Jeffrey Salazar
Irritable bowel syndrome (IBS) is a gastrointestinal disorder that affects the muscles of the digestive system, causing abnormal contractions that affect bowel movements. While there is no one-size-fits-all diet for managing IBS, as triggers vary from person to person, certain dietary changes can help alleviate symptoms. These include the low FODMAP diet, which has been shown to improve IBS symptoms, and gluten-free diets, which have been reported to improve symptoms for some people with IBS. Additionally, increasing fiber intake gradually can help with constipation, and soluble fiber is generally better tolerated by people with IBS.
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What You'll Learn
Low FODMAP diets
The low-FODMAP diet is a temporary and restrictive eating plan that helps people with irritable bowel syndrome (IBS) and/or small intestinal bacterial overgrowth (SIBO) identify which foods are problematic and which reduce symptoms. FODMAP is an acronym for a class of carbohydrates called fermentable short-chain carbohydrates, which are harder for people to digest. These include:
- Fermentable Oligosaccharides: soluble plant fibres known as prebiotics, which feed the beneficial bacteria in the gut. Oligosaccharides include onions, garlic, beans/lentils, and many wheat products.
- Disaccharides
- Monosaccharides
- Polyols: sweeteners such as sorbitol, mannitol, xylitol, maltitol, and isomalt found in sugar-free gum and mints, and cough medicines and drops.
The low-FODMAP diet is often prescribed as an elimination diet, which is designed to relieve symptoms and give the digestive system a rest. During the elimination phase, all high-FODMAP foods are avoided, including specific fruits, vegetables, dairy products, and grains. The diet is divided into three phases: elimination, reintroduction, and maintenance. The reintroduction phase involves adding high-FODMAP foods back into the diet one at a time to identify which foods trigger symptoms. The maintenance phase is then customised to the individual, allowing them to understand which foods to limit or avoid in the future.
Research has found that the low-FODMAP diet reduces symptoms in up to 76-86% of people with IBS. However, it is important to note that the diet can lead to a significantly lowered intake of fibre, which could result in micronutrient deficiencies and adverse effects on the microbiome. It is always recommended to consult a doctor or dietitian before starting any new diet, especially one as restrictive as the low-FODMAP diet.
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Gluten-free diets
Irritable bowel syndrome (IBS) is a common gut disorder with symptoms like abdominal pain, cramping, bloating, and changes in bowel habits. While IBS can significantly impact a person's quality of life, there is no one-size-fits-all diet or medicine that works for everyone with the condition. However, dietary changes can help manage the symptoms of IBS, and doctors may recommend a gluten-free diet to see if it improves an individual's IBS symptoms.
Gluten is a protein found in wheat, barley, and rye, and it is present in most cereals, grains, pasta, and many processed foods. A gluten-free diet may improve IBS symptoms such as abdominal pain, stool consistency, and tiredness. Some people with IBS report increased symptoms after consuming gluten, even though they do not have celiac disease.
A 2011 randomised controlled trial (RCT) included 34 patients aged 29 to 59 years with IBS and no celiac disease. The patients were randomised to either remain on a gluten-free placebo diet or switch to a gluten-containing diet. At the end of the six-week trial, the gluten group reported a significant increase in scores for abdominal pain, stool consistency, and tiredness. Significantly more patients on the gluten diet stated that their symptoms were not adequately controlled.
Another 2013 double-blind crossover RCT examined 37 patients aged 24 to 61 years with non-celiac gluten sensitivity and IBS. The patients followed a two-week diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), which has been proven to improve IBS symptoms. The results showed that self-reported symptoms improved with a gluten-free diet in this group of patients.
While the evidence is conflicting, a gluten-free diet may be recommended to patients with IBS to help manage their symptoms. However, it is important to note that a gluten-free diet is not necessary for all people with IBS, and individual triggers may vary. It is always advisable to consult a doctor or dietitian for personalised advice and guidance on dietary changes.
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Lactose intolerance
Irritable bowel syndrome (IBS) and lactose intolerance are two separate conditions with similar symptoms. IBS is a disorder of bowel function, while lactose intolerance is related to the body's inability to produce enough of the enzyme lactase, which is needed to digest the sugar in milk. While IBS and lactose intolerance are not associated with serious medical consequences, they can negatively impact a person's quality of life.
