The expression “You are what you eat” is particularly true for people with irritable bowel syndrome (IBS). The number one reason to miss school or work in the U.S. is the common cold. Number two? Irritable bowel syndrome–a disorder of the large intestine that can cause cramping, pain, gas, constipation, and diarrhea.
It is no surprise that living with IBS can have a significant effect on a person’s quality of life. Given that the gastrointestinal symptoms associated with IBS have both physical and psychosocial impacts, it’s important to tailor treatment to the individual patient and factor in the severity of disease.
Treatment of IBS focuses on relieving symptoms so that you can live as normally as possible. This article addresses the role of diet in the treatment of IBS. Diet is one way people manage IBS symptoms. A common treatment approach is to avoid the foods that trigger symptoms such as:
- High-gas foods. If you experience bloating or gas, you might avoid items such as carbonated and alcoholic beverages, caffeine, raw fruit, and certain vegetables, such as cabbage, broccoli, and cauliflower.
- Gluten. Research shows that some people with IBS report improvement in diarrhea symptoms if they stop eating gluten (wheat, barley, and rye) even if they don’t have celiac disease.
- Caffeine. Because caffeine intake stimulates gut motility, reducing caffeine intake is often recommended.
- Fat. A low-fat diet is often recommended, as fatty foods may cause painful contractions in patients with IBS.
Fiber and fiber-based supplements accelerate colon transit, increase stool bulk, and facilitate passage, resulting in an increase in stool frequency. This increase can benefit patients with chronic constipation and IBS-C. Often used as a first-line therapy, fiber should be gradually increased to a total daily intake of 20 to 30 grams. Research has found that soluble fiber (psyllium and ispaghula husk) but not insoluble fiber (wheat bran) was associated with improved IBS symptoms.
Another diet for IBS was developed in Australia and is having a lot of success in managing IBS symptoms. It’s called the low-FODMAP diet. The idea behind the low-FODMAP diet is to only limit the problematic foods in a category—not all of them. (After all, they do have health benefits.) You may tolerate some foods better than others. FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols. These fermentable short-chain carbohydrates are prevalent in our diet and can cause sensitivity in some people. A person’s IBS symptoms might ease if they follow a strict low-FODMAP diet and then reintroduce foods one at a time.
Studies thus far have shown that a low-FODMAP diet improves IBS symptoms. The low-FODMAP diet recommends eating less of the following foods:
- Lactose: Contained in cow’s milk, yogurt, pudding, custard, ice cream, cottage cheese, ricotta cheese, and mascarpone
- Fructose: Contained in fruits, such as apples, pears, peaches, cherries, mangoes, pears, and watermelon; and sweeteners, such as honey, agave nectar, and products with high fructose corn syrup
- Fructans: Contained in vegetables, such as artichokes, asparagus, Brussels sprouts, broccoli, beetroot, garlic, and onions; grains such as wheat and rye; and added fiber, such as inulin.
- GOS (galactooligosaccharides): Contained in chickpeas, lentils, kidney beans, soy products, and vegetables such as broccoli.
Polyols: Contained in fruits, such as apples, apricots, blackberries, cherries, nectarines, pears, peaches, plums, and watermelon; vegetables, such as cauliflower, mushrooms, and snow peas; and sweeteners, such as sorbitol, mannitol, xylitol, maltitol, and isomalt found in sugar-free gum, mints, cough medicines, and cough drops.
The FODMAP diet recommends eating more of these foods:
- Dairy and other milks: Lactose-free milk, rice milk, almond milk, coconut milk, lactose-free yogurt; aged cheeses such as feta and brie
- Protein: Beef, pork, chicken, fish, eggs, and tofu
- Grain: Oat, oat bran, rice bran, gluten-free pasta, rice, corn, and quinoa
- Fruit: Bananas, blueberries, cantaloupe, grapefruit, honeydew, kiwi, lemon, lime, oranges, and strawberries
- Vegetables: Bamboo shoots, bean sprouts, bok choy, carrots, chives, cucumbers, eggplant, ginger, lettuce, olives, parsnips, potatoes, spring onions, and turnips
- Nuts/seeds (limit to 10-15 each): Almonds, macadamia nuts, peanuts, pine nuts, and walnuts
Diet definitely seems to be a major way to alleviate the symptoms of IBS. A food diary and symptom chart may be helpful tools. The low-FODMAP diet has shown potential in helping people with IBS. It is important to meet and continue monitoring with a registered dietitian before embarking on such an eating plan. Some health professionals believe that the diet is too restrictive. Supporters of the diet report that people stick with it because of how it improves their quality of life.