I’ve got IBS. (Who doesn’t these days?) And I’ve been to my GP, seen the gastroenterologist, and gotten the same half-assed treatment that most other Americans with IBS wind up getting: “Eat lots of fiber, drink lots of water, take lots of probiotics, and don’t be afraid to keep some Imodium around if you need it. Next!”
That was two years ago, and I gotta say, I’m really not doing much better. In fact, I slowly discovered that fiber wasn’t the answer. Not only was it not the answer, but it seemed to make things worse. And then I self-diagnosed (with the input of my mom, who is seeing a functional doctor for the same thing) with Adrenal Fatigue, where I found out about the perils of overhydrating – of drinking too much water. If you have AF, then staying hydrated is tricky because of our body’s weakened ability to retain salt and other minerals, which can make us chronically deficient in magnesium and potassium. And that’s on top of the typical American’s baseline tendency to be minerally deficient.
I had long suspected that probiotics had become a racket, and knew that Imodium, while it technically worked, didn’t actually fix anything. So that left me with no good answers for how to go about dealing with my intestinal woes. Then a few days ago, I came across an interesting website: GutSense.org.
Now, the details are definitely not for the squeamish; suffice to say, I’ve experienced a lot of what the author explains. He’s affiliated with a few of his own interests, namely a book about the myths perpetuated about fiber as an essential part of the human diet, and a series of supplements to help reestablish gut flora after a colonoscopy, after surgery, or anything else that can kill off the bacteria living in your gut. To me, though, this guy seems to be more reliable than a lot of other homeopathic snake oil I’ve seen out there for a few reasons, namely that he cites actual sources for his claims. So I’m inclined to try following his advice.
What’s important about this site is what I wound up learning about fiber, and how it pretty solidly matched my own experience toying with fiber levels in my diet over the past few years.
In his IBS FAQ, he writes this:
Q. How come they recommend “Increased fiber intake for constipation,” if fiber is a well-known gas- and diarrhea-producing substance?
To me, that‘s either the biggest “medical mystery”, or the biggest “medical idiocy,” or simply outrageous negligence, or, perhaps, all of the above. In fact, to unravel this mind-boggling incongruity for myself and others, I wrote a book entitled “Fiber Menace: The Truth About the Leading Role of Fiber in Diet Failure, Constipation, Hemorrhoids, Irritable Bowel Syndrome, Ulcerative Colitis, Crohn’s Disease, and Colon Cancer”, and you are welcome to read it.
If you are a skeptical medical professional reading this, and, all things considered, I don‘t blame you a bit for being skeptical, consider the following two quotes from the American College of Gastroenterology Functional Gastrointestinal Disorders Task Force [link]:
“Fiber doesn’t relieve chronic constipation and all legitimate clinical trials demonstrated no improvement in stool frequency or consistency when compared with placebo.”
“In the management of IBS, psyllium is similar to placebo. In fact, the bloating associated with psyllium use will likely worsen symptoms in an IBS patient.”
Psyllium is a source of soluble and insoluble fibers found in Metamucil-type laxatives, and their digestive properties are identical to all other types of fiber.
There’s a lot more on there. A lot more. Basically, he outlines the following timeline for how and why IBS develops, and how and why it never seems to get resolved:
- It all starts with a loss of bacterial flora in the gut. This can be from antibiotics (whether prescribed or from non-organic meat and dairy products), x-rays, bowel prep for surgeries, excessive use of laxatives, chlorine or arsenic in tap water, mercury in fish, and a whole host of other things. He calls this disbacteriosis, which, while the intestinal flora is considered vital to our health, is not a medically accepted term or condition for reasons unknown.
- Loss of gut flora results in harder, smaller stools, which our bowels aren’t really designed to pass.
- Constipation. Though because “constipation” means that you haven’t had a bowel movement in no fewer than 3 days, the author prefers to call this “impacted stools”. This stage is only apparent if you’re already on a low-fiber diet, apparently. Those of us who eat lots of fiber already have a harder time recognizing that we have a problem, though the problem is still there.
- Treat the constipation with more fiber. He writes: “Medical professionals and Dr. Moms alike recommend dietary fiber and fiber laxatives to “naturally” alleviate hardness, particularly when stools are small and dry. Fiber bulks up (enlarges) and moisturizes stools by either retaining water, blocking water absorption, or both.”
For the purpose of this post, I’ll stop there, since I want to talk about fiber.
What does fiber actually do? If you’ve ever made a flax egg before, then you already know. A gram of fiber can absorb many times its weight in water, and that’s exactly what it does in your body. This can actually dehydrate you, encouraging you to drink more, and inevitably results in loss of minerals through overhydration. And not only that, but it actively discourages the restoration of gut flora. The author explains so here:
The by-products of fiber‘s bacterial fermentation (short chain fatty acids, ethanol, and lactic acid) destroy bacteria for the same reason acids and alcohols are routinely used to sterilize surgical instruments—they burst bacterial membranes on contact. And that‘s how fiber addiction develops: as the fermentation destroys bacteria, you need more and more fiber to form stools. If you suddenly drop all fiber, and no longer have many bacteria left, constipation sets in as soon as the large intestine clears itself of the remaining bulk.
