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Irritable Bowel Syndrome Dietary Therapy |
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 IBS is a very common disorder. Please refer to my essay Irritable Bowel Syndrome for details about this disorder. This information is directed to dietary considerations.
The large bowel or colon is the site of many beneficial bacteria. A Wonderful Colon provides considerable detail on how the colon and its bacteria function together to provide our bodies with certain health benefits. However, the colon is the site for many of the symptoms in IBS patients. Since this organ is where all fiber and other food remnants arrive, it would seem logical that some parts of food we eat might play a role in the symptoms of IBS, which for the most part, are a reflection of an overly sensitive colon.
IBS is currently seen as falling into several major types. Patients will frequently overlap their symptoms or even swing from one type to another. In each case, the diet may play an important role. So there is always some experimentation that each patient must undertake to see which dietary changes work best.
Abdominal Discomfort, Cramps, Bloating
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The gut has been called the second brain because it has so many nerve cells within it. IBS patients have an increased nervous sensitivity built into their intestinal tract. This means that minor changes in the way the intestines contract can be perceived as discomfort, whereas in other people it is not. At times, there may be excessive production of colon gas resulting in bloating and discomfort. It is important that you understand how this occurs, namely that colon bacteria ferment soluble plant fibers in the food you eat and some of these bacteria will create harmless gases. You need to understand the difference between soluble fiber and insoluble fiber in your foods.
All fiber goes through the small intestine unchanged. Soluble fiber as is found in foods such as oats, beans and fruit pectins is fermented by the colon bacteria. It is used as a food by these bacteria which, in turn, provide significant health benefits. Some benign colon bacteria will create intestinal gases, mostly hydrogen, which then can move on down and become flatus. Insoluble fiber, on the other hand, is not fermented by colon bacteria and is evacuated relatively unchanged. No colon gas occurs with insoluble fiber.
Constipation Dominant
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Constipation occurs when the colon just does not contract well enough or often enough. The stool within it becomes dehydrated and hard. Why does the colon become so lazy and what can be done about it? The diet may be important. Insoluble fibers such as wheat and wheat bran are not fermented by colon bacteria so they do not produce colon gas. At the same time, they retain water and create a large, bulky stool. This, in turn, often stimulates the colon to contract and provide easier evacuation. The first step then is to gradually increase the amount of insoluble fiber up to 10-15 grams a day or even more.
Soluble fibers, on the other hand, are trickier since they are used by colon bacteria as a food source and some of these bacteria make colon gas. Still, these fibers, especially the newly discovered prebiotic ones, produce many benefits within the colon. So, the IBS patient should eat enough soluble fiber to create its health benefit but not enough to produce crampy bloating and flatus.
Go to Fiber Content of Foods for the amount of fiber in each food.
Methane Constipation
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Methane is just one of the gases in the colon along with hydrogen sulfide (odor), hydrogen, carbon dioxide and oxygen. There is some early research that suggests that the colon gas, methane, may promote constipation. Prebiotic plant fibers can change the acidity of the colon to an extent that these particular methane producing bacteria can't grow. Were I still in practice, I would encourage my constipation dominant IBS patient to eat prebiotic containing foods. Or they could take prebiotics supplement powders in gradually increasing doses - 1 gram a day for a week, then 2 grams and so forth. If excessive colon gas and bloating or cramps occur before constipation improves, then the test did not work. If it did, then that amount of prebiotic food or supplement is right for you. A signal to look for is to evaluate the malodorous sulfide smell of your flatus. Like the methane producing bacteria, the bacteria that make these sulfide gases also can not grow in an acid environment. If your flatus has no or little smell, your colon may be at the right acidity and so prevent the methane producing bacteria from growing.
Diarrhea Dominant
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 There are many causes of diarrhea. Your physician will want to be sure there is not a correctible cause present. For instance, some patients chew sugar free gum, which is high in the sweetening agent, sorbitol. This can lead to diarrhea. Read the labels. Others may have lactose intolerance, meaning they don't digest the milk sugar, lactose. The lactose ends up in the colon where it can promote colon gas and diarrhea. There may be chronic infections, such as the parasite, Giardia, residing in the small bowel. Celiac sprue may be a concomitant or even the major problem. When all of these and more are ruled out, then diarrhea dominant IBS can be diagnosed with confidence.
