Irritable Bowel Syndrome (IBS) is a medical disorder with symptoms including gas, bloating, abdominal pain and diarrhea or constipation. Since IBS is typically broken down by its, er, most predominant bathroom habit — diarrhea or constipation — it’s also referred to as IBS-D or IBS-C.
Experts still don’t understand the exact cause of IBS — and there’s likely more than one — but there is some good news. IBS isn’t an (necessarily) an inflammatory disease like Crohn’s or Ulcerative Colitis, which can permanently damage intestinal tissue and lead to bigger, long-term health problems.
Even without a one-size-fits-all “cure” just yet, dietary changes can help to mitigate both the short- and long-term symptoms of IBS. The thing is, not everyone’s issues are triggered by the same foods, so regardless of whether or not you’ve been diagnosed with IBS-D or IBS-C, you’re in for some trial and error. Here, get your IBS questions answered before figuring out an eating plan that’s right for you.
How do you get IBS?
Proposed mechanisms include changes in your gut bacteria, residual effects of medications and psychological or psychosocial stress. But part of what makes IBS tough for healthcare professionals is that we’re often trying to treat both the cause and the symptoms at the same time — none of which is completely clear-cut and all of which varies from person to person!
Whether it’s getting back into yoga, trying therapy or exploring medication options, anxiety reduction is often a component of IBS treatment. I’d also recommend talking to your doctor about symptom management. He/she may refer you to a specialist, or recommend certain medications to help manage the goings-on in your gut.
I’ve just been diagnosed. What do I do first?
Traditional IBS-treatment diets follow something called the National Institute for Health and Care Excellence (NICE) guidelines. Those include loading up on high-fiber foods, drinking plenty of water, skipping caffeine and alcohol and limiting total dietary fat to mitigate some of the discomfort associated with IBS.
But the best way to learn about your specific triggers is keeping a detailed food journal, documenting your symptoms both 15 minutes and two hours after eating. That will help you determine if there’s a specific food or food group that sets you off, or if there’s something that triggers you when consumed in higher amounts throughout the course of a day.
Okay, got it, write down what I eat. But wait … what should I eat?!
A 2017 meta-analysis has linked a low-FODMAP diet with greater symptom management and general improvement in how IBS patients felt overall. (That’s a huge deal when you consider just how different the symptoms of IBS-C and IBS-D can be!)
FODMAP is an acronym that stands for fermentable oligosaccharides-disaccharides-monosaccharides and polyols. These short-chain carbohydrates found in a wide range of nutritious foods are particularly susceptible to malabsorption in your small intestine. That can cause a whole host of lovely symptoms, but there are two main ways it works.
The first is speedily drawing water into your small intestine, causing gas, bloating, distension and diarrhea. The second is improper absorption throughout your GI tract, with food ultimately fermenting in your colon, causing more gas and bloating. High FODMAP foods include those with lactose (dairy), fructose (fruits and veggies), plus certain grains, legumes and sweeteners, like sugar alcohols. You should also check labels for added sugars, which pull water into your gut and make you feel nauseous.
If you’re trying out an IBS diet for symptom management, I’d start by limiting these as much as possible:
- Milk products: milk, ice cream, yogurt and some soft cheeses
- Cruciferous veggies: cauliflower, cabbage, brussel sprouts and broccoli
- Legumes: beans and chickpeas
- Fructose-containing foods: cherries, oranges, apples, pears and honey
- Wheat-based foods: breads, cereals and wheat-containing whole-grains
- Sugar alcohols: xylitol, sorbitol and mannitol
- Ultra high-fat items: anything battered and deep-fried
- Sugary beverages and snacks
So basically I can’t eat anything?
Not true! Try gravitating toward the following:
- Low FODMAP veggies
- Low FODMAP fruit
- Meat, poultry and seafood
How long do I have to do this for?
Try to sticking to it for two to three weeks. Menu planning can be tricky, but after the initial phase you can slowly reintroduce one type of sugar every week or so. This will help you identify which specific type of carb is triggering you the most and if you’re able to tolerate it at all.
The good news is that the problem often stems from one or two types of carbs, or a build-up of high-FODMAP foods over the course of a day — or week! Be patient with yourself and allow some time for your gut to adjust, rest and heal.
My doc thinks I have chronic constipation, but not IBS. Is the diet any different?
If you’re constipated (and have not been diagnosed with IBS-C), here’s the deal: Fill up that water bottle! More often than not, constipation is the result of not drinking enough fluids — including unsweetened beverages like coffee, tea, sparkling H2O and the occasional diet soda – to keep everything moving along. Most of us need a minimum of 8 cups per day, and starting off with a cup o’ joe in the morning can help get the ball rolling. Research has shown that caffeine plus coffee’s plant-based antioxidants can help you stay regular.
Also key: Eating foods that provide both soluble (whole grains, legumes, fruit) and insoluble (leafy greens, nuts and seeds, bran, veggies) fiber. Since women need at least 25 to 35 grams per day, adding these nutrient-dense foods helps draw water into the digestive tract and create bulk in your large intestine, the combo of which can help you get back to business as usual in no time.
The Bottom Line
It’s important to address one major issue I see when it comes to IBS, especially in women. (Ladies are twice as likely to have IBS compared to the boys!) It’s not something we can just brush off or dismiss with “I have IBS — but it’s no big deal,” or “It’s just IBS, not an allergy!”
Just because IBS isn’t incurable or life-threatening doesn’t mean it’s nothing! In fact, it can be pretty darn uncomfortable, awkward, embarrassing, isolating and annoying for so many of us! Since both the etiology and the symptoms of the disorder tie back to anxiety, we certainly don’t need to take on the added stress of blowing it off or staying mum about trigger foods.
My ultimate tip: Find a registered dietitian (RD) who can help you navigate the inevitable pitfalls of eating with IBS. We’re trained to help you make individualized eating plans that work for you in the context of your everyday lifestyle. In other words, we’re here to help!