Live Chat: Eating for IBS on a Plant-Based Diet with Kate Scarlata

Learn how to manage your IBS symptoms while eating a plant-based diet, including vegan, vegetarian, or flexitarian diets.

IBS (irritable bowel syndrome) is the most common gastrointestinal disorder in the world, with about 10-15% of people suffering from this sometimes debilitating condition. Its hallmark symptoms are abdominal pain, diarrhea, and constipation. Among people that have IBS, 25% report severe symptoms, which can create havoc on one’s quality of life. So, no wonder so many people across the world are interested in how you can eat to manage IBS. Many of those who suffer from IBS are committed to a plant-based diet (such as vegetarian or vegan) for a variety of reasons. Yet they may have difficulty managing their symptoms while eating mostly plants. But IBS doesn’t mean you have to forego your hopes to eat a plant-based diet. It just takes a little educated know-how.

That’s why I sat down with my friend and colleague Kate Scarlata, MS, RDN, LDN, one of the country’s most prominent experts on IBS, to weigh in on what you can do to manage IBS while eating a plant-based diet.

Plant-Based Eating for IBS with Sharon Palmer and Kate Scarlata

Listen in on my chat with Kate Scarlata, internationally renowned expert on digestive health and IBS and nutrition. You’ll learn everything you need to know about eating a plant-based diet, such as a vegan and vegetarian diet, while managing IBS. Check out our recorded interview below, as well as our transcribed chat on Kate’s best tips for managing IBS with a plant-based diet.

 

Tips on Managing IBS on a Plant-Based Diet with Kate Scarlata 

I sat down with Kate to talk to her about her best tips for managing a plant-based diet. Read on to learn more.

Sharon: I hear from so many people on plant-based diets that they suffer horribly from IBS, but they don’t want to give up their diet. What are the main concerns for people on a vegetarian/vegan diet if they have IBS?

Kate: We know common dietary triggers for GI symptoms in people with IBS are poorly digested short-chain carbohydrates, known collectively as FODMAPs. FODMAPs is an acronym used to describe a group of sugars and fibers that are rapidly fermented by our gut microbes and can drag water into the intestine, contributing to pain, cramping, gas, bloating, diarrhea or constipation. One of the FODMAP subtypes, galacto-oligosaccharides are abundant in legumes, a key source of protein for vegans and vegetarians. To break down the acronym in further detail:

F: fermentable
O: oligosaccharides (beans, wheat, onion, garlic, artichokes, chicory root extract)
D: disaccharide (lactose in cow’s, sheep and goat milk)
M: monosaccharide (fructose, when in excess of glucose in a food such as: apples, pears, asparagus, watermelon, mango, honey and agave syrup)
A: and
P: polyols (stone fruits: plum, peach, pear; apples and pears; watermelon, cauliflower and mushrooms)

The low FODMAP diet is an evidenced based diet therapy that helps manage symptoms in about 70-75% of people with IBS. The concern for those who enjoy a vegan lifestyle is that the low FODMAP diet might not provide enough plant based protein options as bean consumption is significantly reduced on the elimination phase of the diet. To by-pass this concern, we generally do a more liberalized approach to the low FODMAP diet for vegans and/or encourage the diet to be followed for a shorter duration. There are 3 parts to the low FODMAP diet: the initial elimination phase, the re-introduction phase, and the modified or liberalized low FODMAP diet.

Sharon: For many plant-based eaters, they have chosen this lifestyle for ethical reasons, thus they really want to make it work. Is it possible for a vegan/vegetarian with IBS to continue eating this way?

Kate: It is quite possible that we can modify some FODMAP food sources in the vegan diet to offer symptom relief but maintain a well-balanced and nourishing diet. For plant-based eaters, I tend to do an abbreviated low FODMAP elimination diet to assess if the person is FODMAP sensitive. By removing high FODMAP foods for only a week or two, it is possible to assess if the patient will benefit from a reduction in FODMAP rich foods. In a FODMAP sensitive vegan, I would be sure to provide suggestions on how to reduce intake of FODMAP rich plant foods for symptom management while ensuring low FODMAP vegan protein options are consumed at every meal.

Low FODMAP vegan protein sources include:

• Firm tofu (silken tofu is high in FODMAPs), tempeh (read ingredients and avoid those with wheat, barley, onion or garlic or other FODMAP ingredients)
• ¼ cup canned chickpeas or ½ cup canned lentils per meal (canned chick peas and lentils have less FODMAPs than dry beans, soaked and cooked)
• Nuts, seeds and nut/seed butters (avoiding high FODMAP containing pistachios and cashews)
• Quinoa and buckwheat offer a protein boost too.
• Lacto-ovo vegetarians can enjoy lactose free yogurt and milk, hard, aged cheeses and eggs, as they are all low FODMAP.
• The FODMAP content of beans varies from variety to variety: Black beans (canned) have moderate amounts of FODMAP, a ¼ cup portion may be tolerated per meal while kidney beans are higher in FODMAPs and generally excluded on the low FODMAP diet. A great resource to check for a general guideline for FODMAP content of beans is the Monash University low FODMAP diet app.

Sharon: What is the first step for vegetarians/vegans in trying to discover which foods might be triggers?

