Best Strategies to Improve Constipation, Diarrhea, Gas and Bloating

Our guest contributor is Marie Murphy, MS, RDN, CSSD.


With the holiday season in full swing, our dietary habits can get out of whack. Hello, panettone, latkes, cookies, and eggnog! For some, such indulgences can lead to gut discomfort and dysfunction. The most common complaints include bloating, gas, constipation and diarrhea. Whether you’re someone who deals with these symptoms on an ongoing basis, or for whom gastrointestinal (GI) upset is only occasional, I wanted to share my top tips for keeping your gut happy and healthy without missing out on the treats.

Before we dive in, I want to be clear that the following strategies are intended for general management of occasional gut issues and not intended to treat any medical condition. If you are experiencing GI symptoms regularly, and the strategies below are not effective, it’s time to work with a dietitian!


Gut health is the foundation of overall health. Optimal gut health means optimal absorption and elimination, and support for hormone regulation and immune function. Not only that, but poor gut health is associated with depression and fatigue. (1) Addressing underlying dysfunction can improve mental health as well as overall health.



Limit the FODMAPS

If you’ve been struggling with gut symptoms for any amount of time, you’ve likely heard of the low FODMAP diet. This approach to treating IBS symptoms originated in Australia, where researchers at Monash University demonstrated the relationship between consumption of poorly digested and fermentable short-chain carbohydrates (FODMAPS) and the primary symptoms of IBS (bloating, cramping, gas, diarrhea and constipation).


FODMAP stands for: fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Monash researchers measured the levels of these carbohydrates in various foods, creating lists that help individuals and healthcare practitioners develop personalized low FODMAPS diet plans. You can find a summary of low and high FODMAP foods here. The tricky bit is that sensitivity to each FODMAP varies from person to person. Thus, it’s not a one-size-fits-all approach.

Garlic is a high FODMAP food.

However, common culprits include wheat, onions, garlic, and cow’s milk. Thus, when possible, choose a gluten-free option, minimize onion and garlic intake, and avoid cow’s milk in the form of eggnog, ice cream, cream cheese, sour cream, etc. Evidence indicates that cheeses and yogurts are better tolerated.


My advice is to consume these items in moderation and observe the effects. If you need a plant-based milk alternative for your latte or morning smoothie, check out this article to help you find an alternative that suits your needs.


A full-blown FODMAP elimination diet can be helpful for those with IBS or stubborn GI complaints. It is advisable to consult your physician before undertaking such a diet, and to work with a dietitian to ensure your nutritional needs are being met and that your outcomes are being properly evaluated.


The Benefits of Peppermint

Peppermint tea may help with digestive upset.

Peppermint has long been used for digestive upset, and for good reason. A recent meta-analysis published in BMC Complementary and Alternative Medicine and Therapies confirms that peppermint oil is safe and effective as a treatment for GI pain and cramping.(2) Thus, this remedy should be considered by those whose primary GI symptoms are pain and/or cramping, or as a strategy when these symptoms crop up. Peppermint can be consumed as an herbal tea or in the form of an essential oil. The oil can be taken orally, in capsule form or mixed into a beverage. The previously mentioned research applies to the oil form of peppermint, not the tea form. You will get a higher dose of peppermint by consuming the oil. However, tea can also be helpful, not to mention being a soothing and tasty beverage, which ties into the next strategy discussed here: stress management!


Reduce and Manage Stress

Managing stress can help with GI symptoms.

As evidenced by research, and likely your own personal experience, stress plays an important role in triggering GI symptoms.(4) We can’t always control how much stress we’re exposed to. However, we can find ways of managing it. Effective methods of managing stress include meditation, regular exercise, mental health counseling and mindfulness, among others. I encourage clients to engage in more than one stress management technique. Try different methods and see what works best for you. The most important thing is to make sure it’s something you enjoy enough to continue with long-term. Once your stress is managed, it is useful to examine your stressors to determine if it’s possible to eliminate or reduce any.


Probiotics and Fermented Foods

Multi-strain probiotics have been shown to be safe and effective for treating constipation (3), in particular; however, improving gut flora via probiotics has broad-ranging benefits. In order to maximize the benefits of this supplement, you’ll want to pay attention to dose and strain. Be sure to find a probiotic with more than one strain. It should include some combination of the following:

  • Lactobacillus Plantarum

  • Lactobacillus casei

  • Lactobacillus reuteri

  • Bifidobacterium lactis

  • Bifidobacterium longum

  • Bifidobacterium infantis

  • Saccharomyces Boulardii

In terms of dose, aim for 100 billion or more CFUs per day, which is often 3-4 times what is directed on supplement packaging. This is what is called the “therapeutic dose,” which is the amount required to achieve the desired effect. Probiotics should be taken for about one month. If symptoms improve, the dosage can gradually be reduced to the lowest level capable to maintaining symptom relief.

Yogurt contains gut-healthy probiotics.

Probiotics are also found naturally in fermented foods. It is important to note that fermented foods are different from pickled foods. Pickled foods are preserved with vinegar and/or salt, while naturally fermented foods are colonized by beneficial bacteria from the environment in which they are fermented. These are so-called “wild fermented” foods. They are simple make at home. Some small batch operations produce wild fermented kimchi, pickles, sauerkraut, etc. that can be found in stores, if home fermentation is not appealing. Consuming fermented foods is part of a healthy diet and can contribute to gut health. However, since we don’t know dose and strain information for these foods, they are less reliable in treating active gut issues. Thus, consider fermented foods as on-going support of a healthy gut rather than a treatment for acute symptoms.


I hope these strategies help you understand how GI symptoms can be addressed at the dietary and lifestyle levels, even during busy, indulgent, and perhaps stressful times. Take care of your gut, and it will take care of you!



Sources

1. Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome. Clin Epidemiol. 2014;6:71-80. Published 2014 Feb 4.

2. Alammar, N., Wang, L., Saberi, B. et al. The impact of peppermint oil on the irritable bowel syndrome: a meta-analysis of the pooled clinical data. BMC Complement Altern Med 19, 21 (2019).

3. Zhang C, Jiang J, Tian F, Zhao J, Zhang H, Zhai Q, Chen W. Meta-analysis of randomized controlled trials of the effects of probiotics on functional constipation in adults. Clin Nutr. 2020 Oct;39(10):2960-2969. doi: 10.1016/j.clnu.2020.01.005. Epub 2020 Jan 14.

4. Qin HY, Cheng CW, Tang XD, Bian ZX. Impact of psychological stress on irritable bowel syndrome. World J Gastroenterol. 2014 Oct 21;20(39):14126-31.


Author Bio Marie Murphy is Owner and Registered Dietitian at MEM Nutrition & Wellness, a nutrition counseling practice providing a functional and integrative approach to gut health and wellness. Marie also enjoys writing about nutrition science and helping bring clarity to often-confusing nutrition topics. Marie calls the Hudson Valley of New York home, where she enjoys exploring the local mountains, rivers, and lakes and their abundant vegetation and wildlife, and of course, cooking.


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