Irritable bowel syndrome (IBS) is a complex disorder with a wide range of symptoms, some of which may be related to diet.
Poor eating habits such as skipping meals, low intake of fibre and fluid, excessive fatty food intake, sensitivity to milk and other dairy products (see lactose intolerance) and excessive caffeine and alcohol need to be addressed as a first step in helping relieve symptoms in IBS.
General advice for an IBS diet
The most common dietary treatment for IBS has been, and still is, a high fibre diet. While this is still a positive recommendation for many patients, especially those who suffer from constipation, some patients will not benefit from an increase in dietary fibre, and in some the symptoms may even worsen. As with any change in diet the increase in fibre should be gradual, involve a variety of fibres and an adequate fluid intake of at least 1.5 litres per day. The major sources of fluid should be water, but dilute tea or juices may be suitable in some patients. Caffeinated drinks such as coffee, and carbonated soft drinks can aggravate symptoms and should be limited, especially in the initial stages of dietary modification.
IBS symptoms tend to be increased following large meals, particularly if the meal is high in fat, and if the meal is eaten quickly. It can be helpful to spread the food over 3 meals and 3 snacks per day. Avoid
eating quickly and try to relax after a meal. Regular light exercise can also help reduce symptoms.
If excessive wind is a problem then exclusion of the ‘windy vegetables’ including broccoli, cauliflower, cabbage and legumes including baked beans may be helpful. These may be reintroduced once the symptoms have settled. Carbonated soft drinks can also exacerbate symptoms. Like food, fluid should be spread across the day.
Some individuals with IBS may find a trial of lactose exclusion helpful. Lactose is found principally in dairy products such as milk and ice creams (see lactose free diet). Remember that these foods supply important nutrients, and reduced consumption can affect calcium intakes.
Recent studies have highlighted the possible role of food sensitivities in some IBS sufferers (1,2). This can involve the exclusion of obvious trigger foods. In complex cases an elimination diet may be necessary. This involves the exclusion of a wide range of food, followed by ‘challenges’ to identify the problem foods. Elimination diets are for short-term use only as they are nutritionally unbalanced. They should be supervised by a dietitian who has experience in this field. The RPAH guide ‘Friendly Food’ is a general guide to the elimination diet and associated recipes.
Sensible eating for IBS sufferers
Keep a food, fluid and symptoms diary to help observe the role of diet and other factors such as stress in symptoms. Check your diet against the general guidelines for a healthy diet (see other sections of this website). Maintain a high fibre diet, provided this is tolerated. Start with the basics of 3 low fat, high fibre meals and 2 -3 snacks per day. Maintain an adequate fluid intake, avoiding excessive intake of fizzy drinks and caffeine. Eat slowly and make meal times as relaxing as possible. If you are excluding foods, eliminate one food at a time, and record the results. Once symptoms have settled reintroduce the foods to maintain variety. Consider consulting a dietitian for individual advice regarding your diet and any modifications.
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