IBS Diet: Irritable Bowel Syndrome

Fix IBS symptoms such as abdominal pain and bloating by improving your nutrition and diet

First things first: work with your doctor and a GI Specialist to diagnose your Irritable Bowel Syndrome (IBS).  The condition is typically associated with cramping, abdominal pain, bloating, gas, diarrhea or constipation, or all of the above (ugh).

As you may know, there are two different types of IBS: IBS with Constipation (IBS-C), and IBS with Diarrhea (IBS-D).  Before digging in, learn more about IBS-C, IBS-D, and the major differences between the two conditions.

Like many other conditions, you will experience these symptoms along a sliding scale of severity.  Luckily, when you have a "flare up", there are things you can do to relieve your discomfort.  Call it a better IBS diet.  Read on for our recommendations for how diet can help relieve your IBS symptoms.  Enjoy!

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Don't let IBS get the best of you

Wait a minute, what is IBS anyway?

Irritable bowel syndrome, also known as IBS, affects the large intestine and can cause bloating, gas, constipation and sharp stomach pains. IBS can strike at any age and usually gets worse during stressful times. Although the exact cause of IBS is unclear, researchers believe IBS is caused by irregular intestine muscle contractions, nervous system abnormalities, inflammation, infection and changes in gut bacteria. Although IBS is considered a chronic disease, you can manage and even eliminate your symptoms through specific IBS diet changes.

 

First, what are the biggest IBS Diet misconceptions that we hear today?

Misinformation on eating for IBS is rampant. Just ask the Google machine.  You will find thousands of results, with recommendations as varied as low-glycemic, low-carbohydrate, low-fiber, high-fiber, low-fat, no-high-fructose-corn-syrup, and detox diets (wow, that was a mouthful).

The IBS head-scratching exists among patients, physicians, and dietitians too.  Our team has identified three main misconceptions:

  1. IBS can only be managed with medication: NO-NO-NO! (did we say no?!)  Because IBS has multiple causes, existing medication does not always work.  Medication is one piece of a complicated puzzle.  However, improving your diet can be an effective first step in alleviating your IBS symptoms.  Your doctor, GI specialist, and nutritionist can help build a multi-faceted regimen to help you feel better.

  2. IBS diets can be fixed with one "golden ticket": 'Just have your patient eat more fiber.’ Sadly, this isn't true.  Although a higher-fiber IBS diet works for some, it doesn’t always.  For some clients, high-fiber IBS diets can even make symptoms worse.

  3. IBS, Crohn’s disease and ulcerative colitis are all basically the same thing:  Also false.  Although all of these conditions are GI issues, each has different underlying causes and slightly different treatment regimens.  The numbers bear this out: IBS is two to three times more common in individuals with inflammatory bowel disease than in the general population.

 

So, what are the triggers of an IBS flare up?

The truth is, leading a busy, hectic, life can trigger IBS...

But, do we actually know what causes IBS?

The short answer is no, but scientists have a few ideas about what causes IBS

  • Muscle contractions in the intestine. The walls of the intestines are lined with layers of muscle that contract as they move food through your digestive tract.  This is how digestion works!  Stronger contractions that last longer than normal can cause gas, bloating and diarrhea. To the contrary, weak intestinal contractions can slow food passage and lead to hard, dry bowel movements.

  • Nervous system. Your digestive organs are covered with nerves.  That's what makes you feel hungry, full, and everything in between.  Abnormalities in the nerves in your digestive system may cause you to experience increased discomfort when your abdomen stretches from gas or stool. Irregular signals between your brain and intestines can cause your body to overreact to changes that normally occur in the digestive process.  The result: pain, diarrhea or constipation.

  • Inflammation in the intestines. Some people with IBS have an increased number of immune-system cells in their intestines. Like other suspected causes, this immune-system response is associated with pain and diarrhea.

  • Severe infection. IBS can develop after a severe bout of diarrhea (gastroenteritis) caused by bacteria or a virus. IBS might also be associated with a surplus of bacteria in the intestines (bacterial overgrowth).

  • Changes in bacteria in the gut (microflora). Microflora are the "good" bacteria that reside in the intestines and play a key role in health. Research indicates that microflora in people with IBS might differ from microflora in healthy people.

Read our full piece on IBS causes here

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Here's what you can do about it!

