First, what is IBS?
Irritable Bowel Syndrome, commonly known by the acronym IBS, is a disorder that affects the large intestine. It is a chronic condition, and there is no cure. Meanwhile the American College of Gastroenterology estimates that between 10 and 15 percent of adults suffer from IBS. Although not a serious condition, it can negatively impact a person’s quality of life.
Fortunately, many people with IBS find that a change in lifestyle and diet can help keep symptoms at bay without using medication. Eating the right foods and figuring out food triggers can be life-changing. Read on to learn more about IBS and some of the best and worst foods for preventing or controlling an IBS flare.
How is IBS diagnosed?
Unfortunately there is no standard screening for IBS in the general population. It is typically a diagnosis of exclusion, meaning that a doctor makes a diagnosis through a process of elimination. In most cases people are screened for IBS only after they experience symptoms such as diarrhea and/or constipation, pain or bloating. Therefore an IBS diagnosis usually comes only after other disorders or diseases have been ruled out.
If you think you might have IBS, it is important to talk to your doctor about your symptoms, to get a clear idea of what your gut issue or issues might be. Your doctor might refer you to a team of specialists including a gastroenterologist, a dietitian, and/or a mental health counselor. There may also be more going on than just IBS including celiac disease, GERD, SIBO, and other conditions.
How does IBS impact quality of life?
There are three different types of IBS. We discuss these below, along with the gastrointestinal symptoms that are common with each type. In addition, many people with IBS also have non-gastrointestinal symptoms including fatigue, muscle pain, sexual dysfunction, and sleep disturbances. IBS can impact many facets of a person’s daily life:
- Sleep
- Physical appearance (ie. abdominal distention)
- Energy level
- Romantic relationships & relationships with family/friends
- Daily fear/anxiety of when those symptoms will appear
- Fear of travel
- Increased sick days, or reduced productivity
All three types of IBS can reduce quality of life. That’s why it’s important to get a clear diagnosis, and know which type of IBS you have. This allows you to make nutrition choices that can help prevent or alleviate symptoms.
The three different types of IBS
Irritable Bowel Syndrome with Constipation (IBS-C)
IBS-C is a type of IBS that includes abdominal discomfort and/or bloating along with constipation. Constipation is when stools don’t pass often, meaning less than three times per week. Signs of constipation include having hard stools that are difficult to pass or the feeling of an incomplete bowel movement. Significant bloating and pain are the main symptoms that differentiate IBS-C from normal constipation.
Along with abdominal pain and discomfort, other symptoms of IBS-C include changes in bowel function, and possible bloating and/or gas. Below is a list of typical symptoms of IBS-C:
- Less than three bowel movements per week
- Abnormal stool form (hard or lumpy)
- Straining to have bowel movements
- Urgency (the need to get to the toilet quickly) with bowel movements
- A feeling of incomplete bowel movements
- Bowel movements with mucus
Irritable Bowel Syndrome with Diarrhea (IBS-D)
IBS-D is a type of IBS that includes abdominal pain or bloating along with stools that are often loose, sometimes with mucus. This is caused by abnormally fast contractions of the intestines that may affect the absorption of water from digested foods, causing stools to be looser than usual. (Note: Waking up because of diarrhea is not a typical symptom for IBS-D and should be mentioned to your doctor.)
Food sensitivities or allergies may cause IBS-D if people develop symptoms after eating certain foods or drinks. Some people may find that gluten or lactose trigger IBS-D. Other possible causes include:
- Increased sensitivity in the gut, which may increase pain or discomfort
- A change in the amount or type of good gut bacteria
- Stress and anxiety, which may worsen symptoms
Mixed-Type Irritable Bowel Syndrome (IBS-M)
IBS-M is a type of IBS where bowel habits are not consistent. If you have IBS-M, you may find that stools are sometimes lumpy and hard, and at other times loose and watery. You may experience changes in your stools and bowel habits on a daily or weekly basis. People who suffer from IBS-M can switch from constipation to diarrhea and tend to suffer more stomach pain than a person who suffers from IBS-D or IBS-C.
IBS-M shares symptoms of both IBS-C and IBS-D. The main difference with IBS-M is that these symptoms alternate. The symptoms present in all subtypes of IBS include:
- Abdominal pain or cramping
- An urgent need to go to the bathroom
- Feeling as though your bowels are not completely empty after a bowel movement
What to eat for your type of IBS
You can manage some symptoms of irritable bowel syndrome by adjusting your diet. Avoiding certain carbohydrates, paying attention to fiber intake, and avoiding fried foods may all help. A Registered Dietitian can help you determine which strategies will work best for you.
Foods to eat when you have IBS-C
To ease IBS-C, you will need to eat more fiber. It is important to increase the intake gradually to allow your body time to adjust. Soluble fiber is better tolerated by people with IBS versus insoluble fiber. In addition, hydration is beneficial, as an increase in fiber can cause gas, bloating and sometimes acute constipation. You should also try to increase healthy fat intake, including poly and monounsaturated fats. Meanwhile keep in mind that foods high in saturated fat and sugar actually promote constipation, so should be eaten in moderation.
