Tell Me What to Eat If I Have Irritable Bowel Syndrome: Elaine Magee, MPH, RD

By Elaine Magee, MPH, RD
WebMD Weight Loss Clinic - Live Events Transcript

Reviewed By Kathleen Zelman, MPH, RD, LD

The opinions expressed herein are those of the guest's alone. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome! Our guest today is Elaine Magee, MPH, RD. We will be talking about what you can eat when you have IBS (irritable bowel syndrome). Welcome Elaine. How are you today?

Elaine Magee: Feeling great!

Moderator: Before we begin taking questions, Elaine, can you please tell everyone a little bit about your background and area of expertise?

Elaine Magee: I have a degree in nutrition and a master's from the University of California at Berkeley in public health nutrition, and I am a registered dietician and my job, so to speak, is helping people make better food choices and I do that by writing books. I have written 18 books so far, and I have a national column called the Recipe Doctor. I do consulting for two magazine and food companies.

Moderator: You are most famous as the Recipe Doctor, helping people reduce the fat in their favorite recipes. Why did you decide to write about IBS?

Elaine Magee: Great question! I am in the middle of a nutrition series called Tell Me What To Eat. In that series, there are books on menopause, helping to prevent breast cancer, type II diabetes, and the publisher wanted me to do one on irritable bowel syndrome. I was happy to do that because I am a third-generation IBS sufferer.

Moderator: So the information in the book not only comes from your professional expertise, but also your personal experience?

Elaine Magee: Yes, and I also interviewed many IBS sufferers while I was writing the book. I also interviewed dieticians on what works and what doesn't for people. I have the most common type of IBS and that is what they call diarrhea-predominate IBS, so it really helped me to write the book, and I actually give personal stories and tips when appropriate.

Moderator: Speaking of tips, let's talk about your 10 Food Steps to Freedom.

Elaine Magee: Yeah! Yeah! People don't like to see this: The first step is that people keep a diary of their food intake and their stress and symptoms from day to day. Nobody likes to keep a diary, but it's so important because you begin to understand the links between diet, stress, and symptoms for yourself. It also helps you manage your symptoms.

Moderator: So the first step is to keep the diary, and the next step is to increase fiber. Why is fiber so important when you have IBS?

Elaine Magee:  It gets a little bit tricky. There are two types of fiber: water-soluble and water-insoluble. It's the soluble type like oat bran, beans, apples, psyllium seed, and flaxseed that tend to be the most helpful for people with the diarrhea-predominate IBS. So while fiber is important, depending on the type of IBS you have, you might need to gear yourself toward some different fiber sources because of it. But generally, people have said that having high-fiber foods throughout the day and drinking plenty of liquids, water mainly, is very helpful for them, particularly if they have constipation-type IBS.

Moderator: The next step is to drink eight or more glasses of water each day. Could you please explain why this is important?

Elaine Magee:  Yes. Healthy bowels need plenty of water to be able to do their job right and drinking more water goes hand-in-hand with eating more fiber-rich foods.

Moderator: Why should IBS sufferers avoid caffeine?

Elaine Magee:  That morning cup of "Joe" gives your intestines a jolt along with your brain. We all know it's a stimulant, and maybe it's no surprise that it also stimulates the intestines. The No. 1 caffeine source in the U.S. is coffee; No. 2 is cola and other caffeinated soft drinks.

Moderator: Your next step might be difficult for some people: avoiding high-fat meals and snacks.

Elaine Magee: The reason is because fat in food is known to exaggerate the gastrointestinal-colonic response. Keep in mind, fat is better tolerated when eaten in small amounts throughout the day, rather than all at once. So enjoy your potato chips, just have a handful, not the bag! Actually, people with IBS should probably avoid the kind of potato chips with artificial fats like olestra (sucrose polyester). With people who are irregular, the effect is loose bowels and an accident waiting to happen! This one of my favorite food steps, because although people think it would be difficult to do, it's not as bad as you think. My favorite cookbook that I've done is The Recipe Doctor, and you'll find all your favorite dishes in this book. The recipes are lightened in such a way that most people will not even miss the fat that is cut out. In fact, most people will like these recipes better.

Moderator: The recipes in that book are great. Step six just seems to be common sense, that is, avoiding hot spices.

Elaine Magee:  It's a problem with some spices. Some people with IBS have trouble tolerating certain spicy condiments, such as hot sauce, spicy BBQ sauce, chili powder, hot chili peppers, garlic, curry, and ginger. With ginger, small amounts may be fine for you.

Moderator: Again, keeping the diary will help you to keep track of whether or not you can tolerate those small amounts?

Elaine Magee:  Totally. You don't have to do it all the time. Once you get a handle on your personal trigger foods, you may only need to keep a diary every now and then.

Moderator: How does alcohol affect someone with IBS?

Elaine Magee:  Alcohol stimulates the digestive track by getting digestive juices flowing. This can cause heartburn, stomach pain, and diarrhea for some people. Notice, the food step says overdoing alcohol. Some people do just fine keeping it moderate, which is no more than one drink for women and no more than two drinks a day for men.

