Medically Reviewed by Dr. Yasir Bari
Bsc, (Med) Bsc, (Nutrition), MBBS, DCN (Diploma in Clinical Neurology) – Reviewed & Approved on June 09, 2019
-Written by Marc Seward
What is IBS?
Irritable Bowel syndrome is a very common condition affecting as many as 1 in every 5 adults in the U.S. The condition affects the colon or ‘large intestine’ and causes a variety of unwanted symptoms including cramping, bloating, diarrhea, gas, constipation and stomach pain.
The condition is usually chronic although symptoms can vary in severity at any time and only the minority of people with the condition have very severe symptoms. Many sufferers may even be unaware they have the condition and not all will seek medical help.
IBS can be brought under control with certain lifestyle and dietary changes; it is likely however that finding the right diet will come down to trial and error as not everybody’s symptoms are triggered by the same food.
Food to Avoid
Before we look at the various diet options for IBS, it is important to look at the food that people commonly need to avoid because they are well known triggers in the majority of patients. There is not one definitive list of food to avoid and with trial and error, you can start adding to the list by elimination.
1. Grains and Gluten
Grains can be problematic for several reasons; first of all certain whole grains contain insoluble fiber which is difficult for IBS sufferers to absorb and digest. Secondly, products containing other grains such as rye, barley and wheat have high gluten content.
Gluten is known to trigger intestinal reactions and worsen IBS symptoms. Around half of the people with IBS are gluten intolerant. If you are determined to continue eating cakes, cookies and pizza, look for gluten free alternatives which are readily available these days.
2. Insoluble Fiber
We are always told how good fiber is for you; it helps to add healthy bulk into your diet and is found in fruit, vegetable and grains. On the other hand, insoluble fiber such as the fiber found in grains can aggravate certain symptoms like diarrhea and eating a lot of insoluble fiber will increase your discomfort and your bathroom visits.
Instead, try to increase your intake of the soluble fiber found in fruit and veg.
Milk has a fat content that can make diarrhea worse so try drinking non or low- fat milk instead. Another problem with dairy is that many IBS sufferers are lactose intolerant meaning they are unable to digest the lactose from dairy products. Consider switching to products made from soymilk. If you choose to completely avoid dairy products, you might need to take a calcium supplement.
4. Fried food
Fried foods like chicken and French fries play a big part in the standard Western diet these days and let’s face it, they are cheap, convenient and mostly delicious. Unfortunately, the very high content of fat is very difficult for IBS sufferers to digest. Try grilling your chicken or baking your potatoes instead.
We all know the effect that eating too many beans can have on the digestive system. They are rich in fiber and protein but can be an absolute nightmare for patients with IBS. Beans are very likely to increase cramps, gas and bloating and should definitely be avoided if you suffer with IBS.
Not everybody will have a bad reaction to drinking coffee and many people swear that it helps them to stay regular. Unfortunately for others, coffee can stimulate the intestines and produce more diarrhea and should be avoided by those with IBS.
Alcohol, caffeine, carbonated drinks (even mineral water for some), artificial sweeteners, MSG and artificial fats like Olestra can all be potential triggers. If it is artificial or processed—your best bet is to avoid altogether.
The Elimination Approach
IBS symptoms and triggers vary from person to person which is why an elimination diet often proves effective. Over time, try to find out exactly which foods are causing your symptoms and keep detailed notes and lists. Once you have identified a potential culprit, you should avoid it for 2 or 3 months to see if your symptoms have improved.
If you would prefer to try a more controlled diet plan, there are a bewildering number available. Unfortunately, many of these offer contradictory opinions but we will look at some of the most popular in this article.
1. The Low-fat Diet
Fried foods and other unhealthy fatty foods contribute to a variety of illnesses and health problems like obesity. The standard western diet includes far too many fatty foods and even where I live in South East Asia, I have seen a massive change in the average weight of children over the past few decades as their diets have changed towards a more western diet.
Fatty foods are also low in fiber content which is a problem for IBS patients with constipation symptoms. The Cleveland Clinic suggests that high fat foods are especially problematic for patients with mixed symptoms of both diarrhea and constipation.
Going on a healthy low fat diet will not only benefit your overall health, but should have an immediate impact on your symptoms especially if you were overeating the fatty products on offer.
Try to avoid the fast food joints and try to prepare your food in a different way at home. Try grilling, boiling and baking instead of frying and make sure you are eating plenty of lean meats, fish (with healthy fats), fruits and vegetables. Try to replace full fat milk with a lower fat variety or switch to unsweetened soy milk instead.
2. Low Fiber Diet
How much fiber is too much for IBS patients and exactly what type of fiber should you be eating? Fiber can actually help certain IBS patients by bulking their stools but ironically increasing your insoluble fiber consumption can have a detrimental effect especially if you suffer from diarrhea and gas.