Kate: First step is to meet with a dietitian who can review your medical and nutrition history to develop an individualized nutritional approach for your IBS symptoms. We suggest meeting with health professional always before altering your diet.

Sharon: Are there particular plant-based foods that often pose problems for IBS?

Kate: Legumes are well known for contributing to gas. In a person without IBS, the gas production can be a mere nuance while in a person with IBS, the gas can contribute to debilitating pain and GI distress. In addition to beans, onions, garlic, whole grain wheat are likely dietary culprits for GI symptoms. Additives such as chicory root or sweeteners such as agave syrup or honey may also be problematic. For those who enjoy dairy products, milk, traditional yogurt and wet-style cheeses contain higher amounts of lactose and might contribute to symptoms too.

Sharon: How much fiber and what types of fiber do you recommend for plant-based eaters who have IBS?

Kate: Tolerance to fiber is very variable for the person with IBS. This is likely due to the nature of the various microbes that inhabit our gut. We all have our own ‘footprint’ of microbes. Some microbes are vigorous carbohydrate fermenters. An intestine filled with carb fermenters might benefit from a lower fiber diet, at least for the short term. I find most of my patients can tolerate 20-25 grams of fiber but some patients do better with less. Since different forms of fiber offer different health benefits, I encourage a variety of different fibers from whole grains, fruits, vegetables and grains as tolerated. The skins of fruits and vegetables are rich in fiber that adds bulk to stool, which can aid elimination patterns while the fiber in oats provides prebiotics otherwise known as food for beneficial gut microbes. Enjoying a variety of fiber to your personal tolerance is key to gut health.

Sharon: Are there any foods or strategies that might help someone with IBS, for example, peppermint oil, probiotics, stress reduction?

Kate: Our gut and central nervous system arrived from the same cells in utero so they interact with each other, in what we often call: brain/gut cross talk. If a person is nervous or stressed this can lead to enhance GI motility leading to diarrhea or cramping while gastrointestinal distress, in turn, can impact our brain signaling. Yoga, gentle exercise, meditation and hypnosis are great ways to de-stress and helpful activities for people with IBS. Peppermint oil works in 2 potential ways in the gut to aid symptoms, it acts as a mild antimicrobial and relaxes smooth muscle, which can minimize pain. I recommend enteric-coated peppermint oil for individuals who suffer particularly with pain as a primary symptom. The research in probiotics in IBS is a bit ambiguous. The probiotics with the best evidence for use with IBS include: Align, Culturelle and VSL#3. Overall, probiotics have a good safety track record for use in IBS, but it is a bit of a trial in error to assess benefit in different people.

Sharon: Please offer your tips for managing IBS on a plant-based diet.

Kate:   Here are my tips.

5 Tips for FODMAP Sensitive Vegans 

• Meet with a dietitian and your primary care doctor before altering your diet on your own. Be sure you have been evaluated for more serious conditions such as: celiac disease, inflammatory bowel disease or more. Don’t self diagnose!
• Fill your plate with a mix of foods to balance high FODMAP legumes with lower FODMAP grains or starches such as white potatoes, rice and quinoa.
• To meet protein needs: include protein rich vegan option at each meal: ¼ cup canned chick peas and ½ cup canned lentils, firm tofu, tempeh (w/o high FODMAP ingredients), peanut or almond butters, pumpkin seeds, chia seeds, or brown rice protein powder, soy milk (8th Continent, appears to be the only low FODMAP US based soy milk option), quinoa
• Guided by a dietitian, follow the low FODMAP elimination diet for a shorter duration such as 1 to 2 weeks to identify if it offers symptom benefit and then initiate the re-introduction phase.
• Consider a multivitamin to ensure adequate nutrition, particularly in the elimination phase or as guided by your dietitian.

You can find more information on IBS friendly vegan eating advice here.

Here are a few of Sharon’s favorite plant-based recipes that are IBS-friendly:

Greek Chickpea and Vegetable Filled Pitas
Mango Carrot Ginger Smoothie
Super Acai Berry Bowl

Here is one of Kate’s favorite recipes: Quinoa Kale Low FODMAP Vegan Nourish Bowl

About Kate Scarlata

Kate Scarlata, MS, RDN, LDN  is a Boston-based dietitian with over 25 years of experience in the nutrition field. Kate earned her Bachelor in Science from Simmons College in Boston, Massachusetts and her postgraduate training was completed at Brigham and Women’s Hospital, a Harvard Medical School teaching affiliate. Kate’s focus is digestive health nutrition with a particular focus on IBS and the application of the low FODMAP diet for functional gut disorders. She is the recipient of the 2015 Outstanding Massachusetts Dietitian award and recognized as Boston’s 2015 Best Dietitian by Boston Magazine. Kate is the author of numerous publications including The Complete Idiot’s Guide to Eating Well with IBS and the coauthor of the New York Times Best Seller, 21 Day Tummy Diet. She has been an invited speaker at many leading gastroenterology conferences nationally and internationally. Kate shares her digestive health knowledge with health professionals and FODMAP diet followers via her internationally known and subscribed blog, Well Balanced FODMAPer.

Main image: celery, Sharon Palmer, MSFS, RDN