What and how you eat can make all the difference when it comes to digestive health.
By Mia James
The good news about digestive disorders— and, really, there is good news—is that many of them can be managed with dietary changes. And while giving up certain foods, increasing quantities of others, and creating new mealtime habits is not necessarily easy, changing the way you eat is a far more agreeable alternative to long-term discomfort, potentially serious complications, and complex treatment.
The term digestive disorder, also known as gastrointestinal (GI) disorder, covers a wide range of problems and diseases that affect any portion of the digestive tract. This includes the esophagus, stomach, large and small intestines, liver, pancreas, and gallbladder. Problems range from minor to very serious, with some issues as mild as a slight intolerance to a certain food and others as severe as cancer. Examples of common digestive disorders include irritable bowel syndrome (IBS), food allergies and intolerances, celiac disease (gluten intolerance), inflammatory bowel diseases, and gastroesophageal reflux disease (heartburn). Nutritional support is often part of the management of these conditions.
The dietary changes you will make to improve your digestive health, of course, depend on the GI condition you have. Some minor digestive irritations can be controlled with relatively simple changes, such as avoiding certain foods in large quantities or big meals right before bed. On the more extreme side are serious disorders, where even a little bit of the problem food will make you very sick. People with celiac disease, for example, cannot digest gluten and must strictly avoid all foods containing it.
Foods for Healthy Digestion
Certain foods appear to be easier on the GI tract than others, according to Christine L. Frissora, MD, FACG, FACP, associate professor of clinical medicine in the Division of Gastroenterology and Hepatology at Weill Cornell Medical College and assistant attending physician at NewYork-Presbyterian Hospital Cornell campus.
Your own sensitivities and experiences and possibly a diagnosis from your doctor will help you figure out which foods to keep off your plate. In other words, there is no one-size-fits-all list of foods that might upset your digestive tract. You might find, for example, that chocolate and caffeine trigger your symptoms, while your friend has more trouble with dairy products.
No matter what you are eating, certain habits will help you keep your digestive tract healthy. As a general rule, Dr. Frissora recommends cooked foods. “Cooked foods go down easier,” she explains. “So if you want to eat a lot of vegetables, homemade soup is best.” Thoroughly chewed food is also easier to digest— digestion starts in the mouth, after all. “Chew all food as well as you can,” Dr. Frissora recommends.
Gabriela Gardner, RD, clinical dietitian at Memorial Hermann– Texas Medical Center, recommends a diet with plenty of variety that includes a lot of fruits and vegetables. “I encourage at least two servings of fruit and three servings of vegetables per day,” she says. “They’re a good source of antioxidants, which can regenerate cells and keep the GI tract healthy.”
Of course, you should choose your fruits and vegetables according to your digestive needs; in other words, don’t eat something that causes GI symptoms even if it is loaded with nutrients. If you can tolerate fruits and vegetables with fiber, they can be very good for your digestive health. “Fiber is like a brush,” says Gardner. “It cleans the lower GI tract.” Legumes, like beans and lentils, as well as whole grains are also good sources of fiber.
Common Problem Foods
Dr. Frissora says that certain foods are more likely to cause a digestive issue. “It seems that fats, additives, and foods that are high in FODMAPs [certain types of carbohydrates and polyols, which are used as sugar substitutes] are triggers,” she explains.
A common dietary guideline for people suffering from IBS, the most common GI disorder worldwide, is to follow a diet known as FODMAP. This stands for fermentable oligo-di-monosaccharides and polyols, or, more simply, certain types of carbohydrates found in foods that are hard to digest. By following FODMAP, also known as a low-FODMAP diet, you avoid or limit these particular carbohydrates. Here are some of the foods that contain FODMAPs:1,2
Fruits such as apples, apricots, blackberries, cherries, mangos, nectarines, pears, plums, and watermelon—and juice containing any of these fruits
Canned fruit in natural fruit juice, or large quantities of fruit juice or dried fruit
Vegetables such as artichokes, asparagus, beans, cabbage, cauliflower, garlic and garlic salts, lentils, mushrooms, onions, sugar snap peas, and snow peas
Dairy products such as milk, milk products, soft cheeses, yogurt, custard, and ice cream
Wheat and rye products
Honey and foods with high fructose corn syrup
Products, including candy and gum, with sweeteners ending in ol, such as sorbitol, mannitol, xylitol, and maltitol
Dr. Frissora says that, in particular, onions, garlic, pears, and apples (all very high in FODMAPs) need to be avoided. Additional common causes of GI distress include artificial sweeteners, high-fructose corn syrup, and—for people with these particular intolerances—lactose and gluten.
