Humans have been consuming probiotics for thousands of years via fermented foods, but over the last century, supplements have emerged to deliver high concentrations of specific strains, such as Lactobacillus acidophilus and Bifidobacterium bifidum. Probiotic supplements are hugely popular, generating $759 million in U.S. sales in 2020. If you’re looking to improve your gut health, you may have considered taking a probiotic supplement—but experts warn against doing so without the guidance of a gut-health specialist.

“[American College of Gastroenterology] guidelines don’t recommend widespread use of probiotic supplements, even for the majority of gastrointestinal conditions,” says Vanessa Méndez, MD, triple board-certified gastroenterologist. She notes that supplements may be helpful in specific instances—for example, to help treat infections or to restore gut microbiota following a course of antibiotics—but in other instances, they may be ineffectual, at best.

In general, Méndez recommends getting probiotics the old-fashioned way: from fermented plant foods, such as tempeh, miso, and kimchi. A 2016 review published in Critical Reviews in Food Science and Nutrition analyzed a number of studies and concluded that for healthy people, probiotic foods appeared more effective than supplements; the researchers posited that this may have to do with a buffering effect of foods to help probiotics pass through the gut.

But all probiotics, whether from food or supplement, will only take up residence in environments that are hospitable to their strain. Otherwise, they’ll act more like tourists. “Consuming the microbes themselves can have a temporary effect,” says Méndez. The real long-term benefit comes from giving your existing beneficial microbes what they need to thrive and multiply. That’s where prebiotics come in.

Prebiotics: Premium Fuel for a Healthy Gut

Most of what we eat is broken down and absorbed in the small intestine, but fibrous nutrients known as prebiotics move on to the large intestine and serve as food for beneficial microbes. As the microbes break down prebiotics, they release biochemicals that carry out important tasks in the body (more on that below).

While only a few types of resistant starch and fiber have been confirmed to be prebiotic, experts expect the list to grow. “Ten years ago, the entire conversation around prebiotics revolved around inulin, so people started focusing on Jerusalem artichokes and asparagus. But we now know that consuming a wide variety of plants is far healthier than only consuming Jerusalem artichokes and asparagus,” says Will Bulsiewicz, MD, MSCI, board-certified gastroenterologist and the author of The Fiber Fueled Cookbook. “I think the important point is that all plants, without question, contain prebiotic fiber.”

Bulsiewicz and Méndez emphasize that probiotic supplements can be useful in certain medically supervised contexts, and probiotic-rich foods can help bring diversity to your gut microbiome—but prebiotic foods are the bedrock of sustainable gut health.

“The great thing about a whole-food, plant-based diet is that you can be consuming both [prebiotics and probiotics],” says Méndez. “Fill your plate with more fiber-rich foods, and you’re going to be feeding a healthy gut microbiome.”

Food manufacturers are hip to the growing interest in prebiotics. The next time you’re at the grocery store, you’ll likely spot granola bars or sugary cereals sporting claims about prebiotics on their labels. Don’t buy it. “They’re still ultraprocessed foods,” explains Bulsiewicz. He instead advises choosing dietary fiber “in its native state”—i.e., whole plant foods.

What Are Postbiotics?

One of the most exciting developments in the gut-health world is the discovery of postbiotics: short-chain fatty acids (SCFAs) and other biochemical byproducts that gut microbes release as they consume prebiotics. SCFAs such as butyrate, acetate, and propionate carry out important functions throughout the body, reducing inflammation and insulin resistance, killing cancer cells, and maintaining the integrity of the intestinal barrier. They also appear to help synthesize neurotransmitters and influence the brain in other profound ways.

“For a long time, we thought that the intestinal tract was essentially just a hollow tube that churned food and absorbed nutrients,” says Méndez. “Then we discovered that gut microbes are really involved in the process of breaking down fiber. And recently, we’ve realized that they actually do so much more.”

The post Why You Probably Don’t Need a Probiotic Supplement appeared first on Forks Over Knives.

A 2017 study published in The American Journal of Gastroenterology assigned 412 participants to either a high-fiber diet or low-fiber diet over the course of several months, and found that people eating high-fiber diets were 41% more likely to experience bloating than those on the low-fiber diets.

The biochemistry behind your increased need to pass gas is pretty simple: As you digest, bacteria in your gut ferments food that isn’t fully digestible (i.e., fiber) and produces gas as a byproduct. The more fiber you eat, the more flatulence you might experience. The good news? Over time your digestive system will adjust to the diversity of your new diet and become more adept at processing high-fiber foods, reducing the frequency of post-meal gassiness. 

How Much Farting is Normal?

While you may notice an uptick in flatulence when you go vegan, the average person already farts between 10-20 times a day. Sound like a lot of passed gas? You probably don’t notice the frequency of your own flatulence because the vast majority of gas doesn’t smell. Only compounds that contain sulfur, such as hydrogen sulfide, give your farts any sort of noticeable stink. Lots of veggies, legumes, and nuts contain small amounts of sulfur, but it likely won’t change the odor of your gas very much because a healthy diet promotes a balanced gut microbiome. The main thing to remember is that flatulence is normal and is an essential part of a healthy digestive system—so keep the gas coming!

How Can I Naturally Relieve Gas?

