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Question : I have irritable bowel syndrome (IBS) with constipation. I'm also about 20-25 pounds overweight. What kind of diet do I need to follow to address both of these issues?
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The Trusted Source
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Howard LeWine, M.D.

Mary Pickett, M.D. is an Associate professor at Oregon Health & Science University where she is a primary care doctor for adults. She supervises and educates residents in the field of Internal Medicine, for outpatient and hospital care. She is a Lecturer for Harvard Medical School and a Senior Medical Editor for Harvard Health Publications.

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October 09, 2013
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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.

The best diet for you will be highly personalized. Here is some general advice for you to work with:

Avoid fats. Fats are full of calories, so they are an obvious contributor to obesity. Fats also may cause the abdominal cramping episodes that can be common in IBS. Fats in your stomach cause your colon to respond to a meal with a more exaggerated set of contractions, so that the “gastrocolic reflex” that happens after eating can be more painful. Cholesterol concerns have caused doctors to describe different fat types as either “good fats” or “bad fats.” But all fats can cause problems if you have IBS or a weight concern.

Eat more soluble 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. Some forms of fiber are able to mix evenly with water, forming a soft gel. This fiber type is known as soluble fiber. Some examples are the fiber in oats, apples, lentils, and barley.

Soluble fiber can improve every symptom of an irritable bowel. Soluble fiber gel thickens stool that would otherwise cause diarrhea. It prevents constipation by softening and hydrating stool, making it easier to move along the colon.

In general, fiber is a great help to weight management. Since it is not itself absorbed, it does not add calories. But unfortunately, many sources of soluble fiber also contain large quantities of “carbs”, like white flour, white rice, pasta or polenta. Carbs can contribute to weight concerns because they trigger you to snack between meals.

Eat small, slow and frequent meals. If you keep your portions small, this will help to reduce your total calories. Frequent meals may offset the snacking urges from carbs that are associated with soluble fiber sources. Hurried eating or drinking can cause you to have increased gas due to swallowed air. So slow meals can improve bloating symptoms.

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 in chocolate, bananas, avocados, tomatoes and some fish products.

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. One study showed that 40% of IBS patients who restricted dietary fructose and sorbitol had improved symptoms.

 

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