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!
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.
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:
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.
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.
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.
Food: Many people have worse IBS symptoms when they eat or drink certain foods or beverages. These foods include wheat, dairy products, citrus fruits, beans, cabbage, milk and carbonated drinks.
Stress: Most people with IBS experience worse or more frequent signs and symptoms when they are stressed. But while stress may trigger your symptoms, it doesn't cause them.
Hormones. Women are twice as likely to have IBS, which might indicate that hormones play a role with IBS. Many women report that their IBS symptoms are worse during their menstrual periods.
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
High-gas foods such as broccoli stems (the heads are good!), cauliflower, cabbage, and beans
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 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.
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
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.
Sometimes it's best to take a detailed and regimented approach. Below is the process we follow with our clients:
Make a detailed list of your diet
Write down your your symptom history
Connect your diet patterns to your symptoms to identify individual food intolerances and responses.
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
Biochemical and clinical parameters
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
Yes and no. The "LEAP" stands for Lifestyle, Eating, And Performance protocol, which is a standardized elimination process used to identify specific food sensitivities. This of it this way: the LEAP approach is one discreet part of a comprehensive nutrition assessment.
Here are a few things you should know about the LEAP approach:
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.
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.
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.
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.
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.
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.
There are 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
Prescription medicines: studies have shown that despite their side effects, prescription medicines do their job well
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:
The first part is a very strict diet that eliminates many foods known to cause IBS
The second part of the diet involves adding previously eliminated foods back into your diet one at a time to identify gastrointestinal irritants.
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.
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:
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:
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.
The direct costs include diagnostic tests, medications, and physician visits -- estimated to range from $1.5 billion to $10 billion. Patients with IBS have been found to have a greater number of healthcare visits per year than population controls. The indirect costs, including diminished productivity or missed work, are estimated to be as high as $20 billion, although this estimate is based on IBS patients who sought medical attention and is likely to be much higher.
Your symptoms are unique to you. Your nutritionist tracks your food with you and makes specific recommendations to help you feel better
Based upon your daily routine, we will build a custom plan to help alleviate your GI and IBS issues
Success does not happen overnight. If something isn't working quite right, we make changes right away
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.
Our dietitians and nutritionists build custom plans tailored to help you find relief from your GI issues. Our expertise includes:
Let's tackle your IBS challenges. Why wait another day?