The next step is to consider the types of fiber in your diet. Increasing insoluble fiber in the diet or with a dietary supplement is worth a try as these can bulk up the stool which, of course, is desirable. Soluble fibers can aggravate diarrhea. However, they, along with probiotic bacteria, can also change the bacterial makeup of the colon in such a beneficial way that it may reduce the diarrhea.
Go to Fiber Content of Foods for details.
I suggest gradually increasing the insoluble fiber in the diet up to 10 grams or more a day. Following this, I would add prebiotic fibers, either in foods or a dietary supplement in very gradual increasing doses. If there were no change in symptoms, then I would add a probiotic at the direction of your physician. There is no secret here. What works for one IBS patient with diarrhea may not work for another. Judicious trial and error is recommended.
Colon Bacteria in the IBS Patient
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We, in medicine, are in a new era regarding what we know about the colon and its inhabitants. What we have known for a long while is that the density and numbers of bacteria within the human colon are greater than any other place in the animal kingdom or, in fact, any place in the world. There are more bacteria within the colon by a factor of 10 than there are cells in the entire body. This is amazing! There is likely a reason and, yes, a good healthy reason for this. We have always thought that there were around 400-500 different species of colon bacteria. We were wrong. The number just discovered in 2007 is closer to 1,000 different species.
A key and likely a very important fact, again just discovered in 2007, is that IBS patients have a significantly different colon bacterial makeup than those people without IBS. This has been a startling finding but, thinking it through, it should not have come as a great surprise. Bacteria flourish in the colon and they provide huge numbers of benefits for us. They rely on the foods we eat and what we used to call waste products for their health. However, in some way they may be a problem as well. Can changing the bacterial makeup of the colon change the symptoms in IBS patients? This is a key question. A recent research study showed that a certain probiotic formula may reduce the symptoms of cramping and bloating in some IBS patients. We will await more research on what these interesting findings mean for the IBS patients.
Changing Colon Bacteria
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 This may be difficult but not impossible. A change in the foods you eat is central.
Gradually reduce animal foods - meat, poultry, fish to a more balanced diet with increasing fresh fruits and vegetables. You can go to our Fiber Content of Food to get a great deal of information of fiber of various food groups.
Add probiotics to your diet. There is no consensus yet on which are the best ones. There is still much research being done. The three types of bacteria which have been studied most are the Bifidos (Bifidobacterium), the Lactos (Lactobacillus) and streptococcus. You can get these in many low calorie dairy products and yogurt as well as over-the-counter pills.
Increase prebiotics in the diet with specific foods that contain them. The main ones are inulin and oligofructase. North Americans generally have a very low consumption of these, getting most in wheat and onions. An easy way to add prebiotics is with a dietary supplement (products).
Summary
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There are no specific and right answers for every IBS patient. There will always be some trial and error necessary to see what is right for you. Still, there are some general principals that may apply to most patients.
- Gradually reduce animal protein, especially red meat and increase the vegetables and fruit content proportionally. Select a balanced mix of soluble and insoluble fiber, aiming for 25-35 grams a day. Go to Fiber Content of Foods for specifics.
- You can try adding a probiotic. The product with some evidence behind it for improving cramps and bloating is VSL#3. There are likely other healthy probiotics that work but we just don't have the evidence for them yet. There are likely beneficial bacteria in many yogurt and dairy food preparations. The ones that have been best studied are the Bifidos (Bifidobacterium), Lactos (Lactobacillus) and certain streptococcus species. Always check with your physician before using probiotics.
- Increase prebiotics fibers in the diet by eating specific foods (Sources of Prebiotics) and/or a supplement (product).
