What should I eat with ibs? It’s a common question asked of the doctors who treat this disorder. IBS, or irritable bowel syndrome is one of the most common diseases that affects the colon or large intestine. IBS comes in three types including the constipation type, diarrhea type, and the alternating bouts of constipation and diarrhea. There are different treatment options for each type of IBS which makes it important to know what type you suffer from.
What Is Irritable Bowel Syndrome?
Irritable bowel syndrome is a disorder that affects the large intestine. It is a chronic condition for which there is no definitive cure, but many people with IBS find that a change in lifestyle and diet works to help keep symptoms at bay without using medication.
Irritable bowel syndrome is not a serious condition, but it can be an uncomfortable one and can affect patients’ quality of life when there is a flare-up. IBS is known as a functional GI disorder. These disorders, also known as disorders of the gut-brain interaction, are concerned with how your gut and brain interact together. The long-term outlook for IBS is good, provided the patient is compliant with diet and lifestyle changes.
Because the gut and brain are not working properly together, this can cause sensitivity in the digestive tract, which can lead to uncomfortable symptoms such as diarrhea. Common symptoms of IBS include:
- Gas and bloating
- Abdominal pain
- Changes in bowel habits
There are also several types of IBS, depending on the symptoms you describe to your team of healthcare professionals. These include:
- IBS-D (IBS with diarrhea): Most of your bowel movements are watery and loose.
- IBS-C (IBS with constipation): Most of your bowel movements are hard and difficult to pass
- IBS-M (IBS with mixed bowel habits): Bowel movements vary between constipation and diarrhea, often on the same day
If your gastroenterologist gives you an IBS diagnosis, it’s important to know what type. If it’s decided that medication is appropriate, only certain medicines will work with certain types of IBS.
IBS most commonly appears between the late teens and early 40s and is more common in women. Other risk factors include a family history of IBS, food intolerances, stress and anxiety, or a history of sexual or physical abuse.
Triggers for IBS are different for every individual. Those who eat the worst foods for IBS, such as high-FODMAP food, will likely have more flare-ups than those who are paying more attention to their triggers. Eating the right foods for IBS is imperative to help manage symptoms and prevent flare-ups. Elimination diets can help identify triggers. Patients may also want to adopt a gluten-free diet or lactose-free diet to monitor changes.
Diagnosis for IBS may require several different things. First, your physician will give you a physical exam and ask about your medical history. Then, you will discuss your symptoms with your physician. Because IBS symptoms and symptoms of more serious gastrointestinal disorders or similar, your doctor may want to order other tests to rule out other conditions. These may include X-rays, blood tests, and stool samples.
Depending on your symptoms, your gastroenterologist may order a colonoscopy. This diagnostic test can help diagnose colorectal cancer as well as many other diseases of the large intestine. While you do have to prep for the test by emptying your bowels, the test itself is a short, outpatient procedure, where you’ll receive anesthesia so you won’t be uncomfortable. The physician uses the colonoscope to look for diseases, if polyps are found, they can be removed during the procedure. The doctor will also likely take biopsies and tissue samples to be sent to the lab.
There are various diets you can try if you are trying to manage your IBS symptoms. Read the pros, cons, and our recommendations below:
FODMAP is an acronym for fermentable oligo-, di-, and monosaccharides and polyols. In simpler terms, “FODMAP” foods are carbohydrate-containing foods that may cause gastrointestinal discomfort.
In recent years, research has shown that a diet low in FODMAP-containing foods can be helpful as a short-term elimination diet to alleviate symptoms of IBS. Although this is not meant to be a forever diet, temporarily following a low FODMAP diet can potentially provide you long-term relief from IBS by helping identify what foods act as triggers for your IBS symptoms.
There are two steps to the low FODMAP diet:
- The first step is following a very strict diet that eliminates many foods known to cause IBS. Here is a list of high FODMAP foods to avoid during the elimination phase:
- The second part of the diet involves adding previously eliminated foods back into your diet one at a time to identify which foods exacerbate your IBS symptoms. This will give you an idea of what FODMAP foods you are able to eat without experiencing irritation.
Download our IBS Diet Nutrition Guide for more information on a successful Low FODMAP & IBS Diet.
LEAP (Lifestyle, Eating, and Performance)
The “LEAP” stands for Lifestyle, Eating, And Performance protocol. Similar to the low FODMAP diet, LEAP is a standardized elimination-style process used to identify specific food sensitivities.
Here are a few things you should know about the LEAP approach:
- The first step of the LEAP approach is a simple blood test called a Mediator Release Test. This blood test measures how your body reacts in response to certain IBS triggers. When it comes to IBS, there is no “one size fits all” approach. Each person may be more or less sensitive to certain foods. There are 170 different foods identified in the MRT that are classified as ‘non-reactive’, ‘moderately-reactive’, or ‘reactive’. Because of the test’s ability to identify particular “trigger foods”, this test can serve as the foundation to an elimination diet.
