While I recognize that Michael Phelps fueled many an Olympic Gold Medal with his McDonald's-based diet, he appears a notable exception to the general rule that people feel their best and most energetic when eating healthy foods. But when you've got digestive woes – like acid reflux, irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) like Crohn's or ulcerative colitis – sometimes it's the healthiest food that can make you feel the most miserable.
As a dietitian in a gastroenterology practice, I commonly find myself in the unexpected position of steering patients away from eating certain healthy foods like salad, fruit or whole grains for reasons of digestive tolerance.
Inevitably, my patients respond with the same incredulity: "But all this time I thought I was being so healthy!" To which I explain that healthfulness and digestive tolerance are two completely separate issues. Just because a food is nutritious and health-promoting doesn't mean everyone can eat it comfortably.
When you have a digestive disease or disorder, the goal should be to consume the healthiest diet that also agrees with you.
If you suspect certain healthy foods may be making you feel worse, read on to see some of the more common healthy food intolerances I encounter and some nutritious workarounds.
1. Raw salads and acid reflux: You've been diagnosed with gastroesophageal reflux disease (GERD) and your doctor told you that losing weight would help improve your symptoms. So you replaced those burger lunches with salads. Strangely, you now feel incredibly bloated within an hour of eating; or perhaps you're waking with a sore, scratchy throat the morning after a salad dinner – evidence of overnight acid reflux. Sound familiar? You're not alone. I've noticed that large portions of raw veggies can really do a number on my patients with reflux.
To see whether salads are indeed a problem, I advise my patients to avoid them for a week. (For weight loss, we replace salads with cooked veggies, lean proteins and small portions of cooked grains or beans instead.) If symptoms disappear with the salads, we've identified the culprit. Et tu, Romaine?
[Read: Digestive Enzymes: Help or Hype?]
Even when entrée-sized portions of roughage are problematic, however, some patients find they can tolerate smaller portions of softer raw vegetables. Texture-modified salads – like avocado, beet and finely-shredded carrots, for example – are often a gentler way to keep that salad course on the menu.
Similarly, having appetizer-sized portions of soft, baby greens with some thinly-sliced vegetables as a palate cleanser toward the end of a meal – much like the French do – is another way my reflux patients have improved their salad tolerance. In many cases, we find some way for raw veggies to comfortably coexist with the stomach … though usually not as the focal point of the meal.
[Read: Raw Food Diet.]
2. High-fructose fruits and IBS: About 30 percent of Caucasians have dietary fructose intolerance, or an impaired capacity to absorb free fructose sugar molecules in the small intestine. Studies have suggested the prevalence is even higher among people with IBS.
Research has implicated fructose intolerance as a prime culprit behind the abdominal pain, bloating and diarrhea experienced in some people with IBS; a recent study has further raised the possibly that fructose can trigger symptoms even in IBS patients who don't have trouble digesting fructose!
When people with fructose intolerance consume fructose-rich foods, the unabsorbed sugar makes its way to the colon, attracting large amounts of water by osmosis and providing a fermentable treat to the resident bacteria. The result? Diarrhea, bloating and gas, generally about 6 to 8 hours after eating the fructose load.
When my patients with IBS regularly consume nutritious but fructose-rich fruits like mango, apple, pear, watermelon, grapes, cherries, dried fruit or fruit juices, my radar goes off. If a breath test confirms the diagnosis of fructose intolerance, I advise them to say goodbye to some of these vitamin-rich fructose bombs for good … or suffer the unpleasant consequences. (Some veggies that contain chains of fructose molecules called fructans – like artichokes, asparagus and jicama – are also likely to be problematic.)
Fortunately, even when fructose isn't your friend, there are plenty of other nutritious fruits in whose flesh you can seek solace – like berries, bananas, cantaloupe, honeydew, oranges, pineapple and grapefruit.
[See: The Best Berries for Your Health.]
3. Whole grains and IBD: My patients with inflammatory conditions like Crohn's and ulcerative colitis often request an "anti-inflammatory" diet to help control their disease and prevent future flares. Specifically, they want to avoid the much-maligned inflammatory staples of the Western diet – refined grains and animal proteins – and eat more whole grains, veggies and nuts.
[Read: Dr. Weil's Anti-Inflammatory Diet.]
Unfortunately, the more undigested residue that passes through an already-inflamed bowel and gut, the more severe one's IBD symptoms – like abdominal pain and diarrhea – are likely to be. The foods most likely to contribute to that residue are ones high in fiber – or, whole grains, veggies and nuts. And the ones least likely to do so are refined grains and low-fat animal proteins, since they are quickly and easily assimilated in the early segments of the small intestine.
In severe or chronic cases of Crohn's Disease where there is also stricturing – or a narrowing of the intestinal passageways – certain high-fiber foods may increase the risk of an obstruction.
Appreciating my patients' desire to use diet therapeutically, I often encourage them to think of adopting two distinct dietary patterns: one for digestive tolerance during a flare and another to promote an anti-inflammatory milieu in the body once remission has been medically achieved. When the going gets tough, temporarily choosing low-fiber "white carbs" like sourdough bread, farina, white rice, potatoes and crackers is appropriate to help manage symptoms. As a flare subsides, a transition toward whole grains can gradually begin as tolerated and continue throughout periods of remission.
[See: Top-Rated Diets Overall.]
Hungry for more? Write to firstname.lastname@example.org with your questions, concerns, and feedback.
Tamara Duker Freuman, MS, RD, CDN, is a NYC-based registered dietitian whose clinical practice specializes in digestive disorders, Celiac Disease, and food intolerances. Her personal blog, www.tamaraduker.com, focuses on healthy eating and gluten-free living.