As part of a successful IBS Diet, here are foods to avoid with IBS:

  • High-gas foods such as broccoli stems (the heads are good!), cauliflower, cabbage, and beans

  • Carbonated beverages

  • Chewing gum or drinking liquids through a straw.  Why?  Both of which can lead to swallowing air, which causes more gas

  • Fried or other high-fat foods

  • Avoid large meals, which may promote cramping and/or diarrhea

  • Minimize consumption of foods high in lactose, such as milk, ice cream, and soft cheeses, especially if lactose intolerance is suspected

  • Avoid or minimize alcohol and caffeine intake, as both substances can stimulate the intestines and lead to diarrhea

  • Avoid artificial sweeteners that contain sugar alcohols, such as sorbitol, mannitol, and xylitol, which may cause diarrhea

  • Avoid High-FODMAP foodsFODMAPs are un-absorbable carbohydrates that act as substrates for bacterial fermentation and gas production, potentially triggering GI symptoms

  • Avoid gluten.  Your doctor may recommend an IBS diet that avoids gluten—a protein found in wheat, barley, and rye—to see if your IBS symptoms improve. Foods that contain gluten include most cereal, grains, and pasta, and many processed foods. Some people with IBS have more symptoms after eating gluten, even though they do not have celiac disease.

A word of caution: because everyone's IBS situation is different, not all of these foods will trigger IBS symptoms in every person.  The list above suggests foods that commonly cause IBS symptoms.

So what should my IBS Diet look like?

We share the foods to eat with IBS

  • Eat smaller, more frequent meals...why? because they are easier to digest!

  • Love savory foods?  Your stomach can better handle hard cheeses, lactose-free milk, lactose-free ice cream, and low-lactose or lactose-free yogurt or kefir.  These products are either low- or lactose-free

  • Drink plenty of fluids (i.e. water!) to help alleviate constipation

  • Foods rich in soluble fiber, such as oatmeal, oat bran, low FODMAP oranges and strawberries, nuts, and low FODMAP carrots

We also suggest eating more fiber.  Fiber may improve IBS constipation because it makes stool soft and easier to pass. The 2015-2020 Dietary Guidelines for Americans recommends that adults should get 22 to 34 grams of fiber a day.

Two types of fiber are:

  • Soluble fiber, which is found in beans, fruit, and oat products.  Research suggests that soluble fiber is more helpful in relieving IBS symptoms.

  • Insoluble fiber, which is found in whole-grain products and vegetables

To help your body get used to more fiber, add higher fiber foods to your diet bit by bit.  Blasting your system with fiber can cause gas, which can trigger IBS symptoms. Adding fiber to your diet slowly, by 2 to 3 grams a day, may help prevent gas and bloating.

In addition to the tips we shared above, one of the most common IBS diets is a low FODMAP diet.  Read more about our low FODMAP diet recommendations.

 

I'd like to take an even more detailed IBS Diet approach.  What should I do?

Sometimes it's best to take a detailed and regimented approach.  Below is the process we follow with our clients:

  1. Make a detailed list of your diet

  2. Write down your your symptom history

  3. Connect your diet patterns to your symptoms to identify individual food intolerances and responses.

If your physician or dietitian has ruled out other conditions such as celiac disease and lactose intolerance, you should move forward to a complete food log:

Share the results with your dietitian (hopefully us!).  We review your log to find connections between your food intake and your symptoms.  We use this information to identify foods and activities that give them trouble.

If we determine that you do have IBS, the ADA’s Nutrition Care Manual suggests a comprehensive nutritional assessment as a next step.  This nutritional assessment includes:

  • Complete food history

  • Anthropometrics

  • Biochemical and clinical parameters

  • Swallowing problems

  • Nausea

  • Vomiting

  • Constipation

  • Diarrhea

  • Heartburn

  • Food allergies and intolerances

  • Cultural food practices

  • Alternative therapies in the assessment

Want to learn about what each of these topics means and why it is important

Read about a full nutrition assessment here!

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Can any of the popular IBS diets alleviate my symptoms?

Fiber-Conscious IBS Diets: High-Fiber and Low Fiber

If constipation is one of your symptoms, you should consider adding more fiber to your diet.  Fiber is a key ingredient in making it easier to go to the bathroom.  A study from National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) estimates that most people only eat about half of the recommended amount.  On the other hand, if your IBS is associated with diarrhea, work with your doctor and dietitian to better track your dietary fiber and determine if you should reduce the amount of fiber in your diet.  Keep soluble fiber (found in apples, berries, carrots), and reduce insoluble fiber (grain, nuts, broccoli, tomatoes).  Oftentimes, small adjustments to the amount of fiber in your diet can improve your IBS symptoms.

Gluten Free IBS Diet

Even if you do not have celiac disease, a gluten sensitivity may trigger IBS symptoms.  Your doctor can perform tests to determine if you have celiac disesase.  Closely monitoring your diet can help you determine if you may have a gluten sensitivity.  Cutting back on gluten-rich foods (think, bread, pasta, beer) could help.  Check out our full take on the gluten craze.

Elimination Diet

A dietitian can help you complete an elimination assessment.  The purpose is to methodically determine the specific foods or ingredients that bother your digestive system.  Note that the complete process requires discipline, logging your food, and keeping track of your symptoms for 20 - 30 days.  Check out our write up for a full elimination diet to get a better sense of how the process works.

