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What should I eat if I have irritable bowel syndrome (IBS)?

Kynthia James
Critical Care Nursing Specialist

 

Management of IBS includes making some dietary modifications. It is important to increase your intake of fiber to at least 20g per day. The intake of fiber should be gradually increased to reduced gas pains and bloating. If gas and bloating are a major issue it would be recommended to eliminate foods that tend to cause gas such as broccoli and cabbages. It you have issues with lactose intolerance it may be helpful to such to yogurt instead of milk products. Probiotics have also been given to help reduce the symptoms.

 

Dietary measures can be helpful in managing IBS. It is usually recommended that larger meals be avoided in favor of smaller, regular meals. Also, drinking at least eight cups of noncaffeinated fluids on a daily basis is encouraged. Increasing soluble fibers such as psyllium and oats is advised, whereas nonsoluble fibers such as whole grain breads, brown rice, and bran should be limited although they may improve symptoms of constipation. Avoiding sorbitol such as that found in apple, prune, and pear juices should be considered if diarrhea is predominant. In addition, limiting wheat products and fat intake to less than 40-50 grams daily can be beneficial.

Christie Korth
Nutrition & Dietetics Specialist

For those with IBS, according to my extensive research, my book and both personal and professional experience, it is best to stick with a whole foods diet. Foods like caffeine and sugar are known to aggrevate various components of IBS, such as ulcers, GERD, nausea, diarrhea, and constipation.

Examining if you have food intolerance is another great idea if you have IBS.  The most common foods people react to are generally dairy, eggs and wheat.  These foods are mucous producing and can cause irriatation to the digestive tract.

Foods that should be consumed are whole foods like fruits, boiled or steamed vegetables, easy to digest grains like millet or qunioa and anti inflammatory foods like salmon, flax seed and coconut oils.

Patsy Catsos
Nutrition & Dietetics Specialist

I don't believe in a one-size-fits-all approach to diet for IBS. You have to work at it a little bit to find out the best diet for you. First, make sure you have tried basic measures like eating regular meals, eating enough fiber and getting enough fluids. If that doesn't work, or if eating more fiber makes your symptoms worse, consider a FODMAP elimination diet. While this diet is not right for everyone with IBS, good candidates for the diet get great results. Research shows that up to 85% of IBS patients who stick to this diet get symptom relief. Good candidates for the diet have had a proper medical evaluation and diagnosis of IBS, have had celiac disease ruled out, are currently eating high FODMAP foods or have a history of not tolerating them (onion, garlic, high-fiber products, milk, sugar-free foods to name just a few), are willing and able to take on a dietary experiment, and are not at risk for an eating disorder.

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Dr. William T. Dierenfeldt, MD
Gastroenterologist

I recommend the Low FODMAP IBS Diet to all my patients with IBS. Dr. Susan Shepard and Dr. Peter Gibson's research performed at the Monash University in Australia has proven that dietary management of IBS is successful in 80% of people when following a low FODMAP diet. The Low FODMAP IBS Diet is a comprehensive plan that incorporates dietary modification and key lifestyle changes needed to improve IBS symptoms. The key components of this diet plan include eating FODMAP friendly foods and lifestyle changes that are outlined in my free ebook "10 Rules for Living With IBS" (http://lowfodmapibsdiet.com.) 

It is recommended that you consult with a dietician when following the Low FODMAP IBS diet but we also recognize that most people in the U.S. will not have access to a dietician trained in this approach. It is for this reason that I recommend our online resource Low FODMAP IBS Diet.com which includes a step by step guide to implement the dietary and lifestyle changes you need to make in order to improve your IBS symptoms.