Until your gut microbiome has adjusted to your new plant-based lifestyle, you can manage this uncomfortable—and sometimes loud—side effect of eating healthier with a few simple yoga poses. All of these postures move your body into shapes that help gas travel through the digestive system and decrease that tight, pressurized feeling in your belly. The next time you experience bloating after a meal try one of these yoga poses to relieve gas before you reach for the bottle of Tums. 

Yoga Poses to Relieve Gas and Bloating

Ardha Apanasana (Knee to Chest)

Quite literally translated into English as “wind-relieving pose,” this posture is great for helping trapped gas move through your intestines.

1. Lie flat on your back with legs extended out on the floor.
2. Pull one knee into your chest, holding your leg around the shin or kneecap. The back of your head should stay planted on the floor.
3. Keep the other leg extended out long. Hold this position for up to 5 minutes before switching sides.
4. Alternatively, you can pull both knees into your chest so you are curled into a ball.

Ananda Balasana (Happy Baby)

While you might feel a little silly in this shape, Happy Baby is an excellent pose for releasing gas and relieving a bloated stomach.

1. Lie flat on your back with knees bent and feet on the floor.
2. Pull both knees up toward your chest and press feet toward the ceiling. Your knees will be bent.
3. Grab onto your shins, ankles, or feet (depending on your flexibility). Gently pull knees closer toward the ground as your feet stay flexed up toward the ceiling and legs move gently apart. 
4. Keep head and neck pressed into the ground. If it feels good, you can rock from side to side. Hold this pose for 1 to 5 minutes.

Supta Matsyendrasana (Spinal Twist)

In this pose, think of your body like a washcloth that’s being wrung out to dry. Deep twists support the digestive system by compressing the organs to help move gas through the body.

1. Lay flat on your back with legs extended out long on the floor.
2. Pull your right knee into your chest by wrapping your hands around your shin or kneecap. Keep the left leg extended long.
3. Draw your right knee across your body to the left. Your knee may touch the floor or it may hover; it just depends on what feels good in your body.
4. Extend your right arm out to the side and turn your head to look over your right hand. Your left hand can stay on the bent knee or you can extend that arm out to the left side.
5. Hold this pose for 1 to 5 minutes. Roll gently onto your back and repeat on the other side.

Anjaneyasana (Low Lunge)

A great hip-opening stretch that’s ideal for anyone who works at a computer all day, low lunges also help you pass gas by stretching out the pelvic muscles.

1. Start in a kneeling position on your knees. Step your right foot forward while keeping the left knee on the ground.
2. Place your hands on top of your right thigh or place them on the ground on either side of your front foot. 
3. To increase the intensity of the stretch in your hips, gently scooch the back left knee further behind you, widening the stance of your lunge.
4. Hold this shape for 1 to 3 minutes. Bring the right knee back underneath your hips and step forward with the left leg to repeat on the other side.

Uttanasana (Forward Fold)

Forward folds use the power of gravity to create length in your spine and settle your stomach.

1. Stand with your feet hip-distance apart.
2. Hinge forward from your waist so that your torso is draped over your thighs. Allow your head and neck to dangle. 
3. Your legs can be straight, or you can bend your knees if you have a tight low back. Your hands can rest on the floor beside your feet, rest on top of your shins, or wrap behind your calves. 
4. Hold this shape for 1 to 3 minutes before slowly rolling back up to standing.

Malasana (Garland Pose)

A great way to make this flatulence-fighting shape more accessible is to tuck a yoga block or footstool underneath your hips so you can relax into the squat instead of muscling your way through it.

1. Start standing with your feet wider than your hips and toes turned out on a diagonal angle.
2. Squat down as far as you can so that your knees are deeply bent and your pelvis is resting between your legs.
3. Bring your palms together in a prayer position in front of your heart and press your elbows into your knees to help keep your legs open wide.

Balasana (Child’s Pose)

A calming posture for both your gut and your mind, this classic yoga pose relieves tension in the pelvic area and low back.

1. Start in a tabletop position on your hands and knees. Bring your big toes together to touch and send your knees out a little wider than your hips.
2. Sink your hips back toward your heels, and crawl your arms out long. Your belly will rest between your thighs. Your forehead can rest on the ground or on a pillow.
3. Hold this position for 2 to 5 minutes at a time. If you feel discomfort in your low back, try raising your hips so they are stacked over your knees while you keep your arms, head, and chest pressed down toward the floor.

Feel free to combine all these postures into a full gas-relieving sequence or simply try one pose at a time when the need arises.

This article was originally published on May 13, 2022, and has been updated. 

To learn more about a whole-food, plant-based diet, visit our Plant-Based Primer. For meal-planning support, check out Forks Meal Planner, FOK’s easy weekly meal-planning tool to keep you on a healthy plant-based path.

The post The 7 Best Yoga Poses to Relieve Gas and Bloating appeared first on Forks Over Knives.

Our everything-you-need-to-know guide is here to help you better understand who the low-FODMAP diet is designed for, how it works, and how to maintain a whole-food, plant-based diet as you heal your digestive issues. Forks Over Knives spoke with gastroenterologist Will Bulsiewicz, MD, MSCI, who offered his best advice on confidently taking control of your health with the low-FODMAP diet.