Dr. Frissora adds that foods that contain what’s known as crude fiber—the fiber that remains after food is digested—can also cause discomfort. Foods with crude fiber include bell peppers, broccoli, and eggplant and cucumber skin. Whole nuts can also cause problems for some people. Dr. Frissora recommends nut butter instead but adds that these should be all-natural products without added sugars. Here are some other foods known to upset the digestive system:
Spicy fried foods and high-fat foods
Carbonated drinks
Anything with high-fructose corn syrup
Garlic and onions
Gardner says that sugar, in particular, is a culprit in many GI issues. “Sugar, in excess, is associated with inflammation, which can be linked to several GI issues,” she explains. This is another reason for choosing whole foods over processed.
In addition, Gardner explains that how you eat can be as important as what you eat. She acknowledges that small, frequent meals can be easier to digest than large meals in fewer sittings. She also stresses the importance of being calm and aware and of paying attention each time you eat. “Be mindful,” she says. “Take time and don’t rush meals.” This attention is important, she says, because “digestion starts in the mouth.”
Dietary habits for healthy digestion start with the food you bring into (or keep out of) your home. “Look at what kinds of food you have at home,” Gardner advises. “Aim to keep more whole foods on hand and fewer or no processed items.”
How Do I Know Which Foods To Avoid?
If you have a digestive disorder such as celiac disease (in which you can’t eat gluten), you know which foods to avoid (anything containing gluten). If, on the other hand, your issue is less clearly diagnosable, it may take a bit of detective work to figure out what you can and cannot eat.
Even with a mild digestive condition, says Gardner, it is important to discuss dietary changes with your provider. “Avoid decreasing or increasing certain foods on your own,” she recommends. You can put yourself at risk of nutritional deficiencies if you take foods out of your diet. For example, if you eliminate gluten, you may be losing important sources of fiber and certain vitamins. “If you’re giving something up,” she says, “it’s important to make up for lost nutrients in another way.” Dr. Frissora recommends following the low- FODMAP diet to determine which foods are causing you problems. “Follow the low-FODMAP diet as strictly as you can for three weeks,” she says, “then introduce one food item at a time.” If your GI symptoms flare up when you start eating a particular item (or items), you will have a good idea of which foods are the offenders.
Good-Bye Forever?
Once you know which foods are to blame— whether through diagnosis of a disorder or dietary experimentation—the extent to which you avoid that food will vary depending on what symptoms you’re willing to put up with and your condition. For example, says Dr. Frissora, “People who are extremely sensitive to lactose can’t have even one drop of lactose. And people with celiac disease can never have any gluten—not even in toothpaste or lipstick.”
In less severe situations, however, you may tolerate a bit of the offending food. If you find, for example, that the crude fiber in bell peppers upsets your stomach, you may be able to have a dish with a few pieces, but snacking on a whole pepper would cause a problem. “In general,” Dr. Frissora explains, “responses are dose related, meaning the more of an irritant you ingest, the more symptoms you will have.”
Making the Best of Changes for the Better
Even when you understand that changing the way you eat will make you feel better, the thought of giving up old favorites or shifting established habits can be daunting. Gardner recommends rallying a variety of support, from medical experts to friends and family.
“Start by meeting with a registered dietitian,” she says. These specially trained professionals will work with your diagnosis and symptoms and, importantly, your tastes to come up with recipes and options you’ll most enjoy.