Here are some options to help you manage your irritable bowel syndrome (IBS) through dietary changes:

  • Avoid high-fat meals. If you have IBS with diarrhea (IBS-D), it's important to limit fats. Most people have an urge to have a bowel movement about 60 minutes after a meal, but for a person with IBS-D, that reaction can occur more quickly and more strongly. The reaction is related to the amount of fat in the meal. High-fat meals can cause vigorous muscle contractions in the colon, triggering cramping and diarrhea in people with IBS-D.
  • Try eliminating certain foods. Some people report more severe symptoms after eating certain foods. Your diet should be individualized for you. If you experience bloating, you may want to try limiting foods likely to cause gas, such as carbonated beverages, raw fruits and cruciferous vegetables, including broccoli, Brussels sprouts, cabbage and cauliflower. For some people, a low-fat, higher-fiber diet may help, while others feel better with a high-protein, low-carbohydrate diet. You may want to consult a dietitian to help you identify food triggers and develop your treatment plan. The dietitian may be able to help you determine how your body reacts to certain foods. Sometimes a food sensitivity (such as lactose or gluten intolerance) is involved. Caffeine, milk, chocolate, nicotine, alcohol and large, high-fat meals can trigger symptoms in some people. If milk products bother you, be sure to include another source of calcium in your diet.
  • Eat dietary fiber. Dietary fiber eases constipation and may provide relief from symptoms. Whole-grain breads and cereals, beans, fruits and vegetables are good fiber sources. About one in six people see improvements from increased dietary fiber. If dietary fiber causes uncomfortable bloating or isn't working, talk to your healthcare provider about fiber supplements or other medications.
  • Take probiotics. Some research says probiotics may help IBS symptoms by affecting bacteria in the gut. Probiotics come in many forms. They are found in live-culture yogurt (such as the brand Activia) and in capsule or powder supplements. Start with a cup or two of yogurt a day and see if your symptoms respond. If more is needed, you may try over-the-counter capsules or packets of probiotics that you can sprinkle on food. Probiotic supplements are available in grocery stores, pharmacies, health food stores and online.

This content originally appeared on HealthyWomen.org.

Dr. Judith Mabel, RD
Nutrition & Dietetics Specialist

IBS is a catchall phrase for a number of gastrointestinal (GI) disturbances. So sometimes omitting a certain food can help, but not always. In general, I would eliminate sugars (feeds yeast and pro-inflammatory). Some people do well by staying off of refined and processed foods, alcohol and dairy. I would also find out which foods are bothering me through an elimination diet or by using a food sensitivity test. I use the LEAP test by Oxford labs with my clients. Probiotics are often helpful and will not cause harmful side-effects. Herbs such as peppermint and chamomile can calm a nervous system.

Angela Lemond
Nutrition & Dietetics Specialist

Nutrition therapy for irritable bowel syndrome (IBS) can help you feel less constipated and bloated. It can also help ease diarrhea. It may be helpful to keep a food diary so when digestive problems arise, it may help you identify the offending food(s). Keep a list of changes that may make you feel better or worse. In general, it is recommended to do the following:

  • Eat meals and snacks on a regular schedule.
  • Aim for 5-6 small meals per day. Do not skip meals.
  • Increase fiber slowly. Aim for 25-35 grams daily. High fiber foods include whole grains, beans and fresh fruits and vegetables.
  • Aim for 6-8 cups of water in addition to your other daily beverages.
  • Follow a low-fat diet, as it is better tolerated.

It may be beneficial to schedule an appointment with a Registered Dietitian (RD) in order to get a customized plan for your specific digestive issues. To find an RD in your area, visit http://www.eatright.org.

 

Dr. Dawn Marcus
Neurologist

The following are some dietary treatments that help improve irritable bowel syndrome (IBS):

  • Fiber therapy: Increasing soluble fiber improves constipation and other irritable bowel symptoms, but not abdominal pain.
  • Peppermint oil: Three to six enteric-coated capsules containing 0.2-0.4 mL peppermint oil daily can reduce irritable bowel symptoms, including abdominal pain. Capsules need to be swallowed and not chewed to avoid reflux.
  • Herbs: Tong xie yao fang, Padma Lax, and STW 5 have been found to reduce the symptoms of IBS.
  • Probiotics: Probiotic supplements or eating more foods rich in probiotics (such as yogurt, kefir (fermented milk), miso and tempeh made from soybeans, and sauerkraut) relieves irritable bowel symptoms and abdominal pain.
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Marilyn Ricci, M.S., R.D.
Nutrition & Dietetics Specialist

My daughter has irritable bowel syndrome. Stress can bring on a flare-up, but since stress is rather difficult to avoid in today's world, she has learned which foods cause distress for her and avoids them. Each person is different as to the foods that they find irritating. Often times, it is foods like nuts and seeds. She began by eliminating these. Then gradually, when better, adding some of them back into her meal plans, but in very small amounts. No one food is usually the culprit, so it will take some trial and error.

