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Controlling your IBD
Diet and Nutrition -
Bloating
Bloating and excessive wind may be a result of the poor absorption
of fructose or lactose sugars.
1. Fructose (fruit sugar) may cause bloating
Fructose is fruit sugar which is slowly absorbed in the small
intestine. If we take more than can be tolerated, the excess travels
along the bowel and is fermented by bacteria. A large amount of wind
and 'explosive' diarrhoea may result. Cutting down on the amount of
fructose taken at one time (the fructose dose) will limit symptoms.
Fructose is found in large quantities in honey, some fruits, fruit
juices and smoothies. The presence of another sugar, glucose, is
important. If glucose is present alongside fructose, fructose is
better tolerated. When there is more fructose than glucose in a
fruit (see below), diarrhoea may result.
Unfavourable foods that have more fructose than glucose
Fruit:
Apple, pear, guava, honeydew melon, nashi fruit, pawpaw/papaya,
quince, star fruit, watermelon, unripe (hard) banana, coconut
and fruit salad made with these fruits.
Dried fruit:
Apple, apricot, currant, date, fig, pear, prune, raisin,
sultana.
Dried fruit bars containing dried apple and pear.
Fruit juices and fruit juice concentrates, fruit smoothies;
apple and pear juice.
Corn syrup solids and high fructose corn syrup solids (HFCS)
found in chutney, relish, sweet & sour sauce, BBQ sauce,
marmalade and jams.
Other:
golden syrup, honey, fortified wines.
Better choice foods that have fructose approximately equal to, or
less than glucose
Stone fruit:
apricot, nectarine, peach, plum.
Berry fruit: blueberry, blackberry, boysenberry, cranberry,
raspberry, strawberry.
Citrus fruit: orange, grapefruit, lemon, lime, mandarin.
Other fruits: ripe banana, kiwi fruit, passion fruit,
pineapple, rhubarb.
2. Lactose (milk sugar) may cause bloating
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Lactose is milk sugar which is digested by an enzyme called lactase
found in the small intestine. If lactase is missing, lactose will
pass along the bowel where bacteria will use it, producing gas and
diarrhoea.
Lactose intolerance related to IBD is usually temporary, but while
it is present modest lactose restriction may help symptoms. If you
think you may be lactose intolerant, cutting out lactose should
improve your symptoms within 48 hours. If your symptoms improve you
have two options available:
Continue to cut out lactose
'Train' your intestine to tolerate lactose
If you feel better on a lactose-free diet then a dietician can help
ensure your diet is nutritionally adequate, and also help with a
reintroduction regime.
Foods to avoid on a lactose-free diet:
Animal milk:*
Any animal source (cow, goat or ewe) and foods containing
yoghurt,* fromage frais, custard, ice-cream
Batters (e.g. Yorkshire pudding, pancake batters)
Salad dressings, savoury dips, sauces, marinades, some muesli
Food ingredients especially whey, whey proteins, casein,
caseinates, lactose, milk solids, buttermilk.
*note that a dash of milk in hot drinks, or a small pot of
bio-yoghurt, may be tolerated on a lactose-free diet as the 'dose'
of lactose is too small to cause symptoms.
Foods to substitute on a lactose-free diet:
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Lactose-free cow’s milk
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Plant milks: choose calcium fortified soya milks; oat milks and
rice milk do not contain calcium
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Soya desserts and yoghurts; fruit sorbet
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Probiotic containing yoghurt
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Cream cheese and ‘hard’ cheeses such as Cheddar are virtually
lactose free
3. Fermentable fibre ('soluble' fibre) may cause bloating
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Soluble fibre is different to the roughage fibre that should be
avoided when IBD is active. Soluble fibre forms a soft gel within
the bowels and can reduce cholesterol levels and also reduce
diarrhoea.
Soluble fibre is food for healthy 'probiotic' bacteria. When bowel
bacteria use soluble fibre, they make tiny fats (called 'short chain
fatty acids' or SCFAs) that colon cells use for fuel. Healthy colon
cells absorb salts and water more effectively, reducing diarrhoea.
SCFAs have another benefit, too. Until used by the cells of the
colon they keep bowel contents slightly acidic, favouring growth of
other healthy 'probiotic' bacteria and keeping down levels of
unhealthy bacteria ('pathogens') such as Clostridium difficile.
The only drawback to soluble fibre is that the feeding bacteria
produce gas (wind). The link between baked beans and wind is well
known, and shows how bacteria use the soluble fibre in baked beans
to produce a noticeable amount of wind. Eating foods rich in soluble
fibre regularly, though, eventually lessens the amount of gas
produced.
Foods rich in soluble fibre: peas, beans, lentils; wheat and
wheat products, white or brown (bread, pasta, biscuits);
avocado, mango, papaya; green leafy vegetables, broccoli, onions;
Psyllium seeds, flaxseeds (linseeds).
It is important to make sure you drink enough to be well-hydrated.
If you have diarrhoea you need to increase your intake of fluid; the
average daily need is 6-8 cups a day, which doesn't need to be
water. Tea, coffee, squash, juice, soup, and milk all count towards
your daily fluids.If your diarrhoea is severe you need to include
more salty fluids; you could add salt to soups, or take an oral
rehydration solution to supplement your fluid intake.
If you have specific symptoms you may need to modify your choice of
drinks. Urgency and diarrhoea after drinking may be related to
caffeine content. You can reduce your caffeine intake by using
decaffeinated tea, coffee, or cola drinks, or naturally caffeine
free Rooibos tea and herbal teas. Caffeine is also found in
functional drinks and fast-acting pain medications.
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