Foods to eat when you have IBS-D
If your IBS symptoms involve diarrhea, it is best to stick with bland foods, especially if your symptoms are severe. Fatty, greasy, or creamy foods can cause cramping and runny stools.
Avoid insoluble fiber as it makes stools loose or watery. Although fruits and vegetables should be part of your diet, it is best to limit your intake of fiber to less than 1.5 grams per half-cup during acute episodes.
Is there an IBS diet?
The Low FODMAP diet is often used for symptom relief. It is important that you work with a dietitian to implement this diet because of its restrictive nature.
This is not a diet intended for long-term use. Rather, it is a tool we use to identify which foods might be triggers. A low-FODMAP diet has two phases as part of an elimination diet:
- Phase 1: We restrict foods high in FODMAPs for a short period of time, generally between three and six weeks.
- Phase 2: We reintroduce the foods into the diet, one FODMAP type at a time, to assess your tolerance to each.
FODMAP is an abbreviation for:
Fermentable
Oligo‐ saccharides
Di‐saccharides
Mono‐saccharides
Polyols
You can see why we shorten it to FODMAP! In other words, these are short-chain carbohydrates and sugar alcohols that if poorly digested, can ferment in the large intestine. Fermentation can draw out water and produce carbon dioxide, hydrogen, and even methane gas. These can cause the intestine to expand. Unfortunately as a result, some people may experience pain, bloating, gas, and other GI symptoms.
Common Triggers for IBS
Certain foods can be common triggers for many people with IBS. However, some of these foods may have a greater effect on you than on other people. Treating IBS is based on each individual’s own symptoms. No gut is the same! That’s why it’s important to meet with a registered dietitian to get the guidance you need for your specific situation. It may help to keep a temporary food diary to learn which foods are triggers for you. Here are a few common triggers to limit or avoid if you do suffer from IBS:
- Anxiety or high stress situations
- Eating too quickly
- Very high-intensity exercise or no exercise at all
- Too much or too little fiber
- Inadequate water intake
- Caffeinated drinks, alcohol, and carbonation
- Artificial sweeteners and sugar alcohols
- High-fat foods
- Spicy foods
- Certain supplements/medications (if not necessary)
What to Eat During an IBS Flare Up
Listening to your body and hunger cues will be helpful during this time. If the nausea or bloating is causing decreased appetite, do not force it. If hunger persists, proceed with caution. But again, choose to consume low-FODMAP foods.
We also recommend bone broth or teas to help soothe your stomach. Bone broth is made by simmering animal bones and connective tissues and is rich in collagen, amino acids, and minerals that support gut health. Sip on bone broth or use it as a base for soups and stews. Studies also show that green tea has anti-inflammatory properties to help relieve IBS symptoms.
Staying hydrated is also essential for maintaining proper digestion and helping with IBS symptoms. Drink an adequate amount of water throughout the day. Wondering how much water is enough? Click here to read an article on our blog about proper hydration.
Strategies for managing IBS symptoms
Now that we have identified symptoms and triggers, here are some general strategies that can help reduce your IBS symptoms:
1. Aim to eat every 3-4 hours throughout the day
Nothing triggers IBS symptoms like chaotic eating. Eating on an irregular schedule, or going long periods of time without eating then eating a larger amount, can cause more discomfort than any individual food. While there’s no need to follow a strict eating schedule, having a consistent flow with eating is helpful. Don’t skip meals, since eating consistently promotes gut motility!
2. Aim for balance at meals
By “balance” we mean including a source of protein, fat, carb and produce. This is also helpful for ensuring that you are fueling your body adequately, so you are not overly hungry before your next meal/snack.
3. Consider supplements
You may feel overwhelmed with the amount of supplements out there for IBS, and we don’t blame you! Meanwhile many supplements are not backed by research or regulated by the FDA. Reminder that just because something is “natural” doesn’t mean that it’s harmless!
Below are some supplements that we at Anderson’s Nutrition often recommend for our clients. If you choose to try a supplement, please consult your doctor to ensure that these supplements don’t interact with any prescription medication you may be taking.
- Probiotics – Different probiotics do different things, so do some research on the strains in the brand you’re purchasing. We love recommending this one for clients.
- Iberogast – Iberogast is a liquid supplement that promotes gut motility.
- Fiber supplements – Be careful about what types you use. Fermentable fiber supplements, (often marketed as prebiotics), can cause painful bloating for IBS sufferers. We like Fibermend from Thorne.
4. Work with a Registered Dietitian who specializes in IBS
A Registered Dietitian Nutritionist (RDN) can help you manage IBS by developing an individualized eating plan that is tailored to you and your needs. An RDN will work with you to identify which foods and habits might be triggering symptoms. In addition, an RDN can introduce or review healthy eating strategies to help prevent or manage IBS flair ups.
On our team, we have Registered Dietitians who are certified in the use of a Low FODMAP diet by Monash University. They can guide you through the elimination and reintroduction phases, and help you gain control of your IBS symptoms.
They also provide ongoing support, advice, and education to help you feel better, and improve your quality of life. Bonus: We accept most major insurance and we see patients both in person and virtually.
Click here to learn more about our GI Support Nutrition Counseling Programs