Lisa Stollman
Nutrition & Dietetics Specialist

IBS is a very individualized syndrome. Quite often increasing dietary fiber and drinking at least eight cups of fluid per day can be quite helpful. But the starting point should be a daily food journal. Keep a record of everything you eat and drink and the amount, the approximate time that you ate and, lastly, make a notation of how you are feeling. This way you can look back at the journal and see when you felt well and when you were uncomfortable. The journal may help you uncover specific foods that are causing a problem. Meeting with a Registered Dietitian is a smart thing to do as they will be able to give you personalized nutrition care.

Donna Feldman
Nutrition & Dietetics Specialist

Food recommendations for IBS can be very individual. The first step in creating your diet for irritable bowel syndrome is to find out what you're eating when you have symptoms. You should keep a food diary for 2-4 weeks, and note when you have symptoms and how severe they are. You may react immediately, or it may take 1-2 days for the food to cause problems. With the help of a registered dietitian, you can analyze the diary for connections to specific foods or to components common to several foods.

 There are some general recommendations for IBS. Avoid artificial sweeteners like sorbitol and xylitol (and others ending in --ol). These are known to cause diarrhea for some people, and are common in chewing gum and sugarless candies. Milk products can cause problems for lactose-intolerant people, and high fat foods and meals are a problem for others. Caffeine, high sugar foods/meals and gassy foods like cabbage can also be implicated.

Some people cannot digest certain short-chain carbohydrates, referred to as FODMAPS. Fructans, which are chains of fructose, and certain fibers, like inulin, are on the FODMAPS list. The list of foods that contain these fermentable carbohydrates is varied, and includes wheat, apples and onions, as well as any food fortified with inulin. You may find that you tolerate small occasional portions of these, but can't eat a meal with several at one time. FODMAPS food lists are widely available on the Internet, but a qualified dietitian can help you identify those foods in your diet.

IBS diet recommendations do include other fibers, to help normalize bowel function. Whole grains, vegetables and fruits are key, although you certainly need to avoid specific foods known to cause symptoms.

Laura Motosko, MSEd, RD
Nutrition & Dietetics Specialist

It is helpful with IBS to keep a food journal of what, and how much you eat with a note of symptoms to determine if there are foods that you may want to avoid. IBS affects everyone individually, generally avoiding caffeine, alcohol and high fat foods are helpful to decrease symptoms. Eating 6 small meals a day is recommended drinking water for hydration in between meals. Nutrient dense foods are recommended including whole grains, fruits, vegetables, healthy fats such as olive oil, proteins including lean meat, nuts, legumes, beans, soy or dairy and reduced saturated fat, sodium and sugar.

If you have irritable bowel syndrome (IBS), a high-fiber, low-fat diet is a good approach:

  • Eat small, frequent meals. Chewing your food well to aid digestion and eating slowly so you don't swallow a lot of air, which may make you feel gassy.
  • Avoid foods that cause too much gas or irritate your stomach.
  • Limit substances that make symptoms worse, like caffeine, alcohol or fat.
  • Drink more fluids to help prevent constipation.
  • Learn to manage stress.
A registered dietitian can help you create an individualized approach to eating that not only helps manage gastrointestinal (GI) symptoms but also helps prevent malnutrition and helps your GI tract function normally.
Dr. William B. Salt, MD
Gastroenterologist

If you have irritable bowel syndrome (IBS), try to select fresh foods and unprocessed foods whenever possible. Foods prepared by others before they get to our households are more likely to have added salt, sugar, saturated fats, preservatives and artificial coloring. Furthermore, fiber and nutritional content decrease with the increased processing required to give foods a longer shelf life.

Eat in moderation and only when you're hungry and while you are in a relaxed, unhurried atmosphere. Take the time to chew food properly and enjoy the sensations. This nourishes not only your body but also your mind and spirit. Chewing properly and eating slowly are vital to healthy digestion. This alone may relieve many of your uncomfortable irritable bowel syndrome symptoms. In addition, eating more frequent, smaller meals throughout the day may result in less discomfort than eating one or two larger meals.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.