In this article you’ll learn:

• What Are FODMAPs?
• What Is the Low-FODMAP Diet?
• Are High-FODMAP Foods Bad For You?
• Who Should and Shouldn’t Go on the Low-FODMAP Diet?
• How Long Should You Be on a Low-FODMAP Diet?
• What Else Might Be Causing Gut Health Issues?
• Can You Be Whole-Food, Plant-Based While on a Low-FODMAP Diet?
• Our Favorite Low-FODMAP Recipes

What Are FODMAPS?

The acronym FODMAP stands for “fermentable oligosaccharides, disaccharides, monosaccharides, and polyols,” which are certain types of short-chain carbohydrates that aren’t easily digested.

Most digestion occurs in the small intestine, where food is broken down, nutrients are absorbed into the bloodstream, and waste is then pushed into the large intestine. But the small intestine has trouble absorbing nutrients from FODMAPs, because the human body doesn’t produce the enzymes needed to break down these specific types of short-chain carbs; instead, it relies on the trillions of microorganisms that live in our large intestine to do this task. When the small intestine encounters FODMAPs it pulls in extra water to move these foods to the large intestine, which can cause bloating and other GI issues.

Once the food reaches the large intestine, gut bacteria begin to ferment it and get it ready for excretion. While this fermentation is a natural and healthy process, the bacteria can produce excessive amounts of gas when encountering difficult-to-break-down FODMAPs, leading to all the unpleasant symptoms associated with IBS.

What Is the Low-FODMAP Diet?

While people with healthy gut microbiomes are able to digest FODMAPs without issue, those with sensitive digestive systems have a much harder time. The good news is that your gut can be trained to better tolerate the foods it once struggled with, which is where the low-FODMAP diet comes in.

“The [low-FODMAP] diet is generally reserved for people who are having digestive health problems that include food intolerances,” explains Bulsiewicz. “What that means is that when people consume normal foods in a normal serving size, they have unpleasant symptoms like bloating, abdominal pain, cramping, diarrhea, constipation, and nausea. The [low-FODMAP] diet is an approach that allows them to improve their symptoms and eventually to reintroduce these foods that they have struggled with.”

The low-FODMAP diet is typically broken down into three main stages:

• Eliminating high-FODMAP foods from your diet to establish a baseline.
• Reintroducing high-FODMAP foods one at a time so you can determine which are triggering unpleasant symptoms.
• Customizing your diet by figuring out the specific portion sizes of high-FODMAP foods that are tolerable and integrating them back into your normal diet in those portions.

“A properly constructed low-FODMAP approach involves restriction, but it’s just a temporary restriction,” says Bulsiewicz. “Then it’s all about reintroduction, which can be quite complicated. Generally, I recommend that people do it with the support of a dietitian or someone who’s an expert on the topic.”

Are High-FODMAP Foods Bad for You?

The short answer is no! High-FODMAP foods are not intrinsically bad or dangerous unless you have a specific allergy or condition, such as celiac disease. High-FODMAP foods include fruits, vegetables, and whole grains, which are some of the healthiest foods you can eat.

“The vast majority of FODMAPs are actually prebiotic, meaning that they are good for the gut microbiome,” Bulsiewicz explains. “[By] avoiding high-FODMAP foods, you’re depriving yourself of all of the beneficial nutrients that are found in that food, such as polyphenols and phytochemicals and vitamins and minerals. When we categorically remove these foods, it’s potentially problematic because not only are we getting into a restrictive dietary pattern where you are more likely to have a nutritional deficiency, but you are negatively affecting the gut microbiome.”

So while it can be tempting to blame your digestive woes on the foods themselves, it’s better to look at the low-FODMAP diet as a technique to slowly make friends with these foods rather than a way to avoid them. Creating a flourishing gut microbiome that can tolerate a wide range of foods is key to fewer digestive problems in the long run and better health throughout your life.

“When you’re struggling, it’s because the gut microbes are fermenting [FODMAPS] in a way that’s inefficient and gas producing,” says Bulsiewicz. “Your gut microbes can be trained to do better.”

Who Should and Shouldn’t Go on a Low-FODMAP Diet?

The low-FODMAP diet is not meant to be a weight-loss technique and should only be used by people struggling with digestive issues related to food intolerances. While weight loss may occur on the diet, Bulsiewicz emphasizes that it’s important to get enough calories and nutrients while on this diet.

“People who have a history of disordered eating should not be doing this, especially not independently,” he recommends. “They should only do it with the approval of someone who’s managing their disordered eating so they can be in a good place before moving forward with it. Also, if a person has a complex medical condition, such as active Crohn’s disease, and they’re losing weight, then it’s not the time to do something like this. You have to get your disease under control first before going on a low-FODMAP diet.”

How Long Should You Be on a Low-FODMAP Diet?

The low-FODMAP diet is meant to be temporary, with the goal of resuming more normal eating patterns as soon as possible. Total time spent on the diet will vary from person to person. Typically, the elimination phase lasts two to six weeks and then high-FODMAP foods are slowly reintroduced based on your symptoms and sensitivities. The entire process should only last a few months, says Bulsiewicz.

“Ultimately, we want a diet of abundance,” says Bulsiewicz. “The most important rule for gut health is to eat a wide variety of plants. The advantage of a properly constructed FODMAP approach is that it allows you to, number one, feel better. Number two, understand what the source of your problem is. Then number three, to actually have a strategy to bring that food back on board and tolerate it.”

