What to Eat If You Have IBS
Pictured recipe: Bacon-Wrapped Chicken with Roasted Zucchini
If you've been diagnosed with irritable bowel syndrome (IBS) or suspect you have it, you might feel a little overwhelmed by all of the (often conflicting) information out there about how to manage the condition. In fact, IBS itself can be difficult to understand. "IBS is classified as a syndrome because it's defined by the presence of certain symptoms, not as a homogeneous disease," explains Ali Rezaie, M.D., medical director of gastrointestinal motility and assistant professor of medicine at Cedars-Sinai Medical Center in Los Angeles. "Some of the most common symptoms are abdominal discomfort and bloating, diarrhea, constipation, incontinence, distention and the inability to tolerate certain foods," he says.
Related: What to Eat & Avoid with Diarrhea
If you experience any of these symptoms on a regular basis, it's important that you talk to your doctor and set up an appointment with a gastroenterologist. The syndrome typically presents in one of three ways: IBS with constipation, IBS with diarrhea, or IBS with alternating constipation and diarrhea. There's no single way to manage IBS, so a gastroenterologist will recommend an individualized treatment plan based on your particular symptoms.
If you get an IBS diagnosis, your doctor may recommend a low-FODMAP elimination diet in order to identify food triggers.
Since IBS is a digestive disorder, food plays a big role in managing symptoms. "The first thing to try is a low-FODMAP diet," says Rezaie. It's an elimination diet during which you cut out certain carbohydrates (FODMAP stands for fermentable oligo-, di- and monosaccharides and polyols) that are resistant to digestion and feed your gut bacteria. (Learn more about what a low-FODMAP diet is and what foods you should eat.)
"The reason to try a low-FODMAP diet is to help someone figure out what might be causing painful IBS symptoms," explains Leslie Bonci, M.P.H., R.D., author of the American Dietetic Association Guide to Better Digestion. You eliminate all foods containing FODMAPs-certain fruits and vegetables, grains, beans, legumes, dairy and sugar alcohols-and then reintroduce them one at a time in order to figure out which of these foods, if any, are causing symptoms.
The low-FODMAP diet is a diagnostic tool used to identify any trigger foods, and is definitely not a diet that should be followed long-term. Most FODMAP-containing foods (everything except sugar alcohols) are nutrient-dense, which means anyone without a sensitivity can and should be eating them. "You need to start reintroducing foods within 12 weeks, or a low-FODMAP diet may lead to nutrient deficiency," says Rezaie.
Bonci agrees. "You really should only follow a low-FODMAP diet under the guidance of a dietitian," she says. The goal is to identify exactly which foods (if any) you may be sensitive to, so that you can reintroduce all the others and eat as varied a diet as possible.
Be careful about food restriction, though, because it can lead to extra stress.
"I don't like people to be overly restrictive," says Bonci. "It leads to fear of food. When people restrict and still have symptoms, they often think, 'Oh, I should restrict more!' That's really not the answer."
While stress doesn't cause IBS, it can certainly exacerbate it. Food restriction and fear of certain foods is a big stressor and can actually make IBS symptoms worse. Restricting trigger foods that you've identified with the help of a dietitian can be helpful, but restricting anything beyond that will likely work against you.
That said, it's a good idea to cut out carbonated beverages and sugar alcohols.
Excess gas and bloating is a common symptom for IBS. "Carbonated beverages introduce more gas to your digestive system, which leads to more bloating," says Bonci. Likewise, sugar alcohols, used as a sugar replacement in gum and certain low-carb foods, can cause a lot of bloating and distention. Common sugar alcohols are sorbitol, xylitol, maltitol and mannitol. Check ingredient labels and steer clear of anything that contains these sugar alcohols.
Read more: 8 Foods to Help You Debloat
Pictured recipe: Herbal Chamomile Health Tonic
Peppermint and chamomile tea might ease IBS symptoms.
While there are drinks you should limit, certain drinks can help. "Chamomile tea can help because it's a natural antispasmodic," explains Bonci. In other words, it helps relax your gut. "Peppermint, peppermint tea and peppermint oil can also help for the same reason.
A lower-carb diet might help, but isn't necessary.
"Following a lower-carb diet might help," says Rezaie. "But, your body needs carbs. You can't completely take them out." He says that he's had patients report improved symptoms after adopting lower-carb diets.
That said, it's possible to see similar improvements without cutting carbs. Bonci recommends that her patients with IBS follow the same guidelines for balancing meals as healthy individuals: "One-third of your plate should be protein, at least one-third fruits and vegetables, and no more than one-third should be starchy carbs. It only differs from a regular plate in that the types of these fruits, vegetables and starches might be different." Again, it comes down to identifying your specific triggers and reducing or eliminating them, so that you don't need to cut out entire food groups.
Read up: Healthy Plate Method Dinners
Fiber is important, but be careful not to increase your intake too quickly or drastically.
"Fiber is another critical component of IBS management, but you need to be careful," says Bonci. First, she suggests tracking your fiber intake for a week to see how much you currently eat. The recommended daily intake is 25 grams per day for women and 38 grams per day for men, but most Americans don't hit that intake. If you fall short, increase your fiber consumption gradually so that your digestive system can adjust. "I tell clients to up their fiber intake by 2 grams of fiber per day," says Bonci.
Also, be mindful of what type of fiber you're eating. Insoluble fiber from the skin of fruits and vegetables, and the bran of grains, can have a laxative effect and will help if you have IBS with constipation. Soluble fiber from the flesh of fruits and vegetables, and from beans and oats, has a binding effect in your digestive system and can help with IBS with diarrhea.
And, Bonci says, don't eat too much fiber. Going far above the recommended daily intake can make IBS symptoms worse.
How you eat might be as important as what you eat.
"Spacing your meals is important," says Rezaie. "Eat three meals per day, and give your digestive system a rest in between." He also recommends not eating for at least eight hours overnight. This often happens naturally (because, sleep), but it's something to be mindful of if you're someone who often eats late at night.
It can also help to be as relaxed as possible when you eat. "You don't want to eat on the run or eat quickly," says Bonci. "You want to be able to sit down and eat mindfully." If you're frazzled or anxious while you eat, this can affect digestion.
All of this said, many people can't manage IBS through diet and lifestyle changes alone, and that's OK.
"In moderate to severe IBS patients, you won't see 100 percent improvement through diet alone," Rezaie says. "In those cases, you need to target it with medication."
There are several medications available to treat IBS, Rezaie explains. Some are antibiotics that target problematic bacteria, while others target neurotransmitters in your gut in order to help your digestive system function properly. The type of medication a patient needs depends on their unique set of symptoms.
It may seem impossible, but another important part of managing IBS is trying to manage the anxiety you have about it.
"Any chronic disease will cause anxiety, and that anxiety with accentuate the problem," says Rezaie. It's important to accept that you have IBS and work with an expert on a treatment plan. Beyond that, a healthy lifestyle that includes adequate sleep, a balanced diet, exercise, stress management and mindfulness is what will be most helpful in sustainable IBS management, as opposed to constantly trying new diets or "miracle cures" in hopes of, well, a miracle.