If you fear feeling isolated because you can’t eat the way the people around you do, include your family and friends in this transition. “They can be the best support,” says Gardner. “Tell them about your new lifestyle and how they can help you and make it fun.” She suggests making your changes social by choosing recipes with your family and preparing them together or inviting friends to your home to cook together.
There is also a lot of support available beyond your providers and personal connections. Support groups with others going through the same process can provide great forums for sharing tips. In addition, you can find recipe ideas in cookbooks, websites, and magazines dedicated to a particular disorder or allergy. In other words, the journey can be full of discovery and camaraderie.
Bon Appétit
If you suffer from any digestive issues, it is good to know that with an understanding of the foods and dietary habits that keep your digestive system healthy and the help of experts like doctors and dietitians, you can eat well and avoid discomfort. Even better, with your friends and family you may also make some exciting culinary discoveries along the way.
Six Steps to Better Gi Health
Better GI health can have a huge impact on your general well-being, and making it happen can be surprisingly simple. Here Dr. Frissora offers six steps to digestive-friendly eating and lifestyle habits.
Use a crockpot to prepare nutritious meals according to your personal dietary needs. It is a timesaving way to ensure that you will have a good meal that meets your unique requirements at the end of the day (and maybe even leftovers).
Avoid preservatives and artificial sweeteners. This will ensure that you are preparing and eating whole foods instead of processed alternatives.
Stop smoking. Smoking can raise the risk of or worsen many digestive disorders.
Minimize alcohol. It can irritate the digestive system and worsen certain digestive conditions.
If you are taking supplements, including probiotics for digestive health, ask your doctor whether these are necessary. Some are ineffective and not worth the expense; others might even by harmful.
Don’t forget a colonoscopy as you approach age 50. If you have unexplained bleeding, abdominal pain, or a family history of colon cancer, you may need to have one earlier.
A Diagnosis Leads To Symptom-Free Living—At Long Last
Samantha Williams of Cypress, Texas, had struggled with digestive issues since early childhood. “I was diagnosed with celiac disease at age 25,” she explains, “but I have lived with the symptoms since I was a toddler.”
The mother of two young boys struggled with unintentional weight loss, heartburn, reduced appetite, flatulence, abdominal bloating, and feeling full quickly when she ate. The symptoms persisted and worsened to include anxiety, depression, fatigue, trouble focusing or remembering things, and trouble sleeping.
These issues interfered with Samantha’s daily life and even landed her in the emergency room. At this point she consulted her doctor and was diagnosed with celiac disease. When Samantha began treatment at Memorial Hermann–Texas Medical Center, she started working with Gabriela Gardner, RD, who helped her change her diet. The results of her new eating plan, Samantha says, are dramatic: “All of my symptoms and pain are gone!”
Samantha explains that her current celiac management diet focuses on fresh foods and includes five or six small meals per day, plenty of water, and adequate protein. She has left behind her former dietary staples: processed foods that were certified as gluten-free but that contained trace amounts of gluten. She has also learned to research food companies to find out which products are truly gluten-free versus others that contain trace amounts. Samantha says that she was also missing some essential nutrients in her diet. “I was starving my body of the vitamins and nutrients it needed,” she explains.
Samantha admits that while learning to follow a nutritionally complete gluten-free diet has changed her life for the better, the transition has also had its challenges. Number one, she says, is the lack of convenience and ability to dine anywhere at any time. “I cannot eat out at restaurants,” Samantha explains, “so meal planning and grocery shopping are a necessity. It also makes traveling long distances a challenge.”
Samantha has no doubt, however, that any challenge of her diet is paying off. “It’s worth it to feel the best I’ve ever felt!” she says. “The takeaway lesson for me has been learning how important it is to proactively care for your GI tract by eating well.”
References
Statistics. International Foundation for Functional Gastrointestinal Disorders website. Available at: http://www.aboutibs.org/site/what-is-ibs/facts/statistics. Accessed April 28, 2015.
Eating, Diet, and Nutrition for Irritable Bowel Syndrome. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/irritable-bowel-syndrome/Pages/eating-diet-nutrition.aspx. Accessed April 28, 2015.
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