Bulsiewicz says that you’ll know the low-FODMAP diet has worked once you’re able to enjoy a wide variety of foods free of unpleasant symptoms. Remember, the idea of going on the low-FODMAP diet isn’t to eliminate large categories of food: It’s to slowly retrain your gut microbiome to tolerate the foods that typically trigger it.

“Ease into it and give your body a chance to catch up and adapt to what you’re doing,” Bulsiewicz recommends. “It’s similar to exercise. If you haven’t worked out in a while, you wouldn’t pick up the heaviest weight in the gym. You’d start small and work your way up from there. It’s the same with high-FODMAP foods. As with anything, you’ll get better the more you practice.”

What Else Might Be Causing Gut Health Issues?

There are myriad other reasons for digestive problems besides FODMAP sensitivities. As you work on retraining your gut, it’s likely your physician will also recommend lifestyle changes to help bolster the impact of your dietary changes. Bulsiewicz says there are many aspects of our modern lives that lead to gut issues.

“It’s the lack of sleep, it’s the electronics in the evening before you go to bed, it’s the absence of exercise, it’s the medications, and it’s the large amount of processed foods present in our diet,” he says. “These are all disruptive to the balanced community of microorganisms in our gut.”

Stress can also play a significant role in chronic gut health problems. A 2020 review published in Current Opinion in Behavioral Sciences indicates that the relationship between our mental health, gut microbiome, and dietary choices is deeply interconnected. Depression, anxiety, and other psychological conditions can influence the reactivity of gut bacteria and cause flare-ups of digestive issues. When beginning the low-FODMAP diet, be sure to talk with your doctor about how mental health may be playing a role in your intestinal discomfort.

Can You Eat Whole-Food, Plant-Based While on a Low-FODMAP Diet?

The low-FODMAP diet was created with omnivores in mind, which means it can often be more restrictive for people who follow a whole-food, plant-based diet since meat and dairy are already off the table. Bulsiewicz shared some thoughts on how to get enough calories and nutrients as a vegan who’s traversing the low-FODMAP path.

“I think it’s important to include all of the major [plant-based] food groups,” he says. Don’t eliminate an entire group of food. Instead, opt for low-FODMAP options within that groups. “For example, people may often have issues with whole grains, and those issues are usually specific to wheat, barley, and rye. You can opt for a low-FODMAP option like quinoa.”

While we always recommend going directly to your doctor for health care advice, you can check out this full list of FODMAP foods to get a general idea of what you’ll need to eliminate if you’re exploring a low-FODMAP diet. Bulsiewicz also offers an online class in FODMAP intolerance that includes techniques on reintroduction, healthy recipes, and handy kitchen tricks.

“Be patient, because it takes time,” Bulsiewicz recommends. “It’s not meant to be a quick fix. It’s meant to be about your long-term health and allowing you to have a diet that is sustainable and enjoyable.”

Our Favorite Low-FODMAP Recipes

High-FODMAP foods such as beans, wheat, lentils, and fibrous veggies are some of the healthiest foods on the planet, and diets rich in these foods have been linked to lower rates of heart disease, certain cancers, and Type 2 diabetes. However, should you need to temporarily cut back on these foods to retrain your gut, here are some healthy WFPB recipes you can enjoy on a low-FODMAP diet:

• Sweet Potato Jalapeño Poppers
• Cantaloupe-Cucumber Soup
• Blueberry Farro Grain Bowl
• Jerk Grain Bowls with Air-Fried Plantain Chips
• Berry-Stuffed Breakfast Sweet Potato

The post Everything You Need to Know About the Low-FODMAP Diet appeared first on Forks Over Knives.

As rates of irritable bowel disease and other gastrointestinal disorders have risen in recent years, so, too, has the amount of questionable “gut health” advice floating around on the internet. One prominent voice cutting through the noise is Will Bulsiewicz, MD, MSCI. “Dr. B,” as he’s known to his patients and more than 400,000 Instagram followers, is about as close to a rock star as a gastroenterologist can get. In May 2020, he released his debut book, Fiber Fueled, which explored the fascinating science of the microbiome and broke down why a whole-food, plant-based diet beats fad diets such as Paleo and keto when it comes to sustainable weight loss and long-term health. The book quickly became a New York Times best-seller, highlighting consumers’ hunger for answers to chronic gastrointestinal woes.

Now, two years later, he’s back with The Fiber Fueled Cookbook, a cookbook/guidebook hybrid geared toward helping readers pinpoint their own specific food sensitivities, heal their guts, and develop a repertoire of healthy plant-based recipes they can turn to every day. We spoke with Bulsiewicz about his latest release, the fiber paradox, and the top two foods you should ditch right now if you’re having GI problems. Read on for the full conversation, and check out an exclusive Sweet Potato Shawarma recipe from the new book here.

What made you decide to write this book?

Fiber Fueled was an unexpected success. With that came a lot of enthusiasm from readers, but many came to me saying, “I want to eat the way that you’re describing, but I don’t feel well when I do.” As a gastroenterologist, I understood what they meant, because I see this in clinic all the time—people who suffer with digestive health problems struggling to increase fiber in their diet. I wanted to create a resource that [empowers] people to eat a diet that heals the microbiome—which is a plant-based diet. … Whether you’re healthy or whether you have gut issues and food intolerances, we can share the same common cookbook and pursue a higher level of health together. So that was the goal with this book.

