Healthy Eating Guidelines for Irritable Bowel Syndrome

Introduction

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. The overall goal of dietary treatment for IBS is to find a pattern of eating that gives you good control of your symptoms and the nutrition you need for good health.

Steps You Can Take

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

• If it becomes clear a specific food causes you discomfort, try taking it out of your diet to see if this helps.
• If your symptoms don't improve after a few weeks, add the food back into your diet.
• If you are eliminating all foods from a food group (for example all dairy products), you may be short of important nutrients. Talk to a registered dietitian about other foods to eat to make sure you get all the nutrients you need.

Improve your overall digestion:

• Eat at regular times each day.
• Enjoy three meals and 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.
• Reduce the amount of air you swallow: chew your food well, avoid chewing gum and avoid carbonated beverages.
• If you wear dentures, make sure they fit well so that you are able to chew your food well.

Drink plenty of fluids.

• Choose water as your main fluid.
• Women need about 2.25L (9 cups) of fluid a day, and men about 3 L (12 cups) of fluid each day. This includes fluid from all beverages and also watery foods such as soup.
• If drinking large amounts of fluids with meals causes your symptoms to get worse, try drinking your fluids between meals instead.

Aim for an adequate amount of fibre in your diet.

• Women are to aim for 25g per day of dietary fibre, and men 38g per day. Some people find that either too much or too little fibre can make their symptoms worse. If you eat a lot of fibre, try decreasing it and see if your symptoms improve. If you don't eat enough fibre, try increasing it 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 and are often well tolerated.
  • Insoluble fibre adds bulk to your stool. 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 meals and snacks.

• Eating too much fat at one time may cause cramping and diarrhea. Examples of high fat foods include cheese, cream, whipping and ice cream, prime rib and spareribs, regular ground beef, 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, nuts and seeds, spread throughout the day, may help to improve your symptoms.
• Choose lower fat dairy, lean meats and lower fat cooking methods.

Reduce the amount of gas-producing foods that you eat.

• The human body is unable to digest certain carbohydrates. You may find that eating foods that contain these carbohydrates can cause gas and pain.
• Gas-producing foods include: onions, garlic, wheat-based breads, cereals, pastas, crackers and baked goods, breads, Brussels sprouts, cabbage, red kidney beans, navy beans, chickpeas and lentils.
  • Try gas reducing products such as Beano® to help you digest beans.
  • Rinsing beans with a lot of water before you eat them also helps.

If you are lactose intolerant, reduce the amount of lactose you consume.

• Some people with IBS are unable to digest lactose, a sugar found naturally in milk and milk products. This is called lactose intolerance.
• Symptoms of lactose intolerance include bloating, gas, pain, and diarrhea.
• If you think you are lactose intolerant, speak with your doctor. Try reducing the amount of lactose in your diet by choosing foods lower in lactose such as lactose-free milk, fortified plant-based beverages, and hard cheeses.

Limit fructose.

• Fructose is a sugar that is found naturally in fruit and fruit juices. It is also added to processed foods.
• You may find that eating too much fructose can trigger GI symptoms. Limiting soft drinks, fruit drinks, and fruit juice, and having no more than one serving of fruit at a meal or snack may help to improve your symptoms.

Limit sorbitol, especially if you have diarrhea.

• Sorbitol is a sugar alcohol found in sugar free sweets (including chewing gum) and drinks.
• Sorbitol is a strong laxative in large doses, even for people without IBS. Sorbitol draws water into the colon, causing watery stools. This makes diarrhea worse.

Adjust your caffeine intake based on your symptoms.

• Caffeine stimulates the GI tract. It can help to relieve constipation, but it can also make diarrhea worse.
• It is found in coffee, tea, colas and some other soft drinks, energy drinks and chocolate.
• If you have diarrhea, limit or avoid caffeine.
• 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 two drinks a day to a weekly maximum of 10 for women and three standard drinks a day to a weekly maximum of 15 for men. 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

Other considerations:

• Probiotics and peppermint oil:
  • Some strains of probiotics may improve the symptoms of IBS. These include:
    • Bifiodobacterium infantis 35624 (Align ®)
    • Lactobacillus rhamnosus strains (GG and Lc705)
    • (VSL #3 ®) a blend of 8 strains of probiotics.
  • Probiotics are found in some dairy products and supplements.
  • Peppermint oil may also improve the symptoms of IBS.
  • Talk to your health care provider about taking probiotics or peppermint oil.
• Celiac disease:
  • Symptoms of IBS can be similar to those of other conditions such as celiac disease. If you have a family history of celiac disease, or you have diarrhea often, talk to your doctor about getting tested for celiac disease.

Last updated: September 2015