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IBS Diet

For people with digestive systems that work smoothly, foods are not feared and a person can feel free to eat almost anything they want. Individuals with Irritable Bowel Syndrome do not have that luxury. A sensitive GI tract requires that care be taken with the food that is to pass through. The simple act of eating can become quite a challenge.

Diet tends to be a confusing issue for IBS sufferers. Although there is no specific Irritable Bowel Syndrome diet recommended, there are some foods, which may aggravate the symptoms. Generally though, it may be the act of eating in itself, due to normal or perhaps pronounced stimulation of the digestive system, which may cause the bowel to overreact to food. IBS suffers have been shown to have an enhanced response in the digestive system due to stimuli, referred to as hypervisceral sensitivity. Some suggest to eat smaller meals spread throughout the day rather than larger meals which tend to cause an enhanced gut response.

Certain foods may aggravate the digestive system by creating a lot of gas or by stimulating and/or accelerating activity in your gut because of the enhanced response.

Some typical foods are:

  • Foods high in fat content or fried
  • Caffeine, such as in coffee or tea
  • Alcohol

Sugar malabsorption may cause IBS-like symptoms.  Where the sugar stays in the gut unabsorbed, bacteria will ferment it and produce symptoms of cramps, bloating, diarrhea and noise.  This can be attributed to malabsorption to the sugars lactose and fructose.  Foods high in fructose both added to foods such as soda, and naturally occurring in various fruits, may cause bloating and diarrhea in some people. Some people may also have fructose malabsorption which could also contribute to bloating, gas and diarrhea. Many people also have similar symptoms of bloating and diarrhea when ingesting foods containing sorbitol or xylitol, sweeteners used in candies and gum.  Generally though, fructose malabsorption is not higher in IBS.  There is some evidence that lactose malabsorption causes IBS-like symptoms.  Both IBS and lactose malabsorption have similar symptoms.  Both conditions are quite common, at least 10% of the general population.  Still, the prevalence of IBS does not parallel the prevalence of lactose malabsorption.  The importance of fructose or lactose malabsorption in IBS is questionable and the association between may be just a coincidence due to the increased sensitivity of IBS sufferers.  Fructose or lactose restricted diets do not show a great benefit to reducing IBS symptoms.

There is a prescription medical food product for the management of IBS-D that significantly reduces stool frequency and the number of days with GI-related symptoms. It works by targeting multiple factors in IBS-D, not just treating the symptoms. Research shows that mild inflammation in the lining of the intestine may contribute to IBS symptoms. This new product helps the body deal with this mild inflammation. The main ingredient is a form of protein that has been shown to work with the body's defenses (immune system) in the intestine.

The low FODMAP diet, developed by Sue Shepherd PhD, eliminates more complex sugars, and has demonstrated a greater relief of IBS symptoms and is now accepted and recommended as one of the most effective dietary therapies for IBS.  

FODMAPs is an acronym (abbreviation) referring to Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. These are complex names for a collection of molecules found in food, that can be poorly absorbed by some people. When the molecules are poorly absorbed in the small intestine of the digestive tract, these molecules then continue along their journey along the digestive tract, arriving at the large intestine, where they act as a food source to the bacteria that live there normally. The bacteria then digest/ferment these FODMAPs and can cause symptoms of Irritable Bowel Syndrome (IBS). Symptoms of Irritable Bowel Syndrome include abdominal bloating and distension, excess gas (flatulence), abdominal pain, nausea, changes in bowel habits (diarrhea, constipation, or a combination of both), and other gastro-intestinal symptoms.

Copyright © 2011 Shepherd Works.

Further information about FODMAP dietary research may be found at Monash University, Australia, http://www.med.monash.edu.au/ehcs/research/index.html

The low FODMAP diet is best managed through an educated dietician.  Dietitian's may contact Dr. Sue Shepherd's organization (Australia) for more details.  A worldwide registry of Dietitians who can administer a low FODMAP diet has been established.

Our printable low FODMAP diet page lists suitable and unsuitable foods for a low FODMAP diet.

Some foods may create gas and bloating. These foods which may cause minor discomfort in those not suffering with a digestive disorder, may produce volumes of gas and bloating and abdominal pain in IBS sufferers.

Such foods are:

  • Beans
  • Cabbage
  • Broccoli, cauliflower and brussels sprouts
  • Peas and soybeans
  • Onions
  • Bagels

Some form of fiber in your diet is a necessity to help with producing soft larger stools and attracting water into the gut to ease the passage of stools. Many physicians add fiber to the diet as a bulking agent for mild to moderate IBS sufferers; however, recent research has shown that too much fiber may actually contribute to worse symptoms for constipation-predominant sufferers. It is questionable as to how fiber helps a diarrhea-predominant sufferer. If fiber is to help at all there is evidence that suggests that soluble fiber, found in vegetables and fruits, or a synthetic substance, may be more tolerable than insoluble fiber, found in whole grains. Though in general, recent research suggests that the benefit of fiber isn't as great as once thought.

There is some evidence that a diet low in carbohydrates ("Atkins Diet") may provide some relief of symptoms for a sub-group of IBS sufferers.  The long term effects of this type of diet is unknown.

A food allergy can cause IBS-like symptoms.  An allergy is an abnormal immune response to a food antigen.  Some common symptoms of an allergic response are typically facial swelling, including the tongue, itching, hives and wheezing.  Less common are gastrointestinal symptoms which include nausea, vomiting, pain, diarrhea and bloating.  There is some evidence that food allergies may cause IBS-like symptoms, though this is unlikely in most IBS sufferers as food allergies are quite rare, 1-4% adults, and most people with IBS do not have typical allergy symptoms.

Food intolerance may be more common for IBS sufferers.  Typically food elimination diets may improve IBS symptoms for a sizeable number of sufferers.  The most common implicated foods are wheat, milk, coffee, corn and eggs.

Diet is generally a personal experience in that many people respond differently to various types of food. There is no evidence that any particular IBS diet will ease an IBS sufferers symptoms. IBS sufferers should speak to their physician or a dietitian about their diet and how it may impact their symptoms. Working together with their physician or dietitian it will help an individual to maintain a balanced diet while perhaps easing some of their IBS discomfort.

Keep a Personal Symptom Journal of what you eat and whether you experience symptoms after eating and discuss this with your physician or dietitian.

Source(s):
IBS Chat: Real Life Stories and Solutions, www.ibschat.org
Mayo Clinic, www.mayoclinic.com
About.com: Irritable Bowel Syndrome, ibs.about.com
Peter Whorwell M.D., BMJ 2009
Spencer Dorn MD, MPH, UNC Center for FGID 2010
Low FODMAP Diet, shepherdworks.com.au
Monash University, Medicine Nursing and Health Sciences
EnteraGam.com