You note that dairy and artificial sweeteners are the first things that you recommend people try ditching when they come to you with gastrointestinal problems. Why?

The reason they cause so much trouble is dairy contains lactose, and 70% of the world is actually lactose intolerant. And artificial sweeteners are what we call polyols: sugar alcohols. Although they may not have calories, they can still be fermented, and they can still be disruptive to our gut microbes. In a person who has bloating or diarrhea, when I remove these things, there’s legitimately a 30% chance that we’re done. And that saves my patient a lot of money, they feel better, and now they’re given an opportunity to replace this part of their diet with something better. And I see no reason to include [dairy and artificial sweeteners] in your diet at all, from a health perspective.

If a fiber-rich diet is the key to a healthy gut, why do so many people experience uncomfortable bloating after adding more fiber to their diets?

In the book, I call this the fiber paradox. Fiber is the nutrient that heals the gut microbiome. But the people who need fiber the most are also the ones who struggle the most [when incorporating fiber], because their gut is in a damaged state. We lack the enzymes as humans to process fiber, which means that we are 100% reliant on microbes [living in our guts] to do it for us. If you take a person who has a damaged gut microbiome, their capacity to process and digest fiber may be impaired relative to a person who has a completely healthy microbiome. That doesn’t mean that they’re not capable of consuming fiber. … You can get functionality back and become fully capable of consuming unlimited amounts of fiber. You just have to go through the proper process to do that.

What does it mean to heal your gut?

Your gut is the most adaptable part of your entire body. Like anything else in life, with practice, your gut microbes can become better; they can become more efficient. They can have enhanced functionality. I’m in no position to run a marathon today. If you give me four months to train, I could do it. Similarly, your gut may not be in a position to process and digest large amounts of fiber today, but if you go through this process with me and you train it, in four months, you can do it. So this is a message of hope that we’re not stuck. We just need to know how to fix it, and that’s what I’m trying to teach in the book.

Could you break down the GROWTH strategy that you outline in the book?

Each letter represents a step in the process of healing your gut. “G” stands for “Genesis”: What is the root cause of your problem? Understanding the problem means that we will be able to create more targeted solutions. “R-O-W” is “restrict, observe, work it back in.” This is the approach that we take to identify food intolerances. A blood test can never tell you what foods you are intolerant to. … If you temporarily remove something and your symptoms improve, and then you add it back in and your symptoms get worse, you have identified a food intolerance. Once we know what we’re treating, we can move to the next step, which is the healing phase: “T,” train your gut, “H” stands for holistic healing.

You write that one of the most fulfilling aspects of your career has been helping patients get the help they need to heal emotional wounds, and then watching their “impossible” gut health problems disappear. Why is mental health important to gut health?

It’s very, very important for people to understand that many times it’s the parts that don’t [directly] involve our digestive system that are negatively impacting us. And people may not make these connections. They may think, “Oh, well, the fact that I hate my job has nothing to do with my digestive health problem,” but that’s not actually true. You are a whole person, so we have to look at the whole person and understand that anything that’s affecting you as a human being could eventually downstream affect your gut health. And when we create plans to treat you as a whole person—addressing any trauma in your life—we actually are providing the best treatment for your gut health.

Who is The Fiber Fueled Cookbook for?

My book was designed to help people enhance the health of their microbiome in whatever way suits them. So it jumps out as being for people with food intolerances…but if a person has a healthy gut, I want them to understand that our gut health is proving to be essential not just for our digestion but also our metabolism, our immune system, our hormones, our mood, our brain health, and our energy levels. This is a precious resource and so important to our health.…We should all be living with intention and supporting this part of our body, starting today, because it’s that important.

This interview has been edited and condensed for clarity.

To learn more about a whole-food, plant-based diet, visit our Plant-Based Primer. For meal-planning support, check out Forks Meal Planner, FOK’s easy weekly meal-planning tool to keep you on a healthy plant-based path.

The post 2 Foods to Ditch if You Have GI Issues, Plus More Expert Advice from Gut Whisperer Will Bulsiewicz, MD appeared first on Forks Over Knives.

Irritable bowel syndrome (IBS) affects as many as 45 million people in the United States. It is the most common diagnosis in gastroenterology practices: 1 out of 3 patients seen are suffering from IBS. More people miss work as a result of irritable bowel syndrome than any other reason other than the common cold. In this article, we’ll review the symptoms of IBS and the scientific research regarding IBS and diet.

What Is Irritable Bowel Syndrome?

IBS is a chronic condition that affects the large intestine, causing symptoms that range from mild to debilitating. It is considered a functional bowel disorder, which means the problem isn’t with the structure of the bowels; it’s with how they work. Because symptoms are present without any visible signs of damage to the digestive tract, it is not diagnosed through testing such as blood tests, X-rays, or endoscopy. Doctors may order tests to rule out other digestive problems, such as celiac disease, but IBS is not a diagnosis of exclusion. Instead, diagnosis is made using a well-accepted set diagnostic criteria called the Rome criteria.

