Gut feeling


Don’t let irritable bowel syndrome define who you are. Understand what triggers your problem, so you can manage it better, says Sujata Mukherjee

If you are suffering from IBS, or irritable bowel syndrome, chances are you get irritated by the little things in life. Well, that is not surprising. If you constantly feel some kind of uneasiness in your bowels – either constipation or loose motion – then feeling querulous is par for the course. What is worse is that a visit to a doctor doesn’t always help. After a battery of tests, the doctor says it’s just IBS, nothing serious. Then you get a long list of foods you ought to give up or avoid and friendly advice to “avoid stressful situations and sleep blissfully”. And, maybe, a prescription, which also includes a mild anti-depressant.

The medicines and lifestyle changes usually work for a couple of months or a little longer but soon you are back to square one. That is why people suffering from IBS develop such a fear of eating that they often become malnourished.

And yet that need not be the case – IBS is not a serious health problem and about one in three people have suffered it at some point in their lives.

“This is not a severe or a killer disease but an extremely irritating one,” says interventional gastroenterologist Dr Sabyasachi Pattanayak. “It can be managed if you learn to avoid the triggers – specific food items, irregular habits and situations that stress you out.”

Know the triggers

If you suffer predominantly from constipation, avoid refined and processed food, coffee, carbonated drinks, alcohol, protein-rich food and dairy products. Make sure you get adequate fibre in your diet – men should get at least 38gm and women 25gm of fibre from whole grain bread or cereals, beans, fruits and vegetables. Also, drink enough water.

If your IBS predominantly gives you diarrhoea, restrict the intake of whole grains such as brown bread, oats, barley, brown rice as well as fruits and vegetables. Try and avoid cabbage, cauliflower, chocolate, alcohol, carbonated drinks, coffee and fried food. If you feel that wheat or milk products are the cause of the problem, avoid them. Don’t drink water while eating. Also avoid ingesting ice cold and steaming hot food at the same time.

Learn to manage stress judiciously. Work out regularly and practise yoga and meditation to relax.

Some antibiotics, anti-depressants and cough syrups can irritate the bowel. Consult your physician to identify them. Sometimes, irregular menstrual cycles create problems. Take your doctor’s help to manage this.

Try not to eat too quickly or while doing some other work. This can irritate your bowel as can chewing too much gum.

If the above restrictions do not show results, try a specific diet known as low FODMAP (fermentable oligo, di, and monosaccharides and polyols).

The restriction includes food containing oligosaccharides (like wheat, rye, legumes, some fruits and vegetables, garlic and onion), disaccharides (milk, yogurt, soft cheese), monosaccharides (fruits like mango as well as honey and nectar) and polyols (found in fruits such as blackberry, litchis and in low-calorie sweeteners).

“To follow this diet, you need determination and

patience. You have to go through the following steps,” says Dr Pattanayak.

Step 1: Restriction. Keep away from all high-FODMAP items for 3-8 weeks. In many cases, symptoms improve within a week; in a few cases it doesn’t work at all.

Step 2: Reintroduction. After the acute symptoms subside, one food item is added to the diet. Maintain an IBS journal where you write what you eat, when you eat and how you are feeling. You need to track whether you feel any irritation within 24 hours. If things are okay, increase the amount of food. In three days’ time, you can add another food. This will help you identify your specific FODMAP and the threshold level of the food item.

Step 3: Personalisation. After you have identified your FODMAP, decide on a list of food items that suit you. Determine the amount of irritant food you can tolerate (no need to do away with it altogether). Now follow this personalised guideline while eating out or shopping at the grocer’s. Apart from this, when you buy packaged food, run an eye down the list of ingredients.

There is no reason to panic. Many high-FODMAP items may not even irritate your bowel; and, sometimes, the list of irritants is not that long.


• Protein: Chicken, eggs, fish, prawn/shrimp, tofu, beef, lamb, pork

• Whole grain: Brown rice, buckwheat, maize, millet, oats, quinoa

• Fruits: Banana, blueberry, kiwi, lemon, mandarin, oranges, papaya, pine-apple, strawberry

• Green vegetables: Spinach, carrots, bellpepper, brinjal, tomato, bean sprout

• Nuts: Almond, peanuts, macadamia nut, pecan, pine nuts, walnuts

• Seeds: Pumpkin, sesame, sunflower, linseed

• Dairy: Cheddar cheese, lactose-free milk, parmesan cheese


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