IBS is a chronic gastrointestinal disorder that affects a significant percentage of the population, with varying prevalence across different geographic regions. It is characterised by unpleasant symptoms such as bloating, gas, abdominal pain, constipation, and changes in bowel habits. While there is no cure for IBS, certain foods and medications can exacerbate symptoms. Triggers for IBS include caffeine, chocolate, artificial sweeteners, high-fat dairy, gluten, fried foods, alcohol, and whole dairy products. Managing IBS involves dietary modifications, such as following a low FODMAP diet, reducing processed foods, and increasing liquid intake for constipation. Lifestyle changes, such as reducing stress and improving sleep, are also recommended. Medications, including anti-diarrhoeal drugs and laxatives, can help manage symptoms, but individualised approaches are necessary as triggers can vary between people.
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High-fibre foods
Insoluble fibre, on the other hand, does not dissolve in water. It helps bulk up the stool, which can keep it moving through the digestive system and prevent constipation. However, consuming too much insoluble fibre can lead to excess gas production, causing bloating and abdominal pain. Insoluble fibre is found in whole grains, fruits, nuts, and seeds.
It is important to note that highly fermentable dietary fibre can increase gas production in the gut, leading to bloating, abdominal pain, and flatulence. Therefore, people with IBS are advised to avoid foods high in fermentable fibre, also known as FODMAPs. FODMAPs include garlic, onion, beans, rye, and certain fruits and vegetables.
Instead, it is recommended to consume foods with soluble and non-fermentable fibre, such as potatoes, brown rice, oats, and nuts like almonds. Additionally, during an IBS flare-up, a low-fibre diet can help control diarrhea. This involves choosing more cooked foods over raw fruits and vegetables and reducing bran-based grains, cereals, and breads.
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Individual triggers
Gluten
Some doctors recommend that people with IBS try a gluten-free diet to see if their symptoms improve. Gluten is a protein found in wheat, barley, and rye, and is present in most cereals, grains, pasta, and processed foods. Even without celiac disease, gluten can trigger IBS symptoms. Gluten-free alternatives include millet, quinoa, and gluten-free oats.
Dairy
Dairy is another common trigger for people with IBS. High-fat dairy can lead to diarrhea, and many people with IBS report that milk triggers their symptoms. It is unclear if lactose intolerance is more common in people with IBS, but digestive problems may be alleviated by switching to lactose-free milk and dairy alternatives such as plant-based milk and soy-based cheese.
Alcohol and Caffeine
Alcohol and caffeine are known to trigger IBS symptoms. Caffeine, in particular, can increase diarrhea, and is found in high amounts in coffee, tea, cola drinks, chocolate, and some over-the-counter pain relievers.
Fried Foods
Fried foods are another common trigger for IBS symptoms. These include foods like French fries, fried chicken, and anything deep-fried.
Artificial Sugars
Artificial sugars, such as sorbitol, mannitol, xylitol, maltitol, and isomalt, are often found in sugar-free gum and mints, cough medicines, and drops. These sweeteners can cause diarrhea and should be consumed in moderation.
Whole Grains
Whole grains, such as whole-grain bread and cereals, can be difficult for some people with IBS to digest and may worsen constipation. However, it is important to note that fiber tolerance varies, and for some people, insoluble fiber found in whole grains may not cause any symptoms.
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Frequently asked questions
IBS stands for Irritable Bowel Syndrome, a gastrointestinal disorder in which the gut becomes more sensitive and the muscles of the digestive system have abnormal contractions that affect bowel movements.
IBS affects people differently, and there is no one-size-fits-all diet for managing IBS. However, certain foods are known triggers for IBS symptoms, including dairy products, gluten, and foods containing FODMAPs (a group of carbohydrates that are hard to digest). People with IBS may need to avoid or limit these foods and adopt a diet that suits their individual needs.
The low FODMAP diet is a short-term dietary approach that has shown potential in helping people with IBS. FODMAPs are specific carbohydrates found in some fruits, vegetables, sweeteners, and dairy products that can be difficult to digest for people with IBS. The diet involves eliminating these foods for a few weeks and then slowly reintroducing them to identify specific triggers.