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Symptoms of IBS

According to the Rome criteria, to be diagnosed with IBS, a patient should have abdominal pain and discomfort lasting on average at least one day a week for the last three months. The pain or discomfort should be related to defecation, associated with a change in frequency of bowel movements, and/or associated with a change in stool consistency. Other symptoms of IBS can include bloating, gas, passage of mucus, straining, urgency, or a feeling of incomplete evacuation.

What Causes IBS?

The exact cause of IBS is not known, though we know at the root is a disturbance in the interaction between the gut, brain, and nervous system. “There are millions of neurons in our gut, and the gut and brain are talking to each other all the time through the vagus nerve,” says Dr. Sarina Pasricha, MD, MSCR, a gastroenterologist specializing in gut motility. “The gut, the brain, and the nervous system are like three legs of a stool. If one part is not working properly, the whole thing weakens and falls apart.” 

Two of the biggest factors behind IBS are gut dysbiosis, an imbalance of the bacteria in the GI tract, and stress and anxiety. Studies show that people with IBS have unusually sensitive nerve endings in the GI system and are prone to feeling more intense pain at lower thresholds. This can lead symptoms to flare up in conditions—dealing with a stressful situation or even simply eating a meal—that would not trigger symptoms in those without IBS.

Trigger Foods

“The first thing I usually recommend to my patients is cutting out dairy,” says Pasricha. “Dairy for most people is quite inflammatory. With just that switch alone my patients will have symptom improvement.” Other common triggers include consuming large meals, high-fat meals, caffeine, alcohol, and carbonated drinks. 

It can be helpful for patients with IBS to keep a food diary to uncover their personal food triggers. However, it is important to not jump to conclusions, because foods aren’t the only triggers. “Patients with IBS may be able to eat one food item one day and not have an issue, but the exact same food item on a different day will create an issue,” says Pasricha. “That’s where environment and stress play a role as triggers. It is always worth reintroducing and retrying foods to see if it’s the food or that environment—like eating too quickly that day—causing the issue.”

It is often recommended for people to try a diet low in certain carbohydrates called FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols). FODMAPs are found in dairy products and certain grains, vegetables, and fruits. However, since so many healthy plant foods fall into the FODMAP category, totally cutting them out—while it may reduce symptoms in the short term—will lower the number of healthy microbes in the gut, increase the number of unhealthy ones, and leave you worse off in the long term, says Pasricha. 

“When necessary, the low-FODMAP diet can help reset the gut microbiome, but I only recommend this for 4 to 6 weeks and only for the most severe cases of IBS,” says Pasricha. “After that it is really important that you slowly try to incorporate FODMAPS back into the diet in order to provide the right type of food for your gut microbiome.” 

For severe cases of IBS, Pasricha recommends working with a plant-based dietitian.

IBS and Plant-Based Diets

A whole-food, plant-based diet improves the gut microbiome, which can improve IBS symptoms. “I always recommend a whole-food, plant-based diet for my patients and counsel them that the more variety you can eat in fruits and vegetables, the healthier the gut microbiome will be,” says Pasricha. In 2018, the American Gut Project released the largest study of the microbiome to date and found that subjects who ate more than 30 different types of plants (including whole grains) in a week had significantly healthier gut microbiomes compared with those who ate 10 or fewer types of plants each week, with more beneficial gut microbes and fewer harmful microbes. 

Studies show that compared with people eating an animal-based diet, a plant-based diet increases microbiota diversity in part because it provides more fiber. Fiber is considered a first-line therapy in treatment recommendations for patients with IBS, according to the 2021 American College of Gastroenterology clinical guidelines. “A whole-food, plant-based diet that is rich in fiber helps to produce short chain fatty acids, which is the key to building a robust gut microbiome,” says Pasricha. Fiber adds bulk to stool, speeds up its transit through the colon, and can help regulate bowel movements. A 2018 study found that the more fiber participants consumed, the less likely they were to have IBS. Soluble fiber—found beans, oats, lentils, and certain fruits—may serve as a prebiotic, feeding beneficial bacteria in the gut. Research suggests that insoluble fiber, the “roughage” that whole grains and vegetables tend to be rich in, has a laxative effect that can relieve constipation. 

However, most people with IBS will need to go slowly when beginning a plant-based diet. “I always tell my patients not to go from 0 to 100 really quickly,” says Pasricha. “It’s OK to go gradually, to slowly increase fiber intake and slowly transition to a whole-food, plant-based diet, especially if they experience gas and bloating to begin with. It’s important to counsel our patients that when they are transitioning to a whole-food, plant-based diet they might experience some worsening of their gas and bloating. That is expected. It is not harmful.” As noted above (see “Trigger Foods”), it’s important to keep an open mind and remember that it’s not always food causing the issue. “People will have a symptom when eating an apple or broccoli and assume it’s the food, but it doesn’t mean they have to eliminate it permanently,” says Pasricha. “They need to retry those foods again.”

IBS Treatments

While a change in diet is the first powerful step in alleviating symptoms of IBS, studies have found improvements with a range of lifestyle strategies including exercise, yoga, stress reduction, biofeedback, and psychological therapies such as cognitive behavioral therapy. “IBS requires a multifactorial approach to treatment and management,” says Pasricha. “Mind, body, soul, and gut health care are all important.” 