Low Fat Diet

Although dietary fat itself does not have a direct connection to IBS, many high-fat foods are both low in quality and low in fiber.  In general, high quality foods will tend to be lower in fat.  These foods include lean protein, low FODMAP fruits, non-cruciferous vegetables, and low-fat dairy.

Very Low Carbohydrate Diet (quasi-Keto)

Scientific research has not provided definitive evidence that a "Keto-like" diet can alleviate IBS symptoms.  A small study did show improvements in a small sample size.  However, other studies do contradict these findings.  The Keto Diet has drawn attention in recent years.  

Paleo Diet and IBS

Like with Keto, there is no scientific link between the Paleo diet and IBS relief.  Anecdotal methods suggest that a "whole-foods" approach can improve one's digestive issues.  We recommend a high-quality food diet for general health purposes.  GI benefits would be signs of overall improved health.  Check out more about the Paleo Diet and IBS.

 

What about medication?  How does that fit in?

There are a numerous traditional drugs on the market to treat IBS.  Your healthcare providers can determine what is best for you based on your specific circumstances.  However, because there are numerous causes and triggers to IBS, we believe that a proper IBS diet is a key part to living comfortably with gastro-intestinal issues.

Here are a few non pharmaceutical interventions to try:

  • Practice mindfulness: finding ways to de-stress can also calm your digestive system

  • Try eating probiotics: a quick and simple change, eating probiotics has been shown to relieve IBS symptoms

  • Over-the-counter medicines such as immodium or miralax can relieve diarrhea; however, they likely will not fix the underlying causes of your symptoms

  • Prescription medicines: studies have shown that despite their side effects, prescription medicines do their job well

Want more details? Read our full write up on treatment options and medication here!

 

OH, and FODMAPS.  I've heard of them.  How do they work?

Take a deep breath; it's a mouthful: FODMAP stands for fermentable oligo-, di-, and monosaccharides and polyols.

In other words, FODMAPS are carbohydrate-containing foods that can cause gastrointestinal discomfort.  A low-FODMAP approach is considered a short-term elimination IBS diet, not a forever diet.  A low-FODMAP diet has two parts:

Read more about how a low-FODMAP diet can alleviate your IBS

What is IBS-C?  What is IBS-D? What are the major differences between the two?

Overview of IBS-C

As you know, everyone's IBS symptoms are different.  For some, the most common symptom is constipation.  For those with IBS-C, constipation is associated with stomach and abdominal pains, as well as bloating and straining to go to the bathroom.  But know this: this symptom may come and go over time.  Doctors may even define constipation differently than you do.  The doctor definition is "hard, pellet-like stools", while many individuals define constipation as having difficulty going to the bathroom, or the infrequent nature of going to the bathroom.

Passing stool three times per week is a good baseline for whether you should talk to your doctor about IBS-C treatment.  Doctors and scientists think that constipation is caused by two main things:

Treatment includes both medical and dietary improvements.  Like broad IBS recommendations, non-medical treatments include slowly increasing fiber intake, drinking more water, and even increasing physical activity such as walking.  Medical options include over-the counter drugs and prescription medicines.

Read more about IBS-C, including detailed treatments and ways to alleviate your symptoms

Overview of IBS-D

IBS with diarrhea has many of the same symptoms as IBS-C.  The main difference exists in the main symptom: diarrhea vs constipation.  Loose and frequent stool is the main ailment from IBS-D.  There are few specific ways to alleviate diarrhea:

  • Eat regular balanced meals.
  • Reduce caffeine intake.
  • Exercise may help reduce stress.
  • Smoking may worsen symptoms of the syndrome, which is another good reason to quit.
  • Drink plenty of water
  • Avoid soda, which may cause gas and abdominal discomfort
  • Eat smaller meals to help lessen the incidence of cramping and diarrhea.

Read more about IBS-D

What are the major differences between IBS-C and IBS-D

Many symptoms are shared between IBS-C and IBS-D.  What's more?  Some people experience the whole gamut of IBS symptoms, which doctors call IBS-M (short for IBS-Mixed Bowel).  The common symptoms include:

  • Abdominal pain
  • Cramping
  • Bloating
  • Mucus in the stool
  • Excess gas

The main difference is how constipation and diarrhea impact people with IBS.  A combination of diet, medication, and lifestyle improvement can help you get your IBS under control. 

Learn more about the differences between IBS-C and IBS-D

This can't be cheap right?  How much does IBS treatment cost the healthcare system?

Not as much as you may think!  Really!

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Britney Kennedy

Britney Kennedy

Founder

We have worked with hundreds of clients who live with GI issues such as IBS.  We know how hard it can be to live with the condition.  We hope you will allow us to help you tackle your GI issue head-on.

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IBS
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Ulcerative colitis

 

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