Irritable bowel syndrome (IBS) is a chronic condition that affects your gastrointestinal (GI) tract. Common symptoms of IBS include:

• Abdominal pain
• Bloating
• Constipation
• Cramping
• Diarrhea

You may find your symptoms come and go over time and are triggered by stress, illness, specific foods or eating patterns. Different foods may cause different symptoms in individuals. The dietary goal for IBS is to find a healthy way of eating that gives you good control of your symptoms. Below are tips to help you feel your best.

Steps you can take

Keep a food and symptom journal. This will help you to learn if your GI symptoms are related to your current food habits.

• If it becomes clear a specific food or beverage causes you discomfort, try taking it out of your diet to see if this helps. For example, some people may find that spicy foods trigger their symptoms.
• If your symptoms don't improve after a few weeks, you can add the food back into your diet.
• If you eliminate many foods from your diet, you may be missing some important nutrients. Talk to a registered dietitian about other foods to eat to make sure you are getting all the nutrients you need.

Improve your overall digestion.

• Eat at regular times each day.
• Avoid eating late at night.
• Enjoy three meals and up to one to two snacks spaced evenly throughout the day.
• Try not to overeat at any one time.
• Eat when you are relaxed. Give yourself enough time so that you can eat your food slowly.
• Limit distractions and try not to eat at your desk or in front of the TV.
• Reduce the amount of air you swallow: chew your food well, avoid chewing gum and avoid carbonated beverages.

Drink plenty of fluids.

• Choose water as your main fluid.
• Aim for about 1.5-3 L of fluid each day. Keeping well hydrated may help if you have constipation.
• If drinking large amounts of fluids with meals causes your symptoms to get worse, try drinking your fluids between meals instead.

Aim for a fibre intake that works for you.

• Some people find that either too much or too little fibre can make their symptoms worse. If you eat a higher fiber diet, try decreasing the amount of fiber and see if your symptoms improve. If you eat a lower fiber diet, try increasing your fiber intake slowly and see if your symptoms improve.
• There are two main types of fibre:
  • Soluble fibre absorbs extra water in the colon and forms a thick gel that softens stool. It may help to relieve both diarrhea and constipation. Oats, oat bran, ground flax seed and psyllium are good sources of soluble fibre.
  • Insoluble fibre adds bulk to your stool and can help you have regular and pain-free bowel movements. It is found in wheat bran, bran cereals and whole grain products such as whole wheat bread and pasta and brown rice. If you find these foods make your symptoms worse, limit them and eat foods with soluble fibre instead.

Avoid high fat foods and snacks.

• Eating too much fat at one time may cause cramping and diarrhea. Examples of high fat foods include higher fat cheese, whipping cream, ice cream, prime rib and spareribs, regular ground beef, sausages, bacon, chicken with the skin on it, fried foods, pastries, cakes, cookies, and chocolate.
• Eating a moderate amount of healthy dietary fat, such as canola, soy and olive oil, avocado, nuts and seeds, spread throughout the day, is part of a healthy, balanced diet.
• Choose lower fat dairy, such as low-fat yogurt, lean meats and lower fat cooking methods, such as baking instead of pan frying in oil.

Adjust your caffeine intake based on your symptoms.

• Caffeine stimulates the GI tract which may make diarrhea worse. If you have diarrhea, limit or avoid caffeine.
• Caffeine is found in coffee, tea, colas and some other soft drinks, energy drinks and chocolate.
• Health Canada suggests having no more than 400mg of caffeine per day (the amount found in three small cups of coffee).

Limit or avoid alcohol.

• Alcohol irritates the stomach and GI tract which may trigger your symptoms. If you choose to drink alcohol, limit yourself to no more than 10 drinks a week for women and no more than 15 drinks a week for men. Have no more than 3 drinks (for women) and 4 drinks (for men) on any single occasion.
•  A standard drink is:
  • 341 mL (12 oz.) bottle of 5% beer, cider or cooler
  • 142 mL (5 oz.) glass of 12.5% wine
  • 43 mL (1.5 oz.) shot of 40% spirits.

Learn more about the Low FODMAP Diet.

• If following the advice in this handout does not make your symptoms better, consider speaking with a registered dietitian about the low FODMAP diet.
• FODMAP's are types of carbohydrates that are poorly digested and may cause gas, bloating and pain in people with IBS.
• The aim of this diet is to help you find out which of the FODMAP foods cause you symptoms and in what amounts.  The goal is to provide the most flexible and varied pattern of eating that provides the best control of your symptoms.

Other considerations:

• Probiotics:
  • Currently, there is not enough evidence to recommend a specific probiotic for IBS. If you decide to try a probiotic, check the ingredient list. Products that contain lactose, fructose, sorbitol, or inulin may make your symptoms worse.

• Peppermint oil:
  • Peppermint oil may improve IBS symptoms by relaxing the smooth muscle of the intestine.
  • While most people tolerate peppermint oil it can cause heartburn in some.

Talk to your health care provider or pharmacist if you are considering taking probiotics or peppermint oil.

• Lactose intolerance:
  • Some people are unable to digest lactose, a sugar found naturally in milk and milk products. This is called lactose intolerance.
  • Symptoms include bloating, gas, pain, and diarrhea.
  • If you think you are lactose intolerant, speak with your health care provider about getting tested.

• Celiac disease:
  • Symptoms of IBS can be similar to other conditions such as celiac disease. If you have a family history of celiac disease, or you have diarrhea often, talk to your health care provider about getting tested for celiac disease.
  • A gluten free diet is required for people diagnosed with celiac disease.  A gluten free diet is not recommended to manage IBS if you do not have celiac disease.

Additional Resources

For information and advice based on your specific food and nutrition needs and preferences, call 8-1-1 and ask to speak to a HealthLink BC dietitian.

For additional information, see the following resources:

• HealthLink BCwww.healthlinkbc.ca – Get medically approved non-emergency health information.
• Dietitian Services Fact Sheets - Available by mail (call 8-1-1) or visit www.healthlinkbc.ca/healthy-eating:
  • Food Journaling: How to Keep Track of What You Eat www.healthlinkbc.ca/healthy-eating/food-journal
  • Tips to Reduce Gas (fact sheet available by mail only)
• HealthLinkBC File #68h Fibre and Your Health at www.healthlinkbc.ca/healthlinkbc-files/fibre