For people suffering from more severe IBS, treatment may include prescription antispasmodic or antidiarrheal medications, or low-dose antidepressants. “The last resort is medication,” says Pasricha. “We don’t want our patients to be on medications lifelong if they don’t need to be. After transitioning to a whole-food, plant-based diet and making lifestyle changes, many of my patients are able to decrease the dose of medications or come off of them entirely.”

To learn more about a whole-food, plant-based diet, visit our Plant-Based Primer. For meal-planning support, check out Forks Meal Planner, FOK’s easy weekly meal-planning tool to keep you on a healthy plant-based path.

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1. Vegans poop more.

It’s true: Vegans poop more. A University of Oxford study of 20,000 people found that vegans poop more than vegetarians who poop more than meat eaters. Eating a healthy vegan diet (i.e., rich in fruits, veggies, and whole grains) makes it easy to exceed the recommended 25 to 30 grams of fiber a day, and it’s not unusual for that to translate into daily poops for vegans—or two or three!

2. It’s about quality, not quantity.

More important than how often you poop is experiencing a sense of total relief afterward, usually a welcomed side effect of eating plant-based. Without this sense of satisfaction, you could be constipated—even if you poop every day or have diarrhea (called overflow). “The goal is to sit on the toilet for less than three minutes and to have a soft poop that comes out without pushing or straining,” says Dr. Sarina Pasricha, MD, MSCR, a gastroenterologist specializing in gut motility.

3. You can be plant-based and still constipated.  

A plant-based diet lays the foundation for healthy poop (especially when it includes flax and chia seeds), but other factors, such as hormonal changes, play a role. Regular exercise and water help move food through the colon. Stress-reduction techniques such as yoga and meditation can help, too. Pasricha diagnoses about 50 percent of constipated WFPB patients with pelvic floor dysfunction, where muscles that are supposed to relax during pooping actually tighten up. The fix? Pelvic floor physical therapy.

4. Look before you flush. 

Consult the “Bristol stool chart” (the poster you’ll find in any GI doctor’s office) and get to know the illustration for Type 4. That’s your shooting star: poop formed like a long, bulky, soft sausage or snake, smooth without lumps. Sixty percent of stool’s weight comes from gut bacteria of the microbiome. When you feed gut bacteria the fiber-rich plant foods they prefer, they thrive and multiply; as a result, you have larger BMs, says Dr. Will Bulsiewicz, MD, MSCI, a gastroenterologist and author of Fiber Fueled. 

5. Treat poop like a vital sign.

When your poop is off, it’s a red flag that your gut bacteria aren’t being treated with TLC. Heed the warning. Since gut health is integral to all health, dysbiosis may manifest into other disease states, says Bulsiewicz. Constipation can precede diagnosis of Parkinson’s disease by as many as 20 years and is common in up to two-thirds of patients. It’s also linked to an increased risk for breast cancer, according to a study in the Cancer Epidemiological Biomarkers, and mood disorders. Tend to your gut microbes with a diverse menu of 30 different kinds of plants per week, and if you see pencil-thin poops or blood, or don’t feel like you’re completely emptying your bowels, call your doc for a workup.  

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It’s estimated that IBD, which takes the form of Crohn’s disease or ulcerative colitis, affects 5 million people worldwide. The United States accounts for more than half of that number. In recent years the incidence of IBD has increased in several countries where both Crohn’s disease and ulcerative colitis had previously been uncommon. And that increase, the study’s authors note, seems to coincide with these nations adopting a Western diet.

Previous research connecting diet with IBD had been limited and even conflicting. However, most of those studies involved a small number of participants. The current study drew findings from questionnaires given to 116,087 adults aged 35 to 70 who were enrolled in the global Prospective Urban Rural Epidemiology (PURE) study between 2003 and 2016. After a median follow-up of 9.7 years, 467 participants were found to have developed IBD (90 with Crohn’s disease and 377 with ulcerative colitis).

After adjusting for other potentially influencing factors, researchers found that those individuals who reported a higher intake of ultra-processed foods—such as soft drinks, refined sweetened foods, salty snacks, and processed meats—were much more likely to develop IBD.

Participants were grouped according to their level of ultra-processed food consumption: less than one serving a day, one to four servings per day, and more than five servings per day. Compared with people who had less than one serving of ultra-processed food a day, those who consumed one to four servings daily had a 67 percent greater risk of developing IBD. And those who ate at least five daily servings of ultra processed food were 82 percent more likely to develop IBD than those who ate one serving or less. 

Among study participants, ultra-processed food consumption was highest in North America, Europe, and South America. These regions also logged the highest consumption of processed meat and soft drinks. Participants in North America and Southeast Asia ate the most salty snack foods such as chips, while South American participants consumed the most refined sweetened foods such as chocolate.

Researchers found that unprocessed red and white meat; dairy; and whole foods such as fruit, vegetables, and legumes were not associated with IBD risk, leading researchers to posit that it isn’t the type of food but the way a food is processed that relates to the elevated risk.

“Ultra-processed foods often contain high amounts of many non-natural ingredients and additives such as artificial flavors, sugars, stabilizers, emulsifiers, and preservatives,” said the study’s lead author, Neeraj Narula, MD, MPH, FRCPC, director of the IBD Clinic and associate professor of medicine at McMaster University in Ontario, Canada. “Detergents and emulsifiers that are added to foods may have a detrimental impact on the gut barrier, as some translational science research papers have demonstrated increased intestinal permeability—or ‘gut leakiness’—with consumption of these ingredients.” Narula notes that increased intestinal permeability is thought to play a key role in the development of IBD.