For some reason this point is causing intense consternation and controversy among the “experts” on all things fiber. If you are one too, and believe that I am stretching the facts to fit my point of view, please note the following:
(1) The operative phenomenon here isn’t that “fiber causes disbacteriosis,” — but‘excess fiber’ — as in “the fermentation of excess dietary fiber.”
(2) Let me remind you that wine in the vat left for too long turns into vinegar, all the bacteria die off, and the fermentation stops. Bacterial fermentation in the wine vat, dear opponents, and in the pile of feces happens to be exactly the same process.
(3) Finally, consider this corroborating quote: “Colonic bacteria ferment unabsorbed carbohydrates into CO2, methane, H2, and short-chain fatty acids (butyrate, propionate, acetate, and lactate). These fatty acids cause diarrhea. The gases cause abdominal distention and bloating.” (Malabsorption Syndromes; The Merck Manual of Diagnosis and Therapy.) Let the diarrhea run its course a day too long, and disbacteriosis will soon follow. (God, I love those rare moments when Merck and I are singing the same tune.)
I mean, there’s a reason that folks with severe IBS aren’t allowed any fiber in their diets at all. (A relative of mine isn’t allowed fruit and barely any vegetables for this reason.)
So what the hell am I supposed to do? How, exactly, does a vegetarian avoid fiber?? This is actually something I’ve been thinking about for some months now, and I may have to re-think a lot of how I approach food. Honestly, I’m glad to have an educated medical professional confirm what I was already beginning to sense happening with my own body, and not just that, but also provide a plan for getting back to normal. I may not have to deal with IBS forever. And that is definitely worth a diet change to me.
This means doing homework on cuisines that feature few, if any, high-fiber grains, with little emphasis on cheese and dairy products (for other reasons the website outlines; also for my Adrenal Fatigue). I need to be able to get protein from non-meat, fiber-free sources like eggs and tofu. If I do eat high-fiber vegetables, I should see about getting into the habit of pickling and fermenting them to break some of that fiber down, and also to maximize my ingestion of live cultures, which might help me to restore all that gut flora that I don’t have anymore.
I was already into the whole fermenting thing after realizing that I could make kimchi at home, which was my gateway drug to the wide, wonderful, world of Korean pickles and Japanese pickles (tsukemono). Not fermented, exactly, but preserved. And then that research, of course, led me to finding out how to make your own miso paste and soy sauce.
I’ve also been dabbling in fermented drinks since that one time I made Sima, a fermented Finnish lemonade that uses baker’s yeast. (I know how it sounds, but trust me, it was good.) For a few weeks back during summer I was trying to get a ginger bug started so that I could make sodas, but for some reason they were all just not quite coming together. Then I read about how non-organic ginger is irradiated, killing all the natural yeasts present in the root and its skin, and gave it another go with some organic pieces. But that’ll be for another post – if I can get some sodas successfully brewed, that is!
But yes, saurkraut, kimchi, kombucha… these things are all in my future. ;]
In thinking about what the heck I’m going to eat as a low-fiber, dairy-free, vegetarian, only one thing really stood out to me: Buddhist temple food, also called shojin ryori in Japanese. There’s an emphasis on simple preparation, simple flavor, and simple food all around. Seasonal ingredients, boiled, steamed, or fried, and served with a few equally simple sauces. With, of course, plain rice.
I learned a lot about Asian cuisine when I was going to college in NYC – my roomate and friends were Taiwanese and Korean, and we all had a special love for traditional Japanese food. I learned how to make miso soup, kimchi, and Japanese curry. We ate a lot of dim sum, and I wound up working on a little comic about dim sum, so I know my way around that type of food like the back of my hand too! But in my day-to-day, I really did eat a lot of Asian-style food. I had access to people who knew how to read Pinyin packaging, I had access to a really badass rice cooker, and so the big grocery store in Manhattan’s Chinatown became my go-to for cheap groceries. Gai Lan, a very healthy vegetable in the cabbage family, was usually 99c a pound, and I practically lived off the stuff. Bok Choi was similarly priced, and so soup made with that, some miso, dashi, and either somen or Korean-style noodles also became a staple.
In other words, aside from sandwiches and Mexican food (which is what I grew up with), far-east Asian cuisine is stuff I could eat – and have eaten – every day.
Curious about trying out Shojin Ryori with me? Until I get my hands on a book or three, I’ll be going by a guide from Tofugu.com, “How to Eat Like a Buddhist Monk”:
Here are some more recipes from Sotozen-net. And here’s another website dedicated to exploring the food of the Zen monasteries – most blog posts are mindful meditations on and explanations of ingredients, or what’s going on in the culture of the cuisine, but there are some recipes too. And if you’re more curious about traditional Korean food, then there’s always my favorite resource, Maangchi.
This is not going to be very zero waste – as a lot of these ingredients will be packaged, and I may be buying shrink-wrapped produce (bleh), oh well – but it will be seasonal, it will be very easy to buy in bulk, and best of all, this stuff is easy for me to make. If it’s going to be a scale of “raw carrot” to “tempura”, then it’s no big deal. (Tempura is far from the most complex thing I’ve made.) And if all of this helps my IBS? I will definitely be letting the world know.