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Medical References
BACKGROUND: Prebiotics are short-chain carbohydrates that alter the composition, or metabolism, of the gut microbiota in a beneficial manner. It is therefore expected that prebiotics will improve health in a way similar to probiotics, whilst at the same time being cheaper, and carrying less risk and being easier to incorporate into the diet than probiotics. AIM: To review published evidence for prebiotic effects on gut function and human health. METHODS: We searched the Science Citation Index with the terms prebiotic, microbiota, gut bacteria, large intestine, mucosa, bowel habit, constipation, diarrhoea, inflammatory bowel disease, Crohn's disease, ulcerative colitis, pouchitis, calcium and cancer, focussing principally on studies in humans and reports in the English language. Search of the Cochrane Library did not identify any clinical study or meta-analysis on this topic. RESULTS: Three (Sources of Prebiotics), oligofructose, galacto-oligosaccharides and lactulose, clearly alter the balance of the large bowel microbiota by increasing bifidobacteria and Lactobacillus numbers. These carbohydrates are fermented and give rise to short-chain fatty acid and intestinal gas; however, effects on bowel habit are relatively small. Randomized-controlled trials of their effect in a clinical context are few, although animal studies show anti-inflammatory effects in inflammatory bowel disease, while calcium absorption is increased. CONCLUSIONS: It is still early days for prebiotics, but they offer the potential to modify the gut microbial balance in such a way as to bring direct health benefits cheaply and safely.
PURPOSE OF REVIEW: This review summarizes the clinical efficacy of probiotics and prebiotics in gastrointestinal disorders and examines the mechanisms of action related to their therapeutic effect. RECENT FINDINGS: The demonstration that immune and epithelial cells can discriminate between different microbial species has extended the known mechanism(s) of action of probiotics beyond simple barrier and antimicrobial effects. It has also confirmed that probiotic bacteria modulate mucosal and systemic immune activity and epithelial function. The progressive unraveling of these mechanisms of action has led to new credence for the use of probiotics and prebiotics in clinical medicine. Level I evidence now exists for the therapeutic use of probiotics in infectious diarrhea in children, recurrent Clostridium difficile-induced infections and postoperative pouchitis. Level II evidence is emerging for the use of probiotics in other gastrointestinal infections, prevention of postoperative bacterial translocation, irritable bowel syndrome, and in both ulcerative colitis and Crohn disease. Nevertheless, one consistent feature has emerged over the past year: Not all probiotic bacteria have similar therapeutic effects. Future clinical trials will need to incorporate this fact into trial planning and design. SUMMARY: The use of probiotics and prebiotics as therapeutic agents for gastrointestinal disorders is rapidly moving into the "mainstream." Mechanisms of action explain the therapeutic effects and randomized; controlled trials provide the necessary evidence for their incorporation into the therapeutic armamentarium.
Patients with irritable bowel syndrome (IBS) often request dietary recommendations. They must eat, and they want to know what to eat. Present national guidelines recommend dietary treatment with fiber for IBS patients with constipation. Diet recommendations are made based on symptoms. There may be different dietary recommendations for constipation, diarrhea, and pain or bloating. This article reviews the relationship of foods to IBS and issues of food intolerances and hypersensitivities, and recommendations for diet therapy. The role of dietary fiber, both soluble and insoluble, is reviewed. Although there are few studies to substantiate exact diets, broad dietary plans are recommended for the different symptoms of IBS. In addition, the recent literature on probiotics and prebiotics pertinent to IBS is reviewed.
BACKGROUND & AIMS: Irritable bowel syndrome (IBS) is a significant gastrointestinal disorder with unknown etiology. The symptoms can greatly weaken patients' quality of life and account for notable economical costs for society. Contribution of the gastrointestinal microbiota in IBS has been suggested. Our objective was to characterize putative differences in gastrointestinal microbiota between patients with IBS and control subjects. These differences could potentially have a causal relationship with the syndrome. METHODS: Microbial genomes from fecal samples of 24 patients with IBS and 23 controls were collected, pooled in a groupwise manner, and fractionated according to their guanine cytosine content. Selected fractions were analyzed by extensive high-throughput 16S ribosomal RNA gene cloning and sequencing of 3753 clones. Some of the revealed phylogenetic differences were further confirmed by quantitative polymerase chain reaction assays on individual sampl es. RESULTS: The coverage of the clone libraries of IBS subtypes and control subjects differed significantly (P < .0253). The samples were also distinguishable by the Bayesian analysis of bacterial population structure. Moreover, significant (P < .05) differences between the clone libraries were found in several bacterial genera, which could be verified by quantitative polymerase chain reaction assays of phylotypes belonging to the genera Coprococcus, Collinsella, and Coprobacillus. CONCLUSIONS: The study showed that fecal microbiota is significantly altered in IBS. Further studies on molecular mechanisms underlying these alterations are needed to elucidate the exact role of intestinal bacteria in IBS.
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