Growing Research

This is not the first time ultra-processed foods have been linked to disease. A 2018 population-based cohort study of 104,980 participants found that a 10 percent increase in the proportion of ultra-processed food in one’s diet raised their cancer risk by more than 10 percent. Another large observational study linked higher consumption of ultra-processed foods with increased risks of cardiovascular, coronary heart, and cerebrovascular diseases. Meanwhile, there is also evidence that eating an ultra-processed diet increases calorie consumption and leads to weight gain, compared with a diet rich in whole plant foods. 

To learn more about a whole-food, plant-based diet, visit our Plant-Based Primer. For meal-planning support, check out Forks Meal Planner, FOK’s easy weekly meal-planning tool to keep you on a healthy plant-based path.

The post More Processed Foods, More IBD: New Study appeared first on Forks Over Knives.

Natural Strategies for Hormone Balance

Did you know that a simple food prescription can help to gently restore your hormone balance? Myriad common health issues, including menstrual pain, weight gain, menopause symptoms, and hair loss are impacted by hormones that have gone haywire.

In this webinar, Dr. Neal Barnard, adjunct professor of medicine at George Washington University School of Medicine, shares his extensive knowledge and practical advice on how food and hormones play a powerful role in overall health. In this webinar, Dr. Barnard:

• Explains what happens when hormones go haywire and how foods can help to bring them back into balance.
• Provides insight into the hormones that are hiding in foods or are influenced by the foods we eat.
• Shares the science behind how common hormone-related conditions—such as weight gain, endometriosis, menstrual pain, and infertility—can be improved with very simple diet changes.

WATCH THE REPLAY

Originally aired April 7, 2020

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Worsening GERD and IBS

I’d experienced digestive troubles since I was a teenager, but they worsened over the course of my medical training. I began to have uncontrollable episodes of diarrhea, nausea, and abdominal cramps, and I became less focused and more depressed. It was not uncommon for me to skip social meet-ups because of stomach cramps and loose stools. Eventually, I was diagnosed with irritable bowel syndrome. On top of this, I had horrible acne. There was a long list of medical therapies for my ailments; I tried them all and none helped. 

In early 2016, I began to search for the connection between nutrition and health, going through stacks of books and articles, especially about Loma Linda, California, where an unusually high percentage of the local population led healthy, active lives well into their 90s. These were seniors who worked full-time and cycled or even taught fitness classes on the side. Notably, the people of Loma Linda ate mostly plant-based diets. Then I attended the annual American College of Lifestyle Medicine conference and heard lifestyle medicine legends speak about how beneficial plant-based diets can be for a variety of issues, not just longevity.

Taking Charge with Lifestyle Changes

I reflected and realized that my diet was the likely culprit behind my IBS and acne. I decided to make the switch to a plant-based lifestyle. I spent a week cleaning out my kitchen and learning how to shop and cook differently. I explored plant-based substitutions to make healthier versions of some favorite foods. I made dishes such as tofu adobo, peanut butter vegetable stew, and cashew cheese lasagna. It was an enjoyable and meaningful time, because for the first time I wasn’t fearful of my IBS symptoms. I knew if I changed the way I ate, I would minimize the injury to my microbiome.

Over the course of a few months, my bloating, loose stools, and GERD resolved. My acne cleared up, and my mood greatly improved. I began walking daily, which further helped my gut issues as well as my mental health. As I became more mindful, I no longer craved ultra-processed foods, and my performance at work improved, too. 

It’s been nearly five years, and I’m thriving on a plant-based diet. Since making the switch, my mission in medicine has evolved. I now tell my story to patients and educate them about the power of plants, and many have improved their blood sugar and cholesterol levels by eating this way.  Through my personal journey as well as my clinical experience, I deeply understand the impact that daily habits have on health.

Ready to get started? Check out Forks Meal Planner, FOK’s easy weekly meal-planning tool to keep you on a healthy plant-based path. To learn more about a whole-food, plant-based diet, visit our Plant-Based Primer.

The post How Changing My Diet Healed My Gut and Made Me a Better Doctor appeared first on Forks Over Knives.

Good health starts with a healthy gut.

Did you know that most of your immune system resides in your gut, along with 99.5 percent of your genetic code? It’s also home to trillions of microbes—aka your gut microbiome—that help keep your body running like a well-oiled machine. A healthy microbiome is the key to boosting metabolism, balancing hormones, and taming the inflammation that can lead to a host of diseases and conditions.

In this webinar video, Dr. Will Bulsiewicz, gastroenterologist and author of the new Fiber Fueled: The Plant-Based Gut Health Program for Losing Weight, Restoring Health, and Optimizing Your Microbiome, shares cutting-edge research and his extensive clinical knowledge on gut health and diet. In this presentation, you will learn:

• How your microbiome impacts blood sugar, cholesterol levels, immunity, mood, and more.
• Why elimination diets can be hazardous to your health.
• The signs and symptoms of a damaged microbiome, and how simple diet changes can help undo the damage in fairly short order.

WATCH THE REPLAY

Originally aired on May 13, 2020

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