- After obtaining your MRT results to determine which foods act as specific IBS triggers, your doctor and nutritionist will evaluate your MRT results to determine those foods associated with the lowest inflammatory degree. The foods that prompt the lowest inflammatory response are considered your “best” foods. These foods are least likely to exacerbate your IBS symptoms. Normally, you will begin with a list of 20-25 ‘non-reactive’ foods. You will then work with your team to build a comprehensive eating plan around these “Best” foods. Oxford Medical Technologies, the developers of this approach, publish their results here.
So once I know what my “best” foods are, where do I go from there?
The LEAP diet has 3 phases:
- Phase 1: Consume only your “best foods” identified by the MRT test for 10-14 days. The goal of this phase is to reduce inflammation quickly, relieve IBS symptoms, and create a new baseline before slowly reintroducing foods.
- Phase 2: During this phase, you will reintroduce some of the foods that were identified as “moderately reactive”. This phase lasts for 20-35 days and its purpose is to uncover additional foods that do not worsen IBS symptoms. Foods should be reintroduced one at a time and in small amounts. The idea is to only change one variable at a time to be able to identify if that food is what causes the subsequent symptoms, if any.
- Phase 3: Phase 3 is 30-60+ days. I like to think of this phase as the “maintenance” phase. This is meant to be a long-term solution to relieving IBS symptoms as much as possible. The goal is to begin with the foods you have identified in the first two phases as “safe” and continue to reintroduce and “challenge” foods along the way to work your way up to a nutrient-dense, varied diet.
The Autoimmune Protocol (AIP) is one of the more restrictive elimination diets used to identify IBS triggers. This relatively new approach aims to eliminate inflammation in the gut by following a diet that excludes all inflammatory foods. Below is a list of foods to be avoided during the elimination phase of AIP.
- Trans fats
- Chemical additives
- Artificial colors and flavorings
- High fructose corn syrup
- Dairy products
- Processed and refined foods
- Refined sugars
- Sugar substitutes
- Refined vegetable oils
- Nightshade vegetables
In order for this approach to work, the diet must be followed for several weeks (3-4 is recommended as the minimum) before slowly reintroducing the eliminated foods. It is recommended to only reintroduce one food every 5-7 days or so. This allows ample time to take note of the body’s reaction to a certain food. If reintroducing a food causes a flair-up in your IBS symptoms, the protocol recommends that you permanently avoid that specific food.
The Best Foods for IBS Symptoms
Lean meats mainly consist of protein. Protein easily digests and gut bacteria doesn’t ferment it—which means it won’t give you gas. You should be able to eat any of the following with confidence:
- White meat chicken
- White meat turkey
- Lean cuts of beef (sirloin, top round, eye round, bottom round)
Fatty cuts may contain fats or toxins that cause inflammation in your body. Avoid dark meat chicken or turkey and marbled beef cuts if you can.
The only exception to this rule is if you are able to eat grass-fed beef, pasture-raised pork, or free-range poultry. Since these animals have been raised under healthier conditions, some people believe their fat content may actually benefit your gut bacteria.
Eggs digest easily and are a safe choice for someone with IBS. Eggs can be enjoyed hard-boiled, soft-boiled, scrambled, or poached. Omelets and frittatas can be your meal of choice for breakfast, lunch or dinner, and make a great option when eating out in a restaurant.
That said, not every person’s body responds to eggs the same. Some people are sensitive to the proteins in egg whites, while others report that the higher fat content of egg yolks causes a problem. You may need to go through some trial and error to see what works best for you.
Salmon and Other Omega-3 Fish
Omega-3 fatty acids play an anti-inflammatory role in the body. Since inflammation may be adding to your IBS symptoms, eating more omega-3s may help. Good fish sources of omega-3 fatty acids include:
- Black cod
- Rainbow trout
- Wild-caught salmon
Based on past experience, people who have IBS tend to avoid vegetables because eating them makes their symptoms worse. However, vegetables are very good for your gut flora, and therefore may be good for your IBS.
If this sounds like you, start by gradually eating more vegetables that are less likely to cause gas and bloating. Luckily, the FODMAP researchers from Monash University in Australia have studied and identified which vegetables fit that bill.
Ideally, you would start with the vegetables on the following list and then slowly broaden the range of vegetables that you eat:
- Bamboo shoots
- Bell peppers
- Corn (half a cob)
- Green beans
- Scallions (green parts only)
- Sweet potato
- Water chestnut
You may find that cooked vegetables are more gentle on your gut than raw vegetables. You can steam, sauté, or roast them and avoid any spices you are sensitive to.
Your gut flora will be grateful if, along with eating more vegetables, you also eat more leafy greens. Leafy greens are packed with nutrients and are unlikely to cause gut fermentation, making them low-FODMAP foods.
If you can tolerate them raw, leafy greens can be added to green smoothies, green juices, or made into a salad. But if you are like most people with IBS, you may find that your body is less reactive if the greens are cooked.