Instead of eating the problematic insoluble fibers found in various grain based products and certain veg like broccoli and cabbage, you should get your fiber from soluble fiber sources like carrots, oatmeal, berries and apples.
3. Gluten Free Diet
As we mentioned above, gluten can be especially problematic for those suffering from irritable bowel syndrome. Gluten is actually a protein which is found in grain based products like pasta, pastry and bread.
This protein is known to have a detrimental effect on colon especially in those with gluten intolerance. Many people who suffer from IBS also have intolerance to gluten and lactose meaning these foods should be eliminated.
If you want to try the gluten free approach then you will need to avoid rye, barley and wheat products from the diet and with any luck you will see an improvement in your symptoms. These days there are gluten free products and ingredients for home cooking increasingly available at health stores, supermarkets and online.
4. FODMAPS diet for IBS
The low FODMAPS diet is a popular diet for those suffering from IBS as well as other inflammatory conditions like IBD and SIBO.
The principle behind the diet is that a set of short chain carbs known as FODMAPS are not well absorbed in the small intestine.
When eaten, they rapidly ferment due to a reaction with bacteria in the stomach. This is especially problematic in patients with IBS as the fermentation process contributes to the severity of the symptoms experienced by the patient.
Food which should be avoided because it is high on the FODMAPS index includes:
- Certain fruits containing an excess of fructose like apples, pears and tinned fruit.
- Certain vegetables like asparagus and artichokes.
- Dairy products including milk, cheese, custard and yogurt.
- Grains, rye and wheat.
- Artificial sweeteners.
A more comprehensive list can be found here http://www.aboutibs.org/site/treatment/low-fodmap-diet/ but the developers of the diet stress that you should speak to a trained dietician before you embark on the diet. Remember also that moderation is important; the diet is named low FODMAPS as opposed to no FODMAPS and depending on the severity of your symptoms you may have a little flexibility.
More Facts about IBS
IBS and Alcohol
Alcohol is known to cause irritation to the gut and this has been linked to IBS symptoms flaring up. People who drink may have noticed that alcohol is a trigger. They may notice that drinking even small amounts of alcohol causes an increase bloating or cramping while it can also lead to other symptoms like constipation and diarrhea.
People who are very sensitive to alcohol, may notice that even a single alcoholic drink can trigger their symptoms. Some drinks can trigger IBS flare-ups more than others and many patients have reported that beer is one of the worst culprits.
Many people have reported that quitting alcohol entirely has led to significant improvements in their IBS symptoms. Others have experienced a great deal of relief simply from cutting back on their intake of alcohol or eliminating alcoholic drinks that trigger their symptoms.
IBS and Anxiety
There appears to be a link between stress and anxiety and IBS. It is not completely clear how they are linked or which condition comes first. Nevertheless, there is evidence to show they can occur together and many people who suffer IBS will also suffer from stress and anxiety.
According to professor of psychology – Dr. Edward Blanchard, the majority of IBS patients suffer from emotional issues.
“what you find is that about 60% of IBS patients will meet the criteria for one or more psychiatric disorders,”
While people with IBS often suffer from an emotional disorder, anxiety disorder appears to be the most common. Dr. Blanchard estimates that of the IBS patients suffering from a psychiatric disorder, over 60% have a form of anxiety disorder while 20% are suffering from depression.
While the exact link is uncertain, there are a number of theories regarding the relationship between anxiety or stress and IBS :
- While anxiety and other emotional disorders do not cause digestive issues, people who suffer from IBS might be more prone to emotional ailments and psychological disorders.
- IBS might be linked to immune system health which is often affected by anxiety and stress.
- Some experts feel that anxiety can make a person’s mind more keenly aware of digestive spasms.
IBS and Back Pain
There is also a potential link between IBS and back pain although the precise reasons or even whether there is a link, is unknown.
What we do know is that people suffering from IBS often report symptoms that are apparently unrelated to digestive health. One such symptom is back pain that can occur at any time but especially through the night.
Although many IBS sufferers report back pain, it may be entirely unrelated to IBS or it may be what is called ‘referred pain’. This is a pain felt in a part of a body away from the original source of the issue. Most IBS pain originates in the gut and is caused by bloating, gas and constipation. This pain might lead to pain in other parts of the body.
IBS is a common complaint that affects up to 20% of adults in western countries. It causes a range of symptoms including stomach pain, bloating, gas and constipation.
The symptoms can be triggered by certain foods which should be avoided. These include fried food, beans, gluten, milk and soluble fiber. Symptoms may also be triggered by coffee and alcoholic drinks.
There are several IBS diets that many people have found effective. The main diets for IBS are :
- The low fat diet
- The low fiber diet
- The Gluten-free diet
- The FODMAPS diet
Have you ever tried any of the diets mentioned in this article and which were the most effective for you? Please let us know in the comments section.
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