When we hear our clients story of their Irritable Bowel Syndrome (IBS) there’s one thing we notice all clients have in common, frustration. There is so much frustration about living in discomfort, constantly having to think about where the closest bathroom is, being cautious of food choices, and worrying about embarrassing gas in public.
We’ve noticed a shift from patients being told to ‘learn to live with it’ or that it’s ‘not a real diagnosis’ more towards being suggested to start the low FODMAP diet. The low FODMAP diet has excellent evidence for helping IBS symptoms, however, it IS a restrictive diet, is very confusing, and is often done incorrectly without dietitian support.
In reality, we often times find that there are simpler places to start with IBS management, that aren’t so restrictive!
Hi, I’m Jen Rawson, GI dietitian with Ignite Nutrition and I’m excited to talk to you today about where to begin with IBS and nutrition.
Nutrition is one of the pillars of IBS management and as Dietitians, it’s our favourite one to talk about. However, our goal for our patients isn’t to limit foods but instead to have your symptoms managed while being on the most liberal diet possible. One of the most common IBS management mistakes we see at Ignite is jumping right to food restrictions and elimination diets.
Dietary restrictions are just that – restrictive and complicated, particularly if you’re doing it on your own. When it comes to nutrition management of IBS, we often want to start with the basics of nutrition! This may seem like ‘common sense’ – however – we find when we really tailor these recommendations to your needs – we may not need to use the low FODMAP diet or may just use pieces of the low FODMAP diet to complement the work you’ve done already.
What we LOVE about these recommendations is they’re a simple, food-first way to get started on nutrition BEFORE seeing your dietitian. We always like to say that the low FODMAP diet should be implemented under supervision of a trained dietitian, which is why starting with this is often safer, and can provide symptom relief!
One of the most important things we work on with our clients is increasing fibre intake. Health Canada estimates that most Canadians are only consuming around half of their recommended daily fibre intake (25 g for females & 38 g for males).
Fibre is important for maintaining gut motility (how quickly things move through your gut) and stool consistency. When we improve these factors, we usually also see an improvement in other IBS symptoms such as bloating, urgency, and pain. Fibre is found in all plant-based sources – vegetables & fruits, whole grains, nuts & seeds and legumes. There are two types of fibres:
This type of fibre does not dissolve in water. It’s often thought of as “the stuff that keeps you moving” as it helps to provide bulk in stools and increase motility. Examples of insoluble fibre include skins and seeds of vegetables and fruit and bran.
This type of fibre does dissolve in water which forms a gel. It can help absorb water in the bowel, decreasing diarrhea and softening stool consistency to decrease constipation. Examples of soluble fibre include oats, beans, nuts, and applesauce.
There are some simple ways to add more fibre into your diet such as aiming for half a plate of vegetables at lunch and dinner, snacking on fruit or nuts, adding chia seed or ground flaxseed to your yogurt or smoothie, and choosing plant-based proteins such as legumes and nuts & seeds more often. Fibre supplements can also be useful in meeting your fibre guidelines and managing IBS but we always start with a food first approach.
When increasing fibre, we also need to increase water intake to keep stool soft and prevent constipation. Aiming for 2-3 L (8-12 cups) daily is a good target. Strategies such as carrying a water bottle, tracking intake with an app, and pairing water with meals and snacks can help you increase your daily intake.
Caffeine, Alcohol & High-Fat Foods
Classic IBS advice has focused on moderating intake of caffeine, alcohol and high-fat foods. While individual tolerances to these categories vary, it’s a great place to start making adjustments to your diet.
Alcohol impacts the quantity and diversity of gut bacteria and damages the gut mucous lining. Drinking alcohol, especially in excess (greater than 4 drinks/day), is associated with increased IBS symptoms including diarrhea, stomach pain, and nausea (1).
Caffeine increases gastrointestinal motility which can lead to urgency and a shift in stool consistency (2). People with IBS may need to moderate their intake of caffeine from sources such as coffee, green and black tea, pop, energy drinks and chocolate.
