Q: I have irritable bowel syndrome. I'm also about 20-25 pounds overweight. What kind of diet do I need to follow to address both of these issues?
A: Obesity and irritable bowel syndrome (IBS) are common problems. Still, it's not easy to prescribe a diet without considering your own food preferences, calorie vices and symptom triggers.
1. Avoid fats. Fats are full of calories, so they're an obvious contributor to obesity. And fats may contribute to the abdominal cramping common in IBS. Fats in your stomach can cause your colon to respond to a meal with a more exaggerated set of contractions.
2. Eat more fiber. Fiber is food residue that your digestive enzymes can't break down, so it travels the whole length of your colon and exits as stool. Fiber can help both with diarrhea and constipation. And it helps with weight management. Since fiber is not itself absorbed, it does not add calories. Be selective. Just because a food is high in fiber doesn't necessarily mean other ingredients in the food are low in calories.
3. Drink plenty of water. This is a must if you have constipation-predominant IBS. Also drinking a glass of water can help dampen an urge to snack.
4. Eat small portions and eat them slowly. If you keep your portions small, this will help reduce your total calories. Hurried eating or drinking can cause you to have increased gas due to swallowed air, so eating slowly can reduce bloating symptoms.
5. Watch for specific food triggers. By keeping a food diary or by trial and error, some people can identify specific dietary triggers for their symptoms. Lactose (milk products) is a very common trigger. Others include eggs, wheat and foods that contain "salicylates" or "amines."
Salicylates are natural ingredients found in various fruits, vegetables, nuts, tea, coffee, honey, numerous spices, beer, wine, juices and peppermint flavoring. Amines are found in aged or fermenting products, such as cheese, wines, beer, yeast extracts, vinegars and soy sauce. They're also present in chocolate, bananas, avocados, tomatoes and some fish products.
6. Avoid food additives that increase gas. People often use these three sweeteners -- mannitol, sorbitol and fructose. But these carbohydrates are not easily digested and promote gas production by bacteria in the intestines. They are commonly added to many liquid medicines, health foods, juices, candies, dietetic snacks and chewing gum. Avoiding these sugars may be particularly important for people who experience bloating or diarrhea.
(Mary Pickett, M.D., is an Associate Professor of Medicine at Oregon Health and Science University, Portland, where she is a primary care doctor for adults. Dr. Pickett is a Lecturer for Harvard Medical School and a Senior Medical Editor for Harvard Health Publications.)
(For additional consumer health information, please visit http://www.health.harvard.edu.)
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