Moderator: Step eight says to avoid gassy foods, but what are "gassy foods?"

Elaine Magee:  It can help relieve the symptoms of abdominal pain, gas, and bloating. Again, it could be the amount that bothers you. After you eat a certain amount you might start seeing symptoms. Raw vegetables, in general, can cause problems for some including cucumber and lettuce in salads. The following vegetables can cause problems even when cooked: broccoli, brussel sprouts, cabbage, cauliflower, corn, kohlrabi, leeks, onions, bell peppers, pimentos, radishes, rutabaga, sauerkraut, scallions, shallots, turnips, and chili peppers. Dried peas, beans, and lentils (the bean group) can cause problems, and some fruits such as apples with peels, avocadoes, cantaloupe, honeydew melon, prunes, and watermelon. Other foods and drinks that may cause trouble include beer, seeds (sesame, poppy, sunflower and flaxseed), hard-boiled eggs, soft drinks (bubbles), nuts, wheat germ, popcorn, and the spices mentioned earlier.

Moderator: You said beans were a good source of fiber, but they are among the gassy foods. How do you decide if you should eat them?

Elaine Magee:  Amount, amount, amount. You may be able to get away with a smaller amount of beans, especially if in a meal. One of my favorite lunches is a burrito with brown rice, and I have no problems managing that at all. A not-so-spicy chili made with lean meat, if you have a small cup, may be OK.

darher_msn: I have noticed that any fruit that I eat with a skin on it will start IBS, but I can eat any canned or frozen fruits with no problem. Why?

Elaine Magee:  Great comment. Canned fruit or well-ripened fruits tend to be better tolerated. Please understand that some people with IBS are mostly bothered by spicy or high-fat foods, but some are bothered by the peel. There are so many possible triggers. In the book, we try to give you the tools to help you figure your own personal IBS triggers. There is so much individual difference from one sufferer to another.

Moderator: Why should people with IBS eat smaller, more frequent meals?

Elaine Magee:  Large meals can bring on cramping and diarrhea in people with IBS. So by eating smaller meals, we're reducing the intestinal load at one time. This is why so many people have trouble after eating out at a restaurant, because we tend to eat foods we don't normally eat. We eat high-fat foods and large portions of them.

Moderator: Food step 10 is exercise. Could you please explain this further?

Elaine Magee:  Exercise really helps people with bouts of constipation. It is another intestinal stimulant. So people with diarrhea-predominate IBS might find themselves most comfortable exercising at the time of day when they tend not to have their symptoms. For example, I am mostly bothered with symptoms in the morning, so I exercise in the evening. Here's another reason to exercise: It is a great stress reducer, which can help people with IBS who's symptoms tend to worsen under times of stress.

Moderator: Lima asks, "It seems like every time I eat meat, I have a hard time with it in my bowels. Does meat make things worse with this IBS? What are the best things I could eat? I love cereal, is that OK? Thanks so much for your time."

"See your physician or gastroenterologist to make sure you have IBS; there are other gastrointestinal diseases that can have similar symptoms."

Elaine Magee:  I hear this question from a lot of people, and what I would suggest to you is to look at my meat choices. The leaner the better. If you cook your meat and cook it in a lean way and eat smaller portions, like a piece of meat the size of the palm of your hand, about 4 ounces, you might find it actually being better tolerated. I would also try to see if chicken breast, fish, or pork tenderloin are more comfortable for you as well.

Moderator: Omar asks, "I've found that in the past year or so, I can't eat yogurt because it causes massive diarrhea for me. This seems strange to me because yogurt is supposedly good for your digestion because of 'good' bacteria. Does anyone else with IBS react to yogurt so badly?"

Elaine Magee: Only the people who have, perhaps, lactose intolerance, too. Now this is tricky because there is a crossover between people who have lactose intolerance. Lactose is the carbohydrate found in yogurt. They cannot digest it. They lack enough of the enzyme to break it down. That is different than IBS, but there are people with IBS who may have a lactose intolerance, and vice versa. So figuring out which one you are will help you perceive. Let me remind you, if you haven't already done so, please see your physician or gastroenterologist to make sure you indeed have IBS, because there are other gastrointestinal diseases that can have similar symptoms.

Moderator: VJ asks, "I have problems if I have any dairy products, margarine, mayonnaise, caffeine, MSG (monosodium glutamate), or pickles. Are these food sensitivities common to IBS sufferers? It is so difficult to eat anywhere but home. I haven't found products (like Lactaid) helpful. Do you have suggestions?"

