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Dietary strategies for digestive upsets: many "tummy troubles" can be eased by making adjustments to your diet.

You may find it uncomfortable to talk about gut issues j such as constipation, diarrhea, abdominal pain, gas, and bloating, but such symptoms are all too common. An estimated 25 to 30 percent of Americans suffer from digestive problems annually.


Identifying the Problem

"Every person is unique, so it's important to get to the root cause of your digestive tract symptoms with the help of qualified medical experts," says Tanya Freirich, MS, RD, CDN, a registered dietitian at New York-Presbyterian Weill Cornell. "There are many possible culprits, such as medication side effects, infections, and food intolerances." For example, one person may have diarrhea due to the lactose in milk, and someone else may have diarrhea due to celiac disease, an autoimmune condition triggered by gluten, a protein in wheat, barley, and rye.

When doctors can't find a specific cause of digestive symptoms, they may attribute them to irritable bowel syndrome (IBS). A person with IBS may have symptoms similar to those with other gut-related conditions, such as lactose intolerance and celiac disease--including abdominal pain, bloating, and diarrhea. It is estimated that nearly 20 percent of Americans struggle with IBS. Dietary changes to eliminate trigger foods can be very helpful if you have IBS, and diet is crucial for managing conditions such as lactose intolerance, celiac disease, and non-celiac gluten sensitivity (which may be diagnosed after celiac disease and wheat allergy are ruled out). Virtually any food, beverage, seasoning, food additive, or even dietary habit could trigger IBS.


A common diarrhea trigger is lactose, the natural sugar in milk, which is classified as a fermentable carbohydrate, or FODMAP. Many adults are deficient in lactase, the enzyme in the small intestine that breaks down lactose for digestion.

"Some people with lactose intolerance may be able to tolerate small amounts of lactose, especially if consumed with other foods in a meal, while other people find it necessary to completely avoid lactose," Freirich says. Taking supplements of the digestive enzyme lactase, such as Lactaid, with lactose-containing foods also may help.


If you're not having regular bowel movements (ideally, approximately once a day), you have constipation. As time passes without a bowel movement, your stool can become more difficult to pass, which can result in pain and bloating in your abdomen.

"The most common cause of constipation is consuming too little fiber and fluids," Freirich says. "Roughage from plant foods and adequate hydration help move your stool through your large intestine." Women should get at least 25 grams of fiber daily; men, 38 grams. Fruits, vegetables, legumes, whole grains, nuts, and seeds provide fiber. Increase your fiber intake gradually and drink plenty of water to avoid side effects like gas, cramping, and bloating. Without adequate hydration, extra fiber intake can worsen constipation. Aim to drink enough fluids (preferably water) so that your urine is clear when you urinate.

Supplemental support

Nutritional supplements may help some individuals with digestive issues. For example, clinically tested probiotic supplements such as VSL #3 ( and Florastor ( support digestive health and may help manage IBS. Supplements of magnesium citrate (generally 200-500 milligrams daily) may help some people with constipation. Consult your doctor for guidance.


Some people experience IBS symptoms when they eat foods containing carbohydrates called FODMAPs, which stands for:

* Fermentable = Broken down by gut bacteria

* Oligosaccharides = Fructans in wheat, onions, and garlic; galactans in legumes (beans)

* Disaccharides = Lactose in milk products

* Monosaccharides = Fructose, when present in higher amounts in certain fruits and vegetables

* And Polyols = Reduced-calorie sweeteners such as sorbitol and maltitol; naturally present in fruits such as peaches and plums

Digestive health doctors or gastroenterologists can test your tolerance of certain FODMAPs, including fructose and lactose, and they may prescribe a low-FODMAP diet, which typically restricts foods rich in such carbohydrates for two months. Then, you may sequentially reintroduce the different types of FODMAPs to determine your tolerance. Learn more at


Tackling Gut Issues

* Consult your doctor. He/she may order tests for celiac disease, lactose intolerance, and fructose malabsorption, among other diagnostics.

* Don't change your diet before celiac disease testing. If you're already eating gluten-free, the test may fail to detect the disease even though you have it.

* Ask for a referral to a registered dietitian nutritionist (RDN) who specializes in your prescribed diet. An RDN can help ensure you're getting adequate nutrients. Some dietitians utilize elimination diets in conjunction with food sensitivity tests to help identify food triggers in IBS. Even without a clear diagnosis, an RDN can help you manage digestive issues.

* Keep a food/symptom diary. Gut symptoms may take a couple of hours or even a few days to appear after you've eaten the food. You can enlist a smartphone app, such as mySymptoms from, to help track and analyze your data.
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Publication:Women's Nutrition Connection
Date:Aug 1, 2016
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