Irritable Bowel Syndrome

 Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that commonly causes abdominal pain, cramping, bloating, gas, and altered bowel habits. You may have constipation, diarrhea, or urgency. 

IBS is the most commonly diagnosed disorder by gastroenterologists and is also seen very often by primary care physicians. It is estimated that approximately 10-15% of the world’s population has IBS.   

There is no cure for IBS. However, individuals may find relief with treatments specific to their symptoms

Symptoms vary from person to person. Each individual experiences different symptoms and tolerates different foods.

 Food  allergies are rarely the culprit in IBS patients. Allergies are caused by an immune response. Most IBS patients with food-related symptoms have food sensitivities or intolerances, which     are not caused by an immune  response.
  
A few people with IBS symptoms may have specific food-related conditions including     lactose intolerance and celiac disease, but these are not common.
   
Life stressors such as employment changes, travel, relocation, uncomfortable social situations, or illness can trigger or worsen symptoms.
   
A number of other factors may also worsen symptoms, such as excessive use of laxatives or antidiarrheal drugs, lack of regular sleep, and inadequate fluid intake.
 

Diet Suggestions for IBS

The suggestions in this handout have helped some patients with their IBS symptoms. To determine what does and does not work for you, make only one change at a time.

Try smaller, more frequent meals

Try eating a lower-fat diet. High-fat, greasy, rich foods are typically not well tolerated. Some easy ways to reduce fat intake include:

  • Select lean meats (fish, turkey, chicken) and bake or grill, don’t fry.
  • Choose low-fat or non-fat dairy (cow’s milk, soymilk, yogurt, cheese).
  • Use cooking spray instead of butter or vegetable oil.

Try a reduced-lactose diet.  Lactose is found in certain dairy products.  If symptoms improve and you plan on continuing this diet long term, it is very important to get calcium and vitamin D from other food sources or supplements including naturally low-lactose dairy products. The fat in some dairy products, rather than lactose, can also worsen IBS symptoms.

Try reducing the amount of gas-producing foods and poorly absorbed natural sugars in your diet. A low FODMAP diet (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) helps some people. See our FODMAP handout for more details. Some foods that you may try excluding are:

  • High fructose: Apples, pears, oranges, pineapples, melons.
  • High fructans: Onions, leeks, asparagus, artichokes.
  • Wheat-based products.
  • Sugar alcohols: Including sorbitol and mannitol. These are used in many sugar-free gums, candy, and medicine. These aren’t always listed on the medicine label, so you will have to ask a pharmacist.
  • High Raffinose: Legumes, lentils, cabbage, Brussel sprouts.

Try avoiding caffeine (in coffee, tea, and soda), chocolate, and alcohol. For some individuals, these or other certain foods may trigger IBS symptoms.

Try slowly adding soluble fiber to your diet. Soluble fibers (not insoluble) may alleviate some of your symptoms. See the table on the last page for foods rich in soluble fiber. Remember to drink plenty of fluids as you gradually increase the fiber content of your diet.

Alternative Therapies and IBS

Alternative therapies, such as probiotics and herbal supplements, are sometimes used by patients with IBS. Kefir and some yogurts contain natural probiotics. Below is a list of herbal and natural therapies that have been studied. Discuss any supplements you are taking with your physician and Registered Dietitian. 

Generally Safe to Try:

  • Peppermint oil. There is some evidence supporting a benefit for peppermint oil. Some studies have shown improvement of symptoms with enteric coated peppermint oil capsules (0.2-0.4 mL per capsule in doses of 3-6 capsules daily). Peppermint oil may cause or worsen heartburn.
  • Probiotics. There is increasing interest in the possible beneficial effects of so-called "healthy" bacteria in a variety of intestinal diseases including IBS. Whether supplements containing these bacteria, such as Lactobacillus acidophilus, are of any benefit is unproven, but they are generally safe to try.
  • Chamomile tea. Chamomile tea is of unproven benefit in IBS.
  • Evening primrose oil. Evening primrose oil, a supplement containing gamma linolenic acid, is of unproven benefit.
  • Fennel seeds. Fennel seeds are of unproven benefit.

May Be Unsafe:

  • Wormwood. Wormwood is of unproven benefit and may be unsafe. Wormwood oil can cause damage to the nervous system.
  • Comfrey. Comfrey is of unproven benefit and can cause serious liver problems.

Additional Resources

  • University of Virginia Health System GI Nutrition: www.GInutrition.virginia.edu
    • FODMAP Diet Handout
    • Reduced Lactose Handouts
    • “Clinical ramifications of fructose malabsorption of fructose and other short-chain carbohydrates” (article in Practical Gastroenterology, August 2007)
  • International Foundation for Functional Gastrointestinal Disorders (IFFGD) Inc: www.iffgd.org
  • IBS Self Help and Support Group: www.ibsgroup.org
  • National Institute of Diabetes & Digestion & Kidney Diseases: www.niddk.nih.gov.

 

Foods Rich in Soluble Fiber

Food

Serving Size

Soluble Fiber (grams)

Grains

Brown   Rice

½ cup

0.4

Cheerios

1 cup

1

Oatmeal,   rolled or ”old fashion”, dry

1/3 cup

2

Oatmeal,   instant

1 packet

1.5

Raisin   Bran

1 cup

1.3

Whole   wheat bread

1 slice

0.4

White   bread

1 slice

0.2

Legumes

Lima   beans

1 cup

3

Garbanzo   beans (chickpeas)

½ cup

1

Vegetables

Asparagus

2/3 cup

2

Baked   potato w/skin

1 small

1

Broccoli/carrots

½ cup

1

Collard   greens

1 cup

3

Green   beans

½ cup

1

Sweet   peas

½ cup

1.5

Sweet   potato w/skin

1 small

1.5

Fruits

Mango

½ small

1.7

Apricot,   dried

7 slices

1.1

Apricot,   fresh

1 small

1

Banana

1 medium

1

Grapefruit

½ medium

1

Nectarine

1 medium

1

Orange/pear/tangerine

1 medium

2

Peach/plum

1 medium

1