Elaine Magee:  Restaurant Rules. There's a whole chapter on eating out in restaurants in my book. Here are a few tips. Make yourself more comfortable when eating out by making sure you eat only modest amounts and by looking forward to taking a doggie bag home for tomorrow's lunch. Relax and eat slowly. Choose menu items that aren't too high in fat. Stick to dishes we tend to do well with. I can't emphasize enough the idea of portion size and moderation. For example, I personally can get a way with half of a tempura order. The minute I eat a whole dinner, I am uncomfortable. Cramps ensue. I have learned that I can have half the order and take the rest home. I can appreciate your comment about doing better at home. If I eat fettuccine alfredo in a restaurant, I might have trouble because it's so rich in fat, but I have no problems with my lighter version that I make at home. Someone else might have trouble with a hamburger and fries at a restaurant but not have problems with a lean sirloin burger and oven-baked fries made at home.

Moderator: Appetizers are smaller than entree portions and can sometimes substitute for the larger portion.

Elaine Magee: Tell the server to package half of it in the doggie bag right in the beginning. They are there to make you happy! If it's delicious, you will enjoy it later. At one time, it may be too much for your system.

Elaine Magee: Once you find a restaurant and items that you order and that you do well with, you will know where to go back and try again.

Moderator: You have some wonderful recipes in the book: The 20 Recipes You Cannot Live Without. On what basis were these recipes chosen?

Elaine Magee: We tried to give you a potpourri of recipes to get you started, so you'll find a handful of recipes that are low-fat versions of high-fat favorites and soluble fiber sources and recipes, and there are also a handful of recipes for when you are having particular difficulties. Lemon rice is a good one for when you are having more pronounced symptoms.

Moderator: One of the things you recommend is boosting fiber intake. Tell us about your raisin bran muffins recipe.

Elaine Magee:  Mmmm! Raisin bran, as a cereal, for me is very comfortable. I put together a raisin bran-muffin recipe. They are addicting. Make a batch and freeze them! How easy can that be! In this recipe, we use canola oil, and maple syrup becomes a fat substitute. Buttermilk, whole wheat flour, some white flour and some raisin bran cereal. It's a winner.

Moderator: For a delicious and easy meal, I liked your recipes for lemon rice and salmon in wine sauce. Both cooked well in the microwave.

Elaine Magee: This lemon rice recipe uses basmati rice, chicken broth, lemon juice and green peas, if tolerated. But it basically cooks in the microwave for about 15 minutes. Then you sprinkle the peas over the rice and cook another five minutes. Rice is easily tolerated and is easy on the intestines. It tends to be one of the first foods people eat after an intestinal sickness. Another well-tolerated food is yogurt, by the way, as long as you don't have lactose intolerance, and so is the canned fruit we talked about before.

Moderator: The rice would be well paired with the salmon recipe. I love this recipe. Salmon is just one of those super foods because it's one of the richest sources of omega-3 fatty acids (one of the good fats). But to make this recipe, you throw a few things together in the microwave and in the end, you have your salmon with a created wine sauce. All of these recipes that we have been discussing are in Elaine's book, along with several other tasty ideas.

Elaine Magee: It helps people just knowing what they have. Sixty percent of people never go to a doctor. They learn to manage it on their own, although I don't recommend that. The good news is it doesn't cause colon cancer. It doesn't kill you, it is just uncomfortable at times. Information is power. By reading the book, you'll understand what normal intestines and IBS intestines are like and what you can do about it.

nancybeach_webmd: You suggest limiting caffeine. I take a pain medication that includes 130 mg/day, and I seem to tolerate it pretty well. Any objections to that limit?

Elaine Magee: The food steps are there to help all the different people with different types of IBS triggers. So you'll find that certain food steps in the book will help you more than others. For you, it sounds like that particular amount of caffeine is being tolerated, but to another person, it might spell trouble. So the food steps are there to cover the bases. You will be the detective discovering which ones help you the most.

Moderator: Speaking of detective, how can you detect what foods in the market really are low fat, high fiber, etc?

Elaine Magee: There's a whole supermarket chapter in the book. Hopefully, I read the labels for you so you won't have to as much. Basically, what I tell you is to look at the nutrition information label. That is where you'll find the number of grams of fat and the true amount of grams of fiber per serving.

Moderator: We are almost out of time. Before we say goodbye, Elaine, do you have any closing comments?

Elaine Magee:  In all my books and my articles, I represent someone who believes food should be enjoyed. I try to do that in everything that I do. I don't want you to feel deprived or punished. I keep that in mind in everything that I do. Trust me, I understand, and you too can become a lot more comfortable again. If you like to cook the least bit, check out The Recipe Doctor cookbook! I try to cut corners everywhere I can. If you're a small-time cook, I think you'll like it even more.

Moderator: Unfortunately, we are out of time. Thank you very much for joining us today Elaine and thank you for sharing your knowledge and expertise with us. For more information, please read Elaine Magee's book: Tell Me What to Eat If I Have Irritable Bowel Syndrome, and her new book The Flax Cookbook. And please be sure to visit our WebMD Weight Loss Clinic message boards.

Moderator: Thank you everyone for joining us today. Be well and goodbye.

Elaine Magee: Thank you.

nancybeach_webmd: Thank you very much for your participation!

Originally published December 14, 2000.

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