# Diet for IBS - fat and fibre



## Tracey Heynes (Nov 5, 2001)

Can you please clear up a couple of things for me,Heather?On fat,you say "you must strictly limit or,preferably,eliminate altogether...from your diet"(This comes under a section headed Trigger Foods)I am anxious about following this advice.Surely some fat is essential in our diet,especially for older women or underweight people like me,where osteoporosis is a fear?I've been told I should eat plenty of oily fish.Also,recent health advice has stressed the value of oils such as olive and sunflower in the diet.My other question is about soluble fibre.You talk about white bread,pasta and rice(also white I presume) as well as potatoes as being very important.For people like me who have bloating and constipation how can these be helpful?A lot of carbohydrate is supposed to be unhelpful in bloating.Also,aren't refined carbohydrates poor in vitamins etc which the refining process removes?Also,fibre supplements like Metamucil make me very bloated.If I eat refined carbohydrates how will I get enough fibre unless I eat tonnes of fruit and veg?Hope you can help as I desperately need to do something about my diet but am very confused about what to do.Thanks in advance,Ibsed


----------



## Heather Van Vorous (Oct 2, 2001)

Hi Ibsed - You raise some questions that people often have about fats and soluble vs. insoluble fiber.First, I recommend that people "strictly limit or, preferably, eliminate altogether, HIGH FAT FOODS from their diet". I do NOT recommend that the eliminate fats altogether. This is neither necessary for IBS nor is it healthy. What I mean by high fat foods are those not necessary for good overall health at all - things such as red meat, dairy products, egg yolks, deep fried foods, solid chocolate, coconut, etc. It's important that the IBS diet be low fat, as fat is the single greatest trigger of the GI tract's gastrocolic reflex, but there is big difference between low fat and fat free. Since the diet is low fat, this means that the fats you eat need to count for good nutrition. So things like olive oil, canola oil, flaxseed oil, avocados, nuts, and fatty fish should be the source of oils in the diet. They still need to be treated as triggers, as ALL fats trigger the gastrocolic reflex very strongly, so these foods should not be eaten in large quantities, on an empty stomach, or without soluble fiber as a stabilizer. But they certainly should be eaten (and since you have a copy of Eating for IBS, the recipes give good examples of how to use these foods safely).Soluble fiber will help, not worsen, constipation. This is why soluble fiber supplements like Metamucil and Citrucel are marketed as laxatives. Soluble fiber foods will work the same way as soluble fiber supplements. All soluble fiber soothes and regulates the contractions of the GI tract, and normalizes bowel function from either extreme (whether diarrhea or constipation).Most grains, fruits, and veggies have both soluble and insoluble fibers. This is true for wheat, rice, potatoes, corn, apples, pears, squash, etc. Typically, the outer layer is insoluble, and the inner part is soluble. The outer layer of grains, the bran, is very nutritious, but it is also likely to cause IBS attacks if it's not eaten very carefully, as insoluble fiber is right up there with fats in terms of the strength of the gastrocolic reflex it triggers. As with fats, you don't want to eliminate insoluble fiber from your diet. This would be extremely unhealthy. Instead, you need to minimize it when you are in a cycle of attacks, and once you stabilize (which the soluble fiber will help accomplish) you can then add it back in according to specific guidelines - never on an empty stomach, never in large quantities by itself, and never without soluble fiber to keep the gastrocolic reflex at a stable and normal rate. Again, the recipes and guidelines in your book show how to incorporate lots of fruits, veggies, beans, and grains without triggering attacks.Metamucil can make bloating worse for some IBS people, as its source of soluble fiber, psyllium, can cause this problem. Other sources of soluble fiber don't typically do this, so you might try taking Citrucel or Fibercon instead (they don't use psyllium). Hope this helps clear up some of the confusion. Please let me know if you still have questions.Best, Heather


----------



## Tracey Heynes (Nov 5, 2001)

Dear Heather,Many thanks for the clarification on fats,also the info.on fibre supplements.I still don't understand about the white bread,white pasta and other refined carbohydrates as I've always understood -from trillions of self help stuff on constipation !-that these are my enemies!Also,where bloating is a problem,limiting one's carbohydrates is often advised.Dare I ask for your thoughts on these? (I promise I won't continue to bombard you with questions !)


----------



## Heather Van Vorous (Oct 2, 2001)

Hi - White rice, pasta, breads, etc. have soluble fiber but no insoluble. For straightforward constipation, and not IBS-C, insoluble fiber is the fastest solution. It speeds contractions of the GI tract, adds water to the stool, and results in matter passing through the colon more quickly. For IBS, this can result in pain from too-rapid and too-violent colon contractions (something people with IBS are by the very nature of the problem prone to). It can also paradoxically worsen constipation, as these muscle contractions can actually be so strong they cause a spasm that simply doesn't end, and in effect the muscles have just plain seized up. This is not only excruciatingly painful but as there are now no regular contractions of the gut occurring at all, no matter is moving through the colon, and constipation will worsen. For people with IBS-C that fluctuates to D, insoluble fiber can flip the coin and send them off into these painful spasms and diarrhea instead of normalizing the bowel.Refined grains (the breads, rice, etc.) have the insoluble fiber removed, so these foods are very unlikely to trigger an IBS attack. They have the soluble fiber intact, however, and soluble fiber will resolve constipation just as it resolves diarrhea. It normalizes the contractions of the gut, absorbs excess water in the colon (good for diarrhea), and forms a thick, wet gel that expands the colon and gives the muscles something to "grip" in order to move matter along via peristaltic waves (good for constipation) and the wet gel also helps to soften and move along impacted fecal matter (again, good for constipation). You can actually see this wet gel result if you dissolve some cooked white rice or pasta in a glass of water. Soluble fiber is best used daily, regularly, for benefits to IBS-D. It will gently normalize the GI muscle contractions and then keep things stable. Most self-help advice for constipation focuses on high fiber (meaning high insoluble fiber foods) as these are the most effective for solving plain old constipation. They just carry some pretty great risks for people who have IBS-C. Soluble fiber is a safer route to take.Remember, too, that basing meals and snacks on soluble fiber does not mean avoiding insoluble fiber. It just means realizing that these foods can be triggers, so they have to be carefully incorporated (cooking, chopping, peeling, pureeing fruits and veggies into sauces, soups, smoothines, fruit breads, etc.) and eaten with soluble fiber. This is true for whole grains too. You can have unrefined carbohydrates - everyone needs to be eating these. But you can't eat them with abandon if you have IBS. Having them with a high soluble fiber base will make them much less risky. You can also focus on whole unrefined grains that are highest in soluble fiber and safest for IBS - particularly oatmeal, brown rice, and barley.If you just have constipation, and not IBS, feel free to eat the insoluble fiber foods without hesitation. For the bloating, this can actually happen with an increase of any kind of fiber. Drinking lots of fresh water (or the helpful herbal teas, such as peppermint, chamomile, anise, and particularly fennel) will help, and usually people adjust to extra fiber within 1-2 weeks. I'm not sure why carbs in general would be fingered as causing bloating - I actually haven't heard that. Starches can be, and most high soluble fiber foods are starchy, but adjusting to them and increasing water intake (and watching sodium levels) should prevent this from becoming an ongoing problem.Hope this helps. Please feel free to ask as many questions as you like - that's what the board is for.







Best,Heather


----------