The role of fat in IBS is not clearly established, however, many studies have indicated an increase in symptoms (abdominal pain, distension, and bloating) when consuming high-fat meals (3). We frequently find that high intake of high-fat foods displaces intake of more nutrient dense, high fibre foods. High-fat foods include deep-fried foods, ice cream, and pizza but also include healthier options such as avocado, coconut oil, cheese, and meats.
Because individual tolerance to these triggers varies widely, consider using a food journal and monitoring for your current intake of these potential triggers. Use the philosophy “cut back, not cut out”. Full restriction of these are often not required, a reduced amount from your current intake is often enough to reduce symptoms.
Probiotic supplements are helpful for some but it’s important to match the right strain to the right person for the right reason. We always suggest discussing probiotic supplements with your health care provider to ensure you are not wasting your money and achieving the desired effect.
Fuelling the bacteria in our gut is more important than taking a probiotic for gut health specifically. Recent results from the American Gut Project showed that people who ate a wider variety of plant-based foods had an increased diversity of their gut microbiota (5). Observational studies found decreased gut diversity in a variety of diseases including celiac disease, irritable bowel syndrome, inflammatory bowel disease, and diabetes (6).
To increase the variety of plants you eat and maintain a “healthy gut” try a new recipe weekly, pick out a new vegetable or fruit at the grocery store next time you shop, and aim for at least 2 colours of vegetables on your plate.
While we often focus on what we eat for IBS management, we rarely consider when we eat. Skipping meals or eating very light during the day leads to eating large dinner portions and/or raiding the pantry for extra, often less nutrient dense snacks. The larger intake at one time can lead to bloating and indigestion. If you find your symptoms build during the day and are highest in the late afternoon/evening, consider redistributing your food throughout the day. The simplest way to do this is include three balanced meals, and snacks as you notice your hunger. In fact, responding to hunger and fullness (eating when you’re hungry, and stopping when you’re full and satisfied), while working on meal spacing is often enough to improve IBS symptoms immensely. Easier said than done, which is where dietitians can help!
After you’ve focused on the ‘when’ you eat, you should also consider the ‘why and how’. Slowing down, chewing our food, and savouring the taste and flavours can help to improve digestion. After all, digestion starts in the mouth by chewing! Setting aside time to eat without distraction and notice how your body feels can greatly reduce IBS symptoms.
Take Home Message
IBS care doesn’t have to start RIGHT with the low FODMAP diet. Simpler strategies can be tried first to see how good you can feel. Practicing these consistently can make a large impact on IBS symptoms and for many people will eliminate the need for further dietary restriction.
However, for some whose symptoms are still not controlled, working with a specialized dietitian on the low FODMAP diet is often the next step. At Ignite Nutrition our Dietitians specialize in helping clients navigate the basics of IBS management, and are experts in the low FODMAP diet. If you’re ready to take charge of your IBS – get the support, YOU need by working with one of our dietitians today!
- Reding, K., Cain, K., Jarrett M., Eugenio M. & Heitkeper, M.(2013). Relationship between patterns of alcohol consumption and gastrointestinal symptoms among patients with irritable bowel syndrome. Am J Gastroenterol, 108(2), 270-276.
- Rao, S., Welcher, K., Zimmerman, B. & Stumbo, P. (1998). Is coffee a colonic stimulant? Eur J Gastroenterol Hepatol. 10(2);113-118.
- Bohn, L., Storsrud, S., Tornblom, H., Bengtsson, U. & Simren, M. (2013). Self-reported food-related gastrointestinal symptoms in IBS are common and associated iwth more severe symptoms and reduced quality of life. Am J Gastroenterol. 108(5);634-641.
- Marco, M., et al. (2017). Health Benefits of Fermented Foods: Microbiota and Beyond. Current Opinion in Biotechnology. 44;94-102.
- McDonald, D., Et Al. (2018). American Gut: an Open Platform for Citizen Science Microbiome Research. MSystems. 3(3);e00031-18.
- Valdes, A., Walter, J., Segal, E., & Spector, T. (2018). Role of the gut microbiota in nutrition and health. BMJ. 361;36-44.