David L. Katz, MD
Photo: Mackenzie Stroh
Q: I was diagnosed with irritable bowel syndrome and was told by my specialist to avoid all the green vegetables I love. Any suggestions?
— Charmaine Robinson, Pinetown, South Africa

A: Your specialist may be right. In some cases of irritable bowel syndrome (IBS), cutting back on fiber helps since high-fiber foods increase the bulk moving through the intestines, which can worsen symptoms. Just be sure to cut back on other typical causes of IBS as well, such as fatty foods, dairy, alcohol, chocolate, and caffeinated and carbonated drinks.

You'll be happy to know that once your gut calms down, eating greens can help keep it that way. It sounds contradictory, but the majority of IBS sufferers fare better when they add fiber to their diet. There are a couple of other steps you can take to ease your troubles: When we treat IBS in my clinic, I always recommend a probiotic—a supplement of "friendly" bacteria that aid digestion. Bacteria in the intestines play a vital role in digestion, so having the right population of bacteria in place is crucial to the health of the GI tract. You may want to try at least a one- to two-month course of probiotics from a reputable company, such as Metagenics or Culturelle. I also prescribe the amino acid glutamine, 1 gram twice daily; it's an important nutrient for the cells that line the intestines.

If you haven't already done this, try keeping a symptom and diet diary to see if you can identify links between particular foods and flare-ups of your condition. Food allergies may be part of IBS, and common culprits include dairy, wheat, corn, and nuts. While you're tracking what you eat, also write down how you're feeling. Stress doesn't cause IBS, but it can aggravate symptoms. Proven methods of stress reduction include yoga, meditation, and aerobic exercise. I recommend at least aerobic exercise.

And once you get your symptoms controlled, I would certainly add those greens back to your diet. Try one serving a day for a few days straight to see how your body responds. If your gut has no complaints, add another serving. With any luck, in a week or two you'll be eating vegetables without worry.