis factor-alpha-receptor-2.  This association was true individually for total fiber, insoluble fiber, and soluble fiber.  The researchers found no association with C reactive protein.

Bottom line?  High intake of dietary fiber seems to reduce chronic inflammation, which may, in part, explain the observed clinical benefits of fiber.

Rest assured that the Mediterranean diet is naturally high in fiber.

Steve Parker, M.D.

Reference:  Ma, Yensheng, et al.  Association between dietary fiber and markers of systemic inflammation in the Women’s Health Initiative Observational Study.  Nutrition, 24 (2008): 941-949.

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