The diet utilised was completely different to the commonly prescribed low residue diet, instead encouraging the consumption of quality unrefined fibre. The diet included:

Daily consumption of:

• Brown rice
• Eggs
• Milk
• Miso (fermented bean paste) soup
• Vegetables
• Fruits
• Legumes
• Potatoes
• Pickled vegetables
• Plain yoghurt

Meat consumption was restricted to fish once per week, and other meat once every 2^nd week.

The diet provided all the vitamins and minerals needed, including iron. Green tea consumption was encouraged.

This diet was designed to promote the consumption of prebiotic foods, therefore improving the balance of gut flora in the IBD patient.

Foods that were discouraged included:

• Sweets
• Bread
• Cheese
• Margarine
• Fast foods
• Carbonated beverages
• Juices

Healthy habits were also encouraged including:

• Not smoking
• Regular physical activity
• Moderate consumption or avoidance of alcohol
• Regular meals
• Not eating between meals

Although this study was conducted on those with diagnosed crohns disease, and more specifically those who have just undergone medical treatment, it could also be applicable to those with other forms of irritable bowel syndrome.

WARNING: Increasing fibre too quickly could exacerbate symptoms, in this study participants had their fibre gradually increased. This was done by beginning with white rice, then changing to a mixture of white and brown rice, and finally full consumption of brown rice. It is recommended to reader’s considering implementing dietary changes to increase their fibre content gradually.

Reference:

Chiba M, Abe T, Tsuda H, et al. Lifestyle related disease in Crohn’s disease: Relapse prevention by a semi-vegetarian diet. World J Gastroenterology. 2010 May 28; 16 (20): 2484-95.

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Crohn’s disease and a semi-vegetarian diet

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Some methods to manage the symptoms include:

• Eat frequent small meals
• Avoid fatty foods
• High fibre diet

Increasing insoluble fibre through supplements or diet changes might exacerbate symptoms; soluble fibre on the other hand can improve symptoms (e.g. psyllium husks). If you are increasing fibre in your diet, increase it slowly, even in healthy individuals rapid changes in fibre intake can cause unpleasant side effects.

Possible methods of management include:

• The use of prebiotics & probiotics
• Pepperment oil (to relieve mild symptoms)
• Avoiding allergy foods/intolerances – Some patients (not all) with IBS may have food allergies or intolerances that trigger an IBS type reaction, if you suspect this is the case with you, see an allergy specialist or a dietician to undergo a supervised elimination diet.

Possible food triggers:

• Lactose malabsorption – Lactose is a sugar present in milk and other dairy products, the structure of Lactose requires the presence of an enzyme called lactase for absorption. If you do not produce enough of this the lactose will remain undigested and ferment in your bowel, causing pain and discomfort. This can be managed easily by purchasing low lactose/lactose free alternatives such as soy milk, lactose free milk, yoghurt, and avoiding products like cream.
• Fructose malabsorption – Fructose is a type of sugar present naturally in foods, it is also often added to foods such as breakfast cereals, baked goods, jam, and fruit juice. You can manage this by avoiding foods with added fructose (e.g. high fructose corn syrup), and by avoiding foods naturally high in fructose, such as:

-          Honey

-          Dates

-          Oranges

-          Cherries

-          Apples

-          Pears

Mixing this fruit with other foods will slow down the absorption of fructose. Some fruits lower in fructose include bananas and strawberries. Another added sugar is called inulin, this can be added to products such as yoghurt, and can be poorly absorbed.

• Reducing gas forming foods – some examples include:

-          Beans

-          Brussel sprouts

-          Onions

-          Celery

-          Carrots

-          Cabbage

• Wheat and gluten – Avoiding wheat and gluten can reduce symptoms if you are sensitive to the gluten protein. This could be due to a misdiagnosis, as you may not have IBS but might have celiac disease. If you suspect this, get tested before eliminating the food from your diet. Once tested if you would like to eliminate the food as a trial you will need to eliminate it for 3months to get an accurate result.
• Low fat diet – IBS patients have an increased sensitivity to fat, reducing the fat content of your diet might reduce symptoms.
• Coffee – Coffee stimulates the bowel with or without caffeine, eliminating coffee from the diet could reduce symptoms if diarrhoea is a problem.
• Caffeine – Other caffeinated products such as tea and chocolate might trigger symptoms in some individuals.
• Alcohol – Might trigger symptoms in some patients.