The easiest way to do this is to sauté or roast them with some olive oil.
- Arugula (rocket lettuce)
- Bok choy
- Collard greens
- Common cabbage
- Spinach (baby)
- Swiss chard
Like vegetables, fruits have some nutrients that are good for your gut flora and should be good for your IBS. But as you may have found out the hard way, some fruits are likely to make your IBS symptoms worse.
Choosing low-FODMAP fruits is a safer way to go. Just don’t eat too many in one sitting or within one day. Doing so may overwhelm your body’s ability to absorb the sugar in fruit without fermentation and gas.
- Avocado (limit 1/8 of a whole)
- Honeydew melon
- Mandarin oranges
- Papaya (pawpaw)
Diet and lifestyle changes for treatment of IBS
Before making any dietary changes, keep a food and symptom diary for a week. This can be a helpful way to identify foods that may be triggering a response in your body. Record all food and drink consumed for a week and make a note of any symptoms experienced. Try to record an approximate quantity eaten and the time of day. Symptoms may not always be caused by what you eat so consider other factors that may be involved.
Healthy eating and lifestyle changes
A healthy diet
- Plenty of fruit and vegetables.
- Plenty of starchy carbohydrates. Examples include bread, rice, cereals, pasta, potatoes, chapattis and plantain.
- Some milk and dairy products (2-3 portions per day). If you are lactose intolerant include dairy alternatives such as soya, rice or oat milk and yoghurts that are enriched with calcium.
- Some protein foods: meat, fish, eggs and alternatives such as beans and pulses.
- Limited amounts of foods high in fats and sugars. Limit saturated fat that is found in animal products such as butter, ghee, cheese, meat, cakes, biscuits and pastries. Replace these with unsaturated fats found in vegetable oils such as sunflower, rapeseed and olive oil, avocados, nuts and seeds.
- Drink plenty of fluid – at least two litres daily, such as water or herbal teas.
Lifestyle changes to improve symptoms
- Have a regular meal pattern.
- Take time when eating meals.
- Try not to skip meals.
- Sit down to eat; chew food well.
- Try to avoid eating too late at night.
- Exercise regularly, such as walking, cycling, or swimming. If finding time is difficult, incorporate it into your day. For example, cycle to work, get off a train a stop early and walk, and use steps instead of lifts when possible.
If you have a hectic lifestyle, stress and anxiety may also be causing IBS symptoms. There are many complex connections between the brain and the gut. Psychological factors, the nervous system, and muscle contractions in the gut all interact with each other, causing IBS symptoms. This is known as the brain-gut axis. Therefore, stress management can be effective in easing symptoms.
- Create time for relaxation.
- Make the most out of leisure time.
- Try relaxation therapies such as mindfulness.
- Exercise – try yoga or taking a walk.
- Get enough sleep.
- Seek support or counselling.
symptom-specific changes to the diet
Sometimes, a healthy balanced diet and lifestyle changes aren’t enough to improve symptoms. It may be that more specific changes to the diet are needed. Many people report that what they eat affects their symptoms. Therefore, modifying what you eat can help to manage symptoms.
Caffeine can stimulate activity in the colon, which may worsen symptoms of pain and diarrhoea. Limit tea and coffee to no more than three cups per day. Filter coffee contains higher amounts of caffeine (140 mg) compared to instant coffee (100 mg) and tea (75 mg). So, if filter coffee is included in your diet, you may want to limit this to two cups per day. There is also caffeine in cola and some other soft drinks, and in chocolate.
Limit alcohol and fizzy drinks
Fizzy drinks and alcohol can worsen symptoms of diarrhoea. Limit your intake of these drinks to improve symptoms. Aim to have at least two alcohol-free days each week and no more than two units each day.
A unit of alcohol is:
- One 25 ml shot of spirits.
- Half a pint of standard-strength lager/beer (3-4% alcohol by volume).
- One small 125 ml glass of wine (11% alcohol by volume).
Reduce intake of resistant starches
These are starches that are resistant to digestion in the gut (small intestine). Therefore, they reach the colon intact and are fermented by the germs (bacteria) in our gut. This produces gases and waste products, leading to symptoms of, bloating, wind and diarrhoea. People who have IBS react to smaller doses of resistant starches than those who don’t have IBS. Reducing resistant starches may also improve symptoms of diarrhoea.
Reduce intake of foods containing resistant starches
- Processed foods such as crisps, oven chips, supermarket pizza, biscuits and cakes, breakfast cereals.
- Foods that have been cooked and left out to cool – for example, cold potato/pasta salads.
- Ready meals.
- Partially baked bread – for example, garlic bread or pizza bases.
- Whole grains, pulses, sweetcorn, green banana and muesli that contains bran.
- Dried pasta (use fresh instead).
- Savoury snacks.
Cook fresh food whenever possible and eat food that you’ve cooked straightaway. This will help to reduce intake of resistant starches.