There will be a wide variety of differences between individuals as to what‘s a trigger food and what isn’t. Some trial and error will be necessary to determine problem foods.

Reference:

Heizer WD, Southern S, & McGovern S (2009). The Role of Diet in Symptoms of Irritable Bowel Syndrome in Adults: A Narrative Review. Journal of the American Dietetic Association. Volume 109, Issue 7, July 2009, Pages 1204-1214.

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1.      Period pain that is not relieved by over the counter pain relievers is not normal, if you are concerned there may be something wrong, see a doctor.

2.      If you suspect you have endometriosis but are being told nothing is wrong, keep trying, find another doctor. Do not put up with the pain.

3.   Having a child does not cure endometriosis. If you want to have children have them, but do not have them to cure your condition. If your doctor is suggesting this, see another doctor.

4.      Having a hysterectomy is not a cure either, it can be successful in managing the condition, however there are cases of women who have had it return after a hysterectomy, and while rare men can also get endometriosis. Please make an informed decision before consenting to having a hysterectomy, learn all the facts first, be sure it’s what you want. It is your decision, not the doctor’s.

5.      Not all women with endometriosis are infertile; it is NOT the leading cause of infertility. While there is a much higher risk of infertility the diagnosis does not automatically mean you are infertile.

6.      The level of pain is not a reflection of the severity of the disease. Some women have a lot of pain but the disease is minor, others have very little or no pain and have a severe case.

7.      There are endometriosis specialists around, they are much better able to recognise and treat the condition than a regular gynaecologist. Do your homework and find the best doctor you can, if you have to travel to see an endometriosis specialist consider doing this. (An endometriosis specialist is a gynaecologist that specialises in endometriosis)

8.      If getting surgery, look for a surgeon who removes the endometriosis completely, some doctors treat it like a cancer and cut it out, others burn off the top with a laser. There is a much better chance of it not returning if it is cut out completely.

9.      There are various hormonal treatments available to manage the condition, they are also not a cure but can provide relief and can control the progression of the disease. There are side effects with many of the treatments, ask your doctor about what to expect when starting a new treatment.

10.  Your pain is real! Make sure you have adequate pain relief available; you may require strong prescriptions and doctors may be reluctant to prescribe them. Don’t accept it if you are not getting strong enough relief, you can change doctors or be persistent with your current one.

11.  Endometriosis can spread to other parts of your body creating a variety of symptoms. Bowel issues are common; some women may find relief from extra fibre or fibre supplements, probiotics, and changes in dietary patterns to reduce inflammation and gas. (You may need to see a dietician in severe cases to learn to manage the symptoms)

12.  Get enough support, it’s very isolating to have any chronic illness and talking to others with the same condition can help deal with a variety of issues, including emotional.

13.  It is difficult for friends and family to understand what you’re going through, provide them with educational material if they are interested in learning; encourage them to learn.

14.  It is a strain on partners as well. They have to watch you suffering and not know what to do. Endometriosis can impact on intimacy; in some cases it can tear relationships apart. Try to involve your partner where possible, encourage them to understand what’s happening to you. You may need to find a variety of ways to maintain intimacy, if your doctor is not helpful consider seeing a sex therapist.

15.  Diet and exercise can help manage some symptoms; some women find relief cutting out certain foods such as wheat, dairy, red meat, eggs, sugar. You may need to have some trial and error to find what diet works best for you. (If cutting out food groups be sure you continue to meet your nutritional needs)

16.  Maintaining exercise routines can be difficult when exercise aggravates the pain, as best as possible maintain your fitness; if exercises aggravate symptoms try different types until you find a regime that works for you. Some exercises may even help the symptoms (e.g. yoga).

17.  Some women find herbs beneficial e.g. vitex, raspberry leaf, cramp bark, black cohosh, valerian.

18.  Common supplements that may help symptoms include evening primrose oil, fish oil, B complex, magnesium, vitamin C and E (vitamin supplements can only be of assistance when there are deficiencies)

19.  There are a variety of other complementary therapies that can be tried, including acupuncture and therapeutic massage.

Be sure to tell your doctor what other therapies you are trying, it is important your doctor knows